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L Boubli

Publications and source records attributed to L Boubli.

At least 55 records · Page 3Linked to original sources
PubMed1998

Prenatal diagnosis of fetal corpus callosum agenesis by ultrasonography and magnetic resonance imaging.

Corpus callosum agenesis (CCA) was evaluated by ultrasound examination and magnetic resonance imaging (MRI) in 14 cases. Ultrasonography was able to suspect CCA by indirect signs but a definitive diagnosis of CCA was achieved in only four cases. MRI was able to diagnose complete CCA in 13 cases and showed absence of the posterior portion of the corpus callosum in one case. Additional neurological abnormalities including heterotopia, gyration anomaly, asymmetry of the cerebral hemispheres, and Dandy-Walker variant were documented in five cases, as well as an ocular anomaly which was present in one case, by MRI examination. Prenatal counselling for fetal agenesis of the corpus callosum is difficult as the prognosis is uncertain. The association with other cerebral abnormalities increases the likelihood of a poor outcome and ultrasonographic assessment of the fetal brain is limited. We found MRI to be a safe and useful additional procedure to complement ultrasonographic diagnosis or suspicion of CCA.

Adult↗
PubMed1998

[Birth after two cesarean sections: the role of trial of labor].

OBJECTIVE: To study the management of labor following two cesarean sections, we evaluated maternal and neonatal morbidity subsequent to this attitude. PATIENTS AND METHODS: A retrospective study was conducted over a 6-year period (1-1-1990 to 31-12-1995) in 184 women presenting two uterine scars. Trial of labor was allowed in 96 cases with cephalic presentation and a normal pelvis. RESULTS: The rate of vaginal birth was 65%. Three patients presented a uterine scar dehiscence and in one of them hemostasis hysterectomy for uterine atony was performed. Neonatal outcome was good in all cases. CONCLUSION: Trial of labor after two cesarean sections is possible in the majority of cases. Rate of vaginal birth is high and maternal and fetal morbidity is low.

Female↗
PubMed1997

[Examination of the vulva and the vagina: from clinics to biopsy].

The purpose of this article is to describe clinical and colposcopic examination of vaginal and vulvar pathologies. Diagnosis tests are described as Hewitt's test, Collins test and epicutaneous test. According to clinical aspect, samples for bacteriological or cytological examinations are performed. Biopsy sites are selected by colposcopy to exclude atypia or malignancy.

Biopsy↗
PubMed1997

Human thymic B cells largely overexpress the VH4 Ig gene family. A possible role in the control of tolerance in situ?

Human thymus contains a small population of B cells, a fraction of which expresses CD2 and/or CD5, as revealed by FACS analysis. Human thymic B cells enriched on CD19 panning revealed a constant co-expression of CD19 and Ig light chains. In the absence of detectable B precursors, these cells had reached at least the stage of IgM+ immature B lymphocytes. Analysis of Ig transcripts by PCR amplification first revealed a strong bias in favor of the VH4 and sequencing of 45 VH4-D-J cDNA clones isolated from two thymuses indicated that this thymic repertoire significantly differed from that of peripheral blood lymphocytes. Most genes of the VH4 family were used with various D-J combinations and a relatively high frequency of somatic mutations. This repertoire thus appears clearly selected in the thymus. This is of particular interest since the VH4 gene family is frequently encountered in autoimmunity a situation in which the number of thymic B cells is largely increased. They could play a major role in the control of tolerance in situ.

Antigens, CD19↗
PubMed1997

[Hysteroscopy infection risk].

OBJECTIVES: The aim of this study is to evaluate the infectious risk of the hysteroscopy. METHODS: A prospective study was carried for nine months in the Belle-de-Mai maternity, in Marseille. We performed 81 operative or diagnostic hysteroscopies. A vaginal sample was achieved before the intervention and an endo-uterine sample after the procedure. The statistical analysis used the Chi 2 test. RESULTS: Fifty per cent of the patients of whom vaginal sample was contaminated present an endo-uterine sample infected at the end of an operative hysteroscopy. In 25% of cases, whereas the vaginal sample was normal, the endo-uterine prelevment was infected. The relative risk of the endo-uterine bacterial contamination, in case of vaginal contamination was 8.75 during this procedure. Within diagnostic hysteroscopy, no patient with a normal vaginal sample, was contaminated. No patent infection was observed. CONCLUSION: There is a risk of endo-uterine contamination during hysteroscopy. This risk is higher when the vaginal sample is contaminated before the intervention. This risk is smaller than the infectious risk of hysterectomy.

