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Biomedical subjects

J L Pouly

Publications and source records attributed to J L Pouly.

At least 73 records · Page 4Linked to original sources
PubMed1994

Incidence of ectopic pregnancy. First results of a population-based register in France.

A population-based register of ectopic pregnancy was established in 1992 for two French departments, with the primary aim of monitoring the trend in ectopic pregnancy over a prolonged period. In this paper, data collected during the first year of registration (1992) are analysed. The rate of ectopic pregnancy was 20.2 per 1000 live births, 15.8 per 1000 reported pregnancies and 9.5 per 10,000 women aged 15-44 years. The ectopic pregnancy rate per 1000 live births increased steeply after the age of 30 years and especially after the age of 35 years, whereas rates per 10,000 women of reproductive age steadily increased until the age of 35 years and decreased thereafter. The rates of ectopic pregnancy were lower in spring and summer than autumn and winter. These results are discussed and comparisons with similar studies conducted in the USA and Scandinavia are attempted.

Adolescent↗
PubMed1994

[Insufflators for endoscopy].

Operative laparoscopy needs a space to be made inside the abdominal cavity. This can only be achieved by suspension or by positive pressure. The endoscopic insufflator makes it possible to create this positive pressure, and does indeed enable the operating space to remain open. But it would be too limiting to consider these devices from the visibility point of view only, for they can also be exploited for their action on hemostasis and dissection. With this in mind we feel that the endoscopic surgeon ought to be perfectly familiar with his apparatus and not simply limit himself to adjusting the pressure and flowrate at the beginning of the operation. This hyper pressure in the abdomen is not without consequences for the patients' homeostasis and can indeed require an operation to be halted or converted to laparotomy. So knowledge of the biomedical aspects of his equipment will also enable the surgeon to increase the safety of his operations.

Endoscopes↗
PubMed1994

The role of laparoscopic surgery in gynecologic oncology.

As a result of recent technological advances, laparoscopic lymphadenectomy is becoming the standard method for the staging of pelvic cancer. More extensive procedures, such as para-aortic lymph node dissection and radical hysterectomy, have also been demonstrated to be feasible by advanced laparoscopic surgery. This new approach appears to be very promising. In the future, because of its well documented advantages, laparoscopic surgery may appear as a way to decrease the morbidity of cancer treatment in patients with low-risk tumors and to propose more aggressive treatments of patients with tumors associated with a poor prognosis. These new techniques should be reserved for surgical teams trained in oncologic and major laparoscopic surgery. More clinical research is required before this approach can be proposed as an alternative to laparotomy, and guidelines have to be established. Training in oncology is essential to ensure optimal patient care and to avoid the consequences of inadequate laparoscopic management with regard to cases of tumor dissemination reported after laparoscopic biopsy or resection of undiagnosed ovarian cancer.

Endometrial Neoplasms↗
PubMed1994

[Failure factors in endometrial resection. 196 cases].

OBJECTIVE: Study of factors affecting risk of failure after hysteroscopic endometrial resection. METHODOLOGY: A retrospective study of 196 patients treated by hysteroscopic endometrial resection for abnormal uterine bleeding from January 1989 to December 1990. A survey was conducted in February 1993 to study the results of these interventions with a particular attention paid to the failure cases. RESULTS: The survey revealed a satisfaction rate of 82%. Persistence of abnormal bleeding after resection was the most common problem reported, although in 32% of these cases the bleeding began after a period of at least 2 years in remission. A more complete clinical and pathological study was performed in 22 cases of hysterectomy for failure after resection. Enlarged uterine size and presence of adenomyosis increase significantly the failure rates. CONCLUSION: After 2 or 4 years of follow-up, the results are satisfactory but the existence of late recurrences showed that it will be necessary to have long term reviews. Two major risk factors are enlarged uterine size and the presence of adenomyosis.

Adult↗
PubMed1994

Laparoscopic diagnosis of adnexal cystic masses: a 12-year experience with long-term follow-up.

