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Biomedical subjects

J M Reme

Publications and source records attributed to J M Reme.

At least 19 recordsLinked to original sources
PubMed2003

Respective consequences of abdominal, vaginal, and laparoscopic hysterectomies on women's sexuality.

OBJECTIVE: To determine the relative effects of abdominal, vaginal or laparoscopic approaches for hysterectomy on female sexuality. STUDY DESIGN: One hundred and seventy women who underwent abdominal (n=68), vaginal (n=67), and laparoscopic (n=35) hysterectomy for benign disease were studied. Pre- and postoperative sexuality was assessed by questionnaire. RESULTS: Overall, sexuality after hysterectomy remained unchanged in 60.4% of cases, and improved or deteriorated in 21.3 and 18.3%, respectively. Postoperative delay in resuming sexual activity was shorter after vaginal (45.2+/-6.7 days) hysterectomy than after abdominal hysterectomy (62.4+/-9.3 days). Deterioration of sexual function occurred more frequently after abdominal hysterectomy (24%) than after vaginal (13.5%) or laparoscopic (8.5%) hysterectomy. CONCLUSION: These results indicate that the impact of vaginal and laparoscopic hysterectomy on women's sexuality may be milder than that of abdominal hysterectomy.

Female↗
PubMed1999

[Vaginal hysterectomy in fibroma. Apropos of 453 cases. Retrospective comparison with 509 cases of abdominal hysterectomy].

The authors present a series of 962 hysterectomies for fibroma carried out between January 1981 and December 1995 in the Department of Gynecology and Obstetrics of CHU Toulouse-La Grave. They carried out 453 vaginal hysterectomies and 509 abdominal hysterectomies. They compared the largest series reported in the literature, between vaginal and abdominal technique. The vaginal route has the obvious advantages of speed of operation, less operative trauma, lower risk of thrombo-embolic disease and the hospital stay is shorter. Laparoscopic assistance allows to extend indications of vaginal route.

Adult↗
PubMed1995

[Cesarean section trends at the Toulouse University Hospital, from 1983 to 1993. Determinants and consequences].

OBJECTIVE: To examine the factors accounting for the increase in rate of cesarean section, between 1983 and 1993 (from 13.0% to 19.5%) in Toulouse University Hospital, a tertiary level center. DESIGN: Retrospective study of all single deliveries, excluding deaths in utero, between 1983 and 1993. RESULTS: Half the increase in overall rate was due to the numerical increase in women with a cesarean section history. The percentage of cesarean sections in these patients remained constant at 79% over this period. For the other patients, the increase in rate was due partly to an increase in risk factors, but mainly to a change in obstetric practice with a marked increase in elective cesarean section (70% of all cesarean sections in 1993). Major complications in the mothers were relatively rare, albeit significantly more frequent in the cesarean cases. Over the study period the percentage of infants requiring intensive care remained constant for the vaginal deliveries but declined for the cesarean sections. CONCLUSION: The increased rate of cesarean sections has not led to any increase in maternal complications, and appears to have had a small favorable influence on infant morbidity.

Adult↗
PubMed1995

[Vaginal sacral-spinal fixation or Richter's procedure. Experience of a surgical team with 54 cases].

Vaginal sacro-spino-fixation or Richter's procedure is valuable for the treatment of posthysterectomy vaginal prolapse. Although technically difficult, this procedure is associated with minimal trauma and is effective in correcting pelvic static disorders. There seem to be few complications. Results are very promising. The functional and anatomic improvements induced by the operation persist over the long term. Although the main indication is treatment of prolapse of the vaginal vault, Richter's procedure is also useful for the prevention of prolapse. Based on the experience acquired by a surgical team, the technique, indications, complications, and results of Richter's procedure are discussed.

Adult↗
PubMed1994

[Tamoxifen and cervico-vaginal cytology].

The impact of tamoxifen on the genital tract was assessed by cervico-vaginal cytology. Fifty two post-menopausal patients treated with tamoxifen for breast cancer were regularly monitored, with a pre-treatment reference smear showing a profoundly menopausal status, followed by an anual smear. Smears returned to a functional status in 44% of patients after 2 to 5 years treatment. The agonist effect of tamoxifen appears to be beyond any doubt, and responsible for certain adverse reactions. This should not bring into question the usefulness of the drug, but indicates the need for regular monitoring and, in the presence of a functional smear, further investigation by vaginal ultrasonography is essential in order to evaluate the status of the endometrium.

