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Dujardin C, Balcaen T, Vanoost A, Chatelain D, Gondry J, Fumery M, Foulon A. [Risk factors for high-grade squamous intraepithelial lesions or cervical cancer in chronic inflammatory bowel disease]. Gynecol Obstet Fertil Senol 2024:S2468-7189(24)00012-6. [PMID: 38266774 DOI: 10.1016/j.gofs.2024.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 01/03/2024] [Accepted: 01/14/2024] [Indexed: 01/26/2024]
Abstract
INTRODUCTION Chronic inflammatory bowel disease (IBD) is thought to increase the risk of high-grade histological intraepithelial lesions (HGIL) and cervical cancer. The risk factors for developing these lesions are poorly understood. MATERIALS AND METHODS This is a single-center retrospective case-control study including IBD patients followed at our University Hospital Center from 2011 to 2021 who presented with HGIL or cervical cancer. Four controls were case-matched according to IBD type, age, active smoking and multiparity. RESULTS Eighteen cases and 72 controls were included. We found no significant differences between the 2 groups with regard to mean age at IBD diagnosis, mean duration of IBD, IBD location, history of IBD-related surgery or even association with another chronic inflammatory disease. In our study, the use of immunosuppressants/biotherapies in these patients [50% (9/18) for cases vs. 56% (40/72) for controls; P=0.9] was not a risk factor for IGRA or cervical cancer. Similarly, neither the total duration of exposure to immunosuppressants/biotherapies (9.9±8years for cases vs. 6.6±5.3years for controls; P=0.1), nor combined therapies [11% (2/18) for cases vs. 6% (4/72) for controls; P=0.3], nor azathioprine or methotrexate use [22% (4/18) for cases vs. 11% (8/72) for controls; P=0.3] were found to be risk factors. CONCLUSION In our study, we found no risk factors for patients with IBD to develop IGRA or cervical cancer.
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Affiliation(s)
- Clémence Dujardin
- Service de gynécologie-obstétrique, CHU Amiens Picardie, 1, boulevard du Pr-Christian-Cabrol, 80054 Amiens, France
| | - Thibault Balcaen
- Département d'information médicale, CHU Amiens Picardie, 1, boulevard du Pr-Christian-Cabrol, 80054 Amiens, France
| | - Antoine Vanoost
- Service de gynécologie-obstétrique, CHU Amiens Picardie, 1, boulevard du Pr-Christian-Cabrol, 80054 Amiens, France
| | - Denis Chatelain
- Service d'anatomo-cyto-pathologie, CHU Amiens Picardie, 1, boulevard du Pr-Christian-Cabrol, 80054 Amiens, France; UFR de médecine, université Picardie Jules-Vernes, 3, rue des Louvels, 80000 Amiens, France
| | - Jean Gondry
- Service de gynécologie-obstétrique, CHU Amiens Picardie, 1, boulevard du Pr-Christian-Cabrol, 80054 Amiens, France; UFR de médecine, université Picardie Jules-Vernes, 3, rue des Louvels, 80000 Amiens, France
| | - Mathurin Fumery
- Service de gastro-entérologie, CHU Amiens Picardie, 1, boulevard du Pr-Christian-Cabrol, 80054 Amiens, France; UFR de médecine, université Picardie Jules-Vernes, 3, rue des Louvels, 80000 Amiens, France
| | - Arthur Foulon
- Service de gynécologie-obstétrique, CHU Amiens Picardie, 1, boulevard du Pr-Christian-Cabrol, 80054 Amiens, France; UFR de médecine, université Picardie Jules-Vernes, 3, rue des Louvels, 80000 Amiens, France.
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Tonini F, Forret A, Lanta S, Gagneur O, Gondry J, Carcopino X, Foulon A. How to make a LLETZ simulator: LLETZ Simulator. J Gynecol Obstet Hum Reprod 2023; 52:102676. [PMID: 37805076 DOI: 10.1016/j.jogoh.2023.102676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 10/03/2023] [Accepted: 10/05/2023] [Indexed: 10/09/2023]
Abstract
Large loop excision of the transformation zone (LLETZ) of the uterine cervix is a surgical procedure very frequently performed. Simulation of LLETZ under colposcopic guidance has a major role in training practitioners. The objective was to present an ex vivo model of LLETZ.
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Affiliation(s)
- Flavio Tonini
- Service de Gynécologie-Obstétrique, Centre Hospitalier Universitaire Amiens Picardie, 1 Rond-Point du Professeur Christian Cabrol, 80000 Amiens, France
| | - Amaury Forret
- Service de Gynécologie-Obstétrique, Centre Hospitalier Universitaire Amiens Picardie, 1 Rond-Point du Professeur Christian Cabrol, 80000 Amiens, France; Faculté de Médecine, Université Picardie Jules Verne, 3 rue des Louvels, 80000 Amiens, France
| | - Ségolène Lanta
- Faculté de Médecine, Université Picardie Jules Verne, 3 rue des Louvels, 80000 Amiens, France
| | - Odile Gagneur
- Service de Gynécologie-Obstétrique, Centre Hospitalier Universitaire Amiens Picardie, 1 Rond-Point du Professeur Christian Cabrol, 80000 Amiens, France
| | - Jean Gondry
- Service de Gynécologie-Obstétrique, Centre Hospitalier Universitaire Amiens Picardie, 1 Rond-Point du Professeur Christian Cabrol, 80000 Amiens, France; Faculté de Médecine, Université Picardie Jules Verne, 3 rue des Louvels, 80000 Amiens, France
| | - Xavier Carcopino
- Service de Gynécologie-Obstétrique, Hôpital Nord, APHM, Aix-Marseille University (AMU), INSERM, IRD, UMR912 SESSTIM, Équipe Cancers, Biomédecine & Société, 13273 Marseille, France
| | - Arthur Foulon
- Service de Gynécologie-Obstétrique, Centre Hospitalier Universitaire Amiens Picardie, 1 Rond-Point du Professeur Christian Cabrol, 80000 Amiens, France; Faculté de Médecine, Université Picardie Jules Verne, 3 rue des Louvels, 80000 Amiens, France.
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Gayet I, Foulon A, Turck M, Jamard E, Morello R, Simonet T, Fauvet R. RACCE Study: Impact of an enhanced recovery after surgery program (ERAS) in the management of endometrial cancer: A single-center retrospective study. J Gynecol Obstet Hum Reprod 2023; 52:102543. [PMID: 36702400 DOI: 10.1016/j.jogoh.2023.102543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 01/06/2023] [Accepted: 01/20/2023] [Indexed: 01/25/2023]
Abstract
OBJECTIVE This study evaluates the implementation of an ERAS program in the gynecological surgery department of Caen University Hospital and its impact on the management of endometrial cancer. The objective was to show its impact on the length of hospitalization of patients before and after its implementation. PATIENTS AND METHOD We conducted a retrospective study including all women treated surgically for endometrial cancer at Caen University Hospital between January 1, 2015 and December 31, 2021. The ERAS program started in September 2017. We compared the pre-, intra- and postoperative characteristics of two groups: the first one concerning the period before the implementation of ERAS called « prior ERAS group » and the second one after implementation called « post ERAS group ». RESULTS A total of 198 patients were included in our study. 139 patients were included after ERAS implementation. Our study shows that there is a significant reduction in median length of stay between the post ERAS and prior ERAS groups respectively 3 and 4 days (p = 0.004). There was also a reduction of time to resume ambulation (p < 0.001) and re-feeding (p < 0.001) for the post ERAS group compared to the prior ERAS group. Complication rates (p = 0.87) and readmission rates (p = 0.28) were not significant. Overall survival was not significant (p = 0.28). CONCLUSION ERAS is a safe and effective method in the overall management of patients allowing an improvement in the quality of patient care and accelerating recovery to a previous physiological state. Finally, this results in a reduction in the patient's length of stay, without impacting morbidity and readmission rate.
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Affiliation(s)
- Inès Gayet
- Service de Gynécologie et d'Obstétrique, CHU Caen, 1 avenue de la côte de Nacre, F-14033 Caen, France
| | - Arthur Foulon
- Centre de Gynécologie et d'Obstétrique, Université Picardie Jules Verne, CHU Amiens Picardie, 1 rue du Professeur Christian Cabrol, F-80054 Amiens, France
| | - Mélusine Turck
- Service de Gynécologie et d'Obstétrique, CHU Caen, 1 avenue de la côte de Nacre, F-14033 Caen, France
| | - Estelle Jamard
- Service de Gynécologie et d'Obstétrique, CHU Caen, 1 avenue de la côte de Nacre, F-14033 Caen, France
| | - Rémy Morello
- Unit of Biostatistics and Clinical Research, University of Caen Hospital, Caen, France
| | - Thérèse Simonet
- Département d'Anesthésie et de Réanimation, CHU Caen, Avenue de la Côte de Nacre, Caen F-14033, France
| | - Raffaèle Fauvet
- Service de Gynécologie et d'Obstétrique, CHU Caen, 1 avenue de la côte de Nacre, F-14033 Caen, France; Université Caen Normandie, Esplanade de la Paix, CS 14032, F-14032 Caen, France; Unité INSERM ANTICIPE, Centre François Baclesse, 3 Ave du Général Harris, BP 5026, F-14076 Caen, France.
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Foulon A, Mancaux A, Theret P, Naepels P, Mychaluk J, Merviel P, Abboud P, Fauvet R. Efficacy and aesthetic outcomes for quilting sutures in the prevention of seroma after mastectomy. Sci Rep 2023; 13:1898. [PMID: 36732364 PMCID: PMC9894844 DOI: 10.1038/s41598-023-29154-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 01/31/2023] [Indexed: 02/04/2023] Open
Abstract
Worldwide, mastectomy for breast cancer is one of the most frequently performed surgical procedures. As one of the main complications of mastectomy, seroma is associated with pain, infections and a prolonged hospital stay. We performed a prospective multicenter randomized trial to assess the efficacy and esthetic outcomes associated with quilting the skin flap. Eighty-seven patients were included. The proportion of patients with seroma on postoperative day 15 was significantly lower in the quilting group (12 out of 39 (30.8%)) than in a control group with conventional wound closure (21 out of 40 (52.5%); P = 0.05). The mean breast seroma volume was significantly lower in the quilting group (130.2 mL) than in the control group (236.8 mL; P = 0.02). There were no differences in the esthetic outcomes. The pain level on day 1 was similar in the quilting and control groups (mean visual analog scale score: 2.5 vs. 2.1, respectively; P = 0.3). Quilting the skin flap was associated with a lower prevalence of seroma and a lower seroma volume, and did not worsen the esthetic outcomes or pain levels. This technique is technically straightforward and should be offered to all patients scheduled for mastectomy.
