D L Healy

Monash University (Australia), Melbourne, Victoria, Australia

Are you D L Healy?

Claim your profile

Publications (105)578.15 Total impact

  • J. Tsaltas · D. L. Healy · D. Lloyd
    [Show abstract] [Hide abstract]
    ABSTRACT: Objectives Our purpose was to review all the major complications of laparoscopy in 6500 consecutive laparoscopies from one centre. We also felt it was important to conduct this study because of the current debate on the use of the Veress needle or the Hasson cannula. Design All the major complications from laparoscopies performed from June 1 1991 to March 31 1995 were documented. This is the largest series from one centre. Each laparoscopy was registered on computer. A distinction between operative and diagnostic laparoscopies was not made by the computer. Results A major complication was defined as one that required laparotomy. In this series eight major complications were recorded. The incidence of major complications was 1.23 per 1000. No vascular injury occurred as a result of using a Veress needle or closed trocar entry. Conclusion Despite advances in operative and diagnostic laparoscopy, complications still occur. From this study there is currently no evidence to suggest that the Veress needle should be banned in favour of the open Hasson technique. The gynaecologist, anaesthetist and consumer need to be aware of the complication rates for gynaecological day surgery laparoscopy.
    No preview · Article · Oct 2003 · Gynaecological Endoscopy
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: In a previous study we have found that in normal ovulatory women, serum inhibin B levels on days 4-6 of FSH administration correlated with the number of oocytes retrieved. In the current study we examined the significance of earlier inhibin B measurements in predicting the oocyte number, in both normal and low responders. Study A consisted of 19 patients undergoing their first IVF cycle (n = 10) or had a normal response ( vertical line 6 oocytes retrieved, n = 9), while study B consisted of 15 patients with a previous low ovarian response (<or=5 oocytes retrieved). All patients had day 3 FSH levels <10 IU/l. After pituitary suppression, 300 (study A) or 600 IU (study B) of pure FSH was administered daily. Serum FSH, inhibin A, inhibin B and estradiol (E(2)) were determined prior to and every 1-2 days throughout FSH treatment. Study A: oocyte number between 4 and 14 correlated significantly with serum inhibin B levels on all days of FSH treatment, and with inhibin A and E(2) late during treatment. No correlation was found between inhibin B and when oocyte number was >16. Study B: oocyte number correlated significantly with inhibin B and inhibin A on all days of FSH treatment, even on day 2 (r = 0.90, P < 0.001 and r = 0.65, P < 0.05 for inhibin B and A respectively). No significant correlation was found with E(2) levels. In both studies, all patients with inhibin B >100 pg/ml on treatment day 2 had >6 oocytes. Our data suggest that serum inhibin B measured early during FSH stimulation may indicate whether sufficient oocytes will be retrieved, in both normal and low responders. Serum inhibin B measured during early FSH treatment may be of predictive value in monitoring ovarian stimulation treatment for IVF.
    Full-text · Article · Sep 2002 · Human Reproduction
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Development, growth and function of the ovary are controlled by endocrine and paracrine signals. These may also influence the development of ovarian cancer. The aim of this study was to identify the key molecular markers of the unregulated growth and hormone synthesis seen in ovarian tumours, particularly in granulosa cell tumours (GCT). Genes used in this study were chosen on the basis of our understanding of growth and differentiation in the normal ovary. We sought to define the patterns of gene expression in a panel of epithelial and stromal ovarian tumours. Expression was determined by RT-PCR using gene-specific primers for the FSH receptor (FSHR); the FSH early response genes: regulatory subunit of protein kinase A (RII-beta), cyclin D2 (cycD2) and sgk; and late response markers: cyclooxygenase-2 (COX-2) and the LH receptor (LHR). The GCT had high expression of FSHR compared with normal ovaries and the other tumours. cycD2 and RII-beta and COX-2 genes were also highly expressed in the GCT. sgk and LHR expression was lower in all of the tumours than in normal ovaries. Serous cystadenocarcinomas also had an unexpectedly high expression of COX-2. Comparison of the gene expression profiles between each tumour group suggests a molecular phenotype for GCT that is similar to that reported for FSH stimulated pre-ovulatory granulosa cells.
    Full-text · Article · Jun 2002 · Molecular Human Reproduction
  • [Show abstract] [Hide abstract]
    ABSTRACT: With the availability of laparoscopic ovarian cautery, there has been a resurgence in interest in the surgical treatment of clomiphene citrate-resistant polycystic ovary syndrome (PCOS). Comparison of ovulation and pregnancy rates has found no difference in success rates between ovarian cautery and gonadotropin ovulation induction for such women. We have therefore compared the cost of laparoscopic ovarian cautery with that of a typical cycle of gonadotropin ovulation induction, and also found that there is little difference. Because of the potential advantages of ovarian cautery, we recommend this surgery as the next line of treatment if clomiphene citrate fails to induce ovulation in PCOS patients, before gonadotropins are introduced.
    No preview · Article · Mar 2002 · Gynecological Endocrinology
  • Source

