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1.
Oncologist ; 16(10): 1458-68, 2011.
Artigo em Inglês | MEDLINE | ID: mdl-21948650

RESUMO

PURPOSE: This prospective multicenter study explored different definitions of time to deterioration (TTD) in quality of life (QoL) scores, according to different cutoffs of the minimal clinically important difference (MCID) as a modality for longitudinal QoL assessment in breast cancer patients. METHODS: QoL was assessed using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire C30 and BR-23 before surgery, after surgery, and 6 and 12 months later. The global health score, arm symptoms score (BRAS), and breast symptoms score were analyzed. For a given baseline score, QoL was considered to have deteriorated if this score decreased by ≥5 points at any time point after baseline. Analyses were repeated using an MCID of 10 points and taking the score after surgery as the reference score (to explore the occurrence of response shift). TTD was calculated using the Kaplan-Meier method and Cox regression was used to identify independent factors associated with TTD. RESULTS: Two hundred thirty-five patients underwent axillary lymph node dissection (ALND), 222 underwent sentinel lymph node biopsy (SLNB), and 61 underwent SLNB plus ALND. Patients who underwent SLNB had a significantly longer TTD for the BRAS dimension than those who underwent ALND. Cox multivariate analyses showed that treatment using SLNB and age >59 years were independently associated with longer TTD for the BRAS, whereas surgery elsewhere than at the Centre Georges François Leclerc was associated with a shorter TTD. CONCLUSION: Exploration of different definitions of TTD in QoL provides meaningful longitudinal QoL results for clinicians.


Assuntos
Neoplasias da Mama/patologia , Qualidade de Vida , Idoso , Idoso de 80 Anos ou mais , Neoplasias da Mama/cirurgia , Estudos de Coortes , Feminino , Humanos , Estudos Longitudinais , Excisão de Linfonodo , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Estudos Prospectivos , Biópsia de Linfonodo Sentinela
2.
J Exp Clin Cancer Res ; 30: 4, 2011 Jan 07.
Artigo em Inglês | MEDLINE | ID: mdl-21214912

RESUMO

BACKGROUND: The best method to deliver intraperitoneal chemotherapy (IPC) for peritoneal carcinomatosis from ovarian cancer is not well defined. The aim of this study was to assess the ability of hyperthermia and adrenaline to enhance the intratumoral accumulation of cisplatin in a rat model of peritoneal carcinomatosis. METHODS: Four groups of 5 BDIX rats with ovarian peritoneal carcinomatosis underwent IPC with 30 mg/l of cisplatin according to the following conditions: normothermia at 37° for 1 or 2 hours, hyperthermia at 42°C for 1 hour or normothermia at 37°C for 2 hours with 2 mg/l adrenaline. Tissue platinum content was measured by atomic absorption spectroscopy. The effect of hyperthermia, adrenaline and the duration of exposure to the drug was measured in vivo (tissue concentration of platinum in tumor, abdominal and extra abdominal tissues) and in vitro (cytotoxicity on human ovarian cancer cells). RESULTS: In vitro, hyperthermia and longer exposure enhanced the accumulation and the cytotoxic effect of cisplatin on cancer cells. In vivo, only the 2 hours treatment with adrenaline resulted in increased platinum concentrations. The rats treated with adrenaline showed significantly lower concentrations of cisplatin in extra peritoneal tissues than those treated with hyperthermia. CONCLUSION: Adrenaline is more effective than hyperthermia in order to enhance the intratumoral concentration of cisplatin in rats with peritoneal carcinomatosis from ovarian origin. It may also decrease the systemic absorption of the drug.