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Affiliation(s)
- Arthur Foulon
- Service de Gynécologie Obstétrique, CHU Amiens Picardie, 1 Rond-Point Bd du Pr Christian Cabrol, 80000, Amiens, France.
| | - Albine Mancaux
- Service de Gynécologie Obstétrique, CHU Amiens Picardie, 1 Rond-Point Bd du Pr Christian Cabrol, 80000, Amiens, France
| | - Pierrick Theret
- Service de Gynécologie Obstétrique, CHU Amiens Picardie, 1 Rond-Point Bd du Pr Christian Cabrol, 80000, Amiens, France
| | - Philippe Naepels
- Service de Gynécologie Obstétrique, CHU Amiens Picardie, 1 Rond-Point Bd du Pr Christian Cabrol, 80000, Amiens, France
| | - Johanna Mychaluk
- Service de Gynécologie, CH Compiègne, 8 Avenue Henri Adnot, 60200, Compiègne, France
| | - Philippe Merviel
- Service de Gynécologie, CHU Brest, 2 Avenue Foch, 29200, Brest, France.,Université Occidentale de Bretagne, UFR de Médecine, 3 Rue Des Archives, 29238, Brest, France
| | - Pascal Abboud
- Service de Gynécologie, CH Soissons, 46 aAvenue du Général de Gaulle, 02200, Soissons, France
| | - Raffaele Fauvet
- Service de Gynécologie, CHU Caen Normandie, 1 Bd de La Côte de Nacre, 14000, Caen, France.,Université Caen Normandie, UFR de Médecine, Espl. de La Paix, 14000, Caen, France
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Krief D, Foulon A, Tondreau A, Diouf M, Sergent F, Gondry J, Chevreau J. Transperineal ultrasound in routine uterine cervix measurement. Arch Gynecol Obstet 2023; 307:387-393. [PMID: 35318500 DOI: 10.1007/s00404-022-06521-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Accepted: 03/09/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE Transvaginal ultrasound (TVUS) is used in routine practice to evaluate cervical length (CL). This technique is nevertheless invasive and often viewed as uncomfortable, which is less the case with transperineal ultrasound (TPUS). This study was conducted in light of recent technological improvements in the ultrasound field to evaluate whether TPUS could be used as an alternative to TVUS in CL assessment. METHODS This was a prospective single-blind study. Pregnant women requiring CL measurement during their emergency consultation were offered a second assessment by TPUS after an initial TVUS. TPUS was performed by a third-year OBGYN resident, unaware of the CL measurement obtained via TVUS. RESULTS Seventy-three women were included. The mean ∂ was 0.59 mm. The interclass Pearson correlation coefficient between the two techniques was 0.8987 (95% CI [0.8429; 0.9353]). None of the tested factors were found to be associated with a difference between TPUS and TVUS CL measurements. ROC curve analysis indicated that a transperineal CL cut-off measurement of 24.9 mm was predictive of a transvaginal CL measurement below 25 mm. This threshold enabled a 95% sensitivity [75.1-99.9%] and a 100% specificity [93.3-100%] for the TPUS CL measurement technique. CONCLUSION TPUS should be acknowledged as a reliable alternative to TVUS for CL assessment in routine every day practice.
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Affiliation(s)
- David Krief
- Obstetrics and Gynecology Department, CHU Amiens Picardie, Amiens-Picardie University Hospital, 1 rond-point du Pr Christian Cabrol, 80054, Amiens cedex 1, France
| | - Arthur Foulon
- Obstetrics and Gynecology Department, CHU Amiens Picardie, Amiens-Picardie University Hospital, 1 rond-point du Pr Christian Cabrol, 80054, Amiens cedex 1, France.
| | - Ambre Tondreau
- Obstetrics and Gynecology Department, CHU Amiens Picardie, Amiens-Picardie University Hospital, 1 rond-point du Pr Christian Cabrol, 80054, Amiens cedex 1, France
| | - Momar Diouf
- Clinical Research Department, Amiens-Picardie University Hospital, 80000, Amiens, France
| | - Fabrice Sergent
- Obstetrics and Gynecology Department, CHU Amiens Picardie, Amiens-Picardie University Hospital, 1 rond-point du Pr Christian Cabrol, 80054, Amiens cedex 1, France
| | - Jean Gondry
- Obstetrics and Gynecology Department, CHU Amiens Picardie, Amiens-Picardie University Hospital, 1 rond-point du Pr Christian Cabrol, 80054, Amiens cedex 1, France
| | - Julien Chevreau
- Obstetrics and Gynecology Department, CHU Amiens Picardie, Amiens-Picardie University Hospital, 1 rond-point du Pr Christian Cabrol, 80054, Amiens cedex 1, France
- Obstetrics and Gynecology Department, Jura Bernois Hospital, 2345, Saint Imier, Switzerland
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Benarous X, Brocheton C, Bonnay C, Boissel L, Crovetto C, Lahaye H, Guilé JM, Theret P, Gondry J, Foulon A. Postpartum maternal anxiety and depression during COVID-19 pandemic: Rates, risk factors and relations with maternal bonding. Neuropsychiatr Enfance Adolesc 2023; 71:44-51. [PMID: 36540656 PMCID: PMC9755008 DOI: 10.1016/j.neurenf.2022.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Objectives This study aims to determine the rates of clinically-significant anxiety and depressive symptoms during the immediate postpartum in a sample of women referred to a university maternity department, as well as the associated risk factors and the relations with the level of maternal bonding. Patients and methods During the third national lockdown for the COVID-19 pandemic (February-April 2021), on days 2-3 after delivery 127 mothers were administrated the Edinburgh postnatal depression scale (EPDS), the state-trait anxiety inventory (STAI-YA), the mother-to-infant bonding scale (MIBS) and questions issued from the coronavirus health impact survey questionnaire (CRISIS). Results The rate of perinatal clinically-significant symptoms were 17% for depression (EPDS cut-off ≥ 12) and 15% for anxiety (STAI-YA cut-off ≥ 40). In the multivariate analysis, being a single mother, risk of being infected by the SARS-CoV2, risk that a close relative might be infected by the SARS-CoV2 and the length of stay in maternity were associated with an increased EPDS total score, while breastfeeding was associated with a lower EPDS total score. Six variables remained positively associated with the STAI-YA total score in the multivariate model: the maternal level of academic achievement, a hospitalization during the pregnancy, peripartum medical complications, risk of being infected by the SARS-CoV2, risk of a close relative being infected by the SARS-CoV2 and physical fatigue. Low but statistically significant correlations were found between the MIBS total score and the EPDS total score (rs = 0.26) and with the STAI-YA total score (rs = 0.26). Discussion The observed rates of anxiety and depressive symptoms were in the same range as those reported in observational studies conducted in high-resource countries during the COVID-19 pandemic. Risk of being infected by the SARS-CoV2 was both an independent risk factor for anxiety and depressive symptoms. The relations between the measure of maternal bonding and the severity of maternal emotional symptoms call for a better consideration of the long-term consequences of the pandemic on children's socio-emotional development.
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Affiliation(s)
- X. Benarous
- Department of Child and Adolescent Psychopathology, Amiens University Hospital, CHU Amiens-Picardie, Site Sud, 80054 Amiens, France,INSERM Unit U1105 Research Group for Analysis of the Multimodal Cerebral Function, University of Picardy Jules Verne (UPJV), Amiens, France,Corresponding author
| | - C. Brocheton
- INSERM Unit U1105 Research Group for Analysis of the Multimodal Cerebral Function, University of Picardy Jules Verne (UPJV), Amiens, France
| | - C. Bonnay
- Service de gynécologie-obstétrique, Amiens University Hospital, Amiens, France
| | - L. Boissel
- Department of Child and Adolescent Psychopathology, Amiens University Hospital, CHU Amiens-Picardie, Site Sud, 80054 Amiens, France,INSERM Unit U1105 Research Group for Analysis of the Multimodal Cerebral Function, University of Picardy Jules Verne (UPJV), Amiens, France
| | - C. Crovetto
- Department of Child and Adolescent Psychopathology, Amiens University Hospital, CHU Amiens-Picardie, Site Sud, 80054 Amiens, France
| | - H. Lahaye
- Department of Child and Adolescent Psychopathology, Amiens University Hospital, CHU Amiens-Picardie, Site Sud, 80054 Amiens, France,INSERM Unit U1105 Research Group for Analysis of the Multimodal Cerebral Function, University of Picardy Jules Verne (UPJV), Amiens, France
| | - J.-M. Guilé
- Department of Child and Adolescent Psychopathology, Amiens University Hospital, CHU Amiens-Picardie, Site Sud, 80054 Amiens, France,INSERM Unit U1105 Research Group for Analysis of the Multimodal Cerebral Function, University of Picardy Jules Verne (UPJV), Amiens, France,Child and Adolescent Psychiatrie Department, Établissement Publique de Santé Mentale de la Somme, France
| | - P. Theret
- Service de gynécologie-obstétrique, Amiens University Hospital, Amiens, France
| | - J. Gondry
- INSERM Unit U1105 Research Group for Analysis of the Multimodal Cerebral Function, University of Picardy Jules Verne (UPJV), Amiens, France,Service de gynécologie-obstétrique, Amiens University Hospital, Amiens, France
| | - A. Foulon
- INSERM Unit U1105 Research Group for Analysis of the Multimodal Cerebral Function, University of Picardy Jules Verne (UPJV), Amiens, France,Service de gynécologie-obstétrique, Amiens University Hospital, Amiens, France
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Delannoy L, Foulon A, Naepels P, Mancaux A, Théret P, Sergent F. [Interest of systematic shavings to reduce reoperation in breast-conserving surgery of breast cancer]. Gynecol Obstet Fertil Senol 2022; 50:395-401. [PMID: 34896637 DOI: 10.1016/j.gofs.2021.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 12/03/2021] [Accepted: 12/03/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVE The INCa and HAS have developed quality and safety indicators for care specific to breast cancer. Among these, in the conservative surgery of this cancer includes the reoperation rate: target˂10%, alert>20%. The main objective of our study was to evaluate whether the practice of systematic recuts still called "shaving" would meet the objectives of the indicators. METHODS Observational, retrospective, single-center study over two years in a regional referral center. Two groups of patients were compared: one with "shaving" and one without (no shaving or oriented shaving). RESULTS In total, 381 patients were operated on, including 48 (12.6%) with shaving and 333 (87.4%) without. Revision rates for damaged margins were 18.75% (9/48) in the shaving group which met the quality criterias vs. 23.7% (79/333) which did not satisfy them; P=0.4. Furthermore, the rate of discovery of occult sites on recuts was higher in the shaving group: 22.9% (11/48) vs. 9.9% (33/333); P=0.02. In the shaving group, 10.4% (5/48) of the patients were resected again for damaged margins for the initial cancer vs. 18.6% (62/333) in the group without shaving; P=0.23. CONCLUSION Our study confirms the interest of performing "shaving" to meet the requirements of the INCa and HAS quality criteria. The absence of systematic cross-sectioning leads to the risk of not recognizing the existence of occult sites. However, the discovery of occult cancers does not significantly reduce the rate of repeat surgery.
