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1.
BJOG ; 127(1): 88-97, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31544327

RESUMO

OBJECTIVE: To assess the short-term incidence of serious complications of surgery for urinary incontinence or pelvic organ prolapse. DESIGN: Prospective longitudinal cohort study using a surgical registry. SETTING: Thirteen public hospitals in France. POPULATION: A cohort of 1873 women undergoing surgery between February 2017 and August 2018. METHODS: Preliminary analysis of serious complications after a mean follow-up of 7 months (0-18 months), according to type of surgery. Surgeons reported procedures and complications, which were verified by the hospitals' information systems. MAIN OUTCOME MEASURES: Serious complication requiring discontinuation of the procedure or subsequent surgical intervention, life-threatening complication requiring resuscitation, or death. RESULTS: Fifty-two women (2.8%, 95% CI 2.1-3.6%) experienced a serious complication either during surgery, requiring the discontinuation of the procedure, or during the first months of follow-up, necessitating a subsequent reoperation. One woman also required resuscitation; no women died. Of 811 midurethral slings (MUSs), 11 were removed in part or totally (1.4%, 0.7-2.3%), as were two of 391 transvaginal meshes (0.5%, 0.1-1.6%), and four of 611 laparoscopically placed mesh implants (0.7%, 0.2-1.5%). The incidence of serious complications 6 months after the surgical procedure was estimated to be around 3.5% (2.0-5.0%) after MUS alone, 7.0% (2.8-11.3%) after MUS with prolapse surgery, 1.7% (0.0-3.8%) after vaginal native tissue repair, 2.8% (0.9-4.6%) after transvaginal mesh, and 1.0% (0.1-1.9%) after laparoscopy with mesh. CONCLUSIONS: Early serious complications are relatively rare. Monitoring must be continued and expanded to assess the long-term risk associated with mesh use and to identify its risk factors. TWEETABLE ABSTRACT: Short-term serious complications are rare after surgery for urinary incontinence or pelvic organ prolapse, even with mesh.


Assuntos
Diafragma da Pelve/cirurgia , Prolapso de Órgão Pélvico/cirurgia , Telas Cirúrgicas/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Análise de Variância , Colposcopia/efeitos adversos , Colposcopia/mortalidade , Colposcopia/estatística & dados numéricos , Feminino , França/epidemiologia , Humanos , Incidência , Complicações Intraoperatórias/etiologia , Complicações Intraoperatórias/mortalidade , Pessoa de Meia-Idade , Prolapso de Órgão Pélvico/mortalidade , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/mortalidade , Estudos Prospectivos , Sistema de Registros , Slings Suburetrais/efeitos adversos , Slings Suburetrais/estatística & dados numéricos , Telas Cirúrgicas/estatística & dados numéricos , Centros Cirúrgicos/estatística & dados numéricos , Adulto Jovem
2.
Gynecol Obstet Fertil Senol ; 47(7-8): 582-590, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31255836

RESUMO

Extra-uterine leiomyomatosis is a rare pathology defined by the presence of benign smooth uterine muscle cells in unusual localizations, including different entities. It mainly affects premenopausal women with a medical history of uterine myoma with or without surgical treatment. Three main types are discribed: intraveinous leiomyomatosis, benign metastatisizing leiomyoma and leiomyomatosis peritonealis disseminata. The diagnosis may be complex with many differential diagnosis, and relies on histology. The treatment depends on multiple factors such as age, localization, size, symptoms and associated comorbidities. It is based on surgical resection and hormonal privation, surgical (adnexectomy) or medical (hormonotherapy). There is a high risk of recurrence. Some malignant evolutions have been reported, mostly leiomyosarcoma following peritoneal disseminated leiomyomatosis. Long term follow-up of these patients is mandatory. A particular manifestation of extra-uterine leiomyomatosis is the hereditary leiomyomatosis and renal cell carcinoma (HLRCC) syndrome. It is an autosomal dominant disorder which confers an increased risk of cutaneous and uterine leiomyomas and renal cell cancer, with a poor prognosis due to the urologic tumor.

