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D Raudrant

Publications and source records attributed to D Raudrant.

At least 19 recordsLinked to original sources
PubMed2006

[Biochemical profile of fetal blood sampled by cordocentesis in 35 pregnancies complicated by growth retardation].

AIM OF THE STUDY: Intra-uterine growth retardation (IUGR) is a frequent pathology in obstetrics characterized by high heterogeneity. Fetal smallness is sometimes constitutional, but can also be accompanied by fetal distress and vital risks for the infant. In 35 pregnancies complicated by IUGR of different etiologies, we measured on fetal blood obtained by cordocentesis, biochemical variables characteristic of the fetuses' respiratory and metabolic status. The aim of the study was to identify the discriminative biological alterations, related to growth retardation and fetal distress. PATIENTS AND METHODS: The studied population includes 27 cases of severe IUGR, of gestational age 30,2+/-4,6 weeks of gestation (WG) (divided into 20 cases of isolated IUGR and 7 cases of IUGR associated with malformative syndrome), as well as 8 cases of moderate IUGR, of gestational age 26+/-4,5 WG; all fetuses had normal karyotypes. A group of 73 normal fetuses, of gestational age 26,3+/-5,7 WG, constituted a reference population. PH, pCO(2), bicarbonate concentration, pO(2) and SaO(2), as well as glucose, pyruvate, lactate, free fatty acids, aceto-acetate, beta-hydroxybutyrate and cholesterol concentrations were measured on umbilical venous blood (UVB). RESULTS: In case of severe but isolated growth retardation, UVB analysis showed the frequency of acid-base and gasometric disturbances: acidemia and hypoxemia (65% of cases), hypercapnia (60% of cases). Metabolic abnormalities were shown: decrease in glycemia (35% of cases), increase in pyruvatemia and lactatemia (40% of cases), increased free fatty acids serum concentration; a diminution of umbilical venous cholesterol level, the most frequent abnormality, can be seen in 70% of fetuses. In case of severe IUGR associated with malformative syndrome, UVB acid-base and metabolic changes were rarely seen; however, UVB cholesterol level is low in some cases. In case of growth retardation classified as moderate, modifications are relatively not frequent and essentially gasometric. CONCLUSION: In about 60% of cases of severe and isolated IUGR, there is a risk of fetal distress, related to an alteration of the transplacental transfer of respiratory gases and nutritional substrates; chronic fetal malnutrition can be involved, with an impact on the growth of the fetus. In case of IUGR associated with malformative syndrome, fetal smallness is probably a result of intrinsic fetal damage, without nutritional origin.

Acid-Base Imbalance↗
PubMed2004

[Sensitivity and specificity of two methods used to identify incident breast cancer in specialized units using claims databases].

BACKGROUND: Hospital claims databases from acute care units are available nationwide and contain most patients at the beginning of their cancer. The goal is to define the ability of these databases to provide a number of incident breast cancer cases using identification methods. Two identification methods were assessed in three specialized sections of a teaching hospital. METHODS: The first method identified women who had at least one stay with a principal diagnosis of breast cancer. The second, which is more restrictive, identified women who had at least one stay with a principal diagnosis of breast cancer and a breast cancer-specific surgical treatment code. Both methods were applied to 4588 women 20 Years of age or older hospitalized in three specialized sections of the Hospices Civils de Lyon in 2000. To categorize these women in two groups, incident breast cancer cases or non-incident breast cancer cases, 150 women were randomized in each of two groups, one for incident breast cancer cases and one for non-incident breast cancer cases. Their medical records were used as references. RESULTS: Sensitivity, specificity and their credibility intervals were respectively 99.4% (84-99.9) and 91.7% (90.3-93.3) for the first method and 93.8% (76.2-98.7) and 97.3% (96.1-98) for the second. Among women wrongly identified with an incident breast cancer in 2000, 75.4% (43/57) had a breast cancer that was not incident that Year with the first method, compared to 96% (24/25) with the second. Among these women wrongly identified with an incident breast cancer, coding errors of the principal diagnosis were found for 24.6% (14/57) of patients with the first method and for 4% (1/25) with the second. Their correction led to 99.2% (86.5-99.9) sensitivity and 92.9% (91.4-94.6) specificity for the first method and to 94.2% (76.5-98.7) sensitivity and 97.3% (96.2-98.1) specificity for the second. CONCLUSIONS: The second method using cancer-specific surgical codes appeared more specific with a slight loss in sensitivity. The use of identification methods to assess the number of incident cancer cases still have to be defined.

