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Biomedical subjects

J B Dubuisson

Publications and source records attributed to J B Dubuisson.

At least 145 records · Page 8Linked to original sources
PubMed1990

[Surgical treatment of endometriosis].

The surgical treatment of endometriosis, which used to be performed by laparotomy, is now in most cases performed by coelioscopy. The purpose of surgery is to destroy or remove as much as possible of the endometriotic lesions and to treat their sequelae, usually adhesions. In the majority of patients, the coelioscopic treatment can be carried out at the same as the initial diagnostic coelioscopy, the stay in hospital not exceeding 48 hours. The pregnancy rate obtained is similar to that reported with laparotomy, but the operator must have a long experience of operative coelioscopy.

Endometriosis↗
PubMed1990

Reproductive outcome after laparoscopic salpingectomy for tubal pregnancy.

Since 1983, we have performed laparoscopic salpingectomy as a routine procedure for ectopic pregnancy (EP) in cases where conservative management is impossible or contraindicated. The main indications are a ruptured tubal gestation, a pathological tube, a history of tuboplasty, and an ipsilateral recurrence. This technique is simple, quick, and safe. Reproductive outcome after laparoscopic total salpingectomy for EP was evaluated in 125 cases between January 1983 and December 1987. The pregnancy rate was 33.6%. In our population, there was a high proportion of patients with a pathological or absent contralateral tube (74.4%). In patients with a normal contralateral tube (32 cases), the live birth rate (46.9%) was greater but not significantly than in patients (39 cases) with a patent but pathological tube (25.6%). In vitro fertilization (IVF) was performed in 59 patients; clinical pregnancy was obtained in 40.7% of cases. These encouraging results lead us rapidly to consider IVF in patients with a pathological contralateral tube.

Fallopian Tubes↗
PubMed1990

Terminal tuboplasties by laparoscopy: 65 consecutive cases.

A series of 65 consecutive laparoscopic distal tuboplasties, performed from May 1986 to May 1988 is reported. Thirty-one were fimbrioplasties and 34 were neosalpingostomies. Outcome was evaluated at 18 months postoperatively. Twenty-two patients obtained pregnancies (33.8%), of which 18 were intrauterine (27.7%). The intrauterine pregnancy rate was 25.8% after fimbrioplasty and 29.4% after neosalpingostomy. These results are comparable with those obtained after microsurgery. Progress in operative laparoscopy may be attributed to the development of an appropriate atraumatic instrumentation and the CO2 laser. The major advantage of laparoscopic techniques is their availability at the time of diagnostic laparoscopy. Immediate opening of hydrosalpinges allows for precise evaluation of the tubal mucosa, thereby establishing prognosis. In cases with a severely altered mucosa, in vitro fertilization may be considered immediately. When the mucosa is satisfactory, laparoscopic fimbrioplasty or neosalpingostomy may be performed. Within 1 year after one of these procedures, a pregnancy is generally achieved in 1 of 3 patients.

Adult↗
PubMed1990

Diagnosis and treatment of ectopic pregnancy by retrograde selective salpingography and intraluminal methotrexate injection: work in progress.

Selective retrograde trans-cervical salpingography was carried out in four patients in whom ectopic pregnancy was suspected. The Fallopian tube was catheterized using a catheter set designed in our centre. The 6F catheter was placed in the cornua and an inner coaxial catheter was easily introduced into the proximal portion of the Fallopian tube, guided by tactile impression. Contrast medium was then injected and a round haloed mass was seen. Thereafter, the Fallopian tube was catheterized using a metallic guidewire until its tip was adjacent to the ectopic pregnancy. The coaxial catheter was then advanced along the guidewire and after removal of the latter, 5-35 mg of methotrexate was injected into the Fallopian tube. This new procedure was simple, well tolerated and had no side effects. A tubal pregnancy was demonstrated and surgery was avoided in all cases.

Adult↗
PubMed1990

[Laparoscopic surgery of ovarian cysts. Indications and limits as found in a series of 169 cysts].