3.
J Gynecol Obstet Hum Reprod ; 47(6): 257-260, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29574053

RESUMO

This article reports a case of cervico-isthmic disjunction unnoticed during childhood, diagnosed in a context of primary infertility and endometriosis, and surgically treated. It is an uncommon condition. The diagnosis is most often made as part of an assessment of primary amenorrhea in a young woman with a history of severe pelvic trauma. It is suspected after imaging assessment and confirmed intraoperatively. The treatment consists in an anastomosis between the cervix and the uterine body, after individualizing these two structures, around a drain guiding healing. After this surgery, multiple pregnancies have been successfully carried out.


Assuntos
Acidentes de Trânsito , Doenças Uterinas , Útero , Adulto , Colo do Útero/lesões , Colo do Útero/patologia , Colo do Útero/cirurgia , Endometriose/diagnóstico , Feminino , Humanos , Infertilidade/diagnóstico , Imagem por Ressonância Magnética , Doenças Uterinas/diagnóstico por imagem , Doenças Uterinas/patologia , Doenças Uterinas/cirurgia , Útero/lesões , Útero/patologia , Útero/cirurgia
4.
J Gynecol Obstet Hum Reprod ; 46(5): 399-404, 2017 May.
Artigo em Inglês | MEDLINE | ID: mdl-28934083

RESUMO

OBJECTIVE: The aim of our study was to evaluate the feasibility of vaginal hysterectomy in an ambulatory care system and the best way to perform it between conventional and bipolar vessel sealing system ligatures. PATIENTS AND METHODS: This was a prospective study of 32 patients with vaginal hysterectomy at Lille University Hospital between December 2013 and May 2015. Two surgical techniques were compared: conventional suture ligature (CSL) and electrosurgical bipolar vessel sealing (BVS). Patients stayed in classical hospitalization but were managed how if they were in an ambulatory unit to evaluate their capacity to come back home the same evening of the surgery. The evaluation of same-day discharge was based on Post Anesthetic Discharge Scoring System (PADSS) score?9/10 and Visual Analogic Scale (VAS) score?4/10. Other data collected were: operative time, uterus weight, peroperative bleeding, PADSS score at the 8th postoperative hour, VAS score at the 4th, 6th, 8th, 12th and 24th postoperative hours, the presence of postoperative nausea/vomiting and rehospitalization. RESULTS: In the BVS group, 93.8% of patients validated the combined score (PADSS+VAS) on the evening of the intervention against 50% of patients in the CSL group (P<0.05). Hundred percent of BVS group patients were discharged on the day after surgery against 87.5% in the CSL group. The VAS was significantly lower in the BVS group at the 8th (1.4), 12th (1.2) and 24th (1.3) postoperative hours. Operative time was significantly shorter in the BVS group. We found more events such as nausea/vomiting in the CSL group. CONCLUSION: Vaginal hysterectomy is feasible in an ambulatory care system most of times. By reducing postoperative pain, electrosurgical bipolar vessel sealing would promote outpatient hospitalization.


Assuntos
Procedimentos Cirúrgicos Ambulatórios/métodos , Perda Sanguínea Cirúrgica/prevenção & controle , Eletrocirurgia/métodos , Hemostasia Cirúrgica/métodos , Histerectomia Vaginal/métodos , Técnicas de Sutura , Adulto , Procedimentos Cirúrgicos Ambulatórios/efeitos adversos , Procedimentos Cirúrgicos Ambulatórios/estatística & dados numéricos , Perda Sanguínea Cirúrgica/estatística & dados numéricos , Eletrocirurgia/efeitos adversos , Estudos de Viabilidade , Feminino , França/epidemiologia , Hemostasia Cirúrgica/efeitos adversos , Humanos , Histerectomia Vaginal/efeitos adversos , Histerectomia Vaginal/estatística & dados numéricos , Ligadura , Pessoa de Meia-Idade , Pacientes Ambulatoriais , Dor Pós-Operatória/epidemiologia , Dor Pós-Operatória/etiologia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Técnicas de Sutura/efeitos adversos , Suturas/efeitos adversos
6.
J Gynecol Obstet Biol Reprod (Paris) ; 45(9): 1054-1059, 2016 Nov.
Artigo em Francês | MEDLINE | ID: mdl-27114064

