J Levêque

Université de Rennes 2, Roazhon, Brittany, France

Are you J Levêque?

Claim your profile

Publications (175)273.3 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: The purpose of this work was to study the continuation rate of intrauterine device (IUD) copper in a nulliparous population.
    Gynécologie Obstétrique & Fertilité 01/2015; DOI:10.1016/j.gyobfe.2015.01.003 · 0.58 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Les mutations constitutionnelles délétères BRCA1&2 sont responsables chez la femme de cancers mammaires et ovariens qui surviennent fréquemment dans le jeune âge : à ce titre, existent des interactions fortes entre les risques cancérologiques et les évènements de la vie reproductive, grossesses, allaitement, prise en charge de l’infertilité.
    Journal de Gynécologie Obstétrique et Biologie de la Reproduction 11/2014; DOI:10.1016/j.jgyn.2014.10.011 · 0.62 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Germline mutations BRCA1&2 are responsible in women for breast and ovarian cancers that commonly occur at a young age: as such, there are strong interactions between the oncological risks and the events of reproductive life, pregnancy, breastfeeding, and management of infertility. A review of the international literature from the PubMed database was conducted, and recommendations of French health agencies were exposed. Published studies are case-control and cohort studies in the majority, with a low level of evidence. Pregnancy and lactation have no effect on breast and ovaries or even decreases the risk. The sex ratio among patients carrying the mutation is in favor of girls. It is not observed more infertility in patients carrying a mutation despite a strong suspicion of premature ovarian failure, and infertility treatments do not increase breast and ovarian risk. There are ethical debates concerning the place of pre-natal diagnosis: both experts and concerned patients recommend a case-by-case analysis of the requests. Copyright © 2014 Elsevier Masson SAS. All rights reserved.
  • [Show abstract] [Hide abstract]
    ABSTRACT: To establish recommendations for early recurrent miscarriages (≥3 miscarriages before 14weeks of amenorrhea). Literature review, establishing levels of evidence and recommendations for grades of clinical practice. Women evaluation includes the search for a diabetes (grade A), an antiphospholipid syndrome (APS) (grade A), a thyroid dysfunction (grade A), a hyperprolactinemia (grade B), a vitamin deficiency and a hyperhomocysteinemia (grade C), a uterine abnormality (grade C), an altered ovarian reserve (grade C), and a couple chromosome analysis (grade A). For unexplained early recurrent miscarriages, treatment includes folic acid and progesterone supplementation, and a reinsurance policy in the first quarter (grade C). It is recommended to prescribe the combination of aspirin and low-molecular-weight heparin when APS (grade A), glycemic control in diabetes (grade A), L-Thyroxine in case of hypothyroidism (grade A) or the presence of thyroid antibodies (grade B), bromocriptine if hyperprolactinemia (grade B), a substitution for vitamin deficiency or hyperhomocysteinemia (grade C), sectionning a uterine septum (grade C) and treating an uterine acquired abnormality (grade C). These recommendations should improve the management of couples faced with early recurrent miscarriages. Copyright © 2014 Elsevier Masson SAS. All rights reserved.
  • [Show abstract] [Hide abstract]
    ABSTRACT: To assess value of sonography, hCG and progesterone for diagnosis of first trimester nonviable pregnancy and to assess first trimester miscarriage management (except evacuation). French and English publications were searched using PubMed, Cochrane Library and international learned societies recommendations. First trimester nonviable pregnancy is established with gestational sac mean diameter and embryo crown-rump length. Mean sac diameter≥25mm without embryo (LE2) or embryo crown-rump length≥7mm without heartbeat (LE2) by transvaginal sonography allows to diagnose pregnancy failure. Intrauterine pregnancy of uncertain viability is defined by intra-uterine gestational sac without embryo with heartbeat or without pregnancy diagnosis failure and requires a new transvaginal sonography. The delay for this second sonography depends on the aspect of intrauterine picture (i.e. presence of yolk sac or not, presence of embryo or not) (LE4). Human chorionic gonadotropin (hCG) and progesterone are useful for pregnancy of unknown location (i.e. no gestational sac at transvaginal sonography): hCG ratio<15% between two-day serum samples when first hCG is<2000UI/mL (LE2) or low serum progesterone level (<3.2ng/mL) (LE2) exclude viable intrauterine pregnancy. There is not known prevention strategy for threatened miscarriage. Copyright © 2014 Elsevier Masson SAS. All rights reserved.
