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Biomedical subjects

P L Giacalone

Publications and source records attributed to P L Giacalone.

At least 19 recordsLinked to original sources
PubMed2006

Doughnut mastopexy lumpectomy versus standard lumpectomy in breast cancer surgery: a prospective study.

AIMS: Doughnut mastopexy lumpectomy (DML) is a unique breast resection in which a tissue segment is removed and the breast reshaped through a periareolar incision. The present prospective investigation compares DML and standard lumpectomy (SL) in relation to surgical variables, histological parameters, postoperative morbidity and cosmetic outcome. METHODS: 127 patients with breast cancer were offered the choice between two conservative surgical approaches: doughnut mastopexy lumpectomy (DML group, n=39) or standard lumpectomy (SL group, n=88). The groups were comparable for radiological tumour size, tumour location within the breast, histological size, and pT category. Comparison was performed in term of surgical variables, histological parameters, postoperative morbidity and cosmetic outcome. RESULTS: The patients undergoing DML were younger than the patients who chose SL. In the DML group, the skin incision was 3-fold longer than in the SL group but was obtained with a final scar located around the nipple areola complex without further postoperative complications. The average volume of the breast specimen was higher in the DML group compared with SL group. The clinician assessment of cosmetic outcome reported a higher rate of acceptable result in the DML group than in the SL group. However, patient's assessment did not show difference of cosmetic satisfaction between groups. CONCLUSION: Our comparative study indicates that DML may be a useful alternative to SL not only in terms of accurate breast tissue resection but also in term of cosmetic results.

Breast Neoplasms↗
PubMed2004

Pre-operative arterial embolisation of a uterine rhabdomyosarcoma in a 14-year-old girl.

We report a young patient suffering from a uterine rhabdomyosarcoma. Particular features of the present case are: accuracy of the tumour spread evaluation performed by MRI of the pelvis; and the use of pre-operative arterial embolisation. The present multimodal management highlights the usefulness of cooperation between surgeons and radiologists in lowering operative bleeding and finally permitting uterine conservation.

Adolescent↗
PubMed2003

[Surrogate mothers and ovarian transposition: two attitudes to be considered in young women with cervical carcinoma. A case report].

In cases of cervical cancer, there are 2 major advantages to preserving the ovaries, with or without transposition: hormone function is maintained during subsequent cancer treatment and patient quality of life is improved. We report the first case of pregnancy in a surrogate mother following stimulation of a transposed ovary before irradiation and chemotherapy for a squamous cell carcinoma of the uterine cervix. Because of the wide dissemination of information on the technical progress in this area, patients are now in a position to make therapeutic choices that are no longer guided by strictly medical considerations.

Adult↗
PubMed2001

[Evaluation and treatment of endometrial cancer].

Endometrial cancer is the most common gynaecologic cancer and its incidence increases with age. Prognosis is good because in over 80% of cases the cancer is discovered early. Preoperative work-up should include definition of the operability of such patients, who are often elderly with frequent co-morbidity. Preoperative evaluation and operative findings allow guiding the treatment and evaluating the prognosis. Main determinants are local extension, penetration into the myometrium, histologic stage of the tumour and involvement of lymph modes or peritoneum. Surgery is the first approach since it establishes the evaluation and comprises the first step of treatment. When necessary, subsequent treatment uses irradiation. Treatment with hormones or antimitotic drugs is less effective and is used for forms that are locally advanced, metastatic or recurrent after initial treatment.

Adenosarcoma↗
PubMed2001

Successful in vitro fertilization-surrogate pregnancy in a patient with ovarian transposition who had undergone chemotherapy and pelvic irradiation.

OBJECTIVE: To present a case of IVF-surrogate pregnancy in a patient with ovarian transposition who had undergone chemotherapy and total pelvic irradiation. DESIGN: Case report. SETTING: Teaching hospital. PATIENT(S): A 29-year-old woman who had undergone Wertheim's hysterectomy for a bulky carcinoma of the uterine cervix. INTERVENTION(S): Ovarian transposition before chemotherapy and total pelvic irradiation. Standard IVF treatment, transabdominal oocyte retrieval, and transfer to the surrogate mother. MAIN OUTCOME MEASURE(S): Results of the IVF cycle. RESULT(S): A twin pregnancy at the first cycle and two live newborns. CONCLUSION(S): This is the first reported case of ovulation induction and oocyte retrieval performed on a transposed ovary.

Adult↗
PubMed2001

The effects of mifepristone on uterine sensitivity to oxytocin and on fetal heart rate patterns.

