Biomedical subjects

P Morice

Publications and source records attributed to P Morice.

At least 127 records · Page 7Linked to original sources

PubMed1994

[Primary malignant lymphoma of the uterine body. Apropos of a case and review of the literature].

We observed a case of primary malignant lymphoma located in the uterine body which was discovered fortuitously after hysterectomy in a 75-year-old patient who suffered from post-menopausal bleeding. Search for extension did not reveal extra-genital involvement. This localization is exceptional and only 7 cases have been reported in the literature. The most frequent histological type is diffuse large-cell lymphoma. Surgical treatment is indicated with possible secondary radiotherapy and/or chemotherapy depending on the clinical presentation.

Aged↗

PubMed1994

[Celiosurgery in gynecology. Indications, benefits and risks].

Initially used exclusively for diagnosis, laparoscopy is now a surgical method in gynecology but also in many other specialties. In gynecology, the results of laparoscopic surgery are comparable to those obtained by laparotomy in many indications: ectopic pregnancy, ovarian cysts, endometriosis, tubo-peritoneal sterility... Because of the advantages of laparoscopic surgery over traditional surgical treatment by laparotomy, operative laparoscopy is, in these indications, now recognized to be the best choice of surgical treatment. The most important advantages of operative laparoscopy are the following: less esthetic drawbacks, minimal risk of parietal and infectious complications, lower risk of post operative adhesions, more comfortable post operative course and lower cost due to considerably shortened hospital stay and recovery period. The risk of complications is directly correlated to the surgeon's experience and the importance of the surgery performed.

Endometriosis↗

PubMed1994

[Gynecology and obstetrics in ancient Egypt].

We analyzed scriptural and archeologic sources of information concerning gynaecology and obstetrics as practiced in ancient Egypt. Knowledge of anatomy was rudimentary but precocious diagnosis of pregnancy was practiced. An obstetrical chair had been used since the VIth dynasty. The Egyptians were the first to describe prolapsus of the genital organs. The pessary was a known treatment. Spermicidal mixtures were used for contraception.

Delivery, Obstetric↗

PubMed1994

[Recurrent acute hepatic steatosis in pregnancy].

Acute fatty infiltration of the liver in pregnancy (AFILP) is a rare disorder with a severe prognosis, improved by diagnosis of the minimally symptomatic form. AFILP is classically considered to be non-recurrent. We nevertheless report the fourth case of the recurrent form.

Acute Disease↗

PubMed1993

[Tubal bilharziasis].

We report a case of tubular bilharziosis discovered on a surgical specimen after salpingectomy. Tubular bilharziosis is not exceptional in endemic zones but is rarely found in Europe. The species most often isolated is Schistosoma haematobium. Contamination occurs via vascular anastomoses between the bladder and the genital organs. Bilharziosis has been shown to be a cause of extra-uterine pregnancy although its effect on fertility is yet to be established.

Adult↗

PubMed1993

[Abdominal approach of rectocele and colpocele].

The authors report a series of 62 female patients operated for rectocele and/or elytrocele via an abdominal approach. The technique was based on insertion of a retrovaginal prosthesis attached to the sacrum. Other surgical procedures can be performed at the same operation: hysterectomy, insertion of a prevaginal prosthesis, retropubic colpopexy. The anatomical and functional results were excellent in these patients previously operated for urinary incontinence or prolapse (99%). The indication for total hysterectomy during the same operation must be limited as this procedure increases the morbidity and impairs the functional results. Dyschexia is improved, but may be followed by postoperative constipation. Abdominal treatment of rectoceles and/or elytroceles by interposition of an interrectovaginal prosthesis attached to the sacrum is particularly indicated after hysterectomy in the case of associated or recurrent genitourinary prolapse.

Douglas' Pouch↗

PubMed1993

Splenectomy in idiopathic thrombocytopenic purpura: its correlation with the sequestration of autologous indium-111-labeled platelets.

