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Gouy G, Attali L, Voillot P, Fournet P, Agostini A. Experiences of Women With Medical Abortion Care Reflected in Social Media (VEILLE Study): Noninterventional Retrospective Exploratory Infodemiology Study. JMIR Infodemiology 2024; 4:e49335. [PMID: 38696232 PMCID: PMC11099808 DOI: 10.2196/49335] [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: 05/30/2023] [Revised: 02/20/2024] [Accepted: 03/06/2024] [Indexed: 05/04/2024]
Abstract
BACKGROUND Abortion (also known as termination of pregnancy) is an essential element of women's reproductive health care. Feedback from women who underwent medical termination of pregnancy about their experience is crucial to help practitioners identify women's needs and develop necessary tools to improve the abortion care process. However, the collection of this feedback is quite challenging. Social media offer anonymity for women who share their abortion experience. OBJECTIVE This exploratory infodemiology study aimed to analyze, through French social media posts, personal medical symptoms and the different experiences and information dynamics associated with the medical abortion process. METHODS A retrospective study was performed by analyzing posts geolocated in France and published from January 1, 2017, to November 30, 2021. Posts were extracted from all French-language general and specialized publicly available web forums using specific keywords. Extracted messages were cleaned and pseudonymized. Automatic natural language processing methods were used to identify posts from women having experienced medical abortion. Biterm topic modeling was used to identify the main discussion themes and the Medical Dictionary for Regulatory Activities was used to identify medical terms. Encountered difficulties were explored using qualitative research methods until the saturation of concepts was reached. RESULTS Analysis of 5398 identified posts (3409 users) led to the identification of 9 major topics: personal experience (n=2413 posts, 44.7%), community support (n=1058, 19.6%), pain and bleeding (n=797, 14.8%), psychological experience (n=760, 14.1%), questioned efficacy (n=410, 7.6%), social pressure (n=373, 6.9%), positive experiences (n=257, 4.8%), menstrual cycle disorders (n=107, 2%), and reported inefficacy (n=104, 1.9%). Pain, which was mentioned in 1627 (30.1%) of the 5398 posts by 1024 (30.0%) of the 3409 users, was the most frequently reported medical term. Pain was considered severe to unbearable in 24.5% of the cases (399 of the 1627 posts). Lack of information was the most frequently reported difficulty during and after the process. CONCLUSIONS Our findings suggest that French women used social media to share their experiences, offer and find support, and provide and receive information regarding medical abortion. Infodemiology appears to be a useful tool to obtain women's feedback, therefore offering the opportunity to enhance care in women undergoing medical abortion.
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Affiliation(s)
- Giulia Gouy
- Service de Gynécologie-Obstétrique, Hôpital de la Croix-Rousse, Lyon, France
| | - Luisa Attali
- Pôle de Gynécologie-Obstétrique et Fertilité, Hôpital de Hautepierre, Centre Hospitalier Universitaire de Strasbourg, Strasbourg, France
| | | | | | - Aubert Agostini
- Service de Gynécologie et d'Obstétrique, Hôpital de la Conception, Assistance Publique-Hôpitaux de Marseille, Marseille, France
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Schmitt A, Crochet P, Pivano A, Tourette C, Faust C, Baumstarck K, Agostini A. The Effects of a Laparoscopy by Single-Port Endoscopic Access in Benign Adnexal Surgery: A Randomized Controlled Trial. J Minim Invasive Gynecol 2024; 31:397-405. [PMID: 38310954 DOI: 10.1016/j.jmig.2024.01.017] [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: 06/03/2023] [Revised: 01/25/2024] [Accepted: 01/26/2024] [Indexed: 02/06/2024]
Abstract
STUDY OBJECTIVE To evaluate whether laparoendoscopic single-site surgery (LESS) offers advantages over conventional laparoscopy (CL) in benign adnexal surgery. DESIGN Randomized controlled study. SETTING Gynecology-Obstetrics Unit of the University Hospital of the Conception in Marseille, France. PATIENTS Patients older than 18 years requiring ovarian cystectomy or salpingo-oophorectomy by laparoscopy for symptomatic ovarian cysts requiring benign or prophylactic surgery. INTERVENTIONS In the case of ovarian cysts, premenopausal patients typically undergo a unilateral cystectomy, whereas postmenopausal patients undergo a unilateral or bilateral salpingo-oophorectomy upon a patient's request. In cases requiring prophylactic surgery, a bilateral salpingo-oophorectomy was performed. All participants were randomly assigned to either the LESS or the CL group. MEASUREMENTS AND MAIN RESULTS Patients in both groups reported similar levels of pain at 24 hours: Simple Numerical Scale was 1.3 (standard deviation, 1.5) in the LESS group vs 1.7 (standard deviation, 1.5) in the CL group (p = .12), and there were no significant differences in postoperative pain at 2 hours, 4 hours, 6 hours, and 7 days. Furthermore, there was no difference in analgesic consumption. Regarding intraoperative criteria, the only difference was the longer operating time in the LESS group than the CL group. We also found that patients' satisfaction with their scar at 1 month may be higher with LESS than with CL. CONCLUSION There was no significant difference between the 2 techniques in postoperative pain, although the LESS technique necessitated a longer operative time than the CL technique, while providing better aesthetic result patients.
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Affiliation(s)
- Andy Schmitt
- Division of Gynecology, Obstetrics, and Reproduction, Gynepôle, Hôpital de la Conception, Marseille, France (Drs. Schmitt, Crochet, Pivano, Tourette, and Agostini).
| | - Patrice Crochet
- Division of Gynecology, Obstetrics, and Reproduction, Gynepôle, Hôpital de la Conception, Marseille, France (Drs. Schmitt, Crochet, Pivano, Tourette, and Agostini)
| | - Audrey Pivano
- Division of Gynecology, Obstetrics, and Reproduction, Gynepôle, Hôpital de la Conception, Marseille, France (Drs. Schmitt, Crochet, Pivano, Tourette, and Agostini)
| | - Claire Tourette
- Division of Gynecology, Obstetrics, and Reproduction, Gynepôle, Hôpital de la Conception, Marseille, France (Drs. Schmitt, Crochet, Pivano, Tourette, and Agostini)
| | - Cindy Faust
- Department of Public Health, Aix-Marseille University, Marseille, France (Drs. Faust and Baumstarck)
| | - Karine Baumstarck
- Department of Public Health, Aix-Marseille University, Marseille, France (Drs. Faust and Baumstarck)
| | - Aubert Agostini
- Division of Gynecology, Obstetrics, and Reproduction, Gynepôle, Hôpital de la Conception, Marseille, France (Drs. Schmitt, Crochet, Pivano, Tourette, and Agostini)
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Miquel L, Liotta J, Pivano A, Gnisci A, Netter A, Courbiere B, Agostini A. Ethanol endometrioma sclerotherapy: safety through 8 years of experience. Hum Reprod 2024; 39:733-741. [PMID: 38327007 DOI: 10.1093/humrep/deae014] [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: 02/03/2023] [Revised: 01/06/2024] [Indexed: 02/09/2024] Open
Abstract
STUDY QUESTION What are the complications of transvaginal ethanol sclerotherapy for the treatment of endometriomas? SUMMARY ANSWER Sclerotherapy is a reliable, minimally invasive method applicable in outpatient procedures but with specific and potential life-threatening complications that need to be identified and prevented. WHAT IS KNOWN ALREADY There are currently few data on the use of transvaginal ethanol sclerotherapy, and we mainly note septic complications. STUDY DESIGN, SIZE, DURATION A retrospective observational cohort study was carried out. The study was conducted at an academic hospital and included 126 women aged 31.9 ± 5.5 years (mean ± SD), between November 2013 and June 2021. We analyzed a total of 157 ethanol sclerotherapy treatment (EST), treated by 131 EST procedures, in 126 women. PARTICIPANTS/MATERIALS, SETTING, METHODS The study included women with an indication for transvaginal ethanol sclerotherapy. Indications were women with at least one endometrioma over 10 mm, isolated or associated with other endometriosis locations, requiring treatment for pain or infertility before assisted reproductive treatment. We followed a standardized transvaginal ethanol sclerotherapy procedure consisting of an ultrasound-guided transvaginal puncture of one or more endometriomas under general anesthesia. The cyst content was completely removed and flushed with saline solution. Ethanol (96%) was injected at 60% of the initial volume of the endometrioma, remained in the cyst for 10 min and was then completely removed. Ethanol loss was defined as a loss of 5 ml or more than 10% of the initial volume of the injected ethanol. Failure was defined by the contraindication of endometrioma puncture because of interposition of the digestive tract, ethanol loss in the previous endometrioma treated (in case of multiple ESTs), failure to aspirate the endometriotic fluid, contraindication to start ethanol injection owing to saline solution leakage, or contraindication to continue ethanol injection owing to suspicions of ethanol leakage at sonography. Intraoperative complications were defined by ethanol loss, positive blood alcohol level, and ethanol intoxication. Postoperative complications were defined by fever, biological inflammatory syndrome, and ovarian abscess. Complications were classified according to the Clavien and Dindo surgical classification, which is a system for classifying postoperative complications in five grades of increasing severity. MAIN RESULTS AND THE ROLE OF CHANCE We reported a total of 17/157 (10.8%) transvaginal ethanol sclerotherapy failures during 14/131 (10.7%) transvaginal ethanol sclerotherapy procedures in 13/126 (10.3%) women. In the same sets of data, complication was reported for 15/157 (9.5%) transvaginal ethanol sclerotherapy in 13/131 (9.9%) transvaginal ethanol sclerotherapy procedures in 13/126 (10.3%) women. Nine of 126 women (7.1%) had a grade I complication, one (0.8%) had a grade II complication (medical treatment for suspicion of pelvic infection), two (1.6%) had a grade III complication (ovarian abscess) and one (0.8%) had a grade IV complication (ethanol intoxication). We did not observe any grade V complications. LIMITATIONS, REASONS FOR CAUTION This was a retrospective study and pain assessment not considered. The benefit-risk balance of endometrioma transvaginal ethanol sclerotherapy was not evaluated. WIDER IMPLICATIONS OF THE FINDINGS Our study is the first to evaluate the complications of transvaginal ethanol sclerotherapy with such a large cohort of women in a standardized protocol. Transvaginal ethanol sclerotherapy seems to be an effective alternative to laparoscopic surgery in the management of endometriomas and limits the alteration of ovarian reserve. Transvaginal ethanol sclerotherapy is a reliable, minimally invasive method applicable on an outpatient basis. The majority of complications are Clavien-Dindo ≤IV, for which preventative measures, or at least early diagnosis and treatment, can be easily performed. The risk of ethanol intoxication is rare, but it is a life-threatening risk that must be avoided by appropriate implementation and promotion of the sclerotherapy procedures. STUDY FUNDING/COMPETING INTEREST(S) None. TRIAL REGISTRATION NUMBER Aix Marseille University's ethics committee registration number 2021-06-03-01.
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Affiliation(s)
- L Miquel
- Department of Obstetrics Gynecology and Reproductive Medicine, Pôle femmes parents enfants, La Conception University Hospital, Marseille, France
| | - J Liotta
- Department of Obstetrics Gynecology and Reproductive Medicine, Pôle femmes parents enfants, La Conception University Hospital, Marseille, France
| | - A Pivano
- Department of Obstetrics Gynecology and Reproductive Medicine, Pôle femmes parents enfants, La Conception University Hospital, Marseille, France
| | - A Gnisci
- Department of Obstetrics Gynecology and Reproductive Medicine, Pôle femmes parents enfants, La Conception University Hospital, Marseille, France
| | - A Netter
- Department of Obstetrics Gynecology and Reproductive Medicine, Pôle femmes parents enfants, La Conception University Hospital, Marseille, France
- Department of Mediterranean Institute of marine and terrestrial Biodiversity and Ecology, Aix Marseille Univ, Avignon Université, CNRS, IRD, IMBE, Marseille, France
| | - B Courbiere
- Department of Obstetrics Gynecology and Reproductive Medicine, Pôle femmes parents enfants, La Conception University Hospital, Marseille, France
- Department of Mediterranean Institute of marine and terrestrial Biodiversity and Ecology, Aix Marseille Univ, Avignon Université, CNRS, IRD, IMBE, Marseille, France
| | - A Agostini
- Department of Obstetrics Gynecology and Reproductive Medicine, Pôle femmes parents enfants, La Conception University Hospital, Marseille, France
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Chene G, Baffet H, Cerruto E, Nohuz E, Agostini A. The role of progestin subdermal implant in the management of adenomyosis: a systematic review. EUR J CONTRACEP REPR 2024; 29:61-68. [PMID: 38426337 DOI: 10.1080/13625187.2024.2314298] [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: 10/27/2023] [Accepted: 01/29/2024] [Indexed: 03/02/2024]
Abstract
PURPOSE The long-acting reversible contraception progestin subdermal implant (ENG implant) may be effective to improve endometriosis-related symptoms. Since adenomyosis is a histopathological form of endometriosis, we aimed to evaluate the effectiveness of ENG implant in adenomyosis management. MATERIALS AND METHODS Electronic search in Medline, Scopus, Embase databases and Google Scholar using combinations of the following keywords: Progestin; subdermal implant; Implanon; Nexplanon; Adenomyosis; Endometriosis. RESULTS Out of 889 articles in the initial database, 5 prospective observational studies were eligible for inclusion in our literature review. Our review involving 152 participants found a significant reduction in pelvic pain and dysmenorrhoea (baseline median VAS score ranged from 10 to 7.62 before implantation vs VAS score ranged from 1.81 to 0.1 after implantation) as well as an increase in the levels of haemoglobin after implantation of the device (from 86 g/L to 129 g/L after implantation). Moreover, the improvement may be sustained throughout the long-term follow-up visits (until 36 months). The most common adverse events were changes in bleeding patterns which were tolerable in most cases. CONCLUSION ENG implant may be a relevant and promising medical option in the management of adenomyosis. Nevertheless, randomised controlled trials and prospective studies with larger cohorts are needed to confirm the potential role of ENG implant in the management of adenomyosis.
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Affiliation(s)
- G Chene
- Department of Gynecology, Hôpital Femme Mère Enfant, HFME, University of Lyon, Lyon, France
- Claude Bernard University of Lyon, Lyon, France
| | - H Baffet
- Department of Gynecology, Jeanne de Flandre Hospital, University Hospital of Lille, Lille, France
| | - E Cerruto
- Department of Gynecology, Hôpital Femme Mère Enfant, HFME, University of Lyon, Lyon, France
| | - E Nohuz
- Department of Gynecology, Hôpital Femme Mère Enfant, HFME, University of Lyon, Lyon, France
| | - A Agostini
- Department of Gynecology, Assistance Publique - Hôpitaux de Marseille, La Conception Hospital, Aix Marseille Université, Marseille, France
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Djemouai S, Agostini A, Loubière S, Auquier P, Pirro N, Netter A, Pivano A. Enhanced recovery after surgery (ERAS) for deep infiltrating endometriosis surgery: experience of a French center. J Gynecol Obstet Hum Reprod 2024:102771. [PMID: 38513805 DOI: 10.1016/j.jogoh.2024.102771] [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: 03/26/2023] [Revised: 03/03/2024] [Accepted: 03/18/2024] [Indexed: 03/23/2024]
Abstract
OBJECTIVE The objective of the study was to evaluate the implementation of an ERAS programme for deep pelvic endometriosis (DPE) surgery in terms of length of stay (LOS), postoperative complications (POC) and rehospitalisation rate. METHODS This was a comparative retrospective monocentric study in the Gynaecologic Department of the La Conception Hospital in Marseille, France. We compared a 'conventional' group, with classic perioperative management corresponding to patients undergoing DPE surgery between April 8, 2014 and January 23, 2018, and an 'ERAS' group after setting up the ERAS protocol from February 6, 2018 to March 6, 2020. RESULTS A total of 101 patients with DPE surgery were included, with 39 in the conventional group and 53 in the ERAS group. The LOS decreased by 1.91 days (p < 0.001). During the 45 postoperative days, no difference was found in rehospitalised rate (p = 1). The POC rate was 15/39 (38.5%) in the conventional group and 12/53 (22.6%) in the ERAS group (p = 0.1). CONCLUSION The implementation of an ERAS programme for DPE surgery is an effective strategy because it can reduce the LOS without increasing the POC rate.
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Affiliation(s)
- Sara Djemouai
- Department of Obstetrics and Gynecology, Hôpital La Conception, Aix-Marseille University, Marseille, France.
| | - Aubert Agostini
- Department of Obstetrics and Gynecology, Hôpital La Conception, Aix-Marseille University, Marseille, France
| | - Sandrine Loubière
- CEReSS - Health Services and Quality of Life Research, Department of Epidemiology, Aix-Marseille University, Marseille, France
| | - Pascal Auquier
- CEReSS - Health Services and Quality of Life Research, Department of Epidemiology, Aix-Marseille University, Marseille, France
| | - Nicolas Pirro
- Department of Digestive Surgery, Hôpital Timone, Aix-Marseille University, Marseille, France
| | - Antoine Netter
- Department of Obstetrics and Gynecology, Hôpital La Conception, Aix-Marseille University, Marseille, France
| | - Audrey Pivano
- Department of Obstetrics and Gynecology, Hôpital La Conception, Aix-Marseille University, Marseille, France
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Niddam R, Netter A, Courbière B, Agostini A, Miquel L. Laparoscopic Multibipolar Radiofrequency Myolysis for Symptomatic Myomas in 10 Steps. J Minim Invasive Gynecol 2024:S1553-4650(24)00114-6. [PMID: 38493828 DOI: 10.1016/j.jmig.2024.03.004] [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: 10/26/2023] [Revised: 02/26/2024] [Accepted: 03/13/2024] [Indexed: 03/19/2024]
Abstract
STUDY OBJECTIVE To describe a minimal invasive 10-step technique of laparoscopic multibipolar radiofrequency myolysis for symptomatic myomas. DESIGN A step-by-step video demonstration of the technique. SETTING A woman with symptomatic FIGO 5 myoma of 60 mm of diameter, confirmed by magnetic resonance imaging. The patient included in this video gave consent for publication of the video and posting of the video online including social media, the journal website, scientific literature websites (such as PubMed, ScienceDirect, Scopus, etc.) and other applicable sites. INTERVENTIONS Approximately 30% of women of child-bearing age with myomas will present with symptoms [1] that include chronic pelvic pain, abnormal uterine bleeding or infertility [2,3]. Data regarding fertility preservation and obstetric outcomes suggest that radiofrequency myoma ablation may offer an alternative to existing treatments for women who desire future fertility [4]. The local institutional review board stated that approval was not required because the video describes a technique and not a clinical case. In our center, all radiofrequency indications are discussed during a monthly multidisciplinary myomas meeting. This video presents the procedure divided into the following 10 steps: planning of the surgery; materials; installation; laparoscopic exploration; transvaginal ultrasound examination; visual and transvaginal ultrasound guided transparietal puncture of the myoma; control of the applicators' position; radiofrequency myolysis; end of myolysis, applicators removal; final check and additional procedures. CONCLUSION Radiofrequency myolysis is a simple and reproductible procedure that can be offered as an alternative to myomectomy [5]. This video presents 10 steps to make the procedure easier to adopt and to reduce its learning curve. VIDEO ABSTRACT.
