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Biomedical subjects

E Cornier

Publications and source records attributed to E Cornier.

At least 19 recordsLinked to original sources
PubMed2001

[Comparison of 2 therapeutic strategies for severe endometriosis, in young women counsulting for sterility or pain. Results in cases of chronic pelvic pain].

AIM OF THE STUDY: Compare two medical strategies associated to surgery in women requiring for chronic pelvic pain due to stage III-IV endometriosis. MATERIAL AND METHODS: Two different patient groups, A (N 27) and B (N 41), requiring for chronic pelvic pain, associated with AFS stage III-IV endometriosis, operated on from 1992 to 1997, were compared. The medium age was 35 and 34 years, respectively. Pelvic pain, classified in three stages, was similar in both groups but they were more AFS stage IV in group A, 67% than in group B, 46% (p < 0.01). Both groups had similar operative procedure: laparoscopic resection of deep endometriotic nodules or endometriomas, plus destruction of small superficial lesions using CO2 laser (A) or bipolar coagulation (B). Associated medical strategy was different: group A: operative laparoscopy without preoperative treatment and in 25% a second laparoscopy taking place after two-three months of LHRH analogues; no postoperative treatment; group B, operative laparoscopy taking place after ovarian blockage with three-six weeks of Diane (Androcur + ethinyl estradiol), then two-three months of analogue postoperative treatment immediately followed by long term progestoid treatment in order to prevent recurrences in women without pregnancy desire. RESULTS: After one year, 6/27 (22%) of A and 3/41 (7%) of B had no follow-up. Of the followed patients, a complete improvement was observed in 18/21 (86%) A, 33/38 (87%) B, moderate pelvic pain continued in 2/21 (10%) A, 4/38 (11%) B, and the treatment was in failure in 1/21 (5%) A, 1/38 (3%) B, without significant difference. After two years, 67% of A and 76% of B had a follow-up and the corresponding rates of complete improvement are 72% (A), 87% (B), incomplete improvement: 22% (A), 10% (B) and failure: 6% (A), 3% (B). The difference is lightly significant (p < 0.05) and remains so if patients without follow-up are considered as failures. There was no persistence nor recurrence of endometriosis nor endometrioma two years after the surgery was completed. CONCLUSION: Since there were more stage IV endometriosis in group A than in B, the different medical strategies and particularly the long term postoperative treatment used in B seem have little influence on results. However, these data was obtained in women of medium age > 30, with a relatively short follow-up. It should be of interest to compare in a prospective multicentric study the long term follow-up of two cohorts of young women operated on for stage III-IV endometriosis, receiving or not a long term medical treatment after surgery in order to prevent recurrences.

Adult↗
PubMed2001

[Comparison of 2 therapeutic strategies in severe endometriosis, in young women consulting for sterility or pain. II. In the case of infertility, value of ovarian stimulation with intrauterine insemination after surgery].

AIM OF THE STUDY: Define the best medico surgical strategy in infertile women with stage III-IV endometriosis. MATERIAL AND METHODS: Two groups, A (N26) and B (N 37), treated for infertility associated or not with pelvic pain, due to stage AFS III or IV endometriosis, were compared. They had similar surgical procedure: operative laparoscopy including resection of endometriotic lesions, more particularly endometriomas and rectovaginal septum nodules. Associated medical strategy was different: group A, operative laparoscopy without preoperative treatment and in 40% a second laparoscopy taking place after 2-3 months of LHRH analogues; no post operative treatment; group B, operative laparoscopy taking place after ovarian blockage with 3-6 weeks of Diane (Androcur + ethinyl estradiol), then 2-3 months of analogue postoperative treatment immediately followed by ovarian stimulation (OS) + intrauterine insemination (IUI) in women more than 30 years old with operative tubes (N 22), no treatment for six months in similar cases less than 30 (N 5), and IVF in women with damaged tubes (N 5) or after OS + IUI failure (N 4). One patient refused two patients with high FSH level had oocyte donation. RESULTS: Two years evolutive pregnancy rate was significantly higher (p < 0.01) in group B (59%) versus group A (23%) and was higher after OS + IUI (68%) than after IVF (55%) or without any treatment in women < 30 (43%). The difference is equally significant by age (p < 0.05), for endometriomas (p < 0.01) and for recurrences (p < 0.01). CONCLUSION: Similar results obtained for pelvic pain (see chapter I) suggest that both strategies are similarly successful in treating endometriosis. These results confirm the interest of an ART after surgery for stage III-IV endometriosis and show that OS + IUI, a less costly than IVF technique, can be used successfully in selected cases with operative tubes.

Adult↗
PubMed1999

[Preliminary evaluation of a histocytological association predicted in a single sample of uterine exploration via a modified pipette: Mark II pipette].

