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Biomedical subjects

J Buvat

Publications and source records attributed to J Buvat.

At least 37 records · Page 2Linked to original sources
PubMed1993

[Treatment of impotence with intracavernous auto-injections: moxisylyte diminishes the risks compared to papaverine].

The alpha-blocking agent Moxisylyte was tested in auto-intracavernous injections (auto-ICI) in 72 impotent patients. The side-effects were compared to those observed in a group of 34 impotent patients treated with auto-ICI of Papaverine during the same period of time. The Moxisylyte auto-ICI improved 83% of the patients including 68% reporting a complete and durable success. Moxisylyte proved to be safer due to a reduced rate of prolonged erections (1.3% of the patients versus 8.8% with Papaverine) and corporeal fibrosis (1.3% versus 32% with Papaverine). Though less potent than Papaverine, and often seeming insufficient when tested in the office, this type of alpha-blocking agent could be tried in a first time in most candidates to auto-ICI before resorting to Papaverine or Prostaglandin E1 if it fails.

Adult↗
PubMed1992

[Outcome of pregnancies obtained by fertilization in vitro. Experience at the V. Olivier Ward (department of Professor Monnier, Lille University Hospital Center) and review of the literature].

The outcome of 87 pregnancies obtained by fertilisation in vitro and progressing beyond 20 weeks of amenorrhea monitored in the Victor-Olivier Ward (Prof. Monnier, Lille Teaching Hospital Group) was analysed. Results were compared with those in the literature. The group was characterised by three features: age, the number of primipara and above all the multiple pregnancy rate. One quarter of FIV pregnancies are multiple pregnancies and almost two newborn out of live are the result of multiple pregnancies. Almost 70 per cent of clinical pregnancies progressed beyond six months. Pregnancy pathology was represented by a marked worsening of the prematurity rate and by a slightly increased risk of fetal under-development. The cesarean section rate was very markedly increased. Sex ratio, and perinatal mortality, malformation and chromosomal aberration rates were similar to those for spontaneous pregnancies. Results are reassuring overall, the pathology being encountered in pregnancies of this type being only partially explained by age, the number of primipara and the multiple pregnancy rate. This pathology could possibly be explained by the underlying situation in which sterility occurred.

Abortion, Spontaneous↗
PubMed1991

[Ovulation disturbances in athletes and their mechanisms].

Delayed menarche, amenorrhea or at least luteal insufficiency are frequent in athletic women, when in intense athletic training. The origin of these disturbances seems to be plurifactorial. The main responsible parameters seem to be: the physical and psychological stresses; nutritional factors often associated with reduced food intake (specially reduced protein and increased vegetable fibers intake), and in some cases with loss of body fat; and affective problems responsible for eating disorders. The paper describes the acute effects of training upon hormones, and the hormonal profile of athletes when in intense training. The reduced or suppressed LH pulsatile secretion determines the ovulatory disturbances. Among the responsible factors, the rise of opioids, as beta-endorphin, and the corticotropin hyperactivity, which probably play an important role, even if other mechanisms will be demonstrated later.

Catecholamines↗
PubMed1991

[First consultation of impotent patient].

This paper defines the main goals of the first consultation of an impotent patient, and describes the practical procedure. First of all, the first consultation must include a thorough history-taking which will make it possible in many cases to have a fairly objective idea of the degree of organic involvement. The most important questions are about the possible occurrence of regular rigid erections in situations that are neither coital nor sexual. Their occurrence rules out any organic involvement almost with certainty, and allows abstaining from additional examinations, or keeping them within minimum limits. Their absence is compatible with an organic involvement, but is not specific for this, and leads to further exploration. The first consultation is also the occasion of a first human contact, and its quality will often influence the prognosis. Besides being sufficient to cure some patients, this first contact is a major condition for the compliance with the therapeutic advice that will be given later on.

Ejaculation↗
PubMed1990

Luteal support after luteinizing hormone-releasing hormone agonist for in vitro fertilization: superiority of human chorionic gonadotropin over oral progesterone.

It has been reported that the pregnancy rate after in vitro fertilization (IVF) after pituitary desensitization with luteinizing hormone-releasing hormone agonist (LH-RH-a) is twice as low if the luteal phase is not supported. We therefore tested the respective advantages of luteal support using human chorionic gonadotropin (hCG, 1,500 IU three times) and progesterone (P, micronized, oral administration, 400 mg/d) after 171 embryo transfers (ET) in which the cycle was stimulated with the LH-RH-a triptoreline. The type of luteal phase support was randomly selected except when the estradiol level exceeded 2,700 pg/mL. The clinical pregnancy rate and the ongoing pregnancy rate were significantly higher using hCG (after the transfer of 3 embryos, 45% and 43% with hCG versus 23% and 17% with P). The same results were noted for the embryo implantation rate per ET (19% of embryos are viable after 6 months of pregnancy after hCG versus 7.5% after P). Adequate luteal support, therefore, significantly improves the results of IVF when LH-RH-a are used. The poor results obtained with P in this study might be related to its poor bioavailability after oral administration.

