Le cancer de l’endomètre est aujourd’hui le plus fréquent des cancers gynécologiques pelviens. Il... more Le cancer de l’endomètre est aujourd’hui le plus fréquent des cancers gynécologiques pelviens. Il est souvent diagnostiqué à un stade précoce. Son pronostic est globalement favorable. Son traitement habituel essentiellement chirurgical repose sur l’hystérectomie avec annexectomie sans élargissement paramétrial associée à la lymphadenectomie pelvienne. Cette présentation simpliste, sans être inexacte, doit être aujourd’hui relativisée. En effet, la situation actuelle est indiscutablement plus complexe et la proposition thérapeutique précédente n’a plus le caractère quasi systématique qui lui a été longtemps reconnu. Dans le souci de parler le même langage, il est nécessaire de rappeler la nouvelle classification FIGO proposée en 2009 [1]. Elle diffère de la précédente sur des points importants. Aujourd’hui le stade 1A correspond aux processus intramuqueux et à ceux pour lesquels l’envahissement du myomètre par le processus carcinomateux est inférieur à la moitié de son épaisseur. Le stade 1B regroupe les cas où cette limite est dépassée, le processus demeurant cependant intra-corporéal. L’ancien stade 1C a donc disparu. En outre, le stade 2 est globalisé, défini par l’atteinte stromale du col utérin, l’atteinte de l’isthme ou celle limitée à la muqueuse endocervicale relevant du stade 1. À ce jour, l’hystérectomie simple associée à l’annexectomie et à la lymphadenectomie pelvienne demeure sans conteste le traitement de référence des cancers de l’endomètre [2]. À ce propos, il est toutefois regrettable de constater combien la voie cœliovaginale parfaitement adaptée à cette procédure est encore si peu utilisée alors que sur le plan de la contrainte et de la morbidité elle est indiscutablement préférable à la laparotomie classique [3].
The ectopic pregnancy (EP) could be treated by spontaneous resolution, or medical treatment or la... more The ectopic pregnancy (EP) could be treated by spontaneous resolution, or medical treatment or laparoscopic treatment. Spontaneous resolution of EP with beta hCG < 1,000 mUl/ml, plasmatic progesterone < 5 ng/ml had 74% success rate. Methotrexate (MTX) injection is the common Medical treatment of EP with beta hCG < or = 5,000 mUl/ml and mean diameter of EP < or = 3 cm: a single dose of 50 mg/m2 or 1 mg/kg intramuscular injection had 93.4% success rate; local injection under sonographic control (1 mg/kg) had 80.2% success rate. The surgical conservative treatment by laparoscopy had 94% success rate.
Questions have been raised about the safety of diagnostic hysteroscopy preceding surgical treatme... more Questions have been raised about the safety of diagnostic hysteroscopy preceding surgical treatment of endometrial carcinoma. Several studies showed that the risk of a positive cytology among patients presenting endometrial adenocarcinoma was increased after diagnostic hysteroscopy, suggesting a peritoneal dissemination of tumor cells due to the exploration. We studied this hypothesis on the basis of a systematic review of the scientific data. Five studies fulfilling inclusion criteria have been selected and have been introduced into a fixed model of meta-analysis. On a total of 756 studied patients, 79 presented a positive peritoneal cytology. The diagnostic hysteroscopy did not increase significantly the risk of abdominal dissemination of tumor cells, the peritoneal cytology being positive among 38 patients in the group having undergone this intervention vs 41 patients in the control group (OR = 1,64; 95% CI: 0,96-2,80). In conclusion, no formal evidence is currently available con...
In France, approximately 2 or 3 million women suffer from urinary incontinence. A consensus has b... more In France, approximately 2 or 3 million women suffer from urinary incontinence. A consensus has been reached about the safety of treatment of genuine urinary stress incontinence by retropubic colposuspension (Burch procedure). The cure rate for the abdominal Burch procedure is 85% after 5 years. Since 1991, laparoscopic retropubic colposuspension has been advocated for the treatment urinary stress incontinence. The procedure can be performed either by laparoscopic intraperitoneal or extraperitoneal approaches or by associated laparoscopic and vaginal routes. The feasibility of laparoscopic colposuspension has been proved. Indeed, a series including 578 patients, showed a laparoconversion rate of 3.6%. The most frequent complication of colposuspension is bladder injury. The majority of cystotomics were treated laparoscopically. The follow-up in this series is relatively short. After one year, the success rate was 96%. However, these results must be confirmed by other series with long...
