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Biomedical subjects

P Puttemans

Publications and source records attributed to P Puttemans.

16 recordsLinked to original sources
PubMed2005

Transvaginal laparoscopy.

Transvaginal laparoscopy (TvL) offers an alternative to standard diagnostic laparoscopy in subfertile patients without obvious pelvic pathology. With a specially developed needle-trocar system, access to the pouch of Douglas is gained through a needle puncture of the posterior fornix. Performed under local anaesthesia or sedation with the patient in a dorsal decubitus position and using prewarmed Ringer lactate as a distension medium, TvL allows complete exploration of the tubo-ovarian structures without supplementary manipulation. The combination of transvaginal sonography and transvaginal endoscopy, including minihysteroscopy, TvL, salpingoscopy and chromopertubation test, permits the most complete exploration of the reproductive tract and can be used as a first-line investigation of female fertility in a one-stop infertility clinic. As the transvaginal route offers easy access to the tubes, ovaries and fossa ovarica, some operative procedures are possible. However, in the absence of a panoramic view, these will be limited to minor interventions.

Ambulatory Surgical Procedures↗
PubMed2005

Belgian legislation and the effect of elective single embryo transfer on IVF outcome.

In order to reduce the number of multiple pregnancies following IVF, the Belgian government agreed to reimburse laboratory expenses for six IVF cycles up to the age of 42 years, in exchange for restriction of the number of embryos replaced. Data on assisted reproduction outcome before and after the introduction of this new legislation were analysed retrospectively in terms of implantation, pregnancy and multiple pregnancy rates. After the introduction of the new law, the percentage of single embryo transfer increased from 14 to 49%. Implantation rates were 25.9 and 23% respectively. There was no difference in the overall pregnancy rate before and after the introduction (36 versus 37%). Twin pregnancies, however, decreased from 19 to 3%. These findings indicate that elective single embryo transfer significantly decreases the twin pregnancy rate without a reduction in the overall pregnancy rate.

Belgium↗
PubMed2003

Endometriosis: modern surgical management to improve fertility.

Endometriosis is a pleiotropic reproductive condition and the lesions visualized at laparoscopy are only one aspect of this disease process. At present, there is no evidence that surgery for endometriosis can cure infertility. The most important surgery in infertility is ovarian surgery. It is generally accepted that, in most cases, the invagination of the cortex results in the formation of an endometriotic pseudocyst. As a consequence, primordial follicles are present at the base of the cyst. Since surgery is of limited value, the utmost care has to be given to conservation of the patient's fertility. Ablative surgery offers advantages over excision of the cyst in terms of less adhesion formation and better preservation of the ovarian reserve. The ablative eversion technique differs from fenestration and drainage by its access through the site of inversion and resection of the fibrotic ring. Using the new technique of transvaginal hydrolaparoscopy, access to the site of pathology in the fossa ovarica is facilitated. Furthermore, the aqueous distension medium keeps the organs afloat and provides a clear delineation between the organs and adhesions allowing atraumatic reconstructive surgery.

Endometriosis↗
PubMed2000

Hydrosalpinx and ART: hydrosalpinx--functional surgery or salpingectomy?

The debate on the effect of the hydrosalpinx on medically-assisted reproduction has demonstrated the importance of understanding the complex pathophysiology of the hydrosalpinx in outlining the principles of its clinical management, whether it is by functional surgery or IVF, preceded or not by salpingectomy. New endoscopic techniques are available to accurately assess, both in the operating room and the office, the quality of the tubal mucosa. The direct endoscopic evaluation of the tubal mucosa in hydrosalpinges is at present the most reliable technique to select between functional surgery and preventive salpingectomy. In future, prospective randomized studies on salpingectomy will benefit greatly from accurate clinicopathological data.

Fallopian Tube Diseases↗
PubMed1996

Reconstruction of the ovary containing large endometriomas by an extraovarian endosurgical technique.

OBJECTIVE: To describe and evaluate the surgical treatment of large ovarian endometriomas by an extraovarian endosurgical technique. DESIGN: Prospective case series study. SETTING: University center and tertiary referral center for endoscopic surgery. PATIENTS: Patients with large ovarian endometriomas. INTERVENTION: A two-step endosurgical procedure: the first step is a combined diagnostic and operative procedure confirming the diagnosis and preparing the involution of the pseudocyst and the second step includes adhesiolysis and superficial coagulation of the inverted cortex. MAIN OUTCOME MEASURES: Operative findings and recurrence of endometriomas in the operated ovaries. RESULTS: Sixteen patients presenting with 20 large typical ovarian endometriomas were operated using the two-step endosurgical technique. Both steps were performed on 18 endometriomas. One patient with bilateral endometriomas refused the second endoscopic procedure. The long-term follow-up showed no recurrence in the 18 ovaries that were treated by the two-step endoscopic technique. CONCLUSIONS: The two-step extraovarian endosurgical technique can be applied in large typical endometriomas to reconstruct the ovary without excision and is followed by a low recurrence rate.

Adult↗
PubMed1995

Reflections on the way to conduct an investigation of subfertility.

Infertility is a worldwide issue in reproductive health. In view of the World Health Organization's definition of health, the psychological and social consequences of infertility simply cannot be ignored. Prevention of infertility is difficult and does not help the couple seeking medical advice for infertility, whereas efficient treatment for infertility is time consuming, expensive and often unsuccessful. This article reflects on a shortened, yet full investigation of both partners' fertility before any treatment whatsoever, which is indispensable once the decision to help the couple medically has been made. By optimizing the use of modern gynaecological endoscopy within the woman's cycle, an exhaustive infertility investigation can be conducted within the span of two couple-physician contacts, thereby responding to the couple's concern, avoiding loss of time and energy due to inappropriate therapies, and directing the subfertility treatment correctly from the start. Trained gynaecologists can easily conduct this investigation in fertility centres in developed countries, as well as in centres for family planning in developing countries. The investigation can be employed either with an emphasis on diagnosis alone (and then even under local anaesthesia) or, if the necessary infrastructure is available, in combination with operative endoscopy under general anaesthesia where indicated.