RESUMO

INTRODUCTION: Randomized controlled trials (RCT) in surgery are often subject to difficulties inherent in the study design and recruitment of patients. Women's participation rate to RCTs in surgery is relatively low and varies from 30 to 70%. These recruitment problems might induce a weak scientific value and even stop the study. Thus, optimizing recruitment is a challenge for surgical research. In contemporary literature, we lack data on motivations and profile of women who refuse to participate in a RCT in surgery. OBJECTIVE: To explore the potentially influential factors affecting women's decision to decline participation in PROSPERE trial, comparing laparoscopic sacrocolpopexy (LSCP) to vaginal mesh for cystocele repair. PATIENT AND METHOD: Retrospective, observational, qualitative, bicentric study conducted in the department of gynecology of Poissy and Lille hospitals. Patients included were those who refused to participate to PROSPERE trial in both centers. Factors of non-participation in the trial were recorded at the time of the first visit. A control group consisted of women who agreed to participate in the trial was also analyzed. RESULTS: In both centers, 139 were eligible to participate in the trial but 35 of them (25%) refused. Thirty-two women agreed to declare their refusal motivations. Vaginal mesh was finally performed in 18 (56,2%) patients and LSCP in 14 patients (43,8%). The control group consisted of 20 women, including 9 operated by vaginal mesh and 11 by LSCP. Patient's characteristics were similar in the both groups. Most influencing factor in refusal for participation was "previous choice of technique" in 50% cases (16/32), followed by "geographical remoteness and difficulties for additional visits" in 40.6% cases (13/32), and finally by "do not accept the concept of randomization" in 21.8% cases (7/32). The most influencing factor in women's acceptance was interest in helping others by "supporting medical research" in 100% cases (20/20), followed by "potential personal benefits and close follow-up" in 60% (12/20). CONCLUSION: Our study identified the most influential factors relevant to women decision-making whether or not to participate in RCT in surgery. A number of factors leading to refusal of participation are potentially correctable leading to better recruitment rates in future RCTs. Optimization of information on the principle of randomization, limiting the number of additional visits could help researchers improve participation rates.


Assuntos
Comportamento de Escolha , Procedimentos Cirúrgicos em Ginecologia/psicologia , Motivação , Seleção de Pacientes , Ensaios Clínicos Controlados Aleatórios como Assunto , Idoso , Feminino , Humanos , Pessoa de Meia-Idade , Pesquisa Qualitativa , Estudos Retrospectivos
7.
Eur J Obstet Gynecol Reprod Biol ; 201: 27-30, 2016 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-27042768

RESUMO

OBJECTIVE: Description of the aims, the framework and the results of a postpartum hemorrhage surgery workshop for residents. STUDY DESIGN: This article is the first publication to describe a simulation workshop for the surgical management of maternal hemorrhage. Training was divided into both theoretical and practical workshops. Four obstetrician-gynecologists supervised residents who performed all the surgical procedures on a cadaver. This training course included the oldest residents at the Faculty of Medicine of Lille and was evaluated by participants using pre-test and post-test questionnaires. Medical knowledge was also evaluated. RESULTS: The pre-test questionnaire showed that medical knowledge for the treatment of postpartum hemorrhage was acceptable but that real practice was lacking. Eighty-six percent of the residents responded that they were not able deal with the situation correctly and most considered it stressful. The post-test questionnaire showed that training greatly improved the participants' theoretical knowledge and technical skills as well as significantly improving self-confidence. CONCLUSIONS: Based on these positive results this workshop will be included in the resident training program and also be extended to professionals as a part of the continuing medical education program.


