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D Querleu

Publications and source records attributed to D Querleu.

At least 73 records · Page 4Linked to original sources
PubMed1999

Virilizing ovarian dermoid cyst with peripheral steroid cells. A case study with immunohistochemical study of steroidogenesis.

A case of virilizing ovarian dermoid cyst with peripheral steroid cells and virilization is reported in a 62-year-old woman. The level of testosterone dropped to normal after oophorectomy. The cyst wall was bordered by a discontinuous band of steroid cells focally accompanied by smooth muscle cells. Immunohistochemically, the steroid cells were enzymatically active and displayed a profile similar to the internal theca cells of ovarian follicles. These steroid cells were most probably modified stromal cells associated with smooth muscle metaplasia of the ovarian stroma.

DNA-Binding Proteins↗
PubMed1999

[Relevance of surgical lymph node staging for malignant ovarian germ cell tumors].

BACKGROUND: The purpose of the study was to investigate the relevance of infrarenal paraaortic lymph node staging in the surgical procedure of malignant ovarian germ cell tumors in adults. METHODS: 84 cases (39 dysgerminoma, 45 nondysgerminatous tumors) were studied by means of a retrospective multicentric survey. RESULTS: Among the tumors limited to the ovaries, 36 were not completely staged, in particular the infrarenal paraaortic lymph nodes had not been explored. Disease recurred in 6 of these non-staged cases: 3 recurrences arose from the lymph nodes, and 2 patients died. However no recurrence was noted among the 13 patients who underwent complete surgical staging (statistically non-significative). We observed the same tendency among patients with advanced tumors that required complete peritoneal excision: there was no recurrence among the 6 patients having undergone lymph node dissection, whereas recurrence was noted in 2 of the 10 cases without lymph node dissection, one of which resulted in the death of the patient (statistically non-significative). CONCLUSION: In order to classify a tumor as stage I, it is essential that infrarenal lymph node dissection be performed, given the frequency of lymphatic involvement. Only then can the patient benefit from conservative surgery, possibly without any further treatment. The prognosis of advanced tumors that call for complete intraperitoneal excision also seems to be improved by retroperitoneal lymph node dissection. It can be carried out secondarily by laparoscopy, in which case chemotherapy can be quickly performed, as this type of surgery causes little morbidity.

Adult↗
PubMed1999

[Serous papillary cystadenocarcinoma of the recto-vaginal septum: a rare primary localization].

A primary serous papillary cystadenocarcinoma of the rectovaginal septum was diagnosed in a 35-year-old woman. There were invasive microfoci in peritoneum and lymph node micrometastasis as well as a small superficial non invasive tumor focus in the left ovary. Diagnosis was based on morphological, immunohistochemical and ultrastructural features of tumor tissue. The patient had surgery and post-operative chemotherapy. Progression of peritoneal disease was found six months after surgery. In this very rare location of serous carcinoma, tumor might have developed from peritoneal inclusions in the rectovaginal septum.

Adult↗
PubMed1999

[Treatment of urinary stress incontinence. Crtical review of randomized comparative results].

A large number of operations have been proposed for the treatment of female urinary stress incontinence, but no consensus has been reached about a possible reference technique. The objective of our study was to analyse the quality of the methodology and results of randomized prospective studies comparing various surgical techniques for urinary stress incontinence since 1978. The statistical methodology of most of these studies was far from perfect. They usually compared colposuspension and support techniques, while sling techniques were only rarely studied. Most surgical techniques give a similar short-term success rate, which declines with time. In the long-term, the Burch technique is superior to the other techniques with which it has been compared.

Female↗
PubMed1999

[Abdominal colposacroplexy for the treatment of vaginal vault prolapse with or without urinary stress incontinence].

