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2.
Eur J Gynaecol Oncol ; 36(6): 698-702, 2015.
Article in English | MEDLINE | ID: mdl-26775355

ABSTRACT

PURPOSE OF INVESTIGATION: Accurate preoperative staging of early-stage endometrioid endometrial cancer (EEC) is necessary to avoid under or over surgical treatment. The objective is to determine the rate of understaging and to evaluate the accuracy of different methods: hysteroscopy-curettage versus endometrial biopsy in predicting the final stage. MATERIALS AND METHODS: This retrospective single-centre study led from 2000 to 2010, included women with EEC preoperatively assessed at low- or intermediate-risk. Understaging was defined as a postoperative FIGO Stage > 1 or a determination of high risk after the final histopathologic diagnosis. RESULTS: The study included 101 women (75 low-risk and 26 intermediate-risk). Final diagnosis was upstaged for 26 of them, more frequently in the presumed intermediate-risk group (57.7% vs 14.7%, p < 0.001). The rate of preoperative understaging was higher in the women with endometrial biopsies than those with curettage (34.5% vs 15.2%, p = 0.04). CONCLUSIONS: Hysteroscopy-curettage combined with magnetic resonance imaging (MRI) may improve preoperative staging of early-stage EEC, especially for presumed intermediate-risk disease.


Subject(s)
Carcinoma, Endometrioid/pathology , Endometrial Neoplasms/pathology , Aged , Carcinoma, Endometrioid/surgery , Curettage , Endometrial Neoplasms/surgery , Female , Humans , Hysteroscopy , Magnetic Resonance Imaging , Middle Aged , Neoplasm Staging , Retrospective Studies
3.
Gynecol Obstet Fertil ; 41(12): 715-21, 2013 Dec.
Article in French | MEDLINE | ID: mdl-24268326

ABSTRACT

OBJECTIVE: Radical hysterectomy is one of the treatment options for early stage cervical cancer. This surgery results in significant morbidity, especially urinary complications. The objective of the study is to determine the rate and predictive factors of parametrial involvement in early stage cervical cancer and to define a subset of patient at low risk for parametrial disease and potential applicant to less morbid surgery. METHODS: This review reports recent retrospective and prospective studies and we show randomized trial concerning feasibility of no radical surgery. RESULTS: Parametrial involvement rate in tumors <2 cm, without lymphovascular space invasion, with negative lymph nodes and depth of invasion <10mm is between 0 and 1.96%. CONCLUSION: This result, which suggests simple hysterectomy, is maybe adequate in this case. At present, no randomized trial allows to validate this hypothesis and to change present practices. Radical hysterectomy stays standard of surgical treatment of early stage cervical cancer.


Subject(s)
Hysterectomy/statistics & numerical data , Uterine Cervical Neoplasms/surgery , Clinical Protocols , Female , Humans , Hysterectomy/methods , Neoplasm Staging , Uterine Cervical Neoplasms/pathology
4.
J Gynecol Obstet Biol Reprod (Paris) ; 41(1): 14-25, 2012 Feb.
Article in French | MEDLINE | ID: mdl-22192232

ABSTRACT

Intrauterine infection could be responsible for 25% up to 40% of preterm births. This relationship was initially demonstrated using animal models, inducing their abortion by injecting bacteria or endotoxins. In human research, examination of amniocentesis fluid showed the anteriority of infection over labor induction, and the existence of a subclinical latency phase between these two phenomena. The ascending route is preponderant, and four stages can be distinguished: cervical and vaginal infection, chorio-decidual infection, intra-amniotic infection, fetal infection. The intrauterine infection is very frequent in case of early preterm birth (<30 WG). It is associated with an increase of neurological and pulmonary morbidity. Most commonly found bacterial species are mycoplasma species, but also Escherichia coli, Gardnerella vaginalis and streptococcus B. Several markers of the infection have been studied: a maternal leukocytosis>15,000/mm(3) or a C-Reactive Protein (CRP)>20mg/l, an increase of fibronectin and/or IL-6 cervical, a short cervical length especially before 32 WG, a leukocytosis of the amniotic fluid, and/or high interleukin concentrations. The main marker used for the newborn is the CRP, but other markers can also be used for an early diagnosis of an infection, especially interleukin 6.


