RESUMO
OBJECTIVE: To determine whether combined pentoxifylline (PTX) and tocopherol (vitamin E) treatment can improve uterine radiation-induced sequelae, resulting in an improved embryo implantation rate. DESIGN: Retrospective phase II clinical trial. SETTING: Volunteers in an oocyte donation program in a public hospital. PATIENT(S): Six women aged 31 +/- 4 years, who were irradiated 25 years previously for childhood cancer with 20 to 40 Gy including the pelvic area. INTERVENTION(S): Four women had taken hormone replacement therapy for primary amenorrhea, and two had retained their natural cycle. Treatment consisted of at least 12 months of pentoxifylline at 800 mg/day combined with 1000 IU/day of tocopherol. MAIN OUTCOME MEASURE(S): Endometrial thickness, uterine volume, and uterine artery blood flow were assessed by ultrasonography before and after pentoxifylline-tocopherol treatment, under usual estrogen-progesterone (OP) administration. RESULT(S): This treatment was well tolerated. All six patients improved significantly in endometrial thickness (6.2 +/- 0.6 vs. 3.2 +/- 1.1 mm), myometrial dimensions (44 [+/- 5] x 30 [+/- 3] x 20 [+/- 2] vs. 30 [+/- 7] x 22 [+/- 3] x 16 [+/- 2] mm), and diastolic uterine artery flow. CONCLUSION(S): In young women who want to bear children, the combination of pentoxifylline and vitamin E can reduce fibroatrophic uterine lesions after childhood irradiation.
Assuntos
Antioxidantes/uso terapêutico , Pentoxifilina/uso terapêutico , Lesões por Radiação/tratamento farmacológico , Protetores contra Radiação/uso terapêutico , Radioterapia/efeitos adversos , Tocoferóis/uso terapêutico , Doenças Uterinas/tratamento farmacológico , Doenças Uterinas/etiologia , Adulto , Artérias/diagnóstico por imagem , Quimioterapia Combinada , Estradiol/sangue , Feminino , Humanos , Pentoxifilina/efeitos adversos , Pulso Arterial , Protetores contra Radiação/efeitos adversos , Fluxo Sanguíneo Regional/efeitos dos fármacos , Ultrassonografia , Doenças Uterinas/diagnóstico por imagem , Doenças Uterinas/fisiopatologia , Útero/irrigação sanguínea , Útero/diagnóstico por imagem , Útero/efeitos dos fármacos , Útero/efeitos da radiaçãoRESUMO
The aim of the present study was to demonstrate the usefulness of fetal magnetic resonance imaging (MRI) in ischemic brain injury. We report seven cases of fetal brain ischemia prenatally suspected on ultrasound (US) and confirmed by fetal MRI. Sonographic abnormalities included ventricular dilatation (n=3), microcephaly (n=1), twin pregnancy with in utero death of a twin and suspected cerebral lesion in the surviving co-twin (n=3). MRI was performed with a 1.0 T unit using half-Fourier acquisition single-shot turbo spin-echo (HASTE) sequences between 28 and 35 weeks of gestation. US and MRI images were compared with pathologic findings or postnatal imaging. MRI diagnosed hydranencephaly (n=1), porencephaly (n=2), multicystic encephalomalacia (n=2), unilateral capsular ischemia (n=1), corpus callosum and cerebral atrophy (n=1). In comparison with US, visualization of fetal brain anomalies was superior with MRI. The present cases demonstrate that MRI is a valuable complementary means of investigation when a brain pathology is discovered or suspected during prenatal US.
