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Biomedical subjects

G Body

Publications and source records attributed to G Body.

At least 109 records · Page 6Linked to original sources
PubMed1991

[Spontaneous rupture of the membranes before 28 weeks of amenorrhea. Obstetrical and perinatal outcome. Apropos of 28 cases].

The authors studied the outcome of pregnancies after spontaneous rupture of the membranes before 28 weeks of amenorrhoea in a series of 28 women. The mean time of the rupture was at 25 1/2 weeks. The duration of the time of rupture was a mean of 10 days and deliveries occurred between the 19th and the 32nd weeks. In 5 cases with an average term of 22 1/2 weeks the pregnancy was terminated. Caesarean operation was carried out in 4 cases and spontaneous vaginal delivery occurred between the 26th and 30th weeks of amenorrhoea in 19 cases. Chorio-amnionitis was the most common maternal complication (32.1%). Maternal morbidity was high (82%) without important sequelae. Thirty infants were born out of these 28 pregnancies (two sets of twins). 33% of the infants were stillborn, 46.6% died in the neonatal period, all of these from respiratory complications. 20% of the children are still alive, and all of these weighed at least 1,000 grams and were born after 28 weeks. A child that was born at 27 weeks amenorrhoea has serious neurological deficits. Having studied the bibliography on the subject and their own personal experience the authors suggest a routine to carry out in these cases. Although the prognosis is poor, the totality of these factors could encourage obstetrical teams to be conservative so long as they watch very carefully under well defined conditions.

Adolescent↗
PubMed1991

[Value of ultrasonic diagnosis of fetal malformations in the detection of chromosomal abnormalities].

We report 118 foetal karyotypes studied on the basis of ultrasonographic warning signs which appeared in pregnancies with no significant risk of chromosomal abnormalities, judging from the personal and familial histories. Foetal karyotyping was performed either in amniotic fluid (AF) or in foetal blood. The ultrasonographic warning signs fell into 3 categories: (1) intrauterine growth retardation (IUGR) which was harmonious and below the 5th percentile, without foetal malformation at ultrasonography and without maternal cause (doppler examination, normal Pourcelot's index): 30 cases (24.4%). IUGR was isolated in 22 cases and associated in 8 cases with abnormal amounts of amniotic fluid: oligoamnios 6, hydramnios 2; (2) Isolated abnormality of AF volume: 22 cases (18.8%); hydramnios 19 and oligoamnios 3; (3) Foetal malformations in 66 cases (56%), including 16 central nervous system malformations, 4 cystic hygromas, 10 urinary tract malformations, 9 foetal effusions, 9 abdominal wall abnormalities, 7 gastrointestinal malformations, 5 malformations of the limb and 3 cardiac malformations. The mothers' mean age was 27.5 +/- 4.5 years; the mean term of pregnancy at the time of foetal karyotyping was 28 +/- 6.5 AW. In 51% of the cases the ultrasonographic warning sign was discovered after 29 AW. Among the 118 foetal karyotypes studied, 12 chromosomal abnormalities (10.6%) were detected. During the same period, 712 foetal karyotypes were studied in women aged 38 or more and 18 chromosomal abnormalities (2.53%) were detected. This study confirms that more chromosomal abnormalities can be detected by ultrasonographic warning signs than by relying on the mother's age which is the most frequent reason for foetal karyotype studies. Ultrasonography performed during the second trimester of pregnancy is of value to evaluate foetal growth and the amount of AF and to investigate for possible foetal malformations.

Adult↗
PubMed1991

[Stage I and II endometrial adenocarcinomas. Prognostic value of lymph node invasion].

