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Dupont C, Deneux-Tharaux C, Cortet M, Colin C, Touzet S, Rabilloud M, Lansac J, Harvey T, Tessier V, Chauleur C, Pennehouat G, Morin X, Bouvier-Colle MH, Rudigoz RC. Prise en charge des hémorragies graves du post-partum après un accouchement par voie basse : étude en population dans 106 maternités françaises. ACTA ACUST UNITED AC 2012; 41:279-89. [DOI: 10.1016/j.jgyn.2012.02.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2011] [Revised: 02/04/2012] [Accepted: 02/17/2012] [Indexed: 11/29/2022]
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Deneux-Tharaux C, Dupont C, Colin C, Rabilloud M, Touzet S, Lansac J, Harvey T, Tessier V, Chauleur C, Pennehouat G, Morin X, Bouvier-Colle MH, Rudigoz R. Multifaceted intervention to decrease the rate of severe postpartum haemorrhage: the PITHAGORE6 cluster-randomised controlled trial. BJOG 2010; 117:1278-87. [PMID: 20573150 DOI: 10.1111/j.1471-0528.2010.02648.x] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Decreasing the prevalence of severe postpartum haemorrhages (PPH) is a major obstetrical challenge. These are often considered to be associated with substandard initial care. Strategies to increase the appropriateness of early management of PPH must be assessed. We tested the hypothesis that a multifaceted intervention aimed at increasing the translation into practice of a protocol for early management of PPH, would reduce the incidence of severe PPH. DESIGN Cluster-randomised trial. POPULATION 106 maternity units in six French regions. METHODS Maternity units were randomly assigned to receive the intervention, or to have the protocol passively disseminated. The intervention combined outreach visits to discuss the protocol in each local context, reminders, and peer reviews of severe incidents, and was implemented in each maternity hospital by a team pairing an obstetrician and a midwife. MAIN OUTCOME MEASURES The primary outcome was the incidence of severe PPH, defined as a composite of one or more of: transfusion, embolisation, surgical procedure, transfer to intensive care, peripartum haemoglobin decrease of 4 g/dl or more, death. The main secondary outcomes were PPH management practices. RESULTS The mean rate of severe PPH was 1.64% (SD 0.80) in the intervention units and 1.65% (SD 0.96) in control units; difference not significant. Some elements of PPH management were applied more frequently in intervention units-help from senior staff (P = 0.005), or tended to - second-line pharmacological treatment (P = 0.06), timely blood test (P = 0.09). CONCLUSION This educational intervention did not affect the rate of severe PPH as compared with control units, although it improved some practices.
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Affiliation(s)
- C Deneux-Tharaux
- INSERM, UMR S953, UPMC, Epidemiological Research Unit on Perinatal Health and Women's and Children's Health, Paris, France.
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Dubuisson J, Pennehouat G, Rudigoz RC. Rupture spontanée du pédicule utérin en cours de grossesse : à propos de trois cas. ACTA ACUST UNITED AC 2006; 34:711-5. [PMID: 16891143 DOI: 10.1016/j.gyobfe.2006.07.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2006] [Accepted: 07/04/2006] [Indexed: 11/25/2022]
Abstract
We report a retrospective review of three cases presenting with spontaneous uterine artery rupture during pregnancy. Clinical presentations were intra-peritoneal haemorrhage for two of them and in utero fetal death for the last one. Fetal outcome was poor in all three cases. Uterine vessels spontaneous rupture during pregnancy is an exceptional event. Considering our experience and the literature review, we propose a guideline for vascular rupture during pregnancy.
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Affiliation(s)
- J Dubuisson
- Service de gynécologie-obstétrique, hôpital de la Croix-Rousse, 103, Grande-Rue de la Croix-Rousse, 69004 Lyon, France.
