61 results on '"Jean Jacques Baldauf"'
Search Results
2. Bowel resection performed by gynecologists - Outcomes and learning curves. Activity profile in a Gynecology Department: 7-year observational cohort
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Lise Lecointre, Muriel Vermel, Cherif Akladios, Françoise Futcher, Emilie Faller, Thomas Boisramé, Floriane Jochum, Jean-Jacques Baldauf, and Thomas Schwaab
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Laparoscopic surgery ,medicine.medical_specialty ,Multivariate analysis ,business.industry ,medicine.medical_treatment ,Endometriosis ,Obstetrics and Gynecology ,Retrospective cohort study ,Perioperative ,Bowel resection ,medicine.disease ,Surgery ,Postoperative Complications ,Reproductive Medicine ,Gynecology ,Cohort ,Humans ,Medicine ,Female ,Laparoscopy ,business ,Complication ,Digestive System Surgical Procedures ,Learning Curve ,Retrospective Studies - Abstract
Objective Bowel resection is frequently used when performing oncological surgery to obtain complete cytoreduction or to remove endometriosis in case of intestinal invasion. Acquiring the surgical skills to perform this kind of procedure is crucial to offer to our patients an optimal management. The aim of this study is to describe a 7-years surgical experience in bowel resections of a gynecologic surgeon and to determine his learning curves. Study Design This is a monocentric retrospective cohort study reporting digestive resection performed between January 2013 and April 2020 in the Gynecology Department of Strasbourg University Hospital. Ninety-one consecutive patients were assigned in two groups: gynecological cancer (n = 44) and deep infiltrating endometriosis (DIE) (n = 47). The main outcome measure was the postoperative complications rate at 30 days, based on the modified Clavien-Dindo severity system. Learning curves were evaluated using cumulative sum (CUSUM) analysis of operative time and risk-adjusted cumulative sum (RA-CUSUM) analysis of severe perioperative complications. Identification of predictive factors for operation duration and severe perioperative complication occurrence was conducted using multivariate analysis. Results Minor complications were found in 25% of cases. Major complication rate (Clavien-Dindo ≥ IIIa) was 14% in total and only involved patients operated for cancer. The CUSUM curve for operative time peaked at the 35th case and showed a downward slope after the 45th case. Significant predictive factors of operating time were cytoreductive tumoral surgery, size of the bowel resection and laparoscopic surgery, while learning phase 3 significantly decreased it. The RA-CUSUM curve for severe perioperative complications (Clavien-Dindo ≥ IIIa) showed a progressive decrease in the complication rate as the number of interventions increases without showing clear inflection points. Only cardiopulmonary pathologies were found as significant predictive factor of severe complications. Conclusion Proficiency in performing highly complex surgery was achieved after approximately 45 cases, cancer and DIE all together. Acceptable rates of severe perioperative complications were observed even during the initial learning period and are comparable with those found in the literature concerning bowel resection performed by gynecologic oncologists but also by general and digestive surgeons.
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- 2021
3. Preliminary observational study of the implementation of hyperthermic intraperitoneal chemotherapy in ovarian cancer in the gynecological surgery department at the University Hospital of Strasbourg
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Virginie Collin-Bund, Lise Lecointre, Célia Ross, Emilie Faller, Thomas Boisramé, Chris Minella, Jean-Jacques Baldauf, and Chérif Akladios
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Reproductive Medicine ,Obstetrics and Gynecology - Abstract
According to French guidelines, hyperthermic intraperitoneal chemotherapy (HIPEC) can be performed for Federation of Gynecology and Obstetrics stage III primary epithelial ovarian, tubal, and peritoneal cancers that are initially unresectable after 3 or 4 cycles of intravenous chemotherapy. The main objective of this preliminary study was to analyze the components necessary for the establishment of HIPEC in an expert gynecological oncological surgery center. The secondary objective was to compare HIPEC using conventional laparotomy and laparoscopic approaches.We conducted a single-center retrospective study of patients who received HIPEC. All patients who met the criteria of the French HIPEC guidelines were included from 2019 to 2021.Prior to HIPEC, there were a mean of 3.7 courses of neoadjuvant chemotherapy with carboplatin and paclitaxel. Of the 16 patients who received HIPEC, 9 (56.2%) underwent HIPEC laparoscopically, while 7 (43.8%) underwent laparotomy. There were no differences between the rates of intra- and postoperative complications between the two groups. (p 0.05). The duration of hospitalization was significantly shorter in patients who were operated laparoscopically than in those treated using laparotomy (55.6%10 days vs. 0 by laparotomy, p = 0.01). There was also a tendency, although not significant, for a more rapid resumption of adjuvant chemotherapy in the laparoscopy group, with 57.1% resuming chemotherapy in6 weeks compared to 42.9% in the laparotomy group (p = 0.52).This study demonstrates the feasibility of HIPEC in a center with expertise in gynecological surgery when there is a suitable technical platform and close collaboration between the different teams involved. We also showed the first cases of HIPEC using laparoscopy, which seems to be a promising approach.
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- 2022
4. Sentinel lymph node biopsy and morbidity outcomes in early cervical cancer: Results of a multicentre randomised trial (SENTICOL-2)
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Yves Fouche, Marc Baron, Florent Boutitie, G. Houvenaeghel, Daniel Raudrant, Eric Leblanc, Catherine Uzan, V. Fourchotte, J-M Classe, P. Morice, Anne-Sophie Bats, Fabrice Lecuru, C. Pomel, L. Boulanger, Jean Levêque, G. Mage, Olivier Graesslin, Patrice Mathevet, Frederic Guyon, Emile Daraï, Vanessa Conri, Philippe Descamps, Jean-Jacques Baldauf, Henri Marret, A S Bats, Denis Querleu, Virginie Fourchotte, Laurent Magaud, B. Ott, Serge Douvier, E. Stoeckle, P. Rouanet, P. Mathevet, Manuel González Barón, D. Lanvin, and Y. Delpech
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Adult ,0301 basic medicine ,Cancer Research ,medicine.medical_specialty ,medicine.medical_treatment ,Sentinel lymph node ,Uterine Cervical Neoplasms ,Adenocarcinoma ,Hysterectomy ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Humans ,Prospective Studies ,Radical surgery ,Radical Hysterectomy ,Lymph node ,Cervical cancer ,Sentinel Lymph Node Biopsy ,business.industry ,Middle Aged ,Sentinel node ,Prognosis ,medicine.disease ,Surgery ,Survival Rate ,Dissection ,030104 developmental biology ,medicine.anatomical_structure ,Oncology ,030220 oncology & carcinogenesis ,Carcinoma, Squamous Cell ,Lymph Node Excision ,Female ,Lymphadenectomy ,Morbidity ,Neoplasm Recurrence, Local ,business ,Follow-Up Studies - Abstract
Introduction Pelvic lymph node dissection has been the standard of care for patients with early cervical cancer. Sentinel node (SN) mapping is safe and feasible and may increase the detection of metastatic disease, but benefits of omitting pelvic lymph node dissection in terms of decreased morbidity have not been demonstrated. Materials and methods In an open-label study, patients with early cervical carcinoma (FIGO 2009 stage IA2 to IIA1) were randomly assigned to SN resection alone (SN arm) or SN and pelvic lymph node dissection (SN + PLND arm). SN resection was followed by radical surgery of the tumour (radical hysterectomy or radical trachelectomy). The primary end-point was morbidity related to the lymph node dissection; 3-year recurrence-free survival was a secondary end-point. Results A total of 206 patients were eligible and randomly assigned to the SN arm (105 patients) or SN + PLND arm (101 patients). Most patients had stage IB1 lesion (87.4%). No false-negative case was observed in SN + PLND arm. Lymphatic morbidity was significantly lower in the SN arm (31.4%) than in the SN + PLND arm (51.5%; p = 0.0046), as was the rate of postoperative neurological symptoms (7.8% vs. 20.6%, p = 0.01, respectively). However, there was no significant difference in the proportion of patients with significant lymphoedema between the two groups. During the 6-month postoperative period, the difference in morbidity decreased over time. The 3-year recurrence-free survival was not significantly different (92.0% in SN arm and 94.4% in SN + PLND arm). Conclusion SN resection alone is associated with early decreased lymphatic morbidity when compared with SN + PLND in early cervical cancer.
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- 2021
5. Impact of neoadjuvant chemotherapy cycles on survival of patients with advanced ovarian cancer: A French national multicenter study (FRANCOGYN)
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Ralph Saadeh, Martin Koskas, Lise Lecointre, Marcos Ballester, Massimo Lodi, Cyrille Huchon, Pierre Collinet, Vincent Lavoué, Geoffroy Canlorbe, Demarchi Martin, Emilie Faller, Cyril Touboul, Cherif Akladios, Pierre Adrien Bolze, Charles Coutant, Michel Velten, Sofiane Bendifallah, Lobna Ouldamer, Thomas Boisramé, Jean Jacques Baldauf, and Justine Gantzer
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medicine.medical_specialty ,Time Factors ,medicine.medical_treatment ,Antineoplastic Agents ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Ovarian carcinoma ,Humans ,Medicine ,030212 general & internal medicine ,Survival rate ,Aged ,Proportional Hazards Models ,Retrospective Studies ,Ovarian Neoplasms ,Chemotherapy ,Advanced ovarian cancer ,030219 obstetrics & reproductive medicine ,Proportional hazards model ,business.industry ,Ovary ,Confounding ,Obstetrics and Gynecology ,Cytoreduction Surgical Procedures ,Middle Aged ,Prognosis ,medicine.disease ,Neoadjuvant Therapy ,Progression-Free Survival ,Survival Rate ,Treatment Outcome ,Reproductive Medicine ,Female ,France ,business ,Ovarian cancer ,Cohort study - Abstract
Objective The purpose of this study was to compare two groups of patients presenting advanced ovarian carcinoma benefiting from neoadjuvant chemotherapy (NAC) followed by cytoreductive surgery: after 3–4 cycles (group 1) or ≥ 5 cycles (group 2), regarding overall survival (OS) and progression-free survival (PFS), complications related to surgery as well as the extent of cytoreduction were assessed. Study design We conducted a retrospective, multicenter cohort study in nine referral centers of France, reviewing the charts of all patients who underwent NAC between January 2000 and June 2017. We performed an OS analysis using multivariate Cox regression models adjusted for potential confounders. We also analyzed PFS and surgery-related morbidity. Results Of 501 patients included, 236 (47.1 %) benefited from ≤ 4 NAC cycles and 265 (52.9 %) from ≥ 5 NAC cycles. Characteristics data were similar in both groups. The rate of achievement of complete surgery was similar in both groups (p = 0.28). Surgical morbidity and postoperative complications showed no significant differences between both groups. The median OS was 54.2 months, 64 months for group 1 and 49.2 months for group 2. The 5-year survival rate was 45.6 % and 27.6 %. This difference was not statistically significant [HR 1.81 (0.89–3.71), p = 0.09]. Five-year PFS was 19.7 % and 11.7 % respectively (p = 0.31). Conclusion In a large series of advanced ovarian cancer, patients receiving late IDS (≥ 5 NAC cycles) seem to show a poorer prognosis than patients operated on earlier. The survival appears to be mainly determined by optimal resection and response to chemotherapy.
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- 2020
6. Serious complications and recurrences after pelvic organ prolapse surgery for 2309 women in the VIGI‐MESH registry
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X Fritel, R Tayrac, J Keizer, S Campagne‐Loiseau, M Cosson, P Ferry, X Deffieux, J‐P Lucot, L Wagner, P Debodinance, C Saussine, A‐C Pizzoferrato, C Carlier‐Guérin, T Thubert, L Panel, P‐O Bosset, E Nkounkou, R Ramanah, T Boisramé, T Charles, C Raiffort, A Charvériat, S Ragot, A Fauconnier, Adnan Aboukassem, Chérif Akladios, Emmanuelle Arsène, Jean‐Sébastien Aucouturier, Georges Bader, Emmanuel Bailly, Jean‐Jacques Baldauf, Stéphanie Bartolo, Marie‐Line Barussaud, Fanny Béchard, Simon Bernardeau, Clément Biscans, Deepak Boodhun, Revaz Botchorishvili, Michel Boukaram, Aude Brams, Laurent Bressler, Clément Bruhat, Michel Canis, Victor Cavillon, Olivier Celhay, Armand Chevrot, Pierre Collinet, Arnaud Cornille, Pierre Costa, Christophe Courtieu, Laurent Courtois, Sandra Curinier, Eric Darnis, Pierre‐Olivier Delpech, Véronique Delporte, Anne Dubois, Emilie Faller, Brigitte Fatton, Cécile Féyeux, Victor Gabriele, Pierre Gadonneix, Olivier Garbin, Florent Genty, Géraldine Giraudet, Pascale Gres, Pauline Gueudry, Jean‐François Haab, Audrey Hedde, Aline Host, Michel Hummel, Estelle Jean dit Gautier, Aminata Kane, Sophie Gouic, Isabelle Teuff, Gil Lebreton, Lise Lecointre, Grégoire Léon, Yolande Maisonnette, Lucile Martin, Aurore Marx, Pascal Mouracade, Corinne Palamara, Petit Nicolas, Caroline Pettenati, Laurence Peyrat, Pierre Pillot, Jean‐Luc Pouly, Clothilde Poupon, Michel Prudhomme, Benoît Rabishong, Hélène Ricard, Jérémie Ripoche, Géraldine Rivaux, Jennifer Salerno, Delphine Salet‐Lizée, Richard Sarfati, Maxence Sarradin, Elodie Schuller, An Segaert, François Stoll, Yannick Thirouard, Caroline Trichot, Mélusine Turck, David Vandendriessche, Edouard Vaucel, Sarah Vieillefosse, Anne Villot, Denis Vinatier, Etienne Vincens, Marie Vinchant, Béatrice Vinson‐Bonnet, Soraya Wapler, Sophie Warembourg, CIC - Poitiers, Université de Poitiers-Centre hospitalier universitaire de Poitiers (CHU Poitiers)-Direction Générale de l'Organisation des Soins (DGOS)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre hospitalier universitaire de Poitiers (CHU Poitiers), Hôpital Universitaire Carémeau [Nîmes] (CHU Nîmes), Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), CHU Estaing [Clermont-Ferrand], CHU Clermont-Ferrand, CHU Lille, Hôpital Saint-Louis de La Rochelle (CH La Rochelle), AP-HP - Hôpital Antoine Béclère [Clamart], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Hôpital Saint Vincent de Paul de Lille, Groupement des Hôpitaux de l'Institut Catholique de Lille (GHICL), Université catholique de Lille (UCL)-Université catholique de Lille (UCL), CH Dunkerque, CHU Strasbourg, CHU Caen, Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN), CH de Châtellerault, Centre hospitalier universitaire de Nantes (CHU Nantes), Clinique Beau Soleil [Montpellier], Hôpital Foch [Suresnes], Centre Hospitalier de Béthune (CH Béthune), GHT de l'Artois, Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon), Groupe Hospitalier Diaconesses Croix Saint-Simon, Centre hospitalier intercommunal de Poissy/Saint-Germain-en-Laye - CHIPS [Poissy], Fritel, Xavier, Groupe Hospitalier de l'Institut Catholique de Lille (GHICL), and centre hospitalier intercommunal de Poissy/Saint-Germain-en-Laye - CHIPS [Poissy]
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Reoperation ,medicine.medical_specialty ,Multivariate analysis ,[SDV]Life Sciences [q-bio] ,Population ,registry ,[SDV.MHEP.GEO]Life Sciences [q-bio]/Human health and pathology/Gynecology and obstetrics ,Risk profile ,03 medical and health sciences ,Gynecologic Surgical Procedures ,Postoperative Complications ,0302 clinical medicine ,surgical complication ,Recurrence ,Risk Factors ,Humans ,Medicine ,Prospective Studies ,Registries ,030212 general & internal medicine ,education ,Prospective cohort study ,Aged ,Pelvic organ ,education.field_of_study ,030219 obstetrics & reproductive medicine ,business.industry ,Prolapse surgery ,Incidence (epidemiology) ,Hazard ratio ,Obstetrics and Gynecology ,Middle Aged ,Surgical Mesh ,Vaginal repair ,pelvic organ prolapse ,Confidence interval ,3. Good health ,Surgery ,[SDV] Life Sciences [q-bio] ,[SDV.MHEP.GEO] Life Sciences [q-bio]/Human health and pathology/Gynecology and obstetrics ,mesh ,Vagina ,Female ,Laparoscopy ,Longitudinal study ,business - Abstract
Objective To assess the incidence of serious complications and reoperations for recurrence after surgery for pelvic organ prolapse (POP) and compare the three most common types of repair. Design Prospective cohort study using a registry. Setting Nineteen French surgical centres. Population A total of 2309 women participated between 2017 and 2019. Methods A multivariate analysis including an inverse probability of treatment weighting approach was used to obtain three comparable groups. Main outcome measures Serious complications and subsequent reoperations for POP recurrence. Results The median follow-up time was 17.6 months. Surgeries were native tissue vaginal repairs (n = 504), transvaginal mesh placements (n = 692) and laparoscopic sacropexies with mesh (n = 1113). Serious complications occurred among 52 women (2.3%), and reoperation for POP recurrence was required for 32 women (1.4%). At 1 year the cumulative weighted incidence of serious complications was 1.8% for native tissue vaginal repair, 3.9% for transvaginal mesh and 2.2% for sacropexy, and the rates for reoperation for recurrence of POP were 1.5, 0.7 and 1.1%, respectively. Compared with native tissue vaginal repair, the risk of serious complications was higher in the transvaginal mesh group (weighted hazard ratio, wHR 3.84, 95% CI 2.43-6.08) and the sacropexy group (wHR 2.48, 95% CI 1.45-4.23), whereas the risk of reoperation for prolapse recurrence was lower in both the transvaginal mesh (wHR 0.22, 95% CI 0.13-0.39) and sacropexy (wHR 0.29, 95% CI 0.18-0.47) groups. Conclusions Our results suggest that native tissue vaginal repairs have the lowest risk of serious complications but the highest risk of reoperation for recurrence. These results are useful for informing women and for shared decision making. Tweetable abstract Laparoscopic sacropexy had fewer serious complications than transvaginal mesh and fewer reoperations for recurrence than vaginal repair.
