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Biomedical subjects

F Lecuru

Publications and source records attributed to F Lecuru.

36 records · Page 2Linked to original sources
PubMed1996

Anticoagulant therapy in pregnancy. Report of 54 cases.

BACKGROUND: To investigate the adverse effects of anticoagulant therapy during pregnancy in a tertiary care center. MATERIAL AND METHODS: A prospective study was carried out between 1 January 1977 and 31 December 1994 and included 54 pregnancies in 50 women treated with anticoagulants. In Group I (n=43) oral anticoagulants were replaced for heparin from the sixth until the end of the twelfth week of gestation and acenocoumarol was not substituted. All patients received vitamin K antagonists during the second and third trimesters. Heparin was given after 36 weeks of pregnancy until the tenth day in the postpartum period. Statistical comparisons used Chi square test (with the Yates correction when appropriate) and Student t test. RESULTS: Mechanical heart valve prosthesis was the most frequent indication (68%). There was one artificial heart valve thrombosis during first trimester in Group I and none in Group II (p=0.45). One spontaneous abortion occurred in each group (p=0.86). Seven cardiac complications (13.7%) occurred during the second and third trimesters. We recorded no thrombotic episode of an artificial heart valve after the first trimester of pregnancy. Hemorrhagic complications occurred in mid-pregnancy (one case=2%) and during peripartum (eight cases=16%). Two maternal deaths occurred in the postpartum period, both were linked with the anticoagulant therapy. There was one coumarin embryopathy (Group II: 9%),but no neonatal mortality. CONCLUSIONS: (1) Hemorrhagic complications occur among 16% of patients receiving anticoagulant therapy during pregnancy. (2) Delivery and postpartum are the most critical periods.

Adult↗
PubMed1996

[Granulomatous peritonitis after laparoscopic surgery of an ovarian dermoid cyst. Diagnosis, management, prevention, a case report].

We report a case of granulomatous peritonitis which occurred following laparoscopic exeresis of a dermoid cyst of the ovary performed together with medically induced abortion. The peritoneal cavity was contaminated when the cyst ruptured during the procedure emptying sebum and hairs in the peritoneum. Abondant washing with aspiration of all the visible particles was done with a 5 mm canula. The diagnosis of granulomatous peritonitis was suggested with the development of persistant fever, degradation of the patient's general health, moderate abdominal pain and a nodular image at echography located on the operated ovary. The nodule was found to be an inflammatory granuloma on a foreign body. Two second-look laparotomies, one transrectal and the other via the xypho-pubian route, were required 1 month after the initial operation for complete cure. The diagnosis was confirmed on the pathology report.

Abortion, Therapeutic↗
PubMed1995

[Simultaneous radiochemotherapy in locally advanced cancers of the cervix: a preliminary study].

We have designed a combined treatment strategy of bifractionated split course radiotherapy (RT) and concomitant chemotherapy (CT) to try to improve the results of RT in inoperable cervical carcinoma. After evaluation, patients were submitted to further radical surgery or additional RT-CT depending on the treatment results. Between January 1988 and January 1992, 25 patients with non metastatic inoperable disease entered in the protocol. The stage of the disease was: T3N0 4 patients, T3 with hydronephrosis seven patients, T3N1 12 patients, and T4N0 two patients. Nineteen patients received two courses of CT with fluorouracil (F), cisplatin (P) with or without etoposide. Pelvic RT was given twice daily (two fractions of 3 Gy) on days 1, 3, 15 and 17. A combination of F 400 mg/m2/d and P 15 mg/m2/d in continuous infusion with oral etoposide (100 mg/d) and hydroxyurea (500 mg/d) in 11 patients was delivered concomitantly on days 1-3 and 14-17. A clinical and radiological evaluation was performed four weeks later. Patients with objective response underwent radical hysterectomy (group A) and those with incomplete response received additional RT-CT protocol (group B). All patients had endocavitary brachytherapy at the end of treatment. After two cycles of CT there were four PR in 19 patients and 5 failures. After RT-CT there were 12 CR (48%) and eight PR. There was a relationship between disease status after RT-CT and response to initial CT in those 19 patients who received the neoadjuvant CT. Fifteen patients were in group A, six of whom had no histologically active disease in the post-operative sample. However all 15 patients were rendered free of disease. Ten patients were in group B, five of whom attained the clinical CR status. In total, 20 of 25 patients (80%) were in CR at the end of treatment. Six patients experienced pelvic recurrence and two patients distant metastases. Four of the five patients with incomplete response had evolutive disease. The overall survival is 60% and 36% at 1 and 2 years respectively after a median follow-up of 22 months (14-48 m). The protocol was tolerable. These results compare favorably with those of conventional RT and warrant further evaluation.

