Biomedical subjects

J Y Couturier

Publications and source records attributed to J Y Couturier.

8 recordsLinked to original sources

PubMed1997

[Early debulking surgery after chemotherapy in advanced cancer of the ovary].

The main prognostic factor in advanced ovarian cancer is the volume of residual disease after the initial laparotomy. Early debulking surgery after several cycles of chemotherapy, before the emergence of resistant cell lines, could improve the prognosis of patients with bulky residual disease. This study concerns patients with advanced ovarian cancer entered into three prospective trials including IV cisplatin and anthracycline-based chemotherapy, early debulking surgery after three cycles of chemotherapy in case of initial residual disease superior 2 cm and intraperitoneal consolidation chemotherapy. Among 160 patients with stage III or IV, 80 (50%) had at least a residual tumor of more than 2 cm in diameter. Early debulking surgery was effectively performed in 54 patients (67.5%), leaving 39 patients with no residue over 2 cm. Twenty-one patients had no macroscopic residual disease. The median survival of all patients with initial residual disease over 2 cm was 23 months. Patients with no macroscopic residual disease at early debulking surgery had a median survival of 44 months. Early debulking surgery appears useful in advanced ovarian cancer with bulky residual disease. The objective of this operation is to achieve no macroscopic residual lesion.

Antineoplastic Agents↗

PubMed1992

Sequential cisplatin-doxorubicin, early debulking surgery and intraperitoneal chemotherapy in advanced ovarian cancer. Groupe d'Etude et de Recherche sur les Cancers de l'Ovaire et Digestifs (GERCOD).

40 patients with advanced ovarian cancer were treated with immediate debulking followed by sequential cisplatin and doxorubicin every 4 weeks, followed by second-look laparotomy (SLL). Six courses were given when residual disease (RD) was under 2 cm. When RD was over 2 cm, three courses were followed by early debulking and six more courses before SLL. Immediate debulking was optimal in 15 patients (38%) and early debulking in an additional 15 (38%). Pathological complete responses (34 evaluable cases) were observed in 14 cases (41%), partial response in 13 (38%), stable disease in 3 (9%) and progression in 5 (15%). Toxicity was mainly haematological. 11 patients with negative SLL and 15 with RD under 2 cm received intraperitoneal cisplatin 200 mg/m2 alone or with cytarabine. Median survival was 45 months: 58 months for RD under 2 cm at initial laparotomy and 31 months for RD over 2 cm. Median survival was 46 months when early debulking was successful. 5 year disease-free survival was only 16%. However, this multimodal treatment offers prolonged survival, especially in patients optimally debulked either at initial laparotomy or at early debulking surgery.

Adult↗

PubMed1991

[Functioning of implantable catheters of intraperitoneal chemotherapy].

Intraperitoneal chemotherapy with a totally implantable catheter was performed in 42 patients with advanced ovarian cancer who received 178 courses of chemotherapy administered in 2 l of solution. Major complication was inflow obstruction due to fibrosis around the catheter observed in 10 patients, 23.8% of the cases. Other complications were: leakage 3 (7.1%), pain 3 (7.2%), infection 3 (7.1%) and rectal perforation 1 (2.4%). Overall, these complications occurred in 15 patients (35.7%) and were the cause of treatment interruption in 7 (16.7%). Outflow obstruction which occurred in 23 patients (54.8%), did not create discomfort and could not be considered as a complication. Despite the problems, intraperitoneal chemotherapy with a totally implantable catheter appeared feasible in at least 80% of the patients.

Adult↗

PubMed1982

[In vitro fertilization].

The results of 36 follicular punctures for in vitro fertilization (IVF) performed at the Maternity unit of Hôpital Tenon, Paris, between January and June 1981 are reported. To collect a pre-ovulatory ovocyte by follicular puncture through laparoscopy requires extremely accurate monitoring of ovulation to make sure that the ovocyte collected has completed its nuclear and cytoplasmic maturation in vivo. The criteria for puncture time are the beginning of LH plasma peak level in spontaneous cycles and injection of HCG in stimulated cycles. In this series the ovocyte collection rate was 60% on average. Failures were mostly due to the local status of the genital tract in the women selected for attempted IVF, since all of them had permanent tubal sterility consecutive to severe pelvic inflammatory lesions. The percentage of ovocytes found to be mature was higher in spontaneous than in stimulated cycles. Out of 13 pre-ovulatory ovocytes collected, 8 were fertilized in vitro. Four could be transferred into the uterus, resulting in two pregnancies which had to be interrupted at an early stage. IVF demands full availability of the surgical and laboratory teams concerned.

