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1.
J Gynecol Obstet Hum Reprod ; 50(8): 102138, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33831603

RESUMO

INTRODUCTION: The incidence of grade 3-4 perineal tears, also known as obstetric anal sphincter injury (OASI), is reported to be between 0.5 and 2.5%. Beyond the medico-economic burden, the consequences of OASI on a woman's emotional, psychological, sexual, and physical wellbeing are considerable. Among the various risk factors of OASI, few data are available about the impact of a language barrier on its incidence. MATERIAL AND METHODS: We conducted a case-control study to evaluate the effect of language barriers on the risk of OASI comparing 171 women with OASI and 163 matched controls. The matched criteria included ethnicity, age, previous vaginal delivery, delivery mode, prophylactic episiotomy and birthweight. Patients' characteristics were compared and crude ORs and 95% CIs estimated using unadjusted logistic models. Multivariate analysis was performed with recognized potential confounders. RESULTS: All of the cases had grade 3 tears. Language barrier was a determinant factor of OASI with an OR of 3.32 [1.36-8.90], p = 0.01. Other risk factors were occipito-posterior delivery, African origin and prolonged labor duration (OR 6.33, 95% CI: 2.04-27.78, p = 0.004, OR 1.85, 95% CI: 1.08-3.19, p = 0.03 and OR 1.03, 95% CI: 1.01-1.05, p = 0.004, respectively). CONCLUSION: Our data suggest that language barrier is an independent risk factor of OASI. Physicians and midwives should attempt to identify patients with a language barrier during prenatal visits. Education about simple terms used during delivery could decrease the incidence of this complication.


Assuntos
Barreiras de Comunicação , Episiotomia/efeitos adversos , Adulto , Canal Anal/lesões , Canal Anal/cirurgia , Estudos de Casos e Controles , Episiotomia/métodos , Episiotomia/estatística & dados numéricos , Feminino , Humanos , Trabalho de Parto/fisiologia , Períneo/lesões , Períneo/cirurgia , Gravidez , Estudos Retrospectivos , Fatores de Risco
2.
Oncology ; 91(6): 331-340, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27784027

RESUMO

OBJECTIVE: To evaluate the overall survival (OS) of patients with initially inoperable advanced ovarian cancer, tubal carcinoma, or primary peritoneal carcinoma of stages III or IV undergoing neoadjuvant chemotherapy (NAC) followed by cytoreductive surgery, according to the number of cycles performed. METHODS: This retrospective study was conducted in three main oncology centres in the east of France, reviewing the charts of all patients who underwent NAC between January 1, 1998 and October 31, 2012. We performed an OS analysis using multivariate Cox regression models adjusted for potential confounders. We also analysed progression-free survival (PFS) as well as chemotherapy- and surgery-related morbidity. RESULTS: Of the 204 patients included, 75 (36.8%) underwent ≤4 NAC cycles and 129 (63.2%) ≥5 NAC cycles. Characteristic data were similar in the two groups. Five-year OS was 35.0 and 25.8%, respectively. This difference was non-significant [HR = 1.06 (0.70-1.59), p = 0.79]. We also found no differences in PFS or morbidity between the two groups. CONCLUSIONS: The number of NAC cycles does not seem to play a role in the OS of patients with advanced ovarian cancer. Further evidence and prospective data are needed to assess the value of a high/low number of NAC cycles among these patients.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Carcinoma/secundário , Carcinoma/terapia , Procedimentos Cirúrgicos de Citorredução , Neoplasias das Tubas Uterinas/patologia , Neoplasias das Tubas Uterinas/terapia , Neoplasias Ovarianas/patologia , Neoplasias Ovarianas/terapia , Neoplasias Peritoneais/patologia , Neoplasias Peritoneais/terapia , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Carboplatina/administração & dosagem , Quimioterapia Adjuvante/efeitos adversos , Quimioterapia Adjuvante/métodos , Procedimentos Cirúrgicos de Citorredução/efeitos adversos , Intervalo Livre de Doença , Docetaxel , Feminino , Humanos , Pessoa de Meia-Idade , Terapia Neoadjuvante , Estadiamento de Neoplasias , Estudos Retrospectivos , Taxa de Sobrevida , Taxoides/administração & dosagem
3.
Anticancer Res ; 35(10): 5503-9, 2015 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-26408716

RESUMO

AIM: The aim of our study was to evaluate the impact of systemic pelvic and para-aortic lymphadenectomy on survival in patients with advanced ovarian cancer after neoadjuvant chemotherapy. PATIENTS AND METHODS: This multi-centric descriptive study included patients with initially inoperable advanced ovarian cancer, undergoing neoadjuvant chemotherapy followed by cytoreductive surgery with no residual tumor between 1998 and 2012. They were distributed into two groups depending on if they underwent lymphadenectomy or not during the interval surgery. RESULTS: Among the 101 included patients, 54 underwent lymphadenectomy and 47 did not. The multivariate analysis for overall survival showed no significant difference between the two groups [hazard ratio (HR)=1.88, confidence interval (CI)=0.89-3.94; p=0.08]. The multivariate analysis for progression-free survival showed no significant difference (HR=1.43, 95% CI=0.86-2.39; p=0.17). CONCLUSION: In patients with advanced ovarian cancer, treated by neoadjuvant chemotherapy and interval surgery with no residual tumor, lymphadenectomy does not seem to improve the survival rate.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Excisão de Linfonodo/mortalidade , Terapia Neoadjuvante/mortalidade , Neoplasia Residual/cirurgia , Neoplasias Ovarianas/cirurgia , Glomos Para-Aórticos/patologia , Neoplasias Pélvicas/cirurgia , Idoso , Quimioterapia Adjuvante , Terapia Combinada , Procedimentos Cirúrgicos de Citorredução , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Gradação de Tumores , Estadiamento de Neoplasias , Neoplasia Residual/tratamento farmacológico , Neoplasia Residual/mortalidade , Neoplasia Residual/patologia , Neoplasias Ovarianas/tratamento farmacológico , Neoplasias Ovarianas/mortalidade , Neoplasias Ovarianas/patologia , Neoplasias Pélvicas/tratamento farmacológico , Neoplasias Pélvicas/mortalidade , Neoplasias Pélvicas/patologia , Prognóstico , Taxa de Sobrevida
4.
J Minim Invasive Gynecol ; 22(2): 268-74, 2015 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-25460316