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Affiliation(s)
- Raphael Niddam
- Department of Obstetrics, Gynecology, and Reproductive Medicine (all authors) Pôle Femmes Parents Enfants, AP-HM La Conception University Hospital, Marseille, France.
| | - Antoine Netter
- Department of Obstetrics, Gynecology, and Reproductive Medicine (all authors) Pôle Femmes Parents Enfants, AP-HM La Conception University Hospital, Marseille, France
| | - Blandine Courbière
- Department of Obstetrics, Gynecology, and Reproductive Medicine (all authors) Pôle Femmes Parents Enfants, AP-HM La Conception University Hospital, Marseille, France; Department of Biomarkers, Environment and Health (Dr. Courbière), Aix Marseille University, CNRS, IRD, Avignon University, IMBE, Marseille, France
| | - Aubert Agostini
- Department of Obstetrics, Gynecology, and Reproductive Medicine (all authors) Pôle Femmes Parents Enfants, AP-HM La Conception University Hospital, Marseille, France
| | - Laura Miquel
- Department of Obstetrics, Gynecology, and Reproductive Medicine (all authors) Pôle Femmes Parents Enfants, AP-HM La Conception University Hospital, Marseille, France
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Poscente M, Tolomeo D, Arshadi A, Agostini A, L'Abbate A, Solimando AG, Palumbo O, Carella M, Palumbo P, González T, Hernández-Rivas JM, Bassi L, Isidori R, Dell'Aquila M, Trapè G, Latagliata R, Pessina G, Natoni F, Storlazzi CT. Aggressive systemic mastocytosis with the co-occurrence of PRKG2::PDGFRB, KAT6A::NCOA2, and RXRA::NOTCH1 fusion transcripts and a heterozygous RUNX1 frameshift mutation. Cancer Genet 2024; 284-285:5-11. [PMID: 38471404 DOI: 10.1016/j.cancergen.2024.03.002] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 01/05/2024] [Accepted: 03/05/2024] [Indexed: 03/14/2024]
Abstract
Systemic mastocytosis (SM) is a myeloproliferative neoplasm displaying abnormal mast cell proliferation. It is subdivided into different forms, including aggressive systemic mastocytosis (ASM) and systemic mastocytosis with an associated hematologic neoplasm (SM-AHN). Oncogenic genetic alterations include point mutations, mainly the KIT D816V, conferring poor prognosis and therapy resistance, and fusion genes, with those involving PDGFRA/PDGFRB as the most recurrent events. We here describe an ASM case negative to the KIT D816V and JAK2 V617F alterations but showing a RUNX1 frameshift heterozygous mutation and the co-occurrence of three fusion transcripts. The first one, PRKG2::PDGFRB, was generated by a balanced t(4;5)(q24;q32) translocation as the sole abnormality. Other two novel chimeras, KAT6A::NCOA2 and RXRA::NOTCH1, originated from cryptic intra-chromosomal abnormalities. The patient rapidly evolved towards SM-AHN, characterized by the persistence of the PRKG2::PDGFRB chimera, due to the presence of an extra copy of the der(5)t(4;5)(q24;q34) chromosome and an increase in the RUNX1 mutation allelic frequency. The results indicated that the transcriptional landscape and the mutational profile of SM deserve attention to predict the evolution and prognosis of this complex disease, whose classification criteria are still a matter of debate.
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Affiliation(s)
- M Poscente
- UOSD Laboratorio di Genetica Medica, Ospedale Belcolle, Viterbo, Italy
| | - D Tolomeo
- Department of Biosciences, Biotechnology and Environment, University of Bari Aldo Moro, Bari, Italy
| | - A Arshadi
- Department of Biosciences, Biotechnology and Environment, University of Bari Aldo Moro, Bari, Italy
| | - A Agostini
- Department of Precision and Regenerative Medicine and Ionian Area, Unit of Internal Medicine and Clinical Oncology, University of Bari Aldo Moro, Bari, Italy
| | - A L'Abbate
- Istituto di Biomembrane, Bioenergetica e Biotecnologie Molecolari (IBIOM), Consiglio Nazionale delle Ricerche, Bari, Italy
| | - A G Solimando
- Department of Precision and Regenerative Medicine and Ionian Area, Unit of Internal Medicine and Clinical Oncology, University of Bari Aldo Moro, Bari, Italy; IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - O Palumbo
- Division of Medical Genetics, Fondazione IRCCS-Casa Sollievo della Sofferenza, San Giovanni Rotondo Foggia, Italy
| | - M Carella
- Division of Medical Genetics, Fondazione IRCCS-Casa Sollievo della Sofferenza, San Giovanni Rotondo Foggia, Italy
| | - P Palumbo
- Division of Medical Genetics, Fondazione IRCCS-Casa Sollievo della Sofferenza, San Giovanni Rotondo Foggia, Italy
| | - T González
- Department of Medicine, Universidad de Salamanca, Department of Hematology, Hospital Universitario de Salamanca, IBSAL, IBMCC-Centro de Investigación del Cáncer (USAL-CSIC), Salamanca, Spain
| | - J M Hernández-Rivas
- Department of Medicine, Universidad de Salamanca, Department of Hematology, Hospital Universitario de Salamanca, IBSAL, IBMCC-Centro de Investigación del Cáncer (USAL-CSIC), Salamanca, Spain
| | - L Bassi
- UOSD Laboratorio di Genetica Medica, Ospedale Belcolle, Viterbo, Italy
| | - R Isidori
- UOSD Laboratorio di Genetica Medica, Ospedale Belcolle, Viterbo, Italy
| | - M Dell'Aquila
- UOC Anatomia Patologica, Ospedale Belcolle, Viterbo, Italy
| | - G Trapè
- UOC Ematologia, Ospedale Belcolle, Viterbo, Italy
| | - R Latagliata
- UOC Ematologia, Ospedale Belcolle, Viterbo, Italy
| | - G Pessina
- UOSD Laboratorio di Genetica Medica, Ospedale Belcolle, Viterbo, Italy
| | - F Natoni
- UOSD Laboratorio di Genetica Medica, Ospedale Belcolle, Viterbo, Italy
| | - C T Storlazzi
- Department of Biosciences, Biotechnology and Environment, University of Bari Aldo Moro, Bari, Italy.
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Coma T, Mancini J, Puppo S, Agostini A, Carcopino X. Rate of residual tumor after repeat surgery for positive margins in ductal carcinoma in Situ, and predictive factors. J Gynecol Obstet Hum Reprod 2024; 53:102739. [PMID: 38311001 DOI: 10.1016/j.jogoh.2024.102739] [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: 11/10/2023] [Revised: 01/18/2024] [Accepted: 02/01/2024] [Indexed: 02/06/2024]
Abstract
AIMS To evaluate the rate of residual tumor in re-excision specimen of patients with positive margins in ductal carcinoma in situ (DCIS) following breast-conservative surgery, and to identify predictive factors of residual tumor. MATERIAL AND METHODS We conducted a monocentric, retrospective study, from January 2010 to December 2020. All 103 patients who underwent re-excision for positive margins in DCIS following breast-conservative surgery for in situ or invasive breast carcinoma were included. Positive margins were defined as inferior to 2 mm from the DCIS component. Two groups were defined, depending on the presence of residual tumor or not, and were compared on their clinical and histopathological characteristics to identify predictive factors of residual tumor. RESULTS Residual tumor was found in re-excision specimen of 46 patients (44.7 %). The risk of residual tumor was increased in patients with more than 2 tumor foci (aOR: 12.4; 95 % CI: 1.2 -124.1; p = 0.032) and in those with extensive margin involvement (aOR: 3.2; 95 % CI: 1.3-8.2; p = 0.013). Finally, surgery performed after 2013 was associated with a lower risk of residual tumor (aOR: 0.23; 95 % CI: 0.09-0.058; p = 0.002). CONCLUSION The rate of residual tumor in re-excision specimen of patients with positive margins in DCIS is high. Both the number of tumor foci and the extension of positive margins were identified as risk factors. Finally, the surgical learning curve for this procedure seems to be significantly correlated with the risk of residual tumor and needs to be considered.
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Affiliation(s)
- Tiphaine Coma
- Department of Obstetrics and Gynaecology, Hôpital Nord, APHM, Aix-Marseille University (AMU), Marseille, France.
| | - Julien Mancini
- Aix-Marseille Univ, APHM, INSERM, IRD, ISSPAM, SESSTIM, Public Health Department, Hop Timone, Marseille, France
| | - Séverine Puppo
- Department of Obstetrics and Gynaecology, Hôpital Nord, APHM, Aix-Marseille University (AMU), Marseille, France
| | - Aubert Agostini
- Department of Obstetrics and Gynaecology, Hôpital de la Conception, APHM, Aix-Marseille University (AMU), Marseille, France
| | - Xavier Carcopino
- Department of Obstetrics and Gynaecology, Hôpital Nord, APHM, Aix-Marseille University (AMU), Univ Avignon, CNRS, IRD, IMBE UMR 7263, Marseille 13397, France
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9
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Nehmé L, Agostini A, Piclet H, Bargier J. [The place of sexual health in general medicine]. Gynecol Obstet Fertil Senol 2024; 52:86-94. [PMID: 38070675 DOI: 10.1016/j.gofs.2023.11.009] [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: 08/12/2023] [Revised: 11/15/2023] [Accepted: 11/28/2023] [Indexed: 12/21/2023]
Abstract
OBJECTIVE Assessment of the practices and knowledge of general practitioners in Bouches-du-Rhône and Vaucluse regarding their patients's sexual health. METHOD A descriptive cross-sectional study was conducted among general practitioners in Bouches-du-Rhône and Vaucluse from January 12, 2023 to February 9, 2023. A questionnaire was developed and sent to general practitioners practicing in Bouches-du-Rhône and Vaucluse. It was distributed by personal and professional emails and numbers, and Bouches-du-Rhône and Vaucluse's medical order. The questionnaire was divided into three parts: the first collected demographic and epidemiological data, the second assessed knowledge and practices of general practitioners regarding the sexual health, and the last evaluated practitioner's obstacles to talking about sexual health. RESULTS Ninety-nine general practitioners responded to the questionnaire (99/276, 35.9%). In all, 30.3% obtained a rate of correct answers>60%. The general practitioners with the best response rates had training in sexology or a degree in gynecology (P=0.0109). In their practices, some topics such as contraception for adolescents, the reassessment of contraception, the search for vulvuvaginal disorders in postmenopausal patients are more addressed by doctors and in particular those of the female sex. Other topics such as sexual violence, male sexual dysfunction and sexual health in patients over 70 are less discussed in consultation. CONCLUSION The care of sexual health is an important part of global health, specific to the profession of general practitioner. The results of our study suggest that the knowledge and practices of general practitioners in Bouches-du-Rhône and Vaucluse, are perfectible. The establishment of professional training, consultation dedicated to prevention, or even better awareness of sexual health professionals would promote a better screening.
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Affiliation(s)
- Laurie Nehmé
- Faculté de médecine d'Aix-Marseille, Marseille, France.
| | - Aubert Agostini
- Department of Gynecology and Obstetrics, Assistance publique-Hôpitaux de Marseille, AP-HM, Marseille, France
| | - Hélène Piclet
- Department of Gynecology and Obstetrics, Assistance publique-Hôpitaux de Marseille, AP-HM, Marseille, France
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10
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Andriamanjay D, Castel P, D'Ercole C, Bretelle F, Agostini A, Berbis J, Blanc J. [Development of a measuring tool for performance anxiety in obstetrics]. Gynecol Obstet Fertil Senol 2024:S2468-7189(24)00011-4. [PMID: 38246241 DOI: 10.1016/j.gofs.2024.01.007] [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: 08/27/2023] [Accepted: 01/12/2024] [Indexed: 01/23/2024]
Abstract
OBJECTIVE Developing a measuring tool for physician's performance anxiety during obstetrical procedures, as a self-administered questionnaire. METHODS We used the Delphi method. First, we did a literature review to identify the items to submit for the first round. A panel of experts was asked to rate the relevance of items from one to six. For the first round of Delphi, items were retained if more than 70% of respondents assigned a five or six rating. Items were excluded if more than 70% of respondents assigned a one or two rating. All the other items, plus those suggested by the panel, were submitted to a second round of Delphi. The same item selection conditions were applied to the second round. RESULTS The overall response rate to the Delphi was 79% (19 respondents). At the end of the first round, 14 items were consensually relevant, no item was consensually irrelevant. For the second round, the 18 items that did not find consensus and seven new items suggested by the experts in the first round were submitted. At the end of the second round, nine items were retained by consensus as relevant. CONCLUSION This study defined by consensus 23 items for a self-questionnaire to measure specific performance anxiety in obstetrics divided into five dimensions: perceived stress, assessment of the risk of complications, medico-legal risk, impact of the healthcare team and peers, self-confidence and decision-making confidence. We intend to validate this tool in real population.
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Affiliation(s)
- Dio Andriamanjay
- Department of Obstetrics and Gynecology, Hôpital La Conception, Aix-Marseille University, Marseille, France.
| | - Pierre Castel
- Department of Obstetrics and Gynecology, Hôpital Nord, Aix-Marseille University, Marseille, France
| | - Claude D'Ercole
- Department of Obstetrics and Gynecology, Hôpital Nord, Aix-Marseille University, Marseille, France
| | - Florence Bretelle
- Department of Obstetrics and Gynecology, Hôpital La Conception, Aix-Marseille University, Marseille, France
| | - Aubert Agostini
- Department of Obstetrics and Gynecology, Hôpital La Conception, Aix-Marseille University, Marseille, France
| | - Julie Berbis
- Research Centre on Health Services and Quality of Life, Aix-Marseille University, Marseille, France
| | - Julie Blanc
- Department of Obstetrics and Gynecology, Hôpital Nord, Aix-Marseille University, Marseille, France; Research Centre on Health Services and Quality of Life, Aix-Marseille University, Marseille, France
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11
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D'Angelo A, Peracchini M, Agostini A, Di Matteo C, Fiore M, Ceccanti M, Vitali M, Messina MP. The Impact of Oxidative Stress on Pregnancy. The Neglected Role of Alcohol Misuse. Clin Ter 2024; 175:47-56. [PMID: 38358477 DOI: 10.7417/ct.2024.5033] [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] [Subscribe] [Scholar Register] [Indexed: 02/16/2024]
Abstract
Abstract Oxygen is essential for human life. However, it could cause damaging effects on biological systems causing oxidative stress. Oxidative stress defined as "an alteration in the pro-oxidant-antioxidant balance in favor of the former that leads to potential damage" is characterized by the release of Reactive Oxygen Species (ROS). Oxidative stress is now recognized to play a central role in the pathophysiology of many different disorders, including complications of pregnancy such as placental pathology, PreEclampsia (PE), Intrauterine Growth Restriction (IUGR), gestational diabetes, and miscarriage. This narrative review aims to summarize pieces of evidence about the role of oxidative stress in the pathophysiology of the main obstetric complications with par-ticular interest in the neglected role of alcohol abuse.
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Affiliation(s)
- A D'Angelo
- Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - M Peracchini
- USL Toscana Centro, Ospedale S. Giovanni di Dio, Firenze, Italy
| | - A Agostini
- Department of Gynecology and Obstetrics - ASL Viterbo, Viterbo, Italy
| | | | - M Fiore
- Institute of Biochemistry and Cell Biology, IBBC-CNR, Rome, Italy
| | - M Ceccanti
- SITAC, Società Italiana per il Trattamento dell'Alcolismo e le sue Complicanze, Rome, Italy
| | | | - M P Messina
- Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome, Rome, Italy
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12
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Ode C, Cavelier T, Eydoux R, Federicci M, Hamdaoui N, Piclet H, Amart L, Agostini A. Diagnostic value of a questionnaire for term assessment among women seeking abortion. J Gynecol Obstet Hum Reprod 2023; 52:102639. [PMID: 37549878 DOI: 10.1016/j.jogoh.2023.102639] [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: 03/27/2023] [Revised: 08/03/2023] [Accepted: 08/04/2023] [Indexed: 08/09/2023]
Abstract
INTRODUCTION Since 2020 in France, at-home medical abortion (AHMA) has been authorised for up to nine weeks of gestation. All consultations can be performed via teleconsultation. The determination of gestational age (GA) by interrogation avoids a systematic ultrasound and facilitates the care pathway. The main objective of this study was to evaluate the diagnostic value of a questionnaire to determine a GA lower than seven or nine weeks of gestation (WG). MATERIALS AND METHODS This was a prospective study carried out on patients requesting an abortion in the Gynaecology Department of the North and Conception hospitals (Hôpital Nord and la Conception), AP-HM (Assistance Publique des Hôpitaux de Marseille), from 2 November 2021 to 1 September 2022. A modified translated questionnaire was evaluated. The questionnaire was published in June 2020 by the Royal College of Obstetricians and Gynaecologists (RCOG) to ensure access to abortion in England. All patients included in the study completed the questionnaire and received an ultrasound. We assessed the diagnostic value of the questionnaire for determining GA below seven or nine WG. RESULTS Seven hundred and forty-eight patients were included in the study. The sensitivity of the questionnaire for determining patients with a GA of less than seven and nine WG was 84% and 93%, with a positive predictive value of 71.4% and 91.8% respectively. DISCUSSION The study showed that the questionnaire had good diagnostic value for the selection of patients of under nine WG. Thus, women with limited access to ultrasounds could avoid them.
