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Biomedical subjects

R Shojai

Publications and source records attributed to R Shojai.

At least 19 recordsLinked to original sources
PubMed2007

Diffusion-weighted magnetic resonance imaging with apparent diffusion coefficient (ADC) determination in normal and pathological fetal kidneys.

OBJECTIVES: To assess the use of diffusion-weighted magnetic resonance imaging (DW-MRI) in the evaluation of the fetal kidney and to estimate age-dependent changes in the apparent diffusion coefficient (ADC) of normal and pathological fetal kidneys. METHODS: DW-MRI was performed on a 1.5-T machine at 23-38 gestational weeks in 51 pregnant women in whom the fetal kidneys were normal and in 10 whose fetuses had renal pathology (three with suspected nephropathy, three with renal tract dilatation, one with unilateral renal venous thrombosis, and three with twin-twin transfusion syndrome (TTTS)). The ADC was measured in an approximately 1-cm2 region of interest within the renal parenchyma. RESULTS: ADC values in normal renal parenchyma ranged from 1.1 to 1.8 10(-3) mm2 s-1. There was no significant age-dependent change in the ADC of normal kidneys. In cases of nephropathy, the ADC value was not always pathological but an ADC map could show abnormal findings. In cases of dilatation, the ADC value was difficult to determine when the dilatation was huge. In cases of TTTS, the ADC of the donor twin was higher than that of the recipient twin and the difference seemed to be related to the severity of the syndrome. CONCLUSION: Evaluation of the ADC for fetal kidneys is feasible. Fetal measurement of the ADC value and ADC maps may be useful tools with which to explore the fetal kidney when used in conjunction with current methods. DW-MR images, ADC value and ADC map seem to be useful in cases of suspected nephropathy (hyperechoic kidneys), dilated kidney and vascular pathology (renal venous thrombosis, TTTS).

Diffusion Magnetic Resonance Imaging↗
PubMed2006

Advanced combined abdominal and intrauterine pregnancy: a case report.

We present a case of simultaneous abdominal and intrauterine pregnancy following in vitro fertilization and embryo transfer diagnosed during the second trimester. The patient had a recent history of hysteroscopic metroplasty due to in utero exposition to diethylstilboestrol. The pregnancy was managed conservatively with a favorable outcome for the mother and both fetuses.

Adult↗
PubMed2006

Fetal magnetic resonance hydrography: evaluation of a single-shot thick-slab RARE (rapid acquisition with relaxation enhancement) sequence in fetal thoracoabdominal pathology.

OBJECTIVES: To evaluate the potential of a single-shot thick-slab RARE (rapid acquisition with relaxation enhancement) sequence in fetal thoracoabdominal magnetic resonance (MR) examinations compared with multislice T2-weighted sequence and postnatal imaging. METHODS: RARE sequence is rapid and provides very heavily T2-weighted images. Twenty-seven fetal thoracoabdominal MR imaging examinations were performed at 23-38 weeks using our conventional protocol. This included thin multislice T2-weighted half-Fourier acquired single-shot turbo spin-echo (HASTE) sequence and thin-slice GE (gradient echo) T1-weighted images with a 1.5-T MR unit. A single-shot thick-slab (60 mm) RARE sequence was added to all MR examinations. The acquisitions were obtained with the mother breath-holding. The thick-slab heavily T2-weighted images were compared with HASTE sequence images and with postnatal imaging in all cases. RESULTS: The thick-slab RARE sequence did not show additional abnormalities compared with the conventional protocol but displayed an overall view of the urinary tract, tracheobronchial tract and small bowel. It gave information that was highly correlated with postnatal imaging, such as abdominal plain films, chest film or cystography. The quality of the thick-slab RARE images was considered as good in 13 cases (48%), moderate in 12 cases (45%) and poor in two cases (7%). CONCLUSION: Although thick-slab RARE sequence does not show additional abnormalities compared with the conventional protocol, it illustrates very nicely static fluids such as those in urinary dilatation, the esophagus and small bowel (normal or dilated) and thoracic cystic masses. It is very rapid (5 s) to perform, allows fetal hydrography, and correlates well with postnatal imaging.

Adult↗
PubMed2005

Value of endorectal ultrasonography for diagnosing rectovaginal septal endometriosis infiltrating the rectum.