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Hugues JN, Cédrin-Durnerin I, Howles CM, Amram M, Angelini A, Balen A, Barbereau D, Birkhauser M, Boujenah A, De Leo V, De Placido G, Dessole S, Favrin S, Ferrazi E, Gay C, Germond M, Hedon B, Hocke C, Jolly C, Lamarca-Roth E, Lanzone A, Marchand F, Marcolin G, Mascaretti G, Moreau L, Massobrio M, Nappi C, Pardi G, Pennehouat G, Porcu E, Seibert M, Selvaggi L, Thiers D, Venturini P. The use of a decremental dose regimen in patients treated with a chronic low-dose step-up protocol for WHO Group II anovulation: a prospective randomized multicentre study. Hum Reprod 2006; 21:2817-22. [PMID: 16877376 DOI: 10.1093/humrep/del265] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND In women with chronic anovulation, the choice of the FSH starting dose and the modality of subsequent dose adjustments are critical in controlling the risk of overstimulation. The aim of this prospective randomized study was to assess the efficacy and safety of a decremental FSH dose regimen applied once the leading follicle was 10-13 mm in diameter in women treated for WHO Group II anovulation according to a chronic low-dose (CLD; 75 IU FSH for 14 days with 37.5 IU increment) step-up protocol. METHODS Two hundred and nine subfertile women were treated with recombinant human FSH (r-hFSH) (Gonal-f) for ovulation induction according to a CLD step-up regimen. When the leading follicle reached a diameter of 10-13 mm, 158 participants were randomized by means of a computer-generated list to receive either the same FSH dose required to achieve the threshold for follicular development (CLD regimen) or half of this FSH dose [sequential (SQ) regimen]. HCG was administered only if not more than three follicles >or=16 mm in diameter were present and/or serum estradiol (E(2)) values were <1200 pg/ml. The primary outcome measure was the number of follicles >or=16 mm in size at the time of hCG administration. RESULTS Clinical characteristics and ovarian parameters at the time of randomization were similar in the two groups. Both CLD and SQ protocols achieved similar follicular growth as regards the total number of follicles and medium-sized or mature follicles (>/=16 mm: 1.5 +/- 0.9 versus 1.4 +/- 0.7, respectively). Furthermore, serum E(2) levels were equivalent in the two groups at the time of hCG administration (441 +/- 360 versus 425 +/- 480 pg/ml for CLD and SQ protocols, respectively). The rate of mono-follicular development was identical as well as the percentage of patients who ovulated and achieved pregnancy. CONCLUSIONS The results show that the CLD step-up regimen for FSH administration is efficacious and safe for promoting mono-follicular ovulation in women with WHO Group II anovulation. This study confirms that maintaining the same FSH starting dose for 14 days before increasing the dose in step-up regimen is critical to adequately control the risk of over-response. Strict application of CLD regimen should be recommended in women with WHO Group II anovulation.
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Affiliation(s)
- J N Hugues
- Reproductive Medicine Unit, Jean Verdier Hospital, University Paris XIII, Paris, France.
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Abstract
Choice of antimicrobial agents and length of therapy of infections of the female genital tract and chemotherapy are presented with particular mention to their side effects. Clinical approach and antibiotic regimens of pelvic inflammatory diseases are discussed.
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Affiliation(s)
- G Pennehouat
- Service de Gynécologie-Obstétrique, hôpital de Chambéry, BP 1125, 73011, Chambéry, France.
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Guglielmina JN, Pennehouat G, Deval B, Benifla JL, Darai E, Créquat J, Walker-Combrouze F, Madelenat P. [Treatment of ovarian cysts by laparoscopy]. Contracept Fertil Sex 1997; 25:218-29. [PMID: 9156710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE to define limits, risks and results in the long term of laparoscopic treatment of ovarian tumors. METHOD retrospective study of adnexal tumors managed initially by laparoscopy from January 1986 to December 1992, among which 9 cancers, 25 borderline tumors, and 769 benign lesions. The ultrasonographic appearance was known for 698 of 803 lesions. 86 patients were postmenopausal (92 lesions). RESULTS we treated 191 functional cysts, 160 serous cystadenomas, 178 endometriomas, 105 dermoid cysts, 39 mucinous cystadenomas and 96 miscellaneous lesions among which fibrothecomas, paraadnexal cysts, ovarian pregnancies, ovarian abscess. There is a great diversity of ultrasonographic patterns for a same histological type, specially for functional cysts and borderline tumors. Laparoscopic exploration has misdiagnosed two cancers and 10 borderline tumors and considered wrongly as suspects 19 benign lesions. 714 procedures have been led to term by laparoscopy, 89 have been ended by laparotomy, 26 for suspicion of malignancy and 50 for dissection failure. 27 postoperative complications have been counted among which 2 grafts on trocard sites after non protected extraction of one dermoid cyst and one borderline tumor. CONCLUSION ultrasonographic appearance could not predict reliably the organic or functional nor benign or malignant character of an adnexal mass. Even careful laparoscopic examination can underestimate early stage ovarian cancer or borderline tumors. When diagnosed during or after laparoscopic procedure an ovarian cancer should always be managed by laparotomy. On the other hand, some borderline tumors can be treated by exclusive laparoscopy. When malignancy is suspected, an adnexectomy can be performed laparoscopically as a biopsy and allows a quick and appropriate treatment after paraffin-embedded sections. Both intraperitoneal and transparietal techniques have a minimal morbidity and allow a feasibility of more than 90%. The management of postmenopausal ovarian tumors differs only by the use of systematic oophorectomy if surgical procedure is indicated.