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- 2021
7. Cervical morbidity in Alsace, France: results from a regional organized cervical cancer screening program
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Jean-Jacques Baldauf, Muriel Fender, Christine Bergeron, Pierre Pradat, Emilie Marrer, Marc Arbyn, and Michel Velten
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Adult ,Cancer Research ,medicine.medical_specialty ,Epidemiology ,cervical cancer ,Population ,Prevalence ,Research Papers: Gynecological Cancer ,Uterine Cervical Neoplasms ,morbidity ,Cervical cancer screening ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Humans ,030212 general & internal medicine ,Papillomavirus Vaccines ,Registries ,education ,Cervix ,Early Detection of Cancer ,Gynecology ,Cervical cancer ,education.field_of_study ,business.industry ,Obstetrics ,screening ,Public Health, Environmental and Occupational Health ,Cancer ,Middle Aged ,medicine.disease ,3. Good health ,medicine.anatomical_structure ,Oncology ,Cytopathology ,030220 oncology & carcinogenesis ,ComputingMethodologies_DOCUMENTANDTEXTPROCESSING ,incidence ,Female ,France ,business - Abstract
Supplemental Digital Content is available in the text., In 1994, a pilot program of cervical cancer screening was introduced in the Alsace region, France. Women aged 25–65 years were proposed to have one Pap smear every 3 years. The objective was to assess cervical morbidity in Alsace before the human papillomavirus vaccinated population reaches the age of screening. Data on cervical lesions and cancers were collected by EVE for the period September 2008 to August 2011 from existing medical services and cytopathology laboratories in Alsace. Cytological and histological data were completed with data from the two cancer registries covering the region (Bas-Rhin and Haut-Rhin). Cancer incidence rates were computed for the target population (truncated to 25–64 years) and were age standardized according to the world reference population. World standardized incidence rates for the whole female population were obtained from the two cancer registries. During 2008–2011, 565 153 smears were performed in 498 913 women aged 25–64 years, representing an average of 1.13 smears/woman and 1.62 smears/screened woman. The overall screening coverage was 70.1% over the 3-year period. Histologically confirmed high-grade lesions were found in 2303 women (0.5%). Moreover, 215 cervical cancers were reported among women aged 25–64 years (crude and standardized truncated incidence rate of 10.6 and 10.0/100 000 women-years, respectively). The overall screening coverage of 70% at 3 years is higher than the national rate (57%), and the overall cancer incidence of 5.5/100 000 is below the national French level. The EVE database will be useful to assess trends in cervical morbidity over time and to further assess the effect of screening as well as of human papillomavirus vaccination.
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- 2018
8. Successful retrieval of human papillomavirus DNA after a 4.5 year storage on FTA elute cards
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Alice Baraquin, Muriel Fender, Jean-Luc Prétet, Christine Soret, Jean-Jacques Baldauf, Christiane Mougin, Gerlinde Averous, and Julie Rousselot
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0301 basic medicine ,Hpv genotypes ,medicine.medical_specialty ,Concordance ,030106 microbiology ,Uterine Cervical Neoplasms ,Context (language use) ,Biology ,Alphapapillomavirus ,Specimen Handling ,03 medical and health sciences ,Virology ,Internal medicine ,Human papillomavirus DNA ,medicine ,Humans ,Cervical cancer ,Papillomavirus Infections ,medicine.disease ,female genital diseases and pregnancy complications ,Vaccination ,Hpv testing ,030104 developmental biology ,DNA, Viral ,Female ,Viral load - Abstract
Efficient primary (vaccination) and secondary (screening) prevention strategies have the potential to eliminate cervical cancer worldwide. In this context, surveillance of HPV infections remains mandatory to assess the efficacy and the impact of screening and vaccination policies. Therefore there is a need to safely store cervical samples to conduct long-term studies in vaccinated and non-vaccinated subjects. Up-dated data on cervical specimen preservation on FTA® cards indicate that HPV DNA can be safely retrieved after 54 months of storage. A concordance of 97 % was achieved between HPV genotypes detected in initial cervical samples and on FTA® cards 4.5 years later. Even if a drop in HPV viral loads was observed in some cases at 4.5 years, using FTA® cards for safe and long-term storage of cervical samples represents an interesting option.
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- 2020
9. [Cervical cancer screening must go on!]
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Jean-Jacques, Baldauf, Lise, Lecointre, Chérif-Youssef, Akladios, Émilie, Faller, Thomas, Boisrame, and Muriel, Fender
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Papillomavirus Infections ,Humans ,Mass Screening ,Uterine Cervical Neoplasms ,Female ,Papillomavirus Vaccines ,Early Detection of Cancer - Published
- 2020
10. Diagnostic Accuracy and Clinical Impact of Sentinel Lymph Node Sampling in Endometrial Cancer at High Risk of Recurrence: A Meta-Analysis
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Lise, Lecointre, Massimo, Lodi, Émilie, Faller, Thomas, Boisramé, Vincent, Agnus, Jean-Jacques, Baldauf, Benoît, Gallix, Chérif, Akladios, Laboratoire des sciences de l'ingénieur, de l'informatique et de l'imagerie (ICube), Institut National des Sciences Appliquées - Strasbourg (INSA Strasbourg), Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Université de Strasbourg (UNISTRA)-Centre National de la Recherche Scientifique (CNRS)-École Nationale du Génie de l'Eau et de l'Environnement de Strasbourg (ENGEES)-Réseau nanophotonique et optique, Centre National de la Recherche Scientifique (CNRS)-Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Centre National de la Recherche Scientifique (CNRS)-Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Matériaux et nanosciences d'Alsace (FMNGE), Institut de Chimie du CNRS (INC)-Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Institut de Chimie du CNRS (INC)-Université de Strasbourg (UNISTRA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Immuno-Rhumatologie Moléculaire, Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Strasbourg (UNISTRA), École Nationale du Génie de l'Eau et de l'Environnement de Strasbourg (ENGEES)-Université de Strasbourg (UNISTRA)-Institut National des Sciences Appliquées - Strasbourg (INSA Strasbourg), Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Institut National de Recherche en Informatique et en Automatique (Inria)-Les Hôpitaux Universitaires de Strasbourg (HUS)-Centre National de la Recherche Scientifique (CNRS)-Matériaux et Nanosciences Grand-Est (MNGE), Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS)-Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS)-Réseau nanophotonique et optique, Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Centre National de la Recherche Scientifique (CNRS)-Université de Strasbourg (UNISTRA)-Centre National de la Recherche Scientifique (CNRS), and Université de Strasbourg (UNISTRA)-Institut National de la Santé et de la Recherche Médicale (INSERM)
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sentinel lymph node ,endometrial cancer ,lcsh:R ,lcsh:Medicine ,Review ,high risk ,[SDV.MHEP]Life Sciences [q-bio]/Human health and pathology - Abstract
Purpose. To assess the value of sentinel lymph node (SLN) sampling in high risk endometrial cancer according to the ESMO-ESGO-ESTRO classification. Methods. We performed a comprehensive search on PubMed for clinical trials evaluating SLN sampling in patients with high risk endometrial cancer: stage I endometrioid, grade 3, with at least 50% myometrial invasion, regardless of lymphovascular space invasion status; or stage II; or node-negative stage III endometrioid, no residual disease; or non-endometrioid (serous or clear cell or undifferentiated carcinoma, or carcinosarcoma). All patients underwent SLN sampling followed by pelvic with or without para-aortic lymphadenectomy. Results. We included 17 original studies concerning 1322 women. Mean detection rates were 89% for unilateral and 68% for bilateral. Pooled sensitivity was 88.5% (95%CI: 81.2–93.2%), negative predictive value was 96.0% (95%CI: 93.1–97.7%), and false negative rate was 11.5% (95%CI: 6.8; 18.8%). We noted heterogeneity in SLN techniques between studies, concerning the tracer and its detection, the injection site, the number of injections, and the surgical approach. Finally, we found a correlation between the number of patients included and the SLN sampling performances. Discussion. This meta-analysis estimated the SLN sampling performances in high risk endometrial cancer patients. Data from the literature show the feasibility, the safety, the limits, and the impact on surgical de-escalation of this technique. In conclusion, our study supports the hypothesis that SLN sampling could be a valuable technique to diagnose lymph node involvement for patients with high risk endometrial cancer in replacement of conventional lymphadenectomy. Consequently, randomized clinical trials are necessary to confirm this hypothesis.
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- 2020
11. Clinical Medicine Impact of Lymphadenectomy on Survival of Patients with Serous Advanced Ovarian Cancer After Neoadjuvant Chemotherapy: A French National Multicenter Study (FRANCOGYN)
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Justine Gantzer, Lise Lecointre, Cherif Akladios, Martin Demarchi, Cyrille Huchon, Vincent Lavoué, Marcos Ballester, Thomas Boisramé, Pierre Collinet, Cyril Touboul, Pierre-Adrien Bolze, Martin Koskas, Geoffroy Canlorbe, Emilie Faller, Charles Coutant, Virginie Bund, Michel Velten, Lobna Ouldamer, Sofiane Bendifallah, Jean-Jacques Baldauf, Les Hôpitaux Universitaires de Strasbourg (HUS), Laboratoire des sciences de l'ingénieur, de l'informatique et de l'imagerie (ICube), École Nationale du Génie de l'Eau et de l'Environnement de Strasbourg (ENGEES)-Université de Strasbourg (UNISTRA)-Institut National des Sciences Appliquées - Strasbourg (INSA Strasbourg), Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Centre National de la Recherche Scientifique (CNRS)-Matériaux et nanosciences d'Alsace (FMNGE), Institut de Chimie du CNRS (INC)-Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Institut de Chimie du CNRS (INC)-Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Réseau nanophotonique et optique, Centre National de la Recherche Scientifique (CNRS)-Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Centre National de la Recherche Scientifique (CNRS)-Université de Strasbourg (UNISTRA), L'Institut hospitalo-universitaire de Strasbourg (IHU Strasbourg), Institut National de Recherche en Informatique et en Automatique (Inria)-l'Institut de Recherche contre les Cancers de l'Appareil Digestif (IRCAD)-Les Hôpitaux Universitaires de Strasbourg (HUS)-La Fédération des Crédits Mutuels Centre Est (FCMCE)-L'Association pour la Recherche contre le Cancer (ARC)-La société Karl STORZ, Centre Hospitalier Régional Universitaire de Tours (CHRU TOURS), Gynécologie-obstétrique et médecine de la reproduction - Maternité [CHU Tenon], CHU Tenon [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), CIC Hôpital Bichat, Institut National de la Santé et de la Recherche Médicale (INSERM)-UFR de Médecine-AP-HP - Hôpital Bichat - Claude Bernard [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Centre Hospitalier Lyon Sud [CHU - HCL] (CHLS), Hospices Civils de Lyon (HCL), Hôpital Jeanne de Flandres, Université de Lille, Droit et Santé-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Service d'Oncologie médicale [CHU Pitié-Salpêtrière], CHU Pitié-Salpêtrière [AP-HP], Service de chirurgie gynécologique et mammaire [CHU Pitié-Salpêtrière], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Pitié-Salpêtrière [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Centre Hospitalier Intercommunal de Créteil (CHIC), CHI Poissy-Saint-Germain, Centre Régional de Lutte contre le cancer Georges-François Leclerc [Dijon] (UNICANCER/CRLCC-CGFL), UNICANCER, Centre Paul Strauss, CRLCC Paul Strauss, Groupe Hospitalier Diaconesses Croix Saint-Simon, CHU Pontchaillou [Rennes], Institut National des Sciences Appliquées - Strasbourg (INSA Strasbourg), Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Université de Strasbourg (UNISTRA)-Centre National de la Recherche Scientifique (CNRS)-École Nationale du Génie de l'Eau et de l'Environnement de Strasbourg (ENGEES)-Réseau nanophotonique et optique, Centre National de la Recherche Scientifique (CNRS)-Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Centre National de la Recherche Scientifique (CNRS)-Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Matériaux et nanosciences d'Alsace (FMNGE), Institut de Chimie du CNRS (INC)-Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Institut de Chimie du CNRS (INC)-Université de Strasbourg (UNISTRA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), Service de Chirurgie et Cancérologie Gynécologique et Mammaire [CHU Pitié-Salpêtrière], Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Institut National de Recherche en Informatique et en Automatique (Inria)-Les Hôpitaux Universitaires de Strasbourg (HUS)-Centre National de la Recherche Scientifique (CNRS)-Matériaux et Nanosciences Grand-Est (MNGE), Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS)-Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS)-Réseau nanophotonique et optique, Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Centre National de la Recherche Scientifique (CNRS)-Université de Strasbourg (UNISTRA)-Centre National de la Recherche Scientifique (CNRS), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), AP-HP - Hôpital Bichat - Claude Bernard [Paris], and Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-UFR de Médecine
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medicine.medical_specialty ,medicine.medical_treatment ,Population ,lcsh:Medicine ,[SDV.CAN]Life Sciences [q-bio]/Cancer ,[SDV.MHEP.CHI]Life Sciences [q-bio]/Human health and pathology/Surgery ,[SDV.MHEP.GEO]Life Sciences [q-bio]/Human health and pathology/Gynecology and obstetrics ,Sciences du Vivant [q-bio]/Cancer ,Article ,03 medical and health sciences ,0302 clinical medicine ,Ovarian carcinoma ,Internal medicine ,medicine ,systematic lymphadenectomy ,030212 general & internal medicine ,education ,Chemotherapy ,education.field_of_study ,business.industry ,Proportional hazards model ,lcsh:R ,General Medicine ,Debulking ,3. Good health ,ovarian carcinoma ,Serous fluid ,030220 oncology & carcinogenesis ,Lymphadenectomy ,[SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie ,business ,Cohort study ,neoadjuvant chemotherapy - Abstract
Background: The population of interest to this study comprised individuals with advanced-stage ovarian carcinoma who were exposed to neoadjuvant chemotherapy (NAC) followed by interval debulking surgery (IDS). Those who had not received systematic lymphadenectomy (SL, Group 1) were compared to those who had received SL (Group 2). Outcome measures included progression-free survival (PFS), overall survival (OS), and surgical complications. Methods: This was a retrospective, multicenter cohort study in nine referral centers of France between January 2000 and June 2017. OS analysis using the multivariate Cox regression model was performed. PFS and surgery-related morbidity were analyzed. Results: Of the 255 patients included, 100 were in Group 1 and 155 in Group 2. Patient majority was, on average, younger and less comorbid, with predominant R0 surgery in Group 2. Dindo&ndash, Clavien score was similar between the two groups (p = 0.15). Median OS was 26.8 months in Group 2 and 27.6 months in Group 1. SL was not statistically significant on OS (p = 0.7). Median PFS was 18.3 months in Group 2 and 16.6 months in Group 1. SL had positive impact on PFS (p = 0.005). Conclusions: patients who had received SL (Group 2) had significantly higher PFS regardless of node-positivity status when compared to those who had not received SL (Group 1).
