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Biomedical subjects

M A Bruhat

Publications and source records attributed to M A Bruhat.

At least 145 records · Page 8Linked to original sources
PubMed1986

A preoperative classification to predict the intrauterine and ectopic pregnancy rates after distal tubal microsurgery.

A simple preoperative classification is described to predict the intrauterine and ectopic pregnancy rates following distal tubal microsurgery. Laser CO2 microsurgical salpingostomies were performed on 76 patients between January 1979 and January 1984. All of the patients underwent a preoperative assessment, which included hysterosalpingogram and laparoscopy, to formulate a preoperative classification based on a point system. The patients were divided into four groups according to tubal damage, with a subsequent intrauterine pregnancy rate of 58.3% in grade I, 36.6% in grade II, 9.5% in grade III, and 0% in grade IV. The patients were divided into four groups according to adhesions, with a subsequent intrauterine pregnancy rate of 38.8% with no adhesion, 32.0% with mild adhesions, 26.6% with moderate adhesions, and 5.5% with severe adhesions. From these results, a preoperative management is proposed for patients being considered for either distal tubal microsurgery or in vitro fertilization.

Adult↗
PubMed1986

Conservative laparoscopic treatment of 321 ectopic pregnancies.

From 1974 to 1984, 321 tubal pregnancies were treated conservatively with laparoscopic techniques. Fifteen cases (4.8%) required a subsequent laparotomy or second laparoscopic procedure because of retained trophoblastic tissue. Of 118 patients desiring subsequent pregnancy, 76 had an intrauterine pregnancy (64.4%) and 26 had a second ectopic pregnancy (22%). Eleven of 24 (45.8%) women attempting conception following conservative laparoscopic removal of an ectopic gestation from the sole remaining fallopian tube established an intrauterine pregnancy. In this same group, seven patients (29.2%) had a second ectopic pregnancy. The fertility results were also analyzed according to the previous history. The postoperative intrauterine pregnancy rate was 85.5% among 62 patients without a history of infertility (group I), compared with 41.1% among 56 patients with a history of infertility or a previous ectopic pregnancy (group II). The subsequent ectopic pregnancy rate in group I was 16.1% versus 28.6% in group II. This large series clearly demonstrates the relative safety and efficacy of conservative laparoscopic treatment of tubal pregnancies.

Adolescent↗
PubMed1986

Treatment of acute salpingitis with sulbactam/ampicillin. Comparison with cefoxitin.

Sulbactam/ampicillin and cefoxitin were compared in the treatment of 20 patients with acute salpingitis diagnosed during laparoscopy. Results were evaluated during laparoscopic follow-up at 2 months. Sulbactam/ampicillin appeared to be a better treatment, producing better results in tubal patency, adhesions and persistent inflammation than cefoxitin. In addition, the combination of sulbactam/ampicillin with doxycycline appears to provide better results than the combination of cefoxitin with doxycycline in chlamydial salpingitis. It is concluded that sulbactam/ampicillin is an effective treatment for nonchlamydial salpingitis.

Acute Disease↗
PubMed1986

[Celioscopic treatment of extra-uterine pregnancy].

The treatment of extrauterine pregnancy by coelioscopy is the most extreme refinement of coelioscopic surgery. It is recorded in the modern context of endoscopic surgery. This technique was received with reserve some years ago, when we presented the first case. After more than 250 cases the validity of the treatment has been established, and it has been adopted by other groups, foreigners in particular. It is applicable to non-ruptured tubal pregnancies, and necessitates an early diagnosis. Compared with techniques carried out by laparotomy, it offers the advantage of considerable gain of operative time, and of a considerable reduction in hospitalization, with excellent results on later fertility.

Endoscopy↗
PubMed1985

[Celioscopy in the early follow-up of salpingitis].

The authors report their findings in 34 cases of salpingitis that were diagnosed and controlled laparoscopically one month after treatment had been finished. Four different elements came up: persistence of inflammation, adhesions, tubal patency and the prognosis for future fertility. It would seem that these last three criteria depend greatly on the seriousness at first of the salpingitis, as opposed to the degree of persistent inflammation. The authors show how valuable laparoscopic drainage of a pyosalpinx is and how valuable laparoscopic control after salpingitis is. Having been given these features they can visualise a new approach to the diagnosis and treatment of pelvic infection.

Adolescent↗
PubMed1985

[Vaginal delivery after cesarean section: use of peridural analgesia and oxytocics. Apropos of 87 cases with cicatriceal proof].

The authors report on their experience delivering 87 women vaginally with previous cesarean sections. Epidural anesthesia does not appear to be contraindicated as long as the block is not higher than the level of the tenth thoracic dermatome. The use of an infusion of oxytocin should be accompanied by internal fetal heart monitoring. Furthermore, induction of labor with oxytocic agents appears preferable.

Anesthesia, Epidural↗
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

[Stage 3 intra-epithelial cervical neoplasms. Conservative treatment using CO2 lasers or conization: analysis of 2 years' experience].

Sixty four patients with stage III intra-epithelial neoplasia were seen in colposcopic clinic during a two years period. All were followed up for a minimum of 1 year (ranging 1 to 3 years). 28 patients 43.8%) were treated using the carbon dioxide laser in an ambulatory setting. In 36 patients (56.2%) a cone biopsy was first performed for therapy. Following laser treatment the failure rate is 7%, the failure and recurrence rate 14%. The CO2 laser appears to be an acceptable procedure for C.I.N. III lesions in young women. Selection of lesions is of paramount importance and should be able to reduce the number of therapeutic conizations.

Adolescent↗
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

Pregnancy following salpingostomy: comparison between CO2 laser and electrosurgery procedures.

The purpose of this study was to investigate the value of the CO2 laser in tubal surgery. The results of CO2 laser and electrosurgery procedures in salpingostomy were compared. From January 1977 through December 1978, 30 salpingostomies were carried out by electrosurgery. From January 1979 through January 1981, 38 salpingostomies were carried out by CO2 laser. All cases were performed using a microsurgical approach by the same two surgeons. The results for both groups were analyzed and compared. Despite a slight improvement in the term pregnancy rate with the use of the CO2 laser, no statistically significant difference was found between the two procedures in this series. The CO2 laser's ability to cut bloodlessly through tissue with minimal damage allows all procedures of tuboplasty and results in surgery easily and quickly achieved. This experience suggests that the CO2 laser now represents a safe and effective alternative to electrosurgery in tubal microsurgery.

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↗
PubMed1982

[Induction of ovulation and pregnancy resulting from chronic and pulsatile administration of gonadotropin-releasing-hormone (Gn-RH)].

Amenorrhoea of high origin, namely hypothalamic, reflects inhibition or a drop in endogenous secretion of Gn-RH. Two patients with this trouble were treated with synthetic Gn-RH in a pulsatile way and by a continuous method. We have been using a portable reprogrammable mini-pump (Zyklomat-Ferring) connected up to an intravenous catheter which has delivered 15 to 20 micrograms of Gn-RH for one minute every 90 minutes. This treatment brought about progressive rises in serum concentrations of oestradiol and of LH. The ovulation was obtained in both women, and checked by the demonstration by ultra-sound of rupture of the dominant follicle and by estimation of plasma and progesterone levels. One of them became pregnant following this treatment. This kind of therapy seems to us to be an attractive physiological alternative for induction of ovulation.

Adult↗