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Affiliation(s)
- L Delannoy
- Service de gynécologie-obstétrique et médecine de la reproduction, CHU d'Amiens-Picardie Site Sud, 1, rond-point du Professeur Christian-Cabrol, 80054 Amiens cedex 1, France
| | - A Foulon
- Service de gynécologie-obstétrique et médecine de la reproduction, CHU d'Amiens-Picardie Site Sud, 1, rond-point du Professeur Christian-Cabrol, 80054 Amiens cedex 1, France; Université Picardie Jules-Verne, 1, chemin du Thil - CS 52501, Amiens cedex 1, France
| | - P Naepels
- Service de gynécologie-obstétrique et médecine de la reproduction, CHU d'Amiens-Picardie Site Sud, 1, rond-point du Professeur Christian-Cabrol, 80054 Amiens cedex 1, France
| | - A Mancaux
- Service de gynécologie-obstétrique et médecine de la reproduction, CHU d'Amiens-Picardie Site Sud, 1, rond-point du Professeur Christian-Cabrol, 80054 Amiens cedex 1, France
| | - P Théret
- Service de gynécologie-obstétrique et médecine de la reproduction, CHU d'Amiens-Picardie Site Sud, 1, rond-point du Professeur Christian-Cabrol, 80054 Amiens cedex 1, France
| | - F Sergent
- Service de gynécologie-obstétrique et médecine de la reproduction, CHU d'Amiens-Picardie Site Sud, 1, rond-point du Professeur Christian-Cabrol, 80054 Amiens cedex 1, France; Université Picardie Jules-Verne, 1, chemin du Thil - CS 52501, Amiens cedex 1, France.
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Azaïs H, Simonet T, Foulon A, Fauvet R, Louis-Sylvestre C, Texier C, Bourdel N, Villefranque V, Salaün JP, Canlorbe G. Perioperative parameters to consider for enhanced recovery in surgery (ERS) in gynecology (excluding breast surgery). J Gynecol Obstet Hum Reprod 2022; 51:102372. [PMID: 35395432 DOI: 10.1016/j.jogoh.2022.102372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 04/04/2022] [Indexed: 10/18/2022]
Abstract
The current review explores the Enhanced Rehabilitation in Surgery (ERS) approach in the specific context of gynecological surgery. Implementation of an ERS protocol in gynecological surgery reduces postoperative complications and length of stay without increasing morbidity. An ERS approach is based on maintaining an adequate diet and hydration before the operation, according to the recommended time frame, to reduce the phenomenon of insulin resistance, and to optimize patient comfort. On the other hand, the use of anxiolytic treatment as premedication is not recommended. Systematic preoperative digestive preparation, a source of patient discomfort, is not associated with an improvement in the postoperative functional outcome or with a reduction in the rate of complications. A minimally invasive surgical approach is preferrable in the context of ERS. Prevention of surgical site infection includes measures such as optimized antibiotic prophylaxis, skin disinfection with alcoholic chlorhexidine, reduction in the use of drainage of the surgical site, and prevention of hypothermia. Early removal of the bladder catheter is associated with a reduction in the risk of urinary tract infection and a reduction in the length of hospital stay. Prevention of postoperative ileus is based on early refeeding, and prevention of postoperative nausea-vomiting in a multimodal strategy to be initiated during the intraoperative period. Intraoperative hydration should be aimed at achieving euvolemia. Pain control is based on a multimodal strategy to spare morphine use and may include locoregional analgesia. Medicines should be administered orally during the postoperative period to hasten the resumption of the patient's autonomy. The prevention of thromboembolic risk is based on a strategy combining drug prophylaxis, when indicated, and mechanical restraint, as well as early mobilization. However, the eclectic nature of the implementation of these measures as reported in the literature renders their interpretation difficult. Furthermore, beyond the application of one of these measures in isolation, the best benefit on the postoperative outcome is achieved by a combination of measures which then constitutes a global strategy allowing the objectives of the ERS to be met.
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Affiliation(s)
- Henri Azaïs
- Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpital Européen Georges Pompidou, service de chirurgie cancérologique gynécologique et du sein, F-75015, Paris, France..
| | - Thérèse Simonet
- CHU Caen, Department of Anesthesiology and Critical Care Medicine, Caen University Hospital, Avenue de la Côte de Nacre, Caen, F-14033, France
| | - Arthur Foulon
- Centre de Gynécologie-Obstétrique, Université Picardie Jules Verne, CHU Amiens Picardie, 1 rue du Professeur Christian Cabrol, F-80054, Amiens, France
| | - Raffaele Fauvet
- Obstetrics and Gynecology Department, Caen Normandy University Hospital, 1 avenue de la côte de Nacre, F-14000, Caen, France; Université Caen Normandie, Esplanade de la Paix, CS 14032, F-14032, Caen, France; INSERM ANTICIPE Unit, Centre François Baclesse, 3 Ave du Général Harris, BP 5026, F-14076, Caen, France
| | | | - Célia Texier
- Department of Gynecological Surgery, CHU of Clermont Ferrand, 1 Place Lucie Aubrac, F-63 003, Clermont, Ferrand, France
| | - Nicolas Bourdel
- Department of Gynecological Surgery, CHU of Clermont Ferrand, 1 Place Lucie Aubrac, F-63 003, Clermont, Ferrand, France
| | - Vincent Villefranque
- Maternity Department, Simone Veil Hospital, 14 rue de Saint Prix, F-95600, Eaubonne, France
| | - Jean-Philippe Salaün
- CHU Caen, Department of Anesthesiology and Critical Care Medicine, Caen University Hospital, Avenue de la Côte de Nacre, Caen, F-14033, France
| | - Geoffroy Canlorbe
- Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpital Pitié-Salpêtrière, service de chirurgie et oncologie gynécologique et mammaire, F-75013, Paris, France.; Sorbonne université, biologie et thérapeutique du cancer, centre de recherche Saint-Antoine (CRSA), Paris, France
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Foulon A, Alfonsi P, Slim K, Bourdel N, Fauvet R, Villefranque V, Canlorbe G, Simonet T, Azaïs H, Philippe HJ. To what extent is enhanced recovery in surgery used in French obstetrics and gynecology departments?: use of enhanced recovery in gynecologic and obstetric surgery in France. J Gynecol Obstet Hum Reprod 2022; 51:102374. [PMID: 35395433 DOI: 10.1016/j.jogoh.2022.102374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 04/04/2022] [Indexed: 11/27/2022]
Abstract
The objective of the present study was to evaluate the implementation of Enhanced Recovery in Surgery (ERS) in French obstetrics and gynecology departments. To achieve this objective, we drafted an online questionnaire about ERS protocols for caesarean sections and hysterectomies with a benign indication and put a hyperlink on the 'French National College of Gynecologists and Obstetricians' (Collège National des Gynécologues et Obstétriciens Français) website. We obtained 112 analyzable responses. Respectively 66% and 34% of the surveyed departments had established ERS protocols for cesarean sections and for hysterectomies with a benign indication. However, not all of the key ERS items were sufficiently implemented: despite the establishment of written protocols, the degree of compliance with the guidelines issued by the French-Speaking Group for Enhanced Recovery After Surgery (Groupement Francophone de Réhabilitation Améliorée Après Chirurgie) was variable. There are few published data on the implementation of ERS in obstetrics and gynecology departments worldwide. In 2010, the Enhanced Recovery After Surgery® Society issued guidelines and a checklist for an ERS protocol. The literature data suggest that for most surgical disciplines, the main ERS criteria are not well known or not widely applied. ERS protocols are still not widespread in French gynecologic surgery departments. Moreover, the application of some of the major ERS items differs markedly from one ERS program to other, which is likely to reduce the level of effectiveness. It therefore appears to be essential to formalize and promote ERS protocols in gynecological surgery.
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Affiliation(s)
- Arthur Foulon
- Center of Gynecology-Obstetrics, University Picardie Jules Verne, CHU Amiens Picardie, 1 rue du Professeur Christian Cabrol, F-80054 Amiens, France.