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- 2020
12. Laparoscopic pelvic lymphadenectomy in patients with intermediate-risk endometrial cancer: Is it worth it?
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A. Bryand, M. Rodriguez, M.-A. Metten, M. Hummel, Olivier Garbin, Anne Pinton, Lise Lecointre, Jean-Jacques Baldauf, and Cherif Akladios
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Adult ,Risk ,medicine.medical_specialty ,Pelvis ,03 medical and health sciences ,0302 clinical medicine ,Humans ,Medicine ,In patient ,Laparoscopy ,Pelvic lymphadenectomy ,Aged ,Retrospective Studies ,Potential impact ,030219 obstetrics & reproductive medicine ,medicine.diagnostic_test ,business.industry ,Endometrial cancer ,Process Assessment, Health Care ,Obstetrics and Gynecology ,Retrospective cohort study ,Middle Aged ,medicine.disease ,Endometrial Neoplasms ,Surgery ,Reproductive Medicine ,030220 oncology & carcinogenesis ,Lymph Node Excision ,Female ,business ,Intermediate risk ,Complication - Abstract
Objective The main aim of this study is to evaluate operative and postoperative morbidity of laparoscopic pelvic lymphadenectomy as well as its potential impact on the postoperative management in patients with an intermediate-risk of endometrial cancer. Methods We did a retrospective study between January 2009 and December 2013. We included all patients operated by laparoscopy for endometrial cancer presumed to have an intermediate-risk of recurrence. Pelvic lymphadenectomy in this group of patients was performed at the discretion of operating surgeons. Patients were consequently divided into two groups according to whether or not pelvic lymphadenectomy was performed. We made a comparative analysis between these two groups. Results Overall, 116 patients were managed for endometrial cancer presumed to be intermediate-risk. Among these, 93 received treatment with laparoscopy and were included in the study. Patients’ characteristics did not differ between the two groups. The mean duration of surgery was significantly longer when pelvic lymphadenectomy was performed. The average number of retrieved lymph nodes was 13 and we had seven patients with positive lymph nodes (10%). Conclusion Pelvic lymphadenectomy allows a better postoperative classification for some patients without more complication.
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- 2018
13. Estimation of the epidemiological burden of HPV-related anogenital cancers, precancerous lesions, and genital warts in women and men in Europe: Potential additional benefit of a nine-valent second generation HPV vaccine compared to first generation HPV vaccines
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Silvia de Sanjosé, François Simondon, Laia Alemany, Jean-Jacques Baldauf, Xavier Castellsagué, Géraldine Dominiak-Felden, and Susanne Hartwig
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medicine.medical_specialty ,HPV ,VIN, vulvar intraepithelial neoplasia ,HPV, human papillomavirus ,HPV vaccines ,Article ,Genital warts ,Vulva ,lcsh:Infectious and parasitic diseases ,Precancerous lesions ,Virology ,Epidemiology ,AIN, anal intraepithelial neoplasia ,medicine ,lcsh:RC109-216 ,Cervix ,CIN, cervical intraepithelial neoplasia ,Cancer ,HPV vaccine ,Gynecology ,business.industry ,Burden of disease ,virus diseases ,IARC, International Agency for Research on Cancer ,CI5, Cancer Incidence in Five Continents ,medicine.disease ,Anus ,VaIN, vaginal intraepithelial neoplasia ,Dermatology ,female genital diseases and pregnancy complications ,CI, confidence interval ,Infectious Diseases ,medicine.anatomical_structure ,Vagina ,business - Abstract
Introduction: A second generation HPV vaccine has been developed for the prevention of anogenital cancers and precancerous lesions of the cervix, vulva, vagina, anus and of genital warts due to nine HPV types.We estimated the annual burden of these diseases attributable to the nine HPV types compared to HPV types from first generation vaccines in women and men in Europe. Material and methods: Incidence rates from the IARC database, cancer registries, the literature and Eurostat population data were used.The burden attributable to the HPV types targeted by both vaccines was estimated by applying the relative contribution of the respective HPV types from epidemiological studies. Results: In 2013, the number of new anogenital HPV-attributable cancers was 44,480 with 39,494 of these cases related to second vs. 33,285 to first generation vaccine types.Among the 284,373 to 541,621 new HPV-attributable anogenital precancerous lesions 235,364–448,423 and 135,025–256,830 were estimated to be related to second and first generation vaccine types, respectively.The annual number of new genital warts was 753,608–935,318, with 90% related to HPV6/11. Conclusions: These data demonstrate how the large public health impact that was achieved by the first generation HPV vaccines could be further increased by second generation vaccines. Keywords: HPV, Burden of disease, Cancer, Precancerous lesions, Genital warts, HPV vaccine
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- 2015
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14. Étude de la qualité de vie dans les néoplasies ovariennes : outils et enjeux
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C.Y. Akladios, F. Bonnetain, Jean-Jacques Baldauf, A. Bryand, Carole Mathelin, Z. Hamidou, and S. Paget-Bailly
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Health related quality of life ,Oncology ,Gynecology ,Prognostic factor ,Poor prognosis ,medicine.medical_specialty ,business.industry ,Obstetrics and Gynecology ,Cancer ,General Medicine ,medicine.disease ,humanities ,Natural history ,Reproductive Medicine ,Quality of life ,Internal medicine ,Medicine ,In patient ,business ,Ovarian cancer - Abstract
Health-related quality of life (QoL) in patients treated for ovarian cancer is directly and heavily impacted by the natural history of cancer, its evolution and its therapeutic modalities. The evaluation and consideration of various parameters of QoL seems to be a major issue. Indeed, on the one hand, it is essential to take into account the opinion of patients in the choice of therapeutic strategies for this cancer with a poor prognosis and, on the other hand, more and more studies show that QoL is an independent prognostic factor in ovarian cancer. Improvement in this case, in addition to being an endpoint by itself, would potentially improve the overall survival of patients. To date there are several tools to assess QOL of patients with ovarian cancer. The 2 questionnaires most commonly used are: FACT-O and the EORTC QLQ-OV28. The aim of our study was to evaluate from a review of the literature, the reciprocal effects of ovarian cancer on QoL and QoL on ovarian cancer survival, as well as specificities of each of the 2 questionnaires most commonly used in assessing the QoL.
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- 2015
15. Comparison Between Transperitoneal and Extraperitoneal Laparoscopic Paraaortic Lymphadenectomy in Gynecologic Malignancies
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Valentine Ronzino, Jean Jacques Baldauf, Cherif Akladios, Karolina Afors, Arnaud Wattiez, Stéphanie Schrot-Sanyan, and Rodrigo Fernandes
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Adult ,medicine.medical_specialty ,Time Factors ,Multivariate analysis ,Genital Neoplasms, Female ,medicine.medical_treatment ,Body Mass Index ,Hospitals, University ,Paraaortic lymphadenectomy ,Laparotomy ,Statistical significance ,medicine ,Humans ,Aorta, Abdominal ,Postoperative Period ,Peritoneal Cavity ,Aged ,Retrospective Studies ,Univariate analysis ,business.industry ,Obstetrics and Gynecology ,Middle Aged ,humanities ,Surgery ,Exact test ,Gynecologic malignancy ,Treatment Outcome ,Lymph Node Excision ,Female ,Laparoscopy ,Lymphadenectomy ,France ,Lymph Nodes ,business - Abstract
Study Objective Two validated laparoscopic approaches for para-aortic lymphadenectomy (PAL) exist: the transperitoneal and the extraperitoneal. The aim of this study was to compare the surgical outcomes of both approaches. Design A retrospective review of all patients who underwent laparoscopic PAL for a gynecologic malignancy between January 2008 and October 2013. Setting University Hospital. Patients Two patients groups were compared: transperitoneal (n = 51) and extraperitoneal (n = 21). Interventions Paraaortic lymphadenectomy. Measurements and Main Results The χ 2 test, Fisher's exact test, or Student's t -test were used for univariate analysis and a stepwise logistic regression for multivariate analysis. The threshold of statistical significance was set at 0.05. All patient characteristics were similar between the 2 groups (p > .05 for all variables). There was only 1 (1.3%) conversion to laparotomy encountered in the transperitoneal PAL group and 3 conversions from extraperitoneal to transperitoneal PAL (14.2%). In 1 case of extraperitoneal PAL, the procedure was abandoned because of inadequate equipment (body mass index 48 kg/m 2 ). The mean duration of surgery was longer in the transperitoneal group: 200 min (35–360) versus 125.6 min (45–180) in the extraperitoneal group (p = .001). The mean number of harvested lymph nodes was higher in the transperitoneal group: 17 (4–37) versus 13 (3–25) in the extraperitoneal group (p = .029). There was no difference in postoperative course and complications between both groups in multivariate analysis. Conclusions In nonobese patients, the extraperitoneal PAL is associated with shorter surgical duration, whereas the transperitoneal approach was associated with a higher number of harvested lymph nodes. As a result of improved ergonomy, the transperitoneal approach enables laparoscopic management of operative complications.
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- 2015
16. Retroperitoneal Lumboaortic Lymphadenectomy Using a Vessel-Sealing Device in 10 Steps
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Marie Schaub, Jean-Jacques Baldauf, Thomas Boisramé, Emilie Faller, Lise Lecointre, Cherif Akladios, and Arnaud Wattiez
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medicine.medical_specialty ,medicine.medical_treatment ,Dissection (medical) ,Medicine ,Humans ,Retroperitoneal Space ,Cervical cancer ,business.industry ,Dissection ,Left flank ,Obstetrics and Gynecology ,Vessel sealing ,Institutional review board ,medicine.disease ,Surgical Instruments ,Surgery ,Uterine Neoplasms ,Lymph Node Excision ,Lymphadenectomy ,Female ,Laparoscopy ,Extraperitoneal space ,Lymph Nodes ,Peritoneum ,business ,Ovarian cancer - Abstract
Study Objective Lumboaortic lymphadenectomy is frequently performed in the surgical management of different gynecologic pelvic malignancies: cervical endometrial and ovarian cancer. The retroperitoneal access presents a real advantage, allowing direct access to vascular axes, thus avoiding bowel segments. The use of a vessel-sealing device could facilitate the technique by providing an ergonomic alternative to conventional tools such as a bipolar grasper and scissors. Here the surgical technique of laparoscopic retroperitoneal lumboaortic lymphadenectomy using a vessel-sealing device in 10 steps is described. Design Educative video (Canadian Task Force classification III). Setting Tertiary referral center in Strasbourg, France. Patients Women undergoing lumboaortic lymphadenectomy. Intervention Laparoscopic retroperitoneal lumboaortic lymphadenectomy using a vessel-sealing device. The local institutional review board approved the video. Measurements and Main Results The surgeon and assistant are positioned on the left of the patient and the column is placed in front. After peritoneal exploration 3 trocars are introduced in the left flank according to a very precise arrangement. We use a camera scope with a zero-degree view angle. After development of the extraperitoneal space and identification of the vascular landmarks, lymphadenectomy using a vessel-sealing device involves several steps in an anticlockwise direction starting from the left common iliac group. We first start with the lateroaortic group of lymph nodes. We then continue with the preaortic, interaorticocaval, and precaval supramesenteric group. After that, we perform the inframesenteric dissection of lymph nodes, the bifurcation of the aorta, and finally the right common iliac group. At the end of the procedure, in the absence of signs of metastatic lymph nodes, we open the peritoneum. Conclusion Retroperitoneal lumboaortic lymphadenectomy using a vessel-sealing device is useful because of better ergonomics of the multitasking instrument, avoiding alternating between scissors and bipolar forceps. The surgeon will be able to use both hands for exposure and for surgery. The presence of a metastatic ganglion is an important and decisive factor in the choice of adjuvant or neoadjuvant management of cancers, especially for cervical cancer.
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- 2017
17. Laparoscopic Transperitoneal Para-Aortic Lymphadenectomy in 10 Steps
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Lise Lecointre, Thomas Boisramé, Camille Martel-Billard, Alice Jacquin, Arnaud Wattiez, Cherif Akladios, Jean-Jacques Baldauf, Vinciane Goillot, and Emilie Faller
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medicine.medical_specialty ,medicine.medical_treatment ,Dissection (medical) ,medicine ,Para aortic lymphadenectomy ,Humans ,Retroperitoneal Space ,Laparoscopy ,Lymph node ,060201 languages & linguistics ,medicine.diagnostic_test ,business.industry ,Dissection ,Common iliac lymph node ,Obstetrics and Gynecology ,Aortocaval lymph node ,06 humanities and the arts ,medicine.disease ,Surgery ,medicine.anatomical_structure ,0602 languages and literature ,Lymph Node Excision ,Lymphadenectomy ,Female ,Lymph ,business - Abstract
Study Objective Laparoscopic transperitoneal lymphadenectomy has a few advantages. First, it is a minimally invasive approach, and the transperitoneal approach is also the best option when intra-abdominal surgery is indicated. Although the procedure was described more than 2 decades ago, there is a lack of diffusion of the technique. The main objective of this video is standardization and a simple description of the technique. We described this procedure in 10 logical steps, which should help to understand and perform this procedure. Methods This video presents a systematic approach to transperitoneal lumboaortic lymphadenectomy, which is clearly divided in 10 steps ordered in a counterclockwise direction. Results The 10 steps are as follows: step 1, retroperitoneal access; step 2, creating a space for subsequent lymphadenectomy and identification of anatomic landmarks; step 3, left common iliac lymph node dissection; step 4, right common iliac lymph node dissection; step 5, presacral lymph node dissection; step 6, lateroaortal lymph node dissection; step 7, laterocaval lymph node dissection; step 8, aortocaval lymph node dissection; step 9, vaginal extraction of bags with specimens; and step 10, vaginal suture. Conclusions Laparoscopic transperitoneal access to lumboaortic lymph nodes is an effective method of lymphadenectomy, which may bring benefits to a patient and physician. The presented 10 steps help to perform each part of surgery in a logical sequence, making the procedure ergonomic and easier to adopt and learn. Standardization of laparoscopic techniques could help to reduce the learning curve.
