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Biomedical subjects

B Blanc

Publications and source records attributed to B Blanc.

At least 91 records · Page 5Linked to original sources
PubMed1996

Hysteroscopic management of menstrual disorders: a review of 395 patients.

OBJECTIVE: To evaluate the long-term effectiveness of transcervical resections in menstrual disorders. DESIGN: Retrospective consecutive patient follow-up. PATIENTS: From 1987 to 1993, 395 patients with menstrual disorders (menorrhagia and/or metrorrhagia) were treated with operative hysteroscopy in our department. Resection of endometrial polyps was performed in 65 cases, resection of submucous fibroids in 196, and endometrial ablation in 134. Fourty-one patients had a repeat procedure. RESULTS: Our mean follow-up period was 2.7 years. Thirteen complications were noted (3%), two of which were serious (one hemoperitoneum after uterine perforation, one severe symptomatic hyponatremia). Twenty-eight patients did not remain in contact after hospitalization (7.1%). Menstrual disorders were controlled in 297 patients (75.2%). Failure was noted in 70 patients (17.7%), including hysterectomy in 50 patients and persistent bleeding in 20. CONCLUSION: Hysteroscopic surgery is a satisfying technique for women with abnormal uterine bleeding who want a conservation of the uterus. Better results are noted with resections of polyps and fibroids than with endometrial ablations.

Adult↗
PubMed1996

Hepatic endometriosis: a case report.

OBJECTIVE: To describe a case of hepatic endometriosis. DESIGN: Case report. SETTING: University hospital. PATIENT: A 34-year-old woman with a 2-year history of cyclic right subcostal pain. INTERVENTIONS: Gonadotropin-releasing hormone agonist (GnRH-a) therapy followed by surgical resection. RESULTS: Ultrasonography, computed tomography scan, and magnetic resonance imaging of the liver disclosed a 6-cm diameter mass. The GnRH-a therapy for 4 months led to clinical and radiologic improvement. Surgery performed to allow pregnancy confirmed the diagnosis of hepatic endometriosis. CONCLUSIONS: Hepatic endometriosis is uncommon. It may result from metaplasia of the peritoneum or from hematogenic or lymphatic spread.

Adult↗
PubMed1996

A new cell surface proteinase: sequencing and analysis of the prtB gene from Lactobacillus delbruekii subsp. bulgaricus.

Investigation of the chromosomal region downstream of the lacZ gene from Lactobacillus delbrueckii subsp. bulgaricus revealed the presence of a gene (prtB) encoding a proteinase of 1,946 residues with a predicted molecular mass of 212 kDa. The deduced amino acid sequence showed that PrtB proteinase displays significant homology with the N termini and catalytic domains of lactococcal PrtP cell surface proteinases and is probably synthesized as a preproprotein. However, the presence of a cysteine near the histidine of the PrtB active site suggests that PrtB belongs to the subfamily of cysteine subtilisins. The C-terminal region strongly differs from those of PrtP proteinases by having a high lysine content, an imperfect duplication of 41 residues, and a degenerated sequence compared with the consensus sequence for proteins anchoring in the cell walls of gram-positive bacteria. Finally, the product of the truncated prtM-like gene located immediately upstream of the prtB gene seems too short to be involved in the maturation of PrtB.

Amino Acid Sequence↗
PubMed1996

Attitudes towards cancer predictive testing and transmission of information to the family.

