[Results of microsurgery of tubal sterility. Cooperative studies of French-speaking countries].
Explore the source record for details and available documents.
Biomedical subjects
Publications and source records attributed to A Bremond.
Explore the source record for details and available documents.
There are important barriers in the correct evaluation of the anatomic involvement of malignant ovarian tumors. Nevertheless, it seems advisable to rationalise the criteria of involvement. The authors relate the past classifications of Heyman, Helsel, Munnel, Davis, Gellé, Rutledge and Burns. The most widely accepted present-day classifications are the TNM system of the UICC and above all that of the FIGO. It seems that an attempt at unification between the two systems is recommendable. However, all classifications are arbitrary in nature because of the very diversity of carcinoma of the ovary.
A continuous flow perfusion system which has been improved for the culture of large pieces of tissue, e.g. epididymis and ovarian follicles was tested for the entire oviduct in women, rabbits and rats. The histological properties of the organ were maintained after a day or two of culture; but only in the presence of oestrogens. Progesterone seems to induce a weakness of epithelial cell attachment and these become scattered in the lumen. In women the cultures seemed to be more or less permanently contamined, probably due to commensals, because this problem did not occur with rat or rabbit oviducts.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
The Fallopian tubes of 18 women who were either in reproductive age or were menopausal were studied by scanning electron microscopy. There were different cells seen in the epithelium. These were ciliated and non-ciliated cells, and cells, with a single cilium which was central and cells with short cilia. These elements undergo cyclical changes: secretory phenomena are at their maximum during the ovulatory phase. There is no sudden desquamation in tubal epithelium, nor is there massive deciliation. All the same, there are images that look like marguerites (described in the text) which are evidence of cellular regeneration. The appearance suggests a state of rest in precocious menopausal women and in pregnancy. The phenomena seen during the secretory phases disappear and the distribution of the cells is modified. Deciliation is found 20 to 30 years after the menopause. The physiological significance of these phenomena is still uncertain and their role in pathology has still to be defined.
The authors have studied by step serial sectioning 312 cervix the most obtained by cold knife conization. They have studied too, the frequency of inadequate resection (i.e. non in sano conization) and clinically occult invasion according to the age of patients. Conization is adequate for the treatment of 70 per cent of women less than 30 years of age. But after 50 it is sufficient in only 22 per cent of the patients. Conization must be performed in most cases of grade III to V cervical smear (according to Papanicolaou's classification). The cervical cone must be studied by serial sectioning (every 500 microns). According to the result of this study the treatment must be selected : conization for in situ carcinoma resected in sano, simple hysterectomy for in situ carcinoma not resected in situ and Wertheim type operation for invasive carcinoma.
The authors undertake to show that the obstetric future of women who have been operated on for uterine synechiae is not as poor as would appear from previous publications. 59 p. 100 of 75 women who wanted to become pregnant did so and 46 p. 100 went on to have at least one living child. If one only takes into account those women who were able to be followed up, 71 p. 100 became pregnant and 55 p. 100 had pregnancies with a viable child. When women with only uterine synechiae and without an associated lesion were considered, 81 p. 100 of them became pregnant and 67 p. 100 had a viable child. From this it is important to screen for an associated lesion by laparoscopy. The authors also write about the value of hysteroscopy carried out to find synechiae more easily and to control the treatment.
Seventy seven cases of micropolycystic ovaries were reviewed. All of the patients underwent either coelioscopy or wedge resection of the ovaries. It was thus possible to classify the patients into two groups on the basis of the size of the ovaries (MPCO-A, large ovaries, more than twice the normal size; MPCO-B, ovaries only slightly increased in size or normal). There were differences from a clinical, laboratory and therapeutic standpoint. In MPCO-A, spaniomenorrhea predominated, clinical hyperandrogenism was often absent and 17 ketosteroids lower. Response to hypothalamic gonadotrophic hormone liberation factor was explosive in luteotrophic hormone, but at 120 minutes levels were lower in MPCO-A than in MPCO-B. Wedge resection failed completely in 23% of cases of MPCO-A and in 66% of cases of MPCO-B. This study confirmed current concepts of the heterogeneity of MPCO syndrome.
Explore the source record for details and available documents.