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- 2017
18. Risk of malignancy on suspicion of polyps in menopausal women
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Julien Godet, Victor Viviani, Olivier Garbin, Lise Lecointre, Aline Host, Emilie Faller, Sandra Bel, Cherif Akladios, Jean-Jacques Baldauf, Thomas Boisramé, Camille Billard, Michel Hummel, Laboratoire de Biophotonique et Pharmacologie - UMR 7213 (LBP), Centre National de la Recherche Scientifique (CNRS)-Réseau nanophotonique et optique, Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Centre National de la Recherche Scientifique (CNRS)-Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Centre National de la Recherche Scientifique (CNRS), Immuno-Rhumatologie Moléculaire, Université de Strasbourg (UNISTRA)-Institut National de la Santé et de la Recherche Médicale (INSERM), Laboratoire des sciences de l'ingénieur, de l'informatique et de l'imagerie (ICube), École Nationale du Génie de l'Eau et de l'Environnement de Strasbourg (ENGEES)-Université de Strasbourg (UNISTRA)-Institut National des Sciences Appliquées - Strasbourg (INSA Strasbourg), Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Institut National de Recherche en Informatique et en Automatique (Inria)-Les Hôpitaux Universitaires de Strasbourg (HUS)-Centre National de la Recherche Scientifique (CNRS)-Matériaux et Nanosciences Grand-Est (MNGE), Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS)-Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS)-Réseau nanophotonique et optique, and Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Centre National de la Recherche Scientifique (CNRS)-Université de Strasbourg (UNISTRA)-Centre National de la Recherche Scientifique (CNRS)
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medicine.medical_specialty ,[SDV.CAN]Life Sciences [q-bio]/Cancer ,Hysteroscopy ,Malignancy ,Atypical hyperplasia ,03 medical and health sciences ,0302 clinical medicine ,Polyps ,Risk Factors ,medicine ,Endometrial Polyp ,Humans ,Cervix ,Uterine Neoplasm ,Aged ,Retrospective Studies ,Ultrasonography ,Gynecology ,Aged, 80 and over ,Uterine Diseases ,030219 obstetrics & reproductive medicine ,medicine.diagnostic_test ,Obstetrics ,business.industry ,Endometrial cancer ,Age Factors ,Obstetrics and Gynecology ,Retrospective cohort study ,Middle Aged ,medicine.disease ,medicine.anatomical_structure ,Reproductive Medicine ,030220 oncology & carcinogenesis ,Uterine Neoplasms ,Female ,Menopause ,business - Abstract
Improved performances in gynaecological ultrasonography have enabled an increasing number of often asymptomatic endometrial polyps to be detected. Most of these polyps are removed surgically, as a precautionary measure, so as not to miss a case of endometrial cancer. Nonetheless, this management strategy is based solely on the sonographer's judgement and a number of these operations, which are probably of no benefit, could be avoided. In order to do so, risk factors for malignancy need to be identified.Estimate the prevalence of lesions in menopausal patients with a pre-operative diagnosis of endometrial polyp. Establish risk factors for malignancy.This is a single-centre retrospective study. Enrolment criteria were menopausal patients aged over 45 who had undergone hysteroscopic resection of a polyp. Pre-op diagnosis was made either by ultrasonography or diagnostic hysteroscopy. Malignant lesions included cancers and atypical hyperplasia. Benign lesions consisted of simple polyps, non-atypical simple hyperplasia and non-atypical complex hyperplasia. Risk factors studied were existing abnormal uterine bleeding, endometrial thickness, personal or first-degree family history of gynaecological cancer (breast, cervix, endometrium, ovary) and age on diagnosis.631 patients were enrolled of whom 30 presented a malignant disorder (4.75%); 579 patients (91.76%) presented a simple polyp, 11 a non-atypical simple hyperplasia (1.74%) and 11 a non-atypical complex hyperplasia (1.74%). On univariate analysis age alone proved to be statistically significant (OR 1.05; 95%CI=[1.02-1.09] p0.01), with a threshold of 59 years of age on the ROC curve. On multivariate analysis, factors predictive of a malignant lesion were age (OR=1.06; 95%CI [1.02-1.10]), existence of AUB (OR=2.4; 95% CI [1.07-5.42]) and family history (OR=2.88; 95%CI [1.08-7.67]). Neither the univariate nor multivariate model was able to demonstrate a statistically significant relationship with respect to endometrial thickness. The risk of malignancy was 12.3% in patients aged over 59 presenting AUB. For all other subgroups, the risk varied between 2.31 and 3.78%.The risk of a malignant lesion appears to be high (12%) in menopausal patients aged over 59 presenting an endometrial polyp detected when there is pre-existing AUB. In this situation, hysteroscopic resection of endometrial polyps should therefore be routinely proposed. For other patients, the risk of a malignant lesion is low but not insignificant, standing at about 3%. Each patient record should therefore be discussed on an individual case basis, taking into consideration the patient's pre-existing conditions, after providing clear and appropriate information.
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- 2017
19. Laparoscopic Sacral Colpopexy: The '6-Points' Technique
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Marie Schaub, Emilie Faller, Lise Lecointre, Thomas Boisramé, Cherif Akladios, Arnaud Wattiez, and Jean-Jacques Baldauf
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medicine.medical_specialty ,Uterosacral ligament ,Pelvic Organ Prolapse ,Gynecologic Surgical Procedures ,medicine ,Humans ,Laparoscopy ,060201 languages & linguistics ,medicine.diagnostic_test ,business.industry ,Pelvic pain ,Obstetrics and Gynecology ,06 humanities and the arts ,Surgical Mesh ,Surgery ,Neck of urinary bladder ,medicine.anatomical_structure ,0602 languages and literature ,Ligament ,Female ,Contracture ,medicine.symptom ,Pouch ,business ,Puborectalis muscle - Abstract
Study Objective To illustrate laparoscopic sacral colpopexy for pelvic organ prolapse, a new method using a simplified mesh fixation technique, with only 6 fixing points. Design Step-by-step explanation of the surgery using video (educative video). The video was approved by the local institutional review board. Setting University Hospital of Strasbourg, France (Canadian Task Force Classification III). Patients Women with multicompartment prolapse. Intervention We first dissected the promontorium and vertically incise the posterior parietal peritoneum on the right pelvic sidewall up the pouch of Douglas. We then dissect the rectovaginal septum up to the anal cap, laterally exposing the puborectalis muscle on each side. Middle rectal vessels can be coagulated and cut without increasing the risk of digestive disorders (especially constipation), but it is preferable to conserve them if the space is sufficient for suture. Then, we dissect the vesicovaginal space and realized the subtotal hysterectomy. Finally, we realized the fastening of the anterior and posterior meshes. The particularity is that we performed only 6 points for fixing the meshes: 1 on the puborectalis muscle on each side without tension (to reduce the risk of mesh contracture, dyspareunia, and chronic pelvic pain), 1 for the fixing of the anterior mesh on the anterior vaginal wall at the level of the bladder neck, and 1 on each side of the cervix for the reconstitution of the pericervical ring gathering together the anterior mesh, the pubocervical fascia, and the insertion of the uterosacral ligament at the level of the cervix and the posterior mesh. The sixth stitch fastened 1 of 2 meshes to the anterior paravertebral ligament at the level of the sacral promontory. We finished with the peritonization. Main Results The duration of surgery lasts approximately 120 minutes in well-experienced hands. Based on our experience the 6-point technique was relatively simple (few laparoscopic stiches) with few operative difficulties and was also associated with a low rate of reintervention. Conclusion Surgical management of middle compartment prolapse could be performed quickly and efficiently under laparoscopy with the “6-points” technique.
- Published
- 2017
20. Reporting reactive cellular changes on smears among women who undergo cervical cancer screening: results of a cohort study after seven years of follow-up
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Michel Velten, Jérémie Jégu, Cherif Akladios, Jean-Jacques Baldauf, Muriel Fender, Gerlinde Averous, and Marie Moitry
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Adult ,medicine.medical_specialty ,Multivariate analysis ,Uterine Cervical Neoplasms ,03 medical and health sciences ,0302 clinical medicine ,Medicine ,Humans ,030212 general & internal medicine ,Early Detection of Cancer ,Aged ,Gynecology ,Vaginal Smears ,Cervical screening ,business.industry ,Obstetrics ,Obstetrics and Gynecology ,Cancer ,Middle Aged ,medicine.disease ,Uterine Cervical Dysplasia ,female genital diseases and pregnancy complications ,Reactive cellular changes ,Reproductive Medicine ,Cytopathology ,030220 oncology & carcinogenesis ,High Grade Cervical Intraepithelial Neoplasia ,Cohort ,Female ,business ,Cohort study ,Follow-Up Studies ,Papanicolaou Test - Abstract
Objective To identify whether women presenting with reactive cellular changes (RCC) on their cervical smear face an increased risk for developing high grade cervical intraepithelial neoplasia (CIN2-3) or cancer as compared with women with an entirely normal smear. Study design French data from the association in charge of organized cervical cancer screening in Bas-Rhin administrative region were used to establish a cohort of 96,215 women presenting with a smear classified as entirely normal or with RCC during the year 2001. The Kaplan-Meyer method was used to calculate the probabilities of CIN2-3 and cancer at seven years of follow-up. Univariate and multivariate survival analyses were performed using Cox proportional hazard models. Results Among the 95,559 women included in the final analysis, 32.2% presented a smear with RCC. After seven years of follow-up, 441 women developed a CIN2-3 and 35 a cancer. Probability of CIN2-3 was increased in the RCC group as compared with the group of women with a normal smear (0.7% versus 0.5%, p = 0.002). Multivariate analyses showed that, compared with a normal cervical smear, RCC were associated with a significant 37% increased risk of CIN2-3 (HR = 1.37 CI95 [1.13–1.66]). However, the risk of cancer was not significantly increased (HR = 1.11 CI95 [0.55–2.23]). Conclusion This study showed that, at seven years, women with RCC on their cervical smear face an increased risk of CIN2-3 but no significant increased risk of cancer. The distinction between entirely normal and RCC cervical smears should therefore not lead to specific clinical management.
- Published
- 2017
21. Pertinence du bilan préoperatoire dans l’évaluation du risque de métastases ganglionnaires d’un cancer endométrial
- Author
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F. Stoll, O. Pouget, C.Y. Akladios, B. Groff, Carole Mathelin, and Jean-Jacques Baldauf
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Gynecology ,medicine.medical_specialty ,Reproductive Medicine ,business.industry ,Endometrial cancer ,medicine ,Obstetrics and Gynecology ,General Medicine ,Lymph node metastasis ,medicine.disease ,business - Abstract
Resume Objectif Evaluer la pertinence de l’imagerie par resonance magnetique (IRM) pelvienne, de la biopsie d’endometre (BE) et du curetage dans l’identification des cancers de l’endometre susceptibles de beneficier d’une lymphadenectomie. Patientes et methodes Etude retrospective portant sur une serie continue de patientes operees d’un cancer de l’endometre limite a l’uterus entre janvier 2004 et decembre 2008. Les resultats du bilan preoperatoire concernant les stades evalues a l’IRM, les types et les grades histologiques evalues a la BE et/ou au curetage uterin ont ete confrontes aux resultats de l’analyse histologique definitive. Resultats Cent-soixante-neuf patientes ont ete incluses dont 90 (53,3 %) ont beneficie d’une IRM, 112 (66,2 %) d’un curetage et 61 (36,6 %) d’une BE. La sensibilite (SN), specificite (SP), valeur predictive positive (VPP) et negative (VPN) respectives de l’IRM dans l’identification d’un groupe susceptible de beneficier d’une lymphadenectomie etaient de 65,6 %, 87,2 %, 77,7 %, 79,2 %. Pour la BE et le curetage la SN, SP, VPP et VPN etaient de ; 42,9 %, 96,9 %, 85 %, 79,5 % ; 80,6 %, 98,3 %, 96,2 % et 90,6 % respectivement. 37,8 % des cancers a faible risque de metastases ganglionnaires au bilan preoperatoire se sont averes etre a haut risque a l’examen histologique definitif. Discussion et conclusion Le bilan preoperatoire comportant un ou plusieurs de ces examens : IRM, BE et curetage uterin est performant dans le diagnostic du cancer de l’endometre susceptible de beneficier d’une lymphadenectomie. Cependant, une sous-estimation du risque est retrouvee dans un tiers des cas environ.
- Published
- 2014
22. The Accuracy of Large Loop Excision of the Transformation Zone Specimen Dimensions in Determining Volume: A Multicentric Prospective Observational Study
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Gery Lamblin, Claire Caradec, Angélique Bryand, Anne Mendel, Xavier Carcopino, Aubert Agostini, Julien Chevreau, Jean-Luc Brun, Julien Mancini, Sébastien Henno, Anthony Atallah, Jean-Jacques Baldauf, Serge Douvier, Jean Gondry, Vincent Lavoué, Didier Riethmuller, Lise Preaubert, Hajanarina Rakotomahenina, Adelaide Jarniat, and Walter Prendiville
- Subjects
Adult ,Uterine Cervical Neoplasms ,Mathematical formula ,Specimen Handling ,03 medical and health sciences ,0302 clinical medicine ,Pathology ,Medicine ,Humans ,030212 general & internal medicine ,Loop excision ,Prospective Studies ,030219 obstetrics & reproductive medicine ,business.industry ,Obstetrics and Gynecology ,General Medicine ,Middle Aged ,Models, Theoretical ,Uterine Cervical Dysplasia ,Observational study ,Female ,Nuclear medicine ,business ,Transformation zone ,Volume (compression) - Abstract
The aim of the study was to determine which mathematical formula of specimen dimensions is the most accurate method of determining volume of the excised specimen at loop excision of the transformation zone.A multicenter prospective observational study was conducted. A total of 258 patients who had a loop excision of the transformation zone performed as treatment of cervical intraepithelial neoplasia 2-3 were included. The dimensions and the volume of the specimen were measured at the time of the procedure, before formaldehyde fixation. The volume was measured by immersing the specimen in a graduated cylinder using Archimedes fluid displacement technique. The measured volume was compared with the calculated volume using different volume formulas, that is, a cone, a cylinder, a parallelepiped, and a hemiellipsoid. The main outcome measure was the relationship between calculated volume (using the dimensions of thickness, length, and circumference) and the measured volume of the specimen.The mean (SD) thickness, length, and circumference of specimens were 8.8 mm (3.8), 12.7 mm (5.9), and 45.7 mm (16.8), respectively. The mean (SD) measured volume was 2.53 (1.49) mL. Using the formula for the volume of a cone, a cylinder, a parallelepiped and a hemiellipsoid, estimated volumes were 1.03 mL (1.22), 3.10 mL (3.65), 6.20 mL (7.31), and 2.07 mL (2.44), respectively. The highest intraclass correlation coefficient between measured and calculated volume was observed when using the formula for the volume of a hemiellipsoid specimen (0.47, 95% CI = 0.36-0.56).The hemiellipsoid formula is the most accurate determinant of the excised volume. Other formulas do not allow for an accurate estimation of the excised volume.
- Published
- 2016
23. Laparoscopic Management of a Rudimentary Uterine Horn
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Cherif Akladios, François Becmeur, Emilie Faller, Anne Lehn, Lise Lecointre, and Jean Jacques Baldauf
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medicine.medical_specialty ,Uterus ,Dissection (medical) ,Abdominal cavity ,Pelvic Pain ,03 medical and health sciences ,0302 clinical medicine ,Uterine malformation ,medicine ,Humans ,Child ,Laparoscopy ,030219 obstetrics & reproductive medicine ,medicine.diagnostic_test ,business.industry ,Obstetrics and Gynecology ,Uterine horns ,Unicornuate uterus ,medicine.disease ,Endoscopy ,Surgery ,medicine.anatomical_structure ,Urogenital Abnormalities ,030220 oncology & carcinogenesis ,Female ,Ureter ,business - Abstract
Study Objective To demonstrate a technique of laparoscopic management of a rudimentary horn in a 12-year-old girl. Design A step-by-step explanation of the surgery using a video (instructive video) approved by the local institutional review board. Setting A university hospital (University Hospital of Strasbourg, Strasbourg, France). Patient A 12-year-old girl with a uterine rudimentary horn. Intervention We describe a case of a 12-year-old girl who had no medical history. She had her first menstruation at 11 years old with major left pelvic pain occurring each month. Ultrasonography showed a duplication of the uterus with a liquid collection on the left side; this type of malformation is called an accessory and cavitated uterine mass. Medical treatment was initiated with progestin. Magnetic resonance imaging showed a left noncommunicating rudimentary horn with a unicornuate uterus. No other malformation was present, particularly in the kidneys. A primary vaginal endoscopy was performed showing a single cervix without vaginal malformation. It was decided to perform a laparoscopic excision of the left rudimentary horn. We placed a 10-mm optical port into the umbilicus and 3 accessory 5-mm trocars. Evaluation of the abdominal cavity showed 2 normal adnexas with normal ovaries. We decided to start with a left salpingectomy using the Ligasure device (Medtronic, Minneapolis, MN), staying close to the tube to preserve ovarian vascularization. The remnant fimbria must be removed to avoid cancerization. Then, the vesicouterine septum was divided until we reached the cervix to dissect the bladder from the rudimentary horn. The broad ligament was fenestrated in order to push the left ureter laterally .The utero-ovarian pedicle was transected with the Ligasure device; the left ovary was preserved and vascularized by the left infundibulopelvic ligament. We then dissected the left uterine artery. The posterior peritoneum was opened. The resection of the rudimentary horn was performed by means of a monopolar hook. The dissection was performed slowly with selective coagulation until we reached the cavity of the horn, with old blood flowing out. The entire cavity was removed, and we confirmed the absence of communication with the other part of the uterus. Uterine reconstruction was performed with inverted separated stiches of a 2-0 braided suture, and, finally, an antiadhesion barrier was placed. Conclusions Laparoscopic management of a uterine rudimentary horn is feasible with satisfactory uterine reconstruction. This is not the first case of this surgery performed by laparoscopy. A similar case has been published in 2015 [1] , and recently another video [2] has been published describing 2 other cases.