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Affiliation(s)
- Chloé Ode
- Department of Obstetrics and Gynecology, La Conception Hospital, Assistance Publique-Hôpitaux de Marseille, 147 bd Baille, Marseille 13005, France.
| | - Tiphaine Cavelier
- Department of Obstetrics and Gynecology, La Conception Hospital, Assistance Publique-Hôpitaux de Marseille, 147 bd Baille, Marseille 13005, France
| | - Raphaelle Eydoux
- Department of Obstetrics and Gynecology, La Conception Hospital, Assistance Publique-Hôpitaux de Marseille, 147 bd Baille, Marseille 13005, France
| | - Marine Federicci
- Department of Obstetrics and Gynecology, La Conception Hospital, Assistance Publique-Hôpitaux de Marseille, 147 bd Baille, Marseille 13005, France
| | - Naima Hamdaoui
- Department of Obstetrics and Gynecology, Nord Hospital, Assistance Publique-Hôpitaux de Marseille, Chemin des Bourrely, Marseille 13915, France
| | - Héléne Piclet
- Department of Obstetrics and Gynecology, Nord Hospital, Assistance Publique-Hôpitaux de Marseille, Chemin des Bourrely, Marseille 13915, France
| | - Lise Amart
- Department of Obstetrics and Gynecology, Nord Hospital, Assistance Publique-Hôpitaux de Marseille, Chemin des Bourrely, Marseille 13915, France
| | - Aubert Agostini
- Department of Obstetrics and Gynecology, La Conception Hospital, Assistance Publique-Hôpitaux de Marseille, 147 bd Baille, Marseille 13005, France
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13
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Alasia I, Agostini A, Faust C, Berbis J, Pivano A. Effect of hormonal treatment on evolution of endometriomas: An observational study. J Gynecol Obstet Hum Reprod 2023; 52:102637. [PMID: 37527765 DOI: 10.1016/j.jogoh.2023.102637] [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: 12/13/2022] [Revised: 05/03/2023] [Accepted: 07/26/2023] [Indexed: 08/03/2023]
Abstract
OBJECTIVE To evaluate the evolution of endometriomas with or without medical treatment. METHODS This retrospective observational study was performed at the Gynaecological Center, Hôpital La Conception (Assistance Publique Hopitaux de Marseille). We reviewed clinical data of patients with at least one endometrioma diagnosed by magnetic resonance imaging (MRI) and at least one other MRI exam after more than three months. Patients were divided into groups receiving medical treatment and without medical treatment (high-dose progestins, low-dose progestins or combined contraceptives). The primary objective was to evaluate the evolution of endometriomas with or without hormonal treatment. The primary evaluation criterion was the diameter of the endometriomas, and the secondary evaluation criterion was the number of endometriomas for each patient observed. The secondary objective was to evaluate whether different categories of hormonal treatment have different efficacity in the evolution of endometriomas. RESULTS We included 68 patients, 39 (57,4%) with hormonal treatment and 29 (42,6%) without hormonal treatment. There were 105 total endometriomas identified at the first MRI, 52 in patients with hormonal treatment and 53 in patients without treatment. The mean diameter of the endometriomas in patients with hormonal treatment was 31,48 ± 18,1 mm at the first MRI and 23,60 ± 15,3 mm at the second MRI. The mean diameter of the endometriomas in patients without treatment was 33,57 ± 19,7 mm at the first MRI and 40,11 ± 25,7 mm at the second MRI (statistically significant difference, p = 0.01). The mean number of endometriomas in patients with treatment was 1,79 ± 1,1 at the first MRI and 1,18 ± 0,9 at the second MRI, while the mean number of endometriomas in patients without hormonal treatment was 1,38 ± 0,6 at the first MRI and 1,97 ± 1,5 at the second MRI (difference not statistically significant, p = 0.38). The subgroup analysis differentiated by category of hormonal treatment did not show statistically significant results. CONCLUSIONS The present study shows that there is a positive effect of hormonal treatment on reducing the diameter of endometriomas and also a significative increase in endometrioma size in the absence of treatment. There is no evidence of an advantage of a single category of hormonal treatment on this effect on endometriomas. Thus, any medical treatment could be proposed as a first-line therapy for endometriomas that would reduce the size of the endometrioma and thereby help to avoid surgical intervention.
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Affiliation(s)
- Ilaria Alasia
- Department of Obstetrics and Gynecology, Hôpital La Conception, Aix-Marseille University, 107 avenue de Montredon, Marseille 13008, France
| | - Aubert Agostini
- Department of Obstetrics and Gynecology, Hôpital La Conception, Aix-Marseille University, 107 avenue de Montredon, Marseille 13008, France.
| | - Cindy Faust
- CEReSS - Health Services and Quality of Life Research, Department of Epidemiology, Aix-Marseille University, Marseille, France.
| | - Julie Berbis
- CEReSS - Health Services and Quality of Life Research, Department of Epidemiology, Aix-Marseille University, Marseille, France.
| | - Audrey Pivano
- Department of Obstetrics and Gynecology, Hôpital La Conception, Aix-Marseille University, 107 avenue de Montredon, Marseille 13008, France.
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Fernandez H, Agostini A, Baffet H, Chabbert-Buffet N, Descamps P, Estrade JP, Giraudet G, Hocke C, Salle B, Tremollieres F, Chapron C. Update on the management of endometriosis-associated pain in France. J Gynecol Obstet Hum Reprod 2023; 52:102664. [PMID: 37669732 DOI: 10.1016/j.jogoh.2023.102664] [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: 07/13/2023] [Accepted: 09/02/2023] [Indexed: 09/07/2023]
Abstract
The French National College of Obstetricians and Gynecologists (CNGOF) published guidelines for managing endometriosis-associated pain in 2018. Given the development of new pharmacological therapies and a review that was published in 2021, most national and international guidelines now suggest a new therapeutic approach. In addition, a novel validated screening method based on patient questionnaires and analysis of 109-miRNA saliva signatures, which combines biomarkers and artificial intelligence, opens up new avenues for overcoming diagnostic challenges in patients with pelvic pain and for avoiding laparoscopic surgery when sonography and MRI are not conclusive. Dienogest (DNG) 2 mg has been a reimbursable healthcare expense in France since 2020, and, according to recent studies, it is at least as effective as combined hormonal contraception (CHC) and can be used as an alternative to CHC for first-line treatment of endometriosis-associated pain. Since 2018, the literature concerning the use of DNG has grown considerably, and the French guidelines should be modified accordingly. The levonorgestrel intrauterine system (LNG IUS) and other available progestins per os, including DNG, or the subcutaneous implant, can be offered as first-line therapy, gonadotropin-releasing hormone (GnRH) agonists with add-back therapy (ABT) as second-line therapy. Oral GnRH antagonists are promising new medical treatments for women with endometriosis-associated pain. They competitively bind to GnRH receptors in the anterior pituitary, preventing native GnRH from binding to GnRH receptors and from stimulating the secretion of luteinizing hormone and follicle-stimulating hormone. Consequently, estradiol and progesterone production is reduced. Oral GnRH antagonists will soon be on the market in France. Given their mode of action, their efficacy is comparable to that of GnRH agonists, with the advantage of oral administration and rapid action with no flare-up effect. Combination therapy with ABT is likely to allow long-term treatment with minimal impact on bone mass. GnRH antagonists with ABT may thus be offered as second-line treatment as an alternative to GnRH agonists with ABT. This article presents an update on the management of endometriosis-associated pain in women who do not have an immediate desire for pregnancy.
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Affiliation(s)
- Hervé Fernandez
- AP-HP, Gynecology and Obstetrics Department, Bicetre Hospital, GHU Sud, 78 avenue du Général Leclerc, Le Kremlin Bicetre F-94276, France; Paris Saclay University, 63 rue Gabriel Péri, Le Kremlin Bicetre F-94276, France; Centre of research in epidemiology and population health (CESP), UMR1018, Inserm, Paris Saclay University, Hôpital Paul Brousse, 16 avenue Paul Vaillant Couturier, Villejuif F-94816, France.
| | - Aubert Agostini
- A Agostini, Service de Gynécologie Obstétrique, AP-HM, Assistance Publique-Hôpitaux de Marseille, Marseille, France
| | - Hortense Baffet
- H Baffet, Service de Gynécologie Médicale, Orthogénie et Sexologie, CHU de Lille, université de Lille, Lille, France
| | - Nathalie Chabbert-Buffet
- N Chabbert-Buffet, Service de Gynécologie Obstétrique Médecine de la Reproduction, Centre expert en Endométriose C3E, Hôpital Tenon APHP Sorbonne Université, Paris, France
| | - Philippe Descamps
- P Descamps, Service de Gynécologie Obstétrique et Médecine de la Reproduction, CHU Angers, Centre expert en Endométriose Pays de Loire, Angers, France
| | | | | | - Claude Hocke
- C Hocké, Service de Chirurgie Gynécologique et Médecine de la Reproduction, Centre expert régional Nouvelle Aquitaine, Centre Aliénor d'Aquitaine, Université Bordeaux, Bordeaux, France
| | - Bruno Salle
- B Salle, Service de Médecine de la Reproduction, Hôpital Femme-Mère-Enfant, Hospices Civils de Lyon, Université Claude-Bernard Lyon 1, Bron, France
| | - Florence Tremollieres
- F Trémollieres, Centre de Ménopause, Hôpital Paule de Viguier, CHU Toulouse, Université Toulouse III, Toulouse, France
| | - Charles Chapron
- C Chapron, Service de Chirurgie Gynécologique II et Médecine de la Reproduction, AP-HP, Hôpital Universitaire Paris Centre (HUPC), Centre Hospitalier Universitaire (CHU) Cochin, Université Paris-Cité, Faculté de Médecine Paris-Centre, Paris, France
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15
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Honde C, Agostini A, Pivano A, Piechon L, Courbiere B, Netter A. [Management of endometriomas in France: A survey of practices]. Gynecol Obstet Fertil Senol 2023; 51:408-414. [PMID: 37353080 DOI: 10.1016/j.gofs.2023.06.003] [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: 10/17/2022] [Revised: 04/02/2023] [Accepted: 06/17/2023] [Indexed: 06/25/2023]
Abstract
OBJECTIVES To present an overview of French practices for the management of endometriomas. METHODS We carried out a nationwide survey of practices concerning the management of endometriomas between October 2021 and January 2022. This study was carried out by means of two questionnaires sent to surgical centers used to treat endometriosis (n=62) and to Assisted Reproductive Technology (ART) centers (n=102). RESULTS At the end of the survey, 39/62 (62.9%) surgical teams from the centers contacted had given a response and 51/102 (50.0%) from ART centers. Laparoscopic cystectomy was the technique most frequently used by almost two thirds of the surgical teams (61%) when there was no known infertility, whereas it was the most common technique for only 14% of the ART teams. On the contrary, ultrasound-guided sclerotherapy was the most frequent technique for more than half of the ART teams (56%) and for only 8% of the surgical teams. In case of recurrence, 49% of surgical teams would choose ultrasound-guided sclerotherapy. Prior to IVF, 73% of ARP teams stated that they 'rarely' treated endometriomas. CONCLUSION The results of our study show a certain variability in practices between different centers and depending on the presence or absence of infertility for the management of endometriomas in France.
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Affiliation(s)
- C Honde
- Department of Gynecology and Obstetrics, AP-HM, Assistance publique-Hôpitaux de Marseille, Marseille, France
| | - A Agostini
- Department of Gynecology and Obstetrics, AP-HM, Assistance publique-Hôpitaux de Marseille, Marseille, France
| | - A Pivano
- Department of Gynecology and Obstetrics, AP-HM, Assistance publique-Hôpitaux de Marseille, Marseille, France
| | - L Piechon
- Department of Gynecology and Obstetrics, AP-HM, Assistance publique-Hôpitaux de Marseille, Marseille, France
| | - B Courbiere
- Department of Gynecology and Obstetrics, AP-HM, Assistance publique-Hôpitaux de Marseille, Marseille, France; Institut méditerranéen de biodiversité et d'écologie marine et continentale (IMBE), Aix Marseille University, CNRS, IRD, Avignon University, Marseille, France
| | - A Netter
- Department of Gynecology and Obstetrics, AP-HM, Assistance publique-Hôpitaux de Marseille, Marseille, France; Institut méditerranéen de biodiversité et d'écologie marine et continentale (IMBE), Aix Marseille University, CNRS, IRD, Avignon University, Marseille, France.
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16
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Schmitt A, Tourette C, Pivano A, Rambeaud C, Loundou A, Agostini A. Diagnostic value of a urine test in pregnancy of unknown location. AJOG Glob Rep 2023; 3:100223. [PMID: 37334250 PMCID: PMC10276253 DOI: 10.1016/j.xagr.2023.100223] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/20/2023] Open
Abstract
BACKGRO Pregnancy of unknown location (PUL) is a term used when there is a positive pregnancy test but no sonographic evidence for an intrauterine pregnancy (IUP) or ectopic pregnancy (EP). This term is a classification and not a final diagnosis. OBJECTIVE This study aimed to evaluate the diagnostic value of the Inexscreen test on the outcome of patients with pregnancies of unknown location. STUDY DESIGN In this prospective study, a total of 251 patients with a diagnosis of pregnancy of unknown location at the gynecologic emergency department of the La Conception Hospital, Marseille, France, between June 2015 and February 2019 were included. The Inexscreen (semiquantitative determination of intact human urinary chorionic gonadotropin) test was performed on patients with a diagnosis of pregnancy of unknown location. They participated in the study after information and consent collection. The main outcome measures (sensitivity, specificity, predictive values, and the Youden index) of Inexscreen were calculated for the diagnosis of abnormal pregnancy (nonprogressive pregnancy) and ectopic pregnancy. RESULTS The sensitivity and specificity of Inexscreen for the diagnosis of abnormal pregnancy in patients with pregnancy of unknown location were 56.3% (95% confidence interval, 47.0%-65.1%) and 62.8% (95% confidence interval, 53.1%-71.5%), respectively. The sensitivity and specificity of Inexscreen for the diagnosis of ectopic pregnancy in patients with pregnancy of unknown location were 81.3% (95% confidence interval, 57.0%-93.4%) and 55.6% (95% confidence interval, 48.6%-62.3%), respectively. The positive predictive value and negative predictive value of Inexscreen for ectopic pregnancy were 12.9% (95% confidence interval, 7.7%-20.8%) and 97.4% (95% confidence interval, 92.5%-99.1%), respectively. CONCLUSION Inexscreen is a rapid, non-operator-dependent, noninvasive, and inexpensive test that allows the selection of patients at high risk of ectopic pregnancy in case of pregnancy of unknown location. This test allows an adapted follow-up according to the technical platform available in a gynecologic emergency service.
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Affiliation(s)
- Andy Schmitt
- Department of Gynecology, Obstetrics, and Reproduction, Gynepôle, Hôpital de la Conception, Marseille, France (Dr Schmitt, Dr Tourette, Dr Pivano, Dr Rambeaud, and Dr Agostini)
| | - Claire Tourette
- Department of Gynecology, Obstetrics, and Reproduction, Gynepôle, Hôpital de la Conception, Marseille, France (Dr Schmitt, Dr Tourette, Dr Pivano, Dr Rambeaud, and Dr Agostini)
| | - Audrey Pivano
- Department of Gynecology, Obstetrics, and Reproduction, Gynepôle, Hôpital de la Conception, Marseille, France (Dr Schmitt, Dr Tourette, Dr Pivano, Dr Rambeaud, and Dr Agostini)
| | - Caroline Rambeaud
- Department of Gynecology, Obstetrics, and Reproduction, Gynepôle, Hôpital de la Conception, Marseille, France (Dr Schmitt, Dr Tourette, Dr Pivano, Dr Rambeaud, and Dr Agostini)
| | - Anderson Loundou
- Department of Public Health, Aix-Marseille University, Marseille, France (Dr Loundou)
| | - Aubert Agostini
- Department of Gynecology, Obstetrics, and Reproduction, Gynepôle, Hôpital de la Conception, Marseille, France (Dr Schmitt, Dr Tourette, Dr Pivano, Dr Rambeaud, and Dr Agostini)
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Borgheresi A, Agostini A, Pierpaoli L, Zannotti A, Capodagli-Colarizi S, Gabelloni M, De Muzio F, Brunese MC, Bruno F, Palumbo P, Grassi F, Fusco R, Granata V, Gandolfo N, Miele V, Barile A, Giovagnoni A. Diagnostic approach to focal liver lesions at cross-sectional imaging: a primer for beginners. Eur Rev Med Pharmacol Sci 2023; 27:7201-7225. [PMID: 37606131 DOI: 10.26355/eurrev_202308_33293] [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: 08/23/2023]
Abstract
Liver imaging encompasses a broad spectrum of diseases in different clinical backgrounds. The available literature is vast and reported data often lacks standardization. Because of all these issues, the differential diagnosis and the characterization of liver lesions can be challenging for the beginner. The aim of this narrative review is to provide the basics for an algorithm approach to liver lesions on cross-sectional imaging. First, some tips for the optimization of Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) protocols will be provided. Liver Imaging Reporting and Data System (LI-RADS, version 2018) working group is proposing the adoption of their standardized lexicon beyond the original target population of LI-RADS (i.e., liver cirrhosis). Thus, the main imaging findings will be defined following the LI-RADS lexicon. Since the contrast study is the most important for lesion characterization, this narrative review separates the lesions into avascular, hypovascular, and hypervascular, with a focus on chronic liver disease (CLD) and hepatocellular carcinoma (HCC).
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Affiliation(s)
- A Borgheresi
- Department of Clinical, Special and Dental Sciences, University Politecnica delle Marche, Department of Radiological Sciences, University Hospital "Azienda Ospedaliero Universitaria delle Marche", Ancona, Italy.
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Niddam R, Netter A, Gauthier A, Calderon L, Agostini A, Miquel L. Postoperative Rectal Necrosis after Laparoscopic Multibipolar Radiofrequency Myoma Ablation. J Minim Invasive Gynecol 2023; 30:433-435. [PMID: 36878402 DOI: 10.1016/j.jmig.2023.02.017] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Revised: 02/26/2023] [Accepted: 02/28/2023] [Indexed: 03/07/2023]
Affiliation(s)
- Raphael Niddam
- Department of Obstetrics, Gynecology and Reproductive Medicine, "Women, parents and children unit," AP-HM La Conception University Hospital (Drs. Niddam, Netter, Agostini, and Miquel), Marseille, France.
| | - Antoine Netter
- Department of Obstetrics, Gynecology and Reproductive Medicine, "Women, parents and children unit," AP-HM La Conception University Hospital (Drs. Niddam, Netter, Agostini, and Miquel), Marseille, France; CNRS, IRD, IMBE UMR 7263 FR, AP-HM, Aix Marseille Univ, Avignon University (Dr. Netter), Marseille, France
| | - Adele Gauthier
- Service chirurgie générale et transplantation hépatique, APHM, Hôpital La Timone (Dr. Gauthier), Marseille, France
| | - Lisa Calderon
- Department of Medical Imaging (Dr. Calderon), Assistance Publique Hôpitaux de Marseille, La Timone Hospital, Aix Marseille University, Marseille, France
| | - Aubert Agostini
- Department of Obstetrics, Gynecology and Reproductive Medicine, "Women, parents and children unit," AP-HM La Conception University Hospital (Drs. Niddam, Netter, Agostini, and Miquel), Marseille, France
| | - Laura Miquel
- Department of Obstetrics, Gynecology and Reproductive Medicine, "Women, parents and children unit," AP-HM La Conception University Hospital (Drs. Niddam, Netter, Agostini, and Miquel), Marseille, France
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Netter A, Litaudon C, Tourette C, Miquel L, Courbiere B, Agostini A. Robot-assisted tubo-tubal reanastomosis after sterilization in 10 steps. J Gynecol Obstet Hum Reprod 2023; 52:102605. [PMID: 37210010 DOI: 10.1016/j.jogoh.2023.102605] [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: 12/18/2022] [Revised: 04/07/2023] [Accepted: 05/17/2023] [Indexed: 05/22/2023]
Abstract
Five to 20% of women regret having a tubal ligation. These women are generally otherwise fertile and have a better chance of pregnancy than other patients experiencing infertility, whether by in vitro fertilization or after tubal surgery. Historically, tubal anastomosis surgery has long been performed by microsurgery through laparotomy, which provided very high precision but was associated with some degree of morbidity. The parallel development of in vitro fertilization and laparoscopy have contributed to reducing the indications for tubal surgery. The laparoscopic approach is challenging because of the number and precision of the sutures needed. The robot-assisted laparoscopic approach may reduce the surgical difficulty and improve the accessibility of this technique. We have described the technique of tubo-tubal reanastomosis after sterilization with robot-assisted laparoscopy in 10 steps. Robot-assisted laparoscopy provides favourable conditions for performing tubo-tubal reanastomosis after sterilization due to the camera stability, precision of movement, and amplitude of articulations.
