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Létard P, Wintjens R, Van-Gils J, Martinovic J, Laffargue F, Dufernez F, Egloff M. Intriguing link between fetal intracranial hemorrhage and X-linked recessive chondrodysplasia punctata. Ultrasound Obstet Gynecol 2024. [PMID: 38180709 DOI: 10.1002/uog.27573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 12/18/2023] [Accepted: 12/21/2023] [Indexed: 01/06/2024]
Affiliation(s)
- P Létard
- CHU de Poitiers, Service de Génétique, Poitiers, France
| | - R Wintjens
- Unit of Microbiology, Bioorganic and Macromolecular Chemistry, Department of Research in Drug Development (RD3), Faculté de Pharmacie, Université Libre de Bruxelles, Belgium
| | - J Van-Gils
- Service de Génétique, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - J Martinovic
- Unité de Foetopathologie, Hôpital Antoine-Béclère, Assistance Publique-Hôpitaux de Paris, Clamart, France
| | - F Laffargue
- Service de Génétique, Centre Hospitalier Universitaire de Clermont Ferrand, Clermont Ferrand, France
| | - F Dufernez
- CHU de Poitiers, Service de Génétique, Poitiers, France
| | - M Egloff
- CHU de Poitiers, Service de Génétique, Poitiers, France
- Université de Poitiers, INSERM 1084, LNEC, Poitiers, France
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Bauché S, Sureau A, Sternberg D, Rendu J, Buon C, Messéant J, Boëx M, Furling D, Fauré J, Latypova X, Gelot AB, Mayer M, Laffargue F, Nougues M, Fontaine B, Eymard B, Isapof A, Strochlic L. MYASTHENIA & RELATED DISORDERS. Neuromuscul Disord 2020. [DOI: 10.1016/j.nmd.2020.08.039] [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: 11/25/2022]
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Lerat J, Magdelaine C, Lunati A, Dzugan H, Dejoie C, Rego M, Beze Beyrie P, Bieth E, Calvas P, Cintas P, Delaubrier A, Demurger F, Gilbert-Dussardier B, Goizet C, Journel H, Laffargue F, Magy L, Taithe F, Toutain A, Urtizberea JA, Sturtz F, Lia AS. Implication of the SH3TC2 gene in Charcot-Marie-Tooth disease associated with deafness and/or scoliosis: Illustration with four new pathogenic variants. J Neurol Sci 2019; 406:116376. [PMID: 31634715 DOI: 10.1016/j.jns.2019.06.027] [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: 01/23/2019] [Revised: 06/07/2019] [Accepted: 06/24/2019] [Indexed: 11/30/2022]
Abstract
The autosomal recessive demyelinating form of Charcot-Marie-Tooth can be due to SH3TC2 gene pathogenic variants (CMT4C, AR-CMTde-SH3TC2). We report on a series of 13 patients with AR-CMTde-SH3TC2 among a French cohort of 350 patients suffering from all type of inheritance peripheral neuropathy. The SH3TC2 gene appeared to be the most frequently mutated gene for demyelinating neuropathy in this series by NGS. Four new pathogenic variants have been identified: two nonsense variants (p.(Tyr970*), p.(Trp1199*)) and two missense variants (p.(Leu1126Pro), p.(Ala1206Asp)). The recurrent variant p.Arg954* was present in 62%, and seems to be a founder mutation. The phenotype is fairly homogeneous, as all these patients, except the youngest ones, presented scoliosis and/or hearing loss.
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Affiliation(s)
- J Lerat
- Service Oto-Rhino-Laryngologie, Centre Hospitalier Universitaire de Limoges, Limoges, France; EA6309, Université de Limoges, Limoges, France.
| | - C Magdelaine
- EA6309, Université de Limoges, Limoges, France; Service de Biochimie et Génétique Moléculaire, Centre Hospitalier Universitaire de Limoges, Limoges, France
| | - A Lunati
- EA6309, Université de Limoges, Limoges, France; Service de Biochimie et Génétique Moléculaire, Centre Hospitalier Universitaire de Limoges, Limoges, France
| | - H Dzugan
- EA6309, Université de Limoges, Limoges, France; Service de Biochimie et Génétique Moléculaire, Centre Hospitalier Universitaire de Limoges, Limoges, France
| | - C Dejoie
- Service de Biochimie et Génétique Moléculaire, Centre Hospitalier Universitaire de Limoges, Limoges, France
| | - M Rego
- Service de Biochimie et Génétique Moléculaire, Centre Hospitalier Universitaire de Limoges, Limoges, France
| | | | - E Bieth
- Service de Génétique Médicale, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - P Calvas
- Service de Génétique Médicale, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - P Cintas
- Service de Neurologie et d'explorations fonctionnelles, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - A Delaubrier
- Service de Médecine Physique et Rééducation, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
| | - F Demurger
- Service de Génétique Médicale, Centre Hospitalier Bretagne Atlantique, Vannes, France
| | - B Gilbert-Dussardier
- Service de Génétique Médicale, Centre Hospitalier Universitaire de Poitiers, Poitiers, France; EA3808, Université de Poitiers, Poitiers, France
| | - C Goizet
- Service de Neurogénétique, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - H Journel
- Service de Génétique Médicale, Centre Hospitalier Bretagne Atlantique, Vannes, France
| | - F Laffargue
- Service de Génétique médicale, Centre Hospitalier Universitaire de Clermont-Ferrand, Limoges, France
| | - L Magy
- EA6309, Université de Limoges, Limoges, France; Service de Neurologie, Centre Hospitalier Universitaire de Limoges, Limoges, France
| | - F Taithe
- Service de Neurologie, Centre Hospitalier Universitaire de Clermont-Ferrand, Limoges, France
| | - A Toutain
- Service de Génétique, Centre Hospitalier Universitaire de Tours, Tours, France
| | - J A Urtizberea
- Centre de Compétence Neuromusculaire, APHP, Filnemus, Centre Hospitalier Hendaye, France
| | - F Sturtz
- EA6309, Université de Limoges, Limoges, France; Service de Biochimie et Génétique Moléculaire, Centre Hospitalier Universitaire de Limoges, Limoges, France
| | - A S Lia
- EA6309, Université de Limoges, Limoges, France; Service de Biochimie et Génétique Moléculaire, Centre Hospitalier Universitaire de Limoges, Limoges, France
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Granié A, Chambon F, Rochette E, Laffargue F, Francannet C, Merlin E, Kanold J. P-192 – Le Syndrome de Weaver prédispose-t-il au cancer? Arch Pediatr 2015. [DOI: 10.1016/s0929-693x(15)30372-9] [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: 10/23/2022]
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Yosypiv I, Song R, Preston G, Van Eerde AM, Van Binsbergen E, Konijnenberg Y, Maiburg MC, Lichtenbelt K, Nikkels PGJ, Vd Smagt J, Renkema KY, Giltay JC, De Jong TPVM, Lilien MR, Knoers NVAM, Gueydan C, Serena G, Stephan G, Koesters R, Zeineb B, Laure D, Catherine A, Marie-Therese B, Gauguier D, Lelongt B, Moon SH, Park HC, Lee HY, Hwang JH, Jeong JC, Park JY, Lee SW, Hwang YH, Kang KW, Ahn C, Gattone V, Carr A, Crosler-Roberts R, Wang X, Liu Y, Shen J, Wuthrich R, Serra A, Mei C, Tuta L, Botea F, Guigonis V, Rodier N, Bahans C, Decramer S, Bertholet-Thomas A, Heidet L, Eckart P, Lavocat MP, Vrillon I, Cloarec S, Lahoche A, Bessenay L, Louillet F, Roussey G, Rousset-Riviere C, Dunand O, Baudouin V, Nobili F, Pietrement C, De Parscau L, Gajdos V, Morin D, Laffargue F, Laffargue F, Llanas B, Baudouin V, Lahoche A, Palcoux JB, Morin D, De Parscau L, Bahans C, Delrue MA, Dizier E, Taupiac E, Rodier N, Laroche C, Lacombe B, Bourthoumieu S, Guigonis V, El-Meanawy A, El-Meanawy A, Rufanova V, Stelloh C. Renal development / Cystic diseases. Nephrol Dial Transplant 2012. [DOI: 10.1093/ndt/gfs231] [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: 11/13/2022] Open
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Giacalone PL, Roger P, Dubon O, El Gareh N, Daurés JP, Laffargue F. Traitement conservateur des cancers du sein : zonectomie vs oncoplastie. Étude prospective à propos de 99 patientes. ACTA ACUST UNITED AC 2006; 131:256-61. [PMID: 16530156 DOI: 10.1016/j.anchir.2005.12.011] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2005] [Accepted: 12/20/2005] [Indexed: 11/29/2022]
Abstract
UNLABELLED The integration of oncoplastic techniques with a concomitant contralateral symmetrization procedure is a novel surgical approach that allows wide excisions and prevents breast deformities. AIM OF THE STUDY This prospective study was undertaken to compare the accuracy of breast resection, between standard narrow lumpectomy and oncoplastic surgery. PATIENTS AND METHODS Ninety-nine consecutive women undergoing breast cancer resection were enrolled in a prospective study comparing oncoplastic surgery (42 women) and standard lumpectomy (57 women). The size of the glandular resection, the width of the nearest margins, the ratio of clear margins and the need for further surgery were recorded. RESULTS The oncoplastic approach resulted in significantly greater glandular resection and wider free histological margins than did standard lumpectomy. The need for re-exicsional surgery was significantly lower in the oncoplastic group than in the lumpectomy group. Furthermore, a trend towards fewer secondary mastectomies was seen for the oncoplastic approach versus standard lumpectomy. CONCLUSIONS The use of oncoplastic techniques and concomitant symmetrization of the contralateral breast allows extensive resections for conservative treatment of breast carcinoma achieves accurate tumour resection and reduces the need for further surgery.
