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1.
Faraday Discuss ; 237(0): 224-236, 2022 Sep 15.
Artigo em Inglês | MEDLINE | ID: mdl-35678517

RESUMO

In this paper we study the out-of-equilibrium dynamics associated with photoinduced charge-transfer (CT) in cyanide-bridged Co-Fe Prussian blue analogue nanocrystals. In these coordination networks, the structural trapping of the photoinduced CT polaron involves local electronic and structural reorganizations. Femtosecond X-ray and optical absorption spectroscopies show that the local structural trapping process occurs on similar timescale for particles with 11 nm and 70 nm sizes. The local photoinduced spin transition, elongating the Co-N bonds and driving the CoIIIFeII → CoIIFeIII CT, activates coherent lattice torsion modes. The elastic deformation waves, launched by these bond elongations, drive macroscopic volume expansion and breathing of the particles. The timescale of this macroscopic deformation depends strongly on the size of the particle, which is more evidence of the multiscale nature of photoinduced phenomena in molecular materials.

2.
Arch Gynecol Obstet ; 290(2): 299-308, 2014 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-24622934

RESUMO

BACKGROUND: Cervical cancer is caused by persistent infection with high-risk human papillomavirus (HR-HPV). Conventional human papillomavirus (HPV) testing requires cervical sampling. However, vaginal and urine self-sampling methods are more acceptable for patients and result in increased participation when they are available in screening programs. In this context, we have developed a non-invasive screening method via the detection of HPV DNA in urine samples. PURPOSE: To compare HPV viral loads and genotypes in paired cervical and urine samples, and to assess correlation between virological and cytological results in women seeking gynecological consultation. METHODS: Paired urine and cervical specimens were collected and analyzed from 230 of 245 women participating in the previously described prospective PapU study. HPV DNA detection and quantification were performed using a real-time PCR method with short fragment PCR primers. Genotyping was carried out using the INNO-LiPA HPV genotyping assay. RESULTS: The prevalence of HPV in the 230 paired urine and cervical smear samples was 42 and 49 %, respectively. Overall agreement for HPV positivity and negativity between the paired samples was 90 % (κ = 0.80). High HPV viral load in both cervical and urine samples was associated with cytological abnormalities. HPV-positive women were mostly infected with HR-HPV types. The agreement between high- and low-risk HPV (LR-HPV) detection in both samples was 97 % (κ = 0.95 for HR-HPV and κ = 0.97 for LR-HPV). CONCLUSIONS: High concordance rates for HPV-DNA quantification and high/low-risk HPV genotyping in paired urine/cervical samples suggest that urinary HPV DNA testing could be useful for cervical lesion screening.


Assuntos
Colo do Útero/virologia , DNA Viral/análise , DNA Viral/urina , Testes de DNA para Papilomavírus Humano/métodos , Papillomaviridae/genética , Infecções por Papillomavirus/diagnóstico , Neoplasias do Colo do Útero/diagnóstico , Neoplasias do Colo do Útero/virologia , Adolescente , Adulto , Idoso , Feminino , França/epidemiologia , Genótipo , Humanos , Estudos Longitudinais , Pessoa de Meia-Idade , Papillomaviridae/isolamento & purificação , Infecções por Papillomavirus/epidemiologia , Gravidez , Prevalência , Estudos Prospectivos , Reação em Cadeia da Polimerase em Tempo Real , Sensibilidade e Especificidade , Esfregaço Vaginal , Carga Viral
3.
Rev Esp Cir Ortop Traumatol ; 68(1): 50-56, 2024.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-37541341

