[The constraints of evaluation].
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Education, Nursing↗
Biomedical subjects
B Blanc
Publications and source records attributed to B Blanc.
[Current role of laparoscopy in the diagnosis and treatment of ovarian cysts].
Between October 1986 and March 1990, 220 patients underwent surgical treatment for ovarian cysts. 156 of these patients underwent an initial celioscopy and could potentially benefit from celiosciopic treatment. The group mean age was 33.3 years. The circumstances under which the cysts were discovered usually consisted of pelvic pain or diagnosis during a routine examination. Twenty-four patients underwent laparotomy immediately after coelioscopy either due to a suspect macroscopic diagnosis either due to technical difficulties. 84.6 percent of the patients in the group were able to undergo celioscopic treatment only, essentially consisting of intraperitoneal cystectomy. The main advantages were the reduction in adherent sequelae in these women of a sexually active age, but also some financial savings related to the reduced duration of hospitalization and of sick leave. The theoretical reservations consist of the risk of malignancy and macroscopic diagnosis following coelioscopic exploration must be very restricted, with laparotomy whenever there is any doubt. No malignant tumor was escaped detection in this group.
Adult↗
[Four years of screening cervical smears of cervical lesions].
Twelve thousand two hundred and eighty nine Pap smears were collected from public hospitals and from private practices during a four year period (January 1987 to December 1990). 4.2% of Pap smears exhibited condylomatous or dysplastic lesions. 94.5% of such lesions were encountered in Pap smears taken from the transformation zone and which contained endocervical cells. Therefore, these smears represent the only adequate sample for cervical cancer screening. In our study, a close concertation between biologists and clinicians results in an improvement of the smear quality. The percentage of those containing endocervical cells increased from 49% in 1987 to 72% in 1990. Then, more cervical lesions were encountered on smears of patients from a low socio-economic level. New techniques such as detection of human papillomavirus (HPV) DNA on routine Pap smears by in situ hybridization would allow to improve the cytological diagnosis of HPV infections, mainly for non specific cytological alterations (11% in our series for 1990) and for cytological aspects of dysplasia only. These results point out how a cervical cancer screening can be better carried out.
Colposcopy↗
[Treatment of urinary stress incontinence by a modified Pereyra procedure:Chrub's operation].
The authors report the utility of suspending the cervix by means of the pubo-urethrax ligaments anchored to Cooper's ligaments in treating exercise-related urinary incontinence. A prospective series of 40 female patients gave 97.5% of successful outcomes with regard to the incontinence. The use of the pubo-urethrax ligaments and the absence of subsphincterian dissection confers major urodynamic advantages, particularly with regard to closing pressure. These anatomical and physiological arguments appear to give the procedure an advantage over suspensions using the vagina wall, whether these make use of the upper or lower route. Anchoring to Cooper's ligaments should ensure long-term stability of the outcome.
Adult↗
[Indications for operative hysteroscopy. A series of 418 interventions].
Over a period of 38 months, from October 1, 1987 to December 31, 1990, 418 surgical hysteroscopies were carried out following systematic pre-operative hysteroscopy. Two-hundred and eighty-two patients presenting with a benign intercavitary lesion were treated by transcervical endo-uterine resection (EUR). The efficacy of the surgical method was assessed from the control of hemorrhagic phenomena, the most frequent sign. 89.7 percent of the patients who presented with menometrorrhagia, had become asymptomatic from the first cycle after EUR and 83.5 percent remained asymptomatic after a mean follow-up period of 28 months, 71 endometrectomies were carried out by EUR during this period, after careful hysteroscopic and histological evaluation of the endometrium. The results after one year of cycles were satisfactory in 82 percent of patients. Twenty-two patients presenting with a uterine septum were treated by endoscopic hysteroplasty. In most cases, the authors used the tip of the Charriere 21 resector. The follow-up period exceeds 1 year in 15 patients, 11 of whom became pregnant, giving birth to 9 live infants, 43 cases of synechia were treated by hysteroscopy in the context of Ashermann's syndrome. The functional results were good in 90 percent of patients, with the restoration of normal cycles. Only limited results were obtained in fertility in cases of muscular or fibrous synechia. The risks linked to surgical hysteroscopy are analysed. They appear to be acceptable, on condition that rigorous methods are used. The quality of sequelae and the short hospitalization make operative hysteroscopy preferable in the selected indications.
