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J B Dubuisson

Publications and source records attributed to J B Dubuisson.

At least 163 records · Page 9Linked to original sources
PubMed1987

[Intravaginal culture and embryo transfer. A new method for the fertilization of human oocytes].

This technique was developed at the University Clinic of Port-Royal. It corresponds to the intravaginal culture of embryos and their transfer into the uterus. After ovocyte stimulation, most often by Clomid HMG, the follicles are aspirated under laparoscopic or sonographic control 34 to 36 hours after HCG. After being collected, the ovocytes are placed, whatever their stage of maturity, in one or several 3 ml tubes completely filled with culture medium (B2 of pure Menezo). Up to 4 ovocytes per tube are thus fertilized with 10 to 20,000 mobile spermatozoids/ml, prepared in the usual dilution, centrifugation and migration. Then the tube(s) are placed in the posterior vaginal cul-de-sac, kept in place with a diaphragm where they will remain during the 44 to 48 hours of culture time. Following that time, the contents of the tube are examined in order to evaluate the occurrence and the stage of embryonic division. A first series of 100 aspirations has enabled to obtain 15 pregnancies, still evolving, including two births of healthy children. A randomized series is currently in progress to determine a possible difference in the rates of pregnancy between CIVETE and the classic technique. Beside its new psychological contribution, this technique has demonstrated that it was possible to culture human embryos in the absence of CO2; its extreme simplicity should lead to a broader expansion of this technique.

Adult↗
PubMed1987

[Chronic salpingitis and extra-uterine pregnancy. Results of the histologic study of 215 tubal pregnancies].

215 women who had tubal pregnancy were treated by total salpingectomy at the University Hospital Port-Royal between the 1st January 1977 and the 30th January 1986. All of these had histological examination of the tube in which the pregnancy occurred. Our series of histological examinations confirms that tubal pregnancy occurs in the great majority of cases in a tube that is already pathological. The responsibility for tubal abnormalities in the occurrence of tubal pregnancy has been suggested by a comparative study of a control series where chronic lesions of the tube were statistically far less frequent (p less than 0.001). Ampullary pregnancy, of which there were 200 cases, was associated in 89.5% of the cases with a pathological condition of the ampulla. Isthmic pregnancy, of which there were 15 cases, would seem to be secondary to a pathology in the isthmus in all cases except one, and is nearly always associated with lesions in the ampulla. Chronic salpingitis was the main histological lesion that was observed. It represented 95.5% of the abnormalities of the ampulla in ampullary pregnancies. In isthmic pregnancies it was found in two-thirds of cases attacking the isthmus, the ampulla or the whole tube. Isthmic salpingitis nodosa was the second lesion that was observed in 40% of isthmic pregnancies. As far as endometriosis is concerned, it is very rare and occurred in only one case. Prevention of tubal pregnancy, therefore, necessarily must lie in preventing tubal infections and sexually transmitted diseases.(ABSTRACT TRUNCATED AT 250 WORDS)

Chronic Disease↗
PubMed1986

Tubal causes of ectopic pregnancy.

We did complete histologic study on 148 gravid tubes and found that nearly 90% showed chronic lesions. CS was the most frequent lesion encountered (95.5%), followed by SIN (32.6%). Most frequently the lesions were extensive and both the ampulla and isthmus were involved. We therefore question the conservative approach in the treatment of certain TPs.

Chronic Disease↗
PubMed1986

[Microsurgical desterilizations. Reflections on 65 cases].

Sixty-five patients were operated on for reversal of sterilization between the 1st January 1978 and the 1st January 1984, with a follow-up of longer than 20 months. All had at least one tube which had a healthy distal and ampullary portion. Sterilization had been carried out in 54 cases by laparotomy (31 at caesarean operation) and they represented 83% of the cases, and laparoscopically in 11 cases. Laparotomy is still the most frequently used method to sterilise women in France; but it is to be hoped that in the future it will be superseded by laparoscopy which is less traumatising and allows the use of more conservative methods. The pathological study that was carried out on the segments of tube that were removed during the reversal operation showed that they were usually normal or had only very limited abnormalities (44.7%). When there were lesions these were usually in the proximal isthmic portion, where in 23% of cases there were diverticula or in 10.7% of cases epithelial atrophy. Fifty one out of the 65 patients had an intra-uterine pregnancy that carried to term and this was a success rate of 78.5%. There were four ectopic pregnancies (6.1%). The success rate did not seem to depend at all on the way the sterilization had been carried out except that it seemed that we had greater success in cases where the resection had been cornual. There seemed also to be no difference no matter how long a time interval had occurred from the sterilization to the reversal operation, the site of the anastomosis and the histological appearance of the fragments of the tube that were sent for section. This similarity in results seems to us to depend on using micro-surgical techniques which allow precise resection of pathological portions of the tube and a perfect anastomosis in a healthy zone of the tube.

Adult↗
PubMed1986

[Epidemiology of tubal lesions. Apropos of 588 microsurgical plastic procedures and 69 in vitro fertilisations].

