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Biomedical subjects

B Blanc

Publications and source records attributed to B Blanc.

At least 73 records · Page 4Linked to original sources
PubMed1998

Uterine thermal balloon therapy for the treatment of menorrhagia: the first 300 patients from a multi-centre study. International Collaborative Uterine Thermal Balloon Working Group.

OBJECTIVE: To evaluate the safety and efficacy of thermal balloon therapy for menorrhagia. DESIGN: Prospective, observational study. SETTING: Fifteen centres in Canada and Europe. POPULATION: Two hundred and ninety-six eligible women for whom follow up data were available for three months or more. Eligible women included those for whom further fertility was not a concern, were not postmenopausal, suffered from intractable menorrhagia, had a normal uterine cavity, and who were fully informed regarding the investigational nature of uterine thermal balloon therapy. METHODS: Three hundred and twenty-one procedures of balloon endometrial ablation were performed using the same protocol between June 1994 and August 1996. Exclusion criteria included structural uterine abnormality or (pre) malignant lesions. Treatment entailed controlled heating of fluid in an intrauterine balloon. General anaesthesia was employed in the 61% of procedures while local anaesthesia with or without sedation was used in 39% of cases. ANALYSIS: Follow up data at 3 and/or 6, and/or 12 months were required for inclusion in the analysis. A paired t test, Wilcoxon signed-ranks test, and multiple and logistic regression analyses were used to evaluate the changes in bleeding and dysmenorrhoea patterns, and possible confounding variables, respectively. Success was defined as the subjective reduction of menses to eumenorrhoea or less. RESULTS: No intra-operative complications occurred, and post-operative morbidity was minimal. Success of the procedure was constant over the year (range 88%-91%). Treatment led to a significant decrease in the duration of menstrual flow and severity of pain (P < 0.0001). Increasing age, higher balloon pressure, smaller uterine cavity, and a lesser degree of pre-procedure menorrhagia were associated with significantly improved results. Pre-treatment with gonadotrophin releasing hormone agonists increased amenorrhoea and spotting rates (P = 0.03), but was only used in 5% of cases. CONCLUSION: Thermal balloon endometrial ablation appears to be safe, as well as effective in properly selected women with menorrhagia and is potentially an outpatient procedure.

Catheter Ablation↗
PubMed1998

Prenatal diagnosis of fetal corpus callosum agenesis by ultrasonography and magnetic resonance imaging.

Corpus callosum agenesis (CCA) was evaluated by ultrasound examination and magnetic resonance imaging (MRI) in 14 cases. Ultrasonography was able to suspect CCA by indirect signs but a definitive diagnosis of CCA was achieved in only four cases. MRI was able to diagnose complete CCA in 13 cases and showed absence of the posterior portion of the corpus callosum in one case. Additional neurological abnormalities including heterotopia, gyration anomaly, asymmetry of the cerebral hemispheres, and Dandy-Walker variant were documented in five cases, as well as an ocular anomaly which was present in one case, by MRI examination. Prenatal counselling for fetal agenesis of the corpus callosum is difficult as the prognosis is uncertain. The association with other cerebral abnormalities increases the likelihood of a poor outcome and ultrasonographic assessment of the fetal brain is limited. We found MRI to be a safe and useful additional procedure to complement ultrasonographic diagnosis or suspicion of CCA.

Adult↗
PubMed1998

[Surgical hysteroscopy in the treatment of septate uterus: systemic treatment or selective indications].

OBJECTIVES: A retrospective study to evaluate the fertility rate after endoscopic hysteroplasty in the case of a septate uterus. METHOD: From 1st January 1988-31st December 1996, 93 patients showing a septate uterus were treated by endoscopic hysteroplasty. The hospitalisation is short: one day surgery or out office. A control of uterine cavity by hysteroscopy did next to two months. RESULTS: Patients were evaluated after a period in excess of 6 months (6 months-8 years). 63 pregnancies were achieved amongst the 84 patients to be reviewed (75%). The fertility rate achieved is higher amongst infertile patients (80.3%) compared with that of sterile patients (64%). CONCLUSION: In the presence of septate uterus the endoscopic hysteroplasty is an efficient treatment in the case of secondary infertility and of unexplained sterility.

Adult↗
PubMed1998

[Birth after two cesarean sections: the role of trial of labor].

OBJECTIVE: To study the management of labor following two cesarean sections, we evaluated maternal and neonatal morbidity subsequent to this attitude. PATIENTS AND METHODS: A retrospective study was conducted over a 6-year period (1-1-1990 to 31-12-1995) in 184 women presenting two uterine scars. Trial of labor was allowed in 96 cases with cephalic presentation and a normal pelvis. RESULTS: The rate of vaginal birth was 65%. Three patients presented a uterine scar dehiscence and in one of them hemostasis hysterectomy for uterine atony was performed. Neonatal outcome was good in all cases. CONCLUSION: Trial of labor after two cesarean sections is possible in the majority of cases. Rate of vaginal birth is high and maternal and fetal morbidity is low.