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Affiliation(s)
- Antoine Netter
- Department of Obstetrics and Gynecology, Assistance Publique Hôpitaux de Marseille, La Conception Hospital, 13005 Marseille, Aix Marseille University, France.; Institut Méditerranéen de Biodiversité et d'Écologie marine et continentale (IMBE), Aix Marseille University, CNRS, IRD, Avignon University, Marseille, France..
| | - Charlotte Litaudon
- Department of Obstetrics and Gynecology, Assistance Publique Hôpitaux de Marseille, La Conception Hospital, 13005 Marseille, Aix Marseille University, France
| | - Claire Tourette
- Department of Obstetrics and Gynecology, Assistance Publique Hôpitaux de Marseille, La Conception Hospital, 13005 Marseille, Aix Marseille University, France
| | - Laura Miquel
- Department of Obstetrics and Gynecology, Assistance Publique Hôpitaux de Marseille, La Conception Hospital, 13005 Marseille, Aix Marseille University, France
| | - Blandine Courbiere
- Department of Obstetrics and Gynecology, Assistance Publique Hôpitaux de Marseille, La Conception Hospital, 13005 Marseille, Aix Marseille University, France.; Institut Méditerranéen de Biodiversité et d'Écologie marine et continentale (IMBE), Aix Marseille University, CNRS, IRD, Avignon University, Marseille, France
| | - Aubert Agostini
- Department of Obstetrics and Gynecology, Assistance Publique Hôpitaux de Marseille, La Conception Hospital, 13005 Marseille, Aix Marseille University, France
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Huchon C, Drioueche H, Koskas M, Agostini A, Bauville E, Bourdel N, Fernandez H, Fritel X, Graesslin O, Legendre G, Lucot JP, Panel P, Raiffort C, Giraudet G, Bussières L, Fauconnier A. Operative Hysteroscopy vs Vacuum Aspiration for Incomplete Spontaneous Abortion: A Randomized Clinical Trial. JAMA 2023; 329:1197-1205. [PMID: 37039805 PMCID: PMC10091175 DOI: 10.1001/jama.2023.3415] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 02/22/2023] [Indexed: 04/12/2023]
Abstract
Importance Vacuum aspiration is commonly used to remove retained products of conception in patients with incomplete spontaneous abortion. Scarring of the uterine cavity may occur, potentially impairing future fertility. A procedural alternative, operative hysteroscopy, has gained popularity with a presumption of better future fertility. Objective To assess the superiority of hysteroscopy to vacuum aspiration for subsequent pregnancy in patients with incomplete spontaneous abortion who intend to have future pregnancy. Design, Setting, and Participants The HY-PER randomized, controlled, single-blind trial included 574 patients between November 6, 2014, and May 3, 2017, with a 2-year duration of follow-up. This multicenter trial recruited patients in 15 French hospitals. Individuals aged 18 to 44 years and planned for surgery for an incomplete spontaneous abortion with plans to subsequently conceive were randomized in a 1:1 ratio. Interventions Surgical treatment by hysteroscopy (n = 288) or vacuum aspiration (n = 286). Main Outcomes and Measures The primary outcome was a pregnancy of at least 22 weeks' duration during 2-year follow-up. Results The intention-to-treat analyses included 563 women (mean [SD] age, 32.6 [5.4] years). All aspiration procedures were completed. The hysteroscopic procedure could not be completed for 19 patients (7%), 18 of which were converted to vacuum aspiration (8 with inability to completely resect, 7 with insufficient visualization, 2 with anesthetic complications that required a shortened procedure, 1 with equipment failure). One hysteroscopy failed due to a false passage during cervical dilatation. During the 2-year follow-up, 177 patients (62.8%) in the hysteroscopy group and 190 (67.6%) in the vacuum aspiration (control) group achieved the primary outcome (difference, -4.8% [95% CI, -13% to 3.0%]; P = .23). The time-to-event analyses showed no statistically significant difference between groups for the primary outcome (hazard ratio, 0.87 [95% CI, 0.71 to 1.07]). Duration of surgery and hospitalization were significantly longer for hysteroscopy. Rates of new miscarriages, ectopic pregnancies, Clavien-Dindo surgical complications of grade 3 or above (requiring surgical, endoscopic, or radiological intervention or life-threatening event or death), and reinterventions to remove remaining products of conception did not differ between groups. Conclusions and Relevance Surgical management by hysteroscopy of incomplete spontaneous abortions in patients intending to conceive again was not associated with more subsequent births or a better safety profile than vacuum aspiration. Moreover, operative hysteroscopy was not feasible in all cases. Trial Registration ClinicalTrials.gov Identifier: NCT02201732.
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Affiliation(s)
- Cyrille Huchon
- Department of Gynecology and Obstetrics, APHP, Hopital Lariboisière, University of Paris Cité, Paris, France
- Université Paris-Saclay, UVSQ, Unité de Recherche 7285, Risques Cliniques et Sécurité en Santé des Femmes et en Santé Périnatale (RISCQ), Montigny-le-Bretonneux, France
- Department of Gynecology and Obstetrics, CHI Poissy-St-Germain, Poissy CEDEX, France
| | - Hocine Drioueche
- Department of Clinical Research, Centre Hospitalier Intercommunal de Poissy-Saint-Germain-en-Laye, Poissy, France
| | - Martin Koskas
- Université Paris-Saclay, UVSQ, Unité de Recherche 7285, Risques Cliniques et Sécurité en Santé des Femmes et en Santé Périnatale (RISCQ), Montigny-le-Bretonneux, France
- Department of Gynecology and Obstetrics, APHP, Hôpital Bichat, Paris, France
| | - Aubert Agostini
- Department of Gynecology and Obstetrics, Hôpital La Conception, Marseille CEDEX 5, France
| | - Estelle Bauville
- Department of Gynecology and Obstetrics, Rennes University Hospital, Rennes CEDEX 2, France
| | - Nicolas Bourdel
- Department of Gynecologic Surgery, CHU Estaing Clermont Ferrand, 63058 Clermont Ferrand CEDEX 1, Faculty of Medicine, ISIT – Université d’Auvergne, Clermont-Ferrand, France
| | - Hervé Fernandez
- Department of Gynecology and Obstetrics, AP-HP, Hôpital Bicêtre, Le Kremlin Bicêtre, 94270, France
- Centre for Epidemiology and Population Health-INSERM U1018, Université Paris Sud, Le Kremlin Bicêtre, France
| | - Xavier Fritel
- Department of Gynecology and Obstetrics, CHU de Poitiers, Université de Poitiers, Faculté de Médecine et Pharmacie, Inserm CIC1402, Poitiers, France
| | - Olivier Graesslin
- Department of Gynecology and Obstetrics, Hôpital Alix de Champagne, CHU de Reims, Reims, France
| | - Guillaume Legendre
- Department of Gynecology and Obstetrics, CHU d’Angers, Angers CEDEX 01, France
| | - Jean-Philippe Lucot
- Department of Gynecology and Obstetrics, Hôpital Jeanne-de-Flandre, CHRU de Lille, Lille, France
| | - Pierre Panel
- Department of Gynecology and Obstetrics, Centre Hospitalier de Versailles, Le Chesnay, France
| | - Cyril Raiffort
- Department of Gynecology and Obstetrics, APHP, Hôpital Louis Mourier, Département Hospitalier Universitaire Risque et Grossesse, Colombes, University of Paris Cité, Paris, France
| | - Géraldine Giraudet
- Department of Gynecology and Obstetrics, Hôpital Jeanne-de-Flandre, CHRU de Lille, Lille, France
| | - Laurence Bussières
- Clinical Unit Research/Clinic Investigation Center, Paris Descartes, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Arnaud Fauconnier
- Université Paris-Saclay, UVSQ, Unité de Recherche 7285, Risques Cliniques et Sécurité en Santé des Femmes et en Santé Périnatale (RISCQ), Montigny-le-Bretonneux, France
- Department of Gynecology and Obstetrics, CHI Poissy-St-Germain, Poissy CEDEX, France
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Agostini A, Miquel L, Herman-Demars H, Frantz S, Sicot M. Evaluation of Pain and Use of Analgesics during Medical Termination of Pregnancy in Real-Life Settings. Pain Ther 2023; 12:563-574. [PMID: 36840805 PMCID: PMC10036711 DOI: 10.1007/s40122-023-00477-2] [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: 12/12/2022] [Accepted: 01/17/2023] [Indexed: 02/26/2023] Open
Abstract
INTRODUCTION Women frequently report pain associated with medical termination of pregnancy (MToP), and its management can differ largely between centres. This study aimed at evaluating in real-life settings pain related to MToP and its management in France. METHODS This was a non-interventional prospective, longitudinal study run in 23 centres between 2015 and 2016 that included 893 pregnant women. Pain was reported by women prior any curative analgesic intake (CAI) through a five-level Likert scale (absence, mild, moderated, severe, extreme). Modalities of analgesic prophylaxis prescription (APP) and intake (API) and CAI were collected. Risk factors were investigated using ordinal logistic regression (for pain) or logistic regression (for CAI) with stepwise selection of variables. RESULTS APP was prescribed to 657 (73.7%) women irrespective of the gestational age, among whom 386 (73.7%) took the treatment. Out of 740 women who documented their pain symptoms prior to any CAI, few declared no pain (n = 94, 12.7%) or intense pain (n = 88, 11.9%). The majority reported mild or moderate pain (n = 558, 75.4%). On multivariate analysis adjusted on gestational age, increasing initial [odds ratio (OR) 1.25, 95% confidence interval (CI) 1.06-1.47] or total dose (OR 1.15, 95% CI 1.05-1.26) of misoprostol taken were independent factors associated with risk of more pain. When adjusting for gestational age, initial dose of misoprostol (OR 1.69, 95% CI 1.45-2.66) and pain experienced (OR 3.58, 95% CI 2.82-4.55) were significantly associated with higher risk of CAI while API (OR 0.52, 95% CI 0.36; 0.75) was negatively associated. CONCLUSIONS Most of the women received an APP, but not all used it. API and gestational age were not related to different risks of more pain following MToP, whereas history of at least one child showed a negative association. Higher doses of misoprostol were strongly associated with both pain and CAI. API was associated with a decreased risk of CAI.
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Affiliation(s)
- Aubert Agostini
- Department of Obstetrics and Gynecology, Assistance Publique - Hôpitaux de Marseille, la Conception Hospital, Aix Marseille Université, 147 Boulevard Baille, 13005, Marseille, France.
| | - Laura Miquel
- Department of Obstetrics and Gynecology, Assistance Publique - Hôpitaux de Marseille, la Conception Hospital, Aix Marseille Université, 147 Boulevard Baille, 13005, Marseille, France
| | | | - Sandrine Frantz
- CHU de Bordeaux, Endocrinology and Metabolism, Reproductive Medicine Unit, Bordeaux, France
| | - Marie Sicot
- Department of Obstetrics and Gynecology, Centre Hospitalier Universitaire de Grenoble, 38700, La Tronche, France
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Stoppa M, Agostini A, Pivano A, Siles P, Calderon L, Netter A. Mild endometriosis of the uterosacral ligaments: a retrospective study of MRI performance for diagnosis. Reprod Biomed Online 2023:S1472-6483(23)00155-4. [PMID: 37068977 DOI: 10.1016/j.rbmo.2023.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 03/02/2023] [Indexed: 03/09/2023]
Abstract
RESEARCH QUESTION What are the diagnostic performances of magnetic resonance imaging (MRI) scans when used to identify mild endometriosis of the uterosacral ligaments (USL)? DESIGN Monocentric retrospective study of patients who underwent a pelvic MRI followed by laparoscopy for determination of endometriosis between January 2016 and December 2020. Patients were included whether endometriosis of USL was suspected or not, but patients presenting large lesions that left no doubt as to their endometriotic nature on the MRI were excluded. Six criteria for the description of USL on MRI were studied to determine their diagnostic performances in predicting the presence of endometriosis on laparoscopy as follows: asymmetry, thickening, irregularity, straightness, the presence of a nodule or a hypersignal T1 spot. RESULTS Seventy-seven patients were included. Among the criteria, 'asymmetry' and 'thickening' had the highest sensitivities (0.69 [95% confidence interval 0.54-0.80] and 0.51 [0.40-0.63], respectively) but moderate specificities (0.52 [0.31-0.73] and 0.62 [0.50-0.72]). Conversely, 'irregularity', 'nodule', 'straightness' and 'hypersignal T1 spot' were associated with high specificities (0.81 [0.70-0.89], 0.96 [0.89-0.99], 0.95 [0.87-0.99] and 0.99 [0.93-1.00], respectively) but poor sensitivities (0.22 [0.14-0.33], 0.12 [0.06-0.21], 0.08 [0.03-0.16] and 0.08 [0.03-0.16], respectively). The presence of at least one criterion for the description of the USL was associated with good sensitivity (0.80 [0.66-0.89]) but poor specificity (0.35 [0.16-0.57]). CONCLUSIONS The results suggest that the identification of minimal changes in the normal appearance of USL should not automatically lead to a conclusion of mild endometriosis at this location.
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Salituro N, Landi G, Garelli S, Balsamo F, Rottoli M, Cattivelli R, Tossani E, Grandi S, Pagotto U, Bernante P, Agostini A. The impact of psychological distress on weight regain in post-bariatric patients during the COVID-19 pandemic: A latent profile analysis. J Psychosom Res 2023; 165:111144. [PMID: 36608506 PMCID: PMC9805045 DOI: 10.1016/j.jpsychores.2022.111144] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 12/29/2022] [Accepted: 12/29/2022] [Indexed: 01/02/2023]
Abstract
OBJECTIVE The COVID-19 pandemic has caused a global health crisis disrupting healthcare delivery for people with severe obesity who have undergone bariatric surgery. This study examined the role of psychological distress during the first Italian COVID-19 lockdown in predicting post-operative outcomes in post-bariatric patients reaching the end of the 12-18 months follow-up during the lockdown. By using a person-centered approach, groups of patients with different psychological distress profiles were identified. We hypothesized that compared to post-bariatric patients with low psychological distress, post-bariatric patients with high psychological distress will be more at risk of weight regain. METHODS A total of 67 patients (71.6% female, Mage = 45.9) participated in this observational retrospective cohort study. Patients' anthropometric data were gathered from medical records while the weight at the end of the lockdown through phone interviews. Psychological distress, operationalized with anxiety symptoms, depressive symptoms, and sleep disturbances, was assessed by an online self-report questionnaire. RESULTS Significant differences were highlighted in the high and low psychological distressed group in weight changes, F(1,58) = 5.2, p < 0.001, η2 = 0.3. Specifically, compared to post-bariatric patients in the low psychological distress group, those in the high psychological distressed group reported weight regained (95% CI = 1.0, 2.6). CONCLUSION Results highlight the need to target post-bariatric patients with high psychological distress who are at risk for weight regain during the COVID-19 pandemic. Interventions mitigating psychological distress and obesogenic behaviors during future pandemics or in post-COVID times are needed in vulnerable post-bariatric patients reporting high psychological distress.
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Affiliation(s)
- N. Salituro
- Division of Endocrinology and Diabetes Prevention and Care, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - G. Landi
- Department of Psychology “Renzo Canestrari”, University of Bologna, Italy,Laboratory of Psychosomatics and Clinimetrics, Department of Psychology, University of Bologna, Cesena, Italy,Corresponding author at: Department of Psychology, University of Bologna, viale Berti Pichat 5, Bologna 40127, Italy
| | - S. Garelli
- Division of Endocrinology and Diabetes Prevention and Care, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - F. Balsamo
- Department of Experimental, Diagnostic, and Specialty Medicine (DIMES), S. Orsola-Malpighi Hospital, Alma Mater University of Bologna, Bologna 40138, Italy
| | - M. Rottoli
- Surgery of the Alimentary Tract, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - R. Cattivelli
- Department of Psychology “Renzo Canestrari”, University of Bologna, Italy,Laboratory of Psychosomatics and Clinimetrics, Department of Psychology, University of Bologna, Cesena, Italy
| | - E. Tossani
- Department of Psychology “Renzo Canestrari”, University of Bologna, Italy,Laboratory of Psychosomatics and Clinimetrics, Department of Psychology, University of Bologna, Cesena, Italy
| | - S. Grandi
- Department of Psychology “Renzo Canestrari”, University of Bologna, Italy,Laboratory of Psychosomatics and Clinimetrics, Department of Psychology, University of Bologna, Cesena, Italy
| | - U. Pagotto
- Division of Endocrinology and Diabetes Prevention and Care, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - P. Bernante
- Surgery of the Alimentary Tract, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - A. Agostini
- Department of Experimental, Diagnostic, and Specialty Medicine (DIMES), S. Orsola-Malpighi Hospital, Alma Mater University of Bologna, Bologna 40138, Italy
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Mouton M, Agostini A, Pivano A, Coiplet E, Courbiere B, Netter A. [Diagnosis and management of endometriosis by general practitioners in the south of France]. Gynecol Obstet Fertil Senol 2022; 50:762-769. [PMID: 36183984 DOI: 10.1016/j.gofs.2022.09.007] [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: 05/29/2022] [Revised: 08/26/2022] [Accepted: 09/20/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE Assessment of the practices and knowledge of general practitioners in the south of France regarding the diagnosis and management of endometriosis. METHOD A descriptive cross-sectional study was conducted among general practitioners in the south of France from November 14, 2021 to February 14, 2022. A questionnaire was developed in consultation with and validated by two university endometriosis reference services of the AP-HM and was sent to general practitioners practicing in the south of France. It was distributed via professional emails, care networks and the south of France's medical order. The questionnaire was divided into three parts: the first simply collected demographic and epidemiological data, the second assessed knowledge of the disease, and the last assessed individual practices. The primary endpoint was the percentage of practitioners with>75% correct responses. RESULTS 133 general practitioners responded to the questionnaire (133/407, 32.1%). 60.2% performed more than one gynecological consultation per week. 61.7% obtained a rate of correct answers>75%. The general practitioners with the best response rates were more aware of the latest HAS guidelines (P=0.027) and performed gynecological consultations more regularly in the office (P=0.025). Intense dysmenorrhea, chronic pelvic pain and deep dyspareunia were considered as evocative by 98.1%, 95.5% and 95.5% of respondents respectively. On the other hand, uro-digestive disorders were not often mentioned. In case of suspicion of endometriosis on questioning, 54.9% of general practitioners performed a clinical gynaecological examination. 76.7% prescribed an imaging test and 32.3% introduced hormonal treatment during the consultation. Referral of patients to specialists was made by the general practitioner as soon as clinical suspicion arose for 36.8%. CONCLUSION The results of our study suggest that the knowledge and practices of general practitioners, performing gynecology consultations in the south of France, is perfectible. In the context of the announcement of a regional reorganization of endometriosis-related care, other similar studies should be conducted regularly in order to assess the evolution of general practitioner's practices.
