Biomedical subjects

J L Pouly

Publications and source records attributed to J L Pouly.

At least 55 records · Page 3Linked to original sources

PubMed1997

[Laparoscopically extended hysterectomy for cervix cancer: technique, indications and results. Apropos of a series of 41 cases in Clermont].

We report a study of 41 radical hysterectomies performed through laparoscopic approach for carcinoma of the cervix uteri. According to the FIGO staging, the tumors were classified as 12 stages Ia2, 24 stages Ib, 4 stages IIa and 1 stage IIb. 17 patients were treated by exclusive surgical procedure. 24 patients received a combination of radiation therapy and surgery 2 patients had a tumor of the cervical stump after subtotal hysterectomy. The mean duration of the procedure was 270 minutes. The post-op stay was 6.5 days. There was no major operative and postoperative complication. Only one patient required a blood transfusion. The intravenous pyelogram control was correct in all cases. At this time, with a 4 to 76 months follow-up, no recurrence was observed. This experience suggests the faisability of the laparoscopic radical hysterectomy. This approach seems to be convenient in young and non obese women with a tumor less than 4 cm in the greatest diameter.

Adenocarcinoma↗

PubMed1997

[Operative laparoscopy and the adnexal cystic mass: where to set the limit?].

OBJECTIVE: To study the importance and the consequences of several managements options for adnexal cystic masses suspicious at ultrasound and/or at laparoscopy. MATERIAL AND METHODS: The importance of this question was evaluated by studying the correlation between the ultrasonographic appearance, the macroscopic diagnosis and the pathologic diagnosis in a series of 1098 patients operated over a 14-year period. The laparotomy rates obtained with the managements proposed were calculated by adding the laparotomies which would be performed because of the suspicious appearance to the laparotomies effectively performed in the department when treating the non suspicious masses. RESULTS: 32 of the 323 suspicious cases at ultrasound were malignant. The negative predictive value of the laparoscopic diagnosis of malignancy was 100%. Depending on the management used, the incidence of laparotomy could have varied from 6.1% to 31.3% between 1987 and 1991, and from 12.9% to 41.9% between 1992 and 1993. These results were related to preoperative selection. CONCLUSION: Using a simple management which includes diagnostic laparoscopy for masses suspicious at ultrasound and laparotomy for masses suspicious at laparoscopy, 80.1% of the patients would be treated by laparoscopic. This management seems reasonable until the long term results of large series about the laparoscopic treatment of ovarian cancer become available.

Adnexal Diseases↗

PubMed1997

[Ectopic pregnancy recurrence: role of gynecologic, obstetric, contraceptive and smoking history].

The purpose of this study, based on data from the register of ectopic pregnancy in Auvergne (centre of France), is to identify risk factors of recurrence of ectopic pregnancy (EP). The social characteristics, gynaecological, surgical and reproductive history and conditions of the conception of 96 women with a previous EP were compared to those for 566 women without previous EP. Risk factors associated with the management of the first EP could not be analysed with the data available. Several factors increased the risk of recurrence: previous proved or suspected salpingitis (OR = 3.6), maternal smoking (OR = 1.7 to 2.0 according to the consumption level), maternal age greater than 30 (OR = 2.0), and previous recurrent spontaneous abortions (SA) among childless women (OR = 3.4 to 11.9 according to the number of SA). The last of these factors may reflect another unknown risk factors common to recurrent SA and recurrent EP (for example hormonal or karyotype factors). Previous use of intra uterine device is associated with a decrease in the risk of recurrence of EP (OR = 0.27), but this contraceptive method should be considered as an indicator of good fertility rather than as a protective factor for EP recurrence.

Abortion, Spontaneous↗

PubMed1996

[Limitations of laparoscopic management of pelvic static disorders in gynecology].

