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R Maillet

Publications and source records attributed to R Maillet.

At least 19 recordsLinked to original sources
PubMed2006

[Cost effectiveness of Ligasure Precise versus surgical clips during axillary nodal dissection for breast cancer].

UNLABELLED: Introduction. The techniques used for axillary node dissection are constantly evolving. The advent of the grip Ligasure Precise raise the question of its cost-effectiveness compared with surgical clips. OBJECTIVE: To compare the effectiveness of Ligasure compared with surgical clips for simple axillary node dissection or Patey procedure in terms of duration of drainage, cost of hospitalization and complications. MATERIAL: and method. Retrospective study extending from January 1, 2003 to December 31, 2004, concerning 187 patients who underwent simple axillary dissection (100) or Patey procedure (87), with use of surgical clips or Ligasure followed by drainage. RESULTS: The use of Ligasure increased the operative cost because its price is higher than that of a clip grip with a refill. Ligasure significantly decreased the duration of drainage in the two groups but there was significantly more abundant fluid loss in the dissection group. The cost of hospitalization related to the choice of the technique of hemostasis (cost of the material + lasted of drainage X price of the day of hospitalization), was not significantly favor of Ligasure. Taking into account the choice of the hemostasis technique and the total duration of hospitalization (material cost + duration of hospitalization X price of the day of hospitalization), there is no significant difference between the two groups. CONCLUSION: This study compares grip Ligasure Precise with surgical clips for axillary dissection. The duration of drainage was significantly shorter with Ligasure Precise but its benefit in terms of fluid loss remains to be shown. The use of Ligasure does not significantly reduce the cost of hospitalization.

Axilla↗
PubMed2006

[Prenatal diagnosis and management of a case of rapidly involuting congenital hemangioma. Review of literature].

Rapidly involuting congenital hemangioma (RICH) is a rare vascular lesion, identified in 1996, of elective localization in the dermal-hypodermic tissue. Its name comes from its particular natural course: it is fully developed at birth and then completely involutes, usually in the first year. We present a case of a RICH of the scalp discovered with a screening ultrasonography in the 31st week of gestation. We list the differential diagnoses. After birth, positive diagnosis lies preferably on pathology examination of a biopsy specimen in order to eliminate the hypothesis of a less favorable vascular lesion, teratoma or malignant tumor.

Adult↗
PubMed2006

[Pelvic Burkitt lymphoma mimicking an ovarian tumor].

Primary malignant lymphoma of the ovary is a rare tumor (1,5% of ovarian tumors). Clinically, it occurs as an abdominal mass with pain which can be confused with an epithelial ovary tumor. Most tumors are observed during the fourth decade. Burkitt lymphoma, is sporadic in western countries, usually with abdominal involvement. Diagnosis is guided by biological analysis and imaging. Prognosis depends on medullary and neuromeningeal involvement. Polychemotherapy is required. We report a case of a young woman who developed abdominal Burkitt Lymphoma mimicking advanced-stage bilateral ovarian cancer.

Adult↗
PubMed2006

[Liberal versus restrictive practice of episiotomy: do there exist specific obstetrical indications for episiotomy?].

PURPOSE: To analyze the literature comparing two different policies for episotomy practice: liberal versus restrictive use. To search and discuss specific indications for episiotomy. METHODS: The Medline base was analyzed from 1970 to 2005. The articles where selected by using the key word episiotomy and selective or restrictive and routine or liberal. Every potential indications was crossed with episotomy. RESULTS: A policy implying a liberal practice of episiotomy is not better compared to a restrictive policy. The evidence-based medical literature favors avoiding routine episiotomy in low risk deliveries. Data are quite scarce concerning the different specific indications for episiotomy, and finally we can retain only one specific indication which is the short perineum when the distance between the fourchette and the center of the anus is less than 3 cm. Nevertheless, in order to improve delivery conditions obstetricians can advisably use episiotomy in accordance with their clinical assessment. CONCLUSION: There is no evidence in the literature favoring a liberal policy over a restrictive policy for the use of episiotomy, both in terms of fetal (Grade C) and maternal (Grade A) indications. A number of obstetrical situations considered as at risk do not systematically indicate an episiotomy. There are however circumstances in which a pertinent and prudent clinical assessment will lead the obstetrician to use an episiotomy.

Adult↗
PubMed2005

[Thierry's spatula instrumental extraction: a study of foetal-maternal morbidity].

OBJECTIVE: Assisted delivery is necessary in many obstetrical conditions but is involved in maternal and foetal complications. The legal pressure and the commendable aim consisting in less neonatal morbidity and mortality have called forth a reflection about the type and the way of instrumental foetal extraction. In 1950, Thierry had already felt this problem and he invented spatula to replace obstetrical forceps. Although this instrument appears empirically little deleterious, literature about its evaluation is very poor. We studied this instrument in a retrospective 190 cases series. PATIENTS AND METHOD: Retrospective study of 190 Thierry's spatula extractions, over a seven-year period (January 1996 to December 2002), at the Centre Hospitalier General of Montbeliard. RESULTS: Out of a total of 8126 deliveries for the study period, the instrumental extraction rate was 5.3%, with 40.6% spatula extractions (190 cases). No failure of Thierry's spatula extraction was noted. DISCUSSION ET CONCLUSION: Our study concludes that spatula is efficient but does not usually permit anterior rotation of occipito-posterior presentation. Maternal and foetal morbidity is not frequent.

