The Experts below are selected from a list of 66 Experts worldwide ranked by ideXlab platform

D. Dallay - One of the best experts on this subject based on the ideXlab platform.

  • Management of septate uterus by Flexible hysteroscopy and Nd:YAG laser
    International Journal of Gynecology & Obstetrics, 1998
    Co-Authors: O. Jourdain, F Dabysing, T Harle, C. Lajus, D. Roux, D. Dallay
    Abstract:

    Abstract Objective: To evaluate the efficiency of Flexible Nd-YAG laser hysteroscopic metroplasty. Methods: We present a retrospective study of 17 patients treated for septate uteri between 1990 and 1995. The indication of hysteroscopy was recurrent abortion in nine cases and eight with primary infertility with indication of IVF in another five cases. We did not prescribe any pretreatment. A Flexible Hysteroscope with a 100-W Nd:YAG laser was used with glycine-controlled flow. The septum was divided by the laser after exploration of the cavity. We proposed a control office hysteroscopy 2 months after surgery to prevent uterine adhesions. Results: There was no complication. Twelve patients conceived with 10 live births at term and two spontaneous abortions. Four are still infertile, two were lost from the study and two no longer desired pregnancy. Resectoscopic studies showed the same results. Conclusion: The advantages of this method are the excellent ergonomic properties of the fibroscope and the safety of the laser. We suggest that metroplasty does not improve the pregnancy rate but only the pregnancy outcome of these patients. However, for those with the indication of IVF the procedure seems useful in avoiding abortion.

  • Endometrial Nd-YAG laser ablation by hysterofibroscopy: long-term results of 137 cases
    European Journal of Obstetrics & Gynecology and Reproductive Biology, 1996
    Co-Authors: O. Jourdain, C. Lajus, D. Roux, Patrick Joyeux, Ihmed Sfaxi, Tania Harle, D. Dallay
    Abstract:

    Abstract Objective: In our gynecology department, we have been performing endometrial laser ablation (ELA) under video control using a Flexible Hysteroscope since 1989. The aim of this study is to evaluate the long term results of our experience. Study design: We went back to the files of 137 patients treated between 1989 and 1993. These women (mean age 42 years) exhibited menorrhagia unamenable to medical treatments which had been developing for 28 months. Mean hysterometry was 9.8 cm. A hysteroscopy with ELA was performed. Our procedure lasts 19 min on average and uses 0.9 1 of glycocol. There were no perforations. Six patients presented a fever above 38°C within the next 48 h; only one developed a true endometritis necessitating antibiotherapy. One patient who had received several GnRH agonist courses had a coagulation of the uterus and had to be hysterectomised. Results: Nine patients were lost to follow-up; for the others, mean follow-up was 32 months. Seventeen women (13.3%) were hysterectomised, including the patient with a coagulation necrosis of the myometrium. In most cases, this was for undetected adenomyosis or fibromas evolving after hysteroscopy. Bleeding recurred in two other patients; they refused hysterectomy but should be counted as failures of this method. Among the 109 patients (85.1%) considered a success, 35 have had menopause since the procedure. Conclusion: ELA is a simple quick procedure which significantly reduces the number of hysterectomies. In addition, the economic value of ELA is beginning to be assessed in the literature. This long-term study should allow the indications to be better defined by eliminating patients with a high risk of failure and should lead to improved results.

Evangelos Alexopoulos - One of the best experts on this subject based on the ideXlab platform.

  • The value of outpatient hysteroscopy in the management of postmenopausal bleeding: a review of 862 cases
    Gynaecological Endoscopy, 2000
    Co-Authors: Evangelos Alexopoulos, Chantal D. Simonis, Sally Kidsley
    Abstract:

