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Biomedical subjects

P Seffert

Publications and source records attributed to P Seffert.

At least 19 recordsLinked to original sources
PubMed2004

[Usefulness of a collecting bag for the diagnosis of post-partum hemorrhage].

OBJECTIVE: Depending on the country and the publications, post-partum hemorrhage (PPH) is either the first or second cause of maternal death in the world, including in developed countries. It remains a significant source of morbidity, severe anemia, blood transfusion, transfusion complications, acquired coagulation disorders and hemostasis hysterectomy. Visual assessment underestimates the amount of blood loss in around 45% of cases. Emergency treatment is therefore sometimes undertaken with some delay, giving time for Disseminated Intravascular Coagulation (DIC) to occur, which worsens the prognosis. A collecting plastic bag put under the pelvis of the mother just after delivery is a quantitative and objective method of measuring blood loss. The objective was to assess sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), studying correlation between bag's volume and hemoglobin and hematocrit variation. MATERIALS AND METHODS: Included outpatients were women with unique pregnancy at term. Breech presentations were excluded. We measured serum hemoglobin and hematocrit just after admission for labor. A collecting bag, placed under the pelvis of each woman just after birth, was weighted after delivery. Serum hemoglobin and hematocrit were again assessed at three days. Post-partum hemorrhage was defined by a fall of hematocrit more than 10 points (delta Ht), or by a fall of hemoglobin more than 3g/dL (delta Hb). RESULTS: From January 2003 to May 2003, 272 patients were included. 8.9% of the results were unuseful (n=24). The mean volume of blood loss was 190 ml (5th p=29 ml, 10th p=48 ml, 90th p=610 ml, 95th p=824 ml). The mean delta Ht was 2.7 +/- 4 pts (16.5 / -4.8). The mean delta Hb was 1.2 +/- 1.4 g/dL (5.9 / -1.5). For a delta Ht=10 the calculated bag volume was 564 ml. With this cut off we noted 5.5% PPH (n=15) prevalence=0.06. Sensitivity=34.21%. Specificity=99%. PPV=86%. NPV=90.38%. For a delta Hb=3 the calculated bag volume was 486 ml. With this cut off we noted 10.7% PPH (n=24) prevalence of PPH=0.1. Sensitivity=38.77%. Specificity=95.96%, PPV=67. 85%. NPV=87.7%. CONCLUSION: The collecting pelvis bag is a rapid and precise procedure to diagnose PPH in the delivery room. It also enables a visual and quantitative non-subjective estimation of blood loss. Because of its simplicity and very low cost, the collecting pelvis bag should be used widely as a routine preventive measure.

Delivery, Obstetric↗
PubMed2003

Role of laparoscopy in vaginal malformation.

BACKGROUND: The aim of this study was to assess the role of laparoscopy in the management of vaginal malformations in children, a subject not often discussed in the literature. METHODS: Between 1980 and 2002, we treated 22 children for vaginal malformations. Two main patient populations were distinguished: younger children with asymptomatic hymenal imperforation and hydrocolpos, and adolescents with hematocolpos. A third of the malformations were identified on systematic clinic examination, a third on the basis of abdominal pain, and a third due to various other symptoms. Nine of the girls had associated malformations of the uterus, external genital organs, or urinary tract. Eight patients underwent laparoscopy, either to look for endometriosis in cases of hematocolpos, to make an accurate determination of malformations in cases where clinical and paraclinical methods failed, or to manage an abnormality. RESULTS: Eleven laparoscopic procedures were performed in eight patients. Three diagnostic laparoscopies enabled us to determine the exact nature of the malformations. One newborn underwent two laparoscopic procedures to treat peritoneal fibrous bands that had caused repeated episodes of obstruction. Six patients underwent exploratory laparoscopy to look for endometriosis, but none was found. CONCLUSION: Laparoscopy is not applied systematically in the management of any malformation, but it can be useful when complementary exams fail to make an accurate diagnosis of the anomaly or for the management of the rare complication of adhesions and bands. When used to search for endometriosis, MRI detects ~50% of lesions, but laparoscopy is certainly still appropriate for that purpose. However, the optimal timing of the procedure still needs to be established.

Abnormalities, Multiple↗
PubMed2003

[Prenatal Bartter's syndrome. Report of two cases].

