[Show abstract][Hide abstract] ABSTRACT: To determine whether recent progress in imaging has made it possible to diagnose spontaneous detorsion, which is an accepted concept in the gynecological literature but until now has been a presumptive diagnosis that could not be confirmed because of the lack of imaging proof.
We searched for patients who had a diagnosis of spontaneous detorsion on MRI between January 2000 and January 2003, and selected only patients who met a selection of strict criteria, including mainly enlargement and hyperintensity of ovarian stroma on T2-weighted (T2W) images, clinical findings compatible with torsion and detorsion, and return of the stroma to normal size on follow-up examinations. Other signs of torsion, such as tubal thickening, were appreciated but not mandatory. Clinical follow-up for at least three years was available.
Four patients met the study criteria. No stabilizing procedure was performed in the ovaries. One patient recurred and lost her ovary.
The diagnosis of torsion followed by spontaneous detorsion was made with high probability in a selected number of patients. The clinical management of such patients remains a matter of debate. Laparoscopy with oophoropexy would be useful for young patients in whom close follow-up cannot be achieved.
Journal of Magnetic Resonance Imaging 11/2006; 24(4):880-5. DOI:10.1002/jmri.20711 · 2.79 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: We report the sonographic findings of a rare benign ovarian tumor in a 69-year-old woman. Transvaginal ultrasonography showed a cystic multilocular lesion with a vascularized central solid portion of the left ovary. Surgery revealed an adenomatoid tumor. Adenomatoid tumors are benign lesions of mesothelial origin, usually solid in nature and rarely located in the ovaries. (c) 2005 Wiley Periodicals, Inc. J Clin Ultrasound 33:233-236, 2005.
[Show abstract][Hide abstract] ABSTRACT: We describe the imaging features of a tailgut cyst mistaken for an adnexal mass. A pelvic ultrasound in a 28-year-old woman showed a 10-cm hypoechoic left pelvic mass. Having not seen the left ovary, the radiologist concluded that the mass was an endometrioma. CT disclosed a retrorectal cystic lesion with wall calcifications and internal septa. MR confirmed the extra-ovarian location of the tumor, which was hyperintense on T2-weighted images and had an intermediate signal on T1-weighted images. Surgery revealed a retrorectal cystic hamartoma. Radiological diagnosis of a tailgut cyst requires first correct localization of the tumor and then differentiation from other retrorectal masses.
European Radiology 03/2005; 15(2):263-6. DOI:10.1007/s00330-004-2330-4 · 4.34 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To describe the ultrasound and MR appearance of paraovarian cystadenomas.
We reviewed retrospectively the radiologic findings in 7 patients with surgically proven paraovarian cystic neoplasms, including 6 serous cystadenomas and 1 borderline seromucinous cystadenoma. All had ultrasound and 4 had MR preoperatively.
On ultrasound, the ipsilateral ovary was visualized in six cases, in contact with the cyst in five and separate from it in one. On MR, the ovary and the cyst were visible in four cases, in contact in three and separate in one. Internal papillary excrescences, present at pathology in all cysts, were seen in five on ultrasound and in four on MR.
Although the extraovarian location of these neoplasms is difficult to determine preoperatively by ultrasound and MR, these imaging modalities are more reliable in predicting the histology of these rare lesions and differentiating them from simple paraovarian cysts.
[Show abstract][Hide abstract] ABSTRACT: To evaluate ultrasound (US) and magnetic resonance (MR) findings in the viable twisted adnexa.
Ten patients underwent US and MR studies before surgical detorsion. Corrected cross-sectional area of the ovary was defined as cross-sectional area minus areas of cysts and follicles superior to 1 cm. On T2-weighted images, signal intensity of the stroma was graded as type 1 when it was equal to that of urine and type 2 when it was less than that of urine but markedly more than the contralateral side.
The tube was twisted in six cases and the ovary in nine cases. All adnexa were viable. The largest ovarian cross-sectional area and the largest corrected ovarian cross-sectional area of the twisted ovary were significantly larger than those of the contralateral ovary (P = 0.043 for US; P = 0.012 and 0.017, respectively, for MR). These ovaries contained types 1 and 2 hyperintensity in six cases and only type 2 hyperintensity in three cases. Tubal thickening was seen on MR in five cases.
Tubal thickening, enlargement of ovarian stroma as reflected by the corrected cross-sectional area, and hyperintensity of this stroma on T2-weighted images probably related to edema were useful findings in these viable torsions.
Journal of Magnetic Resonance Imaging 10/2004; 20(3):451-62. DOI:10.1002/jmri.20131 · 2.79 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To assess the effectiveness of a protocol of pulsatile gonadotropin releasing-hormone (GnRH) in treating infertility in women with primary hypothalamic amenorrhea.
Retrospective analysis of 44 cycles treated at an infertility center. Twenty-four patients with primary hypothalamic amenorrhea were treated intravenously with pulsatile GnRH using 5 micrograms per bolus every 90 minutes. Ultrasound monitoring and cervical assessment by Insler's scoring system allowed timed injection of human chorionic gonadotropin (hCG) and intrauterine insemination if needed. Luteal support was provided with hCG.
The ovulation rate was 95% with the 5-microgram dose. A single follicle was produced in 91% of cycles. The overall pregnancy rate per ovulatory cycle was 45%, and the pregnancy rate per patient was 83%. In patients treated previously with exogenous gonadotropins, poor results were observed. Only one case of mild overstimulation was reported.
Pulsatile GnRH is an effective and safe method of treating infertility in women with primary hypothalamic amenorrhea, thus simulating normal ovulation; however, more-interventional management, including the qualitative estrogenic response, may lead to optimal results and increase the pregnancy rate.
