[Characterization of fetal sex in 45 pregnant women with 8 to 39 weeks of gestation].
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Adult↗
Biomedical subjects
L Marpeau
Publications and source records attributed to L Marpeau.
[A uterus with two scars: can we allow vaginal delivery?].
This study gives the results of a year in which the active conduct of a trial of labour was carried out on uteruses that had scars in them. This approach allowed 22% of women to deliver vaginally out of a total of 41 patients. Of 17 patients (41.4%) that were put down for a tentative trial delivery, 9 (53%) did deliver vaginally. This approach seems to have been reasonable and beneficial so long as proper precautions were taken. The prognosis is better if there has been a previous vaginal delivery.
Cesarean Section↗
[The role of pelvic arterial embolization in the treatment of severe postpartum hemorrhages].
Two cases of severe post-partum haemorrhage were treated successfully with pelvic arterial embolisation. The authors explain the place for this technique to be used. They have come to the conclusion that it is possible to carry out this therapy which is very valuable and which can avoid dangerous surgery or be added to it when the surgery itself is insufficient.
Adult↗
Pregnancy-associated idiopathic intrahepatic cholestasis. Hypotheses of physiopathology: a therapeutic case report.
By modification of the circulating pool of biliary acids, the administration of ursodesoxycholic acid has permitted the restoration of normal maternal hepatic function during a triple pregnancy complicated by the precocious onset of an intrahepatic cholestasis. The marked regression in clinical and biological markers of the disease confirms the role of biliary acids in the aggravation of hepatic abnormalities.
Adult↗
[Primary biliary cirrhosis and pregnancy. Apropos of a clinical case. Review of the literature].
The appearance of pruritus and abnormal liver function tests (cellular damage) during pregnancy should of course suggest the diagnosis of intrahepatic cholestasis of pregnancy. However, these signs must also be recognized as signs of other hepatic diseases, especially primary biliary cirrhosis. The diagnosis is based on the search for antimitochondrial antibodies. This mode of presentation must not be overlooked because of major therapeutic consequences. The disease course often stabilizes with ursodeoxycholic acid, if administrated early.
Adult↗
[Rupture of hemorrhagic ovarian cysts. Value of celioscopic surgery].
The rupture of haemorrhagic cysts of the ovary occur frequently and are often missed. Review of the literature and an analysis of our series of 20 patients makes it possible to summarise the typical clinical picture, which is of a young woman who has sudden severe pelvic pain in the second half of her menstrual cycle, during intercourse, or when she has pelvic trauma. Ultrasound in 90% of cases shows up signs suggesting the diagnosis and these are: a mass beside the uterus, or an intra-abdominal effusion. Endoscopic surgery is indicated particularly in women of reproductive age who suffer this pathology which is always benign. The indications to treat the patients should always take in to account the histology; 100% of these are luteal cysts. There is no reported case of cancer of the ovary or of an organic haemorrhagic cyst. On the other hand occasionally a primary ovarian pregnancy may occur and that can be confused with a haemorrhagic cyst. Finally haemorrhagic cysts can occur with an intra-uterine pregnancy and this means that the corpus luteum must be preserved. We propose the following treatment for those cases with symptoms: simple peritoneal washout when pregnancy has been ruled out on the laparoscopy exploration and when the bleeding is widespread: systematic taking of a biopsy for histology if there is the slightest doubt that there is a pregnancy in the ovary and an intraperitoneal removal of the cyst when haemorrhage persists during the operation.
Adult↗
[Functioning of implantable catheters of intraperitoneal chemotherapy].
Intraperitoneal chemotherapy with a totally implantable catheter was performed in 42 patients with advanced ovarian cancer who received 178 courses of chemotherapy administered in 2 l of solution. Major complication was inflow obstruction due to fibrosis around the catheter observed in 10 patients, 23.8% of the cases. Other complications were: leakage 3 (7.1%), pain 3 (7.2%), infection 3 (7.1%) and rectal perforation 1 (2.4%). Overall, these complications occurred in 15 patients (35.7%) and were the cause of treatment interruption in 7 (16.7%). Outflow obstruction which occurred in 23 patients (54.8%), did not create discomfort and could not be considered as a complication. Despite the problems, intraperitoneal chemotherapy with a totally implantable catheter appeared feasible in at least 80% of the patients.
