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Biomedical subjects

J Raiga

Publications and source records attributed to J Raiga.

At least 19 recordsLinked to original sources
PubMed2002

[Peripartum dilated cardiomyopathies: is there a correlation with sexually transmitted diseases?].

A revue of litérature about peripartum cardiomyopathy; a disease of unknown pathogenesis. Some retrospective studies suggest a relation with sexually transmitted diseases. Other risk factors were observed. Diuretics and digoxin are used in the treatment. Cardiac transplantation is the final solution but the affection could appear again. A database must be started with epidemiologic information to understand this disorder and its correlation with sexually transmitted diseases.

Acquired Immunodeficiency Syndrome↗
PubMed2002

[Femoral neuropathy after transversal suspubic laparotomies. Etiopathological explanation on the basis of an anatomical study].

OBJECTIVES: Based on a case of transient troncular femoral neuropathy after the surgical treatment of a genital prolapse in a 46-year-old woman, a study was designed to better understand the mechanism of this postoperative complication. METHODS: The consequences of different varieties of transversal laparotomies were investigated in human cadavers. RESULTS: On the basis of the data from the anatomical evaluation, the most probable etiopathogenic explanation for the complication we observed is the compression of the femoral nerve, inside the psoas muscle, by the retractor lower edge. CONCLUSION: In the reported case, the outcome was simple with full sensory and motor recovery in the lower limb. The different mechanisms potentially involved in this kind of postoperative femoral neuropathies are reviewed and discussed.

Cadaver↗
PubMed2001

[Multidisciplinary management of aortic dissection complicating pregnancy].

BACKGROUND: Most cases of aortic dissection observed in women under 40 years of age occur as a complication of pregnancy in patients with other risk factors. Case report. We report a case of dissection of the ascending aorta in a young primigravida at 35 weeks gestation. The risk factor was aortic regurgitation. Multidisciplinary management enabled fetal extraction followed by repair of the aorta. Outcome was favorable for both mother and child. DISCUSSION: A review of the literature shows a variety of etiological factors leading to this disease. Emergency diagnosis and management is mandatory. Obstetricians should be aware that pregnancy can be a triggering factor in patients with a predisposition, e.g. connective tissue disease. A complete cardiovascular evaluation should be conducted before conception and a suitable surveillance planned for the entire pregnancy. The aim of this careful follow-up it to avoid surgery in an emergency setting that could compromise prognosis for both mother and child.

Adult↗
PubMed2000

[Laparoscopic surgery and "massive" obesity].

OBJECTIVE: Massive obesity is an important risk factor in gynecology surgery. The traumatic effect of traditional laparotomy on the parietal wall is responsible for important per and postoperative morbidity. We evaluated the feasibility and advantages of the laparoscopic approach in these patients, both in terms of surgical procedure and anesthesia. METHODS: To evaluate the technique, we reviewed four patients with massive obesity (BMI > or =40 kg/m(2)) who underwent laparoscopic surgery in our department. For each patient, we studied the cardiovascular risk factors, indications for operation, surgical technique, anesthesia conditions and follow-up. RESULTS: From the surgical point of view, certain technical difficulties were noted such as the problem of exposure and coagulation difficulties for the vascular pedicles enveloped in a layer of fatty tissue. No conversion to laparotomy was necessary. From the anesthesiology point of view, unlike what was previously feared, there was a reduction in the high operative risk due to obesity, especially due to postoperative benefits. Follow-up in these four patients was uneventful. CONCLUSION: Patients who suffer massive obesity are in a high risk category for surgery and anesthesia. This high risk group can benefit most from the advantages of laparoscopic surgery compared with open surgery.

Aged↗
PubMed1999

Laparoscopic surgery in the Cameroon.

A new surgical section of operative laparoscopy was installed in General Hospital of Yaoundé, Cameroon, in April 1992 after many years of collaboration between the University of Clermont-Ferrand and the University of Yaoundé. A total of 735 laparoscopic operations were conducted in the first 5 years. Conditions facilitating such a project are discussed.

Cameroon↗
PubMed1999

[Complications of cordocentesis associated with fetal therapy].

