Vicenç Cararach | Universitat de Barcelona (original) (raw)
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Papers by Vicenç Cararach
European Journal of Obstetrics & Gynecology and Reproductive Biology, 2004
Objectives: The risk of neural tube defects (NTDs) is decreased in women who take folic acid duri... more Objectives: The risk of neural tube defects (NTDs) is decreased in women who take folic acid during the periconceptional period. The main objective of our study was to evaluate the awareness of the need for folic acid supplementation and also the actual intake during the periconceptional period to prevent neural tube defects in a Mediterranean area. Study design: A retrospective study was performed from 1 July to 30 November 2000. One thousand consecutive women who delivered in our hospital were interviewed during the immediate postpartum period about their knowledge of neural tube defects and folic acid intake before and during pregnancy. Results: Most women (85.7%) referred not having been specifically informed about the need to take folic acid to prevent neural tube defects although approximately half of the women (50.6%) were in fact, aware of the need for folic acid intake. Eight percent (8.1%) of the women took folic acid before conception but only 6.9% did so during the effective period from 4 weeks before conception to 4 weeks after conception. Logistic regression analysis showed that awareness of the need to take folic acid together with having had preconceptional counselling and knowledge of NTDs were the strongest variables related to the fact of having taken folic acid during the correct period. Conclusions: Although the population is aware of the need to take folic acid, the real impact of the present recommendations is almost negligible. Information in primary care and preconceptional counselling to specifically inform patients about the need to take folic acid to prevent NTDs seem to be crucial to improve the final intake of folic acid during the protective period.
Fetal Diagnosis and Therapy, 2005
To discuss the prenatal diagnosis and management of fetal xerocytosis associated with ascites. A ... more To discuss the prenatal diagnosis and management of fetal xerocytosis associated with ascites. A 29-year-old woman with hereditary xerocytosis was found to present a fetus with severe ascites on the 20-week scan. Cordocentesis showed mild anemia and blood transfusion was discarded. Ascites worsened and 2 weeks later a new cordocentesis showed lower hematocrit values. Blood transfusion was performed but ascites remained unchanged. Cordocentesis was repeated at 28 weeks and albumin was transfused. Fetal hemoglobin was within the normal range. Peak systolic velocity of the middle cerebral artery remained normal and correctly predicted mild anemia. Expectant management was followed. An elective cesarean section was performed at 32 weeks because of breech presentation and preterm labor which did not respond to aggressive tocolysis. A female newborn weighing 2,615 g was delivered and required paracenteses and exchange transfusion. The newborn was discharged at 4 weeks of life and at 2 months of age, the ascites resolved completely. The mechanism of development of ascites in fetal xerocytosis remains unanswered. As ascites does not seem to be related to fetal anemia or hypoalbuminemia, does not substantially change after blood transfusion and tends to resolve in late gestation, a conservative management is reasonable if fetal anemia is not severe.
