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Biomedical subjects

H Marret

Publications and source records attributed to H Marret.

At least 37 records · Page 2Linked to original sources
PubMed2001

Histologic multifocality is predictive of skin recurrences after conserving treatment of stage I and II breast cancers.

OBJECTIVE: To distinguish various types of local recurrence after conserving treatment of breast cancer and to evaluate their predictive value. MATERIALS AND METHODS: We first researched the pronostic factors after local recurrence and second evaluated the predictive factors of skin and inflammatory recurrences out of a series of 605 cases of stage I and stage II breast cancer of less than 4 cm in diameter that occurred after conserving treatment. RESULTS: Multivariate analysis revealed two major predictors of poor prognosis associated with recurrence: early appearance Hazard ratio 3.0 (1.28-7.00) (p = 0.011) and inflammatory or skin involvement Hazard ratio 3.38 (1.36-8.45) (p = 0.009). A local recurrence multiplied the relative risk for metastasis by 2.6. This result depended on the type of recurrence: when those with inflammatory and cutaneous types were excluded, local recurrence was no longer a poor prognostic factor. Patients who experienced primary invasive tumor with histologic multifocality have a 4.08 (1.44-11.59) (p < 0.004) times greater risk of developing cutaneous or inflammatory recurrences compared with patients who experienced breast cancer unique localization. CONCLUSION: As histologic multifocality is the only factor predictive of dark prognosis local breast cancer recurrences, aggressive therapy at the time of the primary treatment could be the therapeutic implications of such finding on the original tumor.

Adult↗
PubMed2001

Chronological aspects of ultrasonic, hormonal, and other indirect indices of ovulation.

OBJECTIVE: To improve prediction of ovulation in normal cycles. DESIGN: Collection of women's characteristics and their menstrual cycles. Monitoring and analysis of time relationships between several indicators of ovulation: transvaginal ultrasonography, cervical mucus, basal body temperature, urinary luteinising hormone, and ratio of urinary oestrogen to progesterone metabolites. SETTING: Each of eight natural family planning clinics was to study 12 women for at least three cycles. POPULATION: One hundred and seven normally fertile and cycling women aged 18 to 45. METHODS: Daily measurements of urinary luteinising hormone, follicle stimulating hormone, oestrone-3-glucuronide and pregnanediol-3alpha-glucuronide. Basal body temperature recording and cervical mucus checking. Transvaginal ultrasound examination of the ovaries. MAIN OUTCOME MEASURES: Delays between the expected day of ovulation according to the luteinising hormone peak or to ultrasound evidence and the expected days according to the other indices of ovulation. RESULTS: Ultrasonography was able to show evidence of ovulation in 283 out of 326 cycles. The average time lag between luteinising hormone peak and ultrasound evidence was less than one day (+0.46) but premature and late luteinising hormone-expected date of ovulation were observed in nearly 10% and 23% of cycles, respectively. Basal body temperature rise was observed in 98% of cycles. Cervical mucus peak symptom, rapid drop in the ratio of urinary metabolites, and luteinising hormone initial rise were all close to ultrasonographic evidence in more than 72% of cycles. CONCLUSIONS: For accuracy and practical reasons, the cervical mucus peak symptom, the ratio of urinary metabolites and luteinising hormone initial rise might be better indices of ovulation than the luteinising hormone peak.

Adult↗
PubMed2001

[Problems posed by the diagnosis and prenatal management of facial clefts].

OBJECTIVE: To identify the difficulties in relation to prenatal diagnosis of cleft lip and/or palate. To provide useful clue to the clinician in order to evaluate prognosis and for prenatal management of this malformation. PATIENTS AND METHODS: Retrospective study of all cases managed in our fetal medicine unit between January 1991 and December 1999. During this study period 64 cases of fetal cleft lip and/or palate were retrospectively reviewed. From June 1995, all cases were prospectively recorded, giving us the opportunity to compare the performance of three ultrasound signs for associated secondary cleft palate. RESULTS: The mean gestational age at diagnosis was 26 weeks. Associated ultrasound abnormalities were detected in 42% of cases. Chromosome analysis was performed in all fetuses with associated ultrasound findings and in 39% of fetuses with isolated facial clefts. All fetuses with isolated cleft were chromosomally normal, whereas 15 of the 26 with additional abnormalities had chromosomal defects. Prospective assessment of three ultrasound signs of associated secondary cleft palate was considered possible in 57% of facial clefts. Sensitivity of these signs was respectively 78% (interruption of the secondary palate midline linear echo in a sagittal view), 87% (abnormal oro-nasopharyngeal fluid flow with color Doppler imaging) and 31% for ancillary signs (amniotic fluid excess and non-visualized fetal stomach) for the prediction of associated cleft palate. Only the absence of the three signs to rule out secondary cleft palate. CONCLUSION: Prenatal diagnosis of cleft lip and/or palate must draw attention to associated sonographic malformations. When cleft lip and/or palate is isolated, amniocentesis is recommended apart from selected cases. Secondary palate involvement is difficult to ascertain during pregnancy.

