G Akerman

Paris Diderot University, Lutetia Parisorum, Île-de-France, France

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Publications (26)21.37 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: To evaluate the effect of combipatch TachoSil(®) in the prevention of seromas after axillary dissection in local breast cancer. PATIENTS ET MéTHODES: A retrospective, case-control study conducted between January 2007 and December 2009, in two departments of Obstetrics and Gynecology of the AP-HP. Sixty-six patients (45 in the control group and 22 in the group TachoSil(®)) who have undergone an axillary dissection alone, with establishment of a redon or with lumpectomy, were included. The total amount of lymph drained during the stay, the number of days of drainage, duration of hospitalization, the number of lymphoceles and the number of retrievals performed at the waning of hospitalization were collected. The population was similar in age, body mass index (BMI), clinical and pathological data. There was no significant difference in terms of total volume of lymph drained (268.2±220.7mL without TachoSil(®) and 228.6±128.8mL with TachoSil(®), P=0.89) and the number of days of drainage (3.9±1.6days without TachoSil(®) and 3.1±0.9days with TachoSil(®), P=0.10). The duration of hospitalization was significantly higher in the group TachoSil(®) (5±1.6days with TachoSil(®) and 3.8±1.1days without TachoSil(®), P=0.006). This study shows no benefit of combipatch (TachoSil(®)) in prevention of seromas after axillary lymph node dissection. A randomized study with large effective is necessary.
    Gynécologie Obstétrique & Fertilité 10/2013; · 0.58 Impact Factor
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    ABSTRACT: Objective To evaluate the effect of combipatch TachoSil® in the prevention of seromas after axillary dissection in local breast cancer. Patients et méthodes A retrospective, case-control study conducted between January 2007 and December 2009, in two departments of Obstetrics and Gynecology of the AP–HP. Sixty-six patients (45 in the control group and 22 in the group TachoSil®) who have undergone an axillary dissection alone, with establishment of a redon or with lumpectomy, were included. The total amount of lymph drained during the stay, the number of days of drainage, duration of hospitalization, the number of lymphoceles and the number of retrievals performed at the waning of hospitalization were collected. Results The population was similar in age, body mass index (BMI), clinical and pathological data. There was no significant difference in terms of total volume of lymph drained (268.2 ± 220.7 mL without TachoSil® and 228.6 ± 128.8 mL with TachoSil®, P = 0.89) and the number of days of drainage (3.9 ± 1.6 days without TachoSil® and 3.1 ± 0.9 days with TachoSil®, P = 0.10). The duration of hospitalization was significantly higher in the group TachoSil® (5 ± 1.6 days with TachoSil® and 3.8 ± 1.1 days without TachoSil®, P = 0.006). Conclusion This study shows no benefit of combipatch (TachoSil®) in prevention of seromas after axillary lymph node dissection. A randomized study with large effective is necessary.
    Gynécologie Obstétrique & Fertilité 10/2013; 41(10):583–587. DOI:10.1016/j.gyobfe.2013.09.007 · 0.58 Impact Factor
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    ABSTRACT: Assess the degree of satisfaction of medical students regarding their teaching of gynaecology and obstetrics at the medical faculty of Paris-VII in 2008-2009. The aim is to improve the quality of teaching and learning tools mainly with a view to preparing for the national examination competition. This is an observational study on a cohort of 116 students enrolled in 3rd year of graduate medical education, Faculty Paris-VII Denis-Diderot, who was asked to respond anonymously to a questionnaire of satisfaction comprising 13 questions. Participation in course organized by the faculty is 62%. Ninety-three percent of students are enrolled in private lessons to prepare the national examination competition. Eighty-one percent of students believe that teaching private courses is better than the courses offered by the faculty. Sixty-two percent of students consider a medium (Internet or CD-ROM). Quality could replace traditional media's theory of education. Ninety percent of students use as a main working the same book sold in commerce. Among them, 98.2% considered that the external training is useful in the preparation of the national examination competition. It seems that teaching traditional academic lectures of gynaecology and obstetrics is not the preferred method of teaching students in 5th year of medicine. They prefer the education provided by the private preparedness at national examination competition, in the form of clinical cases, even if the courses offered by the faculty try to adapt in this form. The book remains the primary medium of work, but many students believe that a computer could replace or supplement the traditional media. The internship hospital services in gynaecology and obstetrics compulsory Paris-VII seems helpful in learning the specialty including in the context of the national examination class.