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Darai E, Teboul J, Walker F, Benifla JL, Meneux E, Guglielmina JN, Pennehouat G, Renolleau C, Sebban E, Madelenat P. Epithelial ovarian carcinoma of low malignant potential. Eur J Obstet Gynecol Reprod Biol 1996; 66:141-5. [PMID: 8735736 DOI: 10.1016/0301-2115(96)02418-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVE The aim of this study was to evaluate the interest of sonographic features, serum marker tumors and conservative treatment especially by laparoscopic approach of epithelial ovarian tumors of low malignant potential (or borderline tumors). STUDY DESIGN Thirty-four patients with 40 epithelial ovarian tumors of low malignant potential treated at Bichat Claude Bernard hospital were reviewed. Of these patients, 29 had preoperative sonographic control (85.2%), 19 (55.8%) had pretreatment serum CA 125 determination, 17 (50%) serum CA 199 determination and 19 CEA serum levels. Twenty patients (58.8%) had serous tumor and 14 (41.2%) had mucinous tumor. Six out of the 20 serous lesions were bilateral. Of the patients 31 (91%) had a stage I disease, one had stage II (3%) disease and two had stage III (6%) disease. Nine patients (26.5%) had laparotomic management, 25 (73.5%) had first laparoscopic management with seven laparoconversions (28%). RESULTS The majority of borderline tumors (67.7%) exhibited multilocular aspects and seven patients had benign features (unilocular smooth sonolucent). Seven out of the 19 CA 125 serum levels were up to 35 U/ml; 4/17 CA 199 serum levels were above 40 U/ml but the CEA serum levels were always normal. Eighteen patients (52.9%) had radical surgery and 16 patients (47.1%) had conservative surgery including 7 cystectomies. Seven patients (20.6%) had subsequent laparotomic treatment, (five after laparoscopic management, one after laparoconversion management and another one after laparotomic surgery) and no residual disease was found. Fourteen patients (41.1%) had preoperative cyst rupture (13 during laparoscopic management). Four recurrences in stage I disease occurred; one after unilateral salpingo-oophorectomy, three after cystectomy but only one recurrence was in ipsilateral ovary. All four recurrences were diagnosed by sonographic control and one was associated with CA 125 serum level elevation. Ten laparoscopic second look were negative. CONCLUSION No specific sonographic aspect exists for borderline tumors but it is the best way to detect recurrence. The preoperative CA 125 serum levels was elevated in 36.8% of patients. The conservative treatment including laparoscopic procedure in borderline ovarian tumors appears to have a high risk of peroperative rupture but the rate of recurrence is similar to laparotomic treatment.
