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M Canis

Publications and source records attributed to M Canis.

At least 37 records · Page 2Linked to original sources
PubMed2005

[Pyosalpingitis after interadnexal laparoscopic hysterectomy. Two cases].

The prolapse of a uterine tube is a rare event after hysterectomy with adnexal conservation. It is described in the literature after abdominal or vagina hysterectomy. We report two cases occurring after laparoscopic hysterectomy, and complicated by pyosalpingitis. Patients have presented with pelvic pain and vaginal discharge. Diagnosis was not easy, clinically suspected with the transvaginal ultrasonography, and confirmed by celioscopy. It may be helped by biopsy. The laparoscopic management was carried out without complications.

Adult↗
PubMed2004

DNA microarray analysis of gene expression profiles in deep endometriosis using laser capture microdissection.

Endometriosis, a common gynecological disorder that causes infertility and pelvic pain, is defined as the presence of endometrial glands and stroma within extra-uterine sites. However, despite extensive studies its etiology and pathogenesis are not completely understood. Differentially expressed genes were investigated in epithelial and stromal cells from deep endometriosis and matched eutopic endometrium using cDNA microarrays and laser capture microdissection. Validation of results of several up- and down-regulated genes was performed by quantitative real-time RT-PCR. Our data showed that platelet-derived growth factor receptor alpha (PDGFRA), protein kinase C beta1 (PKC beta1) and janus kinase 1 (JAK1) were upregulated, and Sprouty2 and mitogen-activated protein kinase kinase 7 (MKK7) were downregulated in endometriosis stromal cells, suggesting the involvement of the RAS/RAF/MAPK signaling pathway through PDGFRA in endometriosis pathophysiology. In addition, two potential negative regulators of aromatase expression, chicken ovalbumin upstream promoter transcription factor 2 (COUP-TF2) and prostaglandin E2 receptor subtype EP3 (PGE2EP3), were downregulated in endometriosis epithelial cells, which might result in increased local production of estrogen in endometriosis epithelial cells. Furthermore, three potential candidate genes that might be involved in endometriosis related pain were identified: tyrosine kinase receptor B (TRkB) in endometriosis epithelial cells, and serotonin transporter (5HTT) and mu opioid receptor (MOR) in endometriosis stromal cells were all upregulated. One of the candidate genes, MOR, may be involved in a defective immune system in endometriosis. This study has provided new insights into endometriosis pathophysiology.

Endometriosis↗
PubMed2003

The ovarian endometrioma: why is it so poorly managed? Laparoscopic treatment of large ovarian endometrioma: why such a long learning curve?

The laparoscopic management of ovarian endometrioma was reported more than 15 years ago. An anonymous survey conducted among gynaecologists in the UK showed that 50% of ovarian endometrioma are still managed by laparotomy. This surprising result is discussed emphasizing the difficulties of the learning curve, pitfalls in surgical training and mistakes of the pioneers. Endoscopic surgery will become the standard technique when all practising gynaecologic surgeons have been trained during their residency. The goal of the endoscopic surgeon should be to achieve adequate surgical treatment. Endoscopic surgery is not a technical gimmick used to avoid laparotomy and to attract patients.

Education, Medical, Continuing↗
PubMed2003

[Ectopic pregnancy: criteria to decide between medical and conservative surgical treatment?].

OBJECTIVE: To search for criteria which should be used to decide between medical treatment and conservative laparoscopic treatment of ectopic pregnancy. METHOD: A Medline search was conducted via Pubmed and in the Cochrane Library. Other studies were selected from the references used in recent randomized trials. RESULTS: Results of medical and of conservative laparoscopic treatment have been similar in patients selected for prospective randomized trials. The criteria used to include patients in these studies were determined arbitrarily. Two scores were evaluated prospectively, they included criteria which may be difficult to use in clinical practice. CONCLUSION: The treatment should performed surgically if the patient is hemodynamically unstable, ss-hCG is >10,000 mUI/mL, the ectopic pregnancy is > or =4 cm in diameter, if there is a medical contraindication to methotrexate, and if the patient may not be followed adequately after treatment. Medical treatment should be preferred if the patient has undergone surgery many times previously, has extensive pelvic adhesion, a contraindication for general anesthesia, a cornual pregnancy, and after failure of a conservative laparoscopic treatment. Medical treatment is possible: if ss-hCG is below 5,000 or 10,000 mUI/mL, if the ectopic pregnancy is less than 4 cm in diameter or if the score is adequate when a scoring system prospectively evaluated can be used. Medical treatment should be preferred: if ss-hCG<1000 mUI/mL, if the patient has no pain and if the ectopic pregnancy cannot be visualized at ultrasound.

