Biomedical subjects
Publications and source records attributed to D Dargent.
The technique of mastectomy with immediate TRAM flap reconstruction is described. A series of 25 cases is presented. The main risk is a partial necrosis of the flap. The larger the fatty mass, the greater the risk. But it does not contra-indicate the procedure which seems, in severe forms of breast cancer, to improve the chances of survival.
The authors report a series of 120 cancers of the endometrium treated between 1970 and 1985 included. Of all "morphological" factors, the degree of tumor differentiation is the one which has the greatest predictive value for the prognosis. The general condition of the patient have, stricto sensu, a very significant influence on the prognosis of cancer. The Wertheim's procedure offer results which are far superior to those of a simple hysterectomy. It must be favored in all patients who can withstand it. In patients with poor general condition, perform a simple total vaginal hysterectomy. This will be performed with all the less reserve as the tumor was well differentiated.
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A series of 155 observations has been made of uterocervical intraepithelial neoplasias treated by conization and examined by serial section. From the data obtained the author shows that colposcopic and microlposcopic criteria can be used to give a good evaluation of the participation of viruses of the HPV group in the histogenesis of infra-clinical lesions of the uterine neck. The specificity of the colposcopic and microcolposcopic method seems equal to that of exfoliative cytology, and its sensitivity is greater. Increased application of colposcopy and microcolposcopy is recommended in the screening of infraclinical lesions of the uterine neck.
The authors report a study of 157 cases of pregnancy occurring with an intrauterine device (IUD) in place. Particular attentions was paid to developments in patients who had accepted pregnancy (n : 67). The frequency of gravidic complications was much higher when the IUD was in place, and two septic abortions were seen between the fourth and sixth months of pregnancy. The authors put forward a new method of echo-guided removal of the device.
The authors report the results of 59 caesarean operations in which 74 children were born before the end of the 32nd week of amenorrhoea. The gross mortality was 21.9% and the corrected mortality 18.5%. 7.9% of the infants had major neurological sequellae and 8.6% mild sequellae. 65.2% are alive and well with normal psychomotor development. The follow-up has been between 1 and 5 years. The factors that influence survival and the indications for caesarean section at this time are reviewed and discussed.
The known variations in weight for gestational age as well as compounding maternal and/or fetal factors, puts into question the usual definition of small for gestational age (SGA) which is based on gestational age alone. On the basis of more than 20,000 births studied in 4 maternity hospitals from 3 separate regions in France, the authors propose a new definition for growth retardation in full-term babies, taking into account 4 factors: gestational age, sex, birth rank, height and usual weight of mothers. This definition allows constitutionally SGA newborns to be considered normal, while some babies previously classified as normal would now lead one to suspect intra-uterine growth retardation (IUGR). This approach tries to take constitutional and environmental risk factors into account in fetal growth hopefully allowing for help better detection of IUGR.
The authors describe an operation for treating true prolapse of the vagina which can follow total hysterectomy. The vault is fixed to the little sacro-coccygeal ligament. They report 133 case histories. The results are very good indeed in 60% of cases. True failures are rare: 2 out of 100 cases in Richter's series and 3 out of 12 cases in Dargent's series.
Veralipride was given to 74 women with menopausal disorders. Clinical tolérance proved excellent and no abnormal variations were recorded in monitored biological parameters. Effectiveness is very satisfactory, all the more so that disorders are more specific and severe.
An attempt was made by investigation of the operative specimens from 98 patients suffering from epidermoid carcinoma of the cervix to assess the relationship between lymphatic spread on one hand and tumor volume and anatomical stage on the other hand. Within the same anatomical stage the risk of lymphatic spread is more important as the tumor volume increases. The reverse is also true. Within the same volume the risk of lymphatic spread increases when cancer extends beyond the "cervix-parametrium" barrier. The anatomical classification based on the T factor deserves to be retained, classification which some wanted to replace by another one based exclusively on the V factor.