OBJECTIVES: To evaluate the technical and obstetrical risk factors of percutaneous umbilical blood sampling (PUBS) when associated with simultaneous fetal therapy. STUDY DESIGN: Retrospective study. One thousand PUBS have been performed in our department between 1984 and 1992. One hundred and forty one of them were done with another invasive fetal procedure. Technical and obstetrical circumstances were related to pregnancy follow-up and complications. RESULTS: Pregnancy complication rate increased when PUBS was associated with another invasive procedure (fetal losses: 12.9%, premature rupture of membranes (PROM): 11.6%). No chorioamnionitis nor perinatal infection was observed. As expected, previous fetal status was a main risk factor. Significant relationships have been found between fetal loss risk and therapy procedures such as amnioinfusion and severe IUGR and as well as abnormal post operative fetal tracing. The duration of cord bleeding after needle retrieval was the single risk factor pointed out for PROM. CONCLUSION: The study of the predictors of fetal complications is necessary to separate the genuine risk of previous fetal status and the risk of the invasive procedure itself.

Cordocentesis↗
PubMed1998

[Ursodeoxycholic acid: prospect for treatment of gravidic cholestasis? Report of 3 cases].

Ursodeoxycholic acid, employed in treatment of intrahepatic cholestasis as seen in primary biliary cirrhosis, primary sclerosing cholangitis, and chronic hepatitis; does not have marketing approval for prescription during pregnancy because of lack of data. In 3 cases of gravidic cholestasis, we administered oral ursodeoxycholic acid 1 g a day from the 34th week of amenorrhea to delivery. In each case, it took 3 days of treatment for the pruritus to regress incompletely and for plasma levels of biliary acid and transaminases to decrease. The infants, born between the 36th and 38th week of amenorrhea, presented with no problem. Forty-eight cases of gravidic cholestasis treated by ursodeoxocholic acid (0.4 to 1 g a day) have been reported in the literature; 18 cases belonging to 2 randomized studies. In 46 cases pruritus disappeared generally 3 days after treatment onset, and plasma level of biliary acid and transaminase decreased in one week. Only two patients experienced persisting pruritus despite biological improvement. No foetal adverse effect is reported. Ursodeoxycholic acid seems to be an efficient treatment of gravidic cholestasis. Long term observation of fetuses exposed in utero to this treatment is required to assess safety.

Administration, Oral↗
PubMed1997

Laparoscopic fimbrioplasty and neosalpingostomy. Experience of the Yaoundé General Hospital, Cameroon (report of 194 cases).

OBJECTIVE(S): To study the fertility results after laparoscopic distal tuboplasty and compare them with the data in the literature. STUDY DESIGN: 194 laparoscopic distal tuboplasties were carried out from May 1992 to May 1994 in the Yaounde General Hospital (Cameroon). The results were analysed according to the age of the patients, the type and duration of infertility, past history of abortion, laparotomy and Chlamydia trachomatis infection, the tube and adhesion scores, surgical procedures and achievement of pregnancy. The fertility rates were calculated according to Cramer's method [11]. The cumulative pregnancy rate curves were drawn up from the life table [12] and compared using the Log-Rank test. RESULTS: 53 patients obtained pregnancy (27.3%) of which 45 were inter-uterine (23.2%) and 8 ectopic (4.1%). Of the 45 intra-uterine pregnancies (IUP), 36 were obtained after fimbrioplasty (33.3%) and 9 after neosalpingostomy (10.5%). The monthly fertility rate at one year was 1.4%. The rate of IUP for tube stages I and II is significantly higher than that for stages III and IV (p<0.001). However the rate of ectopic pregnancies (EP) is proportional to damage to the tubes. Infection with Chlamydia trachomatis, and residual inflammation could have an effect on the achievement of pregnancy. CONCLUSION(S): Our results are similar to those found in the literature. The tube stage thus remains the decisive factor in terms of fertility (Cox: p<0.001). Operative laparoscopy is the best alternative in our countries compared with laparotomy for distal tubal pathology.

Adult↗
PubMed1997

[Laparoscopically extended hysterectomy for cervix cancer: technique, indications and results. Apropos of a series of 41 cases in Clermont].

