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F Sergent

Publications and source records attributed to F Sergent.

34 records · Page 2Linked to original sources
PubMed2004

[Abdominopelvic actinomycosis: a tumoral syndrome due to bacterial infection].

The purpose of this review is to define the diagnostic steps and treatment of abdominopelvic actinomycosis. Three cases are described which illustrate the variety of clinical presentations ranging from acute peritonitis to chronic pseudo-tumor. The diagnosis of actinomycosis is rarely made pre-operatively. Bacteriologic culture is seldom helpful and imagery findings are non-specific. The diagnosis is usually made retrospectively based on histologic examination. In women, an intrauterine contraceptive device is often a concomitant factor. Long-term antibiotic treatment (several Months) with high-dose penicillin-based medications is the mainstay of therapy. Despite a high risk of complications, surgery is often necessary both for diagnosis and treatment. Resection or drainage may diminish the dosage and duration of antibiotic therapy, and helps to minimize infectious complications. Actinomycosis should be included in the differential diagnosis of abdominopelvic tumors, inflammatory bowel disease, and endometriosis-particularly in a woman with an intrauterine contraceptive device.

Abdominal Abscess↗
PubMed2004

[Factors predictive of uterine rupture after operative hysteroscopy].

OBJECTIVES: To identify factors predictive of uterine rupture after operative hysteroscopy. When these factors are present, to search for means to prevent a later uterine rupture. Lastly to specify criteria allowing extraction of the fetus before rupture. PATIENTS AND METHODS: Dramatic description of a case of uterine rupture, in a patient who presented a history of uterine perforation secondary to operative hysteroscopy and retrospective analysis of 12 similar observations reported in the literature. RESULTS: Two types of situations must be differentiated: uncomplicated hysteroscopic resection of a polyp or sub-mucous fibroid does not seem to modify the obstetrical outcome; metroplasty for uterine malformation, complex synechia resections, and uterine perforations using monopolar current section are high-risk situations predictive of uterine rupture during pregnancy. CONCLUSION: Uterine ruptures secondary to operative hysteroscopy are rare but serious. They can occur before onset of labor, and compromise vital maternofetal outcome. Risk factors can be identified, but nothing can prevent natural history towards uterine rupture during pregnancy. The obstetrician's vigilance in this context must be extreme searching for the least clinical sign in favor of a pre-rupture of the uterus. Furthermore, systematic caesarean is not justified.

Adult↗
PubMed2004

[Does tension-free vaginal tape (TVT) have a place in the treatment of sphincter incompetence?].

OBJECTIVE: The objective of this article is to estimate results and place of TVT in female stress urinary incontinence with intrinsic sphincter incompetence. MATERIAL AND METHOD: This was a retrospective study over a period of 57 months in a population of 38 patients treated by TVT for sphincter incompetence with or without inefficient pressure transmission. Mean patient age was 52 years. Fourteen patients (37%) had a history of incontinence surgery. The physical examination demonstrated urethral mobility in 22 patients (58%) and positive Bonney or Jacquetin tests in 15 patients (39%). Mean maximum urethral closure pressure was 40 cm H2O, with 12 patients (32%) 30 cm. Six patients (16%) had detrusor instability. Seven patients (18%) had pure sphincter incompetence. RESULTS: Median follow-up was eight months (two months to 32 months). Twenty five patients (66%) were cured, nine (24%) improved and treatment failed in four (10%). Results are less satisfactory for patients with preliminary failure of incontinence surgery, fixed urethra, pure sphincter incompetence or with detrusor instability without inefficient pressure transmission. The only major complication was an expulsion of the prosthesis. CONCLUSION: Results of TVT in sphincter incompetence are slightly less satisfactory than in pure urinary stress incontinence. In a short follow-up, they are comparable in sphincter incompetence to those of sling procedures which are the current gold standard. Risk of urinary retention is lesser. The minimally invasive nature of TVT suggests that it will replace sling procedures in the future for this particular indication. Longer follow-up will be necessary for confirmation.

Adult↗
PubMed2004

[Acceptability of the etonogestrel-containing contraceptive implant (Implanon)].

