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B J Paniel

Publications and source records attributed to B J Paniel.

At least 19 recordsLinked to original sources
PubMed1997

[Treatment of vulvar vestibulitis by posterior vestibulectomy. Twelve case reports].

Many patients with dyspareunia suffer from vulvar vestibulitis syndrome. When all conservative treatments have failed, surgery is attempted. We appreciated results and complications of this treatment. During 1993 and 1994, at the gynecological department of the intercommunal hospital of Creteil (France), twelve women suffering from this condition for longer than six months had undergone a posterior crescent-shaped vestibular excision followed by vaginal advancement. Three weeks after surgery, three partial dehiscences have been observed, which secondary healed. The average duration of follow-up was 8 months. The interview of the patients in January 1995 revealed: six patients obtained painless sexual intercourse, four patients improved significantly, one had no improvement and one complained of severe vulvar burning instead of dyspareunia. Our results are weighing against the initial enthusiasm to surgical treatment. Collaboration between gynecologists and psychologists to specify the indications and previous treatment of an associated vaginismus should be helpful for the treatment of these patients.

Adolescent↗
PubMed1997

Vulvovaginal sequelae in toxic epidermal necrolysis.

OBJECTIVE: To evaluate the incidence of vulvar lesions during the acute and healing periods in toxic epidermal necrolysis (TEN), to describe the clinical aspects and functional consequences, and to evaluate surgical treatment. STUDY DESIGN: During the acute period in 40 patients, cutaneous and mucous lesions were described on the day of hospitalization and daily thereafter. To evaluate the healing period, a questionnaire was sent to the same 40 patients to obtain information on symptomatology after the acute period, anatomic modifications, and the quality of sexual and other genital activity. RESULTS: During the acute period, genital lesions were present in 28 of the 40 patients studied (70%). In 24/28 (89%) the lesions were vulvar only, and in 3/28 (11%) they were vulvovaginal. In one case vaginal involvement could not be proven because the patient was a virgin. During the healing period, sequelae occurred in 5 of the 40 patients (12.5%): four cases were known since the patients had visited the Department of Gynecology because of secondary effects, and one case was detected by the questionnaire. The symptoms occurred during hospitalization in 1 case, at the end of the second month in 2, at the 12th month in 1 and unknown in 1. The site was the vulva in all five cases and was the vulva and vagina in three. Again, the virgin could not be examined. The average interval between secondary effects and the original gynecologic visit was 7 months (3-12). The sequelae were treated surgically in two of the five affected patients: on the vulva, nymphoplasty, posthectomy and median perineotomy; in the vagina, sharp and blunt dissection, with use of a soft mold. The first patient had a recurrence six months after surgery, and the second had no recurrence but has been unable to engage in intercourse. CONCLUSION: From our study of the involvement of the vulva and vagina during TEN and the sequelae, it is clear that detection from the questionnaire was insufficient. Some women can have synechiae without functional sequelae, and others can have minor involvement with important psychological repercussions. A prospective study with systematic examination of the vulvovaginal area and systematic follow-up for at least one year is needed. For therapy, a lubricant gel (perhaps topical steroids) could be useful. Placing a soft mold in the vagina as soon as possible, though difficult, and keeping it there until complete healing occurs can lead to infection. It is not clear that use of a mold would promote healing or be tolerated. Intercourse immediately after the acute period would be helpful but probably would not be welcome to the patients. However useful, a prospective survey would be difficult because it would entail many years of study.

Adolescent↗
PubMed1996

[Value of ultrasonography in utero-vaginal aplasia].

The usefulness of pelvic ultrasound in the diagnosis of Rokitansky-Kuster-Hauser syndrome was evaluated retrospectively in 44 patients. Ultrasonography confirmed the diagnosis in 32%, however was wrong in 68% as a uterus was found, though generally described as hypoplasic. The reasons for the low sensitivity of ultrasonography are discussed.

Abnormalities, Multiple↗
PubMed1996

[Uterine velocimetry and vascular pregnancy pathologies prevented with low-dose aspirin].

Several trials have been published about the usefulness of early uterine Doppler waveform in the prediction of pre-eclampsia and intrauterine growth retardation in nulliparous or low risk patients. We reviewed 3 trials introducing aspirin therapy in patients selected by an early abnormal uterine Doppler waveform. In one trial, serum alpha fetoprotein above 2.5 median at 16 weeks was used as a first selection criterion. In two studies, the incidence of pre-eclampsia was significantly decreased in aspirin treated groups: McParland's trial (odds ratio: 0.08; 95% CI:0.01-0.63) and Campbell's preliminary report (odds ratio: 0.15; 95% CI:0.02-0.91). In contrast, the rate of intra-uterine growth retardation was found similar in aspirin and placebo treated patients. To clarify the usefulness of aspirin therapy in patients with early abnormal uterine Doppler in improving maternal and fetal outcome, other prospective large studies are needed.