Adult↗
PubMed1997

[Endometrial resection in the management of menometrorrhagia refractory to medical treatment].

The authors report the results of 197 endometrectomies and analyse the indications, complications and long-term results. A retrospective analysis was performed at La Conception Hospital. Department of Gynaecology-Obstetrics, Prof Blanc, Marseille, between June 1988 and June 1994. The mean follow up was 53 months. 197 endometrectomies were performed in 186 women during this period. The indication was menometrorrhagia failing to respond to medical therapy. We considered patients to be cured when they no longer suffered from menorrhagia or metrorrhagia and when hormone replacement therapy could be started or continued. The success rate with a follow-up of 7 years was 70%. The failure rate was correlated with the woman's age, hysterometry data and histological results. The complication rate was 2.5%. Endometrectomy appears to be a safe and successful technique for the treatment of menometrorrhagia.

Adult↗
PubMed1996

[Transmission of human immunodeficiency virus to the fetus during pregnancy].

Estimates of the rate of human immunodeficiency virus vertical transmission range from 15% to 40%, and the rate is lower in European and American studies than in African studies. There appears to be a relationship between maternal factors, mode of delivery and mother-to-child transmission. The risk factors or markers associated with increased vertical transmission are analyzed in this review. The use of zidovudine, administered to HIV-infected women during pregnancy and labour, and to the offspring for 6 weeks reduce the mother-to-infant transmission rate from 25% to 8%. Other strategies to alter transmission of HIV, including the use of combinaison of anti-retroviral drugs, immunoprophylaxis against HIV or obstetric interventions needs to be evaluated.

Antimetabolites↗
PubMed1996

[Human immunodeficiency virus infection in pregnancy. General aspects].

Seroprevalence of HIV infection in pregnancy is on the increase worldwide. Approximately 10 million infants will have been infected by the year 2000 and the majority of these children will have acquired infection by vertical transmission of HIV from infected mothers. Recent reports suggested that pregnancy does not accelerate the course of HIV infection. Prospective studies from industrialized countries where most women have asymptomatic HIV infection, have not shown an association with increased risk of adverse pregnancy outcome. Estimates of the rate of vertical transmission range from 15% to 40%.

Adolescent↗
PubMed1996

Hysteroscopic management of uterine synechiae: a series of 102 observations.

This retrospective study concerns 102 cases of intra-uterine adhesions treated by exclusive hysteroscopic approach. Fifty-two patients (51%) presented with reproductive problems, 44 patients (43%) with menstrual problems and 6 were asymptomatic. Seventy-eight patients (76.5%) had an antecedent endometrial trauma on a gravid uterus. One hundred and forty-eight operative hysteroscopies were performed to treat 102 patients; 70 patients were treated in one endoscopic session (68.6%), 23 in two sessions (22.6%), 4 in three sessions (3.9%) and 5 in four sessions (4.9%). We report no infectious, hemorragic or metabolic complication but 6 perforations (5.8%). The mean follow-up is 24.4 months (from 6 to 46 months). Ten patients did not keep contact during follow-up. A good anatomical result was obtained in 88 patients (86.2%) after one or two hysteroscopic sessions. A good result on menstrual problems was obtained in 75% of the cases, especially in amenorrhea (90.5% success rate). The reproductive outcome is more disappointing. We obtained 34 pregnancies in 28 patients (10 abortions, 24 live born children). Twenty-two patients achieved no pregnancy (44%), but 13 of these patients presented with additional infertility factors.

Adolescent↗
PubMed1996

Gasless laparoscopic gynecologic surgery.

OBJECTIVE: Evaluate gasless laparoscopic gynecologic surgery as an alternative to conventional technique with carbon dioxide insufflation. STUDY DESIGN: Retrospective study of 49 cases. RESULTS: Gasless laparoscopic gynecologic surgery was successful in 90% of cases. The gasless technique permits the surgical team to use the laparoscopic and vaginal approach simultaneously. CONCLUSIONS: Gasless laparoscopic gynecologic surgery seems to be a reliable alternative to conventional laparoscopy for selected indications.

