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Biomedical subjects

Aubert Agostini

Publications and source records attributed to Aubert Agostini.

At least 19 recordsLinked to original sources
PubMed2006

Management of placenta accreta: morbidity and outcome.

OBJECTIVE: The aim of the study was to evaluate our results in the management of placenta accreta. STUDY DESIGN: In a retrospective study we reviewed cases of placenta accreta diagnosed in two university teaching hospitals between 1993 and 2003. For a subgroup of patients a conservative approach was attempted. In this procedure placenta was left in place until spontaneous resorption. RESULTS: Fifty cases (0.12%) of placenta accreta were observed in 41, 119 deliveries during the study period. Of the 50 cases, 24 patients (48%) were managed by the standard approach and 26 patients (52%) underwent conservative treatment. Additional surgical or medical treatment was performed in 35 of the 50 patients (70%). There was no maternal death. Overall hysterectomy rate was 40%, 10 patients were transferred to intensive care unit (20%), 7 had fever (14%), 5 had endometritis (10%) and 19 patients had blood transfusion (38%). Conservative treatment did not lead to hysterectomy in 21 cases (80.7%) and failed in 5 (19.3%). During the follow-up period, 3 women had successful pregnancy. CONCLUSION: Analysis of management of placenta accreta shows that for a subgroup of selected patients a conservative approach could preserve subsequent fertility without evident increase in morbidity.

Adult↗
PubMed2006

In situ methotrexate injection for treatment of recurrent endometriotic cysts.

OBJECTIVE: Ovarian endometrioma recurrence is frequent. Conventional treatment of ovarian endometrioma is by surgical cystectomy. We proposed an alternative medical treatment for recurrent ovarian endometrioma: cyst aspiration followed by in situ methotrexate injection. STUDY DESIGN: From January 2002 to May 2003, 14 patients with recurrent homolateral ovarian endometrioma underwent transvaginal ultrasound guided cyst puncture and aspiration followed by methotrexate injection, whilst under general anasthesia. Recurrence rate during follow up was evaluated. RESULTS: No complication was reported. After a mean follow up of 20+/-5 month (min: 13, max: 29), four recurrences were diagnosed (28.6%). Two asymptomatic recurrences were not treated and two painful recurrences underwent a second cyst drainage with methotrexate injection. CONCLUSIONS: In situ methotrexate injection is a simple, effective and an interesting alternative to surgical treatment in women with recurrent homolateral ovarian endometrioma.

Adult↗
PubMed2006

Value of laparoscopic assistance for vaginal hysterectomy with prophylactic bilateral oophorectomy.

OBJECTIVE: This study was undertaken to compare morbidity for women undergoing laparoscopy-assisted vaginal hysterectomy with bilateral oophorectomy (LAVHO) and vaginal hysterectomy with bilateral oophorectomy without laparoscopic assistance (VHO). STUDY DESIGN: Between April 1, 2002, and February 1, 2004, a prospective randomized study at Marseille University Hospital (La Conception) included 48 patients who underwent a hysterectomy with prophylactic bilateral oophorectomy for benign uterine conditions. These patients were allocated to 2 groups (LAVHO vs VHO). The study variables were duration of surgery and of hospitalization and surgical and postoperative complications. RESULTS: There was no significant difference in the duration of surgery between the LAVHO and VHO groups (100.2 +/- 27.9 vs 83.9 +/- 34.6, P = .08). The rate of complications was significantly higher in the LAVHO group (13/24 [54.1%] vs 6/24 [25%], P = .039). CONCLUSION: The overall complication rate was higher with LAVHO than VHO. It thus appears that laparoscopic assistance is not useful in performing vaginal hysterectomies with prophylactic bilateral oophorectomies in patients without other related disorders (endometriosis, adhesions, adnexal anomalies).

Blood Loss, Surgical↗
PubMed2005

Immediate complications of tension-free vaginal tape (TVT): results of a French survey.

