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Biomedical subjects

L Cravello

Publications and source records attributed to L Cravello.

At least 73 records · Page 4Linked to original sources
PubMed1998

[Hysteroscopic myomectomy. Functional results with an average follow-up of 6 years].

OBJECTIVE: In 1995, we presented our experience in hysteroscopic resection of hemorrhagic submucous fibroids in 196 patients. The objective of the present work was to analyze functional outcome three years later. PATIENTS: One hundred ninety-six patients with abnormal uterine bleeding were treated between 1987 and 1993. Equipment, techniques, characteristics of the procedures and early results were detailed in the previous article. RESULTS: With a mean follow-up of 73 months (range 50,104), results were: 13.8% of the patients were lost to follow-up; 68.4% had symptomatic improvement and failure was observed in 17.8% (subsequent hysterectomy in 12.7%). Forty-nine patients had repeat resection in this series; 61 became menopausal after surgery, and 21 were taking hormone replacement therapy with good results. CONCLUSION: Developed as an alternative to hysterectomy, operative hysteroscopy has proven to be a safe and effective procedure. This treatment modality appears to give satisfactory long-term results, with a low rate of complications.

Adult↗
PubMed1997

Endoscopic surgery. The end of classic surgery?

Gynecological endoscopy is now a well-established procedure and it has been proved that the laparoscopic surgical technique can be used in the management of most gynecological disorders thus replacing conventional laparotomic procedures. The latest indications apply to such functional pathologic conditions as urinary incontinence and genital prolapse, and oncology (radical hysterectomy, lymphadenectomy). Hysteroscopy has afforded an easier surgical approach to certain pathologies such as septate uterus and endometrial ablation. Indications of conventional surgery are getting fewer. Yet conventional surgery should be part of the training of the gynecologist surgeon as the laparotomic approach is still the only solution in the most difficult cases.

Endoscopy↗
PubMed1997

[Knowledge and behavior of pregnant women towards HIV infection and its screening].

OBJECTIVES: To assess knowledge and attitudes of pregnant women towards HIV infection and testing, and to compare them according to the outcome of the pregnancy (elective abortion vs delivery). METHODS: Between March 30 and April 26, 1992, all women ending their pregnancy in a medical center located in South Eastern France, were asked to complete an anonymous questionnaire: 3,589 (89.6%) responded: 2,825 women who delivered and 764 who chose abortion. RESULTS: 61.7% of the women who delivered and 24.1% of the women who chose abortion declared having been tested for HIV during pregnancy (p < 0.001). Among women who reported not having been tested, very few did so because they refused the test (2% among women who deliver and 1.5% among women who terminated pregnancy). A total of 2.6% of women tested during prenatal care and 19.6% in the context of abortion did not know the result of their test (p < 0.001). Knowledge about HIV transmission among women who delivered dit not differ significantly from that of women who terminated pregnancy. However risky behaviors were more frequent among the latter group (38.8% vs 17.7%, p < 0.001). CONCLUSION: This research confirms that systematic HIV screening during prenatal care was already diffused in France but remained mainly motive by foetal concerns and was not always associated with adequate preventive counselling, specially for migrant women and women with a low level of education. HIV screening and counselling is not guaranteed for women coming for elective abortion although they are more at risk for HIV infection. In spite of psychological difficulties, systematic proposal of HIV screening should be extended to the context of elective abortion.

Abortion, Legal↗
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↗
PubMed1997

[Role of endo-uterine resection using hysteroscopy in the treatment of sub-mucous hemorrhagic fibroma in the peri-menopausal period].

OBJECTIVES: To study retrospectively the long-term outcome after hysteroscopic treatment for intra-uterine fibromas. METHODS: From October 1987 to January 1993, endo-uterine glycocol resection was performed in 196 patients with intra-uterine fibromas. The operation had to be repeated in 39 patients due to incomplete resection or recurrent symptomatology. Patients presented with menometrorrhage. RESULTS: Intra-operative complications were rare, mainly uterine perforations (7 cases) or metabolic syndromes due to reabsorption of glycine (5 cases). Mean follow-up was 2.5 years. In all 196 women consulted for bleeding, good results were achieved in 81.1%. CONCLUSION: Endo-uterine resection is a sure, effective and long-lasting treatment for intra-uterine fibromas.

Adult↗
PubMed1997

[Richter's spinofixation in vaginal prolapse].

The transvaginal sacrospinous fixation, called Richter operation was initially aimed to cure vaginal vault prolapse after hysterectomy. The results are as good as those of the abdominal promontory fixation with the well known advantages of the vaginal route. Indications way be extended to V3 U3 R3 prolapse and cure of elytrocele with good results in our practice. In few cases remnant cystocele may be a trouble some problem.

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

Hepatic endometriosis: a case report.

OBJECTIVE: To describe a case of hepatic endometriosis. DESIGN: Case report. SETTING: University hospital. PATIENT: A 34-year-old woman with a 2-year history of cyclic right subcostal pain. INTERVENTIONS: Gonadotropin-releasing hormone agonist (GnRH-a) therapy followed by surgical resection. RESULTS: Ultrasonography, computed tomography scan, and magnetic resonance imaging of the liver disclosed a 6-cm diameter mass. The GnRH-a therapy for 4 months led to clinical and radiologic improvement. Surgery performed to allow pregnancy confirmed the diagnosis of hepatic endometriosis. CONCLUSIONS: Hepatic endometriosis is uncommon. It may result from metaplasia of the peritoneum or from hematogenic or lymphatic spread.

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

[Treatment of uterine fibromas].

Uterine myomas are frequent tumors, but only some of them need to be treated: only when they are symptomatic. After describing the role of oestrogen and growth factors on the development, and the value of clinical examination and imaging techniques (ultrasonography, outpatient hysteroscopy without anesthesia), the authors study the various treatments. Medical treatments essentially consist of progesterone and preoperative GnRH agonists or in peri-menopause (add-back therapy). When if medical treatment fails, surgery consists of: myomectomy and hysterectomy (by abdominal, laparoscopic or vaginal routes), myolysis and hysteroscopic resection. Three cases are isolated: infertility, pregnancy and menopause associated with uterine myomata.

Female↗
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↗