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Biomedical subjects

M Levardon

Publications and source records attributed to M Levardon.

At least 19 recordsLinked to original sources
PubMed2003

[Imaging pelvic floor prolapse].

OBJECTIVES: Dynamic MR imaging (MRI) may be used as an alternative to dynamic cystoproctography for the evaluation of pelvic floor prolapse. Our study aimed to define the range of dynamic pelvic MRI aspects observed during the exploration of pelvic prolapse. MATERIAL: Fascial and anatomic defects can include a combinaison of cystocele, rectocele, uterine prolapse, enterocele and vault prolapse. Acute diagnosis of the coexisting abnormalities is essential in planning reconstructive procedures so that the risks of recurrence and reoperation can be minimized. At this time colpocystography is the study of choice to evaluate pelvic floor dysfunction. Dynamic magnetic resonance imaging for exploration of pelvic floor dysfunction is under evaluation. RESULTS: Pubococcygeal line and puborectalis muscle were the references points. The grading system is based on degree of organ prolapse through the hiatus and the degree of pubo-rectalis descent and hiatal enlargement. Unfortunately, there is a real discordance between the reality of the prolapse and its imaging. However, a new reference line, the mid pubic line, was drawn on the magnetic resonance image to correspond to the hymeneal ring marker used in clinical staging. Intra-operative findings were considered the gold standard against which physical examination, dynamic colpocystodefecography and MRI were compared. Using these criteria the sensitivity, specificity and positive predictive value of MRI were 70%, 100%, 100% for cystocele; 42%, 81%, 60% for vaginal vault or uterine prolapse; 100%, 83%, 75% for enterocele; 87%, 72% and 66% for rectocele. CONCLUSION: MRI appears to be an important adjunct in the comprehensive evaluation of the female pelvis. Except for vaginal vault, pelvic prolapse is accurately staged and pelvic organ prolapse reliably detected. The technique is rapid, non invasive and cost effective, it allows the clinician to visualize the whole pelvis using a single dynamic study that provides anatomical details.

Adult↗
PubMed2002

[New physiological, diagnostic and therapeutic concepts in the management of rectoceles in women].

Anterior rectocele is not only a herniation of the anterior rectal wall into the vagina, but rather a complex anatomical and functional abnormality which may be isolated or associated with other pelvic floor disorders. It could result in rectal obstruction with dyschezia, manual extraction of feces, and fecal or gas incontinence. The purpose of this review is to describe and to assess the most useful methods for the diagnosis and for the treatment of the rectocele. Data from physical examination may be improved by defecography. Surgery remains the main treatment: several surgical ways (perineal, anal, abdominal, laparoscopic) are described. Analysis of the anatomical and functional results allows to assess these techniques and to determine the best therapeutic option.

Defecation↗
PubMed2002

[Home birth: opinion of French women and perinatal risk. Results of the French overseas departments 2000 survey].

OBJECTIVES: This study has two objectives: firstly, to find out what are the women's views about home birth, and secondly to perform a review of the perinatal risk associated with home birth. PATIENTS AND METHODS: A questionnaire was sent to 121 women in three maternity hospitals and a Medline search was performed using the following keywords: home delivery, hospital delivery, risk factor, perinatal transfer. RESULTS: Fifty two percent of these women think that home delivery "should or could be offered" (group I), 22% think that it "should never be offered" (group II); finally 26% "do not know" whether it should or not be offered (group III). The level of maternity care, educational standards, nationality, parity, annual income, age, location of the place of residence, do not modify the rate of women belonging to group I. Thirty four percent of women who have heard about complications happening during delivery think that home delivery "should never be offered" while 13% of women who have never heard of complications during delivery stated that it should never be offered (p = 0.024). Even if it is not significant the number of women belonging to group II increases with educational standards and maternal age. Most women believed that hospital delivery is safer, more restful, that pain relief is better, but also stated that it is more impersonal than home delivery. CONCLUSION: In this study more than one out of two women believed that home delivery "should or could be offered". Nevertheless, 22% stated that home delivery "should never be offered". The level of opposition to home delivery seems to increase with the level of information about potential obstetrical complications. A study should be designed to confirm this statement. The analysis of perinatal risks related to home delivery shows that two conditions should be fulfilled in order to allow home delivery: a careful selection, with validated risk factor, to eliminate high risk pregnancies, and clear and complete information on the small but real risk of perinatal transfer.

