Biomedical subjects
Publications and source records attributed to P Lopes.
OBJECTIVE: Evaluate of fetal and neonatal risk in cases of maternal varicella or zona. METHODS: A review of the literature of varicella occurring during pregnancy, including a series of 1,373 cases reported by Enders. RESULTS: The role of prenatal diagnosis is discussed as a function of fetal risk, which is dependent on gestational age at the time of varicella infection.
A case of monosomy 22 diagnosed prenatally is reported. During pregnancy, ultrasonic observations already revealed several cardiac malformations of the fetus in the 25th week. Following counselling, the pregnancy was terminated. Fetal autopsy revealed several abnormalities associated with DiGeorge syndrome.
Carbon dioxide laser conisation is a very reliable surgical technique for cervical intraepithelial dysplasia. As cervical morphology and function are better preserved than with other techniques, obstetrical morbidity should be lower in the often young and pauciparous women who undergo this procedure. In our study comparing the course of 71 pregnancies (55 children) in 54 operated women with that of 82 pregnancies (59 children) in these same women before conisation, the rates for complications at the beginning of pregnancy were similar (respectively, 14.1% and 13.4%, early spontaneous abortions; 2.8% and 2.4%, extrauterine pregnancies; and no late spontaneous abortions). The increased risks of premature delivery (13.2% vs. 8.5%), chorioamnionitis (1.9% vs. 0%), premature rupture of membranes (1.9% vs. 0%) and prematurity (11.3% vs. 1.7%) were not statistically significant. Only the percentage of natural term births was significantly reduced (73.6% vs. 90%; P = 0.025), but this difference was no longer apparent after correction for the prevalence of associated obstetrical pathologies and prematurity and/or cesarean factors which was significantly greater for the 53 pregnancies that developed after carbon dioxide laser conisation.
In vitro receptor autoradiography was used to localize, quantify and characterize [125I-Tyr8]bradykinin binding sites in all major spinal cord segments of normal rats and animals subjected to various chemical treatments and surgical lesions. [125I-Tyr8]bradykinin specific binding sites were predominantly located to superficial laminae of the rat dorsal horn, with the substantia gelatinosa showing the highest density of labelling (values ranging from 3.1 fmol/mg tissue in cervical to 4.5 fmol/mg tissue in lumbar segments). A moderate density (1.8-3.0 fmol/mg tissue) of specific binding was observed in lamina III, whereas in other areas, i.e. laminae I and IV-X, lower amounts of labelling were detected. Within the superficial laminae of the dorsal horn, [125I-Tyr8]bradykinin binding was largely distributed over the neurophil with some perikarya showing concentrations of labelling. In contrast, the ventral horn showed a rather homogeneous distribution of [125I-Tyr8]bradykinin binding over the neuropil, with silver grain alignments surrounding motoneuron perikaryas and proximal processes. Bradykinin, [Tyr8]bradykinin and B2 receptor antagonists (D-Arg[Hyp3,Thi5,D-Tic7,Oic8]bradykinin (Hoe 140), D-Arg[Tyr3,D-Phe7,Leu8]bradykinin, D-Arg[Hyp3, Leu8]bradykinin, D-Arg[Hyp2, Thi5,8,-Phe7]bradykinin D-Arg[Hyp3, D-Phe7, Leu8]bradykinin, Tyr0, D-Arg[Hyp3, D-Phe7, Leu8]bradykinin inhibited [125I-Tyr8]-bradykinin binding with very high subnanomolar affinities, while the B1 receptor agonist (Tyr0,des-Arg10-kallidin) and antagonist ([Leu8]-des-Arg9-bradykinin) did not significantly affect [125I-Tyr8]bradykinin binding at up to micromolar concentrations. Two weeks after unilateral lumbar dorsal rhizotomy (L1-L6) or peripheral lesions of the sciatic nerve, significant decreases ( +/- 50%) in [125I-Tyr8]bradykinin binding sites were found in ipsilateral laminae I-III of lumbar spinal cord.(ABSTRACT TRUNCATED AT 250 WORDS)
