[Treatment of genital prolapse. Long term results]. / Traitement des prolapsus génitaux. Résultats à long terme.

From 1975 to 1984 case histories of 237 women operated on for major genital prolapse were looked over. 142 formed the subject of prolonged observation of 4 years and more. 63 over ten years. Prévention of static disorders and tissue atrophy has shown itself to be very useful. The procedure for doing this surgical treatment has been dictated by the clinical, urodynamic and per-operative findings. Vaginal surgery treatment was selected for minor uterine prolapse and for very old patients. Most of them had an operation either through abdominal duct or, more often, mixed abdomino perineal duct. The uterine cervix replacement was realized through presacral cervicopexy, by means of non resolving prothesis. In that manner, an anatomical repair can be achieved. We report the excellent long dated results of this method. Posterior perineorraphy remains a high grad process. His result depends upon the quality of perineal muscles. More difficult is the vesical ptosis and urinary stress incontinence treatment, carried, at one and the same time, through intervesico-vaginal prothesis and/or retropublic pexy. Long dated failures depend usually more on the sphincteral insufficiency than on the recurrence of the cervico-vesical ptosis. Perineal and vesico-sphincteral re-education on one hand, substitutive hormonotherapy on the other hand, add a "plus" essential to the surgical repair. Sphincteral bladder insufficiency remains and ill controlled handicap. These desorders are more the consequence of constitutional fragility of connective tissue rather than obstetrical traumatism.

[Serous tumors of the ovary with limited malignancy. Current analysis of a review of the international literature apropos of a case]. / Les tumeurs séreuses de l'ovaire à malignité limite. Mise au point à partir d'une revue de la littérature internationale à propos d'un cas.

Serous ovarian tumours on malignancy borderline represent 2 to 5% of the epithelial ovarian tumours. They differ from malignant tumours by two particularities, namely: precise histological characteristics, the main one being the absence of stroma invasion, a favourable prognosis. The diagnosis rests on conventional histology in spite of the value of histo-immunoclinical markers or tumoral markers. The treatment is surgical, based on hysterectomy with bilateral adnexectomy, even if a conservative attitude may be considered for the young woman who wishes a pregnancy. Prolonged post-operative surveillance is very important because of possible relapses, whose detection seems to be facilitated by antigen CA 125 assay.

[The characteristics of triphasic estrogen-progesterone contraceptives and their theoretical indications]. / Les particularités des estroprogestatifs triphasés et leurs indications théoriques.

In the long history of oral contraception, unfortunate events have been associated with the use of oestrogens and progestogens. The discovery of new progestational hormones with weak androgenic activity but powerful progestational action has led to the combination of very low doses of ethinyloestradiol with low doses of progestational hormones which progressively increase in three successive stages. The products thus show excellent safety, accompanied by a minimum of incidents, and are extremely reliable contraceptives.

[Value and advantages of laparoscopic surgery in the treatment of ectopic pregnancies]. / Intérêt et avantages de la coeliochirurgie dans le traitement des grossesses extra-utérines.

Laparoscopic treatment of ectopic pregnancies (EP) has been performed for several years. From 1st January 1987 to 14th February 1989, 63 women with an EP were operated in our hospital by surgeons trained in laparoscopic surgery (LS). The decision to perform laparotomy was taken either in the presence of laparoscopic contraindications (n = 2), or after diagnostic laparoscopy in the presence of LS contraindications (n = 13). LS was performed 48 times (76.20%) and laparotomy was performed 15 times (23.80%). The women were classified in two groups: laparoscopic surgery (LS) and laparotomy (L). The mean ages were 30.29 and 31.40 years and mean amenorrhea was 6.48 and 6.83 weeks. The EP was ruptured 11 times in the L group (73.33%) and 4 times in the LS group (8.33%). Hemoperitoneum was more frequent in the L group (80.00%) than in the LS group (52.08%). Treatment more often consisted of salpingectomy with laparotomy (86.66%) than with LS (18.75%). Laparoscopic treatment had to be abandoned only once because of persistent bleeding. The mean operation time and hospital stay were shorter in the case of laparoscopic treatment with respectively 63.14 minutes and 4.14 days for LS versus 86.92 minutes and 7.13 days for laparotomy. There were no deaths in either group. This study shows that LS can be used in 3/4 of cases of EP and that treatment significantly shortens the operation time and the hospital stay.

[Phyllodes tumor associated with in-situ lobular carcinoma. Apropos of a case]. / Tumeur phyllode associée à un carcinome lobulaire in situ. A propos d'un cas.

