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Biomedical subjects

J Donnez

Publications and source records attributed to J Donnez.

At least 73 records · Page 4Linked to original sources
PubMed1997

Endoscopic laser treatment of uterine malformations.

Hysteroscopic resection of an intrauterine septum may benefit patients suffering from infertility or recurrent pregnancy loss. A partial or complete uterine septum can be easily resected using a Nd-YAG laser. If present, the vaginal septum may also be removed during the same procedure. The reproductive outcome of women treated by operative hysteroscopy for an intrauterine septum is reviewed. To avoid pregnancy in a non-communicating rudimentary horn, the removal of the horn and the homolateral tube may be performed by either bipolar coagulation or a CO2 laser.

Female↗
PubMed1997

Rectovaginal septum adenomyotic nodules: a series of 500 cases.

OBJECTIVE: Laparoscopic procedure with excision of deep fibrotic endometriotic nodules of the rectovaginal septum and histological study of the lesions. SETTING: An academic teaching hospital. PARTICIPANTS: A series of 500 women undergoing laparoscopy for pelvic pain or infertility. RESULTS: Laparoscopic (n = 497) and laparotomic (n = 3) excision of endometriotic nodules resulted in considerable pain relief. Histologically the rectovaginal nodule was similar to an adenomyoma as it was a circumscribed nodular aggregate of smooth muscle and endometrial glands and stroma. The variations in oestrogen receptor and progesterone receptor content suggested a regulatory mechanism different from that of eutopic endometrium. CONCLUSION: This form of disease should be considered as an entity distinct from peritoneal and ovarian endometriosis, and originating from the Müllerian rests present in the rectovaginal septum.

Endometriosis↗
PubMed1997

Goserelin acetate (Zoladex) plus endometrial ablation for dysfunctional uterine bleeding: a large randomized, double-blind study.

OBJECTIVE: To confirm the advantages of goserelin prior to endometrial ablation for the treatment of dysfunctional uterine bleeding. DESIGN: Multicenter, prospective, randomized, double-blind study. PATIENT(S): Cycling premenopausal women with dysfunctional uterine bleeding. TREATMENT: Patients were randomized to goserelin or placebo (sham depot) once monthly for 2 months prior to endometrial ablation. Treatment was timed to allow surgery 6 weeks later on day 7 of the menstrual cycle. MAIN OUTCOME MEASURE(S): Amenorrhea rates, endometrial histology and thickness, pain and blood loss scores, and surgical parameters. RESULT(S): At 24 weeks after surgery, significantly more goserelin than placebo patients experienced amenorrhea (40% versus 26%). Blood loss was reduced from baseline, but not different between the groups. At surgery, mean endometrial thickness was 1.6 mm and 3.4 mm for the goserelin and placebo groups, respectively, with significantly more atrophic glands and stroma in the goserelin group. Surgery was significantly shorter (by 22%) and easier in the goserelin than in the placebo group, with a significantly lower median fluid absorption in the goserelin groups. In both groups, pain scores were reduced patient satisfaction was high (> 92%), and re-intervention rate was low (2.8%). CONCLUSION(S): Goserelin in combination with endometrial ablation was superior to endometrial ablation alone for the treatment of dysfunctional uterine bleeding.

Adult↗
PubMed1997

Predictive factors for multiple pregnancy in in vitro fertilization.

OBJECTIVE: To study predictive factors influencing the multiple pregnancy rate in in vitro fertilization (IVF). STUDY DESIGN: Retrospective study. RESULTS: In 1,736 IVF cycles, 453 pregnancies occurred. The rate of singleton, twin and triplet pregnancies was 44%, 22% and 4.5%, respectively. Eighty-one percent of these clinical pregnancies ended with a delivery, giving a "take-home baby" rate of 23.8%/oocyte retrieval. As expected, a statistically significant positive correlation was found between the number and quality of embryos replaced and the occurrence of multiple pregnancies. A statistically significant correlation was also found when parameters such as age, stimulation parameters and embryo characteristics were incorporated into the analysis. This correlation was different for singleton, twin and triplet pregnancies. CONCLUSION: Based on the findings of this study, in patients with a good prognosis for IVF outcome, only two embryos of good quality should be replaced regardless of the maternal age or number of IVF attempts.

Embryo Transfer↗
PubMed1996

Menstrual breakdown of human endometrium can be mimicked in vitro and is selectively and reversibly blocked by inhibitors of matrix metalloproteinases.

