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J L Pouly

Publications and source records attributed to J L Pouly.

At least 37 records · Page 2Linked to original sources
PubMed2000

Cancer and laparoscopy, experimental studies: a review.

OBJECTIVE: To review the experimental studies on laparoscopy and cancer and to propose guidelines for the clinical management of gynecologic cancer. METHODS: The literature in MEDLINE was searched from January 1992 to December 1998 using the terms 'cancer', 'laparoscopy' and 'experimental or animal study'. Cross-referencing identified additional publications. Abstracts and letters to the editor were excluded. All the relevant papers were reviewed. RESULTS: Depending on the model used, controversial results have been reported on the incidence of trocar site metastasis when comparing CO(2) laparoscopy and laparotomy. In contrast, the following conclusions can be proposed: (i) tumour growth after laparotomy is greater than after endoscopy; (ii) tumour dissemination is worse after CO(2) laparoscopy than after laparotomy; (iii) some of the disadvantages of CO(2) laparoscopy may be treated using local or intravenous treatments or avoided using other endoscopic exposure methods, such as gasless laparoscopy. CONCLUSIONS: The laparoscopic treatment of gynecologic cancer has potential advantages and disadvantages, and may only be performed in prospective clinical trials. The risk of dissemination appears high when a large number of malignant cells are present. Adnexal tumours with external vegetations, and bulky lymph nodes should be considered as contra-indications to CO(2) laparoscopy.

Animals↗
PubMed2000

Successful transfer of frozen-thawed embryos obtained immediately before radical surgery for stage IIIa serous borderline ovarian tumour: case report.

A stage IIIA borderline serous ovarian tumour was treated conservatively by laparoscopy to preserve the fertility of a 21 year old nulligravid woman. Six months later, recurrent lesions were resected. An 'urgent' IVF was performed to obtain frozen embryos. Oncological treatment was then completed by radical surgery with uterine conservation. Fifteen months later, two thawed embryos were successfully transferred and the patient delivered one baby. From this observation, the authors discuss an alternative to oocyte donation in cases of bilateral ovariectomy for stage IIIA borderline serous ovarian tumour.

Adult↗
PubMed2000

A population-based analytical approach to assessing patterns, determinants, and outcomes of health care with application to ectopic pregnancy.

OBJECTIVE: Health care has variable features, specific determinants, and consequences on people's health that should be investigated in a population perspective. We present a population-based analytical approach to assessing patterns, determinants, and outcomes of health care. METHODS: The approach uses standard epidemiological methods for sample selection and analysis, as well as statistical methods concerning model fitting and validation strategy. It also uses psychometric methods allowing pattern identification: factor analysis, cluster analysis, and polytomous logistic regression to investigate the factors associated with identified patterns of care. The approach is illustrated with an application to ectopic pregnancy (EP). RESULTS: EP diagnostic and therapeutic procedures appeared to be closely related, suggesting 3 differentiated patterns of care. Predictors of these patterns were not only the clinical features and the woman's prior gynecological history but also center characteristics and location. These patterns were found to influence immediate and middle-term outcomes and risk of recurrence of EP. CONCLUSIONS: We illustrate the feasibility and profitability of a population-based analytical approach to identify patterns, determinants, and consequences of care. This approach could be used to analyze other pathological conditions and health care systems.

Adolescent↗
PubMed2000

Fertility following radical, conservative-surgical or medical treatment for tubal pregnancy: a population-based study.

OBJECTIVE: To investigate the factors influencing the choice of treatment for ectopic pregnancy and to compare the subsequent fertility rates of radical, conservative-surgical or medical treatments. DESIGN: Population-based study of 835 ectopic pregnancies registered between 1992 and 1996. SETTING: Auvergne Ectopic Pregnancy Register (France). SAMPLE: Four hundred and seventy-six women with tubal ectopic pregnancy who were not using contraception at the time of conception. Subsequent fertility was studied for the 291 women who attempted to conceive again. METHODS: Comparison of reproductive outcomes according to ectopic pregnancy treatment. Cumulative fertility curves were calculated by the Kaplan-Meier estimator and compared by log rank test for univariate analysis and by Cox regression to take into account confounding variables. MAIN OUTCOME MEASURE: Recurrence and fertility rates after ectopic pregnancy. RESULTS: The first treatment given was 'radical' for 178 women (37%), 'conservative-surgical' for 262 (55%), and 'medical' for 35 (8%). The treatment failed in 1% for radical treatment, 5% for conservative-surgical treatment, and 36% for medical treatment. The two-year cumulative rate of recurrence was 27% with no significant difference between treatments. For women with previous infertility factors (in particular diseased contralateral tube), the treatments differed significantly, with the rate of intrauterine pregnancy lower for radical treatment and higher for medical treatment than for conservative-surgical treatment. For women with no infertility factor, there was no significant difference between treatments. CONCLUSIONS: These results should be confirmed in a controlled trial. The results of this study provide the elements necessary to plan such a trial.

