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P Madelenat

Publications and source records attributed to P Madelenat.

At least 19 recordsLinked to original sources
PubMed2006

[Levonorgestrel-releasing intrauterine system in the treatment of dysfunctional uterine bleeding: A French multicenter study].

OBJECTIVE: To evaluate the levonorgestrel-releasing intra-uterine system as an alternative to surgical treatment in patients presenting with menorrhagia. PATIENTS AND METHODS: In the set of a prospective multicenter study, 49 patients with menorrhagia resistant to medical treatment and/or referred for hysterectomy or endometrial ablation were included. Medical visits were organized 3, 6, 12, 24 and 36 months after insertion of the levonorgestrel-releasing intra-uterine system. Visual score of menstrual bleeding and satisfaction index were noted on each visit. Transvaginal ultrasound, pap smear, endometrial biopsy, and clinical data were retrieved one month before and 12 months after inclusion for tolerance evaluation. RESULTS: Renouncement rate was 90.0% (95% CI = 80.7-96.6%). After a twelve months follow-up, 86.1% of patients were satisfied or very satisfied with their clinical state. We found a significant increase of hemoglobin rates from baseline (14,0 versus 12,9 g/dl; P < 10(-4)). Similar increases were also found in serum iron and ferritin. DISCUSSION AND CONCLUSION: This study confirms the efficacy of the levonorgestrel-releasing intra-uterine system in the control and reduction of menstrual blood loss in patients with dysfunctional uterine bleeding. The high rate of surgery cancellation is a proof of the potential role of the levonorgestrel-releasing intra-uterine system as an alternative treatment in these patients.

Adult↗
PubMed2006

[Ovarian endometriomas: Effect of laparoscopic cystectomy on ovarian response in IVF-ET cycles].

OBJECTIVE: To investigate the follicular response to controlled ovarian hyperstimulation (COH) in IVF-ET cycles after laparoscopic ovarian cystectomy for large endometriomas. PATIENTS AND METHODS: In the set of a retrospective controlled study, the medical records of 113 infertile women who underwent IVF-ET cycles after laparoscopic surgery were reviewed. The study group (A) consisted of 63 patients with severe pelvic endometriosis and endometrioma excision. The control group (B) consisted of 50 infertile patients with mild or minimal endometriosis. Interventions were laparoscopic ovarian cystectomy in the study group, and COH in both groups. RESULTS: Groups A and B were not different in terms of epidemiologic data. The total numbers of recruited follicles (9.1+/-3.3 vs 10.6+/-4.2; P = 0.001), mature follicles (> or =16 mm) (4.2+/-1.7 vs 4.8+/-2.2; P = 0.04), mature oocytes retrieved (5.8+/-3.8 vs 7.4+/-4.6; P = 0.02), and fertilization rate (48.9+/-34.9 vs 61.8+/-32.1%; P = 0.02) observed in group A were lower than those observed in group B, respectively. While the mean number of rFSH ampoules (75 IU) was increased in group A (38.1+/-20.4) compared to group B (29.3+/-16.4; P = 0.004), cumulative pregnancy rates were similar in both groups (27.5+/-8.8% vs 37.2+/-10.6%; P = 0.37). DISCUSSION AND CONCLUSIONS: Ovarian response was reduced during IVF-ET cycles in patients with history of severe endometriosis and laparoscopic excision of endometriomas compared to women with mild or minimal endometriosis without ovarian surgery.

Adult↗
PubMed2006

[Apoptosis of granulosa cells as a predictive marker of in vitro fertilization success?].

During in vitro fertilization (IVF) morphological criteria are the only means usable today to select embryos before their uterine transfer in order to obtain pregnancy with the best chances of success. Since several years many attempts have been made to find more functional means. Quantification of apoptosis of granulosa cells has been proposed for this purpose. The aim of this review is to take stock of our knowledge on apoptosis and its mechanisms in granulosa cells and to analyse how quantification of these apoptotic cells could be a reliable and predictive marker of success for an attempt of an IVF in terms of pregnancy.

Apoptosis↗
PubMed2006

[Evolution of surgical operations for female stress urinary incontinence in Gynaecology departments of Parisian public hospitals between 2002 and 2004].

