[Treatment of micturation troubles].
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Humans↗
Biomedical subjects
A Pigné
Publications and source records attributed to A Pigné.
[Ureteral endometriosis: three cases. Diagnostic and therapeutic management. Literature review].
Ureteral endometriosis is a rare but serious entity because of its insidious evolution which can lead to the loss of kidney function. Three cases are reported: two patients have received a medical and endoscopic management and the third one has undergone a surgical procedure. According to the literature, the authors suggest a diagnostic and therapeutic tree.
Adult↗
[Incisional hernia after surgical laparoscopy: a case of hepatic ligament incarceration and review of the literature].
The authors report a case of incisonal hernia occurring 5 years after laparoscopic treatment of extra-uterine pregnancy. This involved incarceration of the hepatic suspensor ligament during insertion of a 10 mm umbilical trocard. Laparoscopy permitted diagnosis and treatment of the hernia. Parietal complications after laparoscopy usually concern epigastric vascular lesions, infections at trocard sites, and residual abdominal wall pain. Incisonal umbilical and extra-umbilical hernias, described for the first time in 1968, are highly unusual complications, with an incidence of 21/100,000 in the Mintz study. The hernia sac usually contains omentum or small intestine. The present observation alems to be the first case of incarceration of the hepatic suspensor ligament in an umbilical trocard. This observation is remarkable not only for the hernia sac contents but also for the delay between laparoscopy and the occurrence of the umbilical hernia.
Constriction, Pathologic↗
[Postpartum hemorrhage. Current management].
Post-partum haemorrhage is one of the major worldwide causes of maternal mortality. Better knowledge of risk factors should limit its incidence and short term hazards. In case of excessive bleeding, classical therapeutic means continue to be of major importance. If unsuccessful, modern methods including injections of prostaglandins, vascular ligations, and arterial embolization, should be employed, preserving future fertility.
Embolization, Therapeutic↗
[Surgical indications in female urinary incontinence].
In addition to artificial urinary sphincters, the surgical management of female urinary incontinence includes many surgical procedures of the bladder neck: its retropubic placement within the confines of abdominal pressure, posterior support preventing effort opening or the reduction of its diameter. Whatever the surgical procedure, surgical indications depend on discomfort and patient desire after complete assessment to evaluate risk of failure and postoperative complications. Choice of a technique depends on the surgeon's individual preference; success rate varies from 50 to 80% after 5 years follow-up.
Female↗
[Locoregional recurrences of breast cancer].
AIM OF THE STUDY: To determine the characteristics of 51 cases of isolated local regional breast cancer recurrence. METHODS: Retrospective study from 1980 to 1992, survival calculated according to Kaplan-Meier and log-rank test. RESULTS: Twenty-five patients had had a conservative treatment of her primary tumour, 26 had been treated by modified radical mastectomy. Local regional recurrence rate was 9%: 44% of recurrences after lumpectomy and 43% of recurrences after mastectomy occurred within 2 years after the initial treatment. Site of local regional recurrence was chest wall only (16 cases), breast only (15 cases) or axillary or supraclavicular node with or without chest wall or breast involvement (20 cases). The actuarial 5-year survival rate after recurrence is 54%. It depends on the time to recurrence (40% if time to recurrence was less than 2 years, 68% if more than 2 years, p < 0.10), on initial node involvement (36% for N+, 71% for N-, p < 0.15) and on the site of recurrence (chest wall: 43%; breast: 48%; regional node: 12%, p < 0.10). CONCLUSION: Like in the literature, severe recurrences are early recurrences, lymph node recurrences and recurrences following a primary tumour with involved axillary nodes.
Actuarial Analysis↗
[Immature teratoma of the ovary. Apropos of 3 cases. Review of the literature and an evaluation].
Immature teratoma of the ovary is a rare tumour (1% of cancer of the ovary) usually seen in adolescents or young women. It is a malignant tumour derived from an abnormal germ-cell which undergoes meiotic division. The diagnosis is based on the pathological examination which reveals immature tissue derived from two or three types of embryonic tissue (endo-, meso- and ectoderm). Intraperitoneal dissemination occurs and immature or mature recurrence is observed. The prognosis was particularly severe before the use of polychemotherapy which has also made conservative surgery possible. At the present time, the consensus is to reduce the duration of the chemotherapy with a regular clinical and laboratory (tumour markers, aFP) monitory. A second look laparotomy verifies successful treatment.
