Annales De Medecine Interne[JOURNAL]
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200 papers
[Which patients are at risk for pregnancy vascular diseases?].
Bretelle F
Ann Med Interne (Paris) · 2003 · PMID 15027594
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[Therapeutic indications in placental vascular diseases (antiphospholipid syndrome and thrombophilia) and side effects of the different treatments used].
Clément D, Jacob D
Ann Med Interne (Paris) · 2003 · PMID 15027593
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[Preventing adverse obstetric outcome in women with thrombophilia].
Verspyck E
Ann Med Interne (Paris) · 2003 · PMID 15027592
Thrombophilia may represent a new risk factor for placental vascular disorders. Thromboprophylaxis with low doses of heparin and aspirin may be discussed in order to reduced adverse obstetric outcomes. No randomized cont...
Thrombophilia may represent a new risk factor for placental vascular disorders. Thromboprophylaxis with low doses of heparin and aspirin may be discussed in order to reduced adverse obstetric outcomes. No randomized controlled trials are currently published in the literature. Thromboprophylaxis may be unwarranted in asymptomatic women because of the lack for an association between thrombophilia and pregnancy outcome. Women with antiphospholipid syndrome are at high risk for pregnancy loss and maternal complications. Pregnancy in women with antiphospholipid syndrome appears to be improved by thromboprophylaxis, but adverse obstetric outcome may occur despite treatment. Thromboprophylaxis is recently reported in women with previous poor obstetric outcomes. These preliminary observational studies are still insufficient to recommend a large diffusion for thromboprophylaxis. Prevention for adverse outcomes with a low fixed dose of heparin may only be discussed in women with previous late fetal loss or intrauterine fetal death.
[Indications and monitoring of antithrombotic prophylaxis for venous thromboembolism during pregnancy and post-partum].
Jude B, Wibaut B, Depret S
Ann Med Interne (Paris) · 2003 · PMID 15027591
Pregnancy and puerperium are well-known risk factors for venous thromboembolism, but the actual incidence of the disease is low (about 1/1,500 pregnancies). Pregnancy-associated venous thromboembolism is rare, though it...
Pregnancy and puerperium are well-known risk factors for venous thromboembolism, but the actual incidence of the disease is low (about 1/1,500 pregnancies). Pregnancy-associated venous thromboembolism is rare, though it is still the second cause of maternal death in France. Several types of prophylaxis are available, mainly clinical vigilance and aggressive investigation of women with symptoms of venous thromboembolism, or antithrombotic prophylaxis. Given the low incidence of the pathology, it seems desirable to select high-risk groups of women for such strategies. The most studied and identified risk factors are prior episodes of venous thromboembolism and biological thrombophilias. Prophylaxis through low molecular weight heparin during pregnancy and the puerperium should be considered mainly in these two groups. Noteworthy, no prospective and randomized study is available, and treatment recommendations are grade C.
[Prevention of deep vein thrombosis and preeclampsia. Therapeutic possibilities].
Palot M, Daigremont-Botmans C, Visseaux H
Ann Med Interne (Paris) · 2003 · PMID 15027590
To prevent deep vein thrombosis during pregnancy and the puerperium, compression stockings and heparin have been proposed. These measures are safe for the mothers and their babies, however low molecular weight heparin (L...
To prevent deep vein thrombosis during pregnancy and the puerperium, compression stockings and heparin have been proposed. These measures are safe for the mothers and their babies, however low molecular weight heparin (LMWH) must be preferred to unfractioned heparin if possible. The prevention of preeclampsia (PE) has been widely studied. Among nutrients, calcium supplementation is effective to prevent PE among women with a spontaneous low calcium intake, but fish oil supplementation is not. The effectiveness of folic acid is still controversial. Aspirin has been widely studied to prevent, and also treat, PE. The effectiveness of aspirin depends on an early administration during pregnancy and probably on the dose, while the best results have been observed with doses more than 60 mg/day. The association of aspirin and LMWH was used among patients with systemic pathologies, and no hemorrhagic complications were described. Oral anticoagulants are used only among patients with mechanical heart valves, the use between the 6th and the 12th week of pregnancy is controversial, because of an increased risk of fetal malformation, and near term because of an increased risk of neonatal hemorrhage.
[Thrombophilia and pregnancy: which tests for which patients? The clinician's point of view].
