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Biomedical subjects

F Golfier

Publications and source records attributed to F Golfier.

31 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

Mid-trimester fetal livers are a rich source of CD34+/++ cells for transplantation.

Human fetal livers (FL), between 16 and 24 weeks of gestation, were studied for their potential as a source of hematopoietic stem cells for prenatal and postnatal transplantation. In this report we give a quantitative evaluation of human FL as a source of candidate stem cells, and develop a protocol for the isolation of these cells free of microbial contaminants and almost free of mature T cells. Human FLs contained a median 1.9 x 10(9) viable cells and a mean of 1.3 x 10(8) CD34+/++ cells (range 1.1 x 10(7) to 4.7 x 10(8)). Regardless of gestational age, no significant differences were apparent in the numbers of total progenitors or in the numbers of candidate stem cells (CD34++ CD38- and CD34++CD4+), suggesting that the expansion in the liver of the early compartments of hematopoietic progenitors reaches a plateau after the sixteenth week of gestation. Colony-forming units culture (CFU-C) were found to range from 4.1 x 10(6) to 2.5 x 10(7) per FL. Positive selection of FL CD34++ cells was achieved using the Baxter Isolex 50 device. An average purity of 74% and yield of 29% of CD34+/++ cells was achieved. T cells were depleted by 99.95%, resulting in a mean of 6.5 x 10(3) T cells per processed liver. Analysis of candidate stem cell populations and primitive colony-forming cells (CFC) suggested a preferential enrichment of these cells over the total population of CD34+/++ cells. Processed CD34+/++cells were found to be sterile. In conclusion, purification of FL progenitors between 16 and 24 weeks of gestation results in a large number of early progenitors suitable for in utero and possibly post-natal transplantation.

Antigens, CD34↗
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

Extradural clonidine combined with sufentanil and 0.0625% bupivacaine for analgesia in labour.

We have studied the use of clonidine combined with low doses of sufentanil and bupivacaine in 45 parturients requiring extradural analgesia for the first stage of labour, in a double-blind, randomized study. We gave 0.0625% bupivacaine 10 ml containing 1:200,000 adrenaline and sufentanil 10 micrograms (1 ml) to which was added 0.9% saline, or clonidine 100 or 150 micrograms (1 ml). We compared the quality (VAS scores) and duration of analgesia, motor block, maternal haemodynamic state (mean arterial pressure and heart rate) and fetal and maternal side effects. Mean duration of anaesthesia was prolonged slightly: 105 (SD 21) min without clonidine, 130 (26) min with clonidine 100 micrograms (P < 0.05 vs control) and 144 (40) min with clonidine 150 micrograms (P < 0.01 vs control, ns vs 100 micrograms). There were no differences in VAS scores, onset times, heart rate, ventilatory frequency, motor block, sedation, pruritus or bradycardia between the groups. Analgesia was associated with a reduction in mean arterial pressure with clonidine. However, these adverse side effects were of minor clinical importance regardless of the extradural clonidine dose, except for a high incidence of fetal heart tracing abnormalities when clonidine 150 micrograms was used. These effects associated with a limited effect on analgesia may curtail the widespread use of clonidine as an adjunct to extradural 0.0625% bupivacaine with sufentanil 10 micrograms during labour.

Adrenergic alpha-Agonists↗
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↗
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↗
PubMed1990

[The treatment of carcinoma in situ of the breast].

