The purpose of this study was to compare the surgical outcomes of women undergoing vaginal hysterectomy with and without morcelation.
Between December 1999 and December 2000, 216 women underwent ...vaginal hysterectomy without laparoscopic assistance at the Department of Gynecology of Hôtel-Dieu hospital in Paris. The patients were divided into two groups: 114 of them underwent vaginal hysterectomies with morcelation whereas 102 underwent vaginal hysterectomies without morcelation. The two groups were compared as to demographic data, total complications, operative time, hospital stay length and peri-operative hemoglobin concentration change.
Although women undergoing morcelation were significantly younger (mean 49 versus 52, p = 0.01) and less parous (mean 1.9 versus 2.3, p = 0.03), there were no significant differences in other surgical or anesthetic risks factors, including weight, BMI, nulliparity and preexisting surgical diseases. Mean uterine weight was significantly greater in those undergoing morcelation (331 versus 110 g, p < 0.001); operative time was increased in the group which had undergone morcelation (331 versus 110 g, p < 0.001). There were no significant differences between the two groups with respect to peri-operative hemoglobin concentration change or hospital stay length. Finally, the rate of surgical complication was similar in the two groups (17.5 versus 21.5%).
Although vaginal hysterectomy requires an increase in operative time, morcelation at the time of vaginal hysterectomy is safe and facilitates the vaginal removal of enlarged uteri without increasing peri-operative morbidity.
Objectif :
Comparer la morbidité per- et postopératoire de l’hystérectomie vaginale avec et sans morcellement.
Patientes et méthode :
De décembre 1999 à décembre 2000, 216 patientes ont bénéficié ...d’une hystérectomie vaginale sans assistance à la cœlioscopie à l’Hôtel-Dieu de Paris. Les patientes ont été subdivisées en deux groupes, 114 ayant bénéficié d’une hystérectomie avec morcellement, 102 ayant bénéficié d’une hystérectomie sans morcellement. Les données per- et postopératoires ont été analysées et comparées.
Résultats :
En dehors de l’âge et de la parité plus élevés dans le groupe des utérus non morcelés (
p = 0,03,
p = 0,04 respectivement), aucune différence significative n’a été retrouvée quant au poids, au BMI, aux antécédents chirurgicaux pelviens, au taux de nullipares, aux gestes associés à l’hystérectomie. Le poids moyen des utérus morcelés est significativement augmenté (331 versus 110 g,
p < 0,001). La durée opératoire est significativement plus élevée dans le groupe des utérus morcelés (91 versus 81 minutes,
p = 0,04) sans augmenter la durée d’hospitalisation et le taux de complications per- et postopératoires (17,5 versus 21,5 %).
Conclusion :
Le morcellement utérin au cours de l’hystérectomie vaginale est une technique reproductible et sans danger permettant l’extraction d’utérus de poids élevé sans augmenter la morbidité per- et postopératoire.
Objective:
The purpose of this study was to compare the surgical outcomes of women undergoing vaginal hysterectomy with and without morcelation.
Patients and method:
Between December 1999 and December 2000, 216 women underwent vaginal hysterectomy without laparoscopic assistance at the Departement of Gynecology of Hôtel-Dieu hospital in Paris. The patients were divided into two groups: 114 of them underwent vaginal hysterectomies with morcelation whereas 102 underwent vaginal hysterectomies without morcelation. The two groups were compared as to demographic data, total complications, operative time, hospital stay length and peri-operative hemoglobin concentration change.
Results:
Although women undergoing morcelation were significantly younger (mean 49 versus 52,
p = 0.01) and less parous (mean 1.9 versus 2.3,
p = 0.03), there were no significant differences in other surgical or anesthesic risks factors, including weight, BMI, nulliparity and preexisting surgical diseases. Mean uterine weight was significantly greater in those undergoing morcelation (331 versus 110 g,
p < 0.001); operative time was increased in the group which had undergone morcelation (331 versus 110 g,
p < 0.001). There were no significant differences between the two groups with respect to peri-operative hemoglobin concentration change or hospital stay length. Finally, the rate of surgical complication was similar in the two groups (17.5 versus 21.5%).
Conclusion:
Although vaginal hysterectomy requires an increase in operative time, morcelation at the time of vaginal hysterectomy is safe and facilitates the vaginal removal of enlarged uteri without increasing peri-operative morbidity.