OBJECTIVE: To compare the incidences of tachysystole, hypertonia and fetal heart rate (FHR) abnormalities in women treated by mifepristone plus prostaglandins (PGs), mifepristone alone or PGs alone for an unfavourable cervix. STUDY DESIGN: In this retrospective study, all women between 37 and 42 weeks were eligible for the study if they had undergone cervical ripening prior to labour induction. In group 1, the women were treated with mifepristone plus PGs (n=103). Group 2 women were treated with mifepristone alone (n=96) and group 3 women with PGs alone (n=100). Incidences of tachysystole, hypertonia and FHR abnormalities were compared. RESULTS: During induction of labour, tachysystole and hypertonia occurred more frequently in women treated with mifepristone. Severe bradycardia and recurrent late decelerations were more frequent after the initiation of oxytocin in groups 1 and 2 than in group 3. CONCLUSIONS: In this study, mifepristone increased the incidences of tachysystole, hypertonia and FHR abnormality.

Adult↗
PubMed2000

A randomised evaluation of two techniques of management of the third stage of labour in women at low risk of postpartum haemorrhage.

OBJECTIVE: To determine whether early placental drainage plus cord traction reduces the incidences of manual removal and blood loss, and to determine the risk factors associated with blood loss after delivery. DESIGN: Prospective randomised study. SETTING: University teaching hospital, Montpellier, France. METHODS: A randomised study compared 239 women who had placental cord drainage plus cord traction with 238 women with expectant delivery. The need for manual removal of the placenta and the drop in haemoglobin after delivery were assessed. The duration of the third stage of labour and the time between birth and the beginning of perineal suturing were measured. Statistical analysis used the paired t test for continuous variables, the Kruskal-Wallis test for nonparametric data and chi2 test for categoric variables. Stepwise logistic regression analyses were performed with a drop in haemoglobin as the outcome variable. RESULTS: No significant difference was found in the two groups with regard to the incidence of manual removal of retained complete or incomplete placenta or postpartum haemorrhage. The median values of the duration of the third stage of labour, birth-to-perineal suture time and drop in haemoglobin were significantly lower in the cord drainage group than in the control group. After controlling for confounding variables, parity proved to be the only significant predictor of drop in haemoglobin. CONCLUSION: Cord drainage decreases the duration of the third stage of labour and reduces blood loss but not the incidence of manual removal of the placenta.

Adult↗
PubMed1999

Chemotherapy for breast carcinoma during pregnancy: A French national survey.

BACKGROUND: During pregnancy, the need for maternal chemotherapy for breast carcinoma must be balanced against the fetal risk because modification of cancer therapy to assure the birth of a healthy infant may affect maternal prognosis adversely. To the authors' knowledge few studies have documented the oncologic and obstetric management of this association. METHODS: A retrospective nationwide survey was used to identify women treated with chemotherapy for breast carcinoma during pregnancy. Each member of the Société Française d'Oncologie Gynécologique and the Société Française de Sénologie et de Pathologie Mammaire completed a postal questionnaire regarding cancer staging, oncologic treatment, obstetric details, pregnancy outcome, fetal behavior, and postdelivery follow-up. Twenty women were accrued to the study. RESULTS: The mean gestational age at the first cycle of treatment was 26 weeks. A total of 38 cycles were administered during pregnancy, with a median of 2 cycles. Delivery was performed at a mean of 34.7 weeks. Two pregnancies that were exposed to chemotherapy during the first trimester resulted in spontaneous abortion. One pregnancy exposed in the second trimester resulted in intrauterine death. The remaining 17 pregnancies resulted in live births, although 3 women had complications related to chemotherapy (anemia, leukopenia, and fetal growth retardation) and 1 newborn died 8 days after birth without apparent etiology. Two newborns had complications related to prematurity (transient respiratory distress). At a mean follow-up of 42.3 months, all live infants were reported to have reached normal developmental milestones. CONCLUSIONS: The current study found that even when chemotherapy was initiated after the first trimester, 95% of the pregnancies resulted in live births with low related morbidity in the newborns.

Adult↗
PubMed1999

Randomized study comparing two techniques of conization: cold knife versus loop excision.

