[Laparoscopy-assisted hysterectomy and laparoscopic preparation. Apropos of a series of 177 cases]. / L'hystérectomie coelio-assistée et coelio-préparée. A propos d'une série de 177 cas.

Our objective was to determine the limits of laparoscopic-assisted vaginal hysterectomy (LAVH) and the value of a preoperative scoring system to determine the operative approach to hysterectomy. Between January 1991 and December 1996, 152 out of 177 patients had LAVH and 25 had laparoconversion. The mean operating time was 163 min. The overall postoperative complication rate was 8.4%. The hospital stay was 4.8 days for LAVH versus 6.2 days for laparoconversion (p < 0.01). For each patient, a preoperative scoring system was established according to uterine size, previous laparotomy, uterine mobility, pelvic adhesions and endometriosis stage. The laparoconversion rate increased according to the score, as it was 7.8% for a score < or = 7 and 80% for a score > 7. LAVH offers a technique to convert some abdominal hysterectomies into vaginal hysterectomies. The use of the preoperative scoring system may help to determine patients who may benefit from the laparoscopic route and those with a high risk of laparoconversion.

Fetal fibronectin in the cervical secretion predicts accurately the onset of labor at term.

OBJECTIVE: The objective of our study was to check if presence of fetal fibronectin in the cervical secretion of full term patient predicts accurately the onset of labour at term. STUDY DESIGN: 78 women in the term period were included in the study, serial samples for fetal fibronectin were assessed, each patient underwent spontaneous labour, delay between last sample and delivery were analysed. RESULTS: Patient with positive fetal fibronectin delivered within 3 +/- 1.9 days where as patient with negative fetal fibronectin delivered within 5.7 +/- 3.9 days (P = 0.01). CONCLUSION: Presence of fetal fibronectin in cervical secretions seems to be a powerful tool to predict in a short delay the onset of labour at term, it should be used in conjunction with clinical and fetal assessment data.

[Actinomycotic tubo-ovarian abscess. Contribution of pelvic angioscanner]. / Tubo-ovarite actinomycosique. Apport de l'angioscanner pelvien.

Pelvic actinomycosis is uncommon and usually responsible for tubo-ovarian abscesses which are similar in aspect with nonactinomycotic abscesses. They are usually a complication of an intra-uterine device (IUD) that can be absent as in this case. The differential diagnosis is ovarian cancer. The role of the dynamic CT scan for differential diagnosis in this case is presented. Preoperative diagnosis in this affection is important because of the excellent response to Penicillin.

[Borderline ovarian tumors: a series of 43 patients]. / Tumeurs à malignité atténuée de l'ovaire: à propos d'une série de 43 patientes.

Our objective was to evaluate the sonographic features, serum tumor markers in a series of 43 patients with borderline ovarian tumors. At sonographic examination, the majority of borderline tumors were multilocular. Serum CA-125 levels were elevated in 32.1%, CA-19-9 in 17.4%. In contrast, ACE levels were constantly normal. Twenty-four out of 43 patients (55.8%) had serous tumors, 18 (41.9%) had mucinous tumors and 1 (2.3%) had endometrioid tumor. Among, the 43 patients, 9 (20.9%) had first laparotomic approach and 34 had first laparoscopic treatment. Seven out of 34 patients treated by first laparoscopic approach had a laparoconversion (2 for presumption of invasive carcinoma and 5 for failure of laparoscopic procedure). Therefore, 27 had exclusive laparoscopic management. Among the 43 patients, 22 had conservative treatment and 21 radical surgery. The mean follow-up of patients was 41 months. Thirty-seven patients (86.1%) were alive without recurrence, 4 had a recurrence (9.3%), 1 patient (2.3%) was lost to follow-up and the last died of intercurrent disease. The mean delay of recurrence was 22 months (range 6 to 36). Three out of 4 recurrences occurred after cystectomy (2 ipsilateral and 1 controlateral). The fourth recurrence occurred after unilateral salpingo-oophorectomy. All 10 second look procedures were negative. Our results point out about the feasibility of laparoscopic management of borderline tumors. However, cystectomy is associated with a high risk of recurrence.

[Amnioinfusion: indications and results]. / Amnioinfusion: indications et résultats.

Amnioinfusion is a recent procedure introduced for routine obstetrical care fifteen years ago. The most widely recognized indication for amnioinfusion is in labor, to reduce fetal distress due to variable decceleration associated with oligohydramnios and probable presence of thick meconium stained amniotic fluid. During pregnancy, amnioinfusion can help in the diagnosis and morphologic evaluation in case of anamnios. The indication for amnioinfusion in the management of oligohydramnios at term before labour remains controversial. As a new procedure amnioinfusion must be managed with extreme caution.