Adult↗
PubMed1993

[Anticoagulant treatment and pregnancy. Apropos of 47 cases].

The authors report a series of 47 patients treated with anticoagulants during pregnancy. The commonest indication was the presence of an artificial heart valve (72.3% of cases), most often mitral (58.9%). Thirty seven women were treated with heparin (group I) and ten with oral anticoagulants (OA) (group II) during the first three months. There was one peripheral venous thrombotic event and 2 post-partum deaths. Obstetric complications were equally distributed between the 2 groups, with the exception of spontaneous abortions during the first three months and fetal deaths, which were commoner with OA. Hemorrhagic complications occurred in 17% of cases at the time of delivery and during the immediate post-partum period. One case of coumarin embryopathy was seen. This series confirms that three periods are dangerous in the context of anticoagulant treatment during pregnancy: the first three months, delivery and postpartum. We recommend the use of heparin during the first three months and at the end of pregnancy, restricting OA to the period between 4 and 9 months.

4-Hydroxycoumarins↗
PubMed1993

[Cancer of the ovary and the hormonal context].

Screening for ovarian cancer can only be worthwhile if it is applied to a population at risk. Recent studies show that there is a significant lowering of the risk for cancer of the ovary after all contraceptive preparations containing oestrogens and progestogens have been used. The longer these preparations are used the greater the protection for the user and this protection continues for a long time after treatment has stopped. One finds, in truth, that if the ovary is put functionally at rest whether it is because ovulation has been stopped by pregnancy or by oral contraception or by a premature menopause, or late puberty, the ovaries are somewhat protected from cancer. On the other hand, women whose reproductive life is long without being interrupted as far as ovarian function is concerned, have a higher risk of developing cancer and, therefore, would be worthwhile screening. Furthermore, on the other hand the problems of stimulating the ovaries when treating for sterility must be considered in the relationship to the possibility of provoking cancer of the ovary. A better knowledge of the hormone status would make it easier to decide what cases should be screened for epithelial cancer of the ovary so that the prognosis can be less disastrous than it is.

Age Factors↗
PubMed1992

The effect of tubal injection of methotrexate on fertility in the rabbit.

OBJECTIVE: To investigate the fertility of rabbits after tubal injection of methotrexate (MTX). DESIGN: The side of injection of MTX was randomly decided in a prospective experimental trial. PARTICIPANTS: Fourteen female New Zealand White Rabbits were believed to be of normal reproductive status. INTERVENTIONS: Methotrexate or Ringer's solution were injected into the tubes of the rabbits. The nidation index was used to measure the fertility of the animals. RESULTS: The average nidation index of the control tubes was not statistically different of the one of the tubes treated with MTX. CONCLUSION: Tubal injection of MTX has no adverse effect on fertility of rabbits. It seems ethical to investigate tubal injection of MTX as an alternative to laparoscopic management of unruptured ectopic pregnancy in the human.

Animals↗
PubMed1992

Gonadotrophin-releasing hormone agonist and laparoscopic myomectomy.

The indications for operative laparoscopy have expanded greatly over the past decades, as its many advantages over laparotomy have been recognized. We report our techniques and short-term results concerning myomectomy by laparoscopy. From January 1, 1990 to October 1, 1991, 147 intraperitoneal myomectomies were performed in 70 patients: 46 of 70 were treated preoperatively with a depot gonadotrophin-releasing hormone agonist. No complications were observed. In selected cases, with the advantages of laparoscopic surgery, laparoscopic myomectomy appears to be a safe technique.

Anti-Bacterial Agents↗
PubMed1992

[Experimental histological study of the local toxicity of intra-tubal injections of methotrexate].

