101
|
Abstract
BACKGROUND Alport syndrome is a disorder associated with mutations in the type IV collagen gene and manifested by progressive glomerulonephritis. Little is known about the effect of Alport syndrome on pregnancy outcome. CASE We report a patient with Alport syndrome whose pregnancy was complicated by rapidly progressive severe preeclampsia, fetal growth restriction, and acute renal failure. At 25 weeks of gestation, termination of pregnancy was performed. The patient's renal function was well controlled before pregnancy, but had not recovered at 6 months postpartum, requiring ongoing hemodialysis. CONCLUSION Alport syndrome in pregnancy has the potential for disease acceleration with rapid parallel progression of vasculopathy in the placental and renal circulations.
Collapse
|
102
|
Lambropoulou M, Tamiolakis D, Venizelos J, Liberis V, Galazios G, Tsikouras P, Karamanidis D, Petrakis G, Constantinidis T, Menegaki M, Papadopoulos N. Imbalance of mononuclear cell infiltrates in the placental tissue from foetuses after spontaneous abortion versus therapeutic termination from 8th to 12th weeks of gestational age. Clin Exp Med 2007; 6:171-6. [PMID: 17191109 DOI: 10.1007/s10238-006-0111-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2006] [Accepted: 10/10/2006] [Indexed: 10/23/2022]
Abstract
Placental macrophages (Hofbauer cells) are located close to trophoblastic cells and foetal capillaries, which make them perfect candidates for involvement in regulatory processes within the villous core. Their capacity of producing several cytokines and prostaglandin-synthesising enzymes, and expressing vascular endothelial growth factor, indicate a possible role in placental development and angiogenesis in order to support pregnancy. Common cells to Hofbauer macrophages sharing similar cell surface markers (HLA-A, -B, -C and leukocyte common antigen) have been reported in the stroma, decidua and amnion, indicating additional foetal protection. Yet this is not always the case. Most spontaneous abortions occur before 12 weeks' gestation, and most are due to chromosomal errors in the conceptus. Relatively few truly spontaneous abortions take place between 12 and 20 weeks' gestation. Thereafter, between 20 and 30 weeks, another type of premature spontaneous termination becomes prevalent, which is due to ascending infection. The numbers of cells expressing the various markers of the monocytemacrophage lineage change throughout pregnancy. In the present study, we investigated the immunohistochemical expression of mononuclear infiltrations in paraffin-embedded placentas, from foetuses after spontaneous abortion (8th, 10th and 12th weeks of gestational age), and those after therapeutic abortion at the same time, using a panel of monoclonal antibodies for the identification of leukocytes (CD45/LCA), B-lymphocytes (CD20/L-26), T lymphocytes (CD45RO/UCHL1), CD68 and CD14 cells. Immunologic factors in human reproductive failure are plausible mechanisms of infertility and spontaneous abortion. Approximately 25% of cases of premature ovarian failure appear to result from an autoimmune aetiology. Unfortunately, current therapeutic options for these women are limited to exogenous hormone or gamete substitution. Local inflammations at the sites of endometriosis implants are postulated to mediate the pain and reduced fecundability associated with this clinical syndrome. The recruitment of immune cells, particularly monocytes and T-cells, neovascularisation around foci of invading peritoneal lesions, and the possible development of antiendometrial autoantibodies support an immunologic basis of this disorder. To date, treatment of pain and infertility associated with endometriosis is primarily surgical, although immune-based adjuvants are theoretical possibilities for the future. Finally, although hypotheses supporting immunologic mechanisms of recurrent pregnancy loss have been popular over the past decade, most clinical investigations in this area do not provide compelling evidence for this position. Reputable specialists in reproductive medicine use experimental immunotherapies judiciously in selected cases of repetitive abortion. For example, the use of anticoagulation therapy can be beneficial in cases with documented antiphospholipid antibodies. At present, however, efficacious immunotherapy protocols for general application have not been established. Despite these caveats, continued strides in our understanding of human reproductive immunology should yield considerable future progress in this field. During the physiological changes that occur in the first and in the beginning of the second trimester of pregnancy, spiral arteries of the placental bed are converted into the uteroplacental arteries. The essence of this conversion consists of losing the muscular elements in the vessel walls, making them unable to respond to vasomotor influences. Cells that infiltrate the walls of spiral arteries and replace their normal elements are called migratory, non-villous or intermediate trophoblastic cells. Besides infiltrating and replacing