We present a retrospective analysis of 111In-platelet sequestration studies in 111 patients with the clinical diagnosis of idiopathic thrombocytopenic purpura (ITP). Fifty-one of these patients underwent splenectomy, independent of the results of the 111In-platelet studies to determine if these isotopic results could accurately predict a beneficial response to splenectomy. Between January 1984 and June 1990, 111 patients who presented with ITP were subjected to a study of autologous 111In-labeled platelets through autotransfusion. The platelet sequestration site was splenic (81%), mixed (12%), or hepatic (7%). Fifty-one patients with persistent drug-resistant thrombocytopenia underwent splenectomy regardless of the isotopic results: 33 patients beyond 6 mo after diagnosis and 18 with high hemorrhagic risks before this delay. The follow-up median duration was 2.9 yr. Thirty-three of the 38 patients with splenic sequestration showed a normalized platelet count, as opposed to 2 of the 13 with mixed or hepatic sequestration (p < 0.001). In addition, platelet survival extended beyond 8 days in six patients, with no apparent sequestration site. The platelet isotopic study performed with this technique appears to be indicated in ITP: it guides clinicians in their decision to perform splenectomy and relates to a more central mechanism certain thrombocytopenias that are inappropriately categorized as ITP.

Adolescent↗

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↗

PubMed1992

[Takayasu's disease and pregnancy].

We report one case of pregnancy in a non-oriental woman who had Takayashu's disease. Pregnancy was characterised by toxemia and caesarean section had to be carried out at 31 weeks because of fetal distress. The disease did not worsen and nor were there any maternal complications but the child died on the 7th day.

Adult↗

PubMed1991

[Recurrent inguinal hernia].

Inguinal hernias that recur after parietal herniorraphy are still frequent, the mean recurrence figures obtained from a review of the literature being 7.3, 5.2 and 1.1 percent respectively after the Bassini, Mc Vay and Shouldice repair techniques. The variability of bibliographical data and the factors which facilitate recurrence are analyzed; the choice of the approach route and of the most reliable repair technique is discussed. Although the present tendency is increasingly towards the use of preperitoneal prostheses, there is still room for reoperative surgery by the inguinal route, combining herniorraphy with hernioplasty, and without prosthesis.

Epidemiology↗

PubMed1979

[Functional reinnervation of the larynx. Experimental study (author's transl)].

This study of reinnervation of the larynx results from the research for a functional method of treatment for laryngeal paralysis of peripheral origin. The physiological reality of reinnervation of a denervated muscle by a nerve other than that anatomically destined for it, or "neurotisation", is now an established fact. This experimental study in 12 dogs consisted of neurotisation of a posterior crico-thyroid muscle, denervated by section of the recurrent laryngeal nerve, by implantation of a graft of sub-hyoid muscle with a nerve pedicle. Only one positive result at six months was seen. 8 failures could be explained by the absence of ventilatory difficulty necessary for the sub-hyoid muscles to be brought into action, and the other 3 failures two months after the operation by muscular fibrosis of the graft before neurotisation could occur. Physiology and the experience of other teams justify the continuation of this study.

Animals↗

PubMedDate not supplied

[Place and results of frozen section analysis in the management of malignant and borderline ovarian tumors].

The management of ovarian tumors discovered during laparoscopy depends equally on the surgeon and the pathologist. Thus, the surgeon will undergo a more or less radical surgery depending on frozen section analysis (FSA),which depends mainly on the pathologist's skills, the histopathologic type and the volume and the localization of the tumor. The accuracy of FSA is higher in ovarian cancer than in borderline tumor. In patients treated initially with a laparoscopic approach, if the FSA demonstrates the presence of an invasive carcinoma, a conversion to laparotomy should be performed in order to complete the surgical staging. If the FSA demonstrates the presence of a borderline tumor, an exclusive laparoscopic approach could be discussed.

Clinical Competence↗

PubMedDate not supplied

[Agranulocytosis and connectivitis different from Felty's syndrome: 4 cases. Success of cyclosporin in a case].