In our institution endometrial carcinomas stage I and II were treated with uterovaginal brachytherapy and radical hysterectomy with pelvic lymphadenectomy. We have studied in a retrospective analysis the results of the lymphadenectomy in order to precise his place in the treatment strategy. Between 1976 and 1986, 155 patients were treated these modalities (107 were stage I, 48 were stage II). The mean age was 60.2 years. Brachytherapy delivered 60 Gy and then radical hysterectomy with pelvic lymphadenectomy was performed. 26 patients received a pelvic external beam irradiation on account of lymph node involvement and or deep tumor invasion into the myometrium. 14 patients (9%) had a lymph node involvement. External iliac lymph nodes were involved in 78.5% of these cases. Lymph node involvement rate was higher for stage II, grade 3 tumors and when there was a deep tumor invasion into the myometrium. Pelvic failure rate was 12% for N- patients and 36% for N+ patients. Five years actuarial survival rate was 83% for N- and 41% for N+ patients. Now, we carry out a pelvic external radiotherapy for all stage II, grade 2 or 3 patients and when there is a deep tumor invasion into the myometrium and we do not perform lymphadenectomy for these patients. We perform only external iliac sample for patients with stage I grade 1 tumour without deep tumour invasion.

Adenocarcinoma↗
PubMed1990

Is lymphadenectomy useful in the treatment of endometrial carcinoma?

In our institution endometrial carcinoma stages I and II is treated with uterovaginal brachytherapy and radical hysterectomy with pelvic lymphadenectomy. We have made a retrospective analysis of the results of lymphadenectomy to determine its place in the treatment strategy. Between 1976 and 1986, 155 patients were treated with these modalities (107 were stage I, 48 were stage II). The mean age was 60.2 years. Brachytherapy delivered 60 Gy, and then radical hysterectomy with pelvic lymphadenectomy was performed. Twenty-six patients received pelvic external-beam irradiation because of lymph node involvement and or deep tumor invasion into the myometrium. Fourteen patients (9%) had lymph node involvement. External iliac lymph nodes were involved in 78.5% of these cases. The lymph node involvement rate was higher for patients with stage II disease, patients with grade 3 tumors, and patients in whom there was deep tumor invasion into the myometrium. Pelvic failure rate was 12% for node-negative patients and 36% for node-positive patients. The 5-year actuarial survival rates were 83% for node-negative and 41% for node-positive patients. We administer pelvic external-beam radiotherapy to all stage II patients, grade 2 or 3 patients, and patients in whom there is deep tumor invasion into the myometrium. We do not perform lymphadenectomy on these patients. We perform only external iliac sampling for patients with stage I, grade 1 tumor without deep tumor invasion.

Adenocarcinoma↗
PubMed1990

Vaginal intraepithelial neoplasia.

This study comprised the largest number (76) of cases of vaginal intraepithelial neoplasia (VaIN) so far reported. Women diagnosed with VaIN were older (mean age 50.2 years) than those diagnosed with cervical intraepithelial neoplasia (CIN). Many of the women had previously undergone (71.2%). In the majority of cases, the diagnosis was made after cytologic testing. In 92.4% of the cases, the lesions affected the upper third of the vagina. Grades of VaIN were distributed as follows: grade 1 52.6%, grade 2 191.%, grade 3 28.9%, with a 15-year interval between VaIN 1 and 2 as a group and VaIN 3 as another group. The cases of VaIN were divided into five groups: VaIN de novo; VaIN + CIN; VaIN postradiotherapy; VaIN + CIN + VIN; and incidental finding of VaIN on the surgical specimen. The therapeutic modalities were heterogeneous; CO2 laser therapy was used most frequently (54.2%). Failures are attributed mainly to the multifocal character of the lesions (particularly with human papilloma virus infection) or their localization in the vaginal angles. Overall, the number of cases, the duration of follow-up (39.2 months), and the unsatisfactory results with CO2 laser therapy have led us to propose a therapeutic decision tree where in which 5-fluorouracil plays a major role, CO2 laser and surgical therapeutic modalities having limited and precise indications.

Adult↗
PubMed1990

Preoperative or postoperative brachytherapy for patients with endometrial carcinoma stage I and II.

