Biomedical subjects
Publications and source records attributed to C Racinet.
An attempt to create experimental endometriosis in the rabbit by the usual technique was tried on eight animals. It was disappointing. A new technique which is easier to carry out implanting endometrium was suggested. The results were evaluated in 57 animals. The technique proved to be easier and more reliable. The technique cannot be used unless the animal has been through puberty.
A prospective study was performed in 102 patients, including 40 malignant tumors (13 subclinical), to evaluate colour Doppler in breast tumours. All patients had abnormalities that led to their selection for this study. 92 patients had a mammographic examination. 10% of malignant tumours were not detected by mammography. Mammographic abnormalities without any ultrasonographic confirmation were excluded from this series. All the lesions have been proven by cytology or histology. In the assessment of malignancy only one false negative and two false positive results were obtained. The sensitivity and specificity of colour Doppler are both of 97% with radiate vessels beneath the tumour and intratumoral vessels as malignant criteria. This non invasive method should be performed in lesions with tissue ultrasonographic appearances even before fine needle puncture. So it may be possible to select more surgical indications considering an ultrasonographic abnormality atypical, subclinic or post-therapeutic (radiotherapy or surgery).
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Caesarean sections are performed with an ever increasing frequency, and their morbidity rate due to infection varies between 35 and 40 per cent. The effectiveness of antibiotic prophylaxis has been demonstrated in caesarean sections with a high risk of infection, but few studies have been devoted to caesarean sections without this high risk. The purpose of our study was to evaluate the effectiveness of antibiotic therapy in this second type of caesarean section since its postoperative infection rate is not negligible (about 25 per cent). We therefore set up a two-centre randomized trial comparing two groups of 133 women without any particular risk of infection. At the moment of umbilical cord clamping, one group received cefotetan 1 g intravenously, while the other group received an intravenous injection of a placebo solution. The postoperative infection rate was 12.5 per cent in the treatment group and 26.9 per cent in the control group (P less than 0.05). The relative risk in the placebo-treated women was 2.15 (95 per cent confidence limits, 1.41 to 3.28). Antibiotic prophylaxis prevented 53.5 per cent of postoperative infections (95 per cent confidence limits, 29 to 69.5 per cent). Moreover, in the treatment group infections were less severe, resulting in a significant decrease in hospital stay and a lower overall cost. We conclude that antibiotic prophylaxis with cefotetan is effective in caesarean sections without a high risk of infection, as it significantly reduces the postoperative morbidity due to infection.
We report the first published case of pregnancy obtained with a self-preserved embryo in a woman who, in 1987, had been castrated for a tumoral and painful pelvic disease retrospectively diagnosed as endometriosis. This woman had an old-standing tuboperitoneal infertility, and in vitro fertilization had been performed, followed by cryopreservation of the embryos. Two embryos were transferred during an artificially induced oestro-progestogenic cycle. Pregnancy developed and progressed normally with a simplified therapeutic regimen. This case suggests that preservation of the embryos is a possible solution to the problem of women about to undergo medical or surgical castration and wishing to become pregnant after cure of the disease which motivated the castration.
A randomised double trial was carried out in 266 women who had Caesarean without any high risk of infection in order to study the efficacy of prophylactic antibiotics given during the operation. One group received 1 gram of cefotetan when the cord was being clamped and the other had an injection of placebo under the self-same conditions. Apart from studying the clinical efficacy, evaluation of the economics of the treatment was carried out using, as parameters, the length of stay in hospital and the cost of the antibiotics which were prescribed after the operation. The following results were obtained: 75% of the Caesarean operations carried out in the Maternity Units of the University Regional Hospital Centre were without high risk of infection. Prophylactic antibiotics are proficient because they reduce post Caesarean morbidity due to: endometritis, superficial and deep abscesses and septicaemia. 12.5% in the group who had antibiotics developed infections as against 26% in the placebo group. Post Caesarean infections which required antibiotics cost on an average for each Caesarean 16 francs in the groups who received antibiotics as against 52 francs in the groups that received the placebo. Even including the cost of the antibiotics given prophylactically the costs of antibiotics (prophylactic and curative) was higher in the antibiotic group than in the placebo group. The length of hospital stay was significantly reduced in the group that received prophylactic antibiotics.