Assuntos
Encéfalo/patologia , Doenças Fetais/diagnóstico , Hipóxia-Isquemia Encefálica/diagnóstico , Hemorragia Cerebral/diagnóstico , Feminino , Transfusão Feto-Fetal/complicações , Feto/patologia , Humanos , Imageamento por Ressonância Magnética , Masculino , Gravidez , Diagnóstico Pré-Natal , GêmeosRESUMO
This study was performed to examine the main characteristics of the French Romulus twin population: zygosity, chorionicity, sex, term and birthweight. A sample of 104 pairs of twins was distinguished by zygosity, chorionicity and sex, and divided into concordant and discordant birthweight groups. Fifty-three % (n = 55) of the fetus pairs studied were born at "ideal term" (35-38 weeks), and 25% (n = 26) were delivered at "preterm" (28-34 weeks). The very preterm (< 28 weeks), and "postterm" (> 38 weeks) represented altogether 22% (n = 23) of the sample. Of the 104 twin pairs, 68% (n = 71) differ by less than 15% in birthweight, and 32% (n = 33) have a birthweight difference higher than 15%. In dizygotic (DZ) pairs females had more tendency to be in the discordant group (p = 0.01) while in monochorionic-monozygotic (MC-MZ) pairs males were more discordant (p = 0.07). We found a significant interaction between sex and zygosity type (p = 0.02). Males had a birthweight difference significantly weaker than that of females in dichorionic-monozygotic (DC-MZ) and DZ twins whereas it was higher than that of females in MC-MZ twins. There were no MZ twin pairs with DC placentation over than 15% birthweight difference. Log linear analysis demonstrated a three-way interaction (p < 0.05) between term type, zygosity type and hypotrophy. Our data indicate that in the group of twins born between 35 and 38 weeks' gestation the crucial question still remains unsettled on how term and birthweight are related to zygotism and/or chorionicity.
Assuntos
Peso ao Nascer , Idade Gestacional , Gêmeos Dizigóticos , Gêmeos Monozigóticos , Córion , Feminino , França , Humanos , Masculino , Razão de MasculinidadeRESUMO
Advances in antimitotic treatments have improved the prognosis of cancer in young subjects. The resulting increase in life expectancy raises the question of the subject's future fertility, a question that should be posed before beginning any anticancer therapy which could lead to a gonadal failure. If oocyte donation remains the alternative indication proposed for these patients desiring a child, it is important to assess the tissue alterations in the uterus, to verify its vascularization under suitable treatment and appreciate the other alternative directions.
Assuntos
Antineoplásicos/efeitos adversos , Fertilização in vitro , Infertilidade Feminina/induzido quimicamente , Infertilidade Feminina/terapia , Menopausa Precoce/efeitos dos fármacos , Doação de Oócitos , Seleção de Pacientes , Terapia de Reposição de Estrogênios , Feminino , Humanos , Expectativa de Vida , Gravidez , Resultado da Gravidez , Útero/irrigação sanguíneaRESUMO
Parents of a sample of 76 same sexed pairs of twins aged 3 to 9 months completed a mailed similarity questionnaire. It included the Bonnelykke et al.'s questionnaire and a four anthropological variable scale. To improve each of these two methods, three other combined methods were carried out and results were compared with the biological zygosity diagnosis. The Bonnelykke et al.'s classification combined with anthropological scale (method 4) gave only 1.2% misclassified in the whole sample. It is concluded that zygosity diagnosis using this type of procedure to distinguish MZ and DZ pairs would be important not only for epidemiological study but also for pediatricians and parents.
Assuntos
Gêmeos Dizigóticos , Gêmeos Monozigóticos , Humanos , Lactente , Serviços Postais , Inquéritos e QuestionáriosRESUMO
Menopause, conventionally defined as the permanent cessation of menstruation as a result of loss of ovarian follicular activity, is biologically expressed by the collapse of plasma estradiol levels and increased plasma levels of the gonadotrophins FSH (follicle stimulating hormone) and LH (luteinizing hormone). At present, estimation of the ovarian follicle reserve is based on endocrine capacity tests of the ovaries, with increased FSH representing the first sign of exocrine ovarian failure. We report the case of one of our amenorrhoeic patients after chemotherapy, total body radiation and allogenic bone marrow transplantation for acute immunoblastic leukaemia. This patient was included in an in vitro fertilization with oocyte donation (IVF-OD) programme for iatrogenic premature ovarian failure with increased FSH levels. Instead of high levels of gonadotrophins, this young woman recovered spontaneous follicular development, benefited from standard IVF with her own oocytes and brought a twin pregnancy to term. This observation shows that a high FSH level is not a definitive prediction of ovarian exocrine capacity. In young women of child-bearing age such as these wanting a child and showing signs of endogenous estrogen impregnation, evaluation of the existence and quality of follicular development is an important factor.
