Biomedical subjects
Publications and source records attributed to J Salat-Baroux.
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The selective reduction of embryos in multiple pregnancies poses numerous medical, technical, ethical and psycho-social problems. In a retrospective study, we analysed nine hundred and twenty-two pregnancies obtained using medically assisted procreation between May 1982 and May 1990. Among 922 successful pregnancies, 372 were singleton, 102 were twin and 13 were triplet. Data from this analysis and from a French multicentre study of 262 embryo reduction procedures demonstrated the value of an embryo quality score for minimizing the risk of multiple pregnancy and the existence of extremely infrequent, ethically acceptable indications for embryo reduction. These indications included ultrasound-proven malformations of one fetus, multiple pregnancies in patients with extensive uterine scarring, and multiple pregnancy despite the appropriate use of preventative measures which can be expected to make this technique unnecessary in the future.
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Of 44 pregnancies obtained at the Tenon Maternity Hospital by in vitro fertilization (IVF) using donated oocytes, 25 have already been completed by spontaneous delivery or cesarean section: 22 (88%) single; 2 (8%) twins, and 1 (4%) triple. The most frequently seen complications of pregnancy were hypertension (16%) and preterm labor in the last 3 months (12%). However, as compared to a control group of 275 pregnancies resulting from classical IVF, the only difference was a very high percentage of cesarean sections (72%). No fetal deaths or neonatal malformations were reported.
We retrospectively analyzed the prevalence and prognostic significance of plasma progesterone rises during in vitro fertilization (IVF) protocols including pituitary down-regulation by LHRH agonists in a long protocol and stimulation by hMG (n = 1,116: Group A) or pure FSH (n = 178: Group B). On the day of hCG injection, plasma progesterone level was in the 0.60-0.99 ng/ml range in 7.1% of group A patients and 6.2% of group B patients (NS) and above 1 ng/ml in respectively 4.0% and 3.4% of the cases (NS). On the same day, plasma progesterone was strongly correlated with plasma estradiol (r = 0.26 - p < 0.001 in group A; r = 0.21 - p < 0.01 in group B). However, increased progesterone levels were not associated with changes in plasma LH levels, falls in plasma estradiol levels after hCG injection, or significant modifications in biological and clinical results of IVF. The cause of this pattern of progesterone rise remains to be elucidated.
A hundred and twenty three patients with intraperitoneal cancer (mostly ovarian) were treated between 1980 and 1990 with intraperitoneal chemotherapy administered through a "needle". Local complications were infinitely fewer and less serious than those observed with materials implanted for months. General complications depended on which protocols were being used. But tolerance on the whole was better when the drugs were administered intraperitoneally. This is particularly clear with cisplatin, although the dose is doubled intraperitoneally over a period of 10 months instead of 6. In this ways there was hardly any neurotoxicity and there was a noteworthy prolongation of survival time in cases of ovarian carcinoma.
Fourteen tubo-uterin implantations for endometriosis of the horn and infertility have been carried out. They have been made with microsugery with a reversed transcornual T access. The setting of a retractor pushing off the edges of the uterin muscle allows the removing of the pathological zone, allows also not to hurt the vascularisation during the dissection of the nodule, and allows also to suture edge to edge the tube to the uterus under microsurgical control. This original process allows a new setting up of the continuity (Ten permeabilities cheked with hysterography 2 pregnancies and 2 obstructions among 14 cases after a passing of less than 1 year).
Traditional treatments have proved to be of little effect on inflammatory carcinomas of the breast. The later show a tendency to early metastases and the mean survival is less than 19 months. The preliminary results of the therapeutic protocol reported here and whose originality lies in the primary use of non-specific immunotherapy and of high-dosage chemotherapy appear to be very favourable. The protocol was used in 9 patients. "Thermographic cooling" was taken as the criterion of operability. Initial chemotherapy was restarted after surgery up to a total of 10 courses, and followed by maintenance chemotherapy for one year. Immunotherapy using BCG was routinely associated with the antimitotic agents. After 41 months, the results were as follows: -- local recurrence after tumorectomy in 2 patients (18th and 31st months); these recurrences were controlled by cobalt. -- the other 7 patients show no sign of recurrence. These 9 patients are presently in complete remission.
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65 salpingostomies were carried out using microsurgical techniques between 1976 and 1978. The patency rate was 89 p. 100. There were 30 p. 100 intra-uterine pregnancies and 4 p. 100 ectopic pregnancies. The authors emphasize the prognosis that can be obtained from hysterosalpingography, laparoscopy and histological examination of the tissues and the very poor results that are obtained even using these methods when a second operation is undertaken.
The application technique of a newly developed tissue pH electrode designed for continuous pH monitoring is described. Some parameters are described as criteria of technically accurate records.
Our experience is based on 139 attempts of tissular pH electrode applications in the fetal scalp during labor and includes 119 records comprising 86 tracings of good quality and 33 tracings of bad quality. Technical progress in the electrode and application material allowed an increase in the good quality tracings rate (from 54.5--66%) and a decrease of the complications, particularly the numbers of broken electrodes (from 18 to 2.4%).
A newly developed tissue pH electrode designed for continuous pH monitoring was evaluated in 61 fetuses during labor. The results obtained in this series confirm the reliability of this method. The correlation coefficient between tissular pH and capillary blood pH is 0.94. The correlation coefficient between the last intrapartum tissue pH and the umbilical arterial blood pH is 0.84.
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We report a histological study of a microsurgical tubo-tubal anastomosis undertaken to restore patency after ligation. It confirms the good level of tissue tolerance of the suture material employed. It emphasizes the difficulty of anastomosis in the ampulloisthmial region because of the discrepancy in size of the parts that have to be brought together. From this we can emphasize the need for carrying out sterilizations only on a limited lenght of the isthmus.
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