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Leduc L, Leclère M, Lavoie JP. Towards personalized medicine for the treatment of equine asthma. Vet J 2024:106125. [PMID: 38704018 DOI: 10.1016/j.tvjl.2024.106125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 04/22/2024] [Accepted: 04/26/2024] [Indexed: 05/06/2024]
Abstract
Although horses with asthma share similar clinical signs, the heterogeneity of the disease in terms of severity, triggering factors, inflammatory profile, and pathological features has hindered our ability to define biologically distinct subgroups. The recognition of phenotypes and endotypes could enable the development of precision medicine, including personalized, targeted therapy, to benefit affected horses. While in its infancy in horses, this review outlines the phenotypes of equine asthma and discusses how knowledge gained from targeted therapy in human medicine can be applied to evaluate the potential opportunities for personalized medicine in equine asthma and to suggest avenues for research to advance this emerging field.
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Affiliation(s)
- Laurence Leduc
- Department of Clinical Sciences, Faculté de Médecine Vétérinaire, Université de Montréal, St-Hyacinthe, QC, J2S 2M2, Canada
| | - Mathilde Leclère
- Department of Clinical Sciences, Faculté de Médecine Vétérinaire, Université de Montréal, St-Hyacinthe, QC, J2S 2M2, Canada
| | - Jean-Pierre Lavoie
- Department of Clinical Sciences, Faculté de Médecine Vétérinaire, Université de Montréal, St-Hyacinthe, QC, J2S 2M2, Canada.
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Leduc L, Underwood C, Stefanovski D, Hurcombe S, Navas de Solis C. Evaluation of remote assistance for point-of-care ultrasonography in a large animal hospital: a controlled randomized trial. J Am Vet Med Assoc 2024; 262:680-684. [PMID: 38452487 DOI: 10.2460/javma.23.09.0511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 01/22/2024] [Indexed: 03/09/2024]
Abstract
OBJECTIVE To assess whether remote assistance is beneficial to the accuracy of point-of-care ultrasound (POCUS) examinations during equine emergency evaluations. ANIMALS Adult horses presenting to a tertiary care large animal emergency service for respiratory or gastrointestinal clinical signs. PROCEDURES Prospective, randomized, controlled, clinical study. Cases were assigned to receive POCUS with remote assistance ("POCUS-R" group) or POCUS with no assistance ("POCUS" group). Accuracy of diagnosis, duration of sonograms and survival to discharge were the objective outcomes compared between groups. Perceptions about the use of teleultrasound were gathered using a survey. RESULTS 29 cases were enrolled in the study over an 18-month period. Based on Cox regression estimates, sonogram duration was likely to be longer in the POCUS-R group (n = 13) relative to the POCUS group (16) hazard ratio 0.43 (95% CI, 0.9 to 0.2; P = .03). Whether the final diagnosis was included in the differential diagnosis list, number of diagnoses in the differential list and survival were not different between groups. Educational benefits were the most frequently mentioned benefit by clinician users while logistical and technical problems related to the use of the equipment and inconvenience of enrollment in the study was the most common negative aspect. CLINICAL RELEVANCE Teleultrasound was generally not well adopted by users likely due to inconvenience and time constraints. Further work is indicated to assess differences in clinical outcomes in a setting that would allow a larger sample size to increase statistical power.
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Boucher L, Leduc L, Leclère M, Costa MC. Current Understanding of Equine Gut Dysbiosis and Microbiota Manipulation Techniques: Comparison with Current Knowledge in Other Species. Animals (Basel) 2024; 14:758. [PMID: 38473143 DOI: 10.3390/ani14050758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 02/26/2024] [Accepted: 02/26/2024] [Indexed: 03/14/2024] Open
Abstract
Understanding the importance of intestinal microbiota in horses and the factors influencing its composition have been the focus of many studies over the past few years. Factors such as age, diet, antibiotic administration, and geographic location can affect the gut microbiota. The intra- and inter-individual variability of fecal microbiota in horses complicates its interpretation and has hindered the establishment of a clear definition for dysbiosis. Although a definitive causal relationship between gut dysbiosis in horses and diseases has not been clearly identified, recent research suggests that dysbiosis may play a role in the pathogenesis of various conditions, such as colitis and asthma. Prebiotics, probiotics, and fecal microbiota transplantation to modulate the horse's gastrointestinal tract may eventually be considered a valuable tool for preventing or treating diseases, such as antibiotic-induced colitis. This article aims to summarize the current knowledge on the importance of intestinal microbiota in horses and factors influencing its composition, and also to review the published literature on methods for detecting dysbiosis while discussing the efficacy of gut microbiota manipulation in horses.
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Affiliation(s)
- Laurie Boucher
- Department of Veterinary Biomedical Sciences, Université de Montréal, Saint-Hyacinthe, QC J2S 2M2, Canada
| | - Laurence Leduc
- Department of Clinical Sciences, Université de Montréal, Saint-Hyacinthe, QC J2S 2M2, Canada
| | - Mathilde Leclère
- Department of Clinical Sciences, Université de Montréal, Saint-Hyacinthe, QC J2S 2M2, Canada
| | - Marcio Carvalho Costa
- Department of Veterinary Biomedical Sciences, Université de Montréal, Saint-Hyacinthe, QC J2S 2M2, Canada
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Leduc L, Costa M, Leclère M. The Microbiota and Equine Asthma: An Integrative View of the Gut-Lung Axis. Animals (Basel) 2024; 14:253. [PMID: 38254421 PMCID: PMC10812655 DOI: 10.3390/ani14020253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 01/11/2024] [Accepted: 01/11/2024] [Indexed: 01/24/2024] Open
Abstract
Both microbe-microbe and host-microbe interactions can have effects beyond the local environment and influence immunological responses in remote organs such as the lungs. The crosstalk between the gut and the lungs, which is supported by complex connections and intricate pathways, is defined as the gut-lung axis. This review aimed to report on the potential role of the gut-lung gut-lung axis in the development and persistence of equine asthma. We summarized significant determinants in the development of asthma in horses and humans. The article discusses the gut-lung axis and proposes an integrative view of the relationship between gut microbiota and asthma. It also explores therapies for modulating the gut microbiota in horses with asthma. Improving our understanding of the horse gut-lung axis could lead to the development of techniques such as fecal microbiota transplants, probiotics, or prebiotics to manipulate the gut microbiota specifically for improving the management of asthma in horses.