Adult↗
PubMed1996

Hysteroscopic management of menstrual disorders: a review of 395 patients.

OBJECTIVE: To evaluate the long-term effectiveness of transcervical resections in menstrual disorders. DESIGN: Retrospective consecutive patient follow-up. PATIENTS: From 1987 to 1993, 395 patients with menstrual disorders (menorrhagia and/or metrorrhagia) were treated with operative hysteroscopy in our department. Resection of endometrial polyps was performed in 65 cases, resection of submucous fibroids in 196, and endometrial ablation in 134. Fourty-one patients had a repeat procedure. RESULTS: Our mean follow-up period was 2.7 years. Thirteen complications were noted (3%), two of which were serious (one hemoperitoneum after uterine perforation, one severe symptomatic hyponatremia). Twenty-eight patients did not remain in contact after hospitalization (7.1%). Menstrual disorders were controlled in 297 patients (75.2%). Failure was noted in 70 patients (17.7%), including hysterectomy in 50 patients and persistent bleeding in 20. CONCLUSION: Hysteroscopic surgery is a satisfying technique for women with abnormal uterine bleeding who want a conservation of the uterus. Better results are noted with resections of polyps and fibroids than with endometrial ablations.

Adult↗
PubMed1996

Hysteroscopic surgery in postmenopausal women.

OBJECTIVE: To assess the efficacy of hysteroscopic surgery in postmenopausal women presenting with abnormal uterine bleeding. DESIGN: A retrospective audit of 102 patients. SETTING: The Department of Obstetrics and Gynecology B, La Conception Hospital, Marseilles, France. PATIENTS: One hundred and two women between the ages of 47-67 years with postmenopausal bleeding or bleeding related to hormone replacement therapy were evaluated by pelvic ultrasound and diagnostic hysteroscopy. A benign organic cause was noted in 87 cases (polyps in 51 and fibroids in 36.) Fifteen patients had no significant disease. INTERVENTIONS: Resection of polyps or fibroids, endometrial ablation. RESULTS: One hundred and seven procedures were performed on 102 patients. Major operative complications were rare and included one perforation and one case of glycine toxicity. Eighty-eight patients were satisfied with the results. Six patients were subsequently treated by hysterectomy. Six patients complained of recurrent abnormal bleeding. CONCLUSIONS: This modality of treatment appears to be effective over the long term. The operative criteria should take the causes of bleeding and not just the age of the patient into account.

Aged↗
PubMed1996

[Hysteroscopic treatment of uterine synechias. A report of 102 cases].

This retrospective study of 102 patients with uterine synechias treated exclusively hysteroscopically included 52 (51%) low fertility patients, 44 (43%) with menstrual disorders and 6 (6%) with no other symptoms. More than three-fourth of the patients (76.5%) had a past history of trauma on a gravid uterus. Operative hysteroscopy was performed 148 times, including sections with scissors in 63 cases (42.4%), section with laser in 4 (3%), uterine collapse in 19 (13%) and electrosection in 62 (41.6%). A single endoscopic procedure was sufficient in 70 patients (68.6%) and 2, 3, 4 procedures were required in 22.6%, 3.9% and 4.9% of the patients respectively. No complications due to infection, bleeding or metabolic disorders occurred, but perforations were seen in 6 patients (5.8%) including 4 cases with complexe synechias. Mean follow-up was 24.4 months (range: 6-49 months); 10 patients were lost to follow-up. Good anatomic results were achieved in 88 patients after 1 or 2 hysteroscopic procedures (86.2%). Clinical results were less satisfactory, particularly in cases with low fertility in which another pathology was often associated (59%). We obtained good results in 75% of the patients with dysmenorrhoea. However, one or more pregnancies was achieved in 28 of the 50 patients contacted later (a total of 34 pregnancies including 10 abortions and 24 normal deliveries). A hysteroscopic procedure should be proposed as first intention treatment in all cases with synechia. In addition to diagnosis, hysteroscopy allows selective, reproducible treatment with little morbidity and conservation of the surrounding endometrium. After several unsuccessful procedures, surgery using Musset's technique can be proposed.