| | - Pascal Alfonsi
- Department of Anesthesia, University of Paris Descartes, Groupe Hospitalier Paris Saint-Joseph, 185 rue Raymond Losserand, F-75674 Paris cedex 14, France
| | - Karem Slim
- Digestive Surgery Department and Ambulatory Surgery Unit, University of Clermont Auvergne, CHU Estaing, 1 Place Lucie Aubrac 63003 Clermont-Ferrand, France and GRACE (French-Speaking Group for Enhanced Recovery after Surgery)
| | - Nicolas Bourdel
- Department of Gynecological Surgery, CHU of Clermont Ferrand, 1 Place Lucie Aubrac, F-63 003 Clermont Ferrand, France
| | - Raffaèle Fauvet
- Obstetrics and Gynecology Department, Caen Normandy University Hospital, 1 avenue de la côte de Nacre, F-14000 Caen, France; Université Caen Normandie, Esplanade de la Paix, CS 14032, F-14032 Caen, France; INSERM ANTICIPE Unit, Centre François Baclesse, 3 Ave du Général Harris, BP 5026, F-14076 Caen, France
| | - Vincent Villefranque
- Maternity Department, Simone Veil Hospital, 14 rue de Saint Prix, F-95600 Eaubonne, France
| | - Geoffroy Canlorbe
- AP-HP, Hôpital Pitié-Salpêtrière, Gynecological oncological surgery unit, Faculté de Médecine UPMC, Sorbonne Université, F-75013 Paris, France
| | - Thérèse Simonet
- CHU Caen, Department of Anesthesiology and Critical Care Medicine, Caen University Hospital, Avenue de la Côte de Nacre, Caen F-14033, France
| | - Henri Azaïs
- AP-HP, Hôpital Européen Georges-Pompidou, department of gynecological oncological surgery, F-75015 Paris, France
| | - Henri-Jean Philippe
- Ambulatory Surgery Department, Paris Descartes University, Cochin Hospital, 27 Rue du Faubourg Saint-Jacques, F-75014 Paris, France
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Foulon A, Fauvet R, Villefranque V, Bourdel N, Simonet T, Sylvestre CL, Canlorbe G, Azaïs H. Definition, general principles and expected benefits of Enhanced Recovery in Surgery. J Gynecol Obstet Hum Reprod 2022; 51:102373. [DOI: 10.1016/j.jogoh.2022.102373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 04/04/2022] [Indexed: 10/18/2022]
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Faujour V, Targe SC, Berthier S, Azaïs H, Fauvet R, Foulon A. Implementing enhanced recovery after surgery programmes in a healthcare facility: issues and economic impacts. J Gynecol Obstet Hum Reprod 2022; 51:102375. [DOI: 10.1016/j.jogoh.2022.102375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 04/05/2022] [Indexed: 11/17/2022]
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Graff I, De Broucker C, Vargas J, Vanoost A, Gondry J, Foulon A. [COVID-19 and lockdown: Impact on pregnancy complications]. Gynecol Obstet Fertil Senol 2022; 50:236-239. [PMID: 34915137 PMCID: PMC8668785 DOI: 10.1016/j.gofs.2021.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 12/04/2021] [Accepted: 12/06/2021] [Indexed: 11/26/2022]
Abstract
Introduction L’apparition de la COVID-19 a entraîné la mise en place d’un confinement en France du 17 mars au 11 mai 2020. Notre étude a pour but d’évaluer l’impact du confinement sur le taux d’hospitalisation pour menace d’accouchement prématuré et sur le taux d’accouchement prématuré. Méthodes Étude épidémiologique rétrospective multicentrique réalisée sur la période du confinement du 15 mars au 31 mai 2020, comparée à la même période au cours des deux années précédentes (2018 et 2019) dans les hôpitaux de Picardie (Centre Hospitalier Universitaire Amiens Picardie, Centres Hospitaliers de Beauvais, Compiègne et Saint-Quentin). Résultats Au total, 608 patientes ont été incluses. Nous retrouvons une réduction significative du taux de rupture prématuré des membranes (16,9 % [73/432] en 2018/2019 vs 9,7 % [17/176] en 2020 ; p = 0,02), ainsi que du taux d’accouchement prématuré (9,3 % [276/2961] en 2018/2019 vs 6,8 % [96/1416] en 2020 ; p < 0,05) sur l’ensemble des hôpitaux. Notre étude met également en évidence une diminution des hospitalisations (207 en 2019 vs 176 en 2020). Conclusion Il est observé, au cours de la première période de confinement, une réduction du taux d’accouchement prématuré. Il serait, par ailleurs, intéressant d’évaluer l’impact psychologique du confinement.
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Affiliation(s)
- I Graff
- Service de gynécologie-obstétrique, CHU d'Amiens-Picardie, 1, boulevard du Professeur Christian-Cabrol, 80054 Amiens, France
| | - C De Broucker
- Service de gynécologie-obstétrique, CHU d'Amiens-Picardie, 1, boulevard du Professeur Christian-Cabrol, 80054 Amiens, France; UFR de médecine, université Picardie Jules-Vernes, 3, rue des Louvels, 80000 Amiens, France
| | - J Vargas
- Service de gynécologie-obstétrique, CHU d'Amiens-Picardie, 1, boulevard du Professeur Christian-Cabrol, 80054 Amiens, France
| | - A Vanoost
- Service de gynécologie-obstétrique, CHU d'Amiens-Picardie, 1, boulevard du Professeur Christian-Cabrol, 80054 Amiens, France
| | - J Gondry
- Service de gynécologie-obstétrique, CHU d'Amiens-Picardie, 1, boulevard du Professeur Christian-Cabrol, 80054 Amiens, France; UFR de médecine, université Picardie Jules-Vernes, 3, rue des Louvels, 80000 Amiens, France
| | - A Foulon
- Service de gynécologie-obstétrique, CHU d'Amiens-Picardie, 1, boulevard du Professeur Christian-Cabrol, 80054 Amiens, France; UFR de médecine, université Picardie Jules-Vernes, 3, rue des Louvels, 80000 Amiens, France.
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Bagory H, De Broucker C, Tourneux P, Balcaen T, Gondry J, Foulon A, Sergent F. [Efficacy and safety of oral misoprostol 25μg vs. vaginal dinoprostone in induction of labor at term]. Gynecol Obstet Fertil Senol 2022; 50:229-235. [PMID: 34871786 DOI: 10.1016/j.gofs.2021.11.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 10/29/2021] [Accepted: 11/28/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To compare the efficacy and safety of oral misoprostol 25μg compared to vaginal dinoprostone in the induction of labor at term. METHODS Analytic, retrospective study of patients induced at term by prostaglandins with an unfavorable cervix, over two consecutive periods from 01/01/2019 to 19/02/2020 and from 20/02/2020 to 07/04/2021, within a regional level III university hospital center. We compared the safety and the efficacy between the oral misoprostol Angusta® used since 20/02/2020 and the vaginal dinoprostone previously used in gel or diffuser. The primary endpoint was the rate of vaginal deliveries within 24h. Secondary endpoints were cesarean section rate, indications for cesarean section, uterine contractility abnormalities and neonatal outcomes. RESULTS Our study found no difference in terms of efficacy with similar rates of vaginal deliveries within 24h (51.88% vs. 51.25%; P=0.87) and caesarean sections (misoprostol group: 19.42% vs. dinoprostone group: 16.62%; P=0.33). However, the tolerance criteria revealed in the dinoprostone group an increase in tachysystole (misoprostol group: 9.28% vs. dinoprostone group: 16.90%; P=0.003) and acidosis (arterial pH<7.10, misoprostol group: 3.83% vs. dinoprostone group: 9.29%; P=0.006). CONCLUSION No difference in efficacy was found between the two induction techniques. Oral misoprostol 25μg seems to be better tolerated from a maternal and fetal point of view.
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Affiliation(s)
- H Bagory
- Service de gynécologie-obstétrique et médecine de la reproduction, pôle Femme Couple - Enfants, CHU Amiens-Picardie, 1, rond-point du Professeur-Christian-Cabrol, 80054 Amiens cedex 1, France; Université Picardie Jules-Verne, faculté de médecine, 3, rue des Louvels, 80000 Amiens, France.
| | - C De Broucker
- Service de gynécologie-obstétrique et médecine de la reproduction, pôle Femme Couple - Enfants, CHU Amiens-Picardie, 1, rond-point du Professeur-Christian-Cabrol, 80054 Amiens cedex 1, France; Université Picardie Jules-Verne, faculté de médecine, 3, rue des Louvels, 80000 Amiens, France
| | - P Tourneux
- PériTox UM_I 01, université Picardie Jules-Verne, faculté de médecine, 3, rue des Louvels, 80000 Amiens, France; Université Picardie Jules-Verne, faculté de médecine, 3, rue des Louvels, 80000 Amiens, France; Service de néonatalogie, pôle Femme Couple - Enfants, CHU Amiens-Picardie, 1, rond-point du Professeur-Christian-Cabrol, 80054 Amiens cedex 1, France
| | - T Balcaen
- Service d'information médicale, pôle PRIME, CHU Amiens-Picardie, 1, rond-point du Professeur-Christian-Cabrol, 80054 Amiens cedex 1, France
| | - J Gondry
- Service de gynécologie-obstétrique et médecine de la reproduction, pôle Femme Couple - Enfants, CHU Amiens-Picardie, 1, rond-point du Professeur-Christian-Cabrol, 80054 Amiens cedex 1, France; Université Picardie Jules-Verne, faculté de médecine, 3, rue des Louvels, 80000 Amiens, France
| | - A Foulon
- Service de gynécologie-obstétrique et médecine de la reproduction, pôle Femme Couple - Enfants, CHU Amiens-Picardie, 1, rond-point du Professeur-Christian-Cabrol, 80054 Amiens cedex 1, France; Université Picardie Jules-Verne, faculté de médecine, 3, rue des Louvels, 80000 Amiens, France
| | - F Sergent
- Service de gynécologie-obstétrique et médecine de la reproduction, pôle Femme Couple - Enfants, CHU Amiens-Picardie, 1, rond-point du Professeur-Christian-Cabrol, 80054 Amiens cedex 1, France; Université Picardie Jules-Verne, faculté de médecine, 3, rue des Louvels, 80000 Amiens, France
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Tonini F, Michel D, Foulon A. An unusual cause of cervical bleeding. Int J Gynecol Cancer 2022; 32:214. [DOI: 10.1136/ijgc-2021-002715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/04/2021] [Indexed: 11/04/2022] Open
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Roullier C, Sanguin S, Parent C, Lombart M, Sergent F, Foulon A. General practitioners and endometriosis: Level of knowledge and the impact of training. J Gynecol Obstet Hum Reprod 2021; 50:102227. [PMID: 34520875 DOI: 10.1016/j.jogoh.2021.102227] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 08/30/2021] [Accepted: 09/07/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To assess general practitioners' (GPs') knowledge of and practice in the diagnosis and management of endometriosis following the publication of updated French national guidelines in 2017. MATERIALS AND METHODS A descriptive, anonymous, epidemiological survey of 102 GPs in the Picardie region of France. RESULTS Only 25% of the GPs considered that they knew enough about endometriosis for their routine clinical practice. This proportion was 58.9% amongst GPs with an university diploma in gynaecology and 31.4% amongst those participating in continuing medical education courses on gynaecology. Only 19.6% of the GPs were aware of the updated French national guidelines. With regard to five main suggestive, localizing signs of endometriosis, dyspareunia, dysmenorrhoea and infertility were mentioned as being of diagnostic value by 55.9%, 37.3% and 43.1% of the GPs, respectively; in contrast, functional urinary tract disorders and painful defecation were not mentioned very often. GPs with a qualification in gynaecology and those participating in continuing medical education in gynaecology knew more about treating endometriosis. CONCLUSION In the Picardie region of France, GPs appear to be only moderately aware of how to manage endometriosis; this probably contributes to the diagnostic delay associated with this condition. GPs with a university diploma in gynaecology and those participating in continuing medical education in gynaecology appeared to have a better grasp of the subject. Continuing medical education on this topic should therefore be promoted and expanded.
