[Value of IGF I in gynecology and obstetrics].
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Breast Neoplasms↗
Biomedical subjects
P Dellenbach
Publications and source records attributed to P Dellenbach.
[Nitric oxide: new horizons in gynecology and obstetrics].
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Female↗
Intraperitoneal mitoxantrone as consolidation treatment for patients with ovarian carcinoma in pathologic complete remission.
BACKGROUND: Stages II-IV ovarian cancer in pathologic complete remission (pCR) at second-look surgery have a high relapse rate (50%) during the first 2 years. Considering relapse sites (abdomen and/or pelvis), intraperitoneal (IP) therapy is a logical approach. Mitoxantrone is an effective drug against ovarian cancer cells in vitro and is an attractive agent for IP therapy because of its very low peritoneal clearance. The value of IP mitoxantrone was studied as consolidation treatment of ovarian cancer in pCR at second-look surgery. METHODS: Fifty patients with Stages II-IV ovarian cancer (8, Stage II; 37, Stage III; 5, Stage IV) were included in this Phase II study, which began in June 1988. All patients had undergone initial cytoreductive surgery followed by 6 cyclophosphamide, doxorubicin, and cisplatin cycles. All patients were in pCR, as confirmed by second-look surgery. Consolidation treatment consists of 20 mg (total dose per cycle) IP mitoxantrone every 3 weeks for six cycles. RESULTS: Toxicity was limited to mild abdominal pain not requiring dose reduction (90% pain grade < or = 2). With a median follow-up of 2 years, the 5-year predicted survival is 59.8% (95% confidence interval [CI], 48.3 - 71.3), and the disease-free survival (DFS) rate is 47.3% (95% CI, 36.7 - 57.9). Patients with no or microscopic residual disease after initial surgery had a better 5-year DFS rate (75.8%) than those with macroscopic residual disease (31.2%) (P = 0.01). CONCLUSION: IP mitoxantrone (20 mg/cycle) is feasible with an acceptable abdominal toxicity. The results in terms of DFS are encouraging, but a randomized study versus no treatment is necessary to prove the value of this consolidation treatment.
Abdominal Pain↗
[Pelvic actinomycosis: the value of preoperative diagnosis. Apropos of a case].
Pelvic actinomycosis is a chronic suppurative granulomatous disease caused by an anaerobic Gram positive germ, Actinomyces. This rare disease can be severe and life-threatening. A intra pelvic bridge becomes chronic and produces a pseudo-tumoural syndrome of the pelvis with retroperitoneal infiltration or extension to neighbouring organs. Initially, neoplasia is usually diagnosed, leading to mutilating surgical exeresis before the pathology results reveal the presence of pelvic actinomycosis. The most difficult task is to entertain the diagnosis in a patient with an intrauterine device and poor general health, signs of infection and a pelvic syndrome. We observed such a case where the diagnosis was suspected before surgery. Adapted first intention antibiotic therapy led to spectacular recovery and allowed limited surgery without unnecessary ablation of neighbouring organs.
Abscess↗
Predictive value of transvaginal uterine Doppler assessment in an in vitro fertilization program.
This study evaluates the prognostic value of uterine Doppler performed on the day of embryo transfer in an in vitro fertilization program. Patients were divided into two groups according to the type of ovarian stimulation. The Doppler investigation was carried out using vaginal sonography. The pulsatility index was used to evaluate the uterine blood flow pattern. The hormonal profile (estradiol, luteinizing hormone (LH) and progesterone) was correlated to Doppler results and to the pregnancy rate. The comparison between patients treated with analogs and those who were not shows a significant difference in their hormonal profile. In the first group, we found a higher estradiol and progesterone serum concentration. The LH level and the pulsatility index were statistically lower. The endometrium was thicker in patients treated with gonadotropin releasing hormone agonists. In the group of patients treated with analogs, the statistical analysis showed no significant difference in the mean pulsatility index value in women who achieved a pregnancy and in those who failed. In the group of patients who received no agonists, only one variable was significantly different: the mean age was lower in women who became pregnant. We observed no ongoing pregnancy in women who had a pulsatility index value higher than two standard deviations (pulsatility index = 3.55). We therefore suggest the use of this value as a threshold. Thus, if a patient has a high uterine artery impedance, cryopreservation should be used and embryo transfer should be postponed to a subsequent cycle, or embryo transfer delayed for a few days using co-culture. This study clearly shows the impact of hormonal response on the Doppler value and on the pregnancy rate. However, the use of a threshold value for uterine artery pulsatility index might have a clinical impact in the future management of patients attending an in vitro fertilization program.
