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Biomedical subjects

R Villet

Publications and source records attributed to R Villet.

At least 37 records · Page 2Linked to original sources
PubMed1998

[A new treatment procedure for stress urinary incontinence: sub-urethral support using a Prolene sling under local anesthesia].

An original technique for the treatment of USI under local anaesthesia is described. It consists of insertion of a Prolene sling under the middle part of the urethra. This sling is not placed under tension, but simply supports the suburethral region. In a series of 22 patients without prolapse requiring surgical correction and presenting USI confirmed by clinical examination, 20 were totally cured by this technique and the postoperative voiding flow rate was not decreased. This technique therefore appears to be simple, non-dysuric and effective.

Aged↗
PubMed1998

[A new treatment procedure in stress urinary incontinence (SUI): suburethral prolene sling under local anesthesia].

An original technique for the treatment of USI under local anaesthesia is described. It consists of insertion of a Prolene sling under the middle part of the urethra. This sling is not placed under tension, but simply supports the suburethral region. In a series of 22 patients without prolapse requiring surgical correction and presenting USI confirmed by clinical examination, 20 were totally cured by this technique and the postoperative voiding flow rate was not decreased. This technique therefore appears to be simple, non-dysuric and effective.

Anesthesia, Local↗
PubMed1997

[Elaboration and validation of a specific quality of life questionnaire for urination urgency in women].

Urgent micturition interferes with the quality of life (QoL) of women suffering from this symptom. In order to evaluate this disturbance of quality of life and the benefits of treatment, a self-administered questionnaire, specific to the disorders of urgent micturition in women, was developed from a pre-existing scale (Measurement of Urinary Handicap, MUH). The following developmental methodology was adopted: Generation of a first instrument from the patient's descriptions collected by a multidisciplinary group of clinicians: formulation of questions, regrouping of questions into dimensions, choice of reference period and modalities of response. Content validation and test of comprehension in 20 patients. Transverse pilot study (98 patients) designed to reduce the number of questions and analyse the internal reliability and clinical validity. Reproducibility study. The final questionnaire comprises 24 items grouped into 5 dimensions: activities (8 items), emotional repercussions (5), self-image (5), sleep (3), well-being (3). The relevance of regrouping of the questions in their dimension and of calculation of a global score was confirmed by a principal component analysis and multifactorial analysis. The internal reliability and reproducibility of the scores were satisfactory, with a Cronbach alpha of > 0.70 and an intraclass correlation coefficient > 0.80, respectively. The clinical validity of the questionnaire was verified: the QoL scores of patients became significantly lower as the symptoms became more severe. A specific, reliable and clinically valid questionnaire, expressed in the form of a global score and a profile, was able to be developed. The profile of patients suffering from urgent micturition reflects the repercussions of the disease on the major and specific domains of their QoL. This questionnaire presents the required properties to be used in clinical trials designed to evaluate the effects of treatments on the patients' QoL, as a complement to classical clinical evaluations.

Activities of Daily Living↗
PubMed1997

[Surgical treatment of genito-urinary prolapse by abdominal approach with promotofixation and setting of an anterior subvesical prosthesis combined with retropubic colpopexia: anatomical and functional results in 104 patients].

A homogeneous series of 104 patients with genito-urinary prolapse or urinary incontinence is reported. Surgical treatment combined promotofixation with (n = 45) or without (n = 59) subtotal hysterectomy, retropubic colpopexia and in certain cases posterior colpoperineorraphia with myorraphia of the levator ani (n = 28). Anatomic results were excellent for bladder and uterine ptosis. Moderate results were obtained for rectoceles and procedures involving the posterior perineum. A rectovaginal prosthesis or complete repair of the rectovaginal wall appeared to be required to improve results for rectoceles. Urine function was good for urinary incontinence: 91% success. Results depended on the pressure of the uretral closure. A complete urodynamic work-up is required prior to surgery in case of sphincter failure. Poor results were also related to excessive posterior traction which can open the cervico-uretral angle. Treatment of genito-urinary prolapse with promotofixation in combination with retropubic colpopexia is a reliable reproducible technique which gives excellent long-term results if excessive promontory traction is avoided and if, in certain cases, the rectovaginal wall is repaired or a prosthesis implanted when maximum uretral closure pressure is weak.

Adult↗
PubMed1995

[Exploration of urinary incontinence in women].