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Affiliation(s)
- P-L Giacalone
- Service de Gynécologie-Obstétrique, Unité de Chirurgie Oncologique et Mammaire, Hôpital Arnaud-de-Villeneuve, Montpellier, France.
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Trétarre B, Remontet L, Ménégoz F, Mace-Lesec'h J, Grosclaude P, Buemi A, Guizard AV, Velten M, Arveux P, Peng J, Jougla E, Laffargue F, Daurès JP. [Ovarian cancer: incidence and mortality in France]. ACTA ACUST UNITED AC 2006; 34:154-61. [PMID: 16108112 DOI: 10.1016/s0368-2315(05)82707-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVES To describe the ovarian cancer incidence and mortality trends in France from 1980 to 2000. MATERIALS AND METHODS Incidence data were obtained from 9 French departments covered by cancer registries which systematically record all cancers, of which those of the ovary. Mortality data has been provided by INSERM bureau in charge of the analysis of death certificates. RESULTS With 4500 incident cases and 3500 deaths for the year 2000 in France, ovarian cancer still shows a poor prognosis. Age adjusted incidence and mortality rates are almost stable over the study period at an annual rate of 9 by 100000 for incidence and 5.5 by 100000 for mortality. However the risk of developing this cancer and the risk of dying from it, steadily decreased for the cohort born in 1930 to 1950, and the beginning of this reduction corresponds exactly to the beginning of oral contraception. We present comparisons between departments and analyze the border-line tumors in parallel with invasive cancers. CONCLUSION The cancer of the ovary represents only a small part of female cancers (3.8%) in France and its incidence is stable over time, but its prognosis is very bad.
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Affiliation(s)
- B Trétarre
- Registre des Tumeurs de l'Hérault, Centre de Recherche, 208, rue des Apothicaires, 34298 Montpellier
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Giacalone PL, Deisseignet PH, Roger P, Taourel P, Vernet H, Laffargue F. Pre-operative arterial embolisation of a uterine rhabdomyosarcoma in a 14-year-old girl. Br J Radiol 2004; 77:701-3. [PMID: 15326055 DOI: 10.1259/bjr/31755088] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
We report a young patient suffering from a uterine rhabdomyosarcoma. Particular features of the present case are: accuracy of the tumour spread evaluation performed by MRI of the pelvis; and the use of pre-operative arterial embolisation. The present multimodal management highlights the usefulness of cooperation between surgeons and radiologists in lowering operative bleeding and finally permitting uterine conservation.
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Affiliation(s)
- P L Giacalone
- Oncology Unit, Department of Obstetrics and Gynaecology, Hôpital Arnaud de Villeneuve, 371 rue du Doyen Gaston Giraud, 34295 Montpellier, France
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Giacalone P, Laffargue F. Cancer du sein en cours de grossesse. Les difficultés de la prise en charge. Imagerie de la Femme 2004. [DOI: 10.1016/s1776-9817(04)94799-2] [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: 10/22/2022]
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Laffargue F, Giacalone P. Extension ganglionnaire : échecs de l’imagerie implication sur la prise en charge chirurgicale. Imagerie de la Femme 2004. [DOI: 10.1016/s1776-9817(04)94809-2] [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: 11/29/2022]
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Brémond A, Bataillard A, Thomas L, Achard JL, Fervers B, Fondrinier E, Lansac J, Bailly C, Hoffstetter S, Basuyau JP, d'Anjou J, Descamps P, Farsi F, Guastalla JP, Laffargue F, Rodier JF, Vincent P, Pigneux J. [Standards, Options and Recommendations 2000 for the management of patients with endometrial cancer (non-metastatic)(abridged report)]. Gynecol Obstet Fertil 2002; 30:902-16. [PMID: 12476699 DOI: 10.1016/s1297-9589(02)00464-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- A Brémond
- FNCLCC, SOR, 101 rue de Tolbiac, 75654 Paris, France.
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Giacalone PL, el Gareh N, Haddad O, Bonnier P, Laffargue F. [Evaluation and treatment of endometrial cancer]. Rev Prat 2001; 51:1444-8. [PMID: 11601074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
Endometrial cancer is the most common gynaecologic cancer and its incidence increases with age. Prognosis is good because in over 80% of cases the cancer is discovered early. Preoperative work-up should include definition of the operability of such patients, who are often elderly with frequent co-morbidity. Preoperative evaluation and operative findings allow guiding the treatment and evaluating the prognosis. Main determinants are local extension, penetration into the myometrium, histologic stage of the tumour and involvement of lymph modes or peritoneum. Surgery is the first approach since it establishes the evaluation and comprises the first step of treatment. When necessary, subsequent treatment uses irradiation. Treatment with hormones or antimitotic drugs is less effective and is used for forms that are locally advanced, metastatic or recurrent after initial treatment.
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Affiliation(s)
- P L Giacalone
- Service de gynécologie-obstétrique Hôpital Arnaud-de-Villeneuve 34295 Montpellier.
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Giacalone PL, Laffargue F, Bénos P, Dechaud H, Hédon B. Successful in vitro fertilization-surrogate pregnancy in a patient with ovarian transposition who had undergone chemotherapy and pelvic irradiation. Fertil Steril 2001; 76:388-9. [PMID: 11476793 DOI: 10.1016/s0015-0282(01)01895-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To present a case of IVF-surrogate pregnancy in a patient with ovarian transposition who had undergone chemotherapy and total pelvic irradiation. DESIGN Case report. SETTING Teaching hospital. PATIENT(S) A 29-year-old woman who had undergone Wertheim's hysterectomy for a bulky carcinoma of the uterine cervix. INTERVENTION(S) Ovarian transposition before chemotherapy and total pelvic irradiation. Standard IVF treatment, transabdominal oocyte retrieval, and transfer to the surrogate mother. MAIN OUTCOME MEASURE(S) Results of the IVF cycle. RESULT(S) A twin pregnancy at the first cycle and two live newborns. CONCLUSION(S) This is the first reported case of ovulation induction and oocyte retrieval performed on a transposed ovary.
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Affiliation(s)
- P L Giacalone
- Department of Obstetrics and Gynecology, Hôpital Arnaud de Villeneuve, Montpellier, France.