    Full-text · Article · Feb 2002 · Fertility and Sterility

  • No preview · Article · Feb 2002 · Fertility and Sterility
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Development, growth and function of the ovary are controlled by endocrine and paracrine signals. These may also influence the development of ovarian cancer. The aim of this study was to identify the key molecular markers of the unregulated growth and hormone synthesis seen in ovarian tumours, particularly in granulosa cell tumours (GCT). Genes used in this study were chosen on the basis of our understanding of growth and differentiation in the normal ovary. We sought to define the patterns of gene expression in a panel of epithelial and stromal ovarian tumours. Expression was determined by RT–PCR using gene-specific primers for the FSH receptor (FSHR); the FSH early response genes: regulatory subunit of protein kinase A (RII-β), cyclin D2 (cycD2) and sgk; and late response markers: cyclooxygenase-2 (COX-2) and the LH receptor (LHR). The GCT had high expression of FSHR compared with normal ovaries and the other tumours. cycD2 and RII-β and COX-2 genes were also highly expressed in the GCT. sgk and LHR expression was lower in all of the tumours than in normal ovaries. Serous cystadenocarcinomas also had an unexpectedly high expression of COX-2. Comparison of the gene expression profiles between each tumour group suggests a molecular phenotype for GCT that is similar to that reported for FSH stimulated pre-ovulatory granulosa cells.
    Full-text · Article · Jan 2002 · Molecular Human Reproduction

