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Biomedical subjects

R Henrion

Publications and source records attributed to R Henrion.

At least 19 recordsLinked to original sources
PubMed1992

HIV infection at outcome of pregnancy in the Paris area, France.

The prevalence of HIV infection in women at end of pregnancy, irrespective of outcome, was determined in a comprehensive survey of both women and medical centres during successive 4-week periods in four areas of the Paris region, France. Blood samples were tested anonymously for antibodies to human immunodeficiency virus (HIV)-1 and HIV-2. Of the 11,593 blood samples 0.40% (95% confidence interval [CI] 0.28-0.51) were positive for HIV-1 and 0.02% (95% binomial interval [BI] 0.002-0.065) for HIV-2. Seroprevalence was higher among women with ectopic pregnancy (2%) (95% BI 0.24-7.04); the rate in women having an elective or therapeutic abortion was more than twice that in those delivering babies (0.70% vs 0.28%, p less than 0.05, relative risk 2.54, 95% CI 1.36-4.75). Studies with neonatal HIV seroprevalence as a surrogate for HIV prevalence in pregnant women would underestimate prevalence in these women.

Abortion, Therapeutic↗
PubMed1992

HIV replication during the first weeks of life.

Diagnosis of HIV infection among children born to HIV-positive mothers can be made in the first 12 months, but few studies have examined HIV status during the first weeks of life. In a prospective longitudinal study of 50 infants born to HIV-1 seropositive women, blood samples were obtained at birth and at 4-9 weeks and 5-9 months of age, and were tested for HIV-1 by the polymerase chain reaction (PCR), viral culture, and p24 antigen measurements. 16 were diagnosed as HIV-infected by the age of 4-9 weeks according to both PCR and culture; by contrast, infection could be detected in only 5 children at birth. No changes in HIV status were observed between 4-9 weeks and 5-9 months in the 44 children who could be retested. Perinatal HIV-1 infection can therefore be diagnosed in the first 2 months of life, either by PCR or viral culture. Our inability to detect HIV-1 infection at birth in almost 70% of babies subsequently found infected suggests an active replication of HIV during the first weeks of life. Our results might favour the hypothesis that transmission of HIV-1 takes place either at the end of pregnancy or at delivery.

Acquired Immunodeficiency Syndrome↗
PubMed1992

Thymic abnormalities in fetuses aborted from human immunodeficiency virus type 1 seropositive women.

Pathological abnormalities of the thymus were found in 3 of 37 fetuses aborted from human immunodeficiency virus (HIV)-infected mothers. These lesions were located predominantly in the thymic cortex, which contains mostly immature lymphocytes. Areas of focal lymphocyte depletion were infiltrated with CD4+ macrophages and were associated with abnormalities of the epithelial stromal network. No evidence of extensive HIV infection in any of the 37 thymuses was detected by either immunofluorescence or in situ hybridization techniques, although rare cells that expressed HIV antigens were found in 3 fetuses. Although less extensive, this thymic fetopathy was similar to that described in postnatal acquired immunodeficiency syndrome thymuses, strongly suggesting that the lesions were related to HIV infection. Thymic fetopathy might represent the initial injury to the lymphoid system in HIV-infected infants in whom early and severe immunosuppression develops.

Abortion, Induced↗
PubMed1991

[Epidemiological study of 200 HIV infected pregnant women].

Demographic characteristics and lifestyle were studied among 200 HIV-seropositive women followed in a tertiary care obstetrics/gynecology center in Paris. Between 1985 and 1989, a detailed questionnaire was run by a specialized midwife. The study group, mostly comprised of pregnant women, was compared with the women delivering in the department and with the overall French pregnant population. The women's partners were also studied. There appeared to be a core group of women who are young, single, often unemployed, marginalized members of foreign-born minorities, heavy smokers, and past or present intravenous drug users. Among their partners, drug use was frequent; over half were born in sub-Saharan Africa or North Africa and one third were unemployed. Among women having a job, white collar employees and service workers were over represented, whereas blue collar workers were under represented. The epidemiological profile of HIV-infected women appears to be very different from that of the largely homosexual male population in France. These women are younger and often less intellectual, poorer, more socially marginalized and less receptive to campaigns for prevention. However, the majority of our patients are married or live maritally, work and do not (presently) use drugs.

Adult↗
PubMed1991

[Routes of HIV infection in a pregnant population in metropolitan France: evolution over a three year period].

Routes of HIV transmission among seropositive pregnant women were studied over a three year period in a nationwide multicenter study in France. A total of 2,346 cases were included: 666 in 1987, 809 in 1988 and 871 in 1989. The principal route of transmission was intravenous drug use (IVDU), however an increase in heterosexual transmission was observed. From 1987 to 1989, the proportion of cases related to IVDU decreased from 66.4 percent to 48.2 percent while sexually transmitted cases increased from 24.9 percent to 41.8 percent. The trend towards heterosexual transmission among pregnant women was more marked in the Paris region than in the rest of France. This tendency may be overestimated because of changes in population, such as an increase in women from sub Saharan Africa, the extension of serodiagnosis among IVDU and the extension of systematic testing of pregnant women over the study period. Heterosexual transmission of HIV does appear to be increasing in Europe as can be observed among female AIDS cases.