Before the organisation of breast cancer predictive testing in France, consultands' attitudes towards this kind of testing and towards passing on information about the family cancer risk to their relatives were investigated. This survey was carried out from January 1994 to January 1995 at six specialised cancer genetic clinics located in different parts of France Female consultands who were first degree relatives of cancer patients and who had at least one case of breast cancer in their family, affecting either themselves or a first degree relative or both, participated in this study. Among the 248 eligible consultands attending the clinics during the study period, 84.3% answered a post-consultation questionnaire. Among the 209 respondents, 40.7% (n = 85) were cancer patients and 59.3% (n = 124) were healthy consultands. A high consensus in favour of genetic testing was noted, since 87.7% of the sample stated that they would ask for breast cancer gene testing if this test became available. The underlying assumption of 96.6% of the women was that their health surveillance would be improved after a positive test. A high awareness of the anxiety that would be generated in a family after a positive result was observed and found to be associated (p < 0.05) with the anxiety and depressive profiles of the patients. Half of the healthy respondents said they would not change their attitude towards screening if the results of predictive testing turned out to be negative. Only 13.7% of the 161 patients who stated that the oncogeneticists asked them to contact their relatives firmly refused to do so, mainly because of difficult family relationships.

Adult↗
PubMed1996

Hysteroscopic surgery in postmenopausal women.

OBJECTIVE: To assess the efficacy of hysteroscopic surgery in postmenopausal women presenting with abnormal uterine bleeding. DESIGN: A retrospective audit of 102 patients. SETTING: The Department of Obstetrics and Gynecology B, La Conception Hospital, Marseilles, France. PATIENTS: One hundred and two women between the ages of 47-67 years with postmenopausal bleeding or bleeding related to hormone replacement therapy were evaluated by pelvic ultrasound and diagnostic hysteroscopy. A benign organic cause was noted in 87 cases (polyps in 51 and fibroids in 36.) Fifteen patients had no significant disease. INTERVENTIONS: Resection of polyps or fibroids, endometrial ablation. RESULTS: One hundred and seven procedures were performed on 102 patients. Major operative complications were rare and included one perforation and one case of glycine toxicity. Eighty-eight patients were satisfied with the results. Six patients were subsequently treated by hysterectomy. Six patients complained of recurrent abnormal bleeding. CONCLUSIONS: This modality of treatment appears to be effective over the long term. The operative criteria should take the causes of bleeding and not just the age of the patient into account.

Aged↗
PubMed1996

[Treatment of uterine fibromas].

Uterine myomas are frequent tumors, but only some of them need to be treated: only when they are symptomatic. After describing the role of oestrogen and growth factors on the development, and the value of clinical examination and imaging techniques (ultrasonography, outpatient hysteroscopy without anesthesia), the authors study the various treatments. Medical treatments essentially consist of progesterone and preoperative GnRH agonists or in peri-menopause (add-back therapy). When if medical treatment fails, surgery consists of: myomectomy and hysterectomy (by abdominal, laparoscopic or vaginal routes), myolysis and hysteroscopic resection. Three cases are isolated: infertility, pregnancy and menopause associated with uterine myomata.

Female↗
PubMed1996

[Hysteroscopic treatment of uterine synechias. A report of 102 cases].

This retrospective study of 102 patients with uterine synechias treated exclusively hysteroscopically included 52 (51%) low fertility patients, 44 (43%) with menstrual disorders and 6 (6%) with no other symptoms. More than three-fourth of the patients (76.5%) had a past history of trauma on a gravid uterus. Operative hysteroscopy was performed 148 times, including sections with scissors in 63 cases (42.4%), section with laser in 4 (3%), uterine collapse in 19 (13%) and electrosection in 62 (41.6%). A single endoscopic procedure was sufficient in 70 patients (68.6%) and 2, 3, 4 procedures were required in 22.6%, 3.9% and 4.9% of the patients respectively. No complications due to infection, bleeding or metabolic disorders occurred, but perforations were seen in 6 patients (5.8%) including 4 cases with complexe synechias. Mean follow-up was 24.4 months (range: 6-49 months); 10 patients were lost to follow-up. Good anatomic results were achieved in 88 patients after 1 or 2 hysteroscopic procedures (86.2%). Clinical results were less satisfactory, particularly in cases with low fertility in which another pathology was often associated (59%). We obtained good results in 75% of the patients with dysmenorrhoea. However, one or more pregnancies was achieved in 28 of the 50 patients contacted later (a total of 34 pregnancies including 10 abortions and 24 normal deliveries). A hysteroscopic procedure should be proposed as first intention treatment in all cases with synechia. In addition to diagnosis, hysteroscopy allows selective, reproducible treatment with little morbidity and conservation of the surrounding endometrium. After several unsuccessful procedures, surgery using Musset's technique can be proposed.

