[Placenta percreta at first trimester of pregnancy. Diagnostic and decision-making difficulties: about a case and a review of the literature]. / Placenta percreta en fin de premier trimestre de grossesse. Difficultés diagnostique et décisionnelle: à propos d'un cas et revue de la littérature.

We report the case of a 28-year-old patient, G9P4. Her last pregnancy was marked by a failure of a medical termination at 4 gestational weeks. She consulted as a matter of emergency for acute abdominal pain with moderated hemoperitoneum at 13 weeks of gestation. A laparotomy was performed and allowed to diagnose a placenta percreta (PPer). The treatment consisted in a hemostasis hysterectomy. The PPer is a rare pathology. The diagnosis is difficult to do, especially during the first and second trimester of the pregnancy. The focus of this article is to evaluate medical imaging and conservative treatments or radical treatment, according to the severity of the symptoms and her obstetrical outcome. This unusual etiology of hemoperitoneum at 13 weeks of gestation must to be known in front of the increase of the caesarians rate.

Separation of nonsteroidal anti-inflammatory drugs by capillary electrophoresis using nonaqueous electrolytes.

The aim of the present work was to investigate the separation of nonsteroidal anti-inflammatory drugs (NSAIDs: niflumic acid, flufenamic acid, piroxicam, alclofenac, tiaprofenic acid, flurbiprofen, suprofen, ketoprofen, naproxen, indomethacin, carprofen, indoprofen, sulindac) in capillary electrophoresis (CE) using completely nonaqueous systems. The influence of different parameters such as nature and proportion of organic solvent (methanol, acetonitrile, 2-propanol), apparent pH (ranging from 7 to 9) and temperature (ranging from 25 to 40 degrees C) on selectivity and migration times were studied systematically in an uncoated fused-silica capillary. A nonaqueous electrolyte made of 50 mM ammonium acetate - 13.75 mM ammonia in methanol proved to resolve 11 NSAIDs at 25 degrees C and 13 NSAIDs at 36 degrees C, both within 13 min and without a modifier besides the methanol itself. The same buffer containing 30% acetonitrile provides a satisfactory separation for 13 NSAIDs within 14 min at 25 degrees C.

Determination of six water-soluble vitamins in a pharmaceutical formulation by capillary electrophoresis.

A method was developed for the quantitative analysis of six water-soluble vitamins (thiamine, nicotinamide, riboflavine, pyridoxine, ascorbic acid and pantothenic acid) in a pharmaceutical formulation, using free solution capillary zone electrophoresis (CZE) in uncoated fused silica capillaries and UV detection. The influence of different parameters, such as the nature of the buffer anionic component and buffer concentration on the CZE separation of vitamins was investigated using four vitamins of the B group as model compounds. A good compromise between resolution, analysis time and analyte stability was obtained by use of a 50 mM borax buffer of pH 8.5. This CZE method was found to be very useful for the separation of more complex samples, a mixture of ten water-soluble vitamins being completely resolved in about 10 min. However, cyanocobalamine could not be separated from nicotinamide in this CZE system, the two compounds being in uncharged form at the pH used. These two compounds could easily be resolved by micellar electrokinetic chromatography (MEKC), the anionic surfactant dodecylsulfate being added to the running buffer at 25 mM concentration. In the pharmaceutical formulation, some excipients were found to be adsorbed to the capillary surface, giving rise to a progressive decrease of the electroosmotic flow and consequently to a simultaneous increase of analyte migration times. A capillary wash with sodium hydroxide had to be made between successive runs in order to minimize these effects. Good results with respect to linearity, precision and accuracy were obtained in the concentration range studied for the six vitamins, using nicotinic acid as internal standard.

Resolution improvement by use of carboxymethyl-beta-cyclodextrin as chiral additive for the enantiomeric separation of basic drugs by capillary electrophoresis.

Three beta-cyclodextrin derivatives--carboxymethyl-, dimethyl- and hydroxypropyl-beta-cyclodextrin--were tested as chiral selectors for the enantioseparation of seven basic drugs in free solution capillary electrophoresis, using buffers made of 100 mM phosphoric acid adjusted to pH 3.0 with triethanolamine in fused silica capillaries thermostatted at 15 degrees C. The best results with respect to chiral resolution were obtained with carboxymethyl-beta-cyclodextrin (CMCD): the enantiomers of all compounds examined were completely resolved with this beta-cyclodextrin derivative. The influence of the CMCD concentration on the migration times, the apparent electrophoretic mobility difference and the resolution of the drug enantiomers was investigated thoroughly. Particularly impressive resolution values, up to 23.7, were obtained for several compounds in these capillary electrophoretic systems, using CMCD in the 5-15 mM concentration range.

Quantitative analysis of non-steroidal anti-inflammatory drugs by capillary zone electrophoresis.

