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L Marpeau

Publications and source records attributed to L Marpeau.

At least 19 recordsLinked to original sources
PubMed2003

[Crohn's disease and pregnancy. About 34 cases. Review of the literature].

OBJECTIVE: To define the optimal conditions of pregnancy in patients affected by Crohn's disease. MATERIAL AND METHOD: Retrospective study of 25 patients affected by Crohn's disease, followed during eight years at Rouen's University Hospital. RESULTS: Twenty patients added up 34 pregnancies. Seventeen patients at least had a child, adding up 26 livebirths. Among the 17 pregnancies beginning with an active Crohn's disease, this proved to be still active in 16 cases. Among the eight interrupted pregnancies, six had an active disease. Out of the five menaces of preterm delivery stopped or not, four were in push. Eight neonatal hypotrophies were connected to a push. DISCUSSION AND CONCLUSIONS: From a confrontation between the data of the literature and our experience, it emerges the following essential points: when Crohn's disease is quiescent, it does not affect the pregnancy, except a moderate fetal hypotrophy. When the disease is active, the risk of abortion and prematurity increases. There is no influence of the pregnancy on Crohn's disease, when pregnancy arises during a period of quiescence of the disease. Two thirds of the pregnancies of these women take place without new push of their disease. During pregnancy, there is no contraindication as far as the usual treatments of Crohn's disease are concerned, with a limitation however for the use of immunosuppressants.

Abortion, Spontaneous↗
PubMed2003

[Reflex sympathetic dystrophy involving the ankle in pregnancy: characteristics and therapeutic management].

We report the case of a multigravida presenting in the first trimester of pregnancy with reflex sympathetic dystrophy involving both ankles. Preferential location of reflex sympathetic dystrophy in pregnancy is classically the hip (9 times out of 10). Symptoms develop mostly with primipara in the third trimester of pregnancy or in post-partum. Fracture is the major risk of reflex sympathetic dystrophy. Peculiarities of reflex sympathetic dystrophy's treatment in the course of pregnancy are evoked. The end of the pregnancy can be shortened with the aim of stabilizing disease even to activate its healing. Pathophysiologic mechanisms of reflex sympathetic dystrophy in pregnancy seem multiple and complex. Our observation, by its atypical characteristics, recalls it.

Adult↗
PubMed2003

[Prosthetic restoration of the pelvic diaphragm in genital urinary prolapse surgery: transobturator and infracoccygeal hammock technique].

OBJECTIVES: To describe a surgical technique for genital prolapse via exclusive vaginal access using prosthetic materials. The original feature of this technique is based on the use of a monoprosthesis. This technique aims to reconstitute the ruptured pelvic diaphragm in full with a single mesh. To estimate feasibility and reproducibility of the technique. MATERIAL AND METHOD: After reduction of the elements of prolapse, the intervention consists in positioning under these same elements a single and non-absorbable mesh with two transobturator expansions associated with an infracoccygeal sacropexy. No specific urinary procedure is performed. This process was applied to a preliminary series of 26 patients with Baden and Walker stage 3 and 4 genital prolapse, sometimes associated with urinary stress incontinence. RESULTS: This technique successful in every case with full restitution. No intra-operative complication was observed. Short-term anatomical results were excellent. Urinary stress incontinence when present was corrected or clearly improved. CONCLUSION: Transobturator and infracoccygeal hammock is a fast, solid and easily reproducible original surgical process, causing minimal post-operative discomfort. Indications are posthysterectomy complete prolapse and prolapse of the three floors in menopaused woman, from stage 2 with or without associated urinary stress incontinence. Success of this technique depends on good long-term tolerance of the new prosthetic materials used in female pelvic surgery.

Adult↗
PubMed2003

[Management of ectopic pregnancies complicating in vitro fertilization: a remarkable case of bilateral ectopic pregnancy with independent courses of the pregnancies].

OBJECTIVE: To define management rules for ectopic pregnancy complicating in vitro fertilization. PATIENT AND METHOD: We describe a case of bilateral ectopic pregnancy complicating in vitro fertilization which led to two separate laparoscopic procedures. RESULTS: A first laparoscopy was required to perform salpingectomy for ectopic pregnancy. A second laparoscopy was later required for a second salpingectomy for a second ectopic pregnancy complicating the same in vitro fertilization. DISCUSSION AND CONCLUSION: Pre-existent tubal lesions are frequently observed in women who develop ectopic pregnancies after in vitro fertilization. If serum beta-hCG levels and pelvic ultrasound results are not taken into consideration with sufficient care, delayed diagnosis may lead to the unsuitable management. Women with multiple embryonic reimplantations must be monitored rigorously. Salpingectomy is the best treatment option for this type of complication.