RESUMO

BACKGROUND AND OBJECTIVE: Synthesis with cannulated screws is one of the accepted methods in femoral neck fractures, although its optimal configuration is a subject in continuous debate. The main objective was to compare the results of the patient with a femoral neck fracture fixed with three screws in triangle and inverted triangle configuration in the frontal plane. MATERIALS AND METHODS: Retrospective and comparative study of 53 patients with femoral neck fracture, operated between 2015 and 2022 with fixation with three cannulated screws, 22 with a triangle configuration (triangle group) and 31 in an inverted triangle (inverted triangle group). Functionality was evaluated using the modified Merlé d'Aubigné scale, walking ability using the Koval scale, as well as postoperative complications. RESULTS: On the Merlé d'Aubigné scale, the mean score was 16.7 in the triangle group and 16.1 in the inverted triangle group (P=.259). On the Koval scale, a significant decrease was observed, going from 1.6 preoperative mean to 2.2 after surgery (P=.000), finding no differences between groups. There were six postoperative complications in the triangle group and three in the inverted triangle group (P=.140). CONCLUSION: The configuration of the screws in the femoral neck, both in the form of a triangle and an inverted triangle, did not influence the functional or mechanical outcomes of the patients with a femoral neck fracture fixed with three cannulated screws.

4.
Rev Esp Cir Ortop Traumatol ; 68(1): T50-T56, 2024.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-37995816

RESUMO

BACKGROUND AND OBJECTIVE: Synthesis with cannulated screws is one of the accepted methods in femoral neck fractures, although its optimal configuration is a subject in continuous debate. The main objective was to compare the results of the patient with a femoral neck fracture fixed with three screws in triangle and inverted triangle configuration in the frontal plane. MATERIALS AND METHODS: Retrospective and comparative study of 53 patients with femoral neck fracture, operated between 2015 and 2022 with fixation with three cannulated screws, 22 with a triangle configuration (triangle group) and 31 in an inverted triangle (inverted triangle group). Functionality was evaluated using the modified Merlé d'Aubigné scale, walking ability using the Koval scale, as well as postoperative complications. RESULTS: On the Merlé d'Aubigné scale, the mean score was 16.7 in the triangle group and 16.1 in the inverted triangle group (p=.259). On the Koval scale, a significant decrease was observed, going from 1.6 preoperative mean to 2.2 after surgery (p=.000), finding no differences between groups. There were six postoperative complications in the triangle group and three in the inverted triangle group (p=.140). CONCLUSION: The configuration of the screws in the femoral neck, both in the form of a triangle and an inverted triangle, did not influence the functional or mechanical outcomes of the patients with a femoral neck fracture fixed with three cannulated screws.

5.
J Neurooncol ; 106(1): 177-84, 2012 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-21748490

RESUMO

The effectiveness of radiotherapy and chemotherapy in high grade gliomas (HGG) depends on tumor micro-environment. We summarize our experience of the influence of spinal cord stimulation (SCS) on this micro-environment. Patients with HGG (n = 26) were assessed pre- and post-SCS, using: (1) Doppler in middle cerebral arteries (MCA) and (2) in common carotid arteries (CCA); (3) tumor blood-flow using single photon emission computed tomography (SPECT); (4) tumor-pO(2) (mmHg) using polarographic probes (eight tumor areas from five patients); and (5) tumor glucose metabolism using (18)F-fluoro-2-deoxyglucose ((18)FDG) positron emission tomography ((18)FDG-PET). Pre-SCS: tumor blood-flow was lower (P < 0.001) than peri-tumor areas and healthy contra-lateral areas. Tumor-pO(2) was lower (P < 0.042) than healthy tissue. Tumor glucose metabolism was higher than peri-tumor areas (P = 0.017) and healthy contra-lateral areas (P = 0.048). Post-SCS: there were increases in: MCA blood-flow (P ≤ 0.002), CCA blood-flow (P ≤ 0.013), tumor blood-flow (P = 0.033), tumor glucose metabolism (P = 0.027) and tumor-pO(2) (P = 0.022). The percentage of hypoxic values decreased (P = 0.007). SCS can modify tumor micro-environment. The potential usefulness of SCS in improving the effectiveness of radio-chemotherapy in HGG needs to be evaluated.