OBJECTIVES: To estimate the exact satisfaction of women toward Implanon, the sole contraceptive implant available in France. To clarify the indications of this type of contraception. MATERIAL AND METHOD: Among a population of 182 women with Implanon" inserted in a same family planning service between May 22, 2001 and February 14, 2003, 108 women agreed to answer a questionnaire of satisfaction. Implants were inserted in one third of cases after childbirth, in another third after abortion. The average duration of use of the implant was of 16 months (2 in 24 months). Twenty-nine removals among the 108 insertions (27%) were recorded. RESULTS: Possibility of a long-term and easy -to-use contraception was the most common reason for choosing Implanon (74% of the women). Eighty-one percent of the women were globally satisfied with Implanon but one out of two women had side-effects. Only 62% of the women were ready to use it again. Adverse events were first, menstrual disturbance in 83% of the women, mainly amenorrhea (26%) and bleeding irregularity (40%). Bleeding irregularity was one of the main motives for discontinuing the implant in 41% of cases. Except weight gain present for 37% of patients, the other side-effects, even though they were frequent, were less often the reason for removal. Headache, acne, breast pain, mood and decreased libido were the main reasons for removal. CONCLUSION: Implanon has certainly a place among current contraceptive methods. Because of the frequency raised by adverse events and by their lower tolerance in Europe, this place has to remain limited to the incapacity of classic methods. Preinsertion counseling announcing Implanon's benefit and risk effects is necessary to minimize the early discontinuation rates.

Adolescent↗
PubMed2003

[Crohn's disease and pregnancy. About 34 cases. Review of the literature].

OBJECTIVE: To define the optimal conditions of pregnancy in patients affected by Crohn's disease. MATERIAL AND METHOD: Retrospective study of 25 patients affected by Crohn's disease, followed during eight years at Rouen's University Hospital. RESULTS: Twenty patients added up 34 pregnancies. Seventeen patients at least had a child, adding up 26 livebirths. Among the 17 pregnancies beginning with an active Crohn's disease, this proved to be still active in 16 cases. Among the eight interrupted pregnancies, six had an active disease. Out of the five menaces of preterm delivery stopped or not, four were in push. Eight neonatal hypotrophies were connected to a push. DISCUSSION AND CONCLUSIONS: From a confrontation between the data of the literature and our experience, it emerges the following essential points: when Crohn's disease is quiescent, it does not affect the pregnancy, except a moderate fetal hypotrophy. When the disease is active, the risk of abortion and prematurity increases. There is no influence of the pregnancy on Crohn's disease, when pregnancy arises during a period of quiescence of the disease. Two thirds of the pregnancies of these women take place without new push of their disease. During pregnancy, there is no contraindication as far as the usual treatments of Crohn's disease are concerned, with a limitation however for the use of immunosuppressants.

Abortion, Spontaneous↗
PubMed2003

[Reflex sympathetic dystrophy involving the ankle in pregnancy: characteristics and therapeutic management].

We report the case of a multigravida presenting in the first trimester of pregnancy with reflex sympathetic dystrophy involving both ankles. Preferential location of reflex sympathetic dystrophy in pregnancy is classically the hip (9 times out of 10). Symptoms develop mostly with primipara in the third trimester of pregnancy or in post-partum. Fracture is the major risk of reflex sympathetic dystrophy. Peculiarities of reflex sympathetic dystrophy's treatment in the course of pregnancy are evoked. The end of the pregnancy can be shortened with the aim of stabilizing disease even to activate its healing. Pathophysiologic mechanisms of reflex sympathetic dystrophy in pregnancy seem multiple and complex. Our observation, by its atypical characteristics, recalls it.

Adult↗
PubMed2003

[Prosthetic restoration of the pelvic diaphragm in genital urinary prolapse surgery: transobturator and infracoccygeal hammock technique].