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Affiliation(s)
- Marion Mouton
- Department of Gynecology and Obstetrics, Assistance publique-Hôpitaux de Marseille, AP-HM, Marseille, France.
| | - Aubert Agostini
- Department of Gynecology and Obstetrics, Assistance publique-Hôpitaux de Marseille, AP-HM, Marseille, France
| | - Audrey Pivano
- Department of Gynecology and Obstetrics, Assistance publique-Hôpitaux de Marseille, AP-HM, Marseille, France
| | - Elena Coiplet
- Department of Gynecology and Obstetrics, Assistance publique-Hôpitaux de Marseille, AP-HM, Marseille, France
| | - Blandine Courbiere
- Department of Gynecology and Obstetrics, Assistance publique-Hôpitaux de Marseille, AP-HM, Marseille, France; Institut méditerranéen de biodiversité et d'écologie marine et continentale (IMBE), Aix-Marseille university, CNRS, IRD, Avignon university, Marseille, France
| | - Antoine Netter
- Department of Gynecology and Obstetrics, Assistance publique-Hôpitaux de Marseille, AP-HM, Marseille, France; Institut méditerranéen de biodiversité et d'écologie marine et continentale (IMBE), Aix-Marseille university, CNRS, IRD, Avignon university, Marseille, France
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Macagno N, Mastorino L, Rubatto M, Avallone G, Merli M, Agostini A, Fava P, Ribero S, Quaglino P. Primary cutaneous lymphoma patients seen at a referral dermatological centre in 1 year: A single-centre observational retrospective cohort study of the diagnoses and staging, comorbidities and associated symptoms, treatment performed and clinical course. J Eur Acad Dermatol Venereol 2022; 36:2388-2392. [PMID: 35881645 PMCID: PMC9804410 DOI: 10.1111/jdv.18469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 06/24/2022] [Indexed: 01/05/2023]
Abstract
IMPORTANCE Primary cutaneous lymphomas (PCL) are rare diseases, but the indolent course makes their prevalence high. Although there are many treatment options, no hierarchy is recommended. OBJECTIVE To identify the burden of PCL and describe clinical-pathologic features; associated comorbidities; analyse treatment approaches in real-life and the parameters associated with the achievement of complete response (CR). DESIGN, SETTING AND PARTICIPANTS In this study, all the PCL patients (384 patients) consecutively seen at the Dermatologic Clinic of the University of Turin from January 1, 2019 to December 31, 2019, with follow-up updated to December 2020, were included. MAIN OUTCOMES AND MEASURES Subtype of PCL, demographic data, time elapsed between first lesions and diagnosis, associated symptoms, comorbidities, staging at diagnosis, high-grade transformation, blood involvement, stage progression, therapies used and response were assessed. RESULTS 247 were cutaneous T-cell lymphomas (CTCL, 64.3%), 137 cutaneous B-cell lymphomas (CBCL, 35.7%) and the most frequent subtype was MF (48.4%). 62.3% of CTCL patients showed at least one comorbidity, mainly cardiovascular (28.7%), 20.2% show other not cutaneous neoplasms. The main approaches were skin-directed therapies (topical steroids 65.6%; phototherapy 50.2%). 39.3% patients achieved a CR during the disease course. Pruritus, the presence of comorbidities and high-grade transformation were factors associated with failure to achieve CR, whereas stage IA of MF was associated with greater achievement of CR. CONCLUSIONS AND RELEVANCE The Th2 cytokine related development of pruritus could justify increased resistance to treatment, while the presence of associated comorbidities could reduce treatment options as well as treatment compliance.
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Affiliation(s)
- N. Macagno
- Department of Medical Sciences, Dermatologic ClinicUniversity of TurinTurinItaly
| | - L. Mastorino
- Department of Medical Sciences, Dermatologic ClinicUniversity of TurinTurinItaly
| | - M. Rubatto
- Department of Medical Sciences, Dermatologic ClinicUniversity of TurinTurinItaly
| | - G. Avallone
- Department of Medical Sciences, Dermatologic ClinicUniversity of TurinTurinItaly
| | - M. Merli
- Department of Medical Sciences, Dermatologic ClinicUniversity of TurinTurinItaly
| | - A. Agostini
- Department of Medical Sciences, Dermatologic ClinicUniversity of TurinTurinItaly
| | - P. Fava
- Department of Medical Sciences, Dermatologic ClinicUniversity of TurinTurinItaly
| | - S. Ribero
- Department of Medical Sciences, Dermatologic ClinicUniversity of TurinTurinItaly
| | - P. Quaglino
- Department of Medical Sciences, Dermatologic ClinicUniversity of TurinTurinItaly
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Agostini A, Borgheresi A, Granata V, Bruno F, Palumbo P, De Muzio F, Bicci E, Grazzini G, Grassi F, Fusco R, Barile A, Miele V, Giovagnoni A. Technological advances in body CT: a primer for beginners. Eur Rev Med Pharmacol Sci 2022; 26:7918-7937. [PMID: 36394741 DOI: 10.26355/eurrev_202211_30144] [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] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Many technological advances have entered the clinical routine of Computed Tomography (CT) imaging. The new CT scanners have specific solutions in gantry design to bear the mechanical solicitations. The X-ray tubes have been improved for faster acquisitions at low radiation exposure, while the innovations in CT detectors provide a better image quality. The optimization of image quality and contrast, and the reduction of radiation dose, cannot be achieved without the implementation of adequate reconstruction software, such as Iterative Reconstructions (IR) and Artificial Intelligence (AI). In recent years, dual-energy (DECT) technology has expanded the indications of CT. In this narrative review, a panoramic overview of the technological novelties in CT imaging will be provided for optimal utilization of CT technology.
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Affiliation(s)
- A Agostini
- Department of Clinical, Special and Dental Sciences, University Politecnica delle Marche, Department of Radiology, University Hospital "Ospedali Riuniti Umberto I - G.M. Lancisi - G. Salesi, Ancona, Italy.
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Giordano A, Cinti F, Canese R, Carpinelli G, Colleluori G, Di Vincenzo A, Palombelli G, Severi I, Moretti M, Redaelli C, Partridge J, Zingaretti MC, Agostini A, Sternardi F, Giovagnoni A, Castorina S, Cinti S. The Adipose Organ Is a Unitary Structure in Mice and Humans. Biomedicines 2022; 10:biomedicines10092275. [PMID: 36140375 PMCID: PMC9496043 DOI: 10.3390/biomedicines10092275] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 09/03/2022] [Accepted: 09/08/2022] [Indexed: 12/03/2022] Open
Abstract
Obesity is the fifth leading cause of death worldwide. In mice and humans with obesity, the adipose organ undergoes remarkable morpho-functional alterations. The comprehension of the adipose organ function and organization is of paramount importance to understand its pathology and formulate future therapeutic strategies. In the present study, we performed anatomical dissections, magnetic resonance imaging, computed axial tomography and histological and immunohistochemical assessments of humans and mouse adipose tissues. We demonstrate that most of the two types of adipose tissues (white, WAT and brown, BAT) form a large unitary structure fulfilling all the requirements necessary to be considered as a true organ in both species. A detailed analysis of the gross anatomy of mouse adipose organs in different pathophysiological conditions (normal, cold, pregnancy, obesity) shows that the organ consists of a unitary structure composed of different tissues: WAT, BAT, and glands (pregnancy). Data from autoptic dissection of 8 cadavers, 2 females and 6 males (Age: 37.5 ± 9.7, BMI: 23 ± 2.7 kg/m2) and from detailed digital dissection of 4 digitalized cadavers, 2 females and 2 males (Age: 39 ± 14.2 years, BMI: 22.8 ± 4.3 kg/m2) confirmed the mixed (WAT and BAT) composition and the unitary structure of the adipose organ also in humans. Considering the remarkable endocrine roles of WAT and BAT, the definition of the endocrine adipose organ would be even more appropriate in mice and humans.
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Affiliation(s)
- A. Giordano
- Department of Experimental and Clinical Medicine, Center for the Study of Obesity, Marche Polytechnic University, 60126 Ancona, Italy
| | - F. Cinti
- UOS Centro Malattie Endocrine e Metaboliche, UOC Endocrinologia e Diabetologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Roma, Italy
- Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, 00168 Roma, Italy
| | - R. Canese
- MRI Unit-Core Facilities, Istituto Superiore di Sanità, 00161 Roma, Italy
| | - G. Carpinelli
- MRI Unit-Core Facilities, Istituto Superiore di Sanità, 00161 Roma, Italy
| | - G. Colleluori
- Department of Experimental and Clinical Medicine, Center for the Study of Obesity, Marche Polytechnic University, 60126 Ancona, Italy
| | - A. Di Vincenzo
- Department of Experimental and Clinical Medicine, Center for the Study of Obesity, Marche Polytechnic University, 60126 Ancona, Italy
| | - G. Palombelli
- MRI Unit-Core Facilities, Istituto Superiore di Sanità, 00161 Roma, Italy
| | - I. Severi
- Department of Experimental and Clinical Medicine, Center for the Study of Obesity, Marche Polytechnic University, 60126 Ancona, Italy
| | - M. Moretti
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy
| | | | | | - M. C. Zingaretti
- Department of Experimental and Clinical Medicine, Center for the Study of Obesity, Marche Polytechnic University, 60126 Ancona, Italy
| | - A. Agostini
- Department of Clinical, Special and Dental Sciences, Marche Polytechnic University, 60126 Ancona, Italy
| | - F. Sternardi
- Department of Clinical, Special and Dental Sciences, Marche Polytechnic University, 60126 Ancona, Italy
| | - A. Giovagnoni
- Department of Clinical, Special and Dental Sciences, Marche Polytechnic University, 60126 Ancona, Italy
| | - S. Castorina
- Department of Medical and Surgical Sciences and Advanced Technologies G.F. Ingrassia, University of Catania, 95121 Catania, Italy
| | - S. Cinti
- Department of Experimental and Clinical Medicine, Center for the Study of Obesity, Marche Polytechnic University, 60126 Ancona, Italy
- Correspondence:
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Buono-Michel C, Mancini J, Planta M, Agostini A, Carcopino X. [Outcome of women younger than 30 years of age followed for untreated high-grade cervical intraepithelial lesion]. Gynecol Obstet Fertil Senol 2022; 50:610-614. [PMID: 35513265 DOI: 10.1016/j.gofs.2022.04.008] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 04/05/2022] [Accepted: 04/19/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVES To assess the probability of spontaneous regression of high grade cervical intraepithelial neoplasia (HGCIN) in women under 30 and the predictive factors for such evolution. METHODS We conducted a bicentric retrospective study. A total of 98 patients under 30 and with untreated HGCIN were included from 01/01/2010 to 31/12/2019. For each patient, the initial clinical and colposcopic characteristics were systematically documented. In compliance with French guidelines, these patients were offered repeated 6-months colposcopic follow-up for 2years. The endpoint was the occurrence of spontaneous regression of the HGCIN defined by normalization of colposcopy, and/or a negative biopsy and/or a negative HPV test or histological regression to low grade CIN, or a colposcopy showing simple minor abnormalities requiring no biopsy. RESULTS Spontaneous HGCIN regression was observed in 37/98 patients. The median follow-up was of 16 (10.5-24.3) months. Predictive factors for spontaneous regression were: minor initial cytological abnormalities (HR=3.4; 95% CI: 1.02-11.05) and grade 1 atypical transformation at initial colposcopy (TAG1) (HR=2.3; 95% CI: 1.1-4.7). CONCLUSION Before 30, the probability of spontaneous regression of HGCIN exists but remains low. Predictive factors for such evolution are minor initial cytological abnormalities and TAG1 colposcopic impression.
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Affiliation(s)
- C Buono-Michel
- Service de gynécologie-obstétrique, hôpital Nord, chemin des Bourrely, 13915 Marseille cedex 20, France
| | - J Mancini
- Aix-Marseille université, INSERM, IRD, AP-HM, UMR1252, SESSTIM, department of public health (BIOSTIC), hôpital de la Timone, Marseille, France; Département de santé publique, hôpital de la Timone, 264, rue Saint-Pierre, 13395 Marseille cedex 5, France
| | - M Planta
- Aix-Marseille université, INSERM, IRD, AP-HM, UMR1252, SESSTIM, department of public health (BIOSTIC), hôpital de la Timone, Marseille, France; Département de santé publique, hôpital de la Timone, 264, rue Saint-Pierre, 13395 Marseille cedex 5, France
| | - A Agostini
- Service de gynécologie-obstétrique, hôpital de la Conception, 147, boulevard Baille, 13005 Marseille, France
| | - X Carcopino
- Department of obstetrics and gynaecology, hôpital Nord, AP-HM, Aix-Marseille university (AMU), université Avignon, CNRS, IRD, IMBE UMR 7263, 13397 Marseille, France; Service de gynécologie-obstétrique, hôpital Nord, chemin des Bourrely, 13915 Marseille cedex 20, France.
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Baron C, Netter A, Tourette C, Pivano A, Agostini A, Crochet P. Initial experience with vNOTES hysterectomy for benign conditions in a French university hospital. Facts Views Vis Obgyn 2022; 14:147-153. [DOI: 10.52054/fvvo.14.2.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background: Natural orifice transluminal endoscopic surgery by the vaginal route (vNOTES) is a new approach to performing hysterectomy. Clinical outcomes must be evaluated in centres that have started performing this technique.
Objectives: To compare operative outcomes between vNOTES hysterectomy and laparoscopic hysterectomy during the introduction of the vNOTES approach in a teaching hospital.
Material and Methods: A retrospective study was conducted from November 2019 to May 2021 at a French academic hospital in Marseille. The included patients underwent total hysterectomy for benign indications by vNOTES or conventional laparoscopy.
Main Outcome Measures: Operative time, uterus weight, intraoperative complications, and postoperative complications according to the Clavien-Dindo classification.
Results: Eighty-six patients underwent hysterectomy according to the selected criteria: 36 procedures were performed by vNOTES and 50 by laparoscopy. The mean operative time was shorter in the vNOTES group than in the laparoscopy group [116 min versus 149 min; p=0.003]. The mean uterus weight was not different between the vNOTES group and the laparoscopy group (238g versus 281g; p=0.572). Laparo-conversion occurred in one case in the vNOTES group (2.7%) and three cases in the laparoscopy group (3.4%). One Grade III postoperative complication occurred in the laparoscopy group, and no severe complication occurred in the vNOTES group.
Conclusion: Operative outcomes of the vNOTES hysterectomy were favourable and support good feasibility without additional morbidity compared to laparoscopy.
What is new? During the introduction period of the vNOTES hysterectomy technique in a teaching hospital, reassuring operative outcomes and a low rate of complications were observed.
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Coiplet E, Courbiere B, Agostini A, Boubli L, Bretelle F, Netter A. Endometriosis and environmental factors: a critical review. J Gynecol Obstet Hum Reprod 2022; 51:102418. [PMID: 35667590 DOI: 10.1016/j.jogoh.2022.102418] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [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: 07/28/2021] [Revised: 05/08/2022] [Accepted: 06/01/2022] [Indexed: 11/19/2022]
Abstract
This review provides an overview of current knowledge on the relationship between various environmental factors and endometriosis. We successively searched for a given exposure factor combined with the word "endometriosis." The literature was comprehensively analyzed and summarized by quoting only the most important and recent studies on each exposition factor. The data focused primarily on endocrine disruptors, such as dioxins and polychlorinated biphenyls, that appear to have the strongest effect. Intriguing data suggest a link with night work, sun exposure and red meat consumption. For the other risk factors studied, particularly those related to lifestyle (tobacco consumption, alcohol, coffee, soy, physical exercise), the data are not sufficient to draw conclusions. In summary, the epidemiological evidence does not support a strong, scientific link between exposure to environmental factors and endometriosis. The complexity of this disease requires advanced study designs and standardized methodology. Future studies should be carefully designed to address these issues to advance our understanding of the impact of the environment and its consequences on endometriosis.
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Affiliation(s)
- Eléna Coiplet
- Department of Gynecology and Obstetrics, AP-HM, Assistance Publique-Hôpitaux de Marseille, Marseille, France; Aix Marseille Univ, Avignon Université, CNRS, IRD, IMBE, 13005 Marseille, France
| | - Blandine Courbiere
- Department of Gynecology and Obstetrics, AP-HM, Assistance Publique-Hôpitaux de Marseille, Marseille, France; Aix Marseille Univ, Avignon Université, CNRS, IRD, IMBE, 13005 Marseille, France
| | - Aubert Agostini
- Department of Gynecology and Obstetrics, AP-HM, Assistance Publique-Hôpitaux de Marseille, Marseille, France
| | - Léon Boubli
- Department of Gynecology and Obstetrics, AP-HM, Assistance Publique-Hôpitaux de Marseille, Marseille, France
| | - Florence Bretelle
- Department of Gynecology and Obstetrics, AP-HM, Assistance Publique-Hôpitaux de Marseille, Marseille, France
| | - Antoine Netter
- Department of Gynecology and Obstetrics, AP-HM, Assistance Publique-Hôpitaux de Marseille, Marseille, France; Aix Marseille Univ, Avignon Université, CNRS, IRD, IMBE, 13005 Marseille, France.
