Endometrial laser interstitial hyperthermy: a potential modality for endometrial ablation.

in Obstetrics & Gynecology (1996), 87(3), 459-64

This study was undertaken to evaluate the efficacy and safety of an intrauterine device designed for endometrial ablation by Nd-YAG laser interstitial hyperthermy. Eight hysterectomy specimens were ... [more ▼]

This study was undertaken to evaluate the efficacy and safety of an intrauterine device designed for endometrial ablation by Nd-YAG laser interstitial hyperthermy. Eight hysterectomy specimens were treated in vitro with an output power of 30 W for 5 minutes; tissue temperatures, recorded by thermocouples, were plotted to draw time-temperature and time-distance curves. As a preliminary series, ten patients were treated, with the first five subjected to local temperature monitoring; all ten were followed-up for 6-17 months. Immediate and delayed (6 weeks) histologic data were obtained. The intramural temperature at 6 mm from the fibers ranged from 55-60C). In vivo, the cooling effect of the arterial blood flow lowered the serosal temperatures under 41C. The histologic data and the hysterographic pictures suggest that endometrial ablation was effective. This new device does not require distending medium, hysteroscopic control, or high-powered Nd-YAG laser machines. Preliminary long-term results suggest that the device could be used for endometrial ablation. [less ▲]

Peritoneal endometriosis and "endometriotic" nodules of the rectovaginal septum are two different entities.

in Fertility and Sterility (1996), 66(3), 362-8

OBJECTIVES: To compare histologically and stereologically the endometriotic nodule of the rectovaginal septum to peritoneal endometriosis. DESIGN: Morphometric investigation, cytokeratin and vimentin ... [more ▼]

OBJECTIVES: To compare histologically and stereologically the endometriotic nodule of the rectovaginal septum to peritoneal endometriosis. DESIGN: Morphometric investigation, cytokeratin and vimentin content, and steroid receptor evaluation were performed on endometriotic tissue from the peritoneum (n = 52) and rectovaginal nodules (n = 68). SETTING: An academic teaching hospital. PATIENTS: Biopsies were taken from 120 patients undergoing a laparoscopy for infertility and/ or pelvic pain (52 from typical black peritoneal endometriotic implants and 68 from endometriotic nodule of the rectovaginal septum). None of the patients were treated. RESULTS: Mitotic activity was found to be significantly different in peritoneal and rectovaginal endometriosis. The evaluation suggested that the stroma is not mandatory for the invasion of glandular epithelium in the rectovaginal nodule, which is, like a adenomyoma, a circumscribed nodular aggregate of smooth muscle and glandular elements. Cytokeratin and vimentin content as well as the estrogen receptor (ER) and P receptor (PR) content were significantly lower in both types of lesion when compared with eutopic endometrium. But vimentin immunoreactivity in epithelium, as well as the ER and PR content, were significantly lower in nodules when compared with black peritoneal lesions. CONCLUSION: It is suggested that the rectovaginal endometriotic nodule is a different disease from peritoneal endometriosis and must be called rectovaginal adenomyosis or rectovaginal adenomyoma. Its histopathogenesis probably is not related to the implantation of regurgitated endometrial cells but to the metaplasia of Müllerian rests. [less ▲]

Laparoscopic myomectomy today. Fibroids: management and treatment: the state of the art.

in Human Reproduction (1996), 11(9), 1837-40

Rectovaginal septum, endometriosis or adenomyosis: laparoscopic management in a series of 231 patients.

in Human Reproduction (1995), 10(3), 630-5

A series of 231 cases of deep-infiltrating endometriosis of the rectovaginal septum is presented. Laparoscopic procedures with excision of deep fibrotic endometriotic nodules were performed in all cases ... [more ▼]

A series of 231 cases of deep-infiltrating endometriosis of the rectovaginal septum is presented. Laparoscopic procedures with excision of deep fibrotic endometriotic nodules were performed in all cases. In three cases, the bowel lumen was entered. No other peri-operative complications were observed. Three cases of urinary retention were reported. The nodule resection resulted in considerable pain relief. Histologically, the rectovaginal nodule was similar to an adenomyoma. Indeed it was a circumscribed nodular aggregate of smooth muscle and endometrial glands. This form of disease must be considered as a specific disease which originates from the Mullerian rests present in the rectovaginal septum and we suggest that it be called 'rectovaginal adenomyosis'. [less ▲]

Uterine vascularity during stimulation and its correlation with implantation in in-vitro fertilization.

