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Biomedical subjects

M Canis

Publications and source records attributed to M Canis.

At least 127 records · Page 7Linked to original sources
PubMed1991

Present day endoscopic surgery in gynecology.

The last ten years have been characterized by a tremendous change in laparoscopy. Initially used exclusively for diagnosis, laparoscopy is now a surgical method in its own right and plays a strategic role. Long-term evaluation of results for various pathologies (such as ectopic pregnancy and tubo-peritoneal sterility) means that just one laparoscopic procedure can be used for diagnosis, selection of the best therapeutic approach and also for treatment in those cases where laparoscopy is the optimum choice. Other more recent indications (including hysterectomy, lymphadenectomy etc.) which are now possible thanks to recent technological developments (such as clips and mechanical sutures) need long-term analysis of their results.

Endometriosis↗
PubMed1991

Multifactorial analysis of fertility after conservative laparoscopic treatment of ectopic pregnancy in a series of 223 patients.

OBJECTIVES: To lay down the criteria to clearly define whether conservative or radical laparoscopic treatment should be adopted in cases of ectopic pregnancies (EP). DESIGN: Retrospective, noncomparative. SETTING: At the University Hospital of Clermont Ferrand and the La Pergola Clinic at Vichy from July 1974 to December 1987. PATIENTS: This study was carried out in 223 patients who had been treated laparoscopically for EP and who desired future childbearing and who were not lost to follow-up. MAIN OUTCOME MEASURES: The measures chosen to achieve the objective included age, parity, size of hematosalpinx, volume of hemoperitoneum, tubal rupture, location, intrauterine device, ipsilateral and contralateral adhesions, and patient's previous history of salpingitis, EP, solitary tube, and tubal infertility. RESULTS: The general intrauterine pregnancy rate was 67% (149 patients) and the recurrence rate 12% (27 patients). The results according to the studied factors demonstrated that age, parity, and the type of the EP have no influence on the postectopic fertility. The history of the patient, ipsilateral adhesions, or contralateral tubal status significantly reduce the future fertility prognosis and risk of recurrence. CONCLUSIONS: From a multivariable analysis, the authors propose a scoring system to choose the most suitable treatment to preserve fertility and to reduce the risk of recurrence ranging from laparoscopic conservative treatment to laparoscopic salpingectomy with contralateral sterilization.

Abdomen↗
PubMed1991

Laparoscopic distal tuboplasty: report of 87 cases and a 4-year experience.

OBJECTIVE: To evaluate fertility results after laparoscopic distal tuboplasty and to compare these results with those obtained previously with microsurgery. DESIGN: Retrospective, nonrandomized. SETTING: Department of Obstetrics and Gynecology at the University Hospital of Clermont-Ferrand, France. PATIENTS: All the distal tuboplasties performed between October 1985 and June 1989 were included. Adnexal damage was assessed using tubal and adhesions scoring systems described previously. Tuboplasty was carried out bilaterally except when one tube was absent or severely damaged (tubal stage III or IV and/or with severe adhesions). Patients with bilateral severe adnexal damages were treated only if they refused to undergo in vitro fertilization. Laparoscopic tuboplasty was performed either with the CO2 laser or with conventional instruments. MAIN OUTCOME MEASURE: Fertility after laparoscopic treatment was evaluated using simple and cumulative pregnancy rates (PRs) according to the adnexal damage and compared with the microsurgical results using PRs according to the adnexal damage. RESULTS: The overall intrauterine and extrauterine PRs were 33.3% and 6.9%, respectively. Twenty-six of the 29 intrauterine pregnancies were obtained within the 1st postoperative year. According to tubal and adhesion stages, the results of laparoscopic distal tuboplasty are similar to those obtained using microsurgery. CONCLUSION: We conclude that laparoscopic distal tuboplasty, when performed by experienced surgical laparoscopists, represents an effective alternative to microsurgery.

Adult↗
PubMed1991

Advanced heterotopic pregnancy after in-vitro fertilization and embryo transfer, with survival of both the babies and the mother.