The injection of methotrexate is an alternative to laparoscopic surgical treatment of unruptured ectopic pregnancy. An experimental trial on rabbits was designed to evaluate this new approach. In situ injection of methotrexate does not cause either real tubal epithelial impairment, nor an adverse effect on treated rabbits' fertility. However, sub-peritoneal injections of methotrexate are responsible for a typical histological lesion. These results are discussed emphasising the importance of the way the administration is carried out.

Animals↗
PubMed1991

[Other indications: tubal sterilization, medically assisted procreation, salpingitis, fibromas].

Tubal sterilization is now commonly performed by laparoscopy. Among the available techniques, clips are easy to install and have a low failure rate. Laparoscopy is of considerable value in salpingitis for the diagnosis and treatment of tubo-ovarian abscesses. In medically assisted procreation, laparoscopy is less and less necessary. GIFT and, chiefly, ZIFT are still performed by laparoscopy in case of infertility with normal Fallopian tubes. Laparoscopic myomectomy is a more recent technique, but further experience is needed to assess its value compared with laparotomy.

Female↗
PubMed1991

Myomectomy by laparoscopy: a preliminary report of 43 cases.

OBJECTIVE: To evaluate the technique and short-term results of intraperitoneal (IP) myomectomies. DESIGN: From January 1, 1990, to March 1, 1991, IP myomectomies were performed in all cases in which it appeared feasible. SETTING: This study was conducted in a tertiary care center, the Port-Royal University Hospital. PATIENTS, PARTICIPANTS: Among 49 consecutive patients with interstitial or subserous myomas, 6 patients with voluminous, multiple myomas had laparotomies. Intraperitoneal myomectomy was performed in 43 patients. The indication for laparoscopy was a pelvic mass in 29 cases, infertility in 13, and severe endometriosis in 1 case. INTERVENTIONS: Thermocoagulation or monopolar coagulation was used for the uterine incision. Myometrium and serosa were sutured in 23 of 43 patients. Myomas were removed through the suprapubic puncture site after fragmentation of large myomas. MAIN OUTCOME MEASURE(S): We evaluated the length of the procedures, blood loss, and postoperative course. RESULTS: Ninety-two myomas were removed laparoscopically. No complication was observed. CONCLUSIONS: In selected cases, IP myomectomy appears to be a safe technique with the advantages of laparoscopic surgery.

Adult↗
PubMed1989

[Value of magnetic resonance imaging in cancer of the endometrium. Apropos of 3 cases].

Magnetic nuclear resonance imaging offers a new approach for assessing the spread of endometrial cancer. Clinical and histopathological data correlated well in two cases; in the third patient, the degree of vesicovaginal wall involvement was more difficult to appreciate. RMN accurately characterizes the tumor and provides information on how deeply the myometrial lesion extends, as well as on isthmic and cervical involvement. Such evaluation is conducive to more precise prognostic conclusions and may be strategically influencial on therapeutic behavior.

Adenocarcinoma, Papillary↗
PubMed1989

[Simple goiter and hypothyroidism during pregnancy. Diagnosis--monitoring--treatment].

37 cases of maternal hypothyroidism in 92,130 births (0.04%) were studied: post surgical (40%) or congenital (35%) hypothyroidism or after-effects of thyroiditis (11%) or of undetermined etiology (14%). The past history of these women, shows a sterility (11%) and spontaneous abortions (18%). Substitute hormonal therapy was usually well monitored, with almost always a stable thyroid function. These pregnancies progressed without any specific problems, the children's birth weight was normal and only one presented a hypothyroidism. 94 cases of goiters (0.10%) were reported including 1 out of 3 received an inhibiting hormonal therapy. Here also the pregnancies developed without problems and there was no difference with regards to the stability of the goiter and the development of the pregnancy between treated and non-treated women. The authors insist on strict monitoring of the treatment with assays of FT3, FT4, TSH and anti-thyroid antibodies, performed one or twice per trimester. The interest of thyroid hormones assays in the amniotic fluid or the blood cord may occur.

Adult↗
PubMedDate not supplied

Effect of laparoscopy versus laparotomy on circulating tumor cells using isolation by size of epithelial tumor cells.