Assuntos
Antineoplásicos/metabolismo , Cisplatino/metabolismo , Epinefrina/farmacologia , Hipertermia Induzida , Neoplasias Peritoneais/metabolismo , Animais , Antineoplásicos/farmacologia , Sobrevivência Celular/efeitos dos fármacos , Cisplatino/farmacologia , Modelos Animais de Doenças , Feminino , Humanos , Neoplasias Ovarianas/patologia , Neoplasias Peritoneais/secundário , Ratos , Ratos Endogâmicos , Células Tumorais Cultivadas
3.
Eur J Radiol ; 79(1): 1-6, 2011 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-19875261

RESUMO

PURPOSE: To evaluate the efficacy of pre-myomectomy uterine artery embolization with gelatin sponge particles to reduce operative blood loss and facilitate removal of fibroids. MATERIALS AND METHODS: This retrospective study included 33 women (mean age, 36 years; range, 24-45 years), of whom at least 18 wished to preserve fertility. They presented with at least one large myoma (mean diameter, 90 mm; range, 50-150 mm) and had undergone preoperative uterine artery embolization with resorbable gelatin sponge by unilateral femoral approach between December 2001 and November 2008. Clinical, radiological and surgical data were available for all patients. Mean haemoglobin levels before and after surgery were compared with Student's t-test. RESULTS: No complication or technical failure of embolization occurred. The myomectomies were performed during laparotomy (25 cases) or laparoscopy (8 cases). Dissection of fibroids was easier (mean, 3 per patient; range, 1-11), with a mean operating time of 108±50 min (range, 30-260 min). Bloodless surgery was the rule with a mean estimated peroperative blood loss of 147±249 mL (range, 0-800 mL). Mean pre-(12.9±1.3g/dL) and post-therapeutic (11.4±1.2g/dL) haemoglobin levels were not statistically different (p>0.05). There was no need for blood transfusion. None of the patients required hysterectomy. The mean duration of hospital stay was 7.5±1.3 days (range, 3-12 days). CONCLUSION: Preoperative uterine artery embolization is effective in reducing intraoperative blood loss and improves the chances of performing conservative surgery. It should be considered a useful adjunct to myomectomy in women at high hemorrhagic risk or who refuse blood transfusion.


Assuntos
Leiomioma/terapia , Embolização da Artéria Uterina , Neoplasias Uterinas/terapia , Adulto , Meios de Contraste , Diagnóstico por Imagem , Feminino , Fluoroscopia , Esponja de Gelatina Absorvível , Humanos , Leiomioma/diagnóstico , Leiomioma/cirurgia , Pessoa de Meia-Idade , Seleção de Pacientes , Estudos Retrospectivos , Resultado do Tratamento , Neoplasias Uterinas/diagnóstico , Neoplasias Uterinas/cirurgia
4.
Arch Gynecol Obstet ; 283(1): 25-9, 2011 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-19876638

RESUMO

BACKGROUND: Postpartum hemorrhage (PPH) is the principal cause of maternal death. Blood loss during delivery is often underestimated. The aim of this study was to evaluate the validity of using an underbuttocks collection pouch in the diagnosis of PPH. METHODS: The study included a prospective series of 122 patients, over a period of 6 months, from May to October 2008. Variations in levels of hemoglobin and hematocrit during the 48 h following the childbirth confirmed the diagnosis of PPH. The graduated underbuttocks pouch allowed us to evaluate blood loss. The diagnostic value of the pouch was analyzed. RESULTS: Mean age of the patients was 29.3 years. Mean pregnancy duration was 39.5 weeks of amenorrhea. Mean blood loss was 233.15 ml. Eighteen patients (14.7%) presented PPH and uterine arteries were embolized in two cases (1.6%). For a volume of 500 ml, the sensitivity of the pouch was 6.7%, and the specificity was 94.2%, The positive predictive value (PPV) was 66.7% and the negative predictive value (NPV) was 94.2%. For a threshold of 300 ml, sensitivity was 88.9%, specificity was 82.7%, the PPV was 47.0% and the NPV was 97.7%. CONCLUSION: The underbuttocks collection pouch is a simple, cheap and effective way to make an early objective diagnosis of PPH. It allows medical staff to implement appropriate therapy quickly thus avoiding risks due to delay. The diagnostic threshold to ensure optimal management remains to be determined.


