Three-dimensional imaging of the portal sinus anatomy.
Explore the source record for details and available documents.
Hepatic Veins↗
Biomedical subjects
J Y Grall
Publications and source records attributed to J Y Grall.
[Problems raised by the gynaecologic management of women with BRCA 1 & 2 mutations].
Breast and ovarian cancer occur more frequently in young women with BRCA 1 &2 mutations (respective cumulative risks from 37 to 85% and 10 to 20%), and raise specific gynaecologic problems as prophylactic surgery and hormonal treatments. Two medical files from 2 sisters with BRCA 1 mutation (exon 11) are presented and the authors discuss the therapeutic options chosen. BRCA 1 & 2 tumour suppressor genes seem to play a major role in the repair of cellular damages inducing by the estrogenic proliferative signal. The prophylactic mastectomy is effective for the breast cancer prevention but its acceptance is low. The oophorectomydecreases the ovarian risk (knowing the occurrence of peritoneal carcinomatosis in 1.8% of cases) and currently the breast cancer risk (RR = 0.47) by the hormonal privation: the hormone replacement therapy does not seem to increase the breast cancer risk in the small series published. The HRT is possible in women with BRCA mutation under medical supervision and if the doses of hormones are light. The first results concerning the chemoprevention by Tamoxifen are encouraging (RR = 0.38) in these patients, but more studies are needed. The oral contraception exerts an uncertain effect against ovarian cancer, but possibly enhances the breast cancer risk in this group of women (RR = 3.3). The management of women with BRCA mutation is varying according to their own priorities, which can change during their life.
Adolescent↗
[Factors associated with the choice of breast or bottle-feeding for hospitalized newborns].
UNLABELLED: This study was carried out in Rennes's maternity hospitals (France), to determine the breastfeeding rate for newborns hospitalized after birth, as well as the factors associated with the choice to breastfeed or not in these conditions. METHODS: Three hundred and twenty mothers delivered in Rennes Teaching Hospital, whose neonates were transferred in neonatal care unit, were questioned about their choice for neonate feeding. RESULTS: Three hundred and eight of the 320 mothers concerned by the study answered our interview. Fifty one percent of them chose to breast feed, which is near the breastfeeding rate of the general population of Rennes' maternity hospitals (52%). A high sociocultural level, a mother previously breastfed herself, and a previous breast feeding (RR = 5.2; P < 10(-8)) were associated with the choice of breastfeeding. Factors concerning the information of the mothers were also associated with the choice of breastfeeding information during the preparation to birth sessions (RR = 1.7; P < 10(-5)), individual information on the breastfeeding of an ill newborn (RR = 1.5; P < 0.01), and the simple advice to breastfeed given by a health care professional (RR = 2; P < 10(-8)). Of the four qualities named, the more breast-milk qualities a mother knew, the higher breastfeeding rate was (10% for none, 27% for one, 54% for two, and 76% for three or four). Concerning the postnatal factors, gestational age below 31 weeks multiplied breast feeding by 1.5 (P < 0.05), and an early contact mother-child (first day) by 1.3 (P < 0.05). CONCLUSION: This study pointed out the populations at risk of no breastfeeding. Informations on the properties of breastfeeding given to mothers by health care professionals may influence them in their choice of breast feeding or not their ill newborn.
Adult↗
Polyamine profiles in tumor, normal tissue of the homologous breast, blood, and urine of breast cancer sufferers.
Polyamines are involved in the development of breast cancer. We assayed polyamines in erythrocytes, urines, and breast tissues (tumor tissue and histologically normal breast tissue close to the tumor) of patients with invasive breast cancer (n = 174) and benign breast disease (n = 71, used as controls). Polyamine levels in red blood cells and urine were similar to the polyamine concentrations found in healthy subjects, and thus cannot be used as diagnostic markers of breast cancer. In cancer tissue, polyamines were significantly increased in comparison with the polyamine concentrations in controls, and were correlated to the tumor aggressiveness as evaluated by histological grade and Ki-67 proliferative index. On the other hand, correlation was found between polyamine levels in the tumor and the status of the hormone receptors. In the mammary tissue close to the cancer, polyamines dramatically decreased in comparison with the polyamine levels of tissue samples removed around the histologically proven benign tumors. The changes of the polyamine concentrations in the histologically normal breast tissue in the vicinity of the cancer could play a role in the cancer development and need further studies, especially if polyamines are considered as a potential therapeutic target in breast cancer.
