[Segmental approach to congenital heart diseases: Principles and applications to prenatal imaging]. / Approche segmentaire des cardiopathies congénitales : principes et applications en imagerie prénatale.

This pictorial essay will initially present the origin, definitions, objectives and main principles of the segmental approach to congenital heart diseases. Then, through ultrasound scans iconography we will consider its practical applications to prenatal screening. Eventually, through both ultrasound and MRI cases, we will discuss its potential use in fetal diagnostic evaluation.

Prenatal diagnosis of bowel malposition using T2-weighted fetal MRI sequences.

OBJECTIVE: The goal of this study was to investigate the capability of T2-weighted magnetic resonance imaging (MRI) in revealing fetal bowel malposition. MATERIALS AND METHODS: All fetal MRI examinations (excluding central nervous system MRI examinations) performed in our department from January 2005 to January 2014 were retrospectively studied by 2 independent observers for situs, stomach and jejunum location on T2-weighted images. Patients data were also reviewed for results of ultrasound examinations, MRI indication, and gestational age. Abnormally positioned jejunums were classified into 3 groups: intrathoracic (A), extra-fetal (B) and abnormal intra-fetal (C). Prenatal data were compared to postnatal imaging, surgery or autopsy findings that served as standard of reference. RESULTS: A total of 709 fetal MRI examinations were analyzed. In 64 fetus (9%), the jejunum was not present in the left subgastric area on T2-weighted MR images. In these 64 fetuses, proximal jejunum was intrathoracic (41/64, 64%, group A), extra-fetal (11/64, 17%, group B), or intra-abdominal but abnormally positioned (12/64, 19%, group C). Interobserver agreement was 100%. All diagnoses for fetuses in groups A and B (52 cases) were confirmed postnatally (41 cases) or at autopsy (11 cases). In group C, bowel malposition was suspected after ultrasound in only 2/12 fetuses (16.6%); it was confirmed postnatally in 1 fetus but not confirmed in the remaining one. In the 10 remaining fetuses (83%), malposition was confirmed postnatally although not initially suspected. CONCLUSION: T2-weighted fetal MR images are useful for the prenatal diagnosis of bowel malposition, even when they are unsuspected on ultrasound examination.

Contribution of the foetal uro-MRI in the prenatal diagnosis of uronephropathies.

PURPOSE: To study the complementary diagnostic value and role in the perinatal management of foetal MRI in the prenatal diagnosis of abnormalities of the urinary tract. PATIENTS AND METHODS: Retrospective monocentric study from November 2002 to June 2011 of foetuses benefiting from an MRI after ultrasound diagnosis of uronephropathy abnormalities. Ultrasound and MRI data were compared with postnatal radiological and/or surgical data or with the foetopathology. The MRI analysis focused on the diagnostic concordance with the ultrasound, the complementary diagnostic contribution and/or a change in perinatal care. RESULTS: Of the 154 MRI examined, a follow-up was obtained for 108 cases. The indications for MRI were classified into six groups: suspected renal agenesis (n = 20, 18.5%), posterior urethral valve (n = 20, 18.5%), reflux or megaureter (n = 14, 13%), uretropelvic junction syndrome (n = 24, 22.5%), enlarged kidneys (n = 7, 6.5%) and others (n = 23, 21%). The information supplied by ultrasound was confirmed by MRI in 72 patients (67%). MRI provided additional data for 36 patients (33%) and changed the perinatal care for 16 patients (15%). CONCLUSION: Foetal uro-MRI is a useful complementary tool in the prenatal diagnosis of some uropathy abnormalities.

[Pronostic risk assessment of delivery, in patients admitted for threatened preterm birth, in a tertiary care maternity center]. / Étude pronostique du risque d'accouchement, des patientes hospitalisées pour menace d'accouchement prématuré, dans une maternité de niveau III.

OBJECTIVES: To assess preterm birth rate, in patients admitted for threatened preterm birth (TPB) in a tertiary care maternity center and evaluate our diagnostic and therapeutic tools. MATERIALS AND METHODS: A retrospective cohort study, in a tertiary care maternity center (Marseille, France), reviewed all admissions for TPB from January 1 to December 31, 2009. RESULTS: We recorded 224 admissions for TPB (181 single pregnancies and 43 twin pregnancies), 43.8% of TPB admissions were from materno-fetal transfer. Preterm birth rate was 44.9% (n=89), 39% (n=66) for single pregnancy and 76.6% (n=23) for twins. The 15 mm threshold for transvaginal sonography cervical length (CL) was the most relevant to predict the risk of preterm delivery, 77.3% (85/110) of patients with CL>15 mm having full term delivery. CONCLUSION: For single pregnancy, most of the patients with cervical length>15 mm have full term delivery. It seems important to us to develop the use of more efficient predictive markers of risk-premature labor in order to improve the diagnosis and management of TPB.

