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J L Pouly

Publications and source records attributed to J L Pouly.

142 records · Page 8Linked to original sources
PubMed1984

[Laparoscopy in the diagnosis and treatment of adnexal torsion].

13 uterine adnexal torsions were diagnosed by means of laparoscopy between June 1978 and October 1982. Laparoscopy is an opportunity for the adnexae to be untwisted, and gives precision to estimate the severity of the damage of the adnexae and to elucidate the aetiology. In ten patients, the treatment was performed by means of laparoscopy Three patients underwent immediate laparotomy: two for necrosis of the adnexae, one for a mucinous cystadenoma. The post-operative course was always uneventful. A second look laparoscopy was performed to check the anatomical recovery of primary severe ischaemic lesions (4 cases). The usefulness of laparoscopy in diagnosing torsion of the uterine adnexae is now well established. We can also treat by means of laparoscopy. Contra-indications to this management are necrosis of the adnexae and organic tumours.

Adnexal Diseases↗
PubMed1984

[The use of the CO2 laser in the treatment of endometriosis. Experiments in rabbits].

Laser CO2 was used to treat lesions of endometriosis which were produced experimentally in New Zealand rabbits. After the cornu of the uterus had been resected, hyperplastic endometrium produced by giving oestrogens beforehand was dissected out and fixed on the parietal peritoneum of the lateral walls of the abdomen. Four weeks later the endometrial implants which had grown under oestrogen stimulation were looked at histologically and destroyed by vaporisation using laser CO2. Histological control of the areas that were treated showed at the end of the second week the destruction of the implants and the lesions in its neighbourhood to a range of 0.50 mm. The zones which were treated, although they had been partially deprived of peritoneum because of the infiltrating characteristic of endometriotic lesions, were covered with a new peritoneal serosa which was slightly inflammatory in nature but which did not give rise to secondary adhesions.

Animals↗
PubMed1984

[Distal tubal obstructions: microsurgery or in vitro fertilization].

Laser CO2 microsurgical salpingostomies were performed among 70 infertile patients from 1979 to 1982. 9 patients lost to follow up were excluded. All patients underwent a preoperative hysterosalpingography and a laparoscopy in order to realise a tubal evaluation. 4 groups of tubal damage were defined with a subsequent pregnancy rate of: 66.66% in group I, 37.5% in group II, 5.55% in group III, 0% in group IV. 4 groups of adhesions were defined with a subsequent pregnancy rate of: 42.85% in group 0, 33.33% in group mild, 25% in group moderate, 5.85% in group severe. From this results the authors propose a tubal and adhesions score in order to select patients for microsurgery or in vitro fertilization.

Adult↗
PubMed1983

[Study of fertility following celioscopic treatment of unruptured tubal pregnancy].

54 patients out of a series of 200 with ectopic pregnancies that were treated by laparoscopic means were followed up for more than 18 months so that post-operative fertility could be assessed. 35 have had intra-uterine pregnancy (64.8%), 3 of them after a second ectopic pregnancy treated by laparoscopy. 16 patients (29.7%) failed to conceive, four of them after a second ectopic pregnancy. 8 patients have a "solitary tube", 4 of them have had an intra-uterine pregnancy and one a second ectopic pregnancy. This results compare favorably with those obtained after a conservative management by laparotomy. History of infertility or previous ectopic pregnancy decreases the intra-uterine pregnancy rate (45.8% versus 80%, p less than 0.01).

Endoscopy↗
PubMed1980

Treatment of ectopic pregnancy by means of laparoscopy.

Sixty cases of ectopic pregnancy were treated by laparoscopy without laparotomy. In each case, one of two techniques was used-tubal aspiration or salpingotomy-in conjunction with aspiration of the conceptus and peritoneal rinsing. Of these 60 cases, only 3 were failures. Twenty-five women later desired pregnancy, and 18 conceived. The operated fallopian tube was checked in 18 cases and in 13 of these was found to be patent. A laparoscopic film has been made to illustrate this new technique.

Female↗
PubMed1979

[Carbon dioxide laser and gynaecological surgery (author's transl)].

The authors describe their one year's experience with a CO2 Laser in gynaecology. They emphasise the ease of use of the equipment. Three major divisions of gynaecology can benefit from the CO2 Laser: benign or precancerous lesions of the vulva and of the vagina, dysplasia of the cervix, surgery of the fallopian tubes. In the future, technical progress will enable the CO2 Laser to be used in laparoscopy and its indications will certainly be extended to laparoscopic surgery.

Carbon Dioxide↗
PubMedDate not supplied

Management of adnexal masses: role and risk of laparoscopy.

