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Koskas M, Chereau E, Ballester M, Dubernard G, Lécuru F, Heitz D, Mathevet P, Marret H, Querleu D, Golfier F, Leblanc E, Luton D, Rouzier R, Daraï E. Accuracy of a nomogram for prediction of lymph-node metastasis detected with conventional histopathology and ultrastaging in endometrial cancer. Br J Cancer 2013; 108:1267-72. [PMID: 23481184 PMCID: PMC3619258 DOI: 10.1038/bjc.2013.95] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND We developed a nomogram based on five clinical and pathological characteristics to predict lymph-node (LN) metastasis with a high concordance probability in endometrial cancer. Sentinel LN (SLN) biopsy has been suggested as a compromise between systematic lymphadenectomy and no dissection in patients with low-risk endometrial cancer. METHODS Patients with stage I-II endometrial cancer had pelvic SLN and systematic pelvic-node dissection. All LNs were histopathologically examined, and the SLNs were examined by immunohistochemistry. We compared the accuracy of the nomogram at predicting LN detected with conventional histopathology (macrometastasis) and ultrastaging procedure using SLN (micrometastasis). RESULTS Thirty-eight of the 187 patients (20%) had pelvic LN metastases, 20 had macrometastases and 18 had micrometastases. For the prediction of macrometastases, the nomogram showed good discrimination, with an area under the receiver operating characteristic curve (AUC) of 0.76, and was well calibrated (average error =2.1%). For the prediction of micro- and macrometastases, the nomogram showed poorer discrimination, with an AUC of 0.67, and was less well calibrated (average error =10.9%). CONCLUSION Our nomogram is accurate at predicting LN macrometastases but less accurate at predicting micrometastases. Our results suggest that micrometastases are an 'intermediate state' between disease-free LN and macrometastasis.
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Gauche Cazalis C, Koskas M, Martin B, Palazzo L, Madelenat P, Yazbeck C. [Preoperative imaging of deeply infiltrating endometriosis in: Transvaginal sonography, rectal endoscopic sonography and magnetic resonance imaging]. ACTA ACUST UNITED AC 2012; 40:634-41. [PMID: 23123282 DOI: 10.1016/j.gyobfe.2012.09.014] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2011] [Accepted: 09/13/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVES Compare the accuracy of transvaginal ultrasonography (TVUS), rectal endoscopic sonography (RES), and magnetic resonance imaging (MRI) before deeply infiltrating endometriosis surgery. PATIENTS AND METHODS A retrospective study with 25 deeply endometriosis patients underwent the three imaging examinations before surgery. Calculation of sensitivity, specificity, positive predictive value, negative predictive value and accuracy for the different locations: ovaries, uterosacral ligaments and torus, rectovaginal septum, rectosigmoid junction, bladder. RESULTS Ovarian and deep pelvic endometriosis was found in surgery and confirmed by histology in all patients. Sensitivity and specificity are respectively: for ovaries: 88.2% and 71% of TVUS; 80% and 81.2% of RES; 87.5% and 71% of MRI. For uterosacral ligaments: 63% and 82,6% of TVUS; 37% and 100% of RES; 69% and 82.6% of MRI. For torus: 57.1% and 100% of TVUS; 76.2% and 100% of RES; 76.2% and 100% of MRI. For rectovaginal septum: 63.2% and 100% for TVUS; 89.5% and 66.7% of EER; 47.4% and 100% of MRI. For rectosigmoid junction: 73.7% and 66.7% of TVUS; 94.7% and 66.7% of RES; 89.5% and 50% of MRI. For bladder: 16.7% and 100% of TVUS; 16.7% and 100% of RES; 33.3% and 89.5% of MRI. DISCUSSION AND CONCLUSION We found that TVUS is the more performant for endometriomas, it is MRI for torus, uterosacral ligaments and little bladder lesions, RES for rectovaginal septum and rectosigmoid junction. So in the clinical practice, the three imaging examinations are complementary for the preoperative assessment of deeply endometriosis.
