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G Pennehouat

Publications and source records attributed to G Pennehouat.

At least 19 recordsLinked to original sources
PubMed2006

[Spontaneous rupture of the uterine pedicle during pregnancy: Three case reports].

We report a retrospective review of three cases presenting with spontaneous uterine artery rupture during pregnancy. Clinical presentations were intra-peritoneal haemorrhage for two of them and in utero fetal death for the last one. Fetal outcome was poor in all three cases. Uterine vessels spontaneous rupture during pregnancy is an exceptional event. Considering our experience and the literature review, we propose a guideline for vascular rupture during pregnancy.

Adult↗
PubMed2006

The use of a decremental dose regimen in patients treated with a chronic low-dose step-up protocol for WHO Group II anovulation: a prospective randomized multicentre study.

BACKGROUND: In women with chronic anovulation, the choice of the FSH starting dose and the modality of subsequent dose adjustments are critical in controlling the risk of overstimulation. The aim of this prospective randomized study was to assess the efficacy and safety of a decremental FSH dose regimen applied once the leading follicle was 10-13 mm in diameter in women treated for WHO Group II anovulation according to a chronic low-dose (CLD; 75 IU FSH for 14 days with 37.5 IU increment) step-up protocol. METHODS: Two hundred and nine subfertile women were treated with recombinant human FSH (r-hFSH) (Gonal-f) for ovulation induction according to a CLD step-up regimen. When the leading follicle reached a diameter of 10-13 mm, 158 participants were randomized by means of a computer-generated list to receive either the same FSH dose required to achieve the threshold for follicular development (CLD regimen) or half of this FSH dose [sequential (SQ) regimen]. HCG was administered only if not more than three follicles >or=16 mm in diameter were present and/or serum estradiol (E(2)) values were <1200 pg/ml. The primary outcome measure was the number of follicles >or=16 mm in size at the time of hCG administration. RESULTS: Clinical characteristics and ovarian parameters at the time of randomization were similar in the two groups. Both CLD and SQ protocols achieved similar follicular growth as regards the total number of follicles and medium-sized or mature follicles (>/=16 mm: 1.5 +/- 0.9 versus 1.4 +/- 0.7, respectively). Furthermore, serum E(2) levels were equivalent in the two groups at the time of hCG administration (441 +/- 360 versus 425 +/- 480 pg/ml for CLD and SQ protocols, respectively). The rate of mono-follicular development was identical as well as the percentage of patients who ovulated and achieved pregnancy. CONCLUSIONS: The results show that the CLD step-up regimen for FSH administration is efficacious and safe for promoting mono-follicular ovulation in women with WHO Group II anovulation. This study confirms that maintaining the same FSH starting dose for 14 days before increasing the dose in step-up regimen is critical to adequately control the risk of over-response. Strict application of CLD regimen should be recommended in women with WHO Group II anovulation.

Anovulation↗
PubMed2001

[Treatment of genital infections in gynecology].

Choice of antimicrobial agents and length of therapy of infections of the female genital tract and chemotherapy are presented with particular mention to their side effects. Clinical approach and antibiotic regimens of pelvic inflammatory diseases are discussed.

Anti-Bacterial Agents↗
PubMed1997

[Treatment of ovarian cysts by laparoscopy].