Adult↗
PubMed2002

Color Doppler energy prediction of malignancy in adnexal masses using logistic regression models.

OBJECTIVE: The aim of this study was to assess the usefulness of color Doppler energy in the preoperative diagnosis of ovarian malignancy using multivariate logistic regression analysis. METHODS: One hundred and thirty adnexal masses were studied with transvaginal B-mode, color energy, and pulsed Doppler ultrasonography before surgery in order to develop a model that could be used to determine malignancy. Each ultrasonographic variable (tumor size, wall thickness, septal structure, echogenicity, papillary projection, density (solid or not)) was included individually or combined together as part of the Sassone ultrasound score. Intratumoral blood flow velocity waveforms were obtained to determine pulsatility index and resistance index and a more subjective parameter, location of tumor vascularity, was also assessed. Menopausal status and serum CA 125 levels were also entered as categorical variables. Sonographic parameters were entered alone, then associated with menopausal status and CA 125 serum levels, and finally with Doppler energy measurements. Our model was then validated in a group of 68 adnexal masses and compared to the model of Alcazar. RESULTS: Eighteen adnexal masses (13.8%) were malignant or of low malignant potential. Multivariate analysis showed that papillary projection of the tumor wall, cyst with solid parts, resistance index with a cut-off value of 0.53, CA 125, and central blood flow location, were the only factors to be independent predictors of malignancy. Menopausal status was not an independent factor. For the final model including the Doppler energy parameter the best sensitivity and specificity were 83% and 93%, respectively, at a cut-off value of 10% probability of malignancy compared to 83% and 87% for the morphological variables alone. Validation of the model showed its diagnostic performance to be as good as that reported in the original population and better than the model of Alcazar. CONCLUSION: Sonographic analysis of adnexal masses including color Doppler energy shows the best predictive properties according to histological diagnosis, and improves preoperative diagnosis of malignancy.

Adolescent↗
PubMed2002

[Intrauterine devices in general practice: a prospective study of 300 insertions].

OBJECTIVE: To assess the effectiveness of management practices of copper intrauterine devices (IUD) in general medicine. MATERIAL: and methods. A prospective study was conducted over a four-year period. Thirty-four experimented and volunteer general practitioners inserted 300 IUDs. Two hundred and ninety-seven patients were evaluated. A 375-mg copper IUD was used. Results are presented by 12-month device survival, cumulative discontinuation, and event rates per hundred women. RESULTS: At the end of the study 19.8% (n=59) of the women were lost to follow-up. Exposure time to IUD was 9245 cycles. Mean exposure time was 3917 cycles. Discontinuation rates for IUD were 82%, 67%, and 31% at 12, 36, and 48 months respectively. Renewal rate for this contraceptive device was 31.5%. Results confirmed that IUD were highly effective in this population: Pearl index 0.51% with four pregnancies. A very low expulsion rate (1.68%) and good tolerance (cumulative removal rate for medical reasons at 60 months=6.1%) were observed. At the end of the study, 61.3% of the women included had no complaints and had their IUD removed for desired pregnancy, replacement or personal reasons. CONCLUSIONS: Our findings are similar to reports in the literature; there was no evidence of differences between general practitioners and gynecologists. IUDs inserted by experimented general practitioners are safe and should continue to be offered as a contraceptive option for properly selected women. These findings suggest that specific training on contraceptives should be provided to interested general practitioners

Adult↗
PubMed2001

Functional ovarian cysts and the need to remove them.

OBJECTIVE: To review the need for the removal of functional ovarian cysts. MATERIALS AND METHODS: Over a 5-year period, between July 1994 and June 1999, all functional ovarian cysts files were reviewed in order to determine the main surgical indication. RESULTS: Thirty-four functional ovarian cysts (11.45%) were removed during that period. In 14 cases, the surgical operation was considered justified. In 32 cases, the cysts were not organic as supposed to be and had no reason to be removed. DISCUSSION: Reported functional ovarian cyst removal rates range from 15 to 30%. Present exploration means (particularly ultrasound-guided needle aspiration) does not permit to discriminate functional from organic cysts in more than 70% of the cases. CONCLUSION: It is impossible to reduce functional cyst removal rate to 0% but we should all evaluate our activity yearly and be able to limit this rate to less than 30%.

Adolescent↗
PubMed2001

Transvaginal cervicoisthmic cerclage as an alternative to the transabdominal technique.