- Published
- 2018
24. Transvaginal Resection of an Infected Sacrocolpopexy Mesh by Single-Port Trocar
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Jean-Jacques Baldauf, Cherif Akladios, Lise Lecointre, Emilie Faller, Marie Schaub, and Thomas Boisramé
- Subjects
medicine.medical_specialty ,medicine.medical_treatment ,Vaginal Diseases ,03 medical and health sciences ,Gynecologic Surgical Procedures ,0302 clinical medicine ,Port (medical) ,Salpingectomy ,medicine ,Humans ,Retroperitoneal space ,Laparoscopy ,030219 obstetrics & reproductive medicine ,Hysterectomy ,medicine.diagnostic_test ,business.industry ,Rectocele ,Obstetrics and Gynecology ,Bacterial Infections ,Middle Aged ,Surgical Mesh ,Surgical Instruments ,Surgery ,Dissection ,Treatment Outcome ,medicine.anatomical_structure ,Surgical mesh ,030220 oncology & carcinogenesis ,Vagina ,Female ,business - Abstract
Study Objective Laparoscopy using a single port improves morbidity while keeping the same level of requirement. This technique has been evaluated in gynecology for salpingectomy, ovarian surgery, and hysterectomy. Here, the authors illustrate a new use of a single port using the transvaginal approach. Design Case report (Canadian Task Force classification III). Setting Tertiary referral center in Strasbourg, France. Patient Woman age 59 years. Intervention Single-port platform used in the transvaginal approach for resection of sacrocolpopexy mesh. The local institutional review board approved the video. Measurements and Main Results A 59-year-old woman suffering from insulin-dependent diabetes and a tobacco user had 2 laparoscopic sacrocolpopexies for recurrent rectocele, the first in 2007 and the second in 2012. The sequences were marked by mesh erosion and granuloma in the vagina, requiring its surgical excision in 2016. The patient was then symptomatic, with an increasingly foul-smelling vaginal discharge with recurrent mesh erosion. Magnetic resonance imaging showed an abscess formation along the length of the mesh to the promontory. The patient then underwent surgery, realized under probabilistic antibiotic therapy, consisting of complete excision of the sacrocolpopexy mesh by the transvaginal approach. After putting the single-port trocar (GelPoint; Applied Medical, Rancho Santa Margarita, CA) into the vagina and obtaining distension with the insufflator (AirSeal; Conmed, Utica, NY), classic laparoscopic instruments were introduced by the single-port trocar. The mesh was entirely resected in the retroperitoneal space. Mesh was again used because the exposed space is almost always surrounded by loose granulation tissue that facilitates dissection and also prevents injury to adjacent structures such as bladder, rectum, and peritoneum. Moreover, the opening of adjacent structures will manifest gas leaks and, consequently, loss of the pneumovagina. At the end of procedure, the vagina is not closed to permit optimal drainage with a multitubular drain in the dissection space. The surgery lasted 60 minutes. The mesh excision was completed with relative ease, and there was no blood loss. Bacteriologic examination revealed the presence of Streptococcus anginosus, Klebsiella pneumoniae, and Bacteroides fragili. The operating suites were simple with great cicatrization after 6 weeks. The principal difficulties of this surgery were obtaining a good seal by the creation of cutaneous sutures. Finally, there are less conflicts between the instruments inside the single-port trocar used in transvaginally because of a more limited dissection space. Indeed, the rate of mesh erosion reached 2.4% and, in case of infection, justifies this excision. Conclusion The transvaginal use of a single-port trocar represents a good alternative, allowing easy resection of the sacrocolpopexy mesh while remaining in the retroperitoneal space.
- Published
- 2018
25. Two Surgical Techniques for Essure Device Ablation: The Hysteroscopic Way and the Laparoscopic Way by Salpingectomy with Tubal Interstitial Resection
- Author
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Jean-Jacques Baldauf, Lise Lecointre, Emilie Faller, Solène Petry, Cherif Akladios, Marion Tissot, and Thomas Boisramé
- Subjects
medicine.medical_specialty ,Sterilization, Tubal ,Fistula ,medicine.medical_treatment ,Hysteroscopy ,Pelvis ,Bilateral Salpingectomy ,Salpingectomy ,03 medical and health sciences ,Gynecologic Surgical Procedures ,0302 clinical medicine ,medicine ,Humans ,Device Removal ,Fallopian Tubes ,Ultrasonography ,030219 obstetrics & reproductive medicine ,business.industry ,Uterus ,Obstetrics and Gynecology ,Middle Aged ,medicine.disease ,Surgery ,medicine.anatomical_structure ,Essure ,030220 oncology & carcinogenesis ,Female ,Laparoscopy ,France ,Uterine cavity ,Implant ,business ,Fallopian tube - Abstract
Study Objective To describe 2 different surgical techniques for Essure removal on the same patient: the hysteroscopic and laparoscopic techniques. Design An educational video approved by the local institutional review board (Canadian Task Force classification III). Setting A university hospital (University Hospital of Strasbourg, Strasbourg, France). Patient A 46-year-old woman with many symptoms after Essure device implantation. An ultrasound found a right implant in the uterine cavity and a left intratubal implant. Interventions The first step was the hysteroscopic removal of the right implant. We viewed the 2 internal and external spirals, allowing the gripping of the whole device without risking any fragmentation or tubal lesion. The second step was bilateral salpingectomy with resection of the left interstitial tubal portion. We longitudinally incised the antimesial edge of the fallopian tube 2 to 3 cm from the tubal serous to the implant contact. A circumferential incision was performed at the uterine horn to circumscribe the interstitial tubal portion. The implant was released from the surrounding tissue. It was gently pulled to completely extract it and avoid spiral fragmentation. Then, we performed a bilateral total salpingectomy. An X-ray of the implants and pelvis was performed to ensure complete removal of the device. We made an X-stitch in the uterine horn to avoid the risk of fistula. Conclusion More and more patients are asking for the removal of their implants. The surgical technique has to be adapted to the location of the implants and has to allow their complete removal to avoid leaving fragments that can cause the persistence of side effects.
- Published
- 2019
26. Does the Number of Neoadjuvant Chemotherapy Cycles before Interval Debulking Surgery Influence Survival in Advanced Ovarian Cancer?
- Author
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Jean-Emmanuel Kurtz, Frédéric Marchal, Jean-Jacques Baldauf, Cherif Akladios, Michel Hummel, Karolina Afors, Lise Lecointre, Thierry Petit, Stéphanie Schrot-Sanyan, Laure-Emilie Rebstock, and Carole Mathelin
- Subjects
Oncology ,Cancer Research ,medicine.medical_specialty ,animal structures ,medicine.medical_treatment ,Docetaxel ,Disease-Free Survival ,Carboplatin ,03 medical and health sciences ,0302 clinical medicine ,Primary peritoneal carcinoma ,Internal medicine ,Antineoplastic Combined Chemotherapy Protocols ,Carcinoma ,medicine ,Overall survival ,Fallopian Tube Neoplasms ,Humans ,030212 general & internal medicine ,Peritoneal Neoplasms ,Aged ,Neoplasm Staging ,Retrospective Studies ,Ovarian Neoplasms ,Advanced ovarian cancer ,Chemotherapy ,business.industry ,General Medicine ,Cytoreduction Surgical Procedures ,Middle Aged ,medicine.disease ,Debulking ,female genital diseases and pregnancy complications ,Neoadjuvant Therapy ,Survival Rate ,Chemotherapy, Adjuvant ,030220 oncology & carcinogenesis ,Female ,Taxoids ,business - Abstract
Objective: To evaluate the overall survival (OS) of patients with initially inoperable advanced ovarian cancer, tubal carcinoma, or primary peritoneal carcinoma of stages III or IV undergoing neoadjuvant chemotherapy (NAC) followed by cytoreductive surgery, according to the number of cycles performed. Methods: This retrospective study was conducted in three main oncology centres in the east of France, reviewing the charts of all patients who underwent NAC between January 1, 1998 and October 31, 2012. We performed an OS analysis using multivariate Cox regression models adjusted for potential confounders. We also analysed progression-free survival (PFS) as well as chemotherapy- and surgery-related morbidity. Results: Of the 204 patients included, 75 (36.8%) underwent ≤4 NAC cycles and 129 (63.2%) ≥5 NAC cycles. Characteristic data were similar in the two groups. Five-year OS was 35.0 and 25.8%, respectively. This difference was non-significant [HR = 1.06 (0.70-1.59), p = 0.79]. We also found no differences in PFS or morbidity between the two groups. Conclusions: The number of NAC cycles does not seem to play a role in the OS of patients with advanced ovarian cancer. Further evidence and prospective data are needed to assess the value of a high/low number of NAC cycles among these patients.
- Published
- 2016
27. Excess cervical cancer screening smears: Any benefit? A retrospective cohort in Alsace, France
- Author
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Muriel Fender, Cherif Akladios, Jean-Jacques Baldauf, Alicia Thiery, and François Severac
- Subjects
Adult ,medicine.medical_specialty ,Pediatrics ,Uterine Cervical Neoplasms ,Cervical cancer screening ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Humans ,Mass Screening ,Early Detection of Cancer ,Aged ,Retrospective Studies ,Gynecology ,Cervical cancer ,Vaginal Smears ,030219 obstetrics & reproductive medicine ,business.industry ,Health Policy ,Incidence (epidemiology) ,Incidence ,Public Health, Environmental and Occupational Health ,Reproducibility of Results ,Retrospective cohort study ,Middle Aged ,medicine.disease ,Uterine Cervical Dysplasia ,030220 oncology & carcinogenesis ,Female ,France ,business ,Follow-Up Studies - Abstract
Objectives Although cervical cancer screening guidelines in France recommend a smear test every three years, many physicians order more regular screening. We aimed to assess the benefits or harms of shorter intervals between screenings, both for women and public health. Methods For a retrospective cohort of women aged 25–65 who had two normal smears and at least one additional smear, data were sourced from a regionally organized cervical cancer screening programme in France, with follow-up for nine years. Based on the interval between the second and third smear, two groups were formed; the first comprised overscreened women (interval Results Among 63,821 women, CIN2+ incidence rate per 10,000 women per year was 14.5 for 40,350 overscreened women, and 11.5 for 23,471 correctly screened women. Age-adjusted relative risk was 1.22[1.02; 1.46]. We found no significant difference for cancer (RR = 1.39; 95%CI = [0.60; 3.61]), but did find additional CIN1 in the overscreened group (RR = 2.09; 95%CI = [1.76; 2.51]). Conclusions A shorter interval between smears has a low benefit for CIN2+ lesion detection, which may not help avoid cancer. The excess number of CIN1 detected by overscreening may cause needless risk and excess costs due to overtreatment.