Birth Injuries↗
PubMed2005

[Value of fetal scalp lactate sampling during labour: a comparative study with scalp pH].

OBJECTIVE: To evaluate the validity and the feasibility of fetal scalp lactate sampling during labour in the assessment of non reassuring fetal status. PATIENTS AND METHOD: A prospective observational study was conducted on 129 fetal scalp blood samplings. Scalp lactate measurements were compared to scalp pH (gold standard procedure), neonatal cord blood gas (pH and lactates) and Apgar score. Pathological values taken were for scalp lactates>5 mmol/l, scalp pH<7.20, cord arterial pH<7.10, cord arterial lactates>6,35 mmol/l, and Apgar score<7 at one and five minutes. All measurements were performed using the Rapid Lab 860 device from Bayer. RESULTS: Scalp lactate correlated significantly with scalp pH (R=-0.54, P=0.001), with umbilical artery pH (R=-0.46, P=0,01), with umbilical artery lactate (P=0.49, P=0.01), but with neither Apgar score at one minute (R=-0.21, ns) nor at 5 minutes (R=-0.11, ns). Scalp lactate at a cut-off value of 5 mmol/l had the same predictive values than scalp pH at 7.20 to predict neonatal acidosis. Sampling failure with scalp lactate was inferior to 1 vs 18% for scalp pH. DISCUSSION AND CONCLUSION: The measurement of lactate in fetal blood scalp seems correlated to the fetal scalp pH. It may be an attractive alternative to pH analysis and a useful tool for monitoring fetal asphyxia, especially with the advent of handheld devices requiring small sample volumes.

Adolescent↗
PubMed2005

[Obstetric and perinatal outcomes of a disreputable presentation: the nonfrank breech].

OBJECTIVES: A nonfrank breech is generally believed to be associated with abnormal labor and risk of cord prolapse. Owing to these risks, many authors consider such a presentation as a positive indication for cesarean section. The purpose of this study was to estimate the delivery characteristics of nonfrank breech with a gestational age over 37 weeks and particularities of this presentation. PATIENTS AND METHODS: This retrospective study included all deliveries with a nonfrank breech presentation and a gestational age over 37 weeks over a sixteen years period in our maternity ward. A descriptive analysis of maternal, fetal and obstetrical elements was carried out. RESULTS: 198 deliveries were indexed with 54% vaginal birth, regularly observed throughout the study period. Thirty percent delivered by prelabor planned cesarean section and 16% by cesarean section during labor. When a vaginal birth trial was allowed, at last 77.4% delivered by this route. Average labor time in the vaginal birth group was only 4.5 hours. Eleven cord prolapses were found (5.6%) of which more than half delivered by vaginal birth without fetal complications. Perinatal outcomes were satisfactory for the whole population, without differences between cesarean section and vaginal birth. DISCUSSION: Cord prolapse is a risk of nonfrank breech presentation but abnormal labor is not more frequent than with frank breech presentations if labor is managed rigorously. More than 75% patients of the vaginal birth trial group delivered by vaginal birth with perinatal outcomes as good as the cesarean section group. Unlike traditional reports, in our study a nonfrank breech was not an unfavorable factor for vaginal birth after strict selection of vaginal birth trial candidates.

Adult↗
PubMed2004

[Benefits of ultrasonography in the delivery room].

Ultrasonography should benefit many pathological events which occur in delivery rooms. The authors analyse the scarce literature about this subject and propose indications in which this complementary examination seems to be interesting.

Breech Presentation↗
PubMed2004

[Obstetrical and neonatal prognosis of monoamniotic twin gestations].

Monoamniotic twin gestations result from a late division of the fertilized ovum with development of the two embryos within a common amnionic sac. We performed a retrospective study in our university hospital on nearly 19 years of clinical activities; we found 16 cases of monoamniotic twins. Obstetrical and neonatal outcomes were analyzed and compared to the data in the literature. The pronosis after 28 weeks of gestation does not appear to be influenced by this type of twin gestation and we demonstrate in this study that vaginal delivery is possible and not deleterious.

Adult↗
PubMed2003

[Ectopic pregnancy management: cervical and abdominal pregnancies].

