Biomedical subjects
Publications and source records attributed to J Y Grall.
Thrombophlebitis of the ovarian vein is a well recognized but uncommon complication during the postpartum period. We report a small series and emphasize the contribution of color Doppler and the basic therapeutic measures.
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The initial manifestations of two cases of non-Hodgkin malignant lymphoma of the uterine body were a cauda equina syndrome in one and bowel occlusion in the other. A review of the literature on isolated non-Hodgkin malignant lymphomas of the uterine body was discussed.
OBJECTIVES: Development of diagnostic, therapeutic and preventive measures for breast cancer after cure of Hodgkin disease. STUDY TYPE: Presentation of 4 patients treated conjointly by the Radiotherapy and Gynaecology Surgery Departments of the Rennes University Hospital. RESULTS: Illustrations of difficult management of breast cancer at different stages of diagnosis and therapy. CONCLUSION: A past history of treated Hodgkin disease is a factor of risk for breast cancer and suggests the need for annual mammography screening 10 years after the end of treatment. Though more difficult, mastectomy is recommended over conservative radiosurgical treatment. The choice of drugs for adjuvant chemotherapy should rely on Hodgkin protocols and take into account heart function. Long-term carcinogenic effects of Hodgkin disease treatments requires modulation of the different treatment protocols as a function of stage, clinical and histological factors of prognosis and patient age.
Adenomyoepithelioma of the breast is a rare tumor which exceptionally degenerates, requiring treatment and large exeresis. We report a new case and review the literature.
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We report our experience of 15 cases of gastroschisis which occurred between 1981 and 1993. All but one were diagnosed antenatally by ultrasound between 16 and 32 weeks of pregnancy. We made a termination of the pregnancy in 3 cases, for multiple malformations in 2 cases and one case of very early premature rupture of the membranes (PROM). When checked (11 cases), the karyotype was normal. We made a cesarean section in 11 cases: the indication was a complication for 6 (fetal distress, PROM, polyhydramnios, large dilatation of the gut). We noted growth retardation in 7 newborns and prematurity in 5/12 (mean gestational age of 36.8 weeks). The preoperative study of the gut noted 5 cases with intestinal damage and one case of complete necrosis of the gut. The global prognosis is not as good as usual, with a perinatal mortality of 41.6% (5/12). We discuss this latter point and examine the literature.
The authors report a case of cystosarcoma phyllodes occurring in an adolescent female, thus raising to 19 the number of reported cases. The prognosis of those composite fibro-epithelial tumours is ruled by the malignancy of the connective component: the diagnosis shows no distinctive feature compared with what can be observed in adults. The prognosis (classically better) appears in fact totally similar, justifying the same therapeutic rigour, particularly in the surgical field. A multidisciplinary approach should ensure complete recovery while limiting the harmful effects of the therapy in very young women.
We report 3 cases of sarcomas following irradiation for breast carcinoma. Median latent period ranged from 7 to 17 years. Histologic types were 1 malignant fibrous histiocytoma, 1 osteochondrosarcoma, 1 chondrosarcoma. Diagnosis was often delayed because of non-specific clinical features. The prognosis of these postirradiation sarcomas was poor with the median survival ranging from 10 to 70 months. One patient had a complete resection and is alive at 70 months. In the other 2 non-resectable patients, chemotherapy and/or radiotherapy did not induce an objective response. The poor prognosis when these tumors are diagnosed late emphasizes the need for increased awareness, which should lead to earlier diagnosis and, it is hoped, permit radical surgical treatment.
We retrospectively studied the outcome of pregnancy in 62 cases of absent end diastolic flow (AEDF) of umbilical artery Doppler flow velocity waveform. The history of pregnancies revealed that nearly all were of high risk. Many cases presented cerebral (65%) or uterine (55.5%) Doppler flow abnormalities, or both (38%). We noted 10 fetal deaths and decided 7 pregnancy terminations. Malformation and chromosomal defect rate was 16%. We noted 44 (71%) live-births, a very high rate of cesarean section (86%), prematurity (75%), small for gestational age (39%). Forty-five percent of the neonates had a 1-min Apgar score under 7, which dropped to 27% at 5 min. Neonate mortality rate was 6.9% and the total mortality rate was 34% (21/62). Morbidity was significant (7 cases with severe morbidity, 2 cases with chromosomal abnormality of poor prognosis). We compared different sub-groups with a view to looking for some prenatal factors which predict poor neonatal outcome in case of AEDF.
