Biomedical subjects

M Cosson

Publications and source records attributed to M Cosson.

90 records · Page 5Linked to original sources

PubMed1998

[Is vaginal hysterectomy important for large uterus of more than 500 g? Comparison with laparotomy].

OBJECTIVE: Vaginal hysterectomy is an advantageous surgical technique as compared with abdominal hysterectomy: operating time is shorter, it is safer and hospitalization stay and recovery time are shorter. However in France, 2/3 of all hysterectomies are still performed by laparotomy. Would the vaginal approach be reasonable if a difficult hysterectomy is expected? The purpose of our study was to compare the per- and postoperative complications and the period following vaginal hysterectomy versus the abdominal route in patients with a large uterus. PATIENTS AND METHODS: Forty-nine vaginal hysterectomies were compared retrospectively with 22 abdominal hysterectomies for fibroma during the period from 01.01.91 to 31.12.95. Uterine weight in all cases was between 500 to 1,000 g. RESULTS: The average uterine weight was significantly different between the vaginal and the abdominal groups (644 g vs 747 g, p = 0.02). Operating time, pre- and postoperative complications and analgesic use were not significantly different between the two groups. Operative bleeding was significantly higher in the abdominal group than in the vaginal group (659 ml vs. 359 ml, p = 0.006), as well as hemoglobin loss (2.49 vs. 1.82, p = 0.04). There was also a statistical difference between the vaginal group and the abdominal groups in terms of hospital stay (4 d vs. 6 d respectively, p = 0.0002). CONCLUSION: Vaginal hysterectomy with morcellation is advantageous in comparison with abdominal hysterectomy even when the uterine weight is over 500 g, since it offers better post-operative comfort than laparotomy without endangering the patients. The main contraindications for the vaginal route are uterus beyond the ombilicus and vaginal atresia. Excepting these cases, the indication for the vaginal approach depends on the patient's past surgical history, uterine mobility and vaginal access. In more difficult cases, these factors are assessed under anesthesia.

Adult↗

PubMed1997

[What role should hysterectomy play in benign uterine lesions?].

Since the beginning of the nineties, we have seen an increase in the use of operative hysteroscopy in the surgical treatment of women with dysfunctional uterine bleeding. The aim of this article is to show that these new techniques are surgical acts subject to complications, failures, morbidity and indeed mortality. It seems therefore reasonable to ask whether vaginal hysterectomy represents a good alternative to endometrial ablation. We think so both in terms of functional or clinical results, and cost or quality of life. The endometrial ablation should be reserved to women who have strictly dysfunctional pathologies. In all cases, the difficulty in the diagnosis of adenomyosis, the high rate of failure of endometrial ablation, the degradation of its results with time and finally the better quality of life after hysterectomy must be exposed clearly to all patients. It will be with full knowledge of the facts, that women will be able to choose between radical surgical treatment represented by hysterectomy and so-called conservative surgical treatments.

Endometriosis↗

PubMed1997

[Laparoscopic surgical repair of surgical complication of laparoscopy in gynecology. Experiences at the Paul Gellé de Roubaix Center from 1992 to 1995].

UNLABELLED: From 1992 to 1995, 1565 laparoscopic operations were performed in Roubaix. We report on six complications. OBJECTIVE: To compare this figure with these of the French collaborative study done from 1987 to 1991 by seven departments known for their laparoscopic activity, including Roubaix. RESULTS: The trends are good. The rate of injuries was stable in spite of increasingly complex procedures. The largest portion of visceral and even vascular injuries were repaired by laparoscopy reducing by the same amount use of laparotomy. CONCLUSIONS: Strict adherence to safety guidelines and specific training of surgeons reduce the need of laparotomy for laparoscopic complication.

Blood Loss, Surgical↗

PubMed1996

The feasibility of vaginal hysterectomy.

OBJECTIVE: To assess the feasibility of vaginal hysterectomy for benign uterine disease and to assess how frequently laparoscopic assistance is necessary. METHODS: A prospective series of 806 hysterectomies for benign disease of the uterus without prolapse which were performed in our institution from 1 March 1991 to 28 February 1994 is discussed. The report is an evaluation of a planned approach for hysterectomy. Vaginal hysterectomy was performed whenever possible-laparoscopic hysterectomy was indicated for adnexal pathology, known or anticipated significant pelvic adhesions and for a narrow vaginal access with a moderately enlarged uterus-abdominal hysterectomy was chosen when both laparoscopic and vaginal surgery were judged to be impossible. RESULTS: Vaginal hysterectomy was performed in 80.6% of patients. Laparoscopic assistance was needed in 9.4% of cases. The need for laparotomy was reduced to 10% with an acceptable pre- or postoperative complications rate.

