Biomedical subjects
B Deval
Publications and source records attributed to B Deval.
Sclerosing stromal tumor of the ovary: color Doppler findings.
The sclerosing stromal tumor (SST) of the ovary is a distinct benign neoplasm that differs from fibromas, thecomas, luteinized tumors and lipoid cell tumors. It accounts for 6% of ovarian stromal tumors and tends to occur at an earlier age. On gray-scale ultrasound examination, SSTs of the ovary are solid or cystic and multilocular. We describe here, we believe for the first time, the findings on color Doppler imaging of an SST of the ovary. A 29-year-old woman presented with an organic ovarian mass. She underwent a transvaginal ultrasound examination that revealed an echogenic cyst with acoustic shadowing. Color Doppler demonstrated marked peripheral vascularization. Findings on computed tomography and magnetic resonance imaging strongly suggested the preoperative diagnosis of SST of the ovary, which was confirmed at pathology. Association of an echogenic ovarian mass with acoustic shadowing and a high degree of peripheral vascularization may strongly suggest the diagnosis of SST of the ovary.
[Sub-urethral tape: the French cultural exception].
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[Imaging pelvic floor prolapse].
OBJECTIVES: Dynamic MR imaging (MRI) may be used as an alternative to dynamic cystoproctography for the evaluation of pelvic floor prolapse. Our study aimed to define the range of dynamic pelvic MRI aspects observed during the exploration of pelvic prolapse. MATERIAL: Fascial and anatomic defects can include a combinaison of cystocele, rectocele, uterine prolapse, enterocele and vault prolapse. Acute diagnosis of the coexisting abnormalities is essential in planning reconstructive procedures so that the risks of recurrence and reoperation can be minimized. At this time colpocystography is the study of choice to evaluate pelvic floor dysfunction. Dynamic magnetic resonance imaging for exploration of pelvic floor dysfunction is under evaluation. RESULTS: Pubococcygeal line and puborectalis muscle were the references points. The grading system is based on degree of organ prolapse through the hiatus and the degree of pubo-rectalis descent and hiatal enlargement. Unfortunately, there is a real discordance between the reality of the prolapse and its imaging. However, a new reference line, the mid pubic line, was drawn on the magnetic resonance image to correspond to the hymeneal ring marker used in clinical staging. Intra-operative findings were considered the gold standard against which physical examination, dynamic colpocystodefecography and MRI were compared. Using these criteria the sensitivity, specificity and positive predictive value of MRI were 70%, 100%, 100% for cystocele; 42%, 81%, 60% for vaginal vault or uterine prolapse; 100%, 83%, 75% for enterocele; 87%, 72% and 66% for rectocele. CONCLUSION: MRI appears to be an important adjunct in the comprehensive evaluation of the female pelvis. Except for vaginal vault, pelvic prolapse is accurately staged and pelvic organ prolapse reliably detected. The technique is rapid, non invasive and cost effective, it allows the clinician to visualize the whole pelvis using a single dynamic study that provides anatomical details.
[For anterior levator plasty in the treatment of rectoceles in women].
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[New physiological, diagnostic and therapeutic concepts in the management of rectoceles in women].
Anterior rectocele is not only a herniation of the anterior rectal wall into the vagina, but rather a complex anatomical and functional abnormality which may be isolated or associated with other pelvic floor disorders. It could result in rectal obstruction with dyschezia, manual extraction of feces, and fecal or gas incontinence. The purpose of this review is to describe and to assess the most useful methods for the diagnosis and for the treatment of the rectocele. Data from physical examination may be improved by defecography. Surgery remains the main treatment: several surgical ways (perineal, anal, abdominal, laparoscopic) are described. Analysis of the anatomical and functional results allows to assess these techniques and to determine the best therapeutic option.
[Uterine morcellation during vaginal hysterectomy: apropos of a series of 216 prospective cases].
OBJECTIVE: The purpose of this study was to compare the surgical outcomes of women undergoing vaginal hysterectomy with and without morcelation. PATIENTS AND METHOD: Between December 1999 and December 2000, 216 women underwent vaginal hysterectomy without laparoscopic assistance at the Department of Gynecology of Hôtel-Dieu hospital in Paris. The patients were divided into two groups: 114 of them underwent vaginal hysterectomies with morcelation whereas 102 underwent vaginal hysterectomies without morcelation. The two groups were compared as to demographic data, total complications, operative time, hospital stay length and peri-operative hemoglobin concentration change. RESULTS: Although women undergoing morcelation were significantly younger (mean 49 versus 52, p = 0.01) and less parous (mean 1.9 versus 2.3, p = 0.03), there were no significant differences in other surgical or anesthetic risks factors, including weight, BMI, nulliparity and preexisting surgical diseases. Mean uterine weight was significantly greater in those undergoing morcelation (331 versus 110 g, p < 0.001); operative time was increased in the group which had undergone morcelation (331 versus 110 g, p < 0.001). There were no significant differences between the two groups with respect to peri-operative hemoglobin concentration change or hospital stay length. Finally, the rate of surgical complication was similar in the two groups (17.5 versus 21.5%). CONCLUSION: Although vaginal hysterectomy requires an increase in operative time, morcelation at the time of vaginal hysterectomy is safe and facilitates the vaginal removal of enlarged uteri without increasing peri-operative morbidity.
