[Metrorrhagia in the first trimester of pregnancy. Management, diagnostic orientation].
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Female↗
Biomedical subjects
M Levardon
Publications and source records attributed to M Levardon.
[Retroperitoneal liposarcoma. Disclosure by anemia and prolonged fever].
We report the case of a 79-year old woman with a retroperitoneal liposarcoma. The condition was discovered because of the association, in a woman of that age, of anaemia and persistent fever. The diagnosis was suggested by computed tomography. Treatment was exclusively surgical. Liposarcomas usually affect men in their sixth decade. Postoperative radiotherapy improves the quality of life but does not prolong survival. Metastases are frequent, and death usually occurs in the year that follows discovery.
Aged↗
Benefit of operative laparoscopy for ovarian tumors suspected of benignity.
Ovarian tumors need to be treated systematically due to the risk of complications and degeneracy. The aim of this study was to show the usefulness of laparoscopic surgical treatment of ovarian tumors suspected of benignity. From September 4, 1985 through December 1, 1989, 108 patients were operated on in our unit for ovarian tumors suspected of benignity (absence of clinical and ultrasound scanning signs of malignancy). There were 111 operations due to three recurrences. Operative laparoscopy was carried out 100 times. The laparoscopic operations were 71 transparietal cystectomies, 20 intraperitoneal cystectomies, 8 transparietal oophorectomies, and 1 intraperitoneal oophorectomy. Of these, 43 operations were performed in emergency situations and 57 were not. Eight patients were pregnant at the time of laparoscopic treatment, there were no miscarriages. Average operation time and hospital stay duration were 51.80 min and 3.27 days, respectively. Three borderline tumors were diagnosed (one through laparoscopy and two through histology) and were treated by secondary laparotomy. Operative laparoscopy was the only treatment for ovarian tumors 98 times out of 111 (88.28%). A histological diagnosis was obtained in every case. Laparoscopic treatment of the tumor was efficient and safe. For ovarian tumors suspected of benignity this technique is of double interest: diagnostic and therapeutic. Operative laparoscopy allows determination of a histological certainty without the disadvantages of laparotomy.
Adult↗
Influence of estrogens and progesterone on the venous system of the lower limbs in women.
Treatments with estrogens and progestogens are suspected of causing vascular complications either directly or by metabolic consequences. Although many studies have demonstrated an increased incidence of arterial and deep venous thrombosis, since 1970 the dose of estrogens and progesterones have been lowered with a proportional lowering of side effects. After classification of estrogens and progestogens, we studied their peripheral vascular effects. In our study, we demonstrated that the effects of estroprogestogen treatment on the superficial venous system depend on the dose of estrogen and progestogen.
Adult↗
[Abdominal ectopic pregnancy. Limits of laparoscopic treatment].
We report a case of early abdominal pregnancy (6 weeks amenorrhea). The diagnosis of ectopic pregnancy was suspected according to the usual clinical, serologic, and sonographic procedure. It was confirmed by laparoscopy. Laparoscopic surgery was unable to assess the trophoblastic site and the hemostasis of the lesion that was histologically proven.
Adult↗
[Takayasu's disease and pregnancy].
We report one case of pregnancy in a non-oriental woman who had Takayashu's disease. Pregnancy was characterised by toxemia and caesarean section had to be carried out at 31 weeks because of fetal distress. The disease did not worsen and nor were there any maternal complications but the child died on the 7th day.
Adult↗
[Laparoscopy, appendicitis and pregnancy].
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Adult↗
[Breech extraction of the second twin with or without version by internal maneuvers].
A retrospective study was done to appraise the recent practice of breech extraction of the second twin (with or without internal version) in our unity. From January 1st, 1988 to April 30, 1991 23 patients with a twin gestation were delivered in our unity (0.5% of all deliveries). Nineteen patients (83%) were delivered vaginally. Each procedure was done by a resident under control of a senior obstetrician and in the presence of two midwives, a pediatrician, and an anesthesiologist. Ten patients having had a breech extraction (GE group) were studied, 13 patients were excluded for not having had a breech extraction. In the GE group the presentations were: 7 vertex/breech and 3 breech/breech. Mean Apgar scores of the second twin at 3 minutes were 8 in the GE group. These results suggest that breech extraction of the second twin is not a pernicious technique if done by trained operators with precise limits. These results need to be confirmed through a prospective randomized and comparative study.
Adult↗
[Primary cancer of the fallopian tube. A case revealed by pelvic peritonitis].
