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D Raudrant

Publications and source records attributed to D Raudrant.

At least 37 records · Page 2Linked to original sources
PubMed1999

First case of pregnancy after radical trachelectomy and pelvic irradiation.

BACKGROUND: Invasive carcinoma of the cervix above stage IA1 is usually treated by radical hysterectomy and/or radiotherapy, leading to definitive sterility. CASE REPORT: We report the case of a young patient with stage IB1 carcinoma of the cervix treated in June 1995 by radical trachelectomy (according to the technique described by Dargent) and adjuvant brachy + teletherapy. A hormonal replacement of "menopause" was prescribed. One year later, she became pregnant and at 27 weeks gestation gave birth to a healthy child by cesarean section. CONCLUSION: Radical trachelectomy is one of the most recent therapeutic steps forward in the treatment of early stage invasive cervical carcinoma, which can surely be treated in some cases preserving child-bearing potential.

Adult↗
PubMed1999

Lichenoid cutaneous drug reaction at injection sites of granulocyte colony-stimulating factor (Filgrastim).

Colony-stimulating factors are widely used for bone marrow recovery after chemotherapy. Various cutaneous side-effects have been described in most cases involving neutrophils. We report the first case of lichenoid reaction at injection sites of granulocyte colony-stimulating factor (G-CSF) in a 40-year-old patient treated for breast cancer. The eruption cleared after drug withdrawal, no recurrence was observed after drug replacement by granulocyte-macrophage colony-stimulating factor. Mainly lymphocyte-mediated lichenoid eruption to G-CSF was shown. Cutaneous side-effects to G-CSF do not share unequivocal pathogeny based on stimulation of neutrophils.

Adult↗
PubMed1999

[Hysterectomy for a benign lesion: can the vaginal route be used in all cases?].

OBJECTIVE: To determine which factors indicate the vaginal route cannot be used for hysterectomy and study the morbidity of this technique in comparison with the abdominal route. METHODS: A retrospective study was conducted in 682 patients who underwent hysterectomy for benign lesions between 1992 and 1996. Genital prolapses and/or urinary incontinence accounted for 31% of the indications. Mean patient age was 50 years. There were 75 nulliparous patients and 27% of all patients had a pelvic history (including cesarean section) which might compromise vaginal hysterectomy. RESULTS: Hysterectomy was performed via the abdominal route in 39.7% of the cases and via the vaginal route in 60.3% including 5.7% with laparoscopic assistance. Factors which dictated the abdominal route were: large size of the uterus (47%), pelvic background (30%), tubo-ovarian pathology (6%), multiple elements (6%), unknown (11%). Operation time depended on the surgical route, parity, pelvic background and associated techniques (prolapse, oophorosalpingectomy, uterine segmentation). Morbidity was very low and the same for both routes: 1.8% operative accidents (mainly bladder wounds), 1% reoperation, only one case of thromboembolism and less than 0.5% postoperative fever. DISCUSSION: There is no absolute contraindication to vaginal hysterectomy. It would appear unreasonable to an unexperienced surgeon to use the vaginal route for a fixed uterus with an estimated weight over 400 g in nulliparous patients with a pelvic background. In a department with vaginal training, 84% of all hysterectomies could be performed by vaginal route, because half of the indications for the abdominal route are excessive or a matter for laparoscopic assistance.

Adult↗
PubMed1997

[Laparoscopic external iliac lymphadenectomy in the treatment of cancer of the cervix uteri].

OBJECTIVES: The aims of this study are to evaluate the feasibility of laparoscopic iliac external lymphadenectomy and to define current indications of this technique in pre-treatment staging of cervical carcinoma. MATERIAL AND METHOD: Forty seven patients with FIGO stages IA-IIIB invasive cervical cancer underwent transperitoneal laparoscopic iliac lateral lymphadenectomy prior to initiation of treatment. The mean length of operation was 115 min (35-180). An average of 14 nodes were retrieved from each patient (3-30). Percentage of complete removal was 96% in this study. The rate of complications was 6%, they were always minor. Today's most accepted indications concern: 1) FIGO IA2 stages with lymphovascular involvement or micro-invasion over 3mm, for which a simple resection of lesions can be performed if pN0. 2) Small FIGO IB stages where an exclusive vaginal enlarged colpo-hysterectomy can be performed for pN0. Other indications should not be performed for the moment except for therapeutical trials.

Adult↗
PubMed1996

[Gynecologic laparoscopy with or without curare].

