J Gynecol Obst Bio R
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J Gynecol Obst Bio R · Jan 1997
[Poor vaginal access: excellent indication for laparoscopic hysterectomy].
The great majority of hysterectomies in patients without previous vaginal delivery have been carried out via laparotomy. The purpose of this study was to establish whether laparoscopic surgery can be of use in an attempt to reduce the number of laparotomies for patients with no previous vaginal delivery who underwent an hysterectomy indicated for benign pathologies. ⋯ These results demonstrate that laparoscopic surgery decreased significantly the number of laparotomies necessary for patients without previous vaginal delivery who require hysterectomy. When vaginal access is poor, simple laparoscopic preparation is inadequate and the only possibility of avoiding laparotomy is to carry out the hysterectomy entirely via laparoscopic route.
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Willebrand's disease, the most frequent inborn coagulopathy, is defined as a deficiency in Willebrand's factor required for normal hemostasis as a mediator in platelet adhesion to the subendothelium and which also contributes to plasma coagulation pathway (by preserving the coagulating activity of factor VIII). Classically, Willebrand's disease improves somewhat during pregnancy. We followed 15 pregnancies in 12 patients with Willebrand's disease in an attempt to determine the best management strategy to reduce the risk of bleeding during delivery. ⋯ Antenatal diagnosis is possible in the most severe forms. Programmed delivery is recommended. Spinal analgesia is contraindicated.
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J Gynecol Obst Bio R · Jan 1996
[Mastectomy with immediate reconstruction for invasive breast cancer. Comments on indications and technique. A series of 112 cases].
A series of 112 mastectomies with immediate breast reconstruction performed in women with invasive cancer of the breast were followed for a mean of 30 months to determine cancer outcome, morbidity and aesthetic results of the different surgical techniques. The patients were divided into 3 groups according to indications: 49 cases with local recurrence after conservative treatment; 37 cases of large or multifocal tumours operated after chemotherapy and radiotherapy; 26 cases after tentative conservative surgery with incomplete tumourectomy. A total of 98 patients (87.5%) were irradiated before mastectomy with immediate breast reconstruction. ⋯ Integrated into a well-planned multidisciplinary protocol, mastectomy with immediate breast reconstruction does not appear to affect the cancer outcome. Immediate breast reconstruction is a complex procedure and requires experience in plastic surgery to reduce the number of complications and to improve aesthetic results. Reconstruction with a rectus abdominus flap appears as the superior technique.