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Affiliation(s)
- Laurence Leduc
- Clinical Sciences Department, Université de Montréal, Saint-Hyacinthe, QC J2S 2M2, Canada;
| | - Marcio Costa
- Veterinary Department of Biomedical Sciences, Université de Montréal, Saint-Hyacinthe, QC J2S 2M2, Canada;
| | - Mathilde Leclère
- Clinical Sciences Department, Université de Montréal, Saint-Hyacinthe, QC J2S 2M2, Canada;
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Leduc L, Leclère M, Gauthier LG, Marcil O, Lavoie J. Severe asthma in horses is associated with increased airway innervation. J Vet Intern Med 2024; 38:485-494. [PMID: 38054207 PMCID: PMC10800206 DOI: 10.1111/jvim.16941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 11/02/2023] [Indexed: 12/07/2023] Open
Abstract
BACKGROUND Altered innervation structure and function contribute to airway hyperresponsiveness in human asthma, yet the role of innervation in airflow limitation in asthma in horses remains unknown. HYPOTHESIS To characterize peribronchial innervation in horses with asthma. We hypothesized that airway innervation increases in horses with asthma compared with controls. ANIMALS Formalin-fixed lung samples from 8 horses with severe asthma and 8 healthy horses from the Equine Respiratory Tissue Biobank. Ante-mortem lung function was recorded. METHODS Blinded case-control study. Immunohistochemistry was performed using rabbit anti-s100 antibody as a neuronal marker for myelinating and non-myelinating Schwann cells. The number and cumulative area of nerves in the peribronchial region and associated with airway smooth muscle were recorded using histomorphometry and corrected for airway size. RESULTS Both the number (median [IQR]: 1.87 × 10-5 nerves/μm2 [1.28 × 10-5 ]) and the cumulative nerve area (CNA; 1.03 × 10-3 CNA/μm2 [1.57 × 10-3 ]) were higher in the peribronchial region of horses with asthma compared with controls (5.17 × 10-6 nerves/μm2 [3.76 × 10-6 ], 4.14 × 10-4 CNA/μm2 [2.54 × 10-4 ], Mann-Whitney, P = .01). The number of nerves within or lining airway smooth muscle was significantly higher in horses with asthma (4.47 × 10-6 nerves/μm2 [5.75 × 10-6 ]) compared with controls (2.26 × 10-6 nerves/μm2 [1.16 × 10-6 ], Mann-Whitney, P = .03). CONCLUSIONS AND CLINICAL IMPORTANCE Asthma in horses is associated with greater airway innervation, possibly contributing to airway smooth muscle remodeling and exacerbating severity of the disease.
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Affiliation(s)
- Laurence Leduc
- Department of Clinical Sciences, Faculté de Médecine VétérinaireUniversité de MontréalSaint‐HyacintheQuebecCanada
| | - Mathilde Leclère
- Department of Clinical Sciences, Faculté de Médecine VétérinaireUniversité de MontréalSaint‐HyacintheQuebecCanada
| | | | | | - Jean‐Pierre Lavoie
- Department of Clinical Sciences, Faculté de Médecine VétérinaireUniversité de MontréalSaint‐HyacintheQuebecCanada
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Bellone RR, Tanaka J, Esdaile E, Sutton RB, Payette F, Leduc L, Till BJ, Abdel-Ghaffar AK, Hammond M, Magdesian KG. A de novo 2.3 kb structural variant in MITF explains a novel splashed white phenotype in a Thoroughbred family. Anim Genet 2023; 54:752-762. [PMID: 37697831 DOI: 10.1111/age.13352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 07/12/2023] [Accepted: 08/19/2023] [Indexed: 09/13/2023]
Abstract
Splashed white in horses is characterized by extensive white patterning on the legs, face and abdomen and may be accompanied by deafness. To date, seven variants in microphthalmia-associated transcription factor (MITF) and two variants in Paired Box 3 (PAX3) have been identified to explain this phenotype. A splashed white Thoroughbred stallion, whose sire and dam were not patterned, was hypothesized to have a de novo variant leading to his white coat pattern. A whole-genome sequencing candidate gene approach identified two single nucleotide variants (SNVs) in SOX10, four SNVs in MITF and a 2.3 kb deletion in MITF with the alternative allele present in this stallion but absent in the other 18 horses analyzed. All six SNVs were annotated as modifiers and were not further considered. The deletion in MITF (NC_009159.3:g.21555811_21558139delinsAAAT) encompasses exon 9 encoding a part of the helix-loop-helix domain required for DNA binding. Sanger sequencing and parentage testing confirmed that this deletion was a de novo mutation of maternal origin. Consistent with the published nomenclature, we denote this likely causal variant as SW8. Genotyping three of this stallion's offspring identified SW8 only in the nearly all-white foal that was confirmed deaf by brainstem auditory evoked response testing. This foal was also a compound heterozygote for dominant white variants (W20/W22), but to date, W variants alone have not been connected to deafness. SW8 marks the fourth de novo MITF variant in horses reported to cause white patterning. The link between deafness and all MITF variants with and without other variants impacting melanocyte development and function needs to be further explored.
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Affiliation(s)
- R R Bellone
- Veterinary Genetics Laboratory, School of Veterinary Medicine, UC Davis, Davis, California, USA
- Department of Population Health and Reproduction, School of Veterinary Medicine, UC Davis, Davis, California, USA
| | - J Tanaka
- Veterinary Genetics Laboratory, School of Veterinary Medicine, UC Davis, Davis, California, USA
| | - E Esdaile
- Veterinary Genetics Laboratory, School of Veterinary Medicine, UC Davis, Davis, California, USA
| | - R B Sutton
- Cell Physiology and Molecular Biophysics, School of Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas, USA
| | - F Payette
- Department of Clinical Studies, New Bolton Center, University of Pennsylvania School of Veterinary Medicine, University School of Veterinary Medicine, University of Pennsylvania, Kennett Square, Pennsylvania, USA
| | - L Leduc
- Department of Clinical Studies, New Bolton Center, University of Pennsylvania School of Veterinary Medicine, University School of Veterinary Medicine, University of Pennsylvania, Kennett Square, Pennsylvania, USA
| | - B J Till
- Veterinary Genetics Laboratory, School of Veterinary Medicine, UC Davis, Davis, California, USA
| | - A K Abdel-Ghaffar
- Veterinary Genetics Laboratory, School of Veterinary Medicine, UC Davis, Davis, California, USA
| | - M Hammond
- Veterinary Genetics Laboratory, School of Veterinary Medicine, UC Davis, Davis, California, USA
- Department of Population Health and Reproduction, School of Veterinary Medicine, UC Davis, Davis, California, USA
| | - K G Magdesian
- Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California-Davis, Davis, California, USA
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Coll‐Roman LM, Cabrera C, VanderBroek AR, Bauck AG, Kelleman AA, Pozor MA, Stockler JW, Wiley C, Scully C, Mackay EE, Depenbrock SM, Fecteau M, Abraham M, Leduc L, Noll CV, Hernandez JA, Luethy D. Multicenter study of uterine tears and other reproductive complications in periparturient goats presented to veterinary teaching hospitals. J Vet Intern Med 2023; 37:2623-2630. [PMID: 37698350 PMCID: PMC10658512 DOI: 10.1111/jvim.16858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 08/24/2023] [Indexed: 09/13/2023] Open
Abstract
BACKGROUND Goats are increasingly popular as both production animals and pets. The frequency of and factors associated with periparturient reproductive complications in goats are largely unreported. OBJECTIVES (1) To report the frequency of periparturient reproductive complications in does presented to university veterinary hospitals and (2) to identify factors associated with uterine tears in the study population. ANIMALS A total of 198 periparturient does presented to 9 university veterinary hospitals from October 2021 to June 2022. METHODS Multicenter, cross-sectional study, with data collected from questionnaires completed by attending veterinarians. Logistic regression was used to identify factors associated with diagnosis of uterine tears. RESULTS Ninety-three (47%) does had at least 1 periparturient reproductive complication. Periparturient complications included retained fetal membranes (n = 38, 26%), vaginal or perineal trauma (n = 33, 19%), uterine tears (n = 32, 18%), metritis (n = 22, 13%), uterine or vaginal hemorrhage (n = 8, 5%), Cesarean section complications (n = 8, 8%), and uterine prolapse (n = 1, 0.5%). A positive interaction effect was found between small breeds (Nigerian Dwarf and Pygmy) and manipulation on the farm by a layperson upon diagnosis of uterine tears (odd ratios [OR], 5.48; 95% confidence interval [CI], 1.41, 21.25; P = .01). CONCLUSIONS AND CLINICAL IMPORTANCE Periparturient reproductive complications were common. Small breed combined with manipulation on the farm by layperson was associated with diagnosis of uterine tears. Clients should be educated that in the event of dystocia, small breed does are at greater risk of uterine tears and prompt veterinary intervention is critical.