OBJECTIVES: To describe a surgical technique for genital prolapse via exclusive vaginal access using prosthetic materials. The original feature of this technique is based on the use of a monoprosthesis. This technique aims to reconstitute the ruptured pelvic diaphragm in full with a single mesh. To estimate feasibility and reproducibility of the technique. MATERIAL AND METHOD: After reduction of the elements of prolapse, the intervention consists in positioning under these same elements a single and non-absorbable mesh with two transobturator expansions associated with an infracoccygeal sacropexy. No specific urinary procedure is performed. This process was applied to a preliminary series of 26 patients with Baden and Walker stage 3 and 4 genital prolapse, sometimes associated with urinary stress incontinence. RESULTS: This technique successful in every case with full restitution. No intra-operative complication was observed. Short-term anatomical results were excellent. Urinary stress incontinence when present was corrected or clearly improved. CONCLUSION: Transobturator and infracoccygeal hammock is a fast, solid and easily reproducible original surgical process, causing minimal post-operative discomfort. Indications are posthysterectomy complete prolapse and prolapse of the three floors in menopaused woman, from stage 2 with or without associated urinary stress incontinence. Success of this technique depends on good long-term tolerance of the new prosthetic materials used in female pelvic surgery.

Adult↗
PubMed2003

[Management of ectopic pregnancies complicating in vitro fertilization: a remarkable case of bilateral ectopic pregnancy with independent courses of the pregnancies].

OBJECTIVE: To define management rules for ectopic pregnancy complicating in vitro fertilization. PATIENT AND METHOD: We describe a case of bilateral ectopic pregnancy complicating in vitro fertilization which led to two separate laparoscopic procedures. RESULTS: A first laparoscopy was required to perform salpingectomy for ectopic pregnancy. A second laparoscopy was later required for a second salpingectomy for a second ectopic pregnancy complicating the same in vitro fertilization. DISCUSSION AND CONCLUSION: Pre-existent tubal lesions are frequently observed in women who develop ectopic pregnancies after in vitro fertilization. If serum beta-hCG levels and pelvic ultrasound results are not taken into consideration with sufficient care, delayed diagnosis may lead to the unsuitable management. Women with multiple embryonic reimplantations must be monitored rigorously. Salpingectomy is the best treatment option for this type of complication.

Adult↗
PubMed2003

[Laparoscopic cornual excision with an automatic stapler for ruptured interstitial pregnancies].

OBJECTIVE: Because they are difficult to diagnose, interstitial pregnancies remain dangerous. Rupture is a frequent mode of revelation for this type of ectopic pregnancy. In case of rupture, the classic medical treatment of ectopic pregnancy is unsuitable. Surgery is necessary but laparoscopic treatment not always possible. The objective of this article is to describe an original surgical technique which facilitates laparoscopic management of ruptured interstitial pregnancy. MATERIAL AND METHOD: This laparoscopic procedure is based on the use of a disposable stapler which simultaneously excises and stitches the uterine cornua. RESULTS: This procedure was used three times successfully. CONCLUSION: Laparoscopic treatment of ruptured interstitial pregnancy is feasible if it can be performed rapidly and easily in a patient with a compatible hemodynamic status. The automatic stapler provides an effective easily reproducible means of cornual excision enabling rapid laparoscopic management of ruptured interstitial pregnancy.

Female↗
PubMed2003

[Management of meconium peritonitis: a remarkable case of idiopathic meconium peritonitis diagnosed antenatally].

Meconium peritonitis is an inflammatory peritonitis induced by meconium extruding into the peritoneal cavity through a perforation of the fetal intestine. Antenatal diagnosis is possible. Prognosis depends on the pathology having caused perforation. This is often unknown. The objectives of this article are to analyze the contribution of antenatal investigations to estimating neonatal prognosis of meconium peritonitis, and to define optimal management. We describe a case of meconium peritonitis diagnosed in utero with particularly severe ultrasound presentation suggesting a potentially lethal course for the neonate. An eutrophic infant was delivered vaginally after preliminary aspiration of the meconium ascites. The neonate presented with a very distended abdomen and responded well to neonatal resuscitation. Laparotomy exploration confirmed the diagnosis of meconium peritonitis. No cause was identified. No obvious perforation was found. The postsurgery period was uneventful. At later follow-up the infant was doing well, free of further problems notably of any digestive disorder. Antenatal ultrasound features suggestive of severe meconium peritonitis are distended fetal bowel loops, huge cystic masses, major meconium ascites, and polyhydramnios. These neonates have a high risk of obstruction and intestinal perforation. Intestinal resection is frequently required. Cardiopulmonary resuscitation is necessary more often in these neonates with a higher risk of fatal outcome due to respiratory distress syndrome or surgery complications. Prognosis remains good after antenatal diagnosis for neonates free of cystic fibrosis, providing delivery takes place in a center with adequate technical facilities.