Aspirin↗
PubMed1995

[Pelvic myxoid liposarcoma. A case report].

Myxoid liposarcoma is a rare soft tissue tumour. The authors report one case of retroperitoneal tumour discovered during pregnancy, which recurred after initial surgery. Clinical features, clinical course and prognosis of this disease are examined together with management procedures.

Adult↗
PubMed1995

[Orifice dyspareunia: the surgeons point of view].

Various organic lesions can give rise to superficial dyspareunia. Easily surgically treated, they must be recognised: 1) minor hymenal abnormalities: cribriform, microperforate, septate, fleshy or hyperelastic hymens; 2) vaginal abnormalities: longitudinal or transverse septum; 3) post obstetrical or post operative vulvar outlet stenosis; 4) sexual trauma: tears of the vestibular fossa or hymenal tears; 5) stenosing lichen sclerosus, lichen planus, bowenoid papulosis and Bowen's disease; 6) focal vestibulitis associated with more or less obvious psychological outcomes.

Congenital Abnormalities↗
PubMed1993

[Laparoscopic surgical excision of adnexal cysts. Methods and indications in a series of 70 patients].

Surgical coelioscopy has become a regularly used technique for the treatment of benign cysts of the annexes. Complete exeresis and certain histological diagnosis are assured and the postoperative period is simpler than after laparotomy. The risk of pelvic adherences is reduced. We performed coeliosurgery via the transparietal or intraperitonial method in a series of 70 patients for 85 resections of cysts, ovaries or annexes. Length of hospitalization was short and complications were rare. Despite convincing clinical explorations including echography and coelioscopy, we observed one border line tumour and one stage I serous cystadenocarcinoma at histological examination after coeliosurgery. The two observations led us to question percoelioscopic treatment cysts of the annexes but also emphasize the need for careful preoperative work-up and peroperative technique. The indication for laparotomy should be seriously considered in doubtful cases.

Adult↗
PubMed1993

[Paget disease of the vulva. 36 cases].

Thirty six patients with Paget's disease of the vulva were reviewed. The median age of the patients at diagnosis was 67 years (range: 45-91 years). One patient had a history of previous mammary adenocarcinoma. Screening for malignancy revealed two colonic tumours. Two patients with negative screening at presentation developed, 12 and 18 months respectively after vulvectomy, an ovarian carcinoma stage IIc and a cervical and urethral adenocarcinoma. All patients were treated by surgery based on extent of the disease. The operations performed included total vulvectomy (n = 11), partial vulvectomy (n = 14) and wide local excision (n = 4). Out of the 36 patients, 29 were available to follow-up. The median follow-up period was 74 months (range 2-204 months). Three patients died of metastatic disease due to vulval adenocarcinoma and breast carcinoma, or of liver metastases from an unknown adenocarcinoma. Eighteen of the 29 patients followed up remained free of disease. Five out of the 16 patients with positive margins recurred, as did 5 out of 9 patients with negative margins. Treatment of Paget's disease of the vulva is surgical. In order to prevent recurrence, some authors have proposed surgical excision extending beyond the visible clinical lesions with intraoperative frozen sections. The data we recorded show that free margins do not seem to correlate with recurrence, so that large excision beyond the clinical lesion is not useful.

Aged↗
PubMed1991

The prevalence of autoantibodies during third-trimester pregnancy complicated by hypertension or idiopathic fetal growth retardation.

Lupus anticoagulant, anticardiolipin, antinuclear, anti-deoxyribonucleic acid, antithyroglobulin, and antithyroid microsomal antibodies were assayed during third-trimester pregnancy (100 normal, 100 with complications). In spite of a normal activated partial thromboplastin time in all instances, lupus anticoagulant was further investigated by three additional procedures: tissue thromboplastin inhibition time, platelet neutralization procedure, and cephalin neutralization test. The prevalence of autoantibodies in pregnancies with hypertension reaches 16% (four with lupus anticoagulant, two with anticardiolipin, and two with antithyroid microsomal antibodies), which is significantly greater than that for idiopathic fetal growth retardation (2%) (one with lupus anticoagulant antibodies) and normal pregnancies (3%) (two with antithyroglobulin and one with autithyroid microsomal antibodies) (p less than 0.01). Autoantibodies were equally distributed between patients with gestational hypertension and those with preeclampsia. When compared with the 42 patients with hypertension and no autoantibodies, the eight patients with autoantibody had a more frequent history of fetal growth retardation (p less than 0.05), but there was no difference in the severity of hypertension, the frequency of obstetric complications, or the outcome of pregnancy. They did not require any specific treatment.