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Affiliation(s)
| | - Catalina Cabrera
- Department of Large Animal Clinical Sciences, College of Veterinary MedicineUniversity of FloridaGainesvilleFloridaUSA
| | - Ashley R. VanderBroek
- Department of Large Animal Clinical Sciences, College of Veterinary MedicineMichigan State UniversityEast LansingMichiganUSA
| | - Anje G. Bauck
- Department of Large Animal Clinical Sciences, College of Veterinary MedicineUniversity of FloridaGainesvilleFloridaUSA
| | - Audrey A. Kelleman
- Department of Large Animal Clinical Sciences, College of Veterinary MedicineUniversity of FloridaGainesvilleFloridaUSA
| | - Malgorzata A. Pozor
- Department of Large Animal Clinical Sciences, College of Veterinary MedicineUniversity of FloridaGainesvilleFloridaUSA
| | - Jenna W. Stockler
- Department of Clinical Sciences, College of Veterinary MedicineAuburn UniversityAuburnAlabamaUSA
| | - Caitlin Wiley
- Veterinary Diagnostic and Production Animal Medicine, College of Veterinary MedicineIowa State UniversityAmesIowaUSA
| | - Clare Scully
- Department of Veterinary Clinical Sciences, School of Veterinary MedicineLouisiana State UniversityBaton RougeLouisianaUSA
| | - Evelyn E. Mackay
- Department of Large Animal Clinical Sciences, College of Veterinary Medicine and Biomedical SciencesTexas A&M UniversityCollege StationTexasUSA
| | - Sarah M. Depenbrock
- Department of Veterinary Medicine and Epidemiology, School of Veterinary MedicineUC DavisDavisCaliforniaUSA
| | - Marie‐Eve Fecteau
- Department of Clinical Studies – New Bolton Center, School of Veterinary MedicineUniversity of PennsylvaniaKennett SquarePennsylvaniaUSA
| | - Michelle Abraham
- Department of Clinical Studies – New Bolton Center, School of Veterinary MedicineUniversity of PennsylvaniaKennett SquarePennsylvaniaUSA
| | - Laurence Leduc
- Department of Clinical Studies – New Bolton Center, School of Veterinary MedicineUniversity of PennsylvaniaKennett SquarePennsylvaniaUSA
| | - Charlene V. Noll
- Department of Large Animal Clinical Sciences, College of Veterinary MedicineUniversity of TennesseeKnoxvilleTennesseeUSA
| | - Jorge A. Hernandez
- Department of Large Animal Clinical Sciences, College of Veterinary MedicineUniversity of FloridaGainesvilleFloridaUSA
| | - Daniela Luethy
- Department of Large Animal Clinical Sciences, College of Veterinary MedicineUniversity of FloridaGainesvilleFloridaUSA
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Leduc L, Arango-Sabogal JC, Francoz D, Nichols S, Desrochers A, Schelcher F, Fecteau G. Presence or severity of hypophosphatemia is not associated with survival outcome in postpartum downer dairy cows. J Am Vet Med Assoc 2023; 261:852-857. [PMID: 36884377 DOI: 10.2460/javma.22.08.0345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 02/14/2023] [Indexed: 03/09/2023]
Abstract
OBJECTIVE To evaluate the association between serum phosphorus concentration and the outcome of postpartum downer cows. ANIMALS Postpartum downer dairy cows presented over a 22-year period. PROCEDURES In this cross-sectional study (1994 to 2016), medical records of all postpartum downer cows presented to a referral large animal hospital were reviewed. The association between serum inorganic phosphorus concentration and survival was assessed using a multivariable logistic regression. RESULTS 907 postpartum downer dairy cows were included and classified as hypophosphatemic (mild: > 2.25 to < 3.25 mg/dL, moderate: > 1.50 to ≤ 2.25 mg/dL, and severe: ≤ 1.50 mg/dL), normophosphatemic (≥ 3.25 and ≤ 8.76 mg/dL) or hyperphosphatemic (> 8.76 mg/dL). Hypophosphatemia was observed in 19.4% of the cows (n = 176). Of those, 54.5% (n = 96) were also hypocalcemic. Overall, 58.4% cows (n = 530) survived after hospitalization. Hypophosphatemia was not significantly associated with the outcome of postpartum downer cows (mild: OR = 1.0, 95% CI: 0.6 to 1.8; moderate: OR = 0.5, 95% CI: 0.2 to 1.1; severe: OR = 1.0, 95% CI: 0.4 to 2.4). CLINICAL RELEVANCE Low serum phosphorus concentration was frequently observed with hypocalcemia and was not associated with the outcome of postpartum downer cows.
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Affiliation(s)
- Laurence Leduc
- 1Department of Clinical Sciences, Faculté de Médecine Vétérinaire, Université de Montréal, St-Hyacinthe, QC, Canada
| | - Juan Carlos Arango-Sabogal
- 2Department of Pathology and Microbiology, Faculté de Médecine Vétérinaire, Université de Montréal, St-Hyacinthe, QC, Canada
| | - David Francoz
- 1Department of Clinical Sciences, Faculté de Médecine Vétérinaire, Université de Montréal, St-Hyacinthe, QC, Canada
| | - Sylvain Nichols
- 1Department of Clinical Sciences, Faculté de Médecine Vétérinaire, Université de Montréal, St-Hyacinthe, QC, Canada
| | - André Desrochers
- 1Department of Clinical Sciences, Faculté de Médecine Vétérinaire, Université de Montréal, St-Hyacinthe, QC, Canada
| | - François Schelcher
- 3Interactions Hôtes-Agents Pathogènes, École Nationale Vétérinaire de Toulouse, Université de Toulouse, Toulouse, France
| | - Gilles Fecteau
- 1Department of Clinical Sciences, Faculté de Médecine Vétérinaire, Université de Montréal, St-Hyacinthe, QC, Canada
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Mahdi N, Chaix M, Guerma L, Dore A, Mondesert B, Leduc L, Codsi E, Khairy P, Mongeon F. SEX-RELATED DIFFERENCES AND THE INFLUENCE OF PREGNANCY ON CARDIAC OUTCOMES IN ADULTS WITH A SYSTEMIC RIGHT VENTRICLE AND BIVENTRICULAR PHYSIOLOGY. Can J Cardiol 2022. [DOI: 10.1016/j.cjca.2022.08.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Coelho C, Foret C, Bazin C, Leduc L, Hammada M, Inácio M, Bedell JP. Bioavailability and bioaccumulation of heavy metals of several soils and sediments (from industrialized urban areas) for Eisenia fetida. Sci Total Environ 2018; 635:1317-1330. [PMID: 29710585 DOI: 10.1016/j.scitotenv.2018.04.213] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 04/13/2018] [Accepted: 04/16/2018] [Indexed: 06/08/2023]
Abstract
Soils and sediments are susceptible to anthropogenic contamination with Metallic Trace Elements (MTEs) and it can present some risks to ecosystems and human health. The levels of Cd, Cu, Fe, Ni, Pb and Zn were assessed in soils (C, G, K, L) from Estarreja (Portugal) and sediments from a stormwater basin in Lyon (DJG), a harbour (LDB) and a Rhône river site (TRS) (France). An ecotoxicological study was performed with Eisenia fetida (E. fetida) to infer about potential transfer risks to the soil invertebrates. To assess risks associated with MTEs contamination, it is important to know their total concentrations, fractionation and the potential available fractions. CaCl2, DTPA and NaOAc extractions were performed to assess the extractable and available MTEs fractions. The studied sediments were much more contaminated than the soils for all the MTEs analysed. The trace elements fraction linked with DTPA extraction shows higher values when compared with the NaOAc and the CaCl2 pools. Low mortality effects were recorded in the tests with E. fetida. The MTEs levels in soils and sediments and the concentrations bioaccumulated in adult earthworms contributed to a reduction in the number of juveniles produced. E. fetida adults and juveniles accumulated ETMs as follows: Cd > Cu = Zn > Ni > Pb > Fe. Determined BAFs were mostly lower than 1 with some higher values for Cd, Cu and Zn. Calculated SET and ERITME indexes allowed to classify the samples from the most to the less toxic for E. fetida as: LDB > DJG > L > G > C > K > TRS. Despite this order of toxicity, the earthworms exposed to the sediment TRS presented the lowest reproduction rate. The combination of "chemical" measurements with the calculation of BAFs, but especially SET and ERITME indexes can be a useful tool in risk assessment.
