Biomedical subjects

Jean-Luc Pouly

Publications and source records attributed to Jean-Luc Pouly.

12 recordsLinked to original sources

PubMed2007

Care pathways for ectopic pregnancy: a population-based cost-effectiveness analysis.

OBJECTIVE: To define care pathways in terms of frequency, costs, and outcomes and to assess their cost-effectiveness. DESIGN: Population-based cost-effectiveness study. SETTING: Auvergne EP registry (France). PATIENT(S): Women (n = 1,664) registered between 1994 and 2003. INTERVENTION(S): Standard diagnosis and treatment of EP. MAIN OUTCOME MEASURE(S): Costs before, during, and after hospitalization were assessed from data concerning medical costs of examinations and treatments. One-year fertility was used for effectiveness assessment. We assessed cost-effectiveness for the healthcare system. RESULT(S): Diagnostic ultrasound (47% of scans were nondiagnostic) was essential for the use of methotrexate as a first-line treatment for subacute EP. Hospital and ambulatory care costs were similar for all surgical-care pathways (diagnostic or nondiagnostic ultrasound scan followed by conservative or radical laparoscopy). Hospital and ambulatory-care costs associated with methotrexate treatment were less than half those for surgical-care pathways. In subacute cases, conservative treatments, and methotrexate in particular, were associated with better fertility at similar or lower cost to salpingectomy for EP for reproductive failure. CONCLUSION(S): Conservative treatments are cost-effective with respect to salpingectomy, when subsequent fertility is at stake. Efforts should be made to increase the frequency of diagnostic ultrasound scans, making it possible to increase methotrexate use and cost-effectiveness.

Adolescent↗

PubMed2007

Peritoneal tissue-oxygen tension during a carbon dioxide pneumoperitoneum in a mouse laparoscopic model with controlled respiratory support.

BACKGROUND: Previous animal studies suggested that the peritoneal environment during a carbon dioxide (CO(2)) pneumoperitoneum is hypoxic and that this may contribute to the formation of intra-abdominal adhesions or the growth of malignant cells. There is no study, however, that investigates the relationship between anaesthesia, ventilation and the laparoscopic peritoneal environment to the development of hypoxia. The objective of this study is to monitor the peritoneal tissue-oxygen tension (PitO(2)) under various conditions including anaesthesia alone, during a CO(2) pneumoperitoneum at both low and high intraperitoneal pressure (IPP), and laparotomy, in animal models with controlled respiratory support (CRS). METHODS: C57BL6 mice were divided into eight groups (n = 5) consisting of anaesthesia alone or with CO(2) pneumoperitoneum at low (2 mmHg) or high (8 mmHg) IPP or undergoing laparotomy. Groups were further subdivided into those with or without CRS with endotracheal intubation and mechanical ventilation. Over the course of the 1 h procedure, PitO(2) was continuously monitored. RESULTS: Protocol 1. The PitO(2) levels (104.2 +/- 7.8 mmHg, mean +/- SEM) in non-injured peritoneum during a CO(2) pneumoperitoneum at a low IPP were elevated approximately 2-fold over the levels during laparotomy (49.8 +/- 15.0 mmHg) in ventilated mice. Protocol 2. After insufflation with CO(2), the PitO(2) was immediately elevated and maintained at a higher level. Following laparotomy, it decreased immediately. This elevation was not seen with air insufflation. CONCLUSION: In mice, a significant elevation in PitO(2) occurs during a CO(2) pneumoperitoneum at low IPP with CRS.

Animals↗

PubMed2006

Relationship between delay of surgical diagnosis and severity of disease in patients with symptomatic deep infiltrating endometriosis.

We investigated relationships between delay of surgical diagnosis and severity of disease in 95 patients with symptomatic deep infiltrating endometriosis. The delay before surgical diagnosis of deep infiltrating endometriosis was significantly longer for patients with advanced stage IV (revised American Society for Reproductive Medicine [ASRM] score >70) disease than for those with stage I, II, III, or IV (revised ASRM score <or=70) disease.

Adult↗

PubMed2006

Expression of WT1 is down-regulated in eutopic endometrium obtained during the midsecretory phase from patients with endometriosis.