Adenocarcinoma↗
[Hysterectomy for benign lesions in Brittany: analysis of medical practices].
OBJECTIVES: By who, why and how are done hysterectomies for benign lesions. MATERIAL: and methods. The 413 medical files of all the patients who underwent an hysterectomy for benign lesion during the last trimester of 1997 were recorded by the Medical Information Departments of the 53 health establishments of the Brittany Region. Surgical procedures, medical indications, pathological findings were analyzed according to the guidelines encountered in the medical literature. RESULTS: Hysterectomies were done by many surgeons (112). Inaugural signs noted in the medical files were classical, but various and often associated without a main indication of hysterectomy. Histological diagnose were identical with those found usually in the literature. The abdominal route was mainly used, particularly when the operation was done by a generalist surgeon and in case of uterus weight superior to 250 g. The post operative outcome has revealed the same nature and frequency of complications as usually described. CONCLUSION: In this study, it appears that efforts remain necessary to clarify the indications for hysterectomy in the medical files (in order to promote the alternative procedures to the hysterectomy), and that the proportion of hysterectomies performed by the abdominal route should be reduced in aid of the others surgical routes.
Female↗
[Gestational diabetes: the Rennes Study of joint obstetrical and endocrinological management].
OBJECTIVE: To assess the efficacy of a co-program of care in gestational diabetes conducted by the obstetrical and endocrinological units of the Rennes South Hospital (Hopital Sud) and the possibility of adapting obstetrical care to existing risk factors. PATIENTS AND METHODS: A retrospective analysis was made of 200 cases of gestational diabetes diagnosed between January 1993 and December 1996 in the obstetrical units. RESULTS: Instrumental extraction and cesarean section were required for 13.5% and 20.5% of the deliveries respectively. Shoulder dystocia occurred in 2%. 19.9% of the infants had macrosomia and 5. 3% were small for gestational age. Neonatal morbidity required transfer to the pediatric intensive care unit for only 2.9% of the infants. Frequency of cesarean section and macrosomia correlated with poor blood glucose control and excess maternal weight for gravidic hypertension. At 3 months post-partum, glucose intolerance and non-insulin-dependent diabetes were diagnosed in 13% and 2% respectively. CONCLUSION: Systemic screening and obstetrical and endocrinological care allowed patients to prevent maternal and fetal complications in gestational diabetes and to initiate hygiene and dietary habits for the prevention of post-partum non-insulin-dependent diabetes. Obstetrical care can be adapted to risk factors such as overweight, late screening or poor blood glucose control.
Body Mass Index↗
Immediate breast reconstruction with deepidermalized transverse rectus abdominis musculocutaneous flap after skin-sparing mastectomy.
Use of the transverse rectus abdominis musculocutaneous (TRAM) flap for breast reconstruction is widely accepted and indications have been well-defined over the past years. More recently, the moratorium prohibiting pre-filled silicone gel implants both in esthetic surgery and in reconstruction breast surgery, has incited more and more patients to refuse prostheses, even saline filled implants. Total mastectomy with skin-sparing technique, beyond the limitations dictated by oncology factors which must be taken into account because of the risk of local recurrence, raises the question of immediate breast reconstruction since implants, when possible, may give unsatisfactory results either more or less short-term. The deepidermalized TRAM flap is an interesting alternative for selected patients, especially those with an adapted abdominal morphology, allowing stable and natural autologous breast reconstruction.
Adult↗
[Teaching resources of a hospital Gynecology-Obstetrics service. Review of the literature and practical applications].
OBJECTIVES: To summarize the methods encountered in a gynecological department for teaching medical students. STUDY: Review of the Medline literature underlying the benefits and disadvantages of each method using the issues of the modern theories of teaching. RESULTS: All the methods are helpful for learning, with different and complementary objectives. Students can constitute a set of skills using a teaching program containing clear objectives and evaluation on which the future medical practice will be based. CONCLUSION: Students have immediate benefits from an active clinical learning involving them and are prepared to the Continued Medical Education.