Assuntos
Procedimentos Cirúrgicos em Ginecologia/educação , Internato e Residência/métodos , Hemorragia Pós-Parto/cirurgia , Treinamento por Simulação , Adulto , Feminino , Humanos , Masculino
9.
Clin Exp Obstet Gynecol ; 43(6): 887-888, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-29944245

RESUMO

When bulky fibroids are discovered during pregnancy, they can become acutely complicated. The question of their resection thus arises. The authors report a case of a woman who was diagnosed at eight weeks' gestation by ultrasound and then by MRI, with a uterine fibroma measuring 22x12x15 cm.


Assuntos
Leiomioma/cirurgia , Complicações Neoplásicas na Gravidez/cirurgia , Miomectomia Uterina/métodos , Neoplasias Uterinas/cirurgia , Adulto , Feminino , Humanos , Leiomioma/diagnóstico por imagem , Leiomioma/patologia , Imagem por Ressonância Magnética , Gravidez , Primeiro Trimestre da Gravidez , Carga Tumoral , Ultrassonografia , Neoplasias Uterinas/diagnóstico por imagem , Neoplasias Uterinas/patologia
10.
J Gynecol Obstet Biol Reprod (Paris) ; 45(3): 243-8, 2016 Mar.
Artigo em Francês | MEDLINE | ID: mdl-26096351

RESUMO

OBJECTIVE: Two years after the French guidelines, the objective was to assess the feasibility and efficiency of ultrasound-guided trans-vaginal drainage of tubo-ovarian abscesses (TOA) and to study the responsible germs. MATERIAL AND METHODS: All the patients with a larger abscess than 20mm were included prospectively from May 2011 to July 2014 in the university hospital of Lille. RESULTS: Sixty-nine drainages were performed among 50 patients. Success rate was 94%. No complication occurred. One germ was found in 55% of patients, the TOA was polymicrobian in 20% of cases. CONCLUSION: Ultrasound-guided trans-vaginal drainage of TOA is safe and effective with more than 90% of success rate.


Assuntos
Abscesso/terapia , Drenagem/métodos , Doenças das Tubas Uterinas/terapia , Doenças Ovarianas/terapia , Ultrassonografia de Intervenção/métodos , Abscesso/epidemiologia , Abscesso/microbiologia , Adolescente , Adulto , Antibacterianos/uso terapêutico , Drenagem/efeitos adversos , Doenças das Tubas Uterinas/epidemiologia , Doenças das Tubas Uterinas/microbiologia , Estudos de Viabilidade , Feminino , Humanos , Pessoa de Meia-Idade , Doenças Ovarianas/epidemiologia , Doenças Ovarianas/microbiologia , Complicações Pós-Operatórias/epidemiologia , Resultado do Tratamento , Ultrassonografia de Intervenção/efeitos adversos , Vagina/diagnóstico por imagem , Vagina/microbiologia , Adulto Jovem
11.
Diagn Interv Imaging ; 96(11): 1133-40, 2015 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-26163222

RESUMO

PURPOSE: To retrospectively compare three-dimensional ultrasonography (3D-US) and pelvic X-rays to assess the position of tubal sterilization microinserts. MATERIAL AND METHODS: Forty-four patients who underwent tubal sterilization with Essure(®) microinserts in our institution were included. The microinserts'position was evaluated three months after the procedure using 3D-US and pelvic X-rays. Placement on 3D-US was binary categorized as correct or incorrect and the distance between the two devices was reported. The orientation and symmetric deployment of the microinserts and the distance between the proximal parts of the two devices was assessed on pelvic X-rays. Performance of 3D-US and pelvic X-ray were compared using Mac Nemar test. Comparison of the distance between the two devices measured on pelvic X-rays and 3D-US was made with the paired Student t test. RESULTS: 3D-US images showed microinserts in 93% (41/44). Eighty-six percent (38/44) were correctly positioned on 3D-US and 82% (36/44) on pelvic X-rays. No significant differences between the performances of the two imaging techniques were found. No significant differences for the distance between the two devices measured on pelvic X-ray and 3D-US was found. CONCLUSION: 3D-US is a simple, non-ionizing technique, which appears as a promising alternate technique to pelvic X-rays to assess the correct position of Essure(®) microinserts.


