J Levêque

Université de Rennes 2, Roazhon, Brittany, France

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Publications (162)208.45 Total impact

  • Journal de Gynécologie Obstétrique et Biologie de la Reproduction. 11/2014;
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    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;
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    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;
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    ABSTRACT: 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.
    International journal of gynecological cancer : official journal of the International Gynecological Cancer Society. 09/2014;
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    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.
    Journal de Gynécologie Obstétrique et Biologie de la Reproduction. 09/2014; 43(7):514–520.
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    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. · 1.71 Impact Factor
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    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. · 3.33 Impact Factor
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    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. 01/2014; 43(4):288–293.
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    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; · 0.45 Impact Factor
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    ABSTRACT: 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. 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. 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. 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; · 0.45 Impact Factor
  • J-L Brun, X Fritel, J Levêque
    Journal de Gynécologie Obstétrique et Biologie de la Reproduction 11/2013; · 0.45 Impact Factor
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    ABSTRACT: Triple-negative breast cancers (TNBC) lacking estrogen and progesterone receptors and HER2 amplification have a relatively high risk of metastatic dissemination, but the mechanistic basis for this risk is not understood. Here we report that serum levels of CD95L are higher in TNBC patients compared to other breast cancer patients. Metalloprotease-mediated cleavage of CD95L expressed by endothelial cells surrounding tumors generates a gradient that promotes cell motility, due to formation of an unconventional CD95-containing receptosome termed the motility-inducing signaling complex. Formation of this complex was instrumental for Nox3-driven ROS generation. Mechanistic investigations revealed a Yes-Orai1-EGFR-PI3K pathway that triggered migration of TNBC cells exposed to CD95L. Our findings establish a pro-metastatic function for metalloprotease-cleaved CD95L in triple-negative breast cancers, revisiting its role in carcinogenesis.
    Cancer Research 09/2013; · 9.28 Impact Factor
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    ABSTRACT: Vulvar intraepithelial neoplasia (VIN) and vulvar Paget disease are managed with either vulvectomy, destructive treatments (laser, antimitotic drugs) or immunostimulants. All these options are associated with functional complications. The purpose of this study was to evaluate the surgical technique consisting of skinning vulvectomy with split-thickness skin graft, and its effect on overall quality of life and sexual function. A retrospective study was conducted on thirteen patients who underwent skinning vulvectomy with split-thickness skin graft between 1999 and 2009. Overall quality of life and sexual function were assessed with the Medical Outcome Study Short Form 36 (MOS SF-36) and Female Sexual Function Index (FSFI), respectively. The median age of patients was 54 (range: 33-77) years. Three patients had Paget disease and 10 patients had VIN lesions. The excision margins were clear in 46% of cases. The incidence of occult cancer was 31%. The mean follow-up period was 77 (±35) months. Four patients experienced a relapse of their intraepithelial disease. The mean disease-free survival was 58 (±44) months. There was no significant difference in MOS SF-36 scores between the study population and the general population. The patients assessed with the FSFI regained normal sexual function after the surgical procedure. Skinning vulvectomy with split-thickness skin graft is a feasible technique yielding good results in terms of quality of life and sexual function. It enables occult cancer to be diagnosed in patients with VIN or Paget disease.
    European journal of surgical oncology: the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology 09/2013; · 2.56 Impact Factor
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    ABSTRACT: 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. Retrospective analysis from four cases, in the university hospital of Rennes, during the year 2011. 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. 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.