BACKGROUND: The aim was to evaluate morbidity following operation using tension-free vaginal tape (TVT). METHODS: Between June 2002 and June 2003, a questionnaire was sent to French gynecologists and urologists. Participants reported the number of TVT procedures performed before January 2002, number of minor or major pre- and post-operative complications. RESULTS: The questionnaire was returned by 92 participants (21 urologists and 71 gynecologists) who reported 12,280 TVT procedures (median: 100, minimum: 5, maximum: 2100). Overall, 901 preoperative bladder injuries were reported (7.34%). For 809 patients (6.59%), complete post-operative urinary retention requiring catheterization was noted. There were 26 cases of vaginal defect healing (0.21%). Retropubic or vulvovaginal hematoma was reported for 39 patients (0.32%). Ten major organ injuries were reported (0.08%): one obturator nerve injury, three bowel perforations, four vessel injuries and two ureteral injuries. CONCLUSION: The risk of major complications following the use of tension-free vaginal tape is low. However, these potential complications require experienced surgeons for the practice of tension-free vaginal tape.

Female↗
PubMed2005

Oxytocin during myomectomy: a randomized study.

OBJECTIVE: To evaluate the influence of oxytocin on peroperative blood loss during myomectomy. STUDY DESIGN: From October 1998 to May 2002, 94 patients requiring surgical myomectomy by laparotomy or by the vaginal approach were enrolled in a randomized double blind study. Patients were randomized to two groups. In the first group (47 patients) oxytocin was administered during myomectomy and in the second group (47 patients) a placebo was used. The main outcome measures were peroperative blood loss and rates of blood transfusion and autotransfusion. RESULTS: Peroperative blood loss was no different between the oxytocin group and the placebo group (508 +/- 558 ml versus 451 +/- 336 ml; P=0.55). Rates of autotransfusion and blood transfusion were also similar in both groups. CONCLUSION: Administration of oxytocin during myomectomy did not reduce peroperative blood loss in our study. The benefits of using oxytocin to prevent hemorrhage during myomectomy seem to be limited.

Adult↗
PubMed2005

Transvaginal sonographic evaluation of cervix length after cervical conization.

OBJECTIVE: The purpose of this study was to evaluate transvaginal sonographic cervical length before and after cervical conization for squamous intraepithelial lesions. METHODS: Between November 2002 and October 2004, all women undergoing conization by either cold-knife conization or a loop electrosurgical excision procedure for squamous intraepithelial lesions were prospectively enrolled in this study. Cervical length was measured by transvaginal sonography (TVS) before and after conization. RESULTS: A total of 48 women were studied before and after a mean of 7 days after conization. Complete excision was achieved in 41 patients, and endocervical margins were involved in 7 patients. Mean TVS cervical length was significantly shorter after than before conization (mean +/- SD, 22.7 +/- 6.9 versus 26.7 +/- 8.1 mm; P < .001). The correlation coefficient between cone specimen length and postoperative length was r = 0.75 (P < .001). Mean TVS cervical lengths were 24.3 +/- 6.7 mm in the group of women who underwent a loop electrosurgical excision procedure and 20.7 +/- 9.4 mm in the group of women who underwent cold-knife conization (P = .13). CONCLUSIONS: Transvaginal sonographic measurement of cervical length after conization is well correlated with cone specimen length.

Adult↗
PubMed2005

[Surgical treatment of female stress urinary incontinence].

Stress urinary incontinence is frequent in women, and can have a major impact on quality of life. Surgical treatment is the most effective option in many cases. The current reference treatment is urethral stabilization with the use of a free pelvic sling. Surgical management of female stress urinary incontinence is now effective and relatively complication-free.

Female↗
PubMed2005

Risk of bladder injury during vaginal hysterectomy in women with a previous cesarean section.

OBJECTIVE: To determine the risk of bladder injury during vaginal hysterectomy in women with a previous cesarean section. STUDY DESIGN: Analysis of selected studies found through a MEDLINE search from 1980 to 2003. RESULTS: Four comparative studies (women with or without a previous cesarean section) were selected and analyzed. Risk of bladder injury was significantly increased in only 1 study. Analysis of cumulative data did not find a significant difference (8 of 430 [1.86%] vs. 11 of 1,227 [0.89%], p = 0.12). CONCLUSION: The risk of bladder injury during vaginal hysterectomy does not seem to be increased in women with a previous cesarean section.

