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Biomedical subjects

L Marpeau

Publications and source records attributed to L Marpeau.

At least 73 records · Page 4Linked to original sources
PubMed2002

[Mechanisms of the stagnation of dilatation in the active phase of labor].

OBJECTIVE: Our study was designed to explain determinants of nonprogressive labor in nulliparous patients. STUDY DESIGN: One hundred consecutive nulliparous patients have got a cesarean section for active-phase arrest of labor after two hours of active management. Intrauterine pressure was monitored for all of them and a X-ray pelvimetry was done after surgery. RESULTS: Eighty-three percent of patients showed X-ray data considered as normal; hypotonic labor was found in 50% of cases and occiput posterior position in 60%. CONCLUSIONS: Our results suggest that occiput position and functional dystocia are more common in case of nonprogressive labor than abnormal measurements of the obstetrical pelvis.

Dystocia↗
PubMed2002

[Pregnancy, tuberculosis and inappropriate antidiuretic hormone secretion].

We report a pregnant woman presenting with seizure secondary to hyponatremia by inappropriate antidiuretic hormone secretion. Aetiology was unknown urinary and lung tuberculosis. This case report presents diagnosis strategy of inappropriate antidiuretic hormone secretion and the arguments for its aetiology.

Adult↗
PubMed2002

[Pregnancy: a possible etiology of pyoderma gangrenosum. A case report and review of the literature].

OBJECTIVE: We report an unusual case of pyoderma gangrenosum at 26 weeks gestation and review other cases reported in the literature in order to examine the underlying causes and determine the appropriate diagnostic and therapeutic approach to this uncommon skin disease. Patient and methods. The patient developed an acute abdominal syndrome at 26 weeks gestation (laparotomy was non contributive) followed by pyoderma gangrenosum of the abdominal wall. Seven other cases have been reported in the literature associating pyoderma gangrenosum with pregnancy. We analyzed the clinical findings in these cases. RESULTS: Corticosteroid therapy successfully controlled pyoderma gangrenosum in our patient. Pregnancy outcome was favorable with little effect on the newborn. Complete healing was achieved after several months of treatment. CONCLUSION: Histological lesions are nonspecific. Diagnosis of pyoderma gangrenosum is generally based on clinical signs. Systemic disease is associated in half the cases (inflammatory bowel disease, myelodysplastic syndrome, rheumatoid arthritis). The impact on pregnancy appears to be limited. Treatment is based on high-dose systemic corticosteroid therapy or cyclosporin. The two drugs may have to be combined. Search for an associated disease and appropriate treatment is particularly important for the outcome of pregnancy.

Abdominal Wall↗
PubMed2002

[Biochemical markers for preterm delivery (excepting markers of infection)].

Fetal fibronectin is an extracellular glycoprotein secreted at the maternal-fetal interface by the trophoblast. Fetal fibronectin testing may be useful in women with symptoms of preterm labor to identify those with negatives values and a reduced risk of preterm birth (NP 3). Fetal fibronectin could be either detected by cervical or vaginal sampling (NP 3). Concentrations of fetal fibronectin could be measured by an enzyme-linked immunosorbent assay or by a bedside dipstick technique (NP 3). There are numerous false-positive results in women with cervical dilatation, recent intercourse or cervical examination, and vaginal bleeding (NP 3). In most of the studies, a quantitative test was used with 50ng/ml as the cuttoff point for a positive results. There are no convincing data to recommend fetal fibronectin rather than cervical ultrasonography (and inversely), or to used these two tests together to predict preterm birth (NP 3). The choice should depend on the availability and the cost of each test. Other biochemical markers (salivary estriol or plasma CRH) are still under assessment and should not be used outside research protocols (NP 3).

Biomarkers↗
PubMed2002

[Gas embolism and hyperbaric oxygen treatment during pregnancy: a case report and a review of the literature].

We report the first case of a pregnant woman presenting with a paradoxical air embolism due to accidental removal of a central venous catheter. Secondary right hemiplegia associated with a confused state justified emergency hyperbaric oxygen therapy, which was followed by complete neurological recovery. The aim of this case report is to assess risk situations of gas embolism during pregnancy and puerperium, as well as indications and fetal effects of hyperbaric oxygen therapy.

Adult↗
PubMed2002

[Acute vulval ulcer or Lipschutz's disease].

The case of a 16-year-old woman with typical clinical features of acute vulval ulcer, Lipschutz's disease, is reported. The main differential diagnoses are discussed. Isolated vulval ulcer can reveal a recurrent aphthous ulcer, Behçet's disease or Crohn's disease. In contrast, acute vulval ulcer spontaneously heals with no recurrence, that must be taken into account for diagnosis.

Acute Disease↗
PubMed2002

[Ovarian pregnancies: revaluation of diagnostic criteria].

