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Biomedical subjects

M A Bruhat

Publications and source records attributed to M A Bruhat.

At least 73 records · Page 4Linked to original sources
PubMed1994

[Operative laparoscopy: genuine surgical advance or simple temptation by the feasible?].

Laparoscopic surgery appears now to be not just a series of simple modifications to operative techniques, but more truly a revolution. This is due to three factors: the simultaneous diagnosis of lesions, establishment of the prognosis and actual treatment: greater respect for the anatomy and physiological processes; the shift in the theatre of operations which is now represented by the pelvis itself and not the operating room we were used to. This surgical revolution has achieved a number of indisputable advances, especially where the adnexa are concerned. Tubo-peritoneal infertility, of course, for which Raoul Palmer developed laparoscopy; the approach relies on a thorough knowledge of the tubal condition. Ectopic pregnancy where laparoscopic treatment has become the standard. Ovarian cysts which raise the specific problems of discovering, and even more important, overlooking malignancy. Endometriosis for which surgical treatment has become appropriate again thanks to endoscopy. This revolutionary cycle is not yet complete for subperitoneal surgery is now being addressed. Hysterectomy, so highly symbolic for the gynecologist, is now regularly carried out in this manner. Even cancer surgery may now employ endoscopy, with second-look laparoscopy for ovarian cancer and above all lymphadenectomy techniques which were developed for a large part in France and will no doubt bring about a total change in the strategies for surgical treatment of cancer. Once the technical difficulties have been resolved radical hysterectomy has the potential to become the reference thanks to its precision and radicality. Prolapse too can draw benefit from endoscopic surgery. This is already the case for colpocervical suspension and other factors concerning prolapse are under study. We must not forget that this surgery must not only comply with the standard rules for surgery, but must also benefit from regulated and rigorous training. Collaboration with the engineers and equipment manufacturers is yet another new element with which French medicine is not yet very familiar.

Female↗
PubMed1994

[Failure factors in endometrial resection. 196 cases].

OBJECTIVE: Study of factors affecting risk of failure after hysteroscopic endometrial resection. METHODOLOGY: A retrospective study of 196 patients treated by hysteroscopic endometrial resection for abnormal uterine bleeding from January 1989 to December 1990. A survey was conducted in February 1993 to study the results of these interventions with a particular attention paid to the failure cases. RESULTS: The survey revealed a satisfaction rate of 82%. Persistence of abnormal bleeding after resection was the most common problem reported, although in 32% of these cases the bleeding began after a period of at least 2 years in remission. A more complete clinical and pathological study was performed in 22 cases of hysterectomy for failure after resection. Enlarged uterine size and presence of adenomyosis increase significantly the failure rates. CONCLUSION: After 2 or 4 years of follow-up, the results are satisfactory but the existence of late recurrences showed that it will be necessary to have long term reviews. Two major risk factors are enlarged uterine size and the presence of adenomyosis.

Adult↗
PubMed1994

Laparoscopic diagnosis of adnexal cystic masses: a 12-year experience with long-term follow-up.

OBJECTIVE: To study the value and the immediate and long-term consequences of the laparoscopic diagnosis of adnexal cystic masses. METHODS: We studied all patients who underwent laparoscopy for an adnexal cystic mass at the Department of Obstetrics, Gynecology, and Reproductive Medicine of the Clermont-Ferrand University Hospital between January 1980 and December 1991. The preoperative workup included routine clinical and ultrasonographic examinations. At laparoscopy, the technique involved peritoneal cytology, ovarian and peritoneal inspection, cyst puncture, and endocystic examination. If a malignant mass was encountered or suspected, the patients were treated by immediate laparotomy with a vertical midline incision. The laparoscopic and pathologic diagnoses were compared. Long-term follow-up was studied using data obtained either clinically or by mail using a standardized questionnaire. RESULTS: A total of 757 patients with 819 masses were managed by laparoscopy. The mean age was 35.8 +/- 12.6 years and the mean diameter of the cysts was 6.0 +/- 2.7 cm (range 1-20). During this study, 12 tumors of low malignant potential and seven ovarian cancers were encountered (2.5%). The sensitivity of the laparoscopic diagnosis of malignancy was 100%, the specificity 96.6%, and the negative predictive value 100% (773 cases). The positive predictive value was only 41.3%, as 27 tumors were falsely diagnosed as suspicious or malignant. Among eight complications attributed to the diagnostic procedure, three involved spillage of cyst contents. CONCLUSION: Using cautious management and strict guidelines, laparoscopic diagnosis of adnexal masses appears reliable and safe, allowing immediate and adequate surgical treatment.

Adnexal Diseases↗
PubMed1993

Laparoscopic management of tubal ectopic pregnancy.

As with laparotomy, laparoscopic treatment of ectopic pregnancy (EP) can be either conservative or radical. After conservative laparoscopic treatment by salpingotomy the risk of failure (between 4 and 6%) is comparable with that observed after similar treatment by laparotomy. The fertility results after laparoscopic treatment of EP are comparable if not better than those observed after similar treatment by laparotomy. These two reasons, together with the considerable advantages of endoscopy over laparotomy, mean that today laparoscopic treatment is without question the best surgical treatment for EP. The prognosis for post-EP fertility is unrelated to the characteristics of the EP (size, rupture, location). The post-EP fertility depends mainly on the patient's previous history. We have established the Therapeutic Scoring System for EP by assessing the different factors affecting future fertility and multivariable analysis. This score allowed us to choose the most suitable treatment to preserve fertility and reduce the risk of recurrence between conservative laparoscopic treatment, laparoscopic salpingectomy with or without contralateral tubal sterilization.

