Pierre-Ludovic Giacalone

Comparative Study of the Accuracy of Breast Resection in Oncoplastic Surgery and Quadrantectomy in Breast Cancer

BackgroundThe aim of this study was to determine whether oncoplastic surgery ensures accurate tumor resection and reduces the need for further surgery in comparison with standard quadrantectomies.MethodsThis was a prospective comparative study of 74 patients with breast tumor diameter ≥15 mm. The principal criterion for case selection was breast size that allowed either quadrantectomy or oncoplastic surgery to be scheduled. The following were recorded and compared between groups: the size of the glandular resection, the width of the nearest margins, the ratio of clear margins, and the need for further surgery.ResultsThe patients who underwent oncoplastic surgery were younger than those who had quadrantectomy. All other demographic and oncological preoperative data were comparable. The median volume of the excised specimen in the oncoplastic group was higher than in the quadrantectomy group. The nearest lateral margin widths were larger in the oncoplastic group than in the quadrantectomy group. Free surgical margins ≥5 mm and ≥10 mm were obtained more frequently using oncoplastic surgery than standard quadrantectomy. However, the need for fewer secondary surgeries was not demonstrated in our study.ConclusionsOncoplastic surgery achieves more accurate tumor resection than standard quadrantectomy. This approach might be useful in extending the indications for conservative therapy.

Estrogen induction and overexpression of fibulin-1C mRNA in ovarian cancer cells.

Fibulin-1 is an extracellular matrix protein induced by estradiol in estrogen receptor (ER) positive ovarian cancer cell lines. Alternative splicing of fibulin-1 mRNA results in four different variants named A, B, C and D that may have distinct biological functions. We studied the relative expression of fibulin-1 mRNA variants and their estrogen regulation in human ovarian cancer cells. In ovarian tissues and cancer cell lines, fibulin-1C and -1D are the predominant forms, whereas fibulin-1A and -1B are weakly expressed. We developed a competitive PCR assay based on coamplification of fibulin-1C and -1D to study the relative expression of these fibulin-1 variants in human ovarian samples. In ovarian cancer cell lines and ovarian cancer samples, there was a marked increase in the fibulin-1C:1D and fibulin-1C:HPRT mRNA ratios as compared to normal ovaries. In the BG1 estrogen receptor positive ovarian cancer cell line, fibulin-1C mRNA was induced by estradiol in a dose- and time-dependent manner. Since others and we have previously shown an increased expression of ERα as compared to ERβ in ovarian cancer cells, we investigated whether ERα or ERβ is involved in this induction. For this aim, MDA-MB-231 breast cancer cell line, which expresses both low basal levels of ERs and fibulin-1, was infected with recombinant ERα or ERβ encoding adenovirus and treated with estradiol. Fibulin-1C was induced by estradiol in ERα- but not ERβ-infected cells, suggesting that fibulin-1C induction is mediated through ERα. In ovarian tumors, a trend towards a correlation between fibulin-1C and ERα expression levels was noted. In conclusion, this study showed an increased fibulin-1C:-1D mRNA ratio in ovarian cancer cells as compared to normal ovaries. This finding suggests that the C variant may be involved in ovarian carcinogenesis. Fibulin-1C overexpression may thus be a clue for the understanding of a putative role of estrogens in ERα promoted ovarian tumor progression.

Cervical ripening with mifepristone before labor induction: a randomized study.

Objective To determine the efficacy and safety of mifepristone for cervical ripening in post-term pregnancies. Methods Women with post-term pregnancies and Bishop scores less than 6 were assigned randomly to mifepristone (41 patients) or placebo (42 patients). Mifepristone was given orally in a dose of 400 mg. Efficacy was assessed by change in the Bishop score within 48 hours after treatment; a score of 6 or greater was considered a “strict” success. An “extended” success rate was defined, including all patients with scores of at least 6 or those who delivered within 48 hours of treatment. Antenatal safety was assessed by fetal heart rate testing before and throughout labor. Neonatal safety was assessed by Apgar score, arterial or venous pH of cord blood, and blood glucose level during the first 48 hours. Analysis used Student t test for continuous variables, Kruskal-Wallis test for ordinal data, and χ2 for categoric variables. Results Strict success was achieved in 10 of 18 mifepristone patients (55%) evaluated for Bishop score on day 2 versus 8 of 29 placebo patients (27.5%) (P = .004). Extended success was achieved in 33 mifepristone patients (80.5%) and 21 placebo patients (50.0%) (P = .004). There were no statistical differences with regard to number of cesareans or fetal and neonatal safety. Conclusion Mifepristone proved effective for cervical ripening and reduced the time to delivery compared with placebo, but it did not improve the rate of cesarean. Our study did not include enough pregnancies to reach conclusions about fetal or neonatal safety.

Successful in vitro fertilization–surrogate pregnancy in a patient with ovarian transposition who had undergone chemotherapy and pelvic irradiation

OBJECTIVE To present a case of IVF-surrogate pregnancy in a patient with ovarian transposition who had undergone chemotherapy and total pelvic irradiation. DESIGN Case report. SETTING Teaching hospital. PATIENT(S) A 29-year-old woman who had undergone Wertheims hysterectomy for a bulky carcinoma of the uterine cervix. INTERVENTION(S) Ovarian transposition before chemotherapy and total pelvic irradiation. Standard IVF treatment, transabdominal oocyte retrieval, and transfer to the surrogate mother. MAIN OUTCOME MEASURE(S) Results of the IVF cycle. RESULT(S) A twin pregnancy at the first cycle and two live newborns. CONCLUSION(S) This is the first reported case of ovulation induction and oocyte retrieval performed on a transposed ovary.

