Biomedical subjects

T Miras

Publications and source records attributed to T Miras.

3 recordsLinked to original sources

PubMed2002

[Acute puerperal uterine inversion: two cases].

Acute puerperal inversion is both rare and serious (1/20000 deliveries in France) and may lead to significant morbidity and mortality. Outcome depends on the degree of uterine bleeding and the presence or not of a state of shock. Acute puerperal inversion occurs at the time of placental delivery. Four stages are usually described by degree of exteriorization of the uterus. The diagnosis is essentially clinical. The predisposing factors are hypotonic uterus, fundal implantation of the placenta and placental acretas. 60% of all cases are caused by precipitous manoeuvres including traction on the cord or improper fundal pressure. Once a diagnosis is made immediate measures must be undertaken to assure clinical stability of the mother. Manuel reinversion of the uterus must be done quickly to avoid a cervical stricture that may form within thirty minutes of the inversion making successful manipulation very difficult. Failure or reoccurrence requires surgical treatment either by abdominal or vaginal approach. We report on two cases: one of complete inversion leading to a hysterectomy in order to control bleeding and a second case of incomplete inversion where repositioning was successful.

Acute Disease↗

PubMed2000

[Infraclinical breast lesions: apropos of a retrospective study of 261 cases].

OBJECTIVE: To determinate the rate of malignant lesions discovered after surgery for nonpalpable breast lesions diagnosed by radiology. TOOLS AND METHODS: We performed a retrospective study of 261 patients who underwent surgery for nonpalpable breast lesions at the Saint-Etienne University Hospital between 1991 and 1998. We included women who did not have any palpable breast lesion. We excluded bilateral lesions and nonpalpable lesions associated with a palpable lesion in the same breast. We grouped outcome by alarming signs, those of complementary exams such as mammography, ultrasound, fine-needle aspiration biopsy and setreotaxis core needle breast biopsy in their sensitivity, specificity and predictive values, and classed results by pathology and type of surgery performed. All nonpalpable lesions were localized by stereotaxis maneuvers. RESULTS: In our series, 61.7% of the patients were seen for individual detection, 3% had participated in mass screening programs and 35.3% were referred for suspected conditions. The predictive value of malignant lesions on mammography, analyzed in all cases and interpreted in 275, was 42.2%. The sensitivity and specificity of ultrasound exams performed in 50.2% of the cases were 85% and 91% respectively. Fine-needle aspiration biopsy and core needle biopsy were performed in 45 (18%) and 23 (9%) cases respectively. Twelve patients underwent total mastectomy with axillary dissections, 58 had tumorectomy with axillary dissections, and 191 had simple tumorectomy. Benign lesions were found in 128 (49.1%) cases, atypical hyperplasia in 10.7%, carcinoma in situ in 57 (cases 21.8%). The rate of malignant lesions was 38.6%. I was 50.9% when borderline lesions (atypical hyperplasia and in situ lobular carcinoma) were included. CONCLUSION: In our series, 38.6% of all nonpalpable operated breast lesions were cancers. Ultrasound, fine-needle aspiration and needle core biopsy showed high sensitivity and specificity allowing good biopsy outcome.

Axilla↗

PubMed2000

[Premature rupture of the membranes between 28 and 34 weeks of amenorrhea. Retrospective study apropos of 71 cases].

OBJECTIVE: The aim of our study is to compare the outcome of infants born after preterm premature rupture of the membranes (PPROM) between 28 and 34 weeks gestation. We compare two groups of infants: group A, infants born in hospitals without neonatal intensive care unit, after PPROM with long tocolysis, no maternal prophylactic antibiotic therapy and no systematic maternal steroid therapy. Group B with systematic maternal steroid therapy, maternal prophylactic antibiotic therapy, short tocolysis and born in an hospital with neonatal intensive care unit. The latency period (time from rupture of membranes to the onset of labor) authorized was 15 days in the group B and not limited in the group A. RESULTS: Death (13.8% vs 0%; p=0.022), neonatal infection (66.6% vs 28.6%; p=0.0013), and respiratory distress (63.8% vs 34.3%; p=0.0144) were less frequent in the group B. The group A infants passed more than ten days in intensive care unit (61.1% vs 37.1%; p=0.043). Neonatal infection was not higher in the corticosteroïd therapy group (41.2% vs 70.3%; p=0.0135). There is more neonatal infection in the group A with long latency period (61.7% vs 24.3%; p=0.0014) and more chorioamnionitis (70.6% vs 24.3%; p<0.0001). CONCLUSION: The association maternal steroid and antibiotic therapy, short latency period, and hospitalization of the pregnant woman close to a neonatal intensive care unit reduce significantly the neonatal morbidity after preterm premature rupture of the membranes.

Adrenal Cortex Hormones↗