Advanced endoscopic techniques used in dysfunctional bleeding, fibroids and endometriosis, and the role of gonadotrophin-releasing hormone agonist treatment.
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Danazol↗
Biomedical subjects
F Casanas-Roux
Publications and source records attributed to F Casanas-Roux.
Morphometric study of the stromal vascularization in peritoneal endometriosis.
To evaluate the stromal vascularization of different appearances of peritoneal endometriosis, biopsies were taken from peritoneal areas with endometriosis in a series of 135 infertile women and classified as typical (black), red, or white lesions. The number of capillaries per mm2 of stroma, their mean surface area, and the ratio of capillaries/stroma surface area, and the mitotic activity were analyzed in typical, red, and white lesions. Significant differences were found between the different subgroups. The higher vascularization and mitotic activity observed in red lesions suggested the hypothesis that such lesions are very active and probably the first stage of early implantation of endometrial glands and stroma. The poor vascularization and the absence of mitosis observed in white lesions suggested that these lesions are much less active than red lesions and are a quiescent stage of the disease. Our study proves that the "activity" of peritoneal endometriosis is related to the vascularity. This concept must be considered in the further discussion of American Fertility Society Endometriosis Classification. Typical, red and white lesions are three different stages of the peritoneal disease and their relative relation to infertility is also probably different.
Endometriosis↗
Three-dimensional architectures of peritoneal endometriosis.
OBJECTIVE: To elucidate some biological characteristics of peritoneal endometriosis. DESIGN: A recently advanced stereographic computer technology was applied for the investigation of the three-dimensional (3-D) architectures of peritoneal endometriosis. SETTING: University Hospital of Gynecology. PATIENTS: Biopsies were taken from 42 women with peritoneal endometriosis. Twenty-six of them were in the luteal phase. Seventeen of them received Zoladex (ICI, Cambridge, United Kingdom) for 12 weeks before biopsy. RESULTS: Two different main types could be identified according to the presence or absence of ramifications. The apparently multifocal occurrence (in 2-D) of glandular epithelium was not confirmed by the 3-D study that showed that all epithelial glands are interconnected by luminal structures in each peritoneal lesion. Stereometric study suggests a stronger effect of gonadotropin-releasing hormone agonist therapy on the stroma than on the epithelium. CONCLUSIONS: The study evaluated the 3-D architectures of peritoneal endometriosis and identified two principal types of peritoneal endometriosis.
Biopsy↗
Histologic study of peritoneal endometriosis in infertile women.
The present study included 118 patients undergoing a laparoscopy for infertility. In 86 patients with laparoscopically diagnosed endometriosis (group I), biopsies were taken from areas of apparent endometriosis (n = 86) and from a visually normal peritoneum (n = 52). Histology reveals the presence of endometriosis in 93% of positive sites and in 13% of negative sites. In 32 patients without endometriosis at laparoscopy (group II), biopsies were taken from normal uterosacral ligaments (n = 32). Endometriosis was observed in 6% of cases. Despite the increased ability to detect pigmented and nonpigmented endometriotic lesion, histological study revealed the presence of endometriosis in normal peritoneum in 13% (group I) and 6% (group II) of cases.
Biopsy↗
[Treatment of endometriosis. Evaluation of preoperative therapy with danazol, gestrinone and buserelin (nasal spray and implant)].
In order to adequately assess the effectiveness of danazol, gestrinone, buserelin-nasal spray (IN) and buserelin-implant (SC), a prospective non randomized study was initiated in 178 patients with laparoscopically confirmed ovarian endometriosis. After hormonal therapy, laparotomy with microsurgical resection of endometriotic cysts or laparoscopy laser was carried out. Regression (greater than 25%) of ovarian endometriosis was noted in 30, 34, 73 and 91% of cases after danazol, gestrinone and buserelin IN and buserelin SC respectively. Histological study proves that hormonal treatment leads to an incomplete suppression of ovarian endometriotic implants and this suggests the necessity to remove surgically invasive ovarian endometriosis. The pregnancy rate in moderate endometriosis (55%) differed significantly from the rate obtained in severe endometriosis (44%). The highest percentages were found after buserelin therapy. In conclusion, preoperative use of a potent GnRH agonist, administered subcutaneously, seems to be the best therapeutic approach when associated to surgery (CO2 laser or microsurgery).
Administration, Intranasal↗
Administration of nasal Buserelin as compared with subcutaneous Buserelin implant for endometriosis.