[Placement of a sub-urethral band in the treatment of female urinary incontinence. D. Dargent et al. Gynécol Obstét Fertil 2002;30;576-82].
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[Pubo vaginal and sub urethral slings: review].
BACKGROUND: Sling surgery is considered to be the gold standard for treatment of female stress urinary incontinence resulting from sphincter deficiency. A century of experience is reviewed and evolving new concepts and techniques are presented. METHODS: This article reviews 34 retrospective studies involving 2 967 interventions. RESULTS: and discussion. Sub urethral sling procedures have been reserved traditionally for the treatment of recurrent stress incontinence, autologous or heterologous slings are used and the success rate varies between 65 and 98%. Objective long term results have been excellent but the rate of voiding disorders and de novo detrusor instability is respectively from 12.8% and 16.6%. The TVT procedure (Tension free vaginal tape) was described by U. Ulmsten in 1996. The mesh is placed under the uretra and supports the integral theory of Ulmsten and Papapetros. Its success is bound by its efficacy, its reproducibility and restricted morbidity. CONCLUSION: The pubovaginal sling remains an excellent operation for the cure of stress urinary incontinence related both to sphincter deficiency alone or existing with urethral hypermobility. About Prolene tape, the present review of adverse outcomes may simply reflect an overall increase in the number of sling procedures being performed. Although decreased operative time and morbidity have been attributed to the use of TVT tape, it is essential to ensure that long-term safety and efficacy will not be jeopordised before accepting it as a new standard of care.
[Great elongation of uterine cervix: retrospective study of 20 cases].
BACKGROUND: The aim of the study was to evaluate the safety and efficacy of the Musset Poitout surgical procedure consisting in an anterior uterosacral ligament transposition and a cervix amputation. The main indication is an uterovaginal prolapse with an isolated elongation of the cervix. METHODS: A retrospective consecutive series of 20 women with an elongation of uterine cervix undergoing Musset Poitout procedure over a 10 year period between 1990 and 2001 with analysis of per and post operative complications and success. Four Kelly urethral plications were performed in the same time. The patient's ages, time under anesthesia, change in hemoglobin, days of hospitalization, medical illnesses, complications and follow-up were assessed. Failure was defined as a symptomatic elongation of the cervix or a third degree hysterocele on examination. RESULTS: and discussion. The median age of Musset Poitout procedure was 43.9 years (range 23-83). General anaesthesia could be performed in all patients. Mean operation time was 67 minutes (range 40-130). No major per or post operative complications occurred. The average of post-operative bladder cathetherisation was 3.65 days, the average hospital stay was 6.3 days. Complications were insignificant: urinary tract infection in 2, voiding dysfunction in 2. All the patients but 2 were followed for a mean 59 months (range 6-127). There was one recurence (5.5%). CONCLUSION: In this preliminary assessment the Musset Poitout procedure offered significant avantages in a genital prolapse with elongation of the cervix.
[Prolapse in the young woman: study of risk factors].
OBJECTIVE: To determine the risk factors for genital prolapse in a group of 37 young women less than 45 years old. PATIENTS AND METHODS: We studied 37 young women who had been operated for genital prolapse, whereas the control group consisted of women operated for benign gynaecologic disorders. RESULTS: In the study group the number of pregnancies and deliveries, the babies' weight, the positive family history of prolapse were heavier than in the control group. The women with prolapse had more often chronic pulmonary diseases, asthma, as well as operations for abdominal hernias. The mode of delivery, be it a cesarean section or the use of forceps, and the active second stage of labor had no effect whatever on the occurring of genital prolapse in young women. CONCLUSION: Our data support the suggestion that multiparity, babies' weight and congenital factors are responsible for a higher rate of genital prolapse in young women.
[In response to the article by V. Juhan Duguet et al].
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Objective and subjective cure rates after tension-free vaginal tape for treatment of urinary incontinence.