Assuntos
Neoplasias Encefálicas/patologia , Neoplasias Encefálicas/terapia , Terapia Combinada , Estimulação Elétrica , Medula Espinal/fisiologia , Adulto , Idoso , Biópsia , Feminino , Fluordesoxiglucose F18 , Humanos , Avaliação de Estado de Karnofsky , Masculino , Pessoa de Meia-Idade , Artéria Cerebral Média/fisiologia , Procedimentos Neurocirúrgicos , Consumo de Oxigênio , Polarografia , Tomografia por Emissão de Pósitrons , Compostos Radiofarmacêuticos , Tomografia Computadorizada de Emissão de Fóton Único , Ultrassonografia Doppler Transcraniana , Adulto Jovem
6.
J Nanosci Nanotechnol ; 12(11): 8710-4, 2012 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-23421271

RESUMO

We investigate the assembly of Prussian blue and Cs-Co-Cr Prussian blue analogue molecular nanomagnets into nano-patterned electrodes. Pd or Au gaps - 7-50 nm were fabricated on a SiO2/Si substrate using standard electron beam lithography and lift-off. Nanomagnets were positioned between the gaps via AC dielectrophoresis (DEP). At room temperature, the Cs-Co-Cr Prussian blue analogue nanoparticles exhibited negligible current whereas junction with Prussian blue nanoparticles exhibited - 30 pA at - 1 V.


Assuntos
Eletroforese/métodos , Ferrocianetos/química , Imãs , Microeletrodos , Nanoestruturas/química , Nanoestruturas/ultraestrutura , Nanotecnologia/instrumentação , Desenho de Equipamento , Análise de Falha de Equipamento , Tamanho da Partícula
7.
Ann Chir Plast Esthet ; 56(1): 59-64, 2011 Feb.
Artigo em Francês | MEDLINE | ID: mdl-20557993

RESUMO

Ritual sexual mutilations cause gynaecologic, urologic and obstetric complications. Their surgical treatments like clitoris reconstruction or desinfibulation have been well studied. We describe the Dr Pierre Foldes's (2004, 2006a, b) surgical technique of clitoris reconstruction after ritual excision. After scar resection, clitoris knee and corporeal bodies are liberated with meticulous nerve sparing. A new clitoridian glans is created by cuneiform plasty and then reimplanted in an anatomic situation. The aim of the technique is to restore a normal anatomy and to obtain a sensory and functional organ. We also describe the desinfibulation technique in this article.


Assuntos
Circuncisão Feminina , Clitóris/cirurgia , Procedimentos de Cirurgia Plástica/métodos , Feminino , Humanos
9.
J Gynecol Obstet Hum Reprod ; 49(6): 101682, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31926351

RESUMO

AIM: The main aim of this study is to evaluate the interest of three-dimensional ultrasound perineal in the measurement of the levator hiatus area as an objective reflection of the surgical correction of pelvic organ prolapse (POP). Our hypothesis is that POP surgery decreases the size of the levator hiatus area. MATERIALS AND METHODS: A longitudinal and prospective study was conducted between April and July 2017 in the Department of Gynaecology & Obstetrics at University Hospital of Angers. Surgery was performed either by laparoscopy (sacrocolpopexy) or vaginal surgery (with or without the use of mesh). All patients were handed an information letter and signed an informed consent before being included in the study. A questionnaire was fullfilled before and one month after surgery. A clinical evaluation using the simplified POP-Q classification and a perineal 3D ultrasound were carried out before and after surgery by the same professional. The levator hiatus area was assessed before and after surgery in order to evaluate the impact of surgery on the levator hiatus area. Simplified POP-Q measurements and responses to PFDI-20 and PFDI-7 questionnaires were also collected. RESULTS: A total of 18 patients were included in the study and four were excluded. Seven underwent laparoscopic surgery and seven underwent vaginal surgery. The levator hiatus area decreased substantially from 20.87 to 16.55cm2 on mean (p=0.0001) at rest. Regarding patient satisfaction, the PFDI-20 score improved after surgery from 89.36 to 37.87 on mean (p=0.006), but the PFIQ-7 score did not reveal any significant changes (p=0.096). For the clinical examination, we used the simplified POP-Q with Ba measurement from 2.3 to -1.92cm (p=0.005) or Bp from -1.5 to -2.46cm, which is not a significant change (p=0.14). Points C (or D in cases with a history of hysterectomy) changed from -3.1 to -6.15cm (p=0.03). CONCLUSION: The levator hiatus area seems to decrease after POP surgery. 3D ultrasound seems a new and complementary procedure that allowed to evaluate objectively the levator hiatus area and thus the clinical findings of the surgery.


