Biomedical subjects

F Lécuru

Publications and source records attributed to F Lécuru.

44 records · Page 3Linked to original sources

PubMed1995

[Recurrent tubal pregnancy after a intra-tubal injection of methotrexate. Analysis of an case report with a histological tubal study].

A second tubal pregnancy occurred in the same tube as the first one which had been treated with methotrexate injection. The hysterosalpingogram performed 3 months after the methotrexate injection was normal. The recurrent tubal pregnancy was treated by laparoscopic salpingectomy. The pathology report confirmed non-ruptured tubal pregnancy. No damage to the tube could be imputed to the methotrexate injection. This observation confirms that methotrexate has no deleterious effect on tubal epithelium but also emphasizes that recurrent ectopic pregnancy can occur despite a patent tube.

Adult↗

PubMed1995

[Cost effectiveness of methotrexate treatment of ectopic pregnancy].

OBJECTIVES: Compare the cost of managing unruptured extra-uterine pregnancy with methotrexate injections and with conservative laparoscopic surgery. METHODS: Review of the literature to quantify post-therapeutic follow-up after echoguided methotrexate injections or laparoscopic salpingotomy. The cost of each procedure was determined on the basis of the French National Health Insurance nomenclature (Caisse National d'Assurance-Maladie). Total costs thus induced were then compared. RESULTS: The cost of medical treatment for unruptured extra-uterine pregnancy was similar to laparoscopic surgical treatment (10,267 and 11,858 FFr respectively). The duration of hospitalization was short for methotrexate injection but the number of biology examinations required for post-therapeutic follow-up was greater. CONCLUSION: Cost of medical treatment and laparoscopic surgical treatment reported in the literature vary little. Ambulatory methotrexate injections and the major reduction in biology follow-up examinations are required for significant reduction in medical treatment costs. Rigorous patient selection for methotrexate treatment could both improve effectiveness and reduce costs. Eliminating anaesthesia-related mortality as well as any surgery would be the true beneficial effect of medical treatment.

Ambulatory Care↗

PubMed1995

[Congenital varicella. Problems with prenatal diagnosis after an early, primary maternal infection].

Chickenpox rarely occurs as a primary infection during pregnancy. There is a risk of foetal malformation only if the mother is infected before 20 weeks of gestation. The two main problems encountered for antenatal diagnosis of congenital varicella are the rare incidence of morphology anomalies (less than 35%) and the difficulty of establishing a functional prognosis. Echography is used to detect foetal malformations. In suspected cases the proof of viral infection can be based on results of foetal serology, viral culture or polymerase chain reactions. According to the literature, echographically detected malformations in cases with certain foetal infection have a poor outcome although conflicting cases have been reported.

Chickenpox↗

PubMed1994

Varicella zoster virus infection during pregnancy: the limits of prenatal diagnosis.

In a mother with clinical evidence of chicken-pox at 12.5 weeks, fetal herpes varicella zoster infection was revealed by transient fetal ascites with liver calcifications at 27 weeks routine ultrasound. At 27 and 35 weeks fetal blood sampling and amniocentesis failed to demonstrate fetal viral infection. However, the diagnosis was confirmed postnatally based on thoracic herpes zoster at 8 months in an otherwise healthy infant. Polymerase chain reaction (PCR) on stored amniotic cells performed retrospectively was positive for varicella zoster virus (HVZV). This observation suggests that (1) in contrast to PCR, conventional fetal biology lacks sensitivity for prenatal diagnosis of HVZV infection, (2) the association of fetal sonographic abnormalities and positive amniotic PCR can be associated with a favorable pediatric outcome. Therefore, prenatal diagnosis of HVZV infection should be considered with the greatest caution.

Adult↗

PubMed1994

[Surgical treatment of genito-urinary prolapses by abdominal approach. Results in a continuous series of 203 operations].

A series of 203 abdominal operations for correction of genital prolapse performed between 1985 and 1992 is reviewed. We performed abdominal sacral colpopexy systematically associated with a Burch retropubic uretropexy. Resection of the peritoneum of the pouch of Douglas, and myorraphy of the levator ani were performed according to the findings of the clinical examination. 94 patients underwent a sacral colpopexy using a single suture of the cervix to the promontory, 41 had an anterior mesh, 33 had a suture associated with an anterior mesh, and 35 had 2 meshes (anterior and posterior). 96% of the patients were between 41 and 65 years old, and 90% were perimenopausal. 78.6% were multiparous and 32% had a neonate weighting 4kg or more. Urinary stress incontinence was isolated in 38%, and associated with another disorder in 57.8%. Urodynamic studies revealed detrusor instability in 12.3% of patients, and sphincter incompetence in 15.2%. Urinary tract insection was the most frequent postoperative complication (61.5%). One month post-surgical evaluation showed good anatomic results in 94.2 to 100% of cases, and good functional results in 56 to 70.5%. The longterm results were anatomically good in 86.7 to 100% of the patients, and functionally good in 53.3 to 80.5% (mean follow-up = 32.5 months). Results were not significantly different between the 4 surgical procedures.