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Affiliation(s)
- C Coelho
- Université de Lyon, CNRS, UMR 5023 LEHNA, Université Lyon 1, ENTPE, 2 rue Maurice Audin, Vaulx-en-Velin F-69518, France.
| | - C Foret
- Université de Lyon, CNRS, UMR 5023 LEHNA, Université Lyon 1, ENTPE, 2 rue Maurice Audin, Vaulx-en-Velin F-69518, France
| | - C Bazin
- INSAVALOR - PROVADEMSE, 20 Avenue Albert Einstein, F-69621 Villeurbanne, France
| | - L Leduc
- Université de Lyon, CNRS, UMR 5023 LEHNA, Université Lyon 1, ENTPE, 2 rue Maurice Audin, Vaulx-en-Velin F-69518, France; INSAVALOR - PROVADEMSE, 20 Avenue Albert Einstein, F-69621 Villeurbanne, France
| | - M Hammada
- Université de Lyon, CNRS, UMR 5023 LEHNA, Université Lyon 1, ENTPE, 2 rue Maurice Audin, Vaulx-en-Velin F-69518, France
| | - M Inácio
- GEOBIOTEC Research Centre, Department of Geosciences, University of Aveiro, Portugal.
| | - J P Bedell
- Université de Lyon, CNRS, UMR 5023 LEHNA, Université Lyon 1, ENTPE, 2 rue Maurice Audin, Vaulx-en-Velin F-69518, France
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Leduc L, Monet B, Sansregret A, Gauthier R, Bourque J, Rypens F. Immediate closure of uterine wall following spontaneous rupture at 23 weeks' gestation, allowing prolongation of pregnancy. Ultrasound Obstet Gynecol 2016; 48:534-535. [PMID: 26823145 DOI: 10.1002/uog.15872] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Revised: 01/19/2016] [Accepted: 01/22/2016] [Indexed: 06/05/2023]
Affiliation(s)
- L Leduc
- Department of Obstetrics & Gynecology, CHU Sainte-Justine, 3175 Côte Sainte-Catherine, Montreal, Quebec, H3T 1C5, Canada.
| | - B Monet
- Department of Obstetrics & Gynecology, CHU Sainte-Justine, 3175 Côte Sainte-Catherine, Montreal, Quebec, H3T 1C5, Canada
| | - A Sansregret
- Department of Obstetrics & Gynecology, CHU Sainte-Justine, 3175 Côte Sainte-Catherine, Montreal, Quebec, H3T 1C5, Canada
| | - R Gauthier
- Department of Obstetrics & Gynecology, CHU Sainte-Justine, 3175 Côte Sainte-Catherine, Montreal, Quebec, H3T 1C5, Canada
| | - J Bourque
- Department of Obstetrics & Gynecology, CHU Sainte-Justine, 3175 Côte Sainte-Catherine, Montreal, Quebec, H3T 1C5, Canada
| | - F Rypens
- Department of Radiology, CHU Sainte-Justine, Montreal, Quebec, Canada
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Regnier W, Leduc L, Colamarino R. « Mais qui êtes-vous ? » : une prosopagnosie progressive longtemps isolée révélatrice d’une démence sémantique. Rev Neurol (Paris) 2013. [DOI: 10.1016/j.neurol.2013.01.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Bouhout I, Poirier N, Mercier L, Dore A, Leduc L, El-Hamamsy I. 795 Pregnancy Following Aortic Valve Replacement - Cardiac, Maternal and Fetal Outcomes. Can J Cardiol 2012. [DOI: 10.1016/j.cjca.2012.07.715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Tordjman L, Leduc L, Boutin C. 049 Fetal umbilical vein varices and thrombus formation: Are there identifiable risk factors by fetal echocardiography? Can J Cardiol 2011. [DOI: 10.1016/j.cjca.2011.07.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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15
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Haché S, Takser L, LeBellego F, Weiler H, Leduc L, Forest JC, Giguère Y, Masse A, Barbeau B, Lafond J. Alteration of calcium homeostasis in primary preeclamptic syncytiotrophoblasts: effect on calcium exchange in placenta. J Cell Mol Med 2011; 15:654-67. [PMID: 20178461 PMCID: PMC3922387 DOI: 10.1111/j.1582-4934.2010.01039.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Preeclampsia (PE) is characterized by maternal hypertension, proteinuria, oedema and, in 30% of cases, by intrauterine growth retardation. Causes are still unknown; however, epidemiological and clinical studies have suggested alterations in maternal calcium metabolism. We suggested that in PE, calcium transport by the syncytiotrophoblast (ST) is disturbed. From total placental tissues, we studied the expression of: calcium channels (TRPV5, TRPV6 [transient receptor potential vanilloid]), calcium binding proteins (CaBP-9K, CaBP-28K), plasma membrane calcium ATPase (PMCA)1,2,3,4 pumps, ATP synthase, genes implicated in Ca2+ release [inositol-1,4,5-triphosphate receptor (IP3R)1,2,3; Ryanodine receptor (RyR)1,2,3] and replenishment (SERCA1,2,3 [sarcoendoplasmic reticulum Ca2+ ATPases]) from endoplasmic reticulum, channels implicated in mitochondrial Ca2+ accumulation (VDAC1,2,3 [voltage-dependent anion channels]) and a marker of oxidative stress (hOGG1 [Human 8-oxoguanine-DNA glycosylase 1]), as well as the influence of these variations on calcium transport in primary ST cultures. The mRNA and protein levels were thereby examined by real-time PCR and Western blot analysis, respectively, in two different groups of pregnant women with similar gestational age: a normal group (n= 16) and a PE group (n= 8), diagnosed by a clinician. Our study showed a significant decrease in calcium transport by the ST cultured from preeclamptic placentas. We found a significant (P < 0.05) decrease in mRNA levels of TRPV5, TRPV6, CaBP-9K, CaBP-28K, PMCA1, PMCA4, ATP synthase, IP3R1, IP3R2, RyR1, RyR2 and RyR3 in PE group compared to normal one. We also noted a significant decrease in protein levels of TRPV5, TRPV6, CaBP-9K, CaBP-28K and PMCA1/4 in PE group. In contrast, SERCA1, SERCA2, SERCA3, VDAC3 and hOGG1 mRNA expressions were significantly increased in PE placentas. Calcium homeostasis and transport through placenta is compromised in preeclamptic pregnancies and it appears to be affected by a lack of ATP and an excess of oxidative stress.
