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C Hocke

Publications and source records attributed to C Hocke.

At least 19 recordsLinked to original sources
PubMed2003

Is laparoscopy still the gold standard in infertility assessment? A comparison of fertiloscopy versus laparoscopy in infertility. Results of an international multicentre prospective trial: the 'FLY' (Fertiloscopy-LaparoscopY) study.

BACKGROUND: The aim of this prospective multicentre study was to compare the two endoscopic techniques of laparoscopy and fertiloscopy in routine evaluation of the pelvis in infertile women. METHODS: A total of 92 women was selected in 14 University Hospitals to undergo fertiloscopy followed by transabdominal laparoscopy by a team of two surgeons in each hospital. RESULTS: A high degree of concordance was observed between these two techniques, in that if fertiloscopy did not detect any abnormalities, this was also confirmed by laparoscopy. Discordance was observed in similar numbers of cases: eight after laparoscopy and nine after fertiloscopy. The diagnostic index for fertiloscopy and laparoscopy was calculated; sensitivity (86 and 87% respectively) and negative predictive value (64 and 67% respectively) were similar. The kappa index was also calculated for each of the six structures/regions (right/left tube; right/left ovary; peritoneum of pouch of Douglas; posterior uterus), and concordance (0.78 to 0.91) was considered almost complete. CONCLUSIONS: These results confirm fertiloscopy as a minimally invasive safe procedure that may be considered as an alternative to diagnostic laparoscopy in the routine assessment of women without clinical or ultrasound evidence of pelvic disease. On the basis of the additional advantages of fertiloscopy, namely salpingoscopy or microsalpingoscopy, it is considered that fertiloscopy could replace laparoscopy as a routine procedure in such women.

Adult↗
PubMed2000

[Prognostic factors for survival of ovarian epithelial cancers: apropos of 287 cases].

OBJECTIVES: To evaluate survival and assess prognostic factors in patients with epithelial ovarian cancer. METHODS: Retrospective analysis of 287 patients treated between 1975 and 1995. All operations were performed by senior surgeons. Histologic sections were reviewed by the same pathologist. Successive adjuvant chemotherapy regimens are described. Survival was evaluated in 1997. Follow-up lasted 25-260 months (median 90). Statistical methods included Kaplan-Meier survival curves, logrank test and multivariate analysis. RESULTS: The five-year survival rates 76%, 42%, 21% and 6% for patients with stage I, II, III and IV disease, respectively. Age, FIGO stage, cytology of ascites, histologic type and grade, extent of surgery and number of residual tumors were significant prognostic indicators in univariate analysis. Multivariate analysis showed that the risk of mortality was reduced by 57% for patients whose tumor distribution permitted optimal surgery (RR = 0.43, 95% CI [0.29-0.64]; P < 0.001). The risk of mortality according to FIGO stage was 2.8 (95% CI [1.2-6.3]; P = 0.01) for FIGO II, 5.6 (95% CI [2.9-10.8]; P < 0.001) for FIGO III and 10.5 (95% CI [4.9-22.1]; P < 0.001) for FIGO IV in comparison with FIGO I. The risk of mortality for patients treated with alkylating agents, platinum-based combination chemotherapy taxanes or carboplatin plus paclitaxel regimen compared with patients who did not receive treatment was reduced by 47% (95% CI [8%-69%]; P = 0.025), 55% (95% CI [22%-74%]; P = 0.005) and 70% (95% CI [35%-86%]; P = 0.002), respectively. Patients with a serous epithelial carcinoma had a 1.7-fold higher risk of mortality than patients with other histologic types (RR = 1.7, 95% CI [1.1-2.8]; P = 0.02). CONCLUSION: Our study confirms the benefit of cytoreductive surgery and the efficacy of platinum plus paclitaxel first-line chemotherapy, which has recently been recognized as the standard treatment for advanced epithelial ovarian cancer.

Adult↗
PubMed1999

Devic's neuromyelitis optica during pregnancy in a patient with systemic lupus erythematosus.