    Journal de Gynécologie Obstétrique et Biologie de la Reproduction 08/2013; · 0.45 Impact Factor
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    ABSTRACT: Epithelial ovarian cancer (EOC) is a significant cause of cancer-related mortality in women, and there has been no substantial decrease in the death rates due to EOC in the last three decades. Thus, basic knowledge regarding ovarian tumor cell biology is urgently needed to allow the development of innovative treatments for EOC. Traditionally, EOC has not been considered an immunogenic tumor, but there is evidence of an immune response to EOC in patients. Clinical data demonstrate that an antitumor immune response and immune evasion mechanisms are correlated with a better and lower survival, respectively, providing evidence for the immunoediting hypothesis in EOC. This review focuses on the immune response and immune suppression in EOC. The immunological roles of chemotherapy and surgery in EOC are also described. Finally, we detail pilot data supporting the efficiency of immunotherapy in the treatment of EOC and the emerging concept that immunomodulation aimed at counteracting the immunosuppressive microenvironment must be associated with immunotherapy strategies.
    Journal of Translational Medicine 06/2013; 11(1):147. · 3.46 Impact Factor
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    ABSTRACT: HPV vaccine decreases significantly the risk of cervical cancer in women. However, continuing screening strategies in vaccinated women remains relevant as there is a small residual risk of cancer and pre-cancerous lesions even after prophylactic vaccination. The follow-up strategy to adopt has been the object of reflection by many experts, and especially since the vaccination catch-up population concerning women until 23 years of age will soon become the target screening population following recent guidelines. Finally, the arrival of HPV vaccines forces us to think about screening organization and optimization in a broader way so as it benefits all women concerned, whether vaccinated or not, and not only barely half of them as is the case now. The aim of this work was to clarify the issue and to make proposals for management.
    Journal de Gynécologie Obstétrique et Biologie de la Reproduction 05/2013; · 0.45 Impact Factor
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    ABSTRACT: Introduction The adenocarcinoma of the uterine cervix accounts for 10 to 20% of the premalignant and malignant lesions and is different from the cervical intraepithelial neoplasia and invasive squamous cell carcinoma. Materials and methods Recent literature review (from 1985 to 2012) based on the literature available. Results and discussion Adenocarcinoma in situ is an induced HPV lesion (role of HPV 18) of the glandular epithelium: its preferential endocervical situation explains the difficulties in the diagnosis and follow-up after conservative treatment. If the hysterectomy remains the gold standard for treatment, the conservative treatments (resection in sano of the lesions with margins of more than 1 cm, meticulous study of the operative specimen, compliance with the follow-up) are possible in the young patients who desire to preserve their fertility. The invasive adenocarcinoma is characterized by a more difficult diagnosis because of its endocervical development, and a prognosis less favorable when compared to squamous cell carcinoma with a greater frequency of the lymphatic node involvement and metastatic diffusion. Its treatment must take into account the particular gravity of the factors of worse prognosis (FIGO stage, tumor size, lymphatic node spreading, adenosquamous histological subtype) in particular in the advanced stages and includes beside the surgery, radiotherapy and chemotherapy.
    Journal de Gynécologie Obstétrique et Biologie de la Reproduction. 05/2013; 42(3):207–216.
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    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 26.9mm (±4.9mm) against 18.1mm (±4.4mm) after conization with a mean difference of 8.8mm (±2.4mm) (difference statistically significant P<.0001). The extent of histological specimen was 9mm (±2.2mm) 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 04/2013; · 0.45 Impact Factor

Publication Stats

466 Citations
208.45 Total Impact Points

Institutions

  • 2013
    • Université de Rennes 2
      Roazhon, Brittany, France
  • 1999–2011
    • Centre Hospitalier Universitaire de Rennes
      • Service de gynécologie
      Roazhon, Brittany, France
  • 1994–2011
    • Centre Eugène Marquis
      Roazhon, Brittany, France
  • 2010
    • Centre Hospitalier de Bretagne Sud
      Lorient, Brittany, France
    • Sainte Anne Military Teaching Hospital
      Toulon-sur-Mer, Provence-Alpes-Côte d'Azur, France
  • 2009
    • European University of Brittany
      Roazhon, Brittany, France
  • 2000
    • Université de Rennes 1
      • Faculty of Medicine
      Roazhon, Brittany, France
  • 1994–1997
    • CHRU de Strasbourg
      Strasburg, Alsace, France