[Cryopreservation of ovarian tissue. Current situation and perspectives].
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Cryopreservation↗
Biomedical subjects
Y Aubard
Publications and source records attributed to Y Aubard.
[Follicle freezing and autografting. A new method of medically assisted procreation?].
Although frozen human follicles were shown to be viable after thawing, more than forty years, the low yield of primordial follicles after cryopreservation has greatly limited research in this area. The aim of freezing follicles is to stock a patient's ovocytes before potentially destructive therapy for cancer then to reimplant the follicular tissue after successful treatment. The patient's ovulatory capacity would then theoretically be restored, allowing natural or possibly in vitro fertilization. As have other teams, we recently renewed work in cryopreservation of follicles in experimental models in search for a better cryopreservation agent and have had encouraging results suggesting that primordial human follicles or ovarian fragments can be grafted successfully after cryopreservation. Questions still under study include the optimal site for implantation, the survival time for grafts and the quantity of follicles needed to achieve pregnancy. Work on large animal models or xenografts of human tissues on immunotolerant animals may provide further insight. The possibilities of grafting primordial follicles, either alone or within ovarian tissue, may raise hope for many women, although new questions such as an age limit for reimplantation and use of allografts requiring preparation with major immunosuppressive therapy require further debate.
Animals↗
Laparoscopically assisted vaginal hysterectomy for non-malignant disease of the uterus. Report on a personal series of 126 cases.
OBJECTIVE: A report is given of a series of 126 laparoscopically-assisted vaginal hysterectomies (LAVH) for benign lesions, carried out between September 1990 and December 1995. MATERIALS AND METHOD: The mean age of the patients was 50.3 years, and the main indications for hysterectomy were metrorrhagia (88). The main reasons why LAVH was chosen from among other hysterectomy techniques were a large uterus (55), associated ovarian surgery (45), and a difficult vaginal approach (35). The surgical technique always began with a laparoscopic stage followed by a vaginal stage. The laparoscopic stage generally finished at the lower part of the broad ligament. The vagina was opened and the uterine arteries were ligatured by a vaginal approach (116). Only 10 total laparoscopic hysterectomies were performed. RESULTS: The mean duration of the operation was 72 +/- 28 min, mean blood loss was 1.89 g/dl, and mean uterus weight was 224 g (maximum = 1093 g). Operative complications consisted of two bladder wounds and two switches to abdominal hysterectomy. Postoperative complications were urinary infections (17), hemorrhages needing second-look operations [2] and abscess of the vaginal section requiring evacuation [3]. CONCLUSION: LAVH should never be carried out instead of vaginal hysterectomy (VH), since VH is the best procedure when it is easy to perform. The authors use LAVH when VH is difficult or contraindicated (the aim being to avoid laparotomy) and actually carry out less than 5% of hysterectomies for benign lesions by laparotomy.
Blood Loss, Surgical↗
Low temperature storage and grafting of human ovarian tissue.
Ovarian tissue storage at low temperatures is a promising new method for protecting young cancer patients from the sterilizing effects of chemotherapy and/or radiotherapy. Tissue can be stored and returned to the body in due course as a thin cortical graft since the primordial follicles are distributed peripherally and are relatively resistant to ischaemia. Slices of tissue donated by healthy patients were trimmed to a uniform size and preserved by slow freezing to liquid nitrogen temperatures for up to 2 months in one of the following cryoprotectants: dimethylsulphoxide, ethylene glycol, glycerol, propylene glycol. Their viability was assessed by counting follicles in histological sections 18 days after grafting under the kidney capsules of severe combined immunodeficiency (SCID) mice, and the results were expressed as percentages of the numbers in comparable pieces of ungrafted tissue. While only 10% of the total number of follicles was found in the glycerol group compared to controls, significantly higher percentages (44-84%) survived cryopreservation in the other media. The tissues were sterile when frozen and thawed without a cryoprotectant. These results suggest that if comparable results could be achieved by autografting, a patient's fertility should be safeguarded from cytotoxic treatment.
Adolescent↗
[Prenatal diagnosis of hereditary bullous epidermolysis. A case report].