- Published
- 2016
28. Contents Vol. 91, 2016
- Author
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Masahiro Kobayashi, Eugene Ahn, Yoshiyuki Suzuki, Frédéric Marchal, Jo-Anne Vergilio, Lise Lecointre, Abul Kalam Najmi, Rachel L. Erlich, Ryoju Negishi, Hitomi Sezaki, Jean-Emmanuel Kurtz, George William Daneker, Julia A. Elvin, Vincent A. Miller, Pawan Kirtani, Glen J. Weiss, Yosuke Ando, Oliver Holmes, Jean-Jacques Baldauf, Karolina Afors, Siraj M. Ali, Kaori Ito, Norio Akuta, Sarina Anne Piha-Paul, Akira Tenmoku, Mariko Kobayashi, Nobuhiko Emi, Shigeki Yamada, Yasuji Arase, Fumitaka Suzuki, Carole Mathelin, Pramod Kumar Mishra, Cherif Akladios, Maurie Markman, Yoko Inaguma, Masahiro Tsuge, Anjali Singh, Caterina Vivaldi, Wei-Lien Wang, Maiko Ando, Alexa B. Schrock, Satz Mengensatzproduktion, Michel Hummel, Hiroshi Sasaki, Yukiko Kakumae, Masataka Okamoto, Ayana Tomono, Akinao Okamoto, Hiromitsu Kumada, Alfredo Falcone, Enrico Vasile, David L. Stockman, Thierry Petit, Ricardo H. Alvarez, Chiara Caparello, Masayuki A. Fujino, Sundeep Singh Saluja, Shunichiro Fujiyama, Kim Kramer, Satoshi Saitoh, Stéphanie Schrot-Sanyan, Jeffrey S. Ross, Gianna Musettini, James Suh, Itaru Oi, Druckerei Stückle, Iacopo Petrini, Giulia Pasquini, Takahiro Hayashi, Majid A. Talikoti, Takeshi Ichikawa, Behrang Amini, Ralph Zinner, Hiroaki Kaneko, Yusuke Kawamura, Kenji Ikeda, Daniel Spritz, Maria Alejandra Zarzour, Tetsuya Hosaka, Vivek Subbiah, Funda Meric-Bernstam, Laure-Emilie Rebstock, Monica Lencioni, Philip J. Stephens, Nobuaki Machida, Lorenzo Fornaro, and Kyle Gowen
- Subjects
Cancer Research ,Oncology ,General Medicine - Published
- 2016
29. Benefits of Direct Colposcopic Vision for Optimal LLETZ Procedure: A Prospective Multicenter Study
- Author
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Didier Riethmuller, Julien Mancini, Claire Caradec, Jean-Luc Brun, Xavier Carcopino, Sébastien Henno, Vincent Lavoué, Lise Preaubert, Julien Chevreau, Anne Mendel, Aubert Agostini, Gery Lamblin, Adelaide Jarniat, Julia Villeret, Jean Gondry, Angélique Bryand, Serge Douvier, Anthony Atallah, Jean-Jacques Baldauf, Hajanarina Rakotomahenina, Hôpital Nord [CHU - APHM], Transporteurs membranaires, chimioresistance et drug-design ( TMCD2 ), Aix Marseille Université ( AMU ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), Sciences Economiques et Sociales de la Santé & Traitement de l'Information Médicale ( SESSTIM ), Institut de Recherche pour le Développement ( IRD ) -Aix Marseille Université ( AMU ) -ORS PACA-Institut National de la Santé et de la Recherche Médicale ( INSERM ), Institut Paoli Calmettes, Fédération nationale des Centres de lutte contre le Cancer (FNCLCC), Biostatistique et technologies de l'information et de la communication (BioSTIC) - [Hôpital de la Timone - APHM] ( BiosTIC ), Institut de Recherche pour le Développement ( IRD ) -Aix Marseille Université ( AMU ) -ORS PACA-Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Institut de Recherche pour le Développement ( IRD ) -Aix Marseille Université ( AMU ) -ORS PACA-Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Aix Marseille Université ( AMU ) -Assistance Publique - Hôpitaux de Marseille ( APHM ) - Hôpital de la Timone [CHU - APHM] ( TIMONE ), Hôpital Femme Mère Enfant [CHU - HCL] ( HFME ), Hospices Civils de Lyon ( HCL ), Université Nice Sophia Antipolis - Faculté de Médecine ( UNS UFR Médecine ), Université Nice Sophia Antipolis ( UNS ), Université Côte d'Azur ( UCA ) -Université Côte d'Azur ( UCA ), Service de gynécologie–obstétrique, CHU Strasbourg-Hôpital de Hautepierre [Strasbourg], CHU Pontchaillou [Rennes], UFR des Sciences de Santé (Université de Bourgogne), Université de Bourgogne ( UB ), Service de Gynécologie Obstétrique, Médecine Foetale et Stérilité Conjugale - Chirurgie Gynécologie et Oncologique [CHU de Dijon], Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand ( CHU Dijon ), Service de gynécologie, Centre Hospitalier Régional Universitaire [Besançon] ( CHRU Besançon ) -Hôpital Saint-Jacques, department of pathology, university hospital, parakou, Service de gynécologie-obstétrique [Hôpital Nord - APHM], Aix Marseille Université ( AMU ) -Assistance Publique - Hôpitaux de Marseille ( APHM ) - Hôpital Nord [CHU - APHM], Institut méditerranéen de biodiversité et d'écologie marine et continentale ( IMBE ), Université d'Avignon et des Pays de Vaucluse ( UAPV ) -Aix Marseille Université ( AMU ) -Institut de recherche pour le développement [IRD] : UMR237-Centre National de la Recherche Scientifique ( CNRS ), Sciences Economiques et Sociales de la Santé & Traitement de l'Information Médicale (SESSTIM - U912 INSERM - Aix Marseille Univ - IRD), Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Institut Paoli-Calmettes, Biostatistique et technologies de l'information et de la communication (BioSTIC) - [Hôpital de la Timone - APHM] (BiosTIC ), Assistance Publique - Hôpitaux de Marseille (APHM)- Hôpital de la Timone [CHU - APHM] (TIMONE), Hôpital Femme Mère Enfant [CHU - HCL] (HFME), Hospices Civils de Lyon (HCL), Service de Gynécologie et Obstétrique [Rennes], Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-CHU Pontchaillou [Rennes]-Hôpital Sud, Centre Hospitalier Régional Universitaire [Besançon] (CHRU Besançon)-Hôpital Saint-Jacques, Transporteurs membranaires, chimioresistance et drug-design (TMCD2), Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Institut de Recherche pour le Développement (IRD)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Aix Marseille Université (AMU), Université Nice Sophia Antipolis - Faculté de Médecine (UNS UFR Médecine), Université Nice Sophia Antipolis (... - 2019) (UNS), COMUE Université Côte d'Azur (2015-2019) (COMUE UCA)-COMUE Université Côte d'Azur (2015-2019) (COMUE UCA), Université de Bourgogne (UB), Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon)-Hôpital Saint-Jacques, Hôpital Nord [CHU - APHM]-Assistance Publique - Hôpitaux de Marseille (APHM)-Aix Marseille Université (AMU), Institut méditerranéen de biodiversité et d'écologie marine et continentale (IMBE), Avignon Université (AU)-Aix Marseille Université (AMU)-Institut de recherche pour le développement [IRD] : UMR237-Centre National de la Recherche Scientifique (CNRS), Université Nice Sophia Antipolis (1965 - 2019) (UNS), Aix Marseille Université (AMU)-Assistance Publique - Hôpitaux de Marseille (APHM)- Hôpital Nord [CHU - APHM], Hôpital de la Timone [CHU - APHM] (TIMONE)-Assistance Publique - Hôpitaux de Marseille (APHM), and Auquier, Pascal
- Subjects
Adult ,medicine.medical_specialty ,Pathology ,Electrosurgery ,medicine.medical_treatment ,[SDV]Life Sciences [q-bio] ,[ SDV.MHEP.PSM ] Life Sciences [q-bio]/Human health and pathology/Psychiatrics and mental health ,[SDV.MHEP.PSM] Life Sciences [q-bio]/Human health and pathology/Psychiatrics and mental health ,[SHS.PSY]Humanities and Social Sciences/Psychology ,Cervical intraepithelial neoplasia ,[SHS.PSY] Humanities and Social Sciences/Psychology ,03 medical and health sciences ,[ SHS.PSY ] Humanities and Social Sciences/Psychology ,0302 clinical medicine ,Medicine ,[ SHS.ECO ] Humanities and Social Sciences/Economies and finances ,Humans ,030212 general & internal medicine ,Prospective Studies ,[SHS.ECO] Humanities and Social Sciences/Economics and Finance ,Prospective cohort study ,Cervix ,Fixation (histology) ,Colposcopy ,Intraepithelial neoplasia ,030219 obstetrics & reproductive medicine ,medicine.diagnostic_test ,business.industry ,Obstetrics and Gynecology ,[ SDV.SPEE ] Life Sciences [q-bio]/Santé publique et épidémiologie ,General Medicine ,[SHS.ECO]Humanities and Social Sciences/Economics and Finance ,medicine.disease ,Uterine Cervical Dysplasia ,3. Good health ,Surgery ,medicine.anatomical_structure ,Treatment Outcome ,Multicenter study ,[SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie ,[SDV.MHEP.PSM]Life Sciences [q-bio]/Human health and pathology/Psychiatrics and mental health ,Quality of Life ,[SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie ,Female ,business - Abstract
International audience; Objective The aim of the study was to assess whether direct colposcopic ă vision (DCV) of the cervix during large loop excision of the ă transformation zone (LLETZ) is associated with a decrease in the volume ă and dimensions of specimens or affects margin status at histology. ă Materials and Methods A prospective multicenter observational study of ă 216 women who underwent LLETZ for grades 2 and 3 cervical ă intraepithelial neoplasia was conducted. The volume and dimensions ă (circumference, length, and thickness) of the surgical specimens were ă measured before fixation. Data were compared according to the use of ă colposcopy during LLETZ. The following 3 groups were considered: LLETZ ă performed without colposcopy (n = 91), LLETZ performed immediately after ă colposcopy (n = 51), and LLETZ performed under DCV (n = 74). ă Results Patient characteristics were comparable with regard to age, ă parity, history of excision, indication of the procedure, and the size ă of the cervix. We found a significant decrease in all dimensions of the ă specimens obtained under DCV (p < .001). Margin status was not affected. ă After adjusting for confounders, the mean volumes were significantly ă lower in the DCV group (adjusted mean difference = -0.66 mL; 95% CI = ă -1.17 to -0.14). The probability that negative margins would be achieved ă together with the attainment of a volume less than 5 mL and a thickness ă less than 10 mm was the highest in the DCV group (adjusted OR = 2.80; ă 95% CI = 1.13 to 6.90). ă Conclusions Direct colposcopic vision is associated with a significant ă decrease in the volume and in all dimensions of LLETZ specimens with no ă compromise in the margin status.
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- 2015
30. Type B Laparoscopic Radical Trachelectomy With Pelvic Lymphadenectomy for Early Cervical Cancer
- Author
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Jean-Jacques Baldauf, Emilie Faller, Maia Delaine, Camille Martel-Billard, Thomas Boisramé, and Cherif Akladios
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Adult ,medicine.medical_specialty ,Trachelectomy ,Uterine Cervical Neoplasms ,Cervical intraepithelial neoplasia ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Humans ,Fertility preservation ,Stage (cooking) ,Radical Hysterectomy ,Cervix ,Cervical cancer ,030219 obstetrics & reproductive medicine ,business.industry ,Fertility Preservation ,Obstetrics and Gynecology ,Cancer ,medicine.disease ,Surgery ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,Carcinoma, Squamous Cell ,Lymph Node Excision ,Female ,Laparoscopy ,business - Abstract
Study Objective To demonstrate the technique of laparoscopic radical trachelectomy (LRT) and laparoscopic pelvic lymphadenectomy for early cervical cancer. Design Case report (Canadian Task Force Classification Study design III). Setting Tertiary referral centre in Strasbourg, France. Background Over the past 15 years, gynecologic oncologists have sought ways to preserve female fertility when treating invasive cervical cancer. Many cases of cervical cancer have been diagnosed in young women with a desire to preserve their fertility. As more women are delaying childbearing, fertility preservation has become an important consideration. Radical hysterectomy and bilateral pelvic lymphadenectomy represent the standard surgical treatment for stage IA2-IB1 cervical cancer. In some women with small localized invasive cervical cancer, there is hope for a pregnancy after treatment. Vaginal radical trachelectomy (VRT) is a fertilitypreserving surgical procedure for early-stage cervical cancers. The National Comprehensive Cancer Network has published guidelines stating that radical trachelectomy is part of the standard of care for women desiring to preserve their future fertility. VRTwas introduced in 1987 with its first reported use in 1994, and since then more than 1000 cases of VRT have been reported involving more than 250 live births. The tumor recurrence rate is between 4.2% and 5.3%, and the mortality rate is between 2.5% and 3.2%. However, VRT has several limitations despite results demonstrating the safety of the procedure. One limitation is that it is an inadequate procedure for nulliparous patients and those with history of previous conization with adverse vaginal anatomy. In addition, it is difficult to learn the techniques involved in radical vaginal surgery. Patients A 26 year-old nulliparous women with a FIGO Stage IB1 squamous cell tumor of the cervix. A first conisation was performed with no safe resection margins. Intervention In this video we show a type B laparoscopic radical trachelectomy with round ligament and uterine artery preservation. A laparoscopic pelvic lymphadenectomy was also performed. Our institutional review board approved this study. Measurements and Main Results Operative time was 240 minutes. Intraoperative blood loss was less than 100 mL. The operation was performed successfully with no intraoperative complications. Pathological findings demonstrated the presence of a cervical intraepithelial neoplasia 2 on the anterior lips from an 11 o'clock to a 1 o'clock position. Resection margins were safe. The surgical specimen did not show any residual invasive carcinoma. Twenty one lymph nodes were removed, 7 on the right side, and 14 on the left side. No metastatic adenopathy was found. The patient was discharged on day 11. After 5 months, no late complications or recurrence was detected. Conclusions LRT appears to be a safe option for women who intend to maintain their desire for a future pregnancy.
- Published
- 2017
31. Le dépistage précoce du cancer du col est-il justifié ?
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C. Youssef Azer Akladios, Michel Velten, Jean-Jacques Baldauf, and Muriel Fender
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Gynecology ,Cervical cancer ,medicine.medical_specialty ,business.industry ,Medical screening ,HPV infection ,Obstetrics and Gynecology ,Cancer ,General Medicine ,medicine.disease ,Cervical cancer screening ,Reproductive Medicine ,medicine ,business - Abstract
Resume L’utilisation du frottis cervical comme examen de depistage avant l’âge de 25 ans reste controverse. A ce jour, aucune etude randomisee ne valide la pratique d’un depistage plus precoce. L’impression de benefice individuel prevaut souvent malgre l’absence de preuves d’efficacite ou de rapport benefice–risque favorable. Une revue de la litterature prenant en consideration les donnees epidemiologiques, l’efficacite du depistage du cancer du col de l’uterus chez la femme jeune et les consequences medicales et economiques de ce depistage, fournit davantage d’arguments contre que pour, le depistage avant 25 ans.
- Published
- 2011
32. Impact of Pelvic and Para-aortic Lymphadenectomy in Advanced Ovarian Cancer After Neoadjuvant Chemotherapy
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Lucie, Schwartz, Stephanie, Schrot-Sanyan, Cécile, Brigand, Jean-Jacques, Baldauf, Arnaud, Wattiez, and Cherif, Akladios
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Male ,Ovarian Neoplasms ,Neoplasm, Residual ,Cytoreduction Surgical Procedures ,Middle Aged ,Prognosis ,Combined Modality Therapy ,Neoadjuvant Therapy ,Survival Rate ,Chemotherapy, Adjuvant ,Antineoplastic Combined Chemotherapy Protocols ,Para-Aortic Bodies ,Humans ,Lymph Node Excision ,Female ,Neoplasm Grading ,Aged ,Follow-Up Studies ,Neoplasm Staging ,Pelvic Neoplasms - Abstract
The aim of our study was to evaluate the impact of systemic pelvic and para-aortic lymphadenectomy on survival in patients with advanced ovarian cancer after neoadjuvant chemotherapy.This multi-centric descriptive study included patients with initially inoperable advanced ovarian cancer, undergoing neoadjuvant chemotherapy followed by cytoreductive surgery with no residual tumor between 1998 and 2012. They were distributed into two groups depending on if they underwent lymphadenectomy or not during the interval surgery.Among the 101 included patients, 54 underwent lymphadenectomy and 47 did not. The multivariate analysis for overall survival showed no significant difference between the two groups [hazard ratio (HR)=1.88, confidence interval (CI)=0.89-3.94; p=0.08]. The multivariate analysis for progression-free survival showed no significant difference (HR=1.43, 95% CI=0.86-2.39; p=0.17).In patients with advanced ovarian cancer, treated by neoadjuvant chemotherapy and interval surgery with no residual tumor, lymphadenectomy does not seem to improve the survival rate.
- Published
- 2015
33. Long-term storage and safe retrieval of human papillomavirus DNA using FTA elute cards
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Françoise Stoll-Keller, Pierre Oudet, Samira Fafi-Kremer, Gerlinde Averous, Heidi Barth, Michèle Legrain, Adrien Morel, Christiane Mougin, Jean-Jacques Baldauf, Simone Risch, Michel Velten, and Muriel Fender
- Subjects
0301 basic medicine ,Adult ,Genotyping Techniques ,Cytological Techniques ,Preservation, Biological ,Cervix Uteri ,Hpv detection ,urologic and male genital diseases ,Specimen Handling ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,Virology ,Human papillomavirus DNA ,Medicine ,Humans ,Genotyping ,Papillomaviridae ,Aged ,Retrospective Studies ,Cervical cancer ,business.industry ,Disease mechanisms ,Papillomavirus Infections ,HPV infection ,Reproducibility of Results ,Cervical cells ,Middle Aged ,medicine.disease ,Biobank ,female genital diseases and pregnancy complications ,030104 developmental biology ,030220 oncology & carcinogenesis ,DNA, Viral ,Female ,business - Abstract
Biobanking or collection and storage of specimens for future research purposes have become an essential tool in many fields of biomedical research and aims to provide a better understanding of disease mechanisms as well as the identification of disease-specific biomarkers that can navigate in complex diseases. In this study, we assessed the use of Flinders Technology Associates (FTA) cards as a long-term storage device for cervical specimens with suspected human papillomavirus (HPV) infections. HPV detection and genotyping results in liquid-based transport media were compared to HPV results from FTA cards. The overall agreement for the presence of any HPV infection between liquid-based medium and FTA cards stored for 1 year at ambient temperature was 100%. Reproducibility analysis of HPV detection and genotyping from FTA cards demonstrated that FTA cards are a reliable medium to store and preserve viral nucleic acids. Biobanking of cervical cells on FTA cards may provide a key resource for epidemiological and retrospective HPV studies.
- Published
- 2015
34. Reliability of Endocervical Curettage in the Diagnosis of High-grade Cervical Neoplasia and Cervical Cancer in Selected Patients
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Cherif, Akladios, Lise, Lecointre, Emmanuelle, Baulon, Veronique, Thoma, Gerlinde, Averous, Muriel, Fender, François, Lefebvre, and Jean-Jacques, Baldauf
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Adult ,Biopsy ,Patient Selection ,Reproducibility of Results ,Uterine Cervical Neoplasms ,Cervix Uteri ,Middle Aged ,Uterine Cervical Dysplasia ,Sensitivity and Specificity ,Curettage ,Young Adult ,Colposcopy ,Humans ,Female ,Aged ,Retrospective Studies - Abstract
To analyze the reliability of endocervical curettage (ECC) in the diagnosis of high-grade cervical intraepithelial neoplasia and cervical cancer, and to identify risk factors associated with diagnostic underestimation.A retrospective study was carried-out involving 445 patients who underwent ECC for: endocervical lesion incompletely visible on colposcopy or inaccessible to biopsy; atypical glandular cells on smear, or discrepancy between colposcopic impression and cytological abnormalities.Comparison between ECC and final diagnosis showed a perfect match in 362 patients (81.3%). For 189 patients with pre-cancerous or cancerous endocervical lesions, the sensitivity, specificity, and positive and negative predictive values were 87.3%, 96.9%, 95.4% and 91.9%, respectively. No clinical, cytological or colposcopic characteristics were associated with significantly increased risk of diagnostic underestimation with ECC.ECC is a very reliable tool for reducing the number of unnecessary treatments, without increasing the risk of allowing some lesions to evolve into cancer.