Abortifacient Agents, Nonsteroidal↗
PubMed2002

Total laparoscopic hysterectomy for very enlarged uteri.

STUDY OBJECTIVE: To evaluate short-term outcome of total laparoscopic hysterectomy (TLH) performed in women with very enlarged uteri. DESIGN: Case control study (Canadian Task Force classification II-2). SETTING: Hospital gynecologic service. PATIENTS: Thirty-four consecutive women with very enlarged uteri. INTERVENTION: Total laparoscopic hysterectomy for benign pathology. MEASUREMENTS AND MAIN RESULTS: Women with uterine enlargement (group 1) were compared with 68 women with uteri weighing 300 g or less (group 2) who underwent TLH during the same period. Matching was based on patient age +/- 2 years, surgeon (experienced senior, fellow), whether or not Burch operation was performed, and whether or not adnexectomy was performed. The groups were compared for complication rates, operating time, hospital stay, change in perioperative hemoglobin concentration, and vaginal and laparoscopic uterine morcellation. They did not differ statistically significantly in terms of indications for surgery, parity, postmenopausal status, and preoperative hemoglobin levels. No difference was seen in complication rates between groups. Operating time was significantly shorter (p <0.001) in women with smaller uteri than in those with very enlarged uteri, 108 +/- 35 and 156 +/- 50 minutes, respectively. The groups did not differ significantly in day 1 hemoglobin level drop, analgesia requirement (oral, intravenous opioid), time to passing gas and stool, or hospital stay. No conversion to laparotomy was required in either group. CONCLUSION: A very enlarged uterus should not be considered a contraindication for TLH. However, it may be necessary to undertake certain surgical steps to ensure optimal exposure of the operative field and more effective and safer excision of the uterine vascular pedicle.

Female↗
PubMed2002

The learning curve of total laparoscopic hysterectomy: comparative analysis of 1647 cases.

STUDY OBJECTIVE: To compare the frequency of complications of total laparoscopic hysterectomy performed in the first and more recent years of our experience, and based on that, offer ways to prevent them. DESIGN: Retrospective, comparative study (Canadian Task Force classification II-2). SETTING: University tertiary referral center for endoscopic surgery. PATIENTS: During 1989-1995 and 1996-1999, 695 and 952 women, respectively, with benign pathology. INTERVENTION: Total laparoscopic hysterectomy. MEASUREMENTS AND MAIN RESULTS: No differences in patient characteristics were found between 1989-1995 and 1996-1999. Substantial decreases in major complication rates were noted, 5.6% and 1.3%, respectively. No major vessel injury occurred. Excessive hemorrhage (1.9%) and need for blood transfusion (2.2%) during the first period were statistically higher than in the second period (both 0.1%, p <0.005). Urinary complications (2.2%) including 10 bladder lacerations, 4 ureter injuries, and 1 vesicovaginal fistula occurred more frequently in the first period than in the second period (0.9%), when 6 bladder and 2 ureter lacerations and 1 vesicovaginal fistula occurred (p <0.005). One bowel injury and one bowel obstruction occurred in the first period, but no bowel complications in the second. Between periods, 33 (4.7%) and 8 (1.4%) conversions to laparotomy were necessary. During the first period there were nine reoperations; of six laparotomies, four were due to urinary injuries, one due to heavy vaginal bleeding, and one due to a vesicovaginal fistula; three diagnostic laparoscopies were required due to postoperative abdominal pain. Three reoperations during the second period were two laparoscopies due to heavy vaginal bleeding and one laparotomy due to a vesicovaginal fistula (p <0.005). Statistically significant differences in median (range) uterine weight 179.5 g (22-904 g) and 292.0 g (40-980 g) and operating times 115 minutes (40-270 min) and 90 minutes (40-180 min), respectively, were recorded (p <0.005). CONCLUSION: Laparoscopic hysterectomy was safe, effective, and reproducible after training, and with current technique, had a low rate of complications.

Adult↗
PubMed2001

5-aminolevulinic acid-induced (ALA) fluorescence for the laparoscopic diagnosis of peritoneal metastasis. AST An experimental study.