Assuntos
Imageamento Tridimensional/métodos , Diafragma da Pelve/diagnóstico por imagem , Prolapso de Órgão Pélvico/cirurgia , Qualidade de Vida , Ultrassonografia/métodos , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Laparoscopia/métodos , Estudos Longitudinais , Pessoa de Meia-Idade , Satisfação do Paciente , Diafragma da Pelve/patologia , Estudos Prospectivos , Inquéritos e Questionários , Resultado do Tratamento
10.
Am J Surg ; 218(2): 380-387, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-30470552

RESUMO

BACKGROUND: Double common bile duct ligation plus section in rats is used as a model for bacterial translocation, a phenomenon that has been correlated with the degree of liver damage. This study analyzes whether a simpler variant of the technique is also a valid model to study bacterial translocation. METHODS: Fifty-six male Sprague Dawley rats underwent one of three surgical interventions: a) proximal double ligation and section of the common bile duct; b) proximal simple ligation of the bile duct; and c) sham operation. Bacterial translocation was measured by cultures of mesenteric lymph nodes, blood, spleen and liver. Stool culture and histological analysis of liver damage were also performed. RESULTS: The incidence of bacterial translocation in SBL and DBDL groups was 23,5% and 25% respectively. Mortality was similar between ligation groups (11.2% versus 10%). Liver cirrhosis developed in the group of double ligation and section (100% of the animals at 4 weeks), while portal hypertension appeared starting at week 3. None of the animals submitted to simple ligation developed liver cirrhosis. CONCLUSIONS: Simple bile duct ligation is associated with a similar incidence of bacterial translocation as double ligation, but without cirrhosis or portal hypertension.


Assuntos
Translocação Bacteriana , Ductos Biliares/cirurgia , Complicações Pós-Operatórias/epidemiologia , Animais , Ducto Colédoco/cirurgia , Modelos Animais de Doenças , Ligadura , Masculino , Ratos Sprague-Dawley
11.
J Radiol ; 89(11 Pt 1): 1745-54, 2008 Nov.
Artigo em Francês | MEDLINE | ID: mdl-19106831

RESUMO

UNLABELLED: Deep pelvic endometriosis is an invalidating disorder affecting the retrocervical region, rectosigmoid colon and urinary bladder generally requiring surgical management. MRI is the preoperative imaging modality of choice. The purpose of this paper is to describe the MR imaging features of deep pelvic endometriosis with laparoscopic correlation. METHODS: Thirty-five patients with clinical suspicion of deep pelvic endometriosis underwent pelvic MRI. Results of MRI, including morphological and signal characteristics features of the lesions were compared to laparoscopic fidings. RESULTS: Laparoscopy detected lesions of deep pelvic endometriosis of the uterosacral ligaments (n=10), torus uterinum (n=9), rectosigmoid (n=11), Douglas pouch (n=9), recto-vaginal septum (n=6), bladder (n=4) and posterior vaginal cul-de-sac (n=2). The sensitivity, specificity, positive predictive value and negative predictive value of MRI were assessed for each localization. CONCLUSION: MRI allows diagnosis of deep pelvic endometriosis of the bladder, rectosigmoid and Douglas pouch and with lower sensitivity for lesions of the uterosacral ligaments, posterior vaginal cul-de-sac and rectovaginal septum.