The new laparoscopic surgical techniques which have been adapted for treating ovarian cysts fulfil a double purpose; to reduce the need for traditional surgical treatment while at the same time being sure to remove the whole of the cyst wall. They make it possible in this way to avoid unnecessary laparotomies for many patients. They forestall recurrences of the cyst while at the same time lessening the risk of adhesion formation. We present a series of 169 adnexal masses of which 158 were treated successfully using these techniques. This experience has made it possible for us to work out an exact operative protocol for transparietal and intra-peritoneal cystectomies and for transparietal oophorectomies. All histological kinds of ovarian cysts that are benign can be treated laparoscopically, but endometriomas and dermoid cysts made it fail in 18.1% and 5.7% of cases respectively. Only in a few cases ultrasound guided punctures of the cysts could be carried out and that only in ovarian cysts with clear fluid in women of reproductive age. Apart from this limited group, from now on laparoscopy should be the treatment for most adnexal cystic masses. Laparoscopy is the only way after looking carefully at the whole of the pelvis, to work out whether it is possible to operate on them through the laparoscope and this now allows a varied attitude to treatment to be adapted and changing according to each case.

Adolescent↗
PubMed1990

[Celioscopy and ectopic pregnancy].

The most frequent indication is the treatment of ectopic pregnancy. Salpingotomy with tubal preservation, the procedure of choice for young women wanting to become pregnant, has been used in 88 cases. However, tubal preservation is not always possible (rupture of the ovarian tube, hemosalpinx), and sometimes not even advisable (inflammatory lesions, homolateral recurrence) and salpingectomy was necessary in 294 cases. Another indication for salpingectomy is painful chronic salpingitis, resulting from an undetected or ill-treated Chlamydia trachomatis infection: 84 cases.

Adult↗
PubMed1990

[Tuboperitoneal infertility and operative celioscopy (endometriosis excluded)].

The great progress made in surgical celioscopy now allows most surgery for the repair of the adnexa to be performed through such an approach. The exeresis of adhesions with scissors is the safest, fastest and least traumatic technique. For salpingostomy, the eversion of the cuff is maintained by a defocused CO2 laser shot on the distal tubal serosa, or more simply, by the contact of the serosa with the bipolar pliers or with the tip of the thermocoagulation device. The results of the lysis of adhesions are satisfactory, with 53% intrauterine pregnancies in our 49-patient series. The results of distal plasty, with 27.7% intrauterine pregnancies in our 65-case series, they are quite comparable to those of microsurgical laparotomy. These results, along with the advantages of surgical celioscopy, caused us to give up microsurgical laparotomy for the treatment of operable adhesions and distal tubal lesions, even more so as in vitro fertilization must be contemplated at once for severe lesions.

Fallopian Tubes↗
PubMed1990

[Celiosurgery of the ovary].

Ovarian cysts can also be explored with celioscopy and, when no signs of malignancy are detected, cystectomy can be performed in this way (115 cases). In addition, an ovariectomy was performed in 15 cases and an adnexectomy in 2 cases.

Fallopian Tubes↗
PubMed1989

In vitro fertilization without ovarian stimulation: a simplified protocol applied in 80 cycles.

Ovulation induction with various hormonal agents has become a standard component of in vitro fertilization (IVF) cycles to obtain multiple oocytes. Failure to anticipate the retrieval of more than two oocytes often results in cancellation of the cycle. In this study, we report our results in 80 unstimulated IVF cycles. Serum estradiol (E2) and pelvic ultra-sound monitoring were begun on day 9 of the cycle. Human chorionic gonadotropin (hCG) was administered when the E2 level exceeded 180 pg/mL and the dominant follicle was greater than 18 mm. Eighteen pregnancies were obtained (22.5%/cycle), and 14 (17.5%/cycle) are ongoing. We conclude that favorable results can be obtained from unstimulated IVF cycles, despite replacement of a single embryo.

