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Biomedical subjects

J B Dubuisson

Publications and source records attributed to J B Dubuisson.

191 records · Page 11Linked to original sources
PubMed1977

Fetal death: coagulation defects and management. Report of 20 cases with study of the half-life of [125I]fibrinogen.

This report concerns 20 patients with intrauterine fetal death. Blood samples for coagulation studies were obtained before, during and after delivery. No clinical defibrination or bleeding was noted. Coagulation defects were observed as follows: 2 biological defibrinations: The first case was a pregnancy of 32 wk with retention for more than 12 wk; hypofibrinogenemia was noted in all 6 samples, between 180 and 280 mg/100 ml. The second was a pregnancy of 32 wk with retention for more than 8 wk; fibrinogenemia was between 170 mg/100 ml and 140 mg/100 ml. 2 intravascular coagulations with normal fibrinogenemia, increase of fibrin degradation products and positive ethanol tests. 3 cases with slight coagulation defects that were difficult to explain. The coagulation defects appeared to be transient, and sometimes resolved themselves spontaneously. Induction of labour was made in 19 cases; quinine sulfate, used in 17 cases, was remarkably successful (1 intolerance, 1 failure). Study of the half-life of [125I]fibrinogen was made in 18 of the 20 cases. On average, it was reduced by half in comparison with the half-life of healthy men. The decrease was noted even in cases of fetal deaths without the coagulation defects detected by classical tests. The half-life of [125I]fibrinogen in 6 pregnant women before therapeutic abortion was also studied. The decrease of half-life was noted. Changes of metabolism of fibrinogen during pregnancy are discussed.

Blood Coagulation Disorders↗
PubMedDate not supplied

Diagnosis and management of organic ovarian cysts: indications and procedures for laparoscopy.

In the field of gynaecological surgery, the past few years have been significant due to the development of operative laparoscopy. Originally recommended for the diagnosis of female infertility, over the past 15 years laparoscopy has acquired the standing of a surgical discipline in its own right. Laparoscopic surgical treatment of ovarian cysts, whether conservative or radical, has now been completely standardized. The aim of this work is to specify the indications, procedures and risks involved with this surgery as applied to organic ovarian cysts. Only benign ovarian cysts are suitable for treatment by laparoscopic surgery; ovarian cancer must always be handled by classic surgery using a mid-line laparotomy. Given that clinical and other pre-operative investigations can give only an indication, ovarian lesions require surgical investigation to diagnose the histological type. Laparoscopy appears to be as reliable as laparotomy when assessing whether an ovarian tumour is malignant. The risk of parietal contamination and peritoneal dissemination if a malignancy is not recognized means that, if there are no signs of extra-ovarian extension, adnexectomy is mandatory whenever there is the slightest doubt. This adnexectomy must obey two important rules: it must be accomplished without rupturing the cyst, and the cyst must be placed, intact, inside an endoscopic bag before being extracted. Provided that all stages of the procedure, from pre-operative work-up to the initial diagnostic phase of the laparoscopy, are carried out meticulously, laparoscopic surgery is reliable for both the diagnosis and the management of benign organic-ovarian cysts.

CA-125 Antigen↗
PubMedDate not supplied

Recurrence of leiomyomata after myomectomy.

Abdominal myomectomy (by laparotomy or by laparoscopy) enables all the myomata to be excised while maintaining reproductive function. The actual risk of recurrence after abdominal myomectomy is difficult to assess because of methodological problems. Studies using life-table analysis find a cumulative risk of clinically significant recurrence of approximately 10% at 5 years for myomectomy by laparotomy. This risk probably underestimates the true prevalence of myomata as assessed by systematic ultrasound investigation. After laparoscopic myomectomy there appears to be a greater risk of recurrence. In one third of cases, recurrence becomes the reason for a hysterectomy. The risk of recurrence increases when there is more than one myoma. The use of gonadotrophin-releasing hormone agonists preoperatively could increase the risk of recurrence. Persistence or recurrence of the myoma thus reduces the chances of conception or taking a pregnancy full term after the myomectomy. It is essential to obtain the most complete exeresis possible in order to reduce the risk of recurrence to a minimum. However, it is inevitable that small, undetectable nuclei will remain within the myometrium whatever approach is used (laparoscopy or laparotomy). It would be an advantage to know what the growth factors are and how to identify groups at high risk of recurrence so that the treatment strategies could be better adapted and appropriate prophylactic methods developed.