Assuntos
Endometriose/diagnóstico , Laparoscopia , Imageamento por Ressonância Magnética , Pelve , Adulto , Feminino , Humanos , Pessoa de Meia-Idade , Adulto Jovem
12.
Gynecol Obstet Fertil Senol ; 46(10-11): 673-680, 2018 11.
Artigo em Francês | MEDLINE | ID: mdl-30301618

RESUMO

OBJECTIVE: To compare the effectiveness of an ALTIS® mini-sling and a conventionnal suburethral sling TVT-ABBREVO® for treatment of female stress urinary incontinence. METHODS: A single-center retrospective study included all female patients fitted with a conventional transobturator tape (TVT-ABBREVO®) or mini-sling (ALTIS®), during 2015, in Angers university hospital. The success rate was defined by no urine leakage during a cough test on clinical examination, improved quality of life defined by a PGI-I (Patient Global Impression of Improvement) score of 1 to 3, and no stress urinary incontinence on USP (Urinary Symptom Profile) questionnaire. Morbidity associated with slings and perioperative data were also recorded. RESULTS: Ninety-two patients were included (39 in the ALTIS group and 53 in the ABBREVO group). The average follow-up was 13.55 months. The success rate was not significantly different in ALTIS group for the negative cough test (89.7% vs 94.3% in ABBREVO group, P=0.45), for the absence of urinary leakage reported on the USP questionnaire (87.2% vs 90.6% in ABBREVO group, P=0.61), or for the improvement of the quality of life with a PGI-I score between 1 and 3 (82.1% vs 86.8% in ABBREVO group, P=0.53). On the other hand, more patients were fully satisfied, with a PGI-I quality of life score of 1, in ABBREVO group than in ALTIS group (67.9% compared with 46.2%, P=0.03). Immediate postoperative pain was significantly less intense in ALTIS group than in ABBREVO group (average VAS score of 0.5 comparated with 1.3, P=0.01), but this difference had disappeared one week after surgery. The rates of other complications were similar in both groups. CONCLUSION: The functional results of the ALTIS and TVT-ABBREVO® slings appear similar in the treatment of female stress urinary incontinence.


Assuntos
Slings Suburetrais , Incontinência Urinária por Estresse/cirurgia , Adulto , Idoso , Feminino , Humanos , Pessoa de Meia-Idade , Dor Pós-Operatória/epidemiologia , Qualidade de Vida , Estudos Retrospectivos , Slings Suburetrais/efeitos adversos , Resultado do Tratamento
13.
J Gynecol Obstet Hum Reprod ; 47(8): 341-349, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29879489

RESUMO

OBJECTIVES: The objective of this literature review is to reiterate the epidemiology, clinical signs, and radiological signs that should be consistent with a uterine sarcoma as well as the precautionary pre- and postoperative principles that help prevent morcellation of uterine sarcomas when treating patients with uterine fibroids. METHOD: We conducted this literature review by consulting the Pubmed, Medline, and Cochrane Systematic Review databases up to 28/02/2017 using the following keywords: fibroid, myoma, leiomyoma, sarcoma, leiosarcoma, uterine cancer, myomectomy, hysterectomy, morcellation, and uterine morcellation. We also used the reference lists of the selected articles to find more data on the websites of North-American and European learned societies that specialise in obstetrics and gynaecology. RESULTS: In the case of morcellation of uterine fibroids, the risk of an undiagnosed uterine sarcoma is estimated to be between 1 in 278 to 1 in 1960 women. Preoperative examination, free informed consent following discussion about the risks and complications associated with morcellation, as well as research on the contraindications to the use of morcellation are the crucial points addressed by learned societies. The main solution recommended at present is morcellation confined to a laparoscopic bag. CONCLUSION: There is a risk of morcellating an occult sarcoma when performing a myomectomyor hysterectomy for fibroids. Implementing the use of morcellation containment bags should be the norm. The use of minimally invasive surgery (laparoscopic orvaginal) and the associated benefit-risk ratio compared to a laparotomy should also be discussed with the patient before the operation.


