Effect of vitamin A status at the end of term pregnancy on the saturation of retinol binding protein with retinol.

BACKGROUND: Vitamin A (retinol), which is required for normal fetal development and successful gestation, circulates in the blood bound to a specific protein, the retinol binding protein (RBP). Little is known about the transport and metabolism of this complex protein or about retinol status during normal human pregnancy. OBJECTIVE: The aim of this study was to assess retinol status and transport modalities of retinol in well-nourished women with normal pregnancies, a population poorly investigated compared with pathologic and malnourished pregnant women. DESIGN: The maternal blood and cord blood concentrations of retinol, vitamin E, beta-carotene, RBP, and transthyretin of pregnant French women at term (n = 27) were measured and compared with values from a nonpregnant control group (n = 27). In addition, holo-RBP (retinol bound), apo-RBP (retinol free), and total protein were assessed in both groups to enable the hemodilution occurring during pregnancy to be taken into consideration and to evaluate the extent of saturation of RBP with retinol. RESULTS: Healthy pregnant women at term had normal serum circulatory amounts of retinol, vitamin E, binding proteins, and beta-carotene. However, they had less binding of retinol to RBP (holo-RBP: 49.9% in pregnant women, 54.0% in cord blood, and 77.5% in the control group). CONCLUSION: The results of this study suggest that retinol homeostasis and transport are modified during normal human pregnancy.

[Complications of cordocentesis associated with fetal therapy]. / Les complications des cordocentèses associées à un geste thérapeutique.

OBJECTIVES: To evaluate the technical and obstetrical risk factors of percutaneous umbilical blood sampling (PUBS) when associated with simultaneous fetal therapy. STUDY DESIGN: Retrospective study. One thousand PUBS have been performed in our department between 1984 and 1992. One hundred and forty one of them were done with another invasive fetal procedure. Technical and obstetrical circumstances were related to pregnancy follow-up and complications. RESULTS: Pregnancy complication rate increased when PUBS was associated with another invasive procedure (fetal losses: 12.9%, premature rupture of membranes (PROM): 11.6%). No chorioamnionitis nor perinatal infection was observed. As expected, previous fetal status was a main risk factor. Significant relationships have been found between fetal loss risk and therapy procedures such as amnioinfusion and severe IUGR and as well as abnormal post operative fetal tracing. The duration of cord bleeding after needle retrieval was the single risk factor pointed out for PROM. CONCLUSION: The study of the predictors of fetal complications is necessary to separate the genuine risk of previous fetal status and the risk of the invasive procedure itself.

[Rupture of a splenic artery aneurysm during pregnancy. Report of a case]. / Rupture pergravidique d'un anévrysme de l'artère splénique. A propos d'une observation.

Splenic artery aneurysm rupture during pregnancy is a rare but serious condition. The clinical presentation associates abdominal pain, hypotension and anemia that can mimic uterine rupture or abruptio placentae. An emergency cesarean section and splenectomy are necessary.

[The re-emergence in 1997 of rubella infections during pregnancy. 11 cases in Clermont-Ferrand]. / Recrudescence en 1997 des infections rubéoliques pendant la grossesse. 11 cas à Clermont-Ferrand.

OBJECTIVE: Describe the clinical and laboratory features of rubella observed during the first semester of pregnancy in 11 patients in 1997. PATIENTS AND METHODS: Eleven pregnant women, aged 15-30 years, were referred to the Clermont-Ferrand University Hospital for suspected rubella. Four had had at least 1 prior pregnancy, none had been vaccinated. Rubella serology was obtained for all 11 patients and polymerase chain reaction viral amplification was performed on amniotic fluid in 9 cases. RESULTS: The virology laboratory identified 8 cases of primary rubella (2 prior to 12 weeks gestation) and 3 reinfections (1 prior to 12 weeks gestation). Fetal infection was evidenced in I gravida II patient at 17-18 weeks gestation. All pregnancies were continued to term and no case of congenital rubella malformation was observed. However specific IgM assays were performed at birth in 6 of the 11 infants and revealed infection in 3. CONCLUSION: These observations indicate that a local epidemic of rubella occurred in the general population. They illustrate the risk of a rubella epidemic in France and the lack of sufficient vaccination of the young adult population, finally they emphasize that current anti-rubella vaccination programs should be promoted.