OBJECTIVES: To clarify the clinical features of ovarian pregnancy and to show the incapacity of Spielberg's criteria to establish the diagnosis. MATERIAL AND METHOD: and method. Retrospective experience of ovarian pregnancies in a single maternity unit over seven years with comparison between new diagnostic criteria and those of Spiegelberg. RESULTS: Thirteen ovarian pregnancies identified (incidence=1 for 1400 deliveries). History of pelvic disease (one case), use of an IUCD (five cases), pelvic pain (all the cases), metrorrhagia (four cases), hemorrhagic shock (two cases). Diagnosis was evoked only once by ultrasound. Eleven patients were treated by laparoscopy. None of the ovarian pregnancies in the present series met the criteria of Spiegelberg's definition. CONCLUSION: Ovarian pregnancy is a rare form of ectopic pregnancy, but its incidence is certainly underestimated. Search for difficult to detect ultrasonographic features is essential. Criteria, other than those described by Spiegelberg, when present together confirm ovarian pregnancy: serum beta-hCG level > or = 1000 IU/l and uterine vacuity at vaginal ultrasonography; ovarian implication confirmed by surgical exploration, with bleeding, visualisation of chorionic villi or presence of an atypical cyst on the ovary; normal tubes; absence of serum beta-hCG after treatment of the ovary. Ovarian pregnancy does not compromise subsequent fertility of these patients. Recurrence is exceptional.

Adult↗
PubMed2001

Isolated mild fetal cerebral ventriculomegaly: a retrospective analysis of 26 cases.

We retrospectively studied 26 fetuses with isolated mild cerebral ventriculomegaly diagnosed between 1992 and 1998 and defined by a lateral ventricular atrial diameter of 10-15 mm without any other cerebral anomaly. Our objectives were to determine maternal risk factors, to evaluate complementary investigations, to assess developmental prognosis and to propose possible management. During pregnancy 10/26 patients had regressive ventriculomegalies, ten remained borderline at birth and six were confirmed postnatally. No maternal risk factors were identified. Prenatal investigations were carried out in 69% of cases but in only a few cases supplied any information. Postnatal examinations revealed one case of Down syndrome and one of porencephaly. Four children were lost to follow-up. In the 22 other cases, four had developmental delay. Early and unexplained mild ventriculomegaly appears to have a good prognosis. If ventriculomegaly is persistent, prenatal management should be carried out to investigate chromosomal abnormalities, viral infection, and fetal cerebral parenchymal damage. A long postnatal clinical follow-up is required.

Adult↗
PubMed2001

Intravenous chemotherapy, early debulking surgery, and consolidation intraperitoneal chemotherapy in advanced ovarian carcinoma.

OBJECTIVE: The efficacy of a cisplatin-anthracycline combination, early debulking surgery, and intraperitoneal chemotherapy has been demonstrated through separate studies. We evaluated a multimodal treatment strategy integrating these therapeutic options. METHODS: Women with stage III or IV ovarian carcinoma received six cycles of cisplatin/epirubicin alternating with leucovorin and 5-fluorouracil. Patients with a residual disease (RD) measuring more than 2 cm after the initial laparotomy underwent an early debulking surgery after the first three cycles of chemotherapy. A second-look laparotomy (SLL) was performed after six cycles of intravenous chemotherapy. Intraperitoneal chemotherapy with cisplatin, VP16, and mitoxantrone was then administered in patients with no or RD < 2 cm after SLL. RESULTS: A total of 87 patients were included. After initial laparotomy, 11 patients (12%) had no macroscopic residual disease, 38 (44%) had a RD < or =2 cm, and 38 (44%) had a RD > 2 cm. After early debulking surgery, an additional 18 patients (21%) had a RD < 2 cm. Seventy-five patients were evaluable for response to intravenous chemotherapy: the overall response rate was 80%, and 30 patients achieved a pathological complete response (40%). Eight percent of the patients had stable disease and 12% had a progression. Sixty-eight patients received intraperitoneal chemotherapy after second-look laparotomy. With a 72-month median follow-up, median overall survival and progression-free survival were, respectively, 37 and 19 months. Five-year survival was 41%. CONCLUSION: The prognosis of patients with advanced ovarian carcinoma may be improved by a sequential treatment strategy including intravenous chemotherapy, early debulking surgery, and intraperitoneal chemotherapy.

Adult↗
PubMed2001

[Primary fibromatosis of the breast].

Primary fibromatosis of the breast is a very rare pathology which looks like a malignant tumor, clinically and radiologically. Fibromatosis of the breast is characterised by a local invasion and a risk of recurrence. Positive diagnosis is provided by histology and its treatment is surgical. The aim of this study was to report one case and to emphasize the difficulties encountered in the diagnosis and the treatment.

Adult↗
PubMed2001

False aneurysm of the uterine pedicle: an uncommon cause of post-partum haemorrhage after caesarean section treated with selective arterial embolization.

