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Biomedical subjects

A Audebert

Publications and source records attributed to A Audebert.

At least 19 recordsLinked to original sources
PubMed2006

[Endometriosis coaching].

Coaching is a well-known terminology and an approach currently used, particularly in the worlds of company management and sport, but its use in the medical field appeared only recently. In the latter field, coaching bears behavioral and psychological aspects. It can not only be intended to a medical team, but also the practionner himself, for a better management of any disease, his patient for a better treatment effect and compliance and an optimal coping with the disease. In the case of endometriosis, a chronic disease, two key aspects are briefly reviewed to illustrate the benefits of coaching and to sensitize health providers to this approach. Thus, an appropriate diagnostic strategy should allow to reduce the delay in the diagnosis, so frequently blamed, and to identify other associated painful diseases. Also, management should be improved as well, not only by applying appropriate therapeutic recommandations, and alternative measures, but also by a better multidisciplinary support towards patient expectations with long-term guidance.

Counseling↗
PubMed2005

[Women with endometriosis: are they different from others?].

The objective of this short review is to identify the particularities of women with endometriosis, especially those complaining of pain and with the most severe lesions. Genetic aberrations play, with a high probability, a major role in the development of this disease, its severity, its tendency to recur and also in its capacity to degenerate. The abnormalities of the endometrium, with exacerbated biological activities, are an example. The woman with endometriosis seems more sensitive to pain through various mechanisms, such as central hypersensitivity and decrease threshold to somatoceptive pain and several associated psychological disorders. Endometriosis is often associated with other painful conditions such as irritable bowel syndrome, interstitial cystitis and fibromyalgia. Finally, also appears also to have a higher risk to develop non Hodgkin's lymphoma or ovarian cancer. These particularities, some of them being still speculative or controversial, should be known in routine practise, in order to offer a better multidisciplinary management, not only for short term, but also long term issues.

Breast Neoplasms↗
PubMed2005

[Diaphragmatic hernia in a rare complication of oesophagectomy for cancer].

INTRODUCTION: Diaphragmatic hernia is a rare complication of oesophagectomy for cancer. We report a series of seven patients to determine characteristics of this entity. PATIENTS AND METHODS: Seven patients (six male and one female, 61 to 68 years old) were operated on for diaphragmatic hernia following oesophagectomy for carcinoma (adenocarcinoma N =4, squamous-cell carcinoma N =3). Oesophagectomy had been performed through abdominal transhiatal approach in four patients and transthoracically in three, with hiatal enlargement in all cases. RESULTS: Three patients, all symptomatic, underwent emergency surgery within two years following oesophagectomy. Of the four patients operated between two and seven years after oesophagectomy, two were symptomatic. Presence of symptoms were neither related with technique of oesophagectomy, nor to type of hiatal enlargement (anterior, or by crura division). All patients with hernia containing small bowel were symptomatic. All patients were operated through abdominal approach. Hernia contained colon three times, small bowel once, and both three times. Hernia reduction needed additional phrenotomy in six patients. Two patients underwent colectomy to treat peroperative colonic ischemia. Diaphragmatic hiatus was calibrated around the gastric tube by direct suture in six patients or with absorbable mesh in one. There was no death. No recurrences occurred with a follow up ranging from one to five years. CONCLUSION: The diaphragmatic hernia after oesophagectomy is due to excessive hiatal enlargement. Hernias occurring early after oesophagectomy are badly tolerated and need urgent reoperation. To prevent this complication of oesophagectomy, we advocate calibration of diaphragmatic hiatus fit to width of gastroplasty.

Adenocarcinoma↗
PubMed2005

[Ovarian endometrioma and infertility: when not to treat?].

Ovarian endometrioma is not infrequently encountered in infertile patients. Its etiopathogeny, its relations with attributed symptoms and the recommanded treatment to apply, are still debated. Various therapeutic tools are available, such as abstention, ultrasonographically guided aspiration and drainage, and surgery. Each option carries specific advantages and disadvantages. Ultrasonographically guided aspiration bears infectious risks. Among various proposed surgical procedures, cystectomy appears to offer the best performances. Results of IVF are slightly or not altered, neither by an ovarian endometrioma, nor by previous surgery, except in case of iterative surgery or if operated lesions were very severe. Laparoscopic surgery is still the first line treatment in many cases. Abstention can be applied in particular circumstances. Ultrasonographically guided aspiration needs to be further evaluated.

Endometriosis↗
PubMed2003

Prospective clinical trial of SprayGel as a barrier to adhesion formation: an interim analysis.