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Affiliation(s)
- E Darai
- Department of Gynecology, University Hospital Bichat Claude Bernard, Paris, France
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Darai E, Benifla JL, Naouri M, Pennehouat G, Guglielmina JN, Deval B, Filippini F, Crequat J, Madelenat P. Transvaginal intratubal methotrexate treatment of ectopic pregnancy. Report of 100 cases. Hum Reprod 1996; 11:420-4. [PMID: 8671235 DOI: 10.1093/humrep/11.2.420] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Between November 1988 and December 1993, 100 patients with a common, unruptured ectopic pregnancy were treated with 1 mg/kg injection of intratubal methotrexate under transvaginal sonographic control. Patients were not excluded from this series on the basis of the size of the adnexal mass, the term of ectopic pregnancy or initial beta-human chorionic gonadotrophin (HCG) concentrations. Patients were excluded following uncertain diagnosis, signs of a ruptured ectopic pregnancy, or a significant haemoperitoneum on ultrasound scans. The mean age of the patients was 29.5 years (range 20-41). The mean gestational age and initial HCG concentration were 7.5 weeks (5-11) and 11,614 mIU/ml (192-105,000 respectively). Of the 100 patients, 22 (22%) had an ectopic pregnancy with active cardiac activity. Complete resolution was obtained in 78 out of these 100 ectopic pregnancies. Of these, 66 patients (85%) needed only one intratubal methotrexate injection, and 12 patients (15%) required a second i.m. methotrexate injection of 1 mg/kg. In this study, local treatment with one single intratubal methotrexate injection was successful in only 66% of patients. The mean resolution time for reduction of beta-HCG concentrations was 23.5 days (range 7-40). There was no statistically significant correlation between initial beta-HCG concentrations and outcomes after methotrexate treatment of ectopic pregnancy in our study. Where embryonal heart beats were observed, the success rate of the procedure was 40.9% (nine out of 22 cases). In the absence of cardiac activity, or when ultrasound examination showed no embryo, the success rate achieved was 84.6% (66 out of 78 cases) (P < 0.01). In all, 34 patients were considered to be incompletely cured after only one intratubal methotrexate injection: 12 patients required a second i.m. injection, a stagnation of beta-HCG concentrations was observed in 15 patients, abdominal pain occurred in six patients, and one patient suffered tubal rupture with haemoperitoneum. A total of 22 patients required secondary surgical management (salpingectomy). No biochemical or clinical side-effects of methotrexate treatment occurred. Tubal alteration ascribable to methotrexate injection occurred in one patient in our study. Out of 75 patients in this series who wished to conceive, 21 (28%) became pregnant within 1 year with the following outcomes: 11 pregnancies at term, three miscarriages, one induced abortion and six recurrent ectopic pregnancies (four occurred on the same side). Our findings suggest that treatment of common unruptured ectopic pregnancy without prior selection of patients, by a single intratubal methotrexate administration was associated with a 66% success rate. This was dependent only on the presence of embryonal heart beats and there was no correlation between the success rate and initial beta-HCG concentrations. Successful outcome after methotrexate administration for ectopic pregnancy could be perfected by way of an improved selection of patients based on inactive embryonal hearts and absence of a visualized embryo.
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Affiliation(s)
- E Darai
- Department of Obstetrics and Gynaecology, Hôpital Bichat, Paris, France
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Créquat J, Pennehouat G, Cornier E, Naouri M, Thebault Y, Madelenat P. [Evaluation of intra-uterine pathology and tubal patency by contrast echography]. Contracept Fertil Sex 1993; 21:861-4. [PMID: 8281240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
The contrast ultrasonography (CUS) is a new development of the pelvis ultrasounds. A contrast medium is injected through the cervix and is screened through the uterine cavity, the tubes and the peritoneal cavity. The contrast medium creates a new acoustic interface which improve the quality of the ultrasound imaging and the ability to diagnose endouterine pathologies. Further, tubal patency may be assessed by tracking fluid into the pouch of Douglas. The aim of this study was to assess the feasibility, the accuracy and the side effects of this technique when compared with the conventional procedures. Included were two groups of patients: the group 1 (10 cases) was of patients with menometrorrhagia before undergoing an hysteroscopy; the group II (11 cases) was of infertile patients before undergoing a laparoscopic tubal patency test. This technique, of low cost and without any radiation exposure, seems to be at least as accurate as the conventional methods for the intrauterine diagnostics. It is less effectiveness for the evaluation of the tubal patency. No side effect occurred in this study.
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10
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Benifla JL, Sebban E, Pennehouat G, Proust A, Naouri M, Créquat J, Madelenat P. [Treatment with methotrexate of 4 interstitial, unruptured pregnancies]. Contracept Fertil Sex 1993; 21:845-7. [PMID: 7506609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Successful treatment of four, non ruptured, cases of interstitial pregnancy are reported. Treatment consisted of in situ injection of methotrexate during coelioscopy. Dosage was 1.5 mg methotrexate per kilogram body weight. Negative plasma beta hCG levels were obtained 9 to 22 days after conservative medical treatment. No clinical or biochemical side effects were observed. Of two patients had no radiologically demonstrable cornual abnormality on the hysterosalpingographies effected at the 3 months evaluation after ascertained interstitial pregnancy, one have normal pregnancy. Two further patients had normal uneventful pregnancies 12 to 15 months later. Treatment of interstitial pregnancy by way of one in situ injection of methotrexate seems to be the currently preferred alternative to classical surgery.
