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Biomedical subjects

F Robin

Publications and source records attributed to F Robin.

At least 37 records · Page 2Linked to original sources
PubMed2000

Perioperative morbidity of gynecological laparoscopy. A prospective monocenter observational study.

BACKGROUND: To study the morbidity rate of gynecological laparoscopy and to the most influential variables. METHODS: We conducted a prospective observational study from January 1st 1992 to December 31st 1998 in a single tertiary care center. It concerned patients who underwent gynecological laparoscopic surgery performed by seniors and residents. We have prospectively recorded patients characteristics, indications for laparoscopy, leading diagnosis, main operative procedures, post-operative course, surgical and anesthetic incidents and accidents. Complications were defined as any event that would modify the usual course of laparoscopy or of the post-operative period. RESULTS: One thousand and thirty-three laparoscopies were included. 80.1% of the procedures were major or advanced laparoscopies. The overall complication rate was 3%, with a laparotomy rate of 1.2%. About half of those complications (54.8%) occurred during the installation of laparoscopy. Veress needle and first trocar insertion accounted for 23.5% of those accidents (0.3% of the procedures) and suprapubic trocar insertion for 76.5%. Hemorrhages constituted almost all of the complications occurring during the operative stage (80%). The risk increased with the level of surgery and decreased with surgeon's experience. Prior abdominal surgery had no significant effect on the overall morbidity rate. Post-operative and anesthetic complications were rare. The overall complication rate as well as the laparotomy rate were stable all along the course of the study. CONCLUSIONS: Complication rate of gynecological laparoscopy is not negligible. Efforts should be made to lower the complications induced by the installation of laparoscopy, especially for secondary trocars.

Adolescent↗
PubMed1999

Morbidity in laparoscopic gynecological surgery: results of a prospective single-center study.

BACKGROUND: We set out to investigate prospectively the morbidity rate for gynecological laparoscopy patients at a tertiary care center. METHODS: We prospectively recorded data on 743 laparoscopic procedures performed between January 1, 1992 and December 31, 1996. The procedures included 36 diagnostic laparoscopies (4.8%), 115 laparoscopies carried out for minor surgical acts (15.4%), 523 for major surgical acts (70.4%), and 69 for advanced surgical acts (9. 4%). A total of 127 patients had a history of prior laparotomy (17%). All those procedures were performed by young senior surgeons. We defined a complication as an event that had modified the usual course of the procedure or of the postoperative period. For statistical analysis, we used the chi-squared test or Fisher's exact test. RESULTS: Complications occurred in 22 cases; the overall complication rate was 2.9% when all events were considered. One complication (injury of the left primitive iliac artery) was related to insertion of the Veress needle (0.13%). A total of 2,578 trocars were inserted, giving rise to 10 complications (1.3%). Three unintended laparotomies were required for bowel or bladder injuries (0.4%). Finally, the introduction of the laparoscope was responsible for 11 complications (1.4%); this figure represents 50% of all the complications of this series. Eight intraoperative complications (1%) occurred during the laparoscopic surgery (seven severe bleedings and one ureter injury, but no intestinal lesions); laparotomy was required in six of these cases. Three complications occurred during the postoperative stage: one granulomatous peritonitis after intraabdominal rupture of a dermoid cyst, one incisional hernia, and a fast-resolving cardiac arrhythmia. CONCLUSIONS: In our experience, operative gynecological laparoscopy is associated with an acceptable morbidity rate. Moreover, about half of the complications occur during the installation of the laparoscopic procedure, underscoring the usefulness of safety rules.

Chi-Square Distribution↗
PubMed1999

Anticoagulant therapy in pregnancy.

Anticoagulation during pregnancy should derive benefit from recent advances in anticoagulant therapy. Unfractionated heparin is at present the drug of choice for most of the indications of thromboprophylaxis as well as for acute venous thrombosis during pregnancy but it is likely that, in the near future, low molecular weight heparins will supercede this anticoagulant in many indications. One particular indication is mechanical heart valves that needs a high degree of anticoagulation. The anticoagulant of choice that carries the best efficacy-risk ratio in this situation seems to be oral anticoagulants. Pregnant women receiving anticoagulation should be considered as high-risk patients that should be managed in specialized centres. They are prone to bleeding complications that will mainly occur during delivery or in the postpartum period.