Emmerich J, Bura A
Ann Med Interne (Paris) · 2003 · PMID 15027589
Venous thromboembolism is the leading cause of death in the ante-partum and post-partum period. The role of genetic thrombophilia in venous thrombosis has been analyzed in several studies, but the role of genetic thrombo...
Venous thromboembolism is the leading cause of death in the ante-partum and post-partum period. The role of genetic thrombophilia in venous thrombosis has been analyzed in several studies, but the role of genetic thrombophilia in fetal loss, intra-uterine growth restriction and pre-eclampsia is much more controversial. While we can give some recommendations on thromboprophylaxis of venous thromboembolism, data concerning the usefulness of antithrombotic treatment in obstetric complications of genetic thrombophilia are lacking. When a laboratory work-up of thrombophilia is required, all the known causes of thrombophilia must be checked as none of them is specific of a single clinical feature, but also because they can be associated in the same patient.
[Thrombophilia and pregnancy: who should be tested? Which tests should be performed? The biologist point of view].
Conard J
Ann Med Interne (Paris) · 2003 · PMID 15027588
Pregnancy is associated with an increased risk of venous thromboembolism, especially in women with a congenital predisposition. The detection of these thrombophilias, with an autosomal dominant transmission, is justified...
Pregnancy is associated with an increased risk of venous thromboembolism, especially in women with a congenital predisposition. The detection of these thrombophilias, with an autosomal dominant transmission, is justified if an appropriate prophylaxis is administered during pregnancy and/or post-partum. The aim of the prophylaxis is to prevent thrombotic events and possibly adverse pregnancy complications, such as pregnancy loss at the second or third trimester, intra-uterine fetal growth retardation or pre-eclampsia. The magnitude of the pregnancy-associated risk in the different thrombophilias is taken into account for the selection of the patients to be tested for the detection of thrombophilia. Tests to be performed are proposed and their interpretation depends on whether the patient is pregnant, receiving oral contraception or oral anticoagulants.
[Vascular placental pathology in high-risk groups: definition and synopsis].
Foidart JM, Seak-San S, Emonts P … +1 more , Schaaps JP
Ann Med Interne (Paris) · 2003 · PMID 15027587
The vascular placental pathology (VPP) is associated with many etiologies. Some are the consequence of a maternal genetic or acquired predisposition. Others are associated with a chronic maternal disease (hypertension, l...
The vascular placental pathology (VPP) is associated with many etiologies. Some are the consequence of a maternal genetic or acquired predisposition. Others are associated with a chronic maternal disease (hypertension, lupus, obesity, diabetes, ...). Finally, some others are associated with placental implantation leading to fetal ischemia (multiple pregnancy, chorioangioma, primiparity, feto-placental hydrops) or to environmental (altitude) or nutritional factors (famine and specific alimentary depressions). We classify these factors into three categories according to the risk level (moderate, significant and elevated). While any of these factors can increase the risk of VPP, no one is sufficiently sensitive or specific in predict inevitable onset of VPP. In most cases VPP results from a combination of two (or more) risk factors. The risk factors of VPP classified as moderate include age (> or = 35 years), increased blood pressure during the second trimester of pregnancy, a new paternity, dietetic factors or environmental factors, smoking and controlled diabetes (class B, C), or inactive systemic diseases. Risk is significantly elevated among obese (BMI > or = 25), primiparous women, women with a past familial history (first degree) of preeclampsia or eclampsia, cocaine use or association of tobacco and caffeine use, increased placental mass (associated with twin pregnancy, fetal hydrops or molar pregnancy), uncontrolled diabetes, lupus, active scleroderma. Risk is considered to be high among patients with chronic hypertension, women with a past history of preeclampsia, diabetes (class D, F, R), patients with active systemic disease or with antiphospholipid antibodies or women with lupus or renal lesions and/or proteinuria as well as chronic kidney disease resulting in proteinuria, hypertension and renal insufficiency. Finally, the risk of VPP is considered to be increased in the presence of acquired thrombophilia. It remains moderate in the presence of isolated genetic thrombophilia, except in forms presenting with multiple genetic mutations or associated with an hyperhomocysteinemia. A "high-risk group" is defined among women with past history of deep venous thromboembolic events outside pregnancy, or with a past history of placental vascular pathology (intra-uterine death, placental abruptio, severe and precocious placental, intra-uterine growth retardation, early and repetitive fetal loss) and who, in addition, present with acquired thrombophilia (antiphospholipid antibodies, thrombocytemia), unique homozygous genetic thrombophilia, amultiple genetic thrombophilia or unique heterozygous genetic thrombophilia associated with hyperhomocysteinemia. Prophylactic treatment of acquired thrombophilia and of the multiple genetic forms or associated with hypercysteinemia is a logical rationale, particularly among women with a past history of placental vascular pathology, or with a past history of venous thromboembolic events. On the contrary, prophylaxis using low-molecular-weight heparin in the event of asymptomatic genetic thrombophilic mutations and for women without a past history of deep venous thromboembolism or vascular placental pathology remains controversial.