OBJECTIVE: to define limits, risks and results in the long term of laparoscopic treatment of ovarian tumors. METHOD: retrospective study of adnexal tumors managed initially by laparoscopy from January 1986 to December 1992, among which 9 cancers, 25 borderline tumors, and 769 benign lesions. The ultrasonographic appearance was known for 698 of 803 lesions. 86 patients were postmenopausal (92 lesions). RESULTS: we treated 191 functional cysts, 160 serous cystadenomas, 178 endometriomas, 105 dermoid cysts, 39 mucinous cystadenomas and 96 miscellaneous lesions among which fibrothecomas, paraadnexal cysts, ovarian pregnancies, ovarian abscess. There is a great diversity of ultrasonographic patterns for a same histological type, specially for functional cysts and borderline tumors. Laparoscopic exploration has misdiagnosed two cancers and 10 borderline tumors and considered wrongly as suspects 19 benign lesions. 714 procedures have been led to term by laparoscopy, 89 have been ended by laparotomy, 26 for suspicion of malignancy and 50 for dissection failure. 27 postoperative complications have been counted among which 2 grafts on trocard sites after non protected extraction of one dermoid cyst and one borderline tumor. CONCLUSION: ultrasonographic appearance could not predict reliably the organic or functional nor benign or malignant character of an adnexal mass. Even careful laparoscopic examination can underestimate early stage ovarian cancer or borderline tumors. When diagnosed during or after laparoscopic procedure an ovarian cancer should always be managed by laparotomy. On the other hand, some borderline tumors can be treated by exclusive laparoscopy. When malignancy is suspected, an adnexectomy can be performed laparoscopically as a biopsy and allows a quick and appropriate treatment after paraffin-embedded sections. Both intraperitoneal and transparietal techniques have a minimal morbidity and allow a feasibility of more than 90%. The management of postmenopausal ovarian tumors differs only by the use of systematic oophorectomy if surgical procedure is indicated.

Adolescent↗
PubMed1996

Epithelial ovarian carcinoma of low malignant potential.

OBJECTIVE: The aim of this study was to evaluate the interest of sonographic features, serum marker tumors and conservative treatment especially by laparoscopic approach of epithelial ovarian tumors of low malignant potential (or borderline tumors). STUDY DESIGN: Thirty-four patients with 40 epithelial ovarian tumors of low malignant potential treated at Bichat Claude Bernard hospital were reviewed. Of these patients, 29 had preoperative sonographic control (85.2%), 19 (55.8%) had pretreatment serum CA 125 determination, 17 (50%) serum CA 199 determination and 19 CEA serum levels. Twenty patients (58.8%) had serous tumor and 14 (41.2%) had mucinous tumor. Six out of the 20 serous lesions were bilateral. Of the patients 31 (91%) had a stage I disease, one had stage II (3%) disease and two had stage III (6%) disease. Nine patients (26.5%) had laparotomic management, 25 (73.5%) had first laparoscopic management with seven laparoconversions (28%). RESULTS: The majority of borderline tumors (67.7%) exhibited multilocular aspects and seven patients had benign features (unilocular smooth sonolucent). Seven out of the 19 CA 125 serum levels were up to 35 U/ml; 4/17 CA 199 serum levels were above 40 U/ml but the CEA serum levels were always normal. Eighteen patients (52.9%) had radical surgery and 16 patients (47.1%) had conservative surgery including 7 cystectomies. Seven patients (20.6%) had subsequent laparotomic treatment, (five after laparoscopic management, one after laparoconversion management and another one after laparotomic surgery) and no residual disease was found. Fourteen patients (41.1%) had preoperative cyst rupture (13 during laparoscopic management). Four recurrences in stage I disease occurred; one after unilateral salpingo-oophorectomy, three after cystectomy but only one recurrence was in ipsilateral ovary. All four recurrences were diagnosed by sonographic control and one was associated with CA 125 serum level elevation. Ten laparoscopic second look were negative. CONCLUSION: No specific sonographic aspect exists for borderline tumors but it is the best way to detect recurrence. The preoperative CA 125 serum levels was elevated in 36.8% of patients. The conservative treatment including laparoscopic procedure in borderline ovarian tumors appears to have a high risk of peroperative rupture but the rate of recurrence is similar to laparotomic treatment.

Adolescent↗
PubMed1996

Transvaginal intratubal methotrexate treatment of ectopic pregnancy. Report of 100 cases.