Picometer-scale surface roughness measurements inside hollow glass fibres.

A differential profilometry technique is adapted to the problem of measuring the roughness of hollow glass fibres by use of immersion objectives and index-matching liquid. The technique can achieve picometer level sensitivity. Cross validation with AFM measurements is obtained through use of vitreous silica step calibration samples. Measurements on the inner surfaces of fibre-sized glass capillaries drawn from high purity suprasil F300 tubes show a sub-nanometer roughness, and the roughness power spectrum measured in the range [5 · 10(-3) m(-1) 10(-1) m(-1)] is consistent with the description of the glass surface as a superposition of frozen capillary waves. The surface roughness spectrum of two capillary tubes of differing compositions can be quantitatively distinguished.

[Cervical ripening at term with repeated administration of dinoprostone vaginal pessary]. / Maturation cervicale à terme par utilisation répétée du dispositif intravaginal de dinoprostone.

OBJECTIVES: To evaluate efficacy and safety of cervical ripening with repeated administration of dinoprostone slow release vaginal pessary (Propess®) in current practice. PATIENTS AND METHODS: An observational study of 111 women who underwent cervical ripening with two Propess® during the study period from 1st July 2007 to 31st October 2011. Modes of delivery, success of cervical ripening, failure of labor induction, maternal and neonatal morbidity were reported. RESULTS: The nulliparous rate was 75,7%. The main indications for induction of labor were post-term pregnancy in 34,3% (38/111) and premature rupture of membranes in 25,2% (28/111). The rate of vaginal delivery was 53,1% (59/111). Cesarean sections were performed for failure of labor induction in 27/52 (51,9%) and an abnormal fetal heart rate in 17/52 (32.7%). Indication for induction of labor, nulliparous patients (44 [84.6%] versus 40 [67.8%]; P=0.04), initial Bishop score (2.2±1.2 versus 2.9±1.2; P=0.04) before the cervical ripening and Bishop score before administration of second Propess® (3.3±1.4 versus 4.0±1.2; P=0.05) were significant risk factors of cesarean delivery. DISCUSSION AND CONCLUSION: In more than half of the cases, the cervical ripening by two Propess® is efficient and allows a vaginal delivery. This practice does not appear to increase the maternal or neonatal morbidity.

[Management of preterm and prelabour rupture of membranes in France]. / Pratiques en France de prise en charge des ruptures prématurées des membranes.

INTRODUCTION: Preterm premature rupture of the membranes (PPROM) is a frequent complication of pregnancy leading to prematurity and neonatal infection. The management of PPROM is not consensual in France and practices between maternities are variable. We subjected type 2B and 3 maternity units to a questionnaire regarding their practices concerning the PPROM. RESULTS: Our study includes 59 type 2B maternity units and 59 type 3 maternity units. Corticotherapy is proposed in all of type 3 maternity units and in 96.5% of type 2B maternity units. Antibiotics are administered at the patient admission in 96.6% of type 3 maternity units and 86% of type 2B maternity units. Tocolytics are used systematically in 31% of maternity units and only in case of contractions in 62% of maternity units. No maternity unit indicates birth systematically after corticotherapy before 32 weeks of gestation (WG). An early delivery is proposed in 9.5% of maternity units between 32 and 34 WG and in 58% of maternity units between 34 and 37 WG. CONCLUSION: Corticotherapy and antibiotics are predominantly administered at the time of the diagnosis, as recommended by the HAS and CNGOF. Despite the lack of recommendation, an expectative management until 34 WG, in absence of any sign of chorioamnionitis, seems to be the choice of most maternity units.

Ultraviolet Resonance Raman spectroscopy used to study formulations of salmon calcitonin, a starch-peptide conjugate and TGF-ß3.

Ultraviolet Resonance Raman (UVRR) spectroscopy with excitation at 244 nm was investigated here as a possible useful tool for fast characterization of biopharmaceuticals. Studies were performed on three protein drugs: salmon calcitonin (sCT), starch-peptide conjugate, and transforming growth factor-ß3 (TGF-ß3) adsorbed onto solid granules of tricalcium phosphate (TCP). Secondary structure of sCT was investigated for solutions of 0.5mg/mL up to 200mg/mL, regardless of the turbidity or aggregation states. An increase in ß-sheet content was detected when sCT solutions aggregated. UVRR spectroscopy also detected a small amount of residual organic solvent in a starch-peptide conjugate solution containing only 40 µg/mL of peptide. UVRR spectroscopy was then used to characterize a protein, TGF-ß3, adsorbed onto solid granules of TCP at 50 and 250 µg/cm(3). This study shows that UVRR is suitable to characterize the protein formulations in a broad range of concentrations, in liquid, aggregated, and solid states.

Stability of seasonal influenza vaccines investigated by spectroscopy and microscopy methods.