Adolescent↗
Folinic acid, 5-fluorouracil bolus and infusion and mitoxantrone with or without cyclophosphamide in metastatic breast cancer.
60 patients with metastatic breast cancer were entered in a phase II study using folinic acid, 5-fluorouracil bolus and infusion and mitoxantrone with or without cyclophosphamide. 47 had measurable visceral metastases and 13 had exclusively bone metastases. 36 had received previous adjuvant or metastatic treatment (33/36 with anthracycline-based regimens). Overall response rate in visceral metastatic patients was 57.1% [95% confidence interval (CI) 35.4-78.8%]; 45.5% and 70% in previously and non-previously treated patients, respectively; duration of response was 9 and 13 months, respectively. 10 out 13 patients with exclusive bone metastases improved for a median time of 18 months. Median survival was 22 months for the 60 patients; 18 and 31 months for previously and non-previously treated patients, respectively. Cyclophosphamide was scheduled only in the absence of nadir grade 4 neutropenia. However, this toxicity occurred in the first 7 patients. For this reason, we chose to avoid cyclophosphamide in patients over 60 years, or with a performance status of 1-2, or who had received previous chemotherapy. Overall, cyclophosphamide was stopped due to nadir grade 4 neutropenia in 17/24 patients for whom this drug was planned. When mitoxantrone, 5-fluorouracil and folinic acid were used at the doses scheduled, the addition of cyclophosphamide appeared feasible in only about 25% of the patients. Furthermore, survival was identical for patients receiving or not receiving cyclophosphamide. Therefore, cyclophosphamide does not contribute substantially to this regimen. This study confirms the value of folinic acid, 5-fluorouracil and mitoxantrone in metastatic breast cancer.
Adult↗
Survival with intraperitoneal cisplatin in advanced ovarian cancer after second-look laparotomy.
We studied survival in 36 patients with Stage III/IV ovarian cancer who received intraperitoneal high-dose cisplatin (200 mg/m2) alone or in combination with cytarabine (2 g), after intravenous (i.v.) cisplatin-based chemotherapy followed by second-look laparotomy. Complete responders were scheduled for three courses of IP chemotherapy, and others for six. Eight patients (22%) did not complete treatment (6 catheter failures and 2 renal failures). Peritoneal cytology remained positive in 6 patients (17%). Median overall and progression-free survival after second-look laparotomy were 44 and 37 months, respectively, for 13 complete responders to i.v. chemotherapy; 24 months and 11 months for patients with residual tumors less than 2 cm (17 cases); 15 and 12 months with tumors greater than 2 cm (6 cases). There was a significant difference in overall (p = 0.05) and progression-free (p = 0.001) survival between complete responders to i.v. chemotherapy and patients whose tumor was less than 2 cm. We find no evidence that high-dose cisplatin-based intraperitoneal chemotherapy given after second-look laparotomy will enhance survival in advanced ovarian cancer with zero or minimal residual disease.
Antineoplastic Combined Chemotherapy Protocols↗
[Primary biliary cirrhosis and pregnancy. Apropos of a clinical case. Review of the literature].
The appearance of pruritus and abnormal liver function tests (cellular damage) during pregnancy should of course suggest the diagnosis of intrahepatic cholestasis of pregnancy. However, these signs must also be recognized as signs of other hepatic diseases, especially primary biliary cirrhosis. The diagnosis is based on the search for antimitochondrial antibodies. This mode of presentation must not be overlooked because of major therapeutic consequences. The disease course often stabilizes with ursodeoxycholic acid, if administrated early.
Adult↗
[Functioning of implantable catheters of intraperitoneal chemotherapy].
