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Biomedical subjects

P Droullé

Publications and source records attributed to P Droullé.

16 recordsLinked to original sources
PubMed2004

Inhaled nitric oxide improves oxygenation in very premature infants with low pulmonary blood flow.

AIM: Inhaled nitric oxide (iNO) is used to reduce right-to-left extrapulmonary shunting by decreasing pulmonary vascular resistance in term or near-term infants. The objectives of this study were to determine, first, the pulmonary blood flow status of very preterm infants with hypoxaemic respiratory failure, then the response of oxygenation to iNO therapy according to pulmonary blood flow (PBF) and, finally, to verify the lack of adverse side effects of iNO on the ductus arteriosus. METHODS: Infants below 32 wk gestational age (GA) with hypoxic respiratory failure and aAO2 < 0.22 were randomized as the control or iNO group. PBF was evaluated by pulsed Doppler measurement of mean pulmonary blood flow velocity (MPBFV) in the left pulmonary artery. Low PBF (LPBF) was defined as MPBFV < 0.2 m/s. RESULTS: Seventy infants of 23 to 31 wk GA with hypoxic respiratory failure were randomized either to receive or not to receive 5 ppm iNO in addition to optimal care. Twenty-eight infants were diagnosed with LPBF (11/35 in iNO vs 17/35 in the control groups). Thirty minutes after receiving iNO the number of LPBF infants dropped to 8/35. In the iNO group, aAO2 increased significantly from 0.14 +/- 0.05 to 0.24 +/- 0.08 after iNO, but only in the LPBF infants (mean +/- SD; p = 0.027). CONCLUSION: In infants below 32 wk GA with hypoxic respiratory failure, Doppler echocardiographic assessment of LPBF seems to be able to determine which patients are likely to benefit from iNO therapy on systemic oxygenation.

Administration, Inhalation↗
PubMed2002

[Twin-twin transfusion syndrome: report of two cases with hemodynamic complications].

CASE REPORTS: We report two cases of cardiac dysfunction in twin-twin transfusion syndrome (TTTS) evaluated with serial echocardiography. Two cases of TTTS were referred at 27 and 26 weeks. At delivery at 31 weeks, the first recipient twin had evidence of severe cardiac dysfunction with decreased ventricular function and transient systemic hypertension. There was polycythaemia. Favorable outcome was observed after treatment with arterial vasodilating (nicardipine) and inotropic agents (dobutamine, enoximone), and reduction of haematocrit. At 28 weeks the other recipient twin had cardiac dilatation with hypokinetic myocardium. These alterations were cured by dobutamine. CONCLUSION: These cases show that even severe cardiac dysfunction may be reversed after birth unlike in utero natural evolution.

Adult↗
PubMed2001

Anatomical and sonographical studies on the development of fecal continence and sphincter development in human fetuses.

The aim of this study was to specify the sonographic, anatomical and morphological aspects of the fetal anal sphincter and to compare them with pathological and physiological findings. The sphincter was examined by serial sectioning and staining of embryo and fetal tissue and by real-time ultrasound. Its function was analysed using amniotic fluid digestive enzyme assays in cases of anorectal atresia and cystic fibrosis. Morphological findings indicate that the functional components of the anal sphincter do not differentiate before 30 weeks and therefore do not account for the observed anal continence at 22 weeks. Ultrasound measurements of the sphincter indicate three developmental phases: 1) slow growth from 14 to 19 weeks; 2) rapid growth from 19 to 30 weeks; 3) subsequently, no further increase, but contractions indicative of peristaltism. Amniotic fluid digestive enzyme assays indicate that anal sphincter maturation begins with perforation of the anal membrane at 12 weeks. Comparison of pathological cases (anorectal atresia and cystic fibrosis) suggests two possible explanations of fetal anal obstruction: increasing viscosity of digestive secretion or the presence of the three anal sphincter muscles, even if still immature. Our results clarify the evacuation and retention of meconium during fetal life and the role of the terminal part of the digestive tract, notably the anal sphincter. Prenatal diagnosis of anorectal atresia is therefore possible before 20 weeks of gestation by measurement of amniotic fluid digestive enzymes and ultrasonography, thus enabling better neonatal management.

Amniotic Fluid↗
PubMed2000

A longitudinal study of fetal growth variability.

The aim of this study was to assess the variability in individual fetal growth rhythms in comparison to averaged standard curves obtained from cross-sectional data. Biparietal diameter (BDP), abdominal transverse diameter (ATD) and femur length (FL) were measured by ultrasonography in 24 normal subjects, and the variance in growth rates determined for four time intervals: 12-26, 26-34, 34-37 and 37-39 weeks gestation. BPD, ATD and FL growths were always linear until 26 weeks with low variances in growth rates. Growth rates decreased thereafter whereas related variances increased significantly with a great diversity in individual growth trajectories. This study questions the relevance of mathematically smoothed curves which lead to an erroneous impression of growth trajectory uniformity when ultrasonography does not seem to be able to predict accurately newborn biometrical characteristics by the end of gestation.

Abdomen↗
PubMed1998

[Prenatal diagnosis of a pancreatic cyst due to Ivemark II syndrome].