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Delecourt C, Tourette C, Crochet P, Pivano A, Hamouda I, Agostini A. Benefits of AirSeal® System in Laparoscopic Hysterectomy for Benign Condition: A Randomized Controlled Trial. J Minim Invasive Gynecol 2022; 29:1003-1010. [DOI: 10.1016/j.jmig.2022.05.005] [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: 02/23/2022] [Revised: 05/05/2022] [Accepted: 05/07/2022] [Indexed: 10/18/2022]
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Fiala C, Agostini A, Bombas T, Lertxundi R, Lubusky M, Parachini M, Gemzell-Danielsson K. Abortion: legislation and statistics in Europe. EUR J CONTRACEP REPR 2022; 27:345-352. [PMID: 35420048 DOI: 10.1080/13625187.2022.2057469] [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: 11/03/2022]
Abstract
Objective: The Parliamentary Assembly invited the member states of the Council of Europe to 'guarantee women's effective exercise of their right of access to a safe and legal abortion'. While abortion legislation and statistics give an impression of the legislative, cultural, and religious views of the societies and the socio-economic health of the female population, only one study conducted in 2011 looked into the current legislation and trends in terminations of pregnancy in the European Union.Materials and Methods: From January 2017 to December 2018, a group of experts, the authors of the present article, liaised with colleagues practising in 32 European countries to collect data on abortion legislation and statistics using three different questionnaires.Results: The article presents the results of this initiative and compares the status quo and recent trends in abortion legislation and statistics across Europe.Conclusions: The European legislations are still very heterogenous and abortion rates vary widely between countries, confirming that laws do not correlate with abortion rates. This compilation of data, also available on a website (www.abort-report.eu), may help to change laws to better meet the needs of women who decided to have an abortion as a solution to the underlying problem of an unwanted pregnancy.
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Affiliation(s)
- Christian Fiala
- Gynmed Clinic, Vienna, Austria.,Department of Women's and Children's Health, Karolinska Institutet, and WHO collaborating centre, Karolinska University Hospital, Stockholm, Sweden
| | | | - Teresa Bombas
- Obstetric Unit, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Roberto Lertxundi
- Department of Gynaecology and Human Reproduction, Clinica Euskalduna, Bilbao, Spain
| | - Marek Lubusky
- Department of Obstetrics and Gynaecology, Palacky University Hospital, Olomouc, Czech Republic
| | | | - Kristina Gemzell-Danielsson
- Department of Women's and Children's Health, Karolinska Institutet, and WHO collaborating centre, Karolinska University Hospital, Stockholm, Sweden
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Flammia F, Chiti G, Trinci M, Danti G, Cozzi D, Grassi R, Palumbo P, Bruno F, Agostini A, Fusco R, Granata V, Giovagnoni A, Miele V. Optimization of CT protocol in polytrauma patients: an update. Eur Rev Med Pharmacol Sci 2022; 26:2543-2555. [PMID: 35442469 DOI: 10.26355/eurrev_202204_28491] [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] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Radiologists play a key role in the management of trauma patients. With the improvement of computed tomography (CT), radiologist makes an important contribution to the timely diagnosis of trauma-related findings and the choice of the most suitable treatment, improving patient outcomes. It is important to select the most appropriate imaging technique, which in the trauma patient is CT, and especially the most appropriate CT protocol, to correctly characterize trauma injuries. Currently, there is no agreement on what the optimal protocol is, acquisition times and number of contrast enhanced phases are not standardized. This is a review of the most recent literature on optimizing the CT protocol in polytrauma, with the intent of giving a useful tool for radiologists in the management of trauma patients.
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Affiliation(s)
- F Flammia
- Department of Radiology, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
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Mège D, Bernard C, Pivano A, Nho RLH, Aubert M, Duclos J, Agostini A, Pirro N. Morbidity of diverting stoma during colorectal surgery for deep infiltrating endometriosis – an observational study. J Gynecol Obstet Hum Reprod 2022; 51:102347. [DOI: 10.1016/j.jogoh.2022.102347] [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: 11/21/2021] [Revised: 01/28/2022] [Accepted: 02/24/2022] [Indexed: 11/16/2022]
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35
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Bayoumeu F, Vayssière C, Linet T, Agostini A, Benhamou D. [Not Available]. Gynecol Obstet Fertil Senol 2022; 50:98-99. [PMID: 34478902 DOI: 10.1016/j.gofs.2021.08.005] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Indexed: 06/13/2023]
Affiliation(s)
- F Bayoumeu
- Service de gynécologie-obstétrique, hôpital Paule-de-Viguier, Toulouse III Paul-Sabatier, 31059 Toulouse, France
| | - C Vayssière
- Service de gynécologie-obstétrique, hôpital Paule-de-Viguier, Toulouse III Paul-Sabatier, 31059 Toulouse, France; UMR 1295, Centre d'épidémiologie et de recherche en santé des POPulations (CERPOP), Équipe SPHERE, 330, avenue de Grande-Bretagne, 31059 Toulouse, France.
| | - T Linet
- Service de gynécologie-obstétrique, centre hospitalier Loire Vendée Océan, Challans, France
| | - A Agostini
- Service de gynécologie-obstétrique, hôpital de la Conception, CHU de Marseille, Marseille, France
| | - D Benhamou
- Service d'anesthesie réanimation médecine périopératoire, Université Paris, France Saclay, Hôpital Bicêtre, AP-HP, Le Kremlin-Bicêtre, France
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Houvenaeghel G, Cohen M, Classe JM, Reyal F, Mazouni C, Chopin N, Martinez A, Daraï E, Coutant C, Colombo PE, Gimbergues P, Chauvet MP, Azuar AS, Rouzier R, Tunon de Lara C, Muracciole X, Agostini A, Bannier M, Charaffe Jauffret E, De Nonneville A, Goncalves A. Lymphovascular invasion has a significant prognostic impact in patients with early breast cancer, results from a large, national, multicenter, retrospective cohort study. ESMO Open 2021; 6:100316. [PMID: 34864349 PMCID: PMC8645922 DOI: 10.1016/j.esmoop.2021.100316] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [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: 09/07/2021] [Revised: 10/28/2021] [Accepted: 10/31/2021] [Indexed: 11/17/2022] Open
Abstract
Background We determined the prognostic impact of lymphovascular invasion (LVI) in a large, national, multicenter, retrospective cohort of patients with early breast cancer (BC) according to numerous factors. Patients and methods We collected data on 17 322 early BC patients treated in 13 French cancer centers from 1991 to 2013. Survival functions were calculated using the Kaplan–Meier method and multivariate survival analyses were carried out using the Cox proportional hazards regression model adjusted for significant variables associated with LVI or not. Two propensity score-based matching approaches were used to balance differences in known prognostic variables associated with LVI status and to assess the impact of adjuvant chemotherapy (AC) in LVI-positive luminal A-like patients. Results LVI was present in 24.3% (4205) of patients. LVI was significantly and independently associated with all clinical and pathological characteristics analyzed in the entire population and according to endocrine receptor (ER) status except for the time period in binary logistic regression. According to multivariate analyses including ER status, AC, grade, and tumor subtypes, the presence of LVI was significantly associated with a negative prognostic impact on overall (OS), disease-free (DFS), and metastasis-free survival (MFS) in all patients [hazard ratio (HR) = 1.345, HR = 1.312, and HR = 1.415, respectively; P < 0.0001], which was also observed in the propensity score-based analysis in addition to the association of AC with a significant increase in both OS and DFS in LVI-positive luminal A-like patients. LVI did not have a significant impact in either patients with ER-positive grade 3 tumors or those with AC-treated luminal A-like tumors. Conclusion The presence of LVI has an independent negative prognostic impact on OS, DFS, and MFS in early BC patients, except in ER-positive grade 3 tumors and in those with luminal A-like tumors treated with AC. Therefore, LVI may indicate the existence of a subset of luminal A-like patients who may still benefit from adjuvant therapy. In a study of 17 322 early BC patients, LVI had a significant independent negative prognostic impact on survival. LVI negatively impacted survival in almost every patient category and cancer subtype, with and without AC. LVI did not have a negative survival impact in patients with ER+ grade 3 or with luminal A-like tumors with chemotherapy. Results suggest a possible benefit of AC in LVI-positive luminal A-like patients.
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Affiliation(s)
- G Houvenaeghel
- Department of Surgical Oncology, CRCM, Institut Paoli-Calmettes, Aix-Marseille University, CNRS, INSERM, Marseille, France.
| | - M Cohen
- Department of Surgical Oncology, CRCM, Institut Paoli-Calmettes, Aix-Marseille University, CNRS, INSERM, Marseille, France
| | - J M Classe
- Institut René Gauducheau, Site Hospitalier Nord, St Herblain, France
| | - F Reyal
- Institut Curie, Paris, France
| | - C Mazouni
- Institut Gustave Roussy, Villejuif, France
| | - N Chopin
- Centre Léon Bérard, Lyon, France
| | - A Martinez
- Centre Claudius Regaud, Toulouse, France
| | - E Daraï
- Hôpital Tenon, Paris, France
| | - C Coutant
- Centre Georges François Leclerc, Dijon, France
| | | | | | | | - A S Azuar
- Hôpital de Grasse, Chemin de Clavary, Grasse, France
| | - R Rouzier
- Hôpital René Huguenin, Saint Cloud, France
| | | | | | - A Agostini
- Department of Obstetrics and Gynocology, Hôpital de la Conception, Marseille, France
| | - M Bannier
- Department of Surgical Oncology, CRCM, Institut Paoli-Calmettes, Aix-Marseille University, CNRS, INSERM, Marseille, France
| | - E Charaffe Jauffret
- Department of Pathology, CRCM, Institut Paoli-Calmettes, Aix-Marseille University, Marseille, France
| | - A De Nonneville
- Department of Medical Oncology, CRCM, Institut Paoli-Calmettes, Aix-Marseille University, CNRS, INSERM, Marseille, France
| | - A Goncalves
- Department of Medical Oncology, CRCM, Institut Paoli-Calmettes, Aix-Marseille University, CNRS, INSERM, Marseille, France
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Ribot E, Berbis J, Hamouda I, Cohen D, Agostini A, Courbiere B. Pregnancy outcomes after in vitro fertilization for moderate and severe endometriosis. A case-control study. J Gynecol Obstet Hum Reprod 2021; 51:102274. [PMID: 34844027 DOI: 10.1016/j.jogoh.2021.102274] [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: 08/24/2021] [Revised: 11/10/2021] [Accepted: 11/23/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Previous international studies showed that endometriosis could have a link with obstetrical complications, as an increased risk of preterm birth, gestational diabetes mellitus, and cesarean section. However, the results are difficult to interpret because biases are common, such as heterogeneity in the severity of the endometriosis cases included. That's why some complications as risk of miscarriage and post-partum hemorrhage are still debated. Our objective was to study pregnancy outcome after In Vitro Fertilization (IVF) in women suffering from rAFS stage III and IV endometriosis. METHODS We conducted a case-control study between 2009 and 2019. We compared pregnancy outcomes after IVF in two groups of women matched by age, body mass index and smoking in two hospital centers. Group A was constituted by singleton pregnancies following ART for moderate and severe endometriosis (rAFS stage III and IV endometriosis). Group B was composed of singleton pregnancies in women with no endometriosis following ART for another reproductive disease. All women achieved pregnancy after 22 weeks. RESULTS A total of 240 pregnant women were included: 80 singleton IVF pregnancies (group A) were compared with 160 singleton IVF pregnancies (group B). We observed an increased risk of placenta previa (12.5% Vs 1.9%; p = 0,001), and cesarean section (49.4% (n = 39) Vs 29.6% (n = 47) p = 0,004). Rate of postpartum hemorrhage was not significantly different in endometriosis group (11.2% Vs 7.5% p = 0.47). CONCLUSION Despite conflicting results in literature due to a lot of confounding variables, the impact of endometriosis on pregnancy is still debated in women suffering from rAFS III and IV endometriosis. In our study, we observed statistically higher rates of placenta previa and cesarean section but not an increased risk of postpartum hemorrhage. Further larger series are needed to confirm our findings and a possible link with other obstetrical complications. However, we think that an ART pregnancy in a context of severe endometriosis should be considered at risk of adverse obstetrical outcomes.
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Affiliation(s)
- Edouard Ribot
- Department of Gynecology, Obstetric and Reproductive Medicine, Centre Hospitalier du Pays d'Aix, Aix-en-Provence, France.
| | - Julie Berbis
- Department of Public Health, Research Unit EA3279, Aix Marseille University, 13005 Marseille, France
| | - Ilyes Hamouda
- Department of Public Health, Research Unit EA3279, Aix Marseille University, 13005 Marseille, France
| | - Daniel Cohen
- Department of Gynecology, Obstetric and Reproductive Medicine, Centre Hospitalier du Pays d'Aix, Aix-en-Provence, France
| | - Aubert Agostini
- Department of Gynecology, Obstetric and Reproductive Medicine, AP-HM, Hôpital La Conception, Marseille, France
| | - Blandine Courbiere
- Department of Gynecology, Obstetric and Reproductive Medicine, AP-HM, Hôpital La Conception, Marseille, France; Aix Marseille Univ, CNRS, IRD, Avignon Univ, IMBE, Marseille, France.
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De Gobbi A, Aiello G, Pozzi E, Agostini A, Andrisano A, Fulcoli V, Guttilla A, Invidiato F, Massari D, Costa G, Fiorello M. Self-removal double J stent proposal after endourological procedures during Sars-Cov-2 emergency. EUR UROL SUPPL 2021. [PMCID: PMC8487691 DOI: 10.1016/s2666-1683(21)00739-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
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Allary M, Agostini A, Calderon L, Miquel L, Crochet P, Netter A. Using pneumovaginoscopy to perform the removal of a vaginal fibroid. Fertil Steril 2021; 116:1664-1666. [PMID: 34535294 DOI: 10.1016/j.fertnstert.2021.08.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 04/28/2021] [Revised: 08/17/2021] [Accepted: 08/19/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To describe and assess the feasibility of a novel surgical technique (pneumovaginoscopy) for performing vaginal surgery. DESIGN Video of a single surgical procedure. SETTING A university hospital. PATIENT(S) A 42-year-old woman, gravida 2 para 2, presented with chronic pelvic pain. Vaginal examination revealed a 4-cm spherical mass bulging through her posterior vaginal wall. Magnetic resonance imaging identified this mass as either a subserosal pedunculated uterine fibroid (type 7 according to the FIGO classification) or an ectopic fibroid of the posterior vaginal wall (type 8). INTERVENTION(S) The whole procedure was performed using pneumovaginoscopy. The GelPOINT V-Path (Applied Medical, Rancho Santa Margarita, California) which is the device most often used to perform transvaginal natural orifice transluminal endoscopic surgical procedures, was introduced into the vagina to create a pneumovagina. Monopolar scissors were used to create an incision through the posterior vaginal wall to reach the fibroid. Myomectomy was performed using traction movements of the fibroid associated with the dissection of the capsule. The absence of a uterine pedicle at the end of the myomectomy was in favor of an ectopic fibroid of the vagina (type 8 of the FIGO classification). The vaginal defect was closed with interrupted sutures using the access points on the GelPOINT. MAIN OUTCOME MEASURE(S) The procedure was easily and efficiently performed using the pneumovaginoscopy technique and lasted less than an hour. The patient was discharged on postoperative day 1 without any postoperative complications. She was symptom-free at her 2-month postoperative visit. RESULT(S) Compared to the classical vaginal approach, pneumovaginoscopy improves visualization through targeted lighting and close-up vision. This technique is particularly interesting in cases where the vaginal opening is narrow and for lesions located in the upper half of the vagina. Because of the unusual expansion of the vagina, increased caution is required to avoid bladder or rectal injuries. CONCLUSION(S) Pneumovaginoscopy is a novel technique that can be performed for vaginal pathologies with the same device used for transvaginal natural orifice transluminal endoscopic surgery. We described this technique and assessed its feasibility.
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Affiliation(s)
- Maud Allary
- Department of Obstetrics and Gynecology, Assistance Publique Hôpitaux de Marseille, La Conception Hospital, 13005 Marseille, Aix Marseille University, France
| | - Aubert Agostini
- Department of Obstetrics and Gynecology, Assistance Publique Hôpitaux de Marseille, La Conception Hospital, 13005 Marseille, Aix Marseille University, France
| | - Lisa Calderon
- Department of Medical Imaging, Assistance Publique Hôpitaux de Marseille, La Timone Hospital, 13005 Marseille, Aix Marseille University, France
| | - Laura Miquel
- Department of Obstetrics and Gynecology, Assistance Publique Hôpitaux de Marseille, La Conception Hospital, 13005 Marseille, Aix Marseille University, France
| | - Patrice Crochet
- Department of Obstetrics and Gynecology, Assistance Publique Hôpitaux de Marseille, La Conception Hospital, 13005 Marseille, Aix Marseille University, France
| | - Antoine Netter
- Department of Obstetrics and Gynecology, Assistance Publique Hôpitaux de Marseille, La Conception Hospital, 13005 Marseille, Aix Marseille University, France; Institut Méditerranéen de Biodiversité et d'Écologie marine et continentale (IMBE), Aix Marseille University, CNRS, IRD, Avignon University, Marseille, France.
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Touboul C, Legendre G, Agostini A, Akladios C, Bendifallah S, Bolze PA, Bouet PE, Chauvet P, Collinet P, Dabi Y, Delotte J, Deffieux X, Dion L, Gauthier T, Kerbage Y, Koskas M, Millet P, Narducci F, Ouldamer L, Ploteau S, Santulli P, Golfier F. [Guidelines for Clinical Practice of the French College of Obstetricians and Gynecologists 2021: Prophylactic procedures associated with gynecologic surgery]. ACTA ACUST UNITED AC 2021; 49:805-815. [PMID: 34520857 DOI: 10.1016/j.gofs.2021.09.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 04/02/2021] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To draw up recommendations on the use of prophylactic gynecologic procedures during surgery for other indications. DESIGN A consensus panel of 19 experts was convened. A formal conflict of interest policy was established at the onset of the process and applied throughout. The entire study was performed independently without funding from pharmaceutical companies or medical device manufacturers. The panel applied the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system to evaluate the quality of evidence on which the recommendations were based. The authors were advised against making strong recommendations in the presence of low-quality evidence. Some recommendations were ungraded. METHODS The panel studied 22 key questions on seven prophylactic procedures: 1) salpingectomy, 2) fimbriectomy, 3) salpingo-oophorectomy, 4) ablation of peritoneal endometriosis, 5) adhesiolysis, 6) endometrial excision or ablation, and 7) cervical ablation. RESULTS The literature search and application of the GRADE system resulted in 34 recommendations. Six were supported by high-quality evidence (GRADE 1+/-) and 28 by low-quality evidence (GRADE 2+/-). Recommendations on two questions were left ungraded due to a lack of evidence in the literature. CONCLUSIONS A high level of consensus was achieved among the experts regarding the use of prophylactic gynecologic procedures. The ensuing recommendations should result in improved current practice.
