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Biomedical subjects

A Bongain

Publications and source records attributed to A Bongain.

At least 19 recordsLinked to original sources
PubMed2006

[Sternalis muscle in breast surgery].

The sternalis muscle is a normal anatomic variant, which exists in about 5 to 8% of people. It runs longitudinally superficial to pectoralis major, alongside the sternum. Although the sternalis seems common in cadaveric studies, physicians are not familiar with it, which may lead to confusion in diagnosis. Occasionally, the sternalis may be misinterpreted as a breast mass on mammogramm. In that case, computed tomography and magnetic resonance imaging are useful. We report herein two cases of sternalis muscles encountered during mastectomy.

Breast Neoplasms↗
PubMed2006

[Psychological factors of genital automutilation and medico-ethical interest in emergency vulvoplasty].

The genital self-mutilation is not rare in women. Risk factors found in these cases are: mood disorders, food behavior anomalies and antecedents of sexual aggression. However, surgical repair is not done in emergency: we find no similar report to our clinical case describing an added up bilateral reduction nymphoplasty carried out in emergency after hemorrhagic genital self-mutilation. We discuss psychological risk factors, psychiatric diagnosis and optimal treatment, studied from medico-ethical point of view, for this surgical emergency.

Circumcision, Female↗
PubMed2006

Impact of walking epidural analgesia on obstetric outcome of nulliparous women in spontaneous labour.

BACKGROUND: To explore the effects of walking epidural analgesia on obstetric and neonatal outcomes, we performed a case-control study. METHOD: Each nulliparous woman receiving walking epidural analgesia using 0.0625% bupivacaine (n = 44) was matched to two nulliparous historical controls receiving 0.125% or 0.25% bupivacaine (n = 88 each) for epidural analgesia while recumbent. RESULTS: Maternal and obstetric parameters, fetal status and presentation, and oxytocin use were comparable among groups. Those receiving walking epidural analgesia walked for a mean of 60 min (range: 20-75 min). In the control groups the mean total durations of labour were shorter (58 min in the 0.125% group and 99 min in the 0.25% group, P < 0.05). Significantly fewer walking epidural analgesia cases than controls required instrumental vaginal delivery (P < 0.05). No other differences in obstetric or fetal outcome were observed and no mother fell or stumbled while walking. CONCLUSION: Although it was associated with a prolonged first stage of labour, walking epidural analgesia appeared safe for nulliparous women and their babies.

Adult↗
PubMed2006

[Bening enterogenital fistulas arising from the digestive tract: three cases].

Fistulas between the female genital tract and the digestive tract occur after obstetrical, oncological, or post-operative complications. We report herein 3 rare cases of enterogenital fistulas: one colouterine fistula and one colotubal fistula in a patient with diverticulitis, and one ileovaginal fistula in a patient with Crohn's disease. Vaginal discharge was frequent and incited patients to consult a gynecologist. Better knowledge of enterogenital fistulas is necessary to enable earlier diagnosis and apply specific treatment. The incidence of colovaginal fistulas is increasing in diverticular disease because of increased prevalences of hysterectomies and diverticular disease.

Adult↗
PubMed2005

[Vaginal evisceration. Report of a new case].

Vaginal evisceration is rare and most commonly found in postmenopausal women. We report the case of a postmenopausal woman due to ruptured enterocele. Surgical treatment was done through a midline laparotomy and consisted of bowel resection with primary anastomosis and vaginal vault suture repair. Risk factors for this rare clinical entity are discussed along with the different therapeutic options.

Anastomosis, Surgical↗
PubMed2005

[Pregnancy in type 1 diabetes: insulin pump versus intensified conventional therapy].