Laparoscopic treatment of urinary stress incontinence and urogenital prolapse is a recent development of endoscopic surgery. The aim of this study was to describe the operative techniques of colposuspension and of treatment of urogenital prolapse and to provide data of the results. Although, long-term follow-up data remains to be collected, 12 to 18 month results demonstrate appropriate success rates in correction of urinary stress incontinence using laparoscopic approach to the retropelvic space. An expanded laparoscopic approach is now possible for treatment of urogenital prolapse. It is imperative that the techniques continue in order to provide multicentered clinical data by which clinical investigators and practitioners should thoroughly evaluate these surgical techniques.

Female↗

PubMed1996

Cytogenetics of uncleaved oocytes and arrested zygotes in IVF programs.

PURPOSE: Cytogenetic studies of arrested oocytes and zygotes were used to understand in vitro fertilization (IVF) failures. METHODS: We investigated the cytogenetics (Giemsa banding and FISH) of 710 uncleaved oocytes and 94 arrested zygotes from 208 patients undergoing IVF procedures. RESULTS AND CONCLUSIONS: Of uncleaved oocytes without a polar body, 39% were judged cytogenetically abnormal (17% unbalanced predivision and 21.5% diploid). Of 575 oocytes with a polar body, 124 (21.5%) showed numerical or structural chromosome aberrations. In arrested zygotes, approximately equal cases were found with separate condensed haploid complements (no syngamy), nuclear asynchrony and pulverized DNA, and apparently cytogenetically normal zygotes arrested at mitosis. These data on chromosome abnormalities were also analyzed with respect to two ovarian stimulation protocols and to maternal age. Both ovarian stimulation protocols and to maternal age. Both ovarian stimulation protocols showed the same levels of chromosome abnormalities. Overall chromosome abnormalities and premature chromosome condensation were also unchanged with maternal age. These data illustrate the significance of chromosome aberrations in IVF failures.

Adult↗

PubMed1996

Laparoscopic management of adnexal abscesses: consequences for fertility.

OBJECTIVE: To study fertility of patients with adnexal abscesses treated by laparoscopy, antibiotic therapy, and second-look laparoscopy. DESIGN: A retrospective clinical study. SETTING: Department of Obstetrics Gynecology and Reproductive Medicine, University of Auvergne, University Hospital of Clermont Ferrand, France. PATIENT(S): Thirty-nine patients treated for adnexal abscesses between January 1983 and December 1992. INTERVENTION(S): Laparoscopic drainage of adnexal abscesses was performed in all patients; 35 patients underwent a second laparoscopy 3 to 6 months later. MAIN OUTCOME MEASURE(S): Immediate and long-term clinical results, anatomical data obtained at second-look laparoscopy, spontaneous fertility. RESULT(S): No immediate reoperation was necessary within the first 2 months after the initial laparoscopic surgery. At second-look laparoscopy, an adhesiolysis was necessary in all cases. A distal tuboplasty was performed in 17 patients and 6 patients were referred to IVF-ET. Subsequently, 12 of 19 patients not using any contraception obtained a spontaneous intrauterine pregnancy (63%). CONCLUSION(S): This study confirms that laparoscopic surgery is a safe and efficient technique for treating adnexal abscesses. Anatomical results observed at second-look laparoscopy suggest that this second surgical step is essential for patients desiring future pregnancy.

Abscess↗

PubMed1996

Laparoscopic treatment of symptomatic endometriosis.

From their experience and from data in the literature, the authors try to define the respective place of the different treatments for endometriosis, especially those of operative laparoscopy. In cases of endometriosis-associated infertility, operative laparoscopy is the first line treatment and assisted reproductive technology (ART) the second one. Gonadotrophin-releasing hormone (GnRH) analogues are only useful in cases of extensive endometriosis to render surgery easier, and for ART. The average pregnancy rate following laparoscopic treatment is approximately 50% (range 34-80%). It is poorly related to the type of endometriosis except in cases of large adhesions and tubal involvement. However, duration of infertility, age and sperm quality have a direct influence on it. Therefore the authors propose a scheme for the management of endometriosis-associated infertility. In cases of pain, laparoscopic surgery can also be used; however, drugs have a more important role in these cases, to avoid recurrent surgery.