    Gynécologie Obstétrique & Fertilité 12/2010; 38(12):735-9. DOI:10.1016/j.gyobfe.2010.06.002 · 0.58 Impact Factor
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    ABSTRACT: To evaluate maternal and fetal complications resulting from the use of the Kiwi vacuum extractor and to compare them with those resulting from the use of forceps or spatula. Patients who had instrumental extraction between November 2006 and April 2007 were included in a unicentric retrospective study. Complications resulting from the use of Kiwi vacuum extractor and those of other instruments were compared. One hundred and sixty-nine patients where included, 79 had extraction with Kiwi vacuum extractor. The two populations (women having extraction with Kiwi and woman having extraction with spatula or forceps) were similar in terms of maternal characteristics, progress of labour and delivery. The rate of episiotomies was significantly lower with KIWI (73.1% versus 94.4%; P=0.0001), as well as was postpartum haemorrhage rate (8.9 % versus 18.9%; P=0.04). No perineal tear of second or third degree occurred with Kiwi. Kiwi vacuum extractor was associated with a higher rate of shoulder dystocia (12.8% versus 6.7%, NS), but related fetal complication rates were similar in the two groups. The extraction failure rate was significantly higher with Kiwi (11.4% versus 4.4%; P=0.04), but cesarean section rate was similar for the two groups (1.3 % versus 4.4%). This study is the first comparing complications occurring after extraction with KIWI vacuum extractor to those occurring with other instruments. Although the results are limited by the retrospective nature of the study and the small size of the workforce, our study suggests that Kiwi vacuum extractor is associated with a lower rate of maternal complications and a rate of fetal complication similar to other kind of instruments. This instrument should be promoted and taught to younger patricians. Our study also revealed higher failure and shoulder dystocia rates. Larger studies are needed to better evaluate risks factor concerning these two complications in order to optimise the use of Kiwi vacuum extractor.
    Gynécologie Obstétrique & Fertilité 10/2010; 38(11):653-9. DOI:10.1016/j.gyobfe.2010.08.009 · 0.58 Impact Factor
  • J Bouquier · A Bricou · Y Delpech · L Tulpin · G Akerman · E Barranger
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    ABSTRACT: The indication and extent of lymph node dissection in the surgical management of endometrial cancer remains controversial especially concerning the para-aortic lymph nodes. The therapeutic benefit of the lymph node dissection is criticized mainly for low-risk patients for extra-uterine spread. Surgically staging patients is the best method to predict node involvement and it allows an optimal decision for adjuvant therapy to be taken. The different prognostic factors for para-aortic lymph nodes metastasis are histological grade and size of the tumour, myometrial wall invasion and lymphovascular dissemination, as well as positive pelvic lymph nodes. However, these elements are not correctly evaluated before and during the surgery. Positive para-aortic lymph nodes can be found without a lymphatic spread to the pelvic area. Even though the prevalence of para-aortic node involvement is weak, it seems legitimate to propose in selected cases of important lymph node involvement, it's complete dissection if a pelvic lymphadenectomy is indicated and if it is surgically possible.
    Bulletin du cancer 10/2009; 97(2):199-209. DOI:10.1684/bdc.2009.0956 · 0.64 Impact Factor
  • G Akerman
    Gynécologie Obstétrique & Fertilité 09/2009; 37(9):766-8. DOI:10.1016/j.gyobfe.2009.07.005 · 0.58 Impact Factor
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    ABSTRACT: Radioguided occult lesion localisation (ROLL) is a new technique which allows identification of non palpable breast lesion in breast cancer using, on the model of sentinel node procedure, injection of a radiotracer over the tumour lesion. With a gamma detection probe, it is then possible during surgery to identify in the same time the lesion and the sentinel lymph nodes. Compared with the wire-guided localisation (WGL), ROLL seems easier to achieve for radiologists, the excision procedure seems to be simpler with a good lesions resection in sano rate and a good cosmetic result.
    Gynécologie Obstétrique & Fertilité 01/2009; 37(1):45-49. DOI:10.1016/j.gyobfe.2008.06.028 · 0.58 Impact Factor
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    ABSTRACT: Radioguided occult lesion localisation (ROLL) is a new technique which allows identification of non palpable breast lesion in breast cancer using, on the model of sentinel node procedure, injection of a radiotracer over the tumour lesion. With a gamma detection probe, it is then possible during surgery to identify in the same time the lesion and the sentinel lymph nodes. Compared with the wire-guided localisation (WGL), ROLL seems easier to achieve for radiologists, the excision procedure seems to be simpler with a good lesions resection in sano rate and a good cosmetic result.