The objective of this study was to compare the efficacy and safety of a recombinant follicle stimulating hormone (FSH) preparation (Org 32489, Puregon) with a urinary FSH preparation (Metrodin) in infertile women undergoing in-vitro fertilization (IVF and embryo transfer and who were pituitary-suppressed with triptorelin. In an assessor-blind, group-comparative, multicentre study, 60 women were randomized to Org 32489 and 39 to urinary FSH. An evaluation of the main parameter, the mean total number of oocytes recovered, indicated a similar efficacy for the two preparations: 9.7 with Org 32489 versus 8.9 with urinary FSH. In addition, there were no significant between-group differences with respect to other efficacy variables such as the total dose used, the duration of the treatment, the number of follicles > or = 17 mm in diameter and embryo quality. The ongoing pregnancy rates per attempt (30.2 versus 17.4%) and per transfer (34.0 versus 18.8%) were higher with Org 32489, but this difference was not statistically significant. No clinically relevant differences between Org 32489 and urinary FSH were seen with respect to safety variables. Serum antibodies were not detected in any of the subjects. It is concluded that Org 32489 compares favourably with urinary FSH in the treatment of infertile pituitary-suppressed women undergoing IVF and embryo transfer.
The involvement of proteins extracted from spermatozoa of fertile semen in sperm-zona binding was examined under hemizona assay conditions. One droplet of a suspension of spermatozoa was exposed to sperm proteins and then tested for zona binding, while a parallel semen suspension droplet incubated with culture medium served as a control. The reliability of the test was increased by relating the number of spermatozoa bound to each inseminated hemizona to the surface area of the hemizona and expressed as the binding index. For spermatozoa incubated with extracted proteins, the binding index was greater than (P = 0.001) that of controls (125.2 +/- 45.1 versus 63.6 +/- 29.2, respectively). As a first control, two other protein sources (fetal calf serum and human follicular fluid) were tested in the hemizona assay. No significant differences were found in zona binding for other protein-exposed spermatozoa compared with controls. As a second and reverse control, exposure of one hemizona to sperm proteins before insemination with untreated spermatozoa induced a marked decrease (P = 0.0003) in sperm binding, compared with that of the matched hemizona not exposed to sperm proteins (control) (3.4 +/- 1.4 versus 74.5 +/- 6.8, respectively). Taken together, these findings confirm the involvement of extracted sperm proteins in sperm-zona interactions. Therefore, in the cases in which fertilization in vitro fails because of a lack of sperm-zona binding, incubation of deficient spermatozoa with proteins extracted from spermatozoa of fertile ejaculates should restore their ability to interact with the oocyte and, thus, should enhance the prognosis for in vitro fertilization.
Aging of the population in industrialized countries, as a result of increased life expectancy, is associated with an increased risk of neurological diseases. Prevention of disability is one of the objectives of hormone replacement therapy of menopause (HRTM). Based on a review of the literature, the authors present the benefits of HRTM in terms of prevention of neurological complications. Estrogens directly and indirectly influence the neurological status. A decreased incidence of cerebrovascular accidents and dementia of the Alzheimer type and improvement of cognitive function in cases of dementia have been reported in several clinical and epidemiological papers. These data need to be confirmed by large-scale prospective studies conducted by epidemiologists and neurologists.
Isolated malignant non Hodgkin lymphomas (MNHL) of uterine cervix are rare, and the therapeutic strategy is not always clearly established. The authors report a case of a 78-years-old woman presenting a MNHL FIGO stage IIB and Ann Arbor stage IE. Extention evaluation was negative. The histologic and immunohistochemical examination revealed a centroblastic lymphoma type G in the Working Formulation (WF). The patient was successfully treated by surgery followed with combination chemotherapy and external radiation therapy. Intermediate grade primary MNHL of the uterine cervix are the most frequent. The opportunity of surgery is discussed because lymphoma is a general disease with blood dissemination. We propose a therapeutic strategy according to patient age and the wishes for pregnancy. The young woman could undergo polychemotherapy, perimenopausal woman a combination of chemotherapy and radiation therapy, and post-menopausal woman surgery followed by external radiation therapy.
