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J J Baldauf

Publications and source records attributed to J J Baldauf.

At least 19 recordsLinked to original sources
PubMed2004

Non-Hodgkin malignant lymphoma revealed by an ovarian tumor case report and review of the literature.

BACKGROUND: The initial manifestation of a lymphoma as an ovarian mass is unusual, with a reportedly poor prognosis. An exploratory laparotomy is often performed as the ovarian tumor can mimic an advanced epithelial carcinoma. The criteria of lymphoma used in the selection of a nonsurgical approach, that is, chemotherapy possibly associated with radiation, are rarely defined. CASE: We report the case of a 36-year-old woman who presented with an ovarian tumor suggestive of advanced carcinoma. After an initial approach including optimal surgery, the diagnosis of large B-cell CD30+ non-Hodgkin malignant lymphoma was established. Complete remission was obtained after a chemotherapy regimen, appropriate to the specific histologic type of the lymphoma. CONCLUSION: The choice treatment of ovarian non-Hodgkin lymphoma (NHL) is chemotherapy. In the presence of an ovarian tumor, the possibility of ovarian NHL must be considered, and its clinical, biological, and/or radiological signs must be actively sought. Controlled biopsies must also be included to avoid mutilating surgery.

Adult↗
PubMed2002

[Interest in intestinal resection for treatment of advanced ovarian cancer].

AIM OF THE STUDY: Digestive surgery is often necessary for surgical management of advanced ovarian carcinoma. PATIENTS AND METHODS: In a series of 62 patients with stage III ovarian carcinoma, postoperative morbidity and mortality, overall survival after 5 years and disease-free survival after 2 years were studied and corelated with several patients criteria (age, stage of the disease, residual disease, type of surgery, CA125 normalisation delay, postoperative complications and hospital stay). Patients were divided into two groups according to the surgical treatment. The first group (n = 17) included patients treated by gynecologic and digestive surgery, the second group (n = 45) included patients treated by gynecologic surgery only. All patients were proposed for chemotherapy included platyn salt. Mean age was 60 years (range: 20-83). The stage of the cancer was stage IIIa in 7 cases, stage IIIb in ten and stage IIIc in 45. RESULTS: Postoperative mortality was 3.5% (2/62). Postoperative morbidity was 26% (13/62). No statistical differences were noted for hospital stay, general morbidity, surgical morbidity when a gastric resection or a colon resections or a splenectomy were performed. Overall survival at 5 years was 56%. Residual disease less than 2 cm3 is the only prognostic factor for overall survival (56% vs 23% [P = 0.03]) and disease-free survival (86% vs 46% [P = 0.02]). CONCLUSION: This study including 62 patients confirmed the prognostic significance of extensive cytoreductive surgery for treatment in advanced ovarian epithelial cancer without increasing the postoperative morbidy and mortality.

Adult↗
PubMed2000

Treatment strategy for pelvic actinomycosis: case report and review of the literature.

BACKGROUND: Pelvic actinomycosis is a chronic granulomatous suppurative disease caused by an anaerobic Gram positive organism Actinomyces israelii usually associated with intra-uterine devices. Pelvic actinomycosis can mimick pelvic or intra-abdominal malignancy leading to mutilating surgical exeresis. RESULTS: We present a pelvic actinomycosis secondary to long-standing intra-uterine device use in a 50-year old European woman treated by intravenous antibiotic therapy, and then by a total abdominal hysterectomy and bilateral salpingoophorectomy to free the pelvis from abscess. We point out the difficulty in diagnosis, and the importance of high-dose intravenous antibiotic therapy to reduce the very high risk for nearby pelvic structure injuries, reported in the literature, leading to post-operative morbidity.

Actinomycosis↗
PubMed1999

[Therapeutic results of conization with diathermy].

