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Biomedical subjects

L Marpeau

Publications and source records attributed to L Marpeau.

At least 127 records · Page 7Linked to original sources
PubMed1995

[Cervical pregnancy: conservative treatment with primary embolization of the uterine arteries. A case report. Review of the literature].

Ectopic pregnancies are rarely located in the cervix. In most (50-70%) of the cases, haemostatic hysterectomy is usually performed. We attempted an original approach for ectopic pregnancies located in the cervix which allowed preservation of the uterus. The uterine arteries are embolized before evacuation of the pregnancy and haemostasis of the loge with a balloon probe. In the literature, the incidence has been reported at 1 cases/20,000 births. Past history of curetage is a favouring factor. Echography facilitates diagnosis. When possible, conservative treatment may involve surgery (arterial ligature, endocervical haemostasis), drug therapy (methotrexate) and radiography (arterial embolization).

Adult↗
PubMed1995

[Hysterectomy. Indications, abuse, psychological impact].

Statistical surveys have established that, in France, hysterectomy was carried out too frequently: 50 to 70,000 hysterectomies (perhaps only 40,000) are carried out each year in our country. This fact, together with the deleterious psychological effects of this operation, have urged the authors to express some remarks on the current practice of hysterectomy in France. The currently approved indications are the following: invasive cancer, benign lesions with intractable disabling symptoms and technical requirements (e.g. cure of prolapse in the elderly). Bleeding due to fibromyomas should be managed with conservative means as much as possible. Infections are within the scope of medical treatment. When an hysterectomy is indicated, the vaginal route should be preferred whenever possible, due the lesser impact on the body image and personality. The adverse psychological effects of hysterectomy are due to several factors: fear of the operation, pain, possible complications, breach of the femininity, alteration of the body image, fear of menopause and ageing. These effects could be reduced by an accurate information of the patient on the actual consequences of the operation, which are far from considerable, specially if the hormonal secretion is preserved. Also, a certain period of time between the decision and the operation might help to further reduce this psychological impact.

Adaptation, Psychological↗
PubMed1993

Therapeutic abortion during the 2nd and 3rd trimesters of pregnancy using a synthetic derivative of prostaglandin E2, sulprostone, administrated intravenously. Based upon 182 cases.

OBJECTIVE: The purpose of the study is to assess the efficacy of and adverse events linked to the use of intravenous sulprostone during the 2nd or 3rd trimesters of pregnancy for therapeutic abortion. STUDY DESIGN: One hundred eighty-two patients (70 nulliparous, 112 multiparous) were hospitalized for therapeutic abortion. The route of administration was invariably intravenous and one single dose of sulprostone was used: 1000 micrograms of sulprostone diluted in 1 l of isotonic saline solution given as a 10-h infusion. RESULT: Expulsion within the first 24 h was obtained in 70% of cases with a mean induction-expulsion interval of 14 h. In three cases, laparotomy was required for hemorrhagic syndromes. CONCLUSION: Intravenous sulprostone enable evacuation of uterine contents with minimal adverse reaction. Attention should nevertheless be drawn to the existence of hemorrhagic syndromes.

Abortifacient Agents, Nonsteroidal↗
PubMed1993

Intravenous sulprostone and uterine scarring based upon 22 cases of therapeutic abortion during 2nd and 3rd trimesters of pregnancy.

A preliminary study in 22 patients with uterine scarring was undertaken using sulprostone by intravenous infusion when therapeutic abortion was deemed necessary during the 2nd and 3rd trimesters of pregnancy. The dosage used was 500 micrograms by slow infusion lasting 10 h. There were no cases of ruptured uterus. Adverse reactions were absent. Results were satisfactory. Mean induction-expulsion duration: 11 h. Expulsion rate in 24 h: 63%. With strict monitoring and in a specialized center, this technique may be suggested when a late therapeutic abortion with a scarred uterus is indicated.

Abortifacient Agents, Nonsteroidal↗
PubMed1993

Folinic acid, 5-fluorouracil bolus and infusion and mitoxantrone with or without cyclophosphamide in metastatic breast cancer.

60 patients with metastatic breast cancer were entered in a phase II study using folinic acid, 5-fluorouracil bolus and infusion and mitoxantrone with or without cyclophosphamide. 47 had measurable visceral metastases and 13 had exclusively bone metastases. 36 had received previous adjuvant or metastatic treatment (33/36 with anthracycline-based regimens). Overall response rate in visceral metastatic patients was 57.1% [95% confidence interval (CI) 35.4-78.8%]; 45.5% and 70% in previously and non-previously treated patients, respectively; duration of response was 9 and 13 months, respectively. 10 out 13 patients with exclusive bone metastases improved for a median time of 18 months. Median survival was 22 months for the 60 patients; 18 and 31 months for previously and non-previously treated patients, respectively. Cyclophosphamide was scheduled only in the absence of nadir grade 4 neutropenia. However, this toxicity occurred in the first 7 patients. For this reason, we chose to avoid cyclophosphamide in patients over 60 years, or with a performance status of 1-2, or who had received previous chemotherapy. Overall, cyclophosphamide was stopped due to nadir grade 4 neutropenia in 17/24 patients for whom this drug was planned. When mitoxantrone, 5-fluorouracil and folinic acid were used at the doses scheduled, the addition of cyclophosphamide appeared feasible in only about 25% of the patients. Furthermore, survival was identical for patients receiving or not receiving cyclophosphamide. Therefore, cyclophosphamide does not contribute substantially to this regimen. This study confirms the value of folinic acid, 5-fluorouracil and mitoxantrone in metastatic breast cancer.