Subject(s)
Pregnancy Complications, Infectious , Premature Birth/etiology , Uterine Diseases/complications , Amniotic Fluid/microbiology , Biomarkers/blood , C-Reactive Protein/analysis , Chorioamnionitis/diagnosis , Chorioamnionitis/microbiology , Early Diagnosis , Female , Fetal Diseases/microbiology , Humans , Pregnancy , Pregnancy Complications, Infectious/diagnosis , Pregnancy Complications, Infectious/microbiology , Systemic Inflammatory Response Syndrome/blood , Systemic Inflammatory Response Syndrome/diagnosis , Uterine Diseases/diagnosis , Uterine Diseases/microbiology
5.
Gynecol Obstet Fertil ; 40(3): 148-52, 2012 Mar.
Article in French | MEDLINE | ID: mdl-22018845

ABSTRACT

OBJECTIVE: Assessment of fetal head engagement by digital examination is highly subjective even though this method remains the gold standard. Ultrasonography could be helpful to determine fetal head engagement during the second stage of labor. PATIENTS AND METHODS: Prospective unicentric study to compare the diagnostic of fetal head orientation and engagement between digital examination and ultrasonography. One hundred measurements were performed in 100 patients at complete cervical dilatation. RESULTS: In 80 % of patients, abdominal ultrasound assessments were consistent with digital examinations in depicting fetal head position. We were not able to evaluate engagement by abdominal ultrasonography. Perineum to fetal head distance was measured between 12 and 83mm by translabial ultrasonography. When the head was not engaged (-1), the mean distance was 66.4±7.53mm. The measure was 56.15±10.86mm when the head was at the upper part of the birth canal (+1), 46.47±12.49mm at the middle part (+2) and 35.81±10.42mm at the lower part (+3; +4). A threshold of 55mm was associated with a sensibility and a negative predictive value of 100 % for vaginal birth. DISCUSSION AND CONCLUSION: Abdominal intrapartum ultrasound increases the accuracy of fetal head position assessment. Translabial ultrasound is a simple and easy method to define fetal head engagement by measuring the distance between perineum and fetal head. Ultrasound during the second stage of labor may serve as an educational tool for physicians in training.


Subject(s)
Labor Presentation , Ultrasonography, Prenatal/methods , Adult , Female , Head/diagnostic imaging , Humans , Labor Stage, First , Parity , Perineum/diagnostic imaging , Predictive Value of Tests , Pregnancy , Prospective Studies , Young Adult
6.
Ann Fr Anesth Reanim ; 31(2): 162-5, 2012 Feb.
Article in French | MEDLINE | ID: mdl-22154455

ABSTRACT

Myocardial infarction is rare during pregnancy and is associated with a high maternal and foetal mortality rate. We report the case of a 32-year-old woman at 38 weeks gestation who developed a myocardial infarction with spontaneous coronary dissection treated with coronary angioplasty and who needed an emergency caesarean section. We discuss the anaesthetic management of urgent caesarean section in this context.


Subject(s)
Anesthesia, Obstetrical , Cesarean Section , Coronary Disease/complications , Myocardial Infarction/etiology , Pregnancy Complications, Cardiovascular , Adult , Female , Humans , Pregnancy
7.
J Gynecol Obstet Biol Reprod (Paris) ; 40(8): 902-17, 2011 Dec.
Article in French | MEDLINE | ID: mdl-22056189

ABSTRACT

More and more perimenopausal and menopausal women seek an alternative to hysterectomy because they desire future pregnancy or wish to retain their uteri even if they have completed childbearing. Myomectomy may be an option. We can't know the evolution of leiomyomas. Hysteroscopic myomectomy is the treatment of submucous fibromas. Recurrence and subsequent surgery occurs in 16 to 21 % of cases. Intramural and subserousal myomas can be treated by myomectomy. Myomectomy should be performed laparoscopically because of shorter hospital stay, faster recovery and reduced postoperative pain. Second surgery is needed in 4-16 % of patients. If hysterectomy is performed, it should be by vaginal or laparoscopic route. There is no difference in perioperative morbidity between hysterectomy and myomectomy. Intra- and postoperative complications are similar between myomectomy and hysterectomy. Hysterectomy may be prefered if there is risk factor of malignancy or if the fibroma is discovered or has a rapid growth after menopause.