We report a study of 41 radical hysterectomies performed through laparoscopic approach for carcinoma of the cervix uteri. According to the FIGO staging, the tumors were classified as 12 stages Ia2, 24 stages Ib, 4 stages IIa and 1 stage IIb. 17 patients were treated by exclusive surgical procedure. 24 patients received a combination of radiation therapy and surgery 2 patients had a tumor of the cervical stump after subtotal hysterectomy. The mean duration of the procedure was 270 minutes. The post-op stay was 6.5 days. There was no major operative and postoperative complication. Only one patient required a blood transfusion. The intravenous pyelogram control was correct in all cases. At this time, with a 4 to 76 months follow-up, no recurrence was observed. This experience suggests the faisability of the laparoscopic radical hysterectomy. This approach seems to be convenient in young and non obese women with a tumor less than 4 cm in the greatest diameter.

Adenocarcinoma↗
PubMed1996

Laparoscopic management of adnexal abscesses: consequences for fertility.

OBJECTIVE: To study fertility of patients with adnexal abscesses treated by laparoscopy, antibiotic therapy, and second-look laparoscopy. DESIGN: A retrospective clinical study. SETTING: Department of Obstetrics Gynecology and Reproductive Medicine, University of Auvergne, University Hospital of Clermont Ferrand, France. PATIENT(S): Thirty-nine patients treated for adnexal abscesses between January 1983 and December 1992. INTERVENTION(S): Laparoscopic drainage of adnexal abscesses was performed in all patients; 35 patients underwent a second laparoscopy 3 to 6 months later. MAIN OUTCOME MEASURE(S): Immediate and long-term clinical results, anatomical data obtained at second-look laparoscopy, spontaneous fertility. RESULT(S): No immediate reoperation was necessary within the first 2 months after the initial laparoscopic surgery. At second-look laparoscopy, an adhesiolysis was necessary in all cases. A distal tuboplasty was performed in 17 patients and 6 patients were referred to IVF-ET. Subsequently, 12 of 19 patients not using any contraception obtained a spontaneous intrauterine pregnancy (63%). CONCLUSION(S): This study confirms that laparoscopic surgery is a safe and efficient technique for treating adnexal abscesses. Anatomical results observed at second-look laparoscopy suggest that this second surgical step is essential for patients desiring future pregnancy.

Abscess↗
PubMed1995

[Treatment of endometrial clinical stage I adenocarcinoma by laparoscopic surgery. Seventeen cases].

AIM: Study and follow-up of laparoscopic surgical treatment of endometrial cancer, clinical stage I. METHOD AND MATERIALS: This retrospective study covering the period 01 February 1990 to 31 January 1994 on 17 patients presenting with endometrial cancer, clinical stage I, that is, 35.4% of endometrial cancers operated in our department during that period, and for which laparoscopy was the first step in surgical treatment. RESULTS: Of the 17 cancers assessed by laparoscopy, 12 were also operated by laparoscopy. Conversion to laparotomy concerned 5 cases (29.4%): one case of postoperative adhesions, 2 cases of laparoscopic complications (cardiac rhythm problems, sub cutaneous emphysema), 2 cases of peritoneal granulations giving rise to suspicious of stage III. The mean age of the patients operated via laparoscopy was 59.9 years (extremes: 34-74). Their weight varied from 52 to 94 kg with a mean of 68.1 kg. Two endoscopic surgical complications arose (one bladder injury and one cervico-vaginal bleeding), but did not require conversion to laparotomy. No postoperative complications were noted. The average follow-up for these patients treated by endoscopy is 22.3 months. There was regrettably one early recurrence of the disease 7 months postoperatively. CONCLUSION: Laparoscopic surgery can be used to treat clinical stage I cases of endometrial cancer. This surgical approach must be used only for favourable cases and is reserved for teams trained in endoscopic and cancer surgery.

Adenocarcinoma↗
PubMed1995

[Post-laparoscopic incisional hernia. Apropos of a case].

Incisional hernia occurred in a patient after laparoscopic hysterectomy. The greater omentum was incarcerated in the tract of the suprapubic trocar (12 mm diameter). Diagnosis and treatment were performed during a second laparoscopy procedure. The greater number of trocar instruments and their larger diameter increases the risk of parietal morbidity after laparoscopic procedures. Elective closures of trocar incisions is recommended when exceeding 10 mm. Prevention of extra-umbilical incisional hernias and dehiscences appears to be more effective when suture is performed under laparoscopic vision with the trocar inserted. Both the aponevrosis and the peritoneal membrane should be treated.