in Human Reproduction (1995), 10(6), 1497-1501

The changes in uterine artery blood flow in women undergoing in-vitro fertilization cycles were studied throughout stimulation after gonadotrophin-releasing hormone (GnRH) desensitization. The data ... [more ▼]

The changes in uterine artery blood flow in women undergoing in-vitro fertilization cycles were studied throughout stimulation after gonadotrophin-releasing hormone (GnRH) desensitization. The data obtained showed that the uterine vascularity was related to hormonal changes. The GnRH agonist effect was seen only after the third week of administration, and the uterine perfusion was significantly (P = 0.002) improved by the oestradiol secretion. Human chorionic gonadotrophins increased the resistance index (RI) significantly (P = 0.0001) for a period of 48 h. Then the progesterone secretion modified the curve with a significant improvement in the uterine blood flow (P = 0.03). Comparison of the RI value 2 days before human menopausal gonadotrophin (HMG) commencement, in patients with and without pregnancy, showed a higher RI in patients who did not conceive but no difference was observed on the day of embryo transfer. The pregnancy rates were similar whatever the range of the RI observed. The data available so far suggest that haemodynamic parameters alone, detected by Doppler sonography, do not provide full information on endometrial receptivity on the day of embryo transfer. A resistance index > 0.79 before HMG commencement seems to indicate poor uterine vascularity and may necessitate an increase in the HMG doses to prevent endometrial immaturity. [less ▲]

Hysteroscopic myomectomy.

in Current Opinion in Obstetrics & Gynecology (1995), 7(4), 311-6

Transhysteroscopic myomectomy has proved to be safe and effective with experienced operators. The use of the continuous flow hysteroscope and preoperative monitoring of intrauterine pressure has ... [more ▼]

Transhysteroscopic myomectomy has proved to be safe and effective with experienced operators. The use of the continuous flow hysteroscope and preoperative monitoring of intrauterine pressure has contributed to the prevention of fluid intravasion accidents. Effectiveness has been demonstrated in a number of recently published long-term studies. [less ▲]

Advanced laparoscopic surgery for the removal of rectovaginal septum endometriotic or adenomyotic nodules.

in Bailliere's Clinical Obstetrics & Gynaecology (1995), 9(4), 769-74

In the pelvis, three different forms of endometriosis (Donnez et al, 1992) must be considered: (1) peritoneal, (2) ovarian, (3) rectovaginal septum. By evaluation of the mitotic activity and the stromal ... [more ▼]

In the pelvis, three different forms of endometriosis (Donnez et al, 1992) must be considered: (1) peritoneal, (2) ovarian, (3) rectovaginal septum. By evaluation of the mitotic activity and the stromal vascularization, we have recently suggested (Nisolle et al, 1993) that peritoneal red lesions were the most aggressive form of the disease and progress to the so-called typical or black lesion, which must be considered as an enclosed implant surrounded by fibrosis. This type of infiltration must be clearly differentiated from the rectovaginal endometriotic nodule. Koninckx (1993) recently described three types of deep-infiltrating endometriosis: deep-infiltrating endometriosis of type I is a rather large lesion in the peritoneal cavity, infiltrating conically with the deeper parts becoming progressively smaller. It has been suggested that this type of endometriosis is caused by infiltration. In type II lesions, the main feature is that bowel is retracted over the lesion which thus becomes deeply situated in the rectovaginal septum although not actually infiltrating it. Type III lesions are the deepest and most severe. They are spherically shaped, situated deep in the rectovaginal septum, often only visible as a small typical lesion at laparoscopy or often not visible at all. This lesion is often more palpable than visible and is acutely tender if the patient is examined at the time of menstruation, and gives rise to severe dyspareunia. In our experience there are two different types of 'deep-infiltrating endometriosis': 1. True deep-infiltrating endometriosis caused by the invasion of a very active peritoneal lesion deep in the retroperitoneal space. In cases of lateral peritoneal invasion, uterosacral ligaments can be involved as well as the anterior wall of the rectosigmoid bowel junction resulting in a retraction, adhesions and secondary obliteration of the cul-de-sac. 2. Pseudo deep-infiltrating endometriosis or adenomyosis of the rectovaginal septum. This lesion originates from the rectovaginal septum tissue and consists essentially of smooth muscle with active glandular epithelium and scanty stroma. In our study, the rectovaginal nodule was histologically similar to an adenomyoma (Zaloudek and Norris, 1987). It was a circumscribed, nodular aggregate of smooth muscle, endometrial glands and endometrial stroma. As in the 'adenomyoma', secretory changes were frequently absent in 'endometriotic' rectovaginal nodules. The invasion of the muscle by a very active glandular epithelium, without stroma, proved that the stroma is not necessary for invasion in this particular type of pathology called adenomyosis. In some instances, it can be seen that the vaginal pluristratified epithelium was replaced by a glandular epithelium. The fact that ciliated cells were present and the co-expression of both vimentin and cytokeratin (Donnez and Nisolle, personal communication) proved the Mullerian origin of the nodule, where certain histological characteristics are completely different to those observed in peritoneal lesions (Nisolle et al, 1990). In our series, deep fibrotic tissue assumed to contain endometriosis was excised or vaporized from the anterior rectum with the aid of multiple rectovaginal examinations. Cul-de-sac dissection was followed by excision of deep fibrotic endometriosis, without cul-de-sac reconstruction. In three cases, the bowel lumen was entered. A comprehensive laparoscopic procedure, while not eradicating all the endometriosis, may result in considerable pain relief or a desired pregnancy. [less ▲]