  • No preview · Article · Jan 2002
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The aim of this study was to investigate the relationship of serum inhibin A and inhibin B to ovarian follicular development in women undergoing pituitary down-regulation and ovarian stimulation with a fixed daily dose of recombinant human FSH in an in vitro fertilization program. Thirty-eight patients were treated randomly with either 100 or 200 IU/day recombinant human FSH (Puregon) for a period of 9-14 days. Serum FSH, inhibin A, inhibin B, 17beta-estradiol, and follicular size and number were determined before FSH treatment and every second day from days 4-6 throughout FSH treatment. Serum FSH increased in a dose-related manner to reach a maximum by days 4-6 and remained unchanged over the duration of treatment. Serum inhibin A and 17beta-estradiol also increased with increasing FSH dose and continued to rise throughout the FSH treatment period. By contrast, serum inhibin B was increased by days 4-6 at both doses of FSH to reach a maximum by days 7-8, remaining unchanged thereafter. Serum inhibin B and, to a lesser extent, inhibin A correlated significantly with the number of oocytes retrieved even when assessed early (days 4-6) in the treatment period (inhibin B vs. number of oocytes: r = 0.89; P < 0.001; inhibin A vs. number of oocytes: r = 0.61; P < 0.05). Serum inhibin A, inhibin B, and 17beta-estradiol were weakly correlated with the number of follicles less than 11 mm when assessed on a daily basis; stronger correlations were observed with the greater than 11-mm follicles during the late stages of treatment. It is concluded that serum inhibin B levels determined during the early stages (e.g. days 4-6) of fixed dose FSH treatment provide an early indicator of the number of recruited follicles that are destined to form mature oocytes. In this context, serum inhibin B may be of predictive value in monitoring ovarian hyperstimulation treatment for in vitro fertilization.
    Full-text · Article · Mar 2000 · Journal of Clinical Endocrinology & Metabolism
  • Source
    K M Abberton · D L Healy · P.A.W. Rogers
    [Show abstract] [Hide abstract]
    ABSTRACT: Endometrial spiral arterioles are believed to play a major role in controlling menstruation. These arterioles coil and grow through the secretory stages of the cycle, unlike the `straight' endometrial arterioles that remain uncoiled. We postulate that alterations in the growth and development of spiral arterioles, in particular the vascular smooth muscle cells (VSMC), may contribute to menorrhagia. We examined smooth muscle alpha actin (αSMA) and myosin heavy chains (MHC), two VSMC differentiation markers, in the endometrial arterioles of 64 women, comparing them in controls, menorrhagic tissues and across the menstrual cycle. αSMA and MHC expression were determined immunohistochemically then evaluated using computer-aided image analysis. αSMA expression in the straight arterioles of menorrhagic women was reduced in the early secretory stage of the cycle and significantly decreased at the mid-secretory stage of the cycle (0.67 ± 0.03 versus 0.55 ± 0.04, P ≤ 0.05). No other significant differences were observed in αSMA and MHC expression in straight arterioles. MHC expression was significantly reduced in the spiral arterioles of menorrhagic tissues at the early secretory stage (0.57 ± 0.01 versus 0.38 ± 0.04, P ≤ 0.05). Our results demonstrate differences in the VSMC of menorrhagic women compared with controls, with delayed MHC expression in the spiral arterioles and reduced αSMA expression in straight arterioles during the mid-secretory stage of the cycle.
    Preview · Article · Dec 1999 · Human Reproduction
  • [Show abstract] [Hide abstract]
    ABSTRACT: Menorrhagia affects approximately 15% of all women, often without identifiable cause. Endometrial spiral arterioles are believed to play a major role in controlling menstruation, and are a major site of menstrual loss. We postulate that alterations in the growth and development of spiral arterioles, particularly the vascular smooth muscle cells (VSMC), may contribute to menorrhagia. We examined VSMC proliferation around endometrial arterioles in control and menorrhagic tissues and the possible roles of transforming growth factor beta (TGF-β) and endothelin in this process. Proliferating VSMC were located immunohistochemically, then evaluated using computer-aided image analysis. VSMC proliferation was low and constant during the early stages of the menstrual cycle, increasing at the mid to late secretory stages (P < 0.002). Menorrhagic women had significantly reduced VSMC proliferation in their spiral arterioles at the mid and late secretory stages (P < 0.02). VSMC around straight arterioles proliferated at similar rates across the cycle, apart from a significant decrease in VSMC proliferation in menorrhagic women at the late secretory stage (P < 0.002). Endothelin concentrations decreased significantly in the epithelium of menorrhagic women (P = 0.05), while TGF-β demonstrated no significant differences in the mid to late secretory tissues studied. The results indicate a significant functional difference between the spiral arterioles of control and menorrhagic women that may play a role in menorrhagia, while leaving the roles of endothelin and TGF-β undetermined.
    No preview · Article · May 1999 · Human Reproduction
  • [Show abstract] [Hide abstract]
    ABSTRACT: Previous observations from our laboratory have demonstrated that the levels of immunoreactive inhibin (ir-inh) are elevated in almost all patients with granulosa cell tumors and in the majority of postmenopausal women with mucinous ovarian cancers. The present report confirms these findings in a larger group of post-menopausal women. Immunohistochemistry for the inhibin alpha. beta A and beta B sununits shows predominantly epithelial staining in granulosa cell tumors and in the majority of mucinous cancers. Serous cystadenocarcinomas also frequently show positive staining. Studies seeking to identify G alpha i-2 or FSH receptor mutations have provided negative results in contrast to other reports. Further studies of the roles of the inhibin-related family of peptides in ovarian cancer diagnosis and monitoring are clearly indicated.