Four cases of chronic agranulocytosis in patients with systemic diseases different from Felty's syndrome are reported. Two patients had primary Sjögren's syndrome (confirmed in one, suspected in the other), one had systemic lupus erythematosus and the last patient had an unclassifiable connective tissue disease. Only one severe infection was recorded. The pathophysiological mechanisms involved are discussed. There is a strong suspicion that the cytopenia is of immune origin. Corticosteroid therapy was effective in all four patients. One patient who could not tolerate corticosteroids was successfully treated with cyclosporin A.

Adult↗

PubMedDate not supplied

[New approaches in "conventional" surgery of uterine cervix cancer].

The radical hysterectomy by laparotomy with resection of the proximal and distal parts of the parametria (type III according to the Piver's classification) is the most appropriate treatment of stage Ib and II cervical carcinoma. Nevertheless, a resection of a partial part of the parametria and conservative surgery (of the uterus and/or ovaries) are possible in selected cases of patients with good prognostic factors. The lymphadenectomy has a diagnostic, prognostic but probably also a therapeutic value. Para-aortic lymphadenectomy should be performed in patients with a bulky tumor. Pelvic exenteration with reconstructive surgery could be discussed in young patients with centro-pelvic recurrence of a cervical carcinoma.

Adult↗

PubMedDate not supplied

[Prognosis and fertility after conservative treatment for ovarian tumors of limited malignity: review of 68 cases].

UNLABELLED: The aim of this retrospective study was to evaluate the rate of recurrence and the reproductive outcome after surgical conservative treatment of low malignant ovarian tumors (LMOT). MATERIAL AND METHODS: Sixty-eight patients with 50 Stage I LMOT and 18 LMOT with peritoneal implants treated conservatively at institut Gustave-Roussy, between January 1969 and December 2000. Fifty-nine patients had an unilateral adnexectomy (associated twelve times with a contralateral cystectomy), Seven had a bilateral cystectomy and two an unilateral cystectomy. Five patients received adjuvant therapy. RESULTS: With a median follow-up of 71.5 months, 16 patients recurred and one had evolutive peritoneal disease. The histologic pattern of ovarian recurrences was always of borderline type. The histologic patterns of peritoneal recurrence was similar to those initially diagnosed except in one case. Peritoneal implants, exophytic tumor and serous type tumor were significatively associated with a higher 5-year recurrence rate. Recurrence was more frequent after cystectomy than unilateral adnexectomy (p = 0.13). None of patients treated conservatively recurred under the form of ovarian carcinoma. None patient died of tumor. Nineteen patients experienced 26 pregnancies: 24 were spontaneous in a median delay of 19 months. Seven infertile patients underwent ovarian stimulation. None recurred after infertility treatments. The 2-year and 5-year cumulative pregnancy rate were respectively 41.9% and 59.8%. Four patients experienced a pregnancy after a conservative treatment of their recurrence. CONCLUSION: Despite a high recurrence rate, especially in stage II and III serous LMOT, conservative treatment of LMOT does not affect survival and should be considered in young patients. Such treatment is not advised in case of invasive peritoneal implants. Spontaneous pregnancy rate is good but the frequent infertility associated with these tumors can afterwards require ovarian stimulation. Limited number of stimulation cycles is acceptable in such patients.

Adnexa Uteri↗

PubMedDate not supplied

[Endometrial surveillance of women on tamoxifen].

