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Biomedical subjects

P Mathevet

Publications and source records attributed to P Mathevet.

At least 19 recordsLinked to original sources
PubMed2005

Sexuality after laparoscopic Davydov in patients affected by congenital complete vaginal agenesis associated with uterine agenesis or hypoplasia.

BACKGROUND: Several surgical techniques have been described for the treatment of patients with vaginal agenesis. The simplest intervention that gives good sexual results should be the surgical technique of choice. METHODS: We report anatomic and functional outcome in 28 women after vaginoplasty using laparoscopic Davydov operation. This surgery includes three steps: two laparoscopic and one perineal. The patient then has to use a mould or a vaginal dilatator for 1 month. The functional outcome was assessed by a brief and valid self-report questionnaire evaluating female sexual life (Female Sexual Function Index, FSFI). A control group was recruited to compare the results. RESULTS: Two intra-operative bladder and ureteric injuries were repaired without sequels. Two post-operative complications were observed: one abdominal migration of the mould, which was treated successfully with the laparoscope, and one vesico-vaginal fistula. No patient was lost to follow-up. The anatomical result was judged to be satisfactory (>6 cm) in 26 of the 28 patients: the mean vaginal length was 7.2 +/- 1.5 cm. Among the 28 operated women, 19 had a good or very good result. No statistical difference was found between our operated patients and French controls in all six domains of the FSFI. CONCLUSIONS: Laparoscopic Davydov may be considered a good option for the surgical treatment of women presenting vaginal agenesis. This technique offers advantages such as: short operating time and hospital stay, no particular instrumentation required and no external scars. Sexuality approaches so-called 'normal sexuality'.

Abnormalities, Multiple↗
PubMed2004

[Laparoscopic Davydov or laparoscopic transposition of the peritoneal colpopoeisis described by Davydov for the treatment of congenital vaginal agenesis: the technique and its evolution].

INTRODUCTION: The laparoscopic Davydov is described. The data concerning the surgery and the postoperative course are reported at the same time as the data concerning the anatomical and sexological results. PATIENTS AND METHODS: The surgery includes three steps: (i) cleavage under laparoscopic guidance, (ii) peritoneovestibular stitch by perineal approach, (iii) making the vaginal vault with the laparoscope. The cleavage can be performed in front of the fascia interposed between the bladder and the rectum or behind it. A nymphoplasty can be added to the colpopoeisis. RESULTS: Between February 1996 and March 2003 we operated on 28 patients affected by congenital vaginal agenesis using the laparoscopic Davydov technique. Two peroperative complications occurred (urinary tract injuries during the first step: laparoscopic management) and two postoperative complications (intraperitoneal migration of the mould and vesicovaginal fistula managed successfully with the laparoscope for the first one and trough laparotomy for the second one). Four re-operations (incision and dilation) were necessary. The length of the neovagina was, at the last assessment, 7.2 +/- 1.3 cm. The Female Sexual Function Index was 26.5 +/- 5.6 vs. 27.9 +/- 4.5 in a control cohort. In the patients whose cleavage was performed behind the fascia (13 cases vs. 15) no complication occurred, no re-operation was necessary, the length of the neovagina was 7.0 +/- 0.7 cm and the FSFI was 26.3 +/- 5.9. DISCUSSION AND CONCLUSION: The laparoscopic Davydov is, if the dorsal approach is used for the cleavage, an easy to make operation (operating time: 90 +/- 29 minutes) with a short hospital stay. The postoperative care is simple (vaginal mould useless). Heterosexual activity with penile penetration can start early (6 to 8 weeks). The level of satisfaction is high. Laparoscopic Davydov procedure may be considered a good alternative to the more complex ones (as Vecchietti's technique) or to the more dangerous ones (sigmoid colpoplasty).

Abnormalities, Multiple↗
PubMed2003

[Fertility preservation in early cervical cancer].