OBJECTIVE: To compare the histomorphologic and colposcopic results of cold knife conization and loop excision. METHODS: Sixty-six women were randomly allocated to have the cone specimen removed by cold knife excision (n = 38) or loop excision (n = 28). Subjects eligible for inclusion were those who presented histologically verified grade 3 cervical intraepithelial neoplasia (CIN) or grade 2 CIN with squamocolumnar junction not seen. RESULTS: The mean height of the cone specimens was greater in the cold knife group [18.9 mm (SD = 5. 5) and 12.8 mm (SD = 4.3), respectively; P = 0.0001], as was the frequency of clear margins (100 and 80%, respectively; P = 0.001). In the loop excision group, thermal injuries were present in half of the cone sections. The median (range) thickness of thermal injury was 0.98 mm (0-1.5 mm) in the ectocervix and 0.95 mm (0-1.75 mm) in the endocervix. Histologic evaluation of the endocervical margins was not possible in 2 cases (7%). At follow-up colposcopy, evaluation of the entire squamocolumnar junction was possible in 15 (39%) and 20 (71%) women, respectively (P < 0.01). Four patients in the cold knife group and 6 in the loop group had histologically confirmed persistent dysplasia (P > 0.05), yielding success rates of 90 and 79%, respectively (P > 0.05). CONCLUSIONS: Loop excision provides a sample that is adequate for histologic evaluation in most cases, results in the same success rate as cold knife conization, and allows optimal colposcopic surveillance in significantly more cases than cold knife excision.

Adult↗
PubMed1999

Ultrasound-assisted laparoscopic creation of a neovagina by modification of Vecchietti's operation.

BACKGROUND: In performing Vecchietti's operation laparoscopically, it is important to ensure bladder and rectum integrity. We report new techniques of ultrasonography and suture retrieval that simplify and improve the ease and speed of this operation. TECHNIQUE: The pneumoperitoneum is emptied and the bladder filled with 200 mL of sterile water. The ultrasound probe is placed on the suprapubic wall for a sagittal image. The needle progresses medially through the vesicorectal space, with ultrasound guidance, and its emergence into the pelvis is controlled with laparoscopy. The nylon sutures carrying the dilation ball are threaded through the needle and brought back through the abdominal wall. EXPERIENCE: Seven patients with vaginal aplasia had this procedure. There were no complications, and the mean operative time was 43 minutes (range 35-55). Mean vaginal length was 7 cm (range 6-10). Four women defined sexual intercourse as very satisfying and two as moderately satisfying. CONCLUSION: This original technique was used for easy, safe, and rapid creation of neovaginas.

Adolescent↗
PubMed1998

The Bologna bladder neck suspension procedure for treatment of stress urinary incontinence associated with cystocele.

The object was to study retrospectively the perioperative complications and results of the Bologna procedure for the treatment of stress urinary incontinence associated with cystocele grade 2 or more. In the study, 80 patients underwent a repair of all defects of pelvic support plus the Bologna procedure. Mean duration of follow-up was 40.2 months (range 3-127). The incidence of operative complications was 2.5% for inadvertent cystostomy and for hemorrhage. Mean hospital stay was 7.2 days (range 2-17). At 2-year follow-up 85% of the patients were completely free of incontinence symptoms (95% CI: 75-92) and 76% at 3-year follow-up (95% CI: 66-86). None of the parameters tested in a univariate analysis was independently linked with surgical failure. Further studies are needed to establish the place of this technique in the surgical management of urinary incontinence associated with genital prolapse.

Female↗
PubMed1998

Cervical ripening with mifepristone before labor induction: a randomized study.

OBJECTIVE: To determine the efficacy and safety of mifepristone for cervical ripening in post-term pregnancies. METHODS: Women with post-term pregnancies and Bishop scores less than 6 were assigned randomly to mifepristone (41 patients) or placebo (42 patients). Mifepristone was given orally in a dose of 400 mg. Efficacy was assessed by change in the Bishop score within 48 hours after treatment; a score of 6 or greater was considered a "strict" success. An "extended" success rate was defined, including all patients with scores of at least 6 or those who delivered within 48 hours of treatment. Antenatal safety was assessed by fetal heart rate testing before and throughout labor. Neonatal safety was assessed by Apgar score, arterial or venous pH of cord blood, and blood glucose level during the first 48 hours. Analysis used Student t test for continuous variables, Kruskal-Wallis test for ordinal data, and chi2 for categoric variables. RESULTS: Strict success was achieved in 10 of 18 mifepristone patients (55%) evaluated for Bishop score on day 2 versus 8 of 29 placebo patients (27.5%) (P=.004). Extended success was achieved in 33 mifepristone patients (80.5%) and 21 placebo patients (50.0%) (P=.004). There were no statistical differences with regard to number of cesareans or fetal and neonatal safety. CONCLUSION: Mifepristone proved effective for cervical ripening and reduced the time to delivery compared with placebo, but it did not improve the rate of cesarean. Our study did not include enough pregnancies to reach conclusions about fetal or neonatal safety.

Abortifacient Agents, Steroidal↗
PubMed1998

[Evaluation of combination RU 486-laminaria tents-misoprostol-peridural anesthesia in second and third trimester induced abortions].