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Affiliation(s)
- S Haché
- Biomed Research Center, Department of Biological Sciences, University of Quebec at Montreal, Quebec, Canada
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16
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Rey E, Garneau P, David M, Gauthier R, Leduc L, Michon N, Morin F, Demers C, Kahn SR, Magee LA, Rodger M. Dalteparin for the prevention of recurrence of placental-mediated complications of pregnancy in women without thrombophilia: a pilot randomized controlled trial. J Thromb Haemost 2009; 7:58-64. [PMID: 19036070 DOI: 10.1111/j.1538-7836.2008.03230.x] [Citation(s) in RCA: 144] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND The role of anticoagulants for the prevention of placental-mediated pregnancy complications is uncertain. OBJECTIVES Our aim was to investigate the effectiveness of dalteparin, a low-molecular-weight heparin, in preventing the recurrence of these complications in women without thrombophilia. PATIENTS/METHODS Between August 1 2000 and June 20 2007, 116 pregnant women with: (i) RESULTS Among the 110 women included in the final analysis, dalteparin was associated with a lower rate of the primary outcome [5.5% (n = 3/55) vs. 23.6% (n = 13/55), adjusted odds ratio (OR) 0.15, 95% confidence interval (CI) 0.03-0.70]. Secondary outcomes were not statistically different between the groups. Bleeding problems or thrombocytopenia did not occur. CONCLUSION In this pilot study, dalteparin is effective in decreasing the recurrence of placental-mediated complications in women without thrombophilia. Our results require confirmation in further randomized trials.
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Affiliation(s)
- E Rey
- Division of Obstetrics Medicine, Department of Obstetrics and Gynaecology, CHU Sainte-Justine, Montreal, QC, Canada.
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17
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Grenier E, Ziv E, Delvin E, Leduc L, Spahis S, Lafond J, Levy E. Importance of ΩV-3 fatty acids on developmental programming of insulin resistance, hyperlipidemia and nonalcoholic steatohepatitis in psammomys obesus. Can J Diabetes 2009. [DOI: 10.1016/s1499-2671(09)31016-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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18
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Bensouda B, Fouron JC, Raboisson MJ, Lamoureux J, Lachance C, Leduc L. Relevance of measuring diastolic time intervals in the ductus venosus during the early stages of twin-twin transfusion syndrome. Ultrasound Obstet Gynecol 2007; 30:983-987. [PMID: 18008315 DOI: 10.1002/uog.5161] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
OBJECTIVE To determine if the discrete myocardial diastolic dysfunction documented previously in the recipient twin during the early stages of twin-twin transfusion syndrome (TTTS) has any repercussion on flow velocities through the ductus venosus (DV) and to investigate if this could allow early differentiation between TTTS and selective intrauterine growth restriction (IUGR). METHODS Two groups of monochorionic twin pregnancies with growth discordance between twins were reviewed retrospectively. Group I was composed of fetuses in Stages I and II of TTTS; laser or amnioreduction was not performed in any instance. Group II twin pairs each included one fetus with IUGR due to placental circulatory insufficiency. Intertwin differences (smaller minus larger fetus) were analyzed for myocardial performance index of the right ventricle (MPI-RV) and for time variables in the DV. RESULTS There were 38 pairs of monochorionic twins (24 TTTS and 14 IUGR) in this study. In the TTTS group, the donors had a significantly lower MPI-RV (0.419 +/- 0.18 vs. 0.596 +/- 0.17, F(1,19df) = 24.017, P < 0.001), a significantly longer total ventricular filling time (150.9 +/- 25.6 ms vs. 124.0 +/- 22.6 ms; F(1,21df) = 19.631, P < 0.001) and a significantly longer early filling time (118.9 +/- 22.9 ms vs. 92.6 +/- 18.9 ms, F(1,21df) = 28.419, P < 0.001) than had the recipient. None of these three differences was present in the IUGR group. Probability studies revealed that cut-off values of 12.75 for intertwin differences in total filling time and 8.5 for intertwin differences in early filling time had sensitivities of 71% and 92%, respectively. The false-positive rates were 23% and 15%, respectively, for the early diagnosis of TTTS. CONCLUSION In monochorionic twin pregnancies, shortening of the ventricular filling time in the recipient twin indicates diastolic myocardial dysfunction occurring early in the pathophysiology of TTTS. This early interwin difference in myocardial function is not found in pregnancies with IUGR in one twin due to placental circulatory insufficiency, allowing early differentiation between TTTS and selective IUGR.
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Affiliation(s)
- B Bensouda
- Neonatology Division, Department of Pediatrics, Saint-Justine Hospital, University of Montreal, Montreal, Quebec, Canada
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19
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Raboisson MJ, Fouron JC, Lamoureux J, Leduc L, Grignon A, Proulx F, Gamache S. Early Intertwin Differences in Myocardial Performance During the Twin-to-Twin Transfusion Syndrome. Circulation 2004; 110:3043-8. [PMID: 15520320 DOI: 10.1161/01.cir.0000146896.20317.59] [Citation(s) in RCA: 100] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
In the twin-to-twin transfusion syndrome (TTTS), pressure rather than volume overload is increasingly considered as a key factor in the pathogenesis of the cardiomyopathy of the recipient twin. If this is the case, cardiac dysfunction should be among the first signs observed with TTTS. The objective of this study was to determine whether intertwin differences in myocardial function are modified early in the course of TTTS and whether they can help to differentiate this condition from intrauterine growth restriction (IUGR).
Methods and Results—
Eight variables were analyzed on the first fetal echocardiography on 21 pairs of twins with TTTS and 11 with IUGR. No difference was found between the 2 groups for the cardiothoracic ratio, pulsatility indices in the umbilical and middle cerebral arteries, and peak velocity of the middle cerebral artery. Significant difference was found for ventricular septal thickness, but with no association with the conditions under study. With TTTS, left ventricular shortening fraction was consistently greater in the donor twins, and myocardial performance indices (MPIs) were elevated in the recipient twins. This increase in MPI was caused by a lengthening of the isovolumic periods compared with those of the donor twin: left ventricular and right ventricular isovolumic periods 0.105±0.047 and 0.097±0.026 seconds, respectively, for the recipient twins versus 0.0561±0.46 and 0.065±0.03 seconds, respectively, for the donor twins (
P
<0.001). These changes in the isovolumic periods were mainly due to significant prolongation of isovolumic relaxation times. A change in left ventricular MPI ≥0.09 combined with a change in right ventricular MPI ≥0.05 would identify a TTTS with a sensitivity of 75% and a false-positive rate of 9%.
Conclusions—
The observed diastolic function impairment goes along with the pressure-overload pathogenic concept proposed in TTTS. Assessment of intertwin difference in MPI is a valuable tool for early differential diagnosis between TTTS and isolated IUGR.