Laparoscopic surgery has become the gold standard in the treatment of benign adnexal masses, whereas laparotomy remains the standard for the treatment of malignant tumors. The laparoscopic management of adnexal masses remains controversial because of the potential risks of cancer dissemination suggested by many case reports and national surveys. Experimental data show potential advantages and disadvantages for the laparoscopic treatment of gynecologic cancer. Since the risk of dissemination appears high when a large number of malignant cells are present, adnexal tumors with external growths and bulky lymph nodes may be considered contra-indications to CO(2) laparoscopy. Surgical diagnosis is the key to adequate management of adnexal masses. In our experience, laparoscopic diagnosis of malignancy is reliable after a careful pre-operative evaluation has been performed. Moreover, national surveys have revealed that despite suspicious laparoscopic findings, many malignant masses were considered benign at the outset. Using strict guidelines, laparoscopic diagnosis can be proposed for both non-suspicious and complex masses, thus avoiding many unnecessary laparotomies for benign masses suspicious at ultrasound. The more controversial limits of laparoscopic treatment are discussed. If a laparotomy was performed for all masses suspicious at surgery, 80% of the cases would be treated by laparoscopy. The role of laparoscopy for restaging and second-look operations for ovarian cancer requires further evaluation.

Adnexal Diseases↗
PubMedDate not supplied

Laparoscopic hysterectomy. A preliminary study.

Thirty-three patients were selected for laparoscopic hysterectomy and operated on in the Department of Obstetrics, Gynecology and Reproductive Medicine of Clermont-Ferrand University Hospital. Surgical techniques included blunt dissection with scissors and bipolar coagulation to achieve hemostasis. A case was considered successful when all the uterine vessels were treated by laparoscopy. Twenty-four cases were completed laparoscopically (72.7%). None of these patients had postoperative bleeding; 22 had an uneventful postoperative recovery. Nine procedures were converted to laparotomy (27.3%), five because of a difficult or unsatisfactory hemostasis. We conclude that in selected cases, a total hysterectomy can be performed safely by experienced laparoscopists. Further technological progress is necessary to make this procedure more acceptable. Its value as compared to the others will have to be demonstrated.

Adult↗
PubMedDate not supplied

Laparoscopy procedures to promote fertility ovariolysis and salpingolysis. Results of 93 selected cases.

In 93 selected infertile patients removal of periadnexal adhesions was attempted by laparoscopic procedure. Adhesiolysis was assessed according to Palmer's classification reviewed in Madrid (July 1980). Success was defined in terms of pregnancies, therefore patients with tubal obstruction were excluded. The rate of intra-uterine pregnancies was high (51,6%) and appeared to correlate with the quality of adhesiolysis. The present data strongly suggest that laparoscopic procedures represent a satisfactory method of adhesiolysis and emphasize the critical importance of case selection.

Adult↗
PubMedDate not supplied

[Luteal phase support after vaginal progesterone: comparative study with micronized oral progesterone].

Two progesterone presentations, a vaginal application of 90 mg progesterone per day (Crinone) or 300 mg progesterone orally administered (Utrogestan) were compared for luteal phase support of patients undergoing an in vitro fertilisation (IVF) procedure. 283 patients were randomly allocated to either treatment. The treatment started within 24 hours 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 rate per transfer was not significantly different in the Crinone and Utrogestan groups at day 12 (Crinone: 35.3%, Utrogestan: 29.9%, p = 0.55), at day 30 (Crinone: 28.8%, Utrogestan: 25%, p = 0.61), at day 90 (Crinone: 25.9%, Utrogestan: 22.9%, p = 0.69). No difference in spontaneous abortion rates were seen thereafter. The delivery rate was not significantly different (proportion delivery per patients included, Crinone: 23.0%, Utrogestan: 22.2%, p = 1), as well as the ratio new-born per transferred embryo (Crinone: 11.7%; Utrogestan: 11.1%, p = 0.91). Safety parameters were similar in both groups except for drowsiness, which was more significantly frequent in the oral P 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 metabolic inactivation of progesterone during its first liver pass.

Administration, Intravaginal↗
PubMedDate not supplied

[1997 FIVNAT general balance].

In 1997, the French National Register on in vitro fertilization, FIVNAT, has collected information on 3,854 initiated cycles and 36,583 oocyte recoveries, from which 61.2% were conventional IVF cycles and 38.6% were ICSI. For conventional IVF, the percentage of infertilities of tubal origin was 49.7%, whereas 45% of the recoveries involved a male factor. The stimulation regimen involved a GnRH in 95% of the cases mostly with a long blockage period (82.6%) which was associated to the highest pregnancy rate. The mean number of transferred embryos significantly decreased to 2.50 +/- 0.95 per transfer. Only 9.2% of the transfers involved more than 3 embryos, and were associated to a relatively poor pregnancy rate, confirming that they were preferently realised in couples with poor chances of pregnancy. Finally, the pregnancy rate per recovery (20.5%) and per transfer (26.0%) remained at the same level as in 1996.

Adult↗