Adult↗

PubMed1993

[Non-ruptured ectopic pregnancy. Treatment with methotrexate].

Methotrexate is now being used in the treatment of unruptured ectopic pregnancy. Experimental studies have shown that methotrexate inhibits the proliferation of normal trophoblast cells and that it has nos deleterious effect on tubal epithelium and no long-term teratogenic effect. Its pharmacokinetics is about the same when it is administered systemically or by intratubal injection. The clinical results obtained are independent of the mode of administration, with an 80 percent success rate. Thus, in the treatment of unruptured ectopic pregnancy methotrexate is a good alternative to laparoscopic surgery. The fertility of women treated with this drug seems to be preserved, but the published data are still insufficient and fragmentary.

Adult↗

PubMedDate not supplied

Impact of initial surgical access on staging and survival of patients with stage I ovarian cancer.

The aim of this study was to compare staging by laparoscopy and laparotomy, and to compare survival in patients with laparoscopy versus laparotomy as the first surgical access. We conducted a retrospective analysis of patients with stage I ovarian cancer treated surgically between 1985 and 2001, and we included those patients with stage I epithelial cancer for whom follow-up data were available. For each patient, we recorded whether initial surgical staging was by laparoscopy or by laparotomy, the procedures done at initial staging surgery, and the outcomes. The data were evaluated by analysis of variance, Chi-square test or Fisher's exact test, logistic regression, Cox model, and log-rank test, using SPSS 7.5 and STATA. Initial staging was by laparoscopy in 34 patients, laparotomy in 114 patients, and laparoscopy converted to laparotomy in 30 patients. In the laparotomy group, patient age was significantly greater and tumor size significantly larger, as compared to the laparoscopy group. Staging after first surgery was often inadequate; most notably para-aortic lymph node dissection was done in 0% of laparoscopy patients, 18% of laparotomy patients, and 33% of conversion patients. Restaging surgery has been indicated in 88% of laparoscopy patients, 48% of laparotomy patients, and 46% of conversion ones. After a mean follow-up of 40 months, survival rates were not significantly different among the three patient groups. No deleterious influence of laparoscopy as first surgical access was detected by univariate or multivariate analysis. Despite of inaccurate radicality and staging during initial laparoscopy, this study found no harmful influence of laparoscopy as first initial access on outcomes of patients with stage I ovarian cancer.

Adult↗

PubMedDate not supplied

Laparoscopy in patients with prior surgery: results of the blind approach.

BACKGROUND AND OBJECTIVES: To compare the complication rate due to blind access laparoscopy between patients with or without a prior history of laparotomy. METHODS: We examined a prospective record of data on laparoscopic surgeries performed from 1992 to 1998. Only cases in which the Veress needle and the first trocar were inserted through the umbilicus were included in this study. Results issued from patients without previous abdominal surgery (Group I) were compared with those arising from women with prior laparotomy (Group II). A statistical analysis was performed using the Chi-square test or Fisher exact test when appropriate. RESULTS: One thousand thirty-three laparoscopies were carried out during the study period, 881 of which began with a blind access through the umbilicus. Two hundred two women (19.3%) had an history of abdominal or pelvic surgery. Eight hundred forty-two patients were included in Group I and 39 in Group II. Failure to penetrate into the peritoneal cavity occurred significantly more frequently in Group II (4/39) than in Group I (1/842, P < 0.0001). The insertion of the Veress needle gave rise to 2 complications in Group I and 0 in Group II (P = 1.0). Transumbilical trocar insertion gave rise to 1 complication in each group (1/841 vs. 1/35, P = 0.11). When all events were considered, incidents or accidents were significantly more frequent in Group II (5/39) than in Group I (4/842)(P < 0.0001). CONCLUSIONS: We recorded a higher rate of incidents/complications due to the Veress needle and trocar insertion in patients with a previous history of laparotomy. An adapted approach should be recommended for these patients.

Chi-Square Distribution↗