Endometriosis↗

PubMed1996

Fertility after ectopic pregnancy: first results of a population-based cohort study in france.

The purpose of this paper was to evaluate the reproductive outcome after ectopic pregnancy (EP) from a population-based register in the centre of France. Since 1992, all the women aged 15-44 years, who permanently reside in the target area and who were treated either by surgical or medical procedures for an ectopic pregnancy in one of the area centres, have been registered and prospectively followed until 45 years of age. The analysis presented was based on the 155 women registered between January 1992 and March 1994 who were followed up for at least 6 months, and who were seeking a new pregnancy. The mean follow-up period was 16 months. A total of 102 women (66%) obtained a pregnancy. The first conception was intrauterine for 92 women, and 10 had a recurrence of ectopic pregnancy. Risk factors of recurrence were prior spontaneous abortion and prior tubal damage. For those women who conceived, the mean time to obtain pregnancy ('time to pregnancy') was 4.8 months. The 1 year cumulative intrauterine pregnancy rate (i.e. the probability of obtaining an intrauterine pregnancy within 1 year of seeking pregnancy) was 70%. After multivariate analysis by a Cox regression, the factors associated with higher fertility were age < 30 years, high educational level and no prior tubal damage.

Adolescent↗

PubMed1996

Luteal support after in-vitro fertilization: Crinone 8%, a sustained release vaginal progesterone gel, versus Utrogestan, an oral micronized progesterone.

Two progesterone presentations, a vaginal application of 90 mg progesterone per day (Crinone) or 300 mg progesterone administered orally (Utrogestan), were compared for luteal phase support of patients undergoing an in-vitro fertilization (IVF) procedure. A total of 283 patients were randomly allocated to either treatment. The treatment started within 24 h after the embryo transfer procedure and continued until day 30 in cases of implantation. Efficacy was assessed using the pregnancy and delivery rates. Safety was assessed through specific symptoms and usual safety monitoring. The pregnancy rates per transfer were not significantly different in the Crinone and Utrogestan groups at days 12 (Crinone 35.3%, Utrogestan 29.9%, P = 0.55), 30 (Crinone 28.5%, Utrogestan 25.0%, P = 0.61) and 90 (Crinone 25.9%, Utrogestan 22.9%, P = 0.69). No differences in the spontaneous abortion rates were seen thereafter. The delivery rates (number of deliveries per patient; Crinone 23.0%, Utrogestan 22.2%, P = 1.00), as well as the ratio of newborn babies per embryo transferred (Crinone 11.7%, Utrogestan 11.1%, P = 0.91), were not significantly different. Safety parameters were similar in both groups, except for drowsiness, which was more significantly frequent in the oral progesterone group than in the Crinone group at all time points. No serious adverse events were recorded in this study. The fact that Crinone matches the efficacy of the larger doses of progesterone used orally reflects an advantage of the transvaginal route of administration which avoids the metabolic inactivation of progesterone during its first liver pass.

Administration, Oral↗

PubMed1996

[Fertility after ectopic pregnancy. Results of the first three years of the Auvergne Registry].

The reproductive outcome after ectopic pregnancy is evaluated from a population-based register in the center of France. Since 1992, all the women aged 15-44 years, who permanently reside in the target area and who were treated either by surgical or medical procedures for an ectopic pregnancy in one of the area centers, are registered and prospectively followed until 45 years of age. The analysis presented was based on the 221 women registered between January 1992 and December 1994 who were followed up for at least 6 months, and who were seeking a new pregnancy. The mean follow-up period was 19.8 months. 155 women (70%) obtained a pregnancy. The first conception was intrauterine for 136 women, and 19 had a recurrence of ectopic pregnancy. Risk factors of recurrence were prior spontaneous abortion and prior tubal damage. For those women who conceived, the mean time to obtain pregnancy ("time to pregnancy") was 7.6 months. The one year cumulative intrauterine pregnancy rate (i.e. the probability of obtaining an intrauterine pregnancy within 1 year of seeking pregnancy) was 64%. After multivariate analysis by a Cox regression, the factors associated with lower fertility were aged over 30 years, low educational level, history of infertility and prior tubal damage.

