[Interest of selective progesterone receptor modulators in endometriosis]. / Intérêt actuel des selective progesterone receptor modulators (SPRM) dans l'endométriose.

The SPRM (selective progesterone receptor modulators) are agonists and/or antagonists of progesterone receptor. They are responsible for anovulation, amenorrhea and a lower prostaglandin levels, which leads to an improvement in pain and regression of lesions in endometriosis. On the endometrium, a particular aspect, the progesterone receptor modulator-associated endometrial changes (PAEC), raises additional studies to verify its harmlessness. However, due to the lack of hypoestrogenism and metabolic effects with these drugs, it is very likely that the SPRM will in the near future an important place in the treatment of endometriosis.

[Granulosa cell tumor: difficulty of diagnosis and contribution of imaging]. / Tumeur de la granulosa : difficultés diagnostiques et apport de l'imagerie.

Granulosa tumors (GT) are rare neoplasms, difficult to diagnose in a preoperative stage. We report a set of seven patients affected by GT admitted in Amiens University Hospital, collated with a review of the literature (n=379). Our aim was to report the clinical and radiological characteristics of GT, in order to improve preoperative diagnosis. The average age of the subjects was 50.8 years old among the bibliographical search, and 37years old for the observations reported in Amiens. The principal circumstances of diagnosis were vaginal bleeding, abdominal pain and infertility. Ultrasound was the most frequently investigation, revealing GT as a large unilateral solid and cystic mass. The computed tomodensitometry (CT) allowed to precise the locoregional extension. Magnetic Resonance Imaging (MRI) appeared to be interesting to clarify lesions, showing GT as a solid mass with a cystic component or as a multicystic mass. Hormonal assays (inhibin B and/or anti-Müllerian hormone) can provide valuable assistance in diagnosis, despite their cost and lack of availability. In view of the clinical and radiological presentation of the reported and literature review cases, we suggest hormonal assays among perimenopausal women presenting with an unusual radiological aspect of an annexial mass.

[Do there still exist risk factors for breast cancer?]. / Existe-t-il encore des facteurs de risque de survenue d'un cancer du sein ?

OBJECTIVES: To evaluate the risk factors associated with a breast cancer, and to compare the proportion of women at high and low risk for developing breast cancer. PATIENTS AND METHODS: Retrospective study among 194 women with breast cancer between January 2007 and December 2008 in the Obstetrics, Gynaecology and Reproductive Medicine department of the Amiens' University hospital. RESULTS: Concerning all the series, only age, overweight and family antecedents seem risk factors of breast cancer. The proportion of women in the low-risk group (12.3%) is not significantly different from that of the high-risk group (18.5%). In the low-risk group, the factors which seem to influence a breast cancer are those in connection with high levels of estrogens (early age of the first menstruation, late age of the menopause and oral contraceptive use) and the smoke habitus; whereas in the high-risk group, the factors are the nulliparity and the absence of breast feeding. DISCUSSION AND CONCLUSIONS: One finds in this series a part only of the known risk factors of breast cancer; and the proportion of women at low risk (12.3%) is comparable with that at high risk (18.5%). This study shows the relative weight of the various risk factors of breast cancer, at a time when its prevalence reached 10%.

[Should a laparoscopy be necessary in case of infertility with normal tubes at hysterosalpingography?]. / Peut-on réellement se passer de la cœlioscopie en cas d'infertilité a trompes normales en hystérosalpingographie ?

The aetiological assessment of an infertile couple includes several complementary biological and morphological examinations. Initial exploration of the female genital tract requires the performance of pelvic ultrasound and hysterosalpingography. The value of systematic laparoscopy in infertility assessment is still subject to debate. The aim of the present review is to evaluate arguments against the systematic use of laparoscopy and to define the place of the other tests as Chlamydia Trachomatis serology, hysterosalpingosonography and MR-IRM. In our opinion, laparoscopy is of course indicated in infertility assessments not only when anomalies are revealed by hysterosalpingography but also in the following circumstances: past history of infection (especially a positive Chlamydia antibody blood test) and/or pelvic surgery (a significant risk of adhesions), unexplained secondary infertility, unexplained infertility after the age of 38 (when choosing between artificial insemination and direct enrolment in an IVF programme) and failure of 3 cycles of good-quality intra-uterine inseminations (with ovarian stimulation and a sufficient number of spermatozoids).

[Prepubic TVT: a prospective study of 164 female patients treated for stress urinary incontinence]. / TVT prépubien. Etude prospective longitudinale dans le traitement de l'incontinence urinaire d'effort de la femme: à propos de 164 cas.

