[Pelvic actinomycosis abscess and intrauterine device]. / Abcès actinomycosique pelvien et stérilet.

A case of association between IUD and a left tubal actinomycotic abscess is presented. The 45 year old patient was wearing an IUD for five years. The symptomatology was mainly that of pelvic pain with an associated mass in the left iliac fossa. The working diagnosis was that of a digestive tumor or an adnexal mass. The surgical procedure allowed to identify an inflammatory reaction with a pseudotumoral abscess formation in the left fallopian tube. The etiology was confirmed by the pathology and bacteriology reports. Treatment consists in surgical extirpation of the infected structures and long term antibacterial therapy. Actinomycosis is a rare but potentially serious pelvic disease. It may involve various organs and readily takes on the aspect of tumor formation.

[Screening for trisomy 21 by measuring nuchal translucency during the first trimester of pregnancy]. / Dépistage de la trisomie 21 par mesure de la clarté nucale au premier trimestre de la grossesse.

The purpose of the present literature review is to assess the screening value of trisomy 21 by measurement of fetal nuchal translucency (NT) thickness in the first trimester. NT is a subcutaneous translucency between the skin and the soft tissues overlying the cervical spine, which disappears in the second trimester. Ultrasound examination was used to image a sagittal section of the fetus to measure the maximum thickness of the subcutaneous translucency. NT is physiological for a measurement < 3 mm but the incidence of chromosomal abnormalities (essentially trisomies 21, 18 and 13) increases when NT > or = 3 mm. Differential diagnoses include cystic hygroma and fetal hydrops. For screening purposes, a cut-off threshold value of > or = 3 mm, with a standardized technique, gave a sensitivity > or = 50%, a false positive rate < 5% and a positive predictive value > 1%. In the chromosomally normal group, prognosis was good, but incidence of structural defects and fetal loss increased, with a sharp rise in these complications for fetal translucency thickness > or = 5 mm.

[Vaginal sacral-spinal fixation or Richter's procedure. Experience of a surgical team with 54 cases]. / Sacro-spino-fixation vaginale ou intervention de Richter. Expérience d'une équipe chirurgicale à propos de 54 cas.

Vaginal sacro-spino-fixation or Richter's procedure is valuable for the treatment of posthysterectomy vaginal prolapse. Although technically difficult, this procedure is associated with minimal trauma and is effective in correcting pelvic static disorders. There seem to be few complications. Results are very promising. The functional and anatomic improvements induced by the operation persist over the long term. Although the main indication is treatment of prolapse of the vaginal vault, Richter's procedure is also useful for the prevention of prolapse. Based on the experience acquired by a surgical team, the technique, indications, complications, and results of Richter's procedure are discussed.

[Ovarian cancer and pregnancy]. / Cancer de l'ovaire et grossesse.

The authors report 6 cases of carcinoma of the ovary presenting during pregnancy in the Department of Gynecology and Obstetrics of La Grave University Hospital, Toulouse, between 1972 and 1994. Analysis of this series is followed by a review of the literature which reveals that carcinoma of the ovary fortunately remains a rare event during pregnancy. All reported series conclude that the diagnosis is made at an early stage. Management depends in great part on the age of the pregnancy and stage of malignancy. During the first 6 months, immediate surgery is essential, with sacrifice of the pregnancy, except at stage IA1. During the final 3 months, surgery is delayed until fetal maturity. This classical attitude is currently being questioned. This classical attitude is currently being questioned. Some teams feel that conservative treatment followed by chemotherapy is possible, thereby preserving the pregnancy. The choice of the couple must always be taken into account when making these management decisions.

[Uterine inversion: a cause of obstetric hemorrhage not to be missed. Discussion]. / Inversion utérine: une cause d'hémorragie de la délivrance à ne pas méconnaître. Mise au point.

Severe obstetric bleeding is the primary cause of maternal morbidity and mortality. While classical causes such as uterine inertia or retained placenta are well known, inversion of the uterus is a rare cause which should not be missed. Only very rapid diagnosis and management can avoid serious and irreversible consequences. A case of inversion of the uterus is reported. The circumstances of onset and treatment possibilities are also discussed.

[Gelatinous peritoneal disease]. / La maladie gélatineuse du péritoine.

Gelatinous degeneration of the peritoin is an unusual disorder which inevitably takes the surgeon by surprise during laparotomy. Three cases are reported. The diagnosis, pathogenesis, prognosis and possible therapies are discussed. The tumoral pathogenesis usually appears to be non-malignant and to originate in the ovaries or appendix. However, gelatinous degeneration of the peritoin must be viewed as a disease with attenuated malignancy. The pattern of development is slow, with repeated peritoneal recurrences. The survival time is long. Treatment is essentially surgical even when recurrences occur.

[Monochorionic, monoamniotic twin pregnancies. Diagnostic problems. Outcome risk factors]. / Grossesses gémellaires monochoriales monoamniotiques. Problèmes diagnostiques. Risques évolutifs.

A monochorial monoamniotic twin pregnancy was conducted to term with the delivery of two live infants. The diagnostic problems are due to the rarity of this type of twin pregnancy. The main complications are recalled, essentially related to funicular and dystocic problems at delivery. Such pregnancies require careful management. A caesarean section should always be entertained.

[Pregnancy in a rudimentary uterine horn: rupture in the 15th week of amenorrhea]. / Grossesse dans une corne utérine rudimentaire: rupture à la quinzième semaine d'aménorrhée.

A case of pregnancy in a rudimentary uterine horn with rupture 15 weeks after the LMP is described. Ultrasonography at the beginning of such a pregnancy should allow the diagnosis of these uterine malformations. Closer monitoring of the pregnancy is necessary because of the seriousness of potential complications. The frequent finding of placenta accreta in such situations is pointed out. Management approaches are described.