One hundred infertile patients with laparoscopically confirmed ovarian endometriosis were treated with either intranasal (IN) Buserelin (Hoechst, AG, Frankfurt am Main, West Germany) (300 micrograms three times a day) or subcutaneous (SC) Buserelin implant (6.6 mg Buserelin). Serum estradiol was suppressed in the menopausal range in both groups, but the inhibition of the pituitary ovarian axis appeared more profound and consistent in the SC group than in the IN group. Laparoscopic findings proved that the SC Buserelin emerged superior to the IN Buserelin. Indeed, the score of endometriotic lesions and the ovarian cyst diameter were more reduced in the SC group than in the IN group. Moreover, the histologic study showed a lower incidence of active endometriosis and a lower mitotic index of ovarian endometrial epithelium in the SC group than in the IN group. In conclusion, the release of a gonadotropin-releasing hormone agonist by a biodegradable implant achieved better efficacy in reducing endometriotic lesions than the IN mode of administration.
Administration, Intranasal↗
Histology: a prognostic factor in proximal tubal occlusion.
To evaluate the results of 54 microsurgical anastomoses in relation to histologic findings, serial sections from 102 stenosed tubal portions (n = 54 women) were examined. The term pregnancy rate was 41% in our series. Unfavorable histologic factors influencing the postoperative pregnancy rate were revealed by our study: (1) chronic inflammation, (2) tubal inclusions in the tubal wall, and (3) tubal endometriosis.
Anastomosis, Surgical↗
Histologic study of ovarian endometriosis after hormonal therapy.
To evaluate the persistence of endometriosis and the morphologic changes occurring in endometriotic foci after hormonal therapy, microsurgical resection of ovarian endometriosis was performed in 148 women. After hormonal therapy (n = 116), a high prevalence of active endometriosis without signs of degeneration was found. Mitotic index was similar in the group of untreated women (n = 32) and in the three groups of women treated either with lynestrenol (Organon, Oss, The Netherlands), gestrinone (Roussel UCLAF, Paris, France), or buserelin (Hoechst, Frankfurt, West Germany). In conclusion, hormonal treatment leads to an incomplete suppression of endometriotic foci.
Adult↗
Combined (hormonal and microsurgical) therapy in infertile women with endometriosis.
Fifty patients with moderate or severe endometriosis received 5 mg/day lynestrenol for 6 months prior to microsurgery. A significant regression of the ovarian and peritoneal implants was observed in 72% of the cases after progestative treatment, but the presence of residual epithelium in all cases made surgical resection necessary. After preoperative medical treatment and microsurgery, intrauterine (living births) pregnancy rates of 60 and 47% were obtained in cases of moderate and severe endometriosis, respectively. The following prognostic factors were found in this series: the degree of endometriosis, the concomitant male factors, the decrease of endometriotic lesions after treatment, and the unilaterality of ovarian endometriosis.
Adult↗
Effect on ovulation of surgically induced endometriosis in rabbits.
To study the effect of endometriosis on follicular rupture, endometrial tissue was autografted to New Zealand White rabbits. Endometrium was surgically implanted into the peritoneal cavity or into the rectus muscle. Human chorionic gonadotropin was administered to induce ovulation. During three subsequent laparotomies, the number of corpora lutea and stigmata were counted. The viability of the implants was demonstrated histologically. Ovaries were removed during the last laparotomy and ovarian serial sections were examined. In rabbits with peritoneal induced endometriosis, the percentage of stigmata/corpora lutea was significantly decreased. Macroscopic study was confirmed by histological examination. Indeed, a high incidence of entrapped oocytes was found in rabbits with peritoneal endometriosis. Extraperitoneal endometriosis had no effect on ovulation. Our data demonstrated that endometriosis induced a failure of follicular rupture. After endometriumectomy, no failure to ovulate was observed, suggesting that the effect of endometriosis on the ovulation disappeared with excision of endometrial implants.
Animals↗
[Unruptured luteinized follicle syndrome and experimental endometriosis in the female rabbit].
To study the effect of endometriosis on follicular rupture, endometrial tissue was autografted to New Zealand White rabbits. Endometrium was surgically implanted into the peritoneal cavity. Human chorionic gonadotropin was administered to induce ovulation. The viability of the implants was demonstrated histologically during three subsequent laparotomies, the number of corpora lutea and stigmata were counted. Ovaries were then removed and ovarian serial sections were examined. In rabbits with peritoneal induced endometriosis, the percentage of stigmata per corpora lutea was significantly decreased. Macroscopic study was confirmed by histological examination. Indeed, a high incidence of entrapped oocytes was found in rabbits with peritoneal endometriosis. Our data demonstrated that endometriosis induced a failure of follicular rupture.
Animals↗
Prognostic factors of fimbrial microsurgery.