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Affiliation(s)
- M J Raboisson
- Fetal Cardiology Unit, Cardiology Division, Department of Pediatrics, St. Justine Hospital, Université de Montréal, Montreal, Quebec, Canada
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20
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Legout L, Maulin L, Senneville E, Leduc L, Georges H, Guéry B, Leroy O, Beaucaire G, Mouton Y. Une septicémie à Mycobacterium bovis : intérêt de la corticothérapie en association avec les antituberculeux. Rev Med Interne 2000. [DOI: 10.1016/s0248-8663(00)90272-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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21
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Leduc L. [Handwashing in the hospital, it's vital!]. Infirm Que 2000; 8:30-1. [PMID: 11949619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Affiliation(s)
- L Leduc
- Centre hospitalier régional de Lanaudière
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22
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Sonesson SE, Fouron JC, Leduc L, Lessard M, Grignon A. Reference values for differences between cardio-circulatory variables of normal twin fetuses. Ultrasound Obstet Gynecol 2000; 15:407-412. [PMID: 10976483 DOI: 10.1046/j.1469-0705.2000.00124.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
BACKGROUND No reference values exist concerning the differences between cardio-circulatory variables of normal twin fetuses. The normal data could be useful in the identification of conditions causing opposite hemodynamic effects on each twin. OBJECTIVE To establish the normal differences among cardio-circulatory parameters of twin fetuses during the second and third trimesters of gestation. MATERIALS AND METHODS Twenty-seven normal twin pregnancies were used in this longitudinal and prospective study. Doppler-echocardiographic investigations were performed every 2-3 weeks starting at an average of 23.11 +/- 3.13 (mean +/- standard deviation) weeks' gestation. At each visit, the following cardio-circulatory variables were evaluated: the cardio-thoracic ratio, the ventricular wall and septal thicknesses, end-diastolic and systolic diameters, ventricular fractional shortenings, velocity of circumferential fibre shortenings and left and right ventricular outputs. In addition the following measurements were made from Doppler recordings: through both aortic and pulmonary valve the acceleration and ejection times, the peak systolic velocities and the velocity time integrals; and through both mitral and tricuspid valves peak velocities of E and A waves and the E/A ratios. Finally the pulsatility index of the umbilical artery was also evaluated. RESULTS There was no single variable where the intertwin difference changed with gestational age. No systematic difference between the smaller and larger twin could be demonstrated for any variables except for the cardio-thoracic ratio. CONCLUSION Reference tables should permit a comparative approach between the two twins in the investigation of life threatening complications such as twin-to-twin transfusion syndrome.
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Affiliation(s)
- S E Sonesson
- Astrid Lindgren's Children's Hospital, Karolinska Institute, Stockholm, Sweden
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23
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Strychar IM, Chabot C, Champagne F, Ghadirian P, Leduc L, Lemonnier MC, Raynauld P. Psychosocial and lifestyle factors associated with insufficient and excessive maternal weight gain during pregnancy. J Am Diet Assoc 2000; 100:353-6. [PMID: 10719411 DOI: 10.1016/s0002-8223(00)00107-3] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- I M Strychar
- Research Center of the Centre Hospitalier de l'Université de Montreal (CHUM), Notre-Dame Hospital, Quebec, Canada
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24
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Abstract
Hypertension in pregnancy is a frequent complication that has substantial adverse perinatal outcomes. Hypertension may be preexisting (chronic) essential or secondary hypertension; a second entity is pregnancy induced (gestational hypertension, preeclampsia). Recent advances have identified newer markers for pregnancy hypertension: several potential candidate genes may explain the apparent family inheritance of preeclampsia, and some thrombophilic markers have been associated with the condition. Management options for mild to moderate hypertension include a short hospital stay to exclude ongoing severe hypertension and to ascertain fetal well-being. Outpatient care with appropriate maternal and fetal surveillance, including umbilical artery doppler velocimetry, is recommended for better perinatal outcomes. Acute care for severe hypertension includes the use of magnesium sulfate to prevent eclampsia and antihypertensive medication. Expeditious delivery is recommended when the maternal or fetal states cannot be stabilized. Follow-up after delivery allows the uncovering of any other coexisting hypertensive or cardiovascular disorder.
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Affiliation(s)
- R Shear
- Department of Obstetrics and Gynecology, Sainte-Justine Hospital, Université de Montréal, Montréal, Canada
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25
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Affiliation(s)
- R Shear
- Department of Obstetrics and Gynecology, Sainte-Justine Hospital, University of Montreal, Quebec, Canada
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26
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Abstract
OBJECTIVE With twin reversed arterial perfusion sequence, the normal cotwin is at risk of heart failure. The purpose of this study was to identify ultrasonographic variables that can help predict prognosis. We hypothesized that variables reflecting the hyperdynamic circulatory condition of the normal fetus and the changes in circulatory impedance in the acardiac mass would correlate with final outcome. METHODS Ten twin pregnancies with this condition were identified. Follow-up was available for nine. Adverse outcome was defined as death, cardiac failure, or delivery before 30 weeks' gestation for reasons related to the presence of the mass. The following data were collected on the normal fetus: cardiothoracic ratio and left ventricular shortening fraction; and on the mass: maximal length, presence and size of cysts, and presence of a rudimentary heart. The pulsatility index (PI) of the umbilical arteries (UA) of both twins was measured. RESULTS Four fetuses died, two in utero (22 weeks) and two after cesarean (26 and 31 weeks) for advanced cardiac failure. In the five other cases, the outcome was favorable. The cardiothoracic ratio and presence of cysts or of a rudimentary heart did not correlate with outcome. A PI in the mass' UA significantly lower than that of the normal twin (ratio of 0.71 compared with 1.04 for good outcome, P<.05), an elevated shortening fraction in the second trimester, and a rapid growth rate of the mass were associated with a poor prognosis. CONCLUSION In pregnancies with twin reversed arterial perfusion sequence, final outcome and treatment decisions can be determined based on hemodynamic criteria.
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Affiliation(s)
- M Brassard
- Department of Pediatrics, Sainte-Justine Hospital, University of Montreal, Canada
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27
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Rey E, LeLorier J, Burgess E, Lange IR, Leduc L. Report of the Canadian Hypertension Society Consensus Conference: 3. Pharmacologic treatment of hypertensive disorders in pregnancy. CMAJ 1997; 157:1245-54. [PMID: 9361646 PMCID: PMC1228354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE To provide Canadian physicians with evidence-based guidelines for the pharmacologic treatment of hypertensive disorders in pregnancy. OPTIONS No medication, or treatment with antihypertensive or anticonvulsant drugs. OUTCOMES Prevention of maternal complications, and prevention of perinatal complications and death. EVIDENCE Pertinent articles published from 1962 to September 1996 retrieved from the Pregnancy and Childbirth Module of the Cochrane Database of Systematic Reviews and from MEDLINE; additional articles retrieved through a manual search of bibliographies; and expert opinion. Recommendations were graded according to levels of evidence. VALUES Maternal and fetal well-being were equally valued, with the belief that treatment side effects should be minimized. BENEFITS, HARMS AND COSTS Reduction in the rate of adverse perinatal outcomes, including death. Potential side effects of antihypertensive drugs include placental hypoperfusion, intrauterine growth retardation and long-term effects on the infant. RECOMMENDATIONS A systolic blood pressure greater than 169 mm Hg or a diastolic pressure greater than 109 mm Hg in a pregnant woman should be considered an emergency and pharmacologic treatment with hydralazine, labetalol or nifedipine started. Otherwise, the thresholds at which to start antihypertensive treatment are a systolic pressure of 140 mm Hg or a diastolic pressure of 90 mm Hg in women with gestational hypertension without proteinuria or pre-existing hypertension before 28 weeks' gestation, those with gestational hypertension and proteinuria or symptoms at any time during the pregnancy, those with pre-existing hypertension and underlying conditions or target-organ damage, and those with pre-existing hypertension and superimposed gestational hypertension. The thresholds in other circumstances are a systolic pressure of 150 mm Hg or a diastolic pressure of 95 mm Hg. For nonsevere hypertension, methyldopa is the first-line drug; labetalol, pindolol, oxprenolol and nifedipine are second-line drugs. Fetal distress attributed to placental hypoperfusion is rare, and long-term effects on the infant are unknown. Magnesium sulfate is recommended for the prevention and treatment of seizures. VALIDATION The guidelines are more precise but compatible with those from the US and Australia.