BACKGROUND AND STUDY AIMS: Rectovaginal septal endometriosis (RVSE) can pose serious therapeutic problems when there is infiltration of the rectal septum (which occurs in approximately half of the cases). The aim of this study was to assess the value of endoscopic ultrasonography in diagnosing rectal wall involvement by pelvic endometriosis. PATIENTS AND METHODS: A prospective study was carried out from May 1998 to March 2003 at a single hospital center. The 30 patients included in the study presented with suspected RVSE and underwent systematic anorectal endoscopic ultrasonographic exploration prior to the surgical intervention. The endoscopic ultrasonography was carried out under general anesthesia with a 7.5-MHz miniprobe equipped with a distal balloon. RESULTS: The anorectal endoscopic ultrasonographic examination (EUS) showed the presence of endometriosis in the rectovaginal septum in 26 patients (88 %), in the uterosacral ligaments in 10 patients (33 %), and in the ovaries in two patients (6 %). At EUS, the nodules were infiltrating the rectal wall in 17 patients (56 %). The surgical exploration demonstrated endometriosis in the rectovaginal septum in 26 cases, the uterosacral ligaments in 22 cases, and the ovaries in 16 cases. The rectal wall was completely infiltrated in 12 cases and only partly in four cases, and intestinal tract resection was required in 10 cases. The sensitivity, specificity, and positive and negative predictive value of anorectal endoscopic ultrasonography as a means of diagnosing endometriosis of the rectovaginal septum and infiltration of the rectal wall were found to be 96 %, 100 %, 100 % and 83 %, and 92 %, 66 %, 64 % and 92 %, respectively; and the diagnostic accuracy was at 96 % and 80 %, respectively. The sensitivity for detecting nodules in the uterosacral ligaments or in the ovaries was 42 % and 14 %, respectively, leading to diagnostic accuracy rates of 56 % and 53 %. CONCLUSIONS: In terms of its sensitivity and its negative predictive value, anorectal endoscopic ultrasonography is a very effective means of detecting endometriosis of the rectovaginal septum and assessing possible infiltration of the rectal wall. However, this method is not as accurate for nodules located far from the EUS probe, as is the case with the uterosacral ligaments and ovaries.

Adult↗
PubMed2004

[New insight in physiopathology of preeclampsia and intra-uterine growth retardation: role of inflammation].

Inflammatory response is a major component in physiopathology of preeclampsia and intra-uterine growth retardation. Endothelium is a main connection between placental ischemia and clinical manifestations during vascular pregnancy complications. In this review recent findings concerning inflammatory response and its links with endothelium are reported. Studies concerning isolated intra-uterine growth retardation confirm the hypothesis of a similar pathophysiology with an activation confined to utero-placental bed or at a lower level. Current information on oxidative stress, atherosclerosis, and apoptosis in vascular pregnancy complications are available in this review. These concepts offer innovative possibilities of treatment.

Apoptosis↗
PubMed2004

[Rectal misoprostol for postpartum hemorrhage].

OBJECTIVE: To evaluate a post-partum hemorrhage treatment guideline, using rectally administered misoprostol. PATIENTS AND METHODS: A descriptive study was carried out in a tertiary referral center from January 2002 to March 2003. During this period, 2670 patients delivered and 41 (1.5%) with severe post-partum hemorrhage unresponsive to oxytocin received 1000 microg of misoprostol (five tablets) rectally while awaiting sulprostone. Twenty-eight had delivered by the vaginal route and 13 by cesarean section. RESULTS: Hemorrhage was controlled among 63% (26/41) of the patients within 10 min of the administration of rectal misoprostol. Fifteen (37%) patients received both misoprostol and sulprostone and no major adverse effects were noted when combining these two prostaglandins. Overall, hemorrhage was controlled among 87% (36/41) of the patients when oxytocics were combined with misoprostol and sulprostone. Five patients (12%) did not respond to the combination of uterotonics and required a conservative surgical treatment. DISCUSSION AND CONCLUSION: Rectal misoprostol may be an effective second line treatment for the management of post-partum hemorrhage unresponsive to oxytocin. We did not observe major side effects when combining misoprostol with sulprostone. Our findings encourage further research on rectal misoprostol in the treatment of postpartum hemorrhage.

Administration, Rectal↗
PubMed2004

[Female genital mutilation: generalities, complications and management during obstetrical period].

OBJECTIVES: Evaluation of female genital mutilation complications and their clinical management. MATERIAL AND METHODS: Review of the literature. RESULTS: Female genital mutilation is still performed in some regions of Africa. Although female genital mutilation are often considered as a religious act, tradition and social habits seems to be the best explanation. Infibulation is the most severe form, in which the clitoris, the labia minora and part of labia majora are removed. Stitching of the raw surfaces created covers the urethra and the vaginal entrance. There only remains a small opening at the base of the vulva. Health consequences directly depend on the severity of the initial mutilation. They are more severe in infibulated women. Pregnancy, childbirth and the obstetrical period are particuliary dangerous for the mother and the child. Female genital mutilation contributes to childhood and maternal mortality and morbidity. Decreasing the impact depends on the obstetrical team's competence. Defibulation is absolutely necessary for the delivery of infibulated women. This simple surgical act can be performed under local anesthesia. CONCLUSION: With increasing immigration, obstetrical teams in developed countries can be confronted with such situations. They should be aware of proper clinical management practices for these women.

Circumcision, Female↗
PubMed2004

[Surgical management of primary postpartum hemorrhage].

Despite the development of medical, obstetrical and arterial embolization techniques to control acute postpartum hemorrhage, familiarity with surgical procedures is essential. They may be the ultimate available option in order to obtain hemostasis. Conservative techniques consist of arterial ligations and uterine compression sutures that preserve the reproductive future and may be combined together. Radical options include hysterectomy which may be total or sub-total. To date, there are no comparative trials assessing the superiority of a given surgical option. In this review, the main surgical interventions are described and a practical stepwise approach is discussed according to the etiology, based on a professional consensus work-shop. Surgical management must be timely triggered after failure of first line treatments and integrated in a global strategy aimed to cease hemorrhage. It should be adapted to the available local health resources and in compliance with the various members of the medical staff.