OBJECTIVE: The aim of this study was to assess the factors of success in abdominal colposacropexy (CSP) procedures. PATIENTS AND METHODS: We performed 271 consecutive CSP between 1986 and 1997 (mean age: 48.8 years +/- 11.1). We reviewed 217 patients (80.1%). Mean duration of follow-up was 5.5 years (1-136 months). We performed: 18 CSP with Goretex mesh, 3 with resorbable mesh and 196 with Mersilene; 179 CSP with posterior colporraphy and 38 without; 208 CSP with culdoplasty (Moschowitz's procedure) and 9 without; 182 CSP with anterior and posterior meshes, 26 with posterior mesh only and 9 with anterior mesh only. RESULTS: 97.7% (212/217) of patients were cured for prolapse. 58% (125/217) had urinary stress incontinence totally cured and 82% (178/217) had urinary stress incontinence improved. Rejected grafts were 16.7% (3/18) with Goretex mesh and 1.1% with Mersilene mesh (p = 0.004). Recurrent prolapses were 1.1% (2/196) with CSP with posterior colporrhaphy and 7.9% (3/38) in CSP without (p = 0.009; OR = 0.14, CI = 0.02-0.86); 4/208 with CSP with culdoplasty and 1/9 with CSP without (p = 0.04; OR = 0.17, CI = 0.02-1.58). Recurrent stress incontinence was observed in 4/9 cases with CSP with anterior mesh only and 28/182 with CSP with anterior and posterior meshes (p = 0.03; OR = 0.34, CI = 0.12-0.97). CONCLUSION: CSP must use anterior and posterior Mersilene mesh. The CSP must be systematically combined with posterior colporraphy and culdoplasty (Moschcowitz's procedure).

Adult↗
PubMed1999

[Why we prefer the thin layer technique to conventional Pap smears. A double-blind study of 473 specimens].

The study evaluated the feasibility of a thinlayer technique on a routine basis for cervical smears and compared 473 ThinPrep preparations to the matched conventional Papsmears. The interpretation was double-blind and performed according to the Bethesda system. A consensus was established in discordant cases. The technique was easily mastered by gynecologists and technicians. Main advantages of the thinlayer technique were: a low number (1%) of unsatisfactory samples; a constant quality; homogeneity of cell distribution; the disappearance of problems of interpretation due to fixation or smear artifacts, red cells, polymorphs; a more precise interpretation, a firmer diagnosis; less visual fatigue; a shorter time of interpretation; the possibility of preparing more slides and performing special techniques on the same specimen. Main disadvantages were a higher cost and a necessary period of learning for cytologists.

Adult↗
PubMed1999

[Tolerance of synthetic tissues and vaginal surgery. Report of 287 cases].

OBJECTIVE: In this presentation, we attract attention to the disadvantage of using synthetic material in functional surgery of prolapse and urinary incontinence. PATIENTS AND METHODS: Two hundred eighty seven vaginal operations using synthetic material (Gore Tex, Dacron and Lyodura) were followed. The operations were: Mouchel procedure (127 cases), small slings (118 cases), large slings (11 cases), Stamey procedure (8 cases) and patch for paravaginal repair (23 cases). These operations were performed from 01/01/89 to 31/12/95. RESULTS: Mean follow-up at study end was 49 months. The intolerance phenomenon, leading to rejection, occurred between 1 and 72 months. The Mouchel procedure gave a rejection rate of 28.3% versus 9.3% for the slings (p < 0.001). Dacron was better tolerated (rejection rate at 19.3%) than Gore tex (rejection rate at 30.2%), p < 0.05. CONCLUSION: The substratum of the intolerance process would have two explanations (infection and foreign body reaction) for the early and late rejections. We suggest that the synthetic tissue tolerance is proportional to the exposed surface and to the distance which separates it from the vaginal scar. The ideal synthetic mesh material for pelvic surgery has yet to be developed.

Collagen↗
PubMed1999

[Clinical aspects of primary cancer of the fallopian tube. A retrospective study of 20 cases].