Adult↗
PubMed1993

[Castleman's disease localized in the uterus or an inflammatory uterine pseudotumor. A case report and review of the literature].

The authors report a case of Castleman's disease localised to the uterus. The treatment was surgical removal of the lesion with conservation of the uterus. Though in localised forms the prognosis is always favourable, multicentered lesions can suggest lymphoma. In our case that we report the anatomo-pathological appearances were not characteristic and this has led the authors to think of a differential diagnosis such as an inflammatory pseudo-tumour of the uterus of which only two cases have been previously reported.

Adolescent↗
PubMed1993

[The effect of peridural analgesia on uterine contractions].

OBJECTIVE: To study the impact of 0.25% bupivacaine on the frequency and intensity of uterine contractions. METHODOLOGY: 52 patients in labour. Continuous internal tokographic measurement of uterine activity at 10 minutes before instilling the bupivacaine and at 30 minutes after doing so. The true frequency and intensity of the uterine contractions were the two parameters that were studied. RESULTS: There was a significant variation (matched Student's test) between the two parameters that were studied: there was transitory hypokinesia (p = 0.003) and intense prolonged hyperkinesia (p < 0.001). CONCLUSION: 0.25% bupivacaine produces hyperkinetic increases in intensity of the contractions of which the mechanism has not been elucidated; therefore it is inadvisable to add oxytocics in the minutes after instilling bupivacaine.

Analgesia, Epidural↗
PubMed1993

[Breast cancer and pregnancy].

Breast cancer is generally believed to carry a worse prognosis during pregnancy because of the potential adverse effects of anticancer treatments on the fetus and of pregnancy related hormonal and immunological modifications on the disease. Problems arise both with breast cancers diagnosed during or immediately after pregnancy and with pregnancies occurring in patients previously treated for breast cancer. The incidence of these problems is difficult to estimate, in part because pregnancy-related changes in the breasts obscure clinical and radiological manifestations. Prognosis depends more on patient age than on gestational age at diagnosis. Other prognostic factors include size of the tumor and node involvement. Although the outcome of N+ tumors is more severe during pregnancy, overall the poor prognosis of breast cancer during pregnancy is due to the young age of patients and pregnancy has no bearing on prognosis after adjustment for stage. Similarly, women who become pregnant after being treated for breast cancer do not have worse outcomes. Management is difficult because some treatments cannot be used during pregnancy; the approach is similar to that used in non-pregnant women, although chemotherapy should be given only after 14 or 15 weeks gestational age and irradiation therapy only after delivery.

Adult↗
PubMed1993

[Local and long-term systemic risks of silicone breast implants].

A woman of 59 years of age, who had bilateral breast implants, 20 years earlier, presented with both breasts hard, inflamed and ulcerated, which suggested bilateral siliconomas. Bilateral mastectomy was carried out in two stages because she developed disseminated intravascular coagulation during the first operation.

Breast Diseases↗
PubMed1993

[Postpartum perineal rehabilitation by early electrostimulation at home. Preliminary study].

The authors report a preliminary trial of post-partum perineal physiotherapy by functional electric stimulation at home starting from Day 15. Fifteen primipara used the technique. Perineal muscle testing and urodynamic investigations took place before Perineal muscle testing and urodynamic investigations took place before and after physiotherapy. Testing of the levators showed complete recovery in 20 p. cent of cases and partial in 80 p. cent. Urodynamic results showed a significant increase in resting urethral pressure. Acceptability of physiotherapy was perfect. The early start offered the twin advantages of better muscular recovery and easier motivation of the patient. Physiotherapy at home enabled these women, already busy, to carry out their perineal physiotherapy with minimum difficulty.

Adult↗
PubMed1992

Hysteroscopic diagnosis of ectopic pregnancy.

Although vaginal ultrasonography combined with plasma beta-hCG determination can provide a reliable diagnosis and location of ectopic pregnancy, the results can be difficult to interpret in the early stages when hCG levels are low. Hysteroscopy can be used in such cases to differentiate between ectopic pregnancy and non-viable uterine pregnancy when viable uterine pregnancy has been ruled out. General anaesthesia and laparoscopy are avoided. We performed 60 hysteroscopic procedures between January 1989 and December 1990 in patients with suspected ectopic pregnancies. The pregnancy had been located by means of vaginal ultrasonography in every case in which the hCG was above 1500 IU/ml and in 36% of cases in which the beta-hCG was below this level. Hysteroscopy was hindered by metrorrhagia in three cases and was inconclusive in one, necessitating laparoscopy. Diagnosis was possible in all the remaining cases, as follows: ectopic pregnancy in 41 cases, with an empty uterus and occasional bleeding from an ostium; non-viable uterine pregnancy in 18 cases, with the presence of material within the cavity. Hysteroscopy therefore confirmed the diagnosis in 55% of the cases and was itself diagnostic in a further 43% of cases. Its sensitivity for the diagnosis of ectopic pregnancy was 100% and its specificity 95%. We propose a diagnostic decision tree.