the anatomic structures of spiral arteries, intermediate trophoblastic cells also penetrate into the lumina of these vessels forming endovascular plugs. These plugs are one of the reasons why early uteroplacental blood flow cannot be visualised, even with transvaginal ultrasound, during the first 12 weeks of gestation. In uncomplicated pregnancies, the endovascular trophoblast is bound to disappear by the end of the second trimester of pregnancy, but the literature on this topic is scarce. Here we describe the detection, isolation and characterisation of CD45RO-, L26- and CD68/CD14-positive cells from human early pregnancy deciduas. These cells were found in close vicinity to endometrial glands, with preference to the basal layer of the decidua. We conclude that (1) maternal cells, apparently CD45RO/UCHL1-positive cells, cross the maternofoetal barrier and participate in spontaneous (involuntary) abortions, and (2) a small proportion of maternal cells (approximately 30%), apparently CD68/CD14-positive cells, also cross the maternal-foetal barrier and cause growth delay and recurrent reproductive failure. Further investigation of involvement of the intercellular adhesion molecules 1 and 2, platelet endothelial cell adhesion molecule, vascular cell adhesion molecule and E-selectin in leukocyte accumulation will be needed to support the passage of maternal cells to the foetus. The results were statistically significant (P<0.0001, Student's t-test).
Collapse
|
103
|
Fratelli N, Rich P, Jeffrey I, Bahmaie A, Thilaganathan B, Papageorghiou AT. Prenatal diagnosis of segmental spinal dysgenesis. Prenat Diagn 2007; 27:979-81. [PMID: 17611945 DOI: 10.1002/pd.1807] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
104
|
Canto MJ, Buixeda M, Palau J, Ojeda F. Early ultrasonographic diagnosis of diastrophic dysplasia at 12 weeks of gestation in a fetus without previous family history. Prenat Diagn 2007; 27:976-8. [PMID: 17602446 DOI: 10.1002/pd.1800] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
|
105
|
Lopes KRM, Mennes F, Delazoide AL, Iserin F, Azancot A. Prenatal diagnosis of absent pulmonary valve with membranous tricuspid atresia and intact ventricular septum: report of one case and review of the literature. Prenat Diagn 2007; 27:973-5. [PMID: 17600853 DOI: 10.1002/pd.1799] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
|
106
|
Lao XQ, Thomas GN, Jiang CQ, Zhang WS, Yin P, Schooling M, Heys M, Leung GM, Adab P, Cheng KK, Lam TH. Parity and the metabolic syndrome in older Chinese women: the Guangzhou Biobank Cohort Study. Clin Endocrinol (Oxf) 2006; 65:460-9. [PMID: 16984238 DOI: 10.1111/j.1365-2265.2006.02615.x] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To examine whether parity or gravidity contributes to the development of the metabolic syndrome (MS). METHODS The first phase of the Guangzhou Biobank Cohort Study recruited 7352 women and 3065 men aged 50-93 years in 2003-4. Data on the number of live births and pregnancies, other reproduction-associated factors and socioeconomic and lifestyles factors were collected by standardized interview. The MS components were determined through physical examination and measurement of fasting blood samples. MS was identified if waist circumference was >or= 90 cm for men or >or= 80 cm for women, plus any two of: (a) raised triglyceride (TG) level (1.7 mmol/l) or specific treatment for this lipid abnormality; (b) reduced high density lipoprotein (HDL)-cholesterol (< 1.03 mmol/l in males or < 1.29 mmol/l in females) or specific treatment for this lipid abnormality; (c) raised blood pressure (BP, systolic BP >or= 130 mmHg or diastolic BP >or= 85 mmHg) or hypertension therapy; and (d) raised fasting glucose (>or= 5.6 mmol/l) or previously diagnosed type 2 diabetes. RESULTS Before adjustment for potential confounders, we found associations between the number of births and lifestyle and socioeconomic factors in both sexes. However, in women, but not in men, body mass index (BMI), waist-hip ratio, triglyceride and glucose were positively associated with the number of birth after adjusting for a range of potential confounders. The age-adjusted prevalence of the MS increased with the number of births and pregnancies in women, but the gradient for birth was steeper than that for pregnancies [odds ratio change per birth 1.16, 95% confidence interval (CI) 1.11-1.22, P < 0.001; odds ratio change per pregnancy 1.11, 95% CI 1.06-1.16, P < 0.001], although attenuating the association adjustment did not affect the significance of these findings. There was no association in men with regard to the number of their partners' live births given the same analysis and similar shared living background with the women. CONCLUSION Higher parity or gravidity was associated with a consistent increase in the risk of MS in Chinese women. As the association persisted after adjustment for lifestyle factors and there was no association between the risk of MS and the number of births associated with the partners of the males, the association in women may represent a biological response to pregnancy.