The aim of the study was to evaluate the safety and efficacy of the Musset Poitout surgical procedure consisting in an anterior uterosacral ligament transposition and a cervix amputation. The main ...indication is an uterovaginal prolapse with an isolated elongation of the cervix.
A retrospective consecutive series of 20 women with an elongation of uterine cervix undergoing Musset Poitout procedure over a 10 year period between 1990 and 2001 with analysis of per and post operative complications and success. Four Kelly urethral plications were performed in the same time. The patient's ages, time under anesthesia, change in hemoglobin, days of hospitalization, medical illnesses, complications and follow-up were assessed. Failure was defined as a symptomatic elongation of the cervix or a third degree hysterocele on examination.
and discussion. The median age of Musset Poitout procedure was 43.9 years (range 23-83). General anaesthesia could be performed in all patients. Mean operation time was 67 minutes (range 40-130). No major per or post operative complications occurred. The average of post-operative bladder cathetherisation was 3.65 days, the average hospital stay was 6.3 days. Complications were insignificant: urinary tract infection in 2, voiding dysfunction in 2. All the patients but 2 were followed for a mean 59 months (range 6-127). There was one recurence (5.5%).
In this preliminary assessment the Musset Poitout procedure offered significant avantages in a genital prolapse with elongation of the cervix.
To evaluate the diagnostic relevance to neonatal infections of the soluble intercellular adhesion molecule 1 (sICAM-1) cord serum level.
The case-control study included 66 term newborn infants with ...and without risk factors for neonatal infections. Cord blood serum determinations of white blood cell count, C-reactive protein, fibrinogen, and sICAM-1 were systematically performed associated with bacterial cultures from placenta, ears, and gastric fluids.
6 of 33 infants (18.2%) with risk factors were infected, and 13 (39.4%) were colonized. Two infants included in the group without infection risk factors (n = 33) were colonized. No difference in sICAM-1 cord serum levels was found according to the presence of premature rupture of membrane, fetal tachycardia >160 bpm, meconial amniotic fluid, and duration of labour >10 h. No difference in sICAM-1 was noted between infected and non-infected infants. The cord serum levels of sICAM-1 were significantly higher in infants after forceps extraction (p = 0.01). A correlation was observed between sICAM-1 and C-reactive protein cord serum levels (p = 0.004, r = 0.371) and between sICAM-1 level and neutrophil count (p = 0.01, r = 0.489).
Our results suggest that cord serum sICAM-1 determinations have no diagnostic relevance to neonatal infection. The increase of sICAM-1 cord serum levels in infants after forceps extraction suggests its potential to evaluate cerebral trauma or hypoxia.
Objective.To evaluate (a) the expression of CD31 in benign, borderline, and maligant ovarian tumors; (b) the correlation between CD31 expression and the clinicopathological parameters; and (c) the ...diagnostic interest of serological soluble CD31 (sCD31) in patients with ovarian tumors.
Methods.The intratumoral microvessel density was evaluated by an immunohistochemical technique with the monoclonal antibody JC70 against CD31 at two dilutions in 20 benign, 20 borderline, and 20 malignant tumors of the ovary. Serological determinations of sCD31 with ELISA technique was performed in 35 patients with ovarian tumors (24 benign, 5 borderline, and 6 malignant tumors).
Results.The expression of CD31 was higher in ovarian carcinomas than in borderline and benign tumors (P< 0.001) irrespective of the dilutions of the antibody used. In ovarian carcinomas, a correlation was observed between CD31 expression and the stage of the disease, the histologic type, the degree of histological differentiation, and the survival of the patients. In borderline tumors, no correlation was noted between CD31 expression and the clinicopathologic parameters. No difference in serological levels of sCD31 was noted according to histologic types.
Conclusion.CD31 immunostaining may have a prognostic relevance in ovarian carcinoma but seems to be of limited value in borderline tumors. Serological levels of sCD31 have no diagnostic interest in ovarian tumors.
Objectif. –
Évaluer l'intérêt de l'IRM associée à l'échographie pour la caractérisation des masses annexielles persistantes au cours de la grossesse.
Patientes et méthode. –
Étude rétrospective ...incluant, entre janvier 1999 et novembre 2003, neuf patientes. Les kystes de résolution spontanée au premier trimestre ont été exclus. Le diagnostic suspecté par l'imagerie a été comparé aux résultats histologiques.
