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Biomedical subjects

J Créquat

Publications and source records attributed to J Créquat.

17 recordsLinked to original sources
PubMed2004

[Endorectal sonography in gynecology: usefulness and diagnostic accuracy].

OBJECTIVE: The aim of this study was to assess feasibility and diagnostic accuracy of endorectal sonography (ERS) in comparison with transabdominal sonography (TAS) in women with a contraindication to endovaginal sonography (EVS). PATIENTS AND METHODS: ERS was proposed to 32 patients in the immediate continuation of TAS. It was performed either with a specific probe or with a vaginal probe. The protocol included a complete evaluation of pelvic structures observed with both sonographic techniques. RESULTS: After counselling and assent, 29 of the 32 patients (90%) accepted ERS. The examination was regarded as complete in 28 cases. ERS confirmed the absence of pelvic anomaly in the 12 cases of normal TAS. ERS modified diagnosis in 5 of the 8 cases of anechoic ovarian cysts seen in TAS. In 4 cases, PCOs not seen in TAS were identified. Two partially sub-mucous myomas not recognized by TAS were diagnosed by ERS. Sensibility, specificity, positive predictive value (PPV) and negative predictive value (NPV) of TAS and ERS were 38,4 and 87,5%, 41,6 and 100%, 50 and 100%, 40 and 85,7% respectively. DISCUSSION AND CONCLUSION: These findings suggest ERS is an effective diagnostic tool in pelvic exploration when EVS cannot be performed. It should be widely proposed after information and assent.

Adolescent↗
PubMed2003

[Preoperative endovaginal ultrasound in the assessment of myometrial invasion of endometrial adenocarcinoma].

OBJECTIVE: To determine, according to histological tumor grade, the reliability of preoperative endovaginal ultrasound in the detection of myometrial invasion in patients with stage I endometrial cancer. PATIENTS AND METHODS: Sixty-one patients with stage I endometrial carcinoma were evaluated with preoperative endovaginal ultrasound compared to postoperative results of pathologic examination, in a six-year retrospective study. RESULTS: Twenty-nine patients had a deep myometrial invasion (stage IC). The mean endometrial thickness was 9.5 mm in stage IA, 17.0 mm in stage IB and 20.0 mm in stage IC disease (P = 0.01). The sensitivity and the specificity of the ultrasound in the assessment of myometrial invasion in grade 1 tumors were 100% and 93.7%, respectively. They fell to 69.2% and 88.9% for high-grade tumors. The global accuracy of ultrasound was 82%. DISCUSSION AND CONCLUSIONS: The performance of preoperative ultrasound varies according to the literature. The association of morphological and morphometric criteria enables an increase in the sensitivity of the exam. In grade 1 tumors, the preoperative endovaginal ultrasound could help in identifying a group of patients at low risk of lymph node metastasis for which a pelvic lymphadenectomy would be avoidable.

Adenocarcinoma↗
PubMed2000

[Biometry 2000. Fetal growth charts by the French College of fetal ultrasonography and the Inserm U 155].

OBJECTIVE: The aim of Biometry 2000 was to establish reliable sonographic fetal auxology reference charts for biparietal diameter, head circumference, abdominal diameter, abdominal circumference and femur length. DESIGN: A prospective multicentric longitudinal and transversal study was carried out. SUBJECTS: The data of this study were obtained from 35,456 scans recorded in 10,043 women for a period of one year. METHODS: Sonographic measurements were performed using a single method for each parameter. Twins and unknown gestational ages were not included. No exclusions were made for small-for-age, congenital malformations or any event during pregnancy. Assuming measurements have a normal distribution, centiles were calculated after polynomial regression models from mean and standard deviation according to gestational age in exact weeks from last menstrual period. RESULTS: A total of 32,584 fetal biparietal diameters, 20,400 direct cephalic circumferences, 31,790 transverse abdominal diameters, 21,562 direct abdominal circumferences and 30,960 femur lengths were obtained. Fetal growth charts with means, standard deviations and centiles are presented. CONCLUSION: The multicentric study, Biometry 2000, has established sonographic fetal charts derived from a large sample of scans and unselected pregnant women assuming a normal distribution.

Abdomen↗
PubMed1997

[Treatment of ovarian cysts by laparoscopy].