Anticoagulants↗
PubMed1999

Production of carcinoembryonic antigen (CEA) N-A3 domain in Pichia pastoris by fermentation.

Carcinoembryonic antigen (CEA) is a 180-kDa glycoprotein found on the surface of normal colon and malignant human adenocarcinomas. Recently, a fusion protein containing two of the seven Ig-like domains present in CEA (N and A3) has been constructed and expressed in Pichia pastoris [You, Hefta, Yazaki, Wu and Shively (1998) Anticancer Res. 18, 3193-3201]. Here, we report the generation and selection of a multi-copy clone expressing this fusion protein, the optimization of the shake-flask expression protocol and the upscaled production of CEA N-A3 using fermentation technology. P. pastoris transformants secreting the CEA N-A3 domain were generated by electrotransformation of the GS115 host strain with the pPIC9K vector containing the CEA N-A3 cDNA [You, Hefta, Yazaki, Wu and Shively (1998) Anticancer Res. 18, 3193-3201] then screened for CEA N-A3 expression and G418 resistance. The recombinant CEA N-A3 domain was detected in the culture supernatant using the monoclonal anti-CEA antibody T84.66. Optimization of methanol-induction conditions resulted in a high-methanol shake-flask expression protocol yielding significantly increased CEA N-A3 levels. Fermentation and culture conditions were optimized for 5-l working-volume fermentations and CEA N-A3 was affinity purified using Ni-IDA (imino di-acetic acid) affinity chromatography from the clarified fermentation supernatant. Peptide N-glycosidase F treatment revealed that the recombinant protein was heavily glycosylated but expressed as a single polypeptide of 28 kDa with no evidence of proteolytic degradation. Our results demonstrate that functional CEA N-A3 domain can be produced in sufficient quantities in P. pastoris for structural analysis or diagnostic applications. To our knowledge, this article represents the first report on the production of a human tumour antigen through fermentation.

Base Sequence↗
PubMed1999

Effect of methotrexate on tubal epithelium. A report of three cases.

BACKGROUND: Tubal effects of methotrexate injections have been poorly reported. CASES: Three fallopian tubes were examined with light microscopy 9-13 months after tubal methotrexate injection (one case) and intramuscular methotrexate injection (two cases) given for the treatment of unruptured ectopic pregnancies. No evidence of tubal damage was found. CONCLUSION: These three cases confirm previous experimental and clinical data showing the absence of a direct adverse effect of methotrexate on the fallopian tubes in the treatment of ectopic pregnancy.

Abortifacient Agents, Nonsteroidal↗
PubMed1998

Single-dose methotrexate for unruptured ectopic pregnancy.

OBJECTIVES: To compare the effectiveness of single-dose methotrexate (MTX) and laparoscopic salpingostomy in the treatment of unruptured ectopic pregnancy (UEP). METHODS: 75 patients entered a prospective non-randomized study. Thirty-seven women were submitted to a single-dose methotrexate (Group 1) and 38 underwent laparoscopic salpingostomy (Group 2). Methotrexate (1 mg/kg) was given intramuscularly on an out-patient basis if the beta-hCG level was < 5000 IU/I and the hematosalpinx diameter was < 3 cm and the peritoneal fluid < 300 cm3 on TVS. The follow-up consisted of serial clinical examinations, beta-hCG assays, liver tests and blood cell counts. Laparoscopic salpingostomy was decided in other cases of UEP or when patients refused or could not comply with the follow-up. RESULTS: Group 1 patients (91.8%) were cured with 1-3 doses of MTX, the remainder required a laparoscopy. Seventy-three percent of them were treated on an out-patient basis. The mean time to resolution of hCG was 26.7 days. The initial beta-hCG level significantly correlated with the necessity of a surgical option and the time to resolution of beta-hCG. Whenever beta-hCG was < 3600 IU/l, all patients were cured with a single injection, without hospitalization and with a follow-up of < 27 days. Group 2 patients (81.6%) were cured with laparoscopy and 15.8% required a MTX injection for persistent EP. The mean hospital stay was significantly longer than for those that required the MTX injection (2.7 vs. 0.6; P = 0.0001), but the follow-up was shorter and required significantly less clinical examinations, sonograms and biologic tests. Finally the effectiveness of single-dose MTX and laparoscopic salpingostomy were similar (P = 0.2, 95% CI of the difference: -0.15-0.04). CONCLUSIONS: Single-dose MTX was as effective as laparoscopy in the treatment of UEP. A rigorous selection of the patients for the treatment option is mandatory to guarantee high success rates, in an out-patient basis and a short follow-up.