Immature teratoma of the ovary is a rare tumour (1% of cancer of the ovary) usually seen in adolescents or young women. It is a malignant tumour derived from an abnormal germ-cell which undergoes meiotic division. The diagnosis is based on the pathological examination which reveals immature tissue derived from two or three types of embryonic tissue (endo-, meso- and ectoderm). Intraperitoneal dissemination occurs and immature or mature recurrence is observed. The prognosis was particularly severe before the use of polychemotherapy which has also made conservative surgery possible. At the present time, the consensus is to reduce the duration of the chemotherapy with a regular clinical and laboratory (tumour markers, aFP) monitory. A second look laparotomy verifies successful treatment.
OBJECTIVE. Diagnostic value of breast clustered microcalcifications discovered by mammography. DESIGN. A retrospective study. SETTING. Oncology Center of Rennes. SUBJECTS. 58 women (study group) with breast clustered microcalcifications without palpable tumour were operated. SURGERY. Prior to surgical removal of microcalcification, needle localization was performed. Histological results. We observed, 36 benign lesions (59%), 25 carcinomas (45%), 10 of them in situ and 15 infiltrative. RESULTS. Different radiological parameters were studied in relation to histological results, the vermicular morphology of microcalcification, an increased number, their triangular aspect, provide clue to the presence of breast carcinoma. The cluster of stippled calcification is not, in our series suggestive of a carcinoma, but also requires histopathological study, owig to the fact that in such cases, we have as many carcinomas as benign lesions. FINDING. Careful analysis of microcalcifications, within the clinical context, ensures a safe attitude, and enables one to operate only carcinomas.
A case of juvenile tumour of the granulosa occurred in a pregnant woman. Outcome was rapidly fatal. These tumours are classed as mesenchyma tumours of the sexual cords of the ovaries. The juvenile form occurs before the age of 30 years in 97% of the cases and has characteristic endocrine and anatomic features. The tumour remains localized in the ovary for a long period and may be treated with conservative surgery to preserve fertility in these young patients. Follow-up is aimed at detecting relapse which may occur early. Prognosis in such cases is very poor. Pregnancy does not modify the prognosis which is generally good.
The authors report a case of pregnancy of the uterine horn occurring after total salpingectomy, i.e. including resection of the intramural portion of the tube. They identify the epidemiological, pathophysiological and clinical features of this complication with the help of a review of the literature of cases occurring after partial salpingectomy and total salpingectomy. They discuss the usefulness of resection of the interstitial portion of the tube and feel that prophylactic cesarean section is justified in patients who have remained fertile.
Having treated a case which resulted in the delivery at term of an intrauterine twin when the other twin had been lost after the rupture of a uterine cornu which itself followed a salpingectomy without removal of the interstitial portion of the tube brings the authors to discuss the physiopathology and the symptomatology of such cases. They also discuss the value of resecting the interstitial portion of the tube and what management should be when there is a live intrauterine pregnancy.
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The authors have evaluated the risk of neonatal infection (NNI) by materno-fetal contamination when a rise in temperature occurs in labour and they have worked out the prophylactic measures that should be taken. This has been the results of a prospective study carried out on 6305 deliveries. Any significant conditions associated with NNI are stained liquor and a low Apgar score at birth. When high temperature develops in labour it is important to deliver the infant as quickly as possible particularly if the labour is a premature one. Prevention carried out by very early diagnosis of amniotic fluid infection in pregnancy and by careful attention to the high risk conditions of: early rupture of the membranes, a high level of vaginal infection particularly with Beta streptococci.
The authors report successful in utero treatment by high doses of intravenous gamma globulins in a case of neonatal alloimmune thrombocytopenia. Early diagnosis allows an appropriate management: fetal blood sampling as early as 20 weeks of gestation; in case of fetal thrombocytopenia, treatment by intravenous gamma globulin (1.0 g/kg/b.w.) each week during 8 weeks or more; ultrasound screening of in utero hemorrhage, particularly intracranial hemorrhage; fetal blood sampling before delivery at term and in utero transfusion of platelet antigen negative in case of persistence of fetal thrombocytopenia.