Adult↗
[Conservative treatment of cancer of the ovary].
The authors assess the potential of conservative treatment in a series of cases of ovarian cancer. Surgical evaluation is essential, in order to confirm that the conditions required for conservative treatment are present. The tumor must be a stage IA tumor, with a low histoprognostic score and small in size. Conservative treatment must be proposed in cases of tumors of potential malignancy and tumors of the sexual cords. It is debateable in epithelial tumors. The question of the necessity of further surgery to remove the genital tract after the desired pregnancies may be debateable in cases of epithelial tumors.
Adolescent↗
[Hysteroscopic endometrial reduction. Analysis of 85 cases].
The authors report the results of their experience of hysteroscopic endometrial reduction through a retrospective series of 85 patients who underwent surgery between October 1988 and February 1991. The indication consisted of hemorrhage (menorrhagia and metrorrhagia) of endometrial origin in women with a group mean age of 46 years who had no intention of becoming pregnant in the future. The pre-treatment assessment was based on diagnostic hysteroscopy and was intended to eliminate neoplasm of the endometrium or its precursors. The endometrial reduction procedure always preserved an isthmic ring of endometrial tissue. No peroperative complication was reported. The mean duration of surgery was about 39 minutes. With a follow-up period of more than one year, bleeding had disappeared in 78% of cases. The authors conclude that the technic of endometrial resection in the treatment of benign lesions of the endometrium, on condition that the possibility of any disorder calling for laparotomy is ruled out and that there is regular postoperative follow-up.
Adult↗
[Triplet pregnancies in France. Results of a retrospective, multicenter study of two years (1987-1988). Proposals for optimal management].
The explosion of procedures for medically assisted parenthood (MAP) has resulted in a previously little known type of pregnancy: triple pregnancies. In order to assess the current obstetrical and pediatric situation, the authors have carried out a major retrospective, multicenter survey in France concerning the triple pregnancies from 1987 to 1988: 156 case histories have been collected. The finds are compared with those reported in the French and international literature, showing that in France, three-quarters of such pregnancies result from MAP, mainly due to ovulation-inducing agents. Hospitalization is prolonged (averaging 27 days), early (24 WA) and imposed by complications (in 8 out of 10 cases), prophylactic hospitalization being rarely prescribed. The main complications encountered are late miscarriages (1.9%), in-utero death (6.41%), dysgravidia (16.6%), hydramnios (5.12%) and serious cardio-pulmonary complications related to the use of beta-mimetics. A Cesarian is performed in only 87 percent of cases. The mean birth weight was 1,776 g. Neonatal mortality is on the decline, but still equivalent to 80.3 per thousand. Hypotrophy is common (27%). Birth is nearly always premature (99.3%), but very early prematurity (28-32 WA) was reduced. The approach suggested for optimum management is based on the personal experience of the authors, the findings of their survey and of the international literature. It is based on the prevention of prematurity and a fundamentally multidisciplinary approach.
Adult↗
[Effects of preinduction by mifepristone on therapeutic abortions of the second and third trimesters induced by intravenous sulprostone].