OBJECTIVE: Evaluation of surgical techniques leading to fertility preservation in patients with early cervical cancer. PATIENTS AND METHODS: Carcinological and obstetrical follow-up of 95 patients treated with radical trachelectomy between 1987 and 2002 for a cervical cancer stage less than Ib2. RESULTS: Four recurrences were observed; all of these were in case of tumor more than 2 cm in diameter (P = 0.002), and three of the four recurrences were in case of lymph-vascular space involvement (P = 0.07). Among the 42 patients willing and able to procreate, 33 were pregnant. Fifty-six pregnancies were registered. The rate of late miscarriage was 19% and 34 living newborns were obtained. CONCLUSION: In case of early cervical cancer, radical trachelectomy preserves fertility, leading to a good rate of living newborns without impairing the chances of survival.

Abortion, Spontaneous↗
PubMed2001

[Viruses and cervical cancers].

Currently it is evident that human papillomaviruses are involved in the development of cervical cancer. The mechanisms of cancer initiation are in relation with certain types of papillomavirus. But the discrepancy between the high prevalence of papillomavirus infection and the low frequency of cancer in infected women, gives evidence of the importance of healing process in relation with the host's immune response and the activation of other carcinogenic factors. The understanding of the role of papillomavirus in cervical cancer, gives prospects to prophylactic and therapeutic strategies in relation with antiviral treatments or papillomavirus-specific vaccines.

Female↗
PubMed2001

Neoadjuvant chemotherapy for unresectable ovarian carcinoma: a French multicenter study.

BACKGROUND: Initial debulking surgery followed by chemotherapy is the current treatment for International Federation of Gynecology and Obstetrics Stage IIIC/IV ovarian carcinoma but has a limited efficacy when optimal cytoreduction is not achieved at the end of the surgical procedure. An alternative treatment for these patients could be neoadjuvant chemotherapy. The purpose of this retrospective study was to report the results of neoadjuvant chemotherapy in operable patients (no medical contraindication to surgery) presenting with primary unresectable tumors. METHODS: Between January 1996 and March 1999, operable patients presenting with Stage IIIC or IV ovarian carcinoma underwent, in six French gynecologic oncology departments, surgical staging to evaluate tumor resectability. When the tumor was deemed unresectable by standard surgery, the patient received three to six cycles of platinum-based neoadjuvant chemotherapy according to the response and the center's usual protocol. Patients were surgically explored after completion of neoadjuvant chemotherapy when the tumor did not progress during treatment. Debulking was performed during this secondary surgery when a response to chemotherapy was observed. RESULTS: Fifty-four patients were treated by neoadjuvant chemotherapy. The first surgical staging procedure was laparoscopy in 33 patients (61%) and laparotomy in 21 patients (39%). The median number of neoadjuvant chemotherapy cycles was 4 (range, 0-6). Forty-three patients (80%) responded to neoadjuvant chemotherapy and then tumors were debulked. Optimal cytoreduction was obtained in 39 patients (91% of the patients who underwent debulking) and with standard surgery in 32 patients (82%). For patients whose tumors were optimally debulked, blood transfusions were administered to 17 patients (43%), median intensive care unit stay was 0 days (range, 0-7 days), and median postoperative hospital stay was 10 days (range, 4-62 days). Median overall survival for the total series was 22 months. Survival was better for patients debulked after neoadjuvant chemotherapy compared with patients with nondebulked tumors (P < 0.001). CONCLUSIONS: Neoadjuvant chemotherapy for primary unresectable ovarian carcinoma leads to the selection of a subset of patients sensitive to chemotherapy in whom optimal cytoreduction can be achieved after chemotherapy by standard surgery in a high proportion of cases. Conversely, aggressive surgery can be avoided in patients with initial chemoresistance, in whom the prognosis is known to be poor regardless of treatment.

Adult↗
PubMed2001

Operative injuries during vaginal hysterectomy.