Adolescent↗
PubMed1999

Ruptured tubal ectopic pregnancy: risk factors and reproductive outcome: results of a population-based study in France.

OBJECTIVE: The aim of this study was to investigate the determinants of tubal rupture and to describe its treatment and effect on subsequent fertility. STUDY DESIGN: The data were taken from a population-based register from Auvergne (France). All women aged between 15 and 45 years residing permanently in this area and treated for ectopic pregnancy by surgical or medical procedures have been registered since 1992. They are then followed up prospectively until the age of 45 years. This study is an analysis of 849 tubal ectopic pregnancies registered between January 1992 and December 1996. Women with tubal rupture were compared with those in whom no tubal rupture occurred. The risk factors for tubal rupture were identified by calculating crude and adjusted odds ratios. The effects of tubal rupture on subsequent fertility were assessed by calculating cumulative intrauterine pregnancy rates and were analyzed by log-rank tests and Cox regression. RESULTS: The rate of rupture for this population was 18%. Four factors were identified that increased the risk of rupture (results of the multivariate analysis): never having used contraception (odds ratio 1.7 [1.0 to 3. 3]), a history of tubal damage together with infertility (odds ratio 1.6 [0.9 to 2.7]), induction of ovulation (odds ratio 2.5 [1.1 to 5. 6]), and a high level of beta-human chorionic gonadotropin (at least 10,000 IU/L) when ectopic pregnancy was suspected (odds ratio 2.9 [1. 5 to 5.6]). The overall cumulative frequency of intrauterine pregnancy was not significantly lower after tubal rupture (adjusted risk ratio 0.85 [0.53 to 1.38]). CONCLUSION: Although tubal rupture seriously affects the immediate health of the women concerned, it seems to have no independent effect on subsequent fertility. Better knowledge of the risk factors should make it possible to identify those women who will not benefit from nonsurgical treatment.

Adolescent↗
PubMed1999

Minilaparoscopic hysterectomy.

Minilaparoscopic surgery was performed in a 38-year-old woman scheduled for hysterectomy and ovarian cystectomy. Image resolution was similar to that of conventional laparoscopy. There were no intraoperative or postoperative complications. Since it has many advantages and few complications, minilaparoscopy appears to be an attractive way to decrease morbidity associated with conventional laparoscopy. (J Am Assoc Gynecol Laparosc 5(4):97-100, 1998)

Adult↗
PubMed1999

Fibrogenesis in peritoneal endometriosis. A semi-quantitative analysis of type-I collagen.

OBJECTIVE: To evaluate the degree of fibrosis in the stroma of peritoneal endometriosis, according to the macroscopic appearance. METHODS: Red and black lesions of peritoneal endometriosis were collected and type-I collagen was immunohistochemically identified. The percentage of the stained area in the stroma was measured using a computerized image analysis system. RESULTS: There was a significant difference in the mean percentage of the total stained area between red and black lesions. CONCLUSION: The amount of type-I collagen is significantly higher in the stroma of black peritoneal lesions than in red peritoneal lesions.

Adult↗
PubMed1998

Tumor growth and dissemination after laparotomy and CO2 pneumoperitoneum: a rat ovarian cancer model.