Cervical or abdominal pregnancies are rare forms of ectopic pregnancy and their management differs for different authors. Besides, the literature is mainly made of case-reports. The aim is to propose one or more management possibilities, keeping in mind that the level of proof obtained from the references used is insufficient to be affirmative. For cervical pregnancy, although hysterectomy is the reference treatment (especially in advanced pregnancy or hemorrhagic life-threatening forms), technical improvements in ultrasonography make feasible the diagnosis of non or weakly symptomatic forms, which could be treated conservatively in order to preserve fertility of these women. In this diagnostic situation the present treatment standard is methotrexate combined with intra-amniotic feticide in case of viable cervical pregnancy. Diagnosis of abdominal pregnancy is often made late. Treatment consists in laparotomy which enables better vascular control. Placental ablation remains as often as not dangerous and in most cases, it is better to abandon the attempt.

Abortifacient Agents, Nonsteroidal↗
PubMed2001

[Obstetrical vacuum: a modern instrument].

Contrary to the forceps, the vacuum extractor has clearly progressed in the last years. The use of the vacuum extractor increases in every developed countries, certainly because of an easier learning than forceps. Furthermore, maternal after-effects of the delivery like sphincters injuries and anal incontinence seem to be less frequent with vacuum extractor than with forceps. For these reasons the American College of Gynecologists and Obstetricians (ACOG) recommend a large use and a priority teaching of this fetal extraction instrument. The technical aspects of use of the vacuum extractor are developed in this article, and personnel results are added as commentaries.

Atmospheric Pressure↗
PubMed2000

[Neurodevelopmental outcome of premature infants born at less than 33 weeks of gestational age and not cerebral palsy at the age of 5 years].

AIM: To appreciate the impact of prematurity, fetal hypotrophy and familial environment on the neurodevelopmental performances of very premature infants without cerebral palsy at the age of five years. POPULATION AND METHODS: We followed a regional cohort of 171 very premature infants (< or = 32 weeks of gestation) until they were five years of age. Cognitive functions were tested with the WPPSI test and the development quotient was assessed by the ability to draw a "bonhomme". Twenty-two premature infants suffered from cerebral palsy diagnosed before the age of two years. Another infant had a moderate diplegia at the five-year examination. We had no information for 16 prematures (9.3% of survivors). Twenty-eight premature infants were considered as having no severe disability on phone or mailed contact, and another child had a severe isolated mental retardation. We examined 104/148 infants, and 96/148 survivors without cerebral palsy passed the tests. The cognitive functions of these premature infants are compared to the performances of a control group made up of 108 children born at term > or = 37 weeks, matched for birthplace and single or twin characteristics of the pregnancy. RESULTS: The values of the different quotients are significantly decreased in the preterm group. The global IQ and the performance IQ are 0.8 SD, verbal IQ is 0.5 SD and the development quotient is 0.4 SD below the values observed in the control group. A performance IQ less than -2 SD for the mean of the control group is observed three times more than in the controls (13.5% vs 3.7%, P < 0.01). Multiple linear regression shows that prematurity explains, independent of hypotrophy and socioeconomic environment, 8% of the variation of the performance IQ (P < 0.01), 2% of the variation of the verbal IQ and 2% of the development quotient (P < 0.05). CONCLUSION: The five-year neurologic outcome of the children born prematurely in this regional study is similar to the results observed in regional studies conducted in Europe: 13.4% of the survivors have cerebral palsy, and the cognitive functions of the children with no cerebral palsy are significantly lower than the term control group. Other risk factors such as hypotrophy, which modulates the developmental quotient, and the socioeconomic status, which modulates the verbal IQ, are underlined.

Cerebral Palsy↗
PubMed1999

Some risk factors for cerebral palsy in very premature infants: importance of premature rupture of membranes and monochorionic twin placentation.

OBJECTIVE: To delineate the perinatal risk factors of neurodevelopmental disabilities in very preterm birth applying logistic regression analysis. DESIGN: This prospective, geographically defined collaborative study was carried out in the Franche-Comté region of France. SUBJECTS: From October 1, 1990 to September 30, 1992, perinatal and follow-up data were collected on 203 consecutive live-born singleton or twin non-malformed infants with strictly ascertained gestational ages of less than 33 weeks. MAIN OUTCOME MEASURE: The rate of cerebral palsy and/or severe mental retardation as diagnosed by a family physician or pediatrician with a screening-skill test performed at 2 years of age. RESULTS: 167/171 (98%) survivors were evaluated. Twenty-two of the 167 examined infants (13%) showed signs of cerebral palsy, and 10 of these had severe cerebral palsy or mental retardation. Risk factors for disabilities were selected by a multivariate approach: premature rupture of membranes >/=48 h (OR 4.3, 95% CI 1.6-11.8); monochorionic twin placentation (OR 6.0, 95% CI 1.7-21.3), and respiratory distress syndrome (OR 2.8, 95% CI 1.1-7.1). CONCLUSION: This geographically defined prospective study gives epidemiological data and highly suggests that there is a link between prenatal events (premature rupture of membranes, monochorionic twin placentation), postnatal events (respiratory distress syndrome), and neurological disabilities in former preterm infants.

Birth Weight↗