Collapse
|
107
|
Abstract
Mutations in the BRCA1 and BRCA2 genes confer a high lifetime risk of breast and ovarian cancer. The risk varies from individual to individual, and it appears that the risk has increased in recent generations. These observations imply that non-genetic factors may modify the inherited risk. To date, the factors that appear most strongly to modify the risk include reproductive histories and exogenous hormones. Oral contraceptives are associated with a profound reduction in the risk of ovarian cancer, and with little or no increase in the risk of breast cancer. Other modifying factors include age of menarche, parity, breastfeeding and oophorectomy. The effect of parity is different in BRCA1 and BRCA2 carriers. Multiparity appears to be protective in BRCA1 carriers, but is associated with an increase in risk in BRCA2 carriers. Oophorectomy has been associated with reductions in both the risk of breast and ovarian cancer. Knowledge of these risk factors will be useful for managing risk and for developing prevention strategies.
Collapse
|
108
|
Rehan A, Almanaseer Y, Desai DM, Ali A, Yamasaki H. Complete Resolution of Acute Renal Failure after Left Renal Artery Angioplasty and Stent Placement for Total Renal Artery Occlusion. Cardiology 2006; 108:51-4. [PMID: 17003541 DOI: 10.1159/000095832] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2006] [Accepted: 06/24/2006] [Indexed: 11/19/2022]
Abstract
A 25-year-old female, 17 weeks pregnant presented to our hospital with complaints of progressively increasing dyspnea. She was hypertensive with creatine of 1.0; she was transferred to ICU with multiple medications to control her blood pressure, without success. The patient continued to decompensate, which required intubation. The patient developed acute renal failure, part of her work-up suggested bilateral renal artery stenosis. She was taken to the catheterization lab and was found to have bilateral total renal artery occlusion. The left renal artery was successfully opened. The patient recovered and her blood pressure was controlled after the procedure. In the past, surgery was the preferred treatment in cases of acute renal artery occlusion. This approach has been replaced increasingly by renal artery angioplasty, which is less invasive and is at least as effective as surgical reconstruction. Our case demonstrates a percutaneous approach can be tried for totally occluded renal artery with a successful outcome.
