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Biomedical subjects

J Donnez

Publications and source records attributed to J Donnez.

At least 19 recordsLinked to original sources
PubMed2003

[Peroperative desaturation during gynaecological laparoscopy-hysteroscopy: an unknown aetiology, pleural extravasation].

A 41-year-old patient presented several episodes of desaturation during a gynaecological laparoscopy. The major complication of this procedure is the venous air embolism. Several other side-effects have been reported: heart rate disorders, subcutaneous emphysema or pneumothorax. Pleural effusions during gynaecologic laparoscopy are apparently rare and the volume of effusion must be important to induce clinical symptoms. This fact can probably explain the frequent difficulty of diagnosis. The role of the diaphragmatic lymphatic network and other physiologic aspects are discussed in this article.

Adult↗
PubMed2003

[Laser vaporization of ovarian endometriomas: the impact on the response to gonadotrophin stimulation].

OBJECTIVE: To evaluate the ovarian response to stimulation for IVF in endometriosis patients who have previously undergone laparoscopic treatment of peritoneal and/or ovarian endometriosis (CO2 laser vaporization). PATIENTS AND METHODS: Retrospective study of 455 patients undergoing IVF. The study group, made up of 127 endometriosis patients, was divided into 2 subgroups: Ia: 42 women with peritoneal endometriosis, treated by laparoscopy, who underwent 71 IVF cycles; Ib: 85 women with ovarian endometriomas, treated by vaporization of the internal wall, who underwent 187 IVF cycles. The control group, consisting of 328 women, was also divided into 2 subgroups: IIa: 193 women suffering from tubal infertility who underwent 422 IVF cycles; IIb: 135 women with idiopathic infertility who underwent 275 IVF cycles. RESULTS: The ovarian stimulation parameters (number of gonadotrophin ampoules, number of follicles and mature oocytes, maximum estradiol concentrations) were not significantly different in the various subgroups. The number of embryos obtained and transferred per cycle, the fertilization rates (group Ia: 61.81%; Ib: 60.90%; IIa: 62.48%; IIb: 57.99%), the implantation rates (group Ia: 17.72%; Ib: 15%; IIa: 13.94%; IIb: 18.05%) and the clinical pregnancy rates (group Ia: 32.39%; Ib: 37.40%; IIa: 27.49%; IIb: 30.18%) were not statistically different in the studied subgroups. DISCUSSION AND CONCLUSION: The theoretical risk of loss of ovarian cortex when treating endometriotic cysts can be eliminated by the technique of vaporization of the internal wall of the endometrioma.IVF outcomes are similar in patients treated for endometriosis and those presenting with unexplained or tubal infertility.

Embryo Transfer↗
PubMed2002

What are the implications of myomas on fertility? A need for a debate?

In order to evaluate the relationship between leiomyomas and infertility, which remains a subject of debate, we have tried to evaluate the impact of myomas on fertility and pregnancy outcome in different conditions where myomas are implicated. Medline research was conducted of publications appearing between January 1988 and August 2001 on the subjects of myomas and myomectomy and their impact on fertility and pregnancy outcome in infertile women. A total of 106 manuscripts were consulted. The incidence of myomas in infertile women without any obvious cause of infertility is estimated to be 1-2.4%. The relationship between leiomyomas and infertility remains a subject of debate. The question is: do myomas influence fertility? We are obliged to conclude that the question remains. The absence of an answer to this crucial question is probably due to the fact that we have not yet conducted the appropriate prospective studies required to obtain any clear results.

Female↗
PubMed2001

Therapeutic value and long-term safety of pulsed estrogen therapy.

OBJECTIVES: To demonstrate equivalent efficacy for menopausal symptoms between Aerodiol nasal spray and reference oral estradiol therapy, and to investigate the endometrial safety and tolerability of Aerodiol in the long term. METHODS: The efficacy of Aerodiol 300 microg, once daily, was compared with oral estradiol 2 mg/day in a randomized, double-blind trial. A statistical test of noninferiority was performed on the mean absolute Kupperman index (KI) obtained after 14 and 23 weeks of the two treatments. Long-term safety was assessed in a 1-year open-label study. The initial Aerodiol dose was 300 microg/day, and was adjusted if required. Endometrial biopsies were obtained at inclusion and at the end of the trial and examined independently by two pathologists. RESULTS: In the equivalence trial, the KI improved similarly in the Aerodiol group (n=317) and the oral estradiol group (n=342). Aerodiol was shown statistically to be at least as effective as oral therapy (P<0.001), but the incidences of mastalgia and withdrawal bleeding were significantly lower in the Aerodiol group (P<0.01 and P<0.001, respectively). In the long-term safety trial (n=408), the rate of Aerodiol treatment continuation at 12 months was 85%, and there was no incidence of endometrial hyperplasia or cancer. Aerodiol dose adaptation was performed by 29% of women. CONCLUSIONS: Aerodiol was shown to have equivalent efficacy to reference oral estradiol therapy, but with better gynaecological acceptability. The endometrial safety of Aerodiol was confirmed in the long term, and the ability to adjust the dosage easily was of benefit to a substantial proportion of women.