OBJECTIVE: To compare tumor growth, intraperitoneal implantation, and abdominal wall metastasis after laparotomy and CO2 pneumoperitoneum in a rat ovarian cancer model. METHODS: To mimic intraoperative rupture of an ovarian tumor in a syngenic rat ovarian carcinoma model, 10(5) malignant cells were injected intraperitoneally after a 5-cm vertical midline laparotomy or after the insufflation of a CO2 pneumoperitoneum achieved with 4 mmHg or 10 mmHg intra-abdominal pressure. Two weeks later, the intraperitoneal tumor growth and the tumor dissemination were evaluated semiquantitatively with a scoring system. The scores attributed to each organ were added to calculate the dissemination score of each animal. RESULTS: The mean (+/-SD) dissemination score was 83.4+/-12 in the laparotomy group and 67.3+/-16 and 71.9+/-17 in the 4 and 10 mmHg CO2 pneumoperitoneum groups, respectively (P < .01). The scores for the peritoneum were 21.8+/-3.8 in the 10 mmHg pneumoperitoneum group and 18+/-2.4 in the laparotomy group (P < .01). In the laparotomy group, the implant found along the midline scar accounted for a mean of 62.6+/-15% of the peritoneal score, whereas the trocar site metastases did not influence the peritoneal score in the pneumoperitoneum groups. The incidence of wound metastasis was 96% in the laparotomy group and 55% and 54% in the 4 mmHg and 10 mmHg pneumoperitoneum groups, respectively. CONCLUSION: In this model, tumor growth was greater after laparotomy than after laparoscopy, but peritoneal tumor dissemination was more severe after CO2 pneumoperitoneum.

Animals↗
PubMed1998

Laparoscopic fimbrioplasty: an evaluation of 35 cases.

The aim of this prospective study was to assess the value of laparoscopic treatment of severe fimbrial occlusions. During a period of 52 months infertile patients with fimbrial lesions were treated by operative laparoscopy. Only those patients requiring incision of the tubal serosa (salpingostomy) were included, representing the most severe lesions. The most frequent cases, those patients requiring simple adhesiolysis and deagglutination of the fringes, were excluded. All tubal lesions were documented carefully. Positive Chlamydia trachomatis (CT) serology was found in 65.7% of the patients. All the patients were followed up for at least 2 years. Three patients lost to follow-up were defined as failures. The global conception rate was 74.3%. The intrauterine pregnancy rate was 51.4%, and the 'take home baby rate' was 37.1% (only the first pregnancy being taken into account). The ectopic pregnancy rate was 22.9%. A positive CT serology was found to have a significant influence on the outcome. It can be concluded that the laparoscopic approach provides results similar to those obtained by microsurgery for the treatment of severe fimbrial occlusions, and represents an acceptable alternative to in-vitro fertilization (IVF) in selected cases.

Chlamydia Infections↗
PubMed1998

Angiogenesis in endometriosis.

We evaluated angiogenesis in eutopic endometrium and ectopic endometrium from patients with endometriosis. Microvessels were identified by immunohistochemistry using anti-von-Willebrand factor antibody and vascular parameters were measured using a computerized image analysis system. No relationship was observed between vascular density and type of endometriotic lesion. Heterogeneity in vascular density was observed in different lesions within the same patient. Between red and black peritoneal lesions a significant difference was observed in the frequency distribution of luminal diameter. In black lesions the variability of luminal diameter was decreased and most microvessels were less than 20 mm in diameter. We suggest that the frequency distribution of microvessel luminal diameter of red and black peritoneal lesions may be different and should be important when studying the regulation of angiogenesis in endometriotic implants.

Adult↗
PubMed1998

[Surgical management of adnexal tumors].

Concerning laparoscopy and tumor dissemination, we know from several multivariate analyses that at laparotomy, if the tumor is entirely and immediately removed, the puncture of a stage I ovarian cancer has no influence on the prognosis. In contrast the inadequate surgical management of an undiagnosed ovarian cancer may worsen the prognosis. The diagnosis is the key step. To be able to immediately and completely treat an ovarian cancer when managing an ovarian tumor surgically, Laparoscopic diagnosis is safe and reliable when used cautiously. The surgical diagnosis may and should probably be performed by laparoscopy whatever the ultrasonographic appearance of the tumor. Masses diagnosed as suspicious at surgery should be treated by immediate laparotomy, since the results of laparoscopic treatment of an ovarian cancer are not known. In young patients, conservative surgery is the main advantage of laparoscopy, and should be achieved in most benign masses. The recent progresses of in vitro fertilization should be taken into account when managing an ovarian tumor in a patient who wishes to become pregnant. Frozen sections are useful, when treating highly suspicious masses, allowing an immediate staging and avoiding the disadvantages of a second surgical procedure. Whenever a malignant tumor has been missed at laparoscopy, restaging is required and should be considered to be an oncologic emergency.

Adult↗
PubMed1997

Birth after combination of cryopreservation of sperm recovered from urine and intracytoplasmic sperm injection in a case of complete retrograde ejaculation.