Intraperitoneal chemotherapy with a totally implantable catheter was performed in 42 patients with advanced ovarian cancer who received 178 courses of chemotherapy administered in 2 l of solution. Major complication was inflow obstruction due to fibrosis around the catheter observed in 10 patients, 23.8% of the cases. Other complications were: leakage 3 (7.1%), pain 3 (7.2%), infection 3 (7.1%) and rectal perforation 1 (2.4%). Overall, these complications occurred in 15 patients (35.7%) and were the cause of treatment interruption in 7 (16.7%). Outflow obstruction which occurred in 23 patients (54.8%), did not create discomfort and could not be considered as a complication. Despite the problems, intraperitoneal chemotherapy with a totally implantable catheter appeared feasible in at least 80% of the patients.
Adult↗
[Results of intraperitoneal chemotherapy of ovarian cancer].
We studied a series of 42 patients with advanced ovarian cancer who received intraperitoneal chemotherapy post second-look laparotomy. High-dose cisplatin (200 mg/m2) alone or in combination with cytarabine (2 g) achieved 47% response rate. Median overall survival from second-look laparotomy was 44 months with cisplatin (36 cases), 15 months with carboplatin (600 mg/m2, 5 cases) and not reached at 3 yrs with mitoxantrone (25 mg/m2, 8 cases). Median overall and progression-free survival from second-look laparotomy were 44 and 39 months respectively in complete responders (15 cases), 20 months and 9 months where residual tumor less than 2 cm (21 cases), 22 and 12 months where tumor greater than 2 cm (6 cases). There was a significant difference in survival (P = 0.01) and progression-free survival (P = 0.002) between complete responders and patients whose tumor was less than 2 cm. Toxicity was acceptable except for carboplatin with constant grade 4 leukocytes or platelets toxicity. It was not demonstrated that high-dose intraperitoneal chemotherapy given post second-look laparotomy will improve survival in advanced ovarian cancer. Further studies of polychemotherapy or early administration are needed.
Antineoplastic Agents↗
[Prognosis in ovarian cancer as a function of the results of the second-look laparatomy].
Second-look laparotomy (SLL) was performed after chemotherapy in 106 patients with epithelial ovarian cancer. Thirteen were stage I and II and 93 stage III and IV. Seventy-eight patients received cisplatin-based regimens. Median follow-up was 60 months. Negative SLL was found in 32 patients who had a 5-year survival rate of 43.4% after SLO. Microscopy residual disease was present in 9 patients whose 5-year survival rate was 25%. Maximum residual tumor of 2 cm or less was found in 13 patients with 5-year survival rate of 30%. Residual tumor larger than 2 cm after secondary cytoreduction was present in 21 patients, their 3-year survival rate was 18.3%. Eighteen patients with bulky residual disease who did not have cytoreduction were all dead within 17 months. Patients with initial residual tumor at first laparotomy less than 2 cm had a near significant advantage in survival rate over patients with residual disease greater than 2 cm and stage IV (p = 0.07). Non-responders to initial chemotherapy had a survival rate similar to that of partial-responders. These findings justify discontinuation of conventional systemic chemotherapy for patients showing residual disease after SLL and secondary tumor removal in case of residual tumor at SLL. Therapeutic trials are needed in advanced ovarian cancer testing initial aggressive surgery or early debulking to avoid bulky residual disease and consolidation therapy in patients who achieved complete pathological response or minimal residual intraperitoneal disease.
Adult↗
[Stress urinary incontinence in women. Epidemiologic inquiry. Apropos of 500 cases].
Nearly 50% of women in Tunisia have urinary incontinence, and 30% of these are highly embarassed. This condition is under-estimated in Tunisia by doctors in as far as its functional effects are concerned because the country has other diseases which are more urgent and take priority. Stress incontinence causing invalidism is very frequent: 31.4%. The principal factors that lead to it are home delivery, multiparity, menopause and large babies. There are two frequent associated conditions: incontinence during pregnancy and cystocoele. A contribution is made by the clinical diagnosis, but if investigations stop there a definite diagnosis cannot be made and therefore there is a risk of failure of treatment. In fact the treatment should be according to the cause: it is medical when are purely urinary troubles and surgical or physiotherapeutic when there is true stress incontinence. The best treatment would be to prevent the condition by good obstetrics and this by better methods of delivering the babies.
