P Mares

Université de Nîmes, Nismes, Languedoc-Roussillon, France

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Publications (270)516.7 Total impact

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    Full-text · Article · Nov 2015

  • No preview · Article · Sep 2015 · Ultrasound in Obstetrics and Gynecology
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    ABSTRACT: Post-partum haemorrhage (PPH) is one of the major obstetric complications and remains a cause of avoidable maternal mortality and morbidity. The aims of this study were to assess the success and practicability of a Bakri(™) balloon intrauterine tamponade for PPH and evaluate the predictive factors for success. Women who received the Bakri(™) balloon secondary to uterine atony and subsequent failure of routine drug treatment were identified at 6 hospital sites. Demographic, obstetric and specific factors in regard to the Bakri(™) balloon use were recorded. Factors predictive of Bakri(™) balloon success were evaluated. Intrauterine Bakri(™) balloon tamponade was used in 36 women with uterine atony of which 28 received the balloon treatment after vaginal delivery: more than 50% of women (16/28) presented with PPH with blood loss > 1000 mL (mean blood loss: 1130 mL). Two balloon insertions failures were identified. Bakri balloon success was 100% for women with bleeding < 1000 mL. Twenty-five women (69%) did not require invasive treatment; seven (19%) required arterial embolisation and four (11%) surgical management. No short-term complication was observed after balloon insertion. The use of the Bakri(™) balloon method, if undertaken early, is effective for the management of PPH with uterine atony (100% success compared to 69% overall success rate). Intrauterine balloon tamponade should included in PPH management guidelines. © 2015 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.
    No preview · Article · Jul 2015 · Australian and New Zealand Journal of Obstetrics and Gynaecology

  • No preview · Article · Jun 2015

  • No preview · Article · Jun 2015 · International Urogynecology Journal
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    ABSTRACT: We describe a spontaneous uterine rupture at 14 weeks gestation in a Turner patient. A 39 year-old patient was admitted for abdominal pain and hypotension at 14 weeks of pregnancy. The pregnancy had been obtained by oocyte donation and in vitro fertilization (IVF) because of Turner's syndrome. The abdominal ultrasound scan showed a normal pregnancy and a conserved foetal cardiac activity. It also showed a large amount of free fluid in the perihepatic space. Haemoglobin was 11.2g/dL. After hemodynamic degradation, urgent laparoscopy showed an unrepairable uterine rupture with partial exteriorisation of the pregnancy, and placenta percreta. Urgent conversion to laparotomy allowed haemostatic hysterectomy. Uterine rupture during pregnancy obtained by oocyte donation in Turner's syndrome may be life threatening. The possibility of such a complication should be considered before oocyte donation for IVF in Turner's patients. Early spontaneous uterine rupture (second trimester) is a challenging diagnostic that should be evoked in case of non-specific abdominal pain in the presence of risk factors. Copyright © 2015 Société française d’anesthésie et de réanimation (Sfar). Published by Elsevier Masson SAS. All rights reserved.
    No preview · Article · Apr 2015