Neuropsychiatric forms of systemic lupus erythematosus (SLE) vary, most commonly consisting of seizures, psychiatric disturbances, or focal central nervous deficits. This is a new case of neuromyelitis optica or Devic's syndrome during the course of SLE. Few reports of this association exist in the literature. Our objective is to report this unique case of Devic's neuromyelitis optica during pregnancy in a patient with systemic lupus erythematosus. A 28-year-old woman had been diagnosed as having SLE with cutaneous and articular involvement in 1987 when she was 17 years old. She was treated with a synthetic antimalarial agent associated with corticosteroids. In 1994, during the fourth month of pregnancy, she had signs of transverse myelitis with a sensory level at T6 associated with an optic neuropathy suggesting a Devic's syndrome. The patient was managed by plasmapheresis sessions and intravenous corticosteroids. Transverse myelitis recurred postpartum and three years later at the same thoracic level. Management by bolus administration of a steroid and cyclophosphamide resulted in remission again. There have only been around a dozen reports in the literature of patients who had both Devic's neuromyelitis optica and SLE. Magnetic resonance imaging is contributive to diagnosis and therapeutic follow-up, showing spinal cord lesions with increased intensity on T2-weighted sequences. Although the clinical course of the present patient has been favourable so far, the prognosis of this neurologic disease is generally considered to be poor with elevated mortality.

Adrenal Cortex Hormones↗
PubMed1999

[The value of hysteroscopy after repeated implantation failures with in vitro fertilization].

OBJECT: we attempt to determine the usefulness of uterine re-assessment by hysteroscopy in women with two unsuccessful IVF-ET attempts. MATERIAL AND METHOD: This retrospective study concerns seventy-three infertile women who have had a repeat uterine hysteroscopy after two implantation failures in IVF. RESULTS: In half the cases, an abnormality was diagnosed. Cervical abnormalities (synechia, polyp, false passage) and hormono-dependent abnormalities (polyp, hyperplasia, submucous myoma) were the most frequent findings. The rate of pregnant women raises to twenty-two percent after treatment of these abnormalities. CONCLUSION: Regarding our experience, it seems legitimate to perform hysteroscopy in women who have had two IVF-ET failures before attempting a third procedure.

Adult↗
PubMed1998

Cervical dysplasia and human immunodeficiency virus infection in women: prevalence and associated factors. Groupe d'Epidémiologie Clinique du SIDA en Aquitaine (GESCA).

OBJECTIVE: To study the prevalence of Cervical Intraepithelial Neoplasia (CIN) and its association with HIV-I infection, controlling for other risk factors of CIN. DESIGN: Cross-sectional survey. SUBJECTS AND METHODS: HIV-1 seropositive (HIV+) and seronegative (HIV-) women were enrolled at the Obstetrics-Gynecologic Departments of the Bordeaux University Hospital from April 1993 to June 1995. A gynecologic check-up was performed with a clinical examination, a colposcopy and a Papanicolaou smear. Sexually Transmitted Diseases (STDs) were screened. Colposcopy was interpreted as: normal, low-grade or high-grade lesions. Interpretation of Papanicolaou smears was based on the 1988 Bethesda system using three descriptive diagnoses: normal, low-grade and high-grade Squamous Intraepithelial lesions (SILs). If colposcopy showed a high grade lesion or Papanicolaou smear a high-grade SIL, a cervical biopsy was performed. Absence of CIN was defined by normal Papanicolaou smear and colposcopy. High grade CIN was defined by either identification of high grade SIL on Papanicolaou smear or high grade lesion on colposcopy confirmed by CIN2-3 lesion on biopsy. Other cases were classified as low-grade CIN. HPV infection was diagnosed on presence of koilocytosis on cytological or histological specimens. RESULTS: Prevalence of CIN was significantly higher in the 128 HIV+ women than in the 102 HIV- women: 34.4% vs. 13.7% (O.R.=3.30). Among HIV+ women, 25.8% had low-grade CIN and 8.6% high-grade CIN versus 10.8% and 2.9%, respectively among the HIV- women. Prevalence of HPV infection was 50.0% among women with CIN vs. 5.8% in women without CIN (P= 10(-6)). In the multivariate analysis of the determinants of CIN, smoking more than ten pack-years and HPV infection were the only two variables associated with CIN while association with HIV infection disappeared. Among HIV+ women, the variables associated with CIN were clinical AIDS and HPV infection.

Acquired Immunodeficiency Syndrome↗
PubMed1996

[Can the type of GnRH used during long in vitro fertilization protocols influence the pregnancy rate?].

Luteal defect is common during IVF cycles using GnRH agonist. It could be interesting to make up for this problem by using short acting GnRH agonist (effective for 24 hours), more handy at the end of the stimulation. 160 patients included in a long IVF protocol at the Bordeaux CHRU FIV center have been randomized, from September 1993 to August 1994, for the analog's choice (long or short) at the beginning of the stimulation. The stimulation's parameters, the hormonal dosages and the pregnancy rate are independent of the galenic form used. In close, the use of long-acting GnRH analog (sympler to use) sems preferable.