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The ease of execution and the post-operative quality of 2 types of incision commonly performed in pelvic surgery were compared in a prospective randomised study: Pfannenstiel's incision was used in 59 patients and Mouchel's low transverse abdominal incision (LTA) in 60 patients. Results were evaluated 8 days and 3 months after the operation. There was no difference in immediate post-operative results between these two groups of patients. At the 3 month examination, hypoaesthesia of the skin was less frequent in patients who had been operated upon through the LTA incision. The authors conclude that the transmuscular incision is innocuous.
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A retrospective study was carried out using the obstetric summaries in a computer between the years 1981 and 1986. The percentage of instrumental deliveries using forceps or spatula was significantly reduced whereas the caesarean section rate stayed the same: the majority of forceps deliveries during the year 1986 (14.5% of all deliveries) were carried out under epidural analgesia (70% of the deliveries) and the mean of these (75%) were carried out for delay. This is a definite change as compared with 1981 and it appears to be linked mainly to an increase in the number of epidural analgesics (70% for forceps deliveries in 1986) and a new appreciation of fetal distress. The maternal results were better because most episiotomies were lateral (60% of cases) which meant that only 1.5% of cases affected the sphincters. The immediate neonatal results were good, but do not seem to have been improved by the changes that have been observed, although the methodology for assessing the state of the neonate has improved.
71 samples taken by the transabdominal route were compared with 71 samples taken by forceps through the cervix. A fine (1 mm) transabdominal choriocentesis needle with a thin wall (0.1 mm), a short bevel, and a lateral hole was made to bring together simplicity, effectiveness and safety; success was obtained in 95% of the cases (39/41) of our last 41 samples on the first attempt. For comparison with the forceps, the success rate on the first attempt was only 66% (26/41), but it rose to 97.5% if the patient could take 3 attempts at most. The forceps made it possible to collect a mean quantity large enough (19.9 mg) but it was quite variable (16.7 mg being the range) of complete villi, whereas the choriocentesis needle only gathered a smaller volume (12.7 mg) but more reliable (the range being 3.7 mg). The villi were fragmented, however. To work out the study of the DNA and the karyotype, there is a choice between the forceps and the needle. This choice depends principally on the damage the two techniques can do. This has not been worked out yet in our study except indirectly.
Studies carried out on the phantom have shown how reliable transverse diameter measurements of the pelvis are when carried out by X-Ray scanning pelvimetry compared with conventional X-Ray pelvimetry. The practice of scanning radiopelvimetry (digital radiography) depends on the availability of the machine and of an induced, secondary circuit. The arrival of this new technique makes it necessary for the sake of economy to limit the indications for the investigation. We have studied the indications for the examination in a population of pregnant women in a University Hospital Service as well as pregnant women in a District General Hospital. Since the conditions under which obstetrics are carried out in general hospitals are more precarious, more radiological examinations are carried out in them. Frequently investigations were carried out on primiparous women who have normal pelves. It appeared difficult to lower the number of indications. Digital X-Rays will therefore cost a lot. In university hospitals the indications for carrying out the investigations were studied critically. It seems to be possible to reduce the numbers to 6% of all patients who are delivered. Rationalizing the indications will make it possible to avoid the extra cost which results from carrying out scanning X-Ray pelvimetries more reliably and delivering a lesser dose of X-Rays than ordinary conventional X-Ray pelvimetries deliver.
Proximal tubal surgery is particularly efficacious when it is practised with the objective of "desterilisation". Like M. Cognat, the author established the decrease and even almost total disappearance of extra-uterine gestation.
The authors followed a population of 204 primiparous women in order to be able to tackle the causes of those frequent sexual problems that occur after delivery. Obstetric perineal lesions were found in 46 cases of left lateral episiotomies, 104 cases of midline episiotomies and 54 cases where the perineum was said to be intact. Following delivery at the Maternity Unit, those patients who had a perineal incision suffered more without any difference whether the episiotomy was a midline or a lateral one. After a mean of 78 days following delivery, at the post-partum examination, sexual troubles were found to be frequent and 41% complained of dyspareunia. These troubles were scattered in all three series. There was no difference whether the mother was breast-feeding or not in relationship to her sexuality after delivery. The authors conclude that there is no proper correlation between the way the perineum was dealth with surgically and the quality of sexual activity experienced early after delivery.
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