Female↗
PubMedDate not supplied

[The interstitial pregnancy. Report of three observations (author's transl)].

The recent occurrence at the Port-Royal obstetrics and gynaecology center of three cases of interstitial pregnancy out of a total number of 208 ectopic pregnancies give us the opportunity to discuss the diagnosis and present management of the rarest form of tubal pregnancies. The diagnosis is always difficult. Nowadays, thanks to the use of echography and especially of laparoscopy, interstitial pregnancies can be detected earlier. Thus the precocity of the diagnosis should permit a conservative surgical treatment. Hysterectomy should not be considered but in very special cases.

Adult↗
PubMedDate not supplied

[Vesico-uterine fistulae after Caesarean operation (author's transl)].

The vesico-uterine fistulae represent 4 per cent of all urogenital fistulae. They are rare and are found almost always after Caesarean operation. We have been able to find in the literature 110 vesico-uterine fistulae after Caesarean operation. They very rarely fail to be diagnosed if careful post-operative examination is made and the majority of them are discovered in the year following delivery. Urinary incontinence is the most common reason for consultation. More uncommon is amenorrhoea with menstruation through the bladder. Incontinent women are under constant threat of ascending urinary tract infection. Finally these women, whether they are incontinent or amenorrhoeic, are sterile. Their fertility remains diminished even after surgical cure of the fistula. The only treatment for those who complain of the condition is surgery. It should be undertaken after a careful gynaecological and urological assessment.

Cesarean Section↗
PubMedDate not supplied

[The current role of microsurgery and in vitro fertilization in the treatment of tubal infertility].

Tubal sterility is an important cause of sterility in the couple. Its treatment has been revolutionised, firstly by the progress in microsurgery and, more recently, by the current progress in in vitro fertilisation. Consequently, the gynecologist must have a very good knowledge of sterility in the couple and of tubal pathology. The authors report the results of 400 microsurgical operations performed in the Maternity department of the Port-Royal hospital and compare these results with those of in vitro fertilisation. In the light of these results, they then attempt to define the therapeutic indications which depend on a very precise investigation of the condition of the tubes. Microsurgery and in vitro fertilisation constitute complementary approaches in cases which are difficult to evaluate.

Adult↗
PubMedDate not supplied

[Contact embryoscopy (author's transl)].

Prenatal diagnosis based on anatomic definition of the fetus in utero is an difficult task, in the first trimester of pregnancy. The authors have recently introduced a new method : contact embryoscopy which consist in applying the optic piece of a contact hysteroscope (diameter of six millemeters) to the intact and translucent ovular membranes by the cervix. They have performed fifty embryoscopy prior to termination of pregnancy at 8 to 12 weeks. In 41 cases, they have seen the hands of fetus with the fingers. If this technic fails, it is possible, later, to use Echography and fetoscopy. The side-effects are discussed. Contact embryoscopy would be particularly useful in the detection of malformations of the extremities, for instance : chondro-ectodermal dysplasia (Ellis Van Creveld Syndrome) or ectrodactily.

Female↗
PubMedDate not supplied

[Uterus and diethylstilbestrol: which examinations, which antecedents for an active management? Which treatments?].

Diethylstilbestrol (DES) was widely prescribed to pregnant women from 1946 to 1977. This resulted in multiple abnormalities of the genital tract. Many studies show an increased incidence of infertility, ectopic pregnancy, spontaneous abortions and premature delivery. For women with certain abnormalities such as a construction of the upper uterine cavity, with or without a T configuration of the uterus, hysteroscopic metroplasty is feasible with good anatomic and functional results.

Carcinogens↗