Biomedical subjects

A Pigné

Publications and source records attributed to A Pigné.

13 recordsLinked to original sources

PubMed1992

Survival with intraperitoneal cisplatin in advanced ovarian cancer after second-look laparotomy.

We studied survival in 36 patients with Stage III/IV ovarian cancer who received intraperitoneal high-dose cisplatin (200 mg/m2) alone or in combination with cytarabine (2 g), after intravenous (i.v.) cisplatin-based chemotherapy followed by second-look laparotomy. Complete responders were scheduled for three courses of IP chemotherapy, and others for six. Eight patients (22%) did not complete treatment (6 catheter failures and 2 renal failures). Peritoneal cytology remained positive in 6 patients (17%). Median overall and progression-free survival after second-look laparotomy were 44 and 37 months, respectively, for 13 complete responders to i.v. chemotherapy; 24 months and 11 months for patients with residual tumors less than 2 cm (17 cases); 15 and 12 months with tumors greater than 2 cm (6 cases). There was a significant difference in overall (p = 0.05) and progression-free (p = 0.001) survival between complete responders to i.v. chemotherapy and patients whose tumor was less than 2 cm. We find no evidence that high-dose cisplatin-based intraperitoneal chemotherapy given after second-look laparotomy will enhance survival in advanced ovarian cancer with zero or minimal residual disease.

Antineoplastic Combined Chemotherapy Protocols↗

PubMed1991

[Primary biliary cirrhosis and pregnancy. Apropos of a clinical case. Review of the literature].

The appearance of pruritus and abnormal liver function tests (cellular damage) during pregnancy should of course suggest the diagnosis of intrahepatic cholestasis of pregnancy. However, these signs must also be recognized as signs of other hepatic diseases, especially primary biliary cirrhosis. The diagnosis is based on the search for antimitochondrial antibodies. This mode of presentation must not be overlooked because of major therapeutic consequences. The disease course often stabilizes with ursodeoxycholic acid, if administrated early.

Adult↗

PubMed1991

[Functioning of implantable catheters of intraperitoneal chemotherapy].

Intraperitoneal chemotherapy with a totally implantable catheter was performed in 42 patients with advanced ovarian cancer who received 178 courses of chemotherapy administered in 2 l of solution. Major complication was inflow obstruction due to fibrosis around the catheter observed in 10 patients, 23.8% of the cases. Other complications were: leakage 3 (7.1%), pain 3 (7.2%), infection 3 (7.1%) and rectal perforation 1 (2.4%). Overall, these complications occurred in 15 patients (35.7%) and were the cause of treatment interruption in 7 (16.7%). Outflow obstruction which occurred in 23 patients (54.8%), did not create discomfort and could not be considered as a complication. Despite the problems, intraperitoneal chemotherapy with a totally implantable catheter appeared feasible in at least 80% of the patients.

Adult↗

PubMed1991

[Results of intraperitoneal chemotherapy of ovarian cancer].

We studied a series of 42 patients with advanced ovarian cancer who received intraperitoneal chemotherapy post second-look laparotomy. High-dose cisplatin (200 mg/m2) alone or in combination with cytarabine (2 g) achieved 47% response rate. Median overall survival from second-look laparotomy was 44 months with cisplatin (36 cases), 15 months with carboplatin (600 mg/m2, 5 cases) and not reached at 3 yrs with mitoxantrone (25 mg/m2, 8 cases). Median overall and progression-free survival from second-look laparotomy were 44 and 39 months respectively in complete responders (15 cases), 20 months and 9 months where residual tumor less than 2 cm (21 cases), 22 and 12 months where tumor greater than 2 cm (6 cases). There was a significant difference in survival (P = 0.01) and progression-free survival (P = 0.002) between complete responders and patients whose tumor was less than 2 cm. Toxicity was acceptable except for carboplatin with constant grade 4 leukocytes or platelets toxicity. It was not demonstrated that high-dose intraperitoneal chemotherapy given post second-look laparotomy will improve survival in advanced ovarian cancer. Further studies of polychemotherapy or early administration are needed.

Antineoplastic Agents↗

PubMed1989

[Prognosis in ovarian cancer as a function of the results of the second-look laparatomy].