Tamoxifen estrogenic action in the uterus induces several uterine diseases, benign and/or malignant ones. The risk of endometrial adenocarcinoma is multiplied by two to three in post-menopausal women. It is mainly linked with the doses and the length of the treatment. However, the global benefit of that drug is not questioned anymore. What matters now though is to find the best way to follow patients on tamoxifen. As a matter of fact, there is no such thing as a consensus that would include specific tests, nor a surveillance protocol in women on tamoxifen. Most teams do not propose any special follow-up. Some patients already show uterine anomalies prior to the beginning of tamoxifen treatment. A yearly gynecologic examination, together with a cervico-vaginal smear, is enough when there are no specific endometrial adenocarcinoma risk factors, nor anomalies detected during the pre-therapeutical evaluation, nor clinical symptomatology. In case of risk factors, or cervical stenosis, or again initial abnormalities though, a yearly transvaginal sonography may be proposed. There is no need for other exploratory examinations if the results are satisfying. In case of symptoms, anomalies in the cervico-vaginal smears, intra-uterine liquid retention with a stenosed cervix, or suspicious endometrial thickness, then an endometrial sampling must be carried out. MRI could be of interest in asymptomatic patients with unclear ultrasonography images. Follow-up must be continued after interruption of tamoxifen. It is important to inform patients about the additional risks of developing an endometrial cancer because of tamoxifen, while still being reassuring. Besides, it is absolutely necessary to recommend them to take quickly medical advice in case of gynecologic symptoms.

Adenocarcinoma↗

PubMedDate not supplied

Cisplatin-based chemotherapy regimen (DECAV) for uterine sarcomas.

Uterine sarcomas are an extremely rare event. There is no standard therapy for cases of relapse, although chemotherapy is commonly used. We studied the use of a cisplatin-based chemotherapy regimen for uterine sarcomas with an unusually long follow-up. Thirty-nine women with a median age of 50 years (32-71) entered the study. Histologically, leiomyosarcomas (26), carcinosarcomas (8), and stromal sarcomas (5) were represented. Group 1 consisted of patients undergoing adjuvant therapy (for initial disease, eight patients; for pelvic recurrence, two patients); Group 2 consisted of patients with advanced disease (locoregional after initial local therapy, five patients; local recurrence, six patients) or metastatic disease (stage IV, four patients; recurrence, 14 patients). DECAV therapy consisted of doxorubicin 50 mg/m2 d1, dacarbazine (DTIC) 200 mg/m2/d d1-3, vindesine 2 mg/day d1-2, cisplatin 100 mg/m2 d3, and either cyclophosphamide (CPM) 200 mg/m2/d d1-3 (n = 21), or ifosfamide (IFM) 2 g/m2/d d1-3 with mesna every 4 weeks Toxicity included 18 hospital stays for cytopenia (nine patients), including 13 cases of febrile neutropenia. Twenty blood transfusions in 10 patients and 12 platelet transfusions in seven patients were required. One toxicity-related death (hemorrhage) occurred. The overall response rate was 54% (3 complete response, 11 partial response) with a median duration of 13 months (4-36). Median overall survival was 14 month overall, 45 months for Group 1 and 13 months for Group 2. We conclude that the DECAV regimen is clearly active in uterine sarcomas but is too toxic to be recommended routinely.

Adult↗

PubMedDate not supplied

Adjuvant chemotherapy with cisplatin, ifosfamide, and doxorubicin followed by radiotherapy in localized uterine sarcomas: results of a case-control study with radiotherapy alone.

UNLABELLED: Uterine sarcoma is a poor prognosis disease, with a high risk of metastatic relapse. We conducted a study of adjuvant chemotherapy with cisplatin, ifosfamide, and doxorubicin followed by radiotherapy (n=18). The results were then compared in a matched case-controlled study to radiotherapy alone (n=16) or no therapy at all (n=2). Chemotherapy consisted in three cycles of adriamyein-platinum-ifosfamide (API) (doxorubicin 60 mg /m2 on day 1; cisplatin 100 mg /m2 on day 2; ifosfamide 5 g /m2 on day 1+mesna 5 g /m2 on day 1+granulocyte colony-stimulating factor; q 3 weeks). Drug doses were reduced (20% for ifosfamide and cisplatin) four times (four patients) due to hematologic toxicity. Compared to a case-control study of adjuvant radiotherapy alone, results were not decreased by the addition of a toxic chemotherapy. CONCLUSION: Adjuvant API chemotherapy followed by radiotherapy is a feasible protocol; a multicenter phase III study comparing radiotherapy alone versus API chemotherapy followed by radiotherapy just began in France.

Adult↗