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Giacalone PL, Daurés JP, Faure JM, Boulot P, Hedon B, Laffargue F. The effects of mifepristone on uterine sensitivity to oxytocin and on fetal heart rate patterns. Eur J Obstet Gynecol Reprod Biol 2001; 97:30-4. [PMID: 11435005 DOI: 10.1016/s0301-2115(00)00506-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To compare the incidences of tachysystole, hypertonia and fetal heart rate (FHR) abnormalities in women treated by mifepristone plus prostaglandins (PGs), mifepristone alone or PGs alone for an unfavourable cervix. STUDY DESIGN In this retrospective study, all women between 37 and 42 weeks were eligible for the study if they had undergone cervical ripening prior to labour induction. In group 1, the women were treated with mifepristone plus PGs (n=103). Group 2 women were treated with mifepristone alone (n=96) and group 3 women with PGs alone (n=100). Incidences of tachysystole, hypertonia and FHR abnormalities were compared. RESULTS During induction of labour, tachysystole and hypertonia occurred more frequently in women treated with mifepristone. Severe bradycardia and recurrent late decelerations were more frequent after the initiation of oxytocin in groups 1 and 2 than in group 3. CONCLUSIONS In this study, mifepristone increased the incidences of tachysystole, hypertonia and FHR abnormality.
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Affiliation(s)
- P L Giacalone
- Department of Obstetrics and Gynecology, Hôpital Arnaud de Villeneuve, University of Montpellier, 371 rue du Doyen Gaston Giraud, 34295 Montpellier Cedex 5, France.
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Brémond A, Bataillard A, Thomas L, Achard JL, Fervers B, Fondrinier E, Lansac J, Bailly C, Hoffstetter S, Basuyau JP, d'Anjou J, Descamps P, Farsi F, Guastalla JP, Laffargue F, Rodier JF, Vincent P, Pigneux J. Cancer of the endometrium. Br J Cancer 2001; 84 Suppl 2:31-6. [PMID: 11355966 PMCID: PMC2408833 DOI: 10.1054/bjoc.2000.1760] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Thomas L, Bataillard A, Brémond A, Fondrinier E, Fervers B, Achard JL, Lansac J, Bailly C, Hoffstetter S, Basuyau JP, d'Anjou J, Descamps P, Farsi F, Guastalla JP, Laffargue F, Rodier JF, Vincent P, Pigneux J. [Standards, options, and recommendations for the radiotherapy of patients with endometrial cancer. FNCLCC (National Federation of Cancer Campaign Centers) and CRLCC (Regional Cancer Campaign Centers)]. Cancer Radiother 2001; 5:163-92. [PMID: 11355582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/16/2023]
Abstract
OBJECTIVES To develop clinical practice guidelines according to the definitions of the Standards, Options and Recommendations project for the radiotherapy of carcinoma of the endometrium. METHODS Data were identified by searching Medline and personal reference lists of members of the expert groups. Once the guidelines were defined, the document was submitted for review to independent reviewers, and to the medical committees of the 20 French Cancer Centres. RESULTS The main recommendations for the radiotherapy of carcinoma of the endometrium are: 1) For grade 1 and 2 stage IA tumours, follow-up alone is standard as additional treatment. For grade 1 and 2 stage IB tumours, vaginal brachytherapy or follow-up alone are options. For grade 3, stage IB tumours and stage IC disease, there are two treatment options: external pelvic radiotherapy with a brachytherapy boost or vaginal brachytherapy. 2) Treatment for stage II disease can be preoperative when stage II disease has been suggested by a positive endometrial curettage. Postoperative vaginal brachytherapy is given for stage IIA tumours if the penetration of the myometrium is less than 50% or if the tumour is grade 1 or 2. In the case of deep penetration, or higher grade disease, or for stage IIB external radiotherapy with brachytherapy boosting must be undertaken routinely. 3) After surgery, for stage IIIA disease, either external pelvic radiotherapy or abdomino-pelvic radiotherapy is indicated, along with medical treatment in certain patients. For stage IIIB tumours, postoperative external radiotherapy with brachytherapy (if possible) should be undertaken. For stage IIIC tumours, standard treatment is external (pelvic or pelvic and para-aortic) radiotherapy followed or not by a brachytherapy boost. In case of extrauterine sites involved abdomino-pelvic irradiation is recommended. 4) Standard treatment for inoperable stage I and II disease is external radiotherapy and brachytherapy. For patients with inoperable stage III or IV disease, treatment is often symptomatic, combining external radiotherapy and medical treatment.
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Brémond A, Bataillard A, Thomas L, Achard JL, Fervers B, Fondrinier E, Lansac J, Bailly C, Hoffstetter S, Basuyau JP, d'Anjou J, Descamps P, Farsi F, Guastalla JP, Laffargue F, Rodier JF, Vincent P, Pigneux J. [Standards, Options and Recommendations for the surgical management of carcinoma of the endometrium]. Bull Cancer 2001; 88:181-98. [PMID: 11257593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
CONTEXT The "Standards, Options and Recommendations" (SOR) project, started in 1993, is a collaboration between the Federation of the French Cancer Centres (FNCLCC), the 20 French Cancer Centres and specialists from French Public Universities, General Hospitals and Private Clinics. The main objective is the development of clinical practice guidelines to improve the quality of health care and outcome for cancer patients. The methodology is based on literature review and critical appraisal by a multidisciplinary group of experts, with feedback from specialists in cancer care delivery. OBJECTIVES To develop clinical practice guidelines according to the definitions of the Standards, Options and Recommendations project for the surgical management of carcinoma of the endometrium. METHODS Data were identified by searching Medline and personal reference lists of members of the expert groups. Once the guidelines were defined, the document was submitted for review to independent reviewers, and to the medical committees of the 20 French Cancer Centres. RESULTS The main recommendations for the surgical management of carcinoma of the endometrium are: 1) where-ever possible, surgery is the primary treatment of both localised and advanced disease; 2) surgery is performed according to the stage of the cancer and the status of the patient; 3) surgery for stages I and II disease entails total abdominal hysterectomy and bilateral salpingo-oophorectomy. A modified radical hysterectomy is undertaken in cases of macroscopic cervical involvement. An omenectomy is recommended for serous papillary types. Pelvic lymphadenectomy for the purposes of precise staging is undertaken if the patient is of good performance status and without bad pronostic factors. Para-aortic lymphadenectomy can be undertaken to determine involvement of para-aortic nodes; 4) surgery for stages III and IV: radical surgery must be undertaken if at all possible with additional treatment as indicated. In the case of advanced disease, debulking surgery is indicated.
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El Bouhmadi A, Boulot P, Laffargue F, Brun JF. Rheological properties of fetal red cells with special reference to aggregability and disaggregability analyzed by light transmission and laser backscattering techniques. Clin Hemorheol Microcirc 2000; 22:79-90. [PMID: 10831059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
Blood viscosity factors and fetal erythrocyte aggregability were investigated with light transmission (Myrenne device) during a cross-sectional study of blood drawn in utero by cord venepunctures in 119 normal fetuses between 18 and 39 weeks gestation. There was a progressive increased blood viscosity at native hematocrit (p < 0.01) explained by a gradual increase in both hematocrit (from 33% to 40%, p < 0.05) and Dintenfass' 'Tk' RBC rigidity index (p < 0.05), while plasma viscosity remained constant at 1.18 +/- 0.01 mPa x s as well as the h/eta ratio (188.4 +/- 2.7 mPa(-1) x s(-1)). The RBC aggregation index 'M' remained almost equal to zero (mean value: 0.04 +/- 0.01) before 32 wk gestation and then increased (p < 0.05) until delivery. The upper physiological limit for this parameter before 32 wk (mean +/- 2 SD) is 0.18. The RBC aggregation index 'M1' remained constant during pregnancy at 2.98 +/- 0.26, i.e., the upper physiological limit for this parameter during the intrauterine life (mean +/- 2 SD) is 7.85. Both fibrinogen (r = 0.479, p < 0.05) and albumin (r = 0.494, p < 0.01) correlated with time so that the albumin/fibrinogen ratio remained stable. We then studied with the laser retrodiffusion technique the venous blood of 20 women (18-43 yr, 37-40 wk gestation) and the cord blood of their newborns at birth, comparing RBC aggregation of: mothers (M), maternal RBCs resuspended on newborn plasma (MF), newborn RBCs resuspended on maternal plasma (FM), and newborns (F). Aggregability is higher in M (RBC aggregation time M < MF < FM < F; p < 0.01); RBC aggregation index at 10 s M > MF > FM > F; p < 0.01), with in turn the symmetric inverse picture for the partial disaggregation threshold (M > MF = FM > F). Thus RBC disaggregability is higher in newborns, and suspensions on maternal and newborn plasma suggest that half of this difference in aggregability (and disaggregability) between fetal and adult blood results from plasma factors and another half from erythrocytes.