Adult↗
PubMed1991

[HIV-infected women's decision to continue or terminate pregnancy].

Our purpose was to determine how women's knowledge of HIV seropositivity influenced their decision on whether to continue pregnancy. The study included 2,023 pregnant women from 220 maternities through France, 595 in 1987, 691 in 1988 and 737 in 1989. Approximately one half decided to continue pregnancy. This proportion was higher in the Paris region (58.9 percent) than in the other regions of France (38.2 percent). Motivations for continuing pregnancy included a visceral desire to have a child, a means of transcending one's mortality, a gift to the partner, a means of rehabilitation, a denial of the pathologic state or the conviction that the infant will be unaffected. Motivations for terminating pregnancy included fear of contaminating the infant, fear that pregnancy could accelerate their own disease progression and fear that the infant will become orphaned. The attitude of physicians towards pregnancy in HIV infected women is discussed. The discovery of an effective treatment decreasing materno-fetal transmission and/or an approach to prenatal diagnosis could offer solutions to this difficult dilemma.

Abortion, Induced↗
PubMed1991

[AIDS and perinatal aspects].

The proportion of women among AIDS. patients in Europe is progressively rising. The male-to-female sex ratio had constantly decreased from 11.7% through 1984 (17 countries) to 5 in 1990 (31 countries). The proportion of female cases is greatest in Southern Europe, France and Belgium. This is related to the predominant transmission factors, homosexual in Northern Europe, IV drug use in Southern Europe and heterosexual in Belgium. In France, IV drug use predominates in the South, whereas heterosexual transmission is more frequent in the Paris area. Pregnancy does not appear to accelerate disease progression, except in women with symptomatic infection or low CD4 counts. Over 80% of infant AIDS cases are related to mother-to-child transmission. The rate of transmission is about 20%, higher in patients in advanced disease stages. A number of questions remain open. At what time in pregnancy, early gestation, late gestation and/or during labor, does transmission occur? Is the only mechanism of transmission transplacental, or can it also occur during delivery? Does placental transfer concern free virus, immune complexes and/or intracellular virus? Management of pregnancies with HIV infection concerns the entire European community. In France, pregnancy is discouraged among HIV-seropositive women. However, more than 1,500 do become pregnant each year. Testing is recommended at the first prenatal visit for all women, and repeated regularly for seronegative women with HIV-infected partners. Preconceptional testing should be proposed whenever possible. The decision whether to continue or to terminate pregnancy is a woman's choice. Complete information and counseling must take into account the patient's disease status.(ABSTRACT TRUNCATED AT 250 WORDS)

Acquired Immunodeficiency Syndrome↗
PubMed1990

Social acceptability of HIV screening among pregnant women.

The paper presents the results of a survey about risk perception, knowledge, and attitudes towards HIV infection among 397 pregnant women in France. The survey was carried out between December 1987 and March 1988 in two Paris-region maternity hospitals where HIV testing is routinely proposed during the first prenatal visit. Uptake of HIV prenatal testing has been rapid in France: before coming to the maternity hospitals, 26.5% of women had already been tested. Social acceptability of testing is high, 68.8% of the sample even supporting mandatory prenatal HIV screening. Such acceptability appears to be based less on an in-depth knowledge about the risks of transmission from mother-to-fetus than on the general French context of free-of-charge mandatory prenatal care and on the potentially reassuring effect of a true negative test. Consensus about abortion for HIV-infected pregnant women is strong (80.1%) and is not influenced by religious beliefs, in contrast to attitudes toward abortion in the case of fetal handicaps. This social environment creates special difficulties for the management of the complex dilemmas regarding pregnancy and childbearing for HIV-infected women.

AIDS Serodiagnosis↗
PubMed1990

Precipitants of violence in a psychiatric inpatient setting.

Data gathered from the medical record and in interviews with staff and patients in an inpatient psychiatric setting at a Veterans Affairs medical center were used to examine events preceding 73 episodes in which patients were placed in four-point restraints. The behaviors leading to restraint included physical aggression, verbal threats, and threats with an object as a weapon. These behaviors were more likely to relate to external situations than to the patient's internal psychiatric symptoms. Staff were most frequently the target of patients' aggression, and patients were more likely to view the events leading to restraint as conflict with staff. No differences in the subsequent number of restraint episodes or hours in restraints were found between patients with positive and negative responses to the index restraint episode.

Adult↗
PubMed1990

[The socioeconomic consequences of HIV infection in women and children].