OBJECTIVE: To study the value and the immediate and long-term consequences of the laparoscopic diagnosis of adnexal cystic masses. METHODS: We studied all patients who underwent laparoscopy for an adnexal cystic mass at the Department of Obstetrics, Gynecology, and Reproductive Medicine of the Clermont-Ferrand University Hospital between January 1980 and December 1991. The preoperative workup included routine clinical and ultrasonographic examinations. At laparoscopy, the technique involved peritoneal cytology, ovarian and peritoneal inspection, cyst puncture, and endocystic examination. If a malignant mass was encountered or suspected, the patients were treated by immediate laparotomy with a vertical midline incision. The laparoscopic and pathologic diagnoses were compared. Long-term follow-up was studied using data obtained either clinically or by mail using a standardized questionnaire. RESULTS: A total of 757 patients with 819 masses were managed by laparoscopy. The mean age was 35.8 +/- 12.6 years and the mean diameter of the cysts was 6.0 +/- 2.7 cm (range 1-20). During this study, 12 tumors of low malignant potential and seven ovarian cancers were encountered (2.5%). The sensitivity of the laparoscopic diagnosis of malignancy was 100%, the specificity 96.6%, and the negative predictive value 100% (773 cases). The positive predictive value was only 41.3%, as 27 tumors were falsely diagnosed as suspicious or malignant. Among eight complications attributed to the diagnostic procedure, three involved spillage of cyst contents. CONCLUSION: Using cautious management and strict guidelines, laparoscopic diagnosis of adnexal masses appears reliable and safe, allowing immediate and adequate surgical treatment.

Adnexal Diseases↗
PubMed1993

Laparoscopic management of tubal ectopic pregnancy.

As with laparotomy, laparoscopic treatment of ectopic pregnancy (EP) can be either conservative or radical. After conservative laparoscopic treatment by salpingotomy the risk of failure (between 4 and 6%) is comparable with that observed after similar treatment by laparotomy. The fertility results after laparoscopic treatment of EP are comparable if not better than those observed after similar treatment by laparotomy. These two reasons, together with the considerable advantages of endoscopy over laparotomy, mean that today laparoscopic treatment is without question the best surgical treatment for EP. The prognosis for post-EP fertility is unrelated to the characteristics of the EP (size, rupture, location). The post-EP fertility depends mainly on the patient's previous history. We have established the Therapeutic Scoring System for EP by assessing the different factors affecting future fertility and multivariable analysis. This score allowed us to choose the most suitable treatment to preserve fertility and reduce the risk of recurrence between conservative laparoscopic treatment, laparoscopic salpingectomy with or without contralateral tubal sterilization.

Chorionic Gonadotropin↗
PubMed1993

Classification of endometriosis.

A perfect endometriosis classification should be a common language and an expert system which helps the gynaecologist to decide the treatment of each patient. The staging of endometriosis is not a new idea; the first classification based on histologic criteria was presented in 1941. Since this initial attempt, several classifications have been proposed. These various systems are reviewed in terms of their advantages and defects. The revised American Fertility Society (AFS) endometriosis classification system is now accepted worldwide as the endometriosis international language. Laparoscopic staging and measurement techniques are presented and discussed. In recent reports, changes to the revised AFS classification have been proposed, including a better description of atypical and deep infiltrating peritoneal implants, and a stage V for patients with bilateral, extensive, dense adhesions. Despite its well-known advantages, the revised AFS classification cannot be used as a satisfactory expert system. A better understanding of endometriosis is required to improve the present system. Scientifically based scores for each lesion and a marker for disease 'activity' will be fundamental to a classification which will act as a valuable expert system and become the endometriosis classification of the twenty-first century.

Endometriosis↗
PubMed1993

[Ectopic pregnancy risk factors after assisted reproductive technology].