Administration, Intranasal↗
PubMed2001

Goserelin acetate (Zoladex) plus endometrial ablation for dysfunctional uterine bleeding: a 3-year follow-up evaluation.

OBJECTIVE: To report the results of a 3-year follow-up evaluation of a trial comparing goserelin acetate depot injections with sham injections before endometrial ablation for the treatment of dysfunctional uterine bleeding (DUB). DESIGN: Prospective, randomized, double-blind, parallel-group study. SETTING: Thirty-seven centers in 12 countries. PATIENT(S): Three-hundred and fifty-eight premenopausal women aged over 30 years with DUB. INTERVENTION(S): Goserelin acetate (3.6 mg depot) every 28 days for 8 weeks, or sham depot every 28 days for 8 weeks, with endometrial ablation 6 weeks +/- 3 days after the first depot injection (i.e., when the endometrium is at its thinnest). The follow-up continued for 3 years. MAIN OUTCOME MEASURE(S): At the 3-year follow-up, bleeding in the previous 3 months and need for surgical intervention were recorded. RESULT(S): At 3 years, amenorrhea rates were 21% in the goserelin acetate group and 14% in the control group (estimated odds ratio, 1.8; 95% CI, 0.98-3.25; P=.0571). The surgical intervention rate (since the original procedure) was low and did not differ significantly between groups. For hysterectomy, it was 21% for the goserelin acetate group and 15% for the control group. For repeat ablations, it was 5.6% for the goserelin acetate group and 2.1% for the control group. CONCLUSION(S): Prethinning with goserelin acetate before endometrial ablation resulted in higher long-term amenorrhea rates than ablation without prethinning.

Adult↗
PubMed2001

Does ovarian surgery for endometriomas impair the ovarian response to gonadotropin?

OBJECTIVE: To evaluate the ovarian response to stimulation conducted for IVF treatment in women who have undergone conservative surgery for endometriomas. DESIGN: Retrospective study with prospective selection of participants and controls. SETTING: University infertility clinic. PATIENT(S): A series of 374 women who underwent in vitro fertilization (IVF). The study group consisted of 85 patients with ovarian endometriomas who had undergone laparoscopic surgery in an attempt to become pregnant, but had failed within a year of surgery. The control group consisted of 289 patients with tubal factor infertility. INTERVENTION(S): IVF-embryo transfer procedures. MAIN OUTCOME MEASURE(S): Stimulation parameters, fertilization, implantation, and pregnancy rates were analyzed in both groups. RESULT(S): There was no significant difference between the two groups in stimulation parameters or IVF outcome. CONCLUSION(S): A total of 820 cycles were analyzed. A similar IVF-ET outcome was observed in patients with endometriosis after ablation of endometriomas compared to women with tubal factors. In conclusion, endometrioma surgery by internal wall vaporization does not impair IVF outcome. The clinical pregnancy rate was respectively 37.4% and 34.6% in the endometriosis group and the control group.

Adult↗
PubMed2001

Comparison of G1.2/G2.2 and Sydney IVF cleavage/blastocyst sequential media for the culture of human embryos: a prospective, randomized, comparative study.

OBJECTIVE: To compare two commercially available sequential media, G1.2/G2.2 and Sydney IVF cleavage/blastocyst media, as supports for human embryo culture. DESIGN: Prospective randomized study. SETTING: University-based IVF clinic. PATIENT(S): Two hundred forty-nine patients undergoing IVF treatment for the first or second time, randomly allocated at the time of oocyte retrieval, to either culture in G1.2/G2.2 or Sydney IVF media. INTERVENTION(S): Oocyte recovery, IVF or intracytoplasmic sperm injection, embryo culture, transfer on day 3 or day 5/6. MAIN OUTCOME MEASURE(S): Developmental stage on day 3, blastocyst rate, pregnancy outcome as assessed by beta hCG positive test, implantation rates, and ongoing pregnancies. RESULT(S): Embryos cultured in G1.2/G2.2 media displayed a faster kinetics of cleavage, compaction, blastulation, and hatching, but a lower day 3 embryo quality than those grown in Sydney IVF media. For patients with at least five embryos, G1.2/G2.2 media yielded higher implantation rates (26.2%) in our day 3 embryo transfer program when compared to Sydney IVF medium (15.5%), whereas similar implantation rates were obtained for day 5/6 embryo transfer for both media (43.1% and 36.1%, respectively). CONCLUSION(S): In our day 3 embryo transfer program, G1.2/G2.2 media were superior to Sydney IVF media, whereas both media yielded similar outcomes in our blastocyst transfer program.