Assuntos
Roupas de Cama, Mesa e Banho , Hemorragia Pós-Parto/diagnóstico , Adulto , Nádegas , Estudos de Coortes , Parto Obstétrico/efeitos adversos , Feminino , Hematócrito , Hemoglobinas/metabolismo , Humanos , Gravidez , Estudos Prospectivos , Sensibilidade e Especificidade , Adulto Jovem
5.
Arch Gynecol Obstet ; 283 Suppl 1: 77-8, 2011 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-20838802

RESUMO

PURPOSE: Secretory carcinoma is a rare form of breast cancer most frequently encountered in children or young adults. Several cases have been described in adults with increased aggressiveness and a risk of metastases. CASE REPORT: We report here, in a 30-year-old woman, a case of local relapse and lymph node metastases occurring 16 years after the initial diagnosis of secretory carcinoma. CONCLUSION: We present the clinical, radiological and pathological findings that led to the diagnosis.


Assuntos
Neoplasias da Mama/patologia , Carcinoma/patologia , Recidiva Local de Neoplasia/patologia , Adulto , Neoplasias da Mama/terapia , Carcinoma/terapia , Feminino , Humanos , Metástase Linfática , Radioterapia Adjuvante , Fatores de Tempo
6.
Arch Gynecol Obstet ; 283(3): 659-62, 2011 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-20411270

RESUMO

Hepatic infarction is rare in hemolysis, elevated liver enzymes, and low platelets syndrome. We described a case of a 24-year-old woman who was admitted at week 17 of pregnancy with an antiphospholipid syndrome. Magnetic resonance imaging was the imaging modality of choice for diagnosing hepatic infarction, guiding treatment, ensuring the early detection of bleeding, and monitoring liver recovery.


Assuntos
Síndrome Antifosfolipídica/diagnóstico , Síndrome HELLP/diagnóstico , Infarto/diagnóstico , Hepatopatias/diagnóstico , Imageamento por Ressonância Magnética , Complicações na Gravidez/diagnóstico , Dor Abdominal/diagnóstico , Corticosteroides/uso terapêutico , Anticoagulantes/uso terapêutico , Anti-Hipertensivos/uso terapêutico , Síndrome Antifosfolipídica/tratamento farmacológico , Cesárea , Feminino , Morte Fetal , Síndrome HELLP/tratamento farmacológico , Humanos , Hepatopatias/enzimologia , Gravidez , Segundo Trimestre da Gravidez , Resultado do Tratamento , Adulto Jovem
7.
Acta Obstet Gynecol Scand ; 89(10): 1310-5, 2010 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-20726700

RESUMO

OBJECTIVE: To compare the efficacy, feasibility and morbidity of two preparation techniques for conservative uterine myoma surgery: temporary embolization and temporary surgical ligature of the uterine arteries. DESIGN: Retrospective study. SETTING: Gynecological Surgery and Interventional Radiology departments, Centre Hospitalier Universitaire of Dijon, France. POPULATION: A total of 100 women undergoing myomectomy between 2000 and 2008. METHODS: Three groups were constituted: (1) no preparation (43 patients), (2) uterine artery embolization (UAE) (30 patients) and (3) temporary surgical ligature of the uterine arteries (SLUA) (27 patients). The choice of technique depended on the number, size and topography of the fibromas. MAIN OUTCOMES MEASURES: Quantification of peroperative blood loss, delta hemoglobin, complications, subsequent fertility. RESULTS: Blood loss and delta hemoglobin were both lower in group 2 (p = 0.026 and p = 0.0002) and in group 3 (p = 0.048 and p = 0.001), respectively, than in group 1. The two preparation techniques were efficient. SLUA increased the duration of the operation (p < 0.0001). Hospitalization was longer following UAE (p = 0.0001). The rate of complications was 16.3, 23.3 and 3.7%, and of synechiae 9.3, 13.3 and 0% for groups 1, 2 and 3, respectively. The number of pregnancies was 8, 5 and 6 after a mean postoperative period of 5.6, 4.3 and 3.9 years, respectively. CONCLUSION: Both UAE and SLUA for myomectomy are feasible, reproducible and effective techniques for reducing peroperative blood loss. Use of these techniques must be generalized in patients with a high risk of hemorrhage, but may be compatible with subsequent fertility.