OBJECTIVE: To evaluate incidence, characteristics and consequences of urinary and intestinal tract injuries during vaginal hysterectomy for benign conditions. STUDY DESIGN: From January 1970 to December 1996, 3076 vaginal hysterectomies with or without additional procedures, were performed for benign conditions in our department. We retrospectively analyzed operative injury cases. RESULTS: Incidence of urinary and intestinal tract injuries were 1.7 and 0.5%, respectively. Concerning urinary tract injuries, we observed only one ureteral lesion, all others being bladder lacerations (54 cases). The bladder lacerations occured during the hysterectomy step of the surgery in 61% of cases and during the additional procedures in 39%. All bladder injuries were recognized and treated during the primary operation. We observed four cases of vesico-vaginal fistula as a consequence of these injuries; all fistulas occured after bladder laceration during the hysterectomy step of the surgical procedure. Intestinal tract injuries (16 cases) were rectal lacerations occuring during the hysterectomy step of the surgery (31% of cases) and during the additional procedures (69%). All rectal injuries were recognized and repaired during the primary operation and all healed without sequellae. CONCLUSION: Operative injuries during vaginal hysterectomy are relatively rare. They are easily recognized and treated during the primary operation without important sequellae.

Aged↗
PubMed2001

[Role of ultrasound guided puncture in the management of ovarian cysts].

Ultrasound guided aspiration of ovarian cysts should be performed in well defined indications and under precise and strict modalities. Preoperative evaluation should include vaginal sonography and serum levels of CA125 and CA 19/9. Ultrasound guided aspiration is allowed only in cases of sonographically benign cyst: unilateral unilocular homogenous anechogenic cyst less than 7 cm, and serum levels of CA125 and CA 19/9 less than 35 Ul/ml. The technique of ultrasound guided aspiration is similar to the one used for oocytes recovery in in vitro fertilization treatments. It is mandatory to perform a macroscopic, cytologic and biologic (with concentrations of estradiol, CA125 and CA 19/9) evaluation of cyst fluid. Patients should be told that in case of abnormalities of cyst fluid, a laparoscopy has to be performed immediately or as soon as possible, and that there is a risk of recurrence of the ovarian lesion.

CA-125 Antigen↗
PubMed2000

Laparoscopic vaginal radical trachelectomy: a treatment to preserve the fertility of cervical carcinoma patients.

BACKGROUND: Cervical carcinoma occurs frequently in young women who would like to preserve their childbearing potential. For those with early stage invasive lesions, the authors designed and performed radical trachelectomy, a surgical procedure that preserves the functions of the uterus. METHODS: Radical trachelectomy combines laparoscopic (for pelvic lymphadenectomy) and transvaginal approaches. Between April 1987 and December 1996, 56 patients were scheduled for this procedure, and 47 underwent it. The charts of these patients were retrospectively reviewed for medical and obstetric history, characteristics and complications of surgical procedures, pathologic findings, postoperative obstetric results, and cancer recurrences. RESULTS: The mean durations of the laparoscopic and vaginal steps of the procedure were 62 and 67 minutes, respectively. One intraoperative complication (cystotomy) and seven postoperative complications (drainage of pelvic collection) were observed. The pathologic tumor classification was International Union Against Cancer (UICC) pT1a1 (International Federation of Gynecology and Obstetrics [FIGO] Stage pIA1) in 5 cases, UICC pT1a2 (FIGO Stage pIA2) in 13 cases, UICC pT1b (FIGO Stage pIB) in 25 cases, UICC pT2a (FIGO Stage pIA2) in 1 case, and UICC pT2b (FIGO pIIB) in 3 cases. The mean follow-up was 52 months. Two recurrences (4%) were observed (one lateropelvic and one distant), and one patient died of disease progression. Despite a 25% rate of late miscarriages, 13 normal children were born after radical trachelectomy. CONCLUSIONS: In young patients affected by early invasive cervical carcinoma, radical trachelectomy does not appear to increase the rate of recurrence. It carries a relative risk of infertility and late miscarriage but makes it possible for some patients to become pregnant and give birth to normal newborns. Thus, it seems reasonable to offer this procedure in selected cases, provided that each patient is fully informed and the surgeon properly trained.

Abortion, Spontaneous↗
PubMed2000

Technical development and results of left extraperitoneal laparoscopic paraaortic lymphadenectomy for cervical cancer.