Assuntos
Tubas Uterinas/diagnóstico por imagem , Histerossalpingografia , Imagem Tridimensional , Esterilização Tubária/instrumentação , Adulto , Desenho de Equipamento , Feminino , Humanos , Pelve/diagnóstico por imagem , Estudos Retrospectivos , Ultrassonografia
12.
Gynecol Obstet Fertil ; 43(6): 459-64, 2015 Jun.
Artigo em Francês | MEDLINE | ID: mdl-26004024

RESUMO

Pelvic floor disorders are frequent and source of symptoms which can be invalidating for patients. Between them, hedrocele is a pathology often unknown and clinically difficult to diagnose. It is a herniation of fat pad, small bowel or sigmoid colon in the recto-uterine pouch (cul-de-sac of Douglas) exercising a mass effect on the anterior wall of the rectum. Pelvic magnetic resonance imaging with morphological sequences and dynamic sequences in thrust can be very useful, allowing a comprehensive study of pelvic floor dysfunction and confirming the complete diagnosis, especially before surgery. We suggest you some examples to illustrate this pathology in order to emphasize the importance of its diagnosis, especially preoperative. A better understanding of this pelvic floor dysfunction would improve the care of patients.


Assuntos
Prolapso de Órgão Pélvico/diagnóstico , Idoso , Escavação Retouterina/diagnóstico por imagem , Feminino , Humanos , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Prolapso de Órgão Pélvico/cirurgia , Reto/diagnóstico por imagem , Vagina/diagnóstico por imagem
15.
Gynecol Obstet Fertil ; 43(2): 97-103, 2015 Feb.
Artigo em Francês | MEDLINE | ID: mdl-25618535

RESUMO

OBJECTIVES: Evaluation of pudendal nerve block on the quality of analgesia in perineal or vulvar surgery. PATIENTS AND METHODS: We realised a monocentered, prospective and randomised study of all patients undergoing perineo-vulvar surgery. Two groups of patients were evaluated: general anaesthesia alone (GA group, 41 patients) and both general anaesthesia and bilateral nerve stimulator-guided pudendal nerve block (15 mL of Ropivacaïne 5 mg.mL(-1)+0,5 µg.kg(-1) of Clonidine) (PB group, 42 patients). Evaluation of pain was realised with per- and post-surgical prescription of hypnotics and antalgics was noted. The primary outcome measure was the Visual Analogic Scale (VAS) pain means scores in the first postoperative 24 hours. RESULTS: There was no difference in the VAS pain means scores in the first 24 hours, but it seemed to have a decrease in VAS pain at 2 hours in the PB group. Analgesic consumption during surgery was decreased in the same group. No complication of the pudendal block has been reported. DISCUSSION AND CONCLUSION: The nerve stimulator-guided pudendal nerve block is a simple and useful method which can, when associated with general anesthesia, reduce per-operative antalgics consumption and a decrease in the immediate postoperative pain in perineal or vulvar surgery, without complication or lengthening operating time. Further studies are needed to confirm the effectiveness of this technique and evaluate the costs and potential complications.


Assuntos
Procedimentos Cirúrgicos em Ginecologia , Bloqueio Nervoso/métodos , Dor Pós-Operatória/prevenção & controle , Nervo Pudendo , Amidas/administração & dosagem , Analgésicos/administração & dosagem , Anestesia Geral , Anestésicos Locais/administração & dosagem , Clonidina/administração & dosagem , Feminino , Humanos , Pessoa de Meia-Idade , Períneo/cirurgia , Estudos Prospectivos , Ropivacaina , Escala Visual Analógica , Vulva/cirurgia
16.
Minerva Med ; 106(3): 123-31, 2015 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-25283258