Adult↗
PubMed2004

Vaginal myomectomy using posterior colpotomy: feasibility in normal practice.

BACKGROUND: Myomectomy is classically performed via laparotomy. Endoscopic surgery is limited for some indications. Vaginal myomectomy is a surgical procedure that has recently been evaluated. The aim of this study was to evaluate the feasibility, reproducibility and complication rate of vaginal myomectomy via posterior colpotomy. METHODS: A retrospective study was performed from November 1998 to February 2001 in three departments of gynaecology. RESULTS: Forty-five patients were involved, 17 (37.8%) of whom underwent laparoscopy before vaginal myomectomy for evaluation or treatment of a second pelvic disorder. Myomectomy was performed vaginally in 40 (89%) of the 45 patients. Peroperative laparotomy was required in five patients (11%), either because vaginal myomectomy proved impossible (four cases) or because of rectal injury (one case). One patient needed supplementary laparotomy on day 8 for the treatment of a pelvic abscess. CONCLUSION: Posterior vaginal myomectomy seems to be a feasible and reproducible surgical procedure. The success rate of vaginal myomectomy in this study was over 80%. Further randomised studies are needed to compare this procedure with laparotomy and laparoscopy.

Adult↗
PubMed2004

Risk of vasovagal syndrome during outpatient hysteroscopy.

STUDY OBJECTIVE: To evaluate influence of hysteroscope type and media used during outpatient hysteroscopy on vasovagal syndrome risk. STUDY DESIGN: Prospective observational study (Canadian Task Force classification II-1). SETTING: University hospital. PATIENTS: Two thousand seventy-nine women undergoing outpatient hysteroscopy without analgesia. INTERVENTION: Office hysteroscopy with a flexible or rigid hysteroscope and normal saline or CO(2). MEASUREMENTS AND MAIN RESULTS: Fifteen cases of vasovagal syndrome were reported. The rate of vasovagal syndrome was higher with use of a rigid hysteroscope (12/647 [1.85%]) vs. a flexible hysteroscope (3/1432 [0.21%]), p =.00013; p =.009 after adjustment for medium used; and with the use of CO2 (10/426 [2.34%]) vs. saline solution (5/1653 [0.30%]), p <.0001; p =.014 after adjustment for hysteroscope type. CONCLUSION: Risk of vasovagal syndrome is higher with the use of a rigid hysteroscope and CO2, regardless of the indication for hysteroscopy or the parity and menopausal status of the patient.

Adult↗
PubMed2003

Leiomyoma remaining after vaginal hysterectomy for symptomatic leiomyomas. A case report.

BACKGROUND: A remaining leiomyoma, an uncommon postoperative complication of vaginal hysterectomy for symptomatic leiomyomas, occurred. CASE: A second vaginal operation for a remaining leiomyoma was necessary 1 month after a vaginal hysterectomy for a myomatous uterus. CONCLUSION: Checking the pelvic cavity during hysterectomy may avoid this complication.

Female↗
PubMed2003

The role of frozen section examination of conisations in the management of women with cervical intraepithelial neoplasia.

OBJECTIVE: To determine whether frozen section in conisation improves the management of cervical intraepithelial neoplasia. DESIGN: Randomised trial. SETTING: Department of Obstetrics and Gynaecology, Conception Hospital, Marseille, France. POPULATION: Patients referred for treatment or diagnosis of cervical intraepithelial neoplasia. METHODS: Two hundred and three patients requiring conisation for diagnosis or treatment of cervical pathology were randomly assigned to have (n = 102) or not (n = 101) a frozen section of the endocervical margin of the cone specimen. MAIN OUTCOME MEASURES: The principal criterion was the 12 month residual or recurrent high grade disease rate. RESULTS: At 12 months, the residual or recurrent disease rate of high grade lesions was 12.6% in the group that did not have frozen sections and 1% in the group that did (relative risk, RR, 11.9, 95% CI 1.6-89.5, P = 0.0025). The corresponding rates of margin involvement were 18.9% and 1%, respectively (RR 15.13, 95% CI 2.06-111.27, P = 0.0002). The groups did not differ as to the height of the cone (13.6 [5.6] mm vs 13.7 [4.7] mm, P = 0.75) or post-operative morbidity (6% vs 7%, RR 1.01, 95% CI 0.94-1.09, P = 0.8). The rate of patients lost to follow up was similar in both groups 17% vs 12% (RR 1.42, 95% CI 0.71-2.81, P = 0.31). CONCLUSION: Frozen section is effective in conisation and significantly reduces residual or recurrent high grade disease. This finding improves the management of cervical pathology achieving immediate clear margins in most of conisations. This is of great interest because high rates of patients are lost to follow up as we and others authors have found.

