ABSTRACT
OBJECTIVES: To evaluate efficacy and functional results (sexual activity) of vaginal flap for rectovaginal fistula in Crohn's disease. PATIENTS AND METHODS: From May 2004 to March 2008, we proposed a vaginal flap in patients who had a rectovaginal fistula in Crohn's disease and for which rectal flap was technically impossible. Monitoring included a clinical examination at 1 month and every 3 months for 1 year, Perianal Disease Activity Index for sexual activity evaluation. Every year and in April 2009 the nursing team during a telephone interview filled a standardized questionnaire. RESULTS: We treated 5 patients. At 6 months, 4 of 5 patients were healed. At 7 months, 1 patient presented a new flare up of CD with reopening of the fistula. The other 3 patients were still healed at a median follow-up of 30.66 months (15 to 59). One patient presented dyspareunia during 3 months. DISCUSSION AND CONCLUSION: Vaginal flap is an effective technique that entails neither prolonged dyspareunia nor fecal incontinence. Stoma is not systematic.
Subject(s)
Crohn Disease/complications , Rectovaginal Fistula/surgery , Surgical Flaps , Adult , Aged , Dyspareunia/etiology , Female , Follow-Up Studies , Gynecologic Surgical Procedures/adverse effects , Gynecologic Surgical Procedures/methods , Humans , Middle Aged , Rectovaginal Fistula/etiology , Sexual Behavior/physiology , Surveys and Questionnaires , Treatment OutcomeSubject(s)
Diabetes, Gestational/blood , Glucose Tolerance Test , Patient Compliance , Female , Humans , Postpartum Period , Pregnancy , Prospective StudiesABSTRACT
OBJECTIVE: To determine the relative effects of abdominal, vaginal or laparoscopic approaches for hysterectomy on female sexuality. STUDY DESIGN: One hundred and seventy women who underwent abdominal (n=68), vaginal (n=67), and laparoscopic (n=35) hysterectomy for benign disease were studied. Pre- and postoperative sexuality was assessed by questionnaire. RESULTS: Overall, sexuality after hysterectomy remained unchanged in 60.4% of cases, and improved or deteriorated in 21.3 and 18.3%, respectively. Postoperative delay in resuming sexual activity was shorter after vaginal (45.2+/-6.7 days) hysterectomy than after abdominal hysterectomy (62.4+/-9.3 days). Deterioration of sexual function occurred more frequently after abdominal hysterectomy (24%) than after vaginal (13.5%) or laparoscopic (8.5%) hysterectomy. CONCLUSION: These results indicate that the impact of vaginal and laparoscopic hysterectomy on women's sexuality may be milder than that of abdominal hysterectomy.
Subject(s)
Hysterectomy, Vaginal/adverse effects , Hysterectomy/adverse effects , Hysterectomy/methods , Laparoscopy/adverse effects , Sexuality/physiology , Female , Humans , Marriage , Middle Aged , Postoperative Complications , Retrospective Studies , Self Concept , Sexuality/psychology , Uterine Diseases/surgeryABSTRACT
Ovarian virilizing tumors are rare and can lead to assessment difficulties because of their small size. A 41-yr-old female was referred for evaluation of hirsutism that had increased within the previous 3 yr. Menstrual cycle length was normal. Plasma testosterone was 3.9 ng/ml (normal range, 0.2-0.8 ng/ml), was not suppressible by 2 mg dexamethasone (4.3 ng/ml), and was increased (6.3 ng/ml) after three daily injections of hCG (5000 IU). Abdominal computed tomography scan showed an adrenal nodule (13 x 6 mm) that remained unchanged after 3 months. Ultrasound examination of the pelvis was normal. Ovarian and adrenal venous catheterization did not yield additional information. Topographic assessment was made by intraoperative measurement of testosterone in the samples taken from each ovarian vein (competitive chemiluminescent immunoassay ADVIA Centaur; right ovarian vein, 105 ng/ml; left ovarian vein, 5 ng/ml; peripheral blood, 7 ng/ml). Right annexectomy resulted in normalization of testosterone levels (0.22 ng/ml). Histopathological examination found a Leydig cell tumor of hilar type (1.5 cm). This observation illustrates the usefulness of intraoperative measurement of testosterone by a rapid automated technique for topographic assessment of ovarian virilizing tumor in premenopausal women.
