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V Boucaya

Publications and source records attributed to V Boucaya.

5 recordsLinked to original sources
PubMed1999

Morbidity in laparoscopic gynecological surgery: results of a prospective single-center study.

BACKGROUND: We set out to investigate prospectively the morbidity rate for gynecological laparoscopy patients at a tertiary care center. METHODS: We prospectively recorded data on 743 laparoscopic procedures performed between January 1, 1992 and December 31, 1996. The procedures included 36 diagnostic laparoscopies (4.8%), 115 laparoscopies carried out for minor surgical acts (15.4%), 523 for major surgical acts (70.4%), and 69 for advanced surgical acts (9. 4%). A total of 127 patients had a history of prior laparotomy (17%). All those procedures were performed by young senior surgeons. We defined a complication as an event that had modified the usual course of the procedure or of the postoperative period. For statistical analysis, we used the chi-squared test or Fisher's exact test. RESULTS: Complications occurred in 22 cases; the overall complication rate was 2.9% when all events were considered. One complication (injury of the left primitive iliac artery) was related to insertion of the Veress needle (0.13%). A total of 2,578 trocars were inserted, giving rise to 10 complications (1.3%). Three unintended laparotomies were required for bowel or bladder injuries (0.4%). Finally, the introduction of the laparoscope was responsible for 11 complications (1.4%); this figure represents 50% of all the complications of this series. Eight intraoperative complications (1%) occurred during the laparoscopic surgery (seven severe bleedings and one ureter injury, but no intestinal lesions); laparotomy was required in six of these cases. Three complications occurred during the postoperative stage: one granulomatous peritonitis after intraabdominal rupture of a dermoid cyst, one incisional hernia, and a fast-resolving cardiac arrhythmia. CONCLUSIONS: In our experience, operative gynecological laparoscopy is associated with an acceptable morbidity rate. Moreover, about half of the complications occur during the installation of the laparoscopic procedure, underscoring the usefulness of safety rules.

Chi-Square Distribution↗
PubMed1999

Anticoagulant therapy in pregnancy.

Anticoagulation during pregnancy should derive benefit from recent advances in anticoagulant therapy. Unfractionated heparin is at present the drug of choice for most of the indications of thromboprophylaxis as well as for acute venous thrombosis during pregnancy but it is likely that, in the near future, low molecular weight heparins will supercede this anticoagulant in many indications. One particular indication is mechanical heart valves that needs a high degree of anticoagulation. The anticoagulant of choice that carries the best efficacy-risk ratio in this situation seems to be oral anticoagulants. Pregnant women receiving anticoagulation should be considered as high-risk patients that should be managed in specialized centres. They are prone to bleeding complications that will mainly occur during delivery or in the postpartum period.

Anticoagulants↗
PubMed1998

Single-dose methotrexate for unruptured ectopic pregnancy.

OBJECTIVES: To compare the effectiveness of single-dose methotrexate (MTX) and laparoscopic salpingostomy in the treatment of unruptured ectopic pregnancy (UEP). METHODS: 75 patients entered a prospective non-randomized study. Thirty-seven women were submitted to a single-dose methotrexate (Group 1) and 38 underwent laparoscopic salpingostomy (Group 2). Methotrexate (1 mg/kg) was given intramuscularly on an out-patient basis if the beta-hCG level was < 5000 IU/I and the hematosalpinx diameter was < 3 cm and the peritoneal fluid < 300 cm3 on TVS. The follow-up consisted of serial clinical examinations, beta-hCG assays, liver tests and blood cell counts. Laparoscopic salpingostomy was decided in other cases of UEP or when patients refused or could not comply with the follow-up. RESULTS: Group 1 patients (91.8%) were cured with 1-3 doses of MTX, the remainder required a laparoscopy. Seventy-three percent of them were treated on an out-patient basis. The mean time to resolution of hCG was 26.7 days. The initial beta-hCG level significantly correlated with the necessity of a surgical option and the time to resolution of beta-hCG. Whenever beta-hCG was < 3600 IU/l, all patients were cured with a single injection, without hospitalization and with a follow-up of < 27 days. Group 2 patients (81.6%) were cured with laparoscopy and 15.8% required a MTX injection for persistent EP. The mean hospital stay was significantly longer than for those that required the MTX injection (2.7 vs. 0.6; P = 0.0001), but the follow-up was shorter and required significantly less clinical examinations, sonograms and biologic tests. Finally the effectiveness of single-dose MTX and laparoscopic salpingostomy were similar (P = 0.2, 95% CI of the difference: -0.15-0.04). CONCLUSIONS: Single-dose MTX was as effective as laparoscopy in the treatment of UEP. A rigorous selection of the patients for the treatment option is mandatory to guarantee high success rates, in an out-patient basis and a short follow-up.

Adolescent↗
PubMed1996

[Intracytoplasmic injection of spermatozoa (ICSI). Ethical requirements and assessment].

There is no doubt that the clinical application of intracytoplasmic sperm injection (ICSI) has been a major breakthrough in the treatment of extremely severe male-factor infertility. We analyzed the impact of ICSI on medically assisted reproduction practices. The potential of risks ICSI, whether related to abnormalities associated with male infertility, penetration within the ovocyte or the risk of introducing foreign material, should not be neglected. With ICSI, a situation of human experimentation has been created without adequate prior animal experimentation and research has been conducted without the approval of ethics committees as required by the Huriet Law in France. When first introduced, ICSI was not accompanied by an evaluation protocol to follow the biological risks and societal impact. We thus believe that meeting the requirements of the following ethical criteria deserves discussion. ICSI should still be considered as an experimental clinical procedure. Risk should be evaluated with animal models since all forms of spermatozoa can now be injected into mouse oocytes. Complete independence is needed for biological and genetic assessment, pediatric follow-up on children born and societal and health care impact. Scientific personnel as well as patients and the society in general should be continuously informed of the status of the evaluation work. As for any experimental therapy, the process of obtaining informed consent takes on special significance. Careful explanation of the procedure is needed so the patients can be in a position to determine what level of risk is acceptable.

Ethics, Medical↗