OBJECTIVE: to define limits, risks and results in the long term of laparoscopic treatment of ovarian tumors. METHOD: retrospective study of adnexal tumors managed initially by laparoscopy from January 1986 to December 1992, among which 9 cancers, 25 borderline tumors, and 769 benign lesions. The ultrasonographic appearance was known for 698 of 803 lesions. 86 patients were postmenopausal (92 lesions). RESULTS: we treated 191 functional cysts, 160 serous cystadenomas, 178 endometriomas, 105 dermoid cysts, 39 mucinous cystadenomas and 96 miscellaneous lesions among which fibrothecomas, paraadnexal cysts, ovarian pregnancies, ovarian abscess. There is a great diversity of ultrasonographic patterns for a same histological type, specially for functional cysts and borderline tumors. Laparoscopic exploration has misdiagnosed two cancers and 10 borderline tumors and considered wrongly as suspects 19 benign lesions. 714 procedures have been led to term by laparoscopy, 89 have been ended by laparotomy, 26 for suspicion of malignancy and 50 for dissection failure. 27 postoperative complications have been counted among which 2 grafts on trocard sites after non protected extraction of one dermoid cyst and one borderline tumor. CONCLUSION: ultrasonographic appearance could not predict reliably the organic or functional nor benign or malignant character of an adnexal mass. Even careful laparoscopic examination can underestimate early stage ovarian cancer or borderline tumors. When diagnosed during or after laparoscopic procedure an ovarian cancer should always be managed by laparotomy. On the other hand, some borderline tumors can be treated by exclusive laparoscopy. When malignancy is suspected, an adnexectomy can be performed laparoscopically as a biopsy and allows a quick and appropriate treatment after paraffin-embedded sections. Both intraperitoneal and transparietal techniques have a minimal morbidity and allow a feasibility of more than 90%. The management of postmenopausal ovarian tumors differs only by the use of systematic oophorectomy if surgical procedure is indicated.

Adolescent↗
PubMed1995

[Ectopic pregnancy: criteria to choose therapy].

The ectopic pregnancy (EP) could be treated by spontaneous resolution, or medical treatment or laparoscopic treatment. Spontaneous resolution of EP with beta hCG < 1,000 mUl/ml, plasmatic progesterone < 5 ng/ml had 74% success rate. Methotrexate (MTX) injection is the common Medical treatment of EP with beta hCG < or = 5,000 mUl/ml and mean diameter of EP < or = 3 cm: a single dose of 50 mg/m2 or 1 mg/kg intramuscular injection had 93.4% success rate; local injection under sonographic control (1 mg/kg) had 80.2% success rate. The surgical conservative treatment by laparoscopy had 94% success rate.

Chorionic Gonadotropin↗
PubMed1995

[Thyroid ultrasonography and infertility].

In about 60% of infertile women, clinical or subclinical thyroid disorders can be diagnosed, and specific treatment provides significant improvements of fertility. Sonographic thyroid examination is easily performed and can detect thyroid abnormalities. So it's well-founded to say that it should be included in female infertility investigations.

Female↗
PubMed1993

[Treatment with methotrexate of 4 interstitial, unruptured pregnancies].

Successful treatment of four, non ruptured, cases of interstitial pregnancy are reported. Treatment consisted of in situ injection of methotrexate during coelioscopy. Dosage was 1.5 mg methotrexate per kilogram body weight. Negative plasma beta hCG levels were obtained 9 to 22 days after conservative medical treatment. No clinical or biochemical side effects were observed. Of two patients had no radiologically demonstrable cornual abnormality on the hysterosalpingographies effected at the 3 months evaluation after ascertained interstitial pregnancy, one have normal pregnancy. Two further patients had normal uneventful pregnancies 12 to 15 months later. Treatment of interstitial pregnancy by way of one in situ injection of methotrexate seems to be the currently preferred alternative to classical surgery.

Adult↗
PubMed1993

[Screening for ovarian cancers: critical analysis].

The ovarian cancers have a low incidence rate and a high mortality rate mainly due to a late diagnosis. The potential value of ultrasonography and measurements of tumour associated markers to detect early ovarian cancer suggest the interest of a screening strategy. The analysis of the conditions for efficacy of a such screening program, of the predictive values of ultrasonography and tumour associated markers measurements and of the results of preliminary studies does not confirm on a rational basis the potential interest of screening strategies.

Adult↗
PubMed1993

[Evaluation of intra-uterine pathology and tubal patency by contrast echography].