Adolescent↗

PubMed1996

[Laparoscopic hysterectomy. A series of 318 consecutive cases].

OBJECTIVE: To evaluate the place of laparoscopy in hysterectomy. DESIGN: A retrospective study. SETTING: Département de Gynécologie Obstétrique et Reproduction Humaine. Polyclinique de l'Hôtel-Dieu-CHU de Clermont-Ferrand. SUBJECTS: A 318 cases continuous series of laparoscopic hysterectomies performed from 1989 to 1993. Results were presented and compared to the largest series of vaginal or abdominal hysterectomies reported in the literature. RESULTS: Conversion to a vaginal route or a laparotomy was required in 11.3% of the cases. Operative duration was longer with laparoscopy than with the other technique. But hospital stay was shorter. The complications were extremely rare after laparoscopic hysterectomy. Urological complications rate was high. Operative route remains a controversial question. CONCLUSION: Laparoscopy has become the routine procedure for hysterectomy in our department.

Female↗

PubMed1996

[Bowel endometriosis. Eight cases of colorectal resection].

Colo-rectal endometriosis requiring colon resection are reported in 8 patients to illustrated the diagnostic and therapeutic problems encountered in the management of this uncommon localisation. Pericatamenial or catamenial bowel symptoms associated with pelvic genital involvement were encountered in all cases. Clinical examination, barium enema and colonoscopy are essential to guide surgical management looking for multiple localisations. However their diagnostic value is low as endometriosis rarely involves the mucosa. Endosonography appears to be very promising in evaluating the depth of infiltration of the bowel. The treatment of bowel endometriosis is controversial and varies greatly according to the patient's complaints and clinical data. The indications and limits of all treatment modalities including abstention, medical, and surgical treatment are discussed. From the cases reported we conclude that symptomatic bowel endometriosis should be fully excised whenever possible, and the surgical procedure should be adapted to the depth of infiltration. A full thickness excision or bowel resection is mandatory in patients with deep muscularis involvement. These procedures, which are often difficult due to extensive fibrosis and adhesions, may be achieved by laparoscopy in selected patients.

Adult↗

PubMed1995

[Incidence of extra-uterine pregnancy and characteristics of treated patients. First results of the Auvergne registry].

OBJECTIVES: To evaluate the course and frequency of ectopic pregnancy in a single population for a prolonged period in order to study the simultaneous changes in distribution of risk factors, identify new risk factors and evaluate the effect of new diagnostic and therapeutic methods on subsequent fertility and the effectiveness of preventive measures. METHODS: All women residing in the Registry zone and treated surgically or medically for ectopic pregnancy were included in the study and followed to the age of 45 years. RESULTS: In 1992, the incidence of ectopic pregnancy was 20.2 per 1,000 live births (n = 160). At least one currently recognized risk factor was found in 80% of the women. A past history of salpingitis was noted in 13% and nearly one half smoked or had smoked at the time of conception. Nineteen percent had a past history of pelvic surgery and 19% had a history of infertility. The ectopic pregnancy recorded was the second one in 9%. Nearly one-third of the ectopic pregnancies recorded (31%) were diagnosed in patients with a intrauterine device. None of these latter patients had other risk factors. Vaginal echography was used for diagnosis in 75% of the cases. Surgery was used as first intention treatment in 94% and medical treatment (methotrexate) was used in 6%.