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Affiliation(s)
- A El Bouhmadi
- Service de Gynécologie Obstétrique Hôpital Arnaud de Villeneuve, France
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El Bouhmadi A, Laffargue F, Raspal N, Brun JF. 100 mg acetylsalicylic acid acutely decreases red cell aggregation in women taking oral contraceptives. Clin Hemorheol Microcirc 2000; 22:99-106. [PMID: 10831061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
Since oral contraceptives (OC) are known to impair blood fluidity and to increase the risk of venous and arterial thrombosis, while acetylsalicylic acid (ASA) decreases the thrombotic risk and modifies some rheologic parameters, we compared the hemorheologic effects of ASA on blood rheology between women treated by OC and women who never received this medication. 25 women under OC were compared to 25 matched women who had never used OC. Blood viscosity (MT90 viscometer) and RBC aggregation (Myrenne aggregometer and AFFIBIO erythroaggregometer) were measured before and 1 hr after women received per os 100 mg ASA, after an overnight fast. The only significant difference between women under OC and controls was an increased RBC aggregation ('M' index +28%, p < 0.04; Affibio aggregation time -21%, p < 0.03). On the whole sample of 50 women as well as in the subgroup of women under OC, ASA decreased RBC partial disaggregation threshold (-1.7%, p < 0.01). These results confirm that RBC aggregation is increased under OC and suggest that 100 mg ASA acutely induces a partial reversal of this RBC hyperaggregation.
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Affiliation(s)
- A El Bouhmadi
- Service de Gynécologie Obstétrique, Hôpital Arnaud de Villeneuve, France
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20
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El Bouhmadi A, Laffargue F, Brun JF. Aggregability and disaggregability of erythrocytes in women suffering from ovarian cancer: evidence for an increased disaggregation threshold. Clin Hemorheol Microcirc 2000; 22:91-7. [PMID: 10831060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
In order to further characterize the alterations of erythrocyte aggregation described in ovarian cancer, we measured it with laser backscattering in eleven women suffering from ovarian cancer (mean age: 44.7 +/- 3.6, extreme values: 28-61 yr) compared with thirteen matched control women. Blood rheology exhibited a wide variability in cancer patients, with some unusually high values of plasma viscosity and/or RBC aggregation in individual cases. The only significant differences were found for the RBC disaggregation threshold which was higher in patients than in controls (78.06 +/- 10.14 vs 52.6 +/- 3.15 s(-1), p < 0.05), while hematocrit was lower (34.45 +/- 1.42 vs 38.23 +/- 0.75, p < 0.05). A negative correlation between hematocrit and corrected blood viscosity on the whole sample of subjects (r = 0.454, p < 0.05) indicates that hematocrit is decreased in subjects prone to high viscosity, resulting in similar values of apparent blood viscosity in controls and patients. Thus, a lower disaggregability of RBCs is evidenced in women with ovarian cancer, as well as a tendency to blood hyperviscosity compensated by a reduction of hematocrit which suggests that there may be some degree of 'viscoregulation'.
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Affiliation(s)
- A El Bouhmadi
- Service de Gynécologie Obstétrique, Hôpital Arnaud de Villeneuve, France
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Roger P, Daures JP, Maudelonde T, Pignodel C, Gleizes M, Chapelle J, Marty-Double C, Baldet P, Mares P, Laffargue F, Rochefort H. Dissociated overexpression of cathepsin D and estrogen receptor alpha in preinvasive mammary tumors. Hum Pathol 2000; 31:593-600. [PMID: 10836299 DOI: 10.1053/hp.2000.6687] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The role of estrogen as a promoter agent of sporadic breast cancer has been considered by assaying, in benign breast disease (BBD) and in situ carcinomas (CIS), 2 markers, the estrogen receptor alpha (ERalpha) and cathepsin D (cath-D) involved in estrogen action on mammary tissue. ERalpha and cath-D were assayed by quantitative immunohistochemistry using an image analyzer in 170 lesions of varying histological risk (94 BBD and 76 CIS), and in "normal" glands close to these lesions. The ERalpha level increased significantly in proliferative BBD with atypia (P < .001), in non-high-grade CIS (P < .001), and in adjacent "normal" glands. ERalpha level was decreased in high-grade ductal CIS (DCIS) and also in adjacent "normal" glands. Cath-D level increased in ductal proliferative BBD (P < or = .01) and in high-grade DCIS (P < or = .003), but not in the other lesions. After menopause, ERalpha level was increased (P = .012) but not cath-D level. According to Mac Neman test, the high-grade DCIS were predominantly ERalpha negative and cath-D positive (P = .0017), and the other CIS were predominantly ERalpha positive and cath-D negative (P = .0002). The 2 markers are overexpressed early in premalignant lesions, but independently. This dissociation suggests a branched model of mammary carcinogenesis involving 1 estrogen-independent pathway with high cath-D and low ERalpha levels (including high-grade DCIS) and 1 estrogen-dependent pathway, with high ERalpha level (including proliferative BBD with atypia and low-grade DCIS). We propose that ERalpha-negative breast cancers may develop directly from high-grade DCIS and that ERalpha assay in preinvasive lesions should be considered in prevention trials with antiestrogens.
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Affiliation(s)
- P Roger
- Unité Hormones et Cancer (U 148) Inserm, Montpellier, France
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22
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Giacalone PL, Vignal J, Daures JP, Boulot P, Hedon B, Laffargue F. A randomised evaluation of two techniques of management of the third stage of labour in women at low risk of postpartum haemorrhage. BJOG 2000; 107:396-400. [PMID: 10740337 DOI: 10.1111/j.1471-0528.2000.tb13236.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To determine whether early placental drainage plus cord traction reduces the incidences of manual removal and blood loss, and to determine the risk factors associated with blood loss after delivery. DESIGN Prospective randomised study. SETTING University teaching hospital, Montpellier, France. METHODS A randomised study compared 239 women who had placental cord drainage plus cord traction with 238 women with expectant delivery. The need for manual removal of the placenta and the drop in haemoglobin after delivery were assessed. The duration of the third stage of labour and the time between birth and the beginning of perineal suturing were measured. Statistical analysis used the paired t test for continuous variables, the Kruskal-Wallis test for nonparametric data and chi2 test for categoric variables. Stepwise logistic regression analyses were performed with a drop in haemoglobin as the outcome variable. RESULTS No significant difference was found in the two groups with regard to the incidence of manual removal of retained complete or incomplete placenta or postpartum haemorrhage. The median values of the duration of the third stage of labour, birth-to-perineal suture time and drop in haemoglobin were significantly lower in the cord drainage group than in the control group. After controlling for confounding variables, parity proved to be the only significant predictor of drop in haemoglobin. CONCLUSION Cord drainage decreases the duration of the third stage of labour and reduces blood loss but not the incidence of manual removal of the placenta.