OBJECTIVES: To evaluate and compare the outcome of pregnancies in women with type 1 diabetes treated with continuous subcutaneous insulin pump or multiple insulin injections. PATIENTS AND METHODS: Thirty-three patients treated with pump, 23 with multiple injections. Were mainly investigated: glycemic control (HbA1C), fetal outcome (congenital malformations, preterm delivery, perinatal mortality), rates of gestational hypertension and cesarean section. RESULTS: HbA1C (1st, 2nd and 3rd trimester) with pump was not significantly different from that obtained with multiple injections (respectively, 7.5 +/- 1.24 vs 7.6 +/- 1.4; 6.34 +/- 0.6 vs 6.6 +/- 0.8; 6.6 +/- 0.7 vs 6.4 +/- 0.7). Fetal prognosis was also similar. The occurrence of gestational hypertension was linked to diabetic complications [OR 5,7, IC95% 1.24-25, p = 0.0025]. The rate of cesarean section (70% in women treated with pump) was influenced by diabetes duration. In planned pregnancy, independently of therapeutic device, HbA1C during organogenesis was better (6.9% +/- 0.78 vs 8.51 +/- 1.3, p < 0.0001) with no perinatal death and no major congenital malformation. DISCUSSION AND CONCLUSION: Fetal prognosis is not overall significantly different with insulin pump compared with intensified conventional therapy. The initiation of insulin pump therapy should not be systematic. Instead, the benefits risks ratio must be assessed resulting in a tailored prescription according to individual needs. This therapeutic choice should be discussed before conception, as planned pregnancy is a main prognostic factor. Diabetes duration and complications remain key factors for the prognosis.

Adult↗
PubMed2005

[Evaluation of the TVT technique according to age].

OBJECTIVE: To compare efficacy and long-term morbidity of the TVT between patients younger than 70 years and patients older than 70 years. METHOD: Retrospective monocentric study from January 2000 to May 2001. A postal questionnaire was sent to patients to evaluate their satisfaction and their functional status after surgery. RESULTS: The study included 154 patients, and 137 (89%) answered the questionnaire. Seventy-two were less than 70 years old (52.5%) and 65 were more than 70 years old (47.5%). The satisfaction rate in the total population was 88.3%. Amongst the patients younger than 70 years, 97.5% were cured or improved, versus 78.5% of the oldest patients (p=0.001). The study within age groups showed that the satisfaction rate between 70-74 years was higher (92.6%) than in the total population and lower after 75 years (66.7%). This difference is linked to the rates of de novo and persistent urge incontinence, which increase after 75 years. CONCLUSION: The TVT seems to be a good treatment for urinary incontinence in women younger than 75 years. Patients should be warned that preoperative urge incontinence may persist after surgery.

Adult↗
PubMed2005

[Bowel perforation as late complication of tension-free vaginal tape].

Tension-free vaginal tape (TVT) is considered as the treatment of choice for female stress urinary incontinence. Bowel erosion is a rare complication of TVT that generally occurs a few days after surgery with a clinical picture of peritonitis and/or intestinal obstruction. Herein is reported a case of a bowel erosion with a late clinical manifestation 3 months after hysterectomy and TVT placement for genital prolapse and urinary incontinence. Bowel erosion may complicate TVT operation several months after surgery and should be considered as differential diagnosis in patients presenting with a clinical picture of peritonitis and/or intestinal obstruction.

Aged↗
PubMed2005

Combination of apolipoprotein E2 and lipoprotein lipase heterozygosity causes severe hypertriglyceridemia during pregnancy.

Pregnancy is a physiological condition where plasma triglyceride levels are moderately increased. This results from raised synthesis of very-low-density lipoproteins (VLDL) in response to elevated estrogen levels. The occurrence of marked hypertriglyceridemia (HTG) is rare and may result from combination of heterozygote mutation in the lipoprotein lipase (LPL) gene and apolipoprotein E2 isoform, as reported in this case. This observation illustrates the interaction between genetic and environmental factors, since pregnancy may disclose a silent LPL deficiency. The risk of acute pancreatitis threatens both the mother and fetus lives. Early recognition of severe HTG and appropriate management are essential for a successful pregnancy outcome.