    Objective To evaluate the efficacy, reliability and acceptability of outpatient hysteroscopy in the investigation of postmenopausal bleeding in a major teaching hospital. Design A retrospective descriptive study of 862 women referred with postmenopausal bleeding for outpatient hysteroscopy. Methods Between 1994 and 1997, 862 women were referred to the Women's Endoscopy Unit at Nottingham City Hospital for postmenopausal bleeding. Of these women, 171 were receiving hormone replacement treatment. The endocervical canal and the endometrial cavity were assessed using either a 4-mm rigid or a 3.5-mm Flexible Hysteroscope according to the preference of the operator. All hysteroscopies were performed by consultants or experienced registrars. Pipelle endometrial biopsy was taken when indicated. Results The mean age of patients referred with postmenopausal bleeding was 58 years. Hysteroscopy was completed successfully in 97.2% of all patients. Cervical stenosis and pain were the main reasons for failure to complete the procedure. Local anaesthesia with paracervical infiltration was used in one-third of all patients undergoing hysteroscopy. Intrauterine polyps were the commonest finding (13.9%) while submucous fibroids were detected in 10.7%. Endometrial biopsies were taken in 34.7%. Abnormal histological findings were reported in 28 cases, including eight instances of endometrial adenocarcinoma. After hysteroscopic assessment, 81% of patients were discharged while further surgical treatment was warranted in 14.6%. Conclusion Outpatient hysteroscopy is a reliable, safe and well-tolerated diagnostic procedure for investigating endometrial and endocervical pathology in patients with postmenopausal bleeding. Whenever hysteroscopic findings appear suspicious an endometrial biopsy should be taken to exclude endometrial pathology.

  • A review of 2581 out-patient diagnostic hysteroscopies in the management of abnormal uterine bleeding
    Gynaecological Endoscopy, 1999
    Co-Authors: Evangelos Alexopoulos, Chantal D. Simonis
    Abstract:

    Objective To evaluate the clinical efficacy, reliability and acceptability of out-patient diagnostic hysteroscopy at a large teaching hospital. Setting The Women's Endoscopy Unit at Nottingham City Hospital, Nottingham, UK. Subjects Between 1994 and 1997, 2581 women were referred for menstrual problems and abnormal uterine bleeding. The endocervical canal and endometrial cavity were assessed using either a 4-mm rigid or a 3.5-mm Flexible Hysteroscope, according to the preference of the operator. All hysteroscopies were performed by consultants or experienced registrars. Endometrial biopsy was taken when indicated. Results The main indications for referral for diagnostic hysteroscopy included menorrhagia (37.5%), postmenopausal bleeding (33.4%), intermenstrual bleeding (26.7%) and metrorrhagia (8.8%). Less common indications included treatment with tamoxifen, review of previous endometrial pathology or abnormal glandular cells on cervical cytology, and investigation for infertility. The mean age of patients referred was 49.3 years. Hysteroscopy was completed successfully in 96.8% of all patients, with pain being the main reason for failure to complete the procedure. Local anaesthesia with paracervical infiltration was used in 34% of all patients. Submucous fibroids were the commonest cause of intrauterine pathology (11.4%) with the highest incidence found in women referred for menometrorrhagia (17.2%). Endometrial polyps were detected in 10.6% of all the patients. The endometrium was characterized by the hysteroscopist as atrophic, thickened, polypoid, haemorrhagic or malignant. Endometrial Pipelle biopsies were taken in 48.6% of all cases. Abnormal histological findings were reported in 61 cases including 11 instances of endometrial adenocarcinoma. The concordance rate between hysteroscopic and histological findings for all abnormalities was 63.9%. Further medical treatment was offered to 406 patients (16.3%), while 185 patients (17.3%) needed additional surgery as in-patients. Conclusion Out-patient hysteroscopy is a safe, acceptable and well-tolerated procedure that provides useful information about the uterine cavity. Endometrial biopsy improves the diagnostic accuracy of hysteroscopy in detecting endometrial pathology.

O. Jourdain - One of the best experts on this subject based on the ideXlab platform.

  • Management of septate uterus by Flexible hysteroscopy and Nd:YAG laser
    International Journal of Gynecology & Obstetrics, 1998
    Co-Authors: O. Jourdain, F Dabysing, T Harle, C. Lajus, D. Roux, D. Dallay
    Abstract:

    Abstract Objective: To evaluate the efficiency of Flexible Nd-YAG laser hysteroscopic metroplasty. Methods: We present a retrospective study of 17 patients treated for septate uteri between 1990 and 1995. The indication of hysteroscopy was recurrent abortion in nine cases and eight with primary infertility with indication of IVF in another five cases. We did not prescribe any pretreatment. A Flexible Hysteroscope with a 100-W Nd:YAG laser was used with glycine-controlled flow. The septum was divided by the laser after exploration of the cavity. We proposed a control office hysteroscopy 2 months after surgery to prevent uterine adhesions. Results: There was no complication. Twelve patients conceived with 10 live births at term and two spontaneous abortions. Four are still infertile, two were lost from the study and two no longer desired pregnancy. Resectoscopic studies showed the same results. Conclusion: The advantages of this method are the excellent ergonomic properties of the fibroscope and the safety of the laser. We suggest that metroplasty does not improve the pregnancy rate but only the pregnancy outcome of these patients. However, for those with the indication of IVF the procedure seems useful in avoiding abortion.