The mechanisms underlying the menstrual lysis leading to shedding of the human endometrium and its accompanying bleeding are still largely unknown. In particular, whether breakdown of the endometrial fibrillar extra-cellular matrix that precedes bleeding depends on aspartic-, cysteine-, serine-, or metalloproteinases remains unclear. In the present study, menstrual regression of the human endometrium was mimicked in organ culture. Whereas sex steroids could preserve tissue integrity only in nonperimenstrual explants, matrix breakdown upon sex steroid deprivation was completely and reversibly inhibited at all stages of the menstrual cycle by specific inhibitors of matrix metalloproteinases, but not by inhibitors of the other classes of proteinases. Matrix metalloproteinases are thus identified as the key class of proteinases involved in the initiation of menstruation.

Collagen↗
PubMed1996

Expansive benign lesions: treatment by laser.

Submucous fibroids, polyps and dysfunctional bleeding are responsible for meno-metrorrhagia in women over 40 years of age. The authors describe the technique of hysteroscopic myomectomy and endometrial ablation using the Nd-YAG laser and the advantages of the preoperative use of GnRH agonist therapy. They report their results in a series of 746 patients treated for meno-metrorrhagia (366 cases of myomectomy and 380 cases of endometrial ablation).

Adult↗
PubMed1996

Endometrial laser interstitial hyperthermy: a potential modality for endometrial ablation.

This study was undertaken to evaluate the efficacy and safety of an intrauterine device designed for endometrial ablation by Nd-YAG laser interstitial hyperthermy. Eight hysterectomy specimens were treated in vitro with an output power of 30 W for 5 minutes; tissue temperatures, recorded by thermocouples, were plotted to draw time-temperature and time-distance curves. As a preliminary series, ten patients were treated, with the first five subjected to local temperature monitoring; all ten were followed-up for 6-17 months. Immediate and delayed (6 weeks) histologic data were obtained. The intramural temperature at 6 mm from the fibers ranged from 55-60C). In vivo, the cooling effect of the arterial blood flow lowered the serosal temperatures under 41C. The histologic data and the hysterographic pictures suggest that endometrial ablation was effective. This new device does not require distending medium, hysteroscopic control, or high-powered Nd-YAG laser machines. Preliminary long-term results suggest that the device could be used for endometrial ablation.

Catheter Ablation↗
PubMed1996

A unilateral hydrothorax as the only manifestation of ovarian hyperstimulation syndrome: a case report.

OBJECTIVE: To describe a rare case of unilateral hydrothorax occurrence after ovarian stimulation for IVF. DESIGN: Case report. SETTING: A university hospital. PATIENT(S): A 39-year-old female suffering from primary infertility due to a severe male factor. INTERVENTION(S): Thoracocentesis with IV albumin administration for correction of a concomitant hypoalbuminemia. MAIN OUTCOME MEASURE(S): Laboratory values of hematologic measures and electrolytes, screening of the thoracic fluid aspirated for viral and bacterial infections, resolution of pleural effusion after the second thoracocentesis as determined by chest roentgenogram. RESULT(S): Treatment of this manifestation of the ovarian hyperstimulation syndrome (OHSS) by thoracocentesis with albumin perfusion. CONCLUSION(S): This report describes a very rare case of thoracic complication after ovarian stimulation. It demonstrates that pleural effusion may be the only manifestation of the OHSS and implies a careful management of patients with pulmonary complaints after treatment with exogenous gonadotropins.

Adult↗
PubMed1996

Goserelin Acetate as Adjunctive Therapy for Endometrial Ablation in Women with Dysfunctional Uterine Bleeding