Decision Trees↗
PubMed2002

Ultrasonographic evaluation of cervical length in pregnancies complicated by preterm premature rupture of membranes.

OBJECTIVE: To evaluate the usefulness of transvaginal ultrasonography in the determination of the risk of preterm delivery and chorioamnionitis in pregnancies affected by preterm premature rupture of membranes preterm premature rupture of membranes. DESIGN: One hundred and one singleton pregnancies with preterm premature rupture of membranes were included in this prospective study over a 3-year period. Patients underwent cervical length measurement by transvaginal ultrasonography at admission and thereafter, in the absence of chorioamnionitis, were managed expectantly. RESULTS: The median time interval between admission and delivery (latency period) was 48 h. A cervical length of less than 20 mm was associated with a significant risk of early delivery (mean latency period was 59.44 +/- 159.93 h vs. 240.94 +/- 364.67; P < 0.05). There was no relation between cervical length and occurrence of chorioamnionitis or neonatal sepsis. CONCLUSIONS: These data suggest that the use of transvaginal ultrasonography for cervical length measurement during preterm premature rupture of membranes may predict an early delivery but cannot anticipate the risk of chorioamnionitis or neonatal sepsis.

Adult↗
PubMed2002

[Tocolysis: indications and contraindications. When to start and when to stop].

Clinical trials have demonstrated that most tocolytic agents such as beta mimetics, atosiban and indometacine -exception made for magnesium sulfate- extend the duration of pregnancy, when compared to placebo. They reduce the rate of delivery at 24 hours, 48 hours and at 7 days. There is no proof however for their beneficial effect on perinatal or neonatal outcomes. Usual obstetrical contraindications of tocolytic treatments (infection, genital haemorrhage, fetal distress and certain maternal conditions) are often determined on a case by case basis, rather than upon evidence based medicine. Tocolysis may be considered in case of maternal infection without chorioamniotitis or during moderate hemorrhage due to placenta preavia (NP 4). There is no objective argument to refute a tocolytic attempt due and in accordance with a low gestationnal age limit. The risk for neonatal respiratory distress syndrome is higher at 34 weeks compared to 35 and 36 weeks. The studies were however realized before the corticosteroid era of fetal lung maturation. There are no available randomized trials concerning the benefits of tocolysis after 34 weeks of amenorrhea. Furthermore, there are no satisfactory trials preconising a specific tocolytic agent based on amniotic liquid study of lung maturity. In case of advanced cervical dilatation, rare studies have concluded the usefulness of tocolysis to allow fetal lung maturation by corticosteroids. Most studies have evaluated the effectiveness of tocolytic treatment during 48 hours. There is no evidence for continuing tocolytic treatment after an effective tocolysis prescribed during the first 48 hours. For intermediate situations, between franc success or failure of tocolysis (such as reduction but persistent painful uterine contractions or major cervical modification at a low gestational age despite reduction of uterine contractile activity), literature guidelines are poorly contributive. The management of such patients is most often empirical.

Clinical Trials as Topic↗
PubMed2001

Vaginal birth following two previous cesarean sections.

OBJECTIVE: To evaluate the management of vaginal delivery among women with two previous cesarean sections. The maternal and fetal morbidities of this attitude were studied. SETTING: University hospital. DESIGN: Retrospective study made over 6 years, from January 1st 1990 to December 31st 1995. PATIENTS: Among 180 patients with two uterine scars, 96 patients with cephalic presentation and normal pelvic dimensions were allowed trial of labor. RESULTS: The rate of vaginal birth following trial of labor was 65.6%. Three patients had an uterine scar dehiscence; among them, one hysterectomy was performed for haemorrhage with uterine atony. Neonatal issue was always favorable. Twenty-two newborns had superior birthweights compared to those born from the preceding cesarean section. CONCLUSION: Trial of labor following two previous cesarean sections is acceptable in the majority of cases. It leads to a high vaginal delivery rate and low maternal and fetal morbidity.

Analgesia, Epidural↗
PubMed2001

[Rectal administration of misoprostol for delivery induced hemorrhage. Preliminary study].

OBJECTIVE: Assess the efficacy of one misoprostol tablet (Cytotec) in severe delivery-induced hemorrhage on uterine atony after failure of syntocinon. PATIENTS AND METHODS: A descriptive study was conducted at the Djibouti Army Hospital from September to December 2000. Five patients with severe delivery-induced hemorrhage due to uterine atony unresponsive to syntocinon were give a tablet of misoprostol by rectal administration. RESULTS: The hemorrhage ceased in less than 5 minutes in all patients. No immediate side effect was observed. DISCUSSION: These preliminary findings are encouraging and suggest that further investigations would be useful to assess the beneficial effect of misoprostol by rectal administration for patients with severe delivery-induced hemorrhage due to uterine atony. Case-control studies with a sufficient number of cases should be undertaken to determine the real efficacy of misoprostol in this indication.

Administration, Rectal↗