Administration, Oral↗
PubMed1989

Purified follicle-stimulating hormone in polycystic ovary syndrome: slow administration is safer and more effective.

Twenty-seven infertile patients presenting with clomiphene citrate- (CC) resistant polycystic ovary syndrome (PCOS) were treated with purified urinary follicle-stimulating hormone (pFSH). We compared the conventional stepwise protocol with a slow protocol starting with 75 IU/d, not increased until 14 days, supplemented by human chorionic gonadotropins (hCG). The slow protocol was characterized by a slightly longer duration of stimulation but a more physiological ovarian response (mono- or biovulatory cycles in 70% versus 19% with the conventional protocol, less follicles, and a lower plasma estradiol [E2] resulting in significantly less discontinuation of treatment for risk of hyperstimulation or multiple birth). The pregnancy rate per cycle was higher with the slow protocol (23% versus 15%). The slow protocol could thus be the treatment of choice for CC-resistant PCOS, as it appeared safer and more effective.

Adult↗
PubMed1989

Safety of intracavernous injections using an alpha-blocking agent.

We tested the possibility of using intracavernous injections of the alpha-blocking agent moxisylyte (6-acetoxy-thymoxy-ethyl-dimethylamine) as treatment of erectile impotence. Laboratory studies proved moxisylyte to be more active than saline (double-blind with crossover) but less active than papaverine (crossover), since it induced prolonged erection in most patients but rigid erection in only a few. However, penile vibration proved to enhance the moxisylyte effects, the combination resulting in rigid erection in 5 of 8 patients tested. Repeated office injections of moxisylyte in 70 patients resulted in clear improvement of impotence during the subsequent weeks in 50 per cent of the psychogenic, and 18 per cent of the organic and mixed impotent patients. Of 91 impotent patients 42 achieved satisfactory intercourse within 2 hours after an office injection, although previously the same dose induced a rigid erection in the office in only 24. Of 37 patients instructed in moxisylyte self-injections 92 per cent achieved successful results without any significant side effect. The main advantage of moxisylyte proved to be its safety, allowing for less compelling precautions than with papaverine: only 2 of the 170 patients injected with moxisylyte at our clinic had prolonged erections, that is 1.1 per cent compared to 14 per cent in a personal series who received papaverine. In regard to the therapeutic applications of intracavernous injection facilitating drugs, such as moxisylyte, should be tried first, with use of the more potent but also more dangerous drugs, such as papaverine, only when impotence fails to improve.

Adult↗
PubMed1989

[Intrapenile neurotransmission. Physiologic data and practical consequences].

This paper reviews the intrapenile control of erection and the principal pathophysiological and therapeutic implications (especially intracavernous injections) of these physiological data. The regulation of flaccidity is fairly well known. This principally results from a continuous adrenergic discharge responsible, via activation of the alpha receptors, for tonic contraction of the smooth muscle fibres (SMF) of the corpora cavernosa (CC), preventing blood from entering the spaces of the CC. The complementary role of serotonin, histamine, prostaglandins (PG) F1 and F2 alpha and neuropeptide Y is still unclear. The regulation of erection is less well understood. The principal phenomenon is probably inhibition of the anti-erectile alpha adrenergic tone, allowing relaxation of the SMF and congestion of the areolae of the CC, influx of arterial blood and occlusion of the venous exits. However, an additional relaxing nervous stimulation may also be required. The modulation of anti-erectile adrenergic activity could be the result of Vasoactive-Intestinal-Polypeptide which, however, is unable to induce complete erection on its own, and/or PGE1. Acetylcholine, whose role is still unclear, stimulation of beta adrenergic receptors and presynaptic alpha-2 receptors, histamine, a relaxant factor of endothelial origin and possibly other neurotransmitters as yet unidentified, may also be involved.

Alprostadil↗
PubMed1989

[Diagnostic and therapeutic applications of intracavernous injection of vasoactive drugs in impotence. Defense for the use of facilitating drugs. Part I--Pharmacology, classification and complications of active drugs].