Collapse
|
109
|
Ingec M, Borekci B, Altas S, Kadanali S. Twin pregnancy with partial hydatidiform mole and coexistent normal fetus. J OBSTET GYNAECOL 2006; 26:379-80. [PMID: 16753704 DOI: 10.1080/01443610600618747] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
|
110
|
Vandenput I, Vergote I, Amant F, Neven P, Paridaens R, Christiaens MR. Aromatase Inhibitors in Premenopausal Women: The Need for Proper Contraceptive Counseling. Breast J 2006; 12:507-8. [PMID: 16958981 DOI: 10.1111/j.1075-122x.2006.00318.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
MESH Headings
- Abortion, Therapeutic
- Adult
- Antineoplastic Agents, Hormonal/administration & dosage
- Antineoplastic Agents, Hormonal/pharmacology
- Aromatase Inhibitors/administration & dosage
- Aromatase Inhibitors/pharmacology
- Breast Neoplasms/drug therapy
- Breast Neoplasms/pathology
- Breast Neoplasms/surgery
- Carcinoma, Ductal, Breast/drug therapy
- Carcinoma, Ductal, Breast/secondary
- Carcinoma, Ductal, Breast/surgery
- Chemotherapy, Adjuvant
- Contraception/methods
- Counseling
- Female
- Health Services Needs and Demand
- Humans
- Mastectomy, Modified Radical
- Needs Assessment
- Ovarian Neoplasms/secondary
- Ovary/drug effects
- Pregnancy
- Premenopause
Collapse
|
111
|
Mojoli F, Zanierato M, Campana C, Braschi A. Inhaled nitric oxide test in a pregnant patient with severe pulmonary hypertension. Anaesthesia 2006; 61:912. [PMID: 16922775 DOI: 10.1111/j.1365-2044.2006.04769.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
112
|
Nonaka M, Toyoki H, Imai A. Cesarean section scar pregnancy may be the cause of serious hemorrhage after first-trimester abortion by dilatation and curettage. Int J Gynaecol Obstet 2006; 95:50-1. [PMID: 16919632 DOI: 10.1016/j.ijgo.2006.06.019] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2006] [Revised: 06/06/2006] [Accepted: 06/14/2006] [Indexed: 11/27/2022]
|
113
|
Storgaard T, Frandsen KH, Lauszus FF. [Caesarean section scar pregnancy--various treatment alternatives]. Ugeskr Laeger 2006; 168:2820-1. [PMID: 16942706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Pregnancy in a Caesarean section scar is rare but possibly life-threatening because of the risk of rupture and excessive bleeding. We describe here a case of a pregnant woman with previous Caesarean section. She had no symptoms of ectopic pregnancy, but a transvaginal sonography showed a live seven-week pregnancy in the Caesarean section scar. To terminate the pregnancy and conserve the uterus, she was treated medically with methotrexate and mifepristone, with no effect. Transvaginal intrathoracic injection of 1 mmol of potassium chloride was then performed. After this, the patient's serum HCG level dropped.
Collapse
|
114
|
Brown-Guttovz H. Myths and facts... About ectopic pregnancy. Nursing 2006; 36:70. [PMID: 16888522 DOI: 10.1097/00152193-200608000-00051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
115
|
Dilek I, Topcu N, Demir C, Bay A, Uzun K, Gul A, Faik Oner A, Ugras S. Hematological malignancy and pregnancy: a single-institution experience of 21 cases. ACTA ACUST UNITED AC 2006; 28:170-6. [PMID: 16706933 DOI: 10.1111/j.1365-2257.2006.00781.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The incidence of hematological malignancies during pregnancy is low, and treatment in this setting is problematic. This study observed 21 pregnancies in 18 patients with hematological malignancies. Patients' ages were between 19 and 43 (median 25) years. Two pregnancies ended with spontaneous abortion, one pregnancy ended with in utero death, three therapeutic abortions were carried out, and 15 infants were born alive but three of them died later. The median birth weight was 2.47 kg. Twelve babies survived to a median age of 36 (range 4-117) months. Eight babies were exposed to chemotherapy during the in utero period. One baby was exposed to chemotherapy during all the trimesters and was born prematurely and later died because of intracranial bleeding. Four babies were exposed to chemotherapy during the first trimester, one of them had low birth weight and floating thumb malformation, two of them had only low birth weight, and one was born healthy, but died at 3 months of age as a result of severe gastroenteritis. Two babies were exposed to chemotherapy during the second and third trimesters; one of them had low birth weight, and the other pregnancy ended in in utero death. One infant was exposed to chemotherapy during the third trimester and was born at term, but died because of pulmonary hemorrhage. We concluded that chemotherapy during all trimesters of pregnancy carries a significant risk for an unfavorable outcome.