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Affiliation(s)
- E Rey
- Department of Medicine, University of Montreal, Que
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28
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Lachapelle MF, Leduc L, Côté JM, Grignon A, Fouron JC. Potential value of fetal echocardiography in the differential diagnosis of twin pregnancy with presence of polyhydramnios-oligohydramnios syndrome. Am J Obstet Gynecol 1997; 177:388-94. [PMID: 9290456 DOI: 10.1016/s0002-9378(97)70203-5] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Our purpose was to establish whether index values of cardiac performance could discriminate between the twin-twin transfusion syndrome and placental insufficiency as the etiology of the polyhydramnios-oligohydramnios sequence in monochorionic diamniotic twins. STUDY DESIGN Thirteen monochorionic diamniotic twin pregnancies with ultrasonographic evidence of polyhydramnios-oligohydramnios sequence had a complete echocardiography. The etiology was confirmed postnatally: placental insufficiency in eight pairs and the twin-twin transfusion syndrome in five. Intertwin comparisons were made for the following cardiac parameters: cardiothoracic index, end-diastolic thickness of the ventricular walls and septum, aortic and pulmonary artery Doppler peak velocities, ejection and acceleration times, left ventricular shortening fraction, and combined cardiac output and output indexed to fetal weight. RESULTS All five recipient twins had thickened ventricular walls. The left ventricular shortening fractions and outputs were significantly increased in the donor twin with twin-twin transfusion syndrome and normal in placental insufficiency. CONCLUSION In twin-twin transfusion syndrome the donor twin shows evidence of a hyperdynamic cardiac state. Intertwin comparison of cardiac parameters, especially the left ventricular shortening fraction, can be considered a useful tool in diagnosing the different etiologies of the polyhydramnios-oligohydraminos sequence.
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Affiliation(s)
- M F Lachapelle
- Department of Obstetrics and Gynecology, Sainte-Justine Hospital, University of Montreal, Quebec, Canada
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29
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Dubois J, Garel L, Grignon A, Lemay M, Leduc L. Placenta percreta: balloon occlusion and embolization of the internal iliac arteries to reduce intraoperative blood losses. Am J Obstet Gynecol 1997; 176:723-6. [PMID: 9077641 DOI: 10.1016/s0002-9378(97)70582-9] [Citation(s) in RCA: 146] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Obstetric hemorrhage is still a potential cause of maternal mortality and morbidity. Angiographic embolization techniques have been described in cases of postcesarean bleeding, vaginal wall hematomas, cervical ectopic pregnancies, and postpartum bleeding to control persistent bleeding from pelvic vessels. We describe two cases of pregnancy complicated with placenta percreta. Balloon occlusion and embolization of the hypogastric arteries were performed during the cesarean section and hysterectomy, resulting in a remarkable reduction in intraoperative blood loss. Balloon occlusion and embolization of the internal iliac arteries significantly reduce intraoperative blood losses.
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Affiliation(s)
- J Dubois
- Department of Medical Imaging, Université Montréal, Québec, Canada
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30
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Abstract
Polymorphism exists and complicates the diagnosis of inherited hemolytic anemias. However, with linkage DNA analysis and, on occasion, with characterization of the mutant gene, it is possible to make a diagnosis on the DNA level. This technique increases our understanding of the enzymatic defect and the relationship with clinical findings. In acquired hemolytic anemias, pregnancy is one of the most commonly associated conditions. The physiology is not yet entirely understood and, therefore, does not allow specific treatment. Supportive therapy is usually the rule in these cases.
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Affiliation(s)
- L Leduc
- University of Montreal, Sainte-Justine Hospital, Department of Obstetrics and Gynecology, Montreal, Quebec, Canada
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31
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Leduc L, Ducroix JP, Lafon B, Smail A, Eb F, Orfila J, Baillet J. Traitement des pneumopathies à Chlamydia pneumoniae par la roxithromycine. Rev Med Interne 1995. [DOI: 10.1016/0248-8663(96)86616-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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32
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Fouron JC, Leduc L, Grigon A, Maragnès P, Lessard M, Drblik SP. Importance of meticulous ultrasonographic investigation of the acardiac twin. J Ultrasound Med 1994; 13:1001-1004. [PMID: 7877200 DOI: 10.7863/jum.1994.13.12.1001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Affiliation(s)
- J C Fouron
- Department of Pediatrics, Sainte-Justine Hospital, Montreal, Quebec, Canada
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33
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Bonin A, Leduc L, Rivard C, Delvin E. Microalbuminuria: Predictive index of pre-eclampsia. Clin Biochem 1994. [DOI: 10.1016/0009-9120(94)90138-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Leduc L, Wheeler JM, Kirshon B, Mitchell P, Cotton DB. Coagulation profile in severe preeclampsia. Obstet Gynecol 1992; 79:14-8. [PMID: 1727573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
One hundred women with severe preeclampsia or chronic hypertension with superimposed preeclampsia were seen during a 2-year period. We sought to determine whether a normal platelet count assures that no other clinically significant clotting abnormalities are present, and what level of thrombocytopenia predicts a risk of abnormalities in other coagulation indices. Fifty women had platelet counts below 150,000/microL, of whom 13 had a fibrinogen level below 300 mg/dL and two had a prolonged prothrombin time (PT) or partial thromboplastin time (PTT). The admission platelet count was an excellent predictor of subsequent thrombocytopenia (r = 0.829, P less than .001). No subject had an abnormal fibrinogen level or prolonged PT or PTT in the absence of thrombocytopenia. When monitoring intrapartum coagulation indices in preeclampsia, one can safely follow only the platelet count at admission and subsequently, reserving PT and PTT and fibrinogen levels for those cases complicated by counts less than 100,000/microL.
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Affiliation(s)
- L Leduc
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas
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Abstract
Ehlers-Danlos syndrome (EDS) is a heterogeneous group of inherited connective tissue disorders with at least ten distinct types. We report a case of EDS complicated by cervical incompetence. Treatment was undertaken after confirmation that the patient's EDS was not type IV, hence not associated with potentially serious vascular complications. Because of concern about stretching or tearing of the hyperextensible connective tissue associated with EDS, cerclage was not performed. The cervical incompetence due to defective connective tissue was treated with a Smith-Hodge pessary.
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Affiliation(s)
- L Leduc
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas 77030
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Abstract
The sinoaortic baroreflex is one of the primary mechanisms that regulates blood pressure. Decreased baroreflex sensitivity has been reported in preeclampsia. We sought to determine whether pregnancy altered baroreflex sensitivity. From a radial artery catheter, heart rate and mean arterial pressure were recorded continuously onto a polygraph. The ratio of change in heart rate produced per unit of change in mean arterial pressure was calculated as an index of baroreflex sensitivity. Mean arterial pressure responses to incremental infusions of phenylephrine (0.4 to 2.0 micrograms/kg/min) were measured in the same patients at term (n = 9, 38.0 +/- 0.3 weeks) and again 6 to 8 weeks postpartum (n = 7). The results indicated (1) higher baroreflex sensitivity in pregnancy than in the postpartum period (0.9 vs 0.5 beats/min/mm Hg) (p less than 0.007); (2) attenuated vascular responsiveness to alpha-adrenergic stimulation in pregnancy (p less than 0.05); (3) a relationship between vascular responsiveness and baroreflex sensitivity. We conclude that pregnancy is associated with an increase in baroreflex sensitivity and that the attenuated response to phenylephrine is, at least in part, a result of increased baroreflex sensitivity.