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Delpech Y, Peres A, Koskas M, Margulies A, Brouland J, Perreti I, Sarda L, Thoury A, Luton D, Barranger E. M301 ACCURACY OF PET/CT IN THE DETECTION OF LYMPH NODE METASTASES IN PATIENTS WITH LOCALLY ADVANCED CERVICAL CANCER. Int J Gynaecol Obstet 2012. [DOI: 10.1016/s0020-7292(12)61492-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Beydon N, Mahut B, Maingot L, Guillo H, La Rocca MC, Medjahdi N, Koskas M, Boulé M, Delclaux C. Baseline and post-bronchodilator interrupter resistance and spirometry in asthmatic children. Pediatr Pulmonol 2012; 47:987-93. [PMID: 22328540 DOI: 10.1002/ppul.22526] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2011] [Accepted: 12/31/2011] [Indexed: 11/11/2022]
Abstract
In children unable to perform reliable spirometry, the interrupter resistance (R(int) ) technique for assessing respiratory resistance is easy to perform. However, few data are available on the possibility to use R(int) as a surrogate for spirometry. We aimed at comparing R(int) and spirometry at baseline and after bronchodilator administration in a large population of asthmatic children. We collected retrospectively R(int) and spirometry results measured in 695 children [median age 7.8 (range 4.8-13.9) years] referred to our lab for routine assessment of asthma disease. Correlations between R(int) and spirometry were studied using data expressed as z-scores. Receiver operator characteristic curves for the baseline R(int) value (z-score) and the bronchodilator effect (percentage predicted value and z-score) were generated to assess diagnostic performance. At baseline, the relationship between raw values of R(int) and FEV(1) was not linear. Despite a highly significant inverse correlation between R(int) and all of the spirometry indices (FEV(1) , FVC, FEV(1) /FVC, FEF(25-75%) ; P < 0.0001), R(int) could detect baseline obstruction (FEV(1) z-score ≤ -2) with only 42% sensitivity and 95% specificity. Post-bronchodilator changes in R(int) and FEV(1) were inversely correlated (rhô = -0.50, P < 0.0001), and R(int) (≥35% predicted value decrease) detected FEV(1) reversibility (>12% baseline increase) with 70% sensitivity and 69% specificity (AUC = 0.79). R(int) measurements fitted a one-compartment model that explained the relationship between flows and airway resistance. We found that R(int) had poor sensitivity to detect baseline obstruction, but fairly good sensitivity and specificity to detect reversibility. However, in order to implement asthma guidelines for children unable to produce reliable spirometry, bronchodilator response measured by R(int) should be systematically studied and further assessed in conjunction with clinical outcomes.
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Yazbeck C, Koskas M, Cohen Scali S, Kahn V, Luton D, Madelenat P. [How I do... ethanol sclerotherapy for ovarian endometriomas]. ACTA ACUST UNITED AC 2012; 40:620-2. [PMID: 22959083 DOI: 10.1016/j.gyobfe.2012.07.029] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2012] [Accepted: 07/05/2012] [Indexed: 11/28/2022]
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Cohen R, Levy C, Bingen E, Bechet S, Derkx V, Werner A, Koskas M, Varon E. [Nasopharyngeal carriage of children 6 to 60 months during the implementation of the 13-valent pneumococcal conjugate vaccine]. Arch Pediatr 2012; 19:1132-9. [PMID: 22925540 DOI: 10.1016/j.arcped.2012.07.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2012] [Revised: 07/08/2012] [Accepted: 07/18/2012] [Indexed: 11/30/2022]
Abstract
BACKGROUND Since 2001 in France, a nasopharyngeal carriage study was set up for children six to 24 months old. Any data are available for older children (25 to 60 months). The aim of this study is to compare the nasopharyngeal carriage in children with acute otitis media (AOM) or healthy between both age groups (6/24 months versus 25/60 months). Moreover, during the study period, the 13-valent pneumococcal conjugate vaccine (PCV13) has replaced PCV7 in June 2010. METHODS From October 2010 to June 2011, 58 pediatricians obtained nasopharyngeal swabs from children 6-60 months with acute otitis media (AOM) or healthy controls, to analyse the carriage of pneumococcus, Haemophilus influenzae, Moraxella catarrhalis, group A streptococcus and Staphylococcus aureus. RESULTS Of the 1557 enrolled children, 1258 were 6 to 24 months old (315 healthy and 943 AOM) and 299 were 25 to 60 months (102 healthy and 197 AOM). More then 85% were PCV7 vaccinated and the children of 25/60 months were rarely PCV13 vaccinated (14.1%) compared to younger children (69.9%, P<0.001). For children 6/24 months, the Streptococcus pneumoniae carriage was higher in AOM group (57.3%) versus healthy (28.9%). By contrast for older children, the difference (58.4% versus 50%) was not significant. In the healthy group, older children carried more often S. pneumoniae than younger children (50% versus 28.9%, P<0.0001). This trend was also observed for H. influenzae carriage (49% versus 18.7%, P<0.0001). Multivariate analysis in the healthy group showed that siblings and day care center (or school) increased the carriage of S. pneumoniae and H. influenzae. CONCLUSION These data from nasopharyngeal carriage in children 6 to 60 months old showed that pneumococcus and H. influenzae carriage is high for patients under 2 years, especially in the healthy group. Moreover, these data from the transition PCV7/PCV13, will serve as baseline in France to evaluate the impact of PCV13.