The stability of different seasonal influenza vaccines was investigated by spectroscopy and microscopy methods before and after the following stress-conditions: (i) 2 and 4 weeks storage at 25°C, (ii) 1 day storage at 37°C and (iii) one freeze-thaw cycle. The subunit vaccine Influvac (Solvay Pharma) and the split vaccine Mutagrip (Sanofi Pasteur) were affected by all stresses. The split vaccine Fluarix (GlaxoSmithKline) was affected only by storage at 25°C. The virosomal vaccine Inflexal V (Berna Biotech) was stable after the temperature stresses but aggregated after one freeze-thaw cycle. This study provides new insights into commercial vaccines of low antigen concentration and highlights the importance of using multiple techniques to assess vaccine stability.

Transvaginal ultrasound measurement of cervical length and efficacy of misoprostol in first-trimester pregnancy failure.

OBJECTIVE: The aim of this study was to assess the role of cervical length measurement in predicting successful treatment, by misoprostol administration, of early (first-trimester) pregnancy failure. METHOD: A prospective study was conducted of all patients who agreed to medical treatment of pregnancy failure. Cervical length and other sonographic variables were measured using pelvic ultrasound before medical treatment began. Measurements were compared between the group with successful medical treatment and the group in whom treatment failed. RESULTS: In 125 women included in the study, the success rate of misoprostol treatment was 64.8%. There were no significant differences between the groups with successful and failed treatment for cervical length (29.9 +/- 9.3 vs. 30.4 +/- 6.8 mm, P = 0.75), distance between gestational sac and 'virtual' cervical internal os (23.9 +/- 13 vs. 26.6 +/- 13 mm, P = 0.26), crown-rump length (8.7 +/- 9.7 vs. 6.7 +/- 8.6 mm, P = 0.25), or gestational sac diameter (31.3 +/- 14 vs. 30.1 +/- 15 mm, P = 0.73). CONCLUSION: Cervical length does not predict the success of misoprostol treatment of first-trimester pregnancy failure.

[Cervical ripening using misoprostol before hysteroscopy]. / Préparation cervicale par misoprostol avant hystéroscopie.

Cervical ripening with misoprostol is performed before office or operative hysteroscopy. Aim of this review is to evaluate benefits of cervical ripening with misoprostol before hysteroscopy . Ten studies were selected concerning office or operative hysteroscopy. Cervical ripening with misoprostol seems to be not useful for office hysteroscopy performed with minihysteroscope. Interest of misoprostol in menopausal women with traditional office hysteroscope is debatable. Risk of cervical tear during operative hysteroscopy seems to be reducing with misoprostol. However, interest of misoprostol was not found in all studies. Data were not sufficient to determine adequate dose of misoprostol, time and mode of administration. However, vaginal administration is preferable.

[Pregnancy outcome and the status of the newborn infant after ICSI at La Conception Hospital in Marseille]. / Evolution des grossesses et état des enfants à la naissance après ICSI à l'hôpital de La Conception à Marseille.

OBJECTIVE: To evaluate obstetric outcome of pregnancies and pediatric follow-up of children born after ICSI procedure. MATERIAL AND METHOD: Prospective study from october 1994 to September 1998 in medical assisted procreations center in La Conception hospital in Marseilles. Three hundred forty-two couples undergoing ICSI procedures. INTERVENTIONS: analysis of pregnancy rates, prematurity rates, obstetric outcome and frequency of congenital malformations. RESULTS: One hundred seventy-eight pregnancies have been obtained with 111 children. Multiple pregnancy rate arise 29.7%. The average term at birth in the singleton pregnancies (38.7 weeks) is higher than in the twins (35.7 weeks). The prematurity rate of delivery before 35 weeks of gestation is about 9.6%. Seven of 111 neonates was born with a congenital malformation, no cardiovascular one. One of boys presents a bilateral cryptorchidism with severe bilateral hypotrophy. CONCLUSIONS: Our results are similar with those of others teams. Congenital malformation rates is near rates reported in others studies. However, no bilateral cryptorchidism with bilateral severe hypotrophy has been yet reported in literature.

Influence of the physical state of water on the barrier properties of hydrophilic and hydrophobic films.

Water transfer through different films, as a function of the physical state of water in contact with the film, the relative humidity difference, and the water vapor pressure difference, was investigated. The films were two synthetic packagings (hydrophobic polyethylene and hydrophilic cellophane) and an edible film. The physical state of water affects water sensitive films, such as cellophane, inducing a higher liquid water transfer due to interactions with the polymer. For hydrophobic polymers, such as polyethylene, neither the physical state of water nor the relative humidity has an influence on the water permeability. In complex system, such as an edible film composed of hydrophilic particles dispersed in a lipid phase, barrier efficiency is influenced by the continuous hydrophobic phase but could also be affected by the physical state of water due to the presence of hydrophilic compounds.