Adolescent↗
PubMed1995

[Borderline tumors and cancers of the ovary. Laparoscopic-surgical evaluation].

OBJECTIVES: Benign cysts of the ovary can now be correctly treated with laparoscopic surgery, but it is difficult to confirm the benign nature of the suspected formation. Thus, the major risk of the laparoscopic surgery is the dramatic consequences in case of malignancy as reported in several cases in the literature. We conducted a survey to evaluate this risk. METHODS: A retrospective multicentric survey of laparoscopic procedures performed for a diagnosis of lesions of the annexes or cyst of the ovary was conducted. Forty-four centres reported a total of 7,122 laparoscopic procedures, including 5,307 in which laparoscopic surgery was performed. Laparoscopic treatment included puncture (21.3%), partial exeresis (51.3%) and complete exeresis (25.6%). Conversion to laparotomy was required in 20 cases (25.6%). A complementary surgical procedure was needed after the laparoscopic procedure within a delay of 78 days in 49 cases (58%). Laparoscopy was the only procedure used in 16% of the cases. RESULTS: Pathology reports of the surgical specimen indicated malignant lesions of the ovary in 78/5, 307 cases (1.47%) including 60 borderline tumours and 18 cancers. Among these 78 cases, preoperative work-up and laparoscopy had led to a diagnosis of a benign lesion in 17 (21.8%). Among the 49 cases with secondary surgery, a more advanced FIGO (International Federation of Gynaecology-Obstetrics) stage was observed in 11 (i.e. 8.3% of the 78 malignant cases) compared with the initial assessment. CONCLUSION: These findings demonstrate that it is not rare to discover the malignant nature of an ovarian tumour after initial laparoscopic treatment of a formation initially diagnosed as benign. Such accidents are the result of insufficient security in risk evaluation before laparoscopy. Whenever there is even a minimal risk of malignancy, laparotomy must be performed as the procedure of choice.

Adult↗
PubMed1995

Recurrent congenital toxoplasmosis in a woman with lupus erythematosus.

We describe the case of a patient with systemic lupus erythematosus, treated by corticosteroids, who presented during two successive pregnancies with serological reactivation of toxoplasmosis associated with fetal lesions. The first infected fetus died in utero with signs of hydrops. The second fetus was treated in utero with a combination of sulfadoxine and pyrimethamine, administered to the mother, and is now well. The increasing number of immunocompromised pregnant patients with immunity to Toxoplasma gondii may lead to a higher risk of reactivation of maternal toxoplasmosis and congenital infection.

Adult↗
PubMed1995

Laparoscopic management of malignant ovarian cysts: a 78-case national survey. Part 2: Follow-up and final treatment.

This paper reports a retrospective multi-institutional French survey carried out in 1992 to determine the incidence of laparoscopic management of malignant ovarian cysts. Of 5307 ovarian lesions treated endoscopically, 78 were malignant (1.47%) including 60 borderline tumours (77%) and 18 ovarian cancers (23%). Laparoscopic treatment was puncture in 23% of cases, partial exeresis in 51% and total removal in 26%. Laparotomy was immediately performed in 25% of the cases and as a second stage procedure in 58% (mean delay: 78 days). Laparotomy was not performed in 16% of the cases. Our findings suggest that laparoscopic management of ovarian lesions that subsequently prove to be malignant is not uncommon. To prevent the risk of metastasis, thorough pre-operative and per-operative evaluation is mandatory. In 22.4% of the patients presenting lesions in this study, laparoscopic tampering resulted in an upgrading of FIGO stage.