Ectopic pregnancies are more frequent among pregnancies resulting from assisted reproductive technology (ART) than in natural conceptions (6% to 7% vs 1%). Fivnat registry has allowed us to analyse 349 ectopics among 6049 clinical pregnancies collected from 1986 to 1990. Ectopic rate decreased with increasing women's age, and since 1986. The risk was also decreased in infertilities of non tubal origin, except for those of unknown origin in which it was at the same level than for tubal infertility. The risk was increased by 65% in stimulation regimens involving clomiphene citrate (CC). The observed decrease from 1986 to 1990 was strongly related to the decrease in use of CC.

Adult↗
PubMed1993

[Cocultures: diagnostic and therapeutic value].

Results of french multiple collaborative studies are reported to evaluate the possible benefits of coculture in human IVF program. Prospective randomized study of IVF with transfer on day two versus IVF with transfer on day 6 shows that coculture does not improve overall results but leads to a reduction of triple or quadruple pregnancies. When applied to patients with more than 4 failures of embryo transfers on day 2, delayed transfer of blastocyst results in a high rate of clinical pregnancy (39%). Transfers of frozen-thawed blastocysts result in 17.8% ongoing pregnancies. Coculture is also a powerful tool for understanding early embryo development: when fertilization arises from sperm with poor characteristics or from frozen sperm of donor, embryo development appears to be altered: in these situations, rate of normally developing embryo is reduced and early embryo development becomes independent of fertilization rate.

Adult↗
PubMed1993

[External iliac lymphadenectomy by celioscopy: surgical technique].

A complete description is provided of all the various operating steps for external iliac laparoscopic lymphadenectomy. The umbilical artery is easy to identify via laparoscopy and immediately provides the internal boundary for node excision. Laparoscopic vision also enables the other boundaries to be located, that is, the obturator nerve to the bottom and the iliac external and internal bifurcation towards the top. Examination of the nodes thus removed provides a means of assessing the spread of malignancy from cervical and uterine cancers, using a codified operation which can be included during staging or complete cancer surgery.

Female↗
PubMed1993

[The benefits and risks of laparoscopic surgery].

The advantages of laparoscopic surgery in comparison to those of conventional surgery are mainly due to the very low rates of postoperative infections and adhesions and due to the aesthetic nature of this type of surgery. Endoscopy enables a thorough search of lesions which can then be treated in a more conservative manner. The short hospital stay and rapid postoperative recovery are two key advantages of endoscopic surgery. Complications at endoscopic surgery mainly occur if the safety measures are not strictly followed, due to improper choice and use of instruments (eg. old instruments), an antecedent laparotomy and also depend upon the type of surgery performed. It should be noted that the introduction of the trocar is not a simple affair, that non-recognition of complications is not infrequent and that the incidence of complications is directly proportional to the experience of the operator.

Female↗
PubMed1993

Endoscopic treatment of ectopic pregnancies.

Laparoscopic management is now the gold standard treatment of ectopic pregnancy. It can be performed using different procedures such as salpingotomy and salpingectomy, or it can be combined with methotrexate injection. On the other hand, nonsurgical treatment is available. The authors discuss technique results and indications of these various therapeutic techniques.

Female↗
PubMed1992

Second-look laparoscopy after laparoscopic cystectomy of large ovarian endometriomas.

Forty-two patients who underwent a second-look laparoscopy after a unilateral or bilateral intraperitoneal cystectomy for treatment of an ovarian endometrioma of greater than 3 cm were included. At second-look laparoscopy, 92.4% of the adnexae treated for a large endometrioma had no deep ovarian endometriosis. Adhesion de novo formation occurred in 21% of the treated adnexae and in 17% of the contralateral adnexae. Complete or partial recurrence of dense adhesions occurred in 82% of the cases. Laparoscopic cystectomy is effective in treating large endometriomas. However, operative difficulties may be encountered, explaining persistent endometriomas and postoperative adhesions.

Adnexa Uteri↗