STUDY OBJECTIVE: To evaluate SprayGel, a new sprayable adhesion barrier developed for laparoscopic and open pelvic and abdominal surgical procedures. DESIGN: Prospective, randomized, controlled, multicenter trial (Canadian Task Force classification I). SETTING: University clinic and private clinic. PATIENTS: Forty-five women, 24 randomized to treatment and 21 to control group. INTERVENTIONS: Open or laparoscopic myomectomy with and without application of SprayGel, followed by second-look laparoscopy (SLL) to evaluate postoperative adhesions. MEASUREMENTS AND MAIN RESULTS: Application of SprayGel was fast and easy. On average, 10 weeks after surgery, 18 treated patients (75%) and 13 (61.9%) controls had SLL. That procedure showed 5 (27.8%) of 18 treatment patients to be adhesion free versus 1 (7.7%) of 13 controls (p = 0.163). Patients randomized to SprayGel were 3.6 times more likely to be adhesion free than controls. Mean tenacity scores were significantly lower than in controls (0.5 vs. 1.7), a difference of 0.9 (95% CI 0.3, 1.5, p = 0.003) or 47% (95% CI 17%, 77%) less. Mean adhesion area was reduced in the treatment group (4.1 vs. 5.6) but not significant (p = 0.6747, 95% CI-5.4, 8.4). No adverse events regarding application of SprayGel were seen. CONCLUSION: SprayGel was effective in reducing postoperative adhesion severity, and showed a trend toward reducing frequency and extent of adhesions after laparoscopic and open myomectomy. Further studies are necessary to confirm the promising results of this interim analysis.

Adhesives↗
PubMed2003

[Physiopathology, diagnosis and therapeutic management of stage III and IV endometriosis].

Stage III endometriosis is defined by a r-AFS score respectively ranging from 16 to 40 and stage IV over 40. Deep pelvic endometriosis presents essentially in the form of a painful syndrome dominated by chronic pelvic painful, dysmenorrhea and deep dyspareunia. Pathophysiology of pelvic pain associated with endometriosis remains unknown. In the literature, correlation between extension of the endometriosis and severity of the painful remains controversies. Contraception by levonorgestrel-releasing intra-uterine systems appears to decrease pain related to deeply infiltrating endometriosis. Surgery by laparoscopy remains the first intention treatment when infertility is associated with endometriosis, whereas medical treatment is only palliative in the majority of cases. Success of treatment depends on how radical surgical exeresis is. Spontaneous pregnancy rates are significantly increased after surgical treatment. Recurrent ovarian surgery is not recommended in women with infertility, as it might be deleterious for ovarian reserve. Medical treatment using Gn-RH agonists is indicated when recurrence occurs after surgery.

Endometriosis↗
PubMed2002

[Radiation-induced esophageal carcinoma: report of 11 cases].

STUDY AIM: Radiation-induced oesophageal carcinoma can occur several years after mediastinal irradiation. The aim of this study was to report 11 cases of this rare entity with analysis of its diagnostic, therapeutic and prognostic special features. PATIENTS AND METHODS: From 1983 to 2001, 10 female and one male patients, aged 47 to 76 years, were treated for an oesophageal squamous cell carcinoma which was diagnosed 5 to 25 years after mediastinal irradiation. This irradiation (30 to 78 Gy) was administered in 8 women for breast carcinoma and in other patients for lymphoma. Only one patient had alcoholic consumption and 2 were smokers. An oesophagectomy was performed whenever possible. RESULTS: All (but one) oesophageal tumors were symptomatic. Ten patients underwent an oesophagectomy, including 2 without thoracotomy. Postoperative course was uneventful in 6 cases, 3 patients developed transient respiratory failure and one patient died postoperatively. At late follow-up, 6 patients developed distant metastases (mainly hepatic and pulmonary). These metastases were associated with mediastinal recurrences in 2 cases. No isolated mediastinal recurrence occurred. Median survival was 13 months. CONCLUSION: Clinical presentation and surgical treatment of radiation-induced oesophageal carcinoma are similar to those of other oesophageal squamous cell carcinomas. After oesophagectomy, isolated mediastinal recurrences seem to be rarer than with other cancers. These cancers, which are almost all symptomatic, have a poor prognosis.

Aged↗
PubMed2000

[Characteristics of adolescent endometriosis: apropos of a series of 40 cases].