Adolescent↗
PubMed1995

[Borderline tumors and cancers of the ovary. Laparoscopic-surgical evaluation].

OBJECTIVES: Benign cysts of the ovary can now be correctly treated with laparoscopic surgery, but it is difficult to confirm the benign nature of the suspected formation. Thus, the major risk of the laparoscopic surgery is the dramatic consequences in case of malignancy as reported in several cases in the literature. We conducted a survey to evaluate this risk. METHODS: A retrospective multicentric survey of laparoscopic procedures performed for a diagnosis of lesions of the annexes or cyst of the ovary was conducted. Forty-four centres reported a total of 7,122 laparoscopic procedures, including 5,307 in which laparoscopic surgery was performed. Laparoscopic treatment included puncture (21.3%), partial exeresis (51.3%) and complete exeresis (25.6%). Conversion to laparotomy was required in 20 cases (25.6%). A complementary surgical procedure was needed after the laparoscopic procedure within a delay of 78 days in 49 cases (58%). Laparoscopy was the only procedure used in 16% of the cases. RESULTS: Pathology reports of the surgical specimen indicated malignant lesions of the ovary in 78/5, 307 cases (1.47%) including 60 borderline tumours and 18 cancers. Among these 78 cases, preoperative work-up and laparoscopy had led to a diagnosis of a benign lesion in 17 (21.8%). Among the 49 cases with secondary surgery, a more advanced FIGO (International Federation of Gynaecology-Obstetrics) stage was observed in 11 (i.e. 8.3% of the 78 malignant cases) compared with the initial assessment. CONCLUSION: These findings demonstrate that it is not rare to discover the malignant nature of an ovarian tumour after initial laparoscopic treatment of a formation initially diagnosed as benign. Such accidents are the result of insufficient security in risk evaluation before laparoscopy. Whenever there is even a minimal risk of malignancy, laparotomy must be performed as the procedure of choice.

Adult↗
PubMed1995

Recurrent congenital toxoplasmosis in a woman with lupus erythematosus.

We describe the case of a patient with systemic lupus erythematosus, treated by corticosteroids, who presented during two successive pregnancies with serological reactivation of toxoplasmosis associated with fetal lesions. The first infected fetus died in utero with signs of hydrops. The second fetus was treated in utero with a combination of sulfadoxine and pyrimethamine, administered to the mother, and is now well. The increasing number of immunocompromised pregnant patients with immunity to Toxoplasma gondii may lead to a higher risk of reactivation of maternal toxoplasmosis and congenital infection.

Adult↗
PubMed1995

Laparoscopic management of malignant ovarian cysts: a 78-case national survey. Part 2: Follow-up and final treatment.

This paper reports a retrospective multi-institutional French survey carried out in 1992 to determine the incidence of laparoscopic management of malignant ovarian cysts. Of 5307 ovarian lesions treated endoscopically, 78 were malignant (1.47%) including 60 borderline tumours (77%) and 18 ovarian cancers (23%). Laparoscopic treatment was puncture in 23% of cases, partial exeresis in 51% and total removal in 26%. Laparotomy was immediately performed in 25% of the cases and as a second stage procedure in 58% (mean delay: 78 days). Laparotomy was not performed in 16% of the cases. Our findings suggest that laparoscopic management of ovarian lesions that subsequently prove to be malignant is not uncommon. To prevent the risk of metastasis, thorough pre-operative and per-operative evaluation is mandatory. In 22.4% of the patients presenting lesions in this study, laparoscopic tampering resulted in an upgrading of FIGO stage.

Female↗
PubMed1995

[Unusual twin pregnancy: one in the pseudo-unicornate uterus and the other in the rudimentary uterine horn. Discussion on the diagnosis and management during pregnancy].

An unusual twin pregnancy was diagnosed echographically at 18 weeks gestation and confirmed by magnetic resonance imaging. One foetus was in a pseudo unicornis uterus and the other in a rudimentary uterus cornu. The risk in such cases, as also reported in the literature, is rupture of the rudimentary cornu at about 20 weeks gestation. In this case the patient was carefully monitored to 23 weeks when the pregnancy in the rudimentary cornu stopped spontaneously. The foetus in the pseudounicornis developed normally to 38 week term. This exceptional observation emphasizes the risk of pregnancy in a blind uterus cornu.

Adult↗