PubMed Health⌕ Search

Biomedical subjects

Serge Uzan

Publications and source records attributed to Serge Uzan.

At least 19 recordsLinked to original sources
PubMed2005

Site-select procedure for non-palpable breast lesions: feasibility study with a 15-mm cannula.

BACKGROUND: As screening mammography becomes more commonplace, increasing numbers of non-palpable breast lesions are being found. The aim of this prospective study was to evaluate the feasibility, utility, and patient-perceived cosmesis and satisfaction of the Site-Select procedure in women with non-palpable breast lesions. METHODS: Thirty-two consecutive patients underwent the Site-Select procedure, performed under local anesthesia by the same surgeon. The Site-Select procedure was included in a protocol for small (<15 mm) breast imaging reporting and data system (BI-RADS) grade 3 and 4 breast lesions. The pathologic diagnosis, specimen size, length of the procedure, perioperative and postoperative complications, subsequent interventions, patient satisfaction, and esthetic results were documented. RESULTS: The Site-Select procedure was successful in all 32 patients (mean age, 56 years; range, 44-79 years). Mammographic lesions corresponded to microcalcifications in 21 patients, microcalcifications with architectural distortion in 4 patients, microcalcifications with nodules in 2 patients, and architectural distortion alone in 5 patients. The Site-Select procedure was used on an outpatient basis. Carcinomas were diagnosed in five patients (15.6%). No complications occurred during the procedure. The only postoperative complication was a hematoma, which did not require surgical drainage. No missed cancers were detected by follow-up mammography (mean 8 months later; range, 1-18 months). The esthetic results and patient satisfaction were excellent. CONCLUSIONS: This study demonstrates that the Site-Select procedure is an effective diagnostic method in selected cases. It has a low complication rate, high patient satisfaction, and excellent esthetic results.

Adult↗
PubMed2005

An axilla scoring system to predict non-sentinel lymph node status in breast cancer patients with sentinel lymph node involvement.

BACKGROUND: Axillary lymph node dissection (ALND) is the current standard of care for breast cancer patients with sentinel lymph node (SN) involvement. However, the SN is the only involved axillary node in a significant proportion of these patients. Here we examined factors predictive of non-SN involvement in patients with a metastatic SN, in order to develop a scoring system for predicting non-SN involvement. MATERIALS AND METHODS: This study was based on a prospective database of 337 patients who underwent SN biopsy for breast cancer, of whom 81 (24%) were SN-positive; we examined factors predictive of non SN involvement in the 71 of these 81 women who underwent complementary ALND. All clinical and histological criteria were recorded and analysed according to non-SN status, by using Chi-2 analysis, Student's t-test, and multivariate logistic regression. RESULTS: Univariate analysis showed a significant association between non-SN involvement and histological primary tumor size (p=0.0001), SN macrometastasis (p=0.01), the method used to detect SN metastasis (H&E versus immunohistochemistry) (p=0.03), the number of positive SNs (p=0.049), the proportion of involved SNs among all identified SNs (p=0.0001) and lymphovascular invasion (p=0.006). Histological primary tumor size (p=0.006), SN macrometastasis (p=0.02) and the proportion of involved SNs among all identified SNs (p=0.03) remained significantly associated with non-SN status in multivariate analysis. Based on the multivariate analysis, we developed an axilla scoring system (range 0-7) to predict the likelihood of non-SN metastasis in breast cancer patients with SN involvement. CONCLUSION: In patients with invasive breast cancer and a positive SN, histological primary tumor size, the size of SN metastases, and the proportion of involved SNs among all identified SNs were independently predictive of non-SN involvement.

Adult↗
PubMed2005

Use of mifepristone to ripen the cervix and induce labor in term pregnancies.

OBJECTIVE: This study was undertaken to determine the efficacy of mifepristone for ripening the cervix and inducing labor in term pregnancies. STUDY DESIGN: In a double-blind placebo-controlled dose-finding study, 346 women received 50, 100, 200, 400, or 600 mg of mifepristone or placebo. The main endpoint for efficacy was the number of patients in whom labor occurred between 12 and 45 and 54 hours after treatment or who had a Bishop score 6 or greater. Maternal and fetal tolerability was also studied. RESULTS: No significant efficacy was observed whatever the dose of mifepristone. Mifepristone was well tolerated by the mother and fetus. CONCLUSION: Mifepristone, at doses up to 600 mg, does not induce labor within 54 hours in patients with unfavourable cervical status.