A combination of an extra-uterine and an intra-uterine pregnancy is defined as heterotopic pregnancy. An infertile patient, pregnant at her fourth in-vitro fertilization/embryo transfer attempt, was diagnosed at 21 weeks' gestation as having simultaneous abdominal and intra-uterine pregnancy. Expectant management under strict hospitalization was proposed and accepted by the couple, fetal assessment was by serial ultrasound evaluation of growth and amniotic fluid volume and by non-stress tests. Planned operative delivery was accomplished at 34 weeks' gestation. Both the mother and infants are alive and well.

Adult↗
PubMed1991

Subsequent fertility for patients presenting with an ectopic pregnancy and having an intra-uterine device in situ.

Of 503 ectopic pregnancies (EP) dealt with surgically using conservative laparoscopic techniques, 153 (30.4%) occurred in patients with an intra-uterine device (IUD) in situ. Examination of the characteristics of the EP revealed that the fimbrial location was more frequent among patients with an IUD whereas a significantly higher proportion were located in the isthmus in the group of patients without an IUD. Whereas the condition of the tubal wall did not differ according to the presence or absence of an IUD, adhesions and obstructed or non-existent contralateral tubes were significantly less frequent among patients with an IUD in situ. Two hundred and twenty three patients desired pregnancy, 30 of whom had an IUD in situ when the EP was diagnosed. The subsequent fertility for these 30 patients with an IUD was shown by rates for intrauterine pregnancy (IUP), recurrent EP and infertility of 96.7, 3.3 and 0% respectively. These results were significantly better than those for women who had no IUD, the figures for this group being 59, 13.4 and 27.4%, respectively. The favourable prognosis was due solely to the fact that women with an IUD had far fewer negative antecedents and that the EP probably occurred due to impaired ciliary action which is reversible when the IUD is removed.

Adult↗
PubMed1991

[Ovarian transposition with per-celioscopy before curietherapy in stage IA and IB cancer of the uterine cervix].

Ovarian preservation is recommended for young patients with early invasive cancer of the uterine cervix. We describe the laparoscopic technique of ovariopexy we performed among seven patients before brachytherapy and Wertheim surgery and we report our functional results: menopause was avoided in four instances but three failures were observed. The laparoscopic procedure could be improved with coagulation and section of the utero-ovarian ligament, mobilization of the infundibulopelvic ligament; finally the ovary could be transposed in the paracolic gutter. According to the authors, this protocol must be applied only to patients with stage IA or IB squamous cervical cancer, aged less than 35 years.

Adult↗
PubMed1991

[Acute salpingitis. Celioscopy before and after treatment: 110 cases].

The authors report their experience concerning 110 cases of acute salpingitis that were diagnosed and controlled laparoscopically one month after antibiotic treatment had been achieved. During the second look laparoscopy three parameters were appreciated: pelvic adhesions, tubal patency, and residual inflammation. Laparoscopic findings at the time of early second look have shown relationship between the occurrence of tubal sequelae and the seriousness of initial PID: the relation was statistically significant regarding pelvic adhesions and tubal patency. Chlamydia trachomatis infections were associated with a poorer reproductive potential outcome. Second look laparoscopy seems particularly indicated after severe form of PID (pyosalpinx, tubo-ovarian abscess), in the presence of Chlamydia trachomatis, among young nulliparous woman wishing to conceive.

Acute Disease↗
PubMed1991

[Contribution of celioscopy in the early diagnosis of ovarian cancers].

Four hundred and eighty-one patients with an ovarian cyst considered to be benign on the basis of clinical and ultrasonographic findings underwent diagnostic laparoscopy. All malignant tumours (9 cases) were recognized by diagnostic laparoscopy and were treated immediately via laparotomy. When a cyst was identified as being benign on laparoscopy, the diagnosis was always confirmed by histological examination. Sixty one patients (64 cysts) were treated via laparotomy immediately after laparoscopy for the following reasons: malignant or suspicious lesions (19 cases) dense adhesions or anatomical conditions making laparoscopic surgery difficult (42 cases). 420 patients (444 cysts) were treated by laparoscopic surgery with either intraperitoneal cystectomy or transparietal cystectomy. The postoperative course following laparoscopic surgery for annexal cysts was uneventful in 417 cases (3 patients developed a complication).

Cysts↗
PubMed1991

[Conservative celioscopic treatment of isthmic ectopic pregnancies].