Demography↗
PubMed2002

[Uterine morcellation during vaginal hysterectomy: apropos of a series of 216 prospective cases].

OBJECTIVE: The purpose of this study was to compare the surgical outcomes of women undergoing vaginal hysterectomy with and without morcelation. PATIENTS AND METHOD: Between December 1999 and December 2000, 216 women underwent vaginal hysterectomy without laparoscopic assistance at the Department of Gynecology of Hôtel-Dieu hospital in Paris. The patients were divided into two groups: 114 of them underwent vaginal hysterectomies with morcelation whereas 102 underwent vaginal hysterectomies without morcelation. The two groups were compared as to demographic data, total complications, operative time, hospital stay length and peri-operative hemoglobin concentration change. RESULTS: Although women undergoing morcelation were significantly younger (mean 49 versus 52, p = 0.01) and less parous (mean 1.9 versus 2.3, p = 0.03), there were no significant differences in other surgical or anesthetic risks factors, including weight, BMI, nulliparity and preexisting surgical diseases. Mean uterine weight was significantly greater in those undergoing morcelation (331 versus 110 g, p < 0.001); operative time was increased in the group which had undergone morcelation (331 versus 110 g, p < 0.001). There were no significant differences between the two groups with respect to peri-operative hemoglobin concentration change or hospital stay length. Finally, the rate of surgical complication was similar in the two groups (17.5 versus 21.5%). CONCLUSION: Although vaginal hysterectomy requires an increase in operative time, morcelation at the time of vaginal hysterectomy is safe and facilitates the vaginal removal of enlarged uteri without increasing peri-operative morbidity.

Age Factors↗
PubMed2002

[Pubo vaginal and sub urethral slings: review].

BACKGROUND: Sling surgery is considered to be the gold standard for treatment of female stress urinary incontinence resulting from sphincter deficiency. A century of experience is reviewed and evolving new concepts and techniques are presented. METHODS: This article reviews 34 retrospective studies involving 2 967 interventions. RESULTS: and discussion. Sub urethral sling procedures have been reserved traditionally for the treatment of recurrent stress incontinence, autologous or heterologous slings are used and the success rate varies between 65 and 98%. Objective long term results have been excellent but the rate of voiding disorders and de novo detrusor instability is respectively from 12.8% and 16.6%. The TVT procedure (Tension free vaginal tape) was described by U. Ulmsten in 1996. The mesh is placed under the uretra and supports the integral theory of Ulmsten and Papapetros. Its success is bound by its efficacy, its reproducibility and restricted morbidity. CONCLUSION: The pubovaginal sling remains an excellent operation for the cure of stress urinary incontinence related both to sphincter deficiency alone or existing with urethral hypermobility. About Prolene tape, the present review of adverse outcomes may simply reflect an overall increase in the number of sling procedures being performed. Although decreased operative time and morbidity have been attributed to the use of TVT tape, it is essential to ensure that long-term safety and efficacy will not be jeopordised before accepting it as a new standard of care.

Aging↗
PubMed2002

[Great elongation of uterine cervix: retrospective study of 20 cases].