Adult↗

PubMed1982

[Postovulatory hormones in plasma, peritoneal and follicular compartments].

Eleven women with dysovulatory or unexplained sterility were treated by induction of ovulation and compared with a control group of seven normal women. Laparoscopy was carried out 48 hours after HCG had been injected or after the LH peak in the first group. 48 hours after the rise in temperature in the second group ovulation was presumed and aestradiol 17 beta, progesterone. Delta 4 androstenedione, FSH, LH, prolactin and cyclic AMP estimated in the plasma, the peritoneal fluid and fluid from the persistent follicles. A corpus luteum of recent formation was found in group 1, 5 out of 7 times, and only 7 out of 11 times in group 2. The question of whether non-ruptured luteinised follicles exist is discussed in view of these anatomical and hormonal level findings. These show that there is a good correlation in both groups between aestradiol 17 beta and progesterone, whether estimated in the plasma or in peritoneal fluid. On the other hand, there was poor evidence of correlation between the levels of steroids in each compartment as compared with the other. Finally, the curves for the different steroid levels are important when concentrations of hormones in the follicles, the peritoneal fluid and the plasma are compared. Conclusions have been suggested about the origin of the different steroids and their movement from compartment to compartment.

Adult↗

PubMed1980

[Pathological obstruction of the first portion of the tubal isthmus. An analysis of 50 microsurgical operations (author's transl)].

The authors report a series of 50 cases of proximal tubal microsurgery with an interval of 11.8 months for isthmo-uterine anastomosis and 15 months for isthmo-interstitial anastomosis. The overall results are: 61 per cent of complete patency and 16 per cent of intra-uterine pregnancy. The technique of isthmo-uterine anastomosis after wide excision of the fibrous portion seems to be preferable since it gives an 81 per cent result of satisfactory patency as compared with 20 per cent when the anastomosis is between the isthmus and the interstitial portion of the tube. The fact that endometriosis was present in 34 out of 48 cases, which is a very high proportion, and the short follow-up, may explain the relatively poor results.

Fallopian Tube Diseases↗

PubMed1977

[Moschowitz's disease: efficacy of anti-platelet aggregation agents].

In November 1976, a 52 year old woman presented with a Moschowitz syndrome with clinical manifestations of continuous fever at 39 degrees and a transient Wernicke type aphasia. Laboratory findings included schizocytosis, a peripheral thrombocytopaenia and functional renal insufficiency. The ethanol tests was positive but there was no frank defibrination syndrome. After corticosteroid therapy failed, the patient was treated with Dipyridamole 400 mg/24 hours IV and acetylsalicylic acid 4 g/24 hours IV. Fever disappeared on the same day and the thrombocytopaenia was corrected in 48 hours. The patient was considered to be cured 15 days later. No precise aetiology to explain the Moschowitz syndrome was discovered apart from the recent ingestion of oestrogens. The authors emphasise the considerable progress which this use of a combination of Dipyridamole and aspirin represents, resulting in the cure of Moschowitz syndrome, a condition considered to be fatal up until a few years ago.

Adrenocorticotropic Hormone↗

PubMedDate not supplied

[Menopausal risk factors (author's transl)].

Menopausal disorders coincide with the onset of luteal insufficiency and the resulting relative hyperestrogenism. At this stage the risks to be assessed are mainly related to a worsening of the menstrual syndrome (heaviness of the legs, abdominal distention, water retention, mastodynia, depressive syndrome), cycle changes, or various genital types of hemorrhage requiring investigation for detection of a possible fibroma, hyperplasia, endometriosis, or genital cancer. Once the menopause is settled a reduction in estrogen levels comes with reactive increases in FSM and LM levels, and the principal risk is the development of a cancer. The role of endogenous (obesity, diabetes, Stein-Leventhal, adenomatous hyperplasia) or exogenous (prolonged estrogen therapy alone) estrogens has to be evaluated in endometrial cancer. Cancer of the vulva also appears to be more frequent in menopausal women (natural or artificial), as well as cervical cancer and cancer of the breast. There is an apparent increase in cardiovascular risks in untreated menopausal women, but this is still discussed, as to the benefits of estrogen therapy.

Adult↗