Pfannenstiel versus Maylard incision for cesarean delivery: A randomized controlled trial

OBJECTIVE To compare the Pfannenstiel incision with transverse muscle‐cutting Maylard incision in women who had cesarean delivery. METHODS Patients were assigned randomly to a Pfannenstiel or Maylard incision. Postoperative ttreatment was similar for each group. Surgical characteristics, complications, postoperative pain (visual analog scale, analgesic use), and related quality of life (1‐ and 3‐month self‐administered questionnaires) were analyzed. Abdominal wall muscle recovery was compared objectively by dynamometer. RESULTS Fifty‐four women had a Pfannenstiel incision and 43 had the Maylard incision. There were no differences in intraoperative characteristics, postoperative morbidity, or pain. Womens responses to the Nottingham Health Profile questionnaire at 1 and 3 months postoperatively and clinical and isokinetic testing for abdominal wall strength were similar between the two groups. CONCLUSION Transecting the rectus muscle was no more deleterious than the Pfannenstiel incision. There was no difference in objectively measured abdominal wall strength.

The effects of mifepristone on uterine sensitivity to oxytocin and on fetal heart rate patterns

OBJECTIVE To compare the incidences of tachysystole, hypertonia and fetal heart rate (FHR) abnormalities in women treated by mifepristone plus prostaglandins (PGs), mifepristone alone or PGs alone for an unfavourable cervix. STUDY DESIGN In this retrospective study, all women between 37 and 42 weeks were eligible for the study if they had undergone cervical ripening prior to labour induction. In group 1, the women were treated with mifepristone plus PGs (n=103). Group 2 women were treated with mifepristone alone (n=96) and group 3 women with PGs alone (n=100). Incidences of tachysystole, hypertonia and FHR abnormalities were compared. RESULTS During induction of labour, tachysystole and hypertonia occurred more frequently in women treated with mifepristone. Severe bradycardia and recurrent late decelerations were more frequent after the initiation of oxytocin in groups 1 and 2 than in group 3. CONCLUSIONS In this study, mifepristone increased the incidences of tachysystole, hypertonia and FHR abnormality.

A laparoscopic procedure for the treatment of vaginal aplasia

Colbert D. L., Smith D. S., Landon J. & Sidki A. M. (1986) Singlereagent polarisation fluoroimmunoassay for benzoylecgonine (cocaine metabolite) in urine. Ann Clin Biochem 23, 37-41. Cregler L. L. & Mark H. (1986) Medical complications of cocaine abuse. N Engl J Med 315, 1495-1500. Gill R. (1986) High pressure liquid chromatography. In Clarke’s Isolation and IdentSfication of Drugs (A. C. Moffat, J. V. Jackson, M. S. Moss & B. Widdops, eds), The Pharmaceutical Press, London, pp. 201-220. Hansen R. L., Evans A. T., Gillogley K. M., Hughes C. S. & Krener P. G . (1992) Perinatal toxicology screening. J Perinatol 12, 14831485.

Ultrasound-assisted laparoscopic creation of a neovagina by modification of Vecchietti's operation

BACKGROUND In performing Vecchiettis operation laparoscopically, it is important to ensure bladder and rectum integrity. We report new techniques of ultrasonography and suture retrieval that simplify and improve the ease and speed of this operation. TECHNIQUE The pneumoperitoneum is emptied and the bladder filled with 200 mL of sterile water. The ultrasound probe is placed on the suprapubic wall for a sagittal image. The needle progresses medially through the vesicorectal space, with ultrasound guidance, and its emergence into the pelvis is controlled with laparoscopy. The nylon sutures carrying the dilation ball are threaded through the needle and brought back through the abdominal wall. EXPERIENCE Seven patients with vaginal aplasia had this procedure. There were no complications, and the mean operative time was 43 minutes (range 35-55). Mean vaginal length was 7 cm (range 6-10). Four women defined sexual intercourse as very satisfying and two as moderately satisfying. CONCLUSION This original technique was used for easy, safe, and rapid creation of neovaginas.

Fetal hemangiolymphangioma: a case report.

Hemangiolymphangioma is a malformation of both lymphatic and blood vessels. We present a case of fetal abdominal hemolymphangioma diagnosed by ultrasound at 27 weeks of gestation. The extensive fetal involvement, and the diagnosis before fetal viability led us to propose medical termination of pregnancy. This represents the second reported case of prenatal diagnosis of this malformation.

Expression of adrenomedullin in human ovaries, ovarian cysts and cancers. Correlation with estrogens receptor status.

OBJECTIVE To investigate the expression of adrenomedullin (AM) in benign and malignant ovarian tissues and its correlation with estrogen receptors (ERs) mRNA status. STUDY DESIGN Ovarian carcinoma cell lines, normal ovaries, serous cysts and cancers were analyzed using real-time polymerase chain reaction (PCR) in order to quantify adrenomedullin and ERs mRNAs expression. Some ovarian samples were submitted to laser-capture microdissection to determine the differential expression of target genes in epithelium and stroma. RESULTS Ovarian cancer cells express adrenomedullin mRNA for both the ligand and receptor and produce the peptide. In tumors, the ER alpha/beta ratio was higher than in other tissues. Correlations were found between ER alpha and ER beta mRNA and adrenomedullin mRNA expression in tumors. CONCLUSION Adrenomedullin may be involved in both normal and malignant tissue growth through both vascular and growth factor effects. Because of the correlations with ERs status, there is emerging evidence that ovarian cancer is endocrine-related.