[Evaluation of satisfaction after in-office conization under local anesthesia]. / Évaluation de la satisfaction des patientes après conisation en consultation sous anesthésie locale.

OBJECTIVES: Treating cervical intraepithelial neoplasia is essential in cervix carcinoma prevention and conization is the standard treatment. In the current medical and economic context, which advocates the simplification of procedures, loop excision conization is well adapted to an in-office procedure. Therefore, we evaluated the patient satisfaction after an in-office conization. METHOD: We conducted an observational study at the Besançon University Medical Centre. Between November 2013 and October 2014, all patients treated by an in-office conization were included. Global satisfaction of patient was retrospectively collected by answering a telephone questionnaire. RESULTS: Seventy patients were treated by in-office conization and answered the questionnaire. Global satisfaction was 88.6%. Moreover, 75.7% of patients declared to have felt no pain or moderate pain during the conization. Most of the patients (91.4%) would advise this in-office care to their relatives. The rate of positive margins for dysplasia was 31.4% and postoperative haemorrhage occurred in 7.1%. CONCLUSION: In this context of medical care cost reduction, conization seems to be perfectly adapted to in-office surgery. It was also found to be well accepted by patients without raising neither positive margins rate nor postoperative haemorrhage risk.

[Obstetrical prognosis of breech presentations with premature rupture of membranes at term]. / Pronostic obstétrical des présentations podaliques à terme en cas de rupture des membranes avant travail.

OBJECTIVES: Breech delivery is still a controversial situation in literature. Added complexity exists when breech presentations are associated with premature rupture of membranes (PROM) as such cases are conventionally excluded in studies dealing with PROM and are often indications for elective caesarean section. Thus, the objective of this study was to evaluate the obstetrical prognosis of breech presentations after PROM at term. MATERIALS AND METHODS: We conducted a retrospective observational study at the Besançon University Medical Centre, between 1(st) January 2008 and 31(th) December 2012. Two groups of patients with breech presentations at term were constituted according to the existence or not of a PROM. The primary endpoint was the delivery mode: caesarean section or vaginal. Other endpoints were maternal characteristics, type of onset of labour and neonatal criterias. RESULTS: Two hundred and nine patients were included. In the control group, 67.9 % of vaginal deliveries occurred versus 60 % in the group with PROM (P=0.25). No difference was found on neonatal criterias such as pH, lactate and the Apgar score at 5 minutes. CONCLUSION: PROM at term in breech presentation doesn't seem to change the obstetrical prognosis and should therefore not be a systematic indication for elective caesarean section.

Molecular analysis by fluorescence in situ hybridization of a prenatally detected de novo complex chromosomal rearrangement t(2q;3p;4q;13q).

We report one case of de novo complex chromosomal rearrangement (CCR) t(2q;3p;4q;13q) with at least five chromosomal breakpoints. This CCR was detected prenatally at 22 weeks of gestation, when mild echographic indications were disclosed during a routine examination in a female with no family history of congenital abnormalities. This observation clearly illustrates what the fluorescence in situ hybridization (FISH) technique can offer to the analysis of such rearrangements, together with standard cytogenetic techniques. No chromosomal imbalance was cytologically proved. Nevertheless, the status of the infant at birth and the disorders that he exhibited during the following months demonstrate once again that even in the absence of alarming ultrasonographic verifications and even if standard and molecular cytogenetics do not allow us to confirm evident chromosomal imbalances, genetic counselling in the case of prenatally detected de novo CCR must remain cautious.

[In vivo-acquired resistance to cefsulodin by a strain of Pseudomonas aeruginosa]. / Résistance acquise in vivo à la cefsulodine par une souche de Pseudomonas aeruginosa.

We isolated a Pseudomonas aeruginosa strain which was initially cefsulodin-susceptible (J1, MIC = 4 g/l) and became resistant (J2, MIC greater than 64 g/l) after 12 days of treatment of the patient with cefsulodin. Strain J2 had a constitutive beta-lactamase with hydrolytic activities similar to those of a cephalosporinase and an isoelectric point at 8.1. This enzyme (Case) may be related to the ld type. Concomitant development of resistances to various beta-lactams stable to Case suggests that other mechanisms of resistance may be involved.