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Biomedical subjects

V Roger

Publications and source records attributed to V Roger.

At least 37 records · Page 2Linked to original sources
PubMed1999

Laparoscopic surgery in gynecology: randomized prospective study comparing pneumoperitoneum and abdominal wall suspension.

OBJECTIVE: To compare laparoscopic surgery using insufflation of carbon dioxide gas with laparoscopic surgery using abdominal wall retractor in gynecology. SETTING: University hospital. DESIGN: Prospective randomized study. MATERIAL AND METHODS: Fifty-one patients were assigned to the gasless laparoscopy group, and 52 patients were assigned to the laparoscopy group with pneumoperitoneum. Patients presented with ovarian cyst, endometriosis, acute salpingitis, hydrosalpinx and extra-uterine pregnancy. RESULTS: No severe complications were noted. One conversion to laparotomy was performed in each group. Eight gasless laparoscopic procedures were converted into laparoscopy with pneumoperitoneum; difficulties appeared in patients with adhesions following laparotomy and in cases of unsatisfactory exposure of the pelvis. No differences appeared between the two groups in terms of complications, quality of the operative sequelae, and duration of hospitalization. CONCLUSION: Gasless surgery is a recent technique and progress in modifying the equipment is necessary to reduce conversions.

Abdominal Muscles↗
PubMed1999

Long-term prognostic value of positive peritoneal washing in colon cancer.

BACKGROUND: We examined the potential prognostic value of free malignant cells in the peritoneal cavity of patients with colon adenocarcinoma. METHODS: In 1991 and 1992, 88 patients underwent peritoneal washing with cytologic analysis immediately before elective colon resection for adenocarcinoma with no evidence of peritoneal metastases. Peritoneal washing fluid was collected before abdominal exploration, centrifuged immediately, and stained with the May-Grünwald-Giemsa and Harris Shorr methods. Malignancy was defined as recommended by Papanicolaou. RESULTS: Free malignant cells in peritoneal fluid (positive peritoneal washing) were found in 25 of 88 (28%) patients (Dukes A, 0 of 11; Dukes B, 10 of 31; Dukes C, 11 of 37; Dukes D, 4 of 9). The positivity rate was 24 of 75 (32%) among patients with tumours involving the serous layer and 1 of 13 (8%) among the others (P = 0.0989). With a follow-up of 66.7 to 78.7 months the 5-year survival rates were 48% (95% confidence interval, 28.4-67.6) and 68% (95% CI, 56.2-79.8) among patients with positive and negative peritoneal washing, respectively (P = 0.09). Positive peritoneal washing was not significantly associated with survival in multivariate analysis. CONCLUSION: The presence of free malignant cells in the peritoneal cavity of patients with colon cancer provided no further prognostic information relative to the Dukes classification in this study. Nevertheless, further study is needed, particularly in a larger series of Dukes B patients, for whom a new prognostic factor would be useful for deciding adjuvant therapy.

Adenocarcinoma↗
PubMed1999

[Vaginal hysterectomy for non-prolapse uterus].

Vaginal hysterectomy in the treatment of non prolapsed uterus without malignant disease is a well codified technique. Per operative complications, post operative morbidity are less frequent and less serious than by abdominal surgery and convalescent time is less extended. Financial cost is lower compared with laparoscopic hysterectomy. The successful result of the vaginal way is determined by anatomic factors: volume and mobility of the uterus, accessibility of the vagina, but above all by the training of the surgeons. A rate of seventy per cent of hysterectomies performed by the vaginal way in the case of this indication is a realistic aim in a hospital center.

Adult↗
PubMed1999

[Impact of adenomyosis on results of endometrial ablations].

The authors report the results of a retrospective series concerning 121 patients who presented abnormal uterine bleeding resistant to progestogen therapy. These patients were adenomyosis carriers and who underwent loop endometrial ablation. Over a maximum period of 8 years, the success rate was 56% following one endometrial resection and 67% following one or two resections. The study recorded a repeat resection level of 11%. Seventeen hysterectomies (19%) were performed because of the recurrence of abnormal uterine bleeding. These results are comparable to those observed in endometrial ablation performed for menorrhagia, all benign etiology included. Adenomyosis does not appear to be a factor in the failure of endometrial ablation, except in the case of deep adenomyosis which is difficult to diagnose pre-operatively.

Adult↗
PubMed1999

[Evaluation of two methods for endometrial sampling during diagnostic hysteroscopy].

