[Study of amniotic fluid bacterial colonization sampled by amniocentesis in cases with premature rupture of membranes. Prospective multicenter study]. / Etude de la colonisation bactérienne du liquide amniotique prélevé par amniocentèse en cas de rupture prématurée des membranes. Etude prospective multicentrique.

OBJECTIVE: To determine the relationship between bacterial colonization of the amniotic fluid sampled by amniocentesis and premature rupture of the membranes. METHODS: A prospective multicentric study conducted over a one year period in 6 maternity wards in the suburban area of Paris. Thirty-six women with premature rupture of the membranes were studied. RESULTS: There were 11 patients (30%) with contaminated fluid at the first amniocentesis. Twenty-five patients had sterile fluid. In 7 patients with prolonged rupture for more than one week, repeated amniocentesis. Twenty-five patients had sterile fluid. In 7 patients with prolonged rupture for more than one week, repeated amniocenteses were used to follow bacterial colonization. In one patient, Proteus mirabilis in the amniotic fluid was eradicated by adapted antibiotic therapy. In patients with sterile amniotic fluid, there was no secondary colonization. In the 11 cases with colonized liquid, the vaginal swab could only be considered as positive in 4 cases. Amniocentesis was able to discover 7 bacterial colonizations of the amniotic fluid in patients with an indeterminant vaginal swab. Likewise, C-reactive protein levels were raised only in 26% of the cases with a colonized amniotic fluid.

[Vulvoperineoplasty]. / Vulvo-périnéoplastie.

Vulvoperineoplasty is a surgical operation consisting of: (1) wide cleavage of the posterior vaginal wall, as in posterior colpoperineorrhaphy; (2) excision of a triangular segment of perineal skin, the summit of which touches the margin of the anus; (3) full exposure of the perineal central fibrous core and reduction of its relief by radial incisions and digital dissection; (4) lowering and eversion of a posterior vaginal flap with good blood supply in order to reconstruct the fourchette of the enlarged vaginal opening. This technique is applicable not only to congenital or acquired vulvar stenosis but also to the treatment of sclerous or dystrophic lesions of the fourchette. It was used on 43 occasions between 1978 and 1983, viz. in 6 patients after surgical treatment of prolapse, in 14 patients after obstetrical injury, in 17 cases of lichen sclerosus of the vulva and in 6 cases of Bowen's disease. The results were anatomically perfect in all cases, cosmetically good in 40 cases and functionally satisfactory in 40.

[Surgical treatment of congenital transverse septum below the cervix of the vagina]. / Traitement chirurgical des diaphragmes congénitaux sous-cervicaux du vagin.

Transverse septa underneath the cervix are thick and have above them a funnel-shaped vault covered by pathological mucous membranes. The surgical procedures that are normally used to try to treat the condition and to avoid soft tissue dystocia by carrying out V-Y plasties using Garcia's technique or Z-plasties, or even radial incisions followed by the insertion of a pack, are all somewhat unsatisfactory. The authors, confronted with a similar case, decided to cut out the dome of the vagina and the diaphragm and followed that by a small amputation of the cervix, with anastomosis of the uterus and the remaining vagina.

[Symposium on the management of early breast cancer (stages I and II). Part II: Clinical experience with treatment methods. 2. Conservative surgery followed by cobalt therapy in the treatment of breast cancer]. / Chirurgie limitée suivie de cobaltothérapie dans le traitement des cancers du sein.

At the Institut Curie in Paris 452 invasive breast cancers (T1 and T2 less than 3 cm in diameter) were managed conservatively. The patients were treated by "conservative" surgery with or without axillary dissection. All received radiotherapy postoperatively. The 5-year survival without evidence of disease was 86% (249 cases). The survival at 10 years was 77% (93 cases). These statistics are comparable to those obtained by total mastectomy with axillary clearance. The local recurrence rate was 14.5%, most of these patients being "curable" by radical surgery. There was evidence of isolated axillary node metastases in only 2% of the patients. Radiotherapy is therefore effective in treating subclinical node invasion which was observed in 30% of axillary specimens. The cosmetic results were satisfactory in 80% and complications were rare. Follow-up of these patients is difficult and must be rigorous including clinical examination and mammography and, in case of doubt, cytology by aspiration or "Tru-cut" biopsy. The authors conclude that this conservative method, in addition to its cosmetic and emotional advantages, allows us to treat with as much security as radical surgery, the early cancers of the breast (T1 and T2 less than 3 cm in diameter), with no clinically suspicious node metastases.