[Cervical dysplasia: is there a role for hysterectomy?].
Cervical intraepithelial neoplasia are usually treated by conservative procedures. Hysterectomy straightaway would have advantages but some drawbacks; reasons are listed.
Age Factors↗
Biomedical subjects
J Gondry
Publications and source records attributed to J Gondry.
[Hypertension and pregnancy. Diagnosis, physiopathology and treatment].
This review on hypertension in pregnancy focuses mainly on the pathophysiology and prevention of pregnancy induced hypertension which, when associated with proteinuria, is usually called preeclampsia. Rather than a genuine hypertensive disease, preeclampsia is mainly a systemic endothelial disease causing activation of platelets and diffuse ischemic disorders whose most obvious clinical manifestations involve the kidney (hence the proteinuria, edema and hyperuricemia), the liver (hence the hemolytic elevated liver enzymes and low platelets, or HELLP syndrome), and the brain (hence eclamptic convulsions). Hypertension is explained by increased vascular reactivity rather than by an imbalance between vasoconstrictive and vasodilating circulating hormones. This increased reactivity is due to endothelial dysfunction with imbalance between prostacyclin and thromboxane A2 and possibly dysfunction of NO and endothelin synthesis. The aggressive substances for endothelium are thought to be of placentar origin and the cause of their release is explained by placentar ischemia related to a defect of trophoblastic invasion of the spiral arteries. The etiology of this latter defect is unknown but involves immunologic mechanisms with genetic predisposition. The only effective treatment for PIH is extraction of the baby with the whole placenta. The decision for extraction is often a very delicate obstetric problem. Antihypertensive drugs are mainly indicated in severe hypertension (> 160-100 mm Hg), with the aim of preventing cerebral hemorrhage in the mother, but have not been shown to improve fetal morbidity or mortality. Eclamptic seizures can be prevented and treated more effectively with magnesium sulfate than with diazepam or phenytoin. Prevention of preeclampsia remains the main challenge. Whereas antihypertensive drugs are ineffective, calcium supplementation and low dose aspirin have proven effective but mainly in selected populations with a relatively high incidence of preeclampsia (> 8-10%). In multiparas the selection of such a high risk population is relatively easy when at least 2 (or 1?) previous pregnancies were complicated with early preeclampsia and/or intrauterine growth retardation. In nulliparas the selection of the high-risk population is still a subject of research. The 2 most promising criteria are abnormal Doppler velocimetry of the uterine arteries at around 20 weeks of amenorrhea, and abnormally high plasma levels of beta HCG at 17 weeks of amenorrhea.
Adult↗
[Postpartum. Clinical surveillance, breast feeding and its complications].
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Breast Feeding↗
Plasma atrial natriuretic factor and urinary excretion of a ouabain displacing factor and dopamine in normotensive pregnant women before and after delivery.
Estimation of urinary excretion of a ouabain displacing factor and dopamine was carried out immediately before delivery, and 7 days and 70 to 90 days after delivery in 12 normotensive pregnant women. Simultaneous estimation of plasma 99-126 atrial natriuretic factor, plasma renin activity, and plasma aldosterone were also undertaken. The data were compared with those obtained in a group of nonpregnant normotensive women (n = 14) and a group of pregnant normotensive women in the early phase of the third trimester (n = 14). Urinary ouabain displacing factor and dopamine levels were significantly higher in the early phase of the third trimester, as compared with nonpregnant women. But immediately before delivery, ouabain displacing factor excretion had fallen below nonpregnant values and dopamine excretion had dropped to control values. Both remained low after delivery. Plasma atrial natriuretic factor was higher in pregnant women, as compared with nonpregnant controls and remained high just before delivery and 7 and 70 to 90 days after delivery. Plasma renin activity and plasma aldosterone levels were higher during pregnancy and had fallen to nonpregnant values 7 days post partum. This drop in plasma renin activity and aldosterone by 7 days post partum, in contrast with the unchanged high values of atrial natriuretic factor, may contribute to negative sodium balance after delivery. It is concluded that there is considerable discrepancy in natriuretic and antinatriuretic factors before and after delivery.
Atrial Natriuretic Factor↗
[Increase of the pressor response to angiotensin II in normal pregnancy. A sign of increasing blood volume more than decreasing vascular reactivity].