OBJECTIVE: To investigate whether WT1 protein expression is altered in eutopic endometrium of endometriosis patients. DESIGN: Prospective study. SETTING: University hospital. PATIENT(S): Patients with endometriosis and fertile women with macroscopically normal pelvic cavities. INTERVENTION(S): During surgery, endometrial tissues were obtained from 59 patients with deep infiltrating endometriosis, ovarian endometriosis, or only superficial peritoneal endometriosis. Control endometrial tissue samples were obtained from 40 fertile women who underwent laparoscopic tubal ligation or reversal of tubal sterilization. MAIN OUTCOME MEASURE(S): The percentage of nuclear surface positively immunostained for WT1 (PI) and WT1-positive microvessel density. RESULT(S): The PI was significantly lower in endometrial stromal cells from patients with deep infiltrating endometriosis than in stroma from control subjects during the midsecretory phase, whereas there was no significant difference between the two populations during the proliferative, early secretory, and late secretory phases. The PI was also significantly lower during the midsecretory phase in endometrial stromal cells from patients with ovarian endometriosis and superficial peritoneal endometriosis compared with control subjects. CONCLUSION(S): During the midsecretory phase, PI in endometrial stromal cells is down-regulated in patients with deep infiltrating endometriosis, ovarian endometriosis, and superficial peritoneal endometriosis compared with endometrium from healthy control subjects.

Down-Regulation↗

PubMed2006

Differential expression of genes in eutopic and ectopic endometrium from patients with ovarian endometriosis.

OBJECTIVE: To investigate whether genes that had been found to be differentially expressed in deep-infiltrating endometriosis and matched eutopic endometrium in our previous complementary DNA microarray study also are differentially expressed in ovarian endometriosis and matched eutopic endometrium. DESIGN: Prospective study. SETTING: University hospital in France. PATIENT(S): Patients with ovarian endometriosis. INTERVENTION(S): During surgery, paired samples of tissue representing ovarian endometriosis and eutopic endometrium were obtained from 12 patients. MAIN OUTCOME MEASURE(S): Expression levels of messenger RNA for heat shock protein 90 alpha (HSP90A), chicken ovalbumin upstream promoter transcription factor 2 (COUP-TF2), prostaglandin E(2) receptor subtype EP3 (PGE(2)EP3), tyrosine kinase receptor B (TrKB), and 17beta-hydroxysteroid dehydrogenase type 2 (17betaHSD2; epithelial cells) and of platelet-derived growth factor receptor alpha (PDGFRA), protein kinase C beta 1 (PKCbeta1), Janus kinase 1 (JAK1), mitogen-activated protein kinase kinase (MKK7), Sprouty2, mu-opioid receptor (MOR), and 5HTT (stromal cells) from ovarian endometriosis and matched eutopic endometrium were determined by using laser capture microdissection and real-time reverse-transcription polymerase chain reaction (RT-PCR) techniques. RESULT(S): Expression of PDGFRA, PKCbeta1, JAK1, HSP90A, COUP-TF2, MOR, and 17betaHSD2 was significantly higher in ovarian endometriosis than in eutopic endometrium, whereas that of Sprouty2 and PGE(2)EP3 was significantly lower. There was no significant difference in mitochondrial RNA expression of MKK 7, TrKB, and 5HTT. CONCLUSION(S): Ovarian endometriosis might share several common molecules with deep-infiltrating endometriosis that act to sustain endometriotic lesions, whereas molecules involved in local endocrine control might be different between these two types of endometriosis.

Endometriosis↗

PubMed2006

Analysis of aromatase and 17beta-hydroxysteroid dehydrogenase type 2 messenger ribonucleic acid expression in deep endometriosis and eutopic endometrium using laser capture microdissection.

OBJECTIVE: To investigate mRNA expression of aromatase and 17beta-hydroxysteroid dehydrogenase type 2 (17betaHSD2) in epithelial and stromal cells from eutopic and ectopic endometrium of patients with deep endometriosis. DESIGN: Prospective study. SETTING: University hospital. PATIENT(S): Patients with deep endometriosis and fertile women with macroscopically normal pelvic cavities. INTERVENTION(S): During surgery, 30 endometrial and 16 endometriotic samples were obtained from 30 patients with deep endometriosis. Control endometrial samples were obtained from 24 fertile women with macroscopically normal pelvic cavities who underwent laparoscopic tubal ligation or reversal of tubal sterilization. Epithelial cells and stromal cells from endometrial or endometriotic tissues were microdissected using laser capture microdissection. MAIN OUTCOME MEASURE(S): Expression levels of aromatase and 17betaHSD2 mRNA in microdissected epithelial and stromal cells were determined using quantitative real-time reverse transcriptase polymerase chain reaction. RESULT(S): Aromatase mRNA expression was significantly higher in epithelial cells than in stromal cells in both eutopic and ectopic endometrium obtained from endometriosis patients. In the ectopic endometrium of 8 patients (8/16, 50%), 17betaHSD2 expression was not detected in either epithelial or stromal cells. In eutopic endometrium from endometriosis patients, 17betaHSD2 expression in epithelial cells was significantly increased during the early, middle, and late secretory phases compared with the late proliferative phase, whereas no significant cyclical difference was detected in control endometrium. CONCLUSION(S): Local estrogen concentration may be much higher in epithelial cells than in stromal cells in deep endometriotic tissue.