Abnormalities, Multiple↗
PubMed2001

[Doppler ultrasonography in the diagnosis of ovarian cysts: indications, pertinence and diagnostic criteria].

To discriminate ovarian lesions is of particular importance in gynecological practice. Two main problems need answers: discrimination of benign and malignant adnexal masses and choice of the appropriate surgical treatment if necessary. Nearly 2% of the adnexal masses are ovarian carcinomas or border line tumors. It is now well established that ultrasonography is the gold standard for ovarian cyst diagnosis. The purpose of this work was to review the literature and to establish, with the evidence based medicine model, which parameters and existing diagnostic models using ultrasound and Doppler performs best in the evaluation of adnexal masses. Transvaginal sonography has demonstrated considerable advantage over conventional transabdominal sonography. However, transparietal sonography is still useful in large tumors. It is no longer reasonable to subject all patients undergoing pelvic sonography to bladder distension. Functional ovarian cyst characterization seems easy using sonography and Doppler. In case of complication, discrimination of such functional cyst may be difficult but spontaneous regression confirms usually the expectative management. Dermoid cysts and endometriomas seem to be easier to discriminate from other adnexal masses. Papillary formations on the inside of the cyst wall and masses with a non hyperechoic solid component are the most statistically significant predictors of a malignant ovarian mass. Ultrasound and morphologic parameters have a sensitivity of 80% and a specificity of 93%, that make this exam the gold standard for ovarian masses diagnosis. Another parameter is important: experienced hands with subjective evaluation seems to be one of the best ultrasound method for adnexal masses discrimination. Scoring system help differentiate benign from malignant masses (sensitivity 90%, VPP 50%). Doppler flow measurement and assessment of tumor vascularity by doppler energy increase the confidence with which a correct diagnosis is made. Moreover, combined US techniques and a diagnostic algorithm perform significantly better than morphologic assessment, color doppler or CA125 measurement alone. Logistic regression and neural network models are good methods and may be useful for malignancy prediction but the improvement is small and the concordance with histology far from 100%. In front of a benign and maybe functional cyst, spontaneous resolution may be controlled by sonographic exam at 3 and 6 months. Three-dimensional ultrasound and power doppler, contrast enhanced sonography, and sonography during the laparoscopic procedure are not still validated. Every suspicious ovarian mass needs sonography by an expert which can first use all the techniques and the different parameters to discriminate benign and malignant tumors. Secondly, after control if necessary, he can propose the patient for appropriate surgical treatment.

Diagnosis, Differential↗
PubMed2000

Gonadotropin and body mass index: high FSH levels in lean, normally cycling women.

OBJECTIVE: To characterize the relationships between body mass index (BMI) and LH or FSH levels over the cycle in normally cycling women. METHODS: We compared baseline characteristics, cycle characteristics, follicle sizes, and daily hormone levels among women with low (n = 22), normal (n = 63), or high (n = 22) BMIs over 326 cycles. RESULTS: There were no significant differences in age or other lifestyle characteristics between groups. High BMI was significantly associated with younger age at menarche and less sleeping time. No differences were observed between high- and low-BMI groups in cycle length or diameter of the dominant follicle. Luteinizing hormone levels were significantly higher only in the beginning of the cycle in women with low BMIs than in those with high BMIs. Follicle-stimulating hormone levels were also significantly higher but were high during all three phases of the cycle (early follicular, periovulatory, and luteal phases). Mean levels were approximately 1. 9, 1.8, and 1.2 times higher, respectively, in the low-BMI group than the high-BMI group. CONCLUSION: Luteinizing hormone levels and BMI were inversely associated in normally cycling women during the early follicular phase. Follicule-stimulating hormone levels and BMI were inversely associated during the whole cycle, independent of age.

Adolescent↗
PubMed2000

Sensitivity and specificity of ultrasound indices of ovulation in spontaneous cycles.

