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Biomedical subjects

J Lansac

Publications and source records attributed to J Lansac.

At least 19 recordsLinked to original sources
PubMed2000

[Ultrasonographic diagnosis and prenatal management of fetal ovarian cysts].

OBJECTIVE OF THE STUDY: To evaluate the outcome of fetal ovarian cysts in relation to their ultrasonic appearance and size. To define, on that basis, the contribution of intrauterine aspiration. MATERIAL AND METHODS: Retrospective study of all ovarian fetal cysts detected by prenatal ultrasound examination (n = 25) during a 4 year period. All these cysts were followed during pregnancy and after delivery until spontaneous or surgical resolution. RESULTS: At the time of prenatal sonographic detection at the mean gestational age of 32 1/2 weeks, the mean cyst diameter was 43+/-17 mm and 36% of all these cysts were already complicated (fluid-debris level, septa or finding of a retracting clot). Among the 16 non-complicated cysts (echolucent and thin-walled) 44% became twisted during the perinatal period irrespective of the size or the time of discovery. At birth, all these complicated cysts underwent surgical treatment and needed oophorectomy or adnexectomy. Surgery was therefore performed in a total of 56% of neonates. The pathologic reports confirm in all cases the benign follicular or follicular lutein nature of the cysts. CONCLUSION: Due to this high rate of mechanical complications, cyst decompression may be considered at the time of diagnosis in case of an anechoic fetal ovarian cyst. The safety and efficacy of this approach, on the cases reported in the literature seem encouraging. Although, a prospective randomized evaluation is needed.

Female↗
PubMed1999

Brain damage and hypoxia in an ovine fetal chronic cocaine model.

OBJECTIVE: To assess the development of brain damage in an ovine fetal chronic cocaine model. To evaluate the effect of isolated hypoxic tests on this model and to correlate hemodynamic findings (brain-sparing effect) following fetal hypoxia and the occurrence of brain damage. STUDY DESIGN: Fifteen ewes were divided into a control group (n=7) and a cocaine treated group (n=8). From day 65 to day 134 the cocaine treated animals received a daily (5 days per week) intramuscular injection (2 mg/kg cocaine) and the control animals a placebo injection (2 ml of isotonic solution). Both groups underwent hypoxic tests (cord compression (3 min) and aortic compression (1 min)) at 90 and 134 days. In addition, anesthesia for magnetic resonance imaging (MRI) examination was carried out at 125 days. Fetal blood samples were collected during both series of hypoxic tests and the cerebral and umbilical flows were monitored by Doppler. Samples from 25 brains (control n = 10; cocaine n= 15) were processed for light and electron microscopic examination. Quantification of brain damage was done on semithin sections from six areas of cortex and germinal matrix on each fetus. RESULTS: Similar forms of brain damage (selective neuronal loss limited to the parasaggital cortex, striatum, hippocampus and Purkinje cells) was present in both groups but lesions were more frequent in the cocaine treated group as shown by quantitative analysis for the proportion of abnormal capillaries (65% vs. 35%), capillary edema (61% vs. 34%) and abnormal neurons showing delayed neuronal degeneration (DND) (66% vs. 36%) in the cocaine and control group respectively. There was no significant difference in immunoreactivity for glial fibrillary acidic protein (GFAP) but it was more marked in the cerebellum of cocaine treated animals. Fetal blood samples showed a moderate sustained hypoxia and Doppler findings demonstrated the presence of a brain sparing effect associated with increased uterine and umbilical vascular resistance in the cocaine treated group. Nevertheless, the amplitude of the heart rate increase and cerebral dilatation was significantly lower in the cocaine treated animals. CONCLUSION: This ovine fetal chronic cocaine model showed the presence of brain damage. Cocaine treatment seems to potentiate the effect of the hypoxic tests. Independent of the cause, the brain damage developed in the presence of brain sparing effect, strongly suggesting that this phenomenon is a sign of a pathological fetal condition and no guarantee that it will prevent tissue damage.

Animals↗
PubMed1999

Gastrointestinal injuries during gynaecological laparoscopy.

A retrospective case review study was carried out on gastrointestinal injuries which occur during gynaecological laparoscopy. Fifty-six patients with 62 gastrointestinal injuries were identified. One-third of the complications (32.2%) occurred during the installation phase for laparoscopy. Four of the six complications attributed to electrosurgery were secondary to the use of monopolar coagulation. Diagnosis of these gastrointestinal injuries was made during surgery in only 20 patients (35.7%). The mean time before diagnosis was 4.0 +/- 5.4 (range 0-23) days. Treatment of these complications was performed by laparoscopic surgery in 16.1% of cases. Prevention relies on the surgeon's experience, strict observance of the safety rules, perfect familiarity with the physical properties of the instruments used, systematic use of bowel preparation for patients presenting a risk of bowel complications, systematic supervision of the route taken by the trocars, meticulous inspection on completion of surgery of all areas where bowel adhesiolysis has been used and, in case of any doubt, tests for leakage involving the rectosigmoid. For patients with a risk of bowel complications, the creation of a pneumoperitoneum and performing a mini laparoscopy in the left hypochondrium can be the judicious option.