A premature infant born to a consanguinous couple (mother's age = 27 years) presented Hallopeau-Siemens disease and died at 3 weeks. At a second pregnancy, fetal skin biopsies at 21 weeks gestation demonstrated the absence of the disease. The fetus died in utero at 31 weeks of an unknown cause. A third pregnancy was carried to term successfully and terminated by delivery of a normal infant. Unlike most hereditary bullous epidermolyses, the severe prognosis of Hallopeau-Siemens disease justifies antenatal diagnosis as does Herlitz disease, another familial disease. Fetal skin biopsy at 21 weeks is classically performed, but localization of the genetic abnormalities would suggest that a simple trophoblast biopsy during the first trimester may be sufficient.
Adult↗
[Orthotopic autografts of ovarian slices in pregnant rats].
We carried out orthotopic autografts of ovarian tissue on 15 Wistar rats. One ovary has been removed and cut in 2 or 3 slices. The other ovary has been removed, and the controlateral slices grafted in the empty ovarian bursa by mean of a microscope, without vascular anastomosis. The endocrine function of the graft was assessed by checking the vaginal smears. The animals were mated. Two of them became pregnant with normal offsprings, two others has vaginal bleeding which could be miscarriages. This experimentation suggests that the orthotopic autograft of ovarian slices is possible in rats. The endocrine function of the ovary is restored with a very good rate. Fertility is restored for a small proportion of animals.
Animals↗
[Marfan's syndrome and pregnancy. A case report and review of the literature].
Marfan's syndrome is a collagen tissue disease, identified at the end of the nineteenth century. The gene for this autosomal dominant disease lies on chromosome 15 and leads to a biochemical disorder yet to be described. We report a case of Marfan's disease in a gravid patient and discuss the complications which may occur. The main risk involves the cardiovascular manifestations of the disease with possible dissection or rupture of the aorta. Preventive surgery, with extra-corporal circulation is required when the diameter of the aorta is greater than 6 cm. Spontaneous abortions and risk of premature birth have also been reported. Delivery itself is not a major risk but should be planned in a setting allowing immediate transfer to a cardiac surgery unit. Pregnancy should be discouraged in patients with Marfan's syndrome if the aortic diameter is greater than 4 cm. When pregnancy occurs, echocardiographic examinations of the mother should be performed monthly for the first 6 months, then bimonthly. Prenatal diagnosis is of little interest, except to detect foetuses at risk at delivery.
Adult↗
[The history of cesarean section].
The origins of the Cesarian section date back to the Classical era, and possible even earlier. Ancient India, the Hebrews, the Grecks and the Romans were all familiar with post-mortem Cesarian section. The operation marked time during the Middle Ages. The name "Cesarian section" was first used to designate this operation during the Renaissance period, when it was first carried out in live women. However, until the middle of XIX th century, a Cesarian remained a last chance option which was cautioned against by most obstetricians. It was only after the advent of the "surgical golden tripod" that the Cesarian was gradually rehabilitated through the work of Poro, Kherer and Sanger and the German School. In the XIXth century, segmental incision became the norm and fetal indications for a Cesarian emerged.
Arab World↗
[Hemorrhage in the 3rd pregnancy trimester. Diagnostic orientation].
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Female↗
[Cryopreservation of the ovary and ovarian tissue].
Cryopreservation followed by grafting of ovarian tissue should enable prevention of the irrevocable loss of ovarian function sometimes associated with radio and/or chemotherapy in young women with malignant neoplasms. Cryopreservation of the oocyte should improve the general results of medically assisted procreation by enabling the creation of an oocyte bank. Three research areas have been developed in terms of preservation of the ovary or of the ovarian tissue by refrigeration. Freezing of the whole organ, or of fragments, was the first technique to be studied and did not lead to any practical applications. Freezing of the oocyte is being widely studied at present. Despite some successes, it is still far from possible to create an oocyte bank. Freezing of primary follicles is the latest ovarian cryopreservation technique described. Preliminary results are interesting and this method may offer the solution to the total restoration of ovarian function.
Cryopreservation↗
[Ovarian grafts and transplantations in women: current status].
Ovarian grafts and transplants were performed at the end of the last century to prevent the side effects of bilateral ovariectomy or of the menopause. Fundamental studies (until around 1935) showed that autografts were possible with poor results while allografts were associated with bad results. This was followed by a long period during which these techniques were abandoned. Thanks to recent progress in organ storage, microsurgery and the "management" of grafts in general, it is reasonable to hope for new advances in the area of ovarian grafting and transplantation.