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Levy C, Thollot F, Corrard F, Lécuyer A, Martin P, Boucherat M, Koskas M, Romain O, Goldrey M, Hausdorff WP, Cohen R. Otite moyenne aiguë en pédiatrie ambulatoire : caractéristiques épidémiologiques et cliniques après l’introduction du vaccin antipneumococcique conjugué 7 valent (PCV7). Arch Pediatr 2011; 18:712-8. [DOI: 10.1016/j.arcped.2011.03.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2011] [Revised: 03/15/2011] [Accepted: 03/18/2011] [Indexed: 10/18/2022]
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Koskas M, Uzan C, Gouy S, Pautier P, Lhomme C, Haie-Meder C, Duvillard P, Morice P. Fertility determinants after conservative surgery for mucinous borderline tumours of the ovary (excluding peritoneal pseudomyxoma). Hum Reprod 2011; 26:808-14. [DOI: 10.1093/humrep/deq399] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Chauvin C, Koskas M, Yazbeck C. [Salpingectomy--how I do it]. ACTA ACUST UNITED AC 2010; 38:776-7. [PMID: 21030283 DOI: 10.1016/j.gyobfe.2010.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2010] [Accepted: 09/22/2010] [Indexed: 10/18/2022]
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Yazbeck C, Le Tohic A, Koskas M, Madelenat P. Pour la pratique systématique d’une cœlioscopie dans le bilan d’une infertilité. ACTA ACUST UNITED AC 2010; 38:424-7. [DOI: 10.1016/j.gyobfe.2010.04.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Suster Kenda N, Gergolet M, Yazbeck C, Chauvin C, Oger P, Kahn V, Gout C, Koskas M, Rougier N, Iwase A, Hirokawa W, Goto M, Nagatomo Y, Bayasula B, Kobayashi H, Kobayashi H, Nakahara T, Takikawa S, Manabe S, Kikkawa F, Colpi GM, Castiglioni M, Vaccalluzzo L, Sulpizio P, Colpi EM, Giacchetta D, Tesoriere G, Gazzano G, Rabanal A, Prieto B, Matorras R, Urquijo E, Diez S, Brouard I, Astorquiza TM. Session 43: Reproductive Surgery: Female & Male. Hum Reprod 2010. [DOI: 10.1093/humrep/de.25.s1.43] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Uzan C, Koskas M, Gouy S, Pautier P, Lhomme C, Balleyguier C, Haie-Meder C, Duvillard P, Morice P. Prognosis and prognostic factors of a large retrospective series of mucinous borderline tumors of the ovary (excluding peritoneal pseudomyxoma). J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.5096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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38
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Bader G, Koskas M. Complications des bandelettes sous-urétrales dans la chirurgie de l’incontinence urinaire d’effort féminine. ACTA ACUST UNITED AC 2009; 38:S201-11. [DOI: 10.1016/s0368-2315(09)73579-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Koskas M, Madelenat P, Yazbeck C. [Ovarian low malignant potential tumor: how to preserve fertility?]. ACTA ACUST UNITED AC 2009; 37:942-50. [PMID: 19819742 DOI: 10.1016/j.gyobfe.2009.09.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2009] [Accepted: 09/01/2009] [Indexed: 11/26/2022]
Abstract
Ovarian low malignant potential tumor account for 10 to 20 percent of ovarian epithelial tumors. They differ from typical ovarian cancers in that they do not grow into the ovarian stroma. Likewise, if they spread outside the ovary, for example, into the abdominal cavity, they do not usually grow into the lining of the abdomen. These cancers tend to affect women at a younger age than the typical ovarian cancers and are less life-threatening than most ovarian cancers. Guidelines for surgical treatment of borderline ovarian tumors are similar to those for ovarian cancer and include hysterectomy with bilateral salpingo-oophorectomy. However, patients with borderline ovarian tumors tend to be younger than women with invasive ovarian cancer. For many of these patients, fertility is an important issue. Previous studies have suggested the safety of conservative surgery with unilateral salpingo-oophorectomy or cystectomy for patients with stage I borderline ovarian tumors. Despite infrequent data, this observation has been expanded to include women with advanced-stage disease. Recurrence is noted more often after this type of treatment, but does not seem to have a negative effect on survival. Management of conservative treatment (complete staging, cystectomy or oophorectomy, oophorectomy or adnexectomy) are still under debate since none avoids the malignant transformation risk. Thus, close follow-up is mandatory and the optimal moment for final oophorectomy remains unclear. When ovarian preservation is impossible, oocyte/ovarian cryopreservation or emergency ovarian induction before the surgical procedure to obtain embryos are promising but still under evaluated options.