Abortifacient Agents, Steroidal↗
PubMed2005

Bilateral tubal pregnancy after natural conception: a case report.

BACKGROUND: Bilateral tubal pregnancy is very rare and usually follows ovulation stimulation. CASE: A 36-year-old woman with acute pelvic pain underwent emergency laparoscopy for suspected left ruptured tubal pregnancy. Bilateral hematosalpinx with a ruptured left tubal pregnancy and active bleeding from the right fallopian tube was noted during surgery, and bilateral salpingectomy was performed by laparoscopy. Pathologic examination of the left tube confirmed the presence of conception products and trophoblastic tissue. The right salpingectomy specimen contained some trophoblastic tissue resembling an earlier tubal pregnancy encased in a cyst. CONCLUSION: This was a rare case of spontaneous bilateral tubal pregnancy after conception at different times. The explanation of the presentation is uncertain. Laparoscopy remains the cornerstone of diagnosis and treatment in the majority of women with a tubal pregnancy; this is especially true in complex cases, such as bilateral tubal pregnancy.

Adult↗
PubMed2004

Doppler and immunohistochemical evaluation of decidual spiral arteries in early pregnancy.

OBJECTIVE: The purpose of this study was to estimate spiral artery subchorionic flow at 8-11 gestational weeks (GW) by Doppler ultrasound and then to analyze these vessels in the decidua basalis using histologic, morphometric and immunohistochemical analyses. METHODS: Subchorionic spiral arteries were evaluated in 5 women scheduled for aspiration at 8-11 GW. Flow velocity waveforms were sought using color and pulsed Doppler, and the diastolic/systolic (D/S) index was calculated. Transcervical biopsy specimens and aspiration products were thoroughly examined to investigate the structure of the spiral artery at the implantation site using cytotrophoblastic and arterial smooth muscle cell immunohistochemical markers (anti-cytokeratin 7 and anti-actin monoclonal antibodies). Spiral artery cross-sectional inner areas were measured and compared with the D/S index in each case. RESULTS: Low-impedance pulsatile flow could be detected below the trophoblastic ring in all cases. Complete obstruction of a spiral artery lumen was never observed and cytotrophoblastic cells were incorporated into the vessel wall starting from the perivascular cuff. CONCLUSION: Both techniques evidenced that decidual spiral arteries in the placental bed are not completely obstructed at 8-11 GW.

Actins↗
PubMed2004

Pathophysiology of preeclampsia: links with implantation disorders.

The phenomenon of implantation anchors the embryo into the uterine wall and produces a hemochorial placenta that maintains the pregnancy and fetal growth. Implantation and placentation are intimately linked and cannot be dissociated either in time or in space. Preeclampsia is characterized by hypertension and proteinuria. It is secondary to an anomaly of the invasion of the uterine spiral arteries by extra-villous cytotrophoblast cells, associated with local disruptions of vascular tone, of immunological balance and inflammatory status, and sometimes with genetic predispositions. Preeclampsia is a disease of early pregnancy, a form of incomplete spontaneous abortion, but is expressed late in pregnancy. Aspirin may play a favorable role in implantation which is related to the genesis of preeclampsia and some cases of intra-uterine growth restriction. The most important points in obtaining a preventive effect from low-dose aspirin during the pregnancy are early treatment (before 13 weeks of gestation) and the prescription of a sufficient dose (more than 100 mg per day).

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed2004

Deep pelvic endometriosis: MR imaging for diagnosis and prediction of extension of disease.