Assuntos
Laparoscopia/normas , Leiomioma/cirurgia , Morcelação/normas , Sarcoma , Miomectomia Uterina/normas , Neoplasias Uterinas , Feminino , Humanos , Laparoscopia/efeitos adversos , Morcelação/efeitos adversos , Miomectomia Uterina/efeitos adversos
14.
J Gynecol Obstet Hum Reprod ; 47(8): 359-364, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29654941

RESUMO

OBJECTIVE: The principal objective of our study was to assess women's quality of life (QoL) after surgery for Deep Endometriosis (DE), according to the surgical technique used. MATERIAL AND METHODS: Qualitative single-center survey in the department of obstetrics and gynecology, Angers University Hospital Center, France. All women who underwent surgery for DE from January 2011 to December 2015 were contacted by phone. The Endometriosis Health Profile-5 score was used to assess QoL before and after the surgery. Fifty-two women (response rate=86%) were included and classified into 3 groups according to the surgical technique used: simple shaving, shaving exclusively or in part by plasma vaporization (plasma), and resection. RESULTS: The 3 groups were comparable for surgical history, preoperative QoL score, and characteristics of endometriotic lesions (size and site). All DE symptoms and QoL scores improved significantly after the surgery, all techniques combined (P<0.01). QoL scores for women who had plasma shaving or complete resection were significantly higher than those for women with simple shaving (respectively, 375 [225-800] and 450 [-50 to 725] vs 275 [-100 to 600]; P=0.04). Self-image significantly improved only in the plasma group (P=0.03). The complete resection group had longer hospitals stays than the other groups (P=0.001), as well as a higher surgical revision rate (23% vs 0%; P=0.02). CONCLUSION: Plasma and complete resection improved QoL similarly for women with DE, both more than shaving alone. The advantage of plasma vaporization lies in the lesser morbidity and better self-image, both better than in women with resection.


Assuntos
Endometriose/cirurgia , Procedimentos Cirúrgicos em Ginecologia/métodos , Avaliação de Resultados em Cuidados de Saúde , Qualidade de Vida , Adulto , Feminino , Humanos , Pessoa de Meia-Idade
15.
J Gynecol Obstet Biol Reprod (Paris) ; 36(4): 329-37, 2007 Jun.
Artigo em Francês | MEDLINE | ID: mdl-17400402

RESUMO

The technique of detection and resection of the sentinel lymph node applied to early breast cancer management aims to spare the patient with a low risk of lymph node involvement an unnecessary axillary lymphadenectomy. This innovating technique lies on the double hypothesis of an accuracy to predict non sentinel lymph node status and to induce a lower morbidity when compared with axillary lymphadenectomy. This multidisciplinary technique depends on surgeons, nuclear physicians and pathologists. In practice sentinel lymph nodes are detected thanks to two types of tracers, the Blue and the colloids marked with technetium, harvested by the surgeon guided by the blue lymphatic channel and the use of a gamma probe detection, analyzed by the pathologist according to a particular procedure with the concept of serial slices, and possibly immuno histo chemistry. The objectives of this review are to specify the state of knowledge concerning the different steps: detection, surgical resection and the pathological analysis of the sentinels lymph nodes and to focus on validated and controversial indications, and on the main ongoing trials.


Assuntos
Neoplasias da Mama/patologia , Biópsia de Linfonodo Sentinela , Neoplasias da Mama/cirurgia , Humanos , Imuno-Histoquímica , Excisão de Linfonodo , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Biópsia de Linfonodo Sentinela/métodos , Biópsia de Linfonodo Sentinela/tendências
16.
Neurocirugia (Astur) ; 18(1): 28-32; discussion 33-5, 2007 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-17393043

RESUMO

INTRODUCTION: Generally, high-grade gliomas and head and neck tumors have decreased loco-regional blood flow resulting in reduced delivery of chemotherapy and oxygen, as well as an increases in radiation resistance to radiotherapy. The aim of this study was to analyze the effect of cervical spinal cord electrical stimulation (cSCS) on cerebral blood flow in patients with those tumors. PATIENTS AND METHODS: We have evaluated 27 cancer patients with 12 with high grade gliomas and 15 with advanced head and neck tumors, who had cSCS devices placed after tumor diagnoses and before the commencement initiating of radio-chemotherapy. They were 12 high grade gliomas and 15 advanced head and neck tumors. Before and after cSCS, cerebral blood flow was assessed bilaterally by transcranial Doppler. RESULTS: During cSCS there was a significant (p<0.001) increase in systolic (mean > 22%) and diastolic (> 29%) blood-flow velocities in both, healthy and tumor middle cerebral arteries. The analyses by subgroup of tumors showed similarly significant outcomes findings. CONCLUSIONS: The results suggest that neuro-stimulation spinal cord electrical stimulation can increase cerebral blood flow in cancer patients. The implication is that this technique could be useful in modifying locoregional ischemia in brain tumors thus improving the outcomes of after radio-chemotherapy. Further research is in progress to confirm the advantages of the technique.