OBJECTIVE: The aim of this study was to describe the development of our technique for laparoscopic paraaortic lymphadenectomy for cervical cancer and to evaluate the accuracy of the left extraperitoneal route to perform complete paraaortic lymphadenectomy. METHODS: A retrospective study of a consecutive series of 44 patients with cervical cancer undergoing laparoscopic paraaortic lymphadenectomy between July 1992 and November 1998 was performed, as well as a comparison of the three routes successively used to perform paraaortic lymphadenectomy: transperitoneal, bilateral extraperitoneal, and left extraperitoneal. RESULTS: The initial choice of surgical access was transperitoneal (n = 9) in 20%, bilateral extraperitoneal (n = 14) in 32%, and left extraperitoneal (n = 21) in 48% of cases. Success rates of laparoscopic paraaortic lymphadenectomy were 78% for the transperitoneal approach, 93% for the bilateral extraperitoneal approach, and 95% for the left extraperitoneal approach. Conversion from extraperitoneal to transperitoneal laparoscopic paraaortic lymphadenectomy, because of a peritoneal tear, was necessary in 3 cases (21.4%) for the bilateral extraperitoneal route and in 3 cases (14.3%) for the left extraperitoneal route (P = 0.43). The extent of dissection varied with experience. Systematic paraaortic lymphadenectomy (up to the left renal vein) was performed via the transperitoneal route in 1 case with 19 aortic nodes removed (common iliac nodes excluded) in 160 min, via the bilateral extraperitoneal route in 6 cases with a mean of 16 +/- 2 (range: 14-19) aortic nodes removed in 153 +/- 22 min (range: 130-180), and via the left extraperitoneal route in 12 cases with a mean of 15 +/- 3 (range: 10-19) aortic nodes removed in 119 +/- 14 min (range: 100-150). There were no statistically significant differences in the total number of nodes removed between the two extraperitoneal routes, although the bilateral extraperitoneal route yielded more right-sided aortic nodes (P < 0. 01). The operating time was significantly shortened using the left extraperitoneal route (P < 0.05). CONCLUSION: Systematic paraaortic lymphadenectomy by a left extraperitoneal route is feasible. Information on right-sided aortic nodes can be obtained although the sampling is reduced compared to that of bilateral extraperitoneal route. It provides the advantages related to the use of the extraperitoneal route while reducing manipulations and thus the risk of peritoneal tearing compared to those of the bilateral extraperitoneal route.

Adult↗
PubMed2000

Laparoscopic assessment of the sentinel lymph node in early stage cervical cancer.

OBJECTIVE: The aim of this study was to describe a minimally invasive technique enabling us to identify the sentinel lymph node in patients affected by early stage cervical cancer and to report the preliminary data. METHOD: Patent Blue Violet was injected around the tumor. Laparoscopy was undertaken and the blue-dyed lymph nodes (BDLN) were sought. The evidenced BDLN were removed, and then the systematic dissection was carried out. Material. Thirty-five patients were submitted to surgery. A systematic dissection was performed on 69 pelvic sidewalls (no dissection was performed on the second side of the patient for whom we decided to renounce surgery after assessment of the first side). RESULTS: One or more BDLN was evidenced in 59 of 69 dissections. The rate of failure depends on the quantity of injected blue dye. Failure to identify a BDLN depended on the quantity of injected blue dye: 3 of 6 (50%) for 1.5 ml or less, 3 of 18 (17%) for 2 ml, and only 4 of 45 (10%) after injection of 4 ml (P = 0.05). Among the 63 BDLN (in 4 cases 2 BDLN were identified), 53 were located in contact with the external iliac vein, lateral to the inferior vesical artery, and ventral to the origin of the uterine artery, 7 were located close to the origin of one of the collaterals of the internal iliac artery, and 3 were adjacent to the left common iliac vein. One or more positive pelvic lymph nodes was found in 11 pelvic wall dissections done on 8 patients. The BDLN was the positive node or one of them in all cases. CONCLUSION: If the sensitivity of the assessment of the BDLN is confirmed to be 100%, this laparoscopic approach could transform the management of early cervical cancer.

Adenocarcinoma↗
PubMed2000

[Cervix dysplasias: study of Rb and p53 gene expression and correlation with mitotic activity].

