Biomedical subjects
Publications and source records attributed to V Loffredo.
In the context of organic pelvic pain, alongside post-infectious pain or pain related to endometriosis, ruptured ligaments of the pelvic fascia are an important cause of the pelvic congestion syndrome well known to classical authors. Surgical treatment combines two procedures: suture of the tear and exclusion of the pouch of Douglas.
Conservative surgery, i.e. tumorectomy with lymph nodes ablation and radiotherapy or Iridium 92, has replaced completely mastectomy in limited forms of breast cancer (stage I or II less than 3 cms) with the same results for mid and long term But contradictions must be known: large lymph nodes, aged women, evolutive forms, recurrences after conservative surgery and also intra canal multi foci forms. These forms must impose secondary mastectomy as first treatment.
Pelvic congestion syndrome is common to three pathologies: premenstrual syndrome, intermenstrual syndrome and chronic pelvic fibrous congestion syndrome. The two first syndromes are well-known. They are periodical and hormonal treatment is relevant in premenstrual syndrome (all forms of progesterone and provascular treatment). Chronic pelvic congestion syndrome or fibrous congestion is linked with fibrous changes of the subperitoneal cellular tissue after more or less lasting chronic congestion. It is sometimes secondary to low noised and unknown sepsis (Bret and De Brux fibro-sclerous pelviperitonis). It is usually linked with the traumatical rupture of cellular pelvic tissue from obstetrical etiology (Masters and Allen syndrome). In varicocele, uterine plexus and ilio-lumbar ligament, hormonal action has been suggested. Three signs overnite polymorphic clinical study: deep dyspareunia, moving cervix, uterus retroversion. But primitive or secondary congestion is only in fact evoked by coelioscopy even with its limits. When coelioscopy is negative, hysterophlebography will be achieved and will visualize sometimes extremely pelvic plexus vasodilatation. As function of findings lesions, treatment lays down 3 principles: first principle not to abuse with surgery except in case of testing patent ligamentary lesions. Second principle to prescribe a polyvalent general treatment with triade antibiotic, antiinflammatory and phlebotonic drugs. Third principle to be preventive by improving obstetrical exercise as usually this syndrome succeeds to a more or less traumatic delivery.
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The use of an oestrogen-progesterone combined pill permits the induction of ovulation in the absence of any developing follicle. Two treatments were compared. In the first, patients received no prior treatment before stimulation. In the second, combined oestrogen-progesterone treatment was given during approximately two menstrual cycles prior to stimulation. No differences between the two groups were found in relation to oocyte maturity, fertilization in vitro, cleavage, replacement and pregnancy. Fewer luteinizing hormone surges occurred in patients pre-treated with steroids. The utilization of the oestrogen-progesterone combined pill prior to induction of ovulation facilitates the forward planning of patients for in-vitro fertilization.
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The aim of this work is to study the effects of an antiprogesterone drug (RU 486) on extrauterine pregnancy and to draw from it possible inferences for therapy. The study was carried out on 28 patients presenting an extrauterine pregnancy, the levels of plasma chorionic gonadotrophins of whom were higher than or equal to 250 mIU/ml. Different modes of administration were employed and a coelioscopic salpingotomy was carried out for a pathological study.
68 cases out of a total of 407 patients who were destined to have IVF (16.7%) had most adhesions in the pelvis which made the ovaries inaccessible for laparoscopic recovery, in the two years between September 1981 and September 1983. Using very severe criteria for selection we rejected 46 cases as unsuitable for surgery at that time. Only 22 therefore remained to have preparatory surgery. This surgery was particularly aimed at improving the local conditions for laparoscopic recovery as well as improving the quality of ovulation. The results are encouraging because those women who were operated on had about the same level of success in the three stages of IVF as women who were not operated on. This three-stage protocol of exploratory laparoscopy, operation and recovery laparoscopy does seem to be a heavy one and probably will be able to be replaced by a transvaginal ultrasound technique when this has been developed far enough to show that it has advantages.
