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F Reyal

Publications and source records attributed to F Reyal.

10 recordsLinked to original sources
PubMed2003

[Evidence-based medicine: principles and applications to obstetrics and to gynecologic surgery].

Evidence-based medicine is a concept developed by David Sackett and colleagues since 1980 at the Medical University center MacMaster, Hamilton city, Ontario. The main idea was to propose an evaluating tool of medical practice allowing a structured way of reasoning and the elimination of self-made opinion. We present a short explanation of evidence-based medicine and compare our daily practice in obstetrics and gynecologic surgery with this new practice paradigm.

Evidence-Based Medicine↗
PubMed2002

[Interventional radiology in managing post-partum hemorrhage].

UNLABELLED: EMBOLISATION OF THE UTERINE ARTERIES: Is the technique of choice for the management of post-partum hemorrhage, since it is efficient and virtually non-invasive. However, initial obstetrical measures and appropriate reanimation should never be neglected. The decision for embolisation must be made by all of the competent staff (obstetrician, reanimator, interventional radiologist). The clinical state of the patient must be assessed and the biological controls analyzed and eventually the decision can be made to transfer the patient to a specialized unit equipped not only with a team of interventional radiologists but also a multi-disciplinary team, experienced in the management of this type of pathology. PRACTICAL METHODS: An arterial inducer is placed in the femoral artery under local anesthesia. The angiographic exploration includes, when necessary, a global series showing the aorta and the pelvic vessels followed by the successive exploration of the two internal iliac arteries. Embolisation, conducted under scopic control, must be bilateral. Gelatin fragments or powder is the most appropriate embolus. LIMITS: Very few maternal delivery structures are able to perform an arterial embolisation at any time of the day or night. This raises the problem of transporting patients with uncontrolled hemorrhages; only those who exhibit no hemorrhagic disorders can be transported fairly easily. EFFICACY AND COMPLICATIONS: Concerning the three principle causes at the origin of post-partum hemorrhages, efficacy is constant in the case of uterine atonia; conversely, failures have been reported in the case of cervical-vaginal tearing and abnormal placental insertion (placenta accreta). In young women with healthy arteries, the complications of uterine embolisation during post-partum hemorrhage are exceptional.

Adult↗
PubMed2002

[Corneal asphericity in myopes].

PURPOSE: To study the variations of corneal asphericity in a population of myopic patients. METHODS: One hundred consecutive myopic patients were included in this study. The EyeSys videokeratoscope was used to assess the corneal topography of these patients seeking refractive surgery. We compared the results of cycloplegic refractions with the values of the corneal asphericity and mean central keratometry. RESULTS: Mean corneal asphericity was -0.09. Eighty per cent of the myopic patients had a prolate corneal contour, whereas 20% had an oblate corneal contour. No significant relationship was found between the corneal asphericity value and the mean keratometry value or the mean refractive error. CONCLUSION: The mean corneal asphericity in our myopic population was -0.09. This is slightly more than previously reported data in similar studies. No statistically significant relationship was found between corneal asphericity, mean refractive error, and mean keratometry.

Adult↗
PubMed2002

[Severe post-partum hemorrhage: descriptive study at the Robert-Debré Hospital maternity ward].

OBJECTIVE: To analyze the prevalence, cause, treatment, and risk factors of severe post-partum hemorrhage (transfusion, surgery, radiology) observed at the maternity ward of the Robert-Debré Hospital, Paris. Method. This retrospective cohort was collected from a database including 19182 deliveries from 1992 to 1998. The entire medical file was reviewed in cases of severe hemorrhage. RESULTS: The prevalence of severe post-partum hemorrhage was 23 per 10,000 deliveries (44 patients). Transfusion was performed in 44/44 and hysterectomy in 3/44. Three patients were transferred to the intensive care unit. There were no deaths. At multivariate analysis, risk factors for severe post-partum hemorrhage were: abnormal placental insertion (OR=7.2; 95CI: 2.18-18.3), cesarean (OR=5.8; 95CI: 2.9-11.6), multiple pregnancy (OR=3.2; 95CI: 1.3-7.8), prematurity (OR=3, 95CI: 1.5-6.2), hypertension (OR=2.9; 95CI: 1.3-6.3). Twenty-six percent of the patients had no risk factors. CONCLUSION: The prevalence of severe pot-partum hemorrhage is low in our experience. The methodology used for this retrospective cohort does not enable an explanation. Intensive obstetrical care is necessary in case of abnormal placenta insertion. In 10 out of 44 cases, severe post-partum hemorrhage occurred in a context of insufficient monitoring, late or erroneous diagnosis, or incorrect treatment.