Aged↗
PubMed1995

[Laparoscopic treatment of adnexal abscesses. A series of 39 patients].

OBJECTIVE: Evaluate short- and long-term follow-up of patients treated by laparoscopy and antibiotherapy for tubo-ovarian abscess. METHODS: We report a retrospective study of 39 patients treated from January 1983 to December 1992. Clinical files were examined and a questionnaire was mailed to patients. RESULTS: None of the patients needed to be reoperated for failure of the first laparoscopic treatment. A laparoscopic control after 3 month was done in 35 cases, which allowed complete adhesiolysis in every patients. We performed distal tubal surgery in 17 patients at that time and oriented 6 patients directly towards IVF. Subsequent fertility, in 19 patients followed without contraception, demonstrated a rate of spontaneous intra-uterine pregnancy of 63%. CONCLUSION: This study confirms that laparoscopy remains the technique of choice in initial management of adnexal abscesses.

Abscess↗
PubMed1994

Introduction of gynecologic endoscopic surgery in an African setting.

The new operative endoscopic techniques have been fully tried in the industrialized world and have spread to all surgical specialities. These new technologies present an obvious advantage for certain gynecologic pathologies which are particularly common in Africa. For pelvic inflammatory diseases, ectopic pregnancies and tubal sterility, laparoscopic surgery enables an initial assessment of disease, a less traumatic treatment and therefore a better long-term prognosis for fertility and reduced postoperative morbidity. Recently, an operative endoscopic unit performing laparoscopic surgery and endoscopic resections was created at the Centre Hospitalo-Universitaire de Yaoundé in Cameroon. This facility is the result of close collaboration between the University of Yaoundé and the University Hospital of Clermont-Ferrand. This operative endoscopic unit has been functioning since April 1992. The authors discuss the difficulties involved in such projects, such as initial investment, maintenance of equipment and in particular training of the surgical team.

Cameroon↗
PubMed1994

Laparoscopic Management of Suspicious Adnexal Masses

After our initial experience with 757 patients, we have extended our indications for laparoscopy to suspicious adnexal masses. Twenty of 29 ovarian cancers surgically treated since December 1991 were first evaluated by laparoscopy. In all, 321 patients were evaluated by laparoscopy in 1992 and 1993, including 145 women with an ultrasonographically suspicious mass (45.7%). At laparoscopy, 52 masses were diagnosed as suspicious, including 20 cases of malignant ovarian tumors. Sixteen patients were treated by laparotomy (5%), including 11 women with cancer, 2 with teratomas diagnosed as suspicious, and 3 with benign masses that could not be treated endoscopically (0.9%). In cancer treated by laparotomy, staging, including the assessment of the upper abdomen, was begun laparoscopically. When a cancer was managed laparoscopically, an early second look laparoscopy was performed routinely. Since many laparotomies may be avoided, laparoscopic surgery is promising in the management of suspicious adnexal masses. However, from two cases of tumor dissemination, we conclude that this management should follow strict guidelines and needs to be further evaluated.

Journal Article↗
PubMed1994

The role of laparoscopic surgery in gynecologic oncology.

As a result of recent technological advances, laparoscopic lymphadenectomy is becoming the standard method for the staging of pelvic cancer. More extensive procedures, such as para-aortic lymph node dissection and radical hysterectomy, have also been demonstrated to be feasible by advanced laparoscopic surgery. This new approach appears to be very promising. In the future, because of its well documented advantages, laparoscopic surgery may appear as a way to decrease the morbidity of cancer treatment in patients with low-risk tumors and to propose more aggressive treatments of patients with tumors associated with a poor prognosis. These new techniques should be reserved for surgical teams trained in oncologic and major laparoscopic surgery. More clinical research is required before this approach can be proposed as an alternative to laparotomy, and guidelines have to be established. Training in oncology is essential to ensure optimal patient care and to avoid the consequences of inadequate laparoscopic management with regard to cases of tumor dissemination reported after laparoscopic biopsy or resection of undiagnosed ovarian cancer.

Endometrial Neoplasms↗