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Affiliation(s)
- J L Benifla
- Service de gynécologie obstétrique, Hôpital Bichat, Paris
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11
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Abstract
A series of 30 microlaparoscopies performed under local anaesthesia and sedation are presented. The visualization of the pelvic organs was acceptable and the patients reported mild discomfort only. Microlaparoscopy may potentially replace macrolaparoscopy in selected cases.
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Affiliation(s)
- F Risquez
- Centro Medico Docente La Trinidad, Caracas, Venezuela
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12
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Abstract
The new technique of endoluminal tubal exploration was evaluated by performing transcervical falloposcopy instead of chromoperturbation under control of concurrent laparoscopy. In this feasibility study, catheterization was performed with the use of either a transhysteroscopic or a free-hand tubal cannulation technique. A total of 66 patients were investigated for primary or secondary infertility with proximal and/or distal suspected tubal defects on the basis of prior hysterosalpingography; three patients were investigated for unruptured tubal pregnancy; two patients were investigated to localize the tip of the tubal embryo transfer catheter. Transcervical catheterization was successful in 110 of the 130 tubes (84.6%). Successful and informative falloposcopy was achieved in 30% of the 110 cannulated tubes. The transcervical free-hand cannulation technique was as effective as the transhysteroscopic approach. Recanalization of at least one tube was achieved in 83% of women with proximal obstruction. Tubal cannulation by the tubal embryo transfer catheter was confirmed by falloposcopy in the two cases where free-hand catheterization was used. This study confirms that it is possible to visualize the tubal lumen and demonstrates that the free-hand cannulation technique is a simple and effective alternative to the transhysteroscopic approach. However, further progress in catheter technology has to be achieved in order to perform regularly successful transcervical falloposcopy in damaged tubes.
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Affiliation(s)
- G Pennehouat
- Service de Gynécologie-Obstétrique, University Hospital Bichat, Paris, France
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13
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Pennehouat G, Gugliemina JN, Naouri M, Créquat J, Bouret JM, Thébault Y, Madelenat P. [Screening for ovarian cancers: critical analysis]. Contracept Fertil Sex 1993; 21:223-30. [PMID: 7951617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The ovarian cancers have a low incidence rate and a high mortality rate mainly due to a late diagnosis. The potential value of ultrasonography and measurements of tumour associated markers to detect early ovarian cancer suggest the interest of a screening strategy. The analysis of the conditions for efficacy of a such screening program, of the predictive values of ultrasonography and tumour associated markers measurements and of the results of preliminary studies does not confirm on a rational basis the potential interest of screening strategies.
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Affiliation(s)
- G Pennehouat
- Service de gynécologie-obstétrique, Hôpital Bichat, Paris
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14
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Van Wissen B, Eisenberg C, Debey P, Pennehouat G, Auger J, Bomsel-Helmreich O. In vitro DNA fluorescence after in vitro fertilization (IVF) failure. J Assist Reprod Genet 1992; 9:564-71. [PMID: 1299390 DOI: 10.1007/bf01204255] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
PURPOSE A pilot study was performed to test the diagnostic value of in vitro DNA fluorescence in oocytes that failed to fertilize after IVF. Ten patients with a cleavage rate less than 20% after IVF were included. RESULTS Uncleaved oocytes were observed by fluorescence microscopy after incubation with the DNA fluorescent dye Hoeschst 33342. Four main causes which may have contributed to the low cleavage rate were found: (1) sperm incapacity to penetrate the oocyte despite the absence of the usual criteria for male infertility, (2) oocyte immaturity, (3) delayed fertilization, and (4) oocyte abnormalities revealed by aberrations in the morphology of the female chromatin. CONCLUSIONS The possibility of a rapid and detailed analysis of the maturational status of unfertilized oocytes, the morphology of the female chromatin, the presence and quantity of spermatozoa tightly bound to the zona pellucida, and sperm penetration into the oocyte without subsequent pronucleus formation, using DNA fluorescence, allows us to clarify further the cause of fertilization failure and to orient infertility treatment toward the male, the female, or both partners.