BACKGROUND: The aim of the study was to evaluate the safety and efficacy of the Musset Poitout surgical procedure consisting in an anterior uterosacral ligament transposition and a cervix amputation. The main indication is an uterovaginal prolapse with an isolated elongation of the cervix. METHODS: A retrospective consecutive series of 20 women with an elongation of uterine cervix undergoing Musset Poitout procedure over a 10 year period between 1990 and 2001 with analysis of per and post operative complications and success. Four Kelly urethral plications were performed in the same time. The patient's ages, time under anesthesia, change in hemoglobin, days of hospitalization, medical illnesses, complications and follow-up were assessed. Failure was defined as a symptomatic elongation of the cervix or a third degree hysterocele on examination. RESULTS: and discussion. The median age of Musset Poitout procedure was 43.9 years (range 23-83). General anaesthesia could be performed in all patients. Mean operation time was 67 minutes (range 40-130). No major per or post operative complications occurred. The average of post-operative bladder cathetherisation was 3.65 days, the average hospital stay was 6.3 days. Complications were insignificant: urinary tract infection in 2, voiding dysfunction in 2. All the patients but 2 were followed for a mean 59 months (range 6-127). There was one recurence (5.5%). CONCLUSION: In this preliminary assessment the Musset Poitout procedure offered significant avantages in a genital prolapse with elongation of the cervix.

Adult↗
PubMed2002

[Prolapse in the young woman: study of risk factors].

OBJECTIVE: To determine the risk factors for genital prolapse in a group of 37 young women less than 45 years old. PATIENTS AND METHODS: We studied 37 young women who had been operated for genital prolapse, whereas the control group consisted of women operated for benign gynaecologic disorders. RESULTS: In the study group the number of pregnancies and deliveries, the babies' weight, the positive family history of prolapse were heavier than in the control group. The women with prolapse had more often chronic pulmonary diseases, asthma, as well as operations for abdominal hernias. The mode of delivery, be it a cesarean section or the use of forceps, and the active second stage of labor had no effect whatever on the occurring of genital prolapse in young women. CONCLUSION: Our data support the suggestion that multiparity, babies' weight and congenital factors are responsible for a higher rate of genital prolapse in young women.

Adult↗
PubMed2000

Genetic abnormalities detected by comparative genomic hybridization in a human endometriosis-derived cell line.

Comparative genomic hybridization (CGH) was used in parallel with fluorescence in-situ hybridization (FISH) and conventional karyotyping to perform a genome-wide survey of DNA gains and losses in the endometriosis-derived permanent cell line, FbEM-1. The cytogenetic analysis showed a complex karyotype with numerical changes and multiple chromosome aberrations, including the der(1) complement marker exhibiting a large homogenous staining region (HSR). The chromosomal rearrangement interpreted as der(5) t(5;6)(q34;p11) was found in the majority of the metaphases indicating a clonal abnormality. Repeated CGH experiments demonstrated over-representation of chromosomes 1, 2, 3, 5, 6p, 7, 16, 17q, 20, 21q and 22q, while chromosomes 6q, 9, 11p, 12, 13q, 18 and X were under-represented. Using DNA from the original endometriotic tissues, including a peritoneal implant and ovarian endometrioma, CGH analysis revealed loss of DNA copy number on 1p, 22q and chromosome X, while gain was found on chromosomal arms 6p and 17q. FISH analysis confirmed that the gain at 17q includes amplification of the proto-oncogene HER-2/neu in 16% of the FbEM-1 nuclei and in 12% of cells from the primary ovarian endometrioma tissue. These findings demonstrate that FbEM-1 cells share certain molecular cytogenetic features with the original tissue and suggest that chromosomal instability is important in the development of endometriosis.

Cell Line↗
PubMed1999

[Postpartum hemorrhage].

Postpartum haemorrhage, the second cause of maternal mortality in France, is an obstetric and anaesthetic emergency. Yet, it often seems avoidable as most patients at risk can be identified before or during labour. In this respect, obstetrical conduct regarding delivery is essential; it makes it possible to foresee the necessary preventive and curative measures. Once haemorrhage has begun, any delay or hesitation in assuming multidisciplinary responsibility is potentially detrimental as it may lead to coagulopathy complications. Whenever possible, arterial embolisation presents an enormous progress in noninvasive conservative treatment, especially after vaginal delivery. Stepwise uterine devascularisation seems to be a promising surgical option as it can be used under all conditions, preserves maternal fertility, and is clearly effective.