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Koskas M, Caillod AL, Fauconnier A, Bader G. Impact maternel et néonatal des Recommandations pour la pratique clinique du CNGOF relatives à l’épisiotomie. Étude unicentrique à propos de 5409 accouchements par voie vaginale. ACTA ACUST UNITED AC 2009; 37:697-702. [DOI: 10.1016/j.gyobfe.2009.06.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2009] [Accepted: 06/04/2009] [Indexed: 11/29/2022]
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Koskas M, Martin B, Madelenat P. Cystadénofibrome séreux de l’ovaire : à propos de deux cas. ACTA ACUST UNITED AC 2009; 38:431-5. [DOI: 10.1016/j.jgyn.2009.04.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2008] [Revised: 03/31/2009] [Accepted: 04/08/2009] [Indexed: 10/20/2022]
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Le Tohic A, Chis C, Yazbeck C, Koskas M, Madelenat P, Panel P. Endométriose vésicale : diagnostic et traitement. À propos d’une série de 24 patientes. ACTA ACUST UNITED AC 2009; 37:216-21. [DOI: 10.1016/j.gyobfe.2009.01.018] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2008] [Accepted: 01/28/2009] [Indexed: 11/29/2022]
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Chereau E, Uzan C, Chevalier J, Bressac-de Paillerets B, Caron O, Mathieu M, Koskas M, Bourgier C, André F, Dromain C, Balleyguier C, Delaloge S. Intensive breast cancer screening programs including MRI influence prognosis and treatment of breast cancer among BRCA 1/2 gene mutation carriers. Cancer Res 2009. [DOI: 10.1158/0008-5472.sabcs-5004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Abstract #5004
Background: Several studies have highlighted the potential benefit of early breast cancer (BC) diagnosis through breast MRI for high risk patients (pts). However, MRI is an expensive test with a low positive predictive value and has not been proven to reduce mortality rates in women carrying BRCA1/2 deleterious gene mutations (mut).
 At Institut Gustave Roussy, we started intensive BC screening programs for BRCA1/2 carriers (annual MRI + mammogram + bi-annual US) in 2001. The aim of this study was to compare the characteristics and prognostic features of BC in BRCA1/2 pts diagnosed inside or outside screening programs.
 Patients and Methods: All female BRCA1/2 mut carriers who have been treated for a new BC in our institution between 2001 and 2008, were entered into this study. All BRCA1/2 mut testing have been performed under the French guidelines and recommendations.
 We compared the clinico-pathological data, treatments and prognostic features between group 1 (pts diagnosed while on an intensive dedicated screening program) and group 2 (pts diagnosed outside these programs). Pts characteristics were compared using student T-test, and survival curves using Log-Rank tests.
 Results: 122 pts met the inclusion criteria: 20 in group 1, 102 in group 2. > 95% of pts in group 2 were not aware of their BRCA1/2 mut at time of diagnosis. In group 1, 17 cancers were diagnosed primarily through MRI (85%), while 3 were self-detected interval BC. Pts in group 1 had tumors with significantly better prognostic factors and received less CT.
 3-year DFS significantly differed between groups 1 (100%) and 2 (74% (IC: 64-81 (p=0.04). 3-years MFS was 100 and 80% (p= 0.08), 3-years OS was 100 and 94% (p=0.26) in groups 1 and 2.
 
 Conclusion: These early data strongly suggest an important benefit in terms of disease-free survival and treatment sparing for i. the knowledge of a BRCA1/2 mut; ii. inclusion into intensive BC screening programs including MRI.
Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 5004.
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Picard F, Daudin JJ, Koskas M, Schbath S, Robin S. Assessing the exceptionality of network motifs. J Comput Biol 2008; 15:1-20. [PMID: 18257674 DOI: 10.1089/cmb.2007.0137] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Getting and analyzing biological interaction networks is at the core of systems biology. To help understanding these complex networks, many recent works have suggested to focus on motifs which occur more frequently than expected in random. To identify such exceptional motifs in a given network, we propose a statistical and analytical method which does not require any simulation. For this, we first provide an analytical expression of the mean and variance of the count under any exchangeable random graph model. Then we approximate the motif count distribution by a compound Poisson distribution whose parameters are derived from the mean and variance of the count. Thanks to simulations, we show that the compound Poisson approximation outperforms the Gaussian approximation. The compound Poisson distribution can then be used to get an approximate p-value and to decide if an observed count is significantly high or not. Our methodology is applied on protein-protein interaction (PPI) networks, and statistical issues related to exceptional motif detection are discussed.
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Koskas M, Nizard J, Salomon LJ, Ville Y. Abdominal and pelvic ultrasound findings within 24 hours following uneventful Cesarean section. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2008; 32:520-526. [PMID: 18683208 DOI: 10.1002/uog.6120] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
OBJECTIVES To describe prospectively the normal abdominal and pelvic ultrasound features within 24 h following uneventful Cesarean section. METHODS Transabdominal ultrasound examination was performed between 1 and 3 h, and again at 24 h, following lower-segment Cesarean section (LSCS). The myometrium, endometrium, and amount and distribution of free peritoneal fluid were studied in 30 women with singleton pregnancies who underwent LSCS delivery. RESULTS Examinations were performed easily in all cases except one who was morbidly obese (body mass index > 40 kg/m(2)). At 1-3 h after delivery, mean +/- SD endometrial thickness was 13 +/- 2 mm. Mean uterine length, from the fundus to the cervical external os, was 160 +/- 15 mm. Measurement of uterine length in the mid-sagittal plane of the pelvis was impossible in eight cases (27%) owing to pain. No abnormal intrauterine findings were observed. Mean uterine width was 110 +/- 10 mm. Mean distance between the sacral promontory and uterine fundus was 104 +/- 11 mm. Mean thicknesses of the anterior and posterior walls of the uterus were 40 +/- 5 mm and 39 +/- 7 mm, respectively. No fluid was seen in Morrison's or Douglas' pouches. There was a consistent and significant reduction between the measurements performed at 1-3 h and those at 24 h after LSCS, except for the distance between the fundus and external os. CONCLUSIONS Ultrasound examination is feasible after Cesarean section. Images are obtained easily, even when scanning through the scar. In normal pregnancies, there is no fluid in the abdomen or pelvis. These results could help clinicians in the decision-making process in cases of early postpartum hemorrhage or hemodynamic instability following LSCS.
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Cohen R, Levy C, Thollot F, de La Rocque F, Koskas M, Bonnet E, Fritzell B, Varon E. Pneumococcal Conjugate Vaccine Does Not Influence Staphylococcus aureus Carriage in Young Children with Acute Otitis Media. Clin Infect Dis 2007; 45:1583-7. [DOI: 10.1086/523734] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
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Koskas M, La Rocca M, Maingot L, Guillo H, Boule M. 091 Gêne à l’effort, est-ce de l’asthme ? Évaluation par le Step-test chez l’enfant et l’adolescent. Rev Mal Respir 2007. [DOI: 10.1016/s0761-8425(07)74382-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Cohen R, Thollot F, Lécuyer A, Koskas M, Touitou R, Boucherat M, d'Athis P, Corrard F, Pecking M, de La Rocque F. Impact des tests de diagnostic rapide en ville dans la prise en charge des enfants en période de grippe. Arch Pediatr 2007; 14:926-31. [PMID: 17482437 DOI: 10.1016/j.arcped.2007.02.087] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2006] [Revised: 02/22/2007] [Accepted: 02/28/2007] [Indexed: 11/15/2022]
Abstract
Several studies in children showed at the paediatric emergency hospital the interest of influenza rapid diagnostic tests (IRDT) in this disease for which the clinical diagnosis is difficult in children. The purpose of this prospective study carried out in ambulatory paediatric setting was to evaluate impact of the IRDT in the assumption of responsibility of children suspected of Influenza infection. Thirty paediatricians (14 without IRDT, 16 with IRDT) included 602 children between 2004 and 2005. The influenza was confirmed by IRDT in 54% of the cases. Among the 13 symptoms or signs recorded, only 4 - chills (61.6 vs 48.4%), cough (89.8 vs 71.1%), rhinorrhea (97.9 vs 86.2%), and anorexia (50.3 vs 34.8%) - were significantly more frequent (P </= 0.01) for patients avec with positive IRDT. However, the difference is not sufficient to be contributive. The paediatricians using IRDT prescribed with positive test more oseltamivir (68.5 vs 1.9%, P < 0.0001). The antibiotic prescription was overall low (9.5% with IRDT vs 3.9% without IRDT, P = 0,008), and primarily when the result of IRDT was negative (15.7% if IRDT(-) vs 4.3% if IRDT(+), P = 0.0003). This study confirms the difficulty of clinical diagnosis, and shows the interest of IRDT for the diagnosis of influenza and consequently to improve the management of influenza in children in ambulatory paediatric setting.