The authors investigate the effects of preinduction by administering 600 mg of mifepristone (RU486) per os before medical termination of pregnancy during the third to ninth months of pregnancy by intravenous sulprostone (Nalador). The study included a population of 35 patients treated with RU486 and then Nalador versus a population of 38 patients treated with Nalador only. The characteristics of the two groups did not show any statistically significant differences (medical, surgical and obstetric difference, indication for termination). The gestational age was lower in the RU486-Nalador group (group mean age : 20.9 weeks of amenorrhea versus 23.3, p less than 0.01). The group receiving RU486 significantly demonstrated the following : reduced time for induction of labour to modifications of the cervix (7.2 h versus 10.9 h, p less than 0.05), a higher number of rapid expulsions (within 10 h in 37.1% versus 15.7%, p less than 0.05) and a reduction of side effects (45.7% versus 71.05%, p less than 0.05). The other parameters analysed (duration of termination, total dose of prostaglandin) appeared to be better with RU486, but the values were not significantly different.
Abortifacient Agents, Nonsteroidal↗
[Neonatal consequences of premature rupture of membranes (more than five days) before the 34th week of gestation].
Twenty-six cases of premature braking of the membranes which occurred before week 34 of amenorrhea and lasted for more than 5 days are assessed retrospectively. The mean age when the membranes broke was 26.6 weeks of amenorrhea. Delivery occurred on average at 31.5 +/- 2 WA, with an interval of between 6 and 91 days (mean 35 +/- 23 days). In 4 cases, chorioamniotitis complicated the premature breaking of the membranes. The perinatal mortality rate was 5 out of 27, including 2 still births. Nine of the neonates showed respiratory distress which required artificial ventilation. Four cases of pulmonary hypoplasia were confirmed by pathological examination. In all cases, this was associated with a reduction in the volume of the amniotic fluid, reduced fetal mobility and delayed intrauterine growth. In contrast, when these three factors were absent the prognosis was always good, regardless of the date at which the membranes broke. In the long term, the surviving children showed no neurological sequelae.
Birth Weight↗
Cell-wall-associated proteinase of Lactobacillus delbrueckii subsp. bulgaricus CNRZ 397: differential extraction, purification and properties of the enzyme.
Whole cells of Lactobacillus delbrueckii subsp. bulgaricus CNRZ 397 were able to hydrolyse alpha- and beta-caseins. Irrespective of the growth medium used, milk or De Man-Rogosa-Sharpe (MRS) broth, identical patterns of alpha- and beta-casein hydrolytic products, respectively, were visualized by sodium dodecyl sulphate-polyacrylamide gel electrophoresis. A soluble proteinase present in cell-wall extracts was active on caseins and displayed the same hydrolytic patterns as whole cells. It was purified from cell-wall extract to homogeneity by ultrafiltration and ion exchange chromatography. The enzyme is a monomer with a molecular mass of 170 kDa, an optimum temperature of 42 degrees C and an optimum pH of 5.5. It was strongly activated by dithiothreitol and partially inhibited by E-64. These properties indicate that cysteine residues play an important role in the enzyme mechanism. The purified proteinase was not able to hydrolyse di- or tripeptides.
Amino Acid Sequence↗
Monoclonal antibody 1BE12 immunoreactivity with human endometrium. Correlations with hormone receptors and proliferation cell markers.
The monoclonal antibody (MAb) 1BE12 has recently been reported to react with several human normal and abnormal tissues. In human endometrium, it reacts more strongly with carcinomas than with normal tissue. To investigate the effectiveness of MAb 1BE12 in identifying cell proliferation in human endometrial cancers, 1BE12 immunocytochemical assays (ICAs) were performed on frozen (n = 47) and paraffin (n = 100) sections with subsequent computer-assisted microcytophotometric (SAMBA) evaluation of immunoprecipitate distribution. MAb 1BE12 immunoreactivity was not impaired by tissue fixation and paraffin embedding. It reacted with normal proliferative endometrium but not with normal secretory endometrium, and immunoreactivity increased with the degree of cell proliferation and malignancy, the amount of immunostaining being greater in invasive carcinomas than in normal proliferative endometrium and endometrial hyperplasia. ICAs showed no correlation between MAb 1BE12 immunoreactivity and estrogen and progesterone receptor antigenic sites. On the other hand, MAb 1BE12 staining in frozen sections increased with Ki67, EGFR, pHER-2/neu, and cathepsin immunostaining. These findings suggest that ICAs on frozen and paraffin-embedded biopsy specimens using MAb 1BE12 along with other markers can be useful for early detection and grading of endometrial carcinoma. The relevance of MAb 1BE12 to the selection of patients for laser ablation of the endometrium rather than hysterectomy is also discussed.
