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

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.

Treatment of dysfunctional bleeding and fibroids by advanced endoscopic techniques with the Nd:YAG laser: from the present to the future.

Both the electrical current of the resectoscope and the energy of the Nd:YAG laser have been effective tools in the destruction of endometrial tissue to a sufficient depth to avoid regeneration. GnRH-agonist therapy effects a decrease in the total uterine cavity area which facilitates surgical treatment and reduces the risk of fluid overload syndrome. The recurrence rate of meno/metrorrhagia is higher when the uterine cavity is more than 10 cm2. The use of GnRH-agonists represents an adjunct for preoperative reduction of submucosal myomas so that subsequent hysteroscopic myomectomy is possible. A two-step hysteroscopic therapy combined with GnRH-agonist therapy is performed when the largest portion of the submucosal myoma is located in the uterine wall. In cases of numerous submucosal and intramural myomas, a laparoscopic supracervical hysterectomy is performed because of the high risk of recurrence after the hysteroscopic procedure.

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

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.

[Crohn's disease of the esophagus. Apropos of a case]. / Maladie de Crohn de l'oesophage. A propos d'un cas.

A case of oesophageal Crohn's disease associated with large bowel lesions and with ocular, articular and cutaneous manifestations is reported. The patient, a 45 year old woman, was successfully treated with corticosteroids. The authors review the literature about oesophageal involvement in Crohn's disease and extra-intestinal manifestations.