Adult↗
PubMed2003

Vaginal hysterectomy in nulliparous women without prolapse: a prospective comparative study.

OBJECTIVE: To compare vaginal hysterectomy success and complication rates in nulliparous and primiparous or multiparous women. DESIGN: A comparative prospective study. SETTING: Department of Gynaecology, La Conception Hospital, Marseille, France. POPULATION: Three hundred and forty-five consecutive patients without genital prolapse requiring hysterectomy for benign conditions and without previous pelvic surgery or caesareans were treated prospectively by vaginal hysterectomy. Fifty-two patients were nulliparous and 293 were primiparous or multiparous. METHODS: Data of patients were collected prospectively. MAIN OUTCOME MEASURES: Operative time, length of hospital stay, oophorectomy, conversion to laparotomy, intra- and post-operative complications. RESULTS: The mean operative time was significantly longer in nulliparous patients [95 (55.2) vs 79.9 (34.9) minutes, P < 0.01]. The overall complication rate was significantly higher [7/52 (13.46%) vs 13/293 (4.44%), P = 0.02, RR = 3.03 (1.27-7.23)] as was the haemorrhage rate in nulliparous compared with the primiparous and multiparous women [4/52 (7.69%) vs 5/293 (1.7%), P = 0.03, RR = 4.51 (1.25-16.23)]. Vaginal hysterectomy was successfully performed in 96.2% (50/52) of the nulliparous and 99.7% (292/293) of the parous patients [P = 0.06, RR = 1.04 (0.98-1.09)]. CONCLUSION: The success rate of vaginal hysterectomy in nulliparous women is high. However, the risk of complications seems higher than in the parous women. Laparoscopy assisted vaginal hysterectomy in nulliparous women needs further investigations.

Body Mass Index↗
PubMed2003

Acceptance of outpatient flexible hysteroscopy by premenopausal and postmenopausal women.

OBJECTIVE: To compare tolerance for and feasibility of outpatient flexible hysteroscopy in premenopausal and postmenopausal women. STUDY DESIGN: A comparative, prospective study including 475 premenopausal and 216 postmenopausal women who underwent outpatient hysteroscopy without analgesia. RESULTS: Mean pain score was higher in postmenopausal patients (1.55 +/- 0.56 vs. 1.27 +/- 0.38 [P < .0001]). Outpatient flexible hysteroscopy was feasible without analgesia in 471/475 premenopausal (99.2%) and 210/216 postmenopausal women (97.2%) (P = .07). CONCLUSION: Outpatient flexible hysteroscopy was feasible and well tolerated; local anesthesia should be reserved for postmenopausal women.

Adult↗
PubMed2002

Risk of finding an endometrial cancer when atypical hyperplasia was incidentally diagnosed on hysteroscopic resection products.

OBJECTIVE: To evaluate the risk of discovering an endometrial cancer when atypical hyperplasia was diagnosed by histologic examination of hysteroscopic resection products. STUDY DESIGN: A retrospective monocentric study from January 1994 to January 2001. Seventeen patients with atypical hyperplasia were included. Initial endometrial status was provided by operative hysteroscopy resection products. For all patients, there was no hysteroscopical aspect evocative of adenocarcinoma. Histopathological analysis of the hysterectomy pieces precised the final diagnosis. RESULTS: Among the 17 hysterectomy pieces, one adenocarcinoma was diagnosed. Risk for discovering adenocarcinoma when atypical hyperplasia was diagnosed by operative hysteroscopy resection products was 5.9% (1/17). CONCLUSION: Risk of omitting adenocarcinoma when atypical hyperplasia is discovered by hysteroscopy resection pieces is low.

Adenocarcinoma↗