17-Hydroxysteroid Dehydrogenases↗

PubMed2005

Human ovarian tissue from cortex surrounding benign cysts: a model to study ovarian tissue cryopreservation.

BACKGROUND: The scarcity of human ovarian tissue is a major problem in developing research on ovarian cryopreservation. We were interested in ovarian cortex surrounding benign ovarian cysts harvested during their requisite operations. METHODS: Ovarian tissue was collected from 25 women (mean age = 27.7 +/- 1.0 SEM) and frozen in serum-free cryoprotective medium. Histological and viability analysis were performed on fresh and frozen-thawed slices of tissue. RESULTS: Dermoid (n = 7), endometriosis (n = 13) and serous (n = 5) cysts were observed. Follicular densities (expressed per mm3) in ovarian cortex surrounding dermoid cysts were higher than in endometriosis and serous cysts for both histological (median of follicular densities: 13.04, 0.31 and 0.89 respectively) and viability analysis (2.93, 0.05 and 0.71 respectively). Freezing-thawing did not result in gross abnormality of follicle population either in number or morphology (80% of follicles preserved a normal pattern). However, a slight decrease of the density of living follicles (expressed per mm2) was reported. CONCLUSIONS: Ovarian cortex surrounding ovarian cysts, especially dermoid cysts, could be considered a source of ovarian tissue for future research. In our study, the cryopreservation procedure resulted in high follicular survival assessed by both histological and viability analysis. Nevertheless, further studies of in vivo and in vitro follicular maturation are needed to strengthen this model.

Adult↗

PubMed2005

Efficacy of three adhesion-preventing agents in reducing severe peritoneal trauma induced by bipolar coagulation in a laparoscopic rat model.

OBJECTIVE: To compare the antiadhesion efficacy of three agents (4% icodextrin, ferric hyaluronate gel, and Ringer's lactate) in severe peritoneal trauma caused by bipolar coagulation in a laparoscopic rat model. DESIGN: Prospective, randomized, blinded experimental study. SETTING: International Laparoscopic Surgery Centre, Clermont-Ferrand, France. ANIMAL(S): Female Sprague-Dawley rats. INTERVENTIONS: Animals were prospectively randomized to receive one of the three agents or to be controls. Coagulation of the parietal peritoneum was performed using a bipolar 40-W current followed by administration of an antiadhesion agent. Postoperative adhesion assessment was carried out on day 7 in 42 rats. MAIN OUTCOME MEASURE(S): Adhesions were scored according to their extent and severity. RESULT(S): Adhesions occurred in all rats, however, adhesion and vascular adhesion rate scores were significantly higher in controls compared with treated groups. Adhesions were more likely to be filmy and easily separable in the 4% icodextrin group compared with the Ringer's lactate solution group. CONCLUSION(S): Adhesion scores were decreased by the use of antiadherent agents. However, no rats were found to be free of adhesions after severe peritoneal trauma induced by 40-W bipolar coagulation of the peritoneum.

Animals↗

PubMed2004

Ectopic pregnancy is again on the increase. Recent trends in the incidence of ectopic pregnancies in France (1992-2002).

BACKGROUND: We aimed to assess the recent incidence trends of ectopic pregnancies (EP) in France (1992-2002). METHODS: A population-based register of all women aged 15-44 years with EP was set up in Auvergne (central France). We calculated rates of EP as a 'reproductive failure' or as a 'contraceptive failure', frequencies of exposure to the two main risk factors for EP (cigarette smoking and chlamydial infection) and contraceptive methods between 1992 and 2002. RESULTS: The overall EP rate decreased by 2%, from 96.4 per 100 000 women aged 15-44 in 1992 to 95.3 per 100 000 in 2002. However, the rate of 'reproductive failure' EP increased by 17%, while the rate of 'contraceptive failure' EP, mostly intrauterine device failure, decreased by 29%. CONCLUSION: Appropriate analysis reveals that the rate of EP as reproductive failure is increasing again in France. This result is of interest for many European and North America countries where chlamydial infections or smoking or both are increasing in women of reproductive age. The rates of EP as contraceptive failure and of that as reproductive failure evolve differently in the population and should not be confused in epidemiological studies.