The diagnosis of urinary incontinence is based on history and physical examination. For the patient, the incontinence is related with a wet vulva, but history differentiate stress from urge incontinence and note the associated urinary symptoms and alterations in bowel habit or sexual function. Physical examination confirms urinary incontinence and assess pelvic prolapses, perineal, muscle tone and skin condition. Specialized tests include imaging and urodynamic tests. Imaging tests are dynamics and identify the position and the aspect of the bladder neck during resting and straining view. Urodynamic tests are designed to determine the functional status of the bladder. They assess the detrusor function, the urethral pressure, the transmission of the pressure from the bladder to the urethra. After clinical evaluation and specialized tests, the urinary incontinence could be identified and evaluated so that an adapted treatment can be proposed.

Female↗
PubMed1995

[Surgical abdominal access for prolapse using a Vicryl composite lattice. Preliminary study].

OBJECTIVE: Promontory fixation is a reliable technique for genitourinary prolapsus. Results obtained with Mersurtures are good, but infectious episodes have been described and the fixation is rigid. The pelvic organs loose their mobility with possible functional impairment. To avoid these problems, we tested a composite implant composed of 60% absorbable polyglactine 910 (Vicryl) and 40% non-absorbable terephthalic polyester (Dacron). SUBJECTS AND METHODS: A series of 32 patients with genito-urinary prolapsus were treated by one operator using the new material. Promontory fixation was performed in all cases, with at least one implant. The patients were followed for mean 24.2 months for evaluation of tolerance to the new material and the functional impact. These parameters were compared retrospectively with former experience with Mersutures. RESULTS: The new material was perfectly tolerated and no infectious complication was observed. The anatomic results were identical to those obtained with the Mersutures, giving 93.4% good anatomic results, 68% cure rate for urinary incontinence and 20% major improvement in urinary incontinence. It was difficult to analyse results for sexual activity and digestive tract function. CONCLUSION: The Vicryl composite is useful for promontory fixation in patients with prolapsus. This material which reduces the amount of inert material remaining in the form of a thin lattice of highly flexible Dacron, should be tested prospectively to determine the functional benefit of prolapsus care.

Adult↗
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↗
PubMed1993

Skin-window-induced inflammation in breast cancer patients: a study of macrophage migration.

A decreased number of macrophages has previously been demonstrated by means of skin-window assays in operable breast cancer patients. However, in this type of cellular inflammatory response, a varying intensity of cellular activation, cellular recruitment and macrophage chemotaxis exists. In this study, we performed skin windows after stimulation by a chemo-attractant (FMLP) and a recall antigen (Candidin-latex). Cellular responses were classified in 19 breast cancer patients according to the presence (A+) or absence (A0) of macrophage activation by comparison to healthy controls. In 13 A0 patients, the admixture of a cytokine (IFN alpha) and an immunomodulator (P40) to one agent or the other or both resulted in the restoration of macrophage functions. Our study shows that uniform cellular responses to chemo-attractants and antigens are observed in healthy and not immunocompromised individuals as assessed by skin-window tests. However, the cellular response recorded in immunodeficient cancer patients is altered. It also shows that the admixture to chemoattractants and antigens of particular cytokines or better still of an immunomodulator displaying a wide spectrum of activity offers a way of restoring macrophage functions. Individual responses to immunotherapy in clinical oncology may be related to such results.

Adjuvants, Immunologic↗
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

Ovarian adenocarcinoma: prognostic evaluation after first laparotomy.

The prognostic factors in ovarian carcinoma can be linked to the surgical procedure and depend on histological type and pathological grading. This is an essential prognostic factor and unfortunately it lacks standardization. Being able to re-read slides is essential in evaluating therapeutic trials. Other factors are inherent to the surgical procedure itself: staging enables precise FIGO classification and large cyto-reductive surgery. Under evaluation in the early stages is estimated at 30% and extended visceral resection is justified in advanced carcinoma.

Adenocarcinoma↗
PubMed1993

[Comparison of different types of ovarian wound closure in rats. Role of biological glue].

Three techniques for closing the ovary have been compared. The test was carried out on 30 rats' ovaries. After the ovary had been cut with scissors it was closed with rapid acting Tissucol (a biological glue) or closed with interrupted stitches of 10/0 Vicryl, or left to close by itself. Sixty days later the ovaries were looked at macroscopically and histologically. The macroscopic score was established according to the presence of adhesions, the size of the ovary, the presence of cysts; and the histological score was carried out according to the presence of granulomatous macrophage lesions, the degree of fibrosis and the existence of germ cell cysts. The results were identifically the same as far as these five different criteria were concerned. All the same, Tissucol brought about less fibrosis and less atrophy of the ovary. Tissucol, therefore, is a good alternative for suturing the ovary as compared with stitching or no formal closure after the removal of ovarian cysts, particularly laparoscopically.

