[The "Action Woman Health" program in three Lyons suburbs]. / Le programme "Action Femme Santé" dans trois communes de l'agglomération lyonnaise.

The cervical cancer screening campaign has been led in three cities in Lyons suburbs from October 1st, 1999 to October 31st, 1999. The objectives of this programme whose title was "Action Femme Santé" (Action Woman Health) were to screen cervical cancer systematically for women who accede with difficulties to smear technique, and to settle in an information, screenings and follow-up system. During the three years, 3,127 smears have been declared and have reached about 2,881 women. The rate of detected disorders is about 2.1%. This campaign has succeeded in its goal about the target public but the participation of health professionals was unsatisfactory because of many obstacles. This implementation of the programme and its results, the weak points and strong points to be kept from such experience, are developed.

[Cervical cancer screening for high risk women: is it possible? Results of a cervical cancer screening program in three suburban districts of Lyon]. / Le dépistage de masse du cancer du col utérin peut-il atteindre une population à risque? Résultats d'un programme pilote de dépistage de masse du cancer du col utérin dans trois communes de l'agglomération lyonnaise.

Between november 1993 and october 1996, a cervical screening program was proposed for women 25-65-year-old who tend to have little or no medical supervision, in three suburban districts of Lyon. The data and results of the two last Pap-smears have been collected together with details of gynecological follow-up. Both general practitioners and gynaecologists were actively involved. A total of 3,792 women (12.3% of the target) were registered, with a larger proportion of women over 60 (17.7%). According to the "Consensus of Lille", only 403 women (34.4%) had adequate screening (over 50 y: 25.8%, 35-49 y: 39.4%, 25-35 y: 36.5%) and 2,489 women had inappropriate gynaecological follow-up: no smear for 185 women (4.9%) and inadequate schedule of follow-up visits for 476 others (12.5%). Missing data (date or results of Pap smear) were noted for 1,828 patients (48.2%). The screening procedure for women over 50 years was carried out mainly by general practitioner. Of 3,127 registered smears, 62 positive results were found (2.1%). Of these women, 9 were lost to follow-up and 4 did not have appropriate tests. Others results were: 27 negative further investigations, 9 CIN1, 7 CIN2, 3 CIN3, 1 in situ carcinoma and 2 invasive carcinoma. Despite low participation, this pilot study indicates that a procedure can be established to integrate high risk women in cervical cancer screening programme. Active participation of general practitioners is essential.

[The role of the medical corps in a mass screening program for cervical cancer. The program "Female Health Action in 3 urban districts of Lyons]. / La participation du corps médical à une expérience de dépistage de masse du cancer du col utérin. A propos du programme "action femme santé" dans 3 communes de l'agglomération lyonnaise.

A pilot study of cervical cancer screening has been initiated in three districts of Lyons suburbs. This campaign aims to increase women participation, specially for high risk groups, helped by an intensive collaboration of general practitioners and gynecologists. Despite several campaign of information, a low rate of participation (13%) was noted. A survey has been performed on the medical population, notably for their participation, eventual changes, encountered problems and perception of such a screening. At time of survey, only half of the general practitioners and 75% of gynecologist still participated. Complexity of administrative procedures, involvement in an epidemiologic survey, lack of time or non-gynecological practice were important obstacles. Volunteer practitioners, enhanced value of public health and university formation of doctors could be necessary in the future for such mass screening.

[Sterility of tubal origin: microsurgery and fertilization in vitro]. / Stérilité d'origine tubaire: microchirurgie ou FIV.

Thanks to recent advances, in-vitro fertilization should alter the clinical indications in cases of sterility due to tubar obstruction. In this article, the authors compare two groups of patients: one group of 109 women treated by means of in-vitro fertilization and another group of 117, treated by microsurgery. In tubar sterility, IVF achieved a 16% pregnancy rate per attempt. In the case of microsurgery, the actuarial rates were calculated (Kaplan Meier method) from a prognostic score. It was found that in the group of women with a "good score", tubar surgery gave results which could be achieved only after 3 or 4 attempts at IVF. On the other hand, in the "poor prognosis" group, IVF was better than microsurgery after a single attempt. Clinical teams should, therefore, reconsider the indications for tubar surgery in the light of the indications for in-vitro fertilization.

Acute dopaminergic blockade by sulpiride stimulates beta-endorphin secretion in pregnant women.

The pars intermedia of the pituitary gland is well developed in most animal species but rudimentary in adult human subjects. Unlike the anterior pituitary, the intermediate lobe metabolizes proopiomelanocorticotrophin (POMC) mainly to beta-endorphin and to alpha-melanotrophin (alpha-MSH). This activity of the pars intermedia is under an inhibitory dopaminergic control. Biochemical and immunohistochemical evidence suggests the hyperplasia of the intermediate lobe during human pregnancy. The present study demonstrates that an acute dopaminergic blockade by sulpiride dramatically increases plasma concentrations of beta-endorphin in pregnant women but not in non-pregnant women providing functional evidence for the intermediate lobe hypothesis.

[Polycystic ovaries. Round table]. / Les ovaires polykystiques. Table ronde.

Because of the variety and inconstancy of the clinical symptoms, it is difficult to establish a classification of the clinical forms. However, the laboratory profile, essentially a raised serum LH, is fairly constant in every case. The pathophysiology of the disequilibrium of androgen and gonadotrophin secretion can be explained on the basis of various initial functional abnormalities, such as an excess of adrenal androgens or LH or, conversely, a deficiency of FSH. Cystic disease is very common in veterinary medicine and presents a number of specific features. The treatment of polycystic ovaries depends on the symptoms (hirsutism, amenorrhea, sterility). In the case of sterility, inducers of ovulation are effective, but are very difficult to manipulate. A number of authors propose surgical excision (removal of the larger of the two ovaries).

Increased plasma concentration of N-terminal beta-lipotrophin and unbound cortisol during pregnancy.

The plasma concentration of N-terminal beta-lipotrophin (beta-LPH), total and protein unbound cortisol, progesterone and the transcortin (CBG) binding parameters have been measured in 21 women in the early follicular phase and in 70 pregnant women at various stages of pregnancy. Results showed that the plasma CBG binding capacity and the concentrations of total cortisol and progesterone increased significantly at each trimester of pregnancy while the plasma concentration of unbound cortisol increased significantly only in the 2nd and the 3rd trimesters of pregnancy. In addition, a significant increase of N-terminal beta-LPH level was observed during the 3rd trimester. By chromatography, it is demonstrated that during the 3rd trimester of pregnancy the beta-LPH/gamma-LPH molar ratio decreases dramatically and that the increase of N-terminal beta-LPH concentration is mainly due to a two fold increase in gamma-LPH concentration.