RESUMO
A unique endometrial immune reaction should occur to promote the human embryo implantation. We postulated that an immune disequilibrium may impact the initial dialogue between the mother and her embryo. In 2012, we set a method of uterine immune profiling for patients with unexplained repeated implantation failures (RIF). The method documents the local Th-1/ Th-2 equilibrium and the recruitment and state of maturation/activation of uNK cells. In function of the disequilibrium observed, personalization of assisted reproductive treatments was suggested. As the concept of personalization in function of the uterine immune profile had never been proposed, a large cohort study and a controlled cohort study were first conducted in RIF patients. 80 % of the RIF patients showed a local disequilibrium if compared to fertile controls. The local disequilibrium was identified in 3 categories: over-immune activation in 45 %, low- local immune activation in 25 % and mixed profile in 10 %. Personalization of treatments in function of the immune profile allowed to restore a live birth rate by 40 % at the following embryo transfer. RIF patients with endometriosis show some particularities regarding their immune profiles. We also suggested that immunotherapy (corticoids, intralipids) may have targeted indications based on a better understanding of the immune type of disequilibrium documented. Personalization of treatments for RIF patients seems to be essential to promote the subsequent live birth rate. The endometrial immune profiling is an innovative method aiming to detect a local immune disequilibrium and, if present, to test preventively its correction under treatment.
Assuntos
Implantação do Embrião/imunologia , Transferência Embrionária/efeitos adversos , Endométrio/imunologia , Infertilidade/terapia , Injeções de Esperma Intracitoplásmicas/efeitos adversos , Adulto , Coeficiente de Natalidade , Transferência Embrionária/estatística & dados numéricos , Feminino , Humanos , Gravidez , Taxa de Gravidez , Injeções de Esperma Intracitoplásmicas/estatística & dados numéricos , Falha de TratamentoRESUMO
BACKGROUND: To evaluate fertility and pregnancy outcomes in patients with uterus bicorporeal and blind hemivagina. Our second objective was to investigate factors predicting fertility and pregnancy outcomes in those patients. MATERIAL AND METHODS: We conducted a retrospective analysis in a tertiary referring gynaecological department, in France. We included all patients with uterus bicorporeal and blind hemivagina who underwent at least one surgery in our centre. Initial characteristics of the patients included were extracted from their medical charts and patients were contacted to assess their fertility and pregnancies outcomes upon their consent to participate to the study. RESULTS: Between 1989 and 2010, 79 patients fulfilled inclusion criteria and were selected for analysis. Mean follow up of those patients was of 16.15 (QI 10-21) years. Forty-six patients (58.2%) returned the survey and among them, 21 (45.7%) were fertile, 8 (17.4%) were infertile and 17 (37%) never attempted to get pregnant following initial management. Forty-nine pregnancies were included to assess pregnancies outcomes: 11 (22.5%) early miscarriages, 1 (2.0%) extra-uterine pregnancy, 2 (4.1%) second semester miscarriages and 35 (71.4%) leaded to living birth. Nineteen (54.3%) deliveries occurred by caesarean section and 14 (40.0%) by vaginal delivery. Fifteen pregnancies (42.9%) were complicated. In univariate analysis, adhesiolysis performed at the time of initial surgery was the only factor associated with infertility (p=0.004). CONCLUSIONS: Fertility seems to be perfectly conserved in those patients and they do not have increased rate of adverse pregnancies outcomes.
Assuntos
Anormalidades Múltiplas/cirurgia , Fertilidade , Resultado da Gravidez , Útero/anormalidades , Útero/cirurgia , Vagina/anormalidades , Vagina/cirurgia , Feminino , Procedimentos Cirúrgicos em Ginecologia , Ginecologia , Humanos , Gravidez , Estudos Retrospectivos , Centros de Atenção Terciária , Fatores de TempoRESUMO
The Région Languedoc Roussillon is the umbrella organisation for an interconnected and integrated project on active and healthy ageing (AHA). It covers the 3 pillars of the European Innovation Partnership on Active and Healthy Ageing (EIP on AHA): (A) Prevention and health promotion, (B) Care and cure, (C) and (D) Active and independent living of elderly people. All sub-activities (poly-pharmacy, falls prevention initiative, prevention of frailty, chronic respiratory diseases, chronic diseases with multimorbidities, chronic infectious diseases, active and independent living and disability) have been included in MACVIA-LR which has a strong political commitment and involves all stakeholders (public, private, patients, policy makers) including CARSAT-LR and the Eurobiomed cluster. It is a Reference Site of the EIP on AHA. The framework of MACVIA-LR has the vision that the prevention and management of chronic diseases is essential for the promotion of AHA and for the reduction of handicap. The main objectives of MACVIA-LR are: (i) to develop innovative solutions for a network of Living labs in order to reduce avoidable hospitalisations and loss of autonomy while improving quality of life, (ii) to disseminate the innovation. The three years of MACVIA-LR activities are reported in this paper.