Endometriosis is defined by the presence outside the uterine cavity of tissue histologically and functionally similar to the endometrium. Endometriosis consists of glands and an underlying cytogenic stroma. This ectopic tissue can react to hormonal stimulation: estrogens and progesterone (growth, decidualisation, withdrawal bleeding). Pain is correlated with the depth of implantation of endometriosis lesions. Deeply infiltrating endometriosis exceeds 6 mm in depth, with an incidence of between 6 and 20% of women complaining of pelvic pain. The authors review the various types of treatment and mention the special role of celio-surgery and prolonged hormone therapy.
Polymerase chain reaction (PCR) was used to identify human papillomavirus (HPV) in 216 cervical biopsy specimens from women referred to the gynecological out-patient unit for colposcopy because of an abnormal smear. HPV DNA was screened using type-specific primers for HPV6, 11, 16, 18, 31 and 33 (TS-PCR) as well as a consensus primer located in the E1 region of the HPV genome (C-PCR). TS-PCR specificity was validated by Southern blot analysis. Low-grade (SIL 1) and high-grade (SIL 2) squamous intraepithelial lesions were found in 165 biopsies. HPV16 detection was better with PCR than Southern blot, particularly for SIL 1 and SIL 2. The fact that 10% of HPV16 (all SIL 2) were not detected by C-PCR indicates that both PCR techniques should be performed. C-PCR also detects uncharacterized HPV types (8.6% prevalence in our results), mainly in SIL 1 and SIL 2. HPV16, the most frequently isolated type (prevalence 21%), was associated with SIL 2 in 83% of cases. A low HPV prevalence was found in specimens without dysplastic cells. These results suggest that PCR may be an important tool for identifying women at risk for developing dysplasia or cervical cancer.
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The present study aimed to localize and characterize [125I-Tyr8]-BK binding sites in all major segments of the guinea pig spinal cord using in vitro quantitative receptor autoradiography. [125I-Tyr8]-BK specific binding sites were localized predominantly in superficial layers of the dorsal horn, with lamina II depicting the highest labelling. The density of specific binding in laminae I and III was moderate, whereas in other areas, i.e., laminae IV-X, lower amounts of labelling were noticed. The B2 receptor antagonists D-Arg[Hyp3,Thi5,D-Tic7,Oic8]-BK (Hoe 140), D-Arg[Hyp3,D-Phe7,Leu8]-BK, Tyr0,D-Arg[Hyp3,D-Phe7,Leu8]-BK, D-Arg[Tyr3,D-Phe7,Leu8]-BK, D-Arg[Hyp2,Thi5,8,D-Phe7]-BK, D-Arg[Hyp3,Leu8]-BK and D-Arg[Hyp3,Gly6,Leu8]-BK as well as unlabelled [Tyr8]-BK inhibited [125I-Tyr8]-BK binding with respective Ki values of 0.04, 12.4, 23.4, 34.5, 43.5, 33.5, 23.0, and 0.6 nM while B1 related molecules (Tyr0,des-Arg10-kallidin and [Leu8]-des-Arg9-BK) did not significantly inhibit [125I-Tyr8]-BK binding up to micromolar concentrations. These results indicate that the specific [125I-Tyr8]-BK binding sites present in the guinea pig spinal cord belong to the B2 receptor subtype. The high density of B2 binding sites in the substantia gelatinosa provides an anatomical evidence in favour of a role for BK as a modulator of nociceptive information.
Subzonal sperm insertion is an assisted insemination procedure to enhance IVF in patients with severe male factor. We report a lethal fetal abnormality that occurred in a SUZI-obtained pregnancy. It is essential that such cases be extensively collected to assess the feasibility of using this method in patients with severe semen defects.