Analysis of Variance↗
PubMed2001

Monochorionic monoamnionic twins: vaginal delivery.

Monochorionic monoamnionic pregnancies are rare and have a poor obstetric prognosis. A single amniotic sac promotes cord knotting and entanglement with a high risk of fetal anoxia. The response to this risk has been obstetric management consisting of routine cesarean section at 32 weeks of gestation or when pulmonary maturity is attained. This approach is called into question by the series of seven monochorionic monoamnionic pregnancies we present here. Such pregnancies do indeed require increased surveillance to term, but we think it is possible to apply the usual obstetric management of twin pregnancies.

Adult↗
PubMed2000

Management of fetal thyroid goitres: a report of 11 cases in a single perinatal unit.

Fetal thyroid goitres may reveal hormonal imbalance. This can jeopardize neurological development and fetal outcome even when early postnatal treatment is provided. We report a series of 11 goitres diagnosed antenatally in women with past or present thyroid disorders or discovered fortuitously on ultrasound scan. Fetuses presented with hyperthyroidism in three cases and hypothyroidism in eight. Hypothyroidism was iatrogenic in five cases, due to maternal anti-thyroid drugs. Hyperthyroidism was induced by transplacental transfer of thyroid stimulating antibodies (TSHrab). Accurate diagnosis of fetal thyroid status was obtained by fetal blood sampling but this invasive method was deemed necessary only in four cases as maternal clinical and biological data and ultrasound signs provided sufficient information to infer the type of thyroid disorder in the remaining patients. Fetal therapy relied on reduction of maternal antithyroid medication and, in selected cases, intra-amniotic injection of levothyroxin in hypothyroidism, and on administration of antithyroid drugs in hyperthyroidism. All newborns were healthy and none displayed consequences of severe thyroid imbalance. No caesarean section was performed for dystocia. Fetal thyroid goitres can be managed successfully with selected use of invasive diagnostic and therapeutic techniques.

Female↗
PubMed1999

[Pelvic actinomycosis: a case with secondary localization in the liver].

BACKGROUND: Actinomycosis is uncommonly observed in a pelvic localization. The presence of an intrauterine device is an important risk factor. CASE REPORT: A 50-year-old woman presented a tumoral mass in the pelvis with secondary liver involvement. Pathology examination corrected the initial diagnosis of advanced stage pelvic neoplasia to actinomycosis. Rapid improvement was achieved with penicillin. DISCUSSION: Differential diagnosis is difficult but essential in case of pelvic actinomycosis as misdiagnosis can have disastrous surgical consequences. Medical treatment is indicated. Actinomycosis should be entertained as a possible diagnosis in all cases associating a pelvic tumor and inflammation in women wearing an intrauterine device.

Actinomycosis↗
PubMed1999

[Pelvic actinomycosis].

UNLABELLED: AN UNUSUAL INFECTION: Actinomycosis, uncommon in a pelvic localization, is a severe condition not well known to gynecologists. It is caused by Actinomyces israeli and is closely associated with long-term use of an intrauterine device. In the pelvic localization, the disease generally presents as a pseudoneoplastic formation. DIFFICULT DIAGNOSIS: Diagnosis is generally not established clinically. Pathology provides positive diagnosis. The germ cannot be isolated easily as it does not survive standard bacteriology sampling. Monoclonal antibodies may be helpful. MEDICAL TREATMENT: Intravenous penicillin G followed by at least 6 months oral penicillin is generally successful in eradicating the infection. Indications for surgery should be limited to diagnostic procedures (pathology specimen), drainage in case of abscess formation, and removal of an obstacle compressing the digestive or urinary tract.

Actinomycosis↗
PubMedDate not supplied

Antenatal diagnosis of Bart's hydrops fetalis [correction of homozygous alpha thalassemia]. A case report.

OBJECTIVE: Diagnosis of the Bart's hydrops fetalis [corrected]. METHOD: Bart's hydrops fetalis [corrected] was discovered by chance in the fetus of a female Chinese patient. Major intrauterine growth retardation, oligohydramnios, an immobile fetus, and cardiomegaly were the principal echographic signs. Cordocentesis showed fetal anemia, and electrophoresis of fetal hemoglobin revealed the presence of Bart's hemoglobin. RESULT: As there is no known effective treatment, termination of pregnancy was proposed to the patient. CONCLUSIONS: Bart's hydrops fetallis [corrected] is a lethal condition. Early echographic signs (cardiothoracic index >0.50, placental thickening) can be screened during weeks 17-18 or even during weeks 13-14 of gestation. These signs would permit a reduction of invasive examinations in couples at risk.

Anemia↗