In endometrial carcinoma, vaginal vault brachytherapy is performed to improve the local control rate and to decrease vaginal recurrences. To assess the best chronology of this brachytherapy compared to surgery, we have retrospectively analyzed results of treatment of patients treated either with preoperative brachytherapy (60 Gy) and then radical hysterectomy with bilateral salpingo oophorectomy (RH-BSO) (Group 1), or with RH-BSO and then postoperative brachytherapy (60 Gy) (Group 2). There were one hundred twenty-one patients in Group 1 and 63 in Group 2. The mean age was 61.8 years in Group 1 and 64.3 in Group 2. In Group 1, 73% of the patients were Stage I, and 77.6% were in Group 2. The two groups were comparable for histological grading and depth of tumoral invasion into the myometrium. Brachytherapy was delivered with one uterine and two vaginal sources in Group 1 and with three vaginal sources in Group 2. Doses to the reference volume and to reference points were calculated according to ICRU recommendations. Brachytherapy data were similar in the two groups except reference volume, which was smaller in Group 2. Local control rate was 87% in Group 1 and 91% in Group 2. Distant metastasis occurred in 12% of patients in Group 1 and 9% in Group 2. The 5-year actuarial survival rate was 84% in Group 1 and 89% in Group 2. Regarding stage, histological grading, and depth of tumoral invasion, no differences were observed between the two therapeutic groups. The only prognostic factor in the entire population was Stage. The 5-year actuarial survival rate was 91% for Stage I patients and 69% for Stage II (p value less than 0.03). The late severe complication rate was 14% in Group 1 and 7.9% in Group 2, a difference which was not statistically significant. We concluded that since no differences were observed between the two techniques, vaginal brachytherapy should be performed postoperatively when surgery is the first treatment (Stage I or II, grade 1 or 2, and no deep tumoral invasion into the myometrium).

Brachytherapy↗
PubMed1990

[Predisposing factors for local recurrence after conservative treatment of breast cancer].

The factors predisposing to local relapse after conservative treatment of early stage breast cancer are controversial. To determine these factors, we analysed the results obtained in a series of 512 patients consecutively treated for invasive breast carcinomas by conservative surgery and radiotherapy. All patients were treated by tumorectomy and axillary dissection, radiation therapy of 45 Gy to the whole breast with a boost of 15 Gy to the tumor area, and adjuvant medical treatment for 168 out of 187 patients. The overall 5-year and 10-year survival rates were respectively 92.5% and 79.9%. The actuarial 5-year and 10-year local control rates were respectively 91.2% and 83.6%. Local relapses occurred in 35 patients. Local relapse occurred more frequently in premenopausal patients, in patients less than 50 years-old as compared to older patients, in patients with low body-mass index (BMI), and in patients with small breast size. Local control was not significantly affected by tumor size or node involvement. With multivariate analysis, the only factor influencing local control was the body-mass index: the actuarial risk of local relapse was increased by 5.7 in patients with a BMI less than or equal to 22 as compared to patients with a BMI greater than 22 (p less than 0.02). We concluded that although certain clinical factors such as age, menopausal status, breast size and body-mass index have an influence on local control, these factors are not sufficiently discriminant to question the indication of conservative treatment. There is a need to individualize factors that could allow a better discrimination of patients with a high probability of local relapse.

Adult↗
PubMed1990

[Epithelial cancer of the ovary in adults: prognostic and therapeutic study of 95 cases].

The authors report 95 cases of ovarian carcinoma treated between 1st January 1975 and December 1986 in the department of gynecology and radiotherapy of hospital Bretonneau in Tours. The overall actuarial 5-year survival was 37.5%, for stage I 100%, stage II 51%, stage III 36%, stage IV 5%, grade I 88%, grade II 51%, grade III 18%. The authors stress the prognostic importance of histologic grade and the bad prognosis of small cell ovarian carcinoma with hypercalcemia. The authors propose a therapeutic attitude based on the results and a review of the literature.