Adult↗
PubMed1999

Aromatase activity of human granulosa cells in vitro: effects of gonadotrophins and follicular fluid.

The aim of this study was to assess whether human dominant follicular fluid has the ability to modulate aromatase activity and/or granulosa cell proliferation. Dominant follicular fluid was obtained by laparoscopy before the luteinizing hormone surge in naturally cycling women while granulosa cells used in the tests were obtained from in-vitro fertilization patients. Aromatase was measured by the tritiated water release assay, following a 48 h incubation with follicular fluid and serum, and expressed for 5x10(4) granulosa cells. The effects of a range of follicular fluid or serum concentrations (2.5, 5, 10 and 20%) were compared. A decrease in aromatase activity was observed when high follicular fluid concentrations (20%) (P < 0.01) were added. Low concentrations (2.5%) of follicular fluid significantly increased cell proliferation (P < 0.01) as compared to basal values (0%). No further stimulation was however observed when concentrations increased up to 20%. Further characterization of these compounds is required to understand how they may modulate maturation of the dominant follicle.

Aromatase↗
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↗
PubMed1999

[Management of cleft lip and/or palate diagnosed in utero].

OBJECTIVE OF THE STUDY: To assess the usefulness of fetal karyotyping in the management of facial cleft lip with or without cleft palate diagnosed during pregnancy and to determine which etiologic and prognosis criteria are helpful to consider for prenatal counselling. MATERIAL AND METHODS: Retrospective study on 35 cases of facial cleft lip and/or palate prenatally diagnosed by ultrasound examination and managed in our fetal medicine unit from 1 January 1989 to 31 December 1996. Complete follow-up was obtained for all fetuses. RESULTS: In our series, the mean gestational age at diagnosis was 25 weeks. In 43% of the cases, additional sonographic anomalies were also recognized. These associated anomalies were more frequent when amniotic fluid quantity was abnormal. Fetal chromosomal determination was conducted in 2/3 of fetuses and numeric or structural abnormalities were found in 20% not related to the cleft size or type (lip and/or palate). All fetuses with isolated facial cleft were chromosomally normal. We report 4 midline clefts, all of them were associated with additional sonographic findings and 3 were part of an holoprosencephaly. CONCLUSION: Prenatal diagnosis of cleft lip and/or palate must draw attention to associated sonographic anomalies especially when amniotic fluid quantity is abnormal. Chromosomal karyotyping is not necessary when facial clefting is isolated except in cases diagnosed early in pregnancy. Midline clefts must draw attention on cerebral midline integrity.

Abnormalities, Multiple↗
PubMed1999

[Idiopathic granulomatous mastitis. Review of the literature illustrated by 4 cases].

INTRODUCTION: Idiopathic granulomatous mastitis (IGM) was described as a specific entity in 1972 by Kessler and Wolloch. Despite the 120 cases reported in the international literature, this pathology remains quite unknown. MATERIAL AND METHODS: Four cases of idiopathic granulomatous mastitis are reported in this article in order to outline the main clinical features of this affection. Data in the literature were used to discuss diagnostic and therapeutic particularities. DISCUSSION: The histologic findings of a non-caseating granulomatous inflammation, centered on breast lobules, composed of epithelioid cells and multinucleated giant cells, allow establishing the diagnosis of granulomatous mastitis (GM). The main presenting symptom of GM is a single inflammatory mass of the breast; the diagnosis is thus often mistaken for breast carcinoma (more than 50% of the reported cases). Radiologic and cytologic findings alone do not enable reaching certain diagnosis because they cannot resolve the differential diagnosis of inflammatory process and malignancy. The diagnosis of IGM can be established after the etiological work up remains negative. A course of oral corticosteroid therapy, non-steroidian anti-inflammatory drugs, or colchicine can be used in order to shrink the breast mass, allowing more conservative surgery. Local excision is of limited benefit as there is a strong tendency for recurrence. CONCLUSION: Different therapeutic options of IGM are explained by its clinical variability. A more pragmatic therapeutic approach would be enabled by a new classification based on course and severity.

Adrenal Cortex Hormones↗
PubMed1999

[Varicella pneumonia during pregnancy after double exposure in the 2nd trimester. Value of seroprophylaxis].

We report on a case of varicella pneumonia at 29 weeks of gestation after double contact during the second trimester of pregnancy although passive immunotherapy by polyvalent immunoglobulins was used. Our case report highlights the difficulties of varicella pneumonia diagnosis that was here confirmed by seroconversion and the presence of pathognomonic microcalcifications, on a pulmonary X-ray, realized two years after pregnancy. Although the absence of publications asserting the efficacy of immunotherapy by polyvalent immunoglobulins to prevent maternal complications of varicella during pregnancy, they remain widely employed in such cases. Our point of view is that this indication must be revisited.

Adult↗
PubMed1998

[Surveillance of a woman treated for breast cancer].