OBJECTIVE: Certain HPV types have transforming properties. These oncogenic activities are related to the abilities of the viral proteins E6 and E7 to inhibit the products of two cellular tumor suppressor genes (p53 and Rb respectively). But the early steps of cervical carcinogenesis are not well known. The goal of our study was to evaluate cervical intraepithelial neoplasia (CIN) for the tumor suppressor genes p53 and pRb, the HPV status and the mitotic activity, in order to better understand the mechanism of carcinogenesis. MATERIAL AND METHODS: Twenty formalin-fixed paraffin-embedded cone biopsies were selected because they contained adjacent to normal epithelium different grades of CIN. Immunohistochemistry was performed for evaluation of PCNA, pRb and p53. Expression of these different biomarkers was assessed with the help of an image analysis system, in the different epithelial layers of the different normal and pathological cervical areas. The results were compared to normal controls. RESULTS: There is an increase of PCNA expression in normal epithelium adjacent to CIN, compared to normal controls. As tissues progress from adjacent normal epithelium to condylomatous lesion and to the different grades of CIN, PCNA expression increases (mainly in the superficial epithelial layers). For p53 and pRb, the expression is increased in the basal and parabasal layers of adjacent normal epithelium and condylomatous lesions. The observance of histologic signs of CIN is associated with a disappearance of p53 and pRB expression. CONCLUSIONS: These results indicate that the early steps of cervical carcinogenesis involve proliferative dysregulation in relation to the p53 and pRb modulatory mechanism. So expression of viral proteins of HPV is probably the earlier step of carcinogenesis in cervical carcinoma.

Conization↗
PubMed1999

[Parietal endometriosis in abdominal scars. Report of 3 cases].

Parietal endometriosis is a rare disease. Its diagnosis and treatment are often difficult. We report 3 cases of parietal endometriosis occurring in cesarean and appendectomy scars. Clinical symptoms are not specific and may lead to erroneous diagnosis. Diagnosis is usually made on the histological exam of the resected lesion. Treatment of choice is complete surgical excision.

Abdomen↗
PubMed1998

Paget's disease versus Toker cell hyperplasia in a supernumerary nipple.

We report the second case of mammary Paget's disease arising in a supernumerary nipple of a 29-year-old woman. The epithelium of the nipple was infiltrated by large cells with abundant and pale-staining cytoplasm. The nuclei had a vesicular chromatin pattern and identifiable nucleoli. The cells were strongly immunoreactive with KL1, CEA and EMA, but did not show reactivity with PS100, HMB45, or erb-B2. The pathogenesis of Paget cells is unclear. In our case, the lesion showed nearly all the clinical, histological and histochemical characteristics of Paget's disease, though without involvement of mammary gland epithelium and underlying carcinoma. The possibility of an intraepidermal origin, either by transformation from epidermal keratinocytes or by derivation from intraepidermal precursor cells, has to be considered. The differential diagnosis against Toker cell hyperplasia is also discussed.

Adult↗
PubMed1998

Epidermal growth factor receptor expression in cervical intraepithelial neoplasia and its modulation during an alpha-difluoromethylornithine chemoprevention trial.