Aged↗
PubMed1992

Paradoxical ovarian stimulations in the use of LHRH analogs.

In the case of in vitro fertilization, LHRH analogs are used to induce an hypophysary blockage, before the phase of stimulation, via administration of exogenous gonadotropin. During in vitro fertilization attempts using LHRH analogs, the blockage is controlled after 14 days of treatment through measurement of the plasmatic estradiol and pelvic ultra-sonography. In this retrospective study, which concerned 1075 in vitro fertilization cycles, a paradoxical ovarian stimulation with LHRH analogs was observed in 93 cases (8.7%), with high estradiol levels and follicular growth (detected by ultra-sonography), in spite of low FSH and LH levels. In 4 cases, a follicular puncture was performed, which allowed to collect oocytes from which embryos were obtained, thus confirming the observed follicular growth and maturation. The most probable hypothesis explaining this phenomenon seems to be a direct ovarian stimulation, effectuated in vivo by LHRH analogs. This stimulation is only observed in certain patients, and apparently more frequently, with certain LHRH analogs, probably through a variation in the expression of ovarian LHRH receptors.

Estradiol↗
PubMed1992

Paradoxical ovarian stimulations in the use of LHRH analogs.

In the case of in vitro fertilization, LHRH analogs are used to induce a hypophysial blockage before the phase of stimulation, via administration of exogenous gonadotropin. During in vitro fertilization attempts using LHRH analogs, the blockage is controlled after 14 days of treatment by measuring plasmatic estradiol and by pelvic ultrasonography. In this retrospective study, which concerned 1075 in vitro fertilization cycles, a paradoxical ovarian stimulation with LHRH analogs was observed in 93 cases (8.7%) with high estradiol levels and follicular growth (detected by ultrasonography), in spite of low FSH and LH levels. In 4 cases, a follicular puncture was performed, which made it possible to collect oocytes from which embryos were obtained, thus confirming the observed follicular growth and maturation. The most probable hypothesis explaining this phenomenon seems to be direct ovarian stimulation effectuated in vivo by LHRH analogs. This stimulation is only observed in certain patients, and, more frequently it seems, with certain LHRH analogs, which is probably due to a variation in the expression of ovarian LHRH receptors.

Clinical Protocols↗
PubMed1992

[Complications of hysterectomies].

The authors review results concerning 1,127 hysterectomies performed in the Department of Obstetrics and Gynecology of the La Grave Hospital (Toulouse, France). They compare those of abdominal hysterectomy and those of vaginal hysterectomy (359). With regard to vaginal procedures, they draw a distinction between simple hysterectomies and prolapse repairs. The results of this series are comparable with those in the literature: similar overall morbidity after vaginal (41 per cent) and abdominal (33 per cent) hysterectomy. This morbidity was lower in cases of simple vaginal hysterectomy (26 per cent). The majority of complications were infectious or febrile: 29 per cent of abdominal hysterectomies and 30 per cent of vaginal hysterectomies, including 16.4 per cent of simple vaginal hysterectomies. The authors compared abdominal hysterectomies and simple vaginal hysterectomies. The latter have many advantages: rarer mortality, overall morbidity and thrombo-embolic complications, shorter hospital stay, more comfortable and less costly postoperative course. Thus when the choice is available, gynecologists should opt for vaginal hysterectomy.

Female↗
PubMed1989

Amoxycillin/clavulanic acid ('Augmentin') compared with a combination of aminopenicillin, aminoglycoside and metronidazole in the treatment of pelvic inflammatory disease.

A randomized, multi-centre trial was carried out in 152 hospitalized women with pelvic inflammatory disease to evaluate the efficacy and tolerability of amoxycillin/clavulanic acid compared with that of a standard regimen using three antimicrobial agents (aminopenicillin, an aminoglycoside and metronidazole). Seventy patients initially received 3 to 4 intravenous doses per day of 1 g amoxycillin/200 mg clavulanic acid (mean 7.7 days) and then 4 to 6 tablets per day of 500 mg amoxycillin/125 mg clavulanic acid (mean 11.2 days). The other group of 82 patients initially received parenteral therapy daily (mean 7.7 days) with a combination of 3 to 4 g amoxycillin or ampicillin, 160 mg gentamicin (or 150 mg dibekacin or tobramycin) and 1.5 g metronidazole, and then oral therapy with 2 to 3 g amoxycillin or ampicillin and 1 to 1.5 g metronidazole daily (11.1 days). Clinical results, assessed at discharge from hospital (mean 10 days in both groups), were comparable in both groups, with 96% complete or partial response and no failures in the amoxycillin/clavulanic acid group, and 90% complete or partial successes and 5 failures with the triple therapy regimen. Both treatments were well tolerated and very few side-effects were reported.

