Cholecystectomy by celioscopy. Experience in two Upper Normandy hospital units. Apropos of 178 procedures]

Laparoscopic cholecystectomy (LC) emerges as an effective alternative to classical cholecystectomy, but its safety, benefits and indications still need to be clarified. From September 1989 to March 1991, 178 LC were performed by 8 surgeons in 2 hospitals, on 142 women and 36 men with a mean age of 48.2 years. The gall bladder wall was thin in 160 cases and thick in 18 cases (with 6 cases acute cholecystitis). We observed no deaths, 147 simple procedures with a hospital stay and drug requirement lower than with the usual cholecystectomy via laparotomy. But in 21 cases, the procedure needed a laparotomy, and in 10 cases complications occurred, requiring laparotomy in 6 cases. Our results suggest: a) LC is an improvement in the treatment of uncomplicated gallstones; b) a trained surgeon and extreme caution are required in complicated cholelithiasis; c) classical cholecystectomy is still useful in many circumstances.     

Herpesvirus, cytomegalovirus, human sperm and assisted fertilization

BACKGROUND: The effect of viral particles on the motility of human sperm and the relationship between sperm and virus are of importance particularly in assisted fertilization. METHODS: We incubated ejaculated sperm with or without seminal fluid with either herpes simplex virus type 2 (HSV2) or human cytomegalovirus (HCMV). For each experiment, 5 x 10(5) sperm were incubated with a viral load of between 10(4) and 10(6) plaque-forming units. RESULTS: We detected no apparent variations in the percentage of motile forms when sperm were incubated with either HSV2 or HCMV. Using a computer-aided semen analysis system, a slight difference was reported in the percentage of motile forms when seminal fluid-free sperm were incubated with HSV2 (57.18 versus 64.43 in the control). Although the mean amplitude of lateral head displacement and the curvilinear velocity were significantly higher in infected sperm, the difference in straight line velocity was not statistically significantly different. Few viral particles (HSV2 or HCMV) adhered to the sperm membrane in the presence of seminal fluid. However, more particles stuck when in the absence of seminal fluid, particularly with HSV2 (8% of sperm sections for HSV2; 4% for HCMV). CONCLUSIONS: The relationship between sperm and viruses depends on the type of virus present as well as the presence or absence of seminal fluid. Motility is not a good enough criterion on which to prove the presence of viral elements, either in the medium or on the sperm.     

In-vitro oocyte maturation: some questions concerning the initiation and prevention of this process in humans

Human oocytes isolated from healthy non-preovulatory antralfollicles which had not been stimulated spontaneously resumedmeiosis at a low rate (31%) when compared with those from atreticfollicles (73%). Human follicular fluid did not inhibit spontaneousmaturation of rat oocytes in vitro, regardless of the qualityor maturity of the follicle or the treatment of the patient.In the human, oocyte maturation may involve a stimulatory processas well as a removal of inhibition.     

Effect of cumulus cell mass and follicle quality on in-vitro maturation of cynomolgus monkey oocytes

Cynomolgus monkey oocytes were recovered from healthy or atreticfollicles > 1000 µm in diameter at day 8 of gonadotrophinstimulated cycles and cultured in vitro, cumulus enclosed orcumulus free, for 2 days. Germinal vesicle breakdown (GVBD)occurred in 26.7% of healthy cumulus enclosed oocytes (n= 60)compared to 52.6% of atretic cumulus enclosed oocytes (n = 38).The mechanical removal of the cumulus cell mass increased theGVBD rate of the healthy oocytes (56.5%, n = 23) and acceleratedthe passage of the atretic oocytes (n = 23) from metaphase I(4.3%) to metaphase II (47.8%). In the healthy primate follicle,the dktyate stage could be maintained by aninhibitory substancesecreted by the cumulus; foUicular atresia could either decreasethe synthesis of this substance and/or induce the metabolismof a stimulatory substance.     

Rectal peptic ulceration—A rare cause of rectal bleeding

Analysis of the 27 cases of heterotopic gastric mucosa reported in the literature and a new case described here elucidates the main features of this disease: 1) all but one asymptomatic case were diagnosed in infants or in adults under 26 years old; 2) although rectal bleeding occurred in 24 patients, rectal peptic ulceration was found in only 13; 3) six of the patients also had rectal duplication; and 4) 19 times the limited extension of the heterotopic gastric mucosa was compatible with a complete excision by a transanal approach.     

When can revascularization be limited to the profunda femoris alone?

Dealing with lower limbs arteriopathies with combined aorto iliac and superficial femoral occlusive diease and when ischemia leads to operation should an extension bypass to the popliteal or tibial artery be associated every time it is possible? The authors have investigated the results of revascularizing operation above the profunda femoris on 35 limbs (27 patients). On 19 limbs only, has the revascularization been sufficient to cure the distal ischemia. On the other 16 limbs, a second operation was necessary 7 times an extension bypass to the popliteal or tibial artery, once an above knee amputation, twic a below knee amputation. From the comparison of these results with the degree of ischemia and the arteriographic aspect of the profunda femoris, the author's conclusion is that revascularization must extent below the profunda femoris unless the profunda is in good condition and there is no rest ischemia.     

An obstetric analysis of fifty consecutive pregnancies after transfer of cryopreserved human embryos

This report describes the obstetric outcome in 50 pregnancies resulting from the transfer of human embryos that had been cryopreserved for up to 2 years. The duration of cryopreservation did not influence the pregnancy rate after thawed embryo transfer. Thirty-one babies have been born from 28 pregnancies and a further seven pregnancies are currently in the second and third trimesters. Twenty-eight percent of the pregnancies failed to progress beyond the first trimester. One pregnancy was terminated at 22 weeks' gestation because of severe fetal malformation. Important antenatal events included premature uterine activity in six patients although only one patient with a singleton pregnancy ultimately was delivered prematurely. Retroplacental hemorrhage occurred in four patients but was of clinical consequence in only one. There was a high incidence of breech presentation at term in singleton pregnancies (12%). The cesarean section rate in this series was 21%. An international registry of cryopreserved pregnancies would facilitate data collection in this relatively new clinical field.     

High pregnancy rate after early human embryo freezing

Human embryos produced by in vitro fertilization (IVF) were frozen with 1,2-propanediol as a cryoprotectant. Embryo survival after thawing was related to the presence of a nucleus in frozen cells and decreased with the increasing number of cells in the frozen embryo. None of five embryos frozen 3 or 4 days after IVF survived when thawed. Of 48 early embryos (35 patients) frozen 1 or 2 days after IVF, 42 (87.5%) were transferred in 32 patients. Ten pregnancies were initiated after frozen embryo transfer (ET). If we exclude the three infertile patients who had sexual intercourse in the fertile period, the pregnancy rate for each patient who had 1- or 2-day frozen embryo(s) was 22% (7 of 32). One of the pregnancies was obtained after ET of a 1-cell pronucleated frozen and thawed embryo. The rate of ongoing pregnancies after triple fresh ET was 23%. In patients having four embryos obtained in a single IVF cycle, the expected overall liveborn rate in an IVF-ET program including embryo cryopreservation could theoretically equal that of natural human fertility.     

Absence of predictive value of follicular inhibin on the results of human in vitro fertilization

During the periovulatory period, inhibin did not have a discriminant role in oocyte fertilizability. A possible role in the gonadotropin surge was not revealed by analysis at the time of follicular rupture. Furthermore, inhibin activity appears to be very low. But inhibin could still have an effect upon growth and atresia of the follicles of the following cycles.