Journal Article↗
[Pregnancy by micromanipulation in a case of excretory azoospermia associated with a natural spermatocele].
Microinjection of capacitated sperm into the perivitelline space of oocytes has been performed in a case of male infertility attributed to excretory azoospermia. In this particular case, a spermatocele detected five years ago was observed, which provide motile spermatozoa. These sperm collected by direct puncture into the cyst, were capacitated using discontinuous Percoll gradient. After ovarian stimulation, seventeen oocytes were collected. Nine of them were used for classical IVF whereas the other eight were submitted to microinjection. Only one oocyte of the second group fertilized and cleaved 48 hours later. A clinical pregnancy was achieved after embryo transfer and a normal, healthy boy delivered at term.
Adult↗
[Ogilvie's syndrome after cesarean section. Apropos of 3 cases. Review of the literature].
Ogilvie's syndrome or pseudo-obstruction of the colon shows up as a clinical picture of acute obstruction of the large bowel without an associated pathological lesion as usually occurs in older patients. Three cases of Ogilvie's syndrome following Caesarean section are reported in this work. Caesarean section seems to be the most common operative procedure associated with this syndrome. Up till now 41 cases have been described in the literature. This syndrome is serious because it is possible for the caecum to burst causing faecal peritonitis which carries a heavy mortality. Seventeen cases of perforation of the caecum have been reported in the literature. The diagnosis is made by x-raying the patient's abdomen without any pre-x-ray preparation; if an enema of gastroffin is given it can be shown that there is no organic cause for the obstruction. The pathological cause seems to be disturbance of the autonomic innervation of the colon. The colon should be decompressed rapidly; and the present technique is to do this using a colonoscope with or without epidural anaesthesia. Surgery should be reserved for cases that have complications or that have been refractory to conservative treatment. Of our three cases two were treated successfully by colonoscopic decompression and one with the use of drugs.
Adult↗
[Endometrioid adenocarcinoma of the uterine isthmus associated with atypical endometrial hyperplasia and polycystic ovaries. Apropos of a case with bicornuate uterus in a 38 year old woman].
A 38 year old patient with multiple known risk factors for endometrial carcinoma (monophasic cycles, obesity, familial prediabetes, nulliparity, polycystic ovaries with diffuse thecal hyperplasia) presented with metrorrhagia caused by an endometrial lesion for which the diagnosis hesitated between atypical endometrial hyperplasia and carcinoma. Hysterectomy was performed because of the presence of a bicornuate uterus, obesity of 130 kg and the patient's lack of desire to have children. Examination of the uterus did not reveal any myometrial invasion in contact with the hyperplastic endometrium. The discovery of an endometrioid carcinomatous metastasis in the lower third of the vagina one year later allowed the retrospective detection of a 3 mm endometrioid carcinoma in the isthmus. No other metastases or recurrence were observed with a follow-up of 5 years.
Adult↗
[Teratogenicity of retinoids. A case and review of the literature].
Retinoids are vitamin A derivatives used in dermatology. One of them, isotretinoin, is frequently prescribed for refractory juvenile acne. The teratogenetic power of this drug is substantial, being estimated at 15 to 45% of exposures in utero. The risk is maximum in the first trimester of pregnancy and persists up to one month after treatment has been discontinued. The most frequently described multiple malformation syndrome involves the face, the central nervous system and the heart. There is also a 20 to 30% rate of spontaneous abortion. The authors report a case where exposure during the first trimester did not result in foetal malformation. From a full review of the literature the various malformations observed, the presumed mechanisms of teratogenesis and the strict rules of prescription and surveillance in women child-bearing age are presented. The problem of the measures to be taken in case of retinoid treatment during pregnancy is discussed. The teratogenic risk from other retinoids is dealt with.