RESUMO

STUDY OBJECTIVE: Two validated laparoscopic approaches for para-aortic lymphadenectomy (PAL) exist: the transperitoneal and the extraperitoneal. The aim of this study was to compare the surgical outcomes of both approaches. DESIGN: A retrospective review of all patients who underwent laparoscopic PAL for a gynecologic malignancy between January 2008 and October 2013. SETTING: University Hospital. PATIENTS: Two patients groups were compared: transperitoneal (n = 51) and extraperitoneal (n = 21). INTERVENTIONS: Paraaortic lymphadenectomy. MEASUREMENTS AND MAIN RESULTS: The χ(2) test, Fisher's exact test, or Student's t-test were used for univariate analysis and a stepwise logistic regression for multivariate analysis. The threshold of statistical significance was set at 0.05. All patient characteristics were similar between the 2 groups (p > .05 for all variables). There was only 1 (1.3%) conversion to laparotomy encountered in the transperitoneal PAL group and 3 conversions from extraperitoneal to transperitoneal PAL (14.2%). In 1 case of extraperitoneal PAL, the procedure was abandoned because of inadequate equipment (body mass index 48 kg/m(2)). The mean duration of surgery was longer in the transperitoneal group: 200 min (35-360) versus 125.6 min (45-180) in the extraperitoneal group (p = .001). The mean number of harvested lymph nodes was higher in the transperitoneal group: 17 (4-37) versus 13 (3-25) in the extraperitoneal group (p = .029). There was no difference in postoperative course and complications between both groups in multivariate analysis. CONCLUSIONS: In nonobese patients, the extraperitoneal PAL is associated with shorter surgical duration, whereas the transperitoneal approach was associated with a higher number of harvested lymph nodes. As a result of improved ergonomy, the transperitoneal approach enables laparoscopic management of operative complications.


Assuntos
Neoplasias dos Genitais Femininos/cirurgia , Laparoscopia , Excisão de Linfonodo/métodos , Linfonodos/cirurgia , Adulto , Idoso , Aorta Abdominal , Índice de Massa Corporal , Feminino , França/epidemiologia , Neoplasias dos Genitais Femininos/patologia , Hospitais Universitários , Humanos , Laparoscopia/métodos , Linfonodos/patologia , Pessoa de Meia-Idade , Cavidade Peritoneal/cirurgia , Período Pós-Operatório , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento
5.
Malar J ; 12: 270, 2013 Aug 02.
Artigo em Inglês | MEDLINE | ID: mdl-23914804

RESUMO

BACKGROUND: There is a lack of information regarding the epidemiology of malaria among travellers from non-malaria endemic countries to Sahelian areas. The literature provides general statistics about imported malaria in industrialized countries or extensive recommendations about fever management, but none of these recommendations are applicable to developing countries. METHODS: The aim of the study was to evaluate the aetiologies of fever, malaria prevalence, and best diagnostic methods in a population of 306 non-malaria endemic travellers who, over a one-year period, consulted the French embassy's Centre Médico-Social in Ouagadougou (Burkina Faso) for fever. All patients underwent a clinical examination, a questionnaire, and three different malaria tests: thick blood film, QBC-test and HRP-2-based rapid diagnostic test. RESULTS: Fever was caused by malaria in 69 cases (23%), while 37 (12%) were due to Pneumonia and 35 cases (8%) to ENT infections. Fever remained unexplained in 87 patients (51.3%). Malaria prevalence varied throughout the year: about 90% of malaria cases were diagnosed during and after the rainy season, between July and December, with up to 50% malaria prevalence for fever cases in October. Malaria diagnosis based solely on clinical signs, combined or not, leads to about 80% of unnecessary treatments.Although anti-malarial chemoprophylaxis was used in only 69% of short-stay patients (who travelled for less than three months), this was effective. Under local conditions, and using blood film examination as the reference method, the QBC test appeared to be more reliable than the HRP-2-based rapid diagnostic test, with respective sensitivities of 98.6% versus 84.1%, and specificities of 99.6% versus 98.3%. CONCLUSIONS: Reliable biological diagnosis of malaria among travellers from non-malaria endemic countries in Sahelian areas is necessary because of low malaria prevalence and the poor performance of clinical diagnosis. A fever during the first half of the year requires investigating another aetiology, particularly a respiratory one. Malaria chemoprophylaxis is efficient and must not be overlooked. The QBC test appears to be the most reliable diagnostic test in this context.


Assuntos
Malária/diagnóstico , Malária/epidemiologia , Viagem , Adulto , Burkina Faso/epidemiologia , Técnicas de Laboratório Clínico , Medicina Clínica , Febre/epidemiologia , Febre/etiologia , Humanos , Masculino , Prevalência , Estudos Prospectivos , Inquéritos e Questionários
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