Collapse
MESH Headings
- Abortion, Spontaneous/chemically induced
- Abortion, Therapeutic
- Adult
- Antineoplastic Combined Chemotherapy Protocols/adverse effects
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Fatal Outcome
- Female
- Fetus/abnormalities
- Fetus/drug effects
- Hodgkin Disease/drug therapy
- Humans
- Infant, Newborn
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myeloid, Acute/drug therapy
- Lymphoma, Non-Hodgkin/drug therapy
- Male
- Precursor Cell Lymphoblastic Leukemia-Lymphoma/drug therapy
- Pregnancy
- Pregnancy Complications, Hematologic/drug therapy
- Pregnancy Complications, Neoplastic/drug therapy
Collapse
|
116
|
Wonkam A, Njamnshi AK, Angwafo FF. Knowledge and attitudes concerning medical genetics amongst physicians and medical students in Cameroon (sub-Saharan Africa). Genet Med 2006; 8:331-8. [PMID: 16778594 DOI: 10.1097/01.gim.0000223542.97262.21] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
PURPOSE Little is known about physician's knowledge of, and attitudes toward genetics in sub-Saharan Africa. METHODS Survey of 101 pre-clinical, 95 clinical medical students, and 110 physicians, in Cameroon. RESULTS The awareness of DNA diagnosis was poor: 0, 2.2, and 1.2%, respectively, for sickle cell anemia. The majority of the respondents considered genetic counseling as indispensable (97.6, 98.9 and 100%); and prenatal diagnosis as acceptable. The acceptance of medical abortion increased with the level of medical education (62.6, 74.7 and 90.7%). Sickle cell anemia was considered as a "serious disease" by a greater majority of respondents than Down syndrome (P < 0.001). But, in all three groups, the acceptance of termination of affected pregnancy "if the respondent's own child was affected" was lower for sickle cell anemia than Down syndrome (22.4 versus 40.2%, 10.8 versus 29.3% and 36.1 versus 70.4%). CONCLUSIONS The data suggest a poor knowledge of genetic tests among medical students and physicians. This cohort appears to accept the principles of medical genetics. Our data emphasized a need to introduce genetics and to develop research on its ethical and social implications in Cameroon.
Collapse
MESH Headings
- Abortion, Therapeutic
- Attitude
- Attitude of Health Personnel
- Cameroon
- Education, Medical
- Education, Medical, Undergraduate
- Genetic Diseases, Inborn/diagnosis
- Genetic Diseases, Inborn/genetics
- Genetic Techniques
- Genetics, Medical/education
- Genetics, Medical/trends
- Health Knowledge, Attitudes, Practice
- Physicians
- Prenatal Diagnosis
- Students, Medical
- Surveys and Questionnaires
Collapse
|
117
|
Caliendo L, Marino C, Castorino A, Venturino E. Hypoplastic left heart syndrome. Minerva Cardioangiol 2006; 54:393-5. [PMID: 16733515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
|
118
|
Ramirez C, de Seze J, Delrieu O, Stojkovic T, Delalande S, Fourrier F, Leys D, Defebvre L, Destée A, Vermersch P. [Myasthenia gravis and pregnancy: clinical course and management of delivery and the postpartum phase]. Rev Neurol (Paris) 2006; 162:330-8. [PMID: 16585888 DOI: 10.1016/s0035-3787(06)75019-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To study influences of pregnancy on the time-course of myasthenia gravis (MG) and of MG on pregnancy, delivery, postpartum and newborn. METHODS We retrospectively collected data from 100 women affected with MG, hospitalized between 1994 and 2003 in departments of Neurology of Lille University Hospital. RESULTS Eighteen patients had a total of 36 pregnancies, occurring 7.2 years on average after MG onset. MG exacerbation occurred in 7 patients (26 percent) during pregnancy and in 4 (14.8 percent) during postpartum. One patient died of acute respiratory failure during postpartum. Delay between the onset of MG and pregnancy was the only variable significantly associated with MG exacerbation: 5.8 years when exacerbation and 9.5 years when no exacerbation (p=0.03). Seven miscarriages, two therapeutic abortions and no death at birth were reported. Levels of anti-acetylcholine receptor antibodies were abnormal in 3 of 27 newborns (11 percent), but only one (3.7 percent) developed seronegative transient neonatal myasthenia gravis. DISCUSSION During pregnancy, the clinical course of MG is variable but exacerbations were associated with a shorter delay between MG diagnosis and pregnancy. The risk of transient neonatal myasthenia gravis is relatively small but exists even when the parturient has stable MG without elevated levels of anti-acetylcholine receptor antibodies. CONCLUSION Our study confirms pregnancy is more difficult to manage at the beginning of MG. Given the unpredictable course of MG during pregnancy, we recommend women affected with MG to begin a pregnancy when the disease is stable.
