[Prenatal path of care following the diagnosis of a malformation for which a novel prenatal therapy is available]

OBJECTIVES

Fetal therapy is part of the available care offer for several severe malformations. The place of these emergent prenatal interventions in the prenatal path of care is poorly known. The objective of this study is to describe the decision-making process of patients facing the option of an emergent in utero intervention.

METHODS

We have conducted a retrospective monocentric descriptive study in the department of maternal-fetal medicine of Necker Hospital. We collected data regarding eligibility or not for fetal surgery and the pregnancy outcomes of patients referred for myelomeningocele, diaphragmatic hernia, aortic stenosis and low obstructive uropathies.

RESULTS

All indications combined, 70% of patients opted for fetal surgery. This rate was lower in the case of myelomeningocele with 21% consent, than in the other pathologies: 69% for diaphragmatic hernias, 90% for aortic stenoses and 76% for uropathy. When fetal intervention was declined, the vast majority of patients opted for termination of pregnancy: 86%. In 14% of the considering fetal surgery, the patient was referred too far.

CONCLUSION

The acceptance rate for fetal surgeries depends on condition. It offers an additional option and is an alternative for couples for which termination of pregnancy (TOP) is not an option. Timely referral to an expert center allows to discuss the place of a fetal intervention and not to deprive couples of this possibility.

Corticosterone induces 11 beta-HSD and mineralocorticoid specificity in an amphibian urinary bladder cell line

We have examined the mineralocorticoid specificity in a TBM 18-23 cell line derived from the toad bladder epithelium. In cells grown on porous substrate, corticosterone was more potent than aldosterone in stimulating a sodium transport response, measured by the short-circuit current method 6 h after hormone addition [mean affinity constant (K0.5) for corticosterone = 1 nM vs. K0.5 for aldosterone = 8 nM]. The time course of effects and saturation kinetics were identical for both agonists, suggesting interaction with identical receptors. Whereas the dose-response relationship for aldosterone did not change with time of incubation (6 vs. 24 h), the dose-response curve for corticosterone became biphasic at 24-h incubation (apparent K0.5 as high as 40 nM), demonstrating that corticosterone became apparently less potent with time. Pretreatment with carbenoxolone, a potent inhibitor of 11 beta-hydroxysteroid dehydrogenase (11 beta-HSD), restored full sensitivity at 24-h incubation to corticosterone. The 11 beta-HSD activity was low during the first 3 h of incubation in the presence of 3 nM corticosterone, and only a small fraction (approximately 7%) of corticosterone was metabolized. At 24-h incubation, 11 beta-HSD activity increased approximately 2.5-fold (P < 0.001, n = 8). We conclude that 11 beta-HSD activity is induced by its own substrate in TBM cells in parallel with the induction of the carbenoxolone-sensitive sodium transport response.

[Wounds of the flexor tendons of the fingers at the level of the hand. Results of primary sutures]

The authors review in 100 patients, 182 wounds of flexor tendons of the fingers at the level of the hand emphasize the definite preponderance in young workers, their frequency which is all the greater as one moves away from the thumb, and approches the area of the fibrous pulleys, their common misdiagnosis, especially at the level of the thumb, their prognosis which is all the worse as one approaches the fifth finger and the areas of the pulleys. The poor results simply confirm their reputation of seriousness from an economic and social point of view. The technical problems raised by stiffening of the proximal interphalangeal joints and, above all, the formation of adhesions, are far from solved, it seems that an improvement in the results might be obtained if these wounds were repaired by specialised surgeons in a unit dealing exclusively with surgery of the hand which, under present conditions, is not always the case.