Assuntos
Neoplasias Encefálicas/irrigação sanguínea , Circulação Cerebrovascular , Terapia por Estimulação Elétrica , Glioma/irrigação sanguínea , Neoplasias de Cabeça e Pescoço/irrigação sanguínea , Artéria Cerebral Média/fisiopatologia , Medula Espinal/fisiopatologia , Adulto , Idoso , Antineoplásicos/farmacocinética , Velocidade do Fluxo Sanguíneo , Neoplasias Encefálicas/fisiopatologia , Neoplasias Encefálicas/terapia , Feminino , Glioma/fisiopatologia , Glioma/terapia , Neoplasias de Cabeça e Pescoço/fisiopatologia , Neoplasias de Cabeça e Pescoço/terapia , Hemoglobinas/análise , Humanos , Masculino , Pessoa de Meia-Idade , Pescoço , Tolerância a Radiação , Projetos de Pesquisa , Resultado do Tratamento , Ultrassonografia Doppler Transcraniana
17.
Gynecol Obstet Fertil ; 34(11): 1064-70, 2006 Nov.
Artigo em Francês | MEDLINE | ID: mdl-17052938

RESUMO

The aim of this study was to attempt to identify factors predictive of uterine rupture following operative hysteroscopy. A MEDLINE and EMBASE search (1980 to April 2006) using the keywords "hysteroscopy", "uterine rupture" and "pregnancy" was performed with no limitations of languages. 18 cases of uterine rupture following operative hysteroscopy were retrieved. Hysteroscopic metroplasty (uterine septa and synechiae) was involved in 16 (89%) cases. Hysteroscopic resection was performed with monopolar current cutting, rigid scissors and laser in respectively 14 (78%), 3 (16.5%) and 1 (5.5%) cases. Uterine perforation occurred in 10 (55.5%) cases. The interval between hysteroscopy and subsequent pregnancies varied from 1 month to 5 years with an average delay of 16 months. Uterine rupture occurred between 19 and 41 weeks, with no labour in 12 (66.5%) cases. Four fetal and one maternal deaths followed uterine rupture. Hysteroscopic metroplasty may expose patients to an increased risk of uterine rupture in subsequent pregnancy. Uterine perforation and/or the use of current monopolar section during operative hysteroscopy increase this risk. Uncomplicated hysteroscopic resection of submucous myomas and endometrial polyps do not alter obstetrical outcome. Considering hysteroscopic metroplasty, the use of coaxial bipolar electrode should be preferred.


Assuntos
Histeroscopia/efeitos adversos , Complicações na Gravidez/epidemiologia , Ruptura Uterina/epidemiologia , Feminino , Humanos , Complicações Pós-Operatórias , Gravidez , Complicações na Gravidez/etiologia , Complicações na Gravidez/mortalidade , Taxa de Gravidez , Fatores de Risco , Ruptura Uterina/etiologia , Ruptura Uterina/mortalidade
18.
Gynecol Obstet Fertil ; 34(1): 27-33, 2006 Jan.
Artigo em Francês | MEDLINE | ID: mdl-16406735

RESUMO

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.