PURPOSE: To prospectively evaluate the accuracy of magnetic resonance (MR) imaging for the preoperative diagnosis of deep pelvic endometriosis and extension of the disease. MATERIALS AND METHODS: One hundred ninety-five patients (mean age, 34.2 years; range, 20-71 years) who were suspected of having pelvic endometriosis were recruited at two institutions. Two experienced radiologists evaluated the MR images independently. Deep pelvic endometriosis was defined as implants or tissue masses that appeared as hypointense areas and/or hyperintense foci on T1- or T2-weighted MR images in the following locations: torus uterinus, uterosacral ligaments (USLs), vagina, rectovaginal septum, rectosigmoid, and bladder. MR imaging results were compared with surgical and pathologic findings. Sensitivity, specificity, predictive values, and accuracy of MR imaging for prediction of deep pelvic endometriosis were assessed. RESULTS: Pelvic endometriosis was confirmed at pathologic examination in 163 (83.6%) of 195 patients. Endometriomas, peritoneal lesions, and deep pelvic endometriosis were diagnosed on the basis of surgical findings, alone or combined with pathologic findings, in 111 (68.1%), 83 (50.9%), and 103 (63.2%) of 163 patients, respectively. Torus uterinus and USL were the most frequent sites of deep pelvic endometriosis. The sensitivity, specificity, positive and negative predictive values, and accuracy of MR imaging for deep pelvic endometriosis were 90.3% (93 of 103), 91% (84 of 92), 92.1% (93 of 101), 89% (84 of 94), and 90.8% (177 of 195), respectively. The sensitivity, specificity, and accuracy, respectively, of MR imaging for the diagnosis of endometriosis in specific sites were as follows: USL, 76% (57 of 75), 83.3% (100 of 120), and 80.5% (157 of 195); vagina, 76% (16 of 21), 95.4% (166 of 174), and 93.3% (182 of 195); rectovaginal septum, 80% (eight of 10), 97.8% (181 of 185), and 96.9% (189 of 195); rectosigmoid, 88% (53 of 60), 97.8% (132 of 135), and 94.9% (185 of 195); and bladder, 88% (14 of 16), 98.9% (177 of 179), and 97.9% (191 of 195). CONCLUSION: MR imaging demonstrates high accuracy in prediction of deep pelvic endometriosis in specific locations.

Adult↗
PubMed2004

Contralateral axillary sentinel lymph node drainage in breast cancer: a case report.

BACKGROUND: Since the introduction of sentinel node (SN) mapping in breast cancer, extra-axillary lymph node sites of breast tumor drainage are discovered in about one-quarter of cases, especially after intraparenchymal injection. In most such cases, an ipsilateral axillary SN is associated with an extra-axillary SN. Non visualization of ipsilateral axillary SN and extra-axillary SN drainage are often associated with an increased risk of axillary involvement. CASE: We report a case of contralateral axillary SN drainage on lymphoscintigraphy in a breast cancer patient with a history of bilateral reduction mammoplasty and no ipsilateral axillary lymph node involvement.

Aged↗
PubMed2004

Intraoperative imprint cytology of sentinel nodes in breast cancer.

BACKGROUND AND OBJECTIVES: Sentinel node (SN) biopsy is a new standard of care for axillary node staging in patients with early-stage, clinically node-negative breast cancer. A second operation can be avoided when the results are available intraoperatively. However, there is no standard intraoperative method for SN assessment. The aim of this study was to evaluate intraoperative imprint cytology (IC) for the detection of SN involvement in patients with early-stage breast cancer. METHODS: One hundred eighty-five consecutive patients with a breast tumor underwent SN biopsy with intraoperative IC. The SN was bisected and a touch preparation was made with a glass slide, on both sides of the cut. Permanent sections were evaluated with H&E and immunohistochemical staining. The IC results were compared with the final histologic results. RESULTS: The sensitivity, specificity, accuracy, and positive and negative predictive values of IC were 33.3, 78.4, 78.9, 90, and 77.5%, respectively. IC was more sensitive for macrometastases than for micrometastases. In the 118 patients studied after the learning phase, 9 patients with a positive SN by IC avoided a second operation. CONCLUSIONS: Intraoperative IC of SNs appears to be reasonably reliable in patients with breast cancer, permitting axillary dissection during the same surgical procedure when positive. In contrast, sensitivity for detection of micrometastases is low.

Adult↗
PubMed2004

Fetal toxicity of valsartan and possible reversible adverse side effects.