Adult↗
PubMed1995

Intrauterine insemination: a first-step procedure in the algorithm of male subfertility treatment.

Despite the widespread clinical use of intrauterine insemination (IUI) in the treatment of male subfertility, its therapeutic value remains unclear. The objective of this review was to determine why its efficacy has not been consistently documented in the literature and to give strong evidence supporting the therapeutic merit of ovarian stimulation/IUI in male subfertility treatment. Because (i) this technique is much easier to perform and less expensive than assisted reproduction methods, and seems to be reasonably effective in controlled studies of a male subfertility treatment, and (ii) we may expect that financial resources available for the health care of infertility patients will be limited in the future, we believe that ovarian stimulation/IUI must become the first-line treatment in most cases of male factor subfertility, provided that the multiple gestation incidence can be reduced to an acceptable level.

Algorithms↗
PubMed1989

The clinical value of salpingoscopy in tubal infertility.

A specially designed rigid salpingoscope has been developed to allow inspection of the tubal mucosa during laparoscopy. The presence and extent of intratubal adhesion formation can be evaluated more accurately by this technique than by either HSG or laparoscopy. In 22 patients with bilateral hydrosalpinges, an intrauterine pregnancy rate of 59% was achieved in the group of patients with very mild mucosal lesions and absence of mucosal adhesions.

Fallopian Tubes↗
PubMed1989

Endometriosis--current concepts.

Endometriosis is a disease of unknown aetiology, multiple presentations and an enigmatic course during a woman's reproductive years. Clinical aspects of the diagnosis and the rationale for its treatment are discussed.

Endometriosis↗
PubMed1987

Histology and ultrastructure of human endometriotic tissues treated with dydrogesterone (Duphaston).

The histological and ultrastructural changes of ectopic endometrium were studied during treatment with dydrogesterone (Duphaston) in eighteen infertile patients with laparoscopically confirmed endometriosis. Three types of response to therapy, i.e. no response, moderate and good, are detailed. First, focal secretory transformation of the endometriotic epithelium with decidualization of the ectopic stroma was seen in four patients (no response to therapy). In all other patients, the endometriotic implants were undifferentiated (moderate response to therapy) or revealed morphologic features of involution (good response to therapy). Proliferation of endometriotic cells was not seen during treatment with Duphaston, while total eradication of microscopic implants was never observed. Endometriotic implants with good response to Duphaston therapy demonstrated an enhanced autophagic activity within many epithelial cells. Only two patients conceived during a one-year post-treatment follow-up. Both patients demonstrated a good response to therapy.

Cell Nucleus↗
PubMed1987

Salpingoscopy versus hysterosalpingography in hydrosalpinges.

A technique of translaparoscopic salpingoscopy is utilized to evaluate the ampullary segment of the Fallopian tube in patients suffering from infertility. Comparison of this technique with hysterosalpingography in a series of 32 patients with hydrosalpinges demonstrates its superiority in the evaluation of the tubal mucosa. This new diagnostic approach allows a more accurate selection of patients for either microsurgical repair, in-vitro fertilization (IVF) or gamete intra-Fallopian transfer (GIFT).

Endoscopy↗
PubMed1987

Salpingoscopy: a new pre-operative diagnostic tool in tubal infertility.

Endoscopy of the fallopian tube allows examination of the tubal mucosa in subfertile patients. Clinical and morphological studies have shown a high correlation between the appearance of the tubal mucosa and the ultimate outcome in terms of pregnancies. Salpingoscopy was originally performed during laparotomy for reconstructive tubal surgery. The present study describes the use of a rigid 3 mm telescope passed along the channel of the operating laparoscope to assess the mucosa of the infundibulum and ampullary segment. Lesions of the infundibulum and ampullary segment have been detected in patients with apparently normal tubes on the hysterosalpingogram and at laparoscopy. The extent of the mucosal lesions can be assessed preoperatively in patients with tubal adhesions, tubo-cornual or isthmic lesions and hydrosalpinges.

Endoscopy↗
PubMed1986

Carbon dioxide laser vaporization of cervical subclinical papillomaviral infection and intraepithelial neoplasia: short-term effectiveness.

134 patients with biopsy-proved cervical subclinical papillomaviral infection (SPI) (the so-called 'flat condylomas'), or with associated intraepithelial neoplasia (also called 'atypical condyloma' or 'CIN with features of condyloma'), or with isolated, apparently 'non-warty' intraepithelial neoplasia were treated by means of the carbon dioxide laser between July, 1982, and January, 1985, following a planned approach and on an outpatient clinic basis, without the use of anesthesia or analgesia. The complication rate was extremely low. The overall cure rate was 91.0%. This confirms that laser surgery, combined with colposcopic expertise, can offer acceptable treatment effectiveness, comparable to other techniques of local destruction. Moreover, rapid tissue healing allows early identification of persistent disease. Converging cytological, histopathological, immunochemical and serological evidence has established human papillomavirus - belonging as a subgroup to the papovavirus family - as an important etiologic factor in female genital tract carcinogenesis. The marked increase in prevalence of these mainly sexually transmitted cervical SPI lesions creates a growing problem of their management and/or follow-up.

Adolescent↗