Evaluation Studies as Topic↗
[Aortic valve replacement with extracorporeal circulation in a pregnant woman. Apropos of a case].
The authors report a case of surgical treatment of aortic stenosis in a pregnant woman (first pregnancy after four years treatment of sterility). The aortic valve replacement was performed at 16 weeks of amenorrhea. The valve was replaced by an Ionescu-Shiley bioprosthesis. Delivery was performed by caesarean section after 39 weeks of amenorrhea. There was no complication either for the mother or the child. Review of the literature allows analysis of the influence of aortic stenosis on pregnancy, and of the pregnancy on the tolerance of aortic stenosis. Some aspects of cardiopulmonary bypass for valve replacement in pregnant women are also analysed.
Adult↗
[Diabetes in pregnancy].
Following a review of the literature, often too conflicting, the authors are attempting to define a coherent approach to the problem of diabetes in pregnancy. Described as a diabetic condition occurring during pregnancy, diabetes should be looked for in all pregnant women, using the O'Sullivan's screening test performed between the twenty sixth and thirtieth weeks of amenorrhea. The diagnosis of diabetes will only be confirmed by an oral glucose tolerance test.
Female↗
[Endometriosis localized in the sigmoid. Apropos of a case].
Colic endometriosis is a classical but rare localization. The authors present one case treated by partial colectomy associated with a total hysterectomy and preservation of ovarian parenchyma. The hysterectomy was necessary because of adenomyosis and inflammatory adhesions undissociable from the sigmoid.
Adult↗
[Antibiotic prophylaxis in surgery by vaginal route].
The authors study 56 cases of vaginal hysterectomy divided in two groups of 28, one of which received antibiotics prophylaxis at the time of the procedure. The incidences on post-operative fever, infection of the vaginal section and the number of urinary infections are significantly much lower in the group treated.
Adult↗
[Rupture during pregnancy of the rudimentary horn of a pseudo-unicorn uterus. Apropos of a case].
The rupture of the rudimentary horn of a pseudo-unicorn uterus is a rare accident. The case reported here is very similar to most of those published. It is usually during the fifth month of a pregnancy, normal until then, that a state of shock appear suddenly, requiring a surgical procedure and disclosing this exceptional diagnosis.
Adult↗
[Lymphangioma of the uterus. Apropos of a case].
Lymphangioma of the uterine corpus is a rare tumor and the authors report one case discovered per-operatively. A review of the literature permits to bring out its essential characteristics as far as clinic, etiopathogenesis, evolution and therapy are concerned. This completely benign tumor is more an anatomo-pathological curiosity than a true gynecological problem.
Female↗
[Trapped popliteal arteries. Incidence, epidemiology, therapeutic considerations].
The trapped popliteal artery syndrome is an extrinsic dynamic compression of the vascular structures in the popliteal fossa by the surrounding fibromuscular structures. The condition mainly affects the popliteal artery resulting in atypical intermittent claudication because it often occurs in young and active patients. The arterial lesions are initially purely extrinsic and dynamic; sometimes they progress to thrombosis, embolism or aneurysm due to jet lesions. The diagnosis is obtained by radiology in the uncomplicated forms by showing compression or complete occlusion of the artery during contraction of the gastrocnemius and quadriceps muscles. Doppler studies of the posterior tibial artery may also demonstrate the condition during these manoeuvres. The epidemiological study was performed in 199 medical students and 80 athletes. A positional abolition of the posterior tibial artery was demonstrated in 39 students (19%) and 12 athletes (15%). The entrapment was commoner in females (24%) than males (13%). It was observed more frequently in dancers, cyclists and basket ball players: 12 control digitised intravenous angiographies were performed; the diagnosis was confirmed in 11 cases. Several anatomical anomalies of the popliteal fossa may give rise to this condition. The commonest is a deviation of the artery within the internal head of the gastronemius muscle; compression by the soleus or fibro muscular bands arising from the semi-tendinous or semi-membranous have been described. The treatment is surgical in very symptomatic or complicated cases; uncrossing the artery associated with venous grafting in cases of thrombosis are the procedures of choice.
Constriction, Pathologic↗