Female↗
PubMed1999

Detection of DNA copy number changes in human endometriosis by comparative genomic hybridization.

Endometriosis is characterized by infertility and pelvic pain in 10-15% of women of reproductive age. The genetic events involved in endometriotic cell expansion remain in large part unknown. To identify genomic changes involved in development of this disease, we examined a panel of 18 selected endometriotic tissues by comparative genomic hybridization (CGH), a molecular cytogenetic method that allows screening of the entire genome for chromosomal gains and/or losses. The study was performed on native, nonamplified DNA extracted from manually dissected endometriotic lesions. Recurrent copy number losses on several chromosomes were detected in 15 of 18 cases. Loss of chromosome 1p and 22q were detected in 50% of the cases. Additional common losses occurred on chromosomes 5p (33%), 6q (27%), 7p(22%), 9q (22%), 16 (22%) as well as on 17q in one case. Gain of DNA sequences were seen at 6q, 7q and 17q in three cases. To validate the CGH data, selective dual-color FISH was performed using probes for the deleted regions on chromosomes 1, 7 and 22 in parallel with the corresponding centromeric probes. Cases showing deletion by CGH all had two signals at 1p36, 7p22.1 and 22q12 in less than 30% of the nuclei in comparison to the double centromeric labels found in more than 85% of the cells. These findings indicate that genes localized to previously undescribed chromosomal regions play a role in development and progression of endometriosis.

Chromosome Aberrations↗
PubMed1997

[Effects of micronized natural progesterone on the liver during the third trimester of pregnancy].

In France, prescription of micronized progesterone at high doses of 900 to 1200 mg/day is common practice in the case of preterm delivery, even though this is neither an indication nor a posology given for marketing authorisation. A few cases of gestational pruritus have been reported during such use, associated with cholestasic and/or cytolytic hepatic disorders. We report here the results of a controlled, double-blind study versus a placebo, aimed at assessing the effects on the liver of micronized progesterone administered orally at high doses (900-1200 mg/day), conducted in a population of 201 women presenting moderate menace of preterm delivery during the third trimester of pregnancy. 85 patients received micronized progesterone and 116 the placebo. The increase above normal levels of total biliary acids (TBA) and aminotransferases (ASAT, ALAT), was significantly more frequent in the micronized progesterone than in the placebo group. Among the 26 patients (14%) with a level of TBA superior to 10 mumoles/l during treatment, 18 belonged to the progesterone and 8 to the placebo group (p = 0.004); the 6 patients (3.4%) with increased ASAT were all under micronized progesterone (p < 0.001), as were the 10 patients (5.6%) with increased ALAT (p < 0.001). However, there is no statistically significant difference between the two groups regarding the occurrence of clinical manifestations (icterus, pruritus) which could be attributed to gravid cholestasis. We may conclude from this prospective study that, during the third trimester of pregnancy, micronized progesterone is associated with a significant risk of biological cholestasis. This would suggest that in patients genetically predisposed towards gravid cholestasis, micronized progesterone could be a factor favoursing this disease.

Adult↗
PubMed1995

[Treatment of genital prolapse. Long term results].