Adult↗
PubMed1995

Prospective cohort study of the effect of pregnancy on the progression of human immunodeficiency virus infection. The Groupe d'Epidémiologie Clinique Du SIDA en Aquitaine.

OBJECTIVE: To study the prognostic role of pregnancy on the progression of human immunodeficiency virus (HIV) infection. METHODS: In a prospective cohort study at the Bordeaux University Hospital, France, 57 women who completed a pregnancy during the course of their HIV infection were compared with 114 HIV-infected women who never conceived. The two groups were matched on CD4 lymphocyte count (CD4), age, and year of HIV diagnosis. The main outcome measures were death, occurrence of a first AIDS-defining event, and drop of the CD4 below 200/mm3. RESULTS: The mean follow-up period in pregnant women was 61 months from HIV diagnosis (median CD4 at entry 455/mm3) and 54 months from beginning of pregnancy. Nonpregnant women were followed-up for 50 months since HIV diagnosis (median CD4 460/mm3). The proportion of asymptomatic women at entry in the study was 51 of 57 (90%) in pregnant and 87 of 114 (76%) in nonpregnant women. No significant difference was observed between the two groups with regard to the different end points studied, even after adjustment for other prognostic variables. Adjusted hazard ratios (pregnant/nonpregnant) were 0.92 for death (95% confidence interval [CI] 0.40-2.12), 1.02 for occurrence of a first AIDS-defining event (95% CI 0.48-2.18), and 1.20 for drop of the CD4 to less than 200/mm3 (95% CI 0.63-2.27). CONCLUSION: In a cohort of HIV-infected women with mild to moderate immunosuppression, pregnancy did not accelerate progression to AIDS or death.

Adolescent↗
PubMed1995

[Thromboembolism and ovarian hyperstimulation].

Three new cases of thromboembolic accidents involving the superior vena cave were associated with ovarian hyperstimulation and multiple pregnancy. On the basis of a review of the literature, three syndromes were individualized. First embolic arteries are infrequent and serious with an important morbidity; low doses of gonadotrophines is sufficient for causing this pathology. Second, thrombosis of the superior vena cava is late, during in vitro fertilization regimens with GnRH analogs complicated with serious hyperstimulation (degree III). Third, pregnancy is always present; pulmonary complications are very uncommon. Thrombosis of inferior vena cava is late, pregnancy is often present but women are frequently at risk of thromboembolic accident. Prevention of hyperstimulation is important. When present, HBPM is recommended for prevention of thromboembolism. Diagnostic of thrombosis is made with clinical examination and morphologic complementary exams such colour-vascular Doppler and magnetic resonance imaging. Curative treatment requires heparinization.

Adult↗
PubMed1994

[Evaluation of 3 diagnostic methods in premature rupture of membranes: diamine-oxidase assay, alpha-fetoprotein assay, colorimetric method evaluating the pH].

The authors set out to assess the three diagnostic methods available which can detect early breaking of the membranes: radio-enzymatic assay of diamine-oxidase (DAO), radioenzymatic assay of alpha-fetoprotein (AFP), colorimetric method for determining pH (Amnicator). Between June 1991 and March 1992, 114 samples of vaginal secretions were taken from 104 pregnant patients being followed up at Maternity Unit A, Bordeaux (France). The results of the assays were expressed in quantitative terms (microU/ml for DAO and ng/ml for AFP); ROC (Receiver Operating Characteristic) curves were used to determine the positivity threshold in terms of the sensitivity and specificity (20 microU/ml for DAO and 15 ng/ml for AFP). The sensitivity of the pH test was 97.5%, which was significantly better than that of DAO (90.2%) and even that of AFP (82.9%). However, there was no difference between the specificities of the pH, DAO and AFP tests (93.3%, 96.6% and 93.5% respectively). The data were compared with those in the literature. The problems in collecting the vaginal secretions probably accounts for the better results of the colorimetric test. This is a reliable, fast and easily reproducible test; these qualities make it the preferred test in EBM, and it can be completed using a radioenzymatic method (DAO) or immunoradiometric test (AFP).

Adult↗
PubMed1993

[Prognostic role of pregnancy on the course of HIV infection: a retrospective cohort study (1985-92)].