OBJECTIVES: To analyse the foetal outcome after transvaginal cervicoisthmic cerclage, to determine whether it is a valid alternative to the reference transabdominal technique. STUDY DESIGN: Description of the vaginal operative technique, retrospective review of 20 cervicoisthmic cerclage patients from 1990 to 2000. RESULTS: In the curative group of women with a history of late pregnancy losses or premature deliveries and usually previous failed classical cervical cerclage, the foetal survival rate improved from 18% before cerclage to 79% after cerclage. No operative complications were reported. In the prophylactic group, typically characterised by the absence of the cervix as a consequence of surgery for invasive cervical cancers, the foetal survival rate was 83% after cerclage. CONCLUSIONS: The transvaginal cervicoisthmic cerclage allows a high foetal survival rate without complications in highly selected patients with poor obstetrical history. Because of its simplicity, this technique should replace the transabdominal route for surgeons experienced in vaginal surgery.

Abortion, Spontaneous↗
PubMed2001

Planned vaginal delivery versus elective caesarean section in singleton term breech presentation: a study of 1116 cases.

OBJECTIVE: To compare neonatal and maternal morbidity and mortality between planned vaginal delivery and elective cesarean section for singleton term breech presentation. STUDY DESIGN: We studied retrospectively all deliveries of singleton breech presentations at term in the public Hospitals of Lyon between 1 January 1991 and 31 December 1995. To take only the effect of delivery on the fetus into account, we eliminated high risk pregnancies and fetal malformations. Fetal parameters were corrected perinatal mortality, Apgar score<7 at 1 and 5 min, umbilical cord arterial pH<7.15, neurological disorders, trauma and need for neonatal intensive care. Maternal parameters were mild, moderate and severe complications. RESULTS: Of the 1116 breech presentations, 702 (62.9%) underwent an elective caesarean section and 414 (37.1%) a planned vaginal delivery. In the latter group, 342 (30.6%) had a vaginal delivery and 72 (6.5%) a non-elective caesarean section. Infants for whom the vaginal route was planned were at higher risk of mortality and morbidity. There were 2 deaths in this group and none in the elective caesarean section group and all fetal parameters were poorer: more Apgar<7 at 5 min (RR: relative risk=3.05; 1.03-9.05), arterial pH<7.15 (RR=1.64; 1.11-2.43), intubations (RR=7.35; 2.10-25.6), neurological disorders, trauma (RR=4.24; 1.66-10.8), transfer to intensive care units (RR=3.23; 1.57-6.64). The overall maternal morbidity was lower in the planned vaginal delivery group (RR=0.65; 0.44-0.94) but this was only because of less mild complications. The moderate and severe complications were the same in the two groups (RR=0.97; 0.59-1.57). CONCLUSIONS: Planned vaginal delivery in singleton term breech presentation increases the risk of death and of neonatal complications. Elective caesarean section increases the risk of only mild maternal complications. For these reasons, elective caesarean section should be preferred for singleton term breech presentations.

Adult↗
PubMed2001

[Methods for laparoscopy: open laparoscopy or closed laparoscopy? Attitude of the French Central University Hospital].

Standard technique of insufflation of the pneumoperitoneum includes the use of the Veress needle followed by the blind insertion of the umbilical trocar. To avoid blind trocar insertion, numerous techniques for the creation of the pneumoperitoneum have been reported: open-laparoscopy and micro-laparoscopy are the two major alternative methods used in France. The aim of this study was to determine the incidence of open-laparoscopy in the French departments of Gynecology of the University Hospitals. With this purpose, we send to each chief of the department of Gynecology in a University Hospital a simple questionnaire about the methods used in his division for the creation of pneumoperitoneum. Sixty-three chiefs of department have answered to the questionnaire. Thirteen (21%) answered they only used conventional technique. Ten (16%) departments perfonned always open-laparoscopy, and 40 University Hospital mostly used conventional technique combined sometimes when the initial procedure of insufflation failed or seems to be too dangerous (Obesity, previous laparotomy...). Five surgeons used a lateral rather than umbilical insertion for the openlaparoscopy in case of previous laparatomy. Fifteen departments used micro-laparoscopy since 1995, and mostly since 1998. We conclude that no simple technique can claim to be overwhelmingly superior. It seems tous dangerous to impose or to condemn any methods. Keeping the choice of the technique, learning security and organizing the survey of our results remain our recommendations for the approaches of abdominal entry for laparoscopy.

France↗
PubMed2001

[Operative technique for assumed benign ovarian cysts].