OBJECTIVE: To appreciate the evolution of surgical operations for female stress urinary incontinence. PATIENTS AND METHODS: Sixteen gynaecology departments of Parisian public hospitals were surveyed by postal questionnaire about their surgical practice for the treatment of female stress urinary incontinence in two successive periods, between 1st September 2002 and 31st August 2003 inclusive, and between the 1st of September 2003 and the 31st of August 2004 inclusive. The number, the type of operation, the type of suburethral tapes and their surgical routes were detailed. RESULTS: The participation rate in the survey was 87.5%. Suburethral slings represent the technique of choice for stress urinary incontinence (505 [86.2%] in 2002-2003 and 468 [92.7%] in 2003-2004, P < 0.001). Other practices are exceptional. The transobturator approach has widely progressed between the two periods of the study (157 [31.1%] and 302 [64.5%], P < 0.001), and is more often performed than the ascending retropubic approach (245 [48.5%] in 2002-2003 and 117 [25.0%] in 2003-2004, P < 0.001). DISCUSSION AND CONCLUSION: Suburethral tape placement is nowadays the main surgical treatment for female stress urinary incontinence, in Gynaecology departments in Parisian public hospitals, in particular the transobturator approach.

Female↗
PubMed2006

[Mode of delivery of HIV-infected women: a retrospective study of 358 pregnancies followed in the same hospital between 2000 and 2004].

OBJECTIVE: Evaluate the mode of delivery of HIV-infected women and the risk of mother-to-child transmission. PATIENTS AND METHODS: A retrospective study conducted on HIV-infected women who delivered at the maternity ward of Bichat Hospital in Paris between 1st January 2000 and 31(st) December 2004. Pregnancy care, antiretroviral therapy, decision of the mode of delivery and neonate treatment were conformable to the French recommendations. RESULTS: The analysis was performed on 332 cases out of 358 pregnancies followed during this period. 75% received a Highly Active Anti Retroviral Therapy (HAART), 24% an AZT monotherapy and 1% did not receive any antiretroviral treatment. Plasmatic HIV viral load was under the level of detectability (50 copies/ml) for 64,6% of women under HAART and 28,7% of women under AZT monotherapy. Only 31,7% of women under HAART delivered vaginally. 44,7% of women under HAART with undetectable viral load at the moment of delivery delivered vaginally. 59,5% of women who were allowed to deliver vaginally had finally a vaginal delivery. 332 women gave birth to 341 babies with 9 twin pregnancies and one still-birth at 22 WA. Out of these 340 babies, 3 babies whose mother received HAART were HIV infected (2 in utero and 1 per-partum). DISCUSSION AND CONCLUSION: The reasons why only one third of HIV-infected women could deliver vaginally in this study are primarily the persistence of a detectable HIV viral load under HAART. Women's choice of the mode of delivery comes next, which depends on the quality of the counselling about the benefits and risks of the cesarean section in the context of HIV infection. The third reason is obstetrical contra indications to vaginal delivery in the context of HIV infection. In the future, it is possible to reduce the incidence of cesarean section in HIV-infected women by elevating the level of HIV plasmatic viral load which allowed vaginal delivery (1000 copies/ml), by improving the observance to antiretroviral treatment, by adaptating antiretroviral medications posology using determination of serum protease inhibitors concentration and by modifying obstetrical management with less restrictive contra indications to vaginal delivery. However the impact of prophylactic cesarean section when plasmatic HIV viral load is undetectable must still be evaluated.

Antiretroviral Therapy, Highly Active↗
PubMed2006

[Young women with atypical endometrial hyperplasia or endometrial adenocarcinoma stage I: will conservative treatment allow pregnancy? Results of a French multicentric survey].

OBJECTIVES: To analyse the carcinological and obstetrical results of young women with atypical endometrial hyperplasia or endometrial adenocarcinoma, treated in a conservative way to allow pregnancy. PATIENTS AND METHODS: A retrospective analysis of 13 cases (5 adenocarcinomas and 8 atypical hyperplasias) followed in 8 French centers between 1997 and 2004. RESULTS: After 4.6 months of conservative treatment, there were no residual lesions in 61.5% of the cases. Progestatives seem to be the most effective treatment. Tumoral regression makes it possible to plan a pregnancy, with childbirth in 25% of the cases. In these frequently infertile patients, all the techniques of assisted reproduction can be used. Recurrences are not rare after hormonal treatment (37.5%), so, total hysterectomy is justified after delivery. DISCUSSION AND CONCLUSION: Conservative treatment for young women with atypical endometrial hyperplasia or endometrial adenocarcinoma stage I can be considered in some cases to enable pregnancy.

Adenocarcinoma↗
PubMed2005

[Preliminary results from the OPNI observatory: long-term follow-up of a cohort of women using the progestagen contraceptive implant Implanon].