OBJECTIVE: A prospective open study was conducted to evaluate the prepubic (TPP) route of TVT. PATIENTS AND METHODS: 164 patients suffering from stress or mixed urinary incontinence were operated by prepubic route mainly under spinal anaesthesia. The incision is more proximal and para-uretral dissection directed more lateral to reach ischiopubic bone. The tape is introduced while keeping the needle tip close to bone to perforate between bone and ischiocavernous muscle. Then the needle is brought forwards to get its tip in vertical position and pushed under vulva to supra pubic area. A cough test is done with more pulling than in TVT since in TPP the pulling forces will act more frontally and laterally. Evaluation included detailed clinical examination with stress test, pads, endoscopic and urodynamic assessments and questionnaires in order to detect prognostic factors and to have a global treatment policy for associated low urinary tract symptoms and prolapse. RESULTS: Mean follow-up time was 20 months (14-30). No significant intraoperative complications occurred. All patients urinated the first day. The mean postvoid residual urine was 45 ml. Objective cure rate was achieved in 135 (82.3%) patients and 7 (4.3%) patients were improved while failure was observed in 22 (13,4%) patients. From patients'point of view success and satisfaction rates were 85.4% and 86%. No significant modification of sexual activity occurred. DISCUSSION AND CONCLUSION: TPP is a simple technique with very low risks and the preliminary results are consonant with those of other published techniques.

[Removal or conservation of ovaries during hysterectomy for benign lesions]. / Conservation ou ablation des ovaires lors des hystérectomies pour lésions bénignes.

At the time of hysterectomy, the aging ovary presents a dilemma. We conducted a prospective study to assess the feasibility of systematic oophorectomy in women 50 years or older and a retrospective study of hysterectomy history in patients who developed cancer of the ovary. Our finding and data in the literature point out the requirement for careful assessment of two aspects of the problem, one technical (feasibility of adnexectomy) and the other functional (ovary function and risk of cancer on the retained ovary).

[Role of misoprostol in the delivery outcome]. / Place du misoprostol dans la direction de la délivrance.

OBJECTIVES: Delivery-induced hemorrhage is defined as a blood loss greater than 500 ml within the first 24 hours after delivery. Loss of more than 1000 ml is a sign of gravity. For certain authors, 40% of these hemorrhages could be avoided with systematic preventive measures using uterotonic agents to control the third phase of labor. The aim of our work was to assess the preventive efficacy of active management measures during the third phase of labor and to determine which agents are most effective. PATIENTS AND METHODS: We compared two protocols for controlled deliver: a conventional method using ocytocin (2.5 IU i.v. bolus), and a more recent method using a prostaglandin E1 analog: misoprostol (Cytotec, 3 tablets per os). We compared the two methods with a control group where no preventive measures were used, the standard procedure in our maternity unit. RESULTS: Six hundred two women participated in the study. They were divided into 3 homogeneous groups (ocytocin group misoprostol group, control group). There was a 46% reduction in delivery-induced hemorrhage in the ocytocin group but only a minimal preventive effect against severe hemorrhage. Misoprostol did not demonstrate any efficacy in our study. DISCUSSION: It would appear appropriate to take preventive measures against delivery-induced hemorrhage for all deliveries. A bolus intravenous injection of ocytocin immediately after delivery should bed used. The dose should be greater than that used in this study in order to prevent the development of severe hemorrhage. The most satisfactory results can be obtained with 5 IU (1 ampoule of Syntocinon). It is important to obtain a precise quantification of excessive blood loss in order to institute appropriate care rapidly. Misoprostol should be assessed with other prospective studies because of its easy administration, its low cost and easy storage, important advantages in countries with limited resources.

[Treatment of stress urinary incontinence. Experience at the Gynecology-Obstetrics Center of Amiens]. / Traitement de l'incontinence urinaire d'effort. Expérience du Centre de Gynécologie-Obstétrique d'Amiens.

The authors report their experience of the surgical treatment of stress urinary incontinence. They underline the value of urodynamic tests in the examinations for urinary continence and prolapses. In the presence of a transmission defect, three different techniques are used: indirect colpopexy by strips (Loffredo) in the absence of prolapse, mixed route using vaginal strips (Bologna) in case of cystocele, sub-urethral plication reserved for elderly patients presenting a prolapse with stress urinary incontinence revealed by the urodynamic tests. The follow-up of the patients treated by the Loffredo technique is studied: 92% of good middle-term results (after 5 years).

[Preliminary study of the use of intranasal buserelin in the long-term protocol of ovarian stimulation with the view toward fertilization in vitro]. / Etude préliminaire de l'utilisation de la busereline par voie nasale dans le protocole long de stimulation ovarienne en vue de fécondation in vitro.

A study conducted in 22 patients who used intranasal buserelin, in a long-term protocol for IVF, showed that pituitary desensitization is obtained between 14 days and 1 month. Analysis of the trials in this series, where the results were not satisfactory, suggests that the bioavailability of the product used intranasally, may be in question. A better distribution of nasal sprays causes more discomfort than when used subcutaneously.

[Contribution of urodynamic tests in gynecology. Apropos of 700 cases]. / Apport des épreuves urodynamiques en gynécologie. A propos de 700 observations.

Basic urodynamic tests (cystomanometry-sphincterometry) are absolutely necessary for evaluation of urinary incontinence, urination disorders and prolapses, and are useful in the evaluation following treatment. In a retrospective study including 700 cases, the authors analyze the urodynamic results according to the clinical symptomatology since the clinical diagnosis often is misleading. Then, they study the different treatments advocated and their clinical and urodynamic results: medical treatment: 75 per cent of good results; pelvi-perineal physical therapy: 82 per cent of good results; Loffredo's procedure: 98.5 per cent of good results; Marion's procedure for potential EBI: 92.5 per cent; for obvious EBI: 89 per cent.