Collapse
MESH Headings
- Abortion, Therapeutic
- Adult
- Autoantibodies/immunology
- Autoantigens/immunology
- Cholinesterase Inhibitors/therapeutic use
- Delivery, Obstetric/methods
- Delivery, Obstetric/statistics & numerical data
- Disease Progression
- Female
- France/epidemiology
- Hospitals, University/statistics & numerical data
- Humans
- Immunity, Maternally-Acquired
- Immunosuppressive Agents/therapeutic use
- Infant, Newborn
- Infant, Premature
- Isoantibodies/immunology
- Male
- Myasthenia Gravis/drug therapy
- Myasthenia Gravis/epidemiology
- Myasthenia Gravis/immunology
- Myasthenia Gravis/physiopathology
- Myasthenia Gravis, Neonatal/epidemiology
- Myasthenia Gravis, Neonatal/immunology
- Pregnancy
- Pregnancy Complications/drug therapy
- Pregnancy Complications/epidemiology
- Pregnancy Complications/immunology
- Pregnancy Complications/therapy
- Puerperal Disorders/epidemiology
- Receptors, Cholinergic/immunology
- Recurrence
- Retrospective Studies
- Spironolactone/therapeutic use
Collapse
|
119
|
Wong GY, Wong SF, Chan WP, Ng WF. Three-dimensional ultrasound findings of spondylocostal dysostosis in the second trimester of pregnancy. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2006; 27:580-2. [PMID: 16619382 DOI: 10.1002/uog.2769] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
Spondylocostal dysostosis (SCD) is a rare congenital disorder that is characterized by vertebral segmentation and formation defects, and asymmetrical rib anomalies. We describe a case diagnosed during the second trimester of pregnancy with the sonographic features of abnormal alignment of the spine, hemivertebrae in the thoracic spine and kyphoscoliosis. Three-dimensional ultrasound demonstrated a 'fan-like' rib cage with fusion of the ribs. The postmortem findings confirmed the ultrasound findings and were consistent with SCD.
Collapse
|
120
|
Volpe P, Paladini D, Resta M, Stanziano A, Salvatore M, Quarantelli M, De Robertis V, Buonadonna AL, Caruso G, Gentile M. Characteristics, associations and outcome of partial agenesis of the corpus callosum in the fetus. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2006; 27:509-16. [PMID: 16619387 DOI: 10.1002/uog.2774] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
OBJECTIVES To report, in a population of fetuses diagnosed with partial agenesis of the corpus callosum (PACC), the sonographic characterization, incidence of cerebral, extracerebral and chromosomal anomalies, and outcome. In addition, in some of our cases a comparison was made between findings on ultrasound and fetal magnetic resonance imaging (MRI). METHODS This was a retrospective study of all cases of PACC seen at two referral centers for prenatal diagnosis of congenital anomalies over a 10-year period. The following variables were assessed: indication for referral, additional cerebral and extracerebral malformations, chromosomal abnormalities, and pregnancy and fetal/neonatal outcome. RESULTS Among 54 cases of fetal agenesis of the corpus callosum detected in the referral centers during the observation period, PACC was diagnosed at prenatal sonography in 20 cases and confirmed at pre/postnatal MRI and necropsy examinations in 19 cases (35%). These 19 constituted the study group. The diagnosis was made in the sagittal planes and in 12 cases it was made prior to 24 weeks. In most cases the indication for referral was the presence of indirect signs of callosal anomalies, such as colpocephaly. In 10 cases PACC occurred in association with other anomalies and in nine it was isolated. MRI was particularly useful for demonstrating some additional cerebral anomalies such as late sulcation, migrational pathological conditions and heterotopia. Regarding pregnancy outcome, of those diagnosed before 24 weeks which had associated anomalies, all except two were terminated. Of the nine cases with isolated PACC, all were liveborn. Follow-up was available in eight, and two of these (25%) showed evidence of significant developmental delay. In our series the outcome of isolated PACC was not better than that of complete agenesis of the corpus callosum reported in other series. CONCLUSIONS PACC can be diagnosed reliably and characterized in prenatal life. The sonographic sign present in most cases is colpocephaly. Prenatal MRI can be performed to confirm the diagnosis. It is particularly useful to demonstrate some additional cerebral anomalies such as late sulcation, migrational pathological conditions and heterotopia. The relatively poor survival rate is due to the high rate of terminations and associated major anomalies.