Adult↗
PubMed2000

Histologic and ultrastructural evaluation of fresh and frozen-thawed human ovarian xenografts in nude mice.

OBJECTIVE: To compare histologic and ultrastructural characteristics of fresh and frozen-thawed human ovarian cortical tissue grafted into nude mice. DESIGN: Experimental prospective study. SETTING: An academic research environment. PATIENT(S): Ovarian biopsy specimens were obtained from 13 women undergoing laparoscopy for tubal ligation or infertility. ANIMAL(S): Forty nude mice. INTERVENTION(S): A minilaparotomy was performed to place fresh and frozen-thawed ovarian grafts subcutaneously (sc) or intraperitoneally (ip). Removal of the ovarian grafts was performed at 24 days. MAIN OUTCOME MEASURE(S): [1] the follicular population, [2] fibrosis, [3] vascularization of the grafted tissue, and [4] ultrastructural evaluation. RESULT(S): A greater fibrosis relative surface area was noted in frozen-thawed transplanted tissue than in fresh transplants. Regardless of this fibrosis, a similar follicular density was observed in fresh and frozen-thawed ovarian tissue 24 days after transplantation. Active angiogenesis was proved by both immunohistochemical study of the vascular endothelial growth factor and morphometric study of the vascular network. Normal ultrastructural characteristics were noted in frozen-thawed ovarian biopsies. CONCLUSION(S): Angiogenesis allows implantation of the graft even if it has been cryopreserved and thawed similarly to implantation of fresh tissue. The greater fibrosis observed in grafts after cryopreservation and implantation does not seem to affect the primordial and primary ovocyte population and their ultrastructural characteristics, but further studies must be conducted to prove that after cryopreservation and transplantation, ovocytes may achieve full maturation and fertilization.

Animals↗
PubMed2000

Expression of transforming growth factor-alpha, epidermal growth factor, and epidermal growth factor receptor in follicles of human ovarian tissue before and after cryopreservation.

OBJECTIVE: To study the expression of transforming growth factor-alpha (TGF-alpha), epidermal growth factor (EGF), and EGF receptor in follicles of human ovarian tissue. DESIGN: A retrospective, controlled comparative study. SETTING: In vitro fertilization laboratory of a university hospital. PATIENT(S): Fifteen women with regular menstrual cycles who underwent laparoscopy and the biopsy of ovarian tissue. INTERVENTION(S): Paraffin sections were prepared from ovarian tissues, followed by immunohistochemical staining of TGF-alpha, EGF, and EGF receptor. MAIN OUTCOME MEASURE(S): Immunostaining for TGF-alpha, EGF, and EGF receptor in follicles of fresh and frozen ovarian tissues. RESULT(S): Immunoreactivities for TGF-alpha and EGF receptor were observed simultaneously in the oocytes of primordial, primary, preantral, and antral follicles. Strong staining for TGF-alpha and EGF receptor was present in thecal cells. The TGF-alpha and EGF receptor was also expressed in some granulosa cells of primary to antral follicles. The EGF only stained weakly in the oocytes of primordial and primary follicles and in thecal cells. There was no difference in staining patterns for TGF-alpha, EGF, and EGF receptor between fresh and frozen ovarian tissues. CONCLUSION(S): The TGF-alpha and EGF receptor was expressed in primordial to antral follicles, indicating a role of TGF-alpha in regulating follicular development through binding to the EGF receptor. Freeze-thawing did not substantially alter immunoreactivites for TGF-alpha, EGF, and EGF receptor in frozen ovarian tissue.

Adult↗
PubMed2000

Early-stage endometriosis: adhesion and growth of human menstrual endometrium in nude mice.

OBJECTIVE: To evaluate the implantation of menstrual endometrium and the early stages of evolution of endometriotic lesions. DESIGN: Experimental prospective study. SETTING: An academic research environment. ANIMALS: Ten nude mice. INTERVENTION(S): A minilaparotomy was performed to place fresh human menstrual endometrial samples in the peritoneal cavity. Removal of the transplants was performed successively on days 1, 3, and 5 by laparotomy. MAIN OUTCOME MEASURE(S): Adhesion of endometrial fragments and early stages of endometrial lesions was morphologically and immunohistochemically studied. RESULT(S): As early as day 1, stromal cells were found to be attached to the mesothelium. A progressive reorganization of epithelial and stromal cells into endometrial glands was observed. On day 5, cystic endometriotic lesions were characterized by more extensive proliferative activity in glandular cells and a higher VEGF score in stromal cells than that observed in previously removed transplants. CONCLUSION(S): Menstrual human endometrium is able to implant on intact mesothelium and to reorganize itself into structured glands and stroma under the influence of unknown factors. We suggest that stromal and glandular cells have two distinct roles: stromal cells are involved in the attachment process and glandular cells in the growth of the endometriotic lesion.

