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Biomedical subjects

A J Audebert

Publications and source records attributed to A J Audebert.

At least 19 recordsLinked to original sources
PubMed1998

Laparoscopic fimbrioplasty: an evaluation of 35 cases.

The aim of this prospective study was to assess the value of laparoscopic treatment of severe fimbrial occlusions. During a period of 52 months infertile patients with fimbrial lesions were treated by operative laparoscopy. Only those patients requiring incision of the tubal serosa (salpingostomy) were included, representing the most severe lesions. The most frequent cases, those patients requiring simple adhesiolysis and deagglutination of the fringes, were excluded. All tubal lesions were documented carefully. Positive Chlamydia trachomatis (CT) serology was found in 65.7% of the patients. All the patients were followed up for at least 2 years. Three patients lost to follow-up were defined as failures. The global conception rate was 74.3%. The intrauterine pregnancy rate was 51.4%, and the 'take home baby rate' was 37.1% (only the first pregnancy being taken into account). The ectopic pregnancy rate was 22.9%. A positive CT serology was found to have a significant influence on the outcome. It can be concluded that the laparoscopic approach provides results similar to those obtained by microsurgery for the treatment of severe fimbrial occlusions, and represents an acceptable alternative to in-vitro fertilization (IVF) in selected cases.

Chlamydia Infections↗
PubMed1996

Laparoscopic surgery for ovarian cysts.

Laparoscopic surgery for ovarian cysts is one of the most frequent laparoscopic surgical procedures performed presently. The routine use of pelvic imaging (sonography), in the case of any gynaecological symptom or as a screening method in women at risk, explains why more and more ovarian cysts are encountered. The diagnostic and therapeutic challenge for the clinician to provide the best immediate and long-term benefits for the patient is to identify pre-operatively not only an ovarian malignancy (to be treated in a conventional way) but also functional cysts (usually disappearing spontaneously and requiring no form of treatment in most cases). Ideally, only benign 'organic' cysts should be treated laparoscopically. The technical aspects and the benefits of this approach have been documented extensively in recent years. The routine use of the 'closed technique' and of an impermeable bag for removal should limit the risk of spillage of the cyst contents with its inherent potential problems (chemical peritonitis, malignant cell dissemination and parietal implantation into the laparoscopic port sites). The adnexal torsion can be also properly managed by laparoscopic surgery.

Feasibility Studies↗
PubMed1993

[Treatment using laparoscopic surgery of dermoid cysts. Apropos of a series of 33 cysts].

Laparoscopy is a surgical method which is now widely used for the treatment of ovarian cysts. The authors wish to present their experience concerning the management and treatment of dermoid cysts or dysembryomas since these lesions embody all the problems persisting in this field. They report 33 cases exclusively treated by laparoscopic surgery in a series of 407 adnexal cysts treated over a 4-year period (April 1988 to April 1992). As regards diagnosis, the principal difficulty is not to miss the odd malignant lesion (1 to 2%) encountered mainly in older women. Technically, the most delicate stage in the operation is extraction of the cyst, especially when it is large and has an important solid component. Provided all precautions are taken in the diagnosis and the operative technique, this new method seems to be quite acceptable as it enables women who carry these lesions, which require excision, to benefit from the well-known advantages of laparoscopic surgery.

Adnexal Diseases↗
PubMed1992

[Ovulation induction by endogenous LH released by the administration of an LHRH agonist after follicular stimulation for in vitro fertilization].

Sixty-seven patients whose ovulation was stimulated following a protocol of Clomiphene Citrate/HMG in order to carry out in vitro fertilisation were divided randomly in to two groups. In the first group ovulation was provoked by giving 10,000 IU HCG IM, but in the other group ovulation was provoked by releasing endogenous LH after the administration of Triptoreline in a dose of 0.1 mg in a dose subcutaneously three times in one day at 8 hour intervals. The number of oocytes recovered, cleavage and embryo transfer were compared between the two groups over 48 cycles. The number of conceptions was statistically significantly higher in the group that had triptoreline (28%) as compared with 17.4% pregnancies in the other group (p less than 0.01). These figures confirm that the endogenous LH surge provoked by giving an LHRH agonist can cause adequate final oocyte maturation. This property which is associated with a very low risk of hyperstimulation, should make it possible to stimulate ovulation when it is not used for IVF and so replace the usual injection of chorionic gonadotrophins.