Adult↗

PubMed1995

Laparoscopic radical hysterectomy for cervical cancer.

A laparoscopic approach for radical hysterectomy is described. The laparoscopic procedures are similar to those achieved previously by laparotomy, the extent of surgery being adapted to the volume of the tumour and to the associated treatments. From the results obtained in a preliminary study of 15 patients, this approach appears to be safe. This surgical treatment of cervical cancer which associates a radical procedure complying with oncological rules with a decreased morbidity seems very promising. However, laparoscopic radical hysterectomy should be considered investigational and reserved for oncology surgeons trained in extensive laparoscopic procedures. Large studies with long follow-up are necessary before this approach can be proposed as an alternative to conventional surgical approaches.

Adult↗

PubMed1995

[Treatment of endometrial clinical stage I adenocarcinoma by laparoscopic surgery. Seventeen cases].

AIM: Study and follow-up of laparoscopic surgical treatment of endometrial cancer, clinical stage I. METHOD AND MATERIALS: This retrospective study covering the period 01 February 1990 to 31 January 1994 on 17 patients presenting with endometrial cancer, clinical stage I, that is, 35.4% of endometrial cancers operated in our department during that period, and for which laparoscopy was the first step in surgical treatment. RESULTS: Of the 17 cancers assessed by laparoscopy, 12 were also operated by laparoscopy. Conversion to laparotomy concerned 5 cases (29.4%): one case of postoperative adhesions, 2 cases of laparoscopic complications (cardiac rhythm problems, sub cutaneous emphysema), 2 cases of peritoneal granulations giving rise to suspicious of stage III. The mean age of the patients operated via laparoscopy was 59.9 years (extremes: 34-74). Their weight varied from 52 to 94 kg with a mean of 68.1 kg. Two endoscopic surgical complications arose (one bladder injury and one cervico-vaginal bleeding), but did not require conversion to laparotomy. No postoperative complications were noted. The average follow-up for these patients treated by endoscopy is 22.3 months. There was regrettably one early recurrence of the disease 7 months postoperatively. CONCLUSION: Laparoscopic surgery can be used to treat clinical stage I cases of endometrial cancer. This surgical approach must be used only for favourable cases and is reserved for teams trained in endoscopic and cancer surgery.

Adenocarcinoma↗

PubMed1995

Laparoscopic hysterectomy.

We describe the use of laparoscopic techniques in hysterectomy, and the epidemiology of hysterectomy. We review the advantages and complications of total laparoscopic hysterectomy and subtotal laparoscopic hysterectomy. Finally, we discuss long-term outcomes and the cost of these techniques.

Female↗

PubMed1995

Laparoscopic procedures for stress incontinence and prolapse.

Laparoscopic treatment of urinary stress incontinence and urogenital prolapse is a recent development. We describe the progress of the ideas and techniques, in this field. However, the literature lacks prospective randomized studies with sufficient follow up. So there is a need for these techniques, which seem attractive at first glance, to be fully assessed before they can be adopted as standard practice.

Female↗

PubMed1995

[Laparoscopic treatment of adnexal abscesses. A series of 39 patients].

OBJECTIVE: Evaluate short- and long-term follow-up of patients treated by laparoscopy and antibiotherapy for tubo-ovarian abscess. METHODS: We report a retrospective study of 39 patients treated from January 1983 to December 1992. Clinical files were examined and a questionnaire was mailed to patients. RESULTS: None of the patients needed to be reoperated for failure of the first laparoscopic treatment. A laparoscopic control after 3 month was done in 35 cases, which allowed complete adhesiolysis in every patients. We performed distal tubal surgery in 17 patients at that time and oriented 6 patients directly towards IVF. Subsequent fertility, in 19 patients followed without contraception, demonstrated a rate of spontaneous intra-uterine pregnancy of 63%. CONCLUSION: This study confirms that laparoscopy remains the technique of choice in initial management of adnexal abscesses.

Abscess↗