Feasibility Studies↗

PubMed1996

[Alternatives and access routes in hysterectomies. Are randomizations dangerous?].

Hysterectomy is a common gynaecological operation in Europe. Although the advantages of new minimally invasive procedures seem obvious, prospective randomised trials are essential for proper appraisal. We reviewed all randomised studies about routes for hysterectomy and comparison of conservative or radical surgery. This study points out the many deficiencies of such studies. Referred conclusions are then open to criticism. We concluded that new prospective studies should be performed, adapted to social, cultural and economic conditions in Europe.

Bias↗

PubMed1996

[Prenatal diagnosis of three caudal regression syndromes associated with maternal diabetes].

We report three cases of caudal regression syndrome diagnosed in utero. Caudal regression syndrome (CRS) is a rare condition associating vertebral agenesia and urinary and digestive tract malformations. Pathogenesis is not clear but, as in our three cases, the CRS is often associated with poorly controlled maternal diabetes. Antenatal ultrasound examinations may reveal the disease in major forms with a non-viable foetus. In our 3 cases, a femoral "V" was associated with sudden interruption of the spine. Minor forms may not be recognized until childhood. Prognosis depends essentially on the extent of spinal involvement and associated malformations. Sirenomelus was considered for many years to be the most severe form of caudal regression, but recently acquired evidence suggests that these two conditions are separate entities.

Adolescent↗

PubMed1996

[Enterocele. Retrospective study of 134 cases: risk factors and comparison between abdominal and perineal routes].

OBJECTIVE: Our purpose was to assess etiological factors in enterocele and to compare abdominal sacral colpopexy with mesh and resection of the cul-de-sac of Douglas to transvaginal sacrospinous colpopexy. METHODS: A retrospective study, for 20 years, concerned 134 patients clinically proved enterocele confirmed during the operation. RESULTS: Etiological factors were: multiparity, perineal tear, foetal macrosomia, instrumental extractions, antecedents of gynaecologic operations, tissular and constitutional factors. The analysis of the anatomical and functional results did not distinguish between the two surgical procedures, each with its proper indications. CONCLUSION: For patients 60 years old or older, we propose the transvaginal sacrospinous colpopexy. Before 50 years, we prefer abdominal sacral colpopexy with mesh. Between 50 and 60 years, each case must be examined with the health status of the patients.

Adult↗

PubMed1996

[Value and limits of complementary investigations in cases of toxoplasmosis seroconversion during pregnancy. A case report and review of the literature].

We report a case of acute toxoplasmosis during the first trimester of pregnancy in which antenatal diagnosis was negative. Except for non-specific signs of liver failure, assessment by repeated ultrasound scans, testing of fetal blood for toxoplasmic specific antibodies and competitive PCR to isolate the parasite, had ruled out fetal infection. In spite of early treatment with spiramycin, and although the infant was assumed to be non-contaminated, severe hydrocephalus was noted at 3 and half months of life, arising soon after therapy had been stopped. This case focuses attention on the problem of the shortcomings of the diagnostic techniques currently used, and leads us to question our practical course of action. Several questions are thus raised: how reliable are indirect signs of fetal compromise, what is the real sensitivity of the PCR test and how useful are repeated amniocentesis and inoculation of the amniotic fluid to mice.

Acute Disease↗

PubMed1995

[Obstetrical prognosis of the post-cesarean uterus. 641 cases].

OBJECTIVES: A retrospective study of decisions made in a gynaecology department between January 1990 and December 1993 were analyzed in order to assess management of the post-cesarean uterus. METHOD: Among 9092 women who delivered in the department during the study period, there were 641 patients with a post-cesarean uterus, due to a single prior cesarean section in 451. Results were analyzed and compared with those reported in the literature. RESULTS: Among the 451 patients with a single scar, 184 (41%) delivered by elective cesarean section and in 267 (59%) a decision was made during labour. In this group of 267 patients with a single cicatrix who underwent a labour tests, 227 (85%) had a vaginal delivery compared with 40 (15%) in which the decision for cesarean section was made during labour. CONCLUSION: The results observed were comparable with those found in the literature. Management of pregnancy with post-cesarean uterus is now quite similar to that of a normal uterus. Epidural anaesthesia and ocytotin therapy as well as epidural labour triggering have had an important effect.

Extraction, Obstetrical↗

PubMed1995

[Steinert's disease and pregnancy. A case report and recent literature].