Chorionic Gonadotropin↗
PubMed1992

In utero early suspicion of superfetation by ultrasound examination: a case report.

We report the case of a dichorionic and diamniotic pregnancy with the unique feature of an early ultrasound diagnosis of a 4-week size difference, which persisted throughout pregnancy. At birth, the twins had a 1-month difference in physical and neurological maturity. We believe that only the phenomenon of a superfetation can explain this difference. We report the cases found in the literature.

Journal Article↗
PubMed1992

Sequential cisplatin-doxorubicin, early debulking surgery and intraperitoneal chemotherapy in advanced ovarian cancer. Groupe d'Etude et de Recherche sur les Cancers de l'Ovaire et Digestifs (GERCOD).

40 patients with advanced ovarian cancer were treated with immediate debulking followed by sequential cisplatin and doxorubicin every 4 weeks, followed by second-look laparotomy (SLL). Six courses were given when residual disease (RD) was under 2 cm. When RD was over 2 cm, three courses were followed by early debulking and six more courses before SLL. Immediate debulking was optimal in 15 patients (38%) and early debulking in an additional 15 (38%). Pathological complete responses (34 evaluable cases) were observed in 14 cases (41%), partial response in 13 (38%), stable disease in 3 (9%) and progression in 5 (15%). Toxicity was mainly haematological. 11 patients with negative SLL and 15 with RD under 2 cm received intraperitoneal cisplatin 200 mg/m2 alone or with cytarabine. Median survival was 45 months: 58 months for RD under 2 cm at initial laparotomy and 31 months for RD over 2 cm. Median survival was 46 months when early debulking was successful. 5 year disease-free survival was only 16%. However, this multimodal treatment offers prolonged survival, especially in patients optimally debulked either at initial laparotomy or at early debulking surgery.

Adult↗
PubMed1992

Survival with intraperitoneal cisplatin in advanced ovarian cancer after second-look laparotomy.

We studied survival in 36 patients with Stage III/IV ovarian cancer who received intraperitoneal high-dose cisplatin (200 mg/m2) alone or in combination with cytarabine (2 g), after intravenous (i.v.) cisplatin-based chemotherapy followed by second-look laparotomy. Complete responders were scheduled for three courses of IP chemotherapy, and others for six. Eight patients (22%) did not complete treatment (6 catheter failures and 2 renal failures). Peritoneal cytology remained positive in 6 patients (17%). Median overall and progression-free survival after second-look laparotomy were 44 and 37 months, respectively, for 13 complete responders to i.v. chemotherapy; 24 months and 11 months for patients with residual tumors less than 2 cm (17 cases); 15 and 12 months with tumors greater than 2 cm (6 cases). There was a significant difference in overall (p = 0.05) and progression-free (p = 0.001) survival between complete responders to i.v. chemotherapy and patients whose tumor was less than 2 cm. We find no evidence that high-dose cisplatin-based intraperitoneal chemotherapy given after second-look laparotomy will enhance survival in advanced ovarian cancer with zero or minimal residual disease.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1992

[Major sickle cell anemia and pregnancy. Systematic prophylactic transfusions. 13 case reports].

The seriousness of sickle cell disease together with pregnancy has led doctors to look for therapies which have yet scarcely shown their worth. Systematic blood transfusions in pregnancy did seem to improve the prognosis for both mother and fetus. Prophylactic transfusion has made it possible for us to carry thirteen pregnancies to term. There was no mortality either of fetus or mother while the morbidity either of fetus or mother while the morbidity was significantly cut down to new pathologies which were easily treated. The absence of any side effects from the transfusions encourages us to contribute this treatment working together with a highly competent blood transfusion bank.

Adult↗
PubMed1992

[Ovarian hyperstimulation syndrome during in vitro fertilization stimulations. Comparison between the experience of the Center for Medically Assisted Procreation of the Saint Antoine maternity department and a review of the literature].

The authors present their experience with the severe ovarian hyperstimulation syndrome when they were using stimulation for IVF and ET and they compare it with the literature. Over a period of 23 months. 154 stimulations were carried out using a long protocol associated with a CnRH agonist and hMG. 142 vaginal aspirations were carried out. The clinical pregnancy rate was 19% per aspiration and 21.9% per transfer. Of the 142 patients who were aspirated five had severe ovarian hyperstimulation with a favourable outcome. The authors suggest a physiopathological comparison for ovarian hyperstimulation and the management to be carried out when this complication occurs. They emphasise how potentially serious this complication is and that there has been no physiopathological explanation for its recrudescence since GnRH agonist have started to be used.

Adult↗