The pipelle has become the sampling tool of choice for histological detection of endometrial adenocarcinoma. Some practitioners still prefer cytological sampling. The distal extremity of the pipelle has been modified to allow removal of both types of samples simultaneously. The aim of this preliminary study was to evaluate the feasibility of this method. A positive agreement between histological and cytological results was found in 10 out of the 12 cases examined, among which an adenocarcinoma was positively detected. A prospective study on larger size must confirm these first findings. The new modified pipelle (Pipelle Mark II) offers a possible approach for reduction of false negatives.

Adenocarcinoma↗
PubMed1994

[The M. Kapandji hysteropexy: a laparoscopic technic and preliminary results].

OBJECTIVE. To develop a laparoscopic-assisted technique for the treatment of genital prolapsus. MODALITY. With the Kapandji's technique the vagina and the uterine isthmus is suspended transversally with a subperitoneal prosthesis. This technique has been favourably assessed in comparison with posterior suspension to the lumbo-sacral junction and is easily performed laparoscopically. Details of the technique will be given. CONCLUSION. This technique was simpler and less dangerous than colposuspension to the lumbo-sacral disc and gave functional results which were as good or better. This method also has the advantage of being performed via laparoscopy. Since the immediate post-operative convalescence is shorter and complete recovery can be achieved more rapidly, this is the method of choice for the treatment of genital prolapsus in young women.

Douglas' Pouch↗
PubMed1993

[Evaluation of intra-uterine pathology and tubal patency by contrast echography].

The contrast ultrasonography (CUS) is a new development of the pelvis ultrasounds. A contrast medium is injected through the cervix and is screened through the uterine cavity, the tubes and the peritoneal cavity. The contrast medium creates a new acoustic interface which improve the quality of the ultrasound imaging and the ability to diagnose endouterine pathologies. Further, tubal patency may be assessed by tracking fluid into the pouch of Douglas. The aim of this study was to assess the feasibility, the accuracy and the side effects of this technique when compared with the conventional procedures. Included were two groups of patients: the group 1 (10 cases) was of patients with menometrorrhagia before undergoing an hysteroscopy; the group II (11 cases) was of infertile patients before undergoing a laparoscopic tubal patency test. This technique, of low cost and without any radiation exposure, seems to be at least as accurate as the conventional methods for the intrauterine diagnostics. It is less effectiveness for the evaluation of the tubal patency. No side effect occurred in this study.

Contrast Media↗
PubMed1993

[Endocystic echography by laparoscopy. 6 preliminary cases].

The decision whether to ablate an ovarian cyst using the operating laparoscope depends on a whole bundle of clinical, biological, ultrasound and laparoscopic factors. But opening a uni or multi-locular fluid containing cyst and exploring its walls can leave the operator in doubt as to whether it is benign, malignant or a borderline lesion. Now it is possible to use 3 mm catheters carrying a rotary ultrasound transducer. When this sound is placed inside a cyst it is possible to study the walls topographically. Six preliminary cases are presented; the increased sensitivity of the pictures obtained by this miniaturised sound make it possible to improve ultrasound diagnosis.

Diagnosis, Differential↗
PubMed1990

Effect of Decapeptyl, an agonistic analog of gonadotropin-releasing hormone on estrogens, estrogen sulfates, and progesterone receptors in leiomyoma and myometrium.

Estrogens (estrone [E1] and estradiol [E2]), their sulfates and progesterone receptor (PR) were evaluated in patients with uterine leiomyomata nontreated and treated with Decapeptyl (D-Trp6-gonadotropin-releasing hormone [GnRH]; Ipsen Biotech, Paris, France). Estrogen concentrations are very high in the leiomyoma (secretory phase, pg/g tissue [mean +/- SEM]: n = 10; E1: 147 +/- 24; E2: 850 +/- 116; E1-sulfate: 1,668 +/- 808; E2-sulfate: 718 +/- 126). Decapeptyl treatment provokes a significant decrease in E2 and particularly in E1 and E2 sulfates. Progesterone receptors were higher in the leiomyoma than in the myometrium; after a long treatment (3 to 4 months) a significant decrease in both tissues is observed. The decrease provoked by D-Trp6-GnRH on estrogens (unconjugated and sulfates) and in PR in the leiomyoma after long treatment, supports the hypothesis that estrogens are implicated in the cause of these tumors.

Adult↗
PubMed1990

[Effect of decapeptyl (D-TrpG GnPh) on estrogen receptors, progesterone receptors and tissue levels of estrogens (non-conjugated and sulfate-conjugated) in patients with uterine myoma].

Concentrations of estrogen receptors, progesterone receptors, unconjugated estrogens (estradiol and estrone) and sulfate-conjugated estrogens (estradiol sulfate and estrone sulfate) were determined in patients treated with Decapeptyl and in controls. After prolonged Decapeptyl therapy, a highly significant fall in progesterone receptors was evidenced; estrogen receptors were found to be decreased in the myoma as compared with the secretory phase in controls and in the myometrium as compared with the proliferative phase in controls. Tissue levels of estrone sulfate and estradiol sulfate decreased very substantially. In conclusion, Decapeptyl emerges as a very promising agent for the treatment of uterine myomas.