  • No preview · Article · Mar 2015
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    ABSTRACT: L’objectif principal de cette revue était d’évaluer les conséquences pelvi-périnéales de la poussée en Valsalva et de la poussée en expiration au moment de l’accouchement.
    No preview · Article · Jan 2015 · Progrès en Urologie
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    ABSTRACT: It is widely supported that multicentric disease of the breast (MCDB) is a contraindication of breast conservative surgery (BCS). This is a multicentric study (two breast cancer units from Greece, one from France) involving patients with at least two primary tumors in separate quadrants of the breast and no diffuse suspicious microcalcifications on mammography. Sixty-one patients were included in the study, but 49 were followed up to the end. Patients were randomly assigned in total mastectomy (TM) and BCS groups. End point of the study was disease-free survival rates three and five years after initial operation. Three years after BCS, local recurrence (LR) was observed in two patients (7%) and one after five years (total recurrence rate: 11%). A TM was performed in these patients, and in two there was no LR or distant metastasis (DM) five years after. The third patient was disease free two-years later. Three years after TM, eight patients (36.4%) had DM and 14 (63.6%) did not (p = 0.004). Five years after TM, eight patients (36.4%) had DM and 14 patients (63.6%) di not (p = 0.03). The results showed that conservative surgery was an alternative surgical option in multicentric breast cancer with good results regarding disease-free survival and recurrence.
    No preview · Article · Nov 2014 · European journal of gynaecological oncology
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    ABSTRACT: Few studies have evaluated urine postvoid residuals (PVRs) and their risk factors during the post-partum (PP) period. The aim of this prospective study was to screen postvoid residuals in a cohort of patients in PP, and to identify the risk factors. For three months, patients in PP were given an evaluation of their PVR (ultrasounds method) after a spontaneous urination. Clinical data as regards delivery were collected. One hundred and sixty-eight patients were included. Among them, 61% had a urine volume at the first urination over 500 mL, and 52% presented with a pathological PVR (PVR over 150mL for a urine volume over 150 mL). The median PVR was 153.50 mL. The median volume of the first spontaneous urination was 400mL. Among patients with a pathological PVR, the total duration of the labor and the duration of its second phase were significantly longer (P=0.003 and P<0.05, respectively), and the volume of the first urination was higher. Indwelling catheterization during the delivery decreased the volume of the first spontaneous urination (volume over 500mL in 28% vs 72% of patients, P=0.017) but was not associated with a decreased PVR in non-pathological deliveries. Instrumental deliveries were associated with higher PVRs than caesarean or physiological deliveries (244mL, 180mL et 156mL; P=0.033). A bacteriuria was not significantly associated with PVR (54% vs 49%, P>0.05). We were able to identify risk factors for PVR in the PP, such as the duration of labor, instrumental delivery and elevated volume of the first urination after delivery. 3. Copyright © 2014 Elsevier Masson SAS. All rights reserved.
    No preview · Article · Oct 2014
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    ABSTRACT: Introduction Few studies have evaluated urine postvoid residuals (PVRs) and their risk factors during the post-partum (PP) period. The aim of this prospective study was to screen postvoid residuals in a cohort of patients in PP, and to identify the risk factors. Materials and methods For three months, patients in PP were given an evaluation of their PVR (ultrasounds method) after a spontaneous urination. Clinical data as regards delivery were collected. Results One hundred and sixty-eight patients were included. Among them, 61% had a urine volume at the first urination over 500 mL, and 52% presented with a pathological PVR (PVR over 150 mL for a urine volume over 150 mL). The median PVR was 153.50 mL. The median volume of the first spontaneous urination was 400 mL. Among patients with a pathological PVR, the total duration of the labor and the duration of its second phase were significantly longer (P = 0.003 and P < 0.05, respectively), and the volume of the first urination was higher. Indwelling catheterization during the delivery decreased the volume of the first spontaneous urination (volume over 500 mL in 28% vs 72% of patients, P = 0.017) but was not associated with a decreased PVR in non-pathological deliveries. Instrumental deliveries were associated with higher PVRs than caesarean or physiological deliveries (244 mL, 180 mL et 156 mL; P = 0.033). A bacteriuria was not significantly associated with PVR (54% vs 49%, P > 0.05). Conclusion We were able to identify risk factors for PVR in the PP, such as the duration of labor, instrumental delivery and elevated volume of the first urination after delivery. Level of evidence 3.