The intensive follow up of breast cancer patients is not safer than a minimalist policy for breast cancer surveillance. The survival rate is not modified by the use of expensive exams. The follow up program is anxiogenous, delay the reinsertion of the patients and useless because in 75% of cases the patient herself discovered the relapse. A good clinical examination, including gynaecological examination and a mammography are sufficient for a good follow up practice. The guidelines for the follow up of breast cancer patients include self examination of the breast monthly, clinical examination twice a year and an annual mammography during five years and an annual clinical examination and a mammography after. The radiotherapist, the surgical or medical oncologist should be involved with the general practitioner for this follow up.

Aftercare↗
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

Quantification by magnetic resonance spectroscopy of metabolites in seminal plasma able to differentiate different forms of azoospermia.

The aim was to determine whether proton magnetic resonance spectroscopy (1H-MRS) of metabolites such as glycerophosphorylcholine (GPC), choline, citrate and lactate in human seminal plasma can be used to differentiate (i) different azoospermic patients and (ii) different forms of spermatogenic failure including those who had undergone radiation therapy or chemotherapy. Semen samples were provided by men with obstructive azoospermia and spermatogenic failure who had serum follicle stimulating hormone (FSH) values within the normal range and either more or less than normal. Four prominent constituents of seminal plasma were identified by 1H-MRS: GPC, choline, citrate and lactate. The peak area ratios of choline/citrate as well as choline/lactate were significantly different (P < 0.01) between groups with spermatogenic failure and obstructive azoospermia. When the serum FSH values were normal in men with spermatogenic failure and obstructive azoospermia, a significant difference was found in the GPC/choline ratio (P < 0.001). When the FSH values were normal, the GPC/choline ratio appeared to be a very important parameter able to differentiate not only between cases of spermatogenic failure and obstructive azoospermia but also between different forms of spermatogenic failure. These results demonstrate the potential use of 1H-MRS on human seminal plasma in a new approach in the management of male infertility.

Antineoplastic Agents↗
PubMed1998

Fetal cerebral and umbilical artery blood flow changes during pregnancy complicated by malaria.

The objectives of our study were to quantify the fetal cerebral artery and umbilical artery blood flow changes daily during a malaria crisis in a pregnant patient and evaluate the sensitivity and the specificity of Doppler indices for the prediction of acute fetal distress at the end of the pregnancy. The study, designed as a prospective and observational one, was carried out in the obstetric department of a government hospital in French Guiana, on 23 women with pregnancies complicated by malaria (age range, 23 +/- 5 years; primiparas, 30%); crisis date: 30.8 +/- 2.5 weeks of gestation; start of treatment: 3.7 +/- 1.3 days after crisis started). The main measures of outcome consisted of daily determinations of fetal Doppler indices during the crisis, evidence of fetal distress (fetal heart rate decelerations) during labor, Apgar scores after birth, gestational age at birth, mode of delivery, and birth weight. During the crisis umbilical artery resistance index increased by 5 to 20% (P < 0.05), cerebral artery resistance index decreased by 5 to 20% (P < 0.05), and CURR decreased by 10 to 35% (P < 0.01), indicating flow redistribution toward the brain. No relationship was found between the CURR value and the following data: parasitemia grade, parity, gestational age of the crisis, date and mode of delivery, and fetal weight. A change in the hypoxia index (% change in CURR during the crisis x number of days of crisis) greater than 150 was associated with abnormal fetal heart rate in 75% of the cases, and a hypoxia index lower than 150 was associated with normal fetal heart rate in 90% of the cases (sensitivity, 89%; specificity, 77%). Lastly, the combination (hypoxia index > 150 and CURR < 1) was associated with abnormal fetal heart rate in 80% of the cases, and one or two of these normal parameters were associated with normal fetal heart rate in 84.6% of the cases (sensitivity, 80%; specificity, 84%). The CURR and the hypoxia index during the malaria crisis can be used to predict acute fetal distress at delivery.

Acute Disease↗
PubMed1998

[Follow-up of women treated for breast cancer. State of the art].

The intensive follow up of breast cancer patients is not safer than a minimalist policy for breast cancer surveillance. The survival rate is not modified by the use of expensive exams. Follow up program are stressful, delay the patient rehabilitation and are useless because in 75% of cases the patient discovered the relapse by herself. A good clinical examination, including gynecological examination and a mammography are sufficient for a good follow up practice. The guide lines for the follow up of breast cancer patients include self examination of the breast monthly, clinical examination twice a year and an annual mammography during five years and an annual clinical examination and a mammography after. The radio therapist, the surgical or medical oncologist should be involved with the general practitioner for this follow up.

Aftercare↗
PubMed1998

[Monitoring women on tamoxifen ].

Worldwide, 7 million women are taking tamoxifen for breast cancer. The beneficial effects of tamoxifen on patient survival have been clearly demonstrated. Tamoxifen has few adverse effects and severe complications are very uncommon. An higher risk of endometrial cancer at the 20 mg/d dosage has been discussed and if it does exist, is minimal (RR x 2 instead of 1.3). Patient monitoring is basically clinical with an annual examination of the lower limbs and genital organs and an ophthalmological examination. Further explorations are needed in cases with specific symptoms, especially metrorrhage. There has been no proof that systematic endometrial cytology or ultrasound explorations are useful.

Antineoplastic Agents, Hormonal↗
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↗