Actuarial Analysis↗
PubMed1990

[Termination of pregnancy called "therapeutic." Requirements, limits and insufficiencies of the law].

The authors point out the difficulties in applying the two final paragraphs of article L 162 of the Public Health Code which authorizes and explains the justification for terminating pregnancies later than the legal term of twelve weeks of amenorrhoea. These difficulties arise mainly because of the different ways in which it is possible to interpret how serious a menace to the health of the woman is caused by the pregnancy, which at present cannot be the only reason for provoking a purely medical decision for terminating the pregnancy while deciding how desperate the obvious distress is. On the other hand, the definition of a strong probability that the child to be born would have a particularly serious malformation, recognised as incurable when diagnosed and which constitutes the second indication for terminating the pregnancy on so called therapeutic grounds seems also to lack precision. The authors draw attention to how strictly the law has to be applied as far as termination of pregnancy is concerned as well as basic conditions for carrying out the procedure, which can act as a support for the sole but very definite precise judgement of the Appeal Court of Paris on the 9th July 1982. This can be considered as a judgement for bidding any deviations form the legal requirements of a text that is a very definite one and has to be interpreted strictly.(ABSTRACT TRUNCATED AT 250 WORDS)

Abortion, Legal↗
PubMed1989

[Perfusion of prostaglandins in the cervix uteri. A new method of cervical maturation after premature rupture of the membranes].

Many authors consider that using prostaglandins is the best way of obtaining adequate maturation of the cervix uteri before induction of labour; however, in case of premature rupture of the membranes the conventional methods can seldom be used. An original technique for this relatively rare situation is presented, consisting of an intracervical infusion of prostaglandin F2-alpha at the initial rate of 0.3 mg/hour. Details are given of the technique as well as of the results obtained in a preliminary study of 10 patients. With a mean 7.5 mg total dose of prostaglandin F2-alpha, the mean durations of maturation and delivery were 15 and 20 hours respectively. No infection developed and the procedure was well tolerated by the patients. Nevertheless, this technique should be reserved to those cases where conventional methods cannot be used.

Cervix Uteri↗
PubMed1989

Doppler assessment of the intracerebral circulation of the fetus.

Fetal cerebral arteries have been explored during normal pregnancies (n = 40). The index of cerebral resistance (Rc) as defined by Pourcelot (Rc = (S-D)/S where S is the systolic amplitude and D is the diastolic amplitude) shows variations similar to the placental index (Rp). During normal pregnancy, the cerebral index is higher than the placental index and the cerebro-placental ratio (Rc/Rp) is greater than one. This preliminary study of the umbilical and cerebral circulation during 21 pathological pregnancies with hypertension seems to demonstrate that when fetal growth retardation is also present (n = 6) either or both of the indices Rc and Rp may be outside the normal range but the cerebro-placental ratio (CPR) is always less than one. However, a larger number of patients needs to be explored in order to evaluate the clinical usefulness of such an observation.

Adult↗
PubMed1989

[Sarcoma of the endometrium. Epidemiology and prognostic factors. Apropos of a study of 22 cases].

Endometrial sarcomas (sarcomas of the endometrial stroma and mixed mullerian tumors) are rare tumors with a bad prognosis. Because of our experience in treating these tumors we have been able to make an analysis of epidemiology and the prognostic factors. We have treated 22 patients. The mean age was 61 years. There were 15 stage I, 3 stage II, 2 stage III, and 2 stage IV. 21/22 patients had a surgical resection of the primary tumor, 19/22 had pelvic irradiation after surgery with vaginal radiotherapy given for 14 patients. The actuarial survival rates at 3 and 5 years were 51 and 34%. 5/22 patients had pelvic recurrence, 6/22 had distant metastasis. In our study the prognostic factors were the stage and the histological subtype. Pelvic radiotherapy seems to improve the rates for survival. The main points for discussion are the need to have a definite histological diagnosis done after initial surgery. A CT scan of the lungs and a lymphangiogram must be performed before treatment. After surgery it appears necessary to give pelvic and vaginal radiotherapy. At the present time chemotherapy did not appear to improve survival.