The impact of AIDS is expected to shift dramatically towards women and children during the next decade. By the year 2000, millions of women and children in Africa will have AIDS or be orphan. In Europe and America, HIV infection is also spreading most rapidly among these populations. In the Paris hospitals, 0.9% of pregnant women were HIV infected in 1989. Women in the HIV seropositive population are predominantly young, unmarried, smoke, are foreign-born or have used drugs. In France, there is a clear trend towards infection of pregnant women through heterosexual transmission, 24.7% in 1987 to 41.8% in 1989. Women are increasingly choosing to continue pregnancy despite counseling on the risk of HIV transmission to the fetus. Today, over 50% of infected women in Paris continue pregnancy. In the developed countries, 20 to 25% of the infant of HIV seropositive mothers are infected perinatally and 60% die within the first 5 years. The outlook for many of the uninfected children is also quite break. They may be abandoned or orphaned and/or maintained in various institutions. Medical care for infected children is more expensive than for mothers. The cost of HIV infection includes not only diagnosis and treatment but the social cost as well. In maternities, the strain on personnel and facilities can be considerable. Services attending a high proportion of seropositive women and children must be reorganized. Screening, which is accepted by nearly all pregnant women, must be emphasized. Further emphasis must be placed on the prevention of heterosexual transmission.

Child↗
PubMed1990

[Advantages and disadvantages of celioscopic surgery in gynecology].

In the last decade, operative laparoscopy has been a break through in the practice of gynecology. Recent progress has been made with the development of cold light, appropriate atraumatic instrumentation, video-camera and CO2 laser. Laparoscopy provides access to the pelvis, allowing for diagnosis and treatment of a variety of pathologies. The most frequent indication is the treatment of ectopic pregnancy. Salpingotomy with tubal preservation, the procedure of choice for young women wanting to become pregnant, has been used in 88 cases. However, tubal preservation is not always possible (rupture of the ovarian tube, hemosalpinx), and sometimes not even advisable (inflammatory lesions, homolateral recurrence) and salpingectomy was necessary in 294 cases. Another indication for salpingectomy is painful chronic salpingitis, resulting from an undetected or ill-treated Chlamydia trachomatis infection: 84 cases. Infertility surgery is the second most important indication for laparoscopic procedure. The authors have performed salpingoovariolysis in 49 cases, neosalpingostomy in 34 cases and fimbrioplasty in 31 cases. Reproductive outcome at 18 months post-operatively was comparable to results following microsurgical techniques, with a rate of ongoing pregnancies of 53% for adhesiolysis and 27.7% for distal tuboplasties. Immediate opening of hydrosalpinges at the time of diagnostic laparoscopy allows for precise evaluation of the tubal mucosa, thereby establishing prognosis. Laparoscopy also allows for management or ovarian cyst, first explored to determine the absence of any sign of malignancy. In most cases, the cyst's contents and wall may be entirely removed by laparoscopy: 115 cases.(ABSTRACT TRUNCATED AT 250 WORDS)

Anesthesia, General↗
PubMed1990

[Celioscopy and ectopic pregnancy].

The most frequent indication is the treatment of ectopic pregnancy. Salpingotomy with tubal preservation, the procedure of choice for young women wanting to become pregnant, has been used in 88 cases. However, tubal preservation is not always possible (rupture of the ovarian tube, hemosalpinx), and sometimes not even advisable (inflammatory lesions, homolateral recurrence) and salpingectomy was necessary in 294 cases. Another indication for salpingectomy is painful chronic salpingitis, resulting from an undetected or ill-treated Chlamydia trachomatis infection: 84 cases.

Adult↗
PubMed1990

[Tuboperitoneal infertility and operative celioscopy (endometriosis excluded)].

The great progress made in surgical celioscopy now allows most surgery for the repair of the adnexa to be performed through such an approach. The exeresis of adhesions with scissors is the safest, fastest and least traumatic technique. For salpingostomy, the eversion of the cuff is maintained by a defocused CO2 laser shot on the distal tubal serosa, or more simply, by the contact of the serosa with the bipolar pliers or with the tip of the thermocoagulation device. The results of the lysis of adhesions are satisfactory, with 53% intrauterine pregnancies in our 49-patient series. The results of distal plasty, with 27.7% intrauterine pregnancies in our 65-case series, they are quite comparable to those of microsurgical laparotomy. These results, along with the advantages of surgical celioscopy, caused us to give up microsurgical laparotomy for the treatment of operable adhesions and distal tubal lesions, even more so as in vitro fertilization must be contemplated at once for severe lesions.

Fallopian Tubes↗
PubMed1990

[Celiosurgery of the ovary].

Ovarian cysts can also be explored with celioscopy and, when no signs of malignancy are detected, cystectomy can be performed in this way (115 cases). In addition, an ovariectomy was performed in 15 cases and an adnexectomy in 2 cases.

Fallopian Tubes↗
PubMed1989

RU 486 abortions.

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Abnormalities, Drug-Induced↗