Ultrasound in Obstetrics and Gynecology, 2004
Objectives: To construct normal reference values for JLS size. To determine JLS size in a study g... more Objectives: To construct normal reference values for JLS size. To determine JLS size in a study group with an increased NT. Methods: Ultrasound examinations were carried out on 70 singleton pregnancies and 15 pregnancies complicated by an increased NT (> 3 mm). The NT measurement was performed following criteria of the Fetal Medicine Foundation. The size of the JLS, were measured in a transversal view. Normal reference lines were constructed using Altman's method (1993). The mean Z-scores for the NT and JLS in the increased NT group were calculated and the difference between the means was statistically tested (paired Student-t). Results: The NT and the mean of the JLS outcomes are linear related with gestational age: NT (mm) = 0.306 * GA (wks) −2.278. JLS (mm) = 0.544 * GA (wks) −5.106. In the normal group there is no significant correlation between NT and JLS size, R = 0.16, P = 0.19. However, in the increased NT group a significant (P = 0.02) correlation (R = 0.59) is found. The mean Z-score of the NT size 7.9 (SD = 3.9) is not significant different from the mean Z-score 7.2 (SD = 11.3) of the JLS size (P = 0.77). Conclusion: These data suggests that measuring JLS additional to NT might improve the detection rates in aneuploidy screening. P10.07 Nasal bone assessment in first trimester detection of trisomy 21. Our experience V. Borobio, A. Borrell, V. Penalva, A. Gonce, M. del Río, J. M. Martínez, B. Puerto, V. Cararach
Alcohol and Alcoholism, 2007
Aim: The need for a non-invasive diagnosis of the effects of ethanol in utero on the development ... more Aim: The need for a non-invasive diagnosis of the effects of ethanol in utero on the development of the intestine in humans led us to look for a serum marker of the structural integrity of the intestine. We propose apolipoprotein A-IV (apoA-IV) as a possible candidate. In humans this protein is synthesized only by intestinal mucosa, it is expressed in the enterocyte of the foetus from 20 weeks of gestation, and it is released to the blood stream after synthesis. Methods: We measured the levels of apoA-IV in the umbilical cord serum of neonates whose mothers had consumed alcohol during pregnancy and neonates born to women who had not (controls).The gestational age at delivery of the cases studied ranged from 36 to 42 weeks. ELISA and Western blot analysis were used. Results: There was no difference in the mean body weight of neonates from either group. Nevertheless, exposure to ethanol in utero significantly reduced (by about 30%) the apoA-IV levels in serum at birth, regardless of body weight. Conclusion: Our findings suggest that circulating apoA-IV levels could be used as a clinical marker of the prenatal effects of ethanol on the structural integrity of the intestine. Neonatal diagnosis of these intestinal effects could improve post-natal outcome.
Prenatal Diagnosis, 2004
Objective To assess the effectiveness of the Combined Test in the prenatal detection of trisomy 2... more Objective To assess the effectiveness of the Combined Test in the prenatal detection of trisomy 21 in the general pregnant population using a new timing for the screening approach.
Progresos de Obstetricia y Ginecología, 2004
ABSTRACT Objective To study the effectiveness of biochemical and ultrasonographic screening for t... more ABSTRACT Objective To study the effectiveness of biochemical and ultrasonographic screening for trisomy 21 in the second trimester of pregnancy in a low-risk population.Method We performed a prospective interventional study in 8894 singleton pregnancies at low risk for aneuploidy. Dating ultrasound scan and simultaneous maternal blood sampling for determination of a-fetoprotein (α-FP) and chorionic gonadotrophin (β-hCG) was performed between weeks 14 and 18. The criteria for offering amniocentesis were a biochemical risk of 1/270 or above, serum α-FP levels < 0.4 MoM, β-hCG< 0.2 MoM (risk for trisomy 18), or nuchal fold thickness above the 95th percentile for gestational age.ResultsThe detection rates for trisomy 21 were as follows: 65% with the use of biochemical markers plus maternal age (11% false positive rate) and 45% with the use of nuchal fold measurement (5.3% false positive rate). When either of both risk indicators was taken into account, the detection rates rose to 75% with a false positive rate of 14.9%.Conclusion Simultaneous or independent use of biochemical markers (α-FP and β-hCG) and nuchal fold measurements to assess risk for trisomy 21 in the second trimester provided a detection rate of 75% with a false positive rate of 14.9%.
Progresos de Obstetricia y Ginecología, 2005
ObjetiveTo assess the efectiveness of the Combined Test (first-trimester biochemistry and ultraso... more ObjetiveTo assess the efectiveness of the Combined Test (first-trimester biochemistry and ultrasound) in the prenatal detection of Down syndrome in the general pregnant population.
Progresos de Obstetricia y Ginecología, 2008
OBJECTIVE: To evaluate the effectiveness of the Combined Test for trisomy 21 screening in twin pr... more OBJECTIVE: To evaluate the effectiveness of the Combined Test for trisomy 21 screening in twin pregnancies. To assess the performance of biochemical markers and nuchal translucency (NT) measurement in pregnancies with euploid fetuses and in twin ...