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Affiliation(s)
- C Touboul
- Service de Gynécologie Obstétrique et Médecine de la Reproduction de l'Hôpital Tenon (AP-HP), Sorbonne Université, 4, rue de la Chine, 75020 Paris, France.
| | - G Legendre
- Service de Gynécologie Obstétrique et Médecine de la Reproduction du CHU Anger, 4, rue Larrey, 49933 Angers cedex 9, France
| | - A Agostini
- Service de Gynécologie Obstétrique et Médecine de la Reproduction de l'Hôpital de la Conception (AP-HM), Marseille, France
| | - C Akladios
- Service de Gynécologie Obstétrique et Médecine de la Reproduction des hôpitaux universitaires de Strasbourg, Strasbourg, France
| | - S Bendifallah
- Service de Gynécologie Obstétrique et Médecine de la Reproduction de l'Hôpital Tenon (AP-HP), Sorbonne Université, 4, rue de la Chine, 75020 Paris, France
| | - P A Bolze
- Service de Gynécologie Obstétrique et Médecine de la Reproduction de l'hôpital Lyon Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France
| | - P E Bouet
- Service de Gynécologie Obstétrique et Médecine de la Reproduction du CHU Anger, 4, rue Larrey, 49933 Angers cedex 9, France
| | - P Chauvet
- Service de Gynécologie Obstétrique et Médecine de la Reproduction du CHU Estaing, 1, place Lucie-Aubrac, 63000 Clermont-Ferrand, France
| | - P Collinet
- Service de Gynécologie Obstétrique et Médecine de la Reproduction de l'Hôpital Jeanne-de-Flandre, avenue Eugène-Avinée, 59000 Lille, France
| | - Y Dabi
- Service de Gynécologie Obstétrique et Médecine de la Reproduction de l'Hôpital Tenon (AP-HP), Sorbonne Université, 4, rue de la Chine, 75020 Paris, France
| | - J Delotte
- Service de Gynécologie Obstétrique et Médecine de la Reproduction de l'Hôpital de l'Archet 2, 151, route de Saint-Antoine, 06200 Nice, France
| | - X Deffieux
- Service de Gynécologie Obstétrique et Médecine de la Reproduction de l'hôpital A.-Béclêre (AP-HP), 157, rue de la Porte-de-Trivaux, 92140 Clamart, France
| | - L Dion
- Service de Gynécologie Obstétrique et Médecine de la Reproduction du Centre Hospitalier Universitaire de Rennes, 16, boulevard de Bulgarie, 35200 Rennes, France
| | - T Gauthier
- Service de Gynécologie Obstétrique et Médecine de la Reproduction du CHU de Limoges, 8, avenue Dominique-Larrey, 87000 Limoges, France
| | - Y Kerbage
- Service de Gynécologie Obstétrique et Médecine de la Reproduction de l'Hôpital Jeanne-de-Flandre, avenue Eugène-Avinée, 59000 Lille, France
| | - M Koskas
- Service de Gynécologie Obstétrique et Médecine de la Reproduction de de l'hôpital Bichat (AP-HP), 46, rue Henri-Huchard, 75018 Paris, France
| | - P Millet
- Service de Gynécologie Obstétrique et Médecine de la Reproduction de l'Hôpital de l'Archet 2, 151, route de Saint-Antoine, 06200 Nice, France
| | - F Narducci
- Département de Cancérologie Gynécologique, Centre de Lutte Contre le Cancer Oscar-Lambret, Lille, France
| | - L Ouldamer
- Service de Gynécologie Obstétrique et Médecine de la Reproduction du CHU de Tours, 2, boulevard Tonnellé, 37000 Tours, France
| | - S Ploteau
- Service de Gynécologie Obstétrique et Médecine de la Reproduction du CHU de Nantes, 38 bd Jean-Monnet, 44093 Nantes cedex 1, France
| | - P Santulli
- Service de Gynécologie Obstétrique et Médecine de la Reproduction de l'Hôpital Cochin (AP-HP), 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - F Golfier
- Service de Gynécologie Obstétrique et Médecine de la Reproduction de l'hôpital Lyon Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France
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Netter A, Niddam R, Agostini A, Crochet P. Vaginal NOTES approach for risk-reducing salpingo-oophorectomy in BRCA mutation carriers: A video demonstration. J Gynecol Obstet Hum Reprod 2021; 50:102212. [PMID: 34482210 DOI: 10.1016/j.jogoh.2021.102212] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 05/20/2021] [Revised: 08/22/2021] [Accepted: 08/24/2021] [Indexed: 10/20/2022]
Abstract
Risk-reducing bilateral salpingo-oophorectomy (BSO) is an important option to prevent the development of ovarian and fallopian tube cancers in women with a BRCA1/2 mutation. Conventional laparoscopy is the current preferred technique since it is associated with less morbidity compared to laparotomy. Transvaginal Natural Orifice Transluminal Endoscopic Surgery (vNOTES) is a new minimally invasive technique that allows access to the peritoneal cavity through the vagina without skin incisions. The vNOTES technique for risk-reducing BSO is presented herein. This article includes a narrated, step-by-step video demonstration of the entire procedure. Risk-reducing BSO using the vNOTES approach is a feasible technique that appears to be simple, safe, and reproducible. This technique has the potential to improve patients' surgical experience and provide good long-term functional and cosmetics outcomes. This technique needs to be further evaluated and compared to the conventional laparoscopic approach.
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Affiliation(s)
- Antoine Netter
- Department of Gynecology and Obstetrics, La Conception Hospital, Aix Marseille University, Marseille, France; Institut Méditerranéen de Biodiversité et d'Écologie marine et continentale (IMBE), Aix Marseille University, CNRS, IRD, Avignon University, Marseille, France
| | - Raphael Niddam
- Department of Gynecology and Obstetrics, La Conception Hospital, Aix Marseille University, Marseille, France
| | - Aubert Agostini
- Department of Gynecology and Obstetrics, La Conception Hospital, Aix Marseille University, Marseille, France
| | - Patrice Crochet
- Department of Gynecology and Obstetrics, La Conception Hospital, Aix Marseille University, Marseille, France. '
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Hentschke M, Vasconcelos N, Badalott. Teloken I, Agostini A, Dornelles V, Siqueira D, Trindade V, Petracco Á, Badalotti M. P–334 CT virtual Histerotomography: a new method for the evaluation of fallopian tube patency and pelvic organs in patients seeking pregnancy. Hum Reprod 2021. [DOI: 10.1093/humrep/deab130.333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Study question
Can computerized virtual histerotomography (CT-HSG) be used for the evaluation of fallopian tube patency and pelvic organs in patients seeking pregnancy? Summary answer: CT-HSG seems to be an adequate test for the evaluation of fallopian tube patency, pelvic organs, and the uterine cavity.
What is known already
CT-HSG is a minimally invasive exam, which diagnoses variations in the female reproductive system, uses low radiation doses and is well tolerated by patients. It simultaneously evaluates the uterine wall, cavity and cervix, tubes, and adjacent pelvic structures. The exam enables virtual navigation, which consists of the endoluminal view of the cervical canal and uterine cavity and allows 3D reconstruction of images. The exam remains underused to assess infertility, but previous studies have shown potential and its use may be widespread.
Study design, size, duration
Retrospective cohort study, that included data from 317 women seeking pregnancy, between January/2019 and January/2021. The CT-HSG was indicated for infertility (90.3%) and RPL (0.9%) investigation, and for the evaluation of tubal stump in patients who were planning the tubal reversal surgery (8.8%). Patients filled out a questionnaire about their pain symptoms and data were collected from electronic records.
Participants/materials, setting, methods
The study analyzed patients’ clinical characteristics and image findings regarding tubes, uterine cavity, and ovaries. For the exam, a catheter was positioned in the cervix, where the contrast medium (iopromide) was injected through an infusion pump at 0.30 ml/s, for a total of 20ml. The tomographic slices were obtained at the 50th second. The CT-HSG images were interpreted by the same gynecologist and radiologist. Data were analyzed using SPSS version 20.0.
Main results and the role of chance
Women and partners’ mean age was 32.7 ± 5.6 and 34.6 ± 7.7 years, respectively, and women’s mean BMI was 28.4 ± 6.4 Kg/m². The pain scale was applied in 103 patients, who reported 5.4±3.2 pain scale scores at the end of the exam. Among the infertile patients 67% were nulliparous. Regarding the exam findings, most of the uterus findings were normal (72.6%). The variations found were uterine malformations (including unicornuate uterus, uterus didelphys, bicornuate uterus, septate uterus, and arcuate uterus), synechia, fibroids, endometrial polyps, adenomyosis and retractions/lateralizations that may suggest endometriosis. The tubal findings on the right/left (%) were: 65/67.5 patent horn; 18.9/17.7 obstructed tubes; 4/41 dilatation/hydrosalpinx and 9.4/9.1 with previous history of tubal ligation or salpingectomy; 1.5% of the tubal evaluation were inconclusive. Eleven from 317 patients had to repeat the exam due to occurrences during the execution (for example, improper catheter positioning, cuff fall, stenosis of the internal cervical ostium, severe pain).The 3D analysis and virtual navigation assist in the findings assessment, in addition to being simpler for the gynecologists evaluation.
Limitations, reasons for caution
The sample size is small due to the exam being a new technique. Patient follow-up and correlation with laparoscopy and hysteroscopy, when indicated, are under studied.
Wider implications of the findings: The exam seems to be promising for assessing infertility, RPL and the tubal stump. Moreover, it may be a good option to hysterosalpingography as it seems to cause less pain and allows to evaluate the ovaries and the uterine contour, added to 3D reconstructions and to virtual uterine navigation.
Trial registration number
Not applicable
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Affiliation(s)
- M Hentschke
- Fertilitat - Reproductive Medicine Center, Gynecology, Porto Alegre, Brazil
| | - N Vasconcelos
- Pontifical Catholic University of Rio Grande do Sul PUCRS, School of Medicine, Porto Alegre, Brazil
| | - I Badalott. Teloken
- Pontifical Catholic University of Rio Grande do Sul PUCRS, School of Medicine, Porto Alegre, Brazil
| | - A Agostini
- Pontifical Catholic University of Rio Grande do Sul PUCRS, Radiology, Porto Alegre, Brazil
| | - V Dornelles
- Pontifical Catholic University of Rio Grande do Sul PUCRS, School of Medicine, Porto Alegre, Brazil
| | - D Siqueira
- Pontifical Catholic University of Rio Grande do Sul PUCRS, School of Medicine, Porto Alegre, Brazil
| | - V Trindade
- Pontifical Catholic University of Rio Grande do Sul PUCRS, School of Medicine, Porto Alegre, Brazil
| | - Á Petracco
- Fertilitat - Reproductive Medicine Center, Gynecology, Porto Alegre, Brazil
| | - M Badalotti
- Fertilitat - Reproductive Medicine Center, Gynecology, Porto Alegre, Brazil
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Kgosidialwa O, Bogdanet D, Egan AM, O'Shea PM, Newman C, Griffin TP, McDonagh C, O'Shea C, Carmody L, Cooray SD, Anastasiou E, Wender-Ozegowska E, Clarson C, Spadola A, Alvarado F, Noctor E, Dempsey E, Napoli A, Crowther C, Galjaard S, Loeken MR, Maresh M, Gillespie P, de Valk H, Agostini A, Biesty L, Devane D, Dunne F. A core outcome set for the treatment of pregnant women with pregestational diabetes: an international consensus study. BJOG 2021; 128:1855-1868. [PMID: 34218508 PMCID: PMC9311326 DOI: 10.1111/1471-0528.16825] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2021] [Indexed: 12/21/2022]
Abstract
Objective To develop a core outcome set (COS) for randomised controlled trials (RCTs) evaluating the effectiveness of interventions for the treatment of pregnant women with pregestational diabetes mellitus (PGDM). Design A consensus developmental study. Setting International. Population Two hundred and five stakeholders completed the first round. Methods The study consisted of three components. (1) A systematic review of the literature to produce a list of outcomes reported in RCTs assessing the effectiveness of interventions for the treatment of pregnant women with PGDM. (2) A three-round, online eDelphi survey to prioritise these outcomes by international stakeholders (including healthcare professionals, researchers and women with PGDM). (3) A consensus meeting where stakeholders from each group decided on the final COS. Main outcome measures All outcomes were extracted from the literature. Results We extracted 131 unique outcomes from 67 records meeting the full inclusion criteria. Of the 205 stakeholders who completed the first round, 174/205 (85%) and 165/174 (95%) completed rounds 2 and 3, respectively. Participants at the subsequent consensus meeting chose 19 outcomes for inclusion into the COS: trimester-specific haemoglobin A1c, maternal weight gain during pregnancy, severe maternal hypoglycaemia, diabetic ketoacidosis, miscarriage, pregnancy-induced hypertension, pre-eclampsia, maternal death, birthweight, large for gestational age, small for gestational age, gestational age at birth, preterm birth, mode of birth, shoulder dystocia, neonatal hypoglycaemia, congenital malformations, stillbirth and neonatal death. Conclusions This COS will enable better comparison between RCTs to produce robust evidence synthesis, improve trial reporting and optimise research efficiency in studies assessing treatment of pregnant women with PGDM. 165 key stakeholders have developed #Treatment #CoreOutcomes in pregnant women with #diabetes existing before pregnancy.
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Affiliation(s)
- O Kgosidialwa
- College of Medicine, Nursing and Health Sciences, National University of Ireland Galway, Galway, Ireland
| | - D Bogdanet
- College of Medicine, Nursing and Health Sciences, National University of Ireland Galway, Galway, Ireland
| | - A M Egan
- Division of Endocrinology, Mayo Clinic, Rochester, MN, USA
| | - P M O'Shea
- College of Medicine, Nursing and Health Sciences, National University of Ireland Galway, Galway, Ireland
| | - C Newman
- College of Medicine, Nursing and Health Sciences, National University of Ireland Galway, Galway, Ireland
| | - T P Griffin
- College of Medicine, Nursing and Health Sciences, National University of Ireland Galway, Galway, Ireland
| | - C McDonagh
- College of Medicine, Nursing and Health Sciences, National University of Ireland Galway, Galway, Ireland
| | - C O'Shea
- College of Medicine, Nursing and Health Sciences, National University of Ireland Galway, Galway, Ireland
| | - L Carmody
- College of Medicine, Nursing and Health Sciences, National University of Ireland Galway, Galway, Ireland
| | - S D Cooray
- Diabetes and Endocrinology Units, Monash Health, Clayton, Vic., Australia.,Monash Centre for Health Research and Implementation, Monash University, Clayton, Vic., Australia
| | - E Anastasiou
- Department Diabetes & Pregnancy Outpatients, Mitera Hospital, Athens, Greece
| | - E Wender-Ozegowska
- Department of Reproduction, Poznan University of Medical Sciences, Poznan, Poland
| | - C Clarson
- Department of Paediatrics, University of Western Ontario, London, ON, Canada.,Lawson Health Research Institute, London, ON, Canada
| | - A Spadola
- Mother Infant Research Institute, Tufts Medical Center, Boston, MA, USA
| | - F Alvarado
- Mother Infant Research Institute, Tufts Medical Center, Boston, MA, USA
| | - E Noctor
- Division of Endocrinology, University Hospital Limerick, Limerick, Ireland
| | - E Dempsey
- INFANT Centre and Department of Paediatrics & Child Health, University College Cork, Cork, Ireland
| | - A Napoli
- Department of Clinical and Molecular Medicine, Sant'Andrea University Hospital, Sapienza, University of Rome, Rome, Italy
| | - C Crowther
- Liggins Institute, The University of Auckland, Auckland, New Zealand
| | - S Galjaard
- Department of Obstetrics and Gynaecology, Division of Obstetrics and Prenatal Medicine, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - M R Loeken
- Section of Islet Cell and Regenerative Biology, Joslin Diabetes Center, Boston, MA, USA.,Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Mja Maresh
- Department of Obstetrics, St Mary's Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - P Gillespie
- Health Economics and Policy Analysis Centre (HEPAC), National University of Ireland, Galway, Ireland
| | - H de Valk
- Department of Internal Medicine, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - A Agostini
- A.S.LViterbo Distretto A, Consultorio Montefiascone, Rome, Italy
| | - L Biesty
- School of Nursing & Midwifery, National University of Ireland Galway, Galway, Ireland
| | - D Devane
- School of Nursing & Midwifery, National University of Ireland Galway, Galway, Ireland.,HRB-Trials Methodology Research Network, National University of Ireland Galway, Galway, Ireland
| | - F Dunne
- College of Medicine, Nursing and Health Sciences, National University of Ireland Galway, Galway, Ireland
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Dion L, Agostini A, Golfier F, Legendre G, Touboul C, Koskas M. In which cases should endometrial destruction be performed during an operative hysteroscopy? Clinical practice guidelines from the French College of Gynaecologists and Obstetricians (CNGOF). J Gynecol Obstet Hum Reprod 2021; 50:102188. [PMID: 34166864 DOI: 10.1016/j.jogoh.2021.102188] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 06/16/2021] [Accepted: 06/18/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To provide guidelines from the French College of Obstetricians and Gynaecologists (CNGOF), based on the best evidence available, concerning the impact of endometrial destruction on bleeding and endometrial cancer risk reduction in patients candidates for operative hysteroscopy. METHODS Recommendations were made according to AGREE II and the GRADE® (Grading of Recommendations Assessment, Development and Evaluation) systems to determine separately the quality of evidence (QE) and in the level of recommendation. RESULTS In a retrospective study comparing the incidence of endometrial cancer in 4776 patients with menorrhagia treated with endometrial destruction vs 229 945 patients with a medical treatment. There was a non-significant reduced risk of developing endometrial cancer (HR, 0.45; 95% CI, 0.15-1.40; p = .17). In premenopausal women, five studies compared the incidence of endometrial cancer in patients treated with endometrial ablation/destruction (EA/D) to the incidence of endometrial cancer in a comparable population of women from national registers, all of which show reduced risk of endometrial cancer after endometrectomy. In case of menopausal metrorrhagia, the prevalence of endometrial cancer is 9%, by analogy with the results found in premenopausal patients, the combination of endometrial ablation during operative hysteroscopy seems justified. In a retrospective cohort of 177 non-menopausal patients treated with myomectomy for metrorrhagia and/or menorrhagia, a significantly better control of bleeding at 12 months was found when myomectomy was combined with endometrectomy using roller-ball (OR: 0.18 [95% Cl 0.05-0.63]; p = 0.003). CONCLUSION In premenopausal women with heavy menstrual bleeding, when an operative hysteroscopy is performed, it is recommended to propose an endometrial ablation/destruction in order to prevent the risk of endometrial cancer, (QE3) and to prevent recurrence of bleeding (QE2). In menopausal women, it is probably recommended to also perform an endometrial ablation/destruction in case of operative hysteroscopy in order to prevent the risk of endometrial cancer (QE1).