Adult↗
PubMed2003

[Low grade pulmonary sarcoma preceding the discovery of a uterine primary].

INTRODUCTION: Low grade pulmonary sarcomas are very rare tumours. We report the case of a low grade sarcoma of the lung occurring two years prior to the finding of a uterine primary. CASE REPORT: Complete surgical excision of a low grade pulmonary sarcoma was performed. The initial search for dissemination was negative. Two years later a follow-up scan discovered a uterine mass as well as a para-aortic shadow that proved to be the primary tumour (low grade uterine sarcoma) and a metastasis. CONCLUSION: This is the second case of a pulmonary metastasis discovered before a primary low grade uterine sarcoma. The first was found during the investigation of a pulmonary sarcoma. The main differential diagnosis to consider is metastatic leiomyosarcoma. In both cases their finding justifies the search for a uterine primary by immunohistochemical examination for oestrogen and progesterone receptors as well as pelvic ultrasound or even magnetic resonance imaging.

Aged↗
PubMed2003

[Laparoscopic cornual excision with an automatic stapler for ruptured interstitial pregnancies].

OBJECTIVE: Because they are difficult to diagnose, interstitial pregnancies remain dangerous. Rupture is a frequent mode of revelation for this type of ectopic pregnancy. In case of rupture, the classic medical treatment of ectopic pregnancy is unsuitable. Surgery is necessary but laparoscopic treatment not always possible. The objective of this article is to describe an original surgical technique which facilitates laparoscopic management of ruptured interstitial pregnancy. MATERIAL AND METHOD: This laparoscopic procedure is based on the use of a disposable stapler which simultaneously excises and stitches the uterine cornua. RESULTS: This procedure was used three times successfully. CONCLUSION: Laparoscopic treatment of ruptured interstitial pregnancy is feasible if it can be performed rapidly and easily in a patient with a compatible hemodynamic status. The automatic stapler provides an effective easily reproducible means of cornual excision enabling rapid laparoscopic management of ruptured interstitial pregnancy.

Female↗
PubMed2002

Dilated coronary sinus in prenatal echocardiography; identification, associations and outcome.

The dilated coronary sinus (DCS) has only recently been clearly visualised in the fetus due to progress in prenatal echography. This is a retrospective study of 22 fetuses presenting with DCS revealed by prenatal echography. We report the circumstances leading to the detection of a DCS and the neonatal outcome of these fetuses. The coronary sinus was defined as dilated depending on its visualisation in cross-section from the '4 chamber' view, as well as a pseudo inter-atrial septal defect from a more posterior view. In each case the gestational age, circumstances of detection, associated anomalies and postnatal outcome are reported. The circumstances were: evaluation of a clearly identified DCS in four cases and during detailed fetal echocardiography because of suspected congenital heart disease in 18 cases. Five cases were associated with a cardiac anomaly, three with an extracardiac anomaly, six with both cardiac and extracardiac anomaly and eight were isolated. Postnatal outcome was related to the associated anomaly. In conclusion, it is important that the echography image be correctly interpreted, as a DCS often implies possible associated defects and therefore affects prognosis. When not associated with other anomalies this condition is not considered serious.

Coronary Vessels↗
PubMed2002

[Mechanisms of the stagnation of dilatation in the active phase of labor].

OBJECTIVE: Our study was designed to explain determinants of nonprogressive labor in nulliparous patients. STUDY DESIGN: One hundred consecutive nulliparous patients have got a cesarean section for active-phase arrest of labor after two hours of active management. Intrauterine pressure was monitored for all of them and a X-ray pelvimetry was done after surgery. RESULTS: Eighty-three percent of patients showed X-ray data considered as normal; hypotonic labor was found in 50% of cases and occiput posterior position in 60%. CONCLUSIONS: Our results suggest that occiput position and functional dystocia are more common in case of nonprogressive labor than abnormal measurements of the obstetrical pelvis.

Dystocia↗
PubMed2002

[Pregnancy, tuberculosis and inappropriate antidiuretic hormone secretion].

We report a pregnant woman presenting with seizure secondary to hyponatremia by inappropriate antidiuretic hormone secretion. Aetiology was unknown urinary and lung tuberculosis. This case report presents diagnosis strategy of inappropriate antidiuretic hormone secretion and the arguments for its aetiology.

Adult↗
PubMed2002

[Pregnancy: a possible etiology of pyoderma gangrenosum. A case report and review of the literature].