Subject(s)
Hirsutism/etiology , Leydig Cell Tumor/complications , Leydig Cell Tumor/surgery , Ovarian Neoplasms/complications , Ovarian Neoplasms/surgery , Testosterone/blood , Adult , Female , Humans , Intraoperative Period , Leydig Cell Tumor/blood , Leydig Cell Tumor/pathology , Osmolar Concentration , Ovarian Neoplasms/blood , Ovarian Neoplasms/pathology , Polycystic Ovary Syndrome/complicationsABSTRACT
Since mother to child transmissions of hepatitis C virus (HCV) have been reported to be low, teams involved in assisted reproductive technologies have accepted HCV positive patients into their programmes. We report in the present paper two cases of undoubted patient to patient HCV transmission while patients were attending for assisted conception. In both cases, HCV genotyping and sequencing of the first hypervariable region of the HCV genome provided molecular evidence for nosocomial transmission. Investigations made to elucidate the route of contamination have shown that the most likely route of contamination is through healthcare workers. Such nosocomial HCV infection has been reported in other healthcare situations, mainly in dialysis units, and physical proximity was also suspected to be at the origin of the infection. We conclude that assisted reproduction teams must be very prudent when including such patients in their programmes.
Subject(s)
Ancillary Services, Hospital , Cross Infection/transmission , Fertilization in Vitro , Hepacivirus/isolation & purification , Hepatitis C/transmission , Adult , Cross Infection/drug therapy , Female , Hepacivirus/genetics , Hepatitis C/drug therapy , Humans , Interferon-alpha/therapeutic use , Phylogeny , Pregnancy , Pregnancy, MultipleABSTRACT
The authors report a case of both vesical and ureteral endometriosis diagnosed after recurrent acute pyelonephitis. A Gonadotrophin-Releasing Hormone (GnRH) agonist therapy and a conservative endoscopic management is started allowing an almost complete regression of the lesions. A review of the literature is presented about this unexceptional localisation of endometriosis (1 to 2% of all endometriosis).
Subject(s)
Endometriosis/diagnosis , Ureteral Diseases/diagnosis , Urinary Bladder Diseases/diagnosis , Adult , Endometriosis/complications , Endometriosis/therapy , Endoscopy , Female , Gonadotropin-Releasing Hormone/therapeutic use , Humans , Pyelonephritis/etiology , Recurrence , Ureteral Diseases/complications , Ureteral Diseases/therapy , Urinary Bladder Diseases/complications , Urinary Bladder Diseases/therapyABSTRACT
The authors present a series of 962 hysterectomies for fibroma carried out between January 1981 and December 1995 in the Department of Gynecology and Obstetrics of CHU Toulouse-La Grave. They carried out 453 vaginal hysterectomies and 509 abdominal hysterectomies. They compared the largest series reported in the literature, between vaginal and abdominal technique. The vaginal route has the obvious advantages of speed of operation, less operative trauma, lower risk of thrombo-embolic disease and the hospital stay is shorter. Laparoscopic assistance allows to extend indications of vaginal route.
Subject(s)
Hysterectomy, Vaginal , Hysterectomy , Leiomyoma/surgery , Uterine Neoplasms/surgery , Adult , Evaluation Studies as Topic , Female , Humans , Hysterectomy/adverse effects , Hysterectomy, Vaginal/adverse effects , Middle Aged , Parity , Postoperative ComplicationsABSTRACT
Vaginal sacro-spino-fixation or Richter's procedure is valuable for the treatment of posthysterectomy vaginal prolapse. Although technically difficult, this procedure is associated with minimal trauma and is effective in correcting pelvic static disorders. There seem to be few complications. Results are very promising. The functional and anatomic improvements induced by the operation persist over the long term. Although the main indication is treatment of prolapse of the vaginal vault, Richter's procedure is also useful for the prevention of prolapse. Based on the experience acquired by a surgical team, the technique, indications, complications, and results of Richter's procedure are discussed.