Transabdominal amnioinfusion can be used to facilitate external cephalic version. Our technique i... more Transabdominal amnioinfusion can be used to facilitate external cephalic version. Our technique involves filling the uterine cavity with 700 or 900 mL of 37C saline under continuous echographic monitoring. External cephalic version is done the next morning. We have used this procedure in six women, all of whom had previous unsuccessful attempts at external cephalic version. After amnioinfusion, all six patients were converted to cephalic presentation and delivered normally, without obstetric or neonatal complications.
Resume La localisation ovarienne de l’endometriose sous forme kystique est une des plus frequente... more Resume La localisation ovarienne de l’endometriose sous forme kystique est une des plus frequente. Son diagnostic repose sur l’echographie endovaginale, qui a une bonne sensibilite et specificite malgre la frequence des presentations echographiques atypiques. Les recidives d’endometriose apres traitement chirurgical sont frequentes, estimees entre 8 et 22 %. Le traitement de reference de l’endometriose est actuellement le traitement chirurgical par voie cœlioscopique, avec pour but l’exerese complete des lesions. Trois options chirurgicales sont possibles : la kystectomie intra-peritoneale, le drainage - vaporisation laser secondaire, et l’ovariectomie. La prise en charge des recidives necessite un diagnostic et distingue la patiente en âge de procreer, la patiente en procreation medicalement assistee (PMA), et la patiente proche de la menopause. La ponction echoguidee pourrait se justifier chez des patientes multioperee et les patientes en PMA, et impose d’accepter le fort taux de recidive d’endometriome apres ponction.
ABSTRACT A reasonable assumption is that incontinence would be relieved by increasing urethral re... more ABSTRACT A reasonable assumption is that incontinence would be relieved by increasing urethral resistance through stimulating alpha-adrenergic receptors in urethral smooth muscle. A review of available medical treatment of stress urinary incontinence is done. Alpha-receptor agonists are not in common use because of systemic side-effects. Estrogens do not seem to have beneficial effect on stress urinary incontinence. Currently, new molecules such as duloxetine, are uptake inhibitor of serotonin and noradrenaline could provide a noninvasive therapy for patients with urinary incontinence. Further studies to identify clinical applications are required.
We present a prospective longitudinal study, using both laparoscopy and operative hysteroscopy, w... more We present a prospective longitudinal study, using both laparoscopy and operative hysteroscopy, which investigated the transport of endometrial cells into the peritoneal cavity. The study was carried out between 1 January 1994 and 31 December 1994 at the ...
International Journal of Gynecology & Obstetrics, 2000
Objectives: Little is known about macrophages in human Fallopian tubes. The aim of the study was ... more Objectives: Little is known about macrophages in human Fallopian tubes. The aim of the study was to discuss the possible roles of the tubal macrophages. Study Methods: The tubal macrophages were examined with a focus on their morphological properties by immunohistochemical staining and transmission electron microscopy. The fine structure of the smooth muscle cells in the tubes was also investigated. For immunohistochemistry, we used two monoclonal antibodies that were specific for human macrophages, namely PM-1K and PM-2K. PM-1K recognizes human monocytes/macrophages corresponding to CD68, and PM-2K recognizes tissue macrophages. Results: PM-lK-positive cells were always present and their numbers increased significantly during the menstrual and early to mid-secretory phases. In contrast, relative numbers of PM-2K-positive cells were small throughout the menstrual cycle. The macrophages during the secretory phase in the endosalpingeal stroma had well-developed intracytoplasmic organelles, but relatively few cytoplasmic vacuoles and granules. In the same phase, many cells of the monocyte/macrophage lineage appeared in the vascular lumen of the stroma. The macrophages during the menstrual phase had well-developed intracellular organelles, with cytoplasmic vacuoles and granules of various sizes and configurations. During the late secretory phase, just prior to menstruation, the smooth muscle cells contained few cytoplasmic filaments but electron-lucent or electron-dense lysosome-like bodies were seen. Conclusions: These findings suggested the presence of macrophages in human Fallopian tubes. It is possible that such mcrophages might be involved in the physiological functions of the tubes during the reproductive period and moreover that they might participate in reconstruction of the tubal muscular layer.