Assuntos
Leiomioma/terapia , Embolização da Artéria Uterina , Artéria Uterina/cirurgia , Neoplasias Uterinas/terapia , Adulto , Estudos de Viabilidade , Feminino , Humanos , Leiomioma/cirurgia , Ligadura , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Neoplasias Uterinas/cirurgia
8.
Arch Gynecol Obstet ; 281(3): 505-10, 2010 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-19847452

RESUMO

PURPOSE: The main aim of this study was to show the interest of pelvic posterior exenteration to obtain complete resection of the tumor in case of invasion of the rectum by contiguity in advanced-stage ovarian cancer. The secondary aim was to determine the morbidity of this surgery. METHODS: It is a multicentric, retrospective study of a series of 41 patients, who underwent posterior pelvectomy for advanced-stage ovarian cancer, over a period of 18 years, from July 1989 to July 2007. RESULTS: The surgery resulted in macroscopically complete resection in 19 patients (46.34%), a residual tumor <2 cm in 19 patients (46.34%) and >2 cm in 3 patients (7.32%). In 34 patients (34/41), digestive continuity with satisfactory anal sphincter function was restored immediately or in the short term. The mean delay to the start of complementary treatment was 36 days. Median overall survival was 33 months. CONCLUSION: The main aim of surgery for ovarian peritoneal carcinomatosis is to obtain a complete resection. In the case of direct invasion of the rectum by contiguity, when there is no cleavage plane between the uterus and the rectum, pelvic posterior exenteration is an effective method to achieve this objective. Morbidity is relatively high, but acceptable given the poor prognosis of this disease, the improved survival after surgery, and improvements in post-operative quality of life and functions.


Assuntos
Colo/cirurgia , Neoplasias Ovarianas/cirurgia , Reto/cirurgia , Adulto , Idoso , Intervalo Livre de Doença , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Invasividade Neoplásica , Estadiamento de Neoplasias , Neoplasias Ovarianas/patologia , Estudos Retrospectivos , Análise de Sobrevida
9.
Acta Obstet Gynecol Scand ; 89(3): 407-8, 2010 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-19916887

RESUMO

Hamman's syndrome is the classical association of subcutaneous emphysema and pneumomediastinum, with or without pneumothorax. Its onset during the expulsive phase of childbirth is exceptional. We report here the first case associated with pharyngeal rupture at the level of the piriform sinus and describe the warning signs and the management by endoscopy.


Assuntos
Enfisema Mediastínico/complicações , Faringe/lesões , Enfisema Subcutâneo/complicações , Adulto , Feminino , Adesivo Tecidual de Fibrina/uso terapêutico , Humanos , Enfisema Mediastínico/diagnóstico por imagem , Enfisema Mediastínico/terapia , Complicações do Trabalho de Parto/diagnóstico por imagem , Complicações do Trabalho de Parto/terapia , Gravidez , Ruptura , Enfisema Subcutâneo/diagnóstico por imagem , Enfisema Subcutâneo/terapia , Síndrome , Tomografia Computadorizada por Raios X
10.
Ann Surg Oncol ; 17(3): 898-906, 2010 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-19859770

