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Biomedical subjects

L Cravello

Publications and source records attributed to L Cravello.

At least 37 records · Page 2Linked to original sources
PubMed2001

Vaginal birth following two previous cesarean sections.

OBJECTIVE: To evaluate the management of vaginal delivery among women with two previous cesarean sections. The maternal and fetal morbidities of this attitude were studied. SETTING: University hospital. DESIGN: Retrospective study made over 6 years, from January 1st 1990 to December 31st 1995. PATIENTS: Among 180 patients with two uterine scars, 96 patients with cephalic presentation and normal pelvic dimensions were allowed trial of labor. RESULTS: The rate of vaginal birth following trial of labor was 65.6%. Three patients had an uterine scar dehiscence; among them, one hysterectomy was performed for haemorrhage with uterine atony. Neonatal issue was always favorable. Twenty-two newborns had superior birthweights compared to those born from the preceding cesarean section. CONCLUSION: Trial of labor following two previous cesarean sections is acceptable in the majority of cases. It leads to a high vaginal delivery rate and low maternal and fetal morbidity.

Analgesia, Epidural↗
PubMed2001

Endometrial biopsy during outpatient hysteroscopy: evaluation and comparison of two devices.

OBJECTIVE: Association of office hysteroscopy with outpatient endometrial biopsy is interesting to evaluate correctly endometrium. Purpose of this study was to evaluate and compare two endometrial biopsy devices during outpatient hysteroscopy, based on effectiveness and tolerance of the procedure. STUDY DESIGN: A single blind, randomised prospective study. RESULTS: 200 patients were randomised into two groups following outpatient hysteroscopy: 100 were biopsied with Vacurette and 100 biopsed with Pipelle. Pipelle was less painful compared to Vacurette (1.1+0.2 versus 1.6+0.3; P<0.001), no matter hormonal status (1+0.3 versus 2+0.6; P<0.001 in premenopausal subgroup and 1+0.3 versus 1.4+0.3; P<0.001 in postmenopausal subgroup). Vacurette was more effective than Pipelle (64/100 versus 48/100; P=0.02), in case of normal or hypertrophic endometrium (56/72 (77%) versus 40/65 (61%); P=0.04) but not in case of atrophic endometrium (8/28 (29%) versus 8/35 (23%); P=0.6). Among the 112 patients with adequate sample, histologic results were normal, except for three cases of endometrial hyperplasia. Among the 88 patients with inadequate sample, 47 (53%) presented an atrophic endometrial aspect at hysteroscopy, whereas 41 (47%) were considered as normal. CONCLUSIONS: Vacurette was more effective though more painful than Pipelle. Both instruments were, however, well tolerated. Both instruments were not very effective in case of atrophic endometrium. Outpatient hysteroscopy combined with endometrial biopsy may help avoid further investigations.

Atrophy↗
PubMed2001

Risk of discovering endometrial carcinoma or atypical hyperplasia during hysteroscopic surgery in postmenopausal women.

STUDY OBJECTIVE: To assess the risk of diagnosing endometrial carcinoma or atypical hyperplasia in tissue resected during hysteroscopy performed for intrauterine pathology presumed benign in postmenopausal women. DESIGN: A single-center prospective study (Canadian Task Force classification II-2). SETTING: Department of Gynecology, La Conception Hospital, Marseille, France. PATIENTS: Three hundred twenty-five women with intrauterine pathology, presumed benign, causing postmenopausal bleeding or bleeding related to hormone replacement therapy. INTERVENTION: All women had an endometrial biopsy after diagnostic hysteroscopy to exclude endometrial carcinoma or atypical hyperplasia. Then they underwent hysteroscopic surgical resection (203, 62.5%) or endometrial ablation (122, 37.5%). MEASUREMENTS AND MAIN RESULTS: Two cases each (0.6%) of endometrial carcinoma and endometrial atypical hyperplasia were discovered that were missed by preoperative evaluations. CONCLUSION: Outpatient hysteroscopy and endometrial biopsy do not eliminate the finding of carcinoma or endometrial atypical hyperplasia, as these disorders may be discovered during hysteroscopic surgery.

Aged↗
PubMed2001

[Evaluation of cost of laparoscopic surgery in gynecology].