Adolescent↗

PubMed2004

Cyclooxygenase-2 expression in deep endometriosis and matched eutopic endometrium.

OBJECTIVE: To identify any relationship between cyclooxygenase-2 expression and the intensity of severe, endometriosis-related dysmenorrhea. DESIGN: Prospective study. SETTING: University hospital. PATIENT(S): Patients with deep endometriosis. INTERVENTION(S): During surgery, paired samples of tissue representing deep endometriosis and eutopic endometrium were obtained from 46 patients. Control endometrial tissue samples were obtained from 34 fertile women who underwent laparoscopic tubal ligation or reversal of tubal sterilization. Pain assessment for dysmenorrhea was done with a 10-point linear analogue scale. MAIN OUTCOME MEASURE(S): The percentage of surface immunostained for Cox-2 was determined by an immunohistochemical technique. Relationships between pain score for dysmenorrhea and Cox-2 expression were analyzed. RESULT(S): Cox-2 expression was significantly higher in eutopic endometrial stromal cells from patients with deep endometriosis than in stroma from controls during the early, mid, and late secretory phases. In endometriosis patients, Cox-2 expression in eutopic endometrial stromal cells was significantly higher in women with more severe dysmenorrhea (pain score > or =7 vs. <7) during early and mid secretory phases. CONCLUSION(S): Elevated Cox-2 expression in stromal cells in eutopic endometrium from patients with deep endometriosis may play a role in severe, endometriosis-related dysmenorrhea.

Adult↗

PubMed2004

Adnexal torsion after laparoscopic hysterectomy: description of seven cases.

STUDY OBJECTIVE: To discover the prevalence of adnexal torsion after laparoscopic hysterectomy. DESIGN: Retrospective analysis (Canadian Task Force classification II-3). SETTING: A tertiary referral hospital. PATIENTS: One thousand thirty-three women underwent laparoscopic hysterectomies between the years 1995 and 2002. The mean age (+/- SD) of the women at the time of hysterectomy was 43.87 +/- 4.28 years. Intervention. Laparoscopic hysterectomy in which at least one adnexa was left intact. MEASUREMENTS AND MAIN RESULTS: The files of all women with adnexal torsion diagnosed by laparoscopy from 1995 to 2003 were retrospectively reviewed. In seven women, adnexal torsion occurred after laparoscopic hysterectomy. Torsion occurred 2.64 (+/- 1.79) years (mean +/- SD) after hysterectomy. Torsion was treated by laparoscopy in all of the women; either oophorectomy or detorsion and ovariopexy was performed. We calculated the prevalence of this complication to be 7.91/1000. CONCLUSION: Adnexal torsion can occur after laparoscopic hysterectomy.

Adnexal Diseases↗

PubMed2003

Risk factors for ectopic pregnancy: a comprehensive analysis based on a large case-control, population-based study in France.

This case-control study was associated with a regional register of ectopic pregnancy between 1993 and 2000 in France. It included 803 cases of ectopic pregnancy and 1,683 deliveries and was powerful enough to investigate all ectopic pregnancy risk factors. The main risk factors were infectious history (adjusted attributable risk = 0.33; adjusted odds ratio for previous pelvic infectious disease = 3.4, 95% percent confidence interval (CI): 2.4, 5.0) and smoking (adjusted attributable risk = 0.35; adjusted odds ratio = 3.9, 95% CI: 2.6, 5.9 for >20 cigarettes/day vs. women who had never smoked). The other risk factors were age (associated per se with a risk of ectopic pregnancy), prior spontaneous abortions, history of infertility, and previous use of an intrauterine device. Prior medical induced abortion was associated with a risk of ectopic pregnancy (adjusted odds ratio = 2.8, 95% CI: 1.1, 7.2); no such association was observed for surgical abortion (adjusted odds ratio = 1.1, 95% CI: 0.8, 1.6). The total attributable risk of all the factors investigated was 0.76. As close associations were found between ectopic pregnancy and infertility and between ectopic pregnancy and spontaneous abortion, further research into ectopic pregnancy should focus on risk factors common to these conditions. In terms of public health, increasing awareness of the effects of smoking may be useful for ectopic pregnancy prevention.

Adult↗