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Affiliation(s)
- P L Giacalone
- Department of Obstetrics and Gynaecology, Hôpital Arnaud de Villeneuve, Montpellier, France
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Giacalone PL, Laffargue F, Bénos P. Chemotherapy for breast carcinoma during pregnancy: A French national survey. Cancer 1999; 86:2266-72. [PMID: 10590367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
BACKGROUND During pregnancy, the need for maternal chemotherapy for breast carcinoma must be balanced against the fetal risk because modification of cancer therapy to assure the birth of a healthy infant may affect maternal prognosis adversely. To the authors' knowledge few studies have documented the oncologic and obstetric management of this association. METHODS A retrospective nationwide survey was used to identify women treated with chemotherapy for breast carcinoma during pregnancy. Each member of the Société Française d'Oncologie Gynécologique and the Société Française de Sénologie et de Pathologie Mammaire completed a postal questionnaire regarding cancer staging, oncologic treatment, obstetric details, pregnancy outcome, fetal behavior, and postdelivery follow-up. Twenty women were accrued to the study. RESULTS The mean gestational age at the first cycle of treatment was 26 weeks. A total of 38 cycles were administered during pregnancy, with a median of 2 cycles. Delivery was performed at a mean of 34.7 weeks. Two pregnancies that were exposed to chemotherapy during the first trimester resulted in spontaneous abortion. One pregnancy exposed in the second trimester resulted in intrauterine death. The remaining 17 pregnancies resulted in live births, although 3 women had complications related to chemotherapy (anemia, leukopenia, and fetal growth retardation) and 1 newborn died 8 days after birth without apparent etiology. Two newborns had complications related to prematurity (transient respiratory distress). At a mean follow-up of 42.3 months, all live infants were reported to have reached normal developmental milestones. CONCLUSIONS The current study found that even when chemotherapy was initiated after the first trimester, 95% of the pregnancies resulted in live births with low related morbidity in the newborns.
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Affiliation(s)
- P L Giacalone
- Department of Obstetrics and Gynecology, Hôpital Arnaud de Villeneuve, Montpellier, France
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Giacalone PL, Laffargue F, Aligier N, Roger P, Combecal J, Daures JP. Randomized study comparing two techniques of conization: cold knife versus loop excision. Gynecol Oncol 1999; 75:356-60. [PMID: 10600289 DOI: 10.1006/gyno.1999.5626] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To compare the histomorphologic and colposcopic results of cold knife conization and loop excision. METHODS Sixty-six women were randomly allocated to have the cone specimen removed by cold knife excision (n = 38) or loop excision (n = 28). Subjects eligible for inclusion were those who presented histologically verified grade 3 cervical intraepithelial neoplasia (CIN) or grade 2 CIN with squamocolumnar junction not seen. RESULTS The mean height of the cone specimens was greater in the cold knife group [18.9 mm (SD = 5. 5) and 12.8 mm (SD = 4.3), respectively; P = 0.0001], as was the frequency of clear margins (100 and 80%, respectively; P = 0.001). In the loop excision group, thermal injuries were present in half of the cone sections. The median (range) thickness of thermal injury was 0.98 mm (0-1.5 mm) in the ectocervix and 0.95 mm (0-1.75 mm) in the endocervix. Histologic evaluation of the endocervical margins was not possible in 2 cases (7%). At follow-up colposcopy, evaluation of the entire squamocolumnar junction was possible in 15 (39%) and 20 (71%) women, respectively (P < 0.01). Four patients in the cold knife group and 6 in the loop group had histologically confirmed persistent dysplasia (P > 0.05), yielding success rates of 90 and 79%, respectively (P > 0.05). CONCLUSIONS Loop excision provides a sample that is adequate for histologic evaluation in most cases, results in the same success rate as cold knife conization, and allows optimal colposcopic surveillance in significantly more cases than cold knife excision.
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Affiliation(s)
- P L Giacalone
- Department of Obstetrics and Gynecology (Professor Laffargue), Hôpital Arnaud de Villeneuve, 371 rue du Doyen Gaston Giraud, Montpellier Cedex 5, 34295, France
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25
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Giacalone PL, Laffargue F, Faure JM, Deschamps F. Ultrasound-assisted laparoscopic creation of a neovagina by modification of Vecchietti's operation. Obstet Gynecol 1999; 93:446-8. [PMID: 10074997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
BACKGROUND In performing Vecchietti's operation laparoscopically, it is important to ensure bladder and rectum integrity. We report new techniques of ultrasonography and suture retrieval that simplify and improve the ease and speed of this operation. TECHNIQUE The pneumoperitoneum is emptied and the bladder filled with 200 mL of sterile water. The ultrasound probe is placed on the suprapubic wall for a sagittal image. The needle progresses medially through the vesicorectal space, with ultrasound guidance, and its emergence into the pelvis is controlled with laparoscopy. The nylon sutures carrying the dilation ball are threaded through the needle and brought back through the abdominal wall. EXPERIENCE Seven patients with vaginal aplasia had this procedure. There were no complications, and the mean operative time was 43 minutes (range 35-55). Mean vaginal length was 7 cm (range 6-10). Four women defined sexual intercourse as very satisfying and two as moderately satisfying. CONCLUSION This original technique was used for easy, safe, and rapid creation of neovaginas.
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Affiliation(s)
- P L Giacalone
- Department of Obstetrics and Gynecology, Hôpital Arnaud de Villeneuve, Montpellier, France
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26
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Giacalone PL, Laffargue F. Neoadjuvant chemotherapy in the treatment of locally advanced cervical carcinoma in pregnancy. A report of two cases and review of issues specific to the management of cervical carcinoma in pregnancy including planned delay of therapy. Cancer 1999; 85:1203-4. [PMID: 10091809 DOI: 10.1002/(sici)1097-0142(19990301)85:5<1203::aid-cncr32>3.0.co;2-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Giacalone PL, Laffargue F, Daures JP, Lombard I. The Bologna bladder neck suspension procedure for treatment of stress urinary incontinence associated with cystocele. Int Urogynecol J 1999; 9:370-8. [PMID: 9891958 DOI: 10.1007/bf02199567] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The object was to study retrospectively the perioperative complications and results of the Bologna procedure for the treatment of stress urinary incontinence associated with cystocele grade 2 or more. In the study, 80 patients underwent a repair of all defects of pelvic support plus the Bologna procedure. Mean duration of follow-up was 40.2 months (range 3-127). The incidence of operative complications was 2.5% for inadvertent cystostomy and for hemorrhage. Mean hospital stay was 7.2 days (range 2-17). At 2-year follow-up 85% of the patients were completely free of incontinence symptoms (95% CI: 75-92) and 76% at 3-year follow-up (95% CI: 66-86). None of the parameters tested in a univariate analysis was independently linked with surgical failure. Further studies are needed to establish the place of this technique in the surgical management of urinary incontinence associated with genital prolapse.
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Pujol P, Rey JM, Nirde P, Roger P, Gastaldi M, Laffargue F, Rochefort H, Maudelonde T. Differential expression of estrogen receptor-alpha and -beta messenger RNAs as a potential marker of ovarian carcinogenesis. Cancer Res 1998; 58:5367-73. [PMID: 9850067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Although estrogen receptor (ER)-alpha is expressed in both benign and malignant ovarian tumors, the role of ER in ovarian carcinogenesis of epithelial tumors is still unknown. In view of the recent characterization of ER-beta, a second form of ER that seems to be highly expressed in ovaries, we reexamined this issue by studying the relative expression of ER-alpha and -beta in human ovarian tumor progression. We developed a competitive PCR assay based on coamplification of the two ERs in target nucleotide sequences displaying a high homology (exons 3 and 4). Coamplification experiments with varying amounts of plasmids containing ER-alpha and -beta cDNAs showed that this assay was reliable for discriminating as little as a 2-fold difference in the initial ER-alpha:ER-beta cDNA ratio. The relative expression of ER-alpha compared with ER-beta mRNAs was studied in human ovarian cancer cell lines (n = 5) and in normal ovaries (n = 6), then in human benign and malignant tumor samples including ovarian cysts (n = 24), borderline tumors (n = 3), and cancers (n = 10). In normal ovaries, ER-beta mRNA was the predominant ER form, whereas in ovarian cancer cell lines ER-alpha mRNA was markedly increased as compared with ER-beta. In benign and borderline tumors, ER-beta mRNA was detected in 78% of tumors, whereas ER-alpha mRNA was detected in 29%. In ovarian carcinomas, both ER-alpha and -beta mRNAs were expressed in 80% of tumors. The ER-alpha:ER-beta mRNA ratio was >1 in only one cyst sample (4%). In contrast, the ER-alpha:ER-beta mRNA ratio was markedly increased in ovarian cancers because 60% showed an ER-alpha:ER-beta mRNA >1. In situ hybridization experiments showed overlapping tissular distribution of ER-beta and -alpha expression in cancers and cysts, with a main localization in the epithelium and only a low level of expression in stromal cells. In summary, we found an increase in the ER-alpha:ER-beta mRNA ratio in ovarian carcinomas as compared with normal ovaries and cysts. These data suggest that overexpression of ER-alpha relative to ER-beta mRNA may be a marker of ovarian carcinogenesis.