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Affiliation(s)
- B Van Wissen
- Service Gynecologie Obstetrique, CHU A. Béclère, Clamart, France
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15
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Rísquez F, Pennehouat G, Foulot H, Mathieson J, Dubuisson JB, Bonnin A, Madelenat P, Zorn JR. Transcervical tubal cannulation and falloposcopy for the management of tubal pregnancy. Hum Reprod 1992; 7:274-5. [PMID: 1577943 DOI: 10.1093/oxfordjournals.humrep.a137631] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
This is the first report of transcervical salpingoscopic visualization of tubal pregnancy in two patients. The falloposcope was introduced through a catheter used routinely for transcervical tubal cannulation, guided by tactile impression. We have previously demonstrated that it is possible to diagnose and treat tubal pregnancies via a transcervical intra-Fallopian cannula. Falloposcopy could help select appropriate patients for transcervical intra-Fallopian therapy by verifying the site of implantation and the characteristics of the ectopic pregnancy.
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Affiliation(s)
- F Rísquez
- Clinique Universitaire Baudelocque, Hôpital Cochin, Paris, France
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16
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Zylberberg B, Dormont D, Ravina JH, Madelenat P, Salat-Baroux J, Ferrand G, Antoine JM, Pennehouat G. [Ovarian carcinomas. Intraperitoneal chemotherapy by needle]. Presse Med 1991; 20:1320-6. [PMID: 1833735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Between January 1980 and February 1988, 61 women with ordinary ovarian carcinoma (OC) were treated with combined intraperitoneal and intravenous first-line therapy. For intraperitoneal infusions we did not use implanted systems which are often poorly tolerated and sometimes create non-negligible complications. We simply used a lumbar puncture needle left in situ for less than 2 hours. In second regard laparotomies, the 7 patients with stage I OC and the 3 patients with stage II OC were in histologically and cytologically proven complete remission, as were 34 of the 43 patients with stage III OC (79 percent) and 1 of the 8 patients with stage IV OC. After a mean follow-up of 56 months, the overall actuarial survival rate was 66 percent and the survival rate without recurrence was 54 percent. During the same period, 26 patients with recurrent OC were treated with second-line intraperitoneal chemotherapy. After a mean follow-up of 30 months, 10 were in apparently complete remission, and after a 27 to 61 months period 7 of these 10 patients had no recurrence. These results must be compared with those obtained with other salvage methods.
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17
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Van Wissen B, Bomsel-Helmreich O, Debey P, Eisenberg C, Vautier D, Pennehouat G. Fertilization and ageing processes in non-divided human oocytes after GnRHa treatment: an analysis of individual oocytes. Hum Reprod 1991; 6:879-84. [PMID: 1757529 DOI: 10.1093/oxfordjournals.humrep.a137444] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Some human oocytes cultured together with spermatozoa for in-vitro fertilization (IVF) do not subsequently divide. The arrest of the fertilization process at different moments during development may provide information about the cause of fertilization failure. Oocytes which subsequently divide are transferred 48 h after insemination; when oocytes do not divide, ageing processes can be observed. Therefore these oocytes are interesting material in which to observe both fertilization and ageing. Our study concerns 72 undivided human oocytes 0, 48 or 72 h post-insemination. DNA of the oocyte and spermatozoa was visualized by the DNA fluorescent dye Hoechst 33342. Living oocytes were observed in toto by fluorescence and bright field microscopy which allowed nuclear and pronuclear membranes to be discerned. Oocytes were subsequently fixed and sectioned for bright field microscopy. Both techniques allowed parallel observations. Oocytes at various stages of fertilization are described: sperm penetration in both mature and immature oocytes, decondensation of sperm-heads, premature condensation of male chromatin, polyspermy and pronucleus formation. Typical ageing processes such as the centripetal migration of the metaphase II chromosomes, the formation of a restitution nucleus and the lagging of chromosomes within a metaphase spindle are observed. DNA fluorescence appears to be a quick, easy and valuable means to analyse fertilization and its failure.
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18
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Pennehouat G, Houry S, Huguier M. [Sigmoid duplication in an adult]. J Chir (Paris) 1986; 123:169-70. [PMID: 3722285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Duplications of digestive tract are usually observed in new-born. In most of the case they are located on the small bowel. We observed, in a 69-year old man which complained of abdominal distension and constipation a sigmoid duplication. A colectomy was performed. Carcinoma arising in such duplication have been reported.
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