    No preview · Article · Feb 1999 · Voprosy onkologii
  • J. Tsaltas · P.A.W. Rogers · C. Gargett · D.L. Healy
    [Show abstract] [Hide abstract]
    ABSTRACT: A single cause for the development of endometriosis is unknown. Of the historical hypotheses for the development of endometriosis, coelomic metaplasia and transplantation of retrograde endometrium have been the most widely accepted. Of the modern factors, which appear significant in the subsequent development of endometriosis, genetic predisposition and disturbed angiogenesis are the most intriguing. Active studies are in progress to attempt to identify genes relevant to the development of endometriosis. Active research is also studying the vascular supply to areas of endometriosis and the role of angiogenesis, or new blood vessel formation, in the pathogenesis of this disease. The availability of molecular biology probes, as well as medicines, which inhibit angiogenesis are direct consequences of the application of this basic research to this common clinical problem.
    No preview · Article · Dec 1998 · Current Obstetrics and Gynaecology
  • Source
    D L Healy · PA Rogers · L Hii · M Wingfield
    [Show abstract] [Hide abstract]
    ABSTRACT: Excessive endometrial angiogenesis is proposed as an important mechanism in the pathogenesis of endometriosis. Evidence is reviewed for the hypothesis that the endometrium of women with endometriosis has an increased capacity to proliferate, implant and grow in the peritoneal cavity. Data is summarized indicating that the endometrium of patients with endometriosis shows enhanced endothelial cell proliferation. Results are also reviewed indicating that the cell adhesion molecule integrin alphavbeta3 is expressed in more blood vessels in the endometrium of women with endometriosis when compared with normal women. Taken together, these results provide evidence for increased endometrial angiogenesis in women with endometriosis when compared with normal subjects. Endometriosis is one of the family of angiogenic diseases. Other angiogenic diseases include solid tumours, rheumatoid arthritis, psoriasis and diabetic retanopathy. Excessive endometrial angiogenesis suggests novel new medical treatments for endometriosis aimed at the inhibition of angiogenesis.
    Preview · Article · Sep 1998 · Human Reproduction Update
  • [Show abstract] [Hide abstract]
    ABSTRACT: Previous observations from our laboratory have demonstrated that the levels of immunoreactive inhibin (ir-inh) are elevated in almost all patients with granulosa cell tumours and in the majority of postmenopausal women with mucinous ovarian cancers. The present manuscript confirms these findings in a larger group of postmenopausal women. Immunohistochemistry for the inhibin α, βA and βB subunits shows predominantly epithelial staining in granulosa cell tumours and in the majority of mucinous cancers. Serous cystadenocarcinomas also frequently show positive staining. Studies seeking to identify Gαi-2 or FSH receptor mutations have provided negative results in contrast to other reports. Further studies of the roles of the inhibin-related family of peptides in ovarian cancer diagnosis and monitoring are clearly indicated.
    No preview · Article · Aug 1998 · Journal of Reproductive Immunology
  • [Show abstract] [Hide abstract]
    ABSTRACT: Previous observations from our laboratory have demonstrated that the levels of immunoreactive inhibin (ir-inh) are elevated in almost all patients with granulosa cell tumours and in the majority of postmenopausal women with mucinous ovarian cancers. The present manuscript confirms these findings in a larger group of postmenopausal women. Immunohistochemistry for the inhibin α, βA and βB subunits shows predominantly epithelial staining in granulosa cell tumours and in the majority of mucinous cancers. Serous cystadenocarcinomas also frequently show positive staining. Studies seeking to identify Gαi-2 or FSH receptor mutations have provided negative results in contrast to other reports. Further studies of the roles of the inhibin-related family of peptides in ovarian cancer diagnosis and monitoring are clearly indicated.
    No preview · Article · Jan 1998
  • [Show abstract] [Hide abstract]
    ABSTRACT: The combination of RU486 (mifepristone) and prostaglandin analogues has been used for medical abortion in several European centres. We surveyed 41 Australian women who successfully used this method of abortion in a World Health Organization-sponsored trial. Overall, the women were satisfied with the method and found the associated pain level acceptable.
    No preview · Article · Oct 1997 · The Medical journal of Australia
  • [Show abstract] [Hide abstract]
    ABSTRACT: To compare the cost of laparoscopically assisted vaginal hysterectomy (LAVH) with that of total abdominal hysterectomy (TAH) under casemix. Retrospective comparison of the costs, operating time and length of hospital stay. The 16 women undergoing consecutive LAVH and 16 age-matched women undergoing TAH between 1 February 1994 and 31 July 1995; all women were public patients undergoing hysterectomy for benign disease. Monash Medical Centre, a large tertiary teaching hospital in Melbourne, Australia, where casemix is used to determine funding and budget allocation. The difference between the costs of the two procedures was not statistically significant (P = 0.5), despite the cost of laparoscopic hysterectomy including that of disposables. The mean operating time for TAH was 86 minutes (95% CI, 65.5-106.5), compared with 120 minutes (95% CI, 100.8-140.5) for LAVH (P < 0.01). The mean length of stay in the TAH group was 5.75 days, compared with 3.25 days in the LAVH group (P < 0.001). In hysterectomy for benign gynaecological disease, the laparoscopic procedure costs the same as the total abdominal procedure. Audit such as this is important in patient management and in guiding hospitals in funding and bed allocation.
    No preview · Article · Mar 1997 · The Medical journal of Australia
  • P.A.W. Rogers · F. Lederman · J. Kooy · N.H. Taylor · D.L. Healy