Assuntos
Hormônio Foliculoestimulante/sangue , Menopausa , Ovário/fisiologia , Insuficiência Ovariana Primária/sangue , Insuficiência Ovariana Primária/etiologia , Radioterapia/efeitos adversos , Adulto , Transplante de Medula Óssea , Feminino , Fertilização in vitro , Humanos , Leucemia Linfoide/tratamento farmacológico , Leucemia Linfoide/radioterapia , Leucemia Linfoide/cirurgia , Testes de Função Ovariana , GravidezRESUMO
The analysis of a survey on a representative sample of the whole French women using pill allowed us to measure the number and the consequences of missed pills, to discover the circumstances which induce them and to characterize the most risky groups. It raises the importance of the information given by the doctors.
Assuntos
Anticoncepcionais Orais , Cooperação do Paciente , Recusa do Paciente ao Tratamento , Adolescente , Adulto , Estudos Transversais , Feminino , França , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Educação de Pacientes como Assunto , Fatores de Risco , Inquéritos e QuestionáriosRESUMO
Abnormal connexion of the umbilical vein in the inferior vena cava was diagnosed in a fetus at 18 weeks' gestation. Associated anomalies included nuchal and axillary lymphangiectasia, hypertrophic cardiomyopathy and hepatomegaly. Neonatal death occurred after spontaneous vaginal delivery at 25 weeks. A review of the literature summarizes the diagnostic criteria and associated anomalies.
Assuntos
Anormalidades Múltiplas/diagnóstico por imagem , Cardiomiopatia Hipertrófica/congênito , Linfangiectasia/congênito , Ultrassonografia Pré-Natal , Veias Umbilicais/anormalidades , Veia Cava Inferior/anormalidades , Adulto , Cardiomiopatia Hipertrófica/diagnóstico por imagem , Feminino , Hepatomegalia/congênito , Humanos , Linfangiectasia/diagnóstico por imagem , Gravidez , Veias Umbilicais/diagnóstico por imagem , Veia Cava Inferior/diagnóstico por imagemRESUMO
PURPOSE: The aim of this study was to show the parallel evolution of the pulsatility index of the uterine artery and the one of the median thoracic artery. STUDY DESIGN: The study involved seven volunteer women, below 38, suffering from premature ovarian failure, who received E2 and progesterone replacement therapy. Plasma levels of E2, progesterone, follicle stimulating hormone and luteinizing hormone were measured and PI were studied and compared before treatment and on Days 13, 27 and 41. RESULTS: Before treatment, a high-resistance vascular for both arteries is uniformly found. The curves show with the increasing of the E2 plasma levels, a decrease in the PI of UA and MTA with a fall at Day 13. We compared the mean values in MTA and UA PI. No statistical difference between the three mean values in PI obtained at Day -1, Day 13 and Day 41 was demonstrated. CONCLUSION: The results suggest that median thoracic artery is a target organ artery. Such as the UA, the MTA vascular resistance is according to the variations of plasma levels of E2. In consideration of it rectilinear and superficial type, this led us to study this artery when we use different sorts of replacement therapy, and particularly in the oocyte donation program.