Le cancer de l’endomètre est aujourd’hui le plus fréquent des cancers gynécologiques pelviens. Il... more Le cancer de l’endomètre est aujourd’hui le plus fréquent des cancers gynécologiques pelviens. Il est souvent diagnostiqué à un stade précoce. Son pronostic est globalement favorable. Son traitement habituel essentiellement chirurgical repose sur l’hystérectomie avec annexectomie sans élargissement paramétrial associée à la lymphadenectomie pelvienne. Cette présentation simpliste, sans être inexacte, doit être aujourd’hui relativisée. En effet, la situation actuelle est indiscutablement plus complexe et la proposition thérapeutique précédente n’a plus le caractère quasi systématique qui lui a été longtemps reconnu. Dans le souci de parler le même langage, il est nécessaire de rappeler la nouvelle classification FIGO proposée en 2009 [1]. Elle diffère de la précédente sur des points importants. Aujourd’hui le stade 1A correspond aux processus intramuqueux et à ceux pour lesquels l’envahissement du myomètre par le processus carcinomateux est inférieur à la moitié de son épaisseur. Le stade 1B regroupe les cas où cette limite est dépassée, le processus demeurant cependant intra-corporéal. L’ancien stade 1C a donc disparu. En outre, le stade 2 est globalisé, défini par l’atteinte stromale du col utérin, l’atteinte de l’isthme ou celle limitée à la muqueuse endocervicale relevant du stade 1. À ce jour, l’hystérectomie simple associée à l’annexectomie et à la lymphadenectomie pelvienne demeure sans conteste le traitement de référence des cancers de l’endomètre [2]. À ce propos, il est toutefois regrettable de constater combien la voie cœliovaginale parfaitement adaptée à cette procédure est encore si peu utilisée alors que sur le plan de la contrainte et de la morbidité elle est indiscutablement préférable à la laparotomie classique [3].
The ectopic pregnancy (EP) could be treated by spontaneous resolution, or medical treatment or la... more The ectopic pregnancy (EP) could be treated by spontaneous resolution, or medical treatment or laparoscopic treatment. Spontaneous resolution of EP with beta hCG < 1,000 mUl/ml, plasmatic progesterone < 5 ng/ml had 74% success rate. Methotrexate (MTX) injection is the common Medical treatment of EP with beta hCG < or = 5,000 mUl/ml and mean diameter of EP < or = 3 cm: a single dose of 50 mg/m2 or 1 mg/kg intramuscular injection had 93.4% success rate; local injection under sonographic control (1 mg/kg) had 80.2% success rate. The surgical conservative treatment by laparoscopy had 94% success rate.
Questions have been raised about the safety of diagnostic hysteroscopy preceding surgical treatme... more Questions have been raised about the safety of diagnostic hysteroscopy preceding surgical treatment of endometrial carcinoma. Several studies showed that the risk of a positive cytology among patients presenting endometrial adenocarcinoma was increased after diagnostic hysteroscopy, suggesting a peritoneal dissemination of tumor cells due to the exploration. We studied this hypothesis on the basis of a systematic review of the scientific data. Five studies fulfilling inclusion criteria have been selected and have been introduced into a fixed model of meta-analysis. On a total of 756 studied patients, 79 presented a positive peritoneal cytology. The diagnostic hysteroscopy did not increase significantly the risk of abdominal dissemination of tumor cells, the peritoneal cytology being positive among 38 patients in the group having undergone this intervention vs 41 patients in the control group (OR = 1,64; 95% CI: 0,96-2,80). In conclusion, no formal evidence is currently available con...
In France, approximately 2 or 3 million women suffer from urinary incontinence. A consensus has b... more In France, approximately 2 or 3 million women suffer from urinary incontinence. A consensus has been reached about the safety of treatment of genuine urinary stress incontinence by retropubic colposuspension (Burch procedure). The cure rate for the abdominal Burch procedure is 85% after 5 years. Since 1991, laparoscopic retropubic colposuspension has been advocated for the treatment urinary stress incontinence. The procedure can be performed either by laparoscopic intraperitoneal or extraperitoneal approaches or by associated laparoscopic and vaginal routes. The feasibility of laparoscopic colposuspension has been proved. Indeed, a series including 578 patients, showed a laparoconversion rate of 3.6%. The most frequent complication of colposuspension is bladder injury. The majority of cystotomics were treated laparoscopically. The follow-up in this series is relatively short. After one year, the success rate was 96%. However, these results must be confirmed by other series with long...