  • Journal de Gynécologie Obstétrique et Biologie de la Reproduction 11/2014; DOI:10.1016/j.jgyn.2014.09.020 · 0.62 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Évaluer la valeur diagnostique des examens complémentaires pour affirmer l’arrêt d’une grossesse au premier trimestre de grossesse et la stratégie de prise en charge des patientes ayant une grossesse arrêtée au premier trimestre (hors évacuation).
    Journal de Gynécologie Obstétrique et Biologie de la Reproduction 11/2014; DOI:10.1016/j.jgyn.2014.09.012 · 0.62 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Établir des recommandations concernant les fausses couches à répétition (FCR) (≥ 3 fausses couches avant 14 semaines d’aménorrhée).
    Journal de Gynécologie Obstétrique et Biologie de la Reproduction 11/2014; DOI:10.1016/j.jgyn.2014.09.014 · 0.62 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Transvaginal pelvic ultrasound is the first-line imaging examination for presumed benign ovarian tumors (PBOT) in adult women (Grade A). Ultrasound is sufficient for characterizing a unilocular anechoic cyst smaller than 7 cm (Grade A). Magnetic resonance imaging is the recommended second-line investigation for indeterminate masses or masses larger than 7 cm (Grade B). Serum CA-125 assay is not recommended for first-line diagnosis in adult women (Grade C). In women with a unilocular anechoic cyst, hormone therapy is ineffective and not recommended (Grade A). Ultrasound-guided aspiration is not recommended (Grade B). Abstention is an option in adult women with a unilocular asymptomatic anechoic cyst smaller than 10 cm and no history of cancer (Grade B). If symptoms develop, laparoscopy is the gold standard for surgical treatment of PBOT (Grade A). Conservative surgical treatment (cystectomy) should be preferred to oophorectomy in pre-menopausal women without a previous history of cancer (Grade C). In cases of suspected adnexal torsion, laparoscopic surgical exploration is recommended (Grade B). Conservative treatment or detorsion without oophorectomy is recommended for pre-menopausal women regardless of the estimated torsion duration and macroscopic appearance of the ovary (Grade B). During pregnancy, expectant management is recommended for unilocular asymptomatic anechoic cysts smaller than 6 cm (Grade C).
    European Journal of Obstetrics & Gynecology and Reproductive Biology 10/2014; 183. DOI:10.1016/j.ejogrb.2014.10.012 · 1.63 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Objectives: The aim of this study was to assess the prognostic factors after curative pelvic exenterations performed for recurrent uterine cervical or vaginal cancers in the era of concomitant chemoradiotherapy. Methods: We retrospectively enrolled 16 patients with recurrent uterine cervical or vaginal cancer and tumor-free resection margins on pelvic exenteration pathological analysis between October 1997 and April 2014. Results: Pelvic exenterations were performed for 13 recurrent cervical cancers and 3 recurrent vaginal cancers. All of the patients had received pelvic irradiation (external radiotherapy for 14 patients and brachytherapy for 2 patients). The median age at the recurrence was 59.5 years (49-77 years), and the median tumor size was 4.35 cm (2-9 cm). There were no intraoperative or postoperative deaths. The 5-year disease-free survival and overall survival were 30% and 34.1%, respectively. The following 3 factors affected the disease-free survival: tumor size greater than 5 cm (P = 0.05), mesorectal lymph node involvement (P = 0.02), and vascular emboli (P = 0.0093). Conclusions: The presence of vascular emboli is a new prognostic factor in cases of recurrent cervical or vaginal cancer. Assessing the presence of vascular emboli on pretherapeutic biopsies could facilitate the selection of patients eligible for curative pelvic exenterations.
