Biomedical subjects
Publications and source records attributed to E Cornier.
A mechanical ultrasonographic probe (7.5 MHz ou 10 MHz was enclosed in a 3.5 mm teflon catheter for intrauterine explorations. Correlative illustrations of normal and pathological images are presented.
Estrogens (estrone [E1] and estradiol [E2]), their sulfates and progesterone receptor (PR) were evaluated in patients with uterine leiomyomata nontreated and treated with Decapeptyl (D-Trp6-gonadotropin-releasing hormone [GnRH]; Ipsen Biotech, Paris, France). Estrogen concentrations are very high in the leiomyoma (secretory phase, pg/g tissue [mean +/- SEM]: n = 10; E1: 147 +/- 24; E2: 850 +/- 116; E1-sulfate: 1,668 +/- 808; E2-sulfate: 718 +/- 126). Decapeptyl treatment provokes a significant decrease in E2 and particularly in E1 and E2 sulfates. Progesterone receptors were higher in the leiomyoma than in the myometrium; after a long treatment (3 to 4 months) a significant decrease in both tissues is observed. The decrease provoked by D-Trp6-GnRH on estrogens (unconjugated and sulfates) and in PR in the leiomyoma after long treatment, supports the hypothesis that estrogens are implicated in the cause of these tumors.
Concentrations of estrogen receptors, progesterone receptors, unconjugated estrogens (estradiol and estrone) and sulfate-conjugated estrogens (estradiol sulfate and estrone sulfate) were determined in patients treated with Decapeptyl and in controls. After prolonged Decapeptyl therapy, a highly significant fall in progesterone receptors was evidenced; estrogen receptors were found to be decreased in the myoma as compared with the secretory phase in controls and in the myometrium as compared with the proliferative phase in controls. Tissue levels of estrone sulfate and estradiol sulfate decreased very substantially. In conclusion, Decapeptyl emerges as a very promising agent for the treatment of uterine myomas.
Several types of intra-uterine lesions can be destroyed endoscopically by coagulation with laser Nd-YAG. The use of a small diameter malleable fibroscope makes it possible to direct the energy accurately so that it is easy to use throughout the whole procedure. Operative hysteroscopy using laser has been performed in 12 cases of persistent metrorrhagia. Using this technique it has been possible to avoid open surgery such as hysterectomy or myomectomy. The procedure is quick and painless. It can be used on outpatients.
If a soft malleable thin calibre fibroscope is used it is possible to look into the ampulla endoscopically while carrying out laparoscopy. The technique of the operation will be described. An analysis of the results of the investigation carried out on 96 patients (179 tubes) shows that this procedure is possible to be done harmlessly as a routine measure. This investigation has shown some particular aspects of the intra-ampullary landscape. A change in the folds of the ampulla was seen in women exposed to DES in utero. After the folds had been operated on in cases of hydrosalpinx scars persisted in the ampulla. Early diagnostic of possible ectopic pregnancies was possible. Laparoscopic ampulla salpingoscopy shows changes in the pattern of the intra-ampullary folds that could not be foreseen in about 40% of cases that had simple hysterosalpingography. This is a particularly important finding in women who have unexplained sterility. Furthermore, tubal endoscopy can often make it possible to break down and to cut pathological interfimbrial adhesions. Using this technique in 17 patients who had been sterile for more than 40 months, it was possible to achieve 11 intra-uterine pregnancies after less than 4 months interval.
A microsurgical technique was used to transplant the tube and the ovary in the rat. 49 autografts were carried out (in a pure line of Lewis strain) to study histologically the results of cold ischaemia and the functional future of the graft in the form of pregnancies. 40 hybrid allografts Lewis-DA were transplanted in Lewis or DA rats. 19 animals that were not treated allowed us to study the phenomena of rejection histologically. 21 further rats were treated with Cyclosporin A to study their fertility. The histological results of temporary cold ischaemia are minimal and come down to atresia of the active antral follicles of the cohort. None of the histological structures of the tube seemed to suffer from cold ischaemia that lasted 20 minutes. The average size of the litter for the autografts was 6.4 baby rats with an index of implantation of 0.65. Where no treatment was given, allografts were very quickly rejected. Giving Cyclosporin A allowed the allografts to be tolerated in 60% of cases. 5.6 baby rats per litter were obtained with an index of implantation of 0.65. Cyclosporin A in an immunosuppressive drug which is not teratogenic in animals and is not cytostatic. It inhibits immune responses at the cellular level as well as the production of lymphocyte T dependent antibodies. This study shows again the value of transplants for treating tubo-ovarian sterility.