Adult↗
PubMed1988

A new in vitro fertilization technique: intravaginal culture.

Intravaginal culture (IVC) is a new technique elaborated by the authors for the fertilization and culture of human oocytes. Its principle consists of fertilization and early development of the eggs in a closed, air-free milieu without the addition of CO2. One to five ovocytes are deposited in a tube completely filled with 3 ml of culture medium less than 1 hour after their recovery, with 10,000 to 20,000 spermatozoa per ml previously prepared. The tube is then hermetically closed and it is placed in the maternal vagina and held by a diaphragm for incubation for 44 to 50 hours. After this time, the content of the tube is examined and embryos are transferred to the uterus. In the first 100 consecutive punctures, 22 clinical pregnancies were obtained: 17 deliveries, 3 spontaneous abortions, and 2 tubal pregnancies. Also, a randomized study comparing IVC to in vitro fertilization (IVF) was done (160 cycles) and no statistically different cleavage, transfer, or pregnancy rate was seen between IVC and IVF. By simplifying the laboratory manipulations, this technique decreases the cost of IVF and permits its standardization and diffusion. It creates a psychologic comfort permitting active participation of the mother in this stage of embryo development. Also, the use of this technique may give greater knowledge of human gamete metabolism and of the physiology of reproduction.

Adult↗
PubMed1988

[Intravaginal culture and embryo transfer].

The intra-vaginal culture and embryo transfer is based on the principle of fertilization of hyman ovocytes in the absence of CO2-enriched air. Ovocytes and spermatozoa are placed in a water-tight tube filled with B2 medium and placed in the vagina during the culture. Once the culture is done, the embryos are replaced in the uterus. The various studies done with intra-vaginal culture and embryo transfer, their results as well as future prospects are reviewed in detail.

Cells, Cultured↗
PubMed1988

[Sexually transmissible diseases and female sterility].

Regarding personal studies and a review of the literature, the authors are discussing the consequences of STD on fertility. Thus, through salpingitis, STD represent the main cause of tubal sterility, distal and proximal, and ectopic pregnancies. It seems desirable to look for them in the latter and treat them with a suitable antibiotherapy. The chlamydia serology seems a good screening examination. The best prevention of STD will certainly permit to decrease the frequency of tubal sterility and ectopic pregnancies, in the years to come, limiting therefore the major public health expenses they involve.

Adolescent↗
PubMed1987

Laparoscopic salpingectomy for tubal pregnancy.

This study presents 100 consecutive cases of total salpingectomy by laparoscopy for the treatment of ampullar ectopic pregnancy. A three-puncture technique was used, and the salpingectomy was done by thermocoagulation and transection of the isthmus, mesosalpinx, and tubo-ovarian ligament. Tubal extraction was accomplished by one of the suprapubic punctures with the use of a polyp forceps. No complications have been encountered during the operation. However, because of severe pelvic adhesions or a voluminous hematocele, laparotomy was used in two cases (2%). The only postoperative complication was a deep vein thrombosis in one of the patients. A second-look operation was performed in 36 cases, and good healing with no adhesion formation at or near the site of salpingectomy was found. This technique therefore appears to be simple, fast, and almost complication-free.

Electrocoagulation↗
PubMed1987

[Serology of Chlamydia trachomatis infections in tubal pregnancies. Apropos of 95 cases].

This study concerns the results of serology for Chlamydia trachomatis in 95 patients who were operated on for tubal pregnancies consecutively. The serology (Ig GAM) was carried out using a micro-immunofluorescence technique. It was considered positive when the levels were higher than or equal to 1/32, suggesting an old or continuing infection. It was positive in 66 cases out of the 95, which gives a percentage of 69.5. The positive serology was apparently significant (p less than 0.01) more often in tubal pregnancy than in the two control groups (sterile patients with normal tubes and normally delivered patients). Our results coincide with that in the literature. It therefore seems worth while to look systematically for chlamydial infection in the couple in cases of tubal pregnancy and, if found, to treat them.

Adult↗