[Oocyte and embryo quality and outcome of ICSI cycles in patients with polycystic ovary syndrome (PCOS) versus normo-ovulatory]. / Qualité ovocytaire et embryonnaire et issue des cycles d'ICSI chez les patientes porteuses d'un syndrome des ovaires polykystiques (SOPK) versus normo-ovulantes.

OBJECTIVE: To compare the oocyte and embryo quality and outcomes in polycystic ovary syndrome (PCOS) patients and normo-ovulatory women undergoing intracytoplasmic sperm injection (ICSI) cycles. MATERIALS AND METHODS: We studied retrospectively 100 controlled ovarian stimulation cycles for ICSI in women with PCOS and 200 cycles in normo-ovulatory women. Every PCOS woman was paired according to age with two normo-ovulatory woman undergoing ICSI during the same study period. A long protocol of gonadotrophin releasing hormone (GNRH) agonist was carried out in all patients. The main outcome measures evaluated were: cancellation of the cycles, number of aspirated follicles, oocyte maturity, fertilization rate, embryo quality pregnancy and implantation rates, clinical abortion rate, multiple pregnancy rate and the "take-home baby" rate. Khi(2) test and Student t test were used for differences between normo-ovulatory and PCOS patients and the limit of significance was set at p<0,05. RESULTS: ICSI was performed for male infertility in most cases (79% in PCOS group vs 79,5%; NS). There was no significant difference in term of cancellation rate (5,5% in PCOS group vs 5%; NS). The mean number of follicles was higher in patients with PCOS (18,1+/-8,5 vs 9,4+/-5,5; p<0,001). Oocyte mature rate (67% vs 52%; p<0,001), fertilization rate (75% vs 63,7%; p<0,001) and grade 1 embryo rate (69% vs 53%; p<0,001) were significantly higher in PCOS group. The mean number of transferred embryos was similar in the two groups (2,46+/-0,5 vs 2,54+/-1,01; NS). Implantation rate (16,6% vs 12,1%; NS), clinical pregnancy rate per transfer (31,5% vs 24%; NS) and Live birth rate (22% vs 20%; NS) did not differ statistically in the two groups. Twin and triplet pregnancies rates were similar in the two groups (20% vs 16,7%; NS and 6,6% vs 7,1% ; NS respectively). Miscarriage rate was higher in PCOS group but this did not reach the statistical significance (26,6% vs 16,6%; NS). CONCLUSION: PCOS patients showed better global oocyte and embryo quality. However, pregnancy and live birth rates were similar in the two groups when number and quality of transferred embryos are equivalent.

[Transobturator subvesical mesh: Tolerance and mild-term results. A prospective study]. / La prothèse sous-vésicale transobturatrice: tolérance et résultats à moyen terme Etude prospective à propos de 45cas.

AIM: To evaluate midterm results, tolerance and efficiency of interposition of a transobturator subvesical mesh for the repair of cystoceles. PATIENTS AND METHODS: We report the results of a total of 45 consecutive transobturator mesh fixation between March 1, 2005 and March 1, 2007. We used a transvaginal polypropylen tension-free mesh (Prolène, Ethicon, Johnson & Johnson, France) fixed through the obturator foramen. RESULTS: Before surgery, all patients had cystocele of more or equal than grade II, according to Baden and Walker classification. Five had grade II cystocele (11%), 36 had grade III (80%) and four grade IV (9%). Thirty-nine women had associated median and/or posterior prolapse (86%). Eleven women had urinary incontinence (24%). The procedure was performed in all cases. Duration of a cystocele cure procedure was 25minutes+/-3.2 (12-32). Mean follow-up was 18 months+/-4.2 (13-29). Vaginal erosion ratio was 6%. There was no mesh infection. The objective success rate was 93%. The satisfaction index was 70%. CONCLUSION: Transobturator mesh is a safe and efficient method for anterior segment prolapse repair. This procedure is simple, mini-invasive, reproducible and efficient with low morbidity and good tolerance.

[Foetal rhinopharyngeal teratoma: antenatal diagnosis and prognosis. Case report]. / Tératome foetal du rhinopharynx : diagnostic anténatal et pronostic. A propos d'un cas.

Fetal teratomas are commonly found in the sacrococcygeal area. More rarely, these tumors may be found in cervicofacial forms. Rhinopharyngeal teratoma represent an extremely rare congenital tumor, often resulting in intracranial extension, obstruction of the respiratory or the digestive pathways and rapid asphyxia following birth. We report a case of rhinopharyngeal teratoma identified in a foetus at 18 weeks of gestation. The diagnosis was made by antenatal ultrasound and IRM. Tumor invaded the cavum and the right infratemporal region with no intracranial extension. The pregnancy was interrupted at 27 weeks of gestation. Authors discuss the difficulties to establish antenatal diagnosis by ultrasound, and those to decide what treatment to carry out.

[Necrotizing fasciitis of the perineum secondary to a surgical treatment of Bartholin's gland abscess]. / Fasciite nécrosante du périnée secondaire à un traitement chirurgical d'un abcès de la glande de Bartholin.