Tuboscopy permits the observation of the tubal mucosa and the discernment of two types of lesions: synechiae and mucosal "plates". The coincidence of the interpretation of hysterography and the results of tuboscopy does not exceed 1 case in 2. Experience shows that intrauterine pregnancies which develop beyond the first trimester only survive when tuboscopy shows us a normal mucosa, whatever may be the salpingographic picture. It is better to abandon the idea of a plasty when the tubal mucosa is in a bad condition.
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Cultures of specimens from the abdominal cavity (14) or the lower genital tract (11) were positive for Chlamydia trachomatis in 25 (22.7%) of 110 patients with a laparoscopic diagnosis of acute salpingitis. Microimmunofluorescence serodiagnosis showed positive IgG levels (greater than or equal to 1/64) in 35 patients (32%). Of the 34 patients in whom a second serodiagnosis was performed after 6 weeks, 20 (58%) had positive IgG levels (greater than or equal to 1/64) and 12 (35%) had a fourfold or more change in dilution. Thus, culture and serodiagnosis provided evidence of Chlamydia infection in 46% of the patient population. Forty-six patients were followed up for several months to evaluate the response to antibiotic therapy. Among tetracyclines, lymecycline was effective in 19/25 cases, doxycycline in 15/19 cases and minocycline in 2/4 cases. Switching to another tetracycline after failure of the first one usually gave satisfactory results.
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Chronic inflammation is a frequent cause of tuboplasty failure. Therefore, it would be useful for one to know the microbiologic agent of infection and to treat it before the tuboplasty. By laparoscopy, a search for Chlamydia trachomatis, Ureaplasma urealyticum, and other microbiologic agents was carried out in the peritoneum and tubes of 118 women divided into 3 groups. Sixty-nine had a checkup before tuboplasty, of which 30 were found to have a chronic inflammatory condition discovered during laparoscopy (group 1) and 39 to have no sign of inflammation (group 2). Forty-nine women with a completely normal pelvis, being followed for possible sterility, were used as a control group. Cultures and serodiagnosis show a significant difference for C. trachomatis between the pathologic groups and the control group. They show no noticeable difference for U. urealyticum. These findings, compared with those by other authors, indicate that C. trachomatis could be an important microbiologic agent in tubal sterility, strongly connected with a low-grade chronic inflammatory condition, and their presence at the time of tuboplasty is to be considered.
Two techniques of salpingotomy have been compared in two series of rabbit experiments with the aim of finding out whether, when carrying out conservative surgery in extra-uterine pregnancy with rupture of the tube, it is better to suture the salpingotomy or to leave it open without suture. The two series show that there is no difference as far as the frequency of large adhesions, as far as ovulation and the strength of the scar and the pregnancy rate g out conservative surgery in extra-uterine pregnancy with rupture of the tube, it is better to suture the salpingotomy or to leave it open without suture. The two series show that there is no difference as far as the frequency of large adhesions, as far as ovulation and the strength of the scar and the pregnancy rate g out conservative surgery in extra-uterine pregnancy with rupture of the tube, it is better to suture the salpingotomy or to leave it open without suture. The two series show that there is no difference as far as the frequency of large adhesions, as far as ovulation and the strength of the scar and the pregnancy rate following the two methods. On the other hand, implantation is less good when the tube is left open than when the salpingotomy is sewn up. In the first series there was a significant difference between the side that was operated on and the control side, whereas the second series there was very little difference. In spite of the fact that the scar seemed to be apparently of the same type, the eggs were able to descend more easily in the oviduct when it had been sutured.
We cultured for Chlamydia trachomatis, Ureaplasma urealyticum, and Mycoplasma hominis and performed chlamydial serologic studies in 99 women undergoing laparoscopy. These women included patients with acute salpingitis, infertile women with and without mild pelvic inflammatory disease, and controls. C. trachomatis infection was significantly more common in patients than in controls. We also identified low-grade "silent" PID among women with infertility resulting from tubal obstruction and suggest this may be caused by chlamydiae.