[Is thrombophilia a risk factor for placental vascular disorders?].
Borg JY
Ann Med Interne (Paris) · 2003 · PMID 15027586
First trimester recurrent fetal loss and severe second or third trimester placental vascular disorders are still frequently unexplained. Acquired biological thrombophilia (antiphospholipid syndrome, essential thrombocyth...
First trimester recurrent fetal loss and severe second or third trimester placental vascular disorders are still frequently unexplained. Acquired biological thrombophilia (antiphospholipid syndrome, essential thrombocythemia) are known risk factors. Genetic thrombophilia may represent a new risk factor for placental vascular diseases, but reported data are conflicting. Combined hereditary thrombophilias are indeed a moderate risk factor, but even in these cases most pregnancies are normal giving healthy live birth children. Whether hereditary thrombophilia is associated with recurrent severe placental vascular disorders is unknown.
[Maternal and obstetrical risk factors of placental vascular pathology (biologic and epidemiological data excluded)].
Winer N, Hamidou M, El Kouri D … +1 more , Philippe HJ
Ann Med Interne (Paris) · 2003 · PMID 15027585
The purpose is to identify maternal and prenatal risks factors for placental vascular disorders. We excluded biologic and epidemiological data which are discussed in another chapter. Maternal risks factors are pre-existi...
The purpose is to identify maternal and prenatal risks factors for placental vascular disorders. We excluded biologic and epidemiological data which are discussed in another chapter. Maternal risks factors are pre-existing vascular systemic diseases. Systemic lupus erythematosus (antiphospholipid antibodies are studied in another chapter) is a classical disease associated with unfavorable outcome, particularly when the disease is not quiescent and if the patient has a history of previous poor outcome. Obstetricians' awareness of the influence of inflammatory bowel diseases on pregnancy and fetal outcome is quite poor. These diseases, if they are not quiescent, can induce deleterious perinatal effects. Type 1 or even type 2 diabetes mellitus increases the risk of preeclampsia or hypertension in pregnancy, particularly when there is poor glycemic control early in pregnancy. The duration of type 1 diabetes affects the outcome of pregnancy more than type 2. Smoking during pregnancy is associated with many adverse events including spontaneous abortion, low birth weight and placental abruption. There are data about the dose-response relationship between the number of cigarettes smoked per day and the risk of abortion. Smoking during pregnancy is also protective against preeclampsia and this apparent paradox suggests the complexity of what is called vascular placental pathology. There is a significant relationship between pejorative perinatal vascular outcome and the non quiescence of renal disease. Mid-trimester uterine artery Doppler combining bilateral notches and increased uterine resistance index is the best criterion to predict the placental vascular risk of the pregnancy. Some promising studies suggest the feasibility of uterine Doppler ultrasound screening early in the pregnancy during the first trimester. Large studies are required to confirm this practice. Uterine artery Doppler in combination with other tests (elevated maternal serum hCG or ambulatory 24-hour blood pressure monitoring at 22 weeks gestation) could be a more efficient predictor of vascular complications. A large-scale evaluation is necessary before recommendations can be made. Multiple pregnancies increase the risk of preeclampsia 2- or 3-fold (RR 2.62; 95% CI: 2.03-3.38). A history of preeclampsia is the strongest predictor of unfavorable outcome for the second pregnancy.
[Epidemiology of vascular placental disease].
Lejeune V
Ann Med Interne (Paris) · 2003 · PMID 15027584
Placental vascular diseases consist of obstetrical pathologies assumed to be linked to placental ischemia. Preeclampsia, defined as the association of hypertension, proteinuria and edema, occur in 3% of deliveries, in a...