OBJECTIVE: To assess the frequency, histological grade and time interval of residual and recurrent lesions after loop electrosurgical excision procedure and to analyse their associated risk factors. METHODS: 288 patients treated by loop electrosurgical excision procedure between February 1991 and July 1995 were prospectively included in this study. They agreed to a postoperative cytological and colposcopic follow-up with a first visit between 3 and 6 months after excision, a second one between 9 and 15 months and a third one between 24 and 36 months. We used univariate and multivariate analyses to evaluate the association between clinical variables and residual or recurrent lesions. RESULTS: The pathologic diagnosis of the specimens included 21 normal cervices (7.3%), 35 CIN 1 (12.2%), 43 CIN 2 (14.9%), 180 CIN 3 (62.5%), 1 adenocarcinoma in situ (0.3%) and 8 microinvasive cancers (2.8%). The pathologist considered the excision complete in 244 cases (85%). Among the other 44 patients, 27 had involved endocervical margins, 17 involved exocervical margins but none had both margins involved. The mean postoperative follow-up +/- standard deviation was 39 +/- 13 months (range 24-68 months). Treatment failure, defined as the persistence or recurrence of a cervical lesion, was observed in 20 patients (6.9%) having a squamous cancer stage IB (n = 1), a CIN 3 (n = 15), an adenocarcinoma in situ (n = 1) or a CIN 1 (n = 1). In 6 cases the second treatment was performed before the first cytological and colposcopic visit because of an excision considered incomplete by the pathologist. Overall 19 out of the 20 treatment failures were diagnosed within the first two years of the follow-up. The endocervical localisation of the initial lesion (adjusted RR 13.7; 95% CI 1.3, 150.1; P < 0.05) and incomplete excision (adjusted RR 9.1; 95% CI 3.0, 27.3; P < 0.001) were the only independent risk factors for treatment failure. CONCLUSION: Residual or recurrent lesions occurs rarely after loop electrosurgical excision procedure. They are favoured by totally endocervical lesion and an incomplete excision. With the association of cytology and colposcopy, 95% of treatment failures can be detected in the first 2 postoperative years.

Adult↗
PubMed1999

[Long term progress of low-grade intraepithelial lesions after a smear and colposcopy, directed biopsies and/or normal endocervical curettage].

Low-grade squamous intraepithelial lesions and atypical squamous cells of undetermined significance are the most frequent cytologic abnormalities. Their management is still highly controversial because of the many uncertainties associated with them concerning their histology and their natural history. Cervical smears HPV testing were proposed as an alternative to colposcopy. Neither have a sensitivity equivalent to that of colposcopy. The diagnosis of these abnormalities could be delayed, and a severe lesion may even remain undetected because the cytologic surveillance is frequently omitted, smear sensitivity is far from being perfect and correlation is poor between cytology and histology. The combination of smears with the detection of high risk HPV types increases the triage sensitivity before colposcopy to the detriment of specificity and predictive value, and, therefore, of cost. With colposcopy the histologic diagnosis is rapidly reached and therapeutic management becomes easier because the size and location of the lesion are precisely known. However, the long-term outcome of patients with a normal colposcopy is very poorly known. Our study including 212 patients with a mean follow-up of 79 months, showed an incidence of lesions similar to that found in a control group; 12 CIN (5.7%) were identified, but no cancer. The prevalence of CIN was significantly lower in patients whose initial colposcopy was normal or became normal within the first six months that in patients whose control smear was normal or became normal within six months (1/81 = 1.2% versus 8/143 = 5.6%; P > 0.05). No lesions were observed in patients whose colposcopy and control smear were normal. These results confirm the reliability of colposcopy in patients with minor cytologic abnormalities.

Adolescent↗
PubMed1998

Cytology and colposcopy after loop electrosurgical excision: implications for follow-up.

OBJECTIVE: To analyze risk factors associated with residual and recurrent lesions after loop electrosurgical excision procedure and to assess the reliability of cytology and colposcopy in detection of these lesions. METHODS: Cytology and colposcopy were used to follow up 288 women after treatment by loop electrosurgical excision 3-6 months, 9-15 months, and 24-36 months after the procedure. RESULTS: The mean (+/-standard deviation) postoperative follow-up was 39+/-13 months (range 24-68 months). Treatment failure, defined as the persistence or recurrence of a cervical lesion, was observed in 20 patients (6.9%). The endocervical localization of the initial lesion (adjusted relative risk [RR] 13.7; 95% confidence interval [CI] 1.3, 150.1; P < .05) and incomplete excision (adjusted RR 9.1; 95% CI 3.0, 27.3; P < .001) were the only independent risk factors for treatment failure. In six cases, a second treatment was performed before the first cytologic and colposcopic visit because of incomplete excisions. The remaining 14 treatment failures were diagnosed by postoperative cytology and colposcopy, ten after the first visit, three after the second, and one after the third. To diagnose the treatment failures, colposcopy and cytology provided complementary information at the first (P < .001) and second postoperative visits (P < .05). Although the sensitivity of cytology was not significantly improved by the association of both methods, the latter decreased the number of residual lesions overlooked by cytology alone and contributed to the diagnosis of 95% of treatment failures in less than 2 years. CONCLUSION: The high detection rate obtained by combining cytology and colposcopy during the first 2 postoperative years may allow more leisurely follow-up schedules after that time and may reduce the consequences of subsequent loss to follow-up.