OBJECTIVES: From a review of 20 cases of primary carcinoma of the fallopian tube, we stress the various clinical aspects of the disease and discuss the possibilities of a preoperative diagnosis. MATERIALS AND METHODS: A retrospective study covering the period between 1982 and 1996. An analysis of the different etiological factors mentioned in the literature, of the physical signs and symptoms of the carcinoma, of the patients' age and hormonal status as well as the role of additional investigations was conducted. RESULTS: The average age of the patients was 62.3 years, 90% of the women had reached menopause and 15% were nullipara. A history of salpingitis was noted in 5% of the patients and another 5% had infertility problems. 20% of the patients had suffered from another carcinoma. Metrorrhagia was the most frequent clinical finding revealing the disease (55%) followed by abnormal secretions of blood stained liquid (15%). Hydrops Tubae Profluens was not observed in this series. The main complementary investigations performed were pelvic ultrasound scanning and hysterosalpingography, preoperative diagnosis was possible in 15% of cases; diagnosis was made during the operative procedure in 45% of cases and by pathologic examination in the remaining 40% of patients. CONCLUSION: Primary carcinoma of the fallopian tube is a rare form of cancer of unknown aetiology. Clinical signs are often unrelated and sometimes misleading; however, preoperative diagnosis is possible if one keeps in mind the existence of this carcinoma.

Aged↗
PubMed1998

Comparison of open retropubic and laparoscopic colposuspension for treatment of stress urinary incontinence.

The aim of this study was to compare the results of open retropubic (OC) and laparoscopic (LC) colposuspension to the Cooper's ligament (Burch operation). We matched retrospectively 72 LC and OC subjects according to their ages, the type of associated operations and the clinical stages of their urinary incontinence. We excluded associated prolapsus, previous surgical procedure for urinary incontinence, maximal urethral closure pressure lower than 30 cm of water, and instability of the detrusor. We estimated the comparability of our two series for other criteria which have an effect upon the postoperative results in the literature. The mean follow-up was 17 months for LC and 46 months for OC. LC operative time was longer than OC (mean: LC, 89 min; OC, 42 min), women considered LC less painful than OC. They needed less postoperative analgesia, mostly given only just the day of the procedure. LC length of hospitalization and return to normal activity was shorter than OC (mean: LC, 3 days; OC, 6.7 days; LC, 15 days; OC, 21 days). The graphs of the subjective cure and improvement rates made according to the Kaplan-Meier method could be compared with the log rank test (cure after 1 year: LC 79%; OC 69%; improvement after 1 year: LC 85%; OC 82%; cure after 2 years: LC 68%; OC 64%; improvement after 2 years: LC 80%; OC 75%).

Adult↗
PubMed1998

An objective experimental assessment of the learning curve for laparoscopic surgery: the example of pelvic and para-aortic lymph node dissection.

OBJECTIVES: To date the number of procedures required to become competent to perform new laparoscopic surgical techniques is not known. STUDY DESIGN: The pig model was chosen for assessment of the learning curve associated with an advanced laparoscopic procedure. A unilateral laparoscopic pelvic lymphadenectomy was performed by two residents and a laparoscopic para-aortic lymphadenectomy was performed by a fellow on a series of 20 pigs. The quality of the dissection was checked by immediate laparotomy by an independent observer. RESULTS: The operative objectives were: (a) There should be less than 5% residual lymph nodes. (b) The operating time should be less than 30 min for pelvic and less than 100 min for para-aortic lymphadenectomy. (c) Avoiding conversion because of complications. This target was achieved after 7 and 9 pigs respectively for pelvic lymphadenectomy and after 14 pigs for para-aortic lymphadenectomy. CONCLUSION: It is feasible to assess the learning curve of trainee surgeons while performing laparoscopic pelvic and para-aortic lymphadenectomy on pigs. A training programme such as this should prevent complications due to inexperience and should satisfy ethical and medico-legal considerations.

Animals↗
PubMed1998

Surgical complications of diagnostic and operative gynaecological laparoscopy: a series of 29,966 cases.