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Affiliation(s)
- Chloé Roullier
- Département de médecine générale, Faculté de Médecine, Université Picardie Jules Verne, 3 rue des Louvels, 80000 Amiens, France
| | - Sophie Sanguin
- Service de gynécologie et d'obstétrique, CHU Amiens Picardie, 1 Bd du Pr Christian Cabrol, 80054 Amiens, France
| | - Camille Parent
- Service de gynécologie et d'obstétrique, CHU Amiens Picardie, 1 Bd du Pr Christian Cabrol, 80054 Amiens, France
| | - Mélyne Lombart
- Service de gynécologie et d'obstétrique, CHU Amiens Picardie, 1 Bd du Pr Christian Cabrol, 80054 Amiens, France
| | - Fabrice Sergent
- Service de gynécologie et d'obstétrique, CHU Amiens Picardie, 1 Bd du Pr Christian Cabrol, 80054 Amiens, France; Faculté de Médecine, Université Picardie Jules Verne, 3 rue des Louvels, 80000 Amiens, France
| | - Arthur Foulon
- Service de gynécologie et d'obstétrique, CHU Amiens Picardie, 1 Bd du Pr Christian Cabrol, 80054 Amiens, France.
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Benson B, Theret P, Tonini F, Marang A, Sergent F, Gondry J, Foulon A. [Peripartum cardiomyopathy: A review of the literature]. ACTA ACUST UNITED AC 2021; 50:266-271. [PMID: 34481099 DOI: 10.1016/j.gofs.2021.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Indexed: 10/20/2022]
Abstract
Peripartum cardiomyopathy is a rare and unpredictable pregnancy-related pathology. Idiopathic cardiomyopathy is characterized by a heart failure secondary to left ventricular systolic dysfunction appearing towards the end of pregnancy or in the months following delivery with a non-specific clinic presentation. Through reviewing previous research, our critical literature review wishes to bring a concise and objective summarize for a better understanding of physiopathology, evocative symptoms and knowing of factors influencing prognosis in order to standardize peripartum management. The treatment remains mainly symptomatic but other promising treatments are still in development. In conclusion, early detection and treatment allow a better cardiac function recovery reducing cardiac transplantation.
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Affiliation(s)
- B Benson
- Service de gynécologie-obstétrique, CHU d'Amiens Picardie, 1, rond-point du Professeur-Christian-Cabrol, 80000 Amiens, France
| | - P Theret
- Service de gynécologie-obstétrique, CHU d'Amiens Picardie, 1, rond-point du Professeur-Christian-Cabrol, 80000 Amiens, France; Service de gynécologie-obstétrique, centre hospitalier de Saint-Quentin, 1, avenue Michel-de-l'Hospital, BP 608, 02321 Saint-Quentin, France
| | - F Tonini
- Service de gynécologie-obstétrique, CHU d'Amiens Picardie, 1, rond-point du Professeur-Christian-Cabrol, 80000 Amiens, France
| | - A Marang
- Service de cardiologie, centre hospitalier régional universitaire Tours, avenue de la République, 37170 Chambray-les-Tours, France
| | - F Sergent
- Service de gynécologie-obstétrique, CHU d'Amiens Picardie, 1, rond-point du Professeur-Christian-Cabrol, 80000 Amiens, France; Faculté de médecine, université Picardie Jules-Verne, 3, rue des Louvels, 80000 Amiens, France
| | - J Gondry
- Service de gynécologie-obstétrique, CHU d'Amiens Picardie, 1, rond-point du Professeur-Christian-Cabrol, 80000 Amiens, France; Faculté de médecine, université Picardie Jules-Verne, 3, rue des Louvels, 80000 Amiens, France
| | - A Foulon
- Service de gynécologie-obstétrique, CHU d'Amiens Picardie, 1, rond-point du Professeur-Christian-Cabrol, 80000 Amiens, France.
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Sanguin S, Roman H, Foulon A, Gondry J, Havet E, Klein C. Deep infiltrating endometriosis with sacral plexus involvement: Improving knowledge through human cadaver dissection. J Gynecol Obstet Hum Reprod 2021; 50:102129. [PMID: 33781973 DOI: 10.1016/j.jogoh.2021.102129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 02/19/2021] [Accepted: 03/19/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION The aim of this study was to assess a human cadaver model of sacral plexus dissection for learning about deep innervation in the female pelvis, and the latter's relationship with deep infiltrating endometriosis. METHODS This was a prospective, observational study. Eight residents in obstetrics and gynecology were tested before and after a lecture on innervation of the female pelvis and a cadaver dissection class. Standardized cadaver dissection was used to identify the sacral nerve roots S2 to S4, superior and inferior hypogastric plexuses, hypogastric nerve, and splanchnic nerves. RESULTS The residents' level of knowledge improved significantly after a one-hour lecture (p = 0.9.10-5) and after a cadaver dissection class (p = 0.6.10-6). The improvement was significantly greater for the dissection class (p = 0.0003). All the pelvic nerve structures were identified in all but one of the cadavers and had similar measurements. A vascular anatomical variant was observed in one case. CONCLUSION A human cadaver model is of value for learning about deep pelvic innervation and the latter's relationship with deep infiltrating endometriosis. The reproducibility and safety of cadaver dissection might improve surgical skills.
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Affiliation(s)
- Sophie Sanguin
- Department of Gynecology and Obstetrics, Amiens University Medical Center, Amiens, F-80054, France
| | - Horace Roman
- Endometriosis Center, Clinique Tivoli-Ducos, F- 33000, Bordeaux, France; Department of Gynecology and Obstetrics, Aarhus University Medical Center, Nordre Ringgade 1, 8000 Aarhus C, Denmark
| | - Arthur Foulon
- Department of Gynecology and Obstetrics, Amiens University Medical Center, Amiens, F-80054, France
| | - Jean Gondry
- Department of Gynecology and Obstetrics, Amiens University Medical Center, Amiens, F-80054, France
| | - Eric Havet
- Anatomy Laboratory, Jules Verne University of Picardie, Amiens, F-80054, France
| | - Céline Klein
- Anatomy Laboratory, Jules Verne University of Picardie, Amiens, F-80054, France; Department of Pediatric Orthopedic Surgery, Amiens University Medical Center and Jules Verne University of Picardie, Amiens, F-80054, France.
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Foulon A, Pichois R, Sabbagh C, Fumery M. Bowel Endometriosis Mimicking Crohn Disease. Inflamm Bowel Dis 2021; 27:e26-e27. [PMID: 33393611 DOI: 10.1093/ibd/izaa345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Affiliation(s)
- Arthur Foulon
- Obstetrics and Gynecology Unit, Amiens University Hospital, Université Picardie Jules Verne, Amiens, France
| | - Raphael Pichois
- Radiology Unit, Amiens University Hospital, Université Picardie Jules Verne, Amiens, France
| | - Charles Sabbagh
- Digestive Surgery Unit, Amiens University Hospital, Université Picardie Jules Verne, Amiens, France
| | - Mathurin Fumery
- Gastroenterology Unit, Amiens University Hospital, Université Picardie Jules Verne, Amiens, France
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Dolivet E, Foulon A, Simonet T, Sanguin S, Turck M, Pizzoferrato AC, Fauvet R. AMeTHYST (AMbulatory HYsterectomy surgery). Feasibility of minimally invasive outpatient hysterectomy, a preliminary study. Eur J Obstet Gynecol Reprod Biol 2020; 252:412-417. [PMID: 32712532 DOI: 10.1016/j.ejogrb.2020.07.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 06/30/2020] [Accepted: 07/10/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Hysterectomy, one of the most frequent surgical procedures in women, is commonly performed by a minimally-invasive approach (laparoscopic or vaginal) as recommended by the French guidelines. The French authorities aim to have 66 % of all procedures performed as same-day surgery in 2020. The aim of this study was to evaluate the feasibility and identify factors associated with success or failure of same-day surgery for minimally-invasive hysterectomy. STUDY DESIGN We conducted a prospective double-center observational study at the Caen and Amiens University Hospitals between September 2017 and May 2018 including hospitalized patients managed for a laparoscopic or vaginal hysterectomy. Patients were younger than 70 and have no major medical problems. The patients were placed into a "fit" or "unfit" group according to their Post Anaesthetic Discharge Scoring System (PADSS) score 6 h post-surgery. All the patients were asked to complete an assessment questionnaire during their hospitalization. RESULTS Of the 50 included patients, half were placed in the "fit" group. A history of laparotomy was significantly predictive of failure of same-day discharge (p = 0.003) but not uterine size or Body Mass Index (BMI). The main barriers for discharge were pain (p<0.001) and postoperative nausea/vomiting (PONV) (p<0.001). Four patients, all in the "unfit" group, had Clavien-Dindo grade 1 postoperative complications. CONCLUSION Same-day minimally invasive hysterectomy is a feasible and safe procedure. Factors associated with same-day hysterectomy failure were laparotomy, pain and postoperative nausea/vomiting.
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Affiliation(s)
- Enora Dolivet
- Department of Gynaecology, Obstetrics, and Reproductive Medicine, University Hospital of CAEN, France; Surgery Department, Centre François Baclesse, Caen, France
| | - Arthur Foulon
- Department of Gynaecology, Obstetrics, and Reproductive Medicine, University Hospital of AMIENS, France
| | - Thérèse Simonet
- Department of Anesthesiae, University Hospital of CAEN, France
| | - Sophie Sanguin
- Department of Gynaecology, Obstetrics, and Reproductive Medicine, University Hospital of AMIENS, France
| | - Mélusine Turck
- Department of Gynaecology, Obstetrics, and Reproductive Medicine, University Hospital of CAEN, France
| | - Anne-Cécile Pizzoferrato
- Department of Gynaecology, Obstetrics, and Reproductive Medicine, University Hospital of CAEN, France
| | - Raffaèle Fauvet
- Department of Gynaecology, Obstetrics, and Reproductive Medicine, University Hospital of CAEN, France; Caen Normandie University, Inserm U1086 « ANTICIPE », Unité de Recherche Interdisciplinaire pour la Prévention et le Traitement des Cancers, Axe 2 : Biologie et Thérapies Innovantes des Cancers Localement Agressifs (BioTICLA), France.