OBJECTIVE: To evaluate a new protocol for mid and third trimester medical termination of pregnancy using RU 486-misoprostol-epidural analgesia. DESIGN AND SETTING: Monocentric, prospective and descriptive study in a teaching hospital. MATERIALS AND METHODS: Eighty-three women undergoing legal induced abortion during the second and third trimester. Administration of 600 mg mifepristone 36 hours prior to laminaria tents. 48 hours after RU 486, misoprostol was orally given on a 3 hours basis. Epidural analgesia was systematically performed. MAIN OUTCOME MEASURES: Induction-abortion interval, median dose of misoprostol, maternal complications, number of fetal autopsies obtained within 24 hours. RESULTS: The mean induction abortion interval was 3 h for multiparas and 4.45 h for nulliparas. The median dose of misoprostol was 800 micrograms. A uterine rupture on a scarred uterus occurred. The rate of fetal autopsies in cases of malformations within 24 hours reached 96%. CONCLUSIONS: This protocol allows a safe, rapid, cheap and painless late termination of pregnancy, when compared to other protocols.

Abortifacient Agents↗
PubMed1998

[Urinary stress incontinence. Comparison of the Raz technique and the Bologna technique. Analysis of a series of 188 patients].

OBJECTIVE: Our purpose was to evaluate and compare the perioperative morbidity and the long-term results of the Raz colposuspension and the Bologna operation for the treatment of stress urinary incontinence in women. STUDY DESIGN: Data of 188 women who underwent either a Bologna operation (group 1) or a Raz colposuspension (group 2) for the treatment of stress urinary incontinence between January 1, 1987 and December 1, 1995 were analysed retrospectively regarding history, preoperative evaluation, associated surgical procedures, complications and cure and failure rate. POPULATION AND METHODS: 80 patients were treated with the Bologna operation and 108 with the Raz colposuspension. Patients with prior anti-incontinence surgery, and patients with a preoperative diagnosis of urge incontinence were excluded from the study. Success was defined both subjectively (complete absence of complaint of stress urinary incontinence) and objectively (no evidence of loss of urine on cough provocation during physical examination). Survival curves were generated in each group for time to event data: "time to recurrent stress incontinence" and compared by the logrank test. A multivariate analysis using a Cox proportional hazards regression model was performed to indentify possible outcome predictors. RESULTS: The success rate of group 1 was significantly higher than that of group 2 (p = 0.00001). The median of success was 51 months in group 1 and 21 months in group 2 (p = 0.00001). The incidence of intraoperative complications in each group (inadvertent cystostomy, hemorrhage) did not differ. The multivariate analyses using the Cox regression model showed that the most highly correlated variable with the surgical cure rate was the type of surgical anti-incontinence procedure adopted: Bologna or Raz (p = 0.00001) CONCLUSION: In our hands, the Bologna operation has a higher cure rate than the Raz colposuspension. For us, when treating patients with stress urinary incontinence by the vaginal route, the Bologna operation is indicated when sufficient anterior vaginal tissue is available to create vaginal bands.

Female↗
PubMed1998

[Early prenatal ultrasonographic diagnosis of fetus in fetu].

Fetus in fetu is a very rare abnormality, and is secondary to a pathological diamniotic monochorionic pregnancy. Its discovery is usually postnatal. We report a case of prenatal diagnosis suspected at 16 gestation's week because of a voluminous omphalocele seen at 12 gestation's week.

Adult↗
PubMed1998

[Creation of a neovagina using ultrasonography-assisted laparoscopy (modified Vecchietti technique].

Ultrasonography-assisted laparoscopic creation of a neavagina was performed on 6 patients suffering from vaginal aplasia. As the needle progress through the vesicorectal space, ultrasonography provided an accurate check of the bladder and rectal integrity, and improved the ease of the surgical procedure. Ultrasound can be considered an effective and reliable advance for laparoscopic management of vaginal aplasia.

Adolescent↗
PubMed1998

[Vaginal metastases of breast cancer].

Metastases to the vagina from breast carcinoma are uncommon, and are most often detected during autopsies of patients who have died from a breast cancer or from metastases to the genital tract. A case of symptomatic vaginal metastasis secondary to bilateral breast carcinoma is reported. The potential routes of dissemination include lymphatic and vascular spread. Their respective frequencies vary in the literature. Lymphatic spread in this case is suggested by demonstrable ovarian, myometrial, and lymph node involvement associated with massive submucosal vaginal involvement. This observation of concomitant visceral and lymphatic spread improves our knowledge of metastatic spread from breast cancer to the female genital tract by the lymphatic route.

Breast Neoplasms↗