Antenatal Bartter Syndrome (ABS) is a rare autosomic recessive tubulopathy characterized by idiopathic hydramnios, fetal polyuria and elevated levels of amniotic chloride. It is related to mutations affecting several transporters in the loop of Henle e.g. the Na-K-2Cl cotransporter, the chloride channel CLC-NKB and the potassium channel ROMK. We report two cases of ABS in siblings born to consanguineous parents (first cousins). The first pregnancy showed hydramnios of unknown etiology at week 23. Two amnio drains were performed at weeks 26 and 27. The baby was born in week 29 and developed polyuria with hyponatremia, hypokalemia and hyperaldosteronism. After eliminating diabetes insipidus and adrenal insufficiency, ABS was diagnosed. The baby was treated with 0.5 mg/kg/d indomethacine, which controlled the polyuria and the hydroelectrolytic disorder. The second pregnancy showed idiopathic hydramnios at week 24. The elevated amniotic chloride level (above 112 mmole/l) led to the antenatal diagnosis of ABS. The mother was treated with 1 mg/kg/d indomethacine until week 31 in order to stabilize the hydramnios. Two amnio drains at weeks 31 and 33 allowed the pregnancy to be prolonged until week 34. A genetic study of the family showed homozygosity of the NKCC2 gene marker suggesting its implication in the disease.

Adult↗
PubMed2002

[Acute puerperal uterine inversion: two cases].

Acute puerperal inversion is both rare and serious (1/20000 deliveries in France) and may lead to significant morbidity and mortality. Outcome depends on the degree of uterine bleeding and the presence or not of a state of shock. Acute puerperal inversion occurs at the time of placental delivery. Four stages are usually described by degree of exteriorization of the uterus. The diagnosis is essentially clinical. The predisposing factors are hypotonic uterus, fundal implantation of the placenta and placental acretas. 60% of all cases are caused by precipitous manoeuvres including traction on the cord or improper fundal pressure. Once a diagnosis is made immediate measures must be undertaken to assure clinical stability of the mother. Manuel reinversion of the uterus must be done quickly to avoid a cervical stricture that may form within thirty minutes of the inversion making successful manipulation very difficult. Failure or reoccurrence requires surgical treatment either by abdominal or vaginal approach. We report on two cases: one of complete inversion leading to a hysterectomy in order to control bleeding and a second case of incomplete inversion where repositioning was successful.

Acute Disease↗
PubMed2000

[Infraclinical breast lesions: apropos of a retrospective study of 261 cases].

OBJECTIVE: To determinate the rate of malignant lesions discovered after surgery for nonpalpable breast lesions diagnosed by radiology. TOOLS AND METHODS: We performed a retrospective study of 261 patients who underwent surgery for nonpalpable breast lesions at the Saint-Etienne University Hospital between 1991 and 1998. We included women who did not have any palpable breast lesion. We excluded bilateral lesions and nonpalpable lesions associated with a palpable lesion in the same breast. We grouped outcome by alarming signs, those of complementary exams such as mammography, ultrasound, fine-needle aspiration biopsy and setreotaxis core needle breast biopsy in their sensitivity, specificity and predictive values, and classed results by pathology and type of surgery performed. All nonpalpable lesions were localized by stereotaxis maneuvers. RESULTS: In our series, 61.7% of the patients were seen for individual detection, 3% had participated in mass screening programs and 35.3% were referred for suspected conditions. The predictive value of malignant lesions on mammography, analyzed in all cases and interpreted in 275, was 42.2%. The sensitivity and specificity of ultrasound exams performed in 50.2% of the cases were 85% and 91% respectively. Fine-needle aspiration biopsy and core needle biopsy were performed in 45 (18%) and 23 (9%) cases respectively. Twelve patients underwent total mastectomy with axillary dissections, 58 had tumorectomy with axillary dissections, and 191 had simple tumorectomy. Benign lesions were found in 128 (49.1%) cases, atypical hyperplasia in 10.7%, carcinoma in situ in 57 (cases 21.8%). The rate of malignant lesions was 38.6%. I was 50.9% when borderline lesions (atypical hyperplasia and in situ lobular carcinoma) were included. CONCLUSION: In our series, 38.6% of all nonpalpable operated breast lesions were cancers. Ultrasound, fine-needle aspiration and needle core biopsy showed high sensitivity and specificity allowing good biopsy outcome.