Prenatal Diagnosis, 2004
Objective To assess the effectiveness of the Combined Test in the prenatal detection of trisomy 2... more Objective To assess the effectiveness of the Combined Test in the prenatal detection of trisomy 21 in the general pregnant population using a new timing for the screening approach.
The Ultrasound Review of Obstetrics & Gynecology, 2002
ABSTRACT During the past decade, an increasing number of reports concerning the diagnosis of most... more ABSTRACT During the past decade, an increasing number of reports concerning the diagnosis of most major congenital heart defects (CHDs) using early fetal echocardiography (before the 18th week of gestation) have been reported in both low- and high-risk populations for CHD. The finding of increased nuchal translucency seems to be the strongest predictor of CHD during the first trimester. Although some malformations are detected as early as 11 weeks' gestation, the optimal gestational age to perform the early scan is at least 13 weeks' gestation. Transvaginal ultrasound is the preferred approach, although most authors agree that results can be improved if transabdominal ultrasound is also incorporated. The further application of color Doppler enhances visualization. The sensitivity and specificity for the detection of CHD are of an acceptable level, compared with mid-gestational echocardiography. CHDs diagnosed early in pregnancy tend to be more complex than those detected later, with a higher incidence of associated structural malformations, chromosomal abnormalities and spontaneous abortions. The neonate follow-up or postmortem examination in the case of termination of pregnancy is essential to assess the actual role of early fetal echocardiography.
Ultrasound in Obstetrics and Gynecology, 2003
Obstetrics and Gynecology
In order to evaluate the importance of prolactin in the pathogenesis and clinical evolution of fi... more In order to evaluate the importance of prolactin in the pathogenesis and clinical evolution of fibrocystic disease of the breast, serum prolactin levels were determined in 7 patients affected by this condition before and during treatment with a prolactin inhibitor, 2-Br-alpha-ergocryptine (CB-154). Serum prolactin levels were found to be low or normal before treatment. During treatment with CB-154 there was an improvement in all patients but 2. The results of the study do not allow any conclusion on the possible relation between serum prolactin levels and fibrocystic disease of the breast but they indicate that CB-154 may be useful for treating patients with this disorder.
Medicina Clínica
Fourteen pregnant women with diabetes mellitus according to White's classification were s... more Fourteen pregnant women with diabetes mellitus according to White's classification were studied. The presence or absence of bad signs of prognosis in pregnancy were noted throughout gestation. The development of microangiopathic lesions was evaluated at the beginning and end of gestation by direct ophthalmoscopy with two observers. Microangiopathic lesions were found at the end of gestation in some patients who had not had them at the beginning. This would suggest that pregnancy is a risk factor in the development of diabetic retinopathy. The lecithin-sphingomyelin ratio in the amniotic fluid was determined by thin-layer chromatography as an index of fetal respiratory maturity. This determination served as a reliable index of maturity in all cases except one. Lastly, fetal morbidity and mortality were established according to previous determined classifications.
Medicina Clínica
A study is presented on the incidence and complications of septic abortion in a group of patients... more A study is presented on the incidence and complications of septic abortion in a group of patients admited on the 1st. Obstetric and Gynecologic Clinic of the University of Barcelona during a period of 5 years (1971-1975). Abortion is the cause of admision of 20,2% of patients in the gynecology ward and represents the 12,3% of the overall number of patients during the same period. In 7,8% of the patients admited because of abortion we found the criteria for establishing the diagnosis of septic complication and in 15,2% of those extrapelvic involvement is found, mainly endotoxic shock, acute renal failure and difuse peritonitis. Endocervical cultures were positive in 73% of cases and in 65,7% gram negative germs were isolated, being the most common E. coli. The different clinical patterns are discussed in cases in which anaerobics are implicated and the diagnostic and therapeutic aproaches in the different complications are reviewed particularly in concern to the indications of surgery when this may be the only lifesaving procedure.