Adult↗
[Results of intraperitoneal chemotherapy of ovarian cancer].
We studied a series of 42 patients with advanced ovarian cancer who received intraperitoneal chemotherapy post second-look laparotomy. High-dose cisplatin (200 mg/m2) alone or in combination with cytarabine (2 g) achieved 47% response rate. Median overall survival from second-look laparotomy was 44 months with cisplatin (36 cases), 15 months with carboplatin (600 mg/m2, 5 cases) and not reached at 3 yrs with mitoxantrone (25 mg/m2, 8 cases). Median overall and progression-free survival from second-look laparotomy were 44 and 39 months respectively in complete responders (15 cases), 20 months and 9 months where residual tumor less than 2 cm (21 cases), 22 and 12 months where tumor greater than 2 cm (6 cases). There was a significant difference in survival (P = 0.01) and progression-free survival (P = 0.002) between complete responders and patients whose tumor was less than 2 cm. Toxicity was acceptable except for carboplatin with constant grade 4 leukocytes or platelets toxicity. It was not demonstrated that high-dose intraperitoneal chemotherapy given post second-look laparotomy will improve survival in advanced ovarian cancer. Further studies of polychemotherapy or early administration are needed.
Antineoplastic Agents↗
[Rupture of a healthy uterus in a prostaglandin-induced abortion in the second trimester].
The authors report one case of uterine rupture in a non scarred uterus when an analogue of prostaglandin E2 was being transfused. It was Sulprostone used to terminate a pregnancy because of fetal death in utero after 27 weeks of amenorrhea. This case history and an analysis of the literature makes it possible to point out the need to reach the diagnosis before signs become too severe and to show that pharmacological knowledge of the drug has to be improved as well as the ways of administering prostaglandin analogue. This is to be conducted together with improving the ways of terminating pregnancies in the second trimester. It shows that mechanical accidents can occur even where there are no obvious risk factors. In this case, pain continued from the time of the rupture under epidural anaesthesia. The physiopathology is reviewed. Finally, conservative treatment of the uterus should be carried out whenever possible in order to allow a new pregnancy to occur and to lessen the morbidity of the operation.
Abortifacient Agents, Nonsteroidal↗
[Changes in the cesarean section percentage].
More and more cesarean sections (C/S) are done, rate multiplied by 3 or 4 in occidental countries in these post two decennials, but are really too many done (?), as it is regularly reproched to the obstetricians, even though perineonatal morbidity and mortality rates have improved. By help of files studied in the gynecological and obstetrical Ward of Saint Antoine's Hospital Paris over 60 years, the authors have tried to answer to a few basic questions: The reason to be of the first C/S before labor and during labor, and the reason to be of iterative C/S in the same conditions. What results is: The rate of C/S has barely changed fur the following causes: Important dystocia known before or during labor, or Chronic foetal distress. On the other hand it increased because of: Acute foetal distress revealed during labor by alteration of the foetal heart beat (FHB). Stagnation of dilatation often accompanied by alteration of the FHB. An increase of iterative C/S due themselves to the increased number of scarred uteri. To reduce the progression of the number of C/S, we should therefore try to: Reduce the amount of scarred uteri, therefore have better knowledge of the indication of the first C/S. But is it feasible without compromising the benefits acquired by modern obstetrics, in means of perineonatal mortality and morbidity? Accept more often birth by vaginal route on the scarred uteri, the actual means of surveillance of labor appear to be able to permit it.
Cesarean Section↗
[The diagnostic value of hysteroscopy in extra-uterine pregnancy].