Second-look laparotomy (SLL) was performed after chemotherapy in 106 patients with epithelial ovarian cancer. Thirteen were stage I and II and 93 stage III and IV. Seventy-eight patients received cisplatin-based regimens. Median follow-up was 60 months. Negative SLL was found in 32 patients who had a 5-year survival rate of 43.4% after SLO. Microscopy residual disease was present in 9 patients whose 5-year survival rate was 25%. Maximum residual tumor of 2 cm or less was found in 13 patients with 5-year survival rate of 30%. Residual tumor larger than 2 cm after secondary cytoreduction was present in 21 patients, their 3-year survival rate was 18.3%. Eighteen patients with bulky residual disease who did not have cytoreduction were all dead within 17 months. Patients with initial residual tumor at first laparotomy less than 2 cm had a near significant advantage in survival rate over patients with residual disease greater than 2 cm and stage IV (p = 0.07). Non-responders to initial chemotherapy had a survival rate similar to that of partial-responders. These findings justify discontinuation of conventional systemic chemotherapy for patients showing residual disease after SLL and secondary tumor removal in case of residual tumor at SLL. Therapeutic trials are needed in advanced ovarian cancer testing initial aggressive surgery or early debulking to avoid bulky residual disease and consolidation therapy in patients who achieved complete pathological response or minimal residual intraperitoneal disease.

Adult↗

PubMed1988

[Stress urinary incontinence in women. Epidemiologic inquiry. Apropos of 500 cases].

Nearly 50% of women in Tunisia have urinary incontinence, and 30% of these are highly embarassed. This condition is under-estimated in Tunisia by doctors in as far as its functional effects are concerned because the country has other diseases which are more urgent and take priority. Stress incontinence causing invalidism is very frequent: 31.4%. The principal factors that lead to it are home delivery, multiparity, menopause and large babies. There are two frequent associated conditions: incontinence during pregnancy and cystocoele. A contribution is made by the clinical diagnosis, but if investigations stop there a definite diagnosis cannot be made and therefore there is a risk of failure of treatment. In fact the treatment should be according to the cause: it is medical when are purely urinary troubles and surgical or physiotherapeutic when there is true stress incontinence. The best treatment would be to prevent the condition by good obstetrics and this by better methods of delivering the babies.

Adult↗

PubMed1988

[Treatment of acute non-chlamydial salpingitis. Study of the efficacy and tolerance of a single-therapy antibiotic: Augmentin].

An open randomised comparative trial of the efficacy and safety of Augmentin as against the triple therapy of penicillin-gentamicin-metronidazole in acute salpingitis was conducted in forty women admitted to hospital. Laparoscopy was performed routinely to confirm the diagnosis. The two groups of patients were comparable as to age and clinical and biological symptoms and the severity of the salpingitis (grade I to IV, with the presence or absence of Fitz-Hugh-Curtis syndrome). Treatment was started immediately after the laparoscopy, first by parental route until the patient had been apyrexic for 48 hours. Oral follow-up was then commenced. Twenty women received Augmentin and twenty the triple antibiotic therapy. Specimens for bacteriological study were obtained before treatment (culture of the urine, culture from the IUD and from the cervix, and swabs were taken laparoscopically). This made it possible to identify aerobic and anaerobic organisms. (The gonococcus was found more often in the group treated with triple antibiotics). On discharge, cures had been obtained in 12 women and 6 more were responding out of the Augmentin group. Out of the triple therapy group 8 were cured and 10 were responding. There was one failure in each group (persisting fever). Long-term assessment was carried out in the out-patients three weeks after discharge. 11 out of the 13 reviewed in the Augmentin group and 8 out of the 14 in the triple therapy group were considered as definitely cured. The clinical safety of both treatments was good. These results demonstrate that Augmentin is as effective as the combined therapy in treating acute salpingitis and with the added advantage of its easy use and lower cost.

Acute Disease↗

PubMed1988

[Clinical and urodynamic results of the Burch colposuspension operation in the treatment of female urinary stress incontinence. A study apropos of 370 cases].

The surgical treatment of female genuine stress incontinence remains a not wholly solved problem. We prefer since 1980 the indirect colposuspension according to Burch as it represents 76% of our operations for genuine stress incontinence. We report 370 cases. The operation has been: isolated in 153 cases; associated with a total hysterectomy in 160 cases; associated with an indirect sacral fixation with a prosthesis of non adsorbable tissue in 57 cases. Clinical examination has always been completed with a urodynamic investigation pre-operatively and in the year following the operation. After two years or more, 188 urodynamic controls could be done. Clinical and urodynamic results are excellent and lasting after 5 years. Clinical failures represent only 4.6% of the cases and seem to be in relationship with technical defects as they occur in 78.4% of the cases in the first year following surgery. Associated sacral fixations, second hand cases, sphincter insufficiency appearing after surgery are the main factors giving way to the failures.