Female↗
PubMed1998

[Vaginal myomectomy].

The authors present a retrospective study of 26 patients who have benefited from vaginal myomectomy after culdotomy in the Conception hospital in Marseille between 1992 and 1997. The myomectomy whom technic is described, was performed unically through the vagina or laparoscopically assisted. The mean operating time was 94 mn. The myoma mean weight was 184.3 g. Three patients experienced an abdominal surgery, twice because of a vaginal inaccessness. The immediate and mean-term post-operative period was uncomplicated in most cases. For screened patients, vaginal myomectomy appears as an interesting alternative to abdominal or laparoscopic surgery.

Adult↗
PubMed1998

[Hysteroscopic myomectomy. Functional results with an average follow-up of 6 years].

OBJECTIVE: In 1995, we presented our experience in hysteroscopic resection of hemorrhagic submucous fibroids in 196 patients. The objective of the present work was to analyze functional outcome three years later. PATIENTS: One hundred ninety-six patients with abnormal uterine bleeding were treated between 1987 and 1993. Equipment, techniques, characteristics of the procedures and early results were detailed in the previous article. RESULTS: With a mean follow-up of 73 months (range 50,104), results were: 13.8% of the patients were lost to follow-up; 68.4% had symptomatic improvement and failure was observed in 17.8% (subsequent hysterectomy in 12.7%). Forty-nine patients had repeat resection in this series; 61 became menopausal after surgery, and 21 were taking hormone replacement therapy with good results. CONCLUSION: Developed as an alternative to hysterectomy, operative hysteroscopy has proven to be a safe and effective procedure. This treatment modality appears to give satisfactory long-term results, with a low rate of complications.

Adult↗
PubMed1997

Endoscopic surgery. The end of classic surgery?

Gynecological endoscopy is now a well-established procedure and it has been proved that the laparoscopic surgical technique can be used in the management of most gynecological disorders thus replacing conventional laparotomic procedures. The latest indications apply to such functional pathologic conditions as urinary incontinence and genital prolapse, and oncology (radical hysterectomy, lymphadenectomy). Hysteroscopy has afforded an easier surgical approach to certain pathologies such as septate uterus and endometrial ablation. Indications of conventional surgery are getting fewer. Yet conventional surgery should be part of the training of the gynecologist surgeon as the laparotomic approach is still the only solution in the most difficult cases.

Endoscopy↗
PubMed1997

[Lymphocytic mastitis].

Lymphocytic mastitis is a non infectious inflammatory disease of the breast with lobulocentric lymphocytic infiltrate of variable intensity, collagenous fibrosis and progressive lobular atrophy. The pathogenesis of lymphocytic mastitis is still unknown but some recent reports have suggested an autoimmune origin. We investigated a series of 10 cases by immunohistochemistry and we collected patients' biologic data. The most striking histologic feature was a prominent lobulocentric stromal or intraepithelial lymphocytic infiltrate. Occasionally, the infiltrate was perivascular and nodular along the lobule border. B and T lymphocytes, both demonstrated by immunophenotypic analysis, were shown with a particular pattern of distribution. Pathologists must be aware of this disease in order to recommend immunological investigation.

Adult↗
PubMed1997

[Hysteroscopy infection risk].

OBJECTIVES: The aim of this study is to evaluate the infectious risk of the hysteroscopy. METHODS: A prospective study was carried for nine months in the Belle-de-Mai maternity, in Marseille. We performed 81 operative or diagnostic hysteroscopies. A vaginal sample was achieved before the intervention and an endo-uterine sample after the procedure. The statistical analysis used the Chi 2 test. RESULTS: Fifty per cent of the patients of whom vaginal sample was contaminated present an endo-uterine sample infected at the end of an operative hysteroscopy. In 25% of cases, whereas the vaginal sample was normal, the endo-uterine prelevment was infected. The relative risk of the endo-uterine bacterial contamination, in case of vaginal contamination was 8.75 during this procedure. Within diagnostic hysteroscopy, no patient with a normal vaginal sample, was contaminated. No patent infection was observed. CONCLUSION: There is a risk of endo-uterine contamination during hysteroscopy. This risk is higher when the vaginal sample is contaminated before the intervention. This risk is smaller than the infectious risk of hysterectomy.

Adult↗
PubMed1997

[Endometrial resection in the management of menometrorrhagia refractory to medical treatment].

The authors report the results of 197 endometrectomies and analyse the indications, complications and long-term results. A retrospective analysis was performed at La Conception Hospital. Department of Gynaecology-Obstetrics, Prof Blanc, Marseille, between June 1988 and June 1994. The mean follow up was 53 months. 197 endometrectomies were performed in 186 women during this period. The indication was menometrorrhagia failing to respond to medical therapy. We considered patients to be cured when they no longer suffered from menorrhagia or metrorrhagia and when hormone replacement therapy could be started or continued. The success rate with a follow-up of 7 years was 70%. The failure rate was correlated with the woman's age, hysterometry data and histological results. The complication rate was 2.5%. Endometrectomy appears to be a safe and successful technique for the treatment of menometrorrhagia.