The Journal of reproductive medicine 02/2001; 46(1):23-8. · 0.58 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: During an eighteen-year period, forty-nine patients with invasive epidermoid carcinoma of the vulva were treated by a radical vulvectomy at the Hôtel-Dieu de France hospital in Beirut. The age, the clinical presentation, and the lymph nodes involvement were close to what was published in the literature. The overall five-year survival rate was 72%. Those with stage I disease lesions had an excellent survival rate. A review of the literature would indicate that a conservative approach in the treatment of early invasive lesions can give satisfactory results, and that adjuvant radiotherapy is more beneficial than pelvic lymph nodes dissection when there is a high risk of pelvic involvement.
Le Journal médical libanais. The Lebanese medical journal 01/2000; 48(3):147-51.
[Show abstract][Hide abstract] ABSTRACT: This is an epidemiological study of 1,498 patients who underwent laparoscopic surgery for different reasons. Between 1989 and 1996, 308 cases of endometriosis were identified among 1,498 patients who underwent laparoscopic surgery. One hundred and five patients were admitted for pelvic pain, 794 for infertility, 319 patients had both on admission, and 280 were admitted for non-gynecologic complaints. The incidence of endometriosis is related to the chief complaint on admission. This disease has different clinical manifestations, different locations and different stages. The mean age in our series is greater than that reported by the literature. The symptoms are related to the location of the lesions but not the stage of the disease. Unlike pelvic pain, infertility is correlated to the stages of the disease.
[Show abstract][Hide abstract] ABSTRACT: In a review of the literature the authors describe the complications encountered during gynecological laparoscopy, insisting on the preparation phase, the conversion to laparotomy and the death cases. Vascular, digestive and urinary lesions, as well as anesthetic difficulties are discussed, aiming at a better prevention. Early recognition of the problem is an important prognostic factor for these patients.
[Show abstract][Hide abstract] ABSTRACT: The association between pregnancy and Cushing syndrome is extremely rare. The diagnosis of Cushing syndrome during pregnancy is rendered difficult by hyperoestrogenic state that alters many of the classical tests. An early and precise diagnosis with adequate management will allow us to reduce maternal and fetal risks.
[Show abstract][Hide abstract] ABSTRACT: We report three cases of ovarian carcinoma associated with fertility drugs. Two patients were hyperstimulated by clomiphen citrate (CC). The third had hMG + CC. Two of these patients had a Borderline ovarian carcinoma and the third had an invasive ovarian carcinoma associated with endometrial carcinoma.
[Show abstract][Hide abstract] ABSTRACT: To review our series of radical vulvectomies and to compare it with results of conservatif treatment.
We reviewed the 34 cases of vulvar squamous cell carcinoma treated in Hotel-Dieu de France, between January 1978 and December 1988. The treatment was a radical vulvectomy associated with either ipsilateral inguinofemoral lymphadenectomy (67.64%) or bilateral inguinofemoral and pelvic lymphadenectomy (32.26%).
The age and the clinical presentation were consistent with the world literature as was the incidence of lymph node metastasis correlated with disease stage. The rate of local recurrence was consistent with the world literature (8.82% vs 12%) showing lower risk of urinary incontinence. Seroma and wound dehiscence correlated with stage were 20.6%m 26.5% and 11.8% for stages I, II and III respectively. The 5 year survival correlated with stage for these patients were: 87.5%, 63.1% and 42.8% for stages I, II and III respectively whereas the 5 year survival correlated with lymph nodes metastasis was 78% for node (-) and 42% for node (+).
Between 1978 and 1988,our therapy guideline for vulvar carcinoma was radical total vulvectomy. Modifications to this guideline were made specially in using a more conservative approach and radiotherapy when there was a risk of pelvic node involvement.
Journal de Gynécologie Obstétrique et Biologie de la Reproduction 02/1995; 24(6):595-9. · 0.62 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: We report a case of primary choriocarcinoma of the cervix in which the patient died 9 months later. The treatment consisted to administer 5 cycles of chemotherapy pre-operatively and a colpohysterectomy. The pathogeny is a cervical migration of trophoblastics cells after a normal or molar pregnancy which degenerate to choriocarcinoma.
Journal de Gynécologie Obstétrique et Biologie de la Reproduction 02/1994; 23(2):149-51. · 0.62 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The authors present two cases of uterine rupture by placenta percreta at 27 and 36 weeks of gestation. Conservative treatment was used in the first case, and radical in the second. Concerning placenta percreta, an overview is presented. The pathophysiology is unclear, but a perturbation in the equilibrium between the trophoblast and the caduque is accepted. Many factors, maternal uterine and placental, contributes to this situation. Clinical presentations are hemorrhage, uterine inversion or rupture. The disappearance of the retroplacental anechogenic zone is the recent ultrasound's contribution to the early diagnosis. The treatment is either radical which is the treatment of choice or conservative and the methotrexate could be an interested option.
Journal de Gynécologie Obstétrique et Biologie de la Reproduction 02/1993; 22(6):649-52. · 0.62 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The association between Hodgkin's disease and pregnancy is rare. Hodgkin's disease does not affect the normal progress of the pregnancy nor of the fetus. Pre-therapy investigations of Hodgkin's disease have to be modified by pregnancy and in particular radiological examinations. Three are certain recommendations to be considered: termination of pregnancy is sometimes indicated in the first trimester but it does not have to be carried out routinely. Chemotherapy can be used in pregnancy as can radiotherapy if the disease is localised to the sub-diaphragmatic area.
Journal de Gynécologie Obstétrique et Biologie de la Reproduction 02/1993; 22(7):783-6. · 0.62 Impact Factor