OBJECTIVE: To assess physiological changes and operating conditions during general anaesthesia with or without neuromuscular blockade in patients undergoing gynaecologic laparoscopy. STUDY DESIGN: Prospective, randomized, double-blind study. PATIENTS: Fifty non-obese patients, mean age 31 years, randomly allocated into either a group of 25 with curare (AC) or a group of 25 without curare (SC). METHODS: All patients were anaesthetized with propofol (2.5 mg.kg-1), sufentanil (0.4 microgram.kg-1) midazolam (2 mg) and N2O-O2. In addition, those of the AC group were given atracurium 0.25 mg.kg-1 for intubation, followed by additional boluses to maintain twitch height < 10% of the control value. Blood pressure, heart rate, peak airway pressure, end-tidal carbon dioxide pressure were recorded before and during pneumoperitoneum maintained at a pressure of 15 mmHg. Operating conditions were assessed at 10-min intervals, using a four point scale. RESULTS: In both groups, blood pressure and heart rate decreased following induction. The decrease in blood pressure was more important in the SC group at 5 min and before pneumoperitoneum (25 vs 15%); P < 0.05). The time course of PETCO2 and peak airway pressures were similar between groups. Operating conditions were not influenced by the muscle relaxant. CONCLUSIONS: Neuromuscular blockade influences neither most of the clinical haemodynamic and respiratory changes induced by pneumoperitoneum for gynaecologic laparoscopy not the operating conditions.

Adult↗
PubMed1996

[Pure embryonal carcinoma of the ovary. A review of the literature apropos of a case].

A 25-year-old woman with a stage IA pure embryonal carcinoma of the left ovary, without elevated serum markers namely AFP and HCG (nor-positive immuno-histologic marking at the later pathological analysis) underwent surgery alone (unilateral salpingo-oophorectomy). She relapsed seven weeks later with peritoneal carcinomatosis. She still did not have elevated tumor markers. She then received five courses of a cis platinum-based chemotherapy (bleomycin, etoposide and cisplatinum, BEP) and achieved pathological complete response (as attested by a coelioscopic third look). This response is still lasting, fourteen months after the end of the procedure. Malignant ovarian germ cells tumors account for 2 to 5% of all ovarian cancers and embryonal carcinoma is rare. It may be associated with high serum levels of AFP and/or HCG, but not when the embryonal carcinoma is really pure. These markers are very helpful for patient follow-up but not in our patient's history. These tumors offer a very good chemosensitivity especially when treated with cisplatinum. This treatment dramatically improved their prognosis and extensive debulking surgery is yet unnecessary. Some questions still remains is there any specificity for embryonal carcinoma within malignant germ cell tumors of the ovary group? What is the best treatment for stage IA disease? When is a surgical second look (or a third look as for our patient) justified?

Adult↗
PubMed1995

[Lysine-vasopressin in gynecologic surgery by the vaginal route. Hemodynamic study].

OBJECTIVES: Vasoconstrictors are often used in gynaecology for vaginal surgery. Ornipressin was prohibited in France in 1990 and we studied the haemodynamic effect of a structural analogue marketed in France, lysine-vasopressin infused locally at the operative field. METHODS: Four haemodynamic parameters were evaluated in 7 patients undergoing surgery via the vaginal route under epidural anaesthesia (lidocaine 2%). Arterial pressure and heart rate were measured noninvasively and thoracic bioimpedance was used for measuring cardiac index and systemic vascular resistance. Baseline levels were obtained after induction of anaesthesia and positioning the patient. Five units of lysine-vasopressin diluted in 20 ml of 9/1000 saline solution were infused locally into the cervix. Haemodynamic measures were made for 15 minutes. RESULTS: Five minutes after infusion, there was a significant increase in systolic (+21 +/- 7%) and diastolic (+29 +/- 9%) arterial pressure (p < 0.05) (Mann and Whitney U test). There was a tendency for bradycardia which did not reach significance. The systemic arterial resistances were increased from 3080 +/- 178 to 4965 +/- 227 ohm/m3 with concomitant drom in systolic index from 2.6 +/- 0.3 to 1.6 +/- 0.11 min/m2. The observed haemodynamic effects were similar to those obtained with onipressin and corresponded to a sudden increase in post-charge. Cardiac tolerance was poor with a drop in systolic index to a level corresponding to a fall in cardiac inotropism and coronary blood flow. CONCLUSION: With this product, the patients are exposed to the same diseases and accidents described for ornipressin and thus should be used with extreme care, in adapted situations by competent experienced surgeons for patients without cardiovascular or cerebral diseases.

Adult↗
PubMed1995

Comparison of the effects of different menstrual tampons on the vaginal epithelium: a randomised clinical trial.

The effects on the vaginal epithelium of three different menstrual tampons in normal conditions of use were studied in 41 women during the menstrual period. The vaginal epithelium was studied in a total of 123 cycles at a structural and ultra-structural level with colposcopy, vaginal smear and biopsy on TEM and SEM. One of the three tampons studied showed a lower level of abnormalities on colposcopy (36.6% vs. 56.1% vs. 68.3%), with an inverse correlation between the severity of the dryness and the quantity of blood absorbed by the tampon (4.2 g when the colposcopy was normal vs. 1.8 g in case of severe dryness). Cytology is not a good test for assessing the effects of tampons because of the high rate of acellular and uninterpretable samplings. The biopsy effects were defined according to their depth in the epithelium. The same tampon showed the lowest level in biopsy abnormalities. No correlation was found between severity of the colposcopy and biopsy results. Colposcopy can demonstrate the degree of severity of dryness or any other effect, but biopsy only confirms the effect and does not correlate the degree of severity. Materials and designs of tampons can play a role in reducing the drying effects to the vaginal epithelium.