    Gynécologie Obstétrique & Fertilité 01/2009; 37(1):45-9. · 0.58 Impact Factor
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    ABSTRACT: In 10 to 15% of cases, breast cancer occurs in women under the age of 40. Thanks to the development of novel therapeutic approaches in the past few years, breast cancer prognosis is today far more acute than before and a pregnancy can be planned in these young women. They are expecting from their physician clear information about possibilities for pregnancy and specific risks after breast cancer. Several questions are raised in such situations: Does pregnancy modifies breast cancer prognosis? What is the influence of breast cancer for pregnancy? How do these young patients experience pregnancy and breast cancer? The goal of this paper, based upon literature review, was to clarify guidelines for the follow-up of young women experiencing pregnancy after breast cancer.
    Gynécologie Obstétrique & Fertilité 10/2008; 36(10):1022-1029. DOI:10.1016/j.gyobfe.2008.06.025 · 0.58 Impact Factor
  • Journal de Radiologie 10/2008; 89(10):1345-1345. DOI:10.1016/S0221-0363(08)76037-2 · 0.57 Impact Factor
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    ABSTRACT: In 10 to 15% of cases, breast cancer occurs in women under the age of 40. Thanks to the development of novel therapeutic approaches in the past few years, breast cancer prognosis is today far more acute than before and a pregnancy can be planned in these young women. They are expecting from their physician clear information about possibilities for pregnancy and specific risks after breast cancer. Several questions are raised in such situations: Does pregnancy modifies breast cancer prognosis? What is the influence of breast cancer for pregnancy? How do these young patients experience pregnancy and breast cancer? The goal of this paper, based upon literature review, was to clarify guidelines for the follow-up of young women experiencing pregnancy after breast cancer.
    Gynécologie Obstétrique & Fertilité 10/2008; 36(10):1022-9. · 0.58 Impact Factor
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    ABSTRACT: In vulvar cancer, lymph node status is a major prognostic factor. Currently, the reference regarding nodal exploration is the groin lymphadenectomy responsible for a significant morbidity. The sentinel node technique in breast cancer has become a standard of care. This technique has been studied for fifteen years in vulvar cancer, on small numbers because of its low incidence. There is not yet consensus about its use in practice. This article is a focus on this technology, its feasibility and the benefits of sentinel node detection applied to vulvar cancer.
    Bulletin du cancer 09/2008; 95(7):701-6. DOI:10.1684/bdc.2008.0642 · 0.64 Impact Factor
  • Journal de Gynécologie Obstétrique et Biologie de la Reproduction 08/2008; 37 Spec No 2:F69-76. · 0.62 Impact Factor
  • C Malartic · O Morel · G Akerman · L Tulpin · P Desfeux · E Barranger
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    ABSTRACT: Mifepristone, a progesterone receptor antagonist steroid, can reduce uterine fibroid tumours' growth by several pathways. Its efficiency has been widely evaluated in symptomatic patients for more than 10 years. A significant decrease in fibroid tumours and uterine volume concomitant with better quality of life scores can be obtained with a daily administration of Mifepristone 5mg. Mifepristone can be compared with GnRH agonists in terms of efficiency. Observed adverse outcomes are hot flushes (38%), elevated hepatic enzymes (4%) and benign endometrial hyperplasia (28%). Hot flushes and endometrial hyperplasia are not observed with 5mg daily doses. Data suggest that many invasive procedures could be avoided with the routine use of Mifepristone for fibroid tumours care. However, published study periods are only three to 12 months: long lasting evaluation in larger groups of patients seems necessary before this treatment could be proposed as routine care.
    Gynécologie Obstétrique & Fertilité 07/2008; 36(6):668-74. DOI:10.1016/j.gyobfe.2008.01.017 · 0.58 Impact Factor
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    ABSTRACT: Sentinel lymph node biopsy is nowadays an accepted method of staging breast cancer patients. In case of an injection of radioactive colloid, preoperative lymphoscintigraphy is recommended to establish a lymphatic mapping and to predict the number of sentinel lymph nodes identified during surgery. Preoperative lymphoscintigraphy does not decrease the false-negative rate. However, positive preoperative lymphoscintigraphy significantly improves the identification rate of intraoperative sentinel nodes comparing with negative preoperative lymphoscintigraphy. Detecting extra-axillary sentinel lymph nodes, because of its minimal therapeutic consequences, does not appear to be an indication for preoperative lymphoscintigraphy. Given logistics and cost required, preoperative lymphoscintigraphy should be only performed for patients with a high risk of intraoperative failed localization. In case of negative preoperative lymphoscintigraphy, sentinel lymph node biopsy must be tried because sentinel nodes are still identified in the majority of these patients. Another possibility, with important cost and logistic, should consist in performing a later lymphoscintigraphy on the day after radioactive injection to ameliorate sentinel lymph nodes identification.
