[Show abstract][Hide abstract] 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
[Show abstract][Hide abstract] 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
[Show abstract][Hide abstract] 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.
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).
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
No preview · Article · Oct 2014 · Progrès en Urologie
[Show abstract][Hide abstract] 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
[Show abstract][Hide abstract] 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.
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.
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
[Show abstract][Hide abstract] 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
[Show abstract][Hide abstract] 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.
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.
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
[Show abstract][Hide abstract] 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
[Show abstract][Hide abstract] 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.