The objective of this work was to evaluate hospital and postoperative costs associated with gynecologic laparoscopic surgery for benign pathologies. Hospital costs were broken down into several categories: operating room, postoperative hospitalization, pharmacy, surgical instruments, sterilization of reused equipment, food and laundry, indirect costs. The mean total costs for the hospitalization time were 8547,2 francs. Medical charges in recovery time were calculated with the help of the Social Security. These charges represented less than 5% of the total cost associated with the procedure.

Drug Costs↗
PubMed2001

[Vaginal hysterectomy:apropos of a series of 1008 interventions].

STUDY AIM: The aim of this study was to analyse our vaginal hysterectomies performed for prolapsed uterus and non prolapsed uterus with benign disease. For the latter indication, a comparison was made with abdominal hysterectomy. PATIENTS AND METHODS: From february 1986 to december 1998, 1008 vaginal hysterectomies were performed in our department: 219 for prolapsed uterus and 789 for non prolapsed uterus with benign disease. During the same time, 217 abdominal hysterectomies were performed for non prolapsed uterus with benign disease. RESULTS: Intra-operative and post-operative complications had the same rates in the two groups. Owing to the low number of abdominal hysterectomies, we cannot draw a valuable conclusion. The study of the literature shows in this field an advantage for the vaginal hysterectomy; mean time hospitalization was shorter in the vaginal group. CONCLUSION: Advantages of vaginal hysterectomy are multiple: aesthetic, shorter hospitalization, quicker recovery. The low rate of vaginal hysterectomy on non prolapsed uterus with non malignant disease is linked with the lack in training of surgeons for the vaginal approach. In these cases, a rate of 70% is a realistic one in a well trained hospital center.

Adult↗
PubMed2001

Age-related changes of the hypothalamic-pituitary-adrenal axis: pathophysiological correlates.

The aim of this review was to examine the evidence for age-related changes of the hypothalamic-pituitary-adrenal (HPA) axis in both physiological and pathological aging, on the basis of the many data in the literature, as well as of our personal findings. A statistically significant circadian rhythmicity of serum cortisol was maintained in elderly subjects, even if with a reduced amplitude of the 24 h fluctuations and a trend to an increase of the serum levels in the evening and at night-time, in comparison with young controls. Furthermore, an age-related impairment of HPA sensitivity to steroid feedback was present in elderly people. The occurrence of senile dementia amplified the changes already present in physiological aging. While the cortisol secretion was generally well maintained in aging, the adrenal production of dehydroepiandrosterone and of its sulfate (DHEAS) exhibited an age-related decline. Therefore, the cortisol/DHEAS molar ratio was significantly higher in elderly subjects and even more in demented ones, than in young controls. Due to the opposite effects of cortisol and DHEAS on the brain and particularly on the hippocampal region, the imbalance between glucocorticoids and androgens occurring in physiological and even more in pathological aging, may have adverse effects on the function of this region, whose key role in learning and memory is well known.

Aging↗
PubMed2000

BRCA1 and BRCA2 protein expressions in an ovotestis of a 46, XX true hermaphrodite.

BRCA1 and BRCA2 breast cancer susceptibility genes encode proteins, the normal cellular functions of which are complex and multiple, and germ-line mutations in individuals predispose both to breast and to ovarian cancer. There is nevertheless substantial evidence linking BRCA1 and BRCA2 to homologous recombination and DNA repair, to transcriptional control and to tissue proliferation. There is controversy regarding the localization of BRCA1 and BRCA2 proteins to either nucleus or cytoplasm and whether the expression is present in premeiotic germ cells or can still be expressed in mitotic spermatogonia. We report herein an immunohistochemical study of BRCA1 and BRCA2 distribution in a rather unusual tissue (an ovotestis), which addresses this issue.

BRCA1 Protein↗
PubMed2000

[Conization with positive margins: what strategy should be adopted?].