Between November 1988 and December 1993, 100 patients with a common, unruptured ectopic pregnancy were treated with 1 mg/kg injection of intratubal methotrexate under transvaginal sonographic control. Patients were not excluded from this series on the basis of the size of the adnexal mass, the term of ectopic pregnancy or initial beta-human chorionic gonadotrophin (HCG) concentrations. Patients were excluded following uncertain diagnosis, signs of a ruptured ectopic pregnancy, or a significant haemoperitoneum on ultrasound scans. The mean age of the patients was 29.5 years (range 20-41). The mean gestational age and initial HCG concentration were 7.5 weeks (5-11) and 11,614 mIU/ml (192-105,000 respectively). Of the 100 patients, 22 (22%) had an ectopic pregnancy with active cardiac activity. Complete resolution was obtained in 78 out of these 100 ectopic pregnancies. Of these, 66 patients (85%) needed only one intratubal methotrexate injection, and 12 patients (15%) required a second i.m. methotrexate injection of 1 mg/kg. In this study, local treatment with one single intratubal methotrexate injection was successful in only 66% of patients. The mean resolution time for reduction of beta-HCG concentrations was 23.5 days (range 7-40). There was no statistically significant correlation between initial beta-HCG concentrations and outcomes after methotrexate treatment of ectopic pregnancy in our study. Where embryonal heart beats were observed, the success rate of the procedure was 40.9% (nine out of 22 cases). In the absence of cardiac activity, or when ultrasound examination showed no embryo, the success rate achieved was 84.6% (66 out of 78 cases) (P < 0.01). In all, 34 patients were considered to be incompletely cured after only one intratubal methotrexate injection: 12 patients required a second i.m. injection, a stagnation of beta-HCG concentrations was observed in 15 patients, abdominal pain occurred in six patients, and one patient suffered tubal rupture with haemoperitoneum. A total of 22 patients required secondary surgical management (salpingectomy). No biochemical or clinical side-effects of methotrexate treatment occurred. Tubal alteration ascribable to methotrexate injection occurred in one patient in our study. Out of 75 patients in this series who wished to conceive, 21 (28%) became pregnant within 1 year with the following outcomes: 11 pregnancies at term, three miscarriages, one induced abortion and six recurrent ectopic pregnancies (four occurred on the same side). Our findings suggest that treatment of common unruptured ectopic pregnancy without prior selection of patients, by a single intratubal methotrexate administration was associated with a 66% success rate. This was dependent only on the presence of embryonal heart beats and there was no correlation between the success rate and initial beta-HCG concentrations. Successful outcome after methotrexate administration for ectopic pregnancy could be perfected by way of an improved selection of patients based on inactive embryonal hearts and absence of a visualized embryo.

Adult↗
PubMed1996

[Laparoscopy-assisted and -prepared hysterectomy. A series of 80 cases].

OBJECTIVE: Our objective was to determine the interest of laparoscopic assisted vaginal hysterectomy. STUDY DESIGN: Between January 1991 to december 1994, 80 patients had laparoscopically assisted vaginal hysterectomy. We reviewed with particular emphasis characteristic indications, complications. RESULTS: Eighty were performed as laparoscopically assisted vaginal hysterectomy. 14 patients (17.5%) had laparotomy conversion; because of size of uterus in 3 cases, suspected ovarian tumor in 3 cases. Pelvic adherences in 4 cases, urinary tract injuries in 1 case, hypercapnia in 1 case, hemorrhage in 2 cases. 9 patients experienced febrile morbidity and 1 urinary infection. 1 patient received 2 units of packed red blood cells. The hospital stay was 5 days for laparoscopically assisted vaginal hysterectomy versus 5.9 for laparotomic hysterectomy. CONCLUSION: Laparoscopically assisted vaginal hysterectomy offers a technique to convert certain abdominal hysterectomies into vaginal hysterectomies with a 17.5% laparoconversion rate.

Adult↗
PubMed1994

[Ethnic predisposition of the severity of HELLP syndrome. Retrospective study of 12 cases including 5 during post-partum].