The particularities of endometriosis were analyzed based upon a series of 40 cases of adolescents aged 11 to 19 years. It was possible to distinguish two entities: 1) endometriosis associated with an obstructive genital anomaly sometimes found in young patients, for which the severity depends upon the delay in establish the diagnosis; these lesions may regress spontaneously, sometimes completely, when the anomaly has been surgically treated; and 2) endometriosis of adolescents aged 17 years or older, noted mainly in the case of chronic pelvic pain or severe dysmenorrhea. Lesions are usually mild and are frequently atypical; they are potentially recurrent, but the possible consequences on subsequent fertility need to be studied further.

Adolescent↗
PubMed1999

[Medical treatment of endometriosis].

Medical treatment of endometriosis has been applied since 40 years. Its rational is based upon the hormone-dependency of the endometriotic lesions inducing a resting status. Adhesions, endometriomas or fibrous sequellae do not respond to medical treatment. Its use in case of associated infertility is very limited. Numerous agents are available for clinical use. Progestins are efficient on pelvic pain, contra-indications, clinical and metabolic tolerance are linked to the hormonal activity of the molecules. They have a low cost. Newer pills deserve to be evaluated. Danazol has now few indications in regards to its clinical and metabolic side-effects. Gn-RH analogs bear a potent efficacy and a very low intrinsic toxicity. They are preferentially used in severe cases, in association with surgery and before an IVF. Add back therapy improves the clinical tolerance and reduces bone mass loss. Many parameters should be taken into account when selecting a specific modality.

Bone Density↗
PubMed1998

Pre or post-operative medical treatment with nafarelin in stage III-IV endometriosis: a French multicenter study.

OBJECTIVES: To determine the effectiveness of a 6-month course of nafarelin in the treatment of stage III-IV endometriosis and to determine if pre-operative use of nafarelin facilitates surgery. DESIGN: Prospective, multicenter, clinical trial. SETTING: Eight university hospitals and two private practice institutions in France. PATIENTS: Fifty-five patients with stage III and IV endometriosis. Two were excluded. INTERVENTIONS: The severity of endometriosis was assessed at the time of laparoscopy and patients were randomized to have either laparosopic surgery at that time following 6 months of nafarelin therapy (n=28), or laparoscopic surgery following 6 months of nafarelin therapy (n=25). All had 200 microg intranasal nafarelin twice a day for 6 months and a second look laparoscopy. MAIN OUTCOME MEASURE: Clinical efficacy, tolerance to the treatment. RESULTS: Efficacy and tolerance to the treatment were the same in both groups. AFS scores compared on both laparoscopies were significantly better if nafarelin was given prior to surgery (P=0.007). CONCLUSIONS: This preliminary study shows that in cases of combined medico-surgical treatment for stage III-IV endometriosis, preoperative medical treatment with GnRH-a gives a better AFS score improvement, but no conclusion was possible whether preoperative treatment facilitates surgery.

Adult↗
PubMed1997

Ongoing pregnancies after intracytoplasmic injection using cryopreserved testicular spermatozoa.

We report two clinical pregnancies occurring after intracytoplasmic sperm injection (ICSI) using cryopreserved spermatozoa obtained from testicular biopsy, made in two different infertility situations in our clinic. The first patient showed a secretory azoospermia associated with elevated serum follicular stimulating hormone (FSH) level and spermiogenesis maturation arrest. The second patient was affected by azoospermia resulting from bilateral epididymal obstruction. Spermatozoa present in the wet preparation of testicular biopsy made on the day of scrotal exploration were cryopreserved within the testicular tissue for both men. Intracytoplasmic injections were performed at a later date, using spermatozoa prepared from frozen-thawed tissues. In each case, three embryos were obtained and transferred in utero. The transfers resulted in a twin pregnancy for the first case, and in a singleton pregnancy for the second. Living foetuses were seen in the ultrasound scan at the 7th week and both pregnancies are proceeding to date beyond 30 weeks without complications.

Adult↗
PubMed1997

Diagnostic and operative microlaparoscopy: a preliminary multicentre report.