Assumed benign ovarian cysts are best treated by laparoscopy rather than laparotomy (NP1). A peritoneal sampling for cytology should always be performed first (NP5). Frozen section diagnosis for suspicion of malignancy requires specific conditions (NP5). Laparoscopic treatment of macroscopically functional cysts can not be limited to needle aspiration (NP5). There is not enough evidence to privilege cystectomy after needle aspiration over attempt to achieve enucleation of the cyst; however, uncontrolled rupture of the cyst is the risk associated with the latter procedure (NP5). Authors usually recommend extraction of the cyst through a bag (NP5). There is not enough evidence for or against ovarian suture. Benefits of adhesion barriers after ovarian cystectomy has to be proved. The majority of the authors perform a bilateral oophorectomy in case of unilateral postmenopausal cyst (NP5). As much parenchyma as possible should be preserved in case of large ovarian cysts. For women with small controlateral dermoid cysts, the validity of surgical abstention is not established. Conservative surgery is the rule in case of premenopausal mucinous cysts.

Biopsy↗
PubMed2000

[A plea for the creation of trophoblastic disease reference centers in France].

Gestational trophoblastic diseases include partial and complete molar pregnancies together with trophoblastic tumors, namely invasive mole, choriocarcinoma and placental site trophoblastic tumor. Important advances continue to occur in both our understanding and management of these diseases. The general guidelines we display here are intended to standardize the essential current management of trophoblastic diseases and justify the creation of a reference center in France. The goal of such a center is to optimize the treatment of patients. The center can help in drawing and interpreting the human chorionic gonadotrophin regression curve and give the multidisciplinary current recommendations to the physician in charge of the patient. The aim is to diagnose and treat as soon as possible the malignant forms of the disease as the interval between the previous pregnancy and the initiation of treatment is a major prognostic factor.

Female↗
PubMed2000

[Laparoscopic retropubic colposuspension (Burch procedure). Techniques and continence results].

INTRODUCTION: Laparoscopy allows to perform Burch colposuspension in case of genuine urinary stress incontinence but this approach must not lead to reduced success rates. OBJECTIVE: The aim of this study was to describe laparoscopic Burch techniques and evaluate urinary continence and satisfaction rates. MATERIALS AND METHODS: Clinical and urodynamic data were reviewed for 48 consecutive patients operated on from May 1993 to June 1999. The methods for entering the space of Retzius and performing the colposuspension were analyzed. The continence and satisfaction rates were evaluated with a questionnaire. RESULTS: The operative technique we are now using is the extraperitoneal approach with an umbilical trocar site. A non-absorbable mesh is fixed to the Cooper's ligament and to the vaginal fascia. With a mean follow-up of 41 months, the satisfaction rate is 76.8% with a cure rate of 37.3% and an improvement rate of 41.8%. CONCLUSION: Long term results with laparoscopic Burch colposuspension are relatively good but a bit lower than those published with traditional open technique. The effects of the learning curve with an evolving technique are to be considered when analyzing the results.

Colposcopy↗
PubMed1999

[Rubella in pregnancy. Management and prevention].

DECLINING INCIDENCE: Between 1982 and 1994, the incidence of rubella infections during pregnancy in France declined form 45 to 9 cases per 100,000 births. The incidence of congenital rubella declined from 5 to 0.85 per 100,000 births. These results are the fruit of systematic vaccination of 1-year-old children in France. Eradication of congenital rubella has been achieved in Sweden and requires further efforts to be obtained in our country. SEROLOGY: Physicians must systematically check rubella serologies in all women desiring pregnancy and/or of reproductive age even if they have been vaccinated. Rubella serology must be checked in all pregnant women even if they were seropositive during a prior pregnancy. IN CASE OF EXPOSURE OR ERUPTION DURING PREGNANCY: Serology must be obtained as early as possible in case of suspected rubella infection during pregnancy with a second serology 3 weeks later. The IgM titre should be obtained in case of suspected exposure with significant rise in IgG in successive serologies, if specific IgG titre is elevated after an eruption, if the first serum sample was taken late after suspected exposure, and finally if a systematic serology early in pregnancy is positive after a previously negative serology. ANTENATAL DIAGNOSIS: PCR on amniotic fluid or fetal blood is indicated if a seroversion occurs before 18 weeks gestation. Therapeutic termination of pregnancy should be proposed if fetal infection is certain. After 18 weeks, there is nearly no risk for the fetus: an antenatal diagnostic sample is not required and ultrasound surveillance is sufficient.

Female↗