RESUMO

BACKGROUND: Isolated hepatic perfusion (IHP) of chemotherapy has been proposed to deliver high doses of drug while avoiding systemic toxicity. Hypotonic cisplatin has a high in vitro activity on human colon cancer cells. We studied the safety of a 30-min hypoxic single-pass IHP with hypotonic cisplatin. METHODS: A preliminary in vitro assay was performed to compare the cytotoxicity of cisplatin and oxaliplatin, in either a normotonic or hypotonic medium. Cisplatin in hypotonic medium was then chosen for the in vivo IHP. Eleven pigs underwent 30 min of IHP with 0, 50, 75, or 100 mg/L of cisplatin in a hypotonic solution under total vascular exclusion of the liver. Clinical and biological parameters were recorded for 30 days, and liver histology was performed at necropsy. The cytotoxic activity of the effluent against resistant human colon cancer cells was tested in vitro. RESULTS: No hepatic failure was recorded after IHP with cisplatin, but limited foci of necrosis were found at necropsy in animals receiving 75 or 100 mg/L of cisplatin. No clinical, biological, macroscopic, or microscopic toxicity was observed after IHP with 50 mg/L of hypotonic cisplatin. The liver effluent showed high in vitro cytotoxic activity against colon cancer cells. CONCLUSIONS: A hypoxic single-pass isolated liver perfusion with hypotonic cisplatin is feasible and safe. Effluent from the liver is highly cytotoxic on cancer cells. A clinical study with 50 mg/L of hypotonic cisplatin is warranted in patients with unresectable liver metastases from colon cancer.


Assuntos
Antineoplásicos/administração & dosagem , Quimioterapia do Câncer por Perfusão Regional , Cisplatino/administração & dosagem , Neoplasias do Colo/tratamento farmacológico , Fígado/efeitos dos fármacos , Animais , Neoplasias do Colo/patologia , Neoplasias do Colo/cirurgia , Relação Dose-Resposta a Droga , Feminino , Humanos , Soluções Hipotônicas , Fígado/irrigação sanguínea , Fígado/cirurgia , Sus scrofa , Distribuição Tecidual , Células Tumorais Cultivadas
11.
Anticancer Drugs ; 21(3): 320-5, 2010 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-20032778

RESUMO

BACKGROUND: Intraperitoneal (i.p.) epinephrine was shown to increase the accumulation of i.p. cisplatin in tumours, and thus its antitumour effect in a model of peritoneal carcinomatosis in rats. METHODS: To determine the tolerance to i.p. epinephrine with cisplatin, 18 patients with recurrent ovarian carcinoma were intraoperatively treated in this phase 1 study. After maximal cytoreductive surgery, the peritoneal cavity was filled twice for 1 h with 30 mg/l of cisplatin and increasing concentrations of epinephrine (0, 1, 2, 3 mg/l) in 3 l of saline solution at 37 degrees C. RESULTS: No deaths occurred. Three patients were treated at each of the 0, 1 and 2 mg/l epinephrine levels without adverse events. Two of the three patients who received 3 mg/l epinephrine experienced cardiac intolerance. Six additional patients received 2 mg/l of epinephrine without toxicity. A relationship between the serum concentration of epinephrine and occurrence of cardiac toxicity was established. A 60% decrease in serum area under the curve of platinum was calculated in patients receiving i.p. epinephrine compared with i.p. cisplatin alone. Renal toxicity from cisplatin was not increased by epinephrine. No haematological or neurological toxicity was recorded. The other grade 3-4 adverse events [thromboembolism (5), peritonitis (1), abdominal bleeding (1), bowel fistula (1)] occurred as often as usually reported for this heavy surgical procedure. CONCLUSION: The combination of i.p. epinephrine with cisplatin as intraoperative chemotherapy after optimal cytoreductive surgery is feasible. The recommended concentration for further studies is 2 mg/l for i.p. epinephrine.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica , Cisplatino/uso terapêutico , Epinefrina/uso terapêutico , Recidiva Local de Neoplasia/tratamento farmacológico , Neoplasias Ovarianas/tratamento farmacológico , Adulto , Idoso , Cisplatino/efeitos adversos , Epinefrina/efeitos adversos , Epinefrina/toxicidade , Feminino , França , Traumatismos Cardíacos/induzido quimicamente , Humanos , Injeções Intraperitoneais , Cuidados Intraoperatórios , Pessoa de Meia-Idade , Neoplasias Ovarianas/cirurgia , Resultado do Tratamento
12.
Arch Gynecol Obstet ; 281(3): 491-8, 2010 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-19554339