Adult↗
[Rupture of an unscarred uterus at full term after an intracervical application of dinoprostone (Prepidil) gel].
The authors report a case of uterine rupture following intra-cervical application of dinoprostone (two doses at an interval of 6 hours). No oxytocic had been administered and recording of the contractions had revealed no hyperkinesia or hypertonia one hour before rupture occurred.
Administration, Intravaginal↗
[Benckiser's hemorrhage. 2 case reports and a review of the literature].
Benckiser's haemorrhage is a pure foetal bleeding due to rupture of one or several umbilical vessels located within the presentation area and usually associated with velamentous insertion of the cord. The frequency of this accident has been estimated at 1:2000 to 1:5000 deliveries. The clinical picture consists of haemorrhage occurring during rupture of the membranes and rapid foetal suffering responsible for foetal death from acute exsanguination in 75 to 100% of the cases. The maternal prognosis is excellent. Since the first clinical description, in 1801, less than 200 cases have been published. Many atypical forms delaying the diagnosis have been noted. The authors report 2 lethal cases with misleading clinical presentations. With intact membranes, prevention rests on the diagnosis of vasa praevia made by vaginal palpation, amnioscopy or even ultrasonography combined with colour-coded doppler velocimetry. With ruptured membranes, the diagnosis is usually retrospective and bases on examination of the secundines. Testing foetal haemoglobin in the vaginal blood can be very useful in the absence of acute foetal suffering. The management of this haemorrhage is discussed.
Adult↗
A case of human pregnancy after microinjection of capacitated sperm into the perivitelline space.
Microinjection of capacitated sperm into the perivitelline space of oocyte was offered to one couple with persistent infertility of mixed origin. The husband's semen was subnormal, whereas his wife had definitive tubal occlusion and polycystic ovaries. Four previous in vitro fertilization (IVF) attempts were performed but no fertilization was obtained. After superovulation, 13 oocytes were collected. Ten were submitted to microinjection and two were damaged during the procedure. One of the remaining eight had two pronuclei 18 hr after microinjection and progressed to a four-cell embryo after 48 hr. After reimplantation, a normal pregnancy was initiated, caryotype (46XX) was checked at 17 weeks. A normal and healthy girl has been delivered at term.
Adult↗
Is fetal acidosis in the human fetus maternogenic during labor? A reanalysis.
The purpose of this study was to investigate whether maternogenic fetal acidosis can occur at the time of labor and delivery and to evaluate the extent of the possible maternal contribution to fetal acidosis. We have therefore determined fetal and maternal lactate concentrations and acid-base status under various conditions in 589 women at the end of gestation and during labor. The results show that metabolic acidosis develops in all fetuses because of increased production of lactic acidosis is primarily of fetal origin: 1) the umbilical arteriovenous lactate differences were positive and large in steady-state conditions as well as in depressed newborns; 2) the conditions that could produce a net transfer of lactate from the mother to the fetus, namely a positive maternofetal gradient of lactate and proton, were rarely observed; and 3) the correlation between fetal and maternal lactate levels was very weak, with regression coefficients decreasing from near steady-state conditions to acute stress conditions, indicating that the increase in lactate in the fetus and mother occurs independently. This correlation indicates also that increased maternal lactate production under conditions of labor and delivery can make a contribution by affecting the rate of net transfer from fetus to mother. This is possible in approximately 6% of the fetuses.
Acidosis↗
[Resection under echographic control of septate uteri].
