[Borderline ovarian tumors. A review and 11 cases]. / Tumeurs borderline de l'ovaire. Mise au point, à propos de 11 cas.

OBJECTIVE: To clarify and classify the still debated diagnostic and prognostic elements of borderline tumours of the ovary and analyze the data obtained in our series. AIM: Develop an adapted management scheme, integrating relatively good prognosis and known or suspected factors of poor prognosis. SIEGE: Department of Gynaecology-Obstetrics, Hôtel-Dieu (CHU) Rennes, France. SUBJECTS: Eleven patients with borderline tumour of the ovary diagnosed and managed over the last 5 years. RESULTS: Current morphology and macroscopy examinations of the tumour do not provide data capable of predicting malignancy. The borderline nature of the tumour is not a histological diagnosis. The problems encountered lead to a search for new techniques such as digitalized nuclear morphology. Some progress has been made in classifying prognosis factors. Other than stage, important factors appear to be age, histological type, mitotic index, atypical cells and invasive peritoneal implants. Management decisions depend on prognosis factors but should especially take into account parity. Methods include cystectomy and total hysterectomy with annexectomy. Evaluation of chemotherapy and radiotherapy is still to preliminary. CONCLUSION: The slow clinical course, allowing good mid-term prognosis, is still the best reason for a moderated therapeutic approach relying on conservative or more aggressive surgery alone.

Fetal umbilical Doppler in a population of 541 high-risk pregnancies: prediction of perinatal mortality and morbidity. Doppler Study Group.

OBJECTIVE: To evaluate the usefulness of systematic umbilical Doppler in the assessment of high-risk pregnancies. METHOD: In a prospective multicentre study, a group of high-risk pregnancies (intrauterine growth retardation, hypertension during pregnancy, abnormal obstetric history) was systematically studied by Doppler exploration of the fetal umbilical artery between 28 and 34 weeks. All the details of pregnancy development to the first postnatal days were collected and analysed a posteriori. RESULTS: Three groups were formed according to Doppler results (Index S-D/S) A, index < 90th percentile (n = 458, 84.6%); B, index > or = 90th percentile and diastole over zero (n = 67, 12.4%); C, zero diastole (n = 16, 2.9%). There was a strong correlation between Doppler results and pregnancy development. Group C corresponded to a greatly altered prognosis (hypotrophy, < 3rd percentile in 69%; intrauterine deaths in 9/16). In group B, relative to group A, the prognosis was significantly altered (hypotrophy, 24% versus 6%, P < 0.01; prematurity rate, 25% versus 11%, P < 0.001) but these repercussions were not as severe as in group C. CONCLUSION: In high-risk pregnancies, fetal umbilical artery Doppler study is of interest for prognostic assessment. Normal results should provide temporary reassurance. Abnormal umbilical Doppler indicates that chronic suffering will occur or is onset in at least one-third of cases.

Absent end diastolic flow of umbilical artery Doppler: pregnancy outcome in 62 cases.

We retrospectively studied the outcome of pregnancy in 62 cases of absent end diastolic flow (AEDF) of umbilical artery Doppler flow velocity waveform. The history of pregnancies revealed that nearly all were of high risk. Many cases presented cerebral (65%) or uterine (55.5%) Doppler flow abnormalities, or both (38%). We noted 10 fetal deaths and decided 7 pregnancy terminations. Malformation and chromosomal defect rate was 16%. We noted 44 (71%) live-births, a very high rate of cesarean section (86%), prematurity (75%), small for gestational age (39%). Forty-five percent of the neonates had a 1-min Apgar score under 7, which dropped to 27% at 5 min. Neonate mortality rate was 6.9% and the total mortality rate was 34% (21/62). Morbidity was significant (7 cases with severe morbidity, 2 cases with chromosomal abnormality of poor prognosis). We compared different sub-groups with a view to looking for some prenatal factors which predict poor neonatal outcome in case of AEDF.

[Fever during labor. Evaluation of the risk of maternal-fetal infection and reflections concerning prophylactic measures based on a prospective study of 6,305 deliveries]. / Fièvre au cours du travail. Evaluation du risque d'infection materno-foetale et réflexions à propos de mesures prophylactiques à partir d'une étude prospective sur 6.305 accouchements.

The authors have evaluated the risk of neonatal infection (NNI) by materno-fetal contamination when a rise in temperature occurs in labour and they have worked out the prophylactic measures that should be taken. This has been the results of a prospective study carried out on 6305 deliveries. Any significant conditions associated with NNI are stained liquor and a low Apgar score at birth. When high temperature develops in labour it is important to deliver the infant as quickly as possible particularly if the labour is a premature one. Prevention carried out by very early diagnosis of amniotic fluid infection in pregnancy and by careful attention to the high risk conditions of: early rupture of the membranes, a high level of vaginal infection particularly with Beta streptococci.

[The association of dermatopolymyositis and cancer of the ovary]. / Association d'une dermatopolymyosite et d'un cancer de l'ovaire.