Assuntos
Envelhecimento , Política de Saúde , Promoção da Saúde , Vida Independente , Medicina Preventiva , Acidentes por Quedas/prevenção & controle , Idoso , Idoso de 80 Anos ou mais , Doença Crônica , Comorbidade , União Europeia , França , Hospitalização , Humanos , Múltiplas Afecções Crônicas , Saúde Bucal , Autonomia Pessoal , Polimedicação , Qualidade de Vida , Doenças RespiratóriasRESUMO
The aim of this study was to evaluate the paediatric and maternal outcome after ex utero intrapartum treatment (EXIT). A retrospective review was carried out of the medical charts (gestational age, circumstances of diagnosis, multidisciplinary prenatal decision, date of surgery, paediatric and maternal outcome) of all the fetuses eligible for/delivered via the EXIT procedure in our paediatrics and obstetrics tertiary care and teaching centre, between October 2004 and May 2011. Seven fetuses with cervical teratoma, epignathus tumour or congenital high airway obstruction syndrome (CHAOS) were included in our study. Two pregnancies were terminated and five fetuses were delivered alive. The airway was secured in all five cases (two endotracheal intubations and three tracheostomies). No maternal complications were observed. On average, babies were delivered at 32 gestational weeks, and spent 31 days in the intensive care unit. All but one baby were ventilated for 18 days. Long-term paediatric outcome was favourable. It is concluded that airway management by the EXIT procedure has become an efficient technique. A multidisciplinary prenatal assessment is essential in order to select appropriate cases.
Assuntos
Obstrução das Vias Respiratórias/congênito , Neoplasias de Cabeça e Pescoço/complicações , Placenta , Teratoma/complicações , Obstrução das Vias Respiratórias/cirurgia , Feminino , Doenças Fetais/cirurgia , Neoplasias de Cabeça e Pescoço/congênito , Neoplasias de Cabeça e Pescoço/cirurgia , Humanos , Recém-Nascido , Gravidez , Estudos Retrospectivos , Teratoma/congênito , Teratoma/cirurgiaRESUMO
Epignathus teratoma is a rare tumor whose prognosis essentially depends on its resectability and on neonatal care. When it is undiagnosed prenatally, mortality is close to 100 % at birth, because of obstruction of the upper airways. We present a case of epignathus teratoma detected during obstetrical ultrasound screening. Diagnosis enabled planning for a safe delivery in a suitable multidisciplinary unit and use of the EXIT procedure.
Assuntos
Obstrução das Vias Respiratórias/cirurgia , Doenças Fetais/diagnóstico por imagem , Teratoma/diagnóstico por imagem , Teratoma/cirurgia , Ultrassonografia Pré-Natal , Adulto , Obstrução das Vias Respiratórias/mortalidade , Obstrução das Vias Respiratórias/prevenção & controle , Cesárea , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Laringe , Nariz , Gravidez , Prognóstico , LínguaRESUMO
Menopause is a total follicular depletion leading to menstruation cessation. Climacterics symptoms are linked to estrogen decrease. Hormonal replacement therapy (HRT) was developed in 1940s in order to control these signs and to improve women's quality of life. In United States, conjugated equine estrogen, first estrogens developed, are the most common. In France, customs are different with the transdermic estrogen use. The progesterone use is also different between both countries: in USA, medroxyprogesteron acetate is the most common, whereas this treatment does not exist anymore in France. Indeed, lot of different progestagen is available in France: progesterone, dydrogesterone others progestin. Publication of randomized trials, as the Women's Health Initiative, had shown a long-term unfavorable HRT risk/benefit ratio, as prescribed in USA. These studies have led to prescription modification. Due to these results, recent trials, closers to French customs, allowed a new evaluation of HRT risk/benefit ratio. Today, clinical practices are based on these results and new trials are necessary.
Assuntos
Terapia de Reposição de Estrogênios/métodos , Prática Profissional , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/etiologia , Contraindicações , Terapia de Reposição de Estrogênios/efeitos adversos , Terapia de Reposição de Estrogênios/estatística & dados numéricos , Estrogênios/administração & dosagem , Estrogênios/efeitos adversos , Estrogênios/uso terapêutico , Feminino , França/epidemiologia , Humanos , Neoplasias/epidemiologia , Neoplasias/etiologia , Pós-Menopausa/efeitos dos fármacos , Pós-Menopausa/fisiologia , Congêneres da Progesterona/administração & dosagem , Congêneres da Progesterona/efeitos adversos , Congêneres da Progesterona/uso terapêutico , Fatores de RiscoRESUMO
Ten patients with systemic lupus erythematosis hand deformities were studied. Wrist involvement included distal ulnar subluxation in 14 wrists (with four requiring excision) and various degrees of carpal instability in 12 wrists (usually asymptomatic). Metacarpophalangeal (MP) joint subluxation treated by soft tissue procedures for passively correctable deformities in 30 joints had a failure rate of 70%. MP joint arthroplasties performed in 33 joints gave fair results in 16 joints with fixed deformities and good results in 17 joints with passively correctable deformities. Thumb deformities always involved all three joints, and maintenance of carpometacarpal (CMC) joint stability was the key to thumb reconstruction. CMC joint stabilization with ligamentous reconstruction gave good results in three of four thumbs. Four CMC joint fusions and two CMC joint implant arthroplasties gave good results. Each was accompanied by appropriate procedures on the MP joint or interphalangeal joint.
Assuntos
Deformidades Adquiridas da Mão/cirurgia , Lúpus Eritematoso Sistêmico/complicações , Articulações dos Dedos/cirurgia , Dedos/anormalidades , Dedos/cirurgia , Humanos , Polegar/anormalidades , Polegar/cirurgia , Punho/anormalidades , Punho/cirurgiaRESUMO
In six patients rupture of the radial collateral ligament of the metacarpophalangeal joint of one of the three ulnar fingers, surgical reconstruction was successful using local tissues in five and a tendon graft in one. Operative treatment of this injury is indicated only when significant instability is present.