OBJECTIVE: To define recommended treatment in cases of positive margins on cone biopsy specimens. PATIENTS AND METHODS: This single-center retrospective study concerned 220 conizations performed between January 1996 and June 1998. The results of 70 conizations (31.8%) with positive margins were analysed. There were 32 cold knife conizations (mean age: 43 years) and 38 conizations by the loop electrosurgical excision procedure (mean age: 33 years). RESULTS: Mean depth of conization was 15.94 mm for cold knife conization and 10.08 mm for loop electrosurgical conization. Fifteen patients were excluded (5 with invasive cancer and 10 were lost to follow-up). This study included 55 patients with a mean 12-month follow-up. Six underwent hysterectomy for mini-invasion on the specimen or advanced age. Eleven underwent a second conization (followed by hysterectomy in 2 cases). The other 38 patients were submitted to simple surveillance with cervico-vaginal cytology and colposcopic examination. The rate of residual lesions (cervical intra-epithelial neoplasia: CIN 3) after conization with positive margin was 14.5% (n = 8). CONCLUSION: Residual persistent dysplasia is not present in all patients after conization with positive margins. Cytology and colposcopy allow detection of dysplasia, indicating the need for a second conization. In women with no desire for further pregnancy, systematic repeat surgery must be recommended.

Adult↗
PubMed2000

Hysteroscopic resection of endometrial polyps: a study of 195 cases.

OBJECTIVE: To ascertain the therapeutic efficiency of hysteroscopic resection for the treatment of endometrial polyps in women with abnormal uterine bleeding and postmenopausal metrorrhagia. SETTING: University hospital. DESIGN: Retrospective consecutive patient follow-up. MATERIAL AND METHODS: From 1987 to 1997, 195 patients with haemorrhagic endometrial polyps were treated with hysteroscopic resection in our department. RESULTS: Five complications occurred, but no major complications were noted. A total of 89.2% of the patients remained in contact after hospitalization. After long term follow-up (5.2 years), successful results were obtained in 80% of the patients with polyp resection without associated endometrial ablation. Further surgery (hysterectomy) was required in only five women. CONCLUSION: Transcervical resection is the gold standard for treatment of endometrial polyps.

Adult↗
PubMed2000

Hysteroscopic metroplasty for septate uterus and repetitive abortions: reproductive outcome.

OBJECTIVES: The aim of this study is to assess fertility outcome and obstetrical prognosis of 63 patients after hysteroscopic section of uterine septa. MATERIALS AND METHODS: This is a retrospective study about 63 patients consulting for septate uterus and repeated pregnancy loss or abnormal fetal presentation between January 1988 and December 1996 in La Conception hospital in Marseille. Septal lysis was performed with microscissors or resectoscope. Statistical analysis was performed using the CHI2-test. RESULTS: The anatomical result was considered satisfactory in 57.1% of cases. Forty-five pregnancies were obtained, two after an IVF-program in 56 patients. Twenty-eight living children were born: twenty-six at term. Twenty patients delivered normally. Two women are still pregnant. Obstetrical prognosis of these patients is statistically improved by the treatment (P=0.001). CONCLUSION: Obstetrical prognosis of patients presenting repeated pregnancy loss and septate uterus is statistically improved by hysteroscopic metroplasty.

Abortion, Habitual↗
PubMed2000

Pineal and pituitary-adrenocortical function in physiological aging and in senile dementia.

The simultaneous evaluation of the circadian rhythm of plasma melatonin and ACTH and of serum cortisol and DHEAS represents a clinically reliable tool to appreciate the neuroendocrine changes occurring in physiological and pathological brain aging.A selective impairment of the nocturnal melatonin secretion has been observed in elderly subjects, being significantly related either to the age or to the severity of dementia. A significant increase of serum cortisol levels during evening- and night-times was found in elderly subjects, particularly if demented, when compared to young controls. Besides, both the circadian amplitude of cortisol rhythm and the nocturnal cortisol increase were significantly reduced in relation either to age or to cognitive impairment. By comparison to vascular dementia, patients with Alzheimer's disease exhibited the highest cortisol concentrations throughout the 24h. The sensitivity of the hypothalamic-pituitary-adrenal axis to the steroid feedback was significantly impaired in old subjects and particularly in the demented ones. The serum DHEAS levels were significantly lower in elderly subjects and even more in demented patients than in young controls. Consequently, a significant increase of the cortisol/DHEAS molar ratio was evident when going from young controls to healthy elderly subjects and to demented patients. In conclusion, the aging process affects many neuroendocrine functions resulting in subtle but clinically relevant consequences; the occurrence of senile dementia seems to play an additive role.