The potential utility of capillary zone electrophoresis (CZE) for the separation and quantitative determination of some non-steroidal anti-inflammatory drugs (NSAIDs) was investigated. The influence of different parameters on migration times, peak symmetry, efficiency and resolution was studied; these parameters included the nature and concentration of the anionic and cationic components of the separation buffer. A buffer consisting of 75 mM glycine adjusted to pH 9.1 with triethanolamine was found to provide a very efficient and stable electrophoretic system for the CZE analysis of NSAIDs, giving RSD values of about 0.1 and 0.5% for the within-day reproducibility of migration times and peak areas, respectively at a concentration of 25 micrograms ml-1 (n = 5). Response was linear from 2-100 micrograms ml-1 for both sulindac and tiaprofenic acid, for which the LOQ values were 2.8 and 1.9 micrograms ml-1, respectively, using UV detection at 280 nm. Accuracy for each drug was 102-103%.

Determination of benzodiazepines by micellar electrokinetic chromatography.

A method for the separation and determination of benzodiazepines by micellar electrokinetic chromatography (MEKC) has been developed. Separation buffers consisted of aqueous solutions of glycine and triethanolamine (pH 9.0), containing sodium dodecyl sulfate (SDS) as surfactant and methanol as organic modifier. The effect of the concentration of SDS, methanol, glycine and triethanolamine on migration times and resolution was studied. Ten benzodiazepines were baseline separated at a 25 mM SDS concentration and 20% v/v methanol in a 75 mM glycine-250 mM triethanolamine buffer. Under these conditions, the within-day reproducibilities were 0.3-0.5% for migration times and 1.7-1.9% for peak areas at a concentration of 10 micrograms/mL. The limits of detection and quantification for oxazepam were 0.2 and 0.7 micrograms/mL, respectively, using an injection time of 5 s.

Chiral separation of basic drugs by capillary zone electrophoresis with cyclodextrin additives.

The enantiomers of a series of basic drugs were separated in capillary zone electrophoresis (CZE) in phosphate buffers, pH 3, containing beta-cyclodextrin or one of its derivatives as chiral selectors and uncoated fused silica capillaries thermostated at 15 degrees C. The nature of the cationic component of the background electrolyte was found to have a significant influence on achiral resolution and peak symmetry. The best results were obtained with triethanolamine, which was then used to adjust the buffer pH in all further experiments. The effects on chiral resolution of the nature and concentration of cyclodextrin, of the addition of methanol, and of capillary temperature were studied. Maximum resolution was obtained at a particular cyclodextrin concentration for each analyte, depending on the affinity of the analyte for this cyclodextrin. On the basis of the results, the effects of methanol addition and temperature on enantiomeric resolution could be explained and predicted. Numerous chiral separations are presented and suggestions for the rapid optimization of CZE enantioseparations with cyclodextrin additives are given.

Determination of verapamil and norverapamil in human plasma by liquid chromatography: comparison between a liquid-liquid extraction procedure and an automated liquid-solid extraction method for sample preparation.

A conventional liquid-liquid extraction (LLE) procedure with high-performance liquid chromatography (HPLC) has been developed for the determination of verapamil and its main metabolite, norverapamil, in plasma. After addition of the internal standard, plasma samples were basified with phosphate buffer (pH 9.0) and extracted with a mixture of cyclohexane-dichloromethane. After centrifugation, the organic layer was separated and the analytes were extracted back into a 0.1 N sulphuric acid solution containing 2-aminoheptane. An aliquot of this aqueous phase was then injected directly onto the HPLC column. This LLE procedure has been compared with an automated liquid-solid extraction (LSE) method that has been developed in parallel. Good linearity was obtained using both extraction methods. The absolute recoveries for the two analytes were ca 95% with the automated LSE procedure and slightly lower (ca 84%) for the LLE method. The automated method gives better results with respect to detectability and precision, but the LLE procedure is simpler to develop, requires much less expensive equipment, and remains a useful alternative when the number of samples to be analysed is limited.

Determination of meprobamate in pharmaceutical dosage forms also containing carbromal by liquid chromatography and indirect photometric detection.

In a pharmaceutical form also containing carbromal, meprobamate could not be quantified selectively by classical methods described in pharmacopoeias due to a significant interference from carbromal. Consequently, reversed-phase HPLC methods have been developed to separate the two active ingredients using indirect photometric detection to visualize and determine meprobamate which has very poor chromophoric properties. Different parameters influencing the sensitivity of the indirect response, such as the nature of the highly absorbing compound added to the mobile phase (the marker) as well as the methanol content and the pH of this phase, have been studied. Two chromatographic systems containing benzoic acid or cinnamic acid as the marker, have been optimized and validated. Good linearity and reproducibility have been obtained with both systems but the cinnamic acid method has the advantage that meprobamate and carbromal can be determined simultaneously at 273 nm.