[Case report: electroconvulsive therapy during pregnancy]. / Electroconvulsivothérapie au troisième trimestre de grossesse. A propos d'un cas.

The treatment for psychiatric disorders in pregnancy remains difficult to implement. We report the case of a 28-year-old woman, 20 weeks pregnant when admitted in our psychiatric department. She presented severe depressive disorder, associated with agitation, and psychotic symptoms as delusion and hallucinations occurred. The patient had a history of recurrent mood disorders dating back to eight years before the current admission, including some atypical episodes (psychotic symptoms only), and alternating with free periods without any trouble. A non-specific personality disorder is also probably present. We first used antidepressant (clomipramine) and sedative phenothiazine drugs. Because of the lack of therapeutic efficacy, three weeks later we tried another pharmacologic prescription, that also failed to improve the patient' status. It was hence decided to proceed with electroconvulsive therapy. We describe here the management of the courses, especially the careful monitoring and the anesthetic features we employed, among which endotracheal intubation, oxygen supply, real-time ultrasonography, and recording uterine contractions and fetal heart rate. All theses measures were applied within a surgical-obstetrical theatre. Nine bifrontal courses were performed in five weeks. They rapidly and completely improved the psychiatric symptoms. No sign of fetal neither maternal bad tolerance occurred. While the patient had been authorized to leave hospital, in 34th weeks amenorrhea a routine ultrasonographic examination discovered worrying fetal ascites signs. After the emergency caesarean delivery, the male newborn child undergone immediately surgical treatment for vascular meconium peritonitis, but died nine days later with metabolic post-surgical troubles. This fatal outcome after electroconvulsive therapy leads us to discuss its possible involvement, and in a more general way the safety and place of this treatment in pregnancy psychiatric disorders. They remain critical situations in which therapeutic methods should be rapidly decided. The authors wish others practitioners to bring new case-reports in order to assess the ECT safety-use during pregnancy.

[Axillary lymphadenectomy by lipo-aspiration and endoscopic picking. Apropos of 72 cases]. / Le curage axillaire par lipo-aspiration et prélèvement endoscopique. A propos de 72 cas.

Axillary lymphadenectomy is part of breast cancer treatment. It has two aims: prognosis and treatment. The high morbidity rate of conventional lymphadenectomy is unacceptable in conservative treatment of small tumors. Therefore we developed a new technique combining liposuction and endoscopic picking. So we are able to perform a conservative axillary lymphadenectomy with the same efficiency for prognosis and treatment with a near to zero morbidity. We report here our experience of 72 cases in endoscopic lymphadenectomy.

[Treatment of endometrial clinical stage I adenocarcinoma by laparoscopic surgery. Seventeen cases]. / Le traitement des adénocarcinomes de l'endomètre stade I clinique par coeliochirurgie. A propos de 17 cas.

AIM: Study and follow-up of laparoscopic surgical treatment of endometrial cancer, clinical stage I. METHOD AND MATERIALS: This retrospective study covering the period 01 February 1990 to 31 January 1994 on 17 patients presenting with endometrial cancer, clinical stage I, that is, 35.4% of endometrial cancers operated in our department during that period, and for which laparoscopy was the first step in surgical treatment. RESULTS: Of the 17 cancers assessed by laparoscopy, 12 were also operated by laparoscopy. Conversion to laparotomy concerned 5 cases (29.4%): one case of postoperative adhesions, 2 cases of laparoscopic complications (cardiac rhythm problems, sub cutaneous emphysema), 2 cases of peritoneal granulations giving rise to suspicious of stage III. The mean age of the patients operated via laparoscopy was 59.9 years (extremes: 34-74). Their weight varied from 52 to 94 kg with a mean of 68.1 kg. Two endoscopic surgical complications arose (one bladder injury and one cervico-vaginal bleeding), but did not require conversion to laparotomy. No postoperative complications were noted. The average follow-up for these patients treated by endoscopy is 22.3 months. There was regrettably one early recurrence of the disease 7 months postoperatively. CONCLUSION: Laparoscopic surgery can be used to treat clinical stage I cases of endometrial cancer. This surgical approach must be used only for favourable cases and is reserved for teams trained in endoscopic and cancer surgery.