Biomedical subjects
Publications and source records attributed to V Izard.
Crural hernia is acquired and mainly affects women. We report a case of hernia discovered after two laparoscopic operations. There was no hernia or risk factor for abdominal wall hernia before the operations. We consider that this hernia is the consequence of repeated abdominal distensions over a short period of time. We have not found this complication in the literature.
Ovarian tumours complicate one in every thousand pregnancies. New techniques have changed the way of diagnosing and treating this condition. This study aims to demonstrate the value of laparoscopic surgery for ovarian cysts in the early months of pregnancy. From the 7th November 1985 to the 1st September 1989, eight pregnant women with less than 17 weeks amorrhoea consulted for ovarian tumours that were more than 6 centimeters in diameter. They were all operated on for ovarian tumours of more than 6 centimeters diameter and they were all operated on laparoscopically. Four operations were emergency and four non-emergency. In seven cases cystectomy was carried out transparietally and in one oophorectomy was. Laparoscopic surgery was possible in every case. These was no complication to the pregnancy due to the operation. Laparoscopic surgery permits early treatment of ovarian tumours in pregnancy without the risks of laparotomy. In emergency a quick diagnosis and treatment diminishes the risk of abortion. In non urgent cases a simple technique made it possible to avoid complications of the cyst and to obtain a histological assessment that they were benign.
The diagnostic and therapeutic value of laparoscopic surgery has been established for ovarian cysts and ectopic pregnancies. The diagnosis of appendicitis is difficult and laparoscopy is useful. The aim of this study is to assess feasibility, efficacy and advantages of a new technique of laparoscopic appendectomy. From 1st August to 15th December 1989, the women seen for pelvic pain were divided into three groups: appendicitis, pelvic inflammatory disease (PID) and doubtful. Intra-peritoneal appendectomy was performed when the laparoscopic diagnosis was not PID. Via three supra symphyseal trochars, the appendix was exposed and its mesentery was coagulated. The appendix stump was closed with a clip applicator. Twelve women were included in this study. In two thirds of cases, laparoscopy confirmed the clinical diagnosis. Mean operation time was 39 minutes. Laparotomy was never necessary. There were no post-operative complications and intestinal transit was always complete on the second post-operative day. The patient's and nurse's appreciation was excellent. This operation was possible on every occasion. This technique is sure, quick and easily reproducible. A comfortable post-operative period and esthetic advantages were reported by the women.
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UW (University of Wisconsin) solution, formulated by Belzer's team in Madison, has already been proved to increase cold ischemia time in liver and pancreas preservation. A multicentre clinical trial is being conducted to compare renal preservation in human transplantation using two different solutions: UW and Eurocollins (EC). This paper, whose results will be included in the multicentre trial, reports local comparative results between UW and EC perfused Kidneys. The two donor populations UW (28 cases) and EC (47 cases) were not randomized. They were however comparable in renal function prior to harvesting but not in age (35 +/- 13.4 years EC versus 27.7 +/- 12.4 years UW). The two recipient populations (48 EC versus 48 UW) were more homogeneous. Comparative results were significant with better graft function in the UW group: creatinine at one week: 499.2 +/- 296.3 EC versus 277.6 +/- 226.2 mumol/l, p less than 0.0001; creatinine at one month: 228.7 +/- 135 EC versus 159.7 +/- 135.6 mumol/l, p less than 0.02 and a decrease in acute tubular necrosis (39.5% EC versus 14.5% UW) and hospital stay. These results justify the use of UW solution by intraaortic flush especially during multi-organ procurement.
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In cases of congenital absence of vas deferens (9 patients) or after failure of previous epididymovasostomy (2 patients), in vitro fertilization (IVF) was attempted with spermatozoa surgically obtained at the epididymal caput level. These sperm populations showed little progressive motility (5.9 +/- 6.5%) and an marked necrozoospermia (19.3 +/- 17.4%). Stimulation by caffeine (4.5 mM) alone or associated with heterologue normal seminal fluid resulted in most of the cases in an initiation of motility with an improvement of the progressive velocity. In 9 IVF attempts, 31 mature oocytes were inseminated with 5.10(3) to 1.5.10(6) motile spermatozoa. The dynamic characteristics in 3 inseminated sperm populations were Vp (24.2 +/- 8.3 microns/s), Ah (8.6 +/- 2.0 microns) at room temperature. Sperm binding to zona pellucida was decreased (0 to about 20 spermatozoa per oocyte) and there was no fertilization. In the same period, 21 attempts of intra uterine insemination and 14 attempts of intracervical inseminations were made in 5 couples who remained infertile after patent high epididymovasostomy (4) or vasovasostomy (1) and having immature spermatozoa stimulated as previously described. Antisperm antibodies were detected on the ejaculated spermatozoa in four men. No pregnancy was obtained with these immature stimulated spermatozoa. The fertility of the female partners was confirmed in 3 women after insemination with donor sperm.
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An attempt of sedative procedures associated with a locoregional anesthesia was performed on fifty old patients before cataract operation. The blood gases, the blood pressure and the heartrate were measured and the behaviour of the patient just before he awoke was examined to determinate the sedative value. A parallel study revealed a decrease of the intra ocular pressure of 2,5 mm d'Hg due to a slight decrease of the blood pressure and to the effect of the neurolep mixture: the Innovar. This method seems to be very satisfactory in Ophthalmology.
The diagnostic and therapeutic value of laparoscopic surgery is known for ovarian cysts and ectopic pregnancies. The diagnostic of appendicitis is difficult and laparoscopy is useful. The aim of this study is to assess the feasibility, the efficacy and the advantages of a new technique of laparoscopic appendectomy. From August 1, 1989 to July 31, 1990 the women seen for pelvic pain have been divided in three groups: appendicitis, pelvic inflammatory disease (PID) and doubt. Intra peritoneal appendectomy has been performed if the laparoscopic diagnosis was not PID. Via three supra symphyseal trocars the appendix has been exposed and his meso coagulated. The appendix stump has been closed with a clip applicator (Ethnor T1300). Thirty-one women have been involved in this study. Twenty women had a laparoscopic appendectomy. Mean operation time was 36 minutes. In no occasion laparotomy was necessary. There was no post-operative complication and stool was obtained on the second post operative day. Patients and nurses appreciation was excellent. This operative procedure was possible in each attempt. This technique is sure, quick and easily reproducible. Comfortable post operative period and esthetic advantage have been noticed by the women. This operation has been possible in each attempt. This technique is sure, quick and easily reproducible.
The pregnancy rate after ICSI with surgically retrieved spermatozoa varies according to the etiology and to the level of sperm retrieval in the genital tract. The use of testicular sperm in all cases is discussed.