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Affiliation(s)
- L Dion
- Department of Gynaecology, Rennes University Hospital, 16 Bd de Bulgarie, 35000 Rennes, France.
| | - A Agostini
- Department of Obstetrics and Gynaecology, APHM, 147 Bd Baille, 13005 Marseille, France
| | - F Golfier
- Department of Obstetrics and Gynaecology, CHU Lyon, 69000 Lyon, France
| | - G Legendre
- Department of Obstetrics and Gynaecology, CHU Angers, 49000 Angers, France
| | - C Touboul
- Department of Obstetrics and Gynaecology, APHP.6 Sorbonne Université, Tenon Hospital, 4 rue de la Chine, 75020 Paris, France
| | - M Koskas
- Department of Obstetrics and Gynaecology, APHP, Hôpital Bichat - Claude-Bernard, 46 rue Henri-Huchard, 75018 Paris, France
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Chene G, Cerruto E, Merviel P, Agostini A, Crochet P, Giraudet G, Capmas P, Fernandez H, Graesslin O. Surgical techniques for the removal of Essure ® microinserts: a literature review on current practice. EUR J CONTRACEP REPR 2021; 26:404-412. [PMID: 34096440 DOI: 10.1080/13625187.2021.1925883] [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: 10/21/2022]
Abstract
PURPOSE To evaluate the different techniques for Essure® microinserts removal and to assess the risk of fracture of the device and the intra- and post-operative complications in relation to surgical technique variants. METHODS Electronic search in Medline, Scopus and Embase databases using the following keywords: Essure; Essure removal; Essure surgical technique. RESULTS Out of 95 articles in the initial database, 17 studies were eligible for inclusion in our literature review. Several surgical techniques have been described in which the most frequent were laparoscopic salpingectomy (LS), laparoscopic cornuectomy (LC), laparoscopic or vaginal hysterectomy (LH, VH) with en-bloc salpingectomy. There were more fractures of the device with the LS procedure (6.25%) followed by the LC technique (2.77%), while there was no fracture with hysterectomy. However, peri-and post-operative complications were more severe and frequent with hysterectomy in comparison with the LC and LS procedures (respectively 8.1% Clavien Dindo grade 3 for the hysterectomy group, 1.11% for the LC procedure and 0.69% for the LS technique). CONCLUSION Due to the lack of standardised surgical treatment guidelines, a system of care networks for symptomatic patients with adverse effects related to Essure® headed by specialised centres may offer a suitable and high-quality management with the appropriate removal techniques within two objectives: limiting the risk of fracture (with an en-bloc removal of the Essure® microinserts) and avoiding intra- and post-operative complications.
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Affiliation(s)
- G Chene
- Department of Gynecology, Hôpital Femme Mère Enfant, HFME, University of Lyon, Lyon, France.,Claude Bernard university of Lyon 1, Lyon, France
| | - E Cerruto
- Department of Gynecology, Hôpital Femme Mère Enfant, HFME, University of Lyon, Lyon, France
| | - P Merviel
- Department of Gynecology, Obstetrics and Reproductive Medicine, University Hospital of Brest, Brest, France
| | - A Agostini
- Department of Obstetrics and Gynecology, Assistance Publique - Hôpitaux de Marseille, La Conception Hospital, Aix Marseille Université, Marseille, France
| | - P Crochet
- Department of Obstetrics and Gynecology, Hospital Arnaud de Villeneuve, University of Montpellier, Montpellier, France
| | - G Giraudet
- Department of Gynecology, Jeanne de Flandre Hospital, University Hospital of Lille, Lille, France
| | - P Capmas
- Department of Gynecology, Bicetre Hospital, GHU Sud, AP-HP, Le Kremlin Bicetre, France
| | - H Fernandez
- Department of Gynecology, Bicetre Hospital, GHU Sud, AP-HP, Le Kremlin Bicetre, France
| | - O Graesslin
- Department of Gynecology, Institut Mère Enfant Alix de Champagne, University hospital of Reims, Reims, France
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Baboudjian M, Mhatli M, Bourouina A, Gondran-Tellier B, Anastay V, Perez L, Proye P, Lavieille JP, Duchateau F, Agostini A, Wazne Y, Sebag F, Foletti JM, Chossegros C, Raoult D, Touati J, Chagnaud C, Michel J, Bertrand B, Giovanni A, Radulesco T, Sartor C, Fournier PE, Lechevallier E. Is minor surgery safe during the COVID-19 pandemic? A multi-disciplinary study. PLoS One 2021; 16:e0251122. [PMID: 33974628 PMCID: PMC8112651 DOI: 10.1371/journal.pone.0251122] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 04/20/2021] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND To assess the risk of postoperative SARS-CoV-2 infection during the COVID-19 pandemic. METHODS The CONCEPTION study was a cohort, multidisciplinary study conducted at Conception University Hospital, in France, from March 17th to May 11th, 2020. Our study included all adult patients who underwent minor surgery in one of the seven surgical departments of our hospital: urology, digestive, plastic, gynecological, otolaryngology, gynecology or maxillofacial surgery. Preoperative self-isolation, clinical assessment using a standardized questionnaire, physical examination, nasopharyngeal RT-PCR and chest CT scan performed the day before surgery were part of our active prevention strategy. The main outcome was the occurrence of a SARS-CoV-2 infection within 21 days following surgery. The COVID-19 status of patients after discharge was updated during the postoperative consultation and to ensure the accuracy of data, all patients were contacted again by telephone. RESULTS A total of 551 patients from six different specialized surgical Departments in our tertiary care center were enrolled in our study. More than 99% (546/551) of included patients underwent a complete preoperative Covid-19 screening including RT-PCR testing and chest CT scan upon admission to the Hospital. All RT-PCR tests were negative and in 12 cases (2.2%), preoperative chest CT scans detected pulmonary lesions consistent with the diagnosis criteria for COVID-19. No scheduled surgery was postponed. One patient (0.2%) developed a SARS-CoV-2 infection 20 days after a renal transplantation. No readmission or COVID-19 -related death within 30 days from surgery was recorded. CONCLUSIONS Minor surgery remained safe in the COVID-19 Era, as long as all appropriate protective measures were implemented. These data could be useful to public Health Authorities in order to improve surgical patient flow during a pandemic.
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Affiliation(s)
- Michael Baboudjian
- Department of Urology and Kidney Transplantation, Aix-Marseille University, APHM, Conception University Hospital, Marseilles, France
| | - Mehdi Mhatli
- Department of Otorhinolaryngology- Head & Neck Surgery, APHM, Aix-Marseille University, Conception University Hospital, Marseilles, France.,Department of Head and Neck Surgery, Conception University Hospital, Aix-Marseille University, Marseilles, France
| | - Adel Bourouina
- Department of Endocrine Surgery, Conception University Hospital, Aix-Marseille University, Marseilles, France
| | - Bastien Gondran-Tellier
- Department of Urology and Kidney Transplantation, Aix-Marseille University, APHM, Conception University Hospital, Marseilles, France
| | - Vassili Anastay
- Department of Urology and Kidney Transplantation, Aix-Marseille University, APHM, Conception University Hospital, Marseilles, France
| | - Lea Perez
- Department of Urology and Kidney Transplantation, Aix-Marseille University, APHM, Conception University Hospital, Marseilles, France
| | - Pauline Proye
- Department of Urology and Kidney Transplantation, Aix-Marseille University, APHM, Conception University Hospital, Marseilles, France
| | - Jean-Pierre Lavieille
- Department of Head and Neck Surgery, Conception University Hospital, Aix-Marseille University, Marseilles, France
| | - Fanny Duchateau
- Department of Obstetrics and Gynecology, Conception Hospital, Marseilles, France
| | - Aubert Agostini
- Department of Obstetrics and Gynecology, Conception Hospital, Marseilles, France
| | - Yann Wazne
- Department of Endocrine Surgery, Conception University Hospital, Aix-Marseille University, Marseilles, France
| | - Frederic Sebag
- Department of Endocrine Surgery, Conception University Hospital, Aix-Marseille University, Marseilles, France
| | - Jean-Marc Foletti
- Department of Oral and maxillofacial Surgery, Aix Marseille University, APHM, IFSTTAR, LBA, Conception University Hospital, Marseilles, France
| | - Cyrille Chossegros
- Department of Oral and maxillofacial Surgery, Aix Marseille University, APHM, IFSTTAR, LBA, Conception University Hospital, Marseilles, France
| | - Didier Raoult
- Aix-Marseille University, IRD, AP-HM, IHU Méditerranée Infectious Disease Research Institute, Marseilles, France
| | - Julian Touati
- Department of Radiology, Conception University Hospital, APHM, Marseilles, France
| | - Christophe Chagnaud
- Department of Radiology, Conception University Hospital, APHM, Marseilles, France
| | - Justin Michel
- Department of Otorhinolaryngology- Head & Neck Surgery, APHM, Aix-Marseille University, Conception University Hospital, Marseilles, France
| | - Baptiste Bertrand
- Department of Plastic Surgery, Conception University Hospital, APHM, Marseilles, France
| | - Antoine Giovanni
- Department of Otorhinolaryngology- Head & Neck Surgery, APHM, Aix-Marseille University, Conception University Hospital, Marseilles, France
| | - Thomas Radulesco
- Department of Otorhinolaryngology- Head & Neck Surgery, APHM, Aix-Marseille University, Conception University Hospital, Marseilles, France
| | - Catherine Sartor
- Operational Hospital Hygiene Team, Conception University Hospital, Marseilles, France
| | - Pierre-Edouard Fournier
- Aix-Marseille University, IRD, AP-HM, IHU Méditerranée Infectious Disease Research Institute, Marseilles, France
| | - Eric Lechevallier
- Department of Urology and Kidney Transplantation, Aix-Marseille University, APHM, Conception University Hospital, Marseilles, France
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Schmitt A, Cardinale C, Loundou A, Miquel L, Agostini A. Nitrous oxide for pain management of first-trimester instrumental termination of pregnancy under local anaesthesia and/or minimal sedation: A systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol 2021; 261:193-199. [PMID: 33971381 DOI: 10.1016/j.ejogrb.2021.04.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 12/17/2020] [Revised: 03/17/2021] [Accepted: 04/19/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Inhalation of nitrous oxide and oxygen (N2O/O2) is used to reduce pain that is spontaneous or induced by procedures. N2O/O2 could be useful in the treatment of the pain in first-trimester termination of pregnancy performed under local anaesthesia and/or minimal sedation (FTOPL). OBJECTIVE To evaluate the usefulness of N2O/O2 to reduce pain in FTOPL. SEARCH STRATEGY Electronic databases including PubMed, Embase, and MEDLINE were searched using keywords. STUDY SELECTION All studies comparing the use of N2O/O2 versus a placebo in the management of pain during FTOPL during the first trimester were included. Of the 199 studies identified, four were deemed eligible for this meta-analysis. DATA COLLECTION The extracted results were perioperative pain, immediate and delayed postoperative pain, anxiety scores, and the secondary effects (nausea, vomiting). The data were analysed using Comprehensive Meta-Analysis software version 2.2.064. MAIN RESULTS There was a significant difference in favour of N2O/O2 for perioperative pain (p = 0.006; SMD = - 0.31; 95 % CI, -0.54 - -0.09). No difference was found, however, in postoperative pain, nor was there a difference in the secondary effects (nausea, vomiting) (p = 0.61). A significant decrease in postoperative anxiety scores was seen in the pooled placebo group (p = 0.049; SMD = 0.41; and 95 % CI, 0.001-0.83). CONCLUSIONS N2O/O2 reduces the pain of FTOPL. N2O/O2 could be recommended in FTOPL.
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Affiliation(s)
- A Schmitt
- Division of Gynecology, Obstetrics, and Reproduction, Gynepôle, Hôpital de la Conception, Marseille, France
| | - C Cardinale
- Division of Gynecology, Obstetrics, and Reproduction, Gynepôle, Hôpital de la Conception, Marseille, France
| | - A Loundou
- Department of Public Health, Aix-Marseille University, Marseille, France
| | - L Miquel
- Division of Gynecology, Obstetrics, and Reproduction, Gynepôle, Hôpital de la Conception, Marseille, France
| | - A Agostini
- Division of Gynecology, Obstetrics, and Reproduction, Gynepôle, Hôpital de la Conception, Marseille, France.
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Burzi L, Parietti M, Agostini A, Marra E, Fierro MT, Ribero S, Quaglino P. Eyelashes poliosis as first sign of metastatic melanoma. J Eur Acad Dermatol Venereol 2021; 35:e459-e460. [PMID: 33660293 DOI: 10.1111/jdv.17215] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 01/21/2021] [Accepted: 02/25/2021] [Indexed: 11/30/2022]
Affiliation(s)
- L Burzi
- Department of Medical Sciences, Dermatologic Clinic, University of Turin, Turin, Italy
| | - M Parietti
- Department of Medical Sciences, Dermatologic Clinic, University of Turin, Turin, Italy
| | - A Agostini
- Department of Medical Sciences, Dermatologic Clinic, University of Turin, Turin, Italy
| | - E Marra
- Department of Medical Sciences, Dermatologic Clinic, University of Turin, Turin, Italy
| | - M T Fierro
- Department of Medical Sciences, Dermatologic Clinic, University of Turin, Turin, Italy
| | - S Ribero
- Department of Medical Sciences, Dermatologic Clinic, University of Turin, Turin, Italy
| | - P Quaglino
- Department of Medical Sciences, Dermatologic Clinic, University of Turin, Turin, Italy
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Andriamanjay D, Agostini A, Bourachot M, Siles P, Pivano A. Medical management of psoas muscle deep endometriosis: A case report. J Gynecol Obstet Hum Reprod 2021; 50:102115. [PMID: 33737248 DOI: 10.1016/j.jogoh.2021.102115] [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: 11/12/2020] [Revised: 02/26/2021] [Accepted: 03/14/2021] [Indexed: 11/27/2022]
Abstract
Endometriosis is a common gynaecological pathology characterized by the presence of endometrial tissue outside the uterine cavity, and the most frequent locations of endometriosis are ovaries and posterior compartment of the pelvis. In this paper we report the case of a rare bilateral endometriosis location of posas muscle diagnosed and treated in a 25-year-old patient. This is the third case of psoas endometriosis location reported, but the first one successfully treated by hormone estrogen-progestogen treatment alone. Psoas endometriosis is a rare location and the medical management in first line can be an alternative to surgery and provide optimal patient relief.
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Affiliation(s)
- Dio Andriamanjay
- Department of Obstetrics and Gynecology, Hôpital La Conception, Aix-Marseille University, Marseille, France.
| | - Aubert Agostini
- Department of Obstetrics and Gynecology, Hôpital La Conception, Aix-Marseille University, Marseille, France.
| | - Marie Bourachot
- Department of Radiology, Hôpital Timone, Aix-Marseille University, Marseille, France.
| | - Pascale Siles
- Department of Radiology, Hôpital Timone, Aix-Marseille University, Marseille, France.
| | - Audrey Pivano
- Department of Obstetrics and Gynecology, Hôpital La Conception, Aix-Marseille University, Marseille, France.
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50
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Crochet P, Netter A, Schmitt A, Garofalo A, Loundou A, Knight S, Rabischong B, Agostini A. Performance Assessment for Total Laparoscopic Hysterectomy in the Operating Room: Validity Evidence of a Procedure-specific Rating Scale. J Minim Invasive Gynecol 2021; 28:1743-1750.e3. [PMID: 33621693 DOI: 10.1016/j.jmig.2021.02.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 09/22/2020] [Revised: 02/09/2021] [Accepted: 02/16/2021] [Indexed: 10/22/2022]
Abstract
STUDY OBJECTIVE The technical conduct of total laparoscopic hysterectomy (LH) is critical to surgical outcomes. This study explored the validity evidence of an objective scale specific to the assessment of technical skills (H-OSATS) for 7 tasks of an LH with salpingo-oophorectomy procedure performed in the operating room. DESIGN Observational cohort study. SETTING Two academic hospitals in Marseille and Montpellier, France. PATIENTS Three groups of operators (novice, intermediate, and experienced surgeons) were video recorded during their live performances of LH on a simple case. For each group, a dozen unedited videos were obtained for the following tasks: division of the round ligament, division of the infundibulopelvic ligament, creation of the bladder flap, opening of the posterior peritoneum, division of the uterine vessels, colpotomy, and closure of the vault. INTERVENTIONS Two qualified raters blindly assessed each video using the H-OSATS rating scale. Inter-rater reliability and test-retest reliability were calculated as measures of internal structure. In a separate round of evaluations, the raters provided a global competent/noncompetent decision for each performance. As a measure of consequential validity, a pass/fail score was set for each task using the contrasting group method. MEASUREMENTS AND MAIN RESULTS Three tasks (creation of the bladder flap, colpotomy, and closure of the vault) displayed sound validity evidence: a meaningful total score difference among the 3 groups of experience as well as between the intermediate and experienced surgeons, reliability outcomes of >0.7, and a pass/fail score with a theoretical false-positive rate of <10%. CONCLUSION The validity evidence of the H-OSATS rating scale differed for separate evaluations of the 7 tasks. Three tasks (i.e., creation of the bladder flap, colpotomy, and closure of the vault) revealed sound validity evidence, including at the level of the attending surgeon, whereas other tasks were more consistent with low-stakes formative evaluation standards.
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Affiliation(s)
- Patrice Crochet
- Department of Obstetrics and Gynecology, La Conception Hospital, Aix Marseille University (Drs. Crochet, Netter, Schmitt, Garofalo, Knight, and Agostini); Department of Obstetrics and Gynecology, Arnaud de Villeneuve Hospital, University of Montpellier, Montpellier (Dr. Crochet).
| | - Antoine Netter
- Department of Obstetrics and Gynecology, La Conception Hospital, Aix Marseille University (Drs. Crochet, Netter, Schmitt, Garofalo, Knight, and Agostini); Institut Méditerranéen de Biodiversité et d'Écologie marine et continentale, Aix Marseille University, CNRS, IRD, Avignon University (Dr. Netter)
| | - Andy Schmitt
- Department of Obstetrics and Gynecology, La Conception Hospital, Aix Marseille University (Drs. Crochet, Netter, Schmitt, Garofalo, Knight, and Agostini)
| | - Anna Garofalo
- Department of Obstetrics and Gynecology, La Conception Hospital, Aix Marseille University (Drs. Crochet, Netter, Schmitt, Garofalo, Knight, and Agostini)
| | - Anderson Loundou
- Support Unit for Clinical Research and Economic Evaluation, Assistance Publique Hôpitaux de Marseille, Aix Marseille University (Dr. Loundou), Marseille
| | - Sophie Knight
- Department of Obstetrics and Gynecology, La Conception Hospital, Aix Marseille University (Drs. Crochet, Netter, Schmitt, Garofalo, Knight, and Agostini)
| | - Benoit Rabischong
- Department of Gynecological Surgery, Clermont-Ferrand University Hospital Estaing, Clermont-Ferrand (Dr. Rabischong), France
| | - Aubert Agostini
- Department of Obstetrics and Gynecology, La Conception Hospital, Aix Marseille University (Drs. Crochet, Netter, Schmitt, Garofalo, Knight, and Agostini)
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