Axilla↗
PubMed2000

[Premature rupture of the membranes between 28 and 34 weeks of amenorrhea. Retrospective study apropos of 71 cases].

OBJECTIVE: The aim of our study is to compare the outcome of infants born after preterm premature rupture of the membranes (PPROM) between 28 and 34 weeks gestation. We compare two groups of infants: group A, infants born in hospitals without neonatal intensive care unit, after PPROM with long tocolysis, no maternal prophylactic antibiotic therapy and no systematic maternal steroid therapy. Group B with systematic maternal steroid therapy, maternal prophylactic antibiotic therapy, short tocolysis and born in an hospital with neonatal intensive care unit. The latency period (time from rupture of membranes to the onset of labor) authorized was 15 days in the group B and not limited in the group A. RESULTS: Death (13.8% vs 0%; p=0.022), neonatal infection (66.6% vs 28.6%; p=0.0013), and respiratory distress (63.8% vs 34.3%; p=0.0144) were less frequent in the group B. The group A infants passed more than ten days in intensive care unit (61.1% vs 37.1%; p=0.043). Neonatal infection was not higher in the corticosteroïd therapy group (41.2% vs 70.3%; p=0.0135). There is more neonatal infection in the group A with long latency period (61.7% vs 24.3%; p=0.0014) and more chorioamnionitis (70.6% vs 24.3%; p<0.0001). CONCLUSION: The association maternal steroid and antibiotic therapy, short latency period, and hospitalization of the pregnant woman close to a neonatal intensive care unit reduce significantly the neonatal morbidity after preterm premature rupture of the membranes.

Adrenal Cortex Hormones↗
PubMed1999

[Exanthematic pustulosis of pregnancy: favorable evolution using calcium and vitamin D2].

A 26-year-old pregnant woman was hospitalized in an emergency setting for a skin eruption. She had developed pustules distributed on round patch-like areas of rash localized at the umbilicus and the larger skin folds. She was given calcitriol and calcium with good results. Systemic steroids are usually given for exanthematic pustulosis of pregnancy but with variable efficacy. Few cases of successful treatment with calcium and vitamin D have been reported. We suggest this alternative treatment could be useful in other cases.

Adult↗
PubMed1995

Epidemiologic and molecular investigations of genital mycoplasmas from women and neonates at delivery.

The rates of colonization by Ureaplasma urealyticum and Mycoplasma hominis were evaluated in 208 women at delivery and in their neonates. Mycoplasmas were isolated from the cervicovaginal specimens of 100 mothers (48.1%) and from the gastric secretions of 40 neonates (19.2%). The prevalences of U. urealyticum and M. hominis were 47.6% and 11.0% in women and 19.2% and 1.0% in neonates, respectively. Premature rupture of membranes was significantly associated with colonization of women by U. urealyticum (P = 0.031), and colonization of their neonates by U. urealyticum (P = 0.002) and/or M. hominis (P = 0.023). Forty-four selected strains of mycoplasmas were further characterized by arbitrarily primed polymerase chain reaction. All strains of U. urealyticum belonged to the parvo biovar of the species. Arbitrarily primed polymerase chain reaction demonstrated the similarity of strains isolated from mother-neonate pairs, confirming the importance of vertical transmission of mycoplasmas at delivery.

Bacterial Typing Techniques↗
PubMed1987

[Adenoid cystic carcinoma or cylindroma of the cervix uteri. Review of the literature apropos of a personal case].

The authors report on a case of cylindroma of the cervix combined with a carcinoma in situ. Reviewing the literature which helped them, they studied the anatomo-pathological characteristics as well as the histogenesis and the therapy for cylindromas, which are more often found in other parts of the body. In particular, they are found in the salivary glands. There the origin is still uncertain and the evolution from the same stage is worse than in epidermoid carcinoma of the cervix.

Adult↗
PubMed1986

[Renal transplantation and pregnancy. Apropos of a case].

A cystic disease of the medulla is found in a young women at the 5th month of her first pregnancy and entails the death of the foetus in utero. The chronic renal insufficiency rapidly worsens and necessitates periodic hemodialysis. Renal transplantation is carried out from a brother with identical HLA. Two years later the graft is functioning well enough to permit another pregnancy. It proceeds without accompanying nephropathy. A caesarean operation carried out 36 weeks after amenorrhea gives birth to a girl who presents normal psychomotor development at two years of age. The authors consider the influence of pregnancy on the functioning of the kidney graft and the criteria permitting pregnancy after a renal transplant. They discuss the consequences of a renal transplant on the progress of the pregnancy and delivery. Finally, they study the effects of immunosuppressive treatment on the child in the short and long term.