Adrenocorticotropic Hormone↗
PubMed2000

Overproduction of IFN-gamma and TNF-alpha from natural killer (NK) cells is associated with abnormal NK reactivity and cognitive derangement in Alzheimer's disease.

Alterations of natural killer (NK) function can be involved in the neuroimmune mechanism of neurodegeneration in dementia of the Alzheimer's type (DAT). NK cell cytotoxicity (NKCC) and the generation and release of IFN-gamma and TNF-alpha (spontaneous and modulated by IL-2) from pure NK cells (CD 16+, CD 56+, CD 3-) were studied together with circulating IFN-gamma and TNF-alpha levels and cognitive function in 22 old patients with DAT and 15 healthy old subjects. Higher (p < 0.001) IL-2 modulated NKCC (with IL-2 50 U/mL and 100 U/mL) was demonstrated in DAT patients (+35% and +99% from baseline) than in healthy subjects (+6% and +76% from baseline). Increased spontaneous and IL-2-induced release of IFN-gamma and TNF-alpha from NK cells were found in DAT patients compared to healthy subjects (p < 0.001), whereas no difference of serum IFN-gamma and TNF-alpha was demonstrated between DAT and control groups. Significant negative correlations among the spontaneous release of IFN-gamma and TNF-alpha from NK and the decrease of the score of cognitive function (MMSE) were found in patients with DAT. In conclusion, alterations of NKCC control and NK-derived cytokine release in DAT could be involved in the neuroinflammatory mechanism related to the progression of neurodegeneration and dementia.

Aged↗
PubMed1999

Brachytherapy and vaginal hysterectomy for low-stage uterine cervix carcinoma.

OBJECTIVE: The aim of this study was to assess safety and efficiency of a limited vaginal hysterectomy after brachytherapy in patients with early uterine cervix carcinoma without unfavorable prognostic factors. All tumors were less than 1.5 cm in diameter. MATERIAL AND METHODS: Between October 1992 and December 1995, 22 patients with low-stage uterine cervix carcinoma (stage Ia2 with vascular invasion, 3 cases; stage Ib1, 19 cases) were included in this study. Patients underwent the following procedures: single utero-vaginal brachytherapy after a previous negative laparoscopic lymphadenectomy (median number of lymph nodes: 12) followed 6 weeks later by a limited vaginal hysterectomy. RESULTS: Two mild intraoperative complications were noted. Venous hemorrhage (100 cc) occurred in one patient during lymphadenectomy and another patient experienced bladder injury during hysterectomy. These two complications were successfuly controlled with no need for laparotomy. Only one late complication was observed and was evaluated as a bladder grade G2(b) according to the Franco-Italian glossary. With a 30 (22-50) month follow-up, no recurrence was reported. CONCLUSION: These results appear promising in patients with very early cervix carcinoma but remain to be confirmed on a larger scale.

Adult↗
PubMed1999

Laparoscopic surgery in gynecology: randomized prospective study comparing pneumoperitoneum and abdominal wall suspension.

OBJECTIVE: To compare laparoscopic surgery using insufflation of carbon dioxide gas with laparoscopic surgery using abdominal wall retractor in gynecology. SETTING: University hospital. DESIGN: Prospective randomized study. MATERIAL AND METHODS: Fifty-one patients were assigned to the gasless laparoscopy group, and 52 patients were assigned to the laparoscopy group with pneumoperitoneum. Patients presented with ovarian cyst, endometriosis, acute salpingitis, hydrosalpinx and extra-uterine pregnancy. RESULTS: No severe complications were noted. One conversion to laparotomy was performed in each group. Eight gasless laparoscopic procedures were converted into laparoscopy with pneumoperitoneum; difficulties appeared in patients with adhesions following laparotomy and in cases of unsatisfactory exposure of the pelvis. No differences appeared between the two groups in terms of complications, quality of the operative sequelae, and duration of hospitalization. CONCLUSION: Gasless surgery is a recent technique and progress in modifying the equipment is necessary to reduce conversions.

Abdominal Muscles↗