Animals↗
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

[The reliability of study methods of the endometrium. A comparative study of 178 patients].

OBJECTIVE: To compare the reliability of different methods for investigating the endometrium. DESIGN: A prospective study from November 1990 to October 1991. SETTING: Department of surgery and gynaecology Diaconesses Hospital, Paris. SUBJECTS AND INTERVENTIONS: In a total of 178 symptomatic patients, hysteroscopy with curettage in a day-centre under general anesthesia was performed. Before this operation, 79 women had had endometrial cytology, 98 women had had endometrial biopsy with the endometrial Pipelle, 112 women had ultrasonography and 120 women hysterography. MAIN OUTCOME MEASURES: Endometrial cytology and biopsy, ultrasonography, hysterography and hysteroscopy were correlated with curettage. RESULTS: the Pipelle's diagnostic accuracy appeared better than that of cytology. The hysteroscopic diagnosis agreed with the histologic diagnosis showed by the curettage except for atypical hyperplasia. The positive predictive value for identifying endometrial atrophy with ultrasonography is 100%. A vaginal ultrasonographic examination showing an endometrial thickness of < or = 5 mm can be used to exclude endometrial carcinoma as the cause of post menopausal bleeding. CONCLUSIONS: The combination of hysteroscopy and endometrial biopsy is the diagnostic method of choice for the endometrium. It is possible to avoid some useless curettages for diagnosis in women with abnormal uterine bleeding.

Atrophy↗
PubMed1993

[Evaluation and performance of the follow-up in treated cancer of the breast].

Follow-up of breast cancer is not always the same. On the basis of a retrospective study on 92 patients who presented with a progressive disease, the authors assess the effectiveness of complementary examinations and propose a follow-up protocol: clinical, laboratory tests, consisting of ESR, gamma GT, alkaline phosphatases, CA 15.3 every six months (or even every 4 months for CA 15.3) and radiological follow-up consisting of mammography and chest X-ray every year. Other examinations may also be prescribed if any change is detected by any of the tests listed above. The authors consider that this approach constitutes a balance between the minimalist and maximalist attitudes, and one which corresponds to the physician's duty to his patient.

Bone Neoplasms↗
PubMed1992

[Treatment of prolapse using the abdominal approach].

Genital prolapses are regularly constituted by multiple disorders such as primary stress incontinence anterior and posterior colpocele enterocele. All of these must be taken into account during the treatment by abdominal approach. The principles of treatment consist into a fixation of prolapse with mersilene mesh to the promontory. It could be laid on the anterior wall of the vagina and sometimes on posterior, if it's necessary. Uterus could be preserved but subtotal or total hysterectomy might be done; in this case, aseptic conditions are absolutely imperative. Vaginal section with stapling instrument and absorbable staples is useful. A colpopexy is always made.

Abdomen↗
PubMed1992

[Pelvic thrombosis and uterine fibroids].

The association of thrombosis with an abdomino-pelvic mass should suggest that there is a malignant tumour present, and aetiology must be explored. All the same it is not possible to exclude a benign mass as the cause of the thrombosis. The anatomy of the blood vessels in this region make it more likely that the phlebitis will be on the left side. As far as the physiopathology is concerned the pressure on the vessels is associated probably with an increase in fibrous tissue, and perhaps a local excretion of tissue thromboplastin. The principal complications are: pulmonary embolus, or gangrene of the leg as a primary complication and also as a secondary post-phlebitic complication. Treatment with Heparin prescribed in every case in the correct doses. When the thrombosis is recent and threatening direct surgery may avoid the short and long term consequences. If thrombectomy is not indicated urgently surgery can be postponed unless the tumour is growing rapidly. It is important to avoid migration of the clot during the operation, and this is best done by putting a temporary clip on the vena cava which will avoid the serious vascular consequences after phlebitis and surgery.

Adult↗
PubMed1991

[Overspecialization in surgery].

Surgical specialization is a logical consequence of the evolution of medicine. On the other hand, overspecialization appears in a more perverse way; out of 39 specialist surgeons polled during the latest A.F.C. meeting, 22 think that overspecialization is not a good thing. This situation gives rise to several reflections: early specialization may lead to poor surgical training and some surgeons may be unable to change to a new specialty; overspecialization is an invitation to medical overconsumption; the "overall" patient management in regions with a poor medical infrastructure may be difficult; finally, the legal consequences are still unknown. Thus the changes brought about by surgical specialization and overspecialization require thinking about the nationwide distribution of health facilities and about our country's surgical policy.

Education, Medical, Graduate↗