Adult↗
PubMed1985

[Hysteroplasty for hemi-uterus and divided uterus. Apropos of 45 cases].

The authors present a series of 45 plastic operations for bicornuate uterus. Three women were operated on for functional symptoms, eight for sterility of which seven were primary, and thirty four for infertility. They are sorry that three women were lost to follow up. They used the Bret-Palmer technique with modifications that they themselves describe. They justify this choice as against other techniques of metroplasty. The anatomical results are, in the main, good when controlled by hysterosalpingography 3 to 6 months after the operation. The functional results, by which is meant the pregnancies that have been obtained, are medium as far as sterility is concerned. Four out of the eight women who were operated on became pregnant. But they are very good in cases of infertility, because thirty out of the thirty four cases that were operated on had one or two pregnancies. The authors justify their indications for metroplasty after a first spontaneous abortion by the good results they have had, and because bicornuate uteri give rise to many obstetrical complications. Furthermore in unoperated cases there is often difficulty in attempting a new pregnancy, and quite often spontaneous late abortions or premature labours. In certain cases they carried out the operation after first spontaneous abortions, but they are more conservative in operating in cases of primary sterility. The authors do not think it is necessary always to carry out a cerclage procedure nor a caesarean operation automatically in cases that have become pregnant after metroplasty.

Abortion, Spontaneous↗
PubMed1982

[Frequency of routine examinations in detection of carcinoma of the uterine cervix and carcinoma of the breast].

The prevention of carcinoma of the uterine cervix depends on routine examinations. They should start soon after the first experiences of sexual intercourse then be carried out once every two years in the form of a smear until the age of thirty, then every three years between 40 and 55 years. After 55 years, one should advise a cervical smear every 5 years, although the probability of detecting a carcinoma of the cervix is very small if the woman has until then been well followed up. However, when there is a high risk, in particular during oral contraception, smears should be taken once a year. This type of detection is possible, there are enough doctors, and each should carry out 23 smears a month, similarly there are enough cytologists. Finally, the economy made by not having to treat lesions detected early by this method easily covers the cost. The detection of carcinoma of the breast requires auto-palpation of the breast and mammography. A baseline mammography should be performed for reference purposes between 35 and 40 years. In the absence of a risk factor, and if the mammography shows low density breasts (P1 or N1 according to Wolfe's classification), one mammography every five years until the age of 50 years is suggested. In high risk cases, or if the breasts are denser (N2 or Dy), an annual ray is recommended using sensitive films which permit reduction of the dose received by the breast. After 50 years, annual mammography is strictly necessary until the age of 70 years. Applying these data to the French population, one may consider that four million women will be concerned each year by mammography (15% of the female population). Considering the reduction in costs by treatment of carcinoma of the breast at an early stage, each examination would cost less than 45 F.

Breast Neoplasms↗
PubMed1979

[Tuberculosis of the breast. A revue of the literature in connection with a personal case (author's transl)].

The authors, having had a personal case that they report, have carried out a general review of tuberculosis of the breast. It is a rare affection which usually attacks women during reproductive life, mainly because of the influence of hormones on the condition. Clinically it is difficult to differentiate it from cancer and it can present in two forms, a superficial and a deep one, a diffuse one and a circumscribed one. All the same, there is a definite feature which is fistula formation. The diagnosis depends on the biopsy, which shows specific histological lesions, and on the bacteriological examination, which shows the Koch's bacillus. Mammography is not very characteristic and thermography is of too recent appearance. Treatment consists in anti-tuberculous chemotherapy at first, surgery being reserved for residual lesions.

Aged↗
PubMed1978

[Feto-maternal transfusion. A rare cause of acute fetal distress. A case history (author's transl)].

The authors report a case of feto-maternal transfusion which showed as acute fetal distress spotted by fetal cardiac rhythm monitoring. Following this observation the authors point out such occurrences are rare with a possibility of intra-uterine fetal death at 1/1000. They also point out the value of fetal cardiac monitoring and of systematic performance of amnioscopy at the start of labour and of carrying out the Kleihauer test in every case of neonatal anaemia as well as in every case of unexplained perinatal death.

Acute Disease↗