    No preview · Article · Oct 2014 · Progrès en Urologie
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    ABSTRACT: The aim of this study was to assess the gynecology obstetric residents training on a birth simulator.
    No preview · Article · Sep 2014
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    ABSTRACT: La prévalence de l’infection HPV dans la population féminine varie avec l’âge, avec un pic d’environ 30 % autour de 20–25 ans. Elle diminue ensuite progressivement après l’âge de 30 ans pour devenir inférieure à 10 %. Plusieurs études ont cependant rapporté une ré-augmentation de la prévalence de l’infection HPV pouvant atteindre jusqu’à 15 % à partir de 45–50 ans, autour de la ménopause. La persistance de l’infection HPV, directement corrélée au risque de cancer du col utérin, augmente avec l’âge et dépend de différents cofacteurs dont le terrain immunitaire et le type d’HPV oncogène. Chez les femmes ménopausées, l’épidémiologie de l’infection HPV ainsi que les facteurs de persistance de cette infection sont moins bien connus que dans la population féminine jeune. Notre étude vise à répondre aux questions suivantes : quelles sont les caractéristiques spécifiques de l’infection HPV dans cette population particulière (épidémiologie, persistance, facteurs de risque) ? Le test HPV permet-il d’améliorer la stratégie de dépistage en postménopause ? Il s’agit d’une étude descriptive et rétrospective, portant sur une population de femmes ménopausées recrutées, par le même observateur, lors d’une consultation gynécologique de routine au CHU de Montpellier, entre janvier 2007 et décembre 2012, suivi en moyenne pendant 28 mois. Chaque femme a bénéficié d’un FCV en phase liquide et d’un test de détection HPV oncogène (HC2 High-Risk HPV DNA Test, Qiagen). En cas de test HPV positif, un génotypage HPV par méthode INNO LiPA (Fijirebio) a été réalisé. Les patientes ont été référées en colposcopie si elles présentaient un FCV pathologique (seuil ASC-US) ou une infection HPV persistante (2 prélèvements positifs à 12 mois d’intervalle), avec réalisation de biopsies dirigées en cas d’anomalies. Un traitement adapté, par conisation ou hystérectomie, a permis d’obtenir les données histologiques définitives. Parmi les 406 patientes ménopausées incluses âgées de 44 à 84 ans, 40 présentent un test HPV positif soit une prévalence de 9,85 % ; le taux de persistance s’élève à 50 % soit 20 patientes. Un génotypage HPV a été réalisé chez 21 des 40 patientes avec test HPV positif ; nous observons une prédominante des HPV à haut risque 52 et 31 (respectivement 15 % et 10 %). Un antécédent de dysplasie cervicale, l’ancienneté de la ménopause et le tabagisme apparaissent comme des facteurs de risque significatifs d’infection à HPV persistante. Le recours à un traitement hormonal substitutif, quelle qu’en soit la durée, est un facteur protecteur de persistance de l’infection HPV. L’exploration initiale et le suivi mettent en évidence 7 lésions CIN2+ au sein des patientes avec test HPV HR positif, alors qu’aucune lésion n’est diagnostiquée parmi les 366 patientes présentant un test HPV négatif. Notre étude montre une prévalence de l’infection HPV chez les femmes ménopausées autour de 10 %, semblable aux données de la littérature. La persistance de l’infection HPV semble particulièrement élevée dans cette population (rôle de l’altération immunitaire induite par la carence estrogénique ?). Notre étude montre également que le test HPV est un élément de dépistage pertinent en post ménopause, avec une meilleure sensibilité que le FCV pour le diagnostic des lésions CIN2+. Son excellente valeur prédictive négative (VPN) en fait un outil pertinent pour pallier aux faiblesses du FCV dans cette population (50 % de cellules endocervicales absentes sur le FCV). La prévalence élevée de l’infection à HPV et son taux important de persistance suggèrent la poursuite du dépistage au-delà de 65 ans.
    No preview · Article · Sep 2014 · Revue Francophone des Laboratoires