Antibodies, Monoclonal↗
[Sites of endometriosis].
Endometrious may be located in many parts of the body which are not limited to the pelvic region. While the classical theory of menstrual reflux easily accounts for the genital locations, other theories, notably metaplasia, have been propounded to explain more remote locations. Among the sites of implantation of the disease, the most common is the ovary followed, in order of frequency, by the anterior and posterior parts of the vaginal fornix, the broad ligament of the uterus and the uterosacral ligaments. Endometriosis of the digestive or urinary tract may create problems of differential diagnosis with cancer. External locations are much less frequent.
Adolescent↗
[Management of HIV seropositive pregnant women and HIV seronegative women with seropositive partners].
The population of HIV seropositive women of child-bearing age is increasing regularly. Termination of pregnancy must be offered to pregnant women during the first trimester. When HIV is detected during the last trimester, vaginal delivery must be accepted. Pregnancy does not seen to worsen the prognosis in HIV positive women, but it does so in women with confirmed AIDS.
Female↗
[Fetal blood sampling through the intra-abdominal umbilical vein].
Fetal blood can be sampled by several procedures. Reported here is the method of abdominal umbilical vein catheterisation. The authors detail the technical aspects, advantages and inconveniences of this procedure and analyse the results in a series of 81 samplings.
Abdominal Muscles↗
[Uterine cervix cancers: staging by magnetic resonance imaging].
The accuracy of Magnetic Resonance Imaging in cervical carcinoma staging for clinical stages superior to IB was studied retrospectively in 27 patients. The MRI results were then correlated with operative findings in 12 cases and with examination carried out under general anesthesia in 15 cases for myometrial, bladder, rectal, parametrial, parietal and vaginal extension. The accuracy of MRI was 81.5% for bladder, 92.5% for rectal, 87% for parametrial and 73% for vaginal extension. The accuracy of staging by MRI was 59%. The contribution of MRI in pre-operative studies for cervical carcinomas has not been properly defined until now. Nevertheless it is a particularly valuable technique due to its non invasive nature.
Adult↗
[Metabolic risks in surgical hysteroscopy].
Operative hysteroscopy is often carried out using glycine as an irrigant. This solution has interesting properties but also metabolic effects that are very well known by urologists. This study is concerned with the biological changes that have occurred after one hundred surgical hysteroscopies of which twenty nine were carried out using glycine. In hysteroscopy the significant variations are concerned with blood levels of protein, the haematocrit, changes in sodium levels and glycaemia. 44.9% of patients had changes greater than 5% as compared with the pre-operative levels. These changes concerned the haematocrit readings and in 57.1% the changes in protein in the blood and in sodium in 12%. The haematocrit changes, the protein changes and to a lesser degree the sodium changes could be correlated with one another but not with changes in glycine levels in the blood. Whatever the pathology inside the uterus, glycine went through in equal quantities. It was particularly significant when there was perforation of the uterus. It is linked to the glycine balance and to the length of time the operation had taken. When a mean quantity of fluid of 2.6 litres was used to irrigate, levels after the operation as compared with before the operation had multiplied 4.5 times. This corresponds to the dosage of glycine used. In five patients out of twenty nine post-operative quantities were 10 times those before operation. The consequences of these changes in glycine levels are variable and seem to be more significant in women who have never been pregnant or who are very heavy. Using vasoconstrictor agents does not alter these metabolic changes.
Adult↗
[Contraception using intrauterine devices. Indications, contra-indications, risks].
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Bacterial Infections↗