Steinert's disease or myotonic dystrophy is a heredo-degenerative neuroendocrinal dystrophy. It is an autosomal dominant disorder. The arising of a congenital myotonic dystrophy of one of the new-born children of the maternity hospital enabled to diagnose the Steinert's disease of his mother. A review of the international literature enabled us to recall its interactions with pregnancy. There is an aggravation of myotonia and multiple obstetric complications such as miscarriage, premature onset of labor, polyhydramnios, stillbirth, difficulties during the evacuation, atonic postpartum hemorrhage, anesthetic-accidents. The congenital variant of myotonic dystrophy (6 to 30% of the cases) is a severe disease with a high mortality. It is only seen in the offspring of mothers who themselves have myotonic dystrophy. The myotonic dystrophy gene has been isolated and the mutation-causing myotonic dystrophy was found to result from a series of trinucleotide (CTG) repeats located in the 3' untranslated region of the gene. The direct diagnosis is henceforth possible both on the fetus and parents. Steinert's disease and its association with pregnancy are rare, especially when the affected parent has hypogonadism. The diagnosis of the congenital form is difficult because of the mother is unaware of the disorder. Family and personal history may give hints: hydramnios, appearance delay and reduced fetal movements, and the association at birth of generalized hypotonia with neonatal respiratory distress.

Adult↗

PubMed1994

The Impact of Laparoscopic Surgery on Vaginal Hysterectomy

The development of laparoscopic surgery may be used either to replace (laparoscopic hysterectomy, LH) or to extend the indications (laparoscopically assisted vaginal hysterectomy, LAVH) of the vaginal route. A 2-year (March 1991-March 1993) prospective study of the impact of laparoscopic surgery has been carried out by a group of surgeons experienced in both vaginal and laparoscopic surgery. The design of the study protocol was as follows: use the vaginal route whenever possible; select LH in women with very narrow vaginal access or LAVH to improve the feasibility and safety of vaginal hysterectomy in case of adnexal disease; and select laparotomy only when both laparoscopic and vaginal surgery are impossible. Women with genital prolapse or pelvic relaxation were excluded as well as women with invasive malignant disease of the genital tract. Four hundred twenty-eight patients were included. Abdominal hysterectomy was used in only 44 cases (10.3%), including 4 cases of failure of the vaginal technique. Vaginal hysterectomy was completed without laparoscopic assistance in 339 (79.2%) of cases. LAVH was performed in 45 cases (10.5%), LH in 0. Laparoscopic surgery is an efficient modality for the vaginal surgeon in the presence of adnexal disease, but does not replace the less expensive, quicker and probably safer vaginal hysterectomy.

Journal Article↗

PubMed1992

[Meconium aspiration syndrome in the region of Nord-Pas-de-Calais. Development of a training program for neonatal resuscitation].

In the French region Nord-Pas-de-Calais a Public Health action was undertaken in order to set up a training program for neonatal resuscitation for the maternity-hospitals personnel. The incidence and severity of meconium aspiration among the population of children admitted to the neonatal intensive care unit of Lille University Hospital during two 15 month-periods of time, before and after the training, were compared. The number of neonates who presented with meconium aspiration decreased from 54 during the first period to 9 during the second, i.e. from 7.2 to 1.3% with respect to the total number of hospitalized patients (p less than 0.001). On the contrary, the number of deaths did not decrease significantly. This regression of the meconium aspiration gives evidence for an improved quality of care at birth. Even if training is not the only factor, this evolution gives argument in favour of the efficacy of such actions.

Education, Nursing↗

PubMed1990

[Magnetic resonance imaging in the evaluation in utero of Siamese twins].

The authors report a case of twins conjoined at the umbilicus and diagnosed by ultrasound after 19 weeks of amenorrhoea in whom an assessment in utero was carried out using magnetic resonance imaging after the patient had been curarized. A review of the literature on this very difficult problem of conjoined twins has given us the possibility to assess the diagnostic measures as well as the prognosis of this pathology. In particular we point out the results that can be obtained using MRI in utero during the second and third trimesters of the pregnancy.

Abdomen↗

PubMed1989

[Thyroid cancer and pregnancy].

Thyroid cancer is very rare during pregnancy, but a thyroid nodule is more likely to be cancerous if discovered during pregnancy (43 p. cent versus 15 p. cent). The diagnosis is more difficult. Tests using radioactive substances are contraindicated during pregnancy. Ultrasonography does not permit to specify the nature of the nodule and aspiration biopsy with cytological examination becomes the examination of choice. One should not hesitate to operate on these nodules, during pregnancy, if the diagnosis is made. It is difficult to assert that the prognosis is aggravated by pregnancy since there are so few cases, but several authors report a few cases with an abnormally fast progression during pregnancy. Forms which are properly treated and occurred before the age of 40, are not a contraindication to subsequent pregnancies, if they are not anaplastic or metastatic forms. However, a reasonable delay of the surgery is advised in order to stabilize the hormonal treatment and the calcium-phosphorus balance.

Adult↗

PubMedDate not supplied

[Mechanical resistance of pelvic ligaments used for incontinence or prolapse surgery].