Adolescent↗
PubMed1994

[Role of peroperative radiotherapy in the treatment of uterine cancers. Preliminary experience in Lyon].

AIM: Retrospective analysis of Intra operative Radiotherapy (IORT) in recurrent uterine carcinoma (RUC) and prospective pilot study of IORT in advanced cervix cancer (ACC) with high risk of local failure. PATIENTS-TREATMENTS: 1) RUC: from 1988 to 1991, 34 patients with RUC have been treated. Primary cancer was: cervix uterus: 28, endometrium: six. Site of recurrence: centro pelvis: four, latero pelvis: 25, lombo aortic: five. Total gross resection was only possible in 12 patients. A dose of 15 to 22 Gy was given by IORT according to the residual tumour size. External beam irradiation was added in 16 patients; 2) ACC: January 1991 to November 1992, 20 patients were included in this pilot study, stage IIB: seven, stage III: 12, stage IV: 1. Preoperative retroperitoneal pelviscopy showed 13 pN1 patients and NMR imaging ten tumours of 6 cm or larger in diameter. Treatment started with concommitant pelvic irradiation (44 Gy) and one conommitant cycle of 5 Fu-CDDP, followed by a short course of high dose rate upper vagina brachytherapy (4 Gy). Four weeks later a radical Wertheim operation was performed together with IORT on the lateral pelvis. RESULTS: 1) RUC: overall survival (Kaplan Meier) at 4 years is 32% (+/- 8). Local relapse in the fiedl of IORT was observed in six patients. Grade 2-3 complications: six patients (radiation proctitis, neuritis, vertebral collapse, ureteral stenosis); 2) ACC: the median follow up is hort (18 months). Four cases of pelvic relapse, no postoperative death. The first line radio chemotherapy was associated with two G3 early complications. Postoperative radiation complication was less than 10% G3. DISCUSSION: promising results of IORT in RUC have been observed especially if no irradiation is given during the primary treatment. Good feasibility of the pilot study of IORT in ACC was also observed. It could be followed by a multicentric feasibility trial.

Adult↗
PubMed1994

[Metabolic impact and complications of intra-uterine resection].

Hysteroscopic surgery with the use of a resectoscope are currently going through major developments. They are often aimed at healthy women who consider having relatively minor surgery. Many complications can affect endometrial resection. Some metabolic complications due to the irrigating liquid have been identified recently in gynaecological surgery, and can be defined as the whole group of clinical symptoms linked to the passage of the irrigation liquid into systemic circulation. Neurological and cardiovascular disorders are due to an acute dilutional hyponatremia and to the very toxicity of glycol and/or of its metabolites. The way the irrigating liquid is resorbed has an effect on the order in which these accidents happen. The duration of the resection, its depth, as well as the intrauterine pressure are the three factors which make it easier for a clinical syndrome to appear. Whatever the mechanism responsible, the clinical and biological consequences are the same and can be more or less serious, depending on how much liquid has been resorbed: they are non-existent up to one liter, and appear between 1.5 and 2 liters. Recent studies have shown that natremia and glycinemia are closely and inversely related. By taking a number of precautions, accidents--which are relatively rare but can be very serious--could be prevented.

Endometrium↗
PubMed1993

Fetal liver transplantation: biology and clinical results.

Over the last 18 years, we have developed the transplantation of fetal liver cells to treat severe immunodeficiencies, hematological disorders and inborn errors of metabolism. Post-natally, this treatment is successful in two-third of patients and it is therefore very valuable, especially when there is no perfectly matched donor for a bone marrow transplant. Since 1988 we have carried out these fetal liver transplants (FLTs) in utero, immediately after prenatal diagnosis. Engraftment and reconstitution have been obtained, and several advantages appear to be associated with in utero FLT: increased probability of graft take, ideal isolation of the patient (in the maternal uterus) and optimal environment for the differentiation of the transplanted fetal liver cells (in the fetal host).

Fetal Tissue Transplantation↗
PubMed1992

In utero transplantation of stem cells in humans: immunological aspects and clinical follow-up of patients.

Four human fetuses were treated by transplantation of human fetal liver stem cells. Two of them had severe immunodeficiency disease and the two other ones had thalassemia major. Three of these in utero transplants were followed by engraftment. The three patients are now born: the first one is now very healthy thanks to the reconstitution of cell-mediated immunity associated with this transplant, and he lives normally at home; the two other ones, who have been more recently treated, have a significant improvement of their condition and they also live normally at home. This procedure, for the first time used in humans, has therefore demonstrated its feasibility and its efficacy: during early fetal development, foreign cells engraft readily and may result in cure or significant correction of a large variety of inherited diseases.

Blood Transfusion, Intrauterine↗