AIM: To assess the effect of laparoscopy on circulating tumor cell (CTC) detection in case of carcinosis. MATERIAL AND METHODS: We compared laparoscopy versus laparotomy on tumor cell blood release in an animal model of ovarian carcinosis obtained by intraperitoneal inoculation of IGR-OV1 cells in nude rats. Animals were randomly assigned to one of the following groups: CO(2) laparoscopy (L), gasless laparoscopy (GL), midline laparotomy (ML), or general anesthesia as control (C). A 0.5 ml blood sample was taken in each case before and after experiment and tested with a novel assay, ISET (isolation by size of epithelial tumor cells), which isolates CTC by filtration on account of their size. Statistics were performed with the Fisher's and the Chi-square tests. RESULTS: Ten rats were included in each group. We did not find any significant difference in CTC prevalence before and after surgery (2/14 versus 3/19, respectively, P = 1). Similarly, the three surgical accesses were equivalent with one post-experiment detection per group: 1/5 for L, 1/7 for ML, 1/7 for GL, and 1/6 for C (P = 0.9). CONCLUSION: This trial did not show any deleterious effect of laparoscopy on CTC when compared to laparotomy.

Animals↗
PubMedDate not supplied

Hospital resources used for ectopic pregnancy treatment by laparoscopy and methotrexate.

OBJECTIVE: To compare resources used in the medical and laparoscopic treatment of unruptured ectopic pregnancy. METHODS: We prospectively recorded all the medical resources required in the treatment of unruptured ectopic pregnancy. The study period ranged from January 1, 1995 to June 30, 1998. Single-dose intramuscular methotrexate injections were administered in 55 women (group I). This therapeutic option was provided on an outpatient basis in small EP (beta-HCG level < 5000 IU/L and hematosalpinx diameter < 3 cm). Serial clinical controls and biologic tests were performed until bHCG became negative. Forty women underwent a laparoscopic salpingostomy because they refused the methotrexate regimen or had "social" contra-indications (ie, predictable difficulties in the follow-up) (group II). Twenty-one patients underwent conservative laparoscopic treatment because of "medical" contraindications to methotrexate (group III). We recorded the resources used with the outpatient and inpatient treatment in each group (methotrexate consumption, operating room acts, length of hospital stay, clinical examinations, biological tests, and sonograms during the follow-up). RESULTS: We observed similar cure rates in each group, but it took significantly longer for beta-HCG to become negative in group 1. However, hospitalization was significantly less often required, and the length of hospital stay was shorter in this group. But length of follow-up, number of office visits, biological tests, sonograms, and subsequent readmissions were significantly more frequent after methotrexate. Despite more severe clinical presentations for patients in group III, we didn't find any significant differences in the hospital resources used in this group in comparison with those used in group II. CONCLUSIONS: The outpatient methotrexate option may result in low consumption of resources for a hospital because most of the follow-up can be performed by city practitioners and laboratories. For the laparoscopic option, efforts should be made to reduce the postoperative hospital stay.

Adult↗
PubMedDate not supplied

[Variability of bone response to hormone replacement therapy].

Bone response to hormone replacement therapy (HRT) was assessed in a retrospective longitudinal study. 115 women started on HRT for the first time and 252 controls underwent initial densitometric evaluation (spine and femur) and a second evaluation on average 29 months later. Patients were classified as post-menopausal or perimenopausal according to whether they had had more or less than 6 months amenorrhea. Oral or non-oral 17-beta estradiol was used at the dose generally accepted to be skeletally protective. In the post-menopausal group, prescription of HRT was followed by spinal and femoral bone gain (+ 2.85% and + 1.06% per year respectively). There was no bone gain with HRT in the peri-menopausal women, but the stability seen contrasted greatly with the very marked bone loss found in controls (spine - 3.09% per year and femur - 1.78% per year). Lumbar densitometric variations were correlated, at least in the post-menopausal group, with those in the femur, but the amplitude of femoral variations was half that of the spine. Body mass index (BMI) was not found to be a predictive factor of bone response to HRT in this group, but the time since the menopause and initial densitometric results were. For the spine, the % of subjects losing their bone mass in response to the start of HRT, nil in the post-menopausal group, was 16% in peri-menopausal women. The % of good responders increased from 8% peri-menopausally to more than 59% 2 years after the menopause. The response in the femur appeared to be very different, with 20% good responders and a % of stable subjects similar to that of the control group. Femoral variations and the existence regarding the spine of a group showing no or only a poor response to HRT would be in favor of densitometric monitoring when initial bone mass is low.

Absorptiometry, Photon↗