OBJECTIVE: Describe the initiation and follow-up of Implanon insertion in current office-based practice in France and estimate the rate and causes of early removals. PATIENTS AND METHODS: A prospective cohort study of 1000 women having been inserted with Implanon by a representative national sample of prescribers (gynaecologists and general practitioners) was designed. The follow-up period was 3 years and the enrolment was planned for 2 years starting July 2002 according to a naturalistic design. RESULTS: The results are related to an intermediate analysis describing the situation of the cohort at the date 31 December 2003. 872 women were enrolled, of whom 784 (89.9%) by gynaecologists and 88 (10.1%) by GPs. Implanon was inserted in 691 (79.2%) and 360 (52.1%) had at least one follow-up visit at this date. The mean follow-up period after insertion was 10.5 months. 38 early removals were recorded (actuarial rate at 16 months of 8.8% [CI 95% 5.0-12.7]), integrating the distribution of follow-up duration and the assumption that women with no follow-up visit the still had device. DISCUSSION AND CONCLUSION: The estimated early removal rate was lower than the result of the meta-analysis of international clinical trials but this figure should be confirmed in the final analysis of the study.

Cohort Studies↗
PubMed2005

[Diagnostic hysteroscopy and risk of peritoneal dissemination of tumor cells].

Questions have been raised about the safety of diagnostic hysteroscopy preceding surgical treatment of endometrial carcinoma. Several studies showed that the risk of a positive cytology among patients presenting endometrial adenocarcinoma was increased after diagnostic hysteroscopy, suggesting a peritoneal dissemination of tumor cells due to the exploration. We studied this hypothesis on the basis of a systematic review of the scientific data. Five studies fulfilling inclusion criteria have been selected and have been introduced into a fixed model of meta-analysis. On a total of 756 studied patients, 79 presented a positive peritoneal cytology. The diagnostic hysteroscopy did not increase significantly the risk of abdominal dissemination of tumor cells, the peritoneal cytology being positive among 38 patients in the group having undergone this intervention vs 41 patients in the control group (OR = 1,64; 95% CI: 0,96-2,80). In conclusion, no formal evidence is currently available concerning the role of diagnostic hysteroscopy on the frequency of peritoneal dissemination of tumor cells, or on the vital prognosis of the patients presenting with endometrial carcinoma. From the data available, there is not any reason to avoid diagnostic hysteroscopy in the initial workup of endometrial cancer.

Adenocarcinoma↗
PubMed2005

[The efficacy and acceptability of mifepristone medical abortion with home administration misoprostol provided by private providers linked with the hospital: a prospective study of 433 patients].

BACKGROUND: Until July 2001 medical abortion was only authorized in France in public hospitals or private clinics. A new law effective in July 2001 allows private practitioners (gynaecologists or general practitioners) to provide medical abortion in their offices as long as they are linked to a hospital official agreement. Unfortunately mifepristone was not available outside hospitals before September 2004, so the study was conducted still providing the drugs in the hospital family planning clinic. OBJECTIVE: To evaluate the efficacy and the acceptability of mifepristone medical abortion with home administration of misoprostol provided by private practitioners linked with the hospital. PATIENTS AND METHODS: Four hundred thirty-three women seeking medical abortion before 7 weeks LMP were included between 2 January 2003 and 7 July 2004. All consultations before abortion and 2 weeks after abortion took place in a private provider's office. Drugs were administrated in the hospital family planning clinic: patients were given 3 tablets of mifepristone (600 mg) orally by the midwife and received 2 tablets of misoprostol (400 microg) that they would take at home 48 hours later. In case of any problems or complications, patients could phone or meet their private providers, phone the hospital midwife or go to the hospital emergency service. Private providers received training in medical abortion training and could at any time reach a medical specialist in the hospital family planning clinic for information or to refer a patient. RESULTS: - Efficacy was evaluated for 339 women, because 94 patients were lost to follow-up (21.7%). Efficacy of medical abortion was 93.8% (318/339). There were 21 surgical aspirations (6.2%): for women's decision in 1.5% of cases, for medical decision without complications in 3.5% of cases, and for failure of the method in 1.2% of cases (2 ongoing pregnancies and 2 heavy haemorrhages with transfusion). The family planning midwife received a phone call from 21 patients after mifepristone (4.8%), Twenty-five patients had an emergency consultation (5.7%), and 22 patients went back to their private providers before their appointment for follow-up (5%). Twenty-two patients (5%) were referred by the private provider to the hospital medical specialist. Acceptability is known for 26% of patients; 96.2% thought that the abortion procedure was acceptable. DISCUSSION AND CONCLUSIONS: The failure rate of medical abortion in this study is largely due to aspirations for incomplete abortion. To improve the efficacy of medical abortion offered by private providers linked with the hospital, all the relevant professionals (private providers, residents in the emergency service, family planning providers) must be well trained in medical abortion, especially in how to interpret and react to ultrasound images obtained in the follow up visit. The procedure is very acceptable to women. Medical abortion offered via a network should be well accepted by practitioners, since only 5% of women will need more than two consultations and only 6.2% will need surgical aspiration in the hospital. This study allows us to be optimistic about the expansion of medical abortion in France outside the hospital via a provider-hospital network based on the fact that since September 2004 private providers can get mifepristone directly in the pharmacies of the city.