The authors report a series of 434 patients with invasive cancer of the uterine cervix treated with primary surgery. The results are equivalent to those reported by others who treated cervix cancer with radiotherapy. Post-operative radiotherapy did not improve the results except in the most advanced forms (pT2b, pN1 or 2) when it increases the disease-free interval without altering the survival probability at 5 years. For the clinical stages I, IIA and IIB proximal (infiltration of the parametrium limited to the proximal part) surgery is the elective treatment. In stage IIB distal and for "operable" Stages III and IV, a combination of chemotherapy-surgery and radiotherapy is suggested.
The authors present a series of 45 plastic operations for bicornuate uterus. Three women were operated on for functional symptoms, eight for sterility of which seven were primary, and thirty four for infertility. They are sorry that three women were lost to follow up. They used the Bret-Palmer technique with modifications that they themselves describe. They justify this choice as against other techniques of metroplasty. The anatomical results are, in the main, good when controlled by hysterosalpingography 3 to 6 months after the operation. The functional results, by which is meant the pregnancies that have been obtained, are medium as far as sterility is concerned. Four out of the eight women who were operated on became pregnant. But they are very good in cases of infertility, because thirty out of the thirty four cases that were operated on had one or two pregnancies. The authors justify their indications for metroplasty after a first spontaneous abortion by the good results they have had, and because bicornuate uteri give rise to many obstetrical complications. Furthermore in unoperated cases there is often difficulty in attempting a new pregnancy, and quite often spontaneous late abortions or premature labours. In certain cases they carried out the operation after first spontaneous abortions, but they are more conservative in operating in cases of primary sterility. The authors do not think it is necessary always to carry out a cerclage procedure nor a caesarean operation automatically in cases that have become pregnant after metroplasty.
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A series of 143 cone biopsies performed for carcinoma in situ between October 1st, 1981 and July 31st, 1984 is described. Complications were rare: reoperation in 1.5 per cent of cases. "Oncological" results were good. There were few failures: 3.5 per cent of cases. Examination of the operative specimen revealed occult invasive carcinomas: 12.3 per cent of cases. It was also used to identify patients with a "high risk of recurrence", those in whom the resection had not passed through "healthy" tissue: 28.0 per cent of cases. Performed under local anaesthetic using a cold scalpel and with day hospitalisation, the operation is easy and inexpensive (1 309.71 francs).
The management of a molar pregnancy is envisaged on the basis of experience involving the evacuation and surveillance of a mole in 109 cases. A pathological and cytogenetic distinction is drawn between perivillous hyperplasia (102 cases) and embryonic mole or triploid syndrome (7 cases). The diagnosis of choriocarcinoma (20 cases) and of invasive moles (28 cases) is envisaged on the basis of a series including 59 cases of abnormal post-molar or post-partum course. The diagnosis may be approached by pelvic arteriography and the Ishizuka severity scale. A diagnosis is important in the selection of appropriate treatment: clinical surveillance for simple delayed involution, single drug chemotherapy for invasive moles and polychemotherapy after thorough radiological and echotomographic assessment for choriocarcinoma.
The statistical data reported in this study show that the results obtained with surgery in invasive carcinoma of the cervix uteri are equivalent to those obtained with radiotherapy alone or associated with surgery. The overall proportion of operable patients in this series was 94% (stage I: 98%, stage II: 89%, stage III: 72% and stage IV: 23%). The overall survival rates at 5 years were 90.7% for stage I patients (stage I A 98.0%, stage I B 84.9%), 54.6% for stage II patients (stage II A 68.9%, stage II B proximal 67.1%, stage II B distal 25%). 20.2% for stage III patients and 7.6% for stage IV patients. The drawbacks (mortality, morbidity) of surgery and its advantages (lower psychological and financial cost) are examined. The possibility to adjust the surgical operation to the local and regional extension of the cancerous lesions and the indications for supplementary radiotherapy are discussed.