HELLP syndrome is characterized by association of haemolysis (H), elevated liver enzymes (EL), and low platelets (LP). From 1989 to 1991, we studied retrospectively 12 cases of HELLP syndrome cases that occurred during the third trimester for 7 cases and during post-partum for 5 cases. 83% of patients (10/12) were black people (African or Creole). The most frequent sign of HELLP syndrome during pre- and post-partum was epigastric or dorsal pain, present in 91% of the cases (11/12) and in all cases of preeclampsia. Aggressive treatment was always performed, leading to 12 births: 7 of the 12 children were hypotrophic for gestational age. There were no maternal or neonatal deaths. Post-partum HELLP syndrome occurred 28.8 hours (mean) after delivery. Whether HELLP syndrome occurred during pre- or post-partum, laboratory findings returned to normal levels after equivalent delays: platelets 57 hours, ASAT 68 hours and ALAT 65 hours.

Adult↗
PubMed1993

Microlaparoscopy: a preliminary report.

A series of 30 microlaparoscopies performed under local anaesthesia and sedation are presented. The visualization of the pelvic organs was acceptable and the patients reported mild discomfort only. Microlaparoscopy may potentially replace macrolaparoscopy in selected cases.

Adult↗
PubMed1993

Transcervical falloposcopy: preliminary experience.

The new technique of endoluminal tubal exploration was evaluated by performing transcervical falloposcopy instead of chromoperturbation under control of concurrent laparoscopy. In this feasibility study, catheterization was performed with the use of either a transhysteroscopic or a free-hand tubal cannulation technique. A total of 66 patients were investigated for primary or secondary infertility with proximal and/or distal suspected tubal defects on the basis of prior hysterosalpingography; three patients were investigated for unruptured tubal pregnancy; two patients were investigated to localize the tip of the tubal embryo transfer catheter. Transcervical catheterization was successful in 110 of the 130 tubes (84.6%). Successful and informative falloposcopy was achieved in 30% of the 110 cannulated tubes. The transcervical free-hand cannulation technique was as effective as the transhysteroscopic approach. Recanalization of at least one tube was achieved in 83% of women with proximal obstruction. Tubal cannulation by the tubal embryo transfer catheter was confirmed by falloposcopy in the two cases where free-hand catheterization was used. This study confirms that it is possible to visualize the tubal lumen and demonstrates that the free-hand cannulation technique is a simple and effective alternative to the transhysteroscopic approach. However, further progress in catheter technology has to be achieved in order to perform regularly successful transcervical falloposcopy in damaged tubes.

Adult↗
PubMed1993

[Treatment with methotrexate of 4 interstitial, unruptured pregnancies].

Successful treatment of four, non ruptured, cases of interstitial pregnancy are reported. Treatment consisted of in situ injection of methotrexate during coelioscopy. Dosage was 1.5 mg methotrexate per kilogram body weight. Negative plasma beta hCG levels were obtained 9 to 22 days after conservative medical treatment. No clinical or biochemical side effects were observed. Of two patients had no radiologically demonstrable cornual abnormality on the hysterosalpingographies effected at the 3 months evaluation after ascertained interstitial pregnancy, one have normal pregnancy. Two further patients had normal uneventful pregnancies 12 to 15 months later. Treatment of interstitial pregnancy by way of one in situ injection of methotrexate seems to be the currently preferred alternative to classical surgery.

Adult↗
PubMed1993

[Screening for ovarian cancers: critical analysis].

The ovarian cancers have a low incidence rate and a high mortality rate mainly due to a late diagnosis. The potential value of ultrasonography and measurements of tumour associated markers to detect early ovarian cancer suggest the interest of a screening strategy. The analysis of the conditions for efficacy of a such screening program, of the predictive values of ultrasonography and tumour associated markers measurements and of the results of preliminary studies does not confirm on a rational basis the potential interest of screening strategies.

Adult↗
PubMed1993

[Evaluation of intra-uterine pathology and tubal patency by contrast echography].