The multinational, multicenter, prospective, double-blind study compared randomized 358 premenopausal women with regular cycles to receive two injections 1 month apart of goserelin acetate depot or sham depot before endometrial ablation. Injections were started to permit surgery (resection &plusmn; rollerball) 6 weeks later on day 7 of the cycle when the endometrium would be at its thinnest for the sham group, and allowing down-regulation to continue after surgery. End points were endometrial thickness at surgery, change in blood loss score, amenorrhea, severe hypomenorrhea (score <10), ease and duration of surgery, fluid absorption, change in pain score and endometrial histology. Intent-to-treat analysis was performed. Significantly more women receiving goserelin experienced amenorrhea (40%) than those receiving sham (26%, p = 0.004). The change in blood loss score was significantly reduced from baseline but not different between the groups. The combination of amenorrhea and severe hypomenorrhea favored the goserelin group (p = 0.059). Mean endometrial thickness for goserelin was 1.6 mm and for sham 3.4 mm (p = 0.0001). The majority of women given goserelin had atrophic glands and stroma. Surgery in these patients was significantly shorter (22%, p = 0.0001) and easier than for those treated with sham (p = 0.0001). Operative complications were similar between the groups, with a small but significant difference in favor of goserelin for less fluid absorption (p = 0.04). Pain scores were reduced in both groups. Patient satisfaction was very high in both groups (>92%) with a very low reintervention rate (2.8% for both groups). Overall menstrual loss was reduced. Despite timing the surgery to favor the sham group, the goserelin-treated women had significantly more amenorrhea and significant thinner endometria than seen in the immediate postmenstrual phase, and this resulted in significantly shorter and easier surgery.

Journal Article↗
PubMed1996

Morphometric, immunohistological and three-dimensional evaluation of the endometrium of menopausal women treated by oestrogen and Crinone, a new slow-release vaginal progesterone.

Recently advanced computerized technology was applied to the investigation of morphometric, immunohistological and three-dimensional changes of the endometrial mucosa in order to evaluate quantitatively the effects of three doses of a new slow-release vaginal progesterone on the endometrium in post-menopausal women. A total of 20 menopausal women, deprived of ovarian function, were given oestrogen for 12 days and a combined therapy of oestrogen (administered orally) and progesterone for another 12 day period. Progesterone was administered vaginally through a new gel (Crinone) utilizing a bioadhesive, biocompatible polymer as a base to achieve a sustained release effect. An endometrial biopsy was taken before treatment, after oestrogen-only treatment and after the oestro-progestogen therapy. Before treatment, all the patients exhibited an atrophic endometrium. After oestrogen-only treatment, typical proliferative changes occurred: an increase in the endometrium thickness, an increase in the mitotic index, numerous cylinder-like glands and no coiled glands, and high concentrations of oestrogen receptors (ER) and progesterone receptors (PR). After the oestro-progestogen therapy, whatever the dose of progesterone given, a secretory transformation of the endometrial mucosa occurred, mitotic activity decreased significantly, more ramified and coiled glands were observed, and a decrease in PR content was noted in epithelial and stromal nuclei, and a decrease in PR content was also observed in epithelial nuclei but not in stromal nuclei. Accurate new techniques of image analysis have shown that crinone therapy could eliminate the proliferative effects of oestrogen treatment in post-menopausal women, despite doses as low as 45 mg of progesterone administered vaginally every other day. The results suggest that the sustained release effects of Crinone are clinically relevant.

Capillaries↗
PubMed1996

Large ovarian endometriomas.

The management of large endometriomas was described in a series of 814 patients. Combined therapy using gonadotrophin-releasing hormone agonist (GnRHa) and carbon dioxide laser laparoscopy was proposed. Drainage and GnRHa for 12 weeks provoked a reduction of the endometrioma size up to 50% of the initial value. After vaporization of the internal wall, a cumulative pregnancy of 51% after 1 year was achieved. A recurrence rate of 8% was observed for a follow-up of 2-11 years. Histological data demonstrated that the epithelium covering the ovary which is the mesothelium can invaginate in the ovarian cortex. Some of the invaginations were seen to be continuous with endometrial tissue, strongly suggesting the metaplasia theory in the pathogenesis of ovarian endometrioma.

Combined Modality Therapy↗
PubMed1996

Regulation and restricted expression of interstitial collagenase suggest a pivotal role in the initiation of menstruation.

Collagenases are the only mammalian enzymes able to cleave, at neutral pH, the triple helical domain of fibrillar collagens, major constituents of the extracellular matrix of the endometrium. Interstitial collagenase is expressed, secreted and activated in human endometrium only just before and during menstruation. The expression of interstitial collagenase is restricted to the areas of the functional layer of the endometrium which are breaking down and to fragments which have been shed. In endometrial explants, combined sex steroids tightly control the expression, secretion and activation of interstitial collagenase, as well as the preservation of the extracellular matrix. These observations imply a pivotal role for this proteinase in the initiation of menstruation.

Biopsy↗
PubMed1996

Stereometric evaluation of peritoneal endometriosis and endometriotic nodules of the rectovaginal septum.