In reference to a series of 36 in situ breast carcinomas, the current therapeutic possibilities are considered: 8 lobular carcinomas in situ (LCIS) and 28 ductal carcinomas in situ (DCIS) were diagnosed between January 1985 and July 1988. These are infraclinical forms in 80% of the cases, representing 20% of the breast carcinomas treated during the same period of time. The natural history of carcinomas in situ is presented; LCIS rarely evolve toward an invasive carcinoma and they should not be considered as risk factors. DCIS evolve, after biopsy, toward an infiltrating ductal carcinoma in 26 to 28% of the cases. Axillary node invasion is present in 3% of the cases. After diagnostic biopsy of a LCIS, a subcutaneous mastectomy with prosthetic reconstruction will be offered only if there are bilateral foci or diffuse microcalcifications. Supervision will be recommended in all other cases. The results of the mastectomy-node excision procedure are well known for the LCIS: less than 5% recurrence and a mortality under 1.5%. The current tendency goes toward a limited surgical act: axillary dissection is discussed for small LCIS; lumpectomy is more and more advocated with long-term results still not well known; in case of lumpectomy, two prospective trials are currently in progress in the world, in order to assess the efficacy of radiotherapy.

Adult↗
PubMedDate not supplied

Induction of transplantation tolerance in humans using fetal cell transplants.

When engrafted with donor stem cells and lymphoid cells, patients develop transplantation tolerance to donor antigens. We analyzed the mechanism of tolerance induction in immunoincompetent recipients whose immunity has been reconstituted by transplantation of mismatched stem cells. Seven infants or human fetuses received fetal liver transplants as a treatment for severe combined immunodeficiency disease. After reconstitution of immunity by lymphocytes developed from donor stem cells, T-cell clones were produced and analyzed. Because donors and recipients were HLA mismatched, it was easy to demonstrate the donor origin of the T-cell clones. These clones were shown to have developed tolerance to histocompatibility antigens of the stem cell donor via a process of clonal deletion (probably as a result of contact with donor-derived macrophages and dendritic cells). They were also tolerant to histocompatibility antigens of the host but through a different mechanism: many clones recognized these antigens but had no detrimental effect on the target cells exhibiting host antigens, either in vitro or in vivo. Clonal anergy was therefore the cause of this tolerance to host determinants, resulting in a lack of graft-versus-host disease and of autoimmunity. The contact between developing T cells of donor origin and host epithelial cells within the host thymus may explain this colonal anergy. It should be noted that all patients had high serum levels of interleukin-10, which might have contributed to the persistent engraftment and tolerance.

Fetal Tissue Transplantation↗
PubMedDate not supplied

Laparoscopy versus laparotomy for pelvic and lumbar-aortic lymphadenectomy. A 11-year experience.

UNLABELLED: This study is a retrospective comparison of laparoscopy and laparotomy lymphadenectomy (pelvic and lumbar-aortic) in cervical cancer stage IA1 and more, in a gynaecological service in Lyon, France. MATERIAL AND METHODS: During 11 years, there were 126 cases of cervical cancer patients in which lymphadenectomy was performed, either by laparoscopy or laparotomy. We analysed if there were significant differences regarding the 2 accesses in terms of stage, tumour size, surgical interventions associated, number of lymph nodes extracted, and outcome. RESULTS: Regarding the stage of our cases, 3 of them were IB1, IB2 and IIB; the more advanced the stage, the fewer lymphadenectomies were performed by laparoscopy. As for the tumour size, the smaller tumour was statistical significantly associated with pelvic laparoscopic lymphadenectomy (p = 0.01) while the tumours larger than 4 cm mean lumbar-aortic lymphadenectomy by laparotomy (p = 0.006). Regarding the associated surgical interventions, the laparoscopic lymphadenectomies were associated to low-stage operations: conisation/trachelectomy, vaginal or abdominal simple hysterectomy, or extra-fascial hysterectomy (type 1 or 2). There was no significant difference between laparoscopy and laparotomy ways regarding the number of lymph nodes extracted (median 13.5 vs 11, p = 0.45 for pelvic nodes, and 8 vs 4 for lomb-aortic nodes, p = 0.43, for laparoscopy vs laparotomy). CONCLUSION: Laparoscopic lymphadenectomy is as effective as the laparotomy procedures, and the training of young gynaecologic oncologists should not ignore laparoscopy as an alternative technique for nodes sampling.

Aorta↗