The contrast ultrasonography (CUS) is a new development of the pelvis ultrasounds. A contrast medium is injected through the cervix and is screened through the uterine cavity, the tubes and the peritoneal cavity. The contrast medium creates a new acoustic interface which improve the quality of the ultrasound imaging and the ability to diagnose endouterine pathologies. Further, tubal patency may be assessed by tracking fluid into the pouch of Douglas. The aim of this study was to assess the feasibility, the accuracy and the side effects of this technique when compared with the conventional procedures. Included were two groups of patients: the group 1 (10 cases) was of patients with menometrorrhagia before undergoing an hysteroscopy; the group II (11 cases) was of infertile patients before undergoing a laparoscopic tubal patency test. This technique, of low cost and without any radiation exposure, seems to be at least as accurate as the conventional methods for the intrauterine diagnostics. It is less effectiveness for the evaluation of the tubal patency. No side effect occurred in this study.

Contrast Media↗
PubMed1993

[Endocystic echography by laparoscopy. 6 preliminary cases].

The decision whether to ablate an ovarian cyst using the operating laparoscope depends on a whole bundle of clinical, biological, ultrasound and laparoscopic factors. But opening a uni or multi-locular fluid containing cyst and exploring its walls can leave the operator in doubt as to whether it is benign, malignant or a borderline lesion. Now it is possible to use 3 mm catheters carrying a rotary ultrasound transducer. When this sound is placed inside a cyst it is possible to study the walls topographically. Six preliminary cases are presented; the increased sensitivity of the pictures obtained by this miniaturised sound make it possible to improve ultrasound diagnosis.

Diagnosis, Differential↗
PubMed1992

In vitro DNA fluorescence after in vitro fertilization (IVF) failure.

PURPOSE: A pilot study was performed to test the diagnostic value of in vitro DNA fluorescence in oocytes that failed to fertilize after IVF. Ten patients with a cleavage rate less than 20% after IVF were included. RESULTS: Uncleaved oocytes were observed by fluorescence microscopy after incubation with the DNA fluorescent dye Hoeschst 33342. Four main causes which may have contributed to the low cleavage rate were found: (1) sperm incapacity to penetrate the oocyte despite the absence of the usual criteria for male infertility, (2) oocyte immaturity, (3) delayed fertilization, and (4) oocyte abnormalities revealed by aberrations in the morphology of the female chromatin. CONCLUSIONS: The possibility of a rapid and detailed analysis of the maturational status of unfertilized oocytes, the morphology of the female chromatin, the presence and quantity of spermatozoa tightly bound to the zona pellucida, and sperm penetration into the oocyte without subsequent pronucleus formation, using DNA fluorescence, allows us to clarify further the cause of fertilization failure and to orient infertility treatment toward the male, the female, or both partners.

Adult↗
PubMed1992

Transcervical tubal cannulation and falloposcopy for the management of tubal pregnancy.

This is the first report of transcervical salpingoscopic visualization of tubal pregnancy in two patients. The falloposcope was introduced through a catheter used routinely for transcervical tubal cannulation, guided by tactile impression. We have previously demonstrated that it is possible to diagnose and treat tubal pregnancies via a transcervical intra-Fallopian cannula. Falloposcopy could help select appropriate patients for transcervical intra-Fallopian therapy by verifying the site of implantation and the characteristics of the ectopic pregnancy.

Adult↗
PubMed1992

[Complications of intraperitoneal chemotherapy by the needle technique. Evaluation after ten years].

A hundred and twenty three patients with intraperitoneal cancer (mostly ovarian) were treated between 1980 and 1990 with intraperitoneal chemotherapy administered through a "needle". Local complications were infinitely fewer and less serious than those observed with materials implanted for months. General complications depended on which protocols were being used. But tolerance on the whole was better when the drugs were administered intraperitoneally. This is particularly clear with cisplatin, although the dose is doubled intraperitoneally over a period of 10 months instead of 6. In this ways there was hardly any neurotoxicity and there was a noteworthy prolongation of survival time in cases of ovarian carcinoma.

Antineoplastic Combined Chemotherapy Protocols↗