Adult↗

PubMed1988

[Value and dangers of indomethacin used in pregnancy. Apropos of 304 treated patients].

When Indomethacin in a dosage of 175 mg/day was used to treat threatened premature labour more than 70% of cases carried on until 37 weeks. This treatment therefore is an interesting alternative treatment to beta-mimetics whose the maternal side effects can be serious. As far as the cardiovascular systems of the fetus and neonate are concerned the effects in the dosage used are negligible. On the other hand there may be renal failure which is transitory at birth when delivery has taken place while treatment was going on. The treatment should not be prolonged for more than three weeks because Indomethacin causes oligohydramnios and this can cause in its place malpositions and maldevelopment of the lungs. Finally, it is not certain whether this treatment has any effect on fetal growth causing diminished growth, possibly.

Abortion, Threatened↗

PubMed1988

[Treatment of urogenital prolapse with exertion-induced urinary incontinence using the Bologna technic. Apropos of 90 cases].

The authors describe this operation, which is carried out as a single procedure which they have been doing since 1982. Then the results in 90 patients are studied. The post-operative controls carried out on the clinical state of the patient and on the urodynamic tests show that this operation is very successful, both in curing stress incontinence and in giving a good anatomical result for correcting prolapse of the anterior wall of the vagina. In over one-third of the cases the post-operative follow-up has been carried out for 2 years or more. This follow-up has shown that the relapse rate over a period of time, both for the stress incontinence and the prolapse, is nil. The principal snags that still remain are: post-operative infection in about a third of cases; the rare but possible development of an enterocele and of dyspareunia (2%).

Adult↗

PubMed1987

[Normal pregnancy after a Budd-Chiari syndrome treated by shunting: apropos of a case, review of the literature].

A patient who had a meso-atrial by-pass for a Budd-Chiari syndrome a year before conception carried her pregnancy to term. The authors have reviewed the literature. When they had studied the literature the authors took into account cirrhoses of the liver and portal hypertension in association with pregnancy. They concluded that a patient who had had a Budd-Chiari syndrome, particularly when she had also had a porto-caval shunt, was not in principle unable to have a pregnancy.

Adult↗

PubMed1987

[Urethral instability].

This study was carried out on 121 sets of records of uretrocystomanometry and 25 records of uretrocystomanometry combined with dynamic sphincterometry. The patients consulted us either for stress incontinenceor urgency incontinence. The mean age was 41 years. The urethra was considered to be unstable when variations in pressure reached 20 cm of water or higher. There are four different types of instability described and these correspond to different urodynamic pictures. The treatments that have been proposed resulted from the different aetiologies that we have been proposed resulted from the different aetiologies that we have worked out. Some of these cases are due to an inadequate perineal floor. This has been shown by changes in striated urethral sphincter behaviour and in the improvement that can be brought about by re-education of the levator and muscles.

Adult↗

PubMed1986

[Chemotherapy in 143 advanced epithelial cancers of the ovary. Experience at the Hôtel-Dieu of Quebec and Hôpital Saint-Antoine (Paris)].

Results of initial chemotherapy in 143 patients with advanced epithelial ovarian cancer are presented. Twenty-five patients were treated with alkylating agents, their median survival was 13 months and 15% were alive at 4 years. Nineteen received Cyclophosphamide-Methotrexate-5 Fluorouracil with or without Hexamethylmelamine, median survival was 22 months and 4 years survival was 20%. Forty-eight were treated with Adriamycin and Cisplatinum, their objective response rate proven by second-look laparotomy was 54.4% (26.1% complete response), median survival was 23 months and 35% were alive at 4 years. Thirty-one received Hexamethylmelamine, 5 Fluorouracil, Adriamycin and Cisplatinum with a median survival of 18 months and 4 years survival of 15%. Twenty had various other chemotherapy regimens, their median survival was only 8 months. Recent advances in the therapy of ovarian carcinoma are also discussed.

Altretamine↗