Adult↗
PubMed1990

[External endometriosis: histogenesis, etiology and natural course].

Since the initial description of endometriosis, several histogenetic theories have been put forward. Endometriosis has been attributed either to coelomic metaplasia, or to embryonic remnants or to the dissemination by various routes and subsequent grafting of endometrial fragments; this would explain the different anatomical locations of the disease as found clinically. Several contributing factors are also involved, including menstrual reflux or, more hypothetically, disturbances of local hormonal conditions, familial and genetic factors and possibly immune disorders. The role played by these factors has been demonstrated by clinical, epidemiological or experimental studies. Owing to our knowledge of histogenesis and of the aetiological factors involved in the development of endometriosis, the risk factors of the disease and its natural history are now better understood, and a better approach to its treatment will perhaps be found in the near future.

Endometriosis↗
PubMed1990

[Occult and minimal forms of endometriosis: therapeutic strategies].

The hidden forms of endometriosis, especially the microscopic or non visible endometriosis, are entities presenting difficult problems for the diagnosis and sometimes the selection of a treatment; non visible endometriosis seems to be more of an interesting theoretical concept as long as its existence and clinical significance will not have been better documented and confirmed. Minimal endometriosis (Stage I of the AFS-1985 classification) is frequent in infertility cases and its incidence is probably underestimated because of atypical aspects better known today. Its relationship with infertility still seems hypothetical, even if new data seem to implicate it to a greater degree. Numerous disorders have been found to explain the harmful effect of endometriosis on sterility. All the usual means of treatment of endometriosis may be selected; however, coelioscopic destruction at the time of the diagnosis seems most appropriate in case of pain or infertility; in the latter group, secondarily, a short medical treatment may be used before resorting to Fertilization in vitro of GIFT, which will be preferred if the patient is older and there is a long history of infertility.

Adult↗
PubMed1989

[Use of Polygynax in pregnant women for preventing cervico-vaginal infections].

115 women, distributed in 20 centres, were included in a randomized study designed to assess the efficacy of Polygynax in preventing vaginal infections in women at risk, at the start of pregnancy. Polygynax proved to be markedly effective since only 9.6% of the patients in the Polygynax group had a vaginal infection, in contrast to 42.6% of the patients in the control group. This result is highly significant (p less than 0.0001) and confirms the advantage attached to the use of Polygynax when a first line treatment involving the use of several drugs in combination is indicated.

Adult↗
PubMed1989

[Fertilization in vitro and embryo transfer (FIVET) and endometriosis. Uncertainties and issues].

The progressive improvements in the results and extra simplification of the recent techniques for in vitro fertilisation and embryo transfer (IVFET) have contributed to broadening the indications for this method of assisted reproduction. Endometriosis has not escaped this evolution and more and more works referring to the use of IVFET for this indication. All the same, there are many questions which have not been clearly answered. The possible variety of causes for this condition, the number of factors that may be causing the infertility, make it difficult to assess completely the method of therapy, and require that controlled studies should carried out. These are not always easy to perform. IVFET is no exception to these difficulties. The relationships between endometriosis and infertility are complex and very often difficult to assess. All the same, very many hypotheses have been put out to explain the deleterious effect of this abnormality. Certain mechanisms have been suggested (such as troubles with maturation of the follicle and of the oocyte and the production of a hostile environment for the gametes and for the embryo). These are logical arguments for IVFET which initially produces follicular maturation and takes the gametes and the embryo away from the peritoneal and tubal environment. In spite of certain hypotheses which would be unfavourable in cases of endometriosis (oocytes being less likely to be fertilised, poorer quality of the embryos, defective implantation...) the results that have been obtained after IVFET are overall very favourable and certainly can compare with those obtained when it has been used for, for instance, tubal indication.(ABSTRACT TRUNCATED AT 250 WORDS)

Embryo Transfer↗
PubMed1989

[Rapid determination of plasma progesterone. Its value in ovarian stimulation for in vitro fertilization].