Assuntos
Adenocarcinoma/tratamento farmacológico , Hiperplasia Endometrial/tratamento farmacológico , Neoplasias do Endométrio/tratamento farmacológico , Infertilidade/etiologia , Complicações Neoplásicas na Gravidez/terapia , Adenocarcinoma/cirurgia , Adulto , Hiperplasia Endometrial/cirurgia , Neoplasias do Endométrio/cirurgia , Feminino , Humanos , Infertilidade/prevenção & controle , Recidiva Local de Neoplasia , Estadiamento de Neoplasias , Gravidez , Resultado da Gravidez , Progestinas/uso terapêutico , Técnicas de Reprodução Assistida , Estudos Retrospectivos
19.
J Gynecol Obstet Biol Reprod (Paris) ; 45(8): 936-941, 2016 Oct.
Artigo em Francês | MEDLINE | ID: mdl-27422679

RESUMO

OBJECTIVES: There are many national and international recommendations and guidelines for the management of patients with endometrioma. In this study, we aimed to evaluate the impact of these recommendations on the practice of French surgeons, and to assess their knowledge about the management of endometriomas. MATERIALS AND METHODS: A self-questionnaire has been sent to the French members of the Society of Gynecologic Surgery and Pelvic (SCGP) in May 2015. RESULTS: One hundred and forty-four members of the society (36 %) participated in the survey. Most of the practitioners (71 %) followed recommendations of the Collège National des Gynécologues Obstétriciens (CNGOF), 38 % followed the guidelines of European Society of Human Reproduction and Embryology (ESHRE). One hundred percent of the surgeons declared that they practice laparoscopy when a surgical removal of the endometrioma is indicated. About treatment with GnRH analogue, 38 % of the practitioners declared that they prescribe an add back therapy immediately after the surgery, 43 % at 3 months, and 14 % declared that they never prescribe this treatment. CONCLUSIONS: French surgeons consider the recommendations are useful in their clinical practice; they primarily apply the guidelines of the CNGOF.


Assuntos
Endometriose/cirurgia , Fidelidade a Diretrizes/estatística & dados numéricos , Pesquisas sobre Atenção à Saúde/estatística & dados numéricos , Laparoscopia/estatística & dados numéricos , Guias de Prática Clínica como Assunto , Cirurgiões/estatística & dados numéricos , Adulto , Endometriose/tratamento farmacológico , Feminino , França , Humanos , Progestinas/administração & dosagem
20.
Gynecol Obstet Fertil ; 44(3): 135-40, 2016 Mar.
Artigo em Francês | MEDLINE | ID: mdl-26966036

RESUMO

OBJECTIVES: Uterine myomas are a frequent pathology affecting 20% of women of reproductive age. Myomas induce abnormal uterine bleeding, pelvic pain and increase the risk of infertility and obstetrical complications. Symptomatic sub-mucosal myomas are classically treated by hysteroscopic resection. Simulation is a method of education and training. It could improve quality and security of cares. The aim of this study is to assess the interest of a hysteroscopic simulator for the resection of myoma by novice surgeons. METHODS: Twenty medical students were recruited, in a prospective study, in august 2014. The virtual-reality simulator VirtaMed HystSim™ (VirtaMed AG, Zurich, Switzerland) was used to perform the hysteroscopic training. All students received a short demonstration of myoma resection. The practice consists of a submucous myoma type 0 resection. The procedure and the evaluation were performed before and after a specific training in hysteroscopic resection of sixty minutes long. The main outcome criteria were time for the resection before and after training. The second criteria were fluid quantity used, number of contact between optic and uterine cavity and uterine perforation. RESULTS: Twenty students aged from 22 to 24 years were included. The time for the procedure was significantly reduced after training (170s versus 335s, P<0.01). There is the same for fluid quantity used (335 mL versus 717mL, P<0.01) and the number of contact between optic and uterine cavity (0.2 contact versus 3, P=0.012). No perforation occurred in the simulation. CONCLUSION: The results suggest that hysteroscopic simulator enhances and facilitates hysteroscopic resection for novice surgeons.


Assuntos
Histeroscopia/educação , Leiomioma/cirurgia , Treinamento por Simulação/métodos , Miomectomia Uterina/educação , Neoplasias Uterinas/cirurgia , Educação Médica/métodos , Feminino , Humanos , Masculino , Estudos Prospectivos , Estudantes de Medicina , Miomectomia Uterina/métodos , Adulto Jovem
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