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Foulon A, Chevreau J, Yzet C, Gondry J, Fumery M. [IBD and pregnancy: From conception to birth]. ACTA ACUST UNITED AC 2020; 48:514-519. [PMID: 32145453 DOI: 10.1016/j.gofs.2020.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Indexed: 10/24/2022]
Abstract
Inflammatory Bowel Diseases (IBD) are chronic conditions affecting young people in their reproductive age. Patient misinformation can be responsible for a self-imposed infertility as well as a suboptimal observance during pregnancy. The aim of this work was to review the influence of IBD and pregnancy on one another at each gestational stage and according to current literature. IBD activity is a major influential factor. In case of a well-controlled IBD, fertility won't be affected and pregnancy will take place without increase risk of complications. With the exception of thalidomide and methotrexate, most of treatments used in IBD are compatible with pregnancy and breastfeeding. Each flare should be optimally managed. Vaginal delivery is a safe option except for patients with active anoperineal lesions. Cesarean section should be systematically discuss in patient with ileal pouch-anal anastomosis.
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Affiliation(s)
- A Foulon
- Centre de gynécologie-obstétrique, CHU Amiens-Picardie, 1, rue du Professeur-Christian-Cabrol, 80054 Amiens, France.
| | - J Chevreau
- Centre de gynécologie-obstétrique, CHU Amiens-Picardie, 1, rue du Professeur-Christian-Cabrol, 80054 Amiens, France
| | - C Yzet
- Service de gastro-entérologie, CHU Amiens-Picardie, 1, rue du Professeur-Christian-Cabrol, 80054 Amiens, France; Université Picardie-Jules-Vernes, UFR de médecine, 3, rue des Louvels, 80000 Amiens, France
| | - J Gondry
- Centre de gynécologie-obstétrique, CHU Amiens-Picardie, 1, rue du Professeur-Christian-Cabrol, 80054 Amiens, France; Université Picardie-Jules-Vernes, UFR de médecine, 3, rue des Louvels, 80000 Amiens, France
| | - M Fumery
- Service de gastro-entérologie, CHU Amiens-Picardie, 1, rue du Professeur-Christian-Cabrol, 80054 Amiens, France; Université Picardie-Jules-Vernes, UFR de médecine, 3, rue des Louvels, 80000 Amiens, France
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Chevreau J, Foulon A, Beuvin E, Gondry J, Sergent F. Obstetrical and neonatal outcomes after successful external cephalic version relative to those after spontaneous cephalic presentations. J Gynecol Obstet Hum Reprod 2020; 49:101693. [PMID: 31978624 DOI: 10.1016/j.jogoh.2020.101693] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 01/15/2020] [Accepted: 01/16/2020] [Indexed: 10/25/2022]
Abstract
OBJECTIVE External cephalic version (ECV) is a procedure during which the fetus is rotated from breech or transversal to cephalic presentation. Our aim was to assess the outcomes of successful ECV in terms of obstetrical and immediate neonatal outcomes relative spontaneous cephalic presentation. METHODS We performed a retrospective single-center observational study from January 2007 to December 2017. All included participants benefited from trial of labor with delivery of the fetus in cephalic presentation. They were divided into two groups depending on whether an ECV had been successfully performed or cephalic presentation was spontaneous. RESULTS The cephalic presentation after ECV and spontaneous cephalic groups comprised 55 and 244 patients, respectively. The two groups differed significantly in terms of the proportion of induced labor (20 [36.4 %] and 56 [22.9 %], p = 0.04), use of oxytocin during labor (31 [56.4 %] and 100 [49.9 %], p = 0.04), duration of labor (342 ± 183 min and 279 ± 140 min, p = 0.008), spontaneous delivery (38 [69.1 %] and 199 [81.5 %], p = 0.04), intrapartum cesarean section (9 [16.4 %] and 16 [6.6 %], p = 0.02), occiput-posterior variety at birth (20 [36.4 %] and 56 [22.9 %], p = 0.04), and brace umbilical positioning at birth (3 [5.4 %] and 2 [0.8 %], p = 0.04), respectively. There were no significant intergroup differences in terms of APGAR score, cord arterial pH/lactates, or reanimation/intensive care admission. CONCLUSION A successful ECV does not seem to guaranty an identical labor progress and obstetrical outcome as spontaneous cephalic presentations. Immediate neonatal state, on the other hand, seems unaffected by a history of ECV.
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Affiliation(s)
- J Chevreau
- Department of Obstetrics and Gynecology, University Hospital of Amiens, CHU Amiens-Picardie, Avenue Laennec, 80054 Amiens Cedex 1, France.
| | - A Foulon
- Department of Obstetrics and Gynecology, University Hospital of Amiens, CHU Amiens-Picardie, Avenue Laennec, 80054 Amiens Cedex 1, France
| | - E Beuvin
- Department of Obstetrics and Gynecology, University Hospital of Amiens, CHU Amiens-Picardie, Avenue Laennec, 80054 Amiens Cedex 1, France
| | - J Gondry
- Department of Obstetrics and Gynecology, University Hospital of Amiens, CHU Amiens-Picardie, Avenue Laennec, 80054 Amiens Cedex 1, France
| | - F Sergent
- Department of Obstetrics and Gynecology, University Hospital of Amiens, CHU Amiens-Picardie, Avenue Laennec, 80054 Amiens Cedex 1, France
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Chevreau J, Becart L, Sergent F, Foulon A, Gondry J, Jedraszak G. Risk factors for failed chorionic villus sampling: results of a 4-year retrospective study. J Matern Fetal Neonatal Med 2020; 35:141-146. [PMID: 31928264 DOI: 10.1080/14767058.2020.1712713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objectives: Chorionic villus sampling (CVS) allows for earlier results for aneuploidy or genomic abnormalities compared to amniocentesis. Nevertheless, the inability to provide complete results has been described as being more frequent with CVS. This study was conducted in order to identify risk factors for such failures.Study design: A retrospective single-center study was performed from January 2014 to December 2018. Participants were divided into two groups depending on whether complete CVS results were issued ("successful CVS group") or not ("failed CVS group"). Failure affected preliminary short-term cultures, long-term cultures, or both.Results: During the study period, 214 CVS were performed, 73 (34%) of which were classified in the failed CVS group. We observed significant intergroup differences between the successful and failed CVS groups for four variables: BMI (respectively 23.9 [±5.88] and 25.9 [±6.13] kg/m2), term at sampling (12.9 [±1.35] and 12.6 [±1.09] weeks gestation), trophoblastic location (posterior in 49 [40%] and 37 [66%] cases), and sampling approach (transcervical in 54 [43%] and 36 [64%] cases) (p < .05). In a stepwise binary logistic regression analysis, higher BMI, posterior trophoblastic location, and transcervical sampling approach were the only variables negatively influencing CVS success, with respective aOR [95% CI] of 0.947 [0.898; 0.996], 0.322 [0.160; 0.634], and 0.466 [0.238; 0.900].Conclusions: In the presence of CVS failure risk factors, a discussion could be initiated regarding a deferred amniocentesis as a first option.
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Affiliation(s)
- Julien Chevreau
- Department of Obstetrics and Gynecology, University Hospital of Amiens, CHU Amiens-Picardie, Amiens, France
| | - Lucie Becart
- Department of Obstetrics and Gynecology, University Hospital of Amiens, CHU Amiens-Picardie, Amiens, France
| | - Fabrice Sergent
- Department of Obstetrics and Gynecology, University Hospital of Amiens, CHU Amiens-Picardie, Amiens, France
| | - Arthur Foulon
- Department of Obstetrics and Gynecology, University Hospital of Amiens, CHU Amiens-Picardie, Amiens, France
| | - Jean Gondry
- Department of Obstetrics and Gynecology, University Hospital of Amiens, CHU Amiens-Picardie, Amiens, France
| | - Guillaume Jedraszak
- Department of Genetics, University Hospital of Amiens, CHU Amiens-Picardie, Amiens, France.,INSERM U1088, Picardie Jules Verne University, Amiens, France
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Gaichies L, Blouet M, Comoz F, Foulon A, Heyndrickx M, Fauvet R. Non-traumatic diaphragmatic rupture with liver herniation due to endometriosis: A rare evolution of the disease requiring multidisciplinary management. J Gynecol Obstet Hum Reprod 2019; 48:785-788. [DOI: 10.1016/j.jogoh.2019.03.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 02/21/2019] [Accepted: 03/15/2019] [Indexed: 10/27/2022]
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Pecourt M, Gondry J, Foulon A, Lanta-Delmas S, Sergent F, Chevreau J. Value of large loop excision of the transformation zone (LLETZ) without histological proof of high-grade cervical intraepithelial lesion: Results of a two-year continuous retrospective study. J Gynecol Obstet Hum Reprod 2019; 49:101621. [PMID: 31430562 DOI: 10.1016/j.jogoh.2019.08.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 06/06/2019] [Accepted: 08/14/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Large loop excision of the transformation zone (LLETZ) conization has been associated with adverse obstetrical outcomes. In an approach to reduce the number of performed LLETZ procedures, we conducted this study to evaluate whether "diagnostic" LLETZ should still be performed, by analyzing their yield in terms of detection (and treatment) of real high-grade squamous intraepithelial lesion (HSIL). METHODS During a two-year study period, all patients who underwent a LLETZ procedure in our institution were retrospectively included. Study participants were divided into two groups according to LLETZ indication: a biopsy-proven HSIL group, and a non-biopsy-proven HSIL group. The results of the final histological examination were recorded, as well as excision margin status and specimen dimensions. RESULTS During the two-year study period, 396 LLETZs were performed, 283 (71%) of which were indicated by biopsy-proven HSIL. In the non-biopsy-proven group, final histology showed 50 cases of HSIL (44%) and 4 cases of carcinoma (3.6%), versus respectively, in the biopsy-proven group, 221 (78%) HSIL and 28 (9.9%) carcinoma (p<0.001). Regarding margin status and specimen dimensions, no intergroup difference was observed between the two groups. CONCLUSION So called "diagnostic" LLETZ allowed the detection of severe cervical lesions in almost half of cases, without increasing specimen dimensions in comparison with classical conization indications. Moreover, they also allowed an efficient treatment as showed by similar margins status. Our results therefore strengthen the idea that "diagnostic" LLETZ, when specific indications are respected, should not be overlooked as a major part of our therapeutic arsenal.