We report the case of a primary carcinoma of the fallopian tube in which the diagnosis was done through laparoscopy for pelvic peritonitis. The pathologic diagnosis was possible with tubal sampling at the same time. The treatment associated radical surgery and radiotherapy. This rare kind of tumor is exceptionally diagnosed this way.
Adenocarcinoma, Papillary↗
Role of gonadotrophin-releasing hormone agonists in the treatment of external genital endometriosis: review of 77 cases.
Peritoneal and ovarian endometriosis are anatomically highly polymorphous and can give rise to pain and sterility. Endometriosis can be recognized and evaluated by means of laparoscopy and an appropriate therapeutic strategy determined. Surgical laparoscopy using lasers (CO2, KTP and argon) produces excellent results. More than 80% of cases can be treated by coelioscopy, bearing in mind that severe endometriosis can require classic surgery and remains difficult to perform. However, one basic idea should not be forgotten, ie, that endometriosis is a progressive disease. Restoration of anatomic pelvic integrity (with free pouch of Douglas, mobility of appendages and functional ovaries) is the only guarantee of good fertility, achievable by interruption of progression of the disease. Following therapeutic trials with danazol, norsteroidal progestagens, gonadotrophin-releasing hormone agonists have opened up wide perspectives for use and we use them in combination with coeliac surgery. Our experience has paralleled that of Donnez and Bruhat, with almost identical results.
Combined Modality Therapy↗
Laparoscopic appendectomy using a clip applier.
The diagnostic worth and therapeutic value of laparoscopic surgery are known for ovarian cysts and ectopic pregnancies. Diagnosis of appendicitis is difficult, and laparoscopy is useful in these cases. The present study was done to assess the feasibility, efficacy, and advantages of a new laparoscopic appendectomy technique. Between August 1, 1989, and July 31, 1990, patients exhibiting right pelvic pain associated with fever were divided into three groups according to the pre-operative diagnosis: appendicitis, pelvic inflammatory disease (PID), and diagnostic doubt between appendicitis and PID. An intra-peritoneal appendectomy was performed if the diagnosis was not PID. Via three suprasymphyseal trocars, the appendix was exposed and the mesoappendix was coagulated. The appendix stump was closed using a clip applier (Ethnor T1300). In all, 20 patients underwent laparoscopic appendectomies. The mean duration of the procedure was 36.5 min; in no case was laparotomy necessary. There were no post-operative complications, and digestive transit returned on the 2nd day post-surgery. Both patients and nurses appreciated the technique. The subjects experienced comfortable post-operative periods and gained aesthetic advantages. The operative procedure could be completed on each attempt. We conclude that this technique is sure, quick, and easily reproducible in young patients presenting with right pelvic pain associated with fever.
Appendectomy↗
[Padding of the uterine wall in severe obstetrical hemorrhage].
Severe obstetrical hemorrhage demand an emergency treatment, and hysterectomy is not always adequate. We report our technique of uterine wall padding (UWP), as performed on five women who underwent surgery with UWP for an obstetrical hemorrhage that was severe either at the onset (n = 3) or after transfer to our department (n = 2). The technique consists of padding the uterine walls with X stitches of slowly resorbable thread. The reasons for the operation were: uterine muscle atonia in 2 cases and vaginal laceration, placenta preavia and placenta accreta in 1 case each. The UWP technique was carried out during or after subtotal hysterectomy for hemorrhage in 4 patients, and with preservation of the uterus in one patient. No secondary operation was required after UWP. Less blood products were transfused in women who had immediate UWP than in those for whom UWP was a second-line operation. UWP was more efficient when performed at an early stage. In the woman with placenta accreta the uterus could be salvaged by UWP. This simple technique contributes to the reduction of blood transfusions in severe obstetrical hemorrhage.
Blood Transfusion↗
[Hernias of the groin. A new complication of celioscopy].
Crural hernia is acquired and mainly affects women. We report a case of hernia discovered after two laparoscopic operations. There was no hernia or risk factor for abdominal wall hernia before the operations. We consider that this hernia is the consequence of repeated abdominal distensions over a short period of time. We have not found this complication in the literature.
Adult↗
[Value of celioscopic surgical treatment of ovarian tumors at the beginning of pregnancy].