Placental vascular diseases consist of obstetrical pathologies assumed to be linked to placental ischemia. Preeclampsia, defined as the association of hypertension, proteinuria and edema, occur in 3% of deliveries, in a non-selected population. Eclampsia, defined as the occurrence of convulsions in preeclamptic women, occur in 5 per 10,000 deliveries. Risk factors for preeclampsia are: preeclampsia in the previous pregnancy, maternal age <20 years, multiple pregnancies, and nulliparity. Placenta abruption, defined as premature separation of the placenta before delivery, occur in 5 to 15 per 1,000 deliveries. Risk factors are smoking, infertility, and preeclampsia or placental abruption in the previous pregnancy. Stillbirth, defined as fetal death between 24 weeks of gestation and delivery, occur in 1.5 per 1,000 deliveries, with a higher frequency in case of placental abruption, intrauterine growth restriction or preeclampsia.
[The risk of maternal venous thromboembolism disease. Synopsis and definition of high-risk groups].
Ninet J
Ann Med Interne (Paris) · 2003 · PMID 15027583
Risk factors for venous thromboembolic disease, during pregnancy and post-partum, can be identified in as much as 75% of pregnant women, who present such an accident. Different risk factors are usually associated in the...
Risk factors for venous thromboembolic disease, during pregnancy and post-partum, can be identified in as much as 75% of pregnant women, who present such an accident. Different risk factors are usually associated in the same women. Risk factors can be attribuated to the pregnant women (age over 35 years, overweight, varicose veins, smoking, previous deep venous thrombosis and/or pulmonary embolism) or to the conditions of the pregnancy (multiparity, immobilisation, hypertension and pre-eclampsia, cesarean delivery). Inherited or acquired biological thrombophilia enhance the risk of thrombosis but the magnitude of this effect in ante-partum, puerperium or post-partum depends on the nature of the abnormality. The analysis of all these risk factors and their cumulative effect enable classifying pregnant women into groups with very high risk, high risk or moderate risk for venous thromboembolism and to propose an adapted strategy to prevent the occurrence of such accidents.
[Risk factors of thromboembolism associated with pregnancy and the puerperium. Role of inherited and acquired thrombophilia].
Ducloy-Bouthors AS, Trillot N
Ann Med Interne (Paris) · 2003 · PMID 15027582
Thromboembolism in pregnancy and the puerperium and inherited or acquired thrombophilia are associated. Thrombophilia can be revealed by pregnancy. Thrombotic risk during pregnancy and the puerperium is higher in asympto...
Thromboembolism in pregnancy and the puerperium and inherited or acquired thrombophilia are associated. Thrombophilia can be revealed by pregnancy. Thrombotic risk during pregnancy and the puerperium is higher in asymptomatic women with than without thrombophilia. Antithrombin deficiency, combined deficiencies and homozygous or double-heterozygotes factor V Leiden and factor II G 20210 A mutations are associated with a higher thrombotic risk than heterozygote mutations or protein S and C deficiencies, whereas hyperhomocysteinemia does not appear as a risk factor for maternal thromboembolic disease. Antiphospholipid syndrome with lupus anticoagulant is strongly associated with thrombotic risk in pregnancy and the puerperium. Further studies are required to assess the thrombotic risk in women with preeclampsia as well as early or late recurrent pregnancy loss.
[Risk factors for maternal thromboembolism: obstetrical circumstances].
Demaria F, Fritel X, Benifla JL
Ann Med Interne (Paris) · 2003 · PMID 15027581
We analyzed the statistical relationship described between the principal laboratory anomalies related to thrombophilia and obstetrical pathology and risk of maternal thromboembolism.
We analyzed the statistical relationship described between the principal laboratory anomalies related to thrombophilia and obstetrical pathology and risk of maternal thromboembolism.
[Risk factors for maternal thromboembolism: clinical predisposition].
Planchon B, Pottier P
Ann Med Interne (Paris) · 2003 · PMID 15027580
Predisposing clinical features in pregnant women are poorly evaluated in the literature. Several factors are undeniable, for example extrinsic compression of the iliac vein (Cockett syndrome), post phlebitis disease, var...