  • Endometrial Nd-YAG laser ablation by hysterofibroscopy: long-term results of 137 cases
    European Journal of Obstetrics & Gynecology and Reproductive Biology, 1996
    Co-Authors: O. Jourdain, C. Lajus, D. Roux, Patrick Joyeux, Ihmed Sfaxi, Tania Harle, D. Dallay
    Abstract:

    Abstract Objective: In our gynecology department, we have been performing endometrial laser ablation (ELA) under video control using a Flexible Hysteroscope since 1989. The aim of this study is to evaluate the long term results of our experience. Study design: We went back to the files of 137 patients treated between 1989 and 1993. These women (mean age 42 years) exhibited menorrhagia unamenable to medical treatments which had been developing for 28 months. Mean hysterometry was 9.8 cm. A hysteroscopy with ELA was performed. Our procedure lasts 19 min on average and uses 0.9 1 of glycocol. There were no perforations. Six patients presented a fever above 38°C within the next 48 h; only one developed a true endometritis necessitating antibiotherapy. One patient who had received several GnRH agonist courses had a coagulation of the uterus and had to be hysterectomised. Results: Nine patients were lost to follow-up; for the others, mean follow-up was 32 months. Seventeen women (13.3%) were hysterectomised, including the patient with a coagulation necrosis of the myometrium. In most cases, this was for undetected adenomyosis or fibromas evolving after hysteroscopy. Bleeding recurred in two other patients; they refused hysterectomy but should be counted as failures of this method. Among the 109 patients (85.1%) considered a success, 35 have had menopause since the procedure. Conclusion: ELA is a simple quick procedure which significantly reduces the number of hysterectomies. In addition, the economic value of ELA is beginning to be assessed in the literature. This long-term study should allow the indications to be better defined by eliminating patients with a high risk of failure and should lead to improved results.

Chantal D. Simonis - One of the best experts on this subject based on the ideXlab platform.

  • The value of outpatient hysteroscopy in the management of postmenopausal bleeding: a review of 862 cases
    Gynaecological Endoscopy, 2000
    Co-Authors: Evangelos Alexopoulos, Chantal D. Simonis, Sally Kidsley
    Abstract:

    Objective To evaluate the efficacy, reliability and acceptability of outpatient hysteroscopy in the investigation of postmenopausal bleeding in a major teaching hospital. Design A retrospective descriptive study of 862 women referred with postmenopausal bleeding for outpatient hysteroscopy. Methods Between 1994 and 1997, 862 women were referred to the Women's Endoscopy Unit at Nottingham City Hospital for postmenopausal bleeding. Of these women, 171 were receiving hormone replacement treatment. The endocervical canal and the endometrial cavity were assessed using either a 4-mm rigid or a 3.5-mm Flexible Hysteroscope according to the preference of the operator. All hysteroscopies were performed by consultants or experienced registrars. Pipelle endometrial biopsy was taken when indicated. Results The mean age of patients referred with postmenopausal bleeding was 58 years. Hysteroscopy was completed successfully in 97.2% of all patients. Cervical stenosis and pain were the main reasons for failure to complete the procedure. Local anaesthesia with paracervical infiltration was used in one-third of all patients undergoing hysteroscopy. Intrauterine polyps were the commonest finding (13.9%) while submucous fibroids were detected in 10.7%. Endometrial biopsies were taken in 34.7%. Abnormal histological findings were reported in 28 cases, including eight instances of endometrial adenocarcinoma. After hysteroscopic assessment, 81% of patients were discharged while further surgical treatment was warranted in 14.6%. Conclusion Outpatient hysteroscopy is a reliable, safe and well-tolerated diagnostic procedure for investigating endometrial and endocervical pathology in patients with postmenopausal bleeding. Whenever hysteroscopic findings appear suspicious an endometrial biopsy should be taken to exclude endometrial pathology.

