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Biomedical subjects

M A Bruhat

Publications and source records attributed to M A Bruhat.

At least 19 recordsLinked to original sources
PubMed1992

Effect of administration of an analog of LHRH on appetitive learning in young and middle-aged female rats.

Hypothalamic luteinizing hormone-releasing hormone (LH-RH) had been reported to induce changes in defensive learning. In middle age, females exhibit a decline in their reproductive axis. Several studies in rodents suggested that hypothalamic LHRH function deteriorated in middle-aged females. Our experiments compare T-maze learning in young and middle-aged female rats and study the effect of administration of an analog of LHRH, D-Trp6-LHRH. The ovarian action of the analog was studied and a gonadectomized control group was added. No differences were observed between young and middle-aged females in acquisition, retention, and reversal of a simple discrimination in the T-maze. However, after removal of motor and spatial cues acquisition of the discrimination on visual cues was impaired in middle-aged females compared to young mature ones. Administration of D-Trp6-LHRH enhanced performance during the visual discrimination in younger females and had no action in middle-aged ones, whereas it inhibited ovary function in both groups. Ovariectomy had no effect. These results suggest a direct effect of the analog of LHRH on the CNS and show that this peptide fails to counteract the deleterious effect of age on performance.

Aging↗
PubMed1992

Results of conservative laparoscopic treatment of isthmic ectopic pregnancies: a 26 case study.

Twenty-six ectopic pregnancies located strictly within the isthmus were treated surgically using conservative laparoscopic techniques. In each and every case, the Triton monopolar electrode was used to perform salpingostomy which was followed by aspiration of the trophoblast. This therapeutic approach is very reliable since only one failure was observed (3.9%), requiring a further operation during which salpingectomy was carried out by laparoscopy. It was possible to evaluate subsequent fertility for 11 patients, seven of whom (63.6%) obtained an intrauterine pregnancy and only one patient (9.1%) had a recurrence. This highly satisfactory prognosis is perfectly comparable with that obtained with treatment via laparotomy with segmental resection of the isthmic portion of the tube and immediate or delayed anastomosis. These very encouraging results mean that conservative laparoscopic treatment presents an advantageous alternative to classic surgical treatment for isthmic ectopic pregnancies, in that the patients are spared a laparotomy.

Female↗
PubMed1992

Fertility following laparoscopic management of benign adnexal cysts.

Fertility following laparoscopic treatment of benign adnexal cysts without ovarian suture was studied retrospectively. Patients with endometriomas or who were previously infertile were excluded. Thirty-eight patients treated conservatively were included, 10 after partial resection of functional cysts, 23 after an ovarian cystectomy and six after treatment of a paraovarian cyst. One patient had two cysts. The overall intrauterine pregnancy rate was 92%; one patient had an ectopic pregnancy (2.6%). From these results, we conclude that fertility following laparoscopic treatment of adnexal cysts appears to be normal. Technical guidelines to improve laparoscopic cystectomy are proposed.

Adnexal Diseases↗
PubMed1992

[Use of a local antibiotic combination in the treatment of mycotic vaginitis and mixed vaginitis].

This open clinical trial in 121 patients carried out by gynaecologists shows the difficulty in establishing the clinical diagnosis of vaginal candidosis or vaginal infectious candidosis. On the other hand, specific vaginitis can easily be identified, without carrying out vaginal smear. Bacteriological and clinical arguments show the efficacy of using an antibiotic association by the vaginal route for the treatment of these types of vaginitis (candidosis or infectious candidosis). The product is particularly interesting in all cases where vaginal smear have not been taken.

Adolescent↗
PubMed1992

[Laparoscopic hysterectomy. Results in 44 cases].