Adult↗
[Treatment of acute non-chlamydial salpingitis. Study of the efficacy and tolerance of a single-therapy antibiotic: Augmentin].
An open randomised comparative trial of the efficacy and safety of Augmentin as against the triple therapy of penicillin-gentamicin-metronidazole in acute salpingitis was conducted in forty women admitted to hospital. Laparoscopy was performed routinely to confirm the diagnosis. The two groups of patients were comparable as to age and clinical and biological symptoms and the severity of the salpingitis (grade I to IV, with the presence or absence of Fitz-Hugh-Curtis syndrome). Treatment was started immediately after the laparoscopy, first by parental route until the patient had been apyrexic for 48 hours. Oral follow-up was then commenced. Twenty women received Augmentin and twenty the triple antibiotic therapy. Specimens for bacteriological study were obtained before treatment (culture of the urine, culture from the IUD and from the cervix, and swabs were taken laparoscopically). This made it possible to identify aerobic and anaerobic organisms. (The gonococcus was found more often in the group treated with triple antibiotics). On discharge, cures had been obtained in 12 women and 6 more were responding out of the Augmentin group. Out of the triple therapy group 8 were cured and 10 were responding. There was one failure in each group (persisting fever). Long-term assessment was carried out in the out-patients three weeks after discharge. 11 out of the 13 reviewed in the Augmentin group and 8 out of the 14 in the triple therapy group were considered as definitely cured. The clinical safety of both treatments was good. These results demonstrate that Augmentin is as effective as the combined therapy in treating acute salpingitis and with the added advantage of its easy use and lower cost.
Acute Disease↗
[Clinical and urodynamic results of the Burch colposuspension operation in the treatment of female urinary stress incontinence. A study apropos of 370 cases].
The surgical treatment of female genuine stress incontinence remains a not wholly solved problem. We prefer since 1980 the indirect colposuspension according to Burch as it represents 76% of our operations for genuine stress incontinence. We report 370 cases. The operation has been: isolated in 153 cases; associated with a total hysterectomy in 160 cases; associated with an indirect sacral fixation with a prosthesis of non adsorbable tissue in 57 cases. Clinical examination has always been completed with a urodynamic investigation pre-operatively and in the year following the operation. After two years or more, 188 urodynamic controls could be done. Clinical and urodynamic results are excellent and lasting after 5 years. Clinical failures represent only 4.6% of the cases and seem to be in relationship with technical defects as they occur in 78.4% of the cases in the first year following surgery. Associated sacral fixations, second hand cases, sphincter insufficiency appearing after surgery are the main factors giving way to the failures.
Adult↗
[Value and dangers of indomethacin used in pregnancy. Apropos of 304 treated patients].
When Indomethacin in a dosage of 175 mg/day was used to treat threatened premature labour more than 70% of cases carried on until 37 weeks. This treatment therefore is an interesting alternative treatment to beta-mimetics whose the maternal side effects can be serious. As far as the cardiovascular systems of the fetus and neonate are concerned the effects in the dosage used are negligible. On the other hand there may be renal failure which is transitory at birth when delivery has taken place while treatment was going on. The treatment should not be prolonged for more than three weeks because Indomethacin causes oligohydramnios and this can cause in its place malpositions and maldevelopment of the lungs. Finally, it is not certain whether this treatment has any effect on fetal growth causing diminished growth, possibly.
Abortion, Threatened↗
[Treatment of urogenital prolapse with exertion-induced urinary incontinence using the Bologna technic. Apropos of 90 cases].
The authors describe this operation, which is carried out as a single procedure which they have been doing since 1982. Then the results in 90 patients are studied. The post-operative controls carried out on the clinical state of the patient and on the urodynamic tests show that this operation is very successful, both in curing stress incontinence and in giving a good anatomical result for correcting prolapse of the anterior wall of the vagina. In over one-third of the cases the post-operative follow-up has been carried out for 2 years or more. This follow-up has shown that the relapse rate over a period of time, both for the stress incontinence and the prolapse, is nil. The principal snags that still remain are: post-operative infection in about a third of cases; the rare but possible development of an enterocele and of dyspareunia (2%).
Adult↗