Résultats. –
Pour six patientes le diagnostic de masse annexielle a été fait lors d'une échographie systématique. Pour les trois autres patientes, il a été porté au décours de douleurs pelviennes. L'âge gestationnel moyen lors du diagnostic était de 17 semaines d'aménorrhée. La taille moyenne des kystes ovariens était de 96 mm. Deux patientes ont bénéficié d'une chirurgie au cours de la grossesse, l'une en urgence pour une torsion annexielle et l'autre pour une lésion suspecte de malignité. Une patiente a eu une césarienne programmée en raison d'un obstacle praevia. Après exérèse chirurgicale et analyse histologique définitive, aucune de ces lésions n'était maligne. Pour huit des neuf patientes, le diagnostic suspecté par l'imagerie a été confirmé par l'examen histologique.
Discussion et conclusion. –
L'échographie associée à l'IRM permet la caractérisation des masses annexielles associées à la grossesse.
Objective. –
To evaluate the accuracy of MR imaging combined with sonography for the diagnosis of persistent adnexal masses during pregnancy.
Patients and methods. –
From January 1999 to November 2003, nine patients with a persistent adnexal masse were included in this retrospective study. All patients underwent both transvaginal and transabdominal sonography combined with MR imaging. Accuracy of imaging techniques was evaluated by comparison with histology.
Results. –
Adnexal masse was detected by systematic sonography in six women whereas three patients were symptomatic. Mean gestational age at the diagnosis was 17 weeks of amenorrhea (range 5–36). Mean tumor size was 96 mm (range 2–15). Two patients underwent a surgery during pregnancy; one for acute abdominal pain related to an adnexal torsion and the second for suspicion of malignancy. One patient underwent a caesarean delivery for obstetrical reasons. In all patients, benign ovarian tumours were found. For eight patients the diagnosis suspected by imaging techniques was confirmed by histology.
Discussion and conclusion. –
The combination of sonography and MR imaging allows diagnosing accurately adnexal masses during pregnancy.
L’influence des fibromes utérins sur la gestation est établie. Cependant leurs effets sur la fertilité donnent lieu à des controverses. Le but de cette revue de la littérature, de janvier 1988 à ...décembre 2000, est de clarifier la relation fibrome et infertilité, et d’évaluer l’impact de la myomectomie sur le taux de grossesse au sein d’une population de patientes infertiles. En procréation naturelle, 54 publications ont été sélectionnées et 40 incluses dans l’analyse. Aucune étude rapportant le taux de grossesse comparatif en présence et en l’absence de myome n’a été publiée. Le taux de grossesse après myomectomie chez des femmes infertiles allait de 9,6 % à 76,9 %, sans comparaison avec une population témoin. En assistance médicale à la procréation (AMP), cinq publications ont été retenues. La présence d’un myome, a fortiori sous-muqueux ou interstitiel déformant la cavité utérine, avait un effet délétère sur les résultats du replacement embryonnaire. La résection hystéroscopique de myomes sous-muqueux augmentait le taux de grossesse. La relation myome et infertilité apparaît très probable, cependant aucune preuve formelle n’est, à ce jour, disponible. La myomectomie n’a pas fait la preuve de son intérêt sur le plan statistique, toutefois en procréation naturelle, dans les 24 mois suivants la chirurgie, près de 60 % des femmes infertiles ont débuté une grossesse. Ce résultat est diminué en cas d’association à d’autres facteurs d’infertilité. En AMP, les résultats de la myomectomie sont contradictoires. Des études prospectives randomisées seraient nécessaires.
The influence of myomas on reproduction has been clearly demonstrated, however their effects on fertility remain debated. The aim of this review, between January 1988 and December 2000, was to clarify the relation between myoma and fertility, and to assess pregnancy rates after myomectomy in infertile patients. Spontaneously, 54 publications were selected and 40 eligible. No study compared pregnancy rates with or without myomas. Pregnancy rates after myomectomy varied between 9.6 % and 76.9 %, with descriptive series. In medically assisted procreation, five publications were eligible. Myoma presence was associated with decreased pregnancy rates. Hysteroscopic sub-mucous myoma resection increased pregnancy rates. Relation between myoma and sterility is probable, however no proof was obtained. Myomectomy efficacy has not been statistically proven, but spontaneously almost 60 % of patients became pregnant 24 months after surgery. Decreased pregnancy rates are observed when other infertility factors are associated. Concerning myomectomy in medically assisted procreation, conflicting results are available. Prospective randomised studies are needed.