RESUMO

AIM: The aim of this study was to describe the characteristics of women under 25 years with pelvic endometriosis and assess their potential for recurrence and fertility after surgery. METHODS: In a comparative retrospective study, 108 patients aged less than 25 years who underwent surgery for pelvic endometriosis were included: 49 in the DIE group (deep infiltrating endometriosis) and 59 in the SE group (superficial endometriosis). The main outcome measures were complications, recurrence and fertility. This study received the favorable opinion of the CEROG No 2012-GYN-04-02. RESULTS: The diagnosis was made at 21.6 ± 2.8 years, mainly considering clinical signs (78.4%), and on average 4.3 ± 3.7 years after the onset of symptoms; 16.1% of patients had to be reoperated (N.=5/31) due to a recurrence of their endometriosis. There were more recurrent pain (50% vs. 21.7%, P=0.005) and endometriosis (35.7 vs. 19.6%, P=0.08) in the DIE group. 75% (N.=33/44) patients desired pregnancy after surgery and 50% of them became pregnant, with one third thanks to assisted reproductive technology. CONCLUSION: In young women, endometriosis is often more severe. The early treatment does not improve the rate of recurrence and fertility, but can reduce pain and thus improve the quality of life.


Assuntos
Endometriose , Fatores Etários , Endometriose/complicações , Endometriose/patologia , Endometriose/cirurgia , Feminino , Humanos , Infertilidade Feminina/etiologia , Pelve , Recidiva , Estudos Retrospectivos , Adulto Jovem
17.
Eur J Obstet Gynecol Reprod Biol ; 178: 203-7, 2014 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-24813082

RESUMO

Surgery of genital prolapse causes haemorrhagic complications in about 1% of cases. The pelvis is highly vascular and accessing the usual landmarks of vaginal surgery, in particular the sciatic spine, is delicate work. Meticulous dissection of closed spaces is often difficult, and exposure and haemostatic procedures will be challenging in the event of any bleeding complication. When fixing prosthesis to the sacrospinous ligament, the inferior gluteal artery and its coccygeal branch are at risk. Fixation to the sacrospinous ligament must be performed more than 25mm away from the sciatic spine and, if possible, must not transfixiate it. Safe insertion of prosthesis requires sufficient experience, and an adequate learning curve. Being aware of vascular anatomy allows one to understand and treat haemorrhagic incidents. Packing or selective embolization seem to be the two methods to adopt, depending on the severity of bleeding and the conditions of exposure on the one hand, and on the technical resources available for embolization, on the other. Hypogastric ligature appears to be ineffective in this context.


Assuntos
Hemorragia/terapia , Complicações Intraoperatórias/terapia , Prolapso Uterino/cirurgia , Feminino , Hemostasia Cirúrgica/métodos , Humanos , Ligamentos/cirurgia , Região Sacrococcígea/irrigação sanguínea , Vagina/cirurgia
18.
Gynecol Obstet Fertil ; 42(2): 97-103, 2014 Feb.
Artigo em Francês | MEDLINE | ID: mdl-24461467

RESUMO

OBJECTIVES: To evaluate fertiloscopy's results and to redefine its place in the management of female infertility. PATIENTS AND METHODS: Retrospective study including 262 cases of fertiloscopy and 260 patients with primary or secondary idiopathic infertility. Analysis of infertility assessment's findings (hysterosalpingography), perioperative data (operating technique, laparoscopic conversion, failures and complications). Comparison of hysterosalpingography's findings and peroperative data; comparison of fertiloscopy and laparoscopy's findings. RESULTS: Access to peritoneal cavity was possible for 248 fertiloscopies (95%), and pelvic exploration was considered as complete for 226 cases (86%). Laparoscopic conversion was necessary in 54 cases (21%) and indicated by surgical pathology in more of one third of the cases (n=20). Our failure rate was only 5,3% (n=14), partially thanks to posterior colpotomie (70% of failures avoided). We deplored 8 complications (3.05%) which were not severe (no bowel injury), among which half were linked with the hysteroscopy (uterus perforation). In the cases of laparoscopic conversion, laparoscopic findings confirmed per-fertiloscopic data, considering adhesions and tubal patency. Hysterosalpingography had poor sensibility and positive predictive value. DISCUSSION AND CONCLUSION: Fertiloscopy is a safe, reproducible and not much invasive procedure. It can be substituted to laparoscopy in infertility assessment when there is no obvious surgical indication. Moreover, it could be considered as a first line way of investigation in female infertility management, instead of hysterosalpingography which has poor sensibility and positive predictive value.