OBJECTIVE: To assess whether sperm recovered from postejaculatory urine and cryopreserved can be used successfully for intracytoplasmic sperm injection (ICSI). DESIGN: Case report. SETTING: Laboratory of Developmental and Reproductive Biology, University Hospital. PATIENT(S): A couple with male infertility resulting from complete retrograde ejaculation. INTERVENTION(S): Freezing of sperm recovered from urine and subsequent use for ICSI. MAIN OUTCOME MEASURE(S): Survival, maintenance of fertilization, and pregnancy potential of sperm recovered from urine and cryopreserved. RESULT(S): On thawing, the sperm were still alive (32% viability) and very slightly motile (2% sluggish motility). Of 16 oocytes injected, 10 (62.5%) produced normal, cleaving embryos. A twin pregnancy with the birth of two healthy infant girls was achieved after the transfer of three embryos. CONCLUSION(S): The birth of normal, healthy female infants after ICSI with sperm recovered from postejaculatory urine and then cryopreserved demonstrates the usefulness of freezing such sperm even if motility is very low, to avoid surgery in the patient.

Adult↗
PubMed1997

Laparoscopic management of adnexal masses suspicious at ultrasound.

OBJECTIVE: To evaluate the laparoscopic management of adnexal masses suspicious at ultrasound. METHODS: In a prospective study, adnexal masses suspicious at ultrasound were managed by laparoscopy. Indications for laparotomy included general contraindications to laparoscopy, obviously disseminated ovarian cancer, and technically impossible laparoscopic treatment. After laparoscopic diagnosis, frozen sections were used to confirm a diagnosis of malignancy. Treatment was performed by laparoscopy whenever feasible. RESULTS: Over a 3-year period, 247 of the 599 adnexal masses (41.2%) treated in our department were suspicious or solid at ultrasound. Seventeen patients were evaluated by laparotomy and 230 by laparoscopy. Overall, 204 women (82.6%) were treated by laparoscopy, including seven of the 37 malignant tumors (18.9%) and 197 of the 210 benign masses (93.8%). One case of tumor dissemination occurred after a laparoscopic adnexectomy and morcellation of a grade 1 immature teratoma. CONCLUSION: Laparoscopic diagnosis of adnexal masses suspicious at ultrasound avoids many laparotomies for the treatment of benign masses and allows an improved inspection of the upper abdomen. The laparoscopic treatment of adnexal masses suspicious at surgery should be evaluated further in carefully designed prospective studies.

Adnexal Diseases↗
PubMed1997

Laparoscopic fimbrioplasty and neosalpingostomy. Experience of the Yaoundé General Hospital, Cameroon (report of 194 cases).

OBJECTIVE(S): To study the fertility results after laparoscopic distal tuboplasty and compare them with the data in the literature. STUDY DESIGN: 194 laparoscopic distal tuboplasties were carried out from May 1992 to May 1994 in the Yaounde General Hospital (Cameroon). The results were analysed according to the age of the patients, the type and duration of infertility, past history of abortion, laparotomy and Chlamydia trachomatis infection, the tube and adhesion scores, surgical procedures and achievement of pregnancy. The fertility rates were calculated according to Cramer's method [11]. The cumulative pregnancy rate curves were drawn up from the life table [12] and compared using the Log-Rank test. RESULTS: 53 patients obtained pregnancy (27.3%) of which 45 were inter-uterine (23.2%) and 8 ectopic (4.1%). Of the 45 intra-uterine pregnancies (IUP), 36 were obtained after fimbrioplasty (33.3%) and 9 after neosalpingostomy (10.5%). The monthly fertility rate at one year was 1.4%. The rate of IUP for tube stages I and II is significantly higher than that for stages III and IV (p<0.001). However the rate of ectopic pregnancies (EP) is proportional to damage to the tubes. Infection with Chlamydia trachomatis, and residual inflammation could have an effect on the achievement of pregnancy. CONCLUSION(S): Our results are similar to those found in the literature. The tube stage thus remains the decisive factor in terms of fertility (Cox: p<0.001). Operative laparoscopy is the best alternative in our countries compared with laparotomy for distal tubal pathology.

Adult↗
PubMed1997

Successful oocyte donation after stage 1C serous ovarian cancer.

A stage 1C serous epithelial cancer was discovered and treated during laparoscopy performed for infertility investigation. An immediate in-vitro fertilization (IVF) was scheduled to obtain frozen embryos. Oncological treatment was then completed by radical surgery (with uterine conservation) and chemotherapy. Two years later, the thawed embryos were unsuccessfully transferred. However, following oocyte donation, the patient became pregnant and delivered two babies. From this observation, the authors discuss the strategy required in cases of early ovarian cancer associated with infertility.

Adult↗