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Affiliation(s)
- P Pujol
- Service de Biologie Cellulaire, Centre Hospitalier Universitaire de Montpellier, Hôpital Arnaud de Villeneuve, France
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Giacalone PL, Dumontier C, Roger P, Laffargue F, Baldet P. [Vaginal metastases of breast cancer]. J Gynecol Obstet Biol Reprod (Paris) 1998; 27:714-7. [PMID: 9921442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
Metastases to the vagina from breast carcinoma are uncommon, and are most often detected during autopsies of patients who have died from a breast cancer or from metastases to the genital tract. A case of symptomatic vaginal metastasis secondary to bilateral breast carcinoma is reported. The potential routes of dissemination include lymphatic and vascular spread. Their respective frequencies vary in the literature. Lymphatic spread in this case is suggested by demonstrable ovarian, myometrial, and lymph node involvement associated with massive submucosal vaginal involvement. This observation of concomitant visceral and lymphatic spread improves our knowledge of metastatic spread from breast cancer to the female genital tract by the lymphatic route.
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Affiliation(s)
- P L Giacalone
- Fédération des Services de Gynécologie-Obstétrique, Hôpital Arnaud-de-Villeneuve, Montpellier
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Abstract
OBJECTIVE To determine the efficacy and safety of mifepristone for cervical ripening in post-term pregnancies. METHODS Women with post-term pregnancies and Bishop scores less than 6 were assigned randomly to mifepristone (41 patients) or placebo (42 patients). Mifepristone was given orally in a dose of 400 mg. Efficacy was assessed by change in the Bishop score within 48 hours after treatment; a score of 6 or greater was considered a "strict" success. An "extended" success rate was defined, including all patients with scores of at least 6 or those who delivered within 48 hours of treatment. Antenatal safety was assessed by fetal heart rate testing before and throughout labor. Neonatal safety was assessed by Apgar score, arterial or venous pH of cord blood, and blood glucose level during the first 48 hours. Analysis used Student t test for continuous variables, Kruskal-Wallis test for ordinal data, and chi2 for categoric variables. RESULTS Strict success was achieved in 10 of 18 mifepristone patients (55%) evaluated for Bishop score on day 2 versus 8 of 29 placebo patients (27.5%) (P=.004). Extended success was achieved in 33 mifepristone patients (80.5%) and 21 placebo patients (50.0%) (P=.004). There were no statistical differences with regard to number of cesareans or fetal and neonatal safety. CONCLUSION Mifepristone proved effective for cervical ripening and reduced the time to delivery compared with placebo, but it did not improve the rate of cesarean. Our study did not include enough pregnancies to reach conclusions about fetal or neonatal safety.
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Affiliation(s)
- P L Giacalone
- Department of Obstetrics and Gynecology, Hôpital Arnaud de Villeneuve, Montpellier, France
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Giacalone PL, Laffargue F, Bousquet F, Faure JM, Deschamps F. [Creation of a neovagina using ultrasonography-assisted laparoscopy (modified Vecchietti technique]. J Gynecol Obstet Biol Reprod (Paris) 1998; 27:514-6. [PMID: 9791578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Ultrasonography-assisted laparoscopic creation of a neavagina was performed on 6 patients suffering from vaginal aplasia. As the needle progress through the vesicorectal space, ultrasonography provided an accurate check of the bladder and rectal integrity, and improved the ease of the surgical procedure. Ultrasound can be considered an effective and reliable advance for laparoscopic management of vaginal aplasia.
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Affiliation(s)
- P L Giacalone
- Service de Gynécologie-Obstétrique, Hôpital Arnaud-de-Villeneuve, Montpellier
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Giacalone PL, Laffargue F, Daurés JP, Lombard I, Lombard G. [Urinary stress incontinence. Comparison of the Raz technique and the Bologna technique. Analysis of a series of 188 patients]. J Gynecol Obstet Biol Reprod (Paris) 1998; 27:309-18. [PMID: 9648009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Our purpose was to evaluate and compare the perioperative morbidity and the long-term results of the Raz colposuspension and the Bologna operation for the treatment of stress urinary incontinence in women. STUDY DESIGN Data of 188 women who underwent either a Bologna operation (group 1) or a Raz colposuspension (group 2) for the treatment of stress urinary incontinence between January 1, 1987 and December 1, 1995 were analysed retrospectively regarding history, preoperative evaluation, associated surgical procedures, complications and cure and failure rate. POPULATION AND METHODS 80 patients were treated with the Bologna operation and 108 with the Raz colposuspension. Patients with prior anti-incontinence surgery, and patients with a preoperative diagnosis of urge incontinence were excluded from the study. Success was defined both subjectively (complete absence of complaint of stress urinary incontinence) and objectively (no evidence of loss of urine on cough provocation during physical examination). Survival curves were generated in each group for time to event data: "time to recurrent stress incontinence" and compared by the logrank test. A multivariate analysis using a Cox proportional hazards regression model was performed to indentify possible outcome predictors. RESULTS The success rate of group 1 was significantly higher than that of group 2 (p = 0.00001). The median of success was 51 months in group 1 and 21 months in group 2 (p = 0.00001). The incidence of intraoperative complications in each group (inadvertent cystostomy, hemorrhage) did not differ. The multivariate analyses using the Cox regression model showed that the most highly correlated variable with the surgical cure rate was the type of surgical anti-incontinence procedure adopted: Bologna or Raz (p = 0.00001) CONCLUSION In our hands, the Bologna operation has a higher cure rate than the Raz colposuspension. For us, when treating patients with stress urinary incontinence by the vaginal route, the Bologna operation is indicated when sufficient anterior vaginal tissue is available to create vaginal bands.
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Affiliation(s)
- P L Giacalone
- Service de Gynécologie-Obstétrique, Hôpital Arnaud-de-Villeneuve, Montpellier
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Giacalone PL, Bénos P, Charlier C, Laffargue F. [Chemotherapy during pregnancy: when and how? Particulars in gynecologic and breast cancers]. J Gynecol Obstet Biol Reprod (Paris) 1998; 26:197-200. [PMID: 9471460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- P L Giacalone
- Service de Gynécologie-Obstétrique, Hôpital Arnaud de Villeneuve, Montpellier
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34
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Giacalone PL, Dayrolle S, Boulot P, Hédon B, Laffargue F. [Delivery of the overweight woman. Analysis of 115 patients]. J Gynecol Obstet Biol Reprod (Paris) 1997; 26:288-292. [PMID: 9265051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
OBJECTIVE Our purpose was to assess the effect of weight gain during pregnancy on labor and delivery. Abnormal pregnancies were excluded from the study to avoid interaction with the management of labor. POPULATION AND METHODS A retrospective monocentric case-control study was carried out. We analysed 115 pregnancies delivered in our institution between June 1994 and November 1994. The course of labor was studied in 2 groups of patients: a group of overweight patients and a control group. RESULTS In the overweight patients, the frequency of induction of labor (25%) and of obstetrical analgesia (82%) was significantly higher than in the control group (respectively 7% and 64%), as well as the average duration of labour and the average duration of the rupture of the membranes. The rate of cesarean section was higher in the overweight patient group (16.7%) than in the control group (3.7%). The difference was not significant because of the small number of patients. CONCLUSION These results show a more frequent requirement of induction of labour, analgesia, and cesarean section in overweight patients. This led us to propose a multidisciplinary management of overweight patients to minimize these different obstetrical risks during labor.