Adolescent↗
PubMed1998

Use of hysterosalpingosonography for early diagnosis of ectopic pregnancy.

Diagnosis of unruptured ectopic pregnancy was performed using hysterosonography in a patient with no adnexial mass visible on transvaginal sonography and low hCG level (440 UI l(-1)). This avoided a laparoscopy and allowed treatment by single injection of methotrexate. Hysterosonography may be useful for the diagnosis of small ectopic pregnancies.

Adult↗
PubMed1998

Empirical therapy for nonhospitalized patients with community-acquired pneumonia. Study Group of General Practitioners.

A prospective survey involving a group of 95 general practitioners (GPs) in France was conducted to describe antibiotic therapy prescribed for out-patients with community-acquired pneumonia (CAP). A total of 173 cases of CAP, defined by the association of fever and pulmonary focal crackles and/or radiological changes consistent with a pulmonary infection, were reported between February 1993 and March 1994: 84 males and 89 females (mean age: 48 yrs) of whom 45% had no underlying disease. Nineteen (11%) were immediately hospitalized and the remaining 154 out-patients were treated without microbiological investigation. First-line antibiotic therapy was amoxicillin or amoxicillin-clavulanic acid combination (57%), a first or second generation cephalosporin (12%), ceftriaxone (8%), oral broad-spectrum cephalosporin (3%), a macrolide (16%), a tetracycline (1%) and a fluoroquinolone (2%). A total of 120 (78%) patients recovered with no change in treatment and 34 (22%) patients failed to improve: 18 were hospitalized and 16 had a second-line therapy, mainly a macrolide or a quinolone. Five patients died at hospital. The overall mortality was 3%, and 14% in hospitalized patients. Empirical therapy using a betalactam to target a presumed pneumococcal infection, in agreement with European guidelines, is appropriate for out-patients with mild lobar community-acquired pneumonia.

Adolescent↗
PubMed1998

[Use of ultrasonography as a first-line investigation of the uterus. Results of a prospective study].

OBJECTIVE: To assess the effectiveness of hysterosonography as a first line investigation for uterine bleeding in perimenopausal women. METHODS: 185 women were enrolled in a prospective study. They underwent a hysterosonography indicated for abnormal uterine bleeding or follow-up of a treatment with tamoxifene. Patients with a normal cavity or atrophia were scheduled for a diagnostic hysteroscopy or a hormonal therapy. Patients with uterine cavity abnormalities were scheduled for surgery (operative hysteroscopy or hysterectomy). All the patients were clinically followed after the hysterosonography or the surgery. Results of hysterosonography were compared to data issued from the clinical follow-up or to pathological results when available. RESULTS: Hysterosonography was achieved in 179 patients. In all but 1 case, hysterosonography was well tolerated by the patients. We had no complication during or after the examination. Hysterosonography had a high sensitivity and specificity in the discrimination of women with normal cavity or atrophia from the ones with intrauterine lesions (respectively 96.4% and 98.3%). Hysterosonography was also accurate in the distinction of polyps from sub-mucosal myomas (sensitivity 88.2 à 90.3%, specificity: 98.6 à 95%). The measurement and localization of the lesions were accurate in an equal manner with both procedures. Hysterosonography had similar results in women treated with tamoxifene, but the failure frequency was significantly higher (13% vs 1.8%) (p < 0.05). CONCLUSIONS: Hysterosonography appears as a reliable tool for the investigation of abnormal uterine bleeding in perimenopausal women. It can distinguish women who just need a medical therapy from the ones who will require a surgical exploration. It is easy to learn, and well tolerated by the women. Hysterosonography is more sensitive and specific than transvaginal sonography in the follow-up of patients treated with Tamoxifene.

