Biomedical subjects

Patrick Hohlfeld

Publications and source records attributed to Patrick Hohlfeld.

14 recordsLinked to original sources

PubMed2006

Fondaparinux is a safe alternative in case of heparin intolerance during pregnancy.

Heparin is the drug of choice for the treatment or the prevention of thromboembolic disease during pregnancy. However, treatment options are limited when heparin cannot be used because of hypersensitivity skin reactions. Despite the recent availability of new anticoagulant agents, data relating to their use during pregnancy are lacking. This report describes the successful management with fondaparinux, during 150 days, of a pregnant patient with protein S deficiency and prior deep vein thrombosis (DVT) who developed heparin and danaparoid hypersensitivity.

Adult↗

PubMed2006

Profound impact of uncomplicated pregnancy on diastolic, but not systolic pulse contour of aortic pressure.

OBJECTIVE: To evaluate the impact of uncomplicated pregnancy on the pulse contour of central aortic pressure. METHODS: A total of 66 women with singleton pregnancy were grouped according to pregnancy duration: first trimester (T1, n = 22), second trimester (T2, n = 20), and third trimester (T3, n = 24). Non-pregnant healthy women, who took combined oral contraception, were included as controls (C, n = 21). The pulse contour of aortic pressure was obtained with radial applanation tonometry, using a commercial device (SphygmoCor). The influence of reflected waves on the contour was evaluated not only in systole, as usual with pulse contour analysis (systolic augmentation), but also in diastole (diastolic augmentation). RESULTS: Throughout pregnancy, central systolic and diastolic blood pressure remained unchanged and comparable to values in the non-pregnant state. Systolic augmentation amounted to 8.1 +/- 7.5% of pulse pressure in the control group (mean +/- SD), and there was no statistically significant deviation from this value at any stage of pregnancy (T1, 4.6 +/- 11.4%; T2, 5.0 +/- 9.3%; T3, 4.7 +/- 8.1%). In contrast, the amplitude of the diastolic augmentation wave progressively declined with advancing pregnancy (C, 6.5 +/- 2.4%; T1, 5.2 +/- 3.1%; T2, 3.8 +/- 2.6%; P = 0.002 versus C, T3, 2.3 +/- 2.0%; P < 0.0001 versus C and P = 0.0004 versus T1). CONCLUSION: The systolic shape of the central aortic pressure contour is left unaltered by pregnancy, implying a finely tuned adaptation of the cardiovascular system to the increased demand for blood flow at all stages of the gravid state. In contrast, the amplitude of reflection waves reaching the aortic root in diastole progressively decreases with advancing pregnancy.

Adult↗

PubMed2005

Intrauterine growth restriction and absent or reverse end-diastolic blood flow in umbilical artery (Doppler class II or III): A retrospective study of short- and long-term fetal morbidity and mortality.

OBJECTIVE: Absent or reverse end-diastolic flow (Doppler II/III) in umbilical artery is correlated with poor perinatal outcome, particularly in intrauterine growth restricted (IUGR) fetuses. The optimal timing of delivery is still controversial. We studied the short- and long-term morbidity and mortality among these children associated with our defined management. STUDY DESIGN: Sixty-nine IUGR fetuses with umbilical Doppler II/III were divided into three groups; Group 1, severe early IUGR, no therapeutic intervention (n = 7); Group 2, fetuses with pathological biophysical profile, immediate delivery (n = 35); Group 3, fetuses for which expectant management had been decided (n = 27). RESULTS: In Group 1, stillbirth was observed after a mean delay of 6.3 days. Group 2 delivered at an average of 31.6 weeks and two died in the neonatal period (6%). In Group 3 after a mean delay of 8 days, average gestational age at delivery was 31.7 weeks; two intra uterine and four perinatal deaths were observed (22%). Long-term follow-up revealed no sequelae in 25/31 (81%) and 15/18 (83%), and major handicap occurred in 1 (3%) and 2 patients (11%), respectively, for Groups 2 and 3. CONCLUSION: Fetal mortality was observed in 22% of this high risk group. After a mean period of follow-up of 5 years, 82% of infants showed no sequelae. According to our management, IUGR associated with umbilical Doppler II or III does not show any benefit from an expectant management in term of long-term morbidity.

Adult↗

PubMed2004

Influence of misoprostol or prostaglandin E(2) for induction of labor on the incidence of pathological CTG tracing: a randomized trial.