Adenocarcinoma↗
PubMed1998

Comparison of the risks of cytologic surveillance of women with atypical cells or low-grade abnormalities on cervical smear: review of the literature.

Minor cytological abnormalities--low-grade squamous intraepithelial lesions (LGSIL) and atypical squamous cells of undetermined significance (ASCUS)--are the most frequent abnormalities observed in smears performed in screening for cervical cancer. Surveillance through repeated smears has been proposed as an alternative to immediate colposcopy to reduce cost and avoid overloading colposcopy clinics. The aim of this review is to discuss the advantages and inconveniences of cytological surveillance of women with ASCUS or LGSIL, as reported in the literature. Cervical smears are not sufficient to establish the precise diagnosis of a lesion. In fact, the mean prevalence of normal cervices, high-grade CINs and cancers is estimated to be 58%, 7% and 0.5% for ASCUS and 34%, 27% and 0.2% for LGSIL. Cytological surveillance shows that minor cytological abnormalities regress in 28-69% of cases. In 6-9%, cytological regression masks a high-grade CIN, and a cancer may develop sooner or later in 0.30-1.12% of cases. Cancers often occur in patients temporarily lost to surveillance or in those with normal smears alternating with smears showing minor abnormalities. Strict modalities of surveillance are therefore required. The surveillance has to be carried out with smears repeated every 4-6 months for 2 years. If all smears are normal the regular screening at 3-year intervals may be resumed. On the other hand, an immediate colposcopy is recommended if a new abnormality is observed in these consecutive smears, regardless of its severity and of the time elapsed since the initial abnormality was discovered. With these recommendations in mind, cytological surveillance may slightly reduce the number of colposcopies but without reducing significantly the cost. At present, no arguments based on cost or efficacy clearly favour cytological surveillance over immediate colposcopy.

Cervix Uteri↗
PubMed1998

The prediction of preeclampsia: reassessment of clinical value of increased plasma levels of fibronectin.

OBJECTIVE: To determine whether assessment of plasma fibronectin in primigravidae could predict the pregnant women expected to become preeclamptic. METHODS: We performed a prospective blinded analysis of 156 apparently normotensive primigravidae in an outpatient clinic. Blood samples were taken at 6 week intervals from the 18th week and immediately after delivery or at the onset of preeclampsia. Plasma fibronectin was evaluated by ELISA. Evolution with gestational age was studied using regression curves. RESULTS: We had 148 normal primigravidae (592 determinations). In three women, increased fibronectin anticipated preeclampsia by 3-4 weeks. Five women showed high levels only at the onset of preeclampsia. Sensitivity, specificity, positive and negative predictive values of increased fibronectin levels were 37.5% (95% CI=3.3-71.7), 96.6% (95% CI=93.7-99.6), 37.5% (95% CI=3.3-71.7) and 96.6% (95% CI=93.7-99.6), respectively. CONCLUSIONS: This study shows that plasma fibronectin levels could represent a specific marker for preeclampsia. Its sensitivity has to be improved but its high negative predictive value strongly argues against the development of preeclampsia within the next 4 weeks after the blood sampling.

Adult↗
PubMed1998

[Color Doppler in the prenatal diagnosis of umbilical cord hernia].

Pathologies of the fetal ventral abdominal wall are easily diagnosed by antenatal ultrasonography. The most common anomalies are omphalocele, often associated with other malformations or chromosomal abnormalities, and gastroschisis. We describe an antenatal diagnosis of umbilical cord hernia which could be confirmed by color Doppler. This entity is important to know not to put the umbilical clamp on a bowel loop after delivery.

Adult↗
PubMed1997

The pregnant ewe: an animal model for fetoscopic surgery.