1. The effects of intrathecal (i.t.) pretreatment with selective B1 or B2 kinin receptor antagonists were studied on the cardiovascular response to i.t. injection of bradykinin (BK) in conscious freely moving rats. 2. BK (81 pmol) produced an increase in mean arterial pressure (MAP: 9-13 mmHg) and decrease in heart rate (HR: 20-30 beats min-1) that reached a maximum 2 min after injection. 3. The BK-induced cardiovascular responses were dose-dependently and reversibly reduced by four antagonists with the following rank order of potency: Tyr, D-Arg[Hyp3,D-Phe7,Leu8]-BK = D-Arg[Tyr3,D-Phe7,Leu8]-BK = D- Arg[Hyp3,D-Phe7,Leu8]-BK > D-Arg[Hyp3,Thi5,D-Tic7,Oic8]-BK (Hoe 140). These compounds failed to alter the cardiovascular response to i.t. injection of 8.1 nmol of substance P. 4. Other compounds acting on the B2 receptor, namely D-Arg[Hyp3,Gly6,Leu8]-BK, D-Arg[Hyp3,D-Phe7]-BK, D-Arg[Hyp2,Thi5,8,D-Phe7]-BK and D-Arg[Hyp3,Gly6,D-Phe7,Leu8]-BK or on the B1 receptor, [Leu8]-desArg9-BK, did not influence the cardiovascular responses to BK at doses devoid of intrinsic activity on MAP and HR. 5. None of the kinin receptor antagonists caused motor impairment, respiratory arrest or persisting cardiovascular changes. 6. These results confirm that the cardiovascular effects induced by i.t. BK are mediated by the activation of a B2 receptor in the rat spinal cord. However, the rank order of potency of antagonists does not conform to the classical B2 functional site characterized in peripheral tissues.
Case reports and epidemiologic studies have recently indicated a possible link between ovarian stimulation, ovarian cancer and ovarian tumours. We sent a questionnaire to 116 French IVF centers to determine whether ovarian cancer had occurred in women treated during the last 10 years. The 19 cases of ovarian cancer reported have since been studied more thoroughly in a follow up questionnaire. Six can now be excluded, and the 13 remaining cases are compared. Five of these patients had fewer than 4 stimulation cycles here. Imputability was considered probable for 2 patients, possible for 5 patients, improbable for 3 and highly improbable for 3. Histologically, 6 (46%) cases involved borderline lesions. These results indicate that there is no need to change medical practice, but we are convinced that prospective epidemiologic research should be carried out immediately.
Axillary lymph node dissection, which is now mandatory in the conservative breast cancer surgery and classically involves Berg's two lower levels, is burdened with numerous complications. In 1988 and 1989, two technical modifications were introduced and are described here: padding of the axilla as preventive treatment of postoperative lymphocele and, more recently, functional axillary lymphadenectomy (FAL) in which the medial cutaneous nerve of the arm, the two perforating intercostal nerves and above all the lateral thoracic pedicle (external mammary artery and vein) are spared. These two technical innovations, more respectful of anatomy, are aimed at reducing the morbidity of conservative breast cancer at a time when detection enables breast cancers to be treated at an increasingly early stage, which results in a increase of negative axillary dissections. The postoperative period is simplified (no drainage, immediate mobilization), and the hospital stay is reduced to 2 days. Complementary treatments can thus be started early on, without any functional or cosmetic damage while the number of lymph nodes removes remains the same as in the conventional axillary dissection technique. The authors describe the operative procedures and analyse the 100 cases of conservative breast cancer they have treated with padding and FAL. These two technical modifications are now systematically used by them in the management of breast cancers.
The main vital risks of the menopause and ageing are related to osteoporosis, cardiovascular accidents and cancer. Hormone therapy is effective against the first of these, but its efficacy against the second is difficult to measure in view of the number of factors involved and is even less clear against the third. Without any doubt it does improve all aspects of quality of life, so that it is rather surprising that only a minority of women receive treatment and that compliance with treatment is irregular, which is attributable to a variety of causes. Treatment protocols for the general situation and for specific cases are proposed.
Neonatal retarded growth and hypotrophy are more frequent in monochorial, biamniotic twin pregnancies than in bichorial ones. The authors consider the various pathogeneses which have been suggested to account for this phenomenon.