OBJECTIVE: To compare the efficacy and safety of misoprostol (prostaglandin E(1) (PGE(1))) with dinoprostone (prostaglandin E(2) (PGE(2))) for third trimester cervical ripening and labor induction. STUDY DESIGN: Patients requiring induction of labor were randomly assigned to receive either 50 microg of intravaginal misoprostol every 4 h or 0.5 mg of intracervical dinoprostone gel every 6 h. Eligibility criteria included gestation = 36 weeks. Primary outcome was the time interval from induction to delivery; secondary outcomes were mode of delivery, perinatal outcome, and interpretation of cardiotocogram (CTG) records. RESULTS: Two hundred women were randomly enrolled to receive either misoprostol (n = 100) or dinoprostone (n = 100). Time induction-to-delivery at 12, 24 and 48 h and the need for oxytocin were reduced with misoprostol (P < 0.05). Pathological CTG tracing according to FIGO and Melchior scores were more frequent in the misoprostol-treated group (P < 0.001). CONCLUSION: Misoprostol shortened the induction-to-delivery interval, but is associated with a higher incidence of abnormal CTG than prostaglandin E(2).

Adult↗

PubMed2004

Fetal bone cells for tissue engineering.

We envision the use of human fetal bone cells for engineered regeneration of adult skeletal tissue. A description of their cellular function is then necessary. To our knowledge, there is no description of human primary fetal bone cells treated with differentiation factors. The characterization of fetal bone cells is particularly important as the pattern of secreted proteins from osteoblasts has been shown to change during aging. In the first part of this work, human primary fetal bone cells were compared to adult bone cells and mesenchymal stem cells for their ability to proliferate and to differentiate into osteoblasts in vitro. Cell proliferation, gene expression of bone markers, alkaline phosphatase (ALP) activity, and mineralization were analyzed during a time-course study. In the second part of this paper, bone fetal cells behavior exposed to osteogenic factors is further detailed. The doubling time of fetal bone cells was comparable to mesenchymal stem cells but significantly shorter than for adult bone cells. Gene expression of cbfa-1, ALP, alpha1 chain of type I collagen, and osteocalcin were upregulated in fetal bone cells after 12 days of treatment, with higher inductions than for adult and mesenchymal stem cells. The increase of ALP enzymatic activity was stronger for fetal than for adult bone cells reaching a maximum at day 10, but lower than for mesenchymal stem cells. Importantly, the mineralization process of bone fetal cells started earlier than adult bone and mesenchymal stem cells. Proliferation of fetal and adult bone cells was increased by dexamethasone, whereas 1alpha,25-dihydroxyvitamin D3 did not show any proliferative effect. Mineralization studies clearly demonstrated the presence of calcium deposits in the extracellular matrix of fetal bone cells. Nodule formation and calcification were strongly increased by the differentiation treatment, especially by dexamethasone. This study shows for the first time that human primary fetal bone cells could be of great interest for bone research, due to their fast growth rate and their ability to differentiate into mature osteoblasts. They represent an interesting and promising potential for therapeutic use in bone tissue engineering.

Adult↗

PubMed2004

[Pregnancy and alcohol consumption].

Alcohol consumption during pregnancy causes a major risk of Fetal Alcohol Syndrome (FAS). This article defines the three syndromes linked to alcohol consumption during pregnancy: (1) FAS, with or without confirmed maternal alcohol exposure; (2) alcohol-related birth defect (ARBD) (3) and alcohol-related neurodevelopmental disorder (ARND). The article also reviews data on alcohol use in pregnant women and in women of child-bearing age. The literature indicates that between 6% and 45% pregnant women have an at-risk alcohol use, and suggests that brief counseling interventions designed to prevent at-risk alcohol use are effective. Studies assessing alcohol use and brief intervention efficacy in pregnant women in Switzerland are needed.

Alcohol Drinking↗

PubMed2003

Screening for infectious diseases.

INTRODUCTION: Fetal brain injury is an essential cause of lifelong morbidity. Infection appears as a cause of brain damage. Apart from chorioamnionitis, screening for infectious diseases must be considered in pregnancies with a risk of congenital infection or cases with abnormal cerebral ultrasound findings. DISCUSSION: Congenital infections include most of the major components of the TORCH complex: toxoplasmosis, rubella, cytomegalovirus, herpes, and varicella. Seronegative mothers can develop primary infection, which carries a risk of vertical transmission. The timing of the infection is a critical point, because fetal damage often depends on the gestational age at which acute maternal infection took place and occurs more likely in the first half of pregnancy. Antenatal ultrasound can detect brain abnormalities, like hydrocephalus, periventricular leukomalacia, calcifications or hemorrhage. Maternal serologic tests must be performed to look for an infectious etiology; the most frequent agents are the components of the TORCH complex. But additional serology must include parvovirus B19, HIV, and coxsackieviruses.