Adult↗
PubMed1997

[Role of endo-uterine resection using hysteroscopy in the treatment of sub-mucous hemorrhagic fibroma in the peri-menopausal period].

OBJECTIVES: To study retrospectively the long-term outcome after hysteroscopic treatment for intra-uterine fibromas. METHODS: From October 1987 to January 1993, endo-uterine glycocol resection was performed in 196 patients with intra-uterine fibromas. The operation had to be repeated in 39 patients due to incomplete resection or recurrent symptomatology. Patients presented with menometrorrhage. RESULTS: Intra-operative complications were rare, mainly uterine perforations (7 cases) or metabolic syndromes due to reabsorption of glycine (5 cases). Mean follow-up was 2.5 years. In all 196 women consulted for bleeding, good results were achieved in 81.1%. CONCLUSION: Endo-uterine resection is a sure, effective and long-lasting treatment for intra-uterine fibromas.

Adult↗
PubMed1997

[Richter's spinofixation in vaginal prolapse].

The transvaginal sacrospinous fixation, called Richter operation was initially aimed to cure vaginal vault prolapse after hysterectomy. The results are as good as those of the abdominal promontory fixation with the well known advantages of the vaginal route. Indications way be extended to V3 U3 R3 prolapse and cure of elytrocele with good results in our practice. In few cases remnant cystocele may be a trouble some problem.

Adult↗
PubMed1996

[Transmission of human immunodeficiency virus to the fetus during pregnancy].

Estimates of the rate of human immunodeficiency virus vertical transmission range from 15% to 40%, and the rate is lower in European and American studies than in African studies. There appears to be a relationship between maternal factors, mode of delivery and mother-to-child transmission. The risk factors or markers associated with increased vertical transmission are analyzed in this review. The use of zidovudine, administered to HIV-infected women during pregnancy and labour, and to the offspring for 6 weeks reduce the mother-to-infant transmission rate from 25% to 8%. Other strategies to alter transmission of HIV, including the use of combinaison of anti-retroviral drugs, immunoprophylaxis against HIV or obstetric interventions needs to be evaluated.

Antimetabolites↗
PubMed1996

[Human immunodeficiency virus infection in pregnancy. General aspects].

Seroprevalence of HIV infection in pregnancy is on the increase worldwide. Approximately 10 million infants will have been infected by the year 2000 and the majority of these children will have acquired infection by vertical transmission of HIV from infected mothers. Recent reports suggested that pregnancy does not accelerate the course of HIV infection. Prospective studies from industrialized countries where most women have asymptomatic HIV infection, have not shown an association with increased risk of adverse pregnancy outcome. Estimates of the rate of vertical transmission range from 15% to 40%.

Adolescent↗
PubMed1996

Hysteroscopic management of uterine synechiae: a series of 102 observations.

This retrospective study concerns 102 cases of intra-uterine adhesions treated by exclusive hysteroscopic approach. Fifty-two patients (51%) presented with reproductive problems, 44 patients (43%) with menstrual problems and 6 were asymptomatic. Seventy-eight patients (76.5%) had an antecedent endometrial trauma on a gravid uterus. One hundred and forty-eight operative hysteroscopies were performed to treat 102 patients; 70 patients were treated in one endoscopic session (68.6%), 23 in two sessions (22.6%), 4 in three sessions (3.9%) and 5 in four sessions (4.9%). We report no infectious, hemorragic or metabolic complication but 6 perforations (5.8%). The mean follow-up is 24.4 months (from 6 to 46 months). Ten patients did not keep contact during follow-up. A good anatomical result was obtained in 88 patients (86.2%) after one or two hysteroscopic sessions. A good result on menstrual problems was obtained in 75% of the cases, especially in amenorrhea (90.5% success rate). The reproductive outcome is more disappointing. We obtained 34 pregnancies in 28 patients (10 abortions, 24 live born children). Twenty-two patients achieved no pregnancy (44%), but 13 of these patients presented with additional infertility factors.

Adolescent↗
PubMed1996

Gasless laparoscopic gynecologic surgery.

OBJECTIVE: Evaluate gasless laparoscopic gynecologic surgery as an alternative to conventional technique with carbon dioxide insufflation. STUDY DESIGN: Retrospective study of 49 cases. RESULTS: Gasless laparoscopic gynecologic surgery was successful in 90% of cases. The gasless technique permits the surgical team to use the laparoscopic and vaginal approach simultaneously. CONCLUSIONS: Gasless laparoscopic gynecologic surgery seems to be a reliable alternative to conventional laparoscopy for selected indications.

Adult↗