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Affiliation(s)
- P L Giacalone
- Services de Gynécologie et Obstétrique, Hôpital A. de Villeneuve, Montpellier
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Giacalone PL, Laffargue F, Benos P, Rousseau O, Hedon B. Cis-platinum neoadjuvant chemotherapy in a pregnant woman with invasive carcinoma of the uterine cervix. Br J Obstet Gynaecol 1996; 103:932-4. [PMID: 8813319 DOI: 10.1111/j.1471-0528.1996.tb09918.x] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- P L Giacalone
- Department of Obstetrics and Gynaecology, Hopital Arnaud de Villeneuve, Montpellier, France
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Giacalone PL, Benos P, Donnadio D, Laffargue F. High-dose chemotherapy with autologous bone marrow transplantation for refractory metastatic gestational trophoblastic disease. Gynecol Oncol 1995; 58:383-5. [PMID: 7672706 DOI: 10.1006/gyno.1995.1247] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
A patient with gestational trophoblastic disease failed to respond to all standard multiple-agent chemotherapy and had progressive uterine disease. Total hysterectomy also proved ineffective. We therefore administered high-dose cyclophosphamide, etoposide, and melphalan with autologous bone marrow support. Severe marrow suppression followed but a complete remission was achieved and the patient remains free of disease 3 years after the completion of therapy. This result seems to confirm the value of using high-dose multiagent therapy to optimize the dose-effect of therapy regimens on drug-refractory gestational trophoblastic disease.
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Affiliation(s)
- P L Giacalone
- Department of Obstetrics and Gynecology, Hopital Arnaud de Villeneuve, Montpellier, France
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37
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Eisinger F, Laffargue F, Maraninchi D, Mauvais-Jarvis P, Moatti JP, Namer M, Pujol H, Philip T, Sancho-Garnier H. [Guidelines from the National Federation of Cancer Prevention Centers (FNCLOC) on trials of drug prevention of breast cancer by tamoxifen ]. Bull Cancer 1995; 82 Suppl 3:237s-238s. [PMID: 7492839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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Laffargue F, Giacalone PL, Boulot P, Vigouroux B, Hedon B, Benos P. A laparoscopic procedure for the treatment of vaginal aplasia. Br J Obstet Gynaecol 1995; 102:565-7. [PMID: 7647062 DOI: 10.1111/j.1471-0528.1995.tb11364.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- F Laffargue
- Department of Obstetrics and Gynaecology, Hopital Arnaud de Villeneuve, Montpellier, France
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Rousseau O, Boulot P, Lefort G, Nagy P, Bachelard B, Bonifacj C, Hedon B, Laffargue F, Viala J. Amniocentesis before 15 weeks' gestation: technical aspects and obstetric risks. Eur J Obstet Gynecol Reprod Biol 1995. [DOI: 10.1016/0028-2243(95)80010-p] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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40
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Rousseau O, Boulot P, Lefort G, Nagy P, Bachelard B, Bonifacj C, Hedon B, Laffargue F, Viala JL. Amniocentesis before 15 weeks' gestation: technical aspects and obstetric risks. Eur J Obstet Gynecol Reprod Biol 1995; 58:127-30. [PMID: 7774737 DOI: 10.1016/0028-2243(94)01978-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
In a prospective case-control study, early amniocenteses (EAC, n = 242) at between 12 and 14 weeks gestation, were compared with standard amniocenteses (SAC, n = 242) performed at between 15 and 24 weeks gestation. The medical records of these 484 cases were reviewed for indications, success rate, color and volume of amniotic fluid, gestational age, number of needle insertions, location of the placenta, culture failure rate, obstetric complications and therapeutic abortion rate. There were no significant differences between the two groups in success rate, in culture success rate or in the outcome of the pregnancies. The volume of the sample taken was smaller in the EAC patients (P < 0.001), and therapeutic abortions were performed significantly earlier (P < 0.02.) Results show that EAC is feasible from 11 weeks' gestation, and can be performed for the usual indications as an alternative to chorionic villus sampling. In the near future, cytogenetic techniques will enable results to be obtained in less than a week.
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Affiliation(s)
- O Rousseau
- Department of Obstetrics and Gynecology, Hopital Arnaud de Villeneuve 371, Monpellier, France
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Bonnier P, Romain S, Giacalone PL, Laffargue F, Martin PM, Piana L. Clinical and biologic prognostic factors in breast cancer diagnosed during postmenopausal hormone replacement therapy. Obstet Gynecol 1995; 85:11-7. [PMID: 7800305 DOI: 10.1016/0029-7844(94)00324-7] [Citation(s) in RCA: 79] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVE To ascertain the influence of hormone replacement therapy on clinical and biologic prognostic factors of breast cancer. METHODS Between 1976-1992, we treated 1081 postmenopausal women for breast cancer at our institution. Of these, 68 were undergoing postmenopausal hormone replacement therapy at the time of diagnosis. These patients were compared with a matched control group of 272 breast cancer patients who had not undergone prior hormone replacement therapy. RESULTS Patients who developed breast cancer during hormone replacement therapy had fewer locally advanced cancers (large tumors and extensive lymph node involvement) and more well-differentiated cancers (infiltrating lobular cancers and grade 1 cancer). The number of patients with estradiol or progesterone receptors was lower in the hormone-treated group. Metastasis-free survival curves showed a tendency (P = .05) for better prognosis in hormone-treated patients both overall and in stage T2. CONCLUSIONS Hormone replacement therapy per se does not affect the prognosis of breast cancer. Regular surveillance during hormone replacement therapy reduces the number of locally advanced cancers and thus improves the survival rate. The higher number of well-differentiated cancers and the distribution of hormone receptivity may reflect interaction between neoplastic tissue and exogenous hormones.
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Affiliation(s)
- P Bonnier
- Service de Gynécologie et Obstétrique A, Hôpital de la Conception, Marseille, France
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42
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Giacalone PL, Laffargue F. [Hormonal replacement therapy after breast cancer]. Contracept Fertil Sex 1994; 22:741-5. [PMID: 7827635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- P L Giacalone
- Service de gynécologie-obstétrique, Hôpital A. de Villeneuve, Faculté de médecine, Université Montpellier I
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Roger P, Montcourrier P, Maudelonde T, Brouillet JP, Pages A, Laffargue F, Rochefort H. Cathepsin D immunostaining in paraffin-embedded breast cancer cells and macrophages: correlation with cytosolic assay. Hum Pathol 1994; 25:863-71. [PMID: 8088760 DOI: 10.1016/0046-8177(94)90004-3] [Citation(s) in RCA: 54] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
High cathepsin D (cath-D) concentration in breast cancer cytosol is associated with increased risk of metastasis. To specify the relative contribution of the different cells types responsible for cath-D level in cytosol, we validated semiquantitative cath-D immunoperoxidase staining on formalin-fixed, paraffin-embedded sections, using the M1G8 monoclonal antibody, one of the two antibodies of the cytosolic assay. Using computer-aided image analysis, cath-D level in cancer cells was estimated by integrating both staining intensity in each cell and proportion of stained cells. We confirmed on 41 primary breast cancers a higher expression of cath-D in cancer cells compared with peritumoral mammary glands. Cancer cell staining was mostly in lysosomes and for some invasive ductal carcinomas in large vesicles corresponding to phagosomes. Lymphocytes and fibroblasts were not or were only weakly stained. Macrophages also were stained for cath-D, generally on the periphery of the tumor area. The cytosolic cath-D level was correlated with cath-D expression in cancer cells (r = .76; P = 1 x 10(-4)) rather than with the number of macrophages in the tumor (r = .29; P = .09), as determined by use of the specific anti-CD68 antibody. There was a significant increase in the tissue cath-D level in tumors containing large vesicles compared with tumors without large vesicles. This approach provides a means to separately estimate the prognostic significance of cath-D expression in cancer cells and macrophages when evaluating risk of metastasis.