The contrast ultrasonography (CUS) is a new development of the pelvis ultrasounds. A contrast medium is injected through the cervix and is screened through the uterine cavity, the tubes and the peritoneal cavity. The contrast medium creates a new acoustic interface which improve the quality of the ultrasound imaging and the ability to diagnose endouterine pathologies. Further, tubal patency may be assessed by tracking fluid into the pouch of Douglas. The aim of this study was to assess the feasibility, the accuracy and the side effects of this technique when compared with the conventional procedures. Included were two groups of patients: the group 1 (10 cases) was of patients with menometrorrhagia before undergoing an hysteroscopy; the group II (11 cases) was of infertile patients before undergoing a laparoscopic tubal patency test. This technique, of low cost and without any radiation exposure, seems to be at least as accurate as the conventional methods for the intrauterine diagnostics. It is less effectiveness for the evaluation of the tubal patency. No side effect occurred in this study.

Contrast Media↗
PubMed1992

[Celioscopic removal of cysts: a fortuitous histological discovery of an ovarian carcinoma. A case report].

The authors report a case of cancer of the ovary that had not been recognised but which was discovered after laparoscopic surgical cystectomy. Laparoscopy is very reliable in a presumptive diagnosis of the nature of an ovarian mass, but in this case shows that the operator has to be very attentive especially when there is a rapid recurrence of cyst formation in the ovary that has been operated on. They discuss the indications for intra-peritoneal laparoscopic ovariectomy in short term recurrences after ovarian cyst removal and in particular when these were mucinous. For most authors the risk of dissemination when an ovarian cyst which has proved to be malignant is punctured, seems to be nil, and unlikely to effect the prognosis. It may be possible that in the future the diagnosis of these cases can be improved when the clinical picture, the ultrasound picture and the laparoscopic picture are added to a new development of intraperitoneal laparoscopic ultrasound which will make it possible to view the contents of the cyst with direct contact.

Adenocarcinoma, Mucinous↗
PubMed1990

Treatment of unruptured tubal pregnancy by local injection of methotrexate under transvaginal sonographic control.

Seventeen unruptured tubal gestations were managed on an outpatient basis using local methotrexate (MTX) injection. A single 50-mg dose of MTX was injected into the gestational sac under transvaginal sonographic control. Follow-up included serial assays of the beta-subunit of human chorionic gonadotropin (beta-hCG), clinical and sonographic evaluation. Resolution was obtained in 13 out of 17 patients. The regression curve between days after treatment versus beta-hCG (y = 82.2 - 10.8x + 0.37x2) demonstrated a significant negative correlation (R2 = 0.77; R = 0.88; P less than or equal to 0.02). The mean beta-hCG level on day 15 was 3.2% +/- 3.1% of the initial value. Laparoscopy was performed in 4 patients. Pathological findings suggested that resolution was underway in these four cases despite a slow decline in beta-hCG. No systemic side effects were observed in any of the 17 patients. Long-term follow-up is needed to evaluate tubal patency and reproductive outcome. Our experience suggests that local injection of MTX may be an effective alternative for the treatment of unruptured ectopic pregnancy.

Chorionic Gonadotropin↗
PubMed1990

[Per-celioscopic surgery of the distal fallopian tube in infertility].

Twenty five patients who had distal tubal blocks were operated on laparoscopically between the months of November 1986 and April 1988. Eleven fimbrioplasties and 20 salpingostomies were carried out, 16 patients also had division of adhesions. Both tubes were operated on in 6 patients and only one in 19 patients. After 12 months the cumulative pregnancy rate was 28.4% overall composed of 40% for fimbrioplasties and 20% for salpingostomies. No pregnancy occurred more than 10 months after the operations. There was no inter or post operative complication. The results of this study and an analysis of the literature shows that laparoscopic operations are a worthwhile alternative to laparotomy in distal obstructions of the tubes that are not very severe. In severe stages however, it would seem better to carry out an assisted reproduction technique.

Adult↗
PubMed1985

[Fetal cardiac biometry. Evaluation of the growth of the right and left ventricles using bidimensional echocardiography in normal pregnancies].

Two-dimensional echography makes it possible to study the fetal heart in a routine obstetrical setting. It is easy to see the four cavities of the heart from the long axis. The speed of growth of the internal diameters of the right and left ventricles have been studied at different stages of normal pregnancy. In this way it has been possible to show the morphometric equilibrium between the right and the left side at different stages of the pregnancy by cardiac ventricular biometry. These measurement are the first step in screening for intra-uterine cardiac abnormalities.

Echocardiography↗