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Affiliation(s)
- Mathilde Pecourt
- Department of Obstetrics and Gynecology, University Hospital of Amiens, CHU Amiens-Picardie, Avenue Laennec, 80054, Amiens Cedex 1, France
| | - Jean Gondry
- Department of Obstetrics and Gynecology, University Hospital of Amiens, CHU Amiens-Picardie, Avenue Laennec, 80054, Amiens Cedex 1, France
| | - Arthur Foulon
- Department of Obstetrics and Gynecology, University Hospital of Amiens, CHU Amiens-Picardie, Avenue Laennec, 80054, Amiens Cedex 1, France
| | - Ségolène Lanta-Delmas
- Department of Obstetrics and Gynecology, University Hospital of Amiens, CHU Amiens-Picardie, Avenue Laennec, 80054, Amiens Cedex 1, France
| | - Fabrice Sergent
- Department of Obstetrics and Gynecology, University Hospital of Amiens, CHU Amiens-Picardie, Avenue Laennec, 80054, Amiens Cedex 1, France
| | - Julien Chevreau
- Department of Obstetrics and Gynecology, University Hospital of Amiens, CHU Amiens-Picardie, Avenue Laennec, 80054, Amiens Cedex 1, France.
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Chevreau J, Carcopino X, Foulon A, Preaubert L, Lanta-Delmas S, Sergent F, Gondry J. Risk factors for unsatisfactory colposcopy after large loop excision of the transformation zone: The results of a four-year multicenter prospective study. Eur J Obstet Gynecol Reprod Biol 2019; 240:156-160. [PMID: 31288186 DOI: 10.1016/j.ejogrb.2019.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Revised: 06/23/2019] [Accepted: 07/01/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVES Not being able to completely examine the cervical squamocolummar junction (SCJ) in colposcopy after large loop excision of the transformation zone (LLETZ) is an important issue regarding surveillance, as high-grade cervical intra-epithelial neoplasia recurrence risk is high. This study was conducted in order to identify risk factors for post-LLETZ unsatisfactory colposcopy. METHODS This prospective multicenter observational study was performed in nine French University hospitals, with inclusions running from December 2013 to December 2017. All patients scheduled for LLETZ were included and were divided into two groups after the two to four months post-procedure colposcopic examination: a satisfactory and an unsatisfactory post-LLETZ colposcopy group. RESULTS In total, 601 cases were analyzed and 71 post-LLETZ colposcopies (12%) were described as unsatisfactory (including 19 cervical stenosis). In a univariate analysis, we only observed a statistically significant increase of the following parameters in the unsatisfactory post-LLETZ group in comparison with the satisfactory post-LLETZ group: parity (2.11 [±1.55] and 1.49 [±1.24] respectively, p < .01), depth of the LLETZ specimen (10.9 mm [±3.37] and 9.76 [±3.79] respectively, p < .01), age (45.9 years [±11.7] and 37.9 [±9.42] respectively, p < .001) and an unsatisfactory pre-LLETZ colposcopy (43 satisfactory pre-LLETZ colposcopies [61%] and 456 [86%] respectively, p < .001). In a stepwise binary logistic regression analysis, only the two latter parameters were found to be independently associated with unsatisfactory post-LLETZ colposcopies. CONCLUSIONS Surgeons should consider other therapeutic strategies when contemplating iterative diagnosis-LLETZ in older women with initially invisible SCJ, as an appropriate post-LLETZ surveillance is at higher risk of being impossible to achieve.
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Affiliation(s)
- Julien Chevreau
- Department of Obstetrics and Gynecology, University Hospital of Amiens, CHU Amiens-Picardie, Avenue Laennec, Amiens Cedex 1, France.
| | - Xavier Carcopino
- Department of Obstetrics and Gynaecology, Hôpital Nord, APHM, Aix-Marseille University (AMU), Univ Avignon, CNRS, IRD, IMBE UMR, Marseille, France
| | - Arthur Foulon
- Department of Obstetrics and Gynecology, University Hospital of Amiens, CHU Amiens-Picardie, Avenue Laennec, Amiens Cedex 1, France
| | - Lise Preaubert
- Department of Obstetrics and Gynaecology, Hôpital Nord, APHM, Aix-Marseille University (AMU), Univ Avignon, CNRS, IRD, IMBE UMR, Marseille, France
| | - Ségolène Lanta-Delmas
- Department of Obstetrics and Gynecology, University Hospital of Amiens, CHU Amiens-Picardie, Avenue Laennec, Amiens Cedex 1, France
| | - Fabrice Sergent
- Department of Obstetrics and Gynecology, University Hospital of Amiens, CHU Amiens-Picardie, Avenue Laennec, Amiens Cedex 1, France
| | - Jean Gondry
- Department of Obstetrics and Gynecology, University Hospital of Amiens, CHU Amiens-Picardie, Avenue Laennec, Amiens Cedex 1, France
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Chevreau J, Tonini F, Attencourt C, Foulon A, Sevestre H, Sergent F, Gondry J. Can certain factors for recurrence of placenta-mediated pregnancy complications be identified after an initial small-for-gestational-age birth? J Matern Fetal Neonatal Med 2018; 33:1895-1900. [PMID: 30296876 DOI: 10.1080/14767058.2018.1533942] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Introduction: After a small-for-gestational-age (SGA) birth, recurrence of placenta-mediated pregnancy complications (PMPCs) is a cause for anxiety when contemplating another pregnancy. We sought to identify factors potentially associated with this recurrence.Material and methods: This retrospective single-center observational study was conducted in a tertiary maternity unit between 1 January 2010 and 31 December 2017. We included all women having experienced a non-syndromic SGA birth and who were subsequently monitored for at least one other pregnancy in our institution. PMPCs were defined as recurrent SGA births, three consecutive first-trimester miscarriages, or preeclampsia.Results: Ninety-four women were included over a 7-year study period. Recurrent PMPCs were recorded in 30 (32%) cases, of which 29 featured recurrent SGA births. None of the following characteristics were significantly associated with recurrence: presence of preeclampsia during the initial pregnancy (six [20%] versus 25 [39%] cases in the recurrent PMPCs and non-recurrent PMPCs groups, respectively; p = .11), results of the histopathologic placental examination or thrombophilia screen, or implemented treatment during subsequent pregnancies.Conclusions: PMPCs recur frequently. No risk factor for recurrence was identified in our study. Results of etiologic assessments and treatments implemented after an initial SGA birth should therefore not modify level of clinical and ultrasound monitoring provided during subsequent pregnancies.Rationale: Recurrence of placenta-mediated pregnancy complications is a cause for anxiety when contemplating another pregnancy. We did not identify any risk factor after an initial small-for-gestational-age birth in our study; surveillance should therefore not be modified by the etiologic assessments' results.
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Affiliation(s)
- Julien Chevreau
- Department of Obstetrics and Gynecology, Amiens-Picardie University Medical Center, Amiens, France
| | - Flavio Tonini
- Department of Obstetrics and Gynecology, Amiens-Picardie University Medical Center, Amiens, France
| | - Christophe Attencourt
- Department of Clinical Pathology, Amiens-Picardie University Medical Center, Amiens, France
| | - Arthur Foulon
- Department of Obstetrics and Gynecology, Amiens-Picardie University Medical Center, Amiens, France
| | - Henri Sevestre
- Department of Clinical Pathology, Amiens-Picardie University Medical Center, Amiens, France
| | - Fabrice Sergent
- Department of Obstetrics and Gynecology, Amiens-Picardie University Medical Center, Amiens, France
| | - Jean Gondry
- Department of Obstetrics and Gynecology, Amiens-Picardie University Medical Center, Amiens, France
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Chevreau J, Mercuzot A, Abou Arab O, Foulon A, Mancaux A, Sergent F, Gondry J. Management of labor during registrarship: A prospective study during a two-year registrarship program. J Obstet Gynaecol Res 2018; 45:331-336. [PMID: 30306666 DOI: 10.1111/jog.13835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 09/14/2018] [Indexed: 11/28/2022]
Abstract
AIM Labor management is often considered to be stressful. Increases in cesarean section (CSD) and assisted vaginal (AVD) deliveries rates have been ascribed to inexperience. To address this issue, we observed the obstetric management activity of four obstetrics and gynecology registrars throughout their 2-year registrarship program. METHODS We performed a prospective, observational study of urgent and semi-/nonurgent CSD and AVD in a tertiary maternity unit. The registrars' obstetric management was compared with that of a referral group. Changes over time in the registrars' practice were also monitored. RESULTS A total of 4328 deliveries (including 670 CSD and 736 AVD) were analyzed. The registrars and the experienced obstetricians managed 2930 and 1398 deliveries, respectively, with similar neonatal outcomes. There were no intergroup differences in either total CSD percentage (455 [15.5%] and 215 [15.4%] for registrars and experienced practitioners, respectively, P = 0.90) or AVD percentage (478 [16.3%] and 258 [18.5%], respectively, P = 0.08), or according to degree of urgency. Rates did not change over the course of the registrarship program, regardless of degree of urgency. CONCLUSION Lower degree of experience was not associated with elevated CSD or AVD rates. Skills required to appropriately manage an obstetric ward seemed to have been acquired at the end of residency.