Necrotizing fasciitis of the perineum is a rare but of fast evolution, and potentially fatal infectious disease process. It is characterized by progressive inflammation and extensive necrosis of subcutaneous tissue involving the fascia and other adjacent tissues. This infection may be idiopathic or secondary to local trauma or pelvic surgery. Its mortality rate is 20%. We report a case of necrotzing fasciitis of the perineum in a 34-year-old woman following incision and drainage of Bartholin's gland abscess. Streptococcus A, Proteus mirabilis, Escherichia coli, and Candida albicans were isolated. Intravenous broad spectrum antibiotic therapy was promptly instituted. Concurrent surgical debridement of all necrotic areas was required. Post debridement therapy required a long period of dressing changes until cicatrisation. Necrotizing fasciitis of the perineum is a surgical emergency. Early diagnosis and prompt aggressive debridement are the keys to successful management.

[Early isosexual precocious pseudopuberty revealing a juvenile granulosa cell tumor in a six-year-old girl]. / Pseudo-puberté précoce isosexuelle révélant une tumeur de la granulosa juvénile chez une petite fille de six ans.

Juvenile granulosa cell tumors of the ovary are a rare form of neoplasm that makes up less than 5% of ovarian tumors in childhood and adolescence. About 90% are diagnosed in stage I (FIGO) with a favorable prognosis, whereas those at higher stages have a less favorable outcome. The authors describe a juvenile granulosa cell tumor expressed by an early pseudopuberty occurring in a 6-year old child. Clinically, an endocrine syndrome was associated with a pelvic mass. Hyperoestrogenia and serum alphafoetoprotein level were biologically detected. Tumor was localized strictly to the ovary, so conservative surgery was applied and proved sufficient to remove all tumor tissue. Histological examination showed typical microscopic aspect of a juvenile granulosa cell tumor. The patient is well 14 years after surgery with normal growth and mental development.

[Breast myoepithelioma. Diagnostic and therapeutic difficulties. A case report]. / Le myoépithéliome du sein. Difficultés diagnostiques et thérapeutiques. A propos d'un cas.

Breast myoepithelioma is rare. The case of a 61-year-old female is reported here. The tumor was clinically, radiologically and macroscopically demarcated. Diagnosis was based on histological and immunohistochemical studies. At the time of diagnosis the tumor consisted of myoepithelial cells with few cellular atypias and a low mitotic activity. Tumor cells expressed vimentin, actin, S100 protein and cytokeratin. No local or distant metastases were found. The patient had been treated initially with a large excision of tumor. Local recurrences detected one year after initial surgery and showed a similar morphology and immunoreactivity with higher mitotic activity. Mastectomy with axillary dissection was performed. Neither recurrences nor distant metastases detected two years later. Myoepithelial tumors which are generally considered as benign or low-grade lesions can give rise to a wide range of clinical evolution.

[Fertility after hysteroscopic treatment of intra-uterine adhesions]. / Fertilité après cure hystéroscopique de synéchie.

OBJECTIVE: The main aim of the study was to evaluate the efficacy of hysteroscopy in the treatment of intra-uterine adhesions with infertility. PATIENTS AND METHODS: This retrospective study of patients with uterine synechias treated exclusively hysteroscopically included 120 cases: 109 of them (90.8%) low fertility patients, 110 (91.7%) with menstrual disorders and 2 (1.7%) with no others symptoms. Mean age was 34 years (range: 21-45 years). Operative hysteroscopy was performed in 155 cases including electrosection in 124 cases (80%) and a collapse in 31 cases (20%). A single endoscopic procedure was performed in 96 patients, 2 procedures in 17 patients, 3 in 3 patients and 4 in 4 patients. Mean follow-up was 26.8 months (range: 6-52 months). RESULTS: Good anatomic results were achieved in 116 patients (96.7%) after 1, 2 or 3 hysteroscopic procedures. We obtained good results in 58.2% of the patients with menstrual disorders. One pregnancy was achieved in 49 of patients (44.9%) including: 35 childbirth, 13 abortions and 1 molar pregnancy. DISCUSSION AND CONCLUSION: Hysteroscopy, easy procedure, allowing reproducible treatment with low morbidity should be proposed as first intention treatment in all cases with synechia. Fertility prognosis is tightly related to the gravity of synechia and its topography.

[Uterine adenomyosis. Clinical and therapeutic study. Report of 87 cases]. / Adénomyose utérine. Etude clinique et thérapeutique. A propos de 87 cas.

STUDY OBJECTIVE: The aim of our study is the analysis of Pound epidemiological, clinical, paraclinical and therapeutic aspects of adenomyosis. METHODS: A retrospective analysis was carried out on 87 patients who underwent hysterectomy for a variety of reasons (except for prolapse) between January 1, 1990, and December 31, 1997; and whose Histologic analysis of hysterectomy specimen revealed adenomyosis. RESULTS: 586 hysterectomy (except prolapse) was performed during the study period: frequency of adenomyosis in hysterectomy specimen is of 14.85%. The mean age of our patients is 43.97 years (Range: 26-64 years). 29.88% of them are postmenopausal and 41.37% had a past history of uterine trauma. Main symptoms were pelvic pain (71.22%) and abnormal uterine bleeding (82.77%). Preoperative diagnosis has been suspected on hysteroscopy in 63.22% of cases, hysterography in 58.46% and transvaginal sonography in 40.5%. A radical surgery first has been indicated in 57 cases, after failure of medical treatment in 16 cases and after failure of endometrial resection in 14 cases. Histologic analysis of the hysterectomy specimen shows associated myoma in 32.18% of cases, hyperplasia in 13.79%, polyps in 5.74% and atrophy in 3.44%. CONCLUSION: Adenomyosis, enigmatic disease, escapes always to a well-codified therapeutic strategy and bound closely related to hysterectomy. Earliest diagnosis could avoid the systematic evolution toward the radical treatments.