Subject(s)
Hysterectomy/adverse effects , Ligaments/surgery , Uterine Prolapse/surgery , Adult , Aged , Aged, 80 and over , Female , Humans , Middle Aged , Retrospective Studies , Suture Techniques , Treatment Outcome , Uterine Prolapse/etiologyABSTRACT
The authors report 6 cases of carcinoma of the ovary presenting during pregnancy in the Department of Gynecology and Obstetrics of La Grave University Hospital, Toulouse, between 1972 and 1994. Analysis of this series is followed by a review of the literature which reveals that carcinoma of the ovary fortunately remains a rare event during pregnancy. All reported series conclude that the diagnosis is made at an early stage. Management depends in great part on the age of the pregnancy and stage of malignancy. During the first 6 months, immediate surgery is essential, with sacrifice of the pregnancy, except at stage IA1. During the final 3 months, surgery is delayed until fetal maturity. This classical attitude is currently being questioned. This classical attitude is currently being questioned. Some teams feel that conservative treatment followed by chemotherapy is possible, thereby preserving the pregnancy. The choice of the couple must always be taken into account when making these management decisions.
Subject(s)
Carcinoma, Embryonal , Cystadenocarcinoma, Mucinous , Cystadenocarcinoma, Serous , Ovarian Neoplasms , Pregnancy Complications, Neoplastic , Sertoli-Leydig Cell Tumor , Adult , Antineoplastic Agents/therapeutic use , Carcinoma, Embryonal/drug therapy , Carcinoma, Embryonal/surgery , Cesarean Section , Cisplatin/therapeutic use , Combined Modality Therapy , Cystadenocarcinoma, Mucinous/drug therapy , Cystadenocarcinoma, Mucinous/surgery , Cystadenocarcinoma, Serous/drug therapy , Cystadenocarcinoma, Serous/surgery , Female , Humans , Hysterectomy , Infant, Newborn , Ovarian Neoplasms/drug therapy , Ovarian Neoplasms/surgery , Ovariectomy , Pregnancy , Pregnancy Complications, Neoplastic/drug therapy , Pregnancy Complications, Neoplastic/surgery , Prognosis , Sertoli-Leydig Cell Tumor/drug therapy , Sertoli-Leydig Cell Tumor/surgeryABSTRACT
The impact of tamoxifen on the genital tract was assessed by cervico-vaginal cytology. Fifty two post-menopausal patients treated with tamoxifen for breast cancer were regularly monitored, with a pre-treatment reference smear showing a profoundly menopausal status, followed by an anual smear. Smears returned to a functional status in 44% of patients after 2 to 5 years treatment. The agonist effect of tamoxifen appears to be beyond any doubt, and responsible for certain adverse reactions. This should not bring into question the usefulness of the drug, but indicates the need for regular monitoring and, in the presence of a functional smear, further investigation by vaginal ultrasonography is essential in order to evaluate the status of the endometrium.
Subject(s)
Breast Neoplasms/drug therapy , Drug Monitoring/methods , Postmenopause/drug effects , Tamoxifen/therapeutic use , Vaginal Smears , Aged , Female , Humans , Middle Aged , Time FactorsABSTRACT
OBJECTIVE: To determine if ovarian cysts are associated with a particular basal endocrine profile and impair follicular growth. DESIGN: Retrospective study. SETTING: In Vitro Fertilization (IVF) Center. PATIENTS: Nine hundred fourteen stimulation cycles stimulated with a combination of luteinizing hormone-releasing hormone analogues (LH-RH-a) and human menopausal gonadotropins (hMG) in a long protocol in an IVF program. RESULTS: After 15 days of LH-RH-a therapy, ovarian cysts (> or = 20 mm) were observed in 8% of cases. These cysts were not related to a particular basal endocrine profile and did not impair follicular growth and IVF results. However, puncturing these cysts enhanced the quality of subsequent follicular growth. On the contrary, cysts appearing during hMG treatment (> or = 25 mm) were related with a lower LH:follicle-stimulating hormone ratio (0.79 +/- 0.52 versus 0.92 +/- 0.74 in absence of cyst) and to a lower ovarian response as assessed by the maximal estradiol level to the total number of hMG ampules ratio (51.6 +/- 36.5 versus 65.9 +/- 47.9 in absence of cyst). However, this difference had no influence on the pregnancy per stimulation rate (18% versus 16% in absence of cyst; not significant). CONCLUSIONS: Results show that the pathogens of ovarian cysts appearing during the blockage phase and during the stimulation phase are different. However, they do not impair the results of IVF, and thus it is not necessary to cancel the attempt in case of ovarian cyst.
