[Postpartum venous thrombosis. Differential diagnosis of postpartum anesthetic complications].
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Adult↗
Biomedical subjects
E Nicoloso
Publications and source records attributed to E Nicoloso.
[Borderline tumors and cancers of the ovary. Laparoscopic-surgical evaluation].
OBJECTIVES: Benign cysts of the ovary can now be correctly treated with laparoscopic surgery, but it is difficult to confirm the benign nature of the suspected formation. Thus, the major risk of the laparoscopic surgery is the dramatic consequences in case of malignancy as reported in several cases in the literature. We conducted a survey to evaluate this risk. METHODS: A retrospective multicentric survey of laparoscopic procedures performed for a diagnosis of lesions of the annexes or cyst of the ovary was conducted. Forty-four centres reported a total of 7,122 laparoscopic procedures, including 5,307 in which laparoscopic surgery was performed. Laparoscopic treatment included puncture (21.3%), partial exeresis (51.3%) and complete exeresis (25.6%). Conversion to laparotomy was required in 20 cases (25.6%). A complementary surgical procedure was needed after the laparoscopic procedure within a delay of 78 days in 49 cases (58%). Laparoscopy was the only procedure used in 16% of the cases. RESULTS: Pathology reports of the surgical specimen indicated malignant lesions of the ovary in 78/5, 307 cases (1.47%) including 60 borderline tumours and 18 cancers. Among these 78 cases, preoperative work-up and laparoscopy had led to a diagnosis of a benign lesion in 17 (21.8%). Among the 49 cases with secondary surgery, a more advanced FIGO (International Federation of Gynaecology-Obstetrics) stage was observed in 11 (i.e. 8.3% of the 78 malignant cases) compared with the initial assessment. CONCLUSION: These findings demonstrate that it is not rare to discover the malignant nature of an ovarian tumour after initial laparoscopic treatment of a formation initially diagnosed as benign. Such accidents are the result of insufficient security in risk evaluation before laparoscopy. Whenever there is even a minimal risk of malignancy, laparotomy must be performed as the procedure of choice.
Adult↗
Laparoscopic management of malignant ovarian cysts: a 78-case national survey. Part 2: Follow-up and final treatment.
This paper reports a retrospective multi-institutional French survey carried out in 1992 to determine the incidence of laparoscopic management of malignant ovarian cysts. Of 5307 ovarian lesions treated endoscopically, 78 were malignant (1.47%) including 60 borderline tumours (77%) and 18 ovarian cancers (23%). Laparoscopic treatment was puncture in 23% of cases, partial exeresis in 51% and total removal in 26%. Laparotomy was immediately performed in 25% of the cases and as a second stage procedure in 58% (mean delay: 78 days). Laparotomy was not performed in 16% of the cases. Our findings suggest that laparoscopic management of ovarian lesions that subsequently prove to be malignant is not uncommon. To prevent the risk of metastasis, thorough pre-operative and per-operative evaluation is mandatory. In 22.4% of the patients presenting lesions in this study, laparoscopic tampering resulted in an upgrading of FIGO stage.
Female↗
[Vaginal pressure trauma: a complication of jet-skis].
Vaginal trauma was caused by a jet-ski fall. The lesion occurred due to hyperpressure of the upper half of the vagina. A protocol for diagnosis and treatment are proposed with emphasis on laparoscopy which is not always used.
Adult↗
Laparoscopic management of malignant ovarian cysts: a 78-case national survey. Part 1: Pre-operative and laparoscopic evaluation.
This paper reports a retrospective multi-institutional French survey carried out in 1992 to determine the incidence of laparoscopic management of malignant ovarian cysts. Of 5307 ovarian lesions treated endoscopically, 78 were malignant (1.47%) including 60 borderline tumors and 18 ovarian cancers. In 33% of cases preoperative diagnosis indicated that the tumor was benign. Preoperative findings were suspicious in 59%. Laparoscopic treatment was puncture in 23% of cases, partial exeresis in 51% and total removal in 26%.
Adult↗
[Serious forms of arterial pregnancy-related hypertension].
Pregnancy related hypertension is the primary cause of perinatal mortality and morbidity. Its incidence is of the order of 10%. Serious forms, which account for 10% of all cases of pre-eclamptic toxemia, remain a potential cause of maternal mortality and morbidity. Retroplacental hematoma, neurological problems dominated by eclampsia, coagulation disorders, Hellp syndrome, and hepatic, pulmonary, cardiac and renal problems are the essential complications of this pathology. They are described separately here, but are often associated. These potential complications require the careful evaluation of the severity of materno-fetal status. The management of these patients requires cooperation between the anesthetist/intensive care specialist, obstetrician and pediatrician. Such teamwork results in appropriate management for each individual patient. The various types of treatment are reviewed. Maternal and fetal mortality and morbidity could nevertheless be reduced by the early and careful management of high-risk patients, in particular by the prescription of low doses of aspirin and by careful clinical, ultrasound and velocimetric monitoring.
Aspirin↗
[Risk of systematic celioscopic treatment of ovarian diseases. 2 cases].
We report 2 cases of malignant ovarian tumours. These tumours had been missed at a first laparoscopic examination, and a second examination detected the presence of cancer cells disseminated in the peritoneum and the abdominal wall. The risk of propagation of an overlooked cancer makes it necessary to carry out a preoperative thorough evaluation based on clinical and ultrasonographic data before any attempt at laparoscopic surgery. If a laparoscopic treatment is decided, it must be performed under strict conditions and include meticulous exploration of the abdominal cavity, systematic peritoneal cytology, needle cytology of the cyst, emptying of the cyst in a water-tight manner, extemporaneous biopsy in case of doubt, peritoneal cleansing, and extraction of the cyst or the ovary in a bag. If malignancy is suspected, laparotomy must be performed immediately.
Adult↗
[Uterine ruptures in black Africa. An ever up-to-date problem. Results of a retrospective survey of 653 cases in 6 centers in inter-tropical Africa].
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Adult↗
Fetomaternal hemorrhage: diagnostic problems. Three case reports.
This report describes 3 successive cases in which fetomaternal hemorrhage was suspected but confirmed in only 2. The manifestations of fetomaternal hemorrhage are often nonspecific and diagnosis can be difficult. We discuss diagnostic methods, especially the value of the Kleihauer-Betke test and maternal serum alpha-fetoprotein measurement, and approach.
Adult↗