BACKGROUND: We performed a randomized experimental study in a rat model to evaluate the use of 5-aminolevulinic acid-induced (ALA) fluorescence in the laparoscopic diagnosis of peritoneal metastases of ovarian cancer. METHODS: We injected 103 ovarian adenocarcinoma cells in the peritoneum of 31 rats. One week later, 5-aminolevulinic acid was injected in the peritoneum (100 mg/kg). After 3 h, we examined the rats using a 10-mm endoscope with a mono CCD camera and a light source developed for photodynamic diagnosis. Metastases on the parietal peritoneum were evaluated independently by two surgeons randomly assigned to use either a conventional light mode or the fluorescence mode. RESULTS: The mean number of metastases detected was 2.84 with conventional laparoscopic light and 5.74 with ALA-induced fluorescence (p < 0.0008). Metastases diagnosed by fluorescence were confirmed by pathologic examination. Random peritoneal biopsy specimens taken from nonfluorescent areas were negative. CONCLUSION: In this experiment, ALA-induced fluorescence improved the detection of peritoneal metastases of ovarian cancer.

Adenocarcinoma↗
PubMed2001

Expression of the cyclin-dependent kinase inhibitor p27Kip1 in eutopic endometrium and peritoneal endometriosis.

OBJECTIVE: This study was undertaken to evaluate the immunohistochemical expression of the cell cycle inhibitor p27Kip1 and proliferation marker Ki67 in peritoneal endometriosis and eutopic endometrium. DESIGN: Prospective study. SETTING: University hospital. PATIENT(S): Thirty-one patients with peritoneal endometriosis. INTERVENTION(S): During laparoscopy, 25 samples of predominantly red peritoneal lesions and 27 samples of predominantly black peritoneal lesions were collected from 31 patients with endometriosis. Eutopic endometrium from 25 patients with endometriosis was collected by curettage during laparoscopy or just after surgery. MAIN OUTCOME MEASURE(S): The percentage of glandular and stromal cells exhibiting positive staining for p27Kip1 and Ki67 (labeling index, LI) was determined. RESULT(S): The LI of stromal cells in red peritoneal lesions for both p27Kip1 and Ki67 was similar to that of proliferative eutopic endometrium. Although the LI of glandular epithelial cells for Ki67 in red lesions was comparable to that of proliferative eutopic endometrium, the LI for p27Kip1 was significantly higher. Furthermore, we detected a significantly higher LI of glandular epithelial and stromal cells for p27Kip1 in black lesions compared with red lesions. CONCLUSION(S): Our results suggest that expression of the cyclin kinase inhibitor p27Kip1 is involved in the natural history and progression of peritoneal endometriosis.

Adult↗
PubMed2001

Expression of estrogen receptor alpha and beta in peritoneal and ovarian endometriosis.

OBJECTIVE: To quantify and compare messenger RNA (mRNA) levels of ER-alpha and ER-beta among ovarian endometriotic cysts and red and black peritoneal endometriotic lesions. DESIGN: Prospective study. SETTING: University hospital. PATIENT(S): Patients with or without endometriosis. INTERVENTION(S): Samples of peritoneal (n = 33) and ovarian endometriotic lesions (n = 37) were obtained during laparoscopic surgery. Normal eutopic endometrial tissues and macroscopically normal peritoneal tissues were obtained as controls during or just after surgery. MAIN OUTCOME MEASURE(S): Expression of mRNA for ER-alpha and ER-beta, using a real-time reverse transcription (RT)-PCR assay, TaqMan RT-PCR, and nonradioactive in situ hybridization (ISH) techniques. RESULT(S): Both eutopic endometrium and endometriotic tissues showed predominantly higher levels of ER-alpha than ER-beta mRNA. Relative ratio of ER-alpha to ER-beta (ER-alpha/ER-beta) mRNA in red peritoneal lesions was significantly higher than in black lesions and ovarian endometriotic cysts. There was no significant difference in ER-alpha/ER-beta between proliferative eutopic endometrium and red peritoneal lesions. These results were confirmed by ISH analysis, which also revealed that the two estrogen receptors were localized in both epithelial and stromal cells of endometriotic tissues. CONCLUSION(S): The predominant expression of ER-alpha in both glandular epithelial and stromal cells may be essential for the development and growth of peritoneal and ovarian endometriosis.

Adult↗
PubMed2001

Immunohistochemical analysis of the role of angiogenic status in the vasculature of peritoneal endometriosis.