Hysteroscopy was carried out in 30 in-patients who were admitted with suspicion of ectopic pregnancy between January and November 1989. The presence of a continuing intra-uterine pregnancy was excluded in each case. Twenty one ectopic pregnancies and nine non-viable intra-uterine pregnancies were assessed in this way. Carrying out plasma Beta HCG level assessments and transvaginal ultrasound had not made it possible to diagnose the condition before operation in 16 (53%) of the patients. In one case where it was difficult to interpret the hysteroscopic findings laparoscopy was carried out but this was not helpful; in all the other cases hysteroscopy gave the exact diagnosis. This examination appears to us as a result of this study to be useful in differentiating an extra-uterine pregnancy from a non progressive intra-uterine pregnancy.
Chorionic Gonadotropin↗
[The ideal time for delivery].
The authors analyze the results of a three-year study of the variations of the degree of fetal distress according to the time of spontaneous delivery. The degree of fetal distress during labour is definitely high if the delivery takes place during the 42nd week. In primipara, where labour lasts more than 6 hours, this results in a level of cesarean sections due to fetal distress after 41 weeks which is significantly high (P less than 0.001) compared to the preceding three weeks. The authors conclude that, in terms of minimum fetal distress, the ideal delivery time would be before 41 full weeks of amenorrhea; as for the stagnation of the dilatation, the same observation is made.
Adult↗
[The in vivo effect of the local administration of progesterone on the mitotic activity of human ductal breast tissue. Results of a pilot study].
Breast tissue samples were taken during surgery in premenopausal women with various benign breast diseases. Surgery was scheduled between day 11 to 13 of their menstrual cycle, before presumed ovulation and endogenous production of progesterone. Each patient was treated 11 to 13 days before surgery by daily percutaneous topical application on breast of either a placebo gel, a gel containing progesterone or a gel containing estradiol. Treatments were assigned at random and the study conducted double-blind. The mean estradiol concentration in breast tissue was significantly higher (3,409 pg/g) in the estrogen-treated group than in the placebo (365 pg/g) and the progesterone (523 pg/g) treated groups. The mean progesterone concentration in breast tissue was significantly higher (69.1 ng/g) in the progesterone treated group than in the placebo (1.95 ng/g) and the estradiol (3 ng/g) treated groups. Mitotic activity was calculated by counting with light microscopy mitoses in epithelial cells of normal lobular area. Mean mitotic activity was significantly lower in progesterone treated group (0.04/1,000 cells) than in placebo (0.10/1,000 cells) or in estradiol (0.22/1,000 cells) treated groups. High concentration of progesterone sustained in human breast tissue in vivo during 11 to 13 days does not increase, but actually decreases mitotic activity in normal lobular epithelial cells.
Administration, Cutaneous↗
Survival after second-look laparotomy in advanced ovarian epithelial cancer. Study of 86 patients.
Second-look laparotomy (SLL) was performed after chemotherapy in 86 patients with advanced epithelial ovarian cancer. Seventy-one patients received cisplatin-based regimens. Median follow-up was 66 months. Negative SLL was found in 32 patients who had a 5-year survival rate of 48.3% after SLO. Microscopic residual disease was present in seven patients whose 5-year survival rate was 35.7%. Maximum residual tumor of 2 cm or less was found in 13 patients with a 5-year survival rate of 30%. Residual tumor larger than 2 cm after secondary cytoreduction was present in 20 patients; their 3-year survival rate was 19.7%. Fourteen patients with bulky residual disease who did not have cytoreduction were all dead within 17 months. Patients with initial residual tumor at first laparotomy less than 2 cm had a nearly significant advantage in survival rate over patients with residual disease greater than 2 cm and stage IV (P = 0.07). Non-responders to initial chemotherapy had a survival rate similar to that of partial responders. These findings justify discontinuation of conventional systemic chemotherapy for patients showing residual disease after SLL and secondary tumor removal in case of residual tumor at SLL. Therapeutic trials are needed in advanced ovarian cancer testing initial aggressive surgery or early debulking to avoid bulky residual disease, and consolidation therapy in patients who achieved complete pathological response or minimal residual disease.
Adult↗
[Prognosis in ovarian cancer as a function of the results of the second-look laparatomy].