Adult↗
PubMed2000

Endometrial laser intrauterine thermotherapy: the first series of 100 patients observed for 1 year.

OBJECTIVE: To describe a new instrument (GyneLase) that offers a new approach (endometrial laser intrauterine thermal therapy [ELITT]) to treatment of menorrhagia and to evaluate the efficacy of ELITT in the management of dysfunctional uterine bleeding. DESIGN: Prospective study. SETTING: University hospital. PATIENT(S): 100 premenopausal women with dysfunctional uterine bleeding were observed for 1 year. INTERVENTION(S): Intrauterine laser thermotherapy with a diode laser. MAIN OUTCOME MEASUREMENT(S): Amenorrhea rate after 1 year. RESULT(S): The amenorrhea rate after 1 year of follow-up was 71%, and the rate of amenorrhea/severe hypomenorrhea rate was >90%; these rates are much higher than those in the literature after such procedures as electrosurgery or intrauterine thermal balloon therapy. The ELITT procedure is an inherently safe and simple alternative, providing controlled and effective treatment of the entire endometrium. In contrast to traditional endometrial ablation using a neodymium yttrium-aluminum-garnet laser, the ELITT procedure does not require intensive training or hysteroscopic control; it is also far less risky, because the power used per unit area is 1,000 times lower. CONCLUSION(S): The ELITT procedure is a new nonhysteroscopic technique for endometrial ablation. The technique is very safe and offers the highest amenorrhea rate to date in the literature.

Adult↗
PubMed2000

Atypical hatching of a human blastocyst leading to monozygotic twinning: a case report.

OBJECTIVE: To report a case of monozygotic twinning after atypical hatching of a human blastocyst. DESIGN: Case report. SETTING: University-based IVF program. PATIENT(S): A 33-year-old woman with tubal sterility. INTERVENTION(S): Embryo transfer of a human blastocyst with atypical hatching. MAIN OUTCOME MEASURE(S): Development to the blastocyst stage, hatching process, follow-up of pregnancy. RESULT(S): Development of a monozygotic dichorial pregnancy. CONCLUSION(S): First report of an atypical hatching of a human blastocyst leading to dichorial monozygotic twinning.

Adult↗
PubMed2000

Bladder endometriosis must be considered as bladder adenomyosis.

OBJECTIVE: To present data from a series of 17 cases of bladder endometriosis. DESIGN: Clinical study. SETTING: A university hospital department of gynecology. PATIENT(S): Seventeen patients complaining of menstrual urinary symptoms and/or pelvic pain. INTERVENTION(S): Diagnosis and resection of a bladder adenomyotic nodule. MAIN OUTCOME MEASURE(S): Histologic analysis and postsurgical outcome. RESULT(S): Seventy-six percent of the patients reported menstrual mictalgia and pollakiuria, and 88% reported dysmenorrhea and dyspareunia. Cystoscopy, intravenous pyelography, and magnetic resonance imaging revealed a nodular mass in the anterior fornix adjacent to the uterine wall, developed in the vesical muscularis and involving the vesical mucosa in all cases but one. The bladder nodule was associated with a rectovaginal nodule in six cases (35%). Because recurrence was noted soon after cessation of medical therapy, surgical excision was proposed. The vesical mucosa was found to be intact in almost all cases, so extramucosal laparoscopic excision was the method of choice. Histologic examination proved that 90% of the nodule consisted of smooth muscle hyperplasia. CONCLUSION(S): So-called bladder endometriosis is actually an adenomyotic nodule of the bladder which, from a histologic point of view, is similar to a rectovaginal adenomyotic nodule and frequently (35%) associated with it.

Adult↗
PubMed2000

Twin-to-twin transfusion syndrome: treatment by amniodrainage and septostomy.

OBJECTIVE: Severe previable twin-to-twin transfusion syndrome (TTTS) is associated with a high fetal loss rate and is therefore usually treated. In this paper, serial amniodrainage and inter-twin septostomy are reviewed in terms of technical aspects and fetal outcome. STUDY DESIGN: A review of the literature using a MEDLINE DATA search between 1990 and 2000 was done in order to describe the mechanisms and technical aspects of both procedures with their physiopathological consequences. In addition, data from our experience with septostomy are given. RESULTS: Amniodrainage increases survival rate, with outcome ranging from 40 to 87% (mean: 56%). Inter-twin septostomy is associated with a mean fetal survival rate ranging from 57 to 83% (mean: 70%). CONCLUSION: In severe TTTS, amniodrainage and septostomy are simple therapeutic alternatives with a survival rate similar to what is currently reported for laser coagulation of placental vessels.

Amniotic Fluid↗