Ninety nine cases of carcinoma in situ of the cervix are reported. In all cases, the definitive diagnosis was established after study of an operative specimen (cone biopsy or hysterectomy) examined by serial section. Pre-operative cytology was falsely negative (or suggestive of simple dysplasia) in 35,4 per cent of cases and pre-operative biopsy falsely negative in 40 per cent. These errors were approximately twice as common in cases in which dysplasia was present in association with the caricinoma (40 cases) than in those cases in which the malignancy alone was present (59 cases). The practical conclusions which may be drawn from these findings in relation to detection and diagnosis are discussed.
The authors studied the effects of acute hypoxia of short duration in eight pregnant ewes that had been anaesthetised. They showed that during the experiment the E.E.G. as well as the pH and pCO and the maternal lactate levels were not changed and that therefore changes that can be found in the fetus are due solely to its own hypoxia and not due to transmission from the mother. In the fetus the trace flattens in about 30 minutes on an average. After this interval a moderate drop in pH occurs at the same time as an increase in lactacidemia and the relationship between lactate and pyruvate. The heart rate is changed in a variable manner: it accelerates if the basal rate is less than 180 beats a minute and slows if it is above 180. Blood pressure rises. Changes in the cardio-vascular system always precede those in the electroencephalograms.
Serum gastrin concentration was measured in newborns and infants with no gastrointestinal disorders, in the fasting state and after food stimulation. Mean fasting concentration in 14 newborns aged 1 to 12 days (130 . 4 pg/ml +/- 11 . 4 SE) was significantly higher than the mean value in 23 infants aged 1.5 to 22 months (101.4 +/- 6.6 pg/ml). Ingestion of the usual milk meal resulted in a definite rise of the serum gastrin level in the 5 subjects tested (3 newborns and 2 infants). The mean fasting serum gastrin level in 6 babies with hiatus hernia and gastro-oesophageal reflux was found to be no different from the corresponding value in 8 age-matched controls. However, a conspicuously raised fasting gastrin concentration was observed in one infant with lower oesophageal dyskinesia. The results indicate that the release of gastrin and the reactivity of the hormone-producing sites to food stimulation in early life are similar to those in adult humans. No defect of gastrin release was shown in patients with gastro-oesophageal reflux.
The authors using the information obtained by X-ray pelvimetry and ultrasound cephalometry in 300 cases of contracted pelves, suggest a diagram of cephalo-pelvic disproportion that can be used in the great majority of cases of contracted pelves. It is not applicable to those where there is significant deformation of the middle strait or an abnormality of presentation. It is divided into three zones: 1. A superior zone, favourable, into which the majority (60%) of cases of contracted pelvis fit. The risk of a serious dystocia during delivery is so small (less than 2%) that it can be considered scarcely different from those found in women with a normal pelvis. 2. An intermediate zone into which 24% of cases of contracted pelvis fit where the prognosis is uncertain. The labour should be considered as an "at risk" labour and a trial of labour conducted. 3. A lower zone into which 16% of the cases fit and which consists of two categories: --those in which the biparietal diameter is equal to or less than 90 mm. Prophylactic caesarean section should be avoided in these cases where disproportion is rare and where there is a risk of delivering a premature infant: and --those more numerous (9 out of 10) where the biparietal diameter is more than 90 mm and where, unless there is a clinically definitely favourable prognosis, it is justifiable to carry out prophylactic caesarean section. If this line is followed: one can avoid a large number of trials of labour, all of which are inconvenient and some of which are dangerous for the child; few unnecessary caesarean sections are carried out.
Over recent years, communication within the physician-patient relationship has been profoundly changing. New modes of conveying diagnostic and therapeutic information influence the way in which decisions regarding treatment are made. We propose a critical review of the various theoretical models as presented in the literature, from the paternalistic to the shared decision model, in order to reveal conceptual ambiguities and their related methodological problems. This analysis leads to a project for clarifying these problems through a research protocol based on shared decision-making.
The authors report their experiences in recording foetal E.E.Gs at the time of labour, based on 140 studies. They studied normal E.E.Gs and emphasise the existence of a sleep-waking pattern during dilatation. They consider the E.E.G. changes during the different stages of labour and assess the results against other techniques used to assess foetal well-being. They record the effects on the E.E.G. of various anaesthetics and analgesics given to the mother. The difficulty of the technique is stressed and they conclude that despite the obvious interest of the technique it is not currently suitable for routine obstetric practice.