Objective: The purpose of this study was to evaluate a conservative cold-knife section technique for treatment of cervical intraepithelial neoplasia (CIN). This procedure can be adapted to patient age, preservation of...Objective: The purpose of this study was to evaluate a conservative cold-knife section technique for treatment of cervical intraepithelial neoplasia (CIN). This procedure can be adapted to patient age, preservation of childbearing potential and extent of dysplasia. Design: Prospective study. Setting: Gynecological Oncology Department in French Public Hospital. Population: A total of 460 women treated for CIN between 1985 and 1999 were included. Methods: A conservative cold-knife cervical section followed by blanket suture reconstruction was used in all cases. Main outcome measures: Immediate operative results, recurrence and reproductive function were assessed. Results: The mean length of the cervical specimen was 11.4 mm (range, 4-22 mm). Mean specimen thickness was strongly correlated with age: 10.6 ± 4.1 mm in women < 40 years versus 12.1 in women >40 years; p < 0.001. Complete excision was achieved in 395 cases (85.8% ). Post-operative bleeding was observed in 5 cases (1.1% ). The mean duration of follow-up was 62 months (range, 12.3-156.5 months). Recurrences developed in 26 patients (6.6% ) including CIN 1 in 9 cases, CIN 2 in 9 and CIN 3 in 8. No patient developed carcinoma. The actuarial risk of recurrence was 2.4% (± S.D., 0.9) at 24 months and 7.8% (± S.D., 1.9) at 60 months. A total of 52 pregnancies were observed in 39 patients. No case of de novo infertility was reported post-operatively. Amenorrhea was noted in 1 patient (0.1% ) and dysmenorrhea in 1 patient (0.1% ). Conclusions: This conservative cold-knife section technique is effective for treatment of CIN with low morbidity and little adverse effect on childbearing potential. Exposure of the squamo columnar junction (SCJ) greatly facilitates follow-up.展开更多
Objective:To evaluate the efficacy of cervix ripening with vaginal controlled-release Propess. Patients and methods:A retrospective study of all women who underwent cervical ripening with Propess during the study peri...Objective:To evaluate the efficacy of cervix ripening with vaginal controlled-release Propess. Patients and methods:A retrospective study of all women who underwent cervical ripening with Propess during the study period from 1st January 2002 to 31st December 2004 was carried out. A total of 130 patients who experienced Propess was compared with the next following patient who delivered spontaneously matched on gestational age. Modes of delivery,failure of labor,maternal morbidity were recorded. Results:Indications for induction of labor were:post-term pregnancies in 18.5%,pre-eclampsia in 20.8%,oligohydroamnios in 18.5%,post-term pregnancy and oligohydramnios in 10.8%,intra-uterine fetal growth in 6.9%,premature rupture of membranes in 6.9%,diminution of fetal mobility in 6.1%and miscellaneous in 11.5%. Failure of cervical ripening was 21.2%. Patients in the Propess group had a 3.5 fold higher risk of Cesarean section 95%CI:1.5-8.3; P < 0.04 . There was no case of maternal or fetal death. There was no difference in incidence of maternal complications,and post-partum haemorrhage. Discussion and conclusion:Use of vaginal pessary Propess does not induce adverse maternal or fetal morbidity. However,it was associated with a higher incidence of Cesarean delivery.展开更多
Background. Modalities of inguinal lymphadenectomy in patients with early stage Bartholins gland squamous cell carcinoma (BGC) remain discussed. The aim of this paper is to report 2 patients with stage 1 BGC and neg...Background. Modalities of inguinal lymphadenectomy in patients with early stage Bartholins gland squamous cell carcinoma (BGC) remain discussed. The aim of this paper is to report 2 patients with stage 1 BGC and negative ipsilateral groin nodes who developed a contralateral groin recurrence. Cases. Two patients treated for BGC and undergoing an ipsilateral groin nodes dissection (with absence of nodal involvement)presented contralateral groin recurrence. These recurrences were observed 14 and 3 months after the initial treatment in the first and second case. In the first case, the nodal recurrence was associated with a local vaginal recurrence. Conclusions. These 2 cases suggest that . cross . groin nodal involvement can occur, even in patients with early stage BGC. Bilateral groin dissection should be performed in patients with BGC.展开更多
Objective. To determine risk factors of failed labor in case of fetal macrosomia. Materials and methods. Medical charts of two hundred and forty six women who delivered macrosomic infants ( > 4,000g) between Januar...Objective. To determine risk factors of failed labor in case of fetal macrosomia. Materials and methods. Medical charts of two hundred and forty six women who delivered macrosomic infants ( > 4,000g) between January 2004 and May 2005 were reviewed. Maternal and obstetrical data were analyzed by mode of delivery. Univariate and multivariate (logistic regression analysis) were performed to identify risk factors of failed labor. Results. Rate of cesarean delivery was 18.3% . Indications for cesarean were: failure to progress in 55.6% , arrest in fetal descent in 22.2% , fetal distress in 6.7% , and other in 8.9% . There was a higher risk of failed labor in nulliparous women (p < 0.001), in case of a symphysio-fundal measurements > 34cm (p = 0.004), in nulliparity associated with symphysio-fundal measurements > 34cm (p < 0.001), in case of previous cesarean delivery (p = 0.004), in cases of maternal height < 1.65m (p = 0.02), and with ocytocin use (p = 0.05). In multivariate analysis, nulliparity associated with symphysio-fundal measurements > 34cm (OR = 5.2; CI 1.5- 18.4), previous cesarean section (OR = 3.7; CI 1.1- 12.4) and maternal height < 1.65m (OR = 2.6; CI 1.2- 5.5) were independent factors of failed labor. Conclusion. Failure of labor in case of macrosomia can be predicted in the event of previous cesarean section, shorter maternal height, and association of nulliparity and symphysio- fundal measurements > 34cm.展开更多