Twenty-six ectopic pregnancies located strictly within the isthmus were treated surgically using conservative laparoscopic techniques. In each and every case the Triton's monopolar electrode was used to perform salpingostomy which was followed by the aspiration of the trophoblast. This therapeutic approach is very reliable since only one failure was observed (3.9%), requiring a further operation during which salpingectomy was carried out by laparoscopy. It was possible to evaluate subsequent fertility for 11 patients. 7 of whom (63.6%) obtained an intra-uterine pregnancy and only one patient (9.1%) had a recurrence. This highly satisfactory prognosis is perfectly comparable with that obtained with treatment via laparotomy with segmental resection of the isthmic portion of the tube and immediate or delayed anastomosis. These very encouraging results mean that laparoscopic treatment presents a very advantageous alternative to classic surgical treatment for isthmic ectopic pregnancies, in that the patients are spared a laparotomy.

Adult↗
PubMed1991

[The role of anti-inflammatory agents in the treatment of acute salpingitis. A randomized study of 40 patients with celioscopic control].

In a randomised second look laparoscopic study, concomitant antibiotic--anti-inflammatory therapy for the treatment of pelvic inflammatory disease (P.I.D.) was studied. Six weeks after medical treatment results were evaluated during second look laparoscopy based on three parameters: residual inflammation, pelvic adhesions and tubal patency. The combination treatment resulted in decreased pelvic adhesion and tubal occlusion in severe forms of P.I.D. Anti-inflammatory agents combined with anti-biotics are not more beneficial than anti-biotics alone in mild and moderate forms of P.I.D. so combination therapy must be reserved for severe forms of P.I.D.

Administration, Oral↗
PubMed1991

[Ectopic pregnancies with intrauterine devices. Characteristics and subsequent fertility].

Out of the 503 ectopic pregnancies (EP) dealt with surgically using conservative laparoscopic techniques, 153 (30.42%) occurred in patients with an intrauterine device (IUD) in situ. Examination of the characteristics of the EP reveals that there is a significantly higher proportion located in the isthmus in the group of patients without an IUD, whereas the fimbrial location is more frequent among patients with an IUD. Whereas tube wall condition does not differ according to the presence or absence of an IUD, adhesions and obstructed or not existent contralateral tubes are significantly less frequent among patients with an IUD in situ. 223 patients desired pregnancy, 30 of which had an IUD in situ when the EP was diagnosed. The subsequent fertility for these 30 patients with an IUD resulted in rates for intrauterine pregnancy (IUP), recurrent EP an infertility of 96.7%, 3.3%, and 0% respectively. These results are significantly better than those for women who had no IUD, the figures for their group being 59%, 13.4%, and 27.4% respectively. The favorable prognosis is due solely to the fact that women with an IUD have far less negative antecedents and that the EP probably occurred due to impaired ciliary action, reversible when the IUD is removed.

Female↗
PubMed1991

[Laparoscopic treatment of ovarian cysts. Indications, techniques, results. Apropos of 650 cases].

Laparoscopic management of annexes is now accepted as alternative to classical management by laparotomy. However, a careful pre-operative evaluation, including clinical and ultrasonographic examination is of ut most importance in order to exclude malignant lesion which should be treated by laparotomy. The laparoscopic treatment includes several procedures: intra-peritoneal cystectomy, extra-abdominal cystectomy, oaphorectomy and adnexectomy. These procedures and used according to the laparoscopic diagnosis. About 652 cases managed by laparoscopy, we can concluded: laparoscopic diagnosis of benign lesion is reliable (positive predictive value 100%); most of benign ovarian cysts can be treated by laparoscopy, from 89 to 97% of the benign adnexal cysts; complications are uncommon (8 cases out of 616 patients); the recurrence risk appears to be low (only 2.7% in patients treated for a non endometriotic adnexal cysts).

Biopsy, Needle↗
PubMed1990

Laparoscopic management of adnexal cystic masses.

Four hundred twenty of 481 patients with adnexal cystic masses (508 cysts) confirmed by laparoscopy were treated by translaparoscopic surgery only. The remaining 61 patients were treated by laparotomy for one of the following reasons: malignancy or suspicion of malignancy (19 cases) and dense adhesions or large cysts (42 cases).

Adolescent↗