Adult↗
PubMed1988

[From failure to success? A case of reduction of the number of embryos in a septuplet pregnancy].

The authors report a case of septuplet pregnancy that occurred after stimulation of ovulation using h.M.G.-h.C.G. This multiple pregnancy occurred because of failure of the triple surveillance using clinical, biological and ultrasound techniques. The number of embryos was reduced by needling through the abdominal wall. Two procedures were necessary. The technique that was used is described in detail and illustrated. The twin pregnancy that was left carried on successfully. This describes a technique that should be used rarely and should not in any way modify the strict rules for monitoring ovulation.

Adult↗
PubMed1988

[Ripening of the cervix uteri at term by a single intracervical application of prostaglandin E2 gel].

The efficacy and the side effects of an intracervical PGE2 gel application, as compared to placebo, for priming of the cervix have been studied in 208 patients at term (104 PGE2 and 104 placebo) with an unripe cervix (Bishop score less than 5) and with a medical indication for induction of labour. The cervical ripening success rate (as defined in methodology) is significantly higher in the treated group (58.6%) than in the control group (27.8%; p = 0.0001): 38.5% out of the PGE2 treated patients delivered within 12 hours after the gel application; 12 hours after PGE2 or placebo gel application labour was induced in the remaining patients with intravenous oxytocin infusion. Under these conditions there were 13.5% failures in the PGE2 treated group and 16.3% in the placebo group. We observed a statistically significant decrease in the length of labour of the PGE2 treated patients as compared to the control group. Since signs of myometrial hypercontractility were observed in the PGE2 treated group as compared to the control group (p = 0.01), the authors advocate careful cardiotocographic monitoring for at least three hours after the gel application. It is concluded that intracervical application of Prostaglandin E2 followed by intravenous infusion of oxytocin in an effective and safe method for induction of labour with an unfavorable cervix at term.

Adult↗
PubMed1987

[Fetal blood sampling under ultrasonic control].

Withdrawing foetal blood from the umbilical cord under ultrasonic control requires close co-ordination between obstetricians and echographists. The most important indications for this procedure are infections and foetal karyotype determination.

Blood Specimen Collection↗
PubMed1987

Randomized trial of two media used for in vitro fertilization.

Culture media are important components of IVF. Their selection must meet the need for efficiency, and also economic and practical requirements. From these standpoints, we compared two widely used media: Ham's F10 supplemented with cord serum and Menezo B2 used without serum. The test followed a randomized protocol using two series of 159 and 162 oocytes. Since no difference was seen in efficiency assessed from cleavage rate, the discussion focuses on cost and ease of use.

Cleavage Stage, Ovum↗
PubMed1987

Choice of an ovarian stimulation protocol according to the follicular puncture method in an in vitro fertilization programme.

In order to ascertain the adequacy of ovarian stimulation protocols with a type of follicular puncture, 126 women undergoing in vitro fertilization received either combination clomiphene/hMG or hMG alone according to a randomized test protocol. Within both groups patients for whom a pelvic examination was required had laparoscopies, while others had transvaginal ultrasonically guided punctures as far as possible. Clomiphene/hMG was more efficient than hMG alone as assessed from the cleavage rate (68% vs. 54%; p less than 0.01) and the pregnancy per attempt rate (16% vs. 5%; p less than 0.05). Laparoscopic punctures were more efficient than ultrasonically guided punctures (mean number of recovered oocytes: 4.8 +/- 2.6 vs. 3 +/- 2.5; p less than 0.001), but slightly better results were achieved by this latter method in ongoing pregnancy per puncture rate (18% vs. 8%; NS). With ultrasonically guided punctures, stimulation by clomiphene/hMG allowed better oocyte recoveries (3.8 +/- 2.5 vs. 2.3 +/- 1.9, p less than 0.05). Such results constitute an argument for preferential use of the clomiphene/hMG stimulation protocol with ultrasonically guided punctures.

Clomiphene↗