- Published
- 2015
35. [Vulnerable populations: how shall we improve cervical cancer screening?]
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Jean-Jacques, Baldauf, Cherif Y, Akladios, and Muriel, Fender
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Vaginal Smears ,Humans ,Mass Screening ,Uterine Cervical Neoplasms ,Female ,Patient Participation ,Poverty ,Vulnerable Populations ,Early Detection of Cancer ,Papanicolaou Test - Published
- 2014
36. The prediction of preeclampsia: Reassessment of clinical value of increased plasma levels of fibronectin
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Michel Dreyfus, Jean Ritter, Jean-Rémy Van Cauwenberg, Jean-Jacques Baldauf, Jean-Michel Foidart, and André Hardy
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Adult ,medicine.medical_specialty ,Enzyme-Linked Immunosorbent Assay ,Gestational Age ,Sensitivity and Specificity ,Preeclampsia ,Pre-Eclampsia ,Pregnancy ,Positive predicative value ,Blood plasma ,Humans ,Medicine ,Outpatient clinic ,Prospective Studies ,Prospective cohort study ,business.industry ,Obstetrics ,Obstetrics and Gynecology ,Gestational age ,medicine.disease ,Fibronectins ,Reproductive Medicine ,Female ,business ,Blood sampling - Abstract
Objective: To determine whether assessment of plasma fibronectin in primigravidae could predict the pregnant women expected to become preeclamptic. Methods: We performed a prospective blinded analysis of 156 apparently normotensive primigravidae in an outpatient clinic. Blood samples were taken at 6 week intervals from the 18th week and immediately after delivery or at the onset of preeclampsia. Plasma fibronectin was evaluated by ELISA. Evolution with gestational age was studied using regression curves. Results: We had 148 normal primigravidae (592 determinations). In three women, increased fibronectin anticipated preeclampsia by 3–4 weeks. Five women showed high levels only at the onset of preeclampsia. Sensitivity, specificity, positive and negative predictive values of increased fibronectin levels were 37.5% (95% CI=3.3–71.7), 96.6% (95% CI=93.7–99.6), 37.5% (95% CI=3.3–71.7) and 96.6% (95% CI=93.7–99.6), respectively. Conclusions: This study shows that plasma fibronectin levels could represent a specific marker for preeclampsia. Its sensitivity has to be improved but its high negative predictive value strongly argues against the development of preeclampsia within the next 4 weeks after the blood sampling.
- Published
- 1998
37. Comparison of the risks of cytologic surveillance of women with atypical cells or low-grade abnormalities on cervical smear: review of the literature
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Jean Ritter and Jean-Jacques Baldauf
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medicine.medical_specialty ,Uterine Cervical Neoplasms ,Cervix Uteri ,Cervical intraepithelial neoplasia ,Risk Factors ,Cytology ,medicine ,Humans ,Vaginal Smears ,Gynecology ,Colposcopy ,Cervical cancer ,medicine.diagnostic_test ,Obstetrics ,business.industry ,Obstetrics and Gynecology ,Cancer ,Uterine Cervical Dysplasia ,medicine.disease ,Reproductive Medicine ,Epidermoid carcinoma ,Female ,Abnormality ,business ,Precancerous Conditions ,Ascus - Abstract
Minor cytological abnormalities--low-grade squamous intraepithelial lesions (LGSIL) and atypical squamous cells of undetermined significance (ASCUS)--are the most frequent abnormalities observed in smears performed in screening for cervical cancer. Surveillance through repeated smears has been proposed as an alternative to immediate colposcopy to reduce cost and avoid overloading colposcopy clinics. The aim of this review is to discuss the advantages and inconveniences of cytological surveillance of women with ASCUS or LGSIL, as reported in the literature. Cervical smears are not sufficient to establish the precise diagnosis of a lesion. In fact, the mean prevalence of normal cervices, high-grade CINs and cancers is estimated to be 58%, 7% and 0.5% for ASCUS and 34%, 27% and 0.2% for LGSIL. Cytological surveillance shows that minor cytological abnormalities regress in 28-69% of cases. In 6-9%, cytological regression masks a high-grade CIN, and a cancer may develop sooner or later in 0.30-1.12% of cases. Cancers often occur in patients temporarily lost to surveillance or in those with normal smears alternating with smears showing minor abnormalities. Strict modalities of surveillance are therefore required. The surveillance has to be carried out with smears repeated every 4-6 months for 2 years. If all smears are normal the regular screening at 3-year intervals may be resumed. On the other hand, an immediate colposcopy is recommended if a new abnormality is observed in these consecutive smears, regardless of its severity and of the time elapsed since the initial abnormality was discovered. With these recommendations in mind, cytological surveillance may slightly reduce the number of colposcopies but without reducing significantly the cost. At present, no arguments based on cost or efficacy clearly favour cytological surveillance over immediate colposcopy.
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- 1998
38. Endometriosis of the round ligament revealed by an intermittent hernia
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Carole Meyer, David Hamid, Anne Hoffbeck, Marie-Noëlle Roedlich, Renaud Haberstich, and Jean-Jacques Baldauf
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medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,Round Ligament ,media_common.quotation_subject ,Endometriosis ,Obstetrics and Gynecology ,Magnetic resonance imaging ,Interventional radiology ,medicine.disease ,Surgery ,Surgical oncology ,medicine ,Hernia ,business ,Menstrual cycle ,media_common ,Histological examination - Abstract
Endometriosis is a common gynaecological pathology with pelvic and extra-pelvic localisations. We report a case of endometriosis of the round ligament revealed by an intermittent hernia. The endometriosis of the round ligament is unusual and the diagnosis may be difficult. The appearance of a roundish lump in the inguinal region associated with pain in relation to the menstrual cycle must raise the suspicion of endometriosis among the possible diagnosis. Ultrasonography and magnetic resonance imaging are the most useful examinations. But it is the histological examination of the surgical specimen that confirms the diagnosis.
- Published
- 2006
39. Benefits and Risks of Directed Biopsy in Pregnancy
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Michel Dreyfus, Jean-Jacques Baldauf, and Jean Ritter
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Gynecology ,Colposcopy ,medicine.medical_specialty ,Univariate analysis ,Pregnancy ,medicine.diagnostic_test ,business.industry ,Obstetrics ,Obstetrics and Gynecology ,Gestational age ,General Medicine ,Cervical intraepithelial neoplasia ,medicine.disease ,Occult ,McNemar's test ,Biopsy ,Medicine ,business - Abstract
OBJECTIVES Our aim was to assess the risks of directed biopsy in pregnant women and to compare its reliability to that of colposcopy. METHODS One hundred seventy six gravidas, whose final diagnosis could be ascertained either by the histological analysis of a surgical specimen or by a sufficiently informative postpartum follow-up, were examined by the same colposcopist. The reliability of colposcopy and directed biopsy were compared using the McNemar χ test for univariate analysis and the Mantel-Haenszel χ test for multivariate analysis. RESULTS Directed biopsies were performed in 128 patients (72.7%), only 1 of whom experienced hemorrhage requiring vaginal packing. No other complications occurred, and premature labor was not more frequent after biopsy. The reliability of biopsy was significantly higher than that of colposcopy (82.6 vs 65.2%; p < .005). Among patients with accurate biopsy but discordant colposcopy, the final diagnosis was normal cervix, low-grade cervical intraepithelial neoplasia (CIN), high-grade CIN, and cancer in 48.4, 29.0, 22.6, and 0% of cases, respectively. When results were stratified by final diagnosis, biopsy was no more accurate than was colposcopy, regardless of cytological findings, colposcopic impression, gestational age, parity, or colposcopist's experience. One of the two occult invasive cancers correctly diagnosed by biopsy had an unsatisfactory colposcopy suggesting invasion. CONCLUSIONS The difficulties of colposcopy during pregnancy and the minimal risks of directed biopsy justify a biopsy in gravidas when either cytology or colposcopy suggests at least a high-grade CIN, to ensure that no cancer has been overlooked.
- Published
- 1997
40. Cervicography
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Jean-Jacques Baldauf, Pierre Meyer, Michel Dreyfus, Emile Philippe, and Jean Ritter
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Gynecology ,medicine.medical_specialty ,Pregnancy ,Histology ,Cervical screening ,business.industry ,General Medicine ,Cervical cancer screening ,medicine.disease ,Pathology and Forensic Medicine ,medicine.anatomical_structure ,Cytopathology ,Cytology ,medicine ,False positive paradox ,Cervicography ,business ,Cervix - Abstract
OBJECTIVE: To compare the reliability of cytology with that of cervicography and with the use of both tests when screening for neoplasia of the cervix and to analyze the causes of false positive and false negative results with both methods. STUDY DESIGN: The results of cytology and cervicography in 1,709 patients (1,447 seen for routine screening, 82 for follow-up after treatment for cervical neoplasia and 180 referred because of cytologic anomalies) were correlated with colpohistologic findings. RESULTS: Cervicography entailed more defective examinations than did cytology (8.9% vs. 0.2%, P
- Published
- 1997
41. Screening Histories of Incidence Cases of Cervical Cancer and High Grade SIL
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Jean-Jacques Baldauf, Pierre Meyer, Jean Ritter, Michel Dreyfus, and Emile Philippe
- Subjects
Gynecology ,Cervical cancer ,medicine.medical_specialty ,Histology ,business.industry ,Obstetrics ,General Medicine ,medicine.disease ,Cervical intraepithelial neoplasia ,Pathology and Forensic Medicine ,medicine.anatomical_structure ,Epidermoid carcinoma ,Cytopathology ,High Grade Cervical Intraepithelial Neoplasia ,Medicine ,Cervix neoplasm ,business ,Cervix ,Mass screening - Abstract
OBJECTIVE: To compare the cytologic history of patients with cervical cancer with that of patients with high grade cervical intraepithelial neoplasia (CIN) in order to analyze the causes of screening failure. STUDY DESIGN: In 337 patients treated for high grade CIN and 86 women treated for cancer of the cervix, all cytologic reports from the last five years before diagnosis were reviewed, and slides of normal smears taken within three years of diagnosis were reexamined. RESULTS: Among patients with cancer, 32/86 (37.2 %) never had a smear, for 28/86 (32.6%) the time interval between screenings was greater than three years, 12/66 (18.2%) were incorrectly managed after the first abnormal smear, and 7/69 (10.1 %) had a normal smear within three years of diagnosis. Conversely, among patients with high grade CIN, 45/337 (13.4%) never had a smear, 60/337 (17.8%) had a time interval between screenings greater than three years, 120/337 (35. 6%) were incorrectly managed after the first abnormal smear, and 100/333 (30.0%) had a normal smear within three years of diagnosis. When compared with high grade CIN, cancer of the cervix was associated with absent or insufficient screening (adjusted odds ratio [aOR] = 3.28, 95% confidence interval (95% CI) = 1.86-5.80) but neither with incorrect management of the first abnormal smear (aOR = 1.32, 95% CI = 0.46-3.75 nor with a normal smear within three years of diagnosis (aOR = 0.22, 95% CI = 0.10-0.50). CONCLUSION: Better participation of patients is necessary to improve the efficacity of screening. Conversely, reducing the interval between smears to less than three years would cause a major increase in cost and earlier diagnosis of high grade CIN, but not a significant decrease in the number of cancers.
- Published
- 1997
42. An analysis of the factors involved in the diagnostic accuracy of colposcopically directed biopsy
- Author
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Michel Dreyfus, Jean Ritter, Jean-Jacques Baldauf, and Emile Philippe
- Subjects
Adult ,medicine.medical_specialty ,Adolescent ,Biopsy ,Uterine Cervical Neoplasms ,Endocervical curettage ,Risk Factors ,Odds Ratio ,medicine ,Carcinoma ,Humans ,Aged ,Colposcopy ,Gynecology ,Analysis of Variance ,Pregnancy ,medicine.diagnostic_test ,business.industry ,Histological Techniques ,Squamocolumnar Junction ,Reproducibility of Results ,Obstetrics and Gynecology ,General Medicine ,Middle Aged ,Uterine Cervical Dysplasia ,medicine.disease ,Occult ,Endoscopy ,Logistic Models ,Female ,Radiology ,business - Abstract
To compare the results of colposcopically directed biopsy with the final diagnosis established by the analysis of the surgical specimen, and to determine the clinical and colposcopic factors on which the reliability of biopsy is based.Five hundred and sixty-seven women were seen by the same colposcopist who also performed the directed biopsies and/or the endocervical curettage. The final histological diagnosis identified 29 normal aspects (5.2%), 58 low-grade cervical intraepithelial neoplasias (CIN) (10.2%), 448 high-grade CINs (79.0%), 16 microinvasive cancers (2.8%) and 16 occult invasive cancers (2.8%). The influence of several factors--such as age, parity, menopause, pregnancy, history of cervical treatment, site of the squamocolumnar junction, localization, size and severity of the lesions--on the pertinence of the biopsy was studied in a uni- and multifactorial analysis.Colposcopy was satisfactory in 399 patients (70.4%) in whom the colposcopic aspect was consistent with the final histological diagnosis in 81.2% of cases. The global agreement between biopsy diagnosis and final diagnosis was observed in 89.6% of cases. It was 84.2% for low-grade CINs, 95.8% for high-grade CINs, 31.2% for microinvasive cancers and 81.2% for invasive cancers. No clinical or colposcopic factor could be identified as independent factor associated with the diagnostic agreement with the directed biopsy. Conversely, concordance of biopsy was related to the final diagnosis since the only independent risk factors were a high-grade CIN (adjusted risk ratio (ARR)=1.52, 95% CI=1.11-2.08; p=0.006) and a microinvasive or invasive cancer (ARR=0.56, 95% CI=0.39 0.81; p=0.002).To ensure that a microinvasive cancer has not been overlooked, the excision of high-grade CINs seems to be justified, whatever the clinical status and the colposcopic aspect.
- Published
- 1997
43. Plasma cyclic GMP concentrations and their relationship with changes of blood pressure levels in pre-eclampsia
- Author
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Francis Schneider, Jean Ritter, Michel Dreyfus, Jean-Daniel Tempé, Laurence Quirin, Jean-Jacques Baldauf, and Philippe Lutun
- Subjects
Adult ,medicine.medical_specialty ,Vascular smooth muscle ,Pregnancy Complications, Cardiovascular ,Blood Pressure ,Peptide hormone ,Nitric Oxide ,Preeclampsia ,chemistry.chemical_compound ,Pre-Eclampsia ,Atrial natriuretic peptide ,Pregnancy ,Internal medicine ,Blood plasma ,medicine ,Humans ,Cyclic GMP ,Creatinine ,business.industry ,Obstetrics and Gynecology ,General Medicine ,medicine.disease ,Parity ,Endocrinology ,Blood pressure ,chemistry ,Guanylate Cyclase ,Hypertension ,Uric acid ,Female ,business ,Atrial Natriuretic Factor - Abstract
One of the possible mechanisms responsible for pre-eclampsia is a loss of efficiency of the L-arginine-nitric oxide pathway with subsequent inactivation of the guanylyl cyclases of the vascular smooth muscle cells. As a result there should be a decrease in plasma cyclic 3'-5' guanosine monophosphate (cGMP) concentrations in pre-eclampsia. We assessed the behavior of this nucleotid in the plasma of pre-eclamptic women.Sixteen pre-eclamptic women, 16 normotensive pregnant women matched for gestational age and six nonpregnant controls were investigated. Arterial blood pressure was recorded at inclusion time and then once-a-day until the fourth day after delivery concomitantly with the collection of blood samples for determining plasma cGMP, atrial natriuretic peptides (ANP), creatinine, uric acid and platelet counts. Also 24 h urines were simultaneously collected to calculate renal clearance of cGMP.Before the initiation of antihypertensive treatment, plasma cGMP levels were significantly higher (p0.01) in pre-eclampsia women as compared both to pregnant normotensive controls and nonpregnant women (7.02 +/- 0.9 versus 4.8 +/- 0.76 versus 1.93 +/- 0.15 pmol.ml-1, p0.01). Under antihypertensive treatment, cGMP levels decreased significantly (p0.05) to 5.48 +/- 0.9 pmol.ml-1. The increase of plasma cGMP was associated with high ANP levels; the likelihood that a renal impairment could account for an increase in plasma cGMP was ruled out because the clearance of creatinine was not impaired. Similarly the possibility of a significant linear correlation between cGMP levels and blood pressure values or biological data was excluded in these women.Plasma cGMP concentrations are increased in pre-eclampsia. They decrease to control values when blood pressure returns to normal values; they indicate enhanced guanylyl cyclase activation by ANP and additional factors, but cannot be considered as a direct index of the severity of pre-eclampsia.