Female↗
PubMed1995

[Complications of hysteroscopic resections].

The complications in a series of 699 hysteroscopic resections are presented. These include 10 perforations, 8 métabolic syndromes, 1 endometritis et 2 haemorrhages. The incidents are rare, but can have serious consequences.

Adult↗
PubMed1995

[Hysteroscopic treatment of uterine fibromas].

OBJECTIVES: To study retrospectively the long-term outcome after hysteroscopic treatment for intrauterine fibromas. METHODS: From October 1987 to January 1993, endouterine glycolol resection was performed in 239 patients with intrauterine fibromas. The operation had to be repeated in 39 patients due to incomplete resection or recurrent symptomatology. Patients presented with menometrorrhage, post-menopausal metrorrhage or infertility. 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. The couple was sterile in 16 cases and 4 pregnancies were obtained (25%). Postmenopausal metrorrhage was present in 27 patients and the symptomatology disappeared in 24 (89%). In all, 196 women consulted for bleeding, good results were achieved in 81.1%. CONCLUSION: Endouterine resection is a sure, effective and long-lasting treatment for intrauterine fibromas.

Adult↗
PubMed1995

[Painful pelvic adhesion syndrome].

Pelvic adhesions may be responsible for pelvic pain, at least partially, in the following conditions: sequelae of past infection, chronic active inflammatory state, endometriosis, post-operative adhesions. The problem in the presence of adhesions is to determine whether pain is mechanical, inflammatory and/or linked to associated ovarian dystrophy, and what is the psychological component. The postulate "adhesion = pain" is far from constant and there is no systematic relationship between clinical picture and anatomical findings. After careful clinical and laboratory evaluation, celioscopy is the key diagnostic procedure. It should include thorough examination of all pelvic organs, of the abdomen in general and the peri-hepatic region in particular. A diagnosis of psychosomatic pain can be made only in the absence of any macroscopic, histological and bacteriological lesion, though bearing in mind that this term certainly covers failure to recognise other causes.

Diagnosis, Differential↗
PubMed1994

Laparoscopic management of malignant ovarian cysts: a 78-case national survey. Part 1: Pre-operative and laparoscopic evaluation.

This paper reports a retrospective multi-institutional French survey carried out in 1992 to determine the incidence of laparoscopic management of malignant ovarian cysts. Of 5307 ovarian lesions treated endoscopically, 78 were malignant (1.47%) including 60 borderline tumors and 18 ovarian cancers. In 33% of cases preoperative diagnosis indicated that the tumor was benign. Preoperative findings were suspicious in 59%. Laparoscopic treatment was puncture in 23% of cases, partial exeresis in 51% and total removal in 26%.

Adult↗
PubMed1994

Cloning, sequencing and characterization of the pepIP gene encoding a proline iminopeptidase from Lactobacillus delbrueckii subsp. bulgaricus CNRZ 397.

The proline iminopeptidase (PepIP) of Lactobacillus delbrueckii subsp. bulgaricus is a major peptidase located in the cell envelope. Its structural gene (pepIP) has been cloned into pUC18 and expressed at a very high level in Escherichia coli to give a PepIP activity 15,000-fold higher than that found in L. delbrueckii subsp. bulgaricus. The nucleotide sequence of the pepIP gene revealed an open reading frame of 295 codons encoding a protein with a predicted M(r) of 33,006, which is consistent with the apparent size of the gene product. The amino acid sequence of PepIP shows significant homology with those of other hydrolases involved in the degradation of cyclic compounds. In particular, there is a region which includes an identified catalytic site containing a serine residue and a motif specific for the active sites of prolyloligopeptidases (Gly-X-Ser-X-Gly-Gly). The PepIP opens a new way for supplying cells with proline using the peptides resulting from the proteolytic degradation of caseins.

Amino Acid Sequence↗