Laparoscopic hysterectomy is a recent procedure. We present our preliminary results about 44 patients. In 77.3% of cases (34 patients) the operation was carried out completely by laparoscopy and 10 patients (22.7%) required conversion of the laparoscopy to a standard laparotomy. The indications for laparotomy were: hemostasis difficulties (6 cases); bladder injury (1 case); inability to expose the uterine pedicles and or the ureter (3 cases). Three post-operative complications occurred: one small bowel occlusion which was explored by laparoscopy, and two infection treated by antibiotics only. These preliminary results enable us: to affirm that laparoscopic hysterectomy is feasibility without an important risk of per and or post-operative complications. to specify the four situations in which laparoscopic surgery is particularly advantageous for hysterectomy: absence of genital prolapse; when uni or bilateral adnexectomy is required; previous past-history of abdomino-pelvic surgery, salpingitis, endometriosis ...; neoplastic pathologies (lymphadenectomy); to propose a laparoscopic hysterectomy classification.

Adult↗
PubMed1992

[Technique and preliminary results in second-look laparoscopy in epithelial malignant ovarian tumors].

Second-look laparotomy is the usual mean of intraperitoneal evaluation in patients treated for ovarian carcinoma. We present a preliminary study of 33 second-look. Thirteen of these procedures were performed by laparoscopy. Because of previous surgical history a specific technique is necessary including safety tests, cytologic evaluation after peritoneal washing, and biopsies of any abnormal peritoneal areas, original tumors sites and normal appearing peritoneum. In order to achieve the evaluation of the entire peritoneal cavity a complete bowel adhesiolysis is required. For trained laparoscopists the surgical complication rate is low. In this preliminary study we found that prognosis following negative second-look laparoscopy and second-look laparotomy are similar, suggesting that laparoscopy is a valuable alternative to laparotomy for second-look evaluation in ovarian cancer.

Carcinoma↗
PubMed1992

[Recurrence after conservative celioscopic treatment of a first ectopic pregnancy].

Conservative laparoscopic treatment by salpingotomy was performed on 192 patients who presented with a first ectopic pregnancy (EP). The overall fertility results show that 139 patients (72.4%) obtained an Intra Uterine Pregnancy (IUP), whereas only 18 patients (9.4%) suffered a recurrence. The risk of ipsilateral recurrence is 66.7% (12 cases). For the 14 patients presented with two patent tubes after conservative laparoscopic treatment of a first EP, the ipsilateral recurrence rate is 57.1% (8 cases). The side of the recurrence is directly influenced by the patient's previous history. While 88.9% (8 cases) of recurrence are ipsilateral for patients presenting previous tubal history, this rate is only 44.4% (4 cases) when tubal factors are absent (p less than 0.05). This prompts us to recommend laparoscopic salpingectomy for patients with a serious past tubal history. In these patients recurrence is ipsilateral in more than three out of four cases. On the other hand, for patients with no or few tubal factors the treatment has to be conservative.

Evaluation Studies as Topic↗
PubMed1992

[Complications of gynecologic laparoscopy. Multicentric study of 7,604 laparoscopies].

In a series of 7,604 laparoscopic procedures, the authors report one death and a rate of 2.76 per thousand (21 cases) for complications requiring laparotomy. When exclusively diagnostic laparoscopic procedures are considered (1,191 cases) this rate drops to 1.67 per thousand. The likelihood of laparotomy being required is directly related to the degree of importance of the laparoscopic surgical procedure. For major laparoscopic surgery the rate of laparotomy is 4.46 per thousand (18 cases), whereas it is only 0.42 per thousand (1 case) for minor laparoscopic surgery (p less than 0.01). Intestinal injuries represent 52.4% (11 out of 21) of cases requiring laparotomy. The main problem with this type of accident is to recognize them, because in almost half the cases (42.8%; 3 out of 7) the intestinal injury went unseen during the laparoscopic procedure and gave rise to peritonitis. Vascular complications are less frequent and required laparotomy in only 8 cases (38%; 8 out of 21). This low level of complications is yet further proof that laparoscopic surgery is a reliable technique and does not involve a high risk of laparotomy, provided that the surgeon has received specific training.

Female↗
PubMed1991

[Ectopic pregnancy. Techniques and results of celioscopic treatment].