Ovarian tumours complicate one in every thousand pregnancies. New techniques have changed the way of diagnosing and treating this condition. This study aims to demonstrate the value of laparoscopic surgery for ovarian cysts in the early months of pregnancy. From the 7th November 1985 to the 1st September 1989, eight pregnant women with less than 17 weeks amorrhoea consulted for ovarian tumours that were more than 6 centimeters in diameter. They were all operated on for ovarian tumours of more than 6 centimeters diameter and they were all operated on laparoscopically. Four operations were emergency and four non-emergency. In seven cases cystectomy was carried out transparietally and in one oophorectomy was. Laparoscopic surgery was possible in every case. These was no complication to the pregnancy due to the operation. Laparoscopic surgery permits early treatment of ovarian tumours in pregnancy without the risks of laparotomy. In emergency a quick diagnosis and treatment diminishes the risk of abortion. In non urgent cases a simple technique made it possible to avoid complications of the cyst and to obtain a histological assessment that they were benign.
Adult↗
[Pelvic pain in women. Evaluation of a celioscopic intraperitoneal appendectomy technique].
The diagnostic and therapeutic value of laparoscopic surgery has been established for ovarian cysts and ectopic pregnancies. The diagnosis of appendicitis is difficult and laparoscopy is useful. The aim of this study is to assess feasibility, efficacy and advantages of a new technique of laparoscopic appendectomy. From 1st August to 15th December 1989, the women seen for pelvic pain were divided into three groups: appendicitis, pelvic inflammatory disease (PID) and doubtful. Intra-peritoneal appendectomy was performed when the laparoscopic diagnosis was not PID. Via three supra symphyseal trochars, the appendix was exposed and its mesentery was coagulated. The appendix stump was closed with a clip applicator. Twelve women were included in this study. In two thirds of cases, laparoscopy confirmed the clinical diagnosis. Mean operation time was 39 minutes. Laparotomy was never necessary. There were no post-operative complications and intestinal transit was always complete on the second post-operative day. The patient's and nurse's appreciation was excellent. This operation was possible on every occasion. This technique is sure, quick and easily reproducible. A comfortable post-operative period and esthetic advantages were reported by the women.
Appendectomy↗
[Anatomic recall of the ovary].
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Female↗
[Eclampsia].
Eclampsia is the most serious manifestation of a toxaemic encephalopathy which may also have nonconvulsive manifestations, such as headache, visual disorders or retinal or cortical origin, confusion or disturbances of consciousness. Some authors consider eclampsia as being only one particular aspect of hypertensive encephalopathy. However, recent studies have drawn attention to the importance of angiospasm which might not be a pure reaction to hypertension but might result from a relative deficiency in vascular prostacyclin. These physiopathological factors, to which must sometimes be added disseminated intravascular coagulation, account for computerized tomographic and neuropathological findings showing cerebral oedema and, in complicated cases, ischaemic or haemorrhagic lesions. Medical treatment must rapidly control the convulsive attacks as well as the arterial hypertension. Magnesium sulfate is not much used outside the United States where it is now strongly controverted. The obstetrical management depends on the time when eclampsia occurs and on the efficacy of the medical treatment.
Abortion, Therapeutic↗
[Value and advantages of laparoscopic surgery in the treatment of ectopic pregnancies].
Laparoscopic treatment of ectopic pregnancies (EP) has been performed for several years. From 1st January 1987 to 14th February 1989, 63 women with an EP were operated in our hospital by surgeons trained in laparoscopic surgery (LS). The decision to perform laparotomy was taken either in the presence of laparoscopic contraindications (n = 2), or after diagnostic laparoscopy in the presence of LS contraindications (n = 13). LS was performed 48 times (76.20%) and laparotomy was performed 15 times (23.80%). The women were classified in two groups: laparoscopic surgery (LS) and laparotomy (L). The mean ages were 30.29 and 31.40 years and mean amenorrhea was 6.48 and 6.83 weeks. The EP was ruptured 11 times in the L group (73.33%) and 4 times in the LS group (8.33%). Hemoperitoneum was more frequent in the L group (80.00%) than in the LS group (52.08%). Treatment more often consisted of salpingectomy with laparotomy (86.66%) than with LS (18.75%). Laparoscopic treatment had to be abandoned only once because of persistent bleeding. The mean operation time and hospital stay were shorter in the case of laparoscopic treatment with respectively 63.14 minutes and 4.14 days for LS versus 86.92 minutes and 7.13 days for laparotomy. There were no deaths in either group. This study shows that LS can be used in 3/4 of cases of EP and that treatment significantly shortens the operation time and the hospital stay.
Adolescent↗