We report three cases of post-partum haemorrhage following caesarean delivery attributed to a false aneurysm of the uterine pedicle and treated with artery embolization. These lesion were probably post-traumatic in origin related to hysterotomy. Angiographic study of the anterior division of hypogastric arteries confirmed the diagnosis and embolization of the false aneurysm was successful in controlling the haemorrhage.

Adult↗
PubMed2001

Plasma progesterone kinetics following surgical treatment of ectopic pregnancies.

OBJECTIVES: Comparative study of plasma progesterone and betaHCG kinetics following surgical treatment of ectopic pregnancy. STUDY DESIGN: Prospective study involving 62 patients with tubal ectopic pregnancies. Study of the kinetics of plasma progesterone and betaHCG, and the correlation coefficient between plasma progesterone and betaHCG levels during post-operative follow-up. RESULTS: Thirty-nine patients were treated by salpingostomy and 23 by salpingectomy. Analyzing the betaHCG kinetics according to treatment revealed that both curves were convergent on day 2. Progesterone kinetics differed greatly in that they appeared "parallel and confused". Analyzing the correlation between betaHCG and progesterone levels proved the absence of a significant link. CONCLUSIONS: Studying the kinetics of plasma progesterone after surgical treatment of ectopic pregnancies revealed a fast decrease in progesterone. Statistical analysis of the progesterone concentration showed that post-operative kinetics is fully independent from that of betaHCG. Progesterone therefore cannot be substituted to betaHCG for post-operative follow-up.

Chorionic Gonadotropin, beta Subunit, Human↗
PubMed2001

Adnexal torsion: a report on forty-five cases.

OBJECTIVES: To evaluate the clinical findings, evolution of treatment and ovarian function following conservative therapy. STUDY DESIGN: A case series of 45 patients presenting with adnexal torsion between January 1989 and June 1999. All patients were surgically treated, either conservatively or radically. Patients who had received conservative treatment, interviewed by phone and underwent ovarian sonographic examination. RESULTS: Adnexal torsion is more frequent in young women with adnexal pathology. Conservative therapy by laparoscopy has gained increasing preference as a surgical procedure. It is safe and preserves ovarian function. CONCLUSIONS: Conservative therapy by laparoscopy is recommended to preserve ovarian function in young women.

Adnexal Diseases↗
PubMed2001

Abnormal placentation and selective embolization of the uterine arteries.

OBJECTIVE: Abnormal placentation accounts for more than 50% of uterine artery embolization failure. The authors report their experience in this situation. STUDY DESIGN: Seven women presented with abnormal placentation. Uterine artery embolization was carried out in emergency or prophylactic control of postpartum bleeding. RESULTS: In five patients, control of postpartum hemorrhage was obtained without hysterectomy. In two cases with no placental removal and prophylactic procedures, hysterectomy and blood transfusion were not necessary. The manual removal of the placenta was achieved secondarily, respectively on the 25th and the 12th day. CONCLUSIONS: The success rate of uterine artery embolization for postpartum bleeding appears to be lower with abnormal placentation. In none of the cases with the placenta present was it possible to leave the residual placenta in place. However, embolization may permit a safe waiting period and spontaneous migration of the placenta. When the diagnosis is made before delivery, prophylactic uterine artery embolization without placental removal should be considered to reduce blood transfusion and preserve fertility.

Adult↗
PubMed2001

[Which initial tests should be performed to evaluate meno-metrorrhagias? A comparison of hysterography, transvaginal sonohysterography and hysteroscopy].

OBJECTIVE: Evaluate the feasibility and the value of hysterography, sonohysterography and hysteroscopy for investigation of abnormal uterine bleeding. Method. Longitudinal blind study of thirty-eight patients consulting for abnormal uterine bleeding during pre- and post menopause. All patients underwent an hysterography and transvaginal sonohysterography, in random order, followed by an hysteroscopy with histological sample. The results were compared with the histo-pathological examination that was used for reference diagnosis. Statistical study of sensitivity, specificity and Positive and Negative Predictive Value (PPV-NPV) of each investigation; rate of agreement by the coefficient of Kappa. RESULTS: The hysterography offers a PPV of 83% and a NPV of 100%. The interpretation errors were associated with the simple mucous hypertrophy interpreted as "hyperplasy". The limits correspond to a contrast agent allergy. The sonohysterography had a VPP of 89% and a VPN of 100%. The false positive is due to the difficulties of distinguishing the clots from the polyps. The limits correspond to the difficulties of cervix catheterization (13%). As regards the hysteroscopy, the VPP was 81.5% and the VPN of 75%. The interpretation mistakes were associated with mucous hypertrophy and the hyperplasy. CONCLUSIONS: The most useful examination for abnormal uterine bleeding, in the first instance, is transvaginal sonography with saline instillation. A complement by Doppler study would probably make it possible to limit the false positives.

Adult↗