OBJECTIVE: To develop an animal model for fetal endoscopic surgery which could be feasible and reproducible. The aim of this work was to perform a fetoscopy without the need of a laparotomy. METHODS: Pregnant ewes underwent under general anesthesia laparoscopy with the creation of a maternal pneumoperitoneum. After localizing the placenta by transillumination, we carried out fetoscopy through a 5 mm trocar using a perfusion of Ringer's solution. RESULTS: Five video-assisted procedures have been performed. None of the cases has shown any bleeding from myometrial wounds and no suture was necessary. There was no leakage of amniotic fluid. Intrauterine space was large enough to manipulate instruments without producing any fetal damage. Sharp visualization and anatomical description of the fetus were precise without the use CO2. There were no miscarriages and postnatal examinations of the lambs were normal. CONCLUSION: Fetoscopic surgery can be performed in the pregnant sheep without any complications but preterm labor which is the main problem in human fetal surgery, is infrequent in the sheep. Our model is reproducible and simulates the surgical endoscopic procedures which will occur in a close future in the human species.

Animals↗
PubMed1997

An analysis of the factors involved in the diagnostic accuracy of colposcopically directed biopsy.

OBJECTIVE: To compare the results of colposcopically directed biopsy with the final diagnosis established by the analysis of the surgical specimen, and to determine the clinical and colposcopic factors on which the reliability of biopsy is based. MATERIAL AND METHODS: Five hundred and sixty-seven women were seen by the same colposcopist who also performed the directed biopsies and/or the endocervical curettage. The final histological diagnosis identified 29 normal aspects (5.2%), 58 low-grade cervical intraepithelial neoplasias (CIN) (10.2%), 448 high-grade CINs (79.0%), 16 microinvasive cancers (2.8%) and 16 occult invasive cancers (2.8%). The influence of several factors--such as age, parity, menopause, pregnancy, history of cervical treatment, site of the squamocolumnar junction, localization, size and severity of the lesions--on the pertinence of the biopsy was studied in a uni- and multifactorial analysis. RESULTS: Colposcopy was satisfactory in 399 patients (70.4%) in whom the colposcopic aspect was consistent with the final histological diagnosis in 81.2% of cases. The global agreement between biopsy diagnosis and final diagnosis was observed in 89.6% of cases. It was 84.2% for low-grade CINs, 95.8% for high-grade CINs, 31.2% for microinvasive cancers and 81.2% for invasive cancers. No clinical or colposcopic factor could be identified as independent factor associated with the diagnostic agreement with the directed biopsy. Conversely, concordance of biopsy was related to the final diagnosis since the only independent risk factors were a high-grade CIN (adjusted risk ratio (ARR)=1.52, 95% CI=1.11-2.08; p=0.006) and a microinvasive or invasive cancer (ARR=0.56, 95% CI=0.39 0.81; p=0.002). CONCLUSION: To ensure that a microinvasive cancer has not been overlooked, the excision of high-grade CINs seems to be justified, whatever the clinical status and the colposcopic aspect.

Adolescent↗
PubMed1997

[Consequences and treatment of cervical stenoses after laser conization or loop electrosurgical excision].

OBJECTIVE: To assess the frequency and the consequences of cervical stenosis in patients treated by laser conization or loop electrosurgical excision procedure (LEEP) and to analyse the results of cervical enlargement plastic surgery or neostomia. METHODS: Two hundred and fifty-five women treated by laser conization and 277 by LEEP were regularly followed by postoperative colposcopy, for a mean period of 38 and 16 months, respectively. Stenosis was defined as cervical narrowing which could not admit a 2.5 mm-diameter Hegar's dilator. RESULTS: Stenosis complicated 10.2% of the laser conizations and 4.3% of the LEEP. Thus, 38 cases of cervical stenosis of which 7 were complete were diagnosed 2 to 40 months after treatment. Among the 34 non-menopaused women who developed a stenosis, 5 had a secondary amenorrhea, 6 a severe dysmenorrhea and one an infertility related to oligoamucorrhea. In the patients with stenosis, endocervical cell retrieval was possible in 21 (55%) cases and in none the squamocolumnar junction was visible at colposcopy. Seven patients underwent an enlargement plastic surgery of the cervical canal for incomplete stenosis and two a neostomia for complete stenosis. Cervical restenosis has been observed in 7 of 9 cases in a mean delay of 12 months (3 to 48 months). Nevertheless, the endocervical cell retrieval remained possible in 8 of 9 cases and after a mean follow-up of 26 months no menstrual troubles recurred. CONCLUSION: LEEP provides fewer cervical stenosis than laser conization. The enlargement plastic surgery allows to correct durably the menstrual troubles in spite of the very frequent restenosis.

Adult↗