From January 1978 to December 1983, 600 infertile women underwent microsurgery for tubal infertility. Only 257 women with the same extent of distal lesions on both sides or with unilateral occlusion (after contralateral salpingectomy) were considered. Patients were classified in four subgroups on the basis of the extent of occlusion. After fimbrioplasty for occlusion of degree I and salpingostomy for occlusion of degree II, the term pregnancy rate was more than 50%. After salpingostomy for occlusion of degrees III and IV, the term pregnancy rate was, respectively, 25% and 22%. The ectopic pregnancy rate was the highest (12%) after salpingostomy for occlusion of degree IV. After microsurgical salpingolysis, the term pregnancy rate reached 64%, whereas the ectopic pregnancy rate was as low as 2%. Ampullary dilatation, as determined by hysterosalpingography and laparoscopy, influences the postoperative pregnancy rate. Fimbrial microbiopsies were taken, and the ciliated cell percentage was obtained. Results suggest that the ciliation index is a valuable method of prognosis of tubal surgery. In conclusion, the pregnancy rate after distal surgery is related to the tubal morphologic findings: ampullary dilatation, fimbrial ciliated cell percentage, and tubal wall thickness.
Fallopian Tubes↗
Prognostic factors influencing the pregnancy rate after microsurgical cornual anastomosis.
Eighty-two women with symmetric cornual blockage were selected for evaluation of the results of microsurgical anastomosis in relation to data from preoperative hysterosalpingography and histologic study of excised tubal specimens. Serial sections from 164 occluded tubal portions were examined. The term pregnancy rate was 44%. Several prognostic factors influencing the postoperative pregnancy rate were revealed: maximized tubal length; preserved intramural portion; absence of chronic inflammation; absence of tubal inclusion in the tubal wall; and absence of tubal endometriosis.
Fallopian Tube Diseases↗
Loss of adrenergic innervation in induced rabbit hydrosalpinx.
Ligation of the proximal and distal ends of the rabbit oviducts was used to induce hydrosalpinges. The adrenergic innervation of the induced hydrosalpinx was studied. Depletion of adrenergic innervation in rabbit hydrosalpinges was found. Our findings suggest that not only mucosal changes, but also loss of adrenergic nerves must be taken into account as factors in the pathology of hydrosalpinx.
Animals↗
[Microsurgery of distal tubal lesions. Analysis of 270 operated cases].
Between 1978 and 1983, more than 600 microsurgical tubal operations were performed. Only 270 women with the same extent of distal tubal lesions on both sides or with unilateral tubal occlusion after heterolateral salpingectomy were considered in this study. The authors propose a classification of distal tubal lesions in order to analyze the results of microsurgery. After fimbrioplasty, salpingolysis and salpingostomy for distal occlusion without ampullary dilatation, the term pregnancies rate is more than 50%. The pregnancy rate after salpingostomy for hydrosalpinx is 25%. The prognosis after microsurgery for distal tubal lesions is related to ciliated cells percentage. The prognosis of microsurgical salpingostomy for thick-walled hydrosalpinx is poor. In these cases, in vitro fertilization should be the treatment of preference. In conclusion, the ampullary diameter and the fimbrial ciliated cells percentage are prognostic factors of distal tubal microsurgery.
Constriction, Pathologic↗
[Morphological modifications in experimental hydrosalpinx].
Hydrosalpinges were mechanically induced in rabbits by ligation of the proximal and distal ends of the oviduct. Isthmic and ampullary biopsies were obtained at 2, 4 and 6 months after ligation. Deciliation and decrease of epithelial height were observed in the ampulla, but not in the isthmus. Microstereological study shows a decrease of both the number and the relative volume of capillaries in the ampullary muscularis. Considering the parallelism of time and localization between deciliation and reduction of vascularization, we suggest that epithelial deciliation is caused by vascular disorders. Our study shows also adrenergic denervation occurring in the muscularis.
Animals↗
Monoamine oxidase reactivity in the human fallopian tube.
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Epithelium↗
Cyclic changes in ciliation, cell height, and mitotic activity in human tubal epithelium during reproductive life.
The percentage of ciliated cells, the height, and the mitotic index of human oviductal epithelium were studied during the menstrual cycle and under progestogens. A total of 141 fallopian tubes were examined. During the menstrual cycle, a process of ciliation and deciliation was observed. Maximal ciliation was attained around the time of ovulation, particularly in the fimbria where significant differences were noted. Deciliation was observed under progestogen therapy, but this progestogen effect was easily reversible. The decrease of epithelial height observed after ovulation was also found after progestogen therapy. Cyclic mitotic activity was noted during the menstrual cycle. Estrogens influence the mitotic activity of tubal epithelium, whereas endogenous progesterone and progestogens inhibit this estrogenic effect.
Cell Cycle↗