We present a case of pancreatic cyst associated with other malformations which was diagnosed at antenatal ultrasound. Renal, hepatic, and pancreatic dysplasia as described by Ivemark in 1959 was confirmed by the pathology examination. This uncommon and lethal syndrome demonstrates autosomic recessive transmission. Ultrasound evidence of renal, hepatic and pancreatic dysplasia, associated with femoral abnormalities is suggestive of Meckel's syndrome. Other differential diagnoses are more easily distinguished (chondrodysplasia, chromosomal or metabolic abnormalities).

Abnormalities, Multiple↗
PubMed1995

The Antley-Bixler syndrome: report of two familial cases with severe renal and anal anomalies.

UNLABELLED: The Antley-Bixler syndrome is characterized by premature closure of coronal and lambdoidal sutures, proptosis, depression of the nasal bridge, brachycephaly, radio-humeral synostosis and bowing of ulnae and femora associated with fractures. Most cases have been reported after birth with only one case diagnosed prenatally after recurrence of this autosomal recessive syndrome. The two present cases are of interest because of prenatal diagnosis of renal agenesis in the first case and early detection of clinical signs during the second pregnancy. Beside the unusual severity of the renal abnormalities, both cases had an imperforate anus in addition to the more common genital abnormalities. CONCLUSION: Renal agenesis and imperforate anus may occur in the Antley-Bixler syndrome.

Abnormalities, Multiple↗
PubMed1991

Growth velocity of the biparietal diameter, abdominal transverse diameter and femur length in the fetal period.

In this study, fetal growth rates of the biparietal diameter (BPD), abdominal transverse diameter (ATD) and femur length were established from 4333 ultrasound examinations. The age of the fetuses ranged from 7 to 40 gestational weeks. The growth rates were computed by periods of 3 weeks, and the velocity curves were plotted with their 95% confidence interval. Results displayed multiphasic patterns of growth velocity for these variables, with a common peak of velocity at about 16 weeks. Between 16 and 28 weeks, growth velocity of femur length decreased, while the ATD and the BPD grew at the same constant rate. From 28 to 37 weeks, only the ATD maintained a high rate of growth. After 37 weeks, all growth rates decreased abruptly. In all cases, no sex differences in growth velocity were found.

Abdomen↗
PubMed1990

Brain damage in monozygous twins.

A series of 15 monochorionic twins with a great variety of cerebral lesions is reported. Seven cases illustrate the classical situation: the recipient twin was affected and his co-twin, the donor was macerated. In 5 cases, the lesions were described in the donor twin as well and once, as early as 22 weeks. The lesions were usually hypoxic-ischemic, in 2 they were hemorrhagic. In 1 case there was a malformation. Fetal US were performed in 11 cases and the diagnosis of either IUGR, death of a fetus and/or brain lesions in the survivor could be made in 10 cases and once as early as 21 weeks. In fetuses born alive, transfontanellar US or CT scan have confirmed the diagnosis made on fetal US. The pathogenesis of the lesions is not fully understood. Lesions in the recipient twin may result from emboli or thromboplastic material originating from the macerated co-twin. We suggest that blood pressure instability or episodes of severe hypotension might as well lead to brain and/or visceral lesions in the recipient twin. In the donor, the lesions result from hypotension and/or anemia. With improvement and generalization of imaging techniques, the vitality of the fetuses as well as biometric parameters and anatomical structures will be better controlled. However, in case of a fetal death, occurrence of lesions in the survivor is unpredictable and no uniform policy has been proposed yet. Studies with Doppler and continuous monitoring of funicular circulation should improve our knowledge on feto-fetal transfusion and permit to detect hemodynamic fluctuation or impairment.

Brain Injuries↗
PubMed1990

Prenatal echographic diagnosis of corpus callosum agenesis. The Nancy experience 1982-1989.

In this report we present the Nancy experience on the prenatal echographic diagnosis of corpus callosum agenesis in a consecutive series of 17 patients. The pitfalls and difficulties in the prenatal echographic diagnosis of ACC is emphasized. They are related with the particular development of the corpus callosum and the limitations of diagnostic procedures. Moreover, the variability of corpus callosum anomalies is illustrated, and the difficulties in establishing long term prognosis in the individual patient documented.

Abnormalities, Multiple↗
PubMed1988

[Fetal respiratory movements].

In the human species, foetal breathing movements are detectable from the fifteenth week of gestation and their incidence increases until the start of the third trimester. Over the last 10 weeks, breathing movements are present for 30% of the time. These are contemporaneous with body and ocular movements, suggesting an association between breathing movements and paradoxical sleep, as has been seen in the foetal lamb. These phases of activity alternate with phases of foetal immobility during which breathing movements are often absent. The incidence of foetal movements rises in the late post-prandial period, under the effect of maternal hyperglycaemia. After the establishment of regular uterine contractions, foetal breathing movements disappear, perhaps under the effect of prostaglandins E2 and/or a reduction in placental blood flow. Maternal hypercapnia leads to a rise in foetal breathing movements, which corresponds in the animal to the paradoxical sleep state. In the foetal lamb, hypoxaemia is accompanied by a cessation of breathing movements coinciding with a passage to quiet sleep. It is probable that the human foetus produces a similar reaction to hypoxaemia. During quiet sleep an inhibition of the respiratory centres would exist, disappearing during paradoxical sleep. Alcohol and certain anaesthetic agents lead to an inhibition of foetal breathing movements. The effect of tobacco remains controversial. The role of foetal breathing movements in pulmonary maturation is discussed in the human species.

Blood Glucose↗