Genital infections and in particular sexually transmitted diseases are mainly responsible for tubal sterility. We have studied five factors each of which could carry responsibility for this sterility. All were in some degree associated with infection in the 588 patients who were operated on for tuboplasty and 69 patients who had in vitro fertilisation. There results have been compared with 50 sterile women who had healthy tubes and with 8,356 women who were delivered during the same period of time. The previous histories of women who had extra-uterine pregnancies were significantly more frequent for these infections in the tubes leading to chronic salpingitis. Acute salpingitis was given in the history in about 35% of women who had to have tubal surgery or in vitro fertilisation. This was significantly higher than those sterile women who had healthy tubes and those who were delivered of babies. There was a significantly raised number of those where the serology was positive for chlamydia trachomatis in sterile women with tubal lesions. We have also been able to note that there was correlation between the frequency with which positive serology was found and the degree of severity of the tubal lesions. So, the serology was often positive in cases of hydrosalpinx (77.3%) and in double lesions (91.5%). These figures were significantly higher than those who had proximal blocks (61%) and who had adhesions (54.8%). The frequency of therapeutic terminations of pregnancy in patients with tubal lesions was significantly higher than those in the control groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Chlamydia Infections↗
PubMed1986

[Tubal histology in extra-uterine pregnancies].

141 patients affected by tubal pregnancy have been treated by total salpingectomy at the Port-Royal university clinic between the 1st January 1977 and the 31st January 1984. Tubal pregnancy occurred in the majority of cases in a pathological Fallopian tube, of which the histological state was unrelated to the clinical observations made at laparotomy. Ampullary pregnancy (88% of cases) is secondary to a pathological ampulla in 94 p. cent of cases. The latter was chronic salpingitis in 92 p. cent of cases. Isthmic pregnancy (12% of cases) appears to us to be secondary to isthmic pathology in all cases, and is generally associated with ampullary lesions. There also chronic salpingitis preponderates, whilst endometriosis is very rare. The great frequency of pre-existing lesions which we have noted explains perfectly the high level of recurrences in situ observed after conservative surgery of the gravid tube.

Fallopian Tubes↗
PubMed1985

[Use of the CO2 laser in tubal microsurgery: comparative study of the results of the lysis of adhesions by laparascopic control on the 8th day. Apropos of 172 cases].

Two groups of microsurgical tubal plastic operations have been compared. The first group consisted of 78 cases carried out without using Laser at the Port-Royal maternity unit, and the second group was of 94 cases where CO2 Laser was used at the Hospital Saint-Jacques. All the patients who had plastic tubal operations with associated lysis of adhesions were followed by laparoscopic assessment on the 8th day after operation to see what the results were. The adhesions in the pelvis were classified according to the international classification of Madrid and the lysis operations were classified according to the type of adhesions, i.e. 2nd degree for Type B adhesions, 3rd degree for severe Type C adhesions. In the 1st group, 136 adnexae were treated, associated with 65 2nd degree lysis procedures and 71 3rd degree procedures. In the 2nd group there were 158 adnexae operated on with 53 lysis of the 2nd degree and 105 of the 3rd degree. Control laparoscopy on the 8th day showed that in the 2nd degree lysis cases there were 15% in the group that were operated on without Laser and 9% in the group that were operated on with Laser. In the 3rd degree lysis cases there were 25% recurrences recurrences without Laser and 19% if the Laser was used. It does seem that using Laser improves the results of operations for lysis of adhesions although there was no statistically significant difference (p greater than 0.05).

Carbon Dioxide↗
PubMed1985

[Celioscopic salpingectomy. Apropos of 31 cases].

In this article we describe our experience with the first cases on which we have carried out laparoscopic salpingectomy. We have done this in 31 cases for, in 25 cases, tubal pregnancy and, in 6 cases hydrosalpinx. We describe the technique and results. The laparoscopic technique seemed to us to be especially indicated in cases of ectopic pregnancy when the decision to carry out salpingectomy was taken particularly when it was a second pregnancy in the same tube, or when the pregnancy occurred in a pathological tube or had already been operated on or where the tubal pregnancy had burst. It is also, whatever the reason for the salpingectomy, an alternative treatment of choice in the sterile woman who wants later to have IVF because it is less likely to cause parietal and pelvic adhesions.

Electrocoagulation↗
PubMed1985

[Microsurgical treatment of tuboperitoneal lesions. I. Results of distal tuboplasties: apropos of 135 cases].