European Journal of Obstetrics & Gynecology and Reproductive Biology, 2004
Objectives: The risk of neural tube defects (NTDs) is decreased in women who take folic acid duri... more Objectives: The risk of neural tube defects (NTDs) is decreased in women who take folic acid during the periconceptional period. The main objective of our study was to evaluate the awareness of the need for folic acid supplementation and also the actual intake during the periconceptional period to prevent neural tube defects in a Mediterranean area. Study design: A retrospective study was performed from 1 July to 30 November 2000. One thousand consecutive women who delivered in our hospital were interviewed during the immediate postpartum period about their knowledge of neural tube defects and folic acid intake before and during pregnancy. Results: Most women (85.7%) referred not having been specifically informed about the need to take folic acid to prevent neural tube defects although approximately half of the women (50.6%) were in fact, aware of the need for folic acid intake. Eight percent (8.1%) of the women took folic acid before conception but only 6.9% did so during the effective period from 4 weeks before conception to 4 weeks after conception. Logistic regression analysis showed that awareness of the need to take folic acid together with having had preconceptional counselling and knowledge of NTDs were the strongest variables related to the fact of having taken folic acid during the correct period. Conclusions: Although the population is aware of the need to take folic acid, the real impact of the present recommendations is almost negligible. Information in primary care and preconceptional counselling to specifically inform patients about the need to take folic acid to prevent NTDs seem to be crucial to improve the final intake of folic acid during the protective period.
Fetal Diagnosis and Therapy, 2005
To discuss the prenatal diagnosis and management of fetal xerocytosis associated with ascites. A ... more To discuss the prenatal diagnosis and management of fetal xerocytosis associated with ascites. A 29-year-old woman with hereditary xerocytosis was found to present a fetus with severe ascites on the 20-week scan. Cordocentesis showed mild anemia and blood transfusion was discarded. Ascites worsened and 2 weeks later a new cordocentesis showed lower hematocrit values. Blood transfusion was performed but ascites remained unchanged. Cordocentesis was repeated at 28 weeks and albumin was transfused. Fetal hemoglobin was within the normal range. Peak systolic velocity of the middle cerebral artery remained normal and correctly predicted mild anemia. Expectant management was followed. An elective cesarean section was performed at 32 weeks because of breech presentation and preterm labor which did not respond to aggressive tocolysis. A female newborn weighing 2,615 g was delivered and required paracenteses and exchange transfusion. The newborn was discharged at 4 weeks of life and at 2 months of age, the ascites resolved completely. The mechanism of development of ascites in fetal xerocytosis remains unanswered. As ascites does not seem to be related to fetal anemia or hypoalbuminemia, does not substantially change after blood transfusion and tends to resolve in late gestation, a conservative management is reasonable if fetal anemia is not severe.