Autoantibodies↗
PubMed1991

Maturation of the uterine cervix by repeated intracervical instillation of prostaglandin E2.

An attempt was made to ripen the uterine cervix in 100 high-risk pregnancy patients (pregnancy between 34 to 41 weeks' gestation), with the use of intracervical instillations of 0.25 mg of prostaglandin E2 mixed with a tylose gel. The maturation process was repeated every 48 hours. Forty-nine patients were delivered of infants after the first maturation and 51 patients required between two and nine instillations. In patients requiring multiple instillations, the mean delay between the first procedure and delivery was 9 +/- 4 days (range, 2.4 to 16 days). Among the 59 nulliparous women, only 23 were delivered of infants after a single maturation and 36 required multiple maturations (p less than 0.02). When the group of patients who were delivered of infants after a single maturation process was compared with the group requiring multiple maturations, no difference could be seen with regard to age, term of pregnancy, or Bishop cervical score at the time of inclusion in the study. The myometrial activity and the onset labor induced by prostaglandin E2, were similar in both groups. Fetal heart rate decelerations occurred in 16.3% (8/49) of the patients with single maturations and in 17.6% (9/51) of the patients who required multiple maturations. The outcome of the pregnancy and the rate of cesarean sections (24% and 27%) were similar in both groups. No patients required cesarean sections because of failed induction of labor. Cervical ripening after repeated applications of 0.25 mg of prostaglandin E2 seems to be safe for the fetus, providing that the patient is closely supervised.

Cervix Uteri↗
PubMed1991

Catalase-associated abnormalities and H2O2 increase in pre-neoplastic and neoplastic lesions of the human lower female genital tract and their near adjacent epithelia.

We report that an internal and non-UV-dependent type of neoplasia, the human cervical intraepithelial neoplasia (SIL), is also deficient in catalase activity, like the UV-induced tumors in the autosomal recessive human epithelial disease, xeroderma pigmentosum (XP). Whether or not the lesions are papillomavirus (HPV) positive in the different categories of preneoplastic and neoplastic extracts, the following parameters are affected: i), catalase activity level; ii), kinetic profile of catalase activity; iii), H2O2 increase. Mathematical treatment of these parameters (CONSTEL-Program), unambiguously distinguishes between normal and pathological cases. Such analyses make it possible to grade the pathological samples into 4 classes, depending on their deviance from normality. These classes may be correlated with the gradual steps in the process of malignant transformation defined by histological and clinical diagnosis. We found conformity between catalase activity and histological analyses in 66 biopsies, out of a total of 100 biopsies (35 patients). Moreover, 23 patients presenting decreased catalase activities in 31 biopsies showed disease progression after 3 to 6 months contrary to surgery histological data. We show that ATP synthesis in the presence of catalase and H2O2 (further aspect of catalase function), may occur in neoplastic extracts at much lower concentrations of H2O2 than in normal extracts. Thus, the catalase abnormality seems to be a good tool to study pre-neoplastic to neoplastic evolution of lesions and their adjacent tissues of the lower female genital tract; furthermore, i) it provides an earlier, more powerful means of detecting micro-SIL in progression to squamous cell carcinoma, than combined clinical and histological examinations; ii) model for investigating drugs such as in situ H2O2 scavengers or agents increasing glutathione peroxidase activity (GSH).

Adult↗
PubMed1988

Acute fetal distress after fetal blood sampling (case report).

The authors report a case of acute fetal distress after fetal blood sampling, performed for fetal karyotype because of a precocious and symmetrical fetal growth retardation without maternal hypertension or ultrasonographic evidence of fetal malformation. A cesarean section performed because of acute fetal distress showed the newborn to be hypotrophic, with a major acidosis and a refractory hypoxemia. The new born died despite intensive care. Acute fetal anemia was assumed to be the cause of acute fetal distress. The authors emphasize the use of FHR in fetal survey after fetal blood sampling.

Adult↗
PubMed1988

Peritoneal implants from ovarian tumors: CT findings.

Metastatic peritoneal implants were assessed preoperatively with computed tomography (CT) in 38 patients with ovarian tumors. In the 106 biopsy specimens of gross peritoneal implants and the 118 random biopsy specimens obtained from these patients, metastatic deposits were detected in 27 of 38 (71%) patients and in 104 biopsy sites. CT depicted metastatic lesions in 17 of 27 (63%) patients and in 63 of 104 (61%) biopsy sites. The three sites most commonly involved were the right subphrenic region, the greater omentum, and the pouch of Douglas. The usefulness of CT in detecting lesions depended mainly on the location of the implant and the presence of adjacent ascites, rather than on lesion size.

Adult↗