Different aspects of the relationship between dermatopolymyositis and cancer of the ovary are emphasised here. A clinical case support these aspects. In the incidence of cancer of the ovary it is remarkable that there is often a relationship between the two conditions. Usually the diagnosis of the dermatopolymyositis comes before the cancer is discovered. This means that decisions have to be taken as to how far investigations for the cancer should be carried out when dermatopolymyositis has been diagnosed.

[Management of persistent posterior occipital presentation. 253 extractions by forceps]. / Conduite à tenir devant une présentation en occipito-postérieure persistante. A propos de 253 extractions par forceps.

A retrospective study of the notes of 253 deliveries was carried out in the two maternity units attached to the University of Rennes between 1980 and 1985. This followed a review of the literature on delivery of babies presenting with a persistent occipito posterior position. Tarnier's forceps were used in each case with full rotation of the presenting part carried out or else delivery in the occipito posterior position. There were five cases of failed forceps. We have not been able to show that there was a significant statistical difference as far as the neonatal state of the babies was, because to the methods of delivery. On the other hand, there was a greater frequency of urinary-vaginal lesions after full rotation. We therefore suggest that a trial of forceps delivery should be carried out in the operating theatre when the optimal obstetrical conditions have been fulfilled, so long as the manoeuvres are carried out technically easily and so long as Caesarean section is resorted to if all the obstetrical conditions are not fulfilled, or if it seems difficult to deliver the baby with a forceps.

Antenatal diagnosis of abdominothoracic alimentary tract duplication: a case report.

Alimentary tract duplications are rare, linked in their tubular form with a disturbance of organogenesis at the time of the separation of the notochord during the 4th week of gestation. Its division leads to the formation of a supernumerary esophagus, situated in the posterior mediastinum, associated with vertebral malformations and connected at its distal extremity with the alimentary tract. We report a case of esophageal duplication revealed antenatally as an ultrasound image of fluid tonality in the posterior mediastinum, causing a major pleural effusion. The other diagnostic possibilities are discussed in terms of the anatomy, embryogenesis and ultrasonographic appearance of the lesion.

[Scarred uterus. Results and selection of patients for vaginal delivery. Apropos of 884 cases]. / Utérus cicatriciel. Résultats et sélection des patientes à l'accouchement voie basse. A propos de 884 dossiers.

The authors present their results as far as successful vaginal delivery (in 39.9% of cases) carried out in 884 cases with a scar in the uterus. They also give the morbidity and maternal and fetal mortality as well as those that developed a rupture of the uterus. No mother died in their series and there was no fetal death that could be ascribed to a complete rupture or a uterine dehiscence. Both fetal and maternal mortality was considerably higher when the trial of scar failed or when a Caesarean section was carried out prophylactically, as compared with the results from vaginal delivery. 2.17% of all the 884 patients with a uterine scar had a complete or incomplete rupture of the scar. Finally the describe their criteria for selecting patients for attempts at vaginal delivery and they show that it is necessary to test the ability of the fetus to pass through the pelvis after looking very carefully at the partogram made for the previous Caesarean operation. In this way they were able to use a trial of labour in slightly contracted pelves or where the fetus was big in such a manner as to obtain a vaginal delivery in, respectively, 68 and 72% of cases.

[Periodic disease and pregnancy]. / Maladie périodique et grossesse.

The authors report a case of familial Mediterranean fever in a pregnant woman treated with Colchicine. She delivered normally at term. A review of the literature shows that colchicine does not have a teratogenic effect which it was long thought to have. All the same it is best to carry out fetal karyotype examination using early amniocentesis. Furthermore, colchicine improves fertility which is disturbed in these patients and pregnancy has a good effect on the disease.

[Autoimmune thrombocytopenic purpura and pregnancy: significance of fetal blood punction]. / Purpura thrombopénique auto-immun et grossesse: intérêt de la ponction de sang foetal.

The authors report three cases of percutaneous fetal blood sampling at 38 weeks of pregnancies complicated by immunologic thrombocytopenia. In each case, the purity was perfect which is essential for using the examination with a view to the obstetrical management. The birth is programmed 24 or 48 hours later. In two cases, the neonatal control is in agree with the fetal blood sampling. In the third observation, the fetal platelet count in 142,000/mm3 and the newborn control 55,000/mm3: the only explanation is a very active process as usually state with newborns. There was no accident, and these samplings led to natural births. This approach seems to be the more effective for the evaluation of fetal platelet count and allow the choice of birth management. A cesarean section is decided in case of fetal thrombopenia lower than 50,000/mm3.

[Nasopharyngeal cancer and pregnancy. Review of the literature. Report of a case]. / Cancer du cavum et grossesse. Revue de la littérature. A propos d'un cas.

We present a case of a rare condition of nasopharyngeal cancer and pregnancy occurring together. We review the unusual epidemiological, clinical and prognostic features of this type of cancer. Because of the immunological changes that occur in pregnancy and because of the potential oncogenic role of Epstein Barr virus we consider that pregnancy worsens the prognosis for nasopharyngeal cancer. After having pointed out the risks of radiotherapy and particularly of chemotherapy in pregnancy, we discuss the need to carry out a therapeutic abortion because of the effect that pregnancy will have if it is allowed to go on to term.