RESUMO

OBJECTIVES: Our purpose was to assess development of sentinel lymph node biopsy (SLNB) in two Burgundy districts during the year 2005. METHODS: All women undergoing breast surgery as primary care between 1 January 2005 and 1 January 2006 were eligible for inclusion. Eleven surgeons from five different breast-treatment centres took part in this prospective multicentric study. As our objective was to evaluate practices, patients were not randomized and surgeons were free to choose treatment patterns. RESULTS: The 528 enrolled cases account for 90% of all new breast cancers in 2005 in Cote d'Or and Saône et Loire. Half of these patients (286) fulfilled requirements for SLNB. The others (242) had primary full axillary clearance (AC). Four of our five centres offer double-detection of sentinel lymph nodes as well as intraoperative pathology examination. Most tumours were invasive ductal carcinomas, with an average size of 12 mm in the SLNB group (T1C) and 22 mm in the AC group (T2). Two or three lymph nodes were removed during each SLNB procedure. Whereas most SLNB studies report around 25% positive nodes, we barely recorded 18.5% (53 of our 256 patients). Moreover, 2/3 of these node-positive patients had optimal care since additional axillary clearance was done right away. CONCLUSION: Sentinel lymph node biopsy has become routine practice in our Burgundy area. It is mainly dedicated to early stage breast cancer with limited metastatic risk. Our surgeons follow the most recent guidelines and indications are the same regardless of treatment centre.


Assuntos
Neoplasias da Mama/patologia , Biópsia de Linfonodo Sentinela/estatística & dados numéricos , Neoplasias da Mama/cirurgia , Feminino , França , Fidelidade a Diretrizes , Humanos , Pessoa de Meia-Idade , Guias de Prática Clínica como Assunto , Estudos Prospectivos , Biópsia de Linfonodo Sentinela/métodos
13.
Acta Obstet Gynecol Scand ; 88(9): 1049-52, 2009.
Artigo em Inglês | MEDLINE | ID: mdl-19639463

RESUMO

The obstetrician is more and more frequently faced with the decision to perform a cesarean section in obese women. We describe a technique of supra or subumbilical transverse cesarean section (depending on the height of the projection of the upper edge of the pubic symphysis) specifically designed for morbidly obese women with a voluminous panniculus. We evaluated feasibility and associated morbidity in a retrospective descriptive series of 18 patients operated between 2003 and 2008. We assessed the quality of access to the lower uterine segment and facility to extract the fetus. The mean body mass index was 47.7 kg/m(2) (range 40.1-60.8). The incision was subumbilical in 13 women (72.2%) and supraumbilical in 27.7%. With this technique, the exposition, the section of the lower uterine segment, and extraction of the baby are simple. It can be easily generalized and quickly learnt.


Assuntos
Cesárea , Histerotomia/métodos , Obesidade Mórbida/cirurgia , Complicações na Gravidez/cirurgia , Gordura Abdominal , Adulto , Estudos de Coortes , Estudos de Viabilidade , Feminino , Humanos , Obesidade Mórbida/patologia , Gravidez , Complicações na Gravidez/patologia , Sínfise Pubiana , Estudos Retrospectivos , Resultado do Tratamento , Umbigo , Adulto Jovem
14.
Eur J Obstet Gynecol Reprod Biol ; 146(1): 65-70, 2009 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-19482403