Assuntos
Histeroscopia/métodos , Infertilidade Feminina/diagnóstico , Infertilidade Feminina/etiologia , Adulto , Feminino , Humanos , Histerossalpingografia , Histeroscopia/efeitos adversos , Laparoscopia/efeitos adversos , Estudos Retrospectivos , Perfuração Uterina/etiologia
19.
Gynecol Obstet Fertil ; 42(2): 84-91, 2014 Feb.
Artigo em Francês | MEDLINE | ID: mdl-22306097

RESUMO

OBJECTIVES: To propose a therapeutic approach and follow-up of patients with atypical polypoid adenomyoma (APA) wishing to remain fertile. PATIENTS AND METHOD: We are presenting a retrospective study of eight APA cases. RESULTS: Two patients immediately received radical treatment, and one patient had an endometrial thermocoagulation. The remaining five patients received a conservative treatment with ultrasound and hysteroscopic monitoring. Among them, two had full-term pregnancies, one is being treated for infertility, in one case, the APA disappeared after three hysteroscopy-curettages and macroprogestative treatment. Lastly, one of our patients died from an aggressive endometrioid ovarian bilateral tumour associated with an endometrial adenocarcinoma. DISCUSSION AND CONCLUSION: Radical treatment is necessary for cases of APA in women no longer wishing to remain fertile. For those wishing to remain fertile, we can offer a conservative treatment once they have been informed regarding the associated risk of relapse, degeneration, and ovarian lesions which necessitate stricter follow-up.


Assuntos
Adenomioma/terapia , Neoplasias do Endométrio/terapia , Adenomioma/patologia , Adenomioma/cirurgia , Adulto , Neoplasias do Endométrio/patologia , Neoplasias do Endométrio/cirurgia , Evolução Fatal , Feminino , Preservação da Fertilidade , Humanos , Histeroscopia , Pessoa de Meia-Idade , Gravidez , Progestinas/uso terapêutico , Estudos Retrospectivos , Fatores de Risco
20.
Clin Radiol ; 68(9): 909-16, 2013 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-23726654

RESUMO

AIM: To analyse the value of double contrast-enhanced (DCE) magnetic resonance imaging (MRI) in addition to conventional MRI to characterize ovarian teratomas subtypes with histological correlation. MATERIALS AND METHODS: From January 2005 to December 2008, 38 women undergoing MRI and subsequent resection of ovarian teratomas were identified [40 mature cystic teratomas (MCT), two struma ovarii, three immature teratomas]. MRI images were analysed blindly by two radiologists according to morphological and vascular abnormalities. An experienced histopathologist reviewed all slides to determine the presence and histological composition of Rokitansky protuberances. RESULTS: Thirty-one MCT (77%) had at least one small, regular Rokitansky protuberance presenting at an acute angle with the cyst wall. Ten out of 31 MCT did not display any enhancement on contrast-enhanced MRI related to sebaceous glands, adipose lobules, keratin, and pilosebaceous adnexa at histology. Three different time-intensity curve (TIC), types 1, 2, and 3, were related to presence of smooth muscular cells and fibrous, neuroglial, or thyroid tissue, respectively, found at histology of MCT. Type 3 TIC was also present in one struma ovarii and two immature teratomas. CONCLUSION: TIC types are related to the specific content of the solid tissue of ovarian teratomas but cannot be used to differentiate benign and malignant ovarian teratomas.


Assuntos
Neoplasias Ovarianas/patologia , Teratoma/patologia , Adolescente , Adulto , Criança , Meios de Contraste , Diagnóstico Diferencial , Detecção Precoce de Câncer , Feminino , Humanos , Imagem por Ressonância Magnética/métodos , Pessoa de Meia-Idade , Neoplasias Ovarianas/cirurgia , Teratoma/cirurgia , Adulto Jovem
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