The article discusses drugs which promote erection when injected via the intracavernous (IC) route during consultation. The diagnostic and therapeutic applications in the treatment of impotence are discussed also. 25% of impotent patients noted an improvement after this treatment while 50% of patients suffering from impotence of psychological origin noted an improvement. Auto-injection is also discussed. IC treatment now seems justified in most cases which have not responded to traditional therapeutic approaches and this includes cases of psychological origin. Vasoactive drugs can be described as being inducers (use of these drugs induces a rigid erection, even in the presence of the doctor), facilitating drugs (which produce a rigid erection only if sexual stimulation is present also) and inhibitors (which stop the erection). The former group (which has papaverine as leader) produces a significant number of side effects, not least of these being priapism; there is a risk of lasting iatrogenic impotence which is not negligible. These risks are reduced considerably when one uses facilitating drugs which, although less powerful, suffice in treating a large proportion of cases of impotence. Papaverine can not be replaced as a diagnostic drug but facilitating drugs should be used first in therapy and inducers should be used only if these facilitating drugs have failed.

Adrenergic alpha-Antagonists↗
PubMed1989

[Impotence due to venous incompetence. Research on reliable diagnostic criteria].

"Venous incompetence" is thought to be an organic cause of impotence. Its diagnosis is usually based upon Artificial Erection Test (AET); now, the reliability of this procedure is contested. We tested it in 9 controls, 13 psychogenic impotent patients and 65 impotent patients presenting "venous incompetence" according AET (maintenance flow rate needed for erection--MFR greater than 75 ml/min). Organicity of impotence was evaluated by Nocturnal Penile Tumescence monitoring and by the results of a sex-therapy. AET reproducibility was tested in 24 cases. The interest to perform an intracavernous injection of 80 mg papaverine before AET was tested in 18 impotent patients. Our results confirm that MFR is the most reliable criterion for interpreting AET. But 15% of the impotent patients with a MFR greater than 120 ml/min, 32% of those with a MFR greater than or equal to 80 ml/min and 66% of those with a MFR between 80 and 120 ml/min were in fact psychogenic patients. Moreover, we found "excessive" MFR in 3 of the 13 psychogenic patients and one of the normal controls (160 ml/min). In 50% of our patients, AET results were not reproducible. Injecting papaverine before AET significantly reduces MFR, but false positive results do still exist. Some recent physiopathologic data suggest that AET performed after papaverine injection might logically be disturbed by stress. These data should incite to be cautious when interpreting AET results, and results of "venous incompetence" surgery.

Adult↗
PubMed1989

[Critical evaluation of hidden organic factors causing impotence].

Many studies have pointed out the possibility of "masked" organic factors in erectile impotence, detectable only by means of laboratory investigations: mild hypogonadism, hyperprolactinemia, occlusions selectively located at the site of the sexual arteries, venous incompetence, subclinical neuropathies. This paper critically reviews these conditions, and the methods proposed to diagnose them. Impotence is a multifactorial disorder, involving in most cases psychological factors. Among the preceding conditions only severe venous incompetence can induce impotence only by itself. The other masked organic factors play only a partial role in most cases and need to be potentiated by another organic or psychological factor. In our experience, masked organic factors are present in 50% of the impotent males. But they play a significant role in only 25%.

Endocrine System Diseases↗
PubMed1989

[When and why should hyperandrogenism be searched for in women?].

It is important to diagnose hyperandrogenism in women. By disturbing ovulation, it is actually one of the most frequent causes of infertility. In this particular case, its diagnosis has specific implications: sometimes specific treatment is indicated, or the risk of fetal virilization should be prevented. There is always the possibility of a diagnosis of polycystic ovary, prompting precautionary measures to be taken that are likely to limit the risks linked to the multifollicular development that is so frequent with this disorder. In addition, hyperandrogenism exposes the patient to various gynecological and general complications: cancer of the endometrium, progressive increase in menstrual disturbances and infertility, obesity, metabolic disturbances and probably increase in cardiovascular risks. Certain types of hyperandrogenism give rise to diseases that expose the patient to specific risks: virilizing tumors, Cushing's syndrome, neonatal risks linked to congenital hyperplasia of the adrenal glands. Hyperandrogenism should be borne in mind not only when the clinical picture is that of virilization, but also when there is any disturbance in eugonadal ovulation, whether or not this is manifested as menstrual disturbances or as infertility, and especially whether or not it is accompanied by hirsutism.

Androgens↗
PubMed1989

[Treatment of the gynecologic consequences of hyperandrogenism].

Whether they are of adrenal or mainly ovarian origin, hyperandrogenisms result in consequences on cycle and fertility. In addition to the treatment of hyperandrogenism itself, it is advisable to know how to prevent the gynaecological consequences of the abnormality.

Adrenal Gland Diseases↗