BACKGROUND: Published cases suggest that the use of angiotensin II receptor antagonists is fetotoxic during the third trimester, but not in early pregnancy. CASE: We report a case in which the adverse fetal effect of angiotensin II receptor antagonist treatment was reversed. A woman with chronic hypertension was treated with valsartan until gestation week (GW) 20, when a complete anhydramnios was observed. Six days after interruption of the treatment, amniotic fluid reappeared. It reached a normal level at GW 23.5. The plasmatic creatinine level and the renal ultrasound examination were within normal limits at the six-month follow-up. CONCLUSIONS: Whereas angiotensin-II-receptor antagonist generates a severe renal toxicity, this case suggests that, at least in the first half of pregnancy, these effects can be reversed.

Adult↗
PubMed2004

Luteinizing hormone concentrations after gonadotropin-releasing hormone antagonist administration do not influence pregnancy rates in in vitro fertilization-embryo transfer.

OBJECTIVE: To determine the impact of circulating LH concentrations during controlled ovarian hyperstimulation on the outcome of IVF. DESIGN: Retrospective study. SETTING: University hospital. PATIENT(S): Two-hundred seventy women who had a short stimulation protocol with GnRH antagonist and ovarian stimulation with recombinant FSH (rFSH). INTERVENTION(S): GnRH antagonist and rFSH were administered SC; blood samples were collected on the day of GnRH antagonist administration, 1 day after, and on the day of hCG administration. MAIN OUTCOME MEASURE(S): A threshold of 0.5 IU/L on the day of hCG was chosen to discriminate between women with LH concentrations 0.5 IU/L (group B, n = 151). RESULT(S): The two groups were comparable with regard to the clinical parameters. In group A, significantly lower LH concentrations were observed on day 9 of the cycle and on the day of hCG administration. The numbers of oocytes retrieved, embryos obtained, and embryos cryopreserved were significantly higher in group A compared with group B. The proportion of clinical pregnancies was similar in the two groups (21.1% vs. 22.7 % per ET). CONCLUSION(S): In GnRH antagonist and rFSH protocols, suppressed serum LH concentrations do not have any influence on the final stages of follicular maturation, pregnancy rates, or outcomes.

Adult↗
PubMed2004

Value of intraoperative imprint cytology of sentinel nodes in patients with cervical cancer.

OBJECTIVE: The purpose of this study was to evaluate intraoperative imprint cytology (IC) for the detection of sentinel node (SN) involvement in patients with cervical cancer. METHODS: Thirty-six consecutive patients with cervical cancer underwent a laparoscopic SN procedure with intraoperative IC, followed by complete laparoscopic pelvic lymphadenectomy, with or without laparoscopic para-aortic lymphadenectomy. The SN was bisected and both cut surfaces were applied to the surface of glass slides. Permanent sections were stained with H&E and immunohistochemical methods. The IC results were compared with the final histological results. RESULTS: At least one SN (mean: 2 SN per patient, range: 1-5) was detected in 34 of the 36 patients. Eight patients (22.2%) had a total of 12 metastatic SNs (four macrometastatic, five micrometastatic, and three with isolated tumor cells). No false-negative results of SN biopsy were obtained. Only one metastasis was identified by IC. No false-positive findings were obtained with IC. The overall sensitivity, specificity, accuracy, and positive and negative predictive values of IC were 8.3%, 100%, 85.7%, 100%, and 85.5%, respectively. CONCLUSION: These results suggest that intraoperative imprint cytology of sentinel nodes is unreliable in patients with cervical cancer.

Adult↗
PubMed2004

Laparoscopic sentinel node procedure using a combination of patent blue and radiocolloid in women with endometrial cancer.

BACKGROUND: We assessed the feasibility of a laparoscopic sentinel node (SN) procedure based on the combined use of radiocolloid and patent blue labeling in patients with endometrial cancer. METHODS: Seventeen patients (median age, 69 years) with endometrial cancer of stage I (16 patients) or stage II (1 patient) underwent a laparoscopic SN procedure based on combined radiocolloid and patent blue injected pericervically. After the SN procedure, all patients underwent complete laparoscopic pelvic lymphadenectomy and either laparoscopically assisted vaginal hysterectomy (16 patients) or laparoscopic radical hysterectomy (1 patient). RESULTS: SNs (mean number per patient, 2.6; range, 1-4) were identified in 16 (94.1%) of the 17 patients. Macrometastases were detected in three SNs from two patients by hematoxylin and eosin staining. In three other patients, immunohistochemical analysis identified six micrometastatic SNs and one SN containing isolated tumor cells. No false-negative SN results were observed. CONCLUSIONS: An SN procedure based on a combination of radiocolloid and patent blue is feasible in patients with early endometrial cancer. Combined use of laparoscopy and this SN procedure permits minimally invasive management of endometrial cancer.