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    ABSTRACT: Objective The aim of this study was to assess the gynecology obstetric residents training on a birth simulator. Materials and methods This is a prospective monocentric study, which had included residents at the beginning of their formation and performed on SIMone™, 3B SCIENTIFIC® birth simulator. It had included four sessions (supervised by two seniors registrar): two on instrumental extraction (vacuum and forceps) and two on labor monitoring. The two sessions were performed at one month. A theoretical formation was accomplished after the first assessment. Three assessments were performed based on two score scales (extraction and labor monitoring). A free training was allowed at each extraction session. Results Twelve interns were included in this study. There was a significant scores improvement between first and third session for instrumental extraction (2.4 points on 11 [± 1.8] vs. 8 [± 0.9]; [P < 0.05]) and for labor monitoring (5.2 [± 1.4] points on 9 vs. 6.6 [± 1.3]; [P < 0.05]). Interns considered this training improved their theoretical and practical knowledge for respectively 11 and 12 interns on 12. For 9 interns, a most important debriefing with teachers was desirable. Conclusion Training on birth simulator allows an improvement of knowledge and skill of gynecology obstetric interns. A structured debriefing should be instituted after the sessions.
    No preview · Article · Sep 2014 · Journal de Gynécologie Obstétrique et Biologie de la Reproduction
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    ABSTRACT: Cervical agenesis is a rare congenital pathology linked to an anomaly of development of the Mullerian system. We described a case report about a 22-year old woman, consulting for infertility, who had a complete cervical agenesis. The first evaluation suggested a 46 XX karyotype and a normal ovarian reserve. The surgical examination confirmed the absence of cervix with impossibility of catheterization. She became pregnant thanks to an in vitro fertilization (IVF) with transmyometrial embryo transfer. Caesarean was decided at 36 weeks of gestation (WG) due to spontaneous uterine contractions. An injection of medroxyprogesterone was made after the placenta delivery in order to warning the partum hemorrhage. The ultrasound examination, realized 15 days after caesarean, underlined a good uterine involution. The surgery by cervico-vaginal anastomosis can be offered to patients because it offers chances of spontaneous pregnancies. But this surgery exposes women to a risk of failure, and of severe complications such as pain or infection, and might end in a hysterectomy. By choosing the transmyometrial transfer by vaginal way, the patient was exposed to the risk of spontaneous miscarriage. It was raising the problem of the uterine evacuation. This delivery after 34 WG is encouraging for the infertility by cervical agenesis.
    No preview · Article · Sep 2014 · Journal de Gynécologie Obstétrique et Biologie de la Reproduction
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    ABSTRACT: Objectives Describe the central nervous system (CNS) adverse effects of anticholinergic drugs used for the treatment of overactive bladder (OAB) in the elderly. Patients and methods Relevant data from the literature were identified primarily through a Medline search of articles published through December 2013. The search terms included overactive bladder, central nervous system, elderly, anticholinergic, and antimuscarinic. Articles were chosen for inclusion based on their pertinence to the focus on treatment of OAB in the elderly. Results Several anticholinergic drugs are available for the treatment of OAB, including oxybutinin, tolterodine, trospium chloride, solifenacine, fesoterodine. Among the agents reviewed, penetration of the blood-brain barrier (as predicted by lipophilicity, polarity, and molecular size and structure) is highest for oxybutinin, lower for tolterodine, solifenacine, and darifenacine, and lowest for fesoterodine and trospium chloride. Unwanted CNS adverse effects depend in part on patient specific variability in pharmacokinetic parameters, blood-brain barrier permeability, degree of cholinergic neuronal degeneration, total anticholinergic drug burden and patient's baseline cognitive status. The spectrum of anticholinergic CNS adverse effects ranges from drowsiness to hallucinations, severe cognitive impairment, and coma. Among the different anticholinergic agents, oxybutinin has been associated with cognitive impairment and trospium chloride and fesoterodine have shown favorable CNS tolerability. Conclusions Anticholinergic drugs improve significatively overactive bladder symptoms in older adults. However, potential CNS adverse effects of anticholinergic agents used in OAB must lead to a full evaluation before and during the treatment in order to evaluate benefice, risks and central side effects in this frail population.