Plasma Progesterone levels show definite variations during the periovulatory period of the superovulated cycle similar to those of the physiological cycle. The question arises whether the pattern of these variations is of significance with regard to the success rate of the IVF cycle. This prospective study was conducted with a rapid and highly sensitive radioimmunoassay of plasma progesterone labelled with Iodine 125. A total of 452 cycles were initiated in 328 patients (280 cycles using a clomiphene citrate-HMG regimen, 272 cycles using an association of LHRH analogues with HMG according to three different protocols). Ovarian response was monitored with sonography and rapid plasma radioimmunoassays of 17 beta-estradiol, progesterone and LH (in non-analogue cycles). Plasma progesterone in particular was assayed 17 hours before, at the time, and 7 hours after the administration of HCG. 10,000 UI IM for triggering ovulation. During the Clomiphene-HMG therapy when LH levels are instable, the plasma progesterone assay is highly discriminant between the beginning of a true LH peak (with concomitant rise of progesterone greater than 1 ng/ml, 15.7% of the cycles) and hectic variations of LH (no concomitant rise of progesterone, 4.3% of the cycles); the progesterone assay was also able to detect the occurrence of ovulation in 3 cycles without sensible variation of plasma LH (1.1% of the cycles). Pre- and post-ovulatory levels of plasma progesterone also demonstrate a prognosis significance with regard to the chances of success of the cycle, with all the different types of ovarian stimulation.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1988

[Intra-uterine insemination with activated sperm. Results of conception compared in the various types of infertility in spouses].

A total of 180 infertile couples were treated with intra-uterine insemination of homologous capacitated sperm. The fertility disorder was: a cervical factor in 80 couples (44.4%), a male factor in 68 others (37.8%) and unexplained infertility in 32 couples (17.8%). All the patients received ovarian stimulation with HMG, and with ultrasonographic monitoring. Insemination was performed when the diameter of the dominant follicle reached 18 mm, and HCG 5,000 UI was given on the same day; another insemination was performed 40 hours later if the dominant follicle was still present. The 0.5 ml insemination sample was prepared through a migration-capacitation procedure into Earles medium which yielded 15% of the total motile spermatozoa in the ejaculate. A total of 22 pregnancies were recorded (12% of the couples) in 659 therapeutic cycles; the results however differed according to the infertility disorder: 18.8% of pregnancies in the cervical factor group, 15.6% in the unexplained infertility group and 2.9% only in the male factor group. The lowest number of inseminated motile spermatozoa for pregnancy to occur was 0.4 million. A mild hyperstimulation syndrome was noted in 28 cycles (3.1%); no complications of infectious or immunologic origin occurred. It appears that a procedure which results in a satisfactory pregnancy rate when the sperm is normal (cervical or unexplained infertility) yields poor conceptional results when the semen is abnormal. In cases where the male factor is predominant, intra-uterine insemination should not be performed in the periovulatory period but at ovulation time, and therefore requires either an accurate detection of the LH peak or complete hormonal and sonographic assessment in a stimulated cycle.

Chorionic Gonadotropin↗
PubMed1987

[Contribution of human menopausal gonadotropins purified as to their FSH content in anovulatory sterility presenting a difficult treatment problem].

A preparation of HMG purified to contain only FSH (FSH 75 IU/LH less than 1 IU) was used in 26 patients who had anovulatory sterility because of sclero-polycystic ovaries. It was a selected population in that all the patients had proved to be resistant to Clomiphene Citrate and at risk with HMG therapy. Purified urinary FSH was used and monitored as classical HMG treatment. 44 treatment cycles resulted in 33 ovulatory cycles (75%) and 6 pregnancies (13.6% per cycle). The number of cases of hyperstimulation (13.6%) was low when it is compared to situations at risk when HCG was administered in 2/3 of the treatment cycles. The results obtained in a population with a bad prognosis can be considered to be very encouraging and gives purified urinary FSH a specific place in our therapeutic armamentarium.

Adult↗
PubMed1985

[Unexplained sterility: practical management].

The treatment of unexplained sterility is a gamble, since by definition it is sterility in which investigation does not show any abnormality in the couple. Sterility cannot be regarded as "unexplained" until after an investigation of which the author describes the progression from the simplest to the most complicated. Uncertainties, paradoxes and controversies will still trouble the unexplained sterilities, within the limits of our means of investigation, for a long time to come.

Female↗