OBJECTIVE: We report an unusual case of pyoderma gangrenosum at 26 weeks gestation and review other cases reported in the literature in order to examine the underlying causes and determine the appropriate diagnostic and therapeutic approach to this uncommon skin disease. Patient and methods. The patient developed an acute abdominal syndrome at 26 weeks gestation (laparotomy was non contributive) followed by pyoderma gangrenosum of the abdominal wall. Seven other cases have been reported in the literature associating pyoderma gangrenosum with pregnancy. We analyzed the clinical findings in these cases. RESULTS: Corticosteroid therapy successfully controlled pyoderma gangrenosum in our patient. Pregnancy outcome was favorable with little effect on the newborn. Complete healing was achieved after several months of treatment. CONCLUSION: Histological lesions are nonspecific. Diagnosis of pyoderma gangrenosum is generally based on clinical signs. Systemic disease is associated in half the cases (inflammatory bowel disease, myelodysplastic syndrome, rheumatoid arthritis). The impact on pregnancy appears to be limited. Treatment is based on high-dose systemic corticosteroid therapy or cyclosporin. The two drugs may have to be combined. Search for an associated disease and appropriate treatment is particularly important for the outcome of pregnancy.

Abdominal Wall↗
PubMed2002

[Biochemical markers for preterm delivery (excepting markers of infection)].

Fetal fibronectin is an extracellular glycoprotein secreted at the maternal-fetal interface by the trophoblast. Fetal fibronectin testing may be useful in women with symptoms of preterm labor to identify those with negatives values and a reduced risk of preterm birth (NP 3). Fetal fibronectin could be either detected by cervical or vaginal sampling (NP 3). Concentrations of fetal fibronectin could be measured by an enzyme-linked immunosorbent assay or by a bedside dipstick technique (NP 3). There are numerous false-positive results in women with cervical dilatation, recent intercourse or cervical examination, and vaginal bleeding (NP 3). In most of the studies, a quantitative test was used with 50ng/ml as the cuttoff point for a positive results. There are no convincing data to recommend fetal fibronectin rather than cervical ultrasonography (and inversely), or to used these two tests together to predict preterm birth (NP 3). The choice should depend on the availability and the cost of each test. Other biochemical markers (salivary estriol or plasma CRH) are still under assessment and should not be used outside research protocols (NP 3).

Biomarkers↗
PubMed2002

[Gas embolism and hyperbaric oxygen treatment during pregnancy: a case report and a review of the literature].

We report the first case of a pregnant woman presenting with a paradoxical air embolism due to accidental removal of a central venous catheter. Secondary right hemiplegia associated with a confused state justified emergency hyperbaric oxygen therapy, which was followed by complete neurological recovery. The aim of this case report is to assess risk situations of gas embolism during pregnancy and puerperium, as well as indications and fetal effects of hyperbaric oxygen therapy.

Adult↗
PubMed2002

[Acute vulval ulcer or Lipschutz's disease].

The case of a 16-year-old woman with typical clinical features of acute vulval ulcer, Lipschutz's disease, is reported. The main differential diagnoses are discussed. Isolated vulval ulcer can reveal a recurrent aphthous ulcer, Behçet's disease or Crohn's disease. In contrast, acute vulval ulcer spontaneously heals with no recurrence, that must be taken into account for diagnosis.

Acute Disease↗
PubMed2002

[Ovarian pregnancies: revaluation of diagnostic criteria].

OBJECTIVES: To clarify the clinical features of ovarian pregnancy and to show the incapacity of Spielberg's criteria to establish the diagnosis. MATERIAL AND METHOD: and method. Retrospective experience of ovarian pregnancies in a single maternity unit over seven years with comparison between new diagnostic criteria and those of Spiegelberg. RESULTS: Thirteen ovarian pregnancies identified (incidence=1 for 1400 deliveries). History of pelvic disease (one case), use of an IUCD (five cases), pelvic pain (all the cases), metrorrhagia (four cases), hemorrhagic shock (two cases). Diagnosis was evoked only once by ultrasound. Eleven patients were treated by laparoscopy. None of the ovarian pregnancies in the present series met the criteria of Spiegelberg's definition. CONCLUSION: Ovarian pregnancy is a rare form of ectopic pregnancy, but its incidence is certainly underestimated. Search for difficult to detect ultrasonographic features is essential. Criteria, other than those described by Spiegelberg, when present together confirm ovarian pregnancy: serum beta-hCG level > or = 1000 IU/l and uterine vacuity at vaginal ultrasonography; ovarian implication confirmed by surgical exploration, with bleeding, visualisation of chorionic villi or presence of an atypical cyst on the ovary; normal tubes; absence of serum beta-hCG after treatment of the ovary. Ovarian pregnancy does not compromise subsequent fertility of these patients. Recurrence is exceptional.

Adult↗