Plasma volume and the pressor dose of angiotensin II were estimated in 15 normotensive pregnant women during the second and third trimester and 2-3 months post-partum together. Plasma volume estimated by the Evans Blue technique increased during pregnancy significantly more than the body weight: its increase was 37 and 54% of the post-partum values whereas the body weight increase was only 6 and 12%. The pressor dose of angiotensin II was significantly increased during pregnancy only when it was related to body weight (14.2 +/- 4.3 and 14.9 +/- 5.2 at the 2nd and 3rd trimester versus 11.2 +/- 2.9 ng min-1 kg-1 BW post-partum) but not when it was related to plasma volume (0.25 +/- 07 and 0.26 +/- 0.09 versus 0.25 +/- 0.07 ng min-1 ml-1 PV). It is concluded that the increased pressor dose of angiotensin II (related to body weight) observed in normal pregnancy cannot be interpreted as an evidence for decreased vascular reactivity but that it could be a mere reflection of plasma volume increase.
Adult↗
[Risk of infection and artificial induction of labor].
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C-Reactive Protein↗
[Treatment of stress urinary incontinence. Experience at the Gynecology-Obstetrics Center of Amiens].
The authors report their experience of the surgical treatment of stress urinary incontinence. They underline the value of urodynamic tests in the examinations for urinary continence and prolapses. In the presence of a transmission defect, three different techniques are used: indirect colpopexy by strips (Loffredo) in the absence of prolapse, mixed route using vaginal strips (Bologna) in case of cystocele, sub-urethral plication reserved for elderly patients presenting a prolapse with stress urinary incontinence revealed by the urodynamic tests. The follow-up of the patients treated by the Loffredo technique is studied: 92% of good middle-term results (after 5 years).
Age Factors↗
[Evaluation of ultrasonography. Apropos of a continuous series of 1,000 pregnancies].
2,648 sonograms were performed in a continuous series of 1,000 patients, all of whom had delivered in the department between March 1, 1988 and September 1, 1988; pregnancies resulting in a spontaneous miscarriage, extra-uterine pregnancy, therapeutic abortion as well as invasive sonographies, are excluded. Most patients underwent two or three sonograms during their pregnancy. 74 per cent of the requests come from specialists. The main indications are either systematic (67.7%) or result from early manifestations (25.1%). 12.6 per cent of the sonograms are performed before 12 weeks of amenorrhea, including 36.7 per cent performed systematically, and could be performed at a later date. 90 per cent of the term modifications were correctly indicated, and there were early manifestations in 60 per cent of the cases. 45.1 per cent of intra-uterine growth delays were detected and there were early manifestations in 50 per cent of the cases. 41.6 per cent of the malformations were diagnosed on sonograms. Renal malformations are easily recognized; this is not true of cardiac malformations. 96 per cent of the patients were justifiably reassured or worried. Ultrasonography presents a good sensitivity for term modifications, macrosomia, placental insertion anomalies. The sensitivity is less for intra-uterine growth delays and fetal malformations.
Evaluation Studies as Topic↗
[Practical problems posed by toxoplasmosis during pregnancy].
The occurrence of toxoplasmosis during pregnancy raises numerous problems. Determination of the time of the maternal infection is the first problem since we know that the frequency and gravity of fetal involvement vary according to the term of the pregnancy. Then, with information obtained from prenatal diagnostic tests (sonogram, amniocentesis, fetal blood sampling), it is important to recognize infected fetuses and advocate a management which goes beyond therapeutic abortion. Finally, the final problem is the follow-up of these children; in fact, after all these diagnostic and therapeutic measures, it is unfortunate that many children become lost to follow-up after the first year.
Female↗
[Study of the choice between sampling of the chorionic villi and the amniotic fluid in prenatal diagnosis].
We are reporting the results of a 21-month study during which 653 couples were seen in consultation at the prenatal diagnostic center of the University Hospital in Amiens, referred by their physician. 171 patients presented a theoretical term under 11 weeks of amenorrhea, for whom the choice between chorionic villi biopsy or amniotic fluid tap was possible. The different situations and results are compared for each method. The rate of fetal death was 5.4 per cent for chorionic villi biopsy and 1.5 per cent for amniotic fluid tap.
Amniocentesis↗
[Electro-conization of the cervix uteri].