OBJECTIVE: To investigate the angiogenic status of the vasculature in peritoneal endometriosis based on macroscopic appearance. DESIGN: Prospective study. SETTING: University hospital. PATIENT(S): Patients with peritoneal endometriosis. INTERVENTION(S): During laparoscopy, 25 samples of predominantly red peritoneal lesions and 27 samples of predominantly black peritoneal lesions were collected from a total of 31 patients with endometriosis. Eutopic endometrium from 25 patients with endometriosis was collected by curettage during laparoscopy or just after surgery. MAIN OUTCOME MEASURE(S): A proliferating endothelial cell index (PCI) was determined by calculating the percentage of microvessels that contained proliferating endothelial cells. A vessel maturation index (VMI) was determined by calculating the percentage of microvessels showing colocalization of CD34- and alpha-SMA-positive staining. RESULT(S): Peritoneal endometriotic tissues had extremely low or null PCI. The VMI of red peritoneal lesions was significantly lower than that of black ones. Vessel maturation index of red lesions was higher that that of proliferative eutopic endometrium and similar to that of secretory eutopic endometrium. CONCLUSION(S): Compared with the case of black peritoneal lesions, red lesions had a much higher fraction of immature vessels.

Actins↗
PubMed2001

Promontofixation for the treatment of prolapse.

Genital prolapse is a common problem in women. The wide variety of surgical techniques used to treat this problem demonstrate how difficult it is to manage. Laparoscopic surgery offers a new approach. It allows a good view of the anterior and posterior compartments so that a global approach for the prolapse is possible by the same surgical route. Traditional promontofixation can be combined with a new approach to the posterior compartment. Laparoscopic promontofixation through installation of an intervesicouterine prosthesis for the treatment of hysterocele and cystocele is associated with paravaginal repair of lateral defects and a Burch anterior colposuspension for urinary stress incontinence. When combined with laparoscopic treatment of rectocele by myorrhaphy and reinforcement of the fascia by means of a prosthesis, it provides a complete range of treatment for all types of feminine prolapse. After 20 years of experience through laparotomy, promontofixation using a triangle has been carried out by laparoscopy at the authors' center since 1991 in an attempt to eliminate the cystocele by solidly anchoring the uterus and bladder floor to the promontory. This laparoscopic technique follows the usual steps for pelvic prolapse repair: 1. Total or subtotal hysterectomy or suspension of the uterus is performed in such a way that it returns to normal physiologic position, and a solid subvesical floor is created. 2. The physiologic axis of the vagina is restored by creating a strong, low posterior point of support and by performing culdoplasty. 3. Evident or latent stress incontinence is treated. It would be pointless to treat the hysterocele on its own because, once the prolapse has been cured, the subvesical mass will disappear and allow urinary incontinence to appear. 4. Reconstruction of the posterior rectovaginal support structures seems to be mandatory and is carried out in almost all cases. The first phase of the laparoscopic approach to pelvic prolapse allowed the authors to explore the technical aspects. Several approaches are possible by laparoscopy. Herein, the authors report 8 years of technical research and assessment. This experience confirms the tremendous potential of laparoscopic surgery for the treatment of all aspects of this pathology by the same route. Stress incontinence, cystocele, hysterocele, rectocele, or enterocele can be treated. The operative time is longer than with the open route, and the surgeon must be highly experienced. Based on their experience, the authors are discovering new concepts. More data are required before a conclusion can be drawn concerning this promising new approach.

Culdoscopy↗
PubMed2001

[Management of adnexal tumors: role and risks of laparoscopy].

The laparoscopic management of adnexal tumeurs remains controversial because of the potentials risks of cancer dissemination suggested by many case reports and national surveys. From experimental data, the laparoscopic treatment of gynecologic cancer has potential advantages and disadvantages. The risk of dissemination appears high when a large number of malignant cells are present so that adnexal tumors with external vegetations, and bulky lymph nodes may be considered as contra-indications to CO2 laparoscopy. Laparoscopic surgery has become the gold standard in the treatment of benign adnexal tumeurs, whereas laparotomy remains the standard for the treatment of malignant tumors. The surgical diagnosis is the key to adequate management of adnexal tumeurs. In our experience, after a careful preoperative evaluation, the laparoscopic diagnosis of malignancy is reliable. Moreover in national surveys, many malignant tumeurs were considered as benign despite suspicious laparoscopic findings. Using strict guidelines, laparoscopic diagnosis can be proposed for both non suspicious and complex tumeurs, thus avoiding many unnecessary laparotomies for benign tumeurs suspicious at ultrasound. The more controversial limits of laparoscopic treatment are discussed. If a laparotomy was performed for all tumeurs suspicious at surgery, 80% of the cases would be treated by laparoscopy. The role of laparoscopy for restaging and second look operations for ovarian cancer requires further evaluation.

Adnexal Diseases↗