Brain Injuries↗

PubMed2003

Detection of Ureaplasma urealyticum in second-trimester amniotic fluid by polymerase chain reaction correlates with subsequent preterm labor and delivery.

Ureaplasma urealyticum is the microorganism most frequently isolated from the amniotic fluid of women in preterm labor. The relationship between intra-amniotic U. urealyticum in healthy second-trimester pregnant women and subsequent pregnancy outcome was investigated. Transabdominal amniotic fluid obtained from 254 asymptomatic women at 15-17 weeks' gestation were tested by polymerase chain reaction (PCR). U. urealyticum was identified in 29 subjects (11.4%). A subsequent preterm labor occurred in 17 U. urealyticum-positive women (58.6%), compared with 10 (4.4%) U. urealyticum-negative women (P<.0001). Preterm birth was documented in 7 (24.1%) U. urealyticum-positive women compared with only 1 U. urealyticum-negative woman (0.4%) (P<.0001). U. urealyticum-positive women also had a higher prevalence of preterm labor in a prior pregnancy (20.7%) than did the negative women (2.7%; P=.0008). PCR testing of second-trimester amniotic fluid for U. urealyticum can identify women at risk for subsequent preterm labor and delivery.

Adult↗

PubMed2003

Plasticity of protein expression during culture of fetal skin cells.

In order to gain insight into the biology of fetal skin during culture, cellular proteins were studied during four culture passages (P00, P01, P04 as well as P10) using high-resolution two-dimensional (2-D) gel electrophoresis and mass spectrometry (MS). Bioinformatic analyses were focused on a region of each gel corresponding to pI between 4 and 8 and M(r) from 8000 to 35 000. In this area, 373 +/- 42 spots were detected (N = 18). Twenty-six spots presented an integrated intensity that increased in the higher passages, whereas five spots showed a progressively lower intensity in subsequent passaging. MS analysis was performed on spots that were unambiguously identified on preparative 2-D gels. Among the 26 spots showing an increased size between P00 and P10, 9 were identified, and corresponded to 3 proteins: (i) peptidyl-prolyl cis-trans isomerase A (P05092; cyclophilin A or cyclosporin A-binding protein), (ii) triosephosphate isomerase (P00938), and (iii) enoyl-CoA hydratase (P30084). Among these nine identified spots, three were absent at P00, but were present at P10. They corresponded to isoforms of peptidyl-prolyl cis-trans isomerase and triosephosphate isomerase, respectively. Liquid chromatography-tandem mass spectrometry (LC-MS/MS) analyses of the acidic isoforms of triosephosphate isomerase showed modifications of cysteine residues to cysteic acid. All these isoforms were clearly present in the skin cells of a 4-year-old child, as well as in skin cells from a 80-year-old man, at P00. These observations probably reflect either an oxidative stress related to cell culture, or, alternatively, maturation, differentiation and the aging of the cells.

Aged↗

PubMed2002

Female genital mutilation in Switzerland: a survey among gynaecologists.

QUESTION UNDER STUDY: To evaluate the situation of Female Genital Mutilation (FGM) in Switzerland. METHODS: Through a questionnaire, Swiss gynaecologists were asked if they have been confronted to FGMs, if they have been asked to perform infibulations and FGMs. The health representatives (Kantonsärzte/médecins cantonaux) were interviewed on FGM activity at the Canton level. Swiss Medical Schools were asked if FGM was included in the pregraduate curriculum, and an estimated prevalence rate for FGMs in Switzerland was gathered. RESULTS: Among Swiss gynaecologists, 20% reported having been confronted with patients presenting with FGM and among them 40% had been asked about reinfibulation. Gynaecologists are occasionally asked about the possibility of performing FGMs in Switzerland. No activity concerning FGM is reported by health authorities in the Cantons. Teaching about FGM is not included in the curriculum of any of the Swiss medical schools. Approximately 6,700 girls at risk and women who have undergone FGM live in Switzerland. CONCLUSION: The extent to which gynaecologists are confronted to women with FGM may justify further action to try to better understand the situation in Switzerland. Improvement of care by better education of health care providers (guidelines) and prevention of new cases by women's education should also be considered.

Data Collection↗

PubMed2002

Prenatal diagnosis of congenital cytomegalovirus infection by detection of immunoglobulin M antibodies to the 70-kd heat shock protein in fetal serum.