Transabdominal amnioinfusion can be used to facilitate external cephalic version. Our technique i... more Transabdominal amnioinfusion can be used to facilitate external cephalic version. Our technique involves filling the uterine cavity with 700 or 900 mL of 37C saline under continuous echographic monitoring. External cephalic version is done the next morning. We have used this procedure in six women, all of whom had previous unsuccessful attempts at external cephalic version. After amnioinfusion, all six patients were converted to cephalic presentation and delivered normally, without obstetric or neonatal complications.
Resume La localisation ovarienne de l’endometriose sous forme kystique est une des plus frequente... more Resume La localisation ovarienne de l’endometriose sous forme kystique est une des plus frequente. Son diagnostic repose sur l’echographie endovaginale, qui a une bonne sensibilite et specificite malgre la frequence des presentations echographiques atypiques. Les recidives d’endometriose apres traitement chirurgical sont frequentes, estimees entre 8 et 22 %. Le traitement de reference de l’endometriose est actuellement le traitement chirurgical par voie cœlioscopique, avec pour but l’exerese complete des lesions. Trois options chirurgicales sont possibles : la kystectomie intra-peritoneale, le drainage - vaporisation laser secondaire, et l’ovariectomie. La prise en charge des recidives necessite un diagnostic et distingue la patiente en âge de procreer, la patiente en procreation medicalement assistee (PMA), et la patiente proche de la menopause. La ponction echoguidee pourrait se justifier chez des patientes multioperee et les patientes en PMA, et impose d’accepter le fort taux de recidive d’endometriome apres ponction.
ABSTRACT A reasonable assumption is that incontinence would be relieved by increasing urethral re... more ABSTRACT A reasonable assumption is that incontinence would be relieved by increasing urethral resistance through stimulating alpha-adrenergic receptors in urethral smooth muscle. A review of available medical treatment of stress urinary incontinence is done. Alpha-receptor agonists are not in common use because of systemic side-effects. Estrogens do not seem to have beneficial effect on stress urinary incontinence. Currently, new molecules such as duloxetine, are uptake inhibitor of serotonin and noradrenaline could provide a noninvasive therapy for patients with urinary incontinence. Further studies to identify clinical applications are required.
We present a prospective longitudinal study, using both laparoscopy and operative hysteroscopy, w... more We present a prospective longitudinal study, using both laparoscopy and operative hysteroscopy, which investigated the transport of endometrial cells into the peritoneal cavity. The study was carried out between 1 January 1994 and 31 December 1994 at the ...
International Journal of Gynecology & Obstetrics, 2000
Objectives: Little is known about macrophages in human Fallopian tubes. The aim of the study was ... more Objectives: Little is known about macrophages in human Fallopian tubes. The aim of the study was to discuss the possible roles of the tubal macrophages. Study Methods: The tubal macrophages were examined with a focus on their morphological properties by immunohistochemical staining and transmission electron microscopy. The fine structure of the smooth muscle cells in the tubes was also investigated. For immunohistochemistry, we used two monoclonal antibodies that were specific for human macrophages, namely PM-1K and PM-2K. PM-1K recognizes human monocytes/macrophages corresponding to CD68, and PM-2K recognizes tissue macrophages. Results: PM-lK-positive cells were always present and their numbers increased significantly during the menstrual and early to mid-secretory phases. In contrast, relative numbers of PM-2K-positive cells were small throughout the menstrual cycle. The macrophages during the secretory phase in the endosalpingeal stroma had well-developed intracytoplasmic organelles, but relatively few cytoplasmic vacuoles and granules. In the same phase, many cells of the monocyte/macrophage lineage appeared in the vascular lumen of the stroma. The macrophages during the menstrual phase had well-developed intracellular organelles, with cytoplasmic vacuoles and granules of various sizes and configurations. During the late secretory phase, just prior to menstruation, the smooth muscle cells contained few cytoplasmic filaments but electron-lucent or electron-dense lysosome-like bodies were seen. Conclusions: These findings suggested the presence of macrophages in human Fallopian tubes. It is possible that such mcrophages might be involved in the physiological functions of the tubes during the reproductive period and moreover that they might participate in reconstruction of the tubal muscular layer.
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