RESUMO

OBJECTIVE: To assess the potential impact of new guidelines recommending routine antenatal prophylaxis at 28 weeks of pregnancy on incidence, consequences and cost of rhesus immunization. STUDY DESIGN: All rhesus immunizations of 224,500 ongoing pregnancies in two neighbouring administrative areas in France between 2000 and 2006 were enrolled in this retrospective study. To determine the aetiology of immunization and to specify when sensitization occurred, we searched sensitizing events between the last negative and the first positive red-cell antibody test results. Perinatal consequences and costing were also analyzed. RESULTS: From 138 rhesus negative women bearing anti-D antibodies, none had received routine prophylaxis at 28 weeks. 37% were primary immunizations and 63% were reactivating former immunization. 63% sensitizations occurred after unprovoked foetal-maternal haemorrhage, mostly after 28 weeks (54%). Twenty-five (18.1%) sensitizations resulted from inappropriate management of existing prophylaxis. Immigrants with previously acquired antibodies accounted for 10% of cases. There was no foetal demise and none born before 28 weeks among our 140 babies. Only 25% required intensive care, mostly those born to mothers reactivating immunization, with an overall good perinatal outcome. Systematic 28-week prophylaxis would have cost about euro 2.5 million to reduce overall cost of immunizations by euro 0.6 million. CONCLUSIONS: The incidence of rhesus immunization in our population was low at 0.41 per thousand. Routine antenatal prophylaxis could have avoided 54% of these immunizations but expected perinatal benefits are low, as newborns with the worst issue were born to mothers with unavoidable immunizations. Therefore the cost-effectiveness of this strategy is doubtful.


Assuntos
Isoimunização Rh/prevenção & controle , Adolescente , Adulto , Análise Custo-Benefício , Feminino , Transfusão Feto-Materna/tratamento farmacológico , Transfusão Feto-Materna/imunologia , França/epidemiologia , Humanos , Recém-Nascido , Isoanticorpos/economia , Gravidez , Complicações Hematológicas na Gravidez/imunologia , Estudos Retrospectivos , Isoimunização Rh/economia , Isoimunização Rh/epidemiologia , Isoimunização Rh/imunologia , Sistema do Grupo Sanguíneo Rh-Hr/imunologia , Imunoglobulina rho(D)
15.
Acta Obstet Gynecol Scand ; 88(2): 238-40, 2009.
Artigo em Inglês | MEDLINE | ID: mdl-19089781

RESUMO

Embolization of the uterine arteries with resorbable material is an effective treatment for postpartum hemorrhage. Cases of uterine necrosis were already described but with non-resorbables particles. We report two exceptional cases of uterine necrosis with failure of conservative treatment following selective embolization with gelatine.


Assuntos
Implantes Absorvíveis/efeitos adversos , Hemorragia Pós-Parto/terapia , Embolização da Artéria Uterina/efeitos adversos , Doenças Uterinas/etiologia , Adulto , Feminino , Humanos , Microesferas , Necrose , Gravidez , Doenças Uterinas/patologia , Adulto Jovem
16.
Am J Obstet Gynecol ; 199(5): e9-e12, 2008 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-18984074

RESUMO

Selective serotonin reuptake inhibitor (SSRI) antidepressants are preferred to tricyclics, because, for the same efficacy, they are better tolerated. The mechanisms of action are well understood. These drugs may be used during pregnancy. We present here the case of a voluntary intoxication with SSRI in the third trimester of pregnancy.


Assuntos
Citalopram/intoxicação , Complicações na Gravidez/tratamento farmacológico , Inibidores Seletivos de Recaptação de Serotonina/intoxicação , Tentativa de Suicídio , Corticosteroides , Adulto , Antídotos/uso terapêutico , Bloqueadores dos Canais de Cálcio/uso terapêutico , Carvão Vegetal/uso terapêutico , Depressão , Feminino , Humanos , Nicardipino/uso terapêutico , Gravidez , Resultado da Gravidez , Terceiro Trimestre da Gravidez
17.
Acta Obstet Gynecol Scand ; 87(11): 1256-8, 2008.
Artigo em Inglês | MEDLINE | ID: mdl-18951218

RESUMO

Implanon is a reliable method of contraception widely used in France and around the world. Cases of difficulties encountered in inserting or removing the implant have been described. We report the first case of an insertion accident that led to occlusion of the right brachial artery and required exploratory vascular surgery.


Assuntos
Artéria Braquial/fisiopatologia , Artéria Braquial/cirurgia , Anticoncepção/efeitos adversos , Anticoncepção/métodos , Implantes de Medicamento/efeitos adversos , Adulto , Braço/irrigação sanguínea , Anticoncepcionais Femininos/administração & dosagem , Remoção de Dispositivo , Feminino , Humanos
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