Collapse
|
121
|
Ducray F, Colin P, Cartalat-Carel S, Pelissou-Guyotat I, Mahla K, Audra P, Gaucherand P, Honnorat J, Trouillas P. Prise en charge des gliomes malins découverts au cours d’une grossesse. Rev Neurol (Paris) 2006; 162:322-9. [PMID: 16585887 DOI: 10.1016/s0035-3787(06)75018-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Glioma is seldom diagnosed during pregnancy. In this situation management presents difficult problems for both neuro-oncologists and obstetricians. We report four cases and discuss the management of this unusual situation. CASE REPORT The first patient was admitted to hospital at 29 weeks' gestation because of a generalized seizure and a right hemiparesis. MRI showed a left fronto-insular lesion. A stereotactic biopsy was obtained and revealed an anaplastic oligodendroglioma. With corticosteroids the patient remained stable until cesarean delivery at 36 weeks. In post-partum additional treatment with chemotherapy was started. The second patient was hospitalized at 26 weeks' gestation because of cranial hypertension, right hemiparesis and aphasia. MRI showed an important left fronto-parietal lesion. Partial resection was performed at 28 weeks. Histology revealed a glioblastoma multiforme. With corticosteroids the patient remained stable until cesarean delivery at 33 weeks. In post-partum additional treatment with radiotherapy and chemotherapy was started. The third patient was admitted to the hospital at 12 weeks' gestation because of cranial hypertension. MRI showed a left frontal lesion. A subtotal resection was done at 13 weeks. Histology revealed a glioblastoma multiforme. Two weeks after surgery the patient's neurological condition worsened and in agreement with the patient a therapeutic abortion was decided. Afterwards additional treatment with radiotherapy and chemotherapy was started. The last patient received combined treatment with radiotherapy and chemotherapy for local recurrence of a mesencephalic high-grade glioma. A posteriori it was discovered that the patient was at 4 months' gestation during this treatment. Cesarean delivery was done at 36 weeks. The child was normal at birth and is still in good health 5 years later. CONCLUSION The management of gliomas diagnosed during pregnancy should not be different from the standard management of gliomas in young non-pregnant adults. Pregnant women because of their young age can have a long survival. Their pregnancy should not prevent them from receiving the best treatment for their glioma. Treatment will depend upon clinico-radiological presentation, histology, gestational age and the patient's desires. Generally speaking, surgical resection of high-grade gliomas should not be delayed during pregnancy. Progress in anesthesia and neurosurgery have greatly reduced the risks for the foetus. After delivery, if the delay between surgery and delivery is too long it is possible to begin cerebral radiotherapy during pregnancy. After the first trimester of gestation this treatment can be given without any important risks for the child.
Collapse
MESH Headings
- Abortion, Therapeutic
- Adrenal Cortex Hormones/therapeutic use
- Adult
- Algorithms
- Anesthesia, General
- Antineoplastic Agents/therapeutic use
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Carbamazepine/therapeutic use
- Carmustine/administration & dosage
- Case Management
- Cesarean Section
- Chemotherapy, Adjuvant
- Cranial Irradiation
- Craniotomy
- Dacarbazine/analogs & derivatives
- Dacarbazine/therapeutic use
- Female
- Frontal Lobe
- Glioblastoma/drug therapy
- Glioblastoma/radiotherapy
- Glioblastoma/surgery
- Glioblastoma/therapy
- Humans
- Infant, Newborn
- Intracranial Hypertension/etiology
- Magnetic Resonance Imaging
- Male
- Neoplasm Recurrence, Local
- Nitrosourea Compounds/administration & dosage
- Nitrosourea Compounds/therapeutic use
- Organophosphorus Compounds/administration & dosage
- Organophosphorus Compounds/therapeutic use
- Paresis/drug therapy
- Paresis/etiology
- Prednisolone/therapeutic use
- Pregnancy
- Pregnancy Complications, Neoplastic/drug therapy
- Pregnancy Complications, Neoplastic/radiotherapy
- Pregnancy Complications, Neoplastic/surgery
- Pregnancy Complications, Neoplastic/therapy
- Prenatal Exposure Delayed Effects
- Radiotherapy, Adjuvant
- Remission Induction
- Supratentorial Neoplasms/drug therapy
- Supratentorial Neoplasms/radiotherapy
- Supratentorial Neoplasms/surgery
- Supratentorial Neoplasms/therapy
- Temozolomide
- Temporal Lobe
Collapse
|
122
|
Chuah KH, Mansor M, Rajen G, Wang CY, Chan YK. Technique of anaesthesia in pulmonary hypertension and thrombophilia in early pregnancy. THE MEDICAL JOURNAL OF MALAYSIA 2006; 61:114-6. [PMID: 16708749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
Pulmonary hypertension in pregnancy is a rare condition but is associated with a high mortality. We report the case of a 29 year old female in early pregnancy with Protein C and S deficiency with recurrent deep venous thrombosis and pulmonary embolism and subsequent secondary pulmonary hypertension. The patient was counselled and consented for termination of pregnancy with tubal sterilization. She was administered continuous spinal anaesthesia with invasive monitoring. The successful anaesthetic management of this condition is described.