Subject(s)
Fertilization in Vitro , Ovarian Cysts/physiopathology , Buserelin/therapeutic use , Estradiol/blood , Female , Follicle Stimulating Hormone/blood , Humans , Leuprolide/therapeutic use , Luteinizing Hormone/blood , Menotropins/therapeutic use , Ovarian Follicle/physiopathology , Pregnancy , Retrospective Studies , Triptorelin Pamoate/therapeutic useABSTRACT
In the case of in vitro fertilization, LHRH analogs are used to induce an hypophysary blockage, before the phase of stimulation, via administration of exogenous gonadotropin. During in vitro fertilization attempts using LHRH analogs, the blockage is controlled after 14 days of treatment through measurement of the plasmatic estradiol and pelvic ultra-sonography. In this retrospective study, which concerned 1075 in vitro fertilization cycles, a paradoxical ovarian stimulation with LHRH analogs was observed in 93 cases (8.7%), with high estradiol levels and follicular growth (detected by ultra-sonography), in spite of low FSH and LH levels. In 4 cases, a follicular puncture was performed, which allowed to collect oocytes from which embryos were obtained, thus confirming the observed follicular growth and maturation. The most probable hypothesis explaining this phenomenon seems to be a direct ovarian stimulation, effectuated in vivo by LHRH analogs. This stimulation is only observed in certain patients, and apparently more frequently, with certain LHRH analogs, probably through a variation in the expression of ovarian LHRH receptors.
Subject(s)
Fertilization in Vitro , Gonadotropin-Releasing Hormone/analogs & derivatives , Ovary/drug effects , Estradiol/blood , Female , Follicle Stimulating Hormone/blood , Humans , Luteinizing Hormone/blood , Ovarian Follicle/drug effects , Ovarian Follicle/physiology , Ovary/physiology , Ovulation Induction , Retrospective Studies , Triptorelin Pamoate/administration & dosage , Triptorelin Pamoate/pharmacology , Triptorelin Pamoate/therapeutic useABSTRACT
In the case of in vitro fertilization, LHRH analogs are used to induce a hypophysial blockage before the phase of stimulation, via administration of exogenous gonadotropin. During in vitro fertilization attempts using LHRH analogs, the blockage is controlled after 14 days of treatment by measuring plasmatic estradiol and by pelvic ultrasonography. In this retrospective study, which concerned 1075 in vitro fertilization cycles, a paradoxical ovarian stimulation with LHRH analogs was observed in 93 cases (8.7%) with high estradiol levels and follicular growth (detected by ultrasonography), in spite of low FSH and LH levels. In 4 cases, a follicular puncture was performed, which made it possible to collect oocytes from which embryos were obtained, thus confirming the observed follicular growth and maturation. The most probable hypothesis explaining this phenomenon seems to be direct ovarian stimulation effectuated in vivo by LHRH analogs. This stimulation is only observed in certain patients, and, more frequently it seems, with certain LHRH analogs, which is probably due to a variation in the expression of ovarian LHRH receptors.
Subject(s)
Fertilization in Vitro , Gonadotropin-Releasing Hormone/analogs & derivatives , Ovarian Follicle/drug effects , Ovarian Follicle/physiology , Clinical Protocols , Estradiol/blood , Female , Follicle Stimulating Hormone/blood , Humans , Luteinizing Hormone/blood , Retrospective StudiesABSTRACT
OBJECTIVE: To determine if biochemical differences in luteinizing hormone-releasing hormone analogues (LH-RH-a) have a clinical influence, we studied three of these molecules: buserelin acetate (group B), triptorelin (group T), and leuprorelin (group L). DESIGN: Clinical trial. SETTING: In Vitro Fertilization (IVF) Center. PATIENTS: Two hundred forty-six patients, undergoing their first IVF attempt, were randomly allocated to one group. The analogues were used in a long protocol for ovarian stimulation in an IVF program. RESULTS: After 15 days of LH-RH-a therapy, the follicle-stimulating hormone level was lower in group B (2.9 +/- 1, 4.3 +/- 1.7, 4.8 +/- 2.1 UI/L for B, T, and L groups, respectively; P less than 0.001), although no difference was found in LH and estradiol (E2) levels. After follicular growth stimulation by human menopausal gonadotropins (hMG), E2 level was significantly lower in B group (1,799 +/- 1,101, 2,440 +/- 1,298, 2,137 +/- 1,044 pg/mL for B, T, and L groups, respectively; P less than 0.01), as well as the E2 level per hMG ampule (67 +/- 51, 97 +/- 61, 82 +/- 49 for B, T, and L groups respectively; P less than 0.01). The pregnancy per stimulated cycle rate was not significantly different among the groups. CONCLUSIONS: These results suggest that LH-RH-a could act not only on the pituitary but also on the ovaries. Moreover, these data suggest that buserelin acetate could be preferentially used for high responders and triptorelin for poor responders.