Ultrasound in Obstetrics and Gynecology, 2004
Objectives: To construct normal reference values for JLS size. To determine JLS size in a study g... more Objectives: To construct normal reference values for JLS size. To determine JLS size in a study group with an increased NT. Methods: Ultrasound examinations were carried out on 70 singleton pregnancies and 15 pregnancies complicated by an increased NT (> 3 mm). The NT measurement was performed following criteria of the Fetal Medicine Foundation. The size of the JLS, were measured in a transversal view. Normal reference lines were constructed using Altman's method (1993). The mean Z-scores for the NT and JLS in the increased NT group were calculated and the difference between the means was statistically tested (paired Student-t). Results: The NT and the mean of the JLS outcomes are linear related with gestational age: NT (mm) = 0.306 * GA (wks) −2.278. JLS (mm) = 0.544 * GA (wks) −5.106. In the normal group there is no significant correlation between NT and JLS size, R = 0.16, P = 0.19. However, in the increased NT group a significant (P = 0.02) correlation (R = 0.59) is found. The mean Z-score of the NT size 7.9 (SD = 3.9) is not significant different from the mean Z-score 7.2 (SD = 11.3) of the JLS size (P = 0.77). Conclusion: These data suggests that measuring JLS additional to NT might improve the detection rates in aneuploidy screening. P10.07 Nasal bone assessment in first trimester detection of trisomy 21. Our experience V. Borobio, A. Borrell, V. Penalva, A. Gonce, M. del Río, J. M. Martínez, B. Puerto, V. Cararach
Alcohol and Alcoholism, 2007
Aim: The need for a non-invasive diagnosis of the effects of ethanol in utero on the development ... more Aim: The need for a non-invasive diagnosis of the effects of ethanol in utero on the development of the intestine in humans led us to look for a serum marker of the structural integrity of the intestine. We propose apolipoprotein A-IV (apoA-IV) as a possible candidate. In humans this protein is synthesized only by intestinal mucosa, it is expressed in the enterocyte of the foetus from 20 weeks of gestation, and it is released to the blood stream after synthesis. Methods: We measured the levels of apoA-IV in the umbilical cord serum of neonates whose mothers had consumed alcohol during pregnancy and neonates born to women who had not (controls).The gestational age at delivery of the cases studied ranged from 36 to 42 weeks. ELISA and Western blot analysis were used. Results: There was no difference in the mean body weight of neonates from either group. Nevertheless, exposure to ethanol in utero significantly reduced (by about 30%) the apoA-IV levels in serum at birth, regardless of body weight. Conclusion: Our findings suggest that circulating apoA-IV levels could be used as a clinical marker of the prenatal effects of ethanol on the structural integrity of the intestine. Neonatal diagnosis of these intestinal effects could improve post-natal outcome.
Prenatal Diagnosis, 2004
Objective To assess the effectiveness of the Combined Test in the prenatal detection of trisomy 2... more Objective To assess the effectiveness of the Combined Test in the prenatal detection of trisomy 21 in the general pregnant population using a new timing for the screening approach.
Progresos de Obstetricia y Ginecología, 2004
ABSTRACT Objective To study the effectiveness of biochemical and ultrasonographic screening for t... more ABSTRACT Objective To study the effectiveness of biochemical and ultrasonographic screening for trisomy 21 in the second trimester of pregnancy in a low-risk population.Method We performed a prospective interventional study in 8894 singleton pregnancies at low risk for aneuploidy. Dating ultrasound scan and simultaneous maternal blood sampling for determination of a-fetoprotein (α-FP) and chorionic gonadotrophin (β-hCG) was performed between weeks 14 and 18. The criteria for offering amniocentesis were a biochemical risk of 1/270 or above, serum α-FP levels < 0.4 MoM, β-hCG< 0.2 MoM (risk for trisomy 18), or nuchal fold thickness above the 95th percentile for gestational age.ResultsThe detection rates for trisomy 21 were as follows: 65% with the use of biochemical markers plus maternal age (11% false positive rate) and 45% with the use of nuchal fold measurement (5.3% false positive rate). When either of both risk indicators was taken into account, the detection rates rose to 75% with a false positive rate of 14.9%.Conclusion Simultaneous or independent use of biochemical markers (α-FP and β-hCG) and nuchal fold measurements to assess risk for trisomy 21 in the second trimester provided a detection rate of 75% with a false positive rate of 14.9%.
Progresos de Obstetricia y Ginecología, 2005
ObjetiveTo assess the efectiveness of the Combined Test (first-trimester biochemistry and ultraso... more ObjetiveTo assess the efectiveness of the Combined Test (first-trimester biochemistry and ultrasound) in the prenatal detection of Down syndrome in the general pregnant population.
Progresos de Obstetricia y Ginecología, 2008
OBJECTIVE: To evaluate the effectiveness of the Combined Test for trisomy 21 screening in twin pr... more OBJECTIVE: To evaluate the effectiveness of the Combined Test for trisomy 21 screening in twin pregnancies. To assess the performance of biochemical markers and nuchal translucency (NT) measurement in pregnancies with euploid fetuses and in twin ...