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Koskas M, Jerbi M, Boccara J, Trie A, Jannet D, Lejeune V, Brun L, Camagna O, Milliez J, Carbonne B. [Operative termination of pregnancy between 12 and 14 weeks' gestation: influence of the operator's experience]. ACTA ACUST UNITED AC 2005; 34:334-8. [PMID: 16136659 DOI: 10.1016/s0368-2315(05)82838-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To assess the feasibility of operative termination of pregnancy between 12 and 14 weeks of gestation and the role of the operator's experience in physicians previously unfamiliar to this technique. MATERIALS AND METHODS A prospective study of 251 operative terminations of pregnancy, from July 1st, 2001 to January 31st, 2002, and from May 1st, 2002 to October 31st, 2002, in order to assess the role of operator's experience. 104 terminations between 12 and 14 weeks were compared to 147 terminations at earlier gestational ages. All patients received cervical ripening with 400 mcg oral misoprostol 3-4 hours before operation performed under general anesthesia. Evaluation criteria were: duration of operation, need for use of forceps, and complications: uterine perforation, cervical laceration, bleeding > 500 ml and need for blood transfusion. RESULTS There was no difference in the rate of operative complications between terminations before and after 12 weeks. The duration of operation was slightly longer after 12 weeks than before (12.9 +/- 6.7 min versus 11.1 +/- 2.8 min.; p < 0.05). Forceps use was 0.7% before 12 weeks, 20% between 12 and 13 weeks, and 59% between 13 and 14 weeks (p < 0.01). There was no difference in the complication rate or in the need for forceps according to the operator's experience. The perceived difficulty in cervical dilatation was higher in early experience than in experimented operators (19.6% versus 5.2%; p < 0.05). CONCLUSION Operative termination of pregnancy is technically feasible beyond 12 weeks without dramatic increase in operative complications. Technical skill can be acquired in a short time interval.
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Cohen R, Just J, Koskas M, Bingen E, Boucherat M, Bourrillon A, Foucaud P, François M, Garnier JM, Guillot M, Ployet MJ, Schlemmer C, Gaudelus J. [Recurrent respiratory tract infections: how should we investigate and treat?]. Arch Pediatr 2005; 12:183-90. [PMID: 15694546 DOI: 10.1016/j.arcped.2004.11.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2004] [Accepted: 11/05/2004] [Indexed: 11/23/2022]
Abstract
Recurrent respiratory tract infections are a common reason for visits to primary care practitioners or hospital physicians. They are placed at the junction of several medical specialities: paediatrics, ENT, pneumology, allergology, immunology, infectiology. The great diversity of the laboratory tests requested and on the other hand the proposed treatments, are the consequences of the diversity of the patients encountered and the paucity of the evidence based-medicine studies in this setting. The dilemma is how to identify the child for which recurrent respiratory tract infections are the witness of underlying condition, without performing repeated medical examinations, laboratory tests and treatments for normal children for which immunologic development occurs normally. The essential tools are the history analysis, physical examination and few laboratory tests. The other questions are how to include, for these patients, influenza and pneumococcal vaccines in the immunization program and how to assess the benefit/risk ratio and the cost of surgical treatments. This paper presents the thought of an expert group trying to define the situations where biological tests or treatments are useful.
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