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Biomedical subjects

P Guedj

Publications and source records attributed to P Guedj.

At least 19 recordsLinked to original sources
PubMed1996

Successful outcome of idiopathic nonimmune hydrops fetalis treated by maternal digoxin.

Nonimmune hydrops fetalis (NIHF), occurring in 1 in 2,500-3,000 live births has a reported mortality rate of 50-98%. A similar mortality rate for intrauterine death of fetuses with NIHF probably exists. Many fetal pathological entities have been implicated as causing the condition, but to date, treatment has only been found for cases of fetal tachycardia complicated with hydrops. During a routine ultrasonographic survey of a woman at 32 weeks of gestation, we detected a fetus with severe ascites. There was no apparent etiology, and although no tachycardia was evident, low dosage transplacental digoxin therapy was immediately initiated. The hydropic condition completely resolved within 17 days and at 39 weeks of gestation, a perfectly normal baby was born after a spontaneous and uneventful labor. This is the first report of successful treatment of idiopathic NIHF with maternal digoxin.

Administration, Oral↗
PubMed1995

Evaluation of combinations of procedures in cesarean section.

OBJECTIVE: To evaluate a procedure for cesarean section, consisting of a number of surgical techniques adopted from various sources and further developed. METHODS: The principal elements of the cesarean section procedure followed were: the Joel-Cohen method for opening the abdomen, suturing the uterus in one layer, and non-closure of the visceral and parietal peritoneal layers. The postoperative recovery of women who underwent this procedure (JCl--group) was compared with that of women who had undergone a Pfannenstiel incision, in which the uterus is sutured in two layers, and both peritoneal layers sutured (Pf2++ group). RESULTS: The incidence of postoperative febrile morbidity was 7.7% in the JCl--group compared with 19.8% in the Pf2++ group (P < 0.05). Adhesions were found in 6.3% of repeat operations after the JCl--operation compared with 28.8% after the Pf2++ operation (P < 0.05), and there was a non-significant trend toward fewer postoperative analgesics in the JCl--group. CONCLUSION: The cesarean section procedure we have devised is not only safe, but has a lower risk of long- and short-term complications.

Adult↗
PubMed1994

Conservative treatment with successful outcome of a triplet pregnancy after the miscarriage of one fetus in the second trimester.

Due to the increased availability of infertility treatment, multiple pregnancies, with various resulting complications have become more common. A woman in the 19th week of a triplet pregnancy came to the hospital after the miscarriage of one of the fetuses at home. In keeping with our philosophy of minimal intervention in childbirth, we treated the woman conservatively. After confirming that the remaining two fetuses were in good condition, the woman was released home under ambulatory observation, with no antibiotics or tocolytic drugs. No further complications developed, and the woman gave birth in her 31st week to healthy twin girls 82 days later. The successful outcome of this case demonstrates that non-interventional, conservative methods could be a feasible alternative to invasive intervention. We hope that our case will encourage more physicians to try out and report noninterventional methods, so that enough information could be gathered to help make correct management decisions in the future.

Abortion, Spontaneous↗
PubMed1992

[Anesthesia for cesarean section].

Of 684 parturients who underwent cesarean section between July 1985-August 1990, 371 (54.2%) were given epidural anesthesia; 50 (7.3%) required general anesthesia after a failed attempt at epidural anesthesia; and 5 (0.7%) underwent inadvertent spinal anesthesia because of dural penetration by the epidural needle. In 258 (37.7%) general anesthesia was decided on before operation. The intentional avoidance of spinal anesthesia for cesarean section in this university hospital is criticized.

Anesthesia, Epidural↗
PubMed1992

[Comparative study of conventional spinal anesthesia and combined spinal-epidural anesthesia in gynecological surgery].

A prospective study was carried out to compare the qualities of spinal block with those of combined spinal-epidural anaesthesia (CSEA). It included 63 patients, ranked ASA 1 or 2, aged between 35 and 75 years, scheduled for gynaecological surgery due to last more than 2 hours, and randomly allocated to two groups. In the first group (n = 34), spinal anaesthesia was carried out with the patients sitting, in the L3-4 interspace, using 15 mg of hyperbaric bupivacaine with 0.4 mg of adrenaline. In the second group (n = 29), a catheter was inserted in the epidural space through the L2-3 interspace, and spinal anaesthesia carried out as in the first group, using bupivacaine without adrenaline. Once the highest level of analgesia had been reached, aliquots of 0.5% plain bupivacaine were injected through the epidural catheter, until anaesthesia of T5 was obtained. In the spinal group, general anaesthesia was required in 3 cases, as anaesthesia only reached the T12 level in 2 cases, and as surgery lasted longer than the spinal in the third one. In the CSEA group, excellent analgesia was obtained in all patients. Sensory blockade lasted 308 +/- 48 min at the T12 level, versus 162 +/- 51 min in the spinal group (p < 0.025), and 361 +/- 51 min at the L2 level, versus 210 < 44 min in the other group (p < 0.025). "Topping up" was possible with the epidural catheter only, thus raising the level of sensory blockade, making it deeper, and increasing its duration. It avoids the use of general anaesthesia in case of failed spinal blockade.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1991

[Combined spinal-epidural anesthesia].

Combined spinal and epidural anesthesia is a new regional anesthetic modality which combines the benefits of both the spinal and epidural approaches. 24 patients (11 after cesarean section and 13 after orthopedic operations on the lower limbs) were studied. Muscle relaxation and anesthesia were excellent, and regional anesthesia can be prolonged after the original spinal anesthesia wears off. No other anesthetics were needed. Methadone or morphine were given through the epidural catheter in the recovery room for postoperative analgesia. All patients were followed for 24 hours postoperatively.

Analgesia↗