OBJECTIVES: To assess the objective and subjective cure rates after the tension-free vaginal tape (TVT) procedure in women with urinary incontinence. METHODS: We performed a retrospective analysis of 112 consecutive women with genuine stress (n = 88) and mixed (n = 24) incontinence. The objective cure rate was evaluated by clinical and urodynamic examinations and the subjective cure rate using the Contilife questionnaire. The mean follow-up time was 25 months (range 18 to 34). RESULTS: The mean operative time was 30 minutes (range 25 to 50). Most patients (58%) underwent surgery with locoregional anesthesia. The overall complication rate was 37.5% (42 of 112). The perioperative complication rate was 14.3%, including 13 bladder injuries (11.6%). Five (38.5%) of the latter occurred in 7 patients with a previous history of incontinence surgery (P <0.001). The early postoperative complication rate was 32.1%. The main complication was voiding difficulties, diagnosed in 14 patients. Ten (71.4%) required intermittent self-catheterization for less than 15 days and four for a mean duration of 28 days (range 15 to 90). The late postoperative complication rate was 29.4%, including 29 cases of de novo urge symptoms (25.9%). Anticholinergic drugs were effective in only 15 (51.7%) of the 29. The objective cure rate was 89.3%. No difference was found between patients with genuine stress incontinence and those with mixed incontinence. The subjective cure rate was 66%. The difference in cure rates between the objective and subjective evaluations was significant (P <0.05). The subjective cure rate in patients with de novo urge symptoms was 37.9%. CONCLUSIONS: Our results demonstrate that the TVT procedure is a safe and effective surgical method. The lower subjective cure rate was related to the high incidence of de novo urge symptoms.
Results of recto-vaginal fistula repair: retrospective analysis of 48 cases.
OBJECTIVE: To evaluate the long-term outcome of the Musset technique of recto-vaginal fistula (RVF) repair. STUDY DESIGN: During the years 1992-1998, 48 women underwent recto-vaginal fistula repair. A retrospective study in a university tertiary referral center was conducted. RESULTS: The main etiologies were obstetrical trauma (25), local infection (11), inflammatory disease (7), and post surgery (3). Thirty women (63%) had a previous fistula repair failure. The mean+/-S.D. fistula diameter was 1.4+/-1.0, and in 40% of the patients the fistula diameter was >2.5cm. In 19 cases (39.6%) there was a complete opening of the perineum and anal sphincter. Gas and stool incontinence before the operation were noted in 85 and 75% of the patients, respectively. Successful anatomic results were achieved in all patients. Five patients were re-operated due to gas and stool incontinence, and all but one had satisfactory anatomic and functional satisfactory results. The success rates in women with Crohn's disease and with a previous RVF repair failure were 100 and 98%, respectively. No major intra or postoperative complications were noted. CONCLUSION: The Musset procedure provide excellent anatomic and functional results and women with Crohn's disease or previous RVF repair have comparable long-term results.
Lidocaine spray and outpatient hysteroscopy: randomized placebo-controlled trial.
OBJECTIVE: To assess the efficacy of lidocaine spray during outpatient hysteroscopy for reducing procedure-related pain and to identify risk factors for discomfort. METHODS: One hundred twenty-one women were assigned randomly to have application of lidocaine spray or placebo to the uterine cervix during outpatient hysteroscopy. The main outcome measure was pain during hysteroscopy, assessed on a visual analog scale. RESULTS: There was no statistically significant difference between study and control groups in mean age, rate of nulliparity, postmenopausal state, need for cervical dilation, or percentage of women who used hormone replacement therapy. Indications for diagnostic hysteroscopy were similar between groups. Women in the lidocaine group had statistically significantly less pain during the procedure than women in the placebo group (2.2 +/- 1.9 and 3.7 +/- 2.5, respectively; P <.001). Women with abnormal uterine findings (submucous myoma, endometrial polyps, or intrauterine adhesions) had significantly higher pain scores than women with normal cavities (2.2 +/- 1.9 and 3.2 +/- 2.4, respectively; P <.002). Aerosol anesthesia and normal uterine findings were independently associated with less pain. No procedure had to be abandoned because of excessive pain or complications, and no women required hospitalization. CONCLUSION: Women treated with lidocaine spray had significantly less pain. Uterine cavity abnormality might be associated with a higher degree of pain during hysteroscopy.
[Hormone replacement therapy after endometrial or ovarian cancer].
Use of hormonal replacement therapy after treatment of ovarian or endometrial cancer remains a matter of debate. Novel adjuvant therapies tend to increase the survival of these patients, who are exposed to risk factors of hormonal deficiency subsequent to primary therapy. Therefore, the aims of the present review of literature was to analyse epidemiologic and clinical parameters on behalf on hormonal replacement therapy in this population.
[Bladder endometriosis. Apropos of 4 cases and review of the literature].
The aim of our study is to evaluate the diagnostic and therapeutic attitude toward endometriosis of the bladder. We have analysed four observations treated in the gynecologic service of Hotel-Dieu in Paris between January 1989 and January 1998, which represents 1.3% of all endometriosis operated during this period. Every patient underwent echography, RMN, UIV and cystoscopy. In all for cases a surgical treatment by laparotomy was realised. The choice of this way is explained by the multiple localisations of endometriosis in three cases and the impossibility of a coelioscopic treatment in the forth. The anatomopathologic exam found endometriosis in all of the cases.
[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.