Second-look laparotomy (SLL) was performed after chemotherapy in 106 patients with epithelial ovarian cancer. Thirteen were stage I and II and 93 stage III and IV. Seventy-eight patients received cisplatin-based regimens. Median follow-up was 60 months. Negative SLL was found in 32 patients who had a 5-year survival rate of 43.4% after SLO. Microscopy residual disease was present in 9 patients whose 5-year survival rate was 25%. Maximum residual tumor of 2 cm or less was found in 13 patients with 5-year survival rate of 30%. Residual tumor larger than 2 cm after secondary cytoreduction was present in 21 patients, their 3-year survival rate was 18.3%. Eighteen patients with bulky residual disease who did not have cytoreduction were all dead within 17 months. Patients with initial residual tumor at first laparotomy less than 2 cm had a near significant advantage in survival rate over patients with residual disease greater than 2 cm and stage IV (p = 0.07). Non-responders to initial chemotherapy had a survival rate similar to that of partial-responders. These findings justify discontinuation of conventional systemic chemotherapy for patients showing residual disease after SLL and secondary tumor removal in case of residual tumor at SLL. Therapeutic trials are needed in advanced ovarian cancer testing initial aggressive surgery or early debulking to avoid bulky residual disease and consolidation therapy in patients who achieved complete pathological response or minimal residual intraperitoneal disease.
Adult↗
[Epidermoid cancers of the ovaries in stages I and II. Definitions, epidemiologic and prognostic survey, proposal for management. Apropos of a series of 74 cases].
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Adenocarcinoma↗
[Treatment of acute non-chlamydial salpingitis. Study of the efficacy and tolerance of a single-therapy antibiotic: Augmentin].
An open randomised comparative trial of the efficacy and safety of Augmentin as against the triple therapy of penicillin-gentamicin-metronidazole in acute salpingitis was conducted in forty women admitted to hospital. Laparoscopy was performed routinely to confirm the diagnosis. The two groups of patients were comparable as to age and clinical and biological symptoms and the severity of the salpingitis (grade I to IV, with the presence or absence of Fitz-Hugh-Curtis syndrome). Treatment was started immediately after the laparoscopy, first by parental route until the patient had been apyrexic for 48 hours. Oral follow-up was then commenced. Twenty women received Augmentin and twenty the triple antibiotic therapy. Specimens for bacteriological study were obtained before treatment (culture of the urine, culture from the IUD and from the cervix, and swabs were taken laparoscopically). This made it possible to identify aerobic and anaerobic organisms. (The gonococcus was found more often in the group treated with triple antibiotics). On discharge, cures had been obtained in 12 women and 6 more were responding out of the Augmentin group. Out of the triple therapy group 8 were cured and 10 were responding. There was one failure in each group (persisting fever). Long-term assessment was carried out in the out-patients three weeks after discharge. 11 out of the 13 reviewed in the Augmentin group and 8 out of the 14 in the triple therapy group were considered as definitely cured. The clinical safety of both treatments was good. These results demonstrate that Augmentin is as effective as the combined therapy in treating acute salpingitis and with the added advantage of its easy use and lower cost.
Acute Disease↗
[Clinical and urodynamic results of the Burch colposuspension operation in the treatment of female urinary stress incontinence. A study apropos of 370 cases].
The surgical treatment of female genuine stress incontinence remains a not wholly solved problem. We prefer since 1980 the indirect colposuspension according to Burch as it represents 76% of our operations for genuine stress incontinence. We report 370 cases. The operation has been: isolated in 153 cases; associated with a total hysterectomy in 160 cases; associated with an indirect sacral fixation with a prosthesis of non adsorbable tissue in 57 cases. Clinical examination has always been completed with a urodynamic investigation pre-operatively and in the year following the operation. After two years or more, 188 urodynamic controls could be done. Clinical and urodynamic results are excellent and lasting after 5 years. Clinical failures represent only 4.6% of the cases and seem to be in relationship with technical defects as they occur in 78.4% of the cases in the first year following surgery. Associated sacral fixations, second hand cases, sphincter insufficiency appearing after surgery are the main factors giving way to the failures.
Adult↗