Chemoprevention trials designed to prevent progression to invasive cervical cancer will benefit from the identification of biomarkers that assess the risk of developing tumors, predict likelihood of response to treatment, and measure biological response to intervention. The purpose of this study was to examine expression of epidermal growth factor receptor (EGFR) as a marker for progression of cervical intraepithelial neoplasia (CIN) and as a surrogate end point biomarker in a chemoprevention trial with alpha-difluoromethylornithine (DFMO), an inhibitor of ornithine decarboxylase. To evaluate quantitative and spatial changes in EGFR expression during cervical tumorigenesis, paraffin sections from 42 archival cervical cone biopsies, each containing multiple stages of CIN, were immunohistochemically stained for EGFR, and the level and spatial expression of EGFR were quantitated by image analysis. In the progression from normal epithelium to CIN 1 to CIN 2 to CIN 3 to invasive cancer, EGFR expression showed two types of changes. Normal control epithelium showed EGFR expression predominantly confined to the basal layer, while histologically normal epithelium in specimens containing CIN showed relatively increased EGFR expression in the basal layer and the extension of EGFR expression away from the basal layer. The total EGFR relative staining intensity (RSI) of epithelium increased with the degree of CIN, predominantly due to a progressive expansion of EGFR-expressing cells away from the basal layer rather than an increase in the level of EGFR expression per cell. To determine whether EGFR expression would be modulated by a 1-month chemopreventive intervention with DFMO, pretreatment and posttreatment cervical biopsy specimens from 25 patients (22 evaluable) were examined for EGFR expression. Although the overall levels of EGFR expression were not modulated in either histological responders or nonresponders, responders showed a prominent down-regulation of EGFR expression away from the basal layer after DFMO treatment. Interestingly, pretreatment EGFR expression levels predicted for DFMO response [i.e., eight responses (72.7%) for 11 cases with RSI levels below 0.35 versus one response (9.1%) for 11 cases with RSI levels above 0.35 (P < 0.01)]. These results suggest that CIN progression is associated with a spatial dysregulation of EGFR expression that can be reversed by DFMO treatment, especially in patients whose pretreatment CIN 3 lesions exhibit relatively low EGFR expression.

Anticarcinogenic Agents↗
PubMed1995

Schauta's vaginal hysterectomy combined with laparoscopic lymphadenectomy.

The vaginal radical surgery combined with the laparoscopy is, in the various modalities we applied it, as effective as the abdominal radical surgery while being more 'patient friendly' (surgery without scars and conservation of forms and functions if the radical trachelectomy is used). However, it requires careful patient selection. The use of laparoscopy in the field of radical surgery must not change the rules of good management of cancer patients. The cancer patients should be treated by gynaecological oncologists, who are the people best placed to appreciate all the perspectives of the problem.

Adult↗
PubMed1994

A randomized prospective study comparing three techniques of conization: cold knife, laser, and LEEP.

Three different techniques of cervical excision, cold knife conization, laser conization, and loop electrosurgical excisional procedure (LEEP) were prospectively compared with respect to treatment reliability, effectiveness, and safety. One hundred ten women with CIN1-2 and the squamnocolumnar junction not seen or CIN3 at the original diagnosis were randomized to treatment with cold knife conization (n = 37), laser conization (n = 37), or LEEP (n = 36). All three treatments were performed with local anesthesia on an outpatient basis. The mean age, histologic features (original and histology of the conization), endocervical involvement, and ectocervical extension were similar in the three groups. Blood loss and operating time were less (P < 0.01) in the LEEP group (5.4 cc of mean blood loss and 5.4 min mean duration time) than in the two other groups (16.2 cc and 14.0 min for cold knife conization, 21.5 cc and 15.6 min for laser conization). Volumes of the cones were evaluated: LEEP cones and laser cones were smaller than the cold knife cones (P < 0.001). During the pathological review of the conization, the major problem was difficulty in evaluating the lesion and its margins due to the coagulation induced by the laser or the LEEP. This alteration was present in 53% of the LEEP conization specimens and in 51% of the laser conization specimens. In the majority of the cases the coagulation was mild, but in one case (LEEP group) and in two cases (laser group) the conization was totally altered by the coagulation, and in 31% of all the LEEP conizations and 38% of all the laser conizations, evaluation of the entire margin was not possible due to coagulation of the tissue. During postoperative follow-up, the number of complications was the same in the three groups (two episodes of post-operative bleeding in each of the three groups). Two months after the treatment the cervix was evaluated: the os was diminished in the cold knife group compared to the two other groups and as a result, the squamnocolumnar junction was not seen in entirety in 50% of cold knife cases, in 19% of LEEP cases, and in 20% of laser cases. These results suggest that in our hands: (1) laser conization is relatively costly and time consuming and alters the tissues significantly, and (2) the choice between cold knife and LEEP is more difficult--cold knife gives a sample adequate for histological evaluation (including evaluation of the margins), while the LEEP procedure is technically easier and less time consuming but sometimes induces electrocautery artifact so that evaluation of the margins is not possible.

Adult↗