OBJECTIVE: Antibodies to the 70-kd heat shock protein were evaluated as biomarkers for cytomegalovirus infection. STUDY DESIGN: Fetal sera that was obtained by cordocentesis at 22 to 25 weeks of gestation from 53 mothers with a confirmed primary cytomegalovirus infection and 28 mothers (control group) without cytomegalovirus infection who had been screened for Rh incompatibility, were assayed by enzyme-linked immunosorbent assay for immunoglobulin M and G anti-70-kd heat shock protein antibodies. RESULTS: Eighteen of 53 fetuses (34.0%) from cytomegalovirus-positive mothers were infected, which was determined by culture or polymerase chain reaction. Anti-70-kd heat shock protein immunoglobulin M was detected in 17 of 18 sera (94.4%) from cytomegalovirus-infected fetuses, in 3 of 35 sera (8.6%) from uninfected fetuses, and in 0 of 28 sera from the control group (P <.0001). The level of antibody reactivity was correlated positively with fetal disease. Anti-70-kd heat shock protein immunoglobulin G was detected in sera from 52 of 53 fetuses (98.1%) from cytomegalovirus-infected mothers. CONCLUSION: The anti-70-kd heat shock protein immunoglobulin M assay may be of value in the assessment of fetal cytomegalovirus infection in pregnant women with a primary cytomegalovirus infection.

Cytomegalovirus Infections↗

PubMed2002

Use of sunscreens in families living in Switzerland.

BACKGROUND: The hazards due to sun exposure are well known. Many recent studies have emphasized the protection against the harmful effects of the sun by the use of sunscreens and, moreover, by staying in the shade and wearing long-sleeved shirts, hats and sunglasses. Switzerland has one of the highest rates of skin cancer induction in Europe and the incidence of melanoma in Switzerland is constantly increasing with an incidence of 10-12/100,000 inhabitants/year. Interestingly, some studies have evoked the possibility that sunscreen use can increase the risk of melanoma by increasing overall sun exposure. OBJECTIVE AND METHODS: In this context, the aim of our study was to estimate the amount of sun exposure of children, and their parents, living in Switzerland and to give a description of how they protect themselves against sun irradiation. Questionnaires were provided to pediatricians in every state (canton) in Switzerland and were given to families coming for consultation. RESULTS: A total of 328 forms including 1,285 individuals were returned from most of the cantons in Switzerland. The majority of the Swiss families had 2 children under 16 years of age with middle-aged parents (30-45 years) and a central European skin type (light skin of type II-III, brown or blue eyes, and brown to blond hair). An important sun exposure was noted even though the population seems to be conscious of the associated dangers. Sunscreens were the first-line defense against sun exposure with clothing and shielding oneself from the sun not being highly used. Moreover, sunscreens tended to be misused with most people applying them at the beach or swimming pool (instead of 15 min before exposure) and few applications throughout the day. CONCLUSIONS: Prevention should imperatively be emphasized for lower overall sun exposure as sunscreens are primarily used at the beach and not in routine daily exposure. In addition, it is agreed that prevention campaigns would be better directed towards children because up to 80% of detrimental sun exposure occurs during childhood.

Adolescent↗

PubMed2002

Cesarean section on request: a case for common sense.

Considering the patient's right to autonomy and the trend towards more involvement of the patient in the decision making, it is our belief that obstetricians should consider the woman's request for cesarean section without medical indication. The procedure can only be carried out after obtaining proper consent of the patient with careful information including a detailed description of the possible risks and benefits of both modes of delivery. In order to decrease the risk of respiratory distress syndrome, cesarean section under these circumstances should not be performed prior to 39 weeks' gestation. Debating over whether or not to charge women who request a cesarean section that is not medically indicated is fruitless, since rigorous cost studies are lacking and since any implementation of such a system would be extremely difficult.

Cesarean Section↗

PubMedDate not supplied

Tissue engineered fetal skin constructs for paediatric burns.

Autologous skin-grafting is the gold standard for treatment of deep second and third degree burns. Available bioengineered skin products also necessitate this two-step surgical procedure. Therefore, we developed fetal skin constructs to improve healing of such degree burns. A bank of fetal skin cells was developed from one organ donation (4 cm2 of skin allowing the preparation of several million three-dimensional skin constructs, 9x12 cm, on native horse collagen). Successive fetal constructs were applied to eight patients at every change of dressing during 1-3 weeks in an outpatient setting. Complete closure was rapid (mean 15.3 days [SD 5.5]) with little hypertrophy of new skin and no retraction seen. This simple technique provided complete treatment without auto-grafting, showing that fetal skin cells might have great potential to treat burns and eventually acute and chronic wounds of other types.

Burns↗