Antineoplastic Agents↗
PubMed1986

[Ambulatory hysterofibroscopic treatment of persistent metrorrhagias using the Nd:YAG laser].

Several types of intra-uterine lesions can be destroyed endoscopically by coagulation with laser Nd-YAG. The use of a small diameter malleable fibroscope makes it possible to direct the energy accurately so that it is easy to use throughout the whole procedure. Operative hysteroscopy using laser has been performed in 12 cases of persistent metrorrhagia. Using this technique it has been possible to avoid open surgery such as hysterectomy or myomectomy. The procedure is quick and painless. It can be used on outpatients.

Ambulatory Surgical Procedures↗
PubMed1985

[Per-celioscopic ampullosalpingoscopy].

If a soft malleable thin calibre fibroscope is used it is possible to look into the ampulla endoscopically while carrying out laparoscopy. The technique of the operation will be described. An analysis of the results of the investigation carried out on 96 patients (179 tubes) shows that this procedure is possible to be done harmlessly as a routine measure. This investigation has shown some particular aspects of the intra-ampullary landscape. A change in the folds of the ampulla was seen in women exposed to DES in utero. After the folds had been operated on in cases of hydrosalpinx scars persisted in the ampulla. Early diagnostic of possible ectopic pregnancies was possible. Laparoscopic ampulla salpingoscopy shows changes in the pattern of the intra-ampullary folds that could not be foreseen in about 40% of cases that had simple hysterosalpingography. This is a particularly important finding in women who have unexplained sterility. Furthermore, tubal endoscopy can often make it possible to break down and to cut pathological interfimbrial adhesions. Using this technique in 17 patients who had been sterile for more than 40 months, it was possible to achieve 11 intra-uterine pregnancies after less than 4 months interval.

Adult↗
PubMed1985

[Histological study and functional results of tubal and ovarian transplants in the rat (isografts and allografts treated with cyclosporin A)].

A microsurgical technique was used to transplant the tube and the ovary in the rat. 49 autografts were carried out (in a pure line of Lewis strain) to study histologically the results of cold ischaemia and the functional future of the graft in the form of pregnancies. 40 hybrid allografts Lewis-DA were transplanted in Lewis or DA rats. 19 animals that were not treated allowed us to study the phenomena of rejection histologically. 21 further rats were treated with Cyclosporin A to study their fertility. The histological results of temporary cold ischaemia are minimal and come down to atresia of the active antral follicles of the cohort. None of the histological structures of the tube seemed to suffer from cold ischaemia that lasted 20 minutes. The average size of the litter for the autografts was 6.4 baby rats with an index of implantation of 0.65. Where no treatment was given, allografts were very quickly rejected. Giving Cyclosporin A allowed the allografts to be tolerated in 60% of cases. 5.6 baby rats per litter were obtained with an index of implantation of 0.65. Cyclosporin A in an immunosuppressive drug which is not teratogenic in animals and is not cytostatic. It inhibits immune responses at the cellular level as well as the production of lymphocyte T dependent antibodies. This study shows again the value of transplants for treating tubo-ovarian sterility.

Animals↗
PubMed1984

[Ampulla fibrotuboscopy].

During a microsurgical operation the opportunity was taken to inspect the ampulla of the tube with a soft fibroscope in 68 patients. Several different normal and pathological appearances were found. Ampullary endoscopy gives much more precise information than salpingography and a very valuable prognosis because 14 normal pregnancies occurred where the tubes had been considered to be normal whereas no intra-uterine pregnancy occurred where the tubes were thought to be pathological. Instead, they re-obstructed or were the sites of ectopic pregnancies. This complementary examination carried out during operation seems to be a useful prognostic measure for patients undergoing ampullary surgery.

Endoscopy↗
PubMed1982

[Fibroscopy in gynecology: fibrohysteroscopy and fibrotuboscopy].

Two applications of fiberoscopy to gynaecology -- fiberohysteroscopy and fiberotuboscopy -- have now been tested with very encouraging preliminary results. The small caliber of the instruments, the ease with which they can be manipulated and oriented are opening a new field: endoscopic surgery of the uterus and Fallopian tubes. Simple technical improvements will eventually make this material more suitable for routine gynaecological practice.

Endoscopes↗
PubMed1980

[Ciliated epithelium of the Fallopian tube in women. An ultrastructural study (author's transl)].

The steps in the ultrastructural changes that occur in new cilia formation in tubal epithelium have been well demonstrated in animals. In women, it is difficult to show cilia growing again and some authors deny that new growth occurs. Transmission electron microscopy studies on 32 specimens have shown that human new growth of cilia does occur. It arises in the midst of a cellular population which has as its characteristic a cytoplasm that is more clear than those of the neighbouring cells. Different ultrastructural aspects can be described. They resemble those that have been demonstrated in different animal species. On the other hand no mitoses have been shown. We will study the correlations between plasma hormone levels, the numbers of tissue receptors and the appearance of these clear cells in another article.

Cilia↗