From 1975 to 1984 case histories of 237 women operated on for major genital prolapse were looked over. 142 formed the subject of prolonged observation of 4 years and more. 63 over ten years. Prévention of static disorders and tissue atrophy has shown itself to be very useful. The procedure for doing this surgical treatment has been dictated by the clinical, urodynamic and per-operative findings. Vaginal surgery treatment was selected for minor uterine prolapse and for very old patients. Most of them had an operation either through abdominal duct or, more often, mixed abdomino perineal duct. The uterine cervix replacement was realized through presacral cervicopexy, by means of non resolving prothesis. In that manner, an anatomical repair can be achieved. We report the excellent long dated results of this method. Posterior perineorraphy remains a high grad process. His result depends upon the quality of perineal muscles. More difficult is the vesical ptosis and urinary stress incontinence treatment, carried, at one and the same time, through intervesico-vaginal prothesis and/or retropublic pexy. Long dated failures depend usually more on the sphincteral insufficiency than on the recurrence of the cervico-vesical ptosis. Perineal and vesico-sphincteral re-education on one hand, substitutive hormonotherapy on the other hand, add a "plus" essential to the surgical repair. Sphincteral bladder insufficiency remains and ill controlled handicap. These desorders are more the consequence of constitutional fragility of connective tissue rather than obstetrical traumatism.

Combined Modality Therapy↗
PubMed1993

Prevalence of hepatitis C virus infection in asymptomatic anti-HIV1 negative pregnant women and their children.

The prevalence of hepatitis C virus (HCV) infection was studied prospectively in pregnant women in France and their children by detection of anti-HCV with second-generation ELISA (ELISA2). In ELISA2-positive women, anti-HCV was detected with second- and third-generation RIBA (RIBA2 and RIBA3) and serum HCV RNA was detected with PCR. Among 670 women, anti-HIV1-negative, 26 (3.9%) were positive with ELISA2. RIBA2 was positive in 13 and HCV RNA was found in 10. Ten ELISA2-positive women had a further evaluation with assessment of HCV infection in their children. Among the 10 children born to the index pregnancy, only one was positive with ELISA2 and RIBA2 but negative with RIBA3 and PCR; the nine other children were ELISA2, RIBA2, RIBA3, and PCR negative. All 26 siblings (2-16 years old), of whom 14 were born to PCR-positive mothers, were ELISA2 and RIBA2 negative. We conclude that among anti-HIV1-negative pregnant women with normal serum ALT levels, the prevalence of HCV infection is relatively high but the risk for mother-to-infant transmission of HCV seems to be low.

Adult↗
PubMed1993

[Acute aortic dissection during pregnancy. Surgical treatment with maternal and fetal rescue].

Acute aortic dissection (AD) seldom affects young women, but when it occurs it is, in almost one out of two cases, during pregnancy. We report a case of severe AD during pregnancy in which emergency surgery immediately saved the life of the mother and the foetus. The mother died of cardiac complications 13 days after the operation; the condition of the newborn is satisfactory.

Acute Disease↗
PubMed1993

[Pregnancy and non-Hodgkin's lymphoma: a case].

We report for the first time in the French literature the case of a malignant non Hodgkin's type lymphoma associated with pregnancy in a 19 year old woman. The evolution with corticotherapy was rapidly unfavourable and led to premature birth of a child who died 24 hours later, and to maternal death 48 hours later in spite of an attempt of chemotherapy. The prognosis of these tumours is bad, for the fetus because of the risks of premature delivery, for the woman because of the risks of tumoural evolution during the postpartum period.

Adult↗
PubMed1993

[Inguinal hernia and endometriosis].

Endometriosis is an ubiquitary disease. It can be intra or extragenital. We report the case of a patient with an endometriosic nodule at the end of an inguinal hernia, there was no other sign. The diagnosis was done through pathology. The treatment, exclusively surgical was the cure of the hernia and the excision of the nodule.

Adult↗
PubMed1992

[Retroperitoneal liposarcoma. Disclosure by anemia and prolonged fever].

We report the case of a 79-year old woman with a retroperitoneal liposarcoma. The condition was discovered because of the association, in a woman of that age, of anaemia and persistent fever. The diagnosis was suggested by computed tomography. Treatment was exclusively surgical. Liposarcomas usually affect men in their sixth decade. Postoperative radiotherapy improves the quality of life but does not prolong survival. Metastases are frequent, and death usually occurs in the year that follows discovery.

Aged↗