Advanced endoscopic techniques used in dysfunctional bleeding, fibroids and endometriosis, and the role of gonadotrophin-releasing hormone agonist treatment.
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Danazol↗
Biomedical subjects
J Donnez
Publications and source records attributed to J Donnez.
Laparoscopic supracervical (subtotal) hysterectomy (LASH).
The use of laparoscopically assisted vaginal hysterectomy with or without annexectomy has been widely discussed. We report the technique of laparoscopic supracervical (subtotal) hysterectomy (LASH), which was first performed in 1990. Laparoscopic supracervical hysterectomy was carried out in a series of 36 women. The duration time was 60 min in experienced hands. There were no major complications. The feasibility and low morbidity rate of this laparoscopic approach led us to propose LASH in certain indications, particularly in cases of a uterus with multiple submucosal myomas where hysteroscopic therapy is less successful.
Adult↗
Laparoscopic myolysis with the Nd:YAG laser.
Laparoscopic myomectomy can be carried out in cases of subserosal and intramural fibroids. Laparoscopic myolysis can be proposed as an alternative to laparoscopic myomectomy in cases of large or multiple intramural fibroids in women aged over 40 or not desiring to bear more children but wishing to avoid a future hysterectomy. The authors report the technique and the long-term results in a series of 48 women with fibroids treated by myolysis. Because of the risk of bowel adhesions, further studies with another type of laser fiber are required.
Adult↗
Improving the classification of endometriosis.
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Endometriosis↗
The ovarian hyperstimulation syndrome in in-vitro fertilization: a Belgian multicentric study. I. Clinical and biological features.
The multicentric study regroups 128 cases of the ovarian hyperstimulation syndrome (OHSS) in in-vitro fertilization (IVF) and 256 selected controls. Values of serum oestradiol obtained from different laboratories were found to be normally distributed after logarithmic transformation. Comparative study of clinical and biological characteristics indicates that among OHSS patients (i) mean age was lower; (ii) tubal indications for IVF were less frequent; (iii) polycystic ovary-like conditions (i.e. hyperandrogenism, anovulation, luteinizing hormone/follicle stimulating hormone ratio > 2) were more frequent. OHSS patients displayed ovarian hypersensitivity reflected by higher oestradiol peak concentrations in response to lower dosage of human menopausal gonadotrophin and by a steeper slope of oestradiol increment during stimulation. In these patients, the collection of greater numbers of fertilizable oocytes allowed replacement of more embryos with a good vitality score. Ongoing pregnancy rate was found to be higher among the OHSS patients. The following complications were recorded among OHSS cases: abdominal fluid at echographic examination or clinical ascites (86.7 and 71.1%, respectively); pleural and pericardial effusion (21 and 3%, respectively); haemoconcentration (71.1%); electrolytic disorders (6.2%). Although significantly different between groups, clinical and biological parameters under study showed considerable overlap of their distributions in control and OHSS cases. Therefore, these data must be submitted to discriminant analysis in order to derive a formula predictive of the risk of OHSS.
Adult↗
[The role of GnRH agonists in the endoscopic treatment of endometriosis and fibromyomas].
Uterine myomas and endometriosis are benign pathologies frequently encountered in women. Myomas are often associated with infertility and/or menorrhagia particularly if they are sub-mucosal. Endometriosis is diagnosed in more than 35% of infertile patients. These two common pathologies are oestrogen-dependent and the administration of a GnRH agonist has been proposed as a non-surgical approach to the treatment of myomas and endometriosis. GnRH agonists cannot, however, be considered as definitive medical therapy because most myomas and endometriotic cysts return to their initial size within 4 months following the cessation of treatment. Moreover, because of the menopausal-like state that they induce, GnRH agonists provoke bone demineralization and for this reason, their long-term use is not recommended. These agents should, therefore, be considered as an adjuvant preoperative therapy. The aim is, above all, to achieve a preoperative reduction of tumour size, thus facilitating the endoscopic surgery: either hysteroscopic resection in the case of sub-mucosal myomas, or vaporization of ovarian cysts in the case of cystic endometriotic lesions.
Adult↗
[Role of assisted fertilization techniques in the management of male sterility].
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Clinical Trials as Topic↗
Morphometric study of the stromal vascularization in peritoneal endometriosis.
To evaluate the stromal vascularization of different appearances of peritoneal endometriosis, biopsies were taken from peritoneal areas with endometriosis in a series of 135 infertile women and classified as typical (black), red, or white lesions. The number of capillaries per mm2 of stroma, their mean surface area, and the ratio of capillaries/stroma surface area, and the mitotic activity were analyzed in typical, red, and white lesions. Significant differences were found between the different subgroups. The higher vascularization and mitotic activity observed in red lesions suggested the hypothesis that such lesions are very active and probably the first stage of early implantation of endometrial glands and stroma. The poor vascularization and the absence of mitosis observed in white lesions suggested that these lesions are much less active than red lesions and are a quiescent stage of the disease. Our study proves that the "activity" of peritoneal endometriosis is related to the vascularity. This concept must be considered in the further discussion of American Fertility Society Endometriosis Classification. Typical, red and white lesions are three different stages of the peritoneal disease and their relative relation to infertility is also probably different.