Apolipoprotein E2↗
PubMed2004

[Pregnancy and type 2 diabetes: which fetal prognosis?].

OBJECTIVES: The rise in the prevalence of type 2 diabetes in women of childbearing age leads to an increasing number of pregnant women with type 2 diabetes. But published data on fetal outcome are scarce. PATIENTS AND METHODS: In a prospective study from 1999 to 2002, we assessed fetal outcome (preterm delivery, perinatal mortality, congenital malformations) in 20 pregnancies associated with type 2 diabetes and compared the outcome to 40 pregnancies associated with type 1 diabetes. RESULTS: Women with type 2 diabetes are older (32 +/- 5 vs. 27 +/- 5, P = 0.003), more obese (body mass index: 28.3 +/- 4.8 vs. 22.8 +/- 5.5, P < 0.001) than women with type 1 diabetes. Their pregnancy usually is not planned (10% vs. 55%, P < 0.001). HbA1c during organogenesis is above 8% in 46.6% of type 2 vs. 26.4% of type 1 (P < 0.001). Compared with data obtained in the general population, a fivefold increase in preterm delivery (26.3% vs. 4.7%), a sevenfold increase in perinatal mortality (5% vs. 0.7%) and congenital malformations (15.8% vs. 2.2%) are observed. These results are similar to those obtained in type 1. In planned pregnancy, HbA1c during organogenesis is under 7% with no perinatal death and no major congenital malformation. DISCUSSION AND CONCLUSION: Pregnancy complicated by type 2 diabetes is a high-risk one, as much as in type 1 diabetes. Efficient pre-pregnancy care needs to be strongly encouraged in women with type 2 diabetes who also display many risk factors for adverse fetal outcome.

Adult↗
PubMed2004

[Repeated thromboembolism during pregnancy with constitutional antithrombin deficiency].

We report the case of a twenty-three-year old woman with constitutional antithrombin deficiency, who had oral anticoagulation since she was four years old. During her first pregnancy, after the introduction of unfractionated heparin prophylactic therapy, she presented a first venous thromboembolism at nine weeks, and a second one with low-molecular-weight heparin therapy at nineteen weeks. Because of a severe antithombin deficiency, regular infusions of antithrombin concentrates were necessary until delivery to ensure effective anticoagulation by heparin. Patients with antithrombin deficiency have a very high risk of venous thromboses during the pregnancy and post-partum. We discuss the significant points of management for this period.

Adult↗
PubMed2004

[Unexpected discovery of a bladder tumor during a TVT operation].

With the common use of the tension-free vaginal tape (TVT) procedure, we will probably be facing more and more pathologies that will require a transurethral treatment. We report an intra-operative discovery of a bladder tumor during a cystoscopic TVT procedure. The tumor was easily treated by several transurethral resections without any consequences on the result of the TVT procedure.

Cystoscopy↗
PubMed2003

Delayed delivery of second twin: a multicentre study of 35 cases.

OBJECTIVE: The aim of this study was to conduct a statistical analysis to determine the outcome of conservative treatment after delivery of a first fetus in multiple pregnancy and thus define new prognostic factors. STUDY DESIGN: Multicentre retrospective study involving 12 centers over a 10-year period. RESULTS: Twenty-eight twin pregnancies and seven triplet pregnancies which were managed conservatively. In twin pregnancies, 79% of the delayed-delivery fetuses survived; only 7% of the first delivered fetuses survived. The mean interval between deliveries was 47 days. No statistical difference was found concerning cerclage, antibiotic therapy, tocolysis and hospitalization. Earlier delivery of the first twin and premature rupture of membranes for the second twin were significantly related to a longer interval between deliveries. CONCLUSION: Delayed delivery in multifetal pregnancies can be successful if there are no contraindications and these pregnancies are managed in a tertiary perinatal center. Publications limited to successful cases have undoubtedly introduced some bias in assessment.

Anti-Bacterial Agents↗