OBJECTIVE: Underline the objective strength of the pelvic ligaments. PATIENTS AND METHODS: Twenty nine human female pelvis cadavers, whose storage conditions differed, were used in our study. In each cadaver we dissected all the ligaments used in pelvic surgery. A subjective clinical evaluation of the ligament properties was performed by visual observation as well as by finger palpation. Ligaments were classified into three groups in terms of thickness and apparent strength following finger palpation, high, doubtful and low apparent quality ligaments. Then a suture taking the entire ligament switched the ligaments and a force was applied on the vagina axis until tearing. The device used for strength measurement during traction was a Samson type force gauge, which was developed for the purpose of our study. Results were given in Newtons. RESULTS: We found a great variability in the values obtained at tearing with maximal values at 200 newtons and minimal at 22. Individually measured, ligament strength varied between individuals, and for a same patient between the type of ligaments and the side. The pre-vertebral ligament was on average the strongest. For bilateral ligaments, there was no difference between the left and right side. The iliopectineal ligament was statistically significantly stronger than sacrospinous and arcus tendineus of pelvic fascia. There was a correlation between subjective evaluation and objective strength measurements. DISCUSSION AND CONCLUSION: We performed the only study of the strength of pelvic ligaments at tearing. These are, however, routinely used in the cure of prolapse and urinary incontinence. Our results show that there is a great variability in strength between individuals, and for a same patient between the types of ligaments and side. These observations could explain some of the surgical intervention failures and demonstrate the importance of per-operative strength evaluation. Per-operative subjective evaluation on strength is related to objective measurements and could be used to determine the type of ligaments to be used for surgical assembly suspension.

Biomechanical Phenomena↗

PubMedDate not supplied

Laparoscopy in gynaecological cancer.

The use of laparoscopy in the management of gynaecological malignancies has significantly increased over the last 5 years. Patients with cervical, vaginal, endometrial and ovarian cancer can be managed laparoscopically either for staging or for treating. The feasibility of procedures through the laparoscope (such as hysterectomies, bilateral oophorectomies, pelvic and para aortic lymphadenectomies, omentectomies, colostomies, bowel resections, oophoropexies, radical hysterectomies and ovarian cancer debulking) has been demonstrated by skilled gynaecologists. Many of these procedures have been heralded as avant garde 'surgical standards' without appropriate evaluation of efficacy, effectiveness and efficiency. Larger series of patients have now replaced case reports to try to answer the numerous unanswered questions regarding the value of these procedures. Several prospective trials were begun to compare laparotomy and laparoscopy. If the results of these trials confirm the hope, laparoscopic management of gynaecological malignancies will leave the limited club of specialists to become a widely used technique. But the patients will benefit from laparoscopic procedures only when in the hands of well-trained surgeons.

Female↗

PubMedDate not supplied

Laparoscopic sacrocolpopexy, hysterectomy, and burch colposuspension: feasibility and short-term complications of 77 procedures.

OBJECTIVE: To report our first cases of laparoscopic sacropexy and assess the feasibility and short-term complications. METHODS: We retrospectively studied 77 laparoscopic sacral colpopexies performed from June 1996 to May 1998. Suspension was reinforced with 2 strips of synthetic mesh. Five patients had previously undergone hysterectomy, and 4 others had experienced failure of surgery for prolapse of the uterus. RESULTS: Laparoscopy was performed in 83 women with symptomatic prolapse of the uterus. Six cases required conversion to laparotomy because of technical difficulties. All of the remaining 77 patients underwent laparoscopic sacropexy that included anterior and posterior mesh reinforcement. Subtotal laparoscopic hysterectomy was performed in 60 cases, laparoscopic Burch colposuspension in 74, and levator myorrhaphy via a vaginal approach in 55. Operative time decreased from 292 to 180 minutes as experience was gained. The main operative complications were 1 rectal and 2 bladder injuries. Three patients required reoperations for hematoma or hemorrhage. One patient complained of chronic inflammation of the cervix, and another experienced rejection of the posterior mesh 6 months after the operation. Mean follow-up was 343 days. Three other patients required reoperation, 1 for a third-degree cystocele and 2 for recurrent stress incontinence. CONCLUSION: Laparoscopic sacrocolpopexy is feasible. Operative time and postoperative complications are related to the surgeon's experience but remain comparable to those noted in laparotomy. Long-term assessment is required to confirm the results of this procedure.

Adult↗

PubMedDate not supplied

[Adenomyosis and fertility].

Adenomyosis is a frequent pathology of the uterus for women over 40. Difficult to diagnose, adenomyosis can be responsible of pelvic pain and menorrhagia. Association with infertility is a rare event and the responsibility of adenomyosis is difficult to prove. A medical treatment with LHRH agonist can be propose to improve fertility in case of patent adenomyosis.

Adult↗