Collapse
|
123
|
Devall A, Thompson F, Taylor AA, Pakarian F. Early diagnosis of a complete hydatidiform mole in a twin pregnancy with a viable fetus. J OBSTET GYNAECOL 2006; 26:169-71. [PMID: 16483986 DOI: 10.1080/01443610500460166] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
124
|
Ducarme G, Graesslin O, Alanio E, Bige V, Gaillard D, Gabriel R. [Increased nuchal translucency and cystic hygroma in the first trimester: prenatal diagnosis and neonatal outcome]. ACTA ACUST UNITED AC 2006; 33:750-4. [PMID: 16139544 DOI: 10.1016/j.gyobfe.2005.07.031] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2004] [Accepted: 07/25/2005] [Indexed: 11/19/2022]
Abstract
OBJECTIVE A prospective study of pregnancy outcome in fetuses with increased nuchal translucency above the 95th centile (group NT) or cystic hygroma (group CH) at 10 to 14 weeks of gestation was performed. PATIENTS AND METHODS Maternal and fetal data (nuchal translucency, caryotype, pregnancy outcome) and infant follow-up of 223 fetuses with first trimester nuchal translucency thickness (183 NT and 40 CH) were analysed. RESULTS The measurement of nuchal translucency thickness shows a significant difference between group CH and NT (7.4+/-2.9 mm compared 3.7+/-0.8 mm). Chromosomal abnormalities were present in 55% (22/40) in group CH, with 9 cases/22 (40.9%) of Turner syndrome, compared with 14.2% (26/183) in group NT with trisomy 21 in 15 cases/26 (57.7%) (P<0.05). The rate of unfavourable outcome of pregnancy (spontaneous abortion, elective termination of pregnancy, serious structural anomalies) was 80% (32/40) in group CH compared with 18% (33/183) in group NT (P<0.05). In chromosomally normal pregnancies, the rate of fetus with no visible serious structural anomalies was 44.4% (8/18) in group CH compared with 93% (146/157) in group NT (P<0.05). DISCUSSION AND CONCLUSION Our data show ultrasonographic evaluation of the fetal nuchal translucency thickness at the first trimester is actually indispensable. Neonatal outcome and malformation rate in fetuses with increased nuchal translucency or cystic hygroma are different, even with normal karyotype.
Collapse
|
125
|
Collinet P, Delemer-Lefebvre M, Dharancy S, Lucot JP, Subtil D, Puech F. Le HELLP syndrome : diagnostic et prise en charge thérapeutique. ACTA ACUST UNITED AC 2006; 34:94-100. [PMID: 16483824 DOI: 10.1016/j.gyobfe.2006.01.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2005] [Accepted: 01/13/2006] [Indexed: 11/18/2022]
Abstract
Management of HELLP syndrome is still controversial. In order to improve maternal and foetal prognosis, 2 approaches are usually considered: immediate termination of pregnancy (risk of foetal complications related to prematurity) or conservative treatment (maternal risk of complications related to hematologic disorders). Choice of treatment needs to be taken after evaluation of the maternal and fetal risk/benefit ratio.
Collapse
|