Abortifacient Agents, Nonsteroidal↗
PubMed2005

[Neurological outcome of children from twin pregnancies].

The neurological outcome is an important issue regarding twin pregnancies. In fact, twin pregnancy is clearly associated with an important neurological morbidity, roughly 4 times higher than singleton pregnancy. It is possible to distinguish some high-risk situations, making it possible to calculate more accurately the individual risk. The different aetiologies are analysed: hypotrophy, prematurity, malformations, prenatal occurrence of anoxic and ischemic lesions, and particularly the link with monochorionicity. The neurological outcome is mainly depending on hypotrophy and prematurity. However, the rate of long-term neurological complications is not different between twins and singletons after adjustment for term and birth weight. An increased risk of malformation is associated with twin pregnancies, essentially a high rate of abnormal neural tube closing (RR=2). Monochorionic pregnancies have a specific morbidity, not related to these aetiologies, with characteristic anoxic and ischemic lesions. Cerebral palsy is observed in 10-20% of the monochorionic pregnancies, vs 3.7% of the bichorionic ones. These complications are linked to the constant vascular anastomoses, between the circulations of the two monochorionic twins. When the twin-to-twin transfusion syndrome is severe, a poor neurological outcome is observed in 4 to 18% of the surviving children. However, this rate depends on studies, treatments, and methods of neurological evaluation. The laser destruction of anastomoses could decrease this morbidity. The stillbirth rate, either associated or not with twin to twin transfusion syndrome, is increased by monochorionicity. The death of one of the twins is associated with a 20% higher risk of neurological sequelae for the surviving co-twin.

Congenital Abnormalities↗
PubMed2004

[Hysterectomies in patients with no history of vaginal delivery. A study of 243 cases].

OBJECTIVE: The object of this study was to audit the policy of hysterectomy in nulliparous women in a university hospital. PATIENTS AND METHODS: A retrospective medical records analysis of all hysterectomies performed during an 8-year period. Patients with no history of vaginal delivery were stratified into three groups: group 1, patients who underwent abdominal hysterectomies; group 2, patients undergoing vaginal hysterectomy (2a) or laparoscopy-assisted vaginal hysterectomy (2b). The groups were compared as to demographic data, surgical complications and outcomes. RESULTS: During the study period, there were 243 hysterectomies in patients with no history of vaginal delivery. Among these, vaginal hysterectomies (group 2) were undertaken in 75% (182 patients) and successfully performed in all but 13 patients (7.1%). Mean uterine weight was 943 grams in group 1 and 370 grams in group 2. Abdominal route (group 1) was associated with longer operative time (average: 105 min) than vaginal route (group 2a; 81 min) but shorter operative time that laparoscopy-assisted vaginal route (group 2b; 173 min). There was no significant difference in mean estimated blood loss and complications rates between groups 1 and 2. Hospital stay was shorter in group 2. Laparoscopic assistance was not associated with bigger uteri, neither with fewer complications. DISCUSSION AND CONCLUSION: Nulliparity should no longer be considered a contraindication to vaginal hysterectomy. In such patients, many more hysterectomies should be carried out vaginally and laparoscopic assistance does not offer obvious advantages over the standard vaginal approach.

Adult↗
PubMed2004

[The limits of laparoscopic myomectomy].

Feasibility of laparoscopic myomectomy has been already shown with numerous clinical studies. Short-term benefits of this procedure are nowadays established. Its limits are related to the surgical technique, the myoma process, and the clinical context of the patient. By using preoperative exclusion criteria, particularly the size and the number of myomas, laparoscopic treatment is possible with little laparoconversion and complications rates. One could be in doubt about the risk of uterine rupture during a pregnancy occurring after laparoscopic myomectomy. In infertile patients, this procedure is as effective as laparotomy, even though its benefits in terms of postoperative adhesions should be demonstrated. Less invasive surgery should be preferred.

Female↗
PubMed2004

[Atypical lipomatous tumour of the vulva. About one case].

Liposarcoma of the vulva is a rare entity. This unusual localization with atypical clinical and histological appearance may induce diagnostic and treatment delay. We report the 13th case shown in the literature in a 31-year-old woman initially treated for a vulvar lipoma. Arguments based on clinical short term recurrence, histological infiltrating adipocytes, and cytogenentical findings evoked well-differentiated liposarcoma. Even though cytogenetic abnormalities, involving MDM2 and CDK4 genes, have been found, a certainty in malignity diagnosis could be difficult. In these cases, treatment decision may be uneasy. This case report recalls difficulties encountered in uterine hypercellular leiomyomas.

Adult↗