- Published
- 1996
44. Prenatal Diagnosis of Hepatic Hemangioma
- Author
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Jean Ritter, Karim Dadoun, Jean-Jacques Baldauf, Michel Dreyfus, Françoise Berrut, and François Becmeur
- Subjects
Adult ,Hepatic Hemangioma ,Embryology ,Pathology ,medicine.medical_specialty ,Prenatal diagnosis ,Ultrasonography, Prenatal ,Liver mass ,Benign tumor ,Angioma ,Pregnancy ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Fetus ,Pulsed doppler ,Vascular disease ,business.industry ,Liver Neoplasms ,Obstetrics and Gynecology ,General Medicine ,medicine.disease ,Fetal Diseases ,Pediatrics, Perinatology and Child Health ,Female ,Hemangioma ,business - Abstract
We report the prenatal diagnosis of a hepatic hemangioma presenting as a heterogeneous mass (6 x 5 cm) of the fetal liver, thickly septated with calcifications. Pulsed Doppler confirmed the vascular pattern of the mass. Subsequent postnatal examinations and follow-up have documented the spontaneous regression of this benign tumor. Antenatal diagnosis of fetal liver masses and management after delivery are discussed.
- Published
- 1996
45. Seric and local antibodies against a synthetic peptide of HPV16
- Author
-
Georges Obert, Jean Ritter, Michel Dreyfus, and Jean-Jacques Baldauf
- Subjects
Adult ,Immunoglobulin A ,Molecular Sequence Data ,Uterine Cervical Neoplasms ,Enzyme-Linked Immunosorbent Assay ,Cervix Uteri ,Antibodies, Viral ,Cervical intraepithelial neoplasia ,Immunoglobulin G ,Open Reading Frames ,Antigen ,medicine ,Humans ,Amino Acid Sequence ,Papillomaviridae ,Antigens, Viral ,biology ,business.industry ,Papillomavirus Infections ,HPV infection ,Obstetrics and Gynecology ,Middle Aged ,Uterine Cervical Dysplasia ,medicine.disease ,biology.organism_classification ,Virology ,Tumor Virus Infections ,Reproductive Medicine ,Case-Control Studies ,Vagina ,Immunology ,biology.protein ,Female ,Viral disease ,Antibody ,business - Abstract
An ELISA method was used to detect IgG and IgA directed against a synthetic peptide derived from the E2 ORF of the human papillomavirus (HPV) 16 in sera and in cervico-vaginal secretions from 20 women without evidence of HPV infection and from 41 women with histological diagnosis of HPV infection. The proportion of IgA positive sera (63.4% in the case-group vs. 20.0% in the control-group) and secretions (48.8% in the case-group vs. 15.0% in the control-group) was significantly higher in women with HPV infection and seemed to increase with the severity of the cervical lesion. Such a difference was not found for specific IgG. Comparing, for each patient, the antibody level in the serum and in the secretions, we found that the amount of IgA was at mean 2.4 times higher in the sera than in the secretions.
- Published
- 1995
46. A prospective randomized study of two reminding strategies: telephone versus mail in the screening of cervical cancer in women who did not initially respond
- Author
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Michel Velten, Muriel Fender, D Heranney, and Jean-Jacques Baldauf
- Subjects
Adult ,medicine.medical_specialty ,Histology ,Cost-Benefit Analysis ,Reminder Systems ,education ,MEDLINE ,Uterine Cervical Neoplasms ,Cervical cancer screening ,Pathology and Forensic Medicine ,law.invention ,Randomized controlled trial ,law ,Medicine ,Humans ,Mass Screening ,Prospective randomized study ,Postal Service ,Prospective Studies ,Patient participation ,Prospective cohort study ,Mass screening ,Aged ,Cervical cancer ,business.industry ,General Medicine ,Middle Aged ,medicine.disease ,Prognosis ,Telephone ,Physical therapy ,Female ,Patient Participation ,business ,psychological phenomena and processes - Abstract
Objective: To compare the efficacy and cost-effectiveness of two reminding strategies addressed to women who did not respond to a first invitation to undergo cervical cancer screening. Study Design: A randomized study was carried out by a programme created in Alsace to organize cervical cancer screening. In total, 10,662 women who did not have a smear test 1 year after a first notice was sent, were randomly allocated to receive either a new letter with a reply coupon or a telephone call. The uptake of screening was measured using routine data. Efficacy and direct costs of the two methods were compared. Results: Uptake at 8 months was 6.3% [95% confidence interval (CI) 5.6–7.0%] for telephone calls and 5.8% (95% CI 5.2–6.4%) for letters. The difference was not significant. More information was collected through telephone calls than by letters, but with less reliability. Furthermore, telephone calls were more costly. Conclusions: We found that in our region, a mail reminder was as effective as, and less expensive than, a telephone call; moreover, it was applicable to the whole population, including patients without a telephone.
- Published
- 2011
47. Regression of high-grade cervical intraepithelial neoplasia with TG4001 targeted immunotherapy
- Author
-
Serge Douvier, Christine Clavel, Jean Lévêque, Patrick Raulic, Didier Riethmuller, Martine Baudin, Patrice Mathevet, Jean-Luc Brun, Valérie Calenda, Suzy Scholl, Bernard Huynh, Jean-Jacques Baldauf, Philippe Birembaut, Véronique Dalstein, Jean-Paul Bory, CHU Bordeaux [Bordeaux], Plasticité de l'épithélium respiratoire dans les conditions normales et pathologiques - UMR-S 903 ( PERPMP ), Université de Reims Champagne-Ardenne ( URCA ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -SFR CAP Santé (Champagne-Ardenne Picardie Santé), Université de Reims Champagne-Ardenne ( URCA ) -Université de Picardie Jules Verne ( UPJV ) -Université de Reims Champagne-Ardenne ( URCA ) -Université de Picardie Jules Verne ( UPJV ) -CHU de Reims - Hôpital Maison Blanche, Service de Gynécologie-Obstétrique, CHU Pontchaillou [Rennes], Service de gynécologie–obstétrique, CHU Strasbourg-Hôpital de Hautepierre [Strasbourg], Service de Génétique Oncologique, INSTITUT CURIE, Service de gynécologie obstétrique, Hôpital du Bocage, Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand ( CHU Dijon ) -Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand ( CHU Dijon ), Carcinogénèse épithéliale : facteurs prédictifs et pronostiques - UFC ( CEF2P / CARCINO ), Centre Hospitalier Régional Universitaire [Besançon] ( CHRU Besançon ) -Université Bourgogne Franche-Comté ( UBFC ) -Université de Franche-Comté ( UFC ), Plasticité de l'épithélium respiratoire dans les conditions normales et pathologiques - UMR-S 903 (PERPMP), Université de Reims Champagne-Ardenne (URCA)-Centre Hospitalier Universitaire de Reims (CHU Reims)-Institut National de la Santé et de la Recherche Médicale (INSERM)-SFR CAP Santé (Champagne-Ardenne Picardie Santé), Université de Reims Champagne-Ardenne (URCA)-Université de Reims Champagne-Ardenne (URCA), Service de Gynécologie et Obstétrique [Rennes] = Gynaecology [Rennes], Institut Curie [Paris], Service de Gynécologie Obstétrique, Médecine Foetale et Stérilité Conjugale - Chirurgie Gynécologie et Oncologique [CHU de Dijon], Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), Carcinogénèse épithéliale : facteurs prédictifs et pronostiques - UFC (UR 3181) (CEF2P / CARCINO), Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon)-Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC), Université de Reims Champagne-Ardenne (URCA)-Université de Picardie Jules Verne (UPJV)-Université de Reims Champagne-Ardenne (URCA)-Université de Picardie Jules Verne (UPJV), Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon)-Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), Carcinogénèse épithéliale : facteurs prédictifs et pronostiques - UFC (EA 3181) (CEF2P / CARCINO), Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC)-Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon), Université de Reims Champagne-Ardenne ( URCA ) -Centre Hospitalier Universitaire de Reims ( CHU Reims ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -SFR CAP Santé (Champagne-Ardenne Picardie Santé), Université de Reims Champagne-Ardenne ( URCA ) -Université de Picardie Jules Verne ( UPJV ) -Université de Reims Champagne-Ardenne ( URCA ) -Université de Picardie Jules Verne ( UPJV ), Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand ( CHU Dijon ) -Hôpital du Bocage, Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand ( CHU Dijon ), Carcinogénèse épithéliale : facteurs prédictifs et pronostiques - UFC (EA 3181) ( CEF2P / CARCINO ), and Centre Hospitalier Régional Universitaire [Besançon] ( CHRU Besançon ) -Université Bourgogne Franche-Comté [COMUE] ( UBFC ) -Université de Franche-Comté ( UFC )
- Subjects
MESH: Immunotherapy ,Uterine Cervical Neoplasms ,MESH : Cervical Intraepithelial Neoplasia ,Gastroenterology ,MESH: Cancer Vaccines ,Targeted immunotherapy ,0302 clinical medicine ,Cytology ,MESH : Female ,human papillomavirus ,[ SDV.MHEP.GEO ] Life Sciences [q-bio]/Human health and pathology/Gynecology and obstetrics ,MESH: Treatment Outcome ,Colposcopy ,0303 health sciences ,medicine.diagnostic_test ,MESH : Cancer Vaccines ,Obstetrics and Gynecology ,virus diseases ,female genital diseases and pregnancy complications ,3. Good health ,MESH: Uterine Cervical Neoplasms ,Treatment Outcome ,MESH : Immunotherapy ,030220 oncology & carcinogenesis ,MESH : Vaginal Smears ,Female ,Immunotherapy ,medicine.symptom ,medicine.medical_specialty ,MESH: Vaginal Smears ,MESH : Uterine Cervical Neoplasms ,MESH : Treatment Outcome ,[SDV.MHEP.GEO]Life Sciences [q-bio]/Human health and pathology/Gynecology and obstetrics ,cervical intraepithelial neoplasia ,Cervical intraepithelial neoplasia ,Cancer Vaccines ,Lesion ,03 medical and health sciences ,Internal medicine ,medicine ,Humans ,Human papillomavirus ,030304 developmental biology ,Vaginal Smears ,Gynecology ,MESH: Humans ,business.industry ,MESH : Humans ,Uterine Cervical Dysplasia ,medicine.disease ,Clinical trial ,High Grade Cervical Intraepithelial Neoplasia ,targeted immunotherapy ,business ,MESH: Cervical Intraepithelial Neoplasia ,MESH: Female - Abstract
International audience; OBJECTIVE: We sought to evaluate the safety and efficacy of TG4001 in patients with human papillomavirus (HPV) 16-related cervical intraepithelial neoplasia (CIN) 2/3 at 6 and 12 months. STUDY DESIGN: In all, 21 patients with HPV 16-related CIN 2/3 received 3 weekly subcutaneous injections of TG4001. Regression of the CIN 2/3 lesion and the clearance of HPV 16 infection were monitored by cytology, colposcopy, and HPV DNA/messenger RNA (mRNA) detection. A clinical response was defined by no CIN 2/3 found on conization, or no conization performed because not suspected at cytology or colposcopy. RESULTS: Ten patients (48%) were evaluated as clinical responders at month 6. Nine patients experienced an improvement of their HPV 16 infection, by mRNA ± DNA eradication. HPV 16 mRNA clearance was associated with CIN 2/3 cytologic and colposcopic regression in 7 of 10 patients. At month 12, 7 of 8 patients without conization reported neither suspicion of CIN 2/3 relapse nor HPV 16 infection. The remaining patient was lost to follow-up. CONCLUSION: These promising data warrant further development of TG4001 in CIN 2/3 treatment.
- Published
- 2011
48. Acknowledgement to the Reviewers
- Author
-
Hitomi Sezaki, Carole Mathelin, Kyle Gowen, Vivek Subbiah, Fumitaka Suzuki, Ayana Tomono, Lise Lecointre, Funda Meric-Bernstam, Hiroaki Kaneko, Stéphanie Schrot-Sanyan, Ralph Zinner, Yusuke Kawamura, Julia A. Elvin, Laure-Emilie Rebstock, Pawan Kirtani, Karolina Afors, Kenji Ikeda, Jeffrey S. Ross, Hiromitsu Kumada, Iacopo Petrini, Daniel Spritz, Maria Alejandra Zarzour, Jean-Jacques Baldauf, David L. Stockman, Frédéric Marchal, Jean-Emmanuel Kurtz, Maiko Ando, Nobuhiko Emi, Enrico Vasile, Takeshi Ichikawa, Chiara Caparello, Mariko Kobayashi, Glen J. Weiss, Yosuke Ando, Vincent A. Miller, Masahiro Kobayashi, Kaori Ito, Nobuaki Machida, Itaru Oi, Yoshiyuki Suzuki, Akira Tenmoku, Behrang Amini, Oliver Holmes, Giulia Pasquini, Takahiro Hayashi, Alexa B. Schrock, Yasuji Arase, Masataka Okamoto, Pramod Kumar Mishra, Masahiro Tsuge, Hiroshi Sasaki, Akinao Okamoto, Monica Lencioni, Caterina Vivaldi, Abul Kalam Najmi, Anjali Singh, Philip J. Stephens, Sarina Anne Piha-Paul, George William Daneker, Tetsuya Hosaka, Satoshi Saitoh, Lorenzo Fornaro, Thierry Petit, Cherif Akladios, Norio Akuta, Maurie Markman, Wei-Lien Wang, James Suh, Yoko Inaguma, Kim Kramer, Ricardo H. Alvarez, Satz Mengensatzproduktion, Michel Hummel, Yukiko Kakumae, Masayuki A. Fujino, Gianna Musettini, Druckerei Stückle, Majid A. Talikoti, Sundeep Singh Saluja, Shunichiro Fujiyama, Eugene Ahn, Jo-Anne Vergilio, Ryoju Negishi, Siraj M. Ali, Shigeki Yamada, Rachel L. Erlich, and Alfredo Falcone
- Subjects
Cancer Research ,Medical education ,Oncology ,Acknowledgement ,General Medicine ,Psychology - Published
- 2014
49. [Screening and early diagnosis of cervical cancer]
- Author
-
Jean-Jacques, Baldauf, Muriel, Fender, and Emmanuelle, Baulon
- Subjects
Humans ,Mass Screening ,Uterine Cervical Neoplasms ,Female ,Early Detection of Cancer - Abstract
Because of the natural history of precancerous cervical lesions, cancer of the cervix uteri is easily preventable by screening. Pap smear is an effective and simple test, not very expensive and harmless. In France, 3000 to 3500 new cases still occur every year especially due to insufficient participation of the target population but also because of low sensibility of the test and problems in the management of cytological abnormalities. Organisation of screening, following the Alsatian model, which has been operational for 15 years, would be a cost-effective strategy. Changing Pap smear for HPV testing needs careful assessment by national population based randomized studies before any routine use.
- Published
- 2010
50. Colposcopy and Directed Biopsy Reliability During Pregnancy
- Author
-
Jean-Jacques Baldauf, Philippe E, J. Bitter, and Michel Dreyfus
- Subjects
Colposcopy ,medicine.medical_specialty ,Pregnancy ,medicine.diagnostic_test ,business.industry ,Obstetrics ,Obstetrics and Gynecology ,General Medicine ,medicine.disease ,Biopsy ,Medicine ,business ,Reliability (statistics) ,Cohort study - Published
- 1996
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