OBJECTIVE: Evaluation of sensitivity and specificity of 4 ultrasound indices of ovulation. STUDY DESIGN: Multicenter collaborative study of 794 abdominal and transvaginal ultrasound scanning of ovaries performed during 271 cycles in 107 normally fertile women. Comparison of sensitivities and specificities of indices using McNemar test. RESULTS: The sensitivity and specificity of the indices were 84 and 89.2, respectively, for disappearance or sudden decrease in follicle size; 38.4 and 79.7 for appearance of ultrasonic echoes in the follicle; 61.6 and 87.1 for irregularity of follicular walls; 71.0 and 88.2 for appearance of free fluid in the cul-de-sac of Douglas. CONCLUSION: Ultrasonic echoes had a significantly lower sensitivity (P<0.001) and specificity (P<0.01) than other indices.

Adult↗
PubMed2000

[Body changes during pregnancy].

Pregnancy induces numerous changes in the physiology of the woman. Those changes are necessary for the embryo and fetus to have a normal growth, and for the woman to adapt to that physiologic event. A 50% raised cardiac flow is the consequence of increased systolic flow and cardiac frequency. Blood volume is about 40% larger than in non-pregnant woman. It is the consequence of enlargement of the plasmatic volume (50%), and the red cells mass (30%). Those different changes explain the physiologic anemia of pregnancy. The main part of the blood volume increase corresponds to an enlargement of the venous system, but without any change of the central venous pressure. Arterial pressure remains unchanged throughout the pregnancy, or sometimes gently decreases (10%). Those changes are more important during an effort, particularly during the labor. Increase of cerebral blood flow (as a consequence of a raised cardiac flow) is limited by the cerebral autoregulation. As a consequence, there is no evidence for dramatic cerebral hemodynamic changes during pregnancy. Nevertheless, autoregulation is less effective for arterial pressure over than 150 mmHg, what can induce an hemorrhagic stroke. Blood levels of steroïd (progesterone, oestrogens) and peptidic (HCG, HPL) hormones are increased. Oestrogens are said to make capillary fragile, and progesterone is responsible for the enlargement of the venous system. In order to prevent an hemorrhagic accident, pregnancy induces a lack of fibrinolysis, and an excess in coagulation. The consequence is the ability of the pregnant and post-partum woman to develop venous thrombosis.

Blood Physiological Phenomena↗
PubMed2000

[Prenatal outcome of sex chromosome anomalies diagnosed during pregnancy: a retrospective study of 47 cases].

OBJECTIVE: To study the circumstances of discovery and the prenatal outcome of sex hormone anomalies diagnosed by invasive prenatal techniques during pregnancy and analyze which factors could be implicated in the parents' choice to terminate or carry on with pregnancy. METHODS: We reviewed retrospectively 47 cases of sex chromosome anomalies diagnosed and managed in our prenatal diagnosis unit over a 9-year period between January 1, 1990 and December 31, 1998. Only cases karyotyped in our laboratory and with a complete follow-up were considered. RESULTS: Cytogenic findings were mainly turner syndrome (n=25) and Klinefelter syndrome (n=12). The other karyotypes were the following: 47, XXX (n=6), 47, XYY (n=2), and 49, XXXXY (n=2). Among the 47 pregnancies, 11 (23.4%) were carried to term. The rate of pregnancy termination (68.1%) was high. The decision to terminate varied depending on the abnormal karyotype: 88% for Turner syndrome, 42% for Klinefelter syndrome, 33% for 47, XXX, 50% for 47, XYY and 100% for 49, XXXXY. The pregnancy termination rate was significantly higher when one or more abnormal ultrasound findings was present (92.3% vs 41.2%, p<0.01). CONCLUSION: Our study confirms that termination rates remain high in case of sex hormone anomalies. Associated ultrasonographic findings play a major role in the parents' choice to terminate or carry on with the pregnancy. It would appear that the development of consensual guidelines in pluridisciplinary fetal medicine centers can help reduce the disparities currently observed among French centers in the management of fetuses with sex chromosome anomalies.

Adult↗
PubMed1999

[Rubella in pregnancy. Management and prevention].