135 patients were operated on using a microsurgical technique for distal plastic repairs between April 1978 and April 1983. Recurrences and cases with two lesions were excluded. The patients were classified in the group which corresponded to the tube that was less affected when the lesions were not symmetrical according to the I.F.F.S. classification. Out of 59 operations for fimbrioplasty, 31 had an on-going pregnancy, which is 52.5%, and 8 had an extra-uterine pregnancy, which is 13.5%. Of 76 cases that had neosalpingostomies, 28 had an on-going pregnancy, which was 36.8%, and 17 an extra-uterine pregnancy, which was 22.3%. When we looked at the results as a function of the initial lesion (the 9 cases of mixed lesions being excluded), 39 out of 83 cases of phimosis had an on-going pregnancy (47%) and 15 an extra-uterine pregnancy (18%). Out of 43 cases of hydrosalpinx 17 had an on-going pregnancy (39.5%) and 5 an extra-uterine pregnancy (41.6%). The levels of success obtained after operation on distal tubal lesions according to the criteria of definite selection are relatively satisfactory if one compares the present results with those obtained for in vitro fertilisation. It is therefore still correct to operate on these lesions. All the same, distal reparative surgery does give rise to a high risk of extrauterine pregnancy, which is nearly 20%. In our series the basically more significant rate at p less than 0.05 was shown after making neosalpingostomy in cases of phimosis. The consequences of this complication can now be limited by the progress that has been made in laparoscopic surgery.

Adult↗
PubMed1985

[Microsurgical treatment of tuboperitoneal lesions. II. Results of the release of adhesions: apropos of 46 cases].

Between April 1978 and April 1983 46 patients were operated on for division of adhesions of a first and second degree according to the Madrid classification. They were operated on by laparotomy. 36 patients, which was 78.3%, had an on-going pregnancy and 3 had an extra-uterine pregnancy, which was 6.5%. We give three reasons to explain these results: antibiotic and anti-inflammatory treatment before the operation. This is important because of the high rate of infection and in particular chlamydia trachomatis. This is on-going in these patients. A technique for division of adhesions that was carried out according to a precise and stereotyped protocol used by all three operators. a follow-up of 43 out of these 46 patients that allowed them to be treated in the months following surgery to deal with other factors contributing to lowered fertility.

Adult↗
PubMed1984

[Ciliary activity of cells of the fallopian tubes (apropos of the sequellae of salpingitis)].

A study was made of ciliary movement in tubal epithelium using microphotooscillography on the tubes of 91 patients who were operated on for tubal, ovarian or uterine pathology. Three groups were classified: 31 with healthy tubes, 47 with tubes that showed the consequences of salpingitis. These patients had been operated on for sterility after much treatment with antibiotics and corticoids. 13 sets of tubes from pregnant women (6 cases had intra-uterine pregnancies and underwent tubal ligation after Caesarean section or after a termination of pregnancy) and 7 cases had extra-uterine pregnancies with salpingectomy. This study has made it possible for us to make several observations: The ciliary activity was not altered by the time in the menstrual cycle. When the tubes were healthy tubal activity was hardly changed when a fibroid was present, nor when an ovarian cyst or endometriosis were present (550 beats a minute). In pregnant women ciliary activity is maintained until the pregnancy becomes intra-uterine. It is always abolished in cases of extra-uterine pregnancy, even if this is at some distance from the site of inflammatory reaction caused by implantation of the oocyte. In cases following salpingitis, ciliary activity in the tubes is often altered and sometimes nil. It therefore seems that if one excludes anatomical lesions such as tubal blocks and ampullary phimosis, salpingitis which is the cause of sterility changes tubal physiology greatly. This is true even at some distance from the site of the infective process as is shown by changes in ciliary activity.

Cilia↗
PubMed1984

[Racket-shaped tubal-uterine anastomosis. Technic and results].

Proximal tubal lesions that are discovered when a case of sterility is being worked out are polymorphic in nature and they are variable in extent. Fortunately it is rare that a proximal tubal lesion should involve the whole interstitial portion and the uterine os of the tube. This is why many surgeons have taken up the method of tubo-uterine implantation advocated by Palmer. Salat-Baroux and Cornier published a paper on microsurgical tubo-interine implantation in 1979. We since 1978 have been carrying out a technique of tubo-uterine anastomosis in raquette shape (mostly isthmo-uterine). This is described in detail in this article. The first results on 32 anastomose carried out in 23 patients who were operated on of whom 17 cases had pure cornual lesions and 6 cases bipolar lesions seem to be encouraging with a patency rate 6 months later of 69% and a rate of intra-uterine pregnancy of 23.2% (0.10-0.41) at 12-18 months and 31.1% (0.14-0.56) at 18-24 months (using an actuarial method). Up to now we have not had an extra-uterine pregnancy near the site of suture. Our technique seems to us to give a worthwhile alternative microsurgical method to implantation in interstitial lesions that are widespread and deep.

Actuarial Analysis↗
PubMed1984

[Should one operate on bifocal tubal lesions in 1984? Apropos of 54 cases].

We have analysed 54 cases where the patients had two lesions in the tubes and were treated with microsurgery. The results of histological examinations show that chronic salpingitis in the major lesion. Infection was the aetiological cause in 76% of the cases. The results of microsurgical treatment are poor with a low rate of intra-uterine pregnancy: [19.4% (0.08-0.42) at 24-30 months for pregnancies that were continuing and for abortions, 11.7% (0.04-0.33) at 24-30 months using actuarial techniques for estimating pregnancies that were continuing]. There was a high risk of extra-uterine pregnancy [35% (0.18-0.58) at 24-30 months]. These results make us wonder whether microsurgery or in vitro fertilisation should be the treatment of preference in these cases where the tubes are affected in two areas.

Actuarial Analysis↗