Prenatal Diagnosis, 2004
Objective To assess the effectiveness of the Combined Test in the prenatal detection of trisomy 2... more Objective To assess the effectiveness of the Combined Test in the prenatal detection of trisomy 21 in the general pregnant population using a new timing for the screening approach.
The Ultrasound Review of Obstetrics & Gynecology, 2002
ABSTRACT During the past decade, an increasing number of reports concerning the diagnosis of most... more ABSTRACT During the past decade, an increasing number of reports concerning the diagnosis of most major congenital heart defects (CHDs) using early fetal echocardiography (before the 18th week of gestation) have been reported in both low- and high-risk populations for CHD. The finding of increased nuchal translucency seems to be the strongest predictor of CHD during the first trimester. Although some malformations are detected as early as 11 weeks' gestation, the optimal gestational age to perform the early scan is at least 13 weeks' gestation. Transvaginal ultrasound is the preferred approach, although most authors agree that results can be improved if transabdominal ultrasound is also incorporated. The further application of color Doppler enhances visualization. The sensitivity and specificity for the detection of CHD are of an acceptable level, compared with mid-gestational echocardiography. CHDs diagnosed early in pregnancy tend to be more complex than those detected later, with a higher incidence of associated structural malformations, chromosomal abnormalities and spontaneous abortions. The neonate follow-up or postmortem examination in the case of termination of pregnancy is essential to assess the actual role of early fetal echocardiography.
Ultrasound in Obstetrics and Gynecology, 2003
Obstetrics and Gynecology
In order to evaluate the importance of prolactin in the pathogenesis and clinical evolution of fi... more In order to evaluate the importance of prolactin in the pathogenesis and clinical evolution of fibrocystic disease of the breast, serum prolactin levels were determined in 7 patients affected by this condition before and during treatment with a prolactin inhibitor, 2-Br-alpha-ergocryptine (CB-154). Serum prolactin levels were found to be low or normal before treatment. During treatment with CB-154 there was an improvement in all patients but 2. The results of the study do not allow any conclusion on the possible relation between serum prolactin levels and fibrocystic disease of the breast but they indicate that CB-154 may be useful for treating patients with this disorder.
Medicina Clínica
Fourteen pregnant women with diabetes mellitus according to White's classification were s... more Fourteen pregnant women with diabetes mellitus according to White's classification were studied. The presence or absence of bad signs of prognosis in pregnancy were noted throughout gestation. The development of microangiopathic lesions was evaluated at the beginning and end of gestation by direct ophthalmoscopy with two observers. Microangiopathic lesions were found at the end of gestation in some patients who had not had them at the beginning. This would suggest that pregnancy is a risk factor in the development of diabetic retinopathy. The lecithin-sphingomyelin ratio in the amniotic fluid was determined by thin-layer chromatography as an index of fetal respiratory maturity. This determination served as a reliable index of maturity in all cases except one. Lastly, fetal morbidity and mortality were established according to previous determined classifications.
Medicina Clínica
A study is presented on the incidence and complications of septic abortion in a group of patients... more A study is presented on the incidence and complications of septic abortion in a group of patients admited on the 1st. Obstetric and Gynecologic Clinic of the University of Barcelona during a period of 5 years (1971-1975). Abortion is the cause of admision of 20,2% of patients in the gynecology ward and represents the 12,3% of the overall number of patients during the same period. In 7,8% of the patients admited because of abortion we found the criteria for establishing the diagnosis of septic complication and in 15,2% of those extrapelvic involvement is found, mainly endotoxic shock, acute renal failure and difuse peritonitis. Endocervical cultures were positive in 73% of cases and in 65,7% gram negative germs were isolated, being the most common E. coli. The different clinical patterns are discussed in cases in which anaerobics are implicated and the diagnostic and therapeutic aproaches in the different complications are reviewed particularly in concern to the indications of surgery when this may be the only lifesaving procedure.