  • A review of 2581 out-patient diagnostic hysteroscopies in the management of abnormal uterine bleeding
    Gynaecological Endoscopy, 1999
    Co-Authors: Evangelos Alexopoulos, Chantal D. Simonis
    Abstract:

    Objective To evaluate the clinical efficacy, reliability and acceptability of out-patient diagnostic hysteroscopy at a large teaching hospital. Setting The Women's Endoscopy Unit at Nottingham City Hospital, Nottingham, UK. Subjects Between 1994 and 1997, 2581 women were referred for menstrual problems and abnormal uterine bleeding. The endocervical canal and endometrial cavity were assessed using either a 4-mm rigid or a 3.5-mm Flexible Hysteroscope, according to the preference of the operator. All hysteroscopies were performed by consultants or experienced registrars. Endometrial biopsy was taken when indicated. Results The main indications for referral for diagnostic hysteroscopy included menorrhagia (37.5%), postmenopausal bleeding (33.4%), intermenstrual bleeding (26.7%) and metrorrhagia (8.8%). Less common indications included treatment with tamoxifen, review of previous endometrial pathology or abnormal glandular cells on cervical cytology, and investigation for infertility. The mean age of patients referred was 49.3 years. Hysteroscopy was completed successfully in 96.8% of all patients, with pain being the main reason for failure to complete the procedure. Local anaesthesia with paracervical infiltration was used in 34% of all patients. Submucous fibroids were the commonest cause of intrauterine pathology (11.4%) with the highest incidence found in women referred for menometrorrhagia (17.2%). Endometrial polyps were detected in 10.6% of all the patients. The endometrium was characterized by the hysteroscopist as atrophic, thickened, polypoid, haemorrhagic or malignant. Endometrial Pipelle biopsies were taken in 48.6% of all cases. Abnormal histological findings were reported in 61 cases including 11 instances of endometrial adenocarcinoma. The concordance rate between hysteroscopic and histological findings for all abnormalities was 63.9%. Further medical treatment was offered to 406 patients (16.3%), while 185 patients (17.3%) needed additional surgery as in-patients. Conclusion Out-patient hysteroscopy is a safe, acceptable and well-tolerated procedure that provides useful information about the uterine cavity. Endometrial biopsy improves the diagnostic accuracy of hysteroscopy in detecting endometrial pathology.

Michael Kamrava - One of the best experts on this subject based on the ideXlab platform.

  • Hysteroscopic embryo transfer or implantation- experience of a decade: an alternative objective and reliable method for embryo transfer (HEED) and implantation (SEED).
    British journal of medicine and medical research, 2015
    Co-Authors: Michael Kamrava
    Abstract:

    Aims: Here we present early experience using HEED and SEED along with a description of these procedures in more detail. There is also a new look at the endometrial cavity and the placement of embryo transfer or implantation while under direct visualization. Study Design: Retrospective non-randomized and uncontrolled case series. Place and Duration of Study: West Coast IVF Clinic, Inc. and LA IVF Lab, LLC, Beverly Hills, CA, USA, between June, 2002 and June, 2011. Methodology: Embryo transfer was done using a mini Flexible Hysteroscope with an articulating tip. This was accomplished by either placing the embryo gently on the surface of the endometrium (HEED) in 35 patients undergoing IVF, or embedding the embryo just beneath the endometrial surface (SEED) in 24 patient starts using egg donation. Once pregnancy was confirmed with a positive serum hCG, they were followed up with transvaginal ultrasounds and serial serum hCG’s Clinical Practice Articles Kamrava and Yin; BJMMR, 6(7): 723-729, 2015; Article no.BJMMR.2015.249 724 in the first trimester. They were then referred to their local obstetricians and final outcomes were recorded after deliveries. Results: There were a total of 35 patients in the early (days 2 or 3) embryo transfer group (HEED) which resulted in 16(46%) total pregnancies, which included 2 biochemical pregnancies, 2 ectopics, 5 spontaneous miscarriages, and 3 multiple pregnancies. There were 7 (20%) live births. In the second group of patients with day 5 or 6 embryo implantations (SEED), there were a total of 24 patient starts, with 16(67%), 4, 0, 5, and 4 total, biochemical, ectopic and multiple pregnancies respectively. There were 7(29%) live births. Conclusion: Hysteroscopic embryo transfer or implantation may increase successful pregnancies and decrease risks and side effects from IVF procedures. Further prospective, controlled and randomized studies are needed to determine effectiveness of these procedures.