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Affiliation(s)
- P Roger
- INSERM Unit 148, Hormones and Cancer Department of Cell Biology, Faculty of Medicine, Montpellier, France
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Boulot P, Hedon B, Pelliccia G, Peray P, Laffargue F, Viala J. Effects of selective reduction in triplet gestation: A comparative study of 80 cases managed with or without this procedure. Int J Gynaecol Obstet 1994. [DOI: 10.1016/0020-7292(94)90276-3] [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: 11/25/2022]
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Brun J, El Bouhmadi A, Boulot P, Rousseau O, Laffargue F, Viala J, Orsetti A. Evaluation of erythrocyte hyperaggregation in fetal blood drawn by cordocentesis as a marker of fetal diseases. Clin Hemorheol Microcirc 1994. [DOI: 10.3233/ch-1994-14501] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- J.F. Brun
- Service d'Exploration Physiologique des Hormones et des Métabolismes et Service de Gynécologie Obstétrique, Complexe Hospitalier Lapeyronie et Arnaud de Villeneuve 34059 Montpellier-cédex, France
| | - A. El Bouhmadi
- Service d'Exploration Physiologique des Hormones et des Métabolismes et Service de Gynécologie Obstétrique, Complexe Hospitalier Lapeyronie et Arnaud de Villeneuve 34059 Montpellier-cédex, France
| | - P. Boulot
- Service d'Exploration Physiologique des Hormones et des Métabolismes et Service de Gynécologie Obstétrique, Complexe Hospitalier Lapeyronie et Arnaud de Villeneuve 34059 Montpellier-cédex, France
| | - O. Rousseau
- Service d'Exploration Physiologique des Hormones et des Métabolismes et Service de Gynécologie Obstétrique, Complexe Hospitalier Lapeyronie et Arnaud de Villeneuve 34059 Montpellier-cédex, France
| | - F. Laffargue
- Service d'Exploration Physiologique des Hormones et des Métabolismes et Service de Gynécologie Obstétrique, Complexe Hospitalier Lapeyronie et Arnaud de Villeneuve 34059 Montpellier-cédex, France
| | - J.L. Viala
- Service d'Exploration Physiologique des Hormones et des Métabolismes et Service de Gynécologie Obstétrique, Complexe Hospitalier Lapeyronie et Arnaud de Villeneuve 34059 Montpellier-cédex, France
| | - A. Orsetti
- Service d'Exploration Physiologique des Hormones et des Métabolismes et Service de Gynécologie Obstétrique, Complexe Hospitalier Lapeyronie et Arnaud de Villeneuve 34059 Montpellier-cédex, France
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Brun J, Boulot P, Rousseau O, El Bouhmadi A, Laffargue F, Viala J, Orsetti A. Modifications of erythrocyte aggregation during labor and delivery. Clin Hemorheol Microcirc 1994. [DOI: 10.3233/ch-1994-14502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- J.F. Brun
- Service d'Exploration Physiologique des Hormones et des Metabolismes (Professeur A. Orsetti), Hopital Lapeyronie, 34059 Montpellier-cedex, France ; Laboratoire de Physiologie II, Institut de Biologie, Faculte de Medecine, Montpellier, France
| | - P. Boulot
- Service de Gynecologie et Obstetrique de Montpellier, 13 Avenue du Professeur Grasset, 34050 Montpellier
| | - O. Rousseau
- Service de Gynecologie et Obstetrique de Montpellier, 13 Avenue du Professeur Grasset, 34050 Montpellier
| | - A. El Bouhmadi
- Service de Gynecologie et Obstetrique de Montpellier, 13 Avenue du Professeur Grasset, 34050 Montpellier
| | - F. Laffargue
- Service de Gynecologie et Obstetrique de Montpellier, 13 Avenue du Professeur Grasset, 34050 Montpellier
| | - J.L. Viala
- Service de Gynecologie et Obstetrique de Montpellier, 13 Avenue du Professeur Grasset, 34050 Montpellier
| | - A. Orsetti
- Service d'Exploration Physiologique des Hormones et des Metabolismes (Professeur A. Orsetti), Hopital Lapeyronie, 34059 Montpellier-cedex, France ; Laboratoire de Physiologie II, Institut de Biologie, Faculte de Medecine, Montpellier, France
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Laffargue F, Daures JP. [Estrogens, progestins and cancer of the endometrium]. Rev Prat 1993; 43:2603-9. [PMID: 8146558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
The presence of estrogens alone increases the risk of cancer of the endometrium. The risk increases with dosage and length of administration. Estrogens have a promoting rather than an initiating role since the risk progressively disappears after stopping treatment. Hormone-induced cancers have a better prognosis than spontaneous cancers. The association of progesterone or a progestogen obviates this risk. Prescription of oestrogens after treatment of cancer of the endometrium is non longer strictly contraindicated. Each case should be considered independently.
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Affiliation(s)
- F Laffargue
- Service de gynécologie obstétrique, hôpital Arnaud-de-Villeneuve, Montpellier
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Abstract
Lymphangiomas or cystic hygromas are malformations of the lymphatic vessels and are characterized by single or multiple cysts which have developed within the soft tissues. They occur most commonly in the neck (75 per cent of cases) and are often associated with hydrops or chromosomal abnormalities (Romero et al., 1988). Mediastinal or abdominal locations are rare and represent less than 5 per cent of cases in the literature (Singh et al., 1971). This paper represents the first reported case of prenatal diagnosis of a lymphangioma in the neck, mediastinum, and abdomen. Diagnosis was made before fetal viability, and allowed us to recommend termination of the pregnancy because of the poor prognosis.
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Affiliation(s)
- P L Giacalone
- Department of Obstetrics and Gynecology, Hôpital Arnaud de Villeneuve, Montpellier, France
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Boulot P, Hedon B, Pelliccia G, Peray P, Laffargue F, Viala JL. Effects of selective reduction in triplet gestation: a comparative study of 80 cases managed with or without this procedure. Fertil Steril 1993; 60:497-503. [PMID: 8375533 DOI: 10.1016/s0015-0282(16)56167-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
OBJECTIVE To evaluate the effect of selective termination in triplet pregnancies. DESIGN Comparative, prospective, nonrandomized study. SETTING All 80 pregnancies were managed in a single tertiary center by the same obstetrical team. PATIENTS Eighty women with triplet pregnancies were divided into two groups: group I consisted of 48 women who wished to continue their pregnancies without reduction; in group II were 32 women who choose reduction generally to obtain twins. INTERVENTIONS Selective terminations were performed after an average term of 9.6 weeks of gestation by transcervical or transabdominal approaches. MAIN OUTCOME MEASUREMENTS The rate of miscarriage and prematurity, fetal growth, perinatal morbidity and mortality, and maternal complications in the two groups. RESULTS Prematurity was lower in reduced pregnancies (95.5% in triplets versus 53.5%), especially between 24 to 32 weeks' gestation where prematurity was reduced by half. Birth weight was > 450 g higher in the reduced group. The perinatal mortality rate was lower for reduced pregnancies, but this difference was not statistically significant. Five life-threatening maternal complications occurred in triplets, with none in the reduced group. CONCLUSIONS Selective terminations are effective in decreasing the rate of prematurity, improving fetal growth, and avoiding maternal complications. The procedure thus could be used in triplet gestations. The ultimate decision should be taken by the couple who must be well informed of the risks of the procedure before deciding.
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Affiliation(s)
- P Boulot
- Centres Hospitaliers et Universitaires de l'Université de Montpellier-Nîmes, France
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Abstract
Hemangiolymphangioma is a malformation of both lymphatic and blood vessels. We present a case of fetal abdominal hemolymphangioma diagnosed by ultrasound at 27 weeks of gestation. The extensive fetal involvement, and the diagnosis before fetal viability led us to propose medical termination of pregnancy. This represents the second reported case of prenatal diagnosis of this malformation.
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Affiliation(s)
- P L Giacalone
- Department of Obstetrics and Gynecology, Hospital Arnaud de Villeneuve, Montpellier, France
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