文摘Objective: The purpose of this study was to evaluate a conservative cold-knife section technique for treatment of cervical intraepithelial neoplasia (CIN). This procedure can be adapted to patient age, preservation of childbearing potential and extent of dysplasia. Design: Prospective study. Setting: Gynecological Oncology Department in French Public Hospital. Population: A total of 460 women treated for CIN between 1985 and 1999 were included. Methods: A conservative cold-knife cervical section followed by blanket suture reconstruction was used in all cases. Main outcome measures: Immediate operative results, recurrence and reproductive function were assessed. Results: The mean length of the cervical specimen was 11.4 mm (range, 4-22 mm). Mean specimen thickness was strongly correlated with age: 10.6 ± 4.1 mm in women < 40 years versus 12.1 in women >40 years; p < 0.001. Complete excision was achieved in 395 cases (85.8% ). Post-operative bleeding was observed in 5 cases (1.1% ). The mean duration of follow-up was 62 months (range, 12.3-156.5 months). Recurrences developed in 26 patients (6.6% ) including CIN 1 in 9 cases, CIN 2 in 9 and CIN 3 in 8. No patient developed carcinoma. The actuarial risk of recurrence was 2.4% (± S.D., 0.9) at 24 months and 7.8% (± S.D., 1.9) at 60 months. A total of 52 pregnancies were observed in 39 patients. No case of de novo infertility was reported post-operatively. Amenorrhea was noted in 1 patient (0.1% ) and dysmenorrhea in 1 patient (0.1% ). Conclusions: This conservative cold-knife section technique is effective for treatment of CIN with low morbidity and little adverse effect on childbearing potential. Exposure of the squamo columnar junction (SCJ) greatly facilitates follow-up.
文摘Objective:To evaluate the efficacy of cervix ripening with vaginal controlled-release Propess. Patients and methods:A retrospective study of all women who underwent cervical ripening with Propess during the study period from 1st January 2002 to 31st December 2004 was carried out. A total of 130 patients who experienced Propess was compared with the next following patient who delivered spontaneously matched on gestational age. Modes of delivery,failure of labor,maternal morbidity were recorded. Results:Indications for induction of labor were:post-term pregnancies in 18.5%,pre-eclampsia in 20.8%,oligohydroamnios in 18.5%,post-term pregnancy and oligohydramnios in 10.8%,intra-uterine fetal growth in 6.9%,premature rupture of membranes in 6.9%,diminution of fetal mobility in 6.1%and miscellaneous in 11.5%. Failure of cervical ripening was 21.2%. Patients in the Propess group had a 3.5 fold higher risk of Cesarean section 95%CI:1.5-8.3; P < 0.04 . There was no case of maternal or fetal death. There was no difference in incidence of maternal complications,and post-partum haemorrhage. Discussion and conclusion:Use of vaginal pessary Propess does not induce adverse maternal or fetal morbidity. However,it was associated with a higher incidence of Cesarean delivery.
文摘Background. Modalities of inguinal lymphadenectomy in patients with early stage Bartholins gland squamous cell carcinoma (BGC) remain discussed. The aim of this paper is to report 2 patients with stage 1 BGC and negative ipsilateral groin nodes who developed a contralateral groin recurrence. Cases. Two patients treated for BGC and undergoing an ipsilateral groin nodes dissection (with absence of nodal involvement)presented contralateral groin recurrence. These recurrences were observed 14 and 3 months after the initial treatment in the first and second case. In the first case, the nodal recurrence was associated with a local vaginal recurrence. Conclusions. These 2 cases suggest that . cross . groin nodal involvement can occur, even in patients with early stage BGC. Bilateral groin dissection should be performed in patients with BGC.
文摘Objective. To determine risk factors of failed labor in case of fetal macrosomia. Materials and methods. Medical charts of two hundred and forty six women who delivered macrosomic infants ( > 4,000g) between January 2004 and May 2005 were reviewed. Maternal and obstetrical data were analyzed by mode of delivery. Univariate and multivariate (logistic regression analysis) were performed to identify risk factors of failed labor. Results. Rate of cesarean delivery was 18.3% . Indications for cesarean were: failure to progress in 55.6% , arrest in fetal descent in 22.2% , fetal distress in 6.7% , and other in 8.9% . There was a higher risk of failed labor in nulliparous women (p < 0.001), in case of a symphysio-fundal measurements > 34cm (p = 0.004), in nulliparity associated with symphysio-fundal measurements > 34cm (p < 0.001), in case of previous cesarean delivery (p = 0.004), in cases of maternal height < 1.65m (p = 0.02), and with ocytocin use (p = 0.05). In multivariate analysis, nulliparity associated with symphysio-fundal measurements > 34cm (OR = 5.2; CI 1.5- 18.4), previous cesarean section (OR = 3.7; CI 1.1- 12.4) and maternal height < 1.65m (OR = 2.6; CI 1.2- 5.5) were independent factors of failed labor. Conclusion. Failure of labor in case of macrosomia can be predicted in the event of previous cesarean section, shorter maternal height, and association of nulliparity and symphysio- fundal measurements > 34cm.