In a hospital-based cohort study of HIV-infected patients, we compare the progression of the disease (occurrence of CDC group IV, death, decline of CD4 below 200/mm3) between 55 women with delivery and 89 matched control HIV positive women with no history of pregnancy. After a mean follow-up of three years, no significant difference was observed between the two groups even after adjustment on prognostic variables.

Cohort Studies↗
PubMed1992

[Induction in the scarred uterus].

Labor was induced in 41 women with uterine scarring and a fetus in the cephalic presentation and normal pelvis size. Due to various problems, these patients would have had to undergo cesarean section if this alternative had not been attempted. The use of prostaglandins E2 to increase maturation of the cervix, of Syntocinon and peridural analgesia made it possible to obtain delivery through the genital tract in 24 cases with the same level of fetal morbidity as for the babies delivered by cesarean.

Analgesia, Epidural↗
PubMed1991

[Use of etilefrin as local vasoconstrictor in lower gynecologic surgery ].

In this randomized prospective study the authors have compared the effectiveness and side-effects of two local vasoconstrictor agents, etilefrine (Effortil) and ornithine 8 vasopressin (Por 8) in vaginal gynaecological surgery. Thirty-three patients entered the trial and were divided into two groups: G1 (15 patients) received Effortil, and G2 (18 patients) received Por 8. The products, administered at random, were diluted in saline 40 ml and injected into the cervix through 6 points. A 3-minute interval was allowed between injection and incision. The results were assessed on the basis of trans- and postoperative haemorrhage and haemodynamic variations. Palor of the cervix was achieved after 3 minutes in both groups; moderate bleeding was observed in only one of the G1 patients. Postoperative renewal of packing was necessary in 2 patients in G1 and 4 patients in G2. No electrocardiographic anomaly was recorded in any of the two groups. Diastolic BP was significantly higher in G2 than in G1 (P less than 0.002, Fisher test). Systolic BP was also elevated in that group (P less than 0.03, chi 2 test). Moderate reduction in heart rate was observed in both groups (P less than 0.3, Fischer test), but severe (48 beats/min) bradycardia was noted in one G2 patient.

Adult↗
PubMed1989

[Another case of Sertoli-Leydig cell ovarian tumor (arrhenoblastoma). Review of the literature].

In reporting another case of Sertoli-Leydig cell tumor (SLCT) treated by conservative management, the principal characteristics of these tumors are reviewed and a general review is made: SLCT (arrhenoblastomas) are rare endocrine tumors (1 p. cent of tumors of the ovary). They most frequently occur in young women, are unilateral in 98 p cent of cases, and are manifest after a long period by endocrine signs (75 p. cent of cases) whose most frequent combination is: amenorrhea-hirsutism-hoarse voice. They are classified in four histological types which have different prognoses. Their potential development varies and is variously assessed: these are tumors with a low incidence of malignancy (mean 18 p. cent). Under certain conditions, this permits the institution of conservative therapy conserving future fertility. Malignant types of tumors are treated in the same way as other malignant ovarian tumors: surgery is the main tool; radiotherapy is often insufficient and chemotherapy often provides remission more frequently than cure (80 p. cent 5 year survival).

Adult↗
PubMed1985

[Conservative loco-regional treatment of soft tissue sarcoma in adults after induction chemotherapy].

Between June, 1979 and December, 1983, 23 adult patients with non-metastatic soft tissue sarcoma were treated with induction chemotherapy since local spread precluded primary conservative surgery. Eighteen patients received a combined cyclophosphamide, vincristine, adriamycin and dacarbazine treatment and 5, a combined adriamycin, cis-platinum and vindesine treatment. Both drug combinations exhibited toxic effects, notably on blood and digestive tract. However, tumoral volume was reduced by 50 p. cent or more in 14/23 patients, including 2 complete remissions; the course of the disease remained unchanged under treatment in only 3 cases. Chemotherapy facilitated surgical excision in 14 patients, and subsequent radiotherapy resulted in complete remission in 13 of these. None of the 13 patients relapsed during a mean follow-up period of 12 months (range: 3 to 48 months). Among the 9 patients who could not be operated upon, 5 benefited from radiotherapy with satisfactory local control, but only one still remains in complete remission. Thus, induction chemotherapy made it possible to achieve local control in two-thirds of patients with locally advanced sarcoma. However, a more prolonged follow-up is necessary to confirm that these results are long-lasting and to determine the effects of chemotherapy, if any, on the metastatic potential of these tumours.

Adult↗