As in laparotomy the laparoscopic treatment of ectopic (EP) can be either conservative or radical. After conservative laparoscopic treatment, the risk of failure is comparable to what has been observed after the same treatment by laparotomy and the post-EP fertility results are better than those observed after treatment by laparotomy. These results, associated with the advantages of endoscopy over laparotomy, enable us to say that the laparoscopic treatment is nowdays the best surgical treatment of EP. The post-EP fertility is determined by previous patient's history, whereas the characteristics of the EP do not affect or only slightly affect fertility. A multifactorial analysis enabled us to quantify the pejorative impact on fertility of each of the factors which significantly affect the fertility results. We thus propose a therapeutic scoring system of EP designed to choose the treatment which will better preserve the fertility of the patients who wish to become pregnant.

Female↗
PubMed1991

Present day endoscopic surgery in gynecology.

The last ten years have been characterized by a tremendous change in laparoscopy. Initially used exclusively for diagnosis, laparoscopy is now a surgical method in its own right and plays a strategic role. Long-term evaluation of results for various pathologies (such as ectopic pregnancy and tubo-peritoneal sterility) means that just one laparoscopic procedure can be used for diagnosis, selection of the best therapeutic approach and also for treatment in those cases where laparoscopy is the optimum choice. Other more recent indications (including hysterectomy, lymphadenectomy etc.) which are now possible thanks to recent technological developments (such as clips and mechanical sutures) need long-term analysis of their results.

Endometriosis↗
PubMed1991

Multifactorial analysis of fertility after conservative laparoscopic treatment of ectopic pregnancy in a series of 223 patients.

OBJECTIVES: To lay down the criteria to clearly define whether conservative or radical laparoscopic treatment should be adopted in cases of ectopic pregnancies (EP). DESIGN: Retrospective, noncomparative. SETTING: At the University Hospital of Clermont Ferrand and the La Pergola Clinic at Vichy from July 1974 to December 1987. PATIENTS: This study was carried out in 223 patients who had been treated laparoscopically for EP and who desired future childbearing and who were not lost to follow-up. MAIN OUTCOME MEASURES: The measures chosen to achieve the objective included age, parity, size of hematosalpinx, volume of hemoperitoneum, tubal rupture, location, intrauterine device, ipsilateral and contralateral adhesions, and patient's previous history of salpingitis, EP, solitary tube, and tubal infertility. RESULTS: The general intrauterine pregnancy rate was 67% (149 patients) and the recurrence rate 12% (27 patients). The results according to the studied factors demonstrated that age, parity, and the type of the EP have no influence on the postectopic fertility. The history of the patient, ipsilateral adhesions, or contralateral tubal status significantly reduce the future fertility prognosis and risk of recurrence. CONCLUSIONS: From a multivariable analysis, the authors propose a scoring system to choose the most suitable treatment to preserve fertility and to reduce the risk of recurrence ranging from laparoscopic conservative treatment to laparoscopic salpingectomy with contralateral sterilization.

Abdomen↗
PubMed1991

Laparoscopic distal tuboplasty: report of 87 cases and a 4-year experience.

OBJECTIVE: To evaluate fertility results after laparoscopic distal tuboplasty and to compare these results with those obtained previously with microsurgery. DESIGN: Retrospective, nonrandomized. SETTING: Department of Obstetrics and Gynecology at the University Hospital of Clermont-Ferrand, France. PATIENTS: All the distal tuboplasties performed between October 1985 and June 1989 were included. Adnexal damage was assessed using tubal and adhesions scoring systems described previously. Tuboplasty was carried out bilaterally except when one tube was absent or severely damaged (tubal stage III or IV and/or with severe adhesions). Patients with bilateral severe adnexal damages were treated only if they refused to undergo in vitro fertilization. Laparoscopic tuboplasty was performed either with the CO2 laser or with conventional instruments. MAIN OUTCOME MEASURE: Fertility after laparoscopic treatment was evaluated using simple and cumulative pregnancy rates (PRs) according to the adnexal damage and compared with the microsurgical results using PRs according to the adnexal damage. RESULTS: The overall intrauterine and extrauterine PRs were 33.3% and 6.9%, respectively. Twenty-six of the 29 intrauterine pregnancies were obtained within the 1st postoperative year. According to tubal and adhesion stages, the results of laparoscopic distal tuboplasty are similar to those obtained using microsurgery. CONCLUSION: We conclude that laparoscopic distal tuboplasty, when performed by experienced surgical laparoscopists, represents an effective alternative to microsurgery.

Adult↗