Assuntos
Artérias/efeitos dos fármacos , Estradiol/farmacologia , Progesterona/farmacologia , Artérias Torácicas/efeitos dos fármacos , Útero/irrigação sanguínea , Resistência Vascular/efeitos dos fármacos , Adulto , Artérias/fisiologia , Estradiol/sangue , Terapia de Reposição de Estrogênios/normas , Feminino , Hormônio Foliculoestimulante/sangue , Humanos , Insuficiência Ovariana Primária/sangue , Insuficiência Ovariana Primária/tratamento farmacológico , Progesterona/sangue , Radioimunoensaio , Fluxo Sanguíneo Regional/efeitos dos fármacos , Fluxo Sanguíneo Regional/fisiologia , Artérias Torácicas/fisiologia , Fatores de Tempo , Ultrassonografia Doppler de Pulso , Resistência Vascular/fisiologiaRESUMO
Subtle facial abnormalities, including smallness of the nose, are common findings in trisomy 21 and numerous other genetic conditions. The aim of this study was to construct a normal range for the length of the fetal nasal bones with gestation in a Caucasian population. Ultrasound measurements were performed on a strictly mid-sagittal profile in 376 normal singleton fetuses at 14-34 (mean 24) weeks' gestation. It was found that the length of the nasal bones increased from 4 mm at 14 weeks to 12 mm at 35 weeks' gestation, and that there was a linear relationship between the length of these bones and biparietal diameter and femur length. We conclude that the length of nasal bones can easily be measured in fetuses at 14-34 weeks' gestation and that such measurements might prove useful in the evaluation of pregnancies at high risk for associated fetal abnormalities.
Assuntos
Osso Nasal/embriologia , Ultrassonografia Pré-Natal , Desenvolvimento Embrionário e Fetal , Feminino , Idade Gestacional , Humanos , Variações Dependentes do Observador , Gravidez , Valores de Referência , Reprodutibilidade dos TestesRESUMO
Antimitotic chemotherapy and/or radiation therapy can induce a premature ovarian failure in women. The improvement of the prognosis of cancer and the increasing in long-term survival mean that preservation of fertility should be considered before initiating therapy. An embryo cryopreservation can be proposed if the circumstances allow that possibility. Ten young women were included in our program and benefited from an oocyte retrieval before cancer therapy. Nine of them had an embryo cryopreservation, and one without partner an oocyte cryopreservation. Three patients had an embryo replacement without success, and in one case, a spontaneous full-term pregnancy was obtained after ovarian detransposition through coelioscopy. In the future, oocyte cryopreservation could appear a more suitable answer. Actually, oocyte donation with estrogen and progesterone replacement therapy gives good results (in our experience, 23.2 per cent of ongoing pregnancies per transfer). Nevertheless, after treatment against cancer, a study of the uterus with its arteries, and a particular adaptation of the treatment are necessary because of the risks of tissue damage impairing the embryo implantation. Indeed, in fifteen patients included in this group, eight women had fourteen transfers unfortunately without success. Consequently, the seven other women underwent complementary examinations. Two embryos were replaced in one patient with a more adjustable treatment allowing a full-term pregnancy.
Assuntos
Criopreservação/métodos , Transferência Embrionária/métodos , Neoplasias/terapia , Oócitos/transplante , Indução da Ovulação/métodos , Insuficiência Ovariana Primária/terapia , Adulto , Antineoplásicos/efeitos adversos , Estudos de Avaliação como Assunto , Feminino , Humanos , Gravidez , Resultado da Gravidez , Insuficiência Ovariana Primária/etiologia , Radioterapia/efeitos adversosRESUMO
Currently two genetic pulmonary disorders can be diagnosed before birth: alpha-1-antitrypsin deficiency and mucoviscidosis. For the latter there are two possible diagnostic techniques: first a study of the intestinal enzymes of the amniotic fluid, a reliable method only at the 18th week, and also a study of DNA markers (ADN) of the trophoblastic cells using molecular biological techniques: this can be performed from the 10th to 11th week of pregnancy but presupposes a family study in which there is already a subject suffering from the disorder. Foetal echocardiography enables various pulmonary abnormalities to be detected: pleural effusion, cyst, pulmonary hypoplasia and other disorders. This technique however has some limits, at least at present. Most often these severe malformations are revealed at birth such as respiratory distress or stillbirth. Adenomatous cystic malformations or congenital lobar emphysema, a posterior diaphragmatic hernia, and oesophageal atresia with oesophagotracheal fistula are the most frequent and are curable surgically.