[Prenatal echographic study of esophageal duplication. A case report]. / Aspect échographique anténatal d'une duplication oesophagienne. A propos d'un cas.

We report a case of abdomino-thoracic oesophageal duplication revealed by prenatal ultrasonography as a liquid mass in the posterior mediastinum, responsible for a major chylothorax. Tow our knowledge, this is the first thoroughly documented case occurring in the prenatal period. The various possible ultrasonographic diagnoses and the possibility of therapeutic drainage of pleural effusions are discussed in the light of anatomy, embryogenesis and ultrasonographic images of the lesion.

[Nipple discharge without palpable tumor. Apropos of 46 cases]. / Les écoulements mamelonnaires sans tumeur palpable. A propos de 46 cas.

The authors report 46 cases of nipple discharge without any palpable lesion. The diagnostic is made, most of the time, by 3-views bilateral mammograms. The place of other examinations (ultrasonography, galactography) is reported. The cytology of the discharge, as well as its macroscopic appearance (bloody, serous or greenish), determine the surgical indications. Quadrantectomy centered around the discharging duct, is the procedure of choice in this disease, at the interface between diagnostic and treatment, in fact, if benign tumors (papillomas) or non tumoral diseases (fibrocystic mastopathy and duct ectasia) predominate, invasive or in-situ malignant lesions represent 13 p. cent of these 46 discharges, justifying the significance of this clinical sign.

[Parkinson disease and pregnancy. Apropos of a case]. / Maladie de Parkinson et grossesse. A propos d'un cas.

Parkinson's disease is a neurological condition associated with neuronal degeneration in the corpora nigra with a drop in the level of dopamine in the striatum. It is rarely encountered in women of reproductive age. Treatment is by giving levodopa. We report a case of pregnancy in a woman of 34 years of age who was suffering from severe Parkinson's disease treated with levodopa. We have assessed this case in the light of viewing the literature which confirms that there is no effect on the pregnancy or on the fetus although the symptoms of Parkinson's disease are made worse. Levodopa seems to be quite innocuous as far as the fetus is concerned. There is no teratogenicity although in animal experiments high doses teratogenic effects have been noted.

[Contribution of kidney echography to upper urinary tract infection in pregnancy]. / Apport de l'échographie rénale dans les infections urinaires hautes au cours de la grossesse.

The authors carried out a prospective study and also looked at the literature in order to assess the contribution ultrasound makes in the diagnosis of the aetiology of upper urinary tract infections in pregnancy. They studied two matched series (patients and controls). They note that ultrasound is reliable in the aetiological diagnosis of upper urinary tract infections without complications and they discuss its place and the contribution it can make as compared with more invasive investigations of infections of the upper urinary tract in pregnancy (such as I.V.U. and C.T. scanning).

[Fever during labor. Study of 89 cases]. / Fièvre pendant le travail. Etude de 89 dossiers.

In this retrospective study, 91 neonates were born from 89 patients with high temperature (T. greater than 37.9 degrees C) during labor. This group is distinguished by the high frequency of premature rupture of membranes (44%), low gestational age (25%), and instrumental extractions (30%) or cesarean section (30%). 53 newborns were transferred to pediatric hospitals (58%) for investigations: bacterial infections of neonates were noted in 30 of them (32%). The responsible germ was noted in 21 observations: 7 group B Streptococci (23%), other cocci (3), E. coli (4), other gram negative germ (7). One premature 1420 g. neonate died; four neonates presented a septicemia (group B streptococcus: 3; Staphylococcus aureus: 1). Five neonates had neurological abnormalities. We tried to detect some predictive signs of neonatal infections in labour and delivery. Three factors seemed significant: temperature greater than 38.4 degrees C, fetus cardiac frequency greater than 160, and Apgar score at 1 minute lower.

[Recklinghausen's disease and vascular complications during pregnancy]. / Maladie de Recklinghausen et complications vasculaires au cours de la grossesse.

Von Recklinghausen's neurofibromatosis is an illness that quite often has visceral and neurological side-effects (the former in turn as its side-effects on the blood vessels). Although the patients' fertility is maintained the numbers of spontaneous abortions, of premature births and of perinatal mortality are raised. In fact one of the principal effects of this disease on pregnancy is on the blood vessels, giving rise to hypertension and to a drop in the circulation through the placenta, which in turn has well-known consequences. These are: intra-uterine growth retardation, chronic fetal distress and premature labour. As far as vascular aneurysms are concerned, they constitute an indication for termination of pregnancy. We here give a case history of the condition drawing attention yet once more to the need for a multidisciplinary care of the pregnancy in women who have neurofibromatosis.

[Angioplasty in primary Budd-Chiari syndrome. Apropos of 3 cases]. / L'angioplastie dans le syndrome de Budd-Chiari primitif. A propos de trois observations.

Three patients with the primary Budd-Chiari syndrome were treated by percutaneous transluminal angioplasty. Results showed an apparent poor response to angioplasty of irregular stenoses of the suprahepatic vessels and a good response when stenosis was due to membrane, but recurrence of the latter lesion after several months. The transient efficacy of this procedure in cases with a suprahepatic or caval membrane suggests that it be used pre-operatively for this indication.