Endometriosis↗
Progesterone regulates the activity of collagenase and related gelatinases A and B in human endometrial explants.
Explants of human endometrium were cultured to study the release of matrix metalloproteinases (MMPs). Analysis of conditioned media by zymography revealed latent and active forms of collagenase (MMP-1, EC 3.4.24.7), 72-kDa gelatinase A (MMP-2, EC 3.4.24.24), and 92-kDa gelatinase B (MMP-9, EC 3.4.24.35). These proteinases were identified by their M(r), their inhibition by tissue inhibitor of metalloproteinases, and the activation of their zymogens by trypsin or aminophenylmercuric acetate. In the absence of sex hormone, explants released large amounts of enzyme activities, as measured by densitometry of zymograms or in soluble assays. Physiological concentrations of progesterone (10-200 nM) almost totally abolished the release of collagenase, of total gelatinase activity, and of the active form of gelatinase B and largely inhibited the release of the active form of gelatinase A. These effects, which were antagonized by mifepristone (RU 38486), suggest that progesterone restrains endometrial tissue breakdown by blocking the secretion and activation of MMPs.
Collagenases↗
Vaginoplasty using amniotic membranes in cases of vaginal agenesis or after vaginectomy.
Various treatments have been proposed for vaginal agenesis. The authors describe successful procedures using amniotic membranes as a graft on vaginoplasties. The amnion was not stripped from the chorion. The results showed the vagina to be well formed and of normal depth and caliber.
Adolescent↗
Endometriosis 1991: a discussion document.
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Endometriosis↗
The place of GnRH agonists in the treatment of endometriosis and fibroids by advanced endoscopic techniques.
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Adult↗
Role of gonadotrophin-releasing hormone agonists in the treatment of external genital endometriosis: review of 77 cases.
Peritoneal and ovarian endometriosis are anatomically highly polymorphous and can give rise to pain and sterility. Endometriosis can be recognized and evaluated by means of laparoscopy and an appropriate therapeutic strategy determined. Surgical laparoscopy using lasers (CO2, KTP and argon) produces excellent results. More than 80% of cases can be treated by coelioscopy, bearing in mind that severe endometriosis can require classic surgery and remains difficult to perform. However, one basic idea should not be forgotten, ie, that endometriosis is a progressive disease. Restoration of anatomic pelvic integrity (with free pouch of Douglas, mobility of appendages and functional ovaries) is the only guarantee of good fertility, achievable by interruption of progression of the disease. Following therapeutic trials with danazol, norsteroidal progestagens, gonadotrophin-releasing hormone agonists have opened up wide perspectives for use and we use them in combination with coeliac surgery. Our experience has paralleled that of Donnez and Bruhat, with almost identical results.
Combined Modality Therapy↗
Three-dimensional architectures of peritoneal endometriosis.
OBJECTIVE: To elucidate some biological characteristics of peritoneal endometriosis. DESIGN: A recently advanced stereographic computer technology was applied for the investigation of the three-dimensional (3-D) architectures of peritoneal endometriosis. SETTING: University Hospital of Gynecology. PATIENTS: Biopsies were taken from 42 women with peritoneal endometriosis. Twenty-six of them were in the luteal phase. Seventeen of them received Zoladex (ICI, Cambridge, United Kingdom) for 12 weeks before biopsy. RESULTS: Two different main types could be identified according to the presence or absence of ramifications. The apparently multifocal occurrence (in 2-D) of glandular epithelium was not confirmed by the 3-D study that showed that all epithelial glands are interconnected by luminal structures in each peritoneal lesion. Stereometric study suggests a stronger effect of gonadotropin-releasing hormone agonist therapy on the stroma than on the epithelium. CONCLUSIONS: The study evaluated the 3-D architectures of peritoneal endometriosis and identified two principal types of peritoneal endometriosis.
Biopsy↗
Hysteroscopic surgery.
Because a wide variety of conditions can be diagnosed hysteroscopically, hysteroscopy has become a diagnostic gold standard. Through "operative" hysteroscopes, both the electrical current of the resectoscope and the energy of the neodymium:yttrium-aluminum-garnet laser have been effective tools in many cases and presented a new alternative to laparotomy and hysterectomy. The most frequent procedures are 1) endometrial ablation and partial endometrial ablation, 2) myomectomy for submucous myomas, 3) two-step myomectomy for large submucosal and intramural myomas, 4) hysteroscopic management of müllerian defects, and 5) hysteroscopic management of intrauterine adhesions.
Electrosurgery↗
Laparoscopic management of large ovarian endometrial cyst: use of fibrin sealant.
In order to prevent postoperative adhesions often present after CO 2 laser vaporization of large endometriomas, 62 patients with endometriomas greater than 3 cm diameter were treated with a new procedure. Partial cystectomy was performed using the CO 2 laser. Residual endometrial cyst was then vaporized. After laparoscopic vaporization of the interior cyst wall, a fibrin glue (Tissucol) was injected onto the vaporized area to close laparoscopically the ovarian cyst cavity. When performed, second-look laparoscopy demonstrated healing of the ovary without any periovarian adhesions. The incidence of periovarian adhesions was significantly lower (p less than 0.01) than in the group of women treated by laparoscopy and in whom the glue was not used to close the ovarian cyst cavity.
Endometriosis↗