OBJECTIVE: To compare two endometrial sampling devices, pipelle and vacurette, performed during hysteroscopy, based on the quality of material obtained and pain during the sampling. PATIENTS AND METHODS: During the period from 01.03.96 to 01.12.97, 200 patients were consecutively randomized in a single blind prospective study. Efficacity was evaluated on the quality of material obtained and pain was graded on a scale of 0 to 5. RESULTS: On the average the Vacurette was more painful (1.6 vs 1.1, p = 0.01). Vacurette biopsy was more effective than pipelle biopsy (64% vs 48%, p = 0.05). There was a significative difference of efficacity in the post-menopausal group (34% vs 13%, p = 0.05), but not in the pre-menopausal group (76% vs 64%, p > 0.05). When hysteroscopy diagnosed endometrial atrophy, there was no significative difference of efficacity (29% vs 23%, p > 0.05), whereas vacurette was significatively more effective when there was an other hysteroscopy diagnosis (78% vs 62%, p = 0.05). Both procedures were less effective in post-menopausal women (p = 0.001), and in case of endometrial atrophy (p = 0.001). CONCLUSION: Both procedures were acceptable during ambulatory hysteroscopy. In our study, vacurette was more painful than pipelle. Vacurette was more effective but insufficient tissue for histologic evaluation was important in both procedures. This might be explained by the population included and the histologic method used.

Biopsy↗
PubMed1998

[Contribution of hysteroscopic surgery for the treatment of postmenopausal metrorrhagia].

OBJECTIVES: Determine the effectiveness of hysteroscopic surgery in persistent postmenopausal bleeding. PATIENTS AND METHODS: Transcervical resection was performed in 176 women between the ages of 46-74 years. A benign cause was noted in 135 cases (polyps in 80 and submucous fibroids in 55); 37 patients had no significant disease and 4 had endometrial atypical hyperplasia missed in the preoperative evaluation. Patients underwent resection of polyp, resection of fibroid or endometrial ablation. Major operative complications were rare and included 3 perforations and one case of fluid overload. Patients were followed for 1-10 years after treatment (mean follow-up 52 months). RESULTS: 167 patients completed the study. Clinical manifestations disappeared in 85.2% of the patients; 15 patients had hysterectomy after the hysteroscopic procedure and 11 had repeat transcervical resection. CONCLUSION: Hysteroscopic treatment can be effective in carefully selected patients with postmenopausal bleeding or abnormal uterine bleeding on hormone replacement therapy. The operative criteria should take the causes of bleeding and not just the age of patient into account.

Aged↗
PubMed1998

[Role of diagnostic hysteroscopy in the exploration of postmenopausal metrorrhagia].

DIAGNOSIS: Diagnostic hysteroscopy is an effective method for identifying the causes of postmenopausal bleeding. It evaluates the uterine cavity and visualizes pathologic conditions such as endometrial polyps, submucous fibroids, and focal endometrial abnormalities including adenocarcinoma and its precursors. FURTHER INFORMATION: With directed biopsy, diagnostic hysteroscopy also ensures the recognition of these lesions.

Clinical Protocols↗
PubMed1998

Internal bioartificial liver with xenogeneic hepatocytes prevents death from acute liver failure: an experimental study.

OBJECTIVE: To demonstrate that a bioartificial liver, using allogeneic or xenogeneic hepatocytes protected from rejection by a semipermeable membrane, could prevent death from acute liver failure. SUMMARY BACKGROUND DATA: An implantable bioartificial liver using isolated hepatocytes could be an alternative to orthotopic liver transplantation to treat patients with acute liver failure. It could serve either as a bridge until liver transplantation or as the main treatment until recovery of the native liver. However, allogeneic or xenogeneic hepatocytes that could be used in clinical applications are spontaneously rejected. METHODS: Acute liver failure was induced in rats by 95% liver resection. Twenty-five million hepatocytes harvested in rats (allogeneic) or guinea pigs (xenogeneic) were encapsulated in a semipermeable membrane to protect them from rejection. The hollow fibers containing hepatocytes were transplanted into the peritoneum of recipient rats. Survival rates were compared between rats transplanted or not with hepatocytes. RESULTS: In groups not transplanted with viable hepatocytes, 73% to 93% of rats died after 95% liver resection. The mortality rate was reduced to 39% in rats transplanted with allogeneic hepatocytes and 36% in rats transplanted with xenogeneic hepatocytes. The bioartificial liver could be removed 1 month after transplantation, when regeneration of the native liver was complete. Allogeneic and xenogeneic hepatocytes remained viable. CONCLUSIONS: The implantable bioartificial liver was able to prevent death in this model of acute liver failure. This could be an important step toward clinical application of the method.

Animals↗
PubMed1998

[Surgical hysteroscopy in the treatment of septate uterus: systemic treatment or selective indications].

OBJECTIVES: A retrospective study to evaluate the fertility rate after endoscopic hysteroplasty in the case of a septate uterus. METHOD: From 1st January 1988-31st December 1996, 93 patients showing a septate uterus were treated by endoscopic hysteroplasty. The hospitalisation is short: one day surgery or out office. A control of uterine cavity by hysteroscopy did next to two months. RESULTS: Patients were evaluated after a period in excess of 6 months (6 months-8 years). 63 pregnancies were achieved amongst the 84 patients to be reviewed (75%). The fertility rate achieved is higher amongst infertile patients (80.3%) compared with that of sterile patients (64%). CONCLUSION: In the presence of septate uterus the endoscopic hysteroplasty is an efficient treatment in the case of secondary infertility and of unexplained sterility.