Case Management↗
Prognostic factors of the uterine cervix adenocarcinoma.
BACKGROUND: Prognosis factors for adenocarcinoma of the uterine cervix after primary treatment are poorly established. METHODS: A retrospective study of 45 cases of adenocarcinoma of the cervix with a follow-up of 96 months on average was performed. The primary treatment consisted in combined radical surgery and radiotherapy for stage I-II patients while patients with advanced disease were treated by radiotherapy. In case of poor prognosis factors, they were given chemotherapy. Survival rates were established and prognosis factors influencing survival and recurrences were studied. RESULTS: Fifteen women remained alive without evolutive disease. FIGO stage and pelvic node involvement were the most important parameters influencing overall survival. Local failures (27%, average period of 30 months) were unpredictable and led to a dramatic outcome. Histological grade and pelvic node status were significant predictive factors for metastatic recurrence (40%, average period of 29 months). CONCLUSIONS: Local recurrence and metastatic dissemination of cervical adenocarcinoma after primary treatment prove to be rapidly fatal although life expectancy can be prolonged with adjuvant treatment of the recurrence. In the event of aggressive tumors with high histological grade and pelvic node involvement, an attempt to assess adjuvant systemic chemotherapy could be useful.
Adenocarcinoma↗
[Intracystic breast carcinoma. A case report].
Intracystic breast carcinoma is a malignant which develops within breast ducts. The clinical examination reveals a breast cyst containing a blood fluid which persists after the puncture. Fine-needle aspiration cytology may be benign. The endocystic mass is detected well by the ultrasound and US-guided puncture is possible. Papillary carcinoma is the most frequent histological type. Conservative prophylactic radiotherapy with surgery can be proposed. Prognosis is poorer with stromal involvement.
Biopsy, Needle↗
[Analysis of medical catalog terms using the MAOUSSC model: application to Gyncecology-Obstetrics].
BACKGROUND: The Model of Assistance and Orientation of a User within a System of Coding (MAOUSSC) used to describe activity in human medicine was used to analyse French medical nomenclature in Gynecology and Obstetrics. METHODS: French medical nomenclature for gynecology and obstetrics was translated with the multiaxial model (MAOUSSC) to allow critical analysis. RESULTS: All the 119 medical acts in the French nomenclature involving the female genital tract and obstetrics could be translated with the model. 24% of the acts were imprecise, ambiguous or implicit: the nature of the procedure was not explicit in 7 cases, the surgical route was not given in 86 and the surgical instrumentation not named in 75. Activities involving numerous medical specialties and ambulatory activity can be described with the MOUSSC model. CONCLUSION: The MAOUSSC model is still in the experimental stage. It is however easy to implement, has a high potential for describing various medical acts and is suitable for the description of gynecological and obstetrical activity both in terms of economical and medical efficacy.
Computer Simulation↗
[Value of peritoneal cytology after hysteroscopy in endometrial adenocarcinoma stage I].
Nineteen clinical stage I adenocarcinoma of the uterus with favourable histological prognosis factors (low grade, no myometrial extension, and no pelvic node involvement) were diagnosed using a preoperative hysteroscopy. During the laparotomy, a peritoneal cytology was performed systematically. The frequency of positive peritoneal washings was abnormally high (7 cases) with cytologic findings showing grouped cells in large clusters. However, these patients have not experienced peritoneal recurrences. The endoscopic procedures may have facilitated the transtubal malignant cell dissemination and are questionable in front of endometrial carcinoma.
Adenocarcinoma↗
Diagnosis of post-partum ovarian vein thrombophlebitis by color Doppler ultrasonography: about 10 cases.