    No preview · Article · Sep 2014 · Progrès en Urologie
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    ABSTRACT: Describe the central nervous system (CNS) adverse effects of anticholinergic drugs used for the treatment of overactive bladder (OAB) in the elderly.
    No preview · Article · Sep 2014
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    ABSTRACT: The aim of the present study was to evaluate the value of a box trainer simulator in laparoscopy training. A further aim was to determine if robotic-assisted approaches further improved the young residents' skills in laparoscopic surgery. The study was a prospective randomized study. Twelve residents in obstetrics & gynecology completed four laparoscopy-related procedures of varying complexity using a box trainer simulator. Participants were randomized into two groups; robotic-assisted laparoscopy (LRA) and traditional laparoscopy (TL). All subjects were assessed with a time and technical score, which are quantitative and qualitative approaches (respectively). All residents completed the training and a satisfaction questionnaire, which confirmed that the training was well regarded. Regardless of the workshop type, there was a clear time and technical improvement for the difficult tasks. The improvement of time score was most apparent for simple tasks in LRA and for more complex tasks in TL. After training, we did not find a significant difference for the technical score between Novices and Experts in TL and LRA. These findings suggest that training in laparoscopy surgery is useful, reproducible and well accepted by both novice and more advanced trainees. Furthermore, gynecological endoscopy center consider including robotic-assisted approaches in their surgical training program.
    No preview · Article · Aug 2014 · European Journal of Obstetrics & Gynecology and Reproductive Biology
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    Full-text · Article · Aug 2014 · Annales de biologie clinique
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    ABSTRACT: Cervical agenesis is a rare congenital pathology linked to an anomaly of development of the Mullerian system. We described a case report about a 22-year old woman, consulting for infertility, who had a complete cervical agenesis. The first evaluation suggested a 46 XX karyotype and a normal ovarian reserve. The surgical examination confirmed the absence of cervix with impossibility of catheterization. She became pregnant thanks to an in vitro fertilization (IVF) with transmyometrial embryo transfer. Caesarean was decided at 36weeks of gestation (WG) due to spontaneous uterine contractions. An injection of medroxyprogesterone was made after the placenta delivery in order to warning the partum hemorrhage. The ultrasound examination, realized 15days after caesarean, underlined a good uterine involution. The surgery by cervico-vaginal anastomosis can be offered to patients because it offers chances of spontaneous pregnancies. But this surgery exposes women to a risk of failure, and of severe complications such as pain or infection, and might end in a hysterectomy. By choosing the transmyometrial transfer by vaginal way, the patient was exposed to the risk of spontaneous miscarriage. It was raising the problem of the uterine evacuation. This delivery after 34WG is encouraging for the infertility by cervical agenesis.
    No preview · Article · May 2014

Publication Stats

2k Citations
516.70 Total Impact Points

Institutions

  • 1990-2015
    • Université de Nîmes
      Nismes, Languedoc-Roussillon, France
  • 2001-2013
    • Centre Hospitalier Régional Universitaire de Nîmes
      Nismes, Languedoc-Roussillon, France
    • Centre Hospitalier Universitaire de Montpellier
      Montpelhièr, Languedoc-Roussillon, France
  • 2011
    • College of Obstetrics and Gynecology of Leon
      Aquitaine, France
  • 2007
    • Université de Montpellier 1
      Montpelhièr, Languedoc-Roussillon, France
  • 2006
    • Institut Hospitalo-Universitaire
      Pessac, Aquitaine, France
  • 2002
    • Centre Hospitalier Universitaire de Limoges
      Limages, Limousin, France
  • 1996
    • Clinique Beau-Soleil
      Montpelhièr, Languedoc-Roussillon, France
  • 1993
    • CHRU de Strasbourg
      Strasburg, Alsace, France