Adult↗
PubMed1989

[Carcinoma of the cervical stump. Retrospective analysis of 43 cases].

Seven to eight percent of cervix carcinomas are carcinomas of the cervical stump. The prognosis for these tumors has sometimes been considered more unfavourable than that for carcinomas on intact uterus. From 1976 to 1986 we treated 43 patients with carcinoma of the cervical stump. The mean age was 63.6 years. Staging system used was FIGO classification modified according to the criteria of Institut Gustave Roussy in Villejuif. There were 12 stage IB, 12 early stage II, 5 late stage II and 14 stage III. Twenty-four centropelvic tumors (IB and early stage II) were treated with radiotherapy and surgery, 2 with surgery alone and one with radiotherapy alone. Late stage II and stage III tumors were treated with radiotherapy alone (+ hysterectomy for two patients). Local control rate was 83% for centropelvic tumors and 53% for late stage II and stage III. Seven patients developed distant metastases. Uncorrected 5-year actuarial survival rate was 78% for centro-pelvic tumors and 46% for late stage II and stage III. Three patients developed severe complications (grade 3). Prognostic factors were: stage, nodal status and pathological status of the cervix after radiotherapy. For the same stage the results were similar to those observed for carcinomas on intact uterus treated at our institution during the same time period.

Adult↗
PubMed1989

[Risks of medical complications inherent in technics of assisted procreation (excluding legal incidences)].

Although in France the law is still relatively poor in matters concerning complaints against medical people for accidents and incidents in connection with assisted reproduction, it appeared to the authors that it would be interesting to examine the subjects. There is some French and Anglo-saxon literature about the matter so that the circumstances that can be dangerous for the patients as well as well as for the doctors carrying out the processes can be listed in connection with the medico-legal field. When the legal cases in connection with the manipulation of gametes and of embryos have been excluded, there only remain the risks linked to the complications of the various techniques of assisted reproduction. These include those in connection with induction of ovulation and ovarian hyperstimulation. After having made a list of the risks in connection with In-Vitro Fertilization, with G.I.F.T. and with the various technique similar to it, such as artificial insemination donor, the authors suggest the steps that can be taken to prevent these medical complications and their eventual medico-legal repercussions. These consist of good organisation and improving the facilities dealing with assisted reproduction. The personnel should be well trained, as much information as possible should be given to the patients so that they give informed consent, whether exploratory procedures are being carried out or they are being treated with hormones, or having such manipulations as are necessary to obtain the desired pregnancy for them.

Female↗
PubMed1989

[Carcinoma of the cervix stages Ib, II, III. Results of treatment and prognostic factors. Retrospective analysis of 396 cases].

Between 1976 and 1986 we have treated 396 patients with carcinoma of the uterine cervix, stages Ib, II and III. The mean age was 54.2 years. The staging system used was the FIGO classification, modified according to the Institut Gustave-Roussy criteria. There were in stage Ib 117 cases, in early stage II 124 cases, in late stage II 63 cases and in stage III 92 cases. Treatment methods used were radiotherapy and surgery combined for localised pelvic lesions (stage Ib and stage II) and radiotherapy alone for those cases that were central and going out to the side wall of the pelvis (late stage II and stage III). The actuarial five-year survival rate was 91% for stage Ib, 67% for early stage II, 48% for late stage II and 28% for stage III. The main causes of failure were recurrence in the pelvis in 15% of treated areas and distant metastases in 13%. The state of the lymph nodes was another prognostic factor but the histological subtype and age were not. 7% of cases had severe complications (urinary, digestive and lymphatic).

Carcinoma↗