Advanced endoscopic techniques used in dysfunctional bleeding, fibroids and endometriosis, and the role of gonadotrophin-releasing hormone agonist treatment.

in British Journal of Obstetrics & Gynaecology (1994), 101(suppl 10), 2-9

Immunohistochemical analysis of estrogen and progesterone receptors in endometrium and peritoneal endometriosis: a new quantitative method.

in Fertility and Sterility (1994), 62(4), 751-9

Objective: To evaluate estrogen receptors (ER) and progesterone receptors (PR) content in glandular and stromal cells of eutopic and ectopic endometrium. DESIGN: A recently advanced stereographic computer ... [more ▼]

Objective: To evaluate estrogen receptors (ER) and progesterone receptors (PR) content in glandular and stromal cells of eutopic and ectopic endometrium. DESIGN: A recently advanced stereographic computer technology was applied for the investigation of steroid receptors. SETTING: University hospital department of gynecology. PATIENTS: Biopsies of endometrium and typical peritoneal endometriotic lesions were taken from 19 infertile patients with laparoscopically proved endometriosis. Endometrial biopsies were also taken from 15 patients without endometriosis. All of them were untreated. RESULTS: In normal endometrium, the highest concentrations of ER and PR occurred in the epithelial and stromal cells during the late proliferative phase of the menstrual cycle. Estrogen receptor and PR content declined throughout the secretory phase. Progesterone receptor content was found not to be significantly decreased in the stroma during the early secretory phase and quite high in the late secretory phase. In peritoneal endometriotic lesions, the highest concentrations of ER and PR were found during the late proliferative phase. When compared with normal endometrium, a lower ER content ans a similar PR content were observed, and the cyclic changes in peritoneal endometriosis lesions were also similar. CONCLUSION: A new computerized technology for the evaluation of ER and PR in eutopic and ectopic endometrium. Although the ER content was found to be lower in endometriotic tissue when compared with endometrium, the cyclic pattern was similar in both eutopic and ectopic endometrium. Progesterone receptor content was similar in both tissues, except during the late secretory phase in ectopic glandular epithelium in which a high persistent PR content was observed. [less ▲]

Peritoneal endometriosis: two-dimensional and three-dimensional evaluation of typical and subtle lesions.

in Annals of the New York Academy of Sciences (1994), 734

Endometriosis most commonly affects the pelvic peritoneum close to the ovaries, including the uterosacral ligaments, the ovarian fossa peritoneum, and the perito- neum of the cul-de-sac. The increased ... [more ▼]

Endometriosis most commonly affects the pelvic peritoneum close to the ovaries, including the uterosacral ligaments, the ovarian fossa peritoneum, and the perito- neum of the cul-de-sac. The increased diagnosis of endometriosis at laparoscopy can be explained by the increased experience and ability of the surgeon to detect such subtle lesions. The greatest change has been in the case of “subtle” lesions, which increased from 15% in 1986 to 65% in 1988. The diagnosis of peritoneal endometriosis at the time of laparoscopy is often made by the observation of typically puckered black or bluish lesions. There are, in addition, numerous subtle appearances of peritoneal endometriosis. These lesions, frequently nonpigmented, were diagnosed as endometriosis following confirmation by biopsy by Jansen and Russell in 1986. [less ▲]