After having reported various opposite techniques for the treatment of dysplasia and in situ carcinomas of the uterine cervix, the authors present their experience with 125 cases of conisation, performed between 1984 and 1988. The electroconisation technique, performed in 88 cases, is compared with other conisation techniques: conisation with a cold scalpel, laser conisation. The use of a cold scalpel is simple and effective, but presents the disadvantage of peroperative (22.2% in our series) and secondary (7.4%) haemorrhages requiring preventive overlapping stitches which impede subsequent monitoring. Laser conisation seems long and tedious. On the contrary, electroconisation presents the advantage of being simple and quick, with very few peroperative (6.8%) or secondary (3.4%) haemorrhages, but two minor drawbacks: impeding pathological interpretations (1%), causing secondary stenoses which seem to be related to the height of the cone and not to the type of conisation.
Adult↗
[Contribution of urodynamic tests in gynecology. Apropos of 700 cases].
Basic urodynamic tests (cystomanometry-sphincterometry) are absolutely necessary for evaluation of urinary incontinence, urination disorders and prolapses, and are useful in the evaluation following treatment. In a retrospective study including 700 cases, the authors analyze the urodynamic results according to the clinical symptomatology since the clinical diagnosis often is misleading. Then, they study the different treatments advocated and their clinical and urodynamic results: medical treatment: 75 per cent of good results; pelvi-perineal physical therapy: 82 per cent of good results; Loffredo's procedure: 98.5 per cent of good results; Marion's procedure for potential EBI: 92.5 per cent; for obvious EBI: 89 per cent.
Female↗
[Chlamydia trachomatis perihepatitis].
Fifteen observations of perihepatitis due to Chlamydia trachomatis were studied. Occurring in young women (M: 29, 3 years), genital infection is seldom simultaneous, sometimes not even found in the case history (5 times out of 15). Women consult for a biliary type of pain (11 cases out of 15), associated with pelvic pain (2 cases). The diagnosis of perihepatitis is suspected on the normality of usual further investigations, and confirmed by laboratory tests: rarely by direct sighting (2 cases out of 8) but each time with a positive serology and a titer of antibodies higher than 1/64 by the micro immunofluorescence method. Treatment by Cyclins (13 cases) or Macrolids (2 cases) leads to the regression of the painful symptoms during the first week.
Adolescent↗
[Treatment of coagulation disorders complicating premature detachment of the placenta].
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Abruptio Placentae↗
[Conization with positive margins].
We received all conizations performed between 1986 and 1997. The incidence of positive margins conization for cervical intraepithelial neoplasia is 7.8% (23.8% in others studies). Persistent or recurrence disease occur only in 35% of cases; so new treatment is not always usefull and cytology and colposcopy are adequate for follow-up.
Adult↗
[At what age should oral contraception be stopped?].
The "pill" is generally considered inadvisable after the age of 40, chiefly because of vascular risk. The authors thus raise the question of possible continued oral contraception until the menopause using new estroprogestational agents. They discuss in turn the usefulness of contraception after the age of 40, bearing in mind the significant fall in fertility at this age and the vascular, gynecological and breast risks linked to oral contraception. It emerges, on the basis of data from the literature, that estroprogestational agents can be continued until the menopause, and in particular since they are associated with beneficial effects: protective role against carcinoma of the ovary and endometrium, comfort associated with use of the pill in terms of regular cycle but also the prevention of early estrogen deficiency and osteoporosis in particular, all the more so since a pregnancy after the age of 40 is a far greater risk than that linked to the use of a current oral contraceptive, obviously after patients with a known risk factor have been eliminated.
Adult↗
Electrohysterography during pregnancy: preliminary report.
The purpose of this study was to test the ability of uterine electrical activity recorded by electrohysterography (EHG) from abdominal electrodes during pregnancy to provide reliable information about uterine contractions. In this preliminary study, abdominal EHG was used to monitor the uterine contractions of eight women, three of whom were having spontaneous contractions related to preterm labor and five of whom were having medical abortions after intrauterine fetal death. The EHG signal consisting of one electrical burst (EB) correlated with a single episode of mechanical activity (MA) in more than 66% of the recorded contractions. When mechanical or electrical activity identified as artifactual was excluded, the temporal correlation of EBs with MA was found in 89% of the recorded contractions. Furthermore, the electrical bursts detected had temporal and spectral characteristics similar to those described previously. Reliable detection of mechanical activity during early pregnancy remains problematic. Nevertheless, abdominal EHG appears suitable for noninvasive monitoring of pregnancies at risk. Further studies are needed to elucidate the significance of the EHG signal in both normal and abnormal pregnancies. It may eventually be possible to use EHG as an ambulatory monitoring tool for the early diagnosis of preterm labor.
Abortion, Induced↗