Adult↗
PubMed2002

[Mechanisms of the stagnation of dilatation in the active phase of labor].

OBJECTIVE: Our study was designed to explain determinants of nonprogressive labor in nulliparous patients. STUDY DESIGN: One hundred consecutive nulliparous patients have got a cesarean section for active-phase arrest of labor after two hours of active management. Intrauterine pressure was monitored for all of them and a X-ray pelvimetry was done after surgery. RESULTS: Eighty-three percent of patients showed X-ray data considered as normal; hypotonic labor was found in 50% of cases and occiput posterior position in 60%. CONCLUSIONS: Our results suggest that occiput position and functional dystocia are more common in case of nonprogressive labor than abnormal measurements of the obstetrical pelvis.

Dystocia↗
PubMed2002

[Pregnancy: a possible etiology of pyoderma gangrenosum. A case report and review of the literature].

OBJECTIVE: We report an unusual case of pyoderma gangrenosum at 26 weeks gestation and review other cases reported in the literature in order to examine the underlying causes and determine the appropriate diagnostic and therapeutic approach to this uncommon skin disease. Patient and methods. The patient developed an acute abdominal syndrome at 26 weeks gestation (laparotomy was non contributive) followed by pyoderma gangrenosum of the abdominal wall. Seven other cases have been reported in the literature associating pyoderma gangrenosum with pregnancy. We analyzed the clinical findings in these cases. RESULTS: Corticosteroid therapy successfully controlled pyoderma gangrenosum in our patient. Pregnancy outcome was favorable with little effect on the newborn. Complete healing was achieved after several months of treatment. CONCLUSION: Histological lesions are nonspecific. Diagnosis of pyoderma gangrenosum is generally based on clinical signs. Systemic disease is associated in half the cases (inflammatory bowel disease, myelodysplastic syndrome, rheumatoid arthritis). The impact on pregnancy appears to be limited. Treatment is based on high-dose systemic corticosteroid therapy or cyclosporin. The two drugs may have to be combined. Search for an associated disease and appropriate treatment is particularly important for the outcome of pregnancy.

Abdominal Wall↗
PubMed2002

[Ovarian pregnancies: revaluation of diagnostic criteria].

OBJECTIVES: To clarify the clinical features of ovarian pregnancy and to show the incapacity of Spielberg's criteria to establish the diagnosis. MATERIAL AND METHOD: and method. Retrospective experience of ovarian pregnancies in a single maternity unit over seven years with comparison between new diagnostic criteria and those of Spiegelberg. RESULTS: Thirteen ovarian pregnancies identified (incidence=1 for 1400 deliveries). History of pelvic disease (one case), use of an IUCD (five cases), pelvic pain (all the cases), metrorrhagia (four cases), hemorrhagic shock (two cases). Diagnosis was evoked only once by ultrasound. Eleven patients were treated by laparoscopy. None of the ovarian pregnancies in the present series met the criteria of Spiegelberg's definition. CONCLUSION: Ovarian pregnancy is a rare form of ectopic pregnancy, but its incidence is certainly underestimated. Search for difficult to detect ultrasonographic features is essential. Criteria, other than those described by Spiegelberg, when present together confirm ovarian pregnancy: serum beta-hCG level > or = 1000 IU/l and uterine vacuity at vaginal ultrasonography; ovarian implication confirmed by surgical exploration, with bleeding, visualisation of chorionic villi or presence of an atypical cyst on the ovary; normal tubes; absence of serum beta-hCG after treatment of the ovary. Ovarian pregnancy does not compromise subsequent fertility of these patients. Recurrence is exceptional.

Adult↗
PubMed1997

[Late post-partum hemorrhage after cesarean section due to rupture of a false aneurysm of the uterine pedicle].

We report a recent case of late post-partum hemorrhage attributed to a consecutive aneurysm breaking in the uterine cavity. Childbirth by cesarean section was the main cause of the consecutive aneurysm which was maintained by a wound from the uterine vessels. The diagnosis was confirmed by the angiography. This procedure permits treatment by fistula embolization with decreased morbidity, while preserving future prospects of pregnancy. Consecutive aneurysm is of an unknown etiology and not as rare as commonly thought. Wounds of the uterine vessels caused by cesarean section may occur spontaneously.

Adult↗