    Gynécologie Obstétrique & Fertilité 07/2008; 36(7):808-814. DOI:10.1016/j.gyobfe.2008.06.006 · 0.58 Impact Factor
  • Journal de Gynécologie Obstétrique et Biologie de la Reproduction 07/2008; 37:F69–F75. DOI:10.1016/S0368-2315(08)75576-5 · 0.62 Impact Factor
  • M Saim · J-F Cote · O Morel · C Malartic · G Akerman · F Gray · E Barranger
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    ABSTRACT: Tamoxifen is an antioestrogen widely used in the breast cancer treatment. Its paradoxical antioestrogenic action on breast and its oestrogenic action on the endometer is well-known. Since 1988, few cases of malignant mixed müllerian tumors following tamoxifen were described. We report a new case of uterine malignant mixed müllerian tumor four years after the end of tamoxifen for breast cancer.
    Gynécologie Obstétrique & Fertilité 03/2008; 36(2):166-8. DOI:10.1016/j.gyobfe.2007.06.020 · 0.58 Impact Factor
  • N Douay · G Akerman · D Clément · C Malartic · O Morel · E Barranger
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    ABSTRACT: Since the advent of sentinel node biopsy, which made it possible to reduce the morbidity of axillary surgery, axillary lymph node dissection has been constituting the treatment of reference in certain cases of breast cancer. One of the most frequent complications in the immediate postoperative period is the lymphocele or seroma, the frequency of which is independent of the axillary technique of surgery. Following an analysis of the literature, some risk factors were isolated such as a high body mass index, the high volume of the first three days drainage and arterial hypertension. Some techniques seem to show a benefit in the reduction of the lymphocele: sentinel node biopsy, padding of the axilla and the axillary drainage. The majority of other techniques such as the use of fibrin sealant, hemolymphostatic sponges, various techniques of axillary dissection, external axillary compression, differed mobilization from the upper limb, axillary dissection by lipo-aspiration and endoscopic axillary dissection, have too contradictory results at the present time to be recommended in clinical practice. No consensus is clearly established to decrease the incidence and the volume of the seroma after axillary dissection in breast cancer. Today, two techniques can be nevertheless distinguished: sentinel node biopsy and padding of the axilla.
    Gynécologie Obstétrique & Fertilité 03/2008; 36(2):130-5. DOI:10.1016/j.gyobfe.2007.07.040 · 0.58 Impact Factor
  • American journal of surgery 02/2008; 195(1):135-6. DOI:10.1016/j.amjsurg.2007.01.024 · 2.41 Impact Factor
  • L Tulpin · O Morel · G Akerman · C Malartic · P Desfeux · E Barranger
    [Show abstract] [Hide abstract]
    ABSTRACT: Sentinel lymph node biopsy is nowadays an accepted method of staging breast cancer patients. In case of an injection of radioactive colloid, preoperative lymphoscintigraphy is recommended to establish a lymphatic mapping and to predict the number of sentinel lymph nodes identified during surgery. Preoperative lymphoscintigraphy does not decrease the false-negative rate. However, positive preoperative lymphoscintigraphy significantly improves the identification rate of intraoperative sentinel nodes comparing with negative preoperative lymphoscintigraphy. Detecting extra-axillary sentinel lymph nodes, because of its minimal therapeutic consequences, does not appear to be an indication for preoperative lymphoscintigraphy. Given logistics and cost required, preoperative lymphoscintigraphy should be only performed for patients with a high risk of intraoperative failed localization. In case of negative preoperative lymphoscintigraphy, sentinel lymph node biopsy must be tried because sentinel nodes are still identified in the majority of these patients. Another possibility, with important cost and logistic, should consist in performing a later lymphoscintigraphy on the day after radioactive injection to ameliorate sentinel lymph nodes identification.
    Gynécologie Obstétrique & Fertilité 01/2008; 36(7-8):808-14. · 0.58 Impact Factor

Publication Stats

62 Citations
21.37 Total Impact Points

Institutions

  • 2010
    • Paris Diderot University
      Lutetia Parisorum, Île-de-France, France
  • 2007–2010
    • Hôpital Ambroise Paré – Hôpitaux universitaires Paris Ile-de-France Ouest
      Billancourt, Île-de-France, France
  • 2008
    • Assistance Publique – Hôpitaux de Paris
      Lutetia Parisorum, Île-de-France, France