Adult↗
PubMed1998

[Microinvasive carcinoma uterine cervix. Which approach in 1998?].

Numerous definitions of microinvasive carcinoma (MIC) have been proposed. The SGO takes into account the depth of stromal invasion and presence of capillary like space involvement (LVI). The Figo uses the lesion width and describes different substages according to the depth of stromal invasion. Two major prognostic factors can be identified in the literature: the depth of invasion and the presence of LVI. The lesion volume is probably more accurate than the depth of stromal invasion but cannot be measured in routine. Taking into account that a classification must be a guide for the evaluation of prognosis and treatment, the SGO definition seems more reliable. Pelvic lymph node metastasis rate and recurrence increase with these two factors. MIC with stromal invasion under 3 mm and without LVI have a little risk of parametrial and nodal involvement: with a high rate of survival. Conversely, MIC with invasion over 3.1 mm depth or LVI have a greater risk of spread beyond the cervix (1% versus 7.7%) and many authors now consider them as true invasive cancers. For lesion invading the stroma within 3 mm, the treatment can be limited to a standard hysterectomy with good results. Some authors have proposed more conservative therapy as conization. This procedure is interesting for young women willing to preserve their anatomy, fertility and sexual function. In selected cases, short term results are similar to those of hysterectomy but there is a lack of controlled studies with long term follow-up. Lesions over 3.1 mm with LVI should be treated as true invasive cancers. Intermediate cases should have a conservative therapy associated with a laparoscopic lymphadenectomy.

Female↗
PubMed1997

Laparoscopic pelvic lymphadenectomy in an anatomical model: results of an experimental comparative trial.

OBJECTIVES: The aim of this paper was to compare the accuracy of laparoscopic versus open pelvic lymphadenectomy in an experimental trial. STUDY DESIGN: We performed unilateral laparoscopy pelvic lymphadenectomy (LPL) in 33 non-embalmed cadavers between the external iliac vein, the obliterated umbilical artery and the obturator nerve. Then a laparotomy was performed to inspect the LPL limits, look for laparoscopic complications and finally realize a controlateral lymphadenectomy. The LPL side was randomly decided. A pathologist counted the number of lymph nodes collected with both techniques. We compared the number of retrieved lymph nodes, the completeness of the dissection and the complication rate with those two procedures. Student's t-test, chi 2-test and non-parametric tests were used when appropriate. RESULTS: No dissection had to be aborted. One hundred and twelve nodes were removed laparoscopically (mean, 3.73; S.E., 2.9) and 84 at laparotomy (mean, 2.77; S.E., 2.06). There was no significant difference in the number of nodes retrieved with both procedures. Effectiveness of laparoscopy was not significantly different in the first ten procedures, in the second ten or in the last ten LPL. Residual tissue was observed after LPL in 13.3% of the procedures whereas all open lymphadenectomies were complete. LPL sensitivity reached at least 86% in this paper. Failures were more frequent at the beginning of the study (50% among the first ten dissections), in obese subjects or in subjects with prior history of laparotomy (but the difference was not significant). Two venous injuries occurred during LPL (6.7%). Complication rates for the two techniques were not significantly different. However, the LPL complication rate was higher at the beginning of the study and increased significantly in subjects with prior history of laparotomy (P < 0.05). CONCLUSIONS: This randomized study shows that LPL and laparotomy have similar effectiveness. Incomplete dissections and complications are more frequent in obese subjects or in case of prior history of laparotomy. Fifteen procedures seems necessary to learn the technique and provide constant and safe results in routine practice.

Aged↗
PubMed1997

Saline contrast sonohysterography as first-line investigation for women with uterine bleeding.