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Affiliation(s)
- L Leduc
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas
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Longmire S, Leduc L, Jones MM, Hawkins JL, Joyce TH, Cotton DB. The hemodynamic effects of intubation during nitroglycerin infusion in severe preeclampsia. Am J Obstet Gynecol 1991; 164:551-6. [PMID: 1899533 DOI: 10.1016/s0002-9378(11)80018-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The effectiveness of intravenous nitroglycerin infusion in lowering maternal blood pressure and in blunting the hemodynamic responses to endotracheal intubation was evaluated in six primigravid women with severe preeclampsia. Monitoring consisted of continuous electrocardiogram monitoring, arterial cannulation, and flow-directed pulmonary arterial catheterization in each patient. All patients underwent oxytocin induction of labor and crystalloid and/or colloid expansion to produce a pulmonary capillary wedge pressure of 10 to 15 mm Hg and a colloid osmotic pressure of greater than 17 mm Hg. Intravenous nitroglycerin was administered before induction of general anesthesia. The hemodynamic effects associated with endotracheal intubation revealed a change in the heart rate from 104 +/- 10 to 133 +/- 17 beats/min, an increase in mean arterial pressure from 134 +/- 12 to 164 +/- 32 mm Hg, and an increase in systemic vascular resistance from 1262 +/- 342 to 1351 +/- 259 dynes-sec-cm-5 that was accompanied by a small change in the cardiac index from 4.5 +/- 1.2 to 4.5 +/- 0.9 L.min-1.m-2.
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Affiliation(s)
- S Longmire
- Department of Anesthesiology, Baylor College of Medicine, Houston, TX 77030
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Leduc L, Kirshon B, Diaz SF, Cotton DB. Intrathecal morphine analgesia and low-dose dopamine for oliguria in severe maternal pulmonary hypertension. A case report. J Reprod Med 1990; 35:727-9. [PMID: 2376860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Maternal pulmonary hypertension can be life threatening, and many problems and complications can occur during labor and delivery as well as postpartum. A case of severe maternal pulmonary hypertension was monitored with a pulmonary artery catheter. Intrathecal morphine was administered for labor analgesia, and low-dose dopamine was utilized for maternal oliguria. Neither the morphine nor the dopamine resulted in adverse maternal hemodynamic effects. Both analgesia and resolution of the oliguria were accomplished.
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Affiliation(s)
- L Leduc
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX 77030
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Leduc L, Moise KJ. Prediction of fetoplacental blood volume in isoimmunized pregnancy. Am J Obstet Gynecol 1990; 162:1124. [PMID: 2109535 DOI: 10.1016/0002-9378(90)91333-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Abstract
Direct intravascular fetal transfusion under ultrasound guidance has become an important method of treating fetal anemia secondary to maternal red cell alloimmunization. An estimate of normal circulating volume would be useful in selecting the volume of donor blood to be transfused to achieve a desired final hematocrit. Thirty-five fetuses between 21 and 35 weeks of gestation underwent 67 direct intravascular transfusions. The fetoplacental volume relative to fetal weight estimated by ultrasound was found to be relatively constant throughout gestation at approximately 100 cm3/kg. The severity of fetal hemolytic disease and its treatment with intrauterine transfusions did not appear to alter the fetoplacental volume. A nomogram for fetoplacental blood volume versus gestational age is described.
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Affiliation(s)
- L Leduc
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Tex
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Abstract
Neurokinins regulate gastrointestinal motility by interacting with receptors on both muscle layers and on myenteric plexus neurons. To determine if specific neurokinin (NK) receptor agonists can mediate inhibitory effects on myenteric neurons, we studied the effect of the NK-1 agonist substance P methylester (SPME) and the putative endogenous NK-2 receptor ligand neurokinin A (NKA) on [3H]acetylcholine [( 3H]ACh) release induced by electrical field stimulation from muscle strips cut from the canine gastric antrum. SPME but not NKA caused a dose-dependent inhibition of stimulated [3H]ACh release in tissues containing the myenteric plexus. The inhibition was not seen in longitudinal muscle without myenteric plexus. Pretreatment of tissues with indomethacin or antiserum to vasoactive intestinal polypeptide (VIP) but not naloxone or adrenergic or cholingergic blockade abolished the SPME-induced inhibition. Exogenous VIP stimulated the release of prostaglandin E2 (PGE2) from full thickness strips, and both VIP and PGE2 inhibited [3H]ACh release induced by electrical depolarization. These findings suggest that NK-1 receptor agonists can selectively inhibit stimulated [3H]ACh release and that this inhibition may involve the release of VIP and PGE2 from neurons within the myenteric plexus.
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Affiliation(s)
- E A Mayer
- Department of Medicine, Harbor-University of California, Los Angeles
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Abstract
Real-time ultrasonographic imaging of vascular and anatomic neck structures allows easy visualization of the right internal jugular vein and carotid artery. Application of this technology during pregnancy may reduce potential complications encountered with central venous monitoring and will be especially useful in cases of difficult anatomy.
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Affiliation(s)
- W Lee
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas
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Boucher M, Leduc L, Rinfret D. [The pertinence of microscopic analysis of the urine as a diagnostic test for asymptomatic bacteriuria in pregnancy]. Union Med Can 1989; 118:162-6. [PMID: 2603250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The genito-urinary tract is the most frequent site of infection during pregnancy. Asymptomatic bacteriuria is found in 2 to 12% of the obstetrical population. The importance of its detection is underlined by the fact that 20 to 40% of untreated cases will present acute pyelonephritis. Our study's first aim was determining the incidence of asymptomatic bacteriuria in our population. Our results show an incidence of 3.9%. Second, routine mandatory prenatal laboratory examinations include urinalysis and urine culture. Considering the fact that we already do a routine culture, we questioned the pertinence of the microscopic part of urinalysis for screening asymptomatic bacteriuria. Our study has shown that no amount of erythrocytes, leucocytes, bacteria, pus or combination thereof has sufficient sensitivity and/or specificity to be used for screening. We thus conclude that in our context of budget restrictions, the microscopic analysis of urine should be abandoned as a routine test. The biochemical part of urinalysis could be done easily with dipsticks at a lower cost. Urine culture remains the gold standard for detection of asymptomatic bacteriuria.
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Leduc L, Perrin A, Sergent M. Structure du dichlorure et octaséléniure d'hexarhénium, Re6Se8Cl2: composé bidimensionnel à clusters octaédriques Re6. Acta Crystallogr C 1983. [DOI: 10.1107/s010827018300904x] [Citation(s) in RCA: 35] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Leduc L, Padiou J, Perrin A, Sergent M. Synthèse et caractérisation d'un nouveau chalcohalogénure à clusters octaédriques de rhénium à caractère bidimensionnel: Re6Se8Cl2. ACTA ACUST UNITED AC 1983. [DOI: 10.1016/0022-5088(83)90385-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
Spindles of 12-14 Hz were recorded in the hippocampus of 13 epileptics during sleep. This activity was more prominent in patients in whom the hippocampal region was not the site of the primary focus and in whom the electrical activity was normal during wakefulness. Spindles were more numerous during stage 2 non-rapid-eye-movement sleep, especially in patients who had seizures in this stage. It is postulated that this activity is either a normal activity of human brain or an evoked response of the hippocampus to an epileptic afferent discharge. In either case, hippocampal spindles may contribute to the triggering of nocturnal seizures.
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Bajaj S, Leduc L, Goyal RK, Hersh T. Alpha-fetoprotein in patients with benign and malignant disease of the liver. R I Med J 1973; 56:105-8 passim. [PMID: 4121166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Giorgini GL, Hollinger FB, Leduc L, Issarescu S, George J, Blackman A, Thayer WR. Radioimmunoassay detection of hepatitis type B antigen. A prospective study in blood donors and recipients. JAMA 1972; 222:1514-8. [PMID: 4629325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Naves YR, Sabetay S, Palfray L, Walbaum H, Rosenthal A, Greene LW, Honig P, Ullrich H, Schneider M, Clevenger JF, Atkins F, Leduc L, Mahler E. Ätherische Öle. Anal Bioanal Chem 1942. [DOI: 10.1007/bf01735308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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