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During a microsurgical operation the opportunity was taken to inspect the ampulla of the tube with a soft fibroscope in 68 patients. Several different normal and pathological appearances were found. Ampullary endoscopy gives much more precise information than salpingography and a very valuable prognosis because 14 normal pregnancies occurred where the tubes had been considered to be normal whereas no intra-uterine pregnancy occurred where the tubes were thought to be pathological. Instead, they re-obstructed or were the sites of ectopic pregnancies. This complementary examination carried out during operation seems to be a useful prognostic measure for patients undergoing ampullary surgery.
Two applications of fiberoscopy to gynaecology -- fiberohysteroscopy and fiberotuboscopy -- have now been tested with very encouraging preliminary results. The small caliber of the instruments, the ease with which they can be manipulated and oriented are opening a new field: endoscopic surgery of the uterus and Fallopian tubes. Simple technical improvements will eventually make this material more suitable for routine gynaecological practice.
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The steps in the ultrastructural changes that occur in new cilia formation in tubal epithelium have been well demonstrated in animals. In women, it is difficult to show cilia growing again and some authors deny that new growth occurs. Transmission electron microscopy studies on 32 specimens have shown that human new growth of cilia does occur. It arises in the midst of a cellular population which has as its characteristic a cytoplasm that is more clear than those of the neighbouring cells. Different ultrastructural aspects can be described. They resemble those that have been demonstrated in different animal species. On the other hand no mitoses have been shown. We will study the correlations between plasma hormone levels, the numbers of tissue receptors and the appearance of these clear cells in another article.
The authors report a series of 50 cases of proximal tubal microsurgery with an interval of 11.8 months for isthmo-uterine anastomosis and 15 months for isthmo-interstitial anastomosis. The overall results are: 61 per cent of complete patency and 16 per cent of intra-uterine pregnancy. The technique of isthmo-uterine anastomosis after wide excision of the fibrous portion seems to be preferable since it gives an 81 per cent result of satisfactory patency as compared with 20 per cent when the anastomosis is between the isthmus and the interstitial portion of the tube. The fact that endometriosis was present in 34 out of 48 cases, which is a very high proportion, and the short follow-up, may explain the relatively poor results.
Fourteen tubo-uterin implantations for endometriosis of the horn and infertility have been carried out. They have been made with microsugery with a reversed transcornual T access. The setting of a retractor pushing off the edges of the uterin muscle allows the removing of the pathological zone, allows also not to hurt the vascularisation during the dissection of the nodule, and allows also to suture edge to edge the tube to the uterus under microsurgical control. This original process allows a new setting up of the continuity (Ten permeabilities cheked with hysterography 2 pregnancies and 2 obstructions among 14 cases after a passing of less than 1 year).
65 salpingostomies were carried out using microsurgical techniques between 1976 and 1978. The patency rate was 89 p. 100. There were 30 p. 100 intra-uterine pregnancies and 4 p. 100 ectopic pregnancies. The authors emphasize the prognosis that can be obtained from hysterosalpingography, laparoscopy and histological examination of the tissues and the very poor results that are obtained even using these methods when a second operation is undertaken.
We report a histological study of a microsurgical tubo-tubal anastomosis undertaken to restore patency after ligation. It confirms the good level of tissue tolerance of the suture material employed. It emphasizes the difficulty of anastomosis in the ampulloisthmial region because of the discrepancy in size of the parts that have to be brought together. From this we can emphasize the need for carrying out sterilizations only on a limited lenght of the isthmus.
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