Subject(s)
Buserelin/therapeutic use , Fertilization in Vitro , Gonadotropin-Releasing Hormone/analogs & derivatives , Leuprolide/therapeutic use , Ovary/physiopathology , Female , Gonadotropin-Releasing Hormone/therapeutic use , Humans , Luteinizing Hormone/blood , Ovarian Follicle/physiology , Stimulation, Chemical , Time Factors , Triptorelin PamoateABSTRACT
The authors review results concerning 1,127 hysterectomies performed in the Department of Obstetrics and Gynecology of the La Grave Hospital (Toulouse, France). They compare those of abdominal hysterectomy and those of vaginal hysterectomy (359). With regard to vaginal procedures, they draw a distinction between simple hysterectomies and prolapse repairs. The results of this series are comparable with those in the literature: similar overall morbidity after vaginal (41 per cent) and abdominal (33 per cent) hysterectomy. This morbidity was lower in cases of simple vaginal hysterectomy (26 per cent). The majority of complications were infectious or febrile: 29 per cent of abdominal hysterectomies and 30 per cent of vaginal hysterectomies, including 16.4 per cent of simple vaginal hysterectomies. The authors compared abdominal hysterectomies and simple vaginal hysterectomies. The latter have many advantages: rarer mortality, overall morbidity and thrombo-embolic complications, shorter hospital stay, more comfortable and less costly postoperative course. Thus when the choice is available, gynecologists should opt for vaginal hysterectomy.
Subject(s)
Hysterectomy, Vaginal/adverse effects , Hysterectomy/adverse effects , Postoperative Complications/epidemiology , Female , France/epidemiology , Humans , Hysterectomy/methods , Hysterectomy/standards , Hysterectomy, Vaginal/methods , Hysterectomy, Vaginal/standards , Incidence , Intraoperative Complications/epidemiology , Intraoperative Complications/etiology , Postoperative Complications/etiology , Retrospective StudiesSubject(s)
Postpartum Hemorrhage/diagnosis , Female , Humans , Postpartum Hemorrhage/therapy , PregnancyABSTRACT
The authors describe a case of a desmoid tumor of the anterior abdominal wall. From a review of the world literature, the main characteristics of these tumors are detailed, and the various pathophysiological hypotheses, demonstrating the necessity of exclusively surgical treatment, are presented.
Subject(s)
Abdominal Muscles , Fibroma , Soft Tissue Neoplasms , Adult , Female , Fibroma/etiology , Fibroma/therapy , Humans , Soft Tissue Neoplasms/etiology , Soft Tissue Neoplasms/therapyABSTRACT
The authors report here a new case of hydatid mole in one of the eggs of a mole pregnancy. 48 other cases have been reported in 13 publications. The birth of a viable, well-developed fetus is described in 13 instances (27%), fetal death in utero in 22 instances (46%), birth of a non-viable fetus 11 times (23%) and malignant degeneration twice (4%). Medical interruption of the pregnancy is indicated for the slightest sign of fetal anomaly or maternal complication. Prostaglandins may be used for that purpose. However, it is possible to let such a pregnancy follow its course.
Subject(s)
Hydatidiform Mole/pathology , Pregnancy Complications, Neoplastic/pathology , Pregnancy, Multiple , Uterine Neoplasms/pathology , Female , Humans , Pregnancy , TwinsABSTRACT
Culture media are important components of IVF. Their selection must meet the need for efficiency, and also economic and practical requirements. From these standpoints, we compared two widely used media: Ham's F10 supplemented with cord serum and Menezo B2 used without serum. The test followed a randomized protocol using two series of 159 and 162 oocytes. Since no difference was seen in efficiency assessed from cleavage rate, the discussion focuses on cost and ease of use.