Septate uterus can be responsible for such infertility as requires surgical treatment. This series of this kind of uterine malformation in 37 cases makes it possible to evaluate the efficacy of a new technique for correction of the septum. It has the merit of not requiring laparotomy and above all it avoids carrying out hysterotomy which definitely weakens the uterus. The technique assists in correcting the defect through the cervix with scissors under ultrasound control. The morphological results on the uterine cavity are perfect in 19 patients. In 12 patients there was an arcuate fundus left and in 5 cases the section was insufficient and required a repeat procedure. This brings up to 20 the number of perfect corrections and 16 the number left with an arcuate fundus. The simplicity results were assessed in infertile patients and show that the number of abortions per patient dropped from 1.72 on average to 0.38 thanks to the ultrasound correction that was carried out. The simplicity of this method which can be carried out on an outpatient basis makes it possible to spread the indications to a situation where the Bret-Palmer technique could not be carried out and in particular in cases where IVF was being considered.
Congenital Abnormalities↗
Intraperitoneal mitoxantrone as consolidation treatment for stage III ovarian carcinoma: a pilot study.
In June 1986 we initiated an intra-peritoneal (IP) mitoxantrone chemotherapy trial as consolidation treatment for ovarian carcinoma in CR or PR after induction therapy (surgery + CHAP combination chemotherapy). Thirty-two patients received 25 mg IP mitoxantrone every 3 wk for 6 months. The most frequent side-effects were abdominal pains; haematological toxicity was minimal. The response was assessed by third-look surgery. In group I patients (patients in histological complete remission at second-look surgery) 12 of 14 evaluable patients remained in CR at the time of third look. Ten of the 12 patients are still alive with no evidence of disease (NED) with a median follow-up of 9.7 months after completion of treatment. In group II patients (microscopic residual disease at second-look surgery), 7 of 9 evaluable patients entered in CR at the time of third look; 6 of the 7 are still alive with NED and with a median follow-up of 14.3 months. In 7 group III patients (macroscopic residual disease at the time of second look) no response to IP therapy was observed and all patients progressed. We conclude that IP mitoxantrone is a valuable consolidation treatment for patients in CR or with minimal residual disease; further follow-up is necessary to assess the impact on duration of remission and survival.
Adult↗
Peritoneal fluid and infertility: a comparison of in-vitro fertilization of oocytes in peritoneal fluid and B2-Menezo medium.
Peritoneal fluid probably has an important and complex role in fertility and infertility. In this study, in-vitro fertilization was attempted in peritoneal fluid and the classical B2-Menezo medium. Clinical criteria concerning male and female fertility and biological factors such as fresh semen quality, sperm survival, sperm-zona pellucida binding, cleavage and pregnancy rates were analysed for each infertile couple. The following results have been obtained. The quality of peritoneal fluid appears to fluctuate greatly from one woman to another. Routine use of peritoneal fluid as a culture medium during in-vitro fertilization should not be encouraged. Peritoneal fluid toxicity may explain some cases of 'unexplained' infertility.
Ascitic Fluid↗
Lactate movements in the term human placenta in situ.
Movements of lactate through the human placenta in situ were derived from maternal and fetal blood sampling performed under conditions that approximate as closely as possible the normal fetal metabolic state. It is reported that, at the end of pregnancy, the human fetus produces lactate which is transferred to the placenta. The actuality of this lactate transfer coupled with proton transfer is discussed taking into account the results of multiple linear regression analysis determined between the umbilical arterio-venous lactate differences and fetal and maternal lactate and proton concentrations. It is finally assumed that this lactate is partly metabolized in the placenta, the remaining part being transferred from the placenta to the mother.
Adult↗
[Neuro-endocrine carcinoma of a Bartholin's gland].
This is a case of a 38 year old woman in whom a small basophil cell tumour occurred with inguinal and iliac lymph node metastases followed by pulmonary metastases and extension of the tumour into the vagina and the bladder. The patient died eight months after having started multiple chemotherapy and radiotherapy with telecobalt. Extra studies were carried out ten years later on the cells. This made it possible to diagnose the condition as a neuro-endocrine carcinoma rich in serotonin.
Adult↗