Chorionic Gonadotropin↗
PubMed1993

Administration of LHRH analog can improve working memory in aged female rats.

We had previously found that an age-related deficit in working memory appeared in middle-aged females, possibly related to their ageing reproductive system. This experiment investigates the effect of administering an analog of luteinizing hormone-releasing hormone (LHRH), D-Trp6-LHRH, to 22-mo-old female rats submitted to successive trainings in a water-reinforced matching to sample task since the age of three months. Animals were injected SC with a long-lasting microcapsule formulation (800 micrograms/kg continuously releasing 5 micrograms D-Trp6-LHRH per day for at least 28 days). The action of the analog on ovary weight and estradiol and progesterone levels was also studied. Administration of D-Trp6-LHRH counteracted the deleterious effect of age on performance and inhibited ovary function. However, hormone plasma levels were not modified. These results suggest that the hypothalamo-ovarian axis might be implicated in memory deficits of middle-aged females.

Aging↗
PubMed1993

Classification of endometriosis.

A perfect endometriosis classification should be a common language and an expert system which helps the gynaecologist to decide the treatment of each patient. The staging of endometriosis is not a new idea; the first classification based on histologic criteria was presented in 1941. Since this initial attempt, several classifications have been proposed. These various systems are reviewed in terms of their advantages and defects. The revised American Fertility Society (AFS) endometriosis classification system is now accepted worldwide as the endometriosis international language. Laparoscopic staging and measurement techniques are presented and discussed. In recent reports, changes to the revised AFS classification have been proposed, including a better description of atypical and deep infiltrating peritoneal implants, and a stage V for patients with bilateral, extensive, dense adhesions. Despite its well-known advantages, the revised AFS classification cannot be used as a satisfactory expert system. A better understanding of endometriosis is required to improve the present system. Scientifically based scores for each lesion and a marker for disease 'activity' will be fundamental to a classification which will act as a valuable expert system and become the endometriosis classification of the twenty-first century.

Endometriosis↗
PubMed1993

[External iliac lymphadenectomy by celioscopy: surgical technique].

A complete description is provided of all the various operating steps for external iliac laparoscopic lymphadenectomy. The umbilical artery is easy to identify via laparoscopy and immediately provides the internal boundary for node excision. Laparoscopic vision also enables the other boundaries to be located, that is, the obturator nerve to the bottom and the iliac external and internal bifurcation towards the top. Examination of the nodes thus removed provides a means of assessing the spread of malignancy from cervical and uterine cancers, using a codified operation which can be included during staging or complete cancer surgery.

Female↗
PubMed1993

[The benefits and risks of laparoscopic surgery].

The advantages of laparoscopic surgery in comparison to those of conventional surgery are mainly due to the very low rates of postoperative infections and adhesions and due to the aesthetic nature of this type of surgery. Endoscopy enables a thorough search of lesions which can then be treated in a more conservative manner. The short hospital stay and rapid postoperative recovery are two key advantages of endoscopic surgery. Complications at endoscopic surgery mainly occur if the safety measures are not strictly followed, due to improper choice and use of instruments (eg. old instruments), an antecedent laparotomy and also depend upon the type of surgery performed. It should be noted that the introduction of the trocar is not a simple affair, that non-recognition of complications is not infrequent and that the incidence of complications is directly proportional to the experience of the operator.

Female↗
PubMed1993

Endoscopic treatment of ectopic pregnancies.

Laparoscopic management is now the gold standard treatment of ectopic pregnancy. It can be performed using different procedures such as salpingotomy and salpingectomy, or it can be combined with methotrexate injection. On the other hand, nonsurgical treatment is available. The authors discuss technique results and indications of these various therapeutic techniques.

Female↗
PubMed1992

Effect of administration of an analog of LHRH on appetitive learning in young and middle-aged female rats.

Hypothalamic luteinizing hormone-releasing hormone (LH-RH) had been reported to induce changes in defensive learning. In middle age, females exhibit a decline in their reproductive axis. Several studies in rodents suggested that hypothalamic LHRH function deteriorated in middle-aged females. Our experiments compare T-maze learning in young and middle-aged female rats and study the effect of administration of an analog of LHRH, D-Trp6-LHRH. The ovarian action of the analog was studied and a gonadectomized control group was added. No differences were observed between young and middle-aged females in acquisition, retention, and reversal of a simple discrimination in the T-maze. However, after removal of motor and spatial cues acquisition of the discrimination on visual cues was impaired in middle-aged females compared to young mature ones. Administration of D-Trp6-LHRH enhanced performance during the visual discrimination in younger females and had no action in middle-aged ones, whereas it inhibited ovary function in both groups. Ovariectomy had no effect. These results suggest a direct effect of the analog of LHRH on the CNS and show that this peptide fails to counteract the deleterious effect of age on performance.

Aging↗