BACKGROUND: Post-partum ovarian vein thrombosis is often overlooked or mistaken for other complications such as endometritis. Color Doppler ultrasonography is a very good diagnostic method when properly indicated and correctly interpreted according to clinical data. METHODS: This study reports ten cases that were retrospectively studied, during which color Doppler ultrasonography was used. The clinical signs and the results are reviewed. RESULTS: The lesions were clearly visualized in eight of the ten cases; one of the two failures resulted from a methodological fault (uninterpretable result); the other one was due to the lack of experience of the operator and nonrecognition of the clinical signs. Thrombosis appears as a hypoechogenic and tubular image. This type of examination is particularly indicated in the presence of certain clinical signs that were observed in our cases: fever and iliac pain are the main precursor signs, often associated with abdominal meteorism and slow digestive transit; provoked cul-de-sac pain during vaginal probing was the only constant sign, sometimes associated with painful swelling.
Adult↗
[Uterine leiomyosarcoma. Nine case reports, review of the literature].
OBJECT OF THE STUDY: To evaluate management and outcome of the treatment of uterine leiomyosarcoma. PATIENTS AND METHODS: Retrospective study of a series of 9 patients treated for uterine leiomyosarcoma in this hospital from 1982 to 1994. RESULTS: The condition is rarely suspected preoperatively, diagnosis is usually made on histological examination of the operative specimen. The outcome is related to the mitotic activity of the tumour and to the infiltration of nearly structures. Surgery is the only effective treatment, chemotherapy is ineffective, adjuvant radiotherapy improves local control of the tumour but has no incidence on survival. CONCLUSION: In the absence of an effective adjuvant treatment uterine leiomyosarcoma bears a poor prognosis with the only exception of small non infiltrating tumours with a low mitotic activity.
Adult↗
[Mauriceau's maneuver; comment].
Explore the source record for details and available documents.
Breech Presentation↗
[Gynecologic allergy to spermatic fluid. A case report].
Seminal fluid allergy is a possible diagnosis in front vulvovaginal inflammations occurring rapidly after coitus. The type I reaction (revealed by the immediate hypersensitivity Prick-test) is most frequently encountered. In case of systemic symptoms, the circulating Ig E specific antibodies can be increased. Treatment is palliative (condoms, antihistamines cream). In case of systemic disease, desensibilisation can be proposed. This infrequent but uncomfortable syndrome is also in question in some cases of immunologic infertility.
Adult↗
[Mass screening of gestational diabetes using O'Sullivan's test in a hospital consultation. Experience in Rennes].
The aim of this work was to study the predictive value of 50 gram glucose O'Sullivan test for systematic screening of gestational diabetes. To confirm the diagnostic the test positivity was controlled by a 100 g, 3 hours oral glucose tolerance test. During a 12-month period, 751 women were included in the 7th month pregnancy consultation. The O'Sullivan test was positive in 18% of cases. The oral glucose tolerance test confirmed the diagnostic in 14% of these positive tests. The frequency of gestational diabetes was about 2.5% in this population. We compared then the results of the test with the other available screening modes. For this purpose, we analysed retrospectively 50 gestational diabetes diagnosed during the same time in the entire pregnant population of the clinic. In our experience, the O'Sullivan's test is a reliable and useful test. It is easy to perform. Less women are selected than in analysis of risk factors (18% versus > 30%), and with better sensitivity.
Adult↗
[Müllerian mixed tumors. Experience of the Rennes Regional University Hospital].
Seventeen cases of mixed Muller tumours (tumours of the uterus with malignant epithelial and mesenchymal components) are presented. These recently described tumours are rare and occur in menopaused women. Bloody discharge is the usual clinical manifestation, together with an increase of the volume of the uterus. Pathology examination of the surgical specimen is required for diagnosis using immunolabeling to distinguish between homologous tumours (the sarcomatous component occurs in the primary mesenchyma) and heterologous tumours (the mesenchymatous component results from a metastasis). Prognosis, usually poor, depends on the stage of the tumour. Overall survival at 5 years is about 30%. Survival in early stage I and state II tumours is no greater than 50% at 5 years. Treatment is based on radiosurgical techniques in less advanced tumours and requires radiochemotherapy in more advanced stage tumours. Recurrence is usually seen within 2 years, involving the pelvis alone in 10% of the cases and metastasis in most of the others. Because of their rapid development and poor prognosis, these tumours should be identified separately as a separate entity within a larger group of mixed mesodermic tumours.
Aged↗