DECLINING INCIDENCE: Between 1982 and 1994, the incidence of rubella infections during pregnancy in France declined form 45 to 9 cases per 100,000 births. The incidence of congenital rubella declined from 5 to 0.85 per 100,000 births. These results are the fruit of systematic vaccination of 1-year-old children in France. Eradication of congenital rubella has been achieved in Sweden and requires further efforts to be obtained in our country. SEROLOGY: Physicians must systematically check rubella serologies in all women desiring pregnancy and/or of reproductive age even if they have been vaccinated. Rubella serology must be checked in all pregnant women even if they were seropositive during a prior pregnancy. IN CASE OF EXPOSURE OR ERUPTION DURING PREGNANCY: Serology must be obtained as early as possible in case of suspected rubella infection during pregnancy with a second serology 3 weeks later. The IgM titre should be obtained in case of suspected exposure with significant rise in IgG in successive serologies, if specific IgG titre is elevated after an eruption, if the first serum sample was taken late after suspected exposure, and finally if a systematic serology early in pregnancy is positive after a previously negative serology. ANTENATAL DIAGNOSIS: PCR on amniotic fluid or fetal blood is indicated if a seroversion occurs before 18 weeks gestation. Therapeutic termination of pregnancy should be proposed if fetal infection is certain. After 18 weeks, there is nearly no risk for the fetus: an antenatal diagnostic sample is not required and ultrasound surveillance is sufficient.

Female↗
PubMed1999

[Medical abortion in the second and third trimester. Report of 125 indications from 1992 to 1995].

OBJECTIVE: To verify the indications of second and third trimester termination of pregnancy in a fetal medicine department. METHODS: The medical files of 125 patients who underwent medically-induced abortion between 12 to 39 weeks over a four years period (1992-1995) in the French university hospital of Tours, were studied. The medical termination of pregnancy indications inventory allowed us to compare our study to those from the French literature. RESULTS: Sonographic diagnosis was the main departure point for late abortion indications (70%). Fetal indications were predominant (43%), followed by chromosomal anomalies (30%). If obstetrical indications still existed, maternal indications were exceptional (3%). The reasons for termination were severe structural abnormalities which, in most cases, were not compatible with survival. All the decisions were taken by the physicians from the different specialties concerned by the pathology with respect of the parents opinion. CONCLUSION: With generalization of fetal medicine departments with consulting committees for prenatal diagnosis, misguided abortions can be avoided; but an accurate law, standardized in all European countries, would be necessary.

Abortion, Induced↗
PubMed1999

[Scarred uterus: is routine exploration of the cesarean scar after vaginal birth always necessary?].

OBJECTIVE OF THE STUDY: To determine the risks and benefits of routine transcervical revision of previous cesarean uterine scar in patients with successful vaginal delivery. MATERIAL AND METHODS: Retrospective study, over a 10-year period, of a routine palpation practice in the two units of our Obstetric department. Then, a 30-month prospective study comparing, in each unit, two different attitudes toward uterine revision (routine exploration vs symptomatic patients exploration) was conducted. RESULTS: The retrospective part of our study led us to report 3 uterine ruptures (0.43% of all scarred uterus) and 14 dehiscences (2%) during the ten years. All uterine ruptures were sufficiently symptomatic in order to be suspected prior to scar exploration. No dehiscence needed surgical treatment. Some patients with bloodless dehiscence and no repair had subsequent vaginal deliveries with no scar separation found on uterine exploration. In the prospective part of our study, we found a significative difference in the occurrence of fever (18.9% vs 9.9%; p < 0.05) and antibiotic treatment (22.8% vs 12.7%; p < 0.05) between the two groups based on attitude toward uterine revision. CONCLUSION: These data suggest that transcervical revision of previous cesarean uterine scar should be performed only in symptomatic patients (persistent suprapubic pain, placental retention, excessive bleeding during labor or delivery) or when risk factors are present (prolonged labor, prolonged expulsive efforts, instrumental extraction).

Adult↗
PubMed1998

Bilateral ovarian removal during hysterectomy: what is done and what should be done.

OBJECTIVE: Discussion of the indications for bilateral removal of the ovaries at hysterectomy after the age of forty. DESIGN: A multicenter survey involving 50 university centres and regional hospitals was carried out. RESULTS: The majority of French Obs-Gyn carry out bilateral removal of adnexa when the patient is over fifty years old, rather than after forty years of age. DISCUSSION: Reducing mortality due to ovarian cancer is commendable, as is the reduction of morbidity due to ovarian cysts and pathology after hysterectomy, but it is necessary to evaluate the cost of prematurely induced menopause. CONCLUSION: The authors believe that an age limit of forty years is too low. A consensus has emerged for performing bilateral removal of the ovaries after the age of fifty in the absence of a history of pelvic adhesions and/or endometriosis. It is necessary to explore the condition of the ovaries during the laparotomy.