Adult↗
PubMed1998

[Birth after two cesarean sections: the role of trial of labor].

OBJECTIVE: To study the management of labor following two cesarean sections, we evaluated maternal and neonatal morbidity subsequent to this attitude. PATIENTS AND METHODS: A retrospective study was conducted over a 6-year period (1-1-1990 to 31-12-1995) in 184 women presenting two uterine scars. Trial of labor was allowed in 96 cases with cephalic presentation and a normal pelvis. RESULTS: The rate of vaginal birth was 65%. Three patients presented a uterine scar dehiscence and in one of them hemostasis hysterectomy for uterine atony was performed. Neonatal outcome was good in all cases. CONCLUSION: Trial of labor after two cesarean sections is possible in the majority of cases. Rate of vaginal birth is high and maternal and fetal morbidity is low.

Female↗
PubMed1998

[Vaginal myomectomy].

The authors present a retrospective study of 26 patients who have benefited from vaginal myomectomy after culdotomy in the Conception hospital in Marseille between 1992 and 1997. The myomectomy whom technic is described, was performed unically through the vagina or laparoscopically assisted. The mean operating time was 94 mn. The myoma mean weight was 184.3 g. Three patients experienced an abdominal surgery, twice because of a vaginal inaccessness. The immediate and mean-term post-operative period was uncomplicated in most cases. For screened patients, vaginal myomectomy appears as an interesting alternative to abdominal or laparoscopic surgery.

Adult↗
PubMed1998

[Hysteroscopic myomectomy. Functional results with an average follow-up of 6 years].

OBJECTIVE: In 1995, we presented our experience in hysteroscopic resection of hemorrhagic submucous fibroids in 196 patients. The objective of the present work was to analyze functional outcome three years later. PATIENTS: One hundred ninety-six patients with abnormal uterine bleeding were treated between 1987 and 1993. Equipment, techniques, characteristics of the procedures and early results were detailed in the previous article. RESULTS: With a mean follow-up of 73 months (range 50,104), results were: 13.8% of the patients were lost to follow-up; 68.4% had symptomatic improvement and failure was observed in 17.8% (subsequent hysterectomy in 12.7%). Forty-nine patients had repeat resection in this series; 61 became menopausal after surgery, and 21 were taking hormone replacement therapy with good results. CONCLUSION: Developed as an alternative to hysterectomy, operative hysteroscopy has proven to be a safe and effective procedure. This treatment modality appears to give satisfactory long-term results, with a low rate of complications.

Adult↗
PubMed1997

Endoscopic surgery. The end of classic surgery?

Gynecological endoscopy is now a well-established procedure and it has been proved that the laparoscopic surgical technique can be used in the management of most gynecological disorders thus replacing conventional laparotomic procedures. The latest indications apply to such functional pathologic conditions as urinary incontinence and genital prolapse, and oncology (radical hysterectomy, lymphadenectomy). Hysteroscopy has afforded an easier surgical approach to certain pathologies such as septate uterus and endometrial ablation. Indications of conventional surgery are getting fewer. Yet conventional surgery should be part of the training of the gynecologist surgeon as the laparotomic approach is still the only solution in the most difficult cases.

Endoscopy↗
PubMed1997

[Role of endo-uterine resection using hysteroscopy in the treatment of sub-mucous hemorrhagic fibroma in the peri-menopausal period].

OBJECTIVES: To study retrospectively the long-term outcome after hysteroscopic treatment for intra-uterine fibromas. METHODS: From October 1987 to January 1993, endo-uterine glycocol resection was performed in 196 patients with intra-uterine fibromas. The operation had to be repeated in 39 patients due to incomplete resection or recurrent symptomatology. Patients presented with menometrorrhage. RESULTS: Intra-operative complications were rare, mainly uterine perforations (7 cases) or metabolic syndromes due to reabsorption of glycine (5 cases). Mean follow-up was 2.5 years. In all 196 women consulted for bleeding, good results were achieved in 81.1%. CONCLUSION: Endo-uterine resection is a sure, effective and long-lasting treatment for intra-uterine fibromas.

Adult↗
PubMed1997

[Richter's spinofixation in vaginal prolapse].

The transvaginal sacrospinous fixation, called Richter operation was initially aimed to cure vaginal vault prolapse after hysterectomy. The results are as good as those of the abdominal promontory fixation with the well known advantages of the vaginal route. Indications way be extended to V3 U3 R3 prolapse and cure of elytrocele with good results in our practice. In few cases remnant cystocele may be a trouble some problem.

Adult↗