Subject(s)
Gynecologic Surgical Procedures/statistics & numerical data , Leiomyoma/surgery , Perimenopause , Postmenopause , Uterine Neoplasms/surgery , Disease Progression , Female , Fertility/physiology , Gynecologic Surgical Procedures/adverse effects , Gynecologic Surgical Procedures/methods , Humans , Leiomyoma/epidemiology , Leiomyoma/pathology , Perimenopause/physiology , Postmenopause/physiology , Postoperative Complications/epidemiology , Pregnancy , Uterine Neoplasms/epidemiology , Uterine Neoplasms/pathology , Watchful Waiting/statistics & numerical data
8.
Gynecol Obstet Fertil ; 39(4): 232-44, 2011 Apr.
Article in French | MEDLINE | ID: mdl-21435933

ABSTRACT

The use of mesh for pelvic organ prolapse repair through the vaginal route has increased within the last decade. The main objective is to improve anatomical results (based on the superiority of sacropexy with meshes when compared to vaginal traditional surgery), with the advantages of the vaginal route. An increasing number of cohort series and randomized control trials have been published. There is level-1 evidence that the use of mesh for the treatment of cystocele through the vaginal route improves anatomical results when compared to traditional surgery. The rates of complications between these two techniques seem equivalent, even for de novo dyspareunia.


Subject(s)
Pelvic Organ Prolapse/surgery , Surgical Mesh , Cystocele/surgery , Dyspareunia/surgery , Female , Humans , Randomized Controlled Trials as Topic , Vagina/surgery
9.
J Gynecol Obstet Biol Reprod (Paris) ; 37(4): 400-8, 2008 Jun.
Article in French | MEDLINE | ID: mdl-18406544

ABSTRACT

OBJECTIVE: To survey French trainees in obstetrics and gynaecology on the type of short and long-term professional activity they wish to have following specialisation. MATERIAL AND METHODS: A questionnaire was sent to the 909 trainees in obstetrics and gynaecology during the academic year 2005-2006. RESULTS: Answer rate was 34.5%. Almost all trainees (96.5%) wish to have a two-year hospital position before applying for consultant or beginning a private practice. Only 55.6% of these trainees think this option realistic. Overall, 78.7% of trainees wish to continue practicing obstetrics, 66.9% surgery, 41.4% ultrasound screening or prenatal diagnosis, 34.1% office gynaecology, 28% oncogynaecology and 23.6% assisted medical procreation. An exclusive public hospital position was desired by 51.6% of trainees, with 45.1% in academic hospitals and 54.9% in non academic hospitals. Exclusive private practice was desired by 8.9% of trainees and 47.7% wish a private practice with a part-time public hospital position. CONCLUSION: Actual trainees in obstetrics and gynaecology see their future practice as polyvalent, mostly in public hospitals and including for most at least obstetrics.


Subject(s)
Career Choice , Gynecology/education , Obstetrics/education , Female , France , Humans , Internship and Residency , Male , Surveys and Questionnaires
10.
Int Urogynecol J Pelvic Floor Dysfunct ; 19(3): 397-400, 2008 Mar.
Article in English | MEDLINE | ID: mdl-17874025

ABSTRACT

The aim of our work was to objectify and quantify the mechanical benefits of healing with regards to tearing meshes off of tissues and maximal resistance after cicatrization. In vivo, we tested the mechanical gain in resistance by healing after implantation of a Prolene mesh. We measured the value of forces when traction was exerted until mobilization at different stages of cicatrization. Resistance increased progressively at the beginning of tissue inclusion. A maximal plateau was reached around the 25th day. It is important to understand the role of sustaining and reinforcement we hope tissue integration of the mesh will play. We can thus adapt procedures to have the best kinetics and maximal resistance of montages. Study of the kinetics and maximal plateau allows us to make the best clinical recommendations.


Subject(s)
Materials Testing/methods , Polypropylenes/standards , Prosthesis Implantation/instrumentation , Suburethral Slings/standards , Wound Healing/physiology , Animals , Cicatrix/pathology , Disease Models, Animal , Female , Prosthesis Design , Rats , Rats, Wistar , Stress, Mechanical , Tensile Strength , Urinary Incontinence, Stress/surgery , Uterine Prolapse/surgery
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