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Affiliation(s)
- Julien Chevreau
- Department of Obstetrics and Gynecology, University Hospital of Amiens, CHU Amiens-Picardie, Amiens, France.,Inserm UMR 1105, GRAMFC (Groupe de Recherches sur l'Analyse Multimodale de la Fonction Cérébrale), Picardie Jules Verne University, Amiens, France
| | - Antonin Mercuzot
- Department of Obstetrics and Gynecology, University Hospital of Amiens, CHU Amiens-Picardie, Amiens, France
| | - Osama Abou Arab
- Department of Anaesthesiology and Critical Care Medicine, University Hospital of Amiens, CHU Amiens-Picardie, Amiens, France
| | - Arthur Foulon
- Department of Obstetrics and Gynecology, University Hospital of Amiens, CHU Amiens-Picardie, Amiens, France
| | - Albine Mancaux
- Department of Obstetrics and Gynecology, University Hospital of Amiens, CHU Amiens-Picardie, Amiens, France
| | - Fabrice Sergent
- Department of Obstetrics and Gynecology, University Hospital of Amiens, CHU Amiens-Picardie, Amiens, France
| | - Jean Gondry
- Department of Obstetrics and Gynecology, University Hospital of Amiens, CHU Amiens-Picardie, Amiens, France.,Inserm UMR 1105, GRAMFC (Groupe de Recherches sur l'Analyse Multimodale de la Fonction Cérébrale), Picardie Jules Verne University, Amiens, France
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Chevreau J, Foulon A, Abou Arab O, Luisin M, Parent C, Sergent F, Gondry J. Management of breech and twin labor during registrarship: A two-year prospective, observational study. J Gynecol Obstet Hum Reprod 2018; 47:191-196. [PMID: 29510271 DOI: 10.1016/j.jogoh.2018.03.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 02/26/2018] [Accepted: 03/02/2018] [Indexed: 10/17/2022]
Abstract
INTRODUCTION Breech presentation and twin pregnancy are regarded as stressful situations for medical staff. This stress is often associated with an increased likelihood of intervention during labor - especially when the on-shift obstetrician lacks experience. MATERIAL AND METHODS We performed a 2-year prospective, observational study of cesarean section (CSDs) and assisted vaginal (AVDs) deliveries in a tertiary maternity unit for attempted vaginal deliveries of breech presentations and twin pregnancies. The obstetric management decisions taken by a group of four registrars were compared with those taken by a group of 11 experienced obstetricians. Changes over time in practice were also monitored. RESULTS Registrars managed 66 and 52 breech presentations and twin pregnancies respectively (30 and 27 in the experienced group). Groups' neonatal outcomes were similar. There were no intergroup differences in proportions of CSDs for either breech presentations (25 [37.5%] vs. 15 [50%] in the registrar and experienced groups, respectively; P=0.26) or twin pregnancies (11 [21.1%] vs. 6 [22.2%], respectively; P=0.91) or in proportion of AVDs for twin pregnancies (41 [78.8%] vs. 21 [77.8%], respectively; P=0.91). Proportions of CSDs for breech presentation and AVDs for twin pregnancies did not change over time in either group. However, proportion of CSDs for twin pregnancies increased over time in the registrar group (P=0.004). DISCUSSION Well-trained registrars appeared to have acquired the skills required to safely manage an obstetric ward; this pleads to maintain clinical practice during residency to preserve low CSD and AVD rates.
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Affiliation(s)
- J Chevreau
- Department of Obstetrics and Gynecology, University Hospital of Amiens, CHU Amiens Sud, Amiens cedex 1, France; Inserm UMR 1105, GRAMFC (Groupe de Recherches sur l'Analyse Multimodale de la Fonction Cérébrale), Picardie Jules Verne University, CHU Amiens, avenue Laennec, 80054 Amiens, France.
| | - A Foulon
- Department of Obstetrics and Gynecology, University Hospital of Amiens, CHU Amiens Sud, Amiens cedex 1, France
| | - O Abou Arab
- Department of Anaesthesiology and Critical Care Medicine, University Hospital of Amiens, CHU Amiens Sud, Amiens cedex 1, France
| | - M Luisin
- Department of Obstetrics and Gynecology, University Hospital of Amiens, CHU Amiens Sud, Amiens cedex 1, France
| | - C Parent
- Department of Obstetrics and Gynecology, University Hospital of Amiens, CHU Amiens Sud, Amiens cedex 1, France
| | - F Sergent
- Department of Obstetrics and Gynecology, University Hospital of Amiens, CHU Amiens Sud, Amiens cedex 1, France
| | - J Gondry
- Department of Obstetrics and Gynecology, University Hospital of Amiens, CHU Amiens Sud, Amiens cedex 1, France; Inserm UMR 1105, GRAMFC (Groupe de Recherches sur l'Analyse Multimodale de la Fonction Cérébrale), Picardie Jules Verne University, CHU Amiens, avenue Laennec, 80054 Amiens, France
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Mound A, Vautrin-Glabik A, Foulon A, Botia B, Hague F, Parys JB, Ouadid-Ahidouch H, Rodat-Despoix L. Downregulation of type 3 inositol (1,4,5)-trisphosphate receptor decreases breast cancer cell migration through an oscillatory Ca 2+ signal. Oncotarget 2017; 8:72324-72341. [PMID: 29069790 PMCID: PMC5641133 DOI: 10.18632/oncotarget.20327] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 08/04/2017] [Indexed: 01/02/2023] Open
Abstract
Breast cancer remains a research priority due to its invasive phenotype. Although the role of ion channels in cancer is now well established, the role of inositol (1,4,5)-trisphosphate (IP3) receptors (IP3Rs) remains enigmatic. If the three IP3Rs subtypes expression have been identified in various cancers, little is known about their physiological role. Here, we investigated the involvement of IP3R type 3 (IP3R3) in the migration processes of three human breast cancer cell lines showing different migration velocities: the low-migrating MCF-7 and the highly migrating and invasive MDA-MB-231 and MDA-MB-435S cell lines. We show that a higher IP3R3 expression level, but not IP3R1 nor IP3R2, is correlated to a stronger cell line migration capacity and a sustained calcium signal. Interestingly, silencing of IP3R3 highlights an oscillating calcium signaling profile and leads to a significant decrease of cell migration capacities of the three breast cancer cell lines. Conversely, stable overexpression of IP3R3 in MCF-7 cells significantly increases their migration capacities. This effect is completely reversed by IP3R3 silencing. In conclusion, we demonstrate that IP3R3 expression level increases the migration capacity of human breast cancer cells by changing the calcium signature.
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Affiliation(s)
- Abdallah Mound
- Laboratory of Cellular and Molecular Physiology (EA-4667), "Ion Channels in Breast Cancer", SFR CAP-SANTE (FED-4231), University of Amiens, UFR Sciences, 80039 Amiens, France
| | - Alexia Vautrin-Glabik
- Laboratory of Cellular and Molecular Physiology (EA-4667), "Ion Channels in Breast Cancer", SFR CAP-SANTE (FED-4231), University of Amiens, UFR Sciences, 80039 Amiens, France
| | - Arthur Foulon
- Laboratory of Cellular and Molecular Physiology (EA-4667), "Ion Channels in Breast Cancer", SFR CAP-SANTE (FED-4231), University of Amiens, UFR Sciences, 80039 Amiens, France
| | - Béatrice Botia
- Laboratory of Cellular and Molecular Physiology (EA-4667), "Ion Channels in Breast Cancer", SFR CAP-SANTE (FED-4231), University of Amiens, UFR Sciences, 80039 Amiens, France
| | - Frédéric Hague
- Laboratory of Cellular and Molecular Physiology (EA-4667), "Ion Channels in Breast Cancer", SFR CAP-SANTE (FED-4231), University of Amiens, UFR Sciences, 80039 Amiens, France
| | - Jan B Parys
- Laboratory of Molecular and Cellular Signalling, Department of Cellular and Molecular Medicine, Campus Gasthuisberg O/N1- bus 802-K U Leuven, B-3000 Leuven, Belgium
| | - Halima Ouadid-Ahidouch
- Laboratory of Cellular and Molecular Physiology (EA-4667), "Ion Channels in Breast Cancer", SFR CAP-SANTE (FED-4231), University of Amiens, UFR Sciences, 80039 Amiens, France
| | - Lise Rodat-Despoix
- Laboratory of Cellular and Molecular Physiology (EA-4667), "Ion Channels in Breast Cancer", SFR CAP-SANTE (FED-4231), University of Amiens, UFR Sciences, 80039 Amiens, France
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Ilenko A, Sergent F, Mercuzot A, Zitoun M, Chauffert B, Foulon A, Gondry J, Chevreau J. Could Patients Older than 75 Years Benefit from a Systematic Breast Cancer Screening Program? Anticancer Res 2017; 37:903-907. [PMID: 28179350 DOI: 10.21873/anticanres.11397] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2016] [Revised: 01/26/2017] [Accepted: 01/27/2017] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM To assess prognosis of women aged 75 and older according to breast cancer (BC) diagnosis circumstances. PATIENTS AND METHODS A retrospective cohort study was conducted in the Amiens, France, regional oncologic referral center between 2005 and 2015. Two groups were formed depending on whether the patients followed clinical manifestations (CM) or a prescribed systematic mammography (SM). RESULTS Three hundred and ninenty-three patients were selected. CM and SM represented 72% and 14.5% of BC diagnosis circumstances, respectively. In the SM group statistically significant differences included: earlier stage cancer diagnosis (tumor stages 0 and 1 accounted for 6.3% and 61.4% of cases, respectively), less lymph node invasions (35.7% and 8.8%) and metastases (19.1% and 0%), more frequent possibility of conservative surgery (25.6% and 74.5%), improved global and disease-free survival rates (by 14.2 and 18.4 months). CONCLUSION Screening seems to improve prognosis of older BC patients; this constitutes a strong argument for reconsidering age limits of national BC screening programs.
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Affiliation(s)
- Anna Ilenko
- Department of Gynecology, University Hospital of Amiens, Amiens, France
| | - Fabrice Sergent
- Department of Gynecology, University Hospital of Amiens, Amiens, France
| | - Antonin Mercuzot
- Department of Gynecology, University Hospital of Amiens, Amiens, France
| | - Mickaël Zitoun
- Department of Radiology, University Hospital of Amiens, Amiens, France
| | - Bruno Chauffert
- Department of Medical Oncology, University Hospital of Amiens, Amiens, France
| | - Arthur Foulon
- Department of Gynecology, University Hospital of Amiens, Amiens, France
| | - Jean Gondry
- Department of Gynecology, University Hospital of Amiens, Amiens, France
| | - Julien Chevreau
- Department of Gynecology, University Hospital of Amiens, Amiens, France
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B. H, Duriez M, Foulon A. Comptes nationaux de la santé. La consommation nationale en 1970. Population (French Edition) 1975. [DOI: 10.2307/1530694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Foulon A, Sandier S. Activities, turnover, and income of the private doctors in France 1962-1966-1969. Med Care 1974; 12:377-98. [PMID: 4828922 DOI: 10.1097/00005650-197405000-00001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Foulon A, Sandier S. [Evolution of the occupational resources of physicians from 1962 to 1969]. Nouv Presse Med 1972; 1:897-8. [PMID: 5018467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Foulon A, Sandier S. [Evolution of the training of French physicians from 1962 to 1969]. Nouv Presse Med 1972; 1:829-31. [PMID: 5015467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Foulon A. Konservierung von Leim- und Klebstoffen. STARCH-STARKE 1949. [DOI: 10.1002/star.19490010404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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