Aged↗
PubMed2004

Laparoscopic sentinel node procedure for cervical cancer: impact of neoadjuvant chemoradiotherapy.

BACKGROUND: SN detection based on combined blue dye and radiocolloid labeling can reliably show lymph node status in cervical cancer, but the influence of prior neoadjuvant chemoradiotherapy has not yet been reported. The aim of this study was to evaluate the effect of neoadjuvant chemoradiotherapy on the accuracy of a dual-labeling laparoscopic sentinel node (SN) procedure in patients with cervical cancer. METHODS: Between July 2001 and June 2003, 26 patients (mean age, 50.3 years) with cervical cancer underwent a laparoscopic SN procedure based on dual labeling with patent blue and radiocolloid. After the SN procedure, all the patients underwent complete laparoscopic pelvic lymphadenectomy and laparoscopic radical hysterectomy (n=19), the Schauta-Amreich operation (n=5), or trachelectomy (n=2). The results of the SN procedure were compared between 11 patients who received neoadjuvant chemoradiotherapy and 15 patients who did not receive neoadjuvant treatment. RESULTS: The SN identification rates were 100% in the 11 patients who underwent neoadjuvant chemoradiotherapy and 93.3% in the 15 patients who did not receive adjuvant therapy. A total of 59 SNs were removed. Eight SNs (13.6%) from five patients (19.2%) were found to be metastatic at the final histological assessment. Three SN involvements were detected by hematoxylin and eosin staining of the SN. Immunohistochemical studies identified five metastatic SNs in three patients. There were no false-negative SN results. CONCLUSIONS: This study suggests that SN detection with a combination of radiocolloid and patent blue is feasible and accurate in patients with cervical cancer undergoing neoadjuvant chemoradiotherapy or primary surgery. The combination of laparoscopy and the SN procedure permits minimally invasive management of cervical cancer.

Chi-Square Distribution↗
PubMed2004

Increased serum maternal levels of the HER2 oncoprotein p105 ectodomain in preeclampsia.

HER2/ERBB2 protein is a 185 kDa transmembrane growth factor receptor whose extracellular domain, a 105 kDa fragment (p105), can be released from cell surfaces by proteolytic cleavage. The aim of our study was to compare serum p105 concentrations in normal and pathological pregnancies and to determine whether any correlation exists between preeclampsia and p105 levels. Serum p105 was assayed in 96 non-pregnant women and 89 pregnant women (26 normotensive, 14 normotensive with a history of preeclampsia or fetal hypotrophy, 10 with chronic hypertension, 10 with gestational hypertension and 29 with preeclampsia). Median serum p105 levels (median; 95% confidence interval) were higher in the preeclampsia group (13.9 microg/l; 12.8-16.1 microg/l) than in the normotensive (11.7 microg/l; 10.6-13.3 microg/l; p < 0.05) or non-pregnant groups (9.3 microg/l; 8.9-9.6 microg/l; p < 0.001). There were no significant differences between the other pregnancy groups. In the normotensive group, serum p105 was correlated with the number of gestations (r = 0.46; p < 0.05), parity (r = 0.39; p < 0.05) and placenta weight (r = 0.61; p < 0.05). In preeclamptic women, serum p105 correlated with parity (r = 0.46; p < 0.05). Serum p105 concentrations above 11.9 microg/l were associated with a high odds ratio (OR) for onset of preeclampsia (after adjustment for parity OR = 9.0; 95% CI = 2.3-36.0; p < 0.005). Preeclampsia is associated with increased serum p105 concentrations, which may be related to increased fetomaternal cell traffic.

Adult↗