Adult↗
PubMed1998

Pre or post-operative medical treatment with nafarelin in stage III-IV endometriosis: a French multicenter study.

OBJECTIVES: To determine the effectiveness of a 6-month course of nafarelin in the treatment of stage III-IV endometriosis and to determine if pre-operative use of nafarelin facilitates surgery. DESIGN: Prospective, multicenter, clinical trial. SETTING: Eight university hospitals and two private practice institutions in France. PATIENTS: Fifty-five patients with stage III and IV endometriosis. Two were excluded. INTERVENTIONS: The severity of endometriosis was assessed at the time of laparoscopy and patients were randomized to have either laparosopic surgery at that time following 6 months of nafarelin therapy (n=28), or laparoscopic surgery following 6 months of nafarelin therapy (n=25). All had 200 microg intranasal nafarelin twice a day for 6 months and a second look laparoscopy. MAIN OUTCOME MEASURE: Clinical efficacy, tolerance to the treatment. RESULTS: Efficacy and tolerance to the treatment were the same in both groups. AFS scores compared on both laparoscopies were significantly better if nafarelin was given prior to surgery (P=0.007). CONCLUSIONS: This preliminary study shows that in cases of combined medico-surgical treatment for stage III-IV endometriosis, preoperative medical treatment with GnRH-a gives a better AFS score improvement, but no conclusion was possible whether preoperative treatment facilitates surgery.

Adult↗
PubMed1998

[Management of premature rupture of membranes in a monofetal pregnancy before 28 weeks gestation].

To establish appropriate management of premature rupture of the membranes before 28 weeks, we examined maternal and fetal risks in pregnancies complicated by this rare problem (1-7/1000). Three main factors were identified in such circumstances: prematurity, infection and oligohydramnios. Prematurity is inevitable and depends on three factors: gestational age at rupture of the membranes which is an independent predictor of poor prognosis before 22 weeks; gestational age at delivery as neonates born before 26 weeks gestation have an overall perinatal survival < 50%, and latency period between preterm rupture of the membranes and delivery which ranged from 1 to 161 days with a mean 7.8 days. Infection is the second factor with a high incidence (> 30%) of chorioamnionitis. The third factor is skeletal deformations and pulmonary hypoplasia predicted by severe and prolonged (> 14 days) oligohydramnios. Only about 40% of such women will take home a live baby. Successful outcome can be achieved in about 60% of these survivors. Termination of pregnancy is warranted at 22 weeks gestation or less and may be proposed. Beyond 22 weeks gestation, management is based on a wait-and-see attitude with ultrasonographic and bacteriological surveillance. After 25 weeks gestation, management becomes more active with use of antibiotics, tocolytics and steroids which can help prolong the latency period and improve fetal outcome. Ongoing counselling and psychological support are essential in the management of this morbid complication of pregnancy.

Female↗
PubMed1997

Case report and review of the literature: primary twin ovarian pregnancy.

A case report of primary twin ovarian pregnancy is presented. A 36 year old woman, gravida 4 para 3, was admitted to the hospital for suspected ectopic pregnancy, with vaginal bleeding at 11 weeks after her last menstrual period, associated with pelvic pain. An endovaginal ultrasonography led to the diagnosis of twin ovarian right ectopic pregnancy with two dead fetuses associated with a compartmentalized haemoperitoneum. Unilateral oophorectomy was carried out by laparotomy. Histological studies confirmed an uni-ovular di-amniotic ovarian pregnancy. Seven cases of ovarian twin pregnancies are reviewed in the literature. This case is the first one where diagnosis has been made by endovaginal sonography.

Adult↗
PubMed1997

[Retroperitoneal malignant fibrous histiocytoma].

Malignant fibrous histiocytoma is the commonest soft tissue sarcoma of adults. The soft tissue of the extremities is the commonest primary site of malignant fibrous histiocytoma. It is much less common in the female retroperitoneum, leading to diagnostic errors. The clinical, radiographic and CT signs are non-specific. This tumor can only be diagnosed by histology. An initial complete resection is essential for successful treatment of the primary tumor. Radiation therapy is limited and chemotherapy has only been successful in a limited number of cases. This tumor has a poor prognosis. These lesions are relatively rare and consequently difficult to study. The authors report three cases and review the literature.

Adult↗