Predisposing clinical features in pregnant women are poorly evaluated in the literature. Several factors are undeniable, for example extrinsic compression of the iliac vein (Cockett syndrome), post phlebitis disease, varicose vein disease, and, for most patients, unquantifiable risk factors. Careful assessment of the overall sensitivity to venous thrombosis, on the basis of history taking (patient and family), will allow better assessment of the predisposition to thromboembolism.
[Epidemiology and maternal thrombosis].
Bosson JL
Ann Med Interne (Paris) · 2003 · PMID 15027579
The monthly incidence of deep vein thrombosis during pregnancy varies from 0.1 to 0.8 per 1000 pregnancies, depending on the study. These figures are undoubtedly an underestimation because they were determined from clini...
The monthly incidence of deep vein thrombosis during pregnancy varies from 0.1 to 0.8 per 1000 pregnancies, depending on the study. These figures are undoubtedly an underestimation because they were determined from clinical events with no estimation of asymptomatic forms which, in general, increase the prevalence about 3-fold. Although the absolute figures are reliable, the consequences in terms of maternal mortality and post-phlebitis sequelae warrant the careful attention paid to this condition. Moreover, it should be recalled that the prevalence of superficial venous thrombosis is similar and may be associated with a risk of pulmonary embolism.
[Definition of thrombophilia].
Schved JF
Ann Med Interne (Paris) · 2003 · PMID 15027578
Thrombophilia is characterized by clinical tendency to thrombosis or molecular abnomalities of hemostasis that predisposes to thromboembolic disease. Hereditary thrombophilia may be due to antithrombin deficiency, or pro...
Thrombophilia is characterized by clinical tendency to thrombosis or molecular abnomalities of hemostasis that predisposes to thromboembolic disease. Hereditary thrombophilia may be due to antithrombin deficiency, or protein C or protein S deficiency. More recently, other molecular abnormalities have been described: activated protein C resistance due to factor V Leiden, G 20210 A polymorphism on the prothrombin gene, increased factor VIII plasma levels or hyperhomocysteinemia. Acquired thrombophilia is frequently associated with the antiphospholipid syndrome characterized by thrombosis and presence of lupus anticoagulant or phospholipid-binding antibodies. In some cases, no molecular abnormality is found despite recurrent thrombosis observed in patient and his/her family. This situation can be considered as clinical thrombophilia.
[The need for a consensus conference].
Edelman P
Ann Med Interne (Paris) · 2003 · PMID 15027577
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[Psychological aspects of MDMA (ecstasy) users].
Varescon I
Ann Med Interne (Paris) · 2003 Nov · PMID 14760230
We reviewed the literature on the psychological aspects of MDMA consumption. The present paper examined the characteristics, psychological and psychopathological consequences of synthetic drug use (MDMA). The most freque...
We reviewed the literature on the psychological aspects of MDMA consumption. The present paper examined the characteristics, psychological and psychopathological consequences of synthetic drug use (MDMA). The most frequent features are depression, anxiety, cognitive disorders and sensation seeking. Longer-term, higher dosage, and use of other substances are correlated with higher risk of developing psychopathological disorders. Care should be taken in cross-sectional studies in interpreting signs and symptoms of mental disorder merely as a consequence of MDMA use, because the use of ecstasy may be associated with use of multiple substances from which the mental disorder might be more likely to precede. The consumption pattern of ecstasy and related substances must be carefully analyzed. Knowledge of the MDMA consumption profile is an important for understanding the psychological characteristics of synthetic drug users.
[Opioid tolerance: what if it was just a question of receptor internalization?].
Marie N, Jauzac P, Allouche S
Ann Med Interne (Paris) · 2003 Nov · PMID 14760229
Despite side effects which appear upon chronic administration of opioid agonists, these drugs remain widely used and effective for pain relief. Among these side effects, tolerance is the major factor limiting the effecti...
Despite side effects which appear upon chronic administration of opioid agonists, these drugs remain widely used and effective for pain relief. Among these side effects, tolerance is the major factor limiting the effectiveness of these drugs. Desensitization, defined by a decrease of opioid receptor transduction, would be a crucial step in the development of tolerance. Molecular mechanisms of opioid receptor desensitization have been extensively studied on cellular models and have been found to involve various proteins and different steps such as receptor phosphorylation, internalization, and recycling or degradation into intracellular compartments. In the present review, we discuss the role of opioid receptor internalization and sorting in desensitization and tolerance processes.
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