The objective of this study was to assess the effectiveness of saline contrast sonohysterography (SCSH) as a first-line investigation for perimenopausal women with uterine bleeding. A total of 162 women were enrolled in a prospective study. They underwent SCSH indicated for abnormal uterine bleeding. Patients with normal or atrophic endometrium were scheduled for diagnostic hysteroscopy or hormone therapy. Patients with uterine cavity abnormalities were scheduled for surgery (operative hysteroscopy or hysterectomy). A clinical follow-up was obtained for all the patients after SCSH. Sonohysterographic findings were compared with pathological results. SCSH was carried out in 159 patients. In all but one case, the procedure was well tolerated by the patients. There were no complications either during or after the examination. Surgical and pathological results were available in 109 cases. SCSH was highly sensitive and specific in the differentiation between women with intrauterine lesions and those with normal or atrophic endometrium (98.9% and 76.4%, respectively). SCSH was also accurate in the diagnosis of polyps and submucosal myomas (sensitivity 87.8 and 89.6%, specifically 90.7 and 95%). SCSH and surgery displayed the same reliability in the measurement and the localization of the lesions. SCSH recognized endometrial cancer in only 40% of cases. However, all these patients had abnormalities at sonohysterography which indicated a surgical exploration, leading to a zero false-negative rate. Saline contrast sonohysterography appears to be a reliable tool for the investigation of abnormal uterine bleeding in perimenopausal women. It can distinguish women who only require medical therapy from those who require surgery. The method is easy to learn, and is well tolerated by the patients.

Adult↗
PubMed1997

[Lymphatic drainage of the uterus. Preliminary results of an experimental study].

We carried out an experimental study on the lymphatic drainage of the uterus in 11 female cadavers. We performed 5 injections of a colored fluid in the corpus uterinum and 6 in the cervix. We observed 2 main routes along the external iliac vessels. The first was anterior and drains the lower limb. The second is medial and posterior to the external iliac vessels and drained the uterus (2.4 lymph nodes/side). The number and location of the lymph nodes varied between subjects but also in the same subject (45.5% of cases). The cervix was essentially drained to lymph nodes located on the posterior aspect of the external iliac vein, especially near the hypogastric artery origin. We did not observe any direct connexion between the cervix and the para-aortic area. The corpus uterinum was drained to the lymph nodes located in the lateral part of the parametrium and or under the external iliac vein. One other main route ran along the infudibulo-pelvic ligament. These findings confirm that the first lymph nodes metastases of the cervical carcinoma are under the external iliac vein. and particularly near the hypogastric artery. On the other hand, endometrial carcinomas spread along two lymphatic connections: one extending to the external iliac area and another to the para-aortic area. These results have to be considered in order to define lymphadenectomy margins for these cancers.

Aged↗
PubMed1997

Microinvasive carcinoma of the cervix. Rationale for conservative treatment in early squamous cell carcinoma.

Numerous definitions of microinvasive carcinoma (MIC) have been proposed. Taking into account that a classification must be a guide for the evaluation of prognosis and treatment, the authors reviewed the risk of spread in MIC. Two major prognostic factors can be identified in the literature: the volume of the lesion and the presence of capillary-like space involvement (LVI). The former item is generally assessed by the depth of invasion. Two kinds of MIC can be distinguished. Those with stromal invasion under 3 mm and without LVI, and those with invasion over 3.1 mm depth or LVI. The former have little risk of parametrial and nodal involvement and a high rate of survival. The latter have a greater risk of spread beyond the cervix and many authors now consider them as true invasive cancers. The Society of Gynaecologic Oncologists (SGO) definition seems more reliable. For lesions invading the stroma within 3 mm, treatment can be limited to a standard hysterectomy with good results. Some authors have proposed more conservative therapy such as conization. This procedure could be desirable for young women who want to preserve their anatomical integrity, fertility and sexual function. In selected cases, short term results are similar to those of hysterectomy but there is a lack of controlled studies with long term follow-up.

Carcinoma, Squamous Cell↗