    No preview · Article · Sep 1996 · Human Reproduction
  • Source
    P.A.W. Rogers · F Lederman · J Kooy · N.H. Taylor · D.L. Healy
    [Show abstract] [Hide abstract]
    ABSTRACT: This study tested the hypothesis that alterations in the expression of oestrogen and progesterone receptors (ER and PR) in endometrial vascular smooth musde cells (VSMC) may play a role in the increased blood loss that occurs during menorrhagla. Subject groups were: controls (n±40), those with menorrhagia (menstrual blood loss >80 ml, n±39) and patients post-endometrial ablation (n±16). The aims of our study were to describe the changing distribution of VSMC ER and PR during the menstrual cycle and to look for differences between the three groups. Immunohistochemical double-staining results for VSMC and either ER or PR were highly varied, with 0–85% of endometrial arterioles in a biopsy section having alpha smooth muscle actinlER positive cells, and 0–70% demonstrating PR. There were no significant differences between controls, menorrhagia or post-ablation specimens (analysis of variance for ER P±0.72; for PR P±0.17). There were also no significant differences between the different stages of the menstrual cycle when all three groups were combined (analysis of variance for ER P±0.11; for PR P±0.13). The high variability found in this study may mask biologically relevant differences in endometrial vascular ER and PR distribution between different groups.
    Preview · Article · Sep 1996 · Human Reproduction

Publication Stats

3k Citations
578.15 Total Impact Points

Institutions

  • 1986-2003
    • Monash University (Australia)
      • • Department of Obstetrics and Gynaecology
      • • Monash Medical Centre
      Melbourne, Victoria, Australia
  • 2002
    • Box Hill Institute
      Melbourne, Victoria, Australia
  • 1998-2000
    • Oxford Brookes University
      Oxford, England, United Kingdom
  • 1976-1999
    • Prince Henry's Institute
      Melbourne, Victoria, Australia
  • 1996
    • University of Sydney
      • Discipline in Obstetrics and Gynaecology
      Sydney, New South Wales, Australia
  • 1987-1991
    • University of Vic
      Vic, Catalonia, Spain
  • 1977
    • Royal Hospital for Women
      Sydney, New South Wales, Australia