[Role of the father in the assisted reproduction project]. / Place du père dans le projet parental.

The legal obligations concerning ART and the role assigned to the father, with his active and voluntary participation in all the steps of IVF, but also in the pregnancy and delivery, have contributed to establishing a sort of "pre-conception" ideal paternity model that should not, however, mask a certain number of failures.

[Psychological management of women with implantation failure]. / Prise en charge psychologique de l'échec de l'implantation.

Women who have been proposed to assess endometrial receptivity seem to be very interested in participating to this research. This biological re-start, when repeated failures contributes to self devalorization. Recent progresses in medical understanding of the physiology of implantation (endometrium cytokines) give a possible answer to the question of repeated implantation failures: men and women are able again to do something instead of being victims. Psychological management of the couples at this moment of medical investigation allows them to turn the repeated failures into a positive dynamic. This process is facilitated by the given possibility of a last attempt through a natural cycle.

[The impact of stress in the maternofetal relationship: an immunological approach]. / L'impact du stress dans le dialogue materno-foetal: une approche immunologique.

Pregnancy is controlled primarily, though not exclusively, by a delicate equilibrium between locally acting growth factors and cytokines, some under steroid control. The hypothesis considered here is that stress is able to influence the equilibrium between cytokines and thus lead to abortions or implantation failure. We thus detailed the studies on that topic in order to explore the psycho-neuro-immunological mechanisms concerned. The duration of stress, the patient's strategy for coping with this and the social context might be able to produce some opposite immunological effects. Thus, the link between stress and the immunological events induced is complex, and much care is needed for such patients.

[In vitro fertilization and sperm intracytoplasmic injection: psychological repercussions for the couple]. / FIV + ICSI: retentissement psychologique sur les couples.

The aim of the study was to assess the psychological repercussions of IVF + ICSI on the male partner of infertile couples and on the couples and on the couple itself. The preliminary work has been done on the 23 couples in the waiting list of an ICSI cycle in A. Beclere hospital in Clamart. All couples respond to the same questionnaire. The two members of the couples were present in a semi-structured interview by 2 clinical psychologists. This ICSI scheme requires a complete change about the biological paternity. For infertile men, getting embryos work as a real reparation of their wounded ego, and the guilt goes from the man to the women when embryos are obtained. This study shows that infertile couples involved in IVF + ICSI have not the same concerns that doctors. Genetic abnormality transmission is not mentioned. On the opposite the male patients are strongly concerned by obtention of embryos which restore their fertility power. At this stage, female patients have to prove by carry out a pregnancy that they are as "good" as their partner.

Blunt hepatic injury in adolescents: age makes a difference.

This analysis of mortality from blunt hepatic injury was performed to define outcome in the adolescent age group in relation to that recorded for children and adults. Children (age 0-10 years) were selected from a multi-institutional trauma registry, adults (age > or = 21 years) from the registry of a Level I trauma center, and adolescents (age 11-20 years) from both. Groups were compared by injury frequency, proportion of severe hepatic injuries (code 864.03 or 864.04 in the International Classification of Diseases, Adapted for Use in the United States 9-CM), immediate laparotomy, mortality, and cause of death. Children had the lowest proportion of severe injury and overall mortality. Torso trauma was the primary cause of death in only three children. Adolescent injury patterns were similar to those of adults in the proportion of severe visceral disruption and incidence of fatal torso trauma. Immediate laparotomy was employed almost twice as commonly in adults as in adolescents. The 64 per cent of adolescents who did not undergo laparotomy had a lower mortality than those who did. Conversely, the 36 per cent of adults without exploration had a significantly higher mortality, which usually occurred before laparotomy could be initiated. Increasing hepatic injury severity brought increasing mortality; however, the cause of death differed with age. Although the incidence of severe liver injury did not differ between adolescents and adults, management and outcome did. These data indicate that individualized management based on overall patient status remains the best approach to care of these injuries.

Death from pelvic fracture: children are different.

This study compares outcome from pelvic fractures in children with that of adults. Data for 23,700 children registered in the National Pediatric Trauma Registry (NPTR) were compared with those of 10,720 adults recorded over 5 years in the registry of our level I trauma center. Patients were categorized by open versus closed fracture and by fracture type as defined by a modification of the Key and Conwell system. Outcome was evaluated by mortality rate and incidence of fracture-induced fatal exsanguination. The 722 pelvic fractures recorded in the NPTR represent 3% of the population and is half the frequency represented by the 532 adults evaluated (P < .001). The overall mortality rate was 5% for children and 17% for adults. Two children died of fracture-related exsanguination; there were 18 such deaths among the adults. Pelvic ring disruption was encountered more commonly among adults, and was associated with a significantly higher mortality rate. Patients with initial hemodynamic instability were more likely to die, although children less so than adults. The authors conclude that children do not die of pelvic fracture-associated hemorrhage as often as adults. Massive blood loss in the child occurs most commonly from solid visceral injury rather than from pelvic vascular disruption.