[Comparison of frozen embryo transfer outcomes at blastocyst stage according to freezing method and type of endometrial preparation]. / Comparaison des issues de transferts d'embryons congelés au stade blastocyste selon la technique de congélation et le type de préparation endométriale.

OBJECTIVE: This study intended to compare frozen embryo transfer (FET) outcomes at blastocyst stage according to freezing methods, slow freezing versus vitrification and according to the type of endometrial preparation. PATIENTS AND METHODS: A total of 172 FET at blastocyst stage (day 5 or 6) were included retrospectively from April, 2007 to December, 2012. The FET outcomes from slow freezing (group 1, n=86) were compared with those from vitrification (group 2, n=86). More particularly, the survival rate after thawing, as well as implantation and pregnancy rates (clinical and ongoing pregnancy rates) were compared respectively between these two groups, after matching on women's age at freezing day, embryo number and embryo development stage for transfer. Furthermore, for each freezing method, FET outcomes were compared according to the type of endometrial preparation, i.e. natural cycle (group N) versus stimulated cycle (group S). RESULTS: The survival rate as well as implantation and clinical pregnancy rates were significantly higher for FET after vitrification compared to FET after slow freezing (97% vs 85%, P<0.0001; 32% vs 20%, P=0.02; 43% vs 28%, P=0.04, respectively). By taking into account the number of transferred embryos for each group, the multiple pregnancy rate was three-fold higher in the group of FET after vitrification compared to the group of FET after slow freezing but not significantly (27.3% vs 8.3%, NS). However, FET outcomes were not affected significantly by the type of endometrial preparation whatever freezing methods. Nevertheless, the early spontaneous abortion (ESA) rate was lower in the case of embryos that were frozen by vitrification and transferred in natural cycle (group N2 vs group S2: 20% vs 47%, NS). DISCUSSION AND CONCLUSION: Our study confirms that the survival rate after thawing at blastocyst stage (day 5 or 6) is significantly improved after freezing by vitrification compared to slow freezing method. Likewise, implantation and clinical pregnancy rates are significantly increased in the case of FET at blastocyst stage when these embryos were frozen by vitrification. The results obtained by vitrification are very satisfactory but are also associated with an increased multiple pregnancy rate. Moreover, FET associated with natural or stimulated cycle does not modify significantly the outcomes of attempts, whatever the freezing method. However, the risk of ESA is reduced in the case of FET with natural cycle and after embryo vitrification.

[Pertinence of the preoperative exploration in the evaluation of the risk of lymph node metastasis in endometrial cancer]. / Pertinence du bilan préoperatoire dans l'évaluation du risque de métastases ganglionnaires d'un cancer endométrial.

PURPOSE: To assess the relevance of MRI, endometrial biopsy and curettage in the diagnosis of endometrial cancer at high risk of lymph node metastasis. PATIENTS AND METHODS: A retrospective study on continuous series of patients treated for endometrial cancer limited to the uterus between 2004 and 2008, results of preoperative evaluation of tumor stage using MRI, histological type and grade by endometrial curettage and biopsies were compared to final histological examination. RESULTS: One hundred and sixty-nine patients were included in the study. Ninety (53.3%) had MRI, 112 (66.2%) curettage and 61 (36.6%) endometrial biopsy using Pipelle de Cornier. Sensibility (SN), specificity (SP), positive (PPV) and negative predictive values (NPV) of MRI, in the diagnosis of endometrial cancer at high risk of lymph nodes metastases were of 65.6%, 87.2%, 77.7%, 79.2%. For EB and curettage SN, SP, PPV and NPV were of 42.9%, 96.9%, 85%, 79.5%; 80.6%, 98.3%, 96.2% and 90.6% respectively. 37.8% of cancers diagnosed to be at low risk of lymph node metastasis were at high risk in definitive histologic examination. DISCUSSION AND CONCLUSION: Preoperative evaluation by MRI, endometrial curettage and biopsy has good diagnostic value in the identification of endometrial cancer susceptible to benefit from lymphadenectomy. Underestimation, however, is encountered in approximately one third of cases.

Prospective ultrasonographic follow-up of synthetic mesh in cohort of patients after vaginal repair of cystocele.

OBJECTIVE: We sought to validate a sequence of ultrasonographic mesh measurements to determine the relevant time points in the postoperative monitoring of mesh size. METHODS: Mesh was measured preoperatively ex vivo, prior to insertion, in 25 patients scheduled to undergo vaginal repair of cystocele involving insertion of a Ugytex™ transobturating polypropylene mesh. A 2D/3D perineal ultrasound scan was performed at the end of the surgical procedure (D0), then on third day after surgery (D3) and 6 weeks (W6) after the operation. Medio-sagittal view was used to measure mesh total length and the sagittal arc (length between the most distant points of the mesh). RESULTS: Time-course changes in sagittal arc were marked by a 8% increase on D3 (with respect to D0) and a 20% decrease at W6 (with respect to D3). Mesh total length at W6 on average corresponded to 74% (±20) of mesh total length measured on D3. CONCLUSION: This study showed the changes in the mesh ultrasonographic measurements following vaginal placement by vaginal route. The D3 ultrasound scan should appear to be suitable as a reference for subsequent ultrasonographic monitoring.

[Breast cancer in men: are there similarities with breast cancer in women?]. / Cancer du sein chez l'homme : existe-t-il une similitude avec le cancer du sein chez la femme?

Male breast cancer is an uncommon disease although its incidence has increased over the recent years. Like other orphan diseases, male breast cancer is understudied. This disease has a lot of similarities with female breast cancer. Some differences are yet noticeable. This article describes three cases of carcinoma of the breast in men with a review of the literature on risk factors and treatment. A database must be started with epidemiologic information to understand this disease and its correlation with breast cancer in women.