    International Journal of Gynecological Cancer 09/2014; 24(9). DOI:10.1097/IGC.0000000000000288 · 1.95 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Objective Pregnancy before 15 years old remains a troublesome issue for medical teams which are not used to working with adolescents. The aim of this work is to study the outcome of the pregnancies among very young adolescents, the psycho-social context, the medical management, the professionals involved in it and the follow-up after pregnancy. Materials and methods Retrospective analysis from four cases, in the university hospital of Rennes, during the year 2011. Results All the pregnancies were terminated, half of them on a psychological indication. Three adolescents showed evidence of major psychological distress and two of them had a history of sexual abuse. The medical care was heterogeneous, from the first meet until the follow-up after pregnancy, including the medical abortion. A multidisciplinary teamwork was found in three of the four cases. Conclusion Pregnancy before the age of 15 years old is a rare event and often ends with a medical abortion. The medical management of those vulnerable adolescents is complex and requires a multidisciplinary team approach all along the follow-up. A national evaluation of clinical practice in this area seems to be needed.
    La Revue Sage-Femme 09/2014; 43(7):514–520. DOI:10.1016/j.sagf.2014.09.002
  • [Show abstract] [Hide abstract]
    ABSTRACT: Objectives: To assess cervical regeneration after large loop excision of the transformation zone (LLETZ) by ultrasound (US) measurements of cervical length (CL) before conization as well as in the postoperative short- and long-term and to identify factors affecting regeneration. Patients and Methods: This was a prospective observational study including patients under 45 years of age treated by LLETZ for Cervical Intraepithelial Neoplasia (CIN) with repeated measurements of CL by transvaginal US before and just after LLETZ, at 1 and 6 months postoperatively. Results: A total of 83 patients were enrolled, out of which 53 were included in the study. The mean CL was 28.6 mm (±5.7) preoperatively versus 18.3 mm (±4.2) after surgery; 21.8 mm (± 4.4) at 1 month and 25.5 mm (±4.9) at 6 months. The mean cone length estimated by US was 10.3 mm (±3.4). The differences in CL before/after conization and CL after conization/at 6 months were statistically significant (p<0.0001). Cervical regeneration at 6 months was 71% (±20), statistically greater than regeneration at 1 month (32%, ±16) (p<0.0001). Discussion: Post-conization cervical tissue regeneration occurred with almost three quarters of the initial cervical length restored at 6 months. Further studies evaluating obstetric outcomes after LLETZ according to cervical regeneration might subsequently be used in clinical practice to identify high-risk pregnancies by pre- and postoperative US measurements of the cervical length. A rigorous assessment of CIN treatment risks and benefits remains essential when considering treating patients of childbearing age given a potential obstetric risk from conization.
    Anticancer research 07/2014; 34(7):3799-805. · 1.87 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The orphan receptors COUP-TF (chicken ovalbumin upstream promoter transcription factor) I and II are members of the nuclear receptor superfamily that play distinct and critical roles in vertebrate organogenesis. The involvement of COUP-TFs in cancer development has recently been suggested by several studies but remains poorly understood.
    BMC Cancer 06/2014; 14(1):407. DOI:10.1186/1471-2407-14-407 · 3.32 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Objectives To assess whether there is a correlation between the length of a conization specimen and the length of the cervix measured by vaginal ultrasonography after the operation Patients and methods Prospective observational study including patients less than 45 years with measurement of cervical length before and the day of the conization, and measuring the histological length of the specimen. Results Among the 40 patients enrolled, the average ultrasound measurements before conization was 26.9 mm (± 4.9 mm) against 18.1 mm (± 4.4 mm) after conization with a mean difference of 8.8 mm (± 2.4 mm) (difference statistically significant P < .0001). The extent of histological specimen was 9 mm (± 2.2 mm) on average. A correlation between ultrasound and histological measurements with a correlation coefficient R = 0.85 was found statistically significant (P < 0.0001). Moreover, the rate of cervix length remove by loop-excision in our series is 33% (± 8.5%). Discussion A good correlation between the measurements of the specimen and the cervical ultrasound length before and after conization was found, as a significant reduction in cervical length after conization. The precise length of the specimen should be known in case of pregnancy and the prevention of prematurity due to conization rests on selected indications and efficient surgical technique.