A multicentre study was carried out in seven top French centres for laparoscopic gynaecological surgery. This series covers a period of 9 years, in which 29,966 diagnostic and operative laparoscopic operations were performed. The risk of complications has been assessed according to the complexity of the laparoscopic procedure in question. The means of diagnosis and treatment of the complications have been analysed, together with the importance of the surgeon's degree of experience. The mortality rate was 3.33 per 100,000 laparoscopies. The overall complication rate was 4.64 per 1000 laparoscopies (n = 139). The rate of complications requiring laparotomy was 3.20 per 1000 (n = 96). The complication rate was significantly correlated with the complexity of the laparoscopic procedure (P = 0.0001). One in three complications (34.1%; n = 43) occurred while setting up for laparoscopy, and one in four (28.6%) were not diagnosed during the operation. As new indications for laparoscopic surgery in gynaecology have appeared, there has been a parallel and statistically significant increase in the rate of urological complications (P = 0.001). Increased experience by the surgeons has had three consequences: a statistically significant drop in the number of bowel injuries (P = 0.0003), a drop in the rate of complications requiring laparotomy for those laparoscopic surgical procedures that are well defined (P = 0.01), and a change in the way complications are treated, with a significant increase in the proportion of incidents treated by laparoscopy (P = 0.0001).

Female↗
PubMed1998

[Ovarian mucinous tumor of gastric and intestinal type associated with Peutz-Jeghers syndrome: in situ hybridization study of apomucin gene transcripts].

Occurrence of mucinous tumors is favored by Peutz-Jeghers syndrome (PJS). A case of bilateral ovarian mucinous tumor associated with ovarian mature teratoma occurring in a 22-year-old woman with PJS was reported. Tumor cells included 5 cell types: tall columnar mucinous pale cells with neutral mucins; goblet cells with acidic nonsulfated mucins; non mucinous columnar cells; mucinous cuboidal cells lining small glands; endocrine cells. Expression of the MUC2, MUC3, MUC5AC and MUC6 genes was demonstrated by in situ hybridization according to cell type. Some atypia and numerous mitotic figures were observed in basal glands. Diagnosis was ovarian borderline mucinous tumor with gastric and intestinal phenotype associated with PJS.

Adenocarcinoma, Mucinous↗
PubMed1998

[Value of postoperative urodynamic assessment for long-term urinary function results after treatment of genital prolapse. 103 examinations after treatment of genital prolapse].

OBJECTIVE: To evaluate the predictive value of postoperative urodynamic assessment on the apparition or the resurgence of genuine stress incontinence after a surgical procedure for genitourinary prolapse. SUBJECTS: 103 patients operated on for prolapse, with or without an associated surgical procedure for genuine stress incontinence. A review of the results of the urodynamic assessment carried out during the early post operative period was effected. RESULTS: 77.7% of the patients had an associated procedure for stress incontinence during surgery for prolapse. An urodynamic abnormality such as intrinsic sphincter deficiency and/or transmission ratio default was noted in 83.3% of the women who demonstrated incontinency during postoperative assessment, and in 76.7% of the patients without any problem of continence. During long term follow up, only 41.7% of the women who were incontinent shared intrinsic sphincter deficiency, and an abnormal cytometric parameter was noted in 74.4% of continent patients. 86% of the patients who were incontinent in the early postoperative period will remain so, whatever the result of the cystometric evaluation. CONCLUSION: Our results show that there is no correlation between the various cystometric parameters evaluated during the postoperative period, and the symptoms described by the patients. The absence of abnormal urodynamic assessment cannot consistently predict normal bladder function. Only postoperative symptoms can be considered to be predictive of a satisfactory surgical cure.

Adult↗
PubMed1998

[Security by using a micro-optic introduced by the Veress needle in laparoscopies].

Blind introduction of the Veress needle or the umbilical trocar is the cause of 1 to 4 injuries per 1,000 laparoscopies, particularly in case of abdominal adhesions. The aim of this experimental randomized study was to determine whether the needlescope can improve safety compared with the routinely used syringe test. Adult female rabbits were randomized into two groups of 20. Abdominal adhesions were created surgically in all animals. Three weeks later, a pneumoperitoneum was provoked under general anesthesia and five trocars were introduced into each animal after the needlescope test or the syringe test. The needlescope yielded high sensitivity. Adhesion formations were localized in 95% of the cases. Inversely, the syringe test localized adherences in only 50% of the cases. The number of organ injuries was identical for the two tests: 6.06 versus 6.25%.

Animals↗