Microlaparoscopes have been evaluated for minimally invasive laparoscopy using minimal anaesthesia or analgesia since our preliminary report on microlaparoscopy in 1993. This international multicentre report of safety and efficacy of diagnostic and operative microlaparoscopy was completed to evaluate the role of microlaparoscopy in a wide spectrum of gynaecological indications, diagnoses of pelvic and tubal disease, tubal occlusion and assisted reproduction. A total of 408 patients from seven centres around the world were included in this report. Of the 164 patients who underwent microlaparoscopy under local analgesia only three patients (1.8%) converted to i.v. sedation because of pain intolerance. All 71 patients who underwent microlaparoscopy under i.v. sedation as planned tolerated the procedure with acceptable pain level perception. Only one abdominal wall minor bleeding and one uterine wall minor bleeding were recorded in the remaining 173 patients who underwent microlaparoscopy under general anaesthesia. Visualization of the pelvic organs was sufficient in all 408 cases for diagnosis and treatment of selected pelvic pathology. We concluded, based on this sizeable microlaparoscopy series, that this outpatient procedure can replace large diameter laparoscopy for diagnosis and treatment of various pelvic conditions. Microlaparoscopy can safely replace large diameter laparoscopy in motivated patients who require minor operative procedures such as tubal occlusion, minor adhesiolysis, tubal gamete or embryo transfers and fulguration of endometriotic implants. This series demonstrated that operative microlaparoscopy can be carried out under general anaesthesia, reducing to nil the potential damage of a large diameter tracer. Future improvements in i.v. sedation in combination with i.p. local anaesthesia will potentially eliminate the need for general anaesthesia in some of the patients undergoing minor operative microlaparoscopy.

Feasibility Studies↗
PubMed1995

Coculture of embryos on homologous endometrial cells in patients with repeated failures of implantation.

OBJECTIVE: To evaluate the value of coculture of embryos on endometrial cells in patients with repeated failures of implantation. DESIGN: A retrospective comparison of pregnancy rates between IVF-ET with coculture and standard culture methods. PATIENTS: Ninety patients with repeated failures of transfer (range 4 to 11) underwent IVF-ET for a variety of disorders. METHOD: Embryos were cocultured on homologous endometrial cells and transferred on day 4 after retrieval of oocytes. RESULTS: The overall pregnancy rate for these patients was 21% per transfer versus 8% in previous IVF-ET cycles. A higher percentage (28%) was obtained for women < 39 years of age or on transfer of at least one morula (32.5% pregnancy per transfer). CONCLUSION: Coculture of embryos on homologous endometrial cells is both safe and ethical. It appears to be a valuable approach for the selection of a good quality embryo before transfer. The technique should prove to be of benefit to patients with repeated failures of implantation and also may be of value for assessing the respective responsibility of endometrium and embryo in these repeated failures. However, the mechanisms underlying this improvement need to be determined to simplify the procedure.

Adult↗
PubMed1995

[Age and fertility: value of endometrial co-cultures].

Embryo coculture system may contribute to understand the mechanisms underlying the decrease of fertility with aging. We report here our experience of coculture on maternal endometrial cells and histology of endometrial biopsy in 90 patients with repeated failures of implantation. Histology dating failed to find any age related changes. In coculture system, it is obvious that embryo viability diminishes with aging, but for equal embryonic quality, the maternal age does not interfere significantly on pregnancy rate. Anyway the number of first trimester abortions seems higher in older women. Coculture system emphasizes the major role of oocyte aging in the decrease of fertility and may be useful to establish a prognostic in IVF for older patients.

Adult↗
PubMed1992

[Complications of gynecologic laparoscopy. Multicentric study of 7,604 laparoscopies].

In a series of 7,604 laparoscopic procedures, the authors report one death and a rate of 2.76 per thousand (21 cases) for complications requiring laparotomy. When exclusively diagnostic laparoscopic procedures are considered (1,191 cases) this rate drops to 1.67 per thousand. The likelihood of laparotomy being required is directly related to the degree of importance of the laparoscopic surgical procedure. For major laparoscopic surgery the rate of laparotomy is 4.46 per thousand (18 cases), whereas it is only 0.42 per thousand (1 case) for minor laparoscopic surgery (p less than 0.01). Intestinal injuries represent 52.4% (11 out of 21) of cases requiring laparotomy. The main problem with this type of accident is to recognize them, because in almost half the cases (42.8%; 3 out of 7) the intestinal injury went unseen during the laparoscopic procedure and gave rise to peritonitis. Vascular complications are less frequent and required laparotomy in only 8 cases (38%; 8 out of 21). This low level of complications is yet further proof that laparoscopic surgery is a reliable technique and does not involve a high risk of laparotomy, provided that the surgeon has received specific training.

Female↗
PubMed1991

[Multicentric clinical trial of a combination of 35 micrograms of ethinylestradiol and 2 mg of cyproterone acetate].

The authors report the results of an open multicentric study of 136 women treated by a combination of 35 micrograms ethinylestradiol and 2 mg cyproterone acetate for cutaneous manifestation of hyperandrogenism. No pregnancy occurred during the treatment of 12 months. Comparison between the last treated and non treated cycle showed a significant difference (p less than 0.001) in the severity of acne lesions regardless of their sites. General and gynaecological tolerance were excellent.

Acne Vulgaris↗