    Journal de Gynécologie Obstétrique et Biologie de la Reproduction 04/2014; 43(4):288–293. DOI:10.1016/j.jgyn.2013.03.014 · 0.62 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: To analyse the prevalence of abnormal papsmears in a primary care center and the screening practices. Single-center retrospective study on 1,430 FCU performed in 1,251 patients between January 2009 and December 2011 with analysis of demographic, clinical and epidemiological chararacteristics of the women, and the monitoring of the patients with pathological papsmears. The study population was predominantly young (under 25), unmarried, nulliparous, and using contraception. Among the 1,244 FCU, nearly 90% of them were interpretable with the junction area interested. Nine percent were pathological with mainly ASC-US and L-SIL (3.5% and 4.5%) with no difference between more and less than 25years. Two factors were significantly associated with the presence of pathological papsmear: first intercourse before age 14 and smoking more than 10 cigarettes per day. Monitoring of patients with a pathological papsmear showed that 33% of patients had not an appropriate follow-up especially younger patients. To perform papsmear before 25years because the patient has associated high risk HPV co-factors does not appear justified by the severity or frequency of cytological lesions, especially as it increases the financial cost and is responsible of potential deleterious actions such as conizations probably excessive among the youngest patients. Personalized monitoring of these patients with a pathological papsmear is required. The French practice recommendations on cervical cancer screening (first screening at age 25, 26years cytological control then every 3years up to 65years in patients who have or have had sex) deserve to be applied in young and disadvantaged patients.
    Journal de Gynécologie Obstétrique et Biologie de la Reproduction 12/2013; · 0.62 Impact Factor
  • J.-L. Brun, X. Fritel, J. Levêque
    Journal de Gynécologie Obstétrique et Biologie de la Reproduction 12/2013; 42(8):710–714. DOI:10.1016/j.jgyn.2013.09.025 · 0.62 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Introduction Epithelial ovarian carcinoma (EOC) has a worst prognosis with little progress in terms of survival for the last two decades. Immunology received little interest in EOC in the past, but now appears very important in the natural history of this cancer. This review is an EOC immunology state of art and focuses on the place of immunotherapy in future. Material and methods A systematic review of published studies was performed. Medline baseline interrogation was performed with the following keywords: “Ovarian carinoma, immunotherapy, T-lymphocyte, regulator T-lymphocyte, dendritic cells, macrophage, antigen, chemotherapy, surgery, clinical trials”. Identified publications (English or French) were assessed for the understanding of EOC immunology and the place of conventional treatment and immunotherapy strategy. Results Intratumoral infiltration by immune cells is a strong prognotic factor in EOC. Surgery and chemotherapy in EOC decrease imunosuppression in patients. The antitumoral immunity is a part of the therapeutic action of surgery and chemotherapy. Until now, immunotherapy gave some disappointing results, but the new drugs that target the tolerogenic tumoral microenvironnement rise and give a new hope in the treatment of cancer. Conclusion Immunology controls the EOC natural history. The modulation of immunosuppressive microenvironment associated with the stimulation of antitumoral immunity could be the next revolution in the treatment of cancer.
    Journal de Gynécologie Obstétrique et Biologie de la Reproduction 11/2013; DOI:10.1016/j.jgyn.2013.10.004 · 0.62 Impact Factor
  • J-L Brun, X Fritel, J Levêque
    Journal de Gynécologie Obstétrique et Biologie de la Reproduction 11/2013; · 0.62 Impact Factor
  • Source

Publication Stats

653 Citations
273.30 Total Impact Points

Institutions

  • 2013
    • Université de Rennes 2
      Roazhon, Brittany, France
  • 2000–2013
    • Université de Rennes 1
      • Faculty of medicine
      Roazhon, Brittany, France
  • 1998–2013
    • Centre Hospitalier Universitaire de Rennes
      • Service de gynécologie
      Roazhon, Brittany, France
  • 1994–2012
    • Centre Eugène Marquis
      Roazhon, Brittany, France
  • 2010
    • Centre Hospitalier de Bretagne Sud
      Lorient, Brittany, France
  • 2009
    • European University of Brittany
      Roazhon, Brittany, France
  • 1994–1997
    • CHRU de Strasbourg
      Strasburg, Alsace, France