A computerized morphometrical investigation was performed on endometriotic tissue from the peritoneum (n = 225) and rectovaginal nodules (n = 65) to compare histologically and stereologically the rectovaginal septum endometriotic nodule to peritoneal endometriosis. Mitotic activity, stromal vascularization and the epithelium/stroma ratio were found to be significantly different in peritoneal and rectovaginal endometriosis. The evaluation revealed a major role of glandular epithelium in rectovaginal nodules where the stroma sometimes appeared absent around glandular epithelium. The study demonstrated opposite effects of gonadotrophin-releasing hormone agonists (GnRHa) and lynestrenol on the two lesions. Indeed, in peritoneal endometriosis, after GnRHa therapy, our study demonstrated a lower rate of mitosis and poor stromal vascularization. The same drug was unable to induce the same effects in the nodule although, in contrast, lynestrenol has a strong effect on nodule vascularization. In conclusion, it is suggested that the rectovaginal adenomyotic nodule is a specific disease, different from peritoneal endometriosis. It is not the consequence of 'deep infiltrating' endometriosis but can probably develop from Mullerian rests present in the rectovaginal septum.

Biopsy↗
PubMed1996

Luteal support after in-vitro fertilization: Crinone 8%, a sustained release vaginal progesterone gel, versus Utrogestan, an oral micronized progesterone.

Two progesterone presentations, a vaginal application of 90 mg progesterone per day (Crinone) or 300 mg progesterone administered orally (Utrogestan), were compared for luteal phase support of patients undergoing an in-vitro fertilization (IVF) procedure. A total of 283 patients were randomly allocated to either treatment. The treatment started within 24 h after the embryo transfer procedure and continued until day 30 in cases of implantation. Efficacy was assessed using the pregnancy and delivery rates. Safety was assessed through specific symptoms and usual safety monitoring. The pregnancy rates per transfer were not significantly different in the Crinone and Utrogestan groups at days 12 (Crinone 35.3%, Utrogestan 29.9%, P = 0.55), 30 (Crinone 28.5%, Utrogestan 25.0%, P = 0.61) and 90 (Crinone 25.9%, Utrogestan 22.9%, P = 0.69). No differences in the spontaneous abortion rates were seen thereafter. The delivery rates (number of deliveries per patient; Crinone 23.0%, Utrogestan 22.2%, P = 1.00), as well as the ratio of newborn babies per embryo transferred (Crinone 11.7%, Utrogestan 11.1%, P = 0.91), were not significantly different. Safety parameters were similar in both groups, except for drowsiness, which was more significantly frequent in the oral progesterone group than in the Crinone group at all time points. No serious adverse events were recorded in this study. The fact that Crinone matches the efficacy of the larger doses of progesterone used orally reflects an advantage of the transvaginal route of administration which avoids the metabolic inactivation of progesterone during its first liver pass.

Administration, Oral↗
PubMed1996

Focal cellular origin and regulation of interstitial collagenase (matrix metalloproteinase-1) are related to menstrual breakdown in the human endometrium.

Recent studies suggest that interstitial collagenase (MMP-1) is an essential enzyme in the early events leading to menstruation. This study analyses its cellular origin, regulation and relation to extracellular matrix breakdown in the human endometrium, both in cultured and non-cultured samples. The source of MMP-1 was identified by in situ hybridization and by immunohistochemistry on serial sections. This was compared with the immunolocalization of other MMPs, steroid receptors, macrophages, and laminin. In non-cultured endometrium, MMP-1 was only expressed during the perimenstrual period. It was either restricted to superficial foci of stromal cells or extended towards the entire functional layer. MMP-1 expression remarkably correlated with matrix breakdown, as assessed by silver staining, and was prominent at the periphery of shedding fragments and along some arterioles. In cultured non-menstrual explants, MMP-1 expression was induced within two days after deprivation of sex steroids. Both in cultured and non-cultured samples, progesterone receptors were not detectable in epithelial cells at foci of MMP-1 expression. The same stromal cells could synthesize MMP-1, MMP-2 (gelatinase A) and MMP-3 (stromelysin-1), as well as laminin, and did not correspond to macrophages. In conclusion, MMP-1 is focally expressed in stromal cells of the functional layer of the endometrium, when and where steroid receptors disappear, and especially where tissue breakdown is prominent. These observations point to an essential role for MMP-1 in the early stages of menstruation.

Collagenases↗