In this paper, the authors present a case of phyllodes tumor whose original interest lies in its association with an in situ lobular carcinoma. The authors present the clinical, radiological, and anatomopathological characteristics of these cases. Finally, they discuss the therapeutic management in light of data from the literature.

[Subcutaneous mastectomy. Indications and surgical technics]. / Mammectomie sous-cutanée. Indications et techniques chirurgicales.

After having specified basic anatomy notions (excision line, vascularization, innervation), technics of under cutaneous mammectomy are presented with their alternatives and their difficulties. The opportunity and methods of the prosthetic restoration are debated. Present indications of the under cutaneous mammectomy are related in detail in the malignant and preneoplastic pathology and under other circumstances.

[Ovarian remnant syndrome. Apropos of 4 cases]. / Le syndrome des restes ovariens. A propos de 4 cas.

Four observations of "residual ovarian syndrome" are presented. This syndrome is to be discriminated from the one of "the remaining ovary". These observations are discussed and compared with literature data. After bilateral ovariectomy--or adnexectomy--generally difficult, appear with a variable reaction time, different unrelated or coupled symptoms: signs of renewal of ovarian hormonal activity after a phase of surgical menopause, pelvic pains, dyspareunia, et cetera.... Clinical, biology, echography and even tomodensitometry lead to the diagnosis. The treatment can be: the return of surgery, the pelvic irradiation, antigonadotropic progestogens or abstention.

[Dermoid cyst of the fallopian tube. Apropos of a case]. / Kyste dermoïde de la trompe. A propos d'un cas.

Authors on the subject of a case of fallopian tube dermoid cyst, lay an emphasis on the rarity of this pathology, its clinical polymorphism. With an unknown pathology, the treatment remains only surgical.

[Analysis of and reflections on some abortion request statistics]. / Analyse d'une statistique de demandes d'I.V.G. et les reflexions qu'elle suscite.

PIP: Records of 209 abortion requests covering a period of 6 months in a hospital in Beaujon were examined to determine what light they would shed on the failure of different types of contraception as a factor in abortion. The patients ranged in age from 17-45 years and averaged 26. 71 did not use any method of contraception, 83 used the pill, 12 used the IUD, 4 used a cap, 15 used the Ogino method, 33 used withdrawal, and 4 used Pharmatex. Patients who had used the pill did so irregularly or stopped using it. 2 of the cap failures were due to irregular use and 2 to method failure. 2 Pharmatex failures were due to irregular use and 2 to washing after intercourse. 3 failures were attributable to the IUD. A certain number of the women not using contraception reported they could not use the pill because of contraindications but had been given no other method. Results of the study indicate that oral contraception is associated with a high rate of failure comparable to that of other methods demanding some action on the part of the user, with only the IUD showing few failures. It therefore appears to be an error to state that local chemical contraceptive methods are associated with a higher rate of failure than OC use. It appears that the rate of requests for abortion would be significantly lowered if patients were routinely instructed in the use of local chemical methods.^ieng

Continuous administration of bromocriptine in the prevention of neurological complications in pregnant women with prolactinomas.

Continuous bromocriptine treatment was given throughout pregnancy to 10 pregnant women with prolactinomas. The dosage of bromocriptine was modified to reduce the serum prolactin level to below 20 ng/ml. Eight patients had continuous bromocriptine treatment started early in their pregnancies, and no tumor-related neurological complications were observed. Continuous bromocriptine treatment was not started at the onset of pregnancy in two patients, and bitemporal hemianopia occurred (at 5 and 7 months of pregnancy). With the start of continuous bromocriptine treatment, a normalization of the visual fields rapidly ensued. The course of the pregnancies and the condition of the newborn infants at birth were normal. The subsequent mental and physical development of the newborn infants (observed up to the age of 6 years) was also normal.

Dexamethasone-suppressible hypercorticosteronism in two 46,XX subjects with ambiguous genitalia and ovarian cysts. Partial defect of 17 alpha-hydroxylase or 17-20-desmolase.

The paradoxical association of female pseudohermaphroditism and androgen deficiency was observed in two 46,XX subjects with high corticosterone plasma levels. Subject 1 has been declared a boy due to clitoris enlargement; she had no vagina and uterus. Subject 2 had ambiguous external genitalia. In both, at age 27 and 17 years, fusion of outer labia, impuberism, ovarian cysts, and histologically normal ovarian tissue were observed. Blood pressure was normal. Basal cortisol levels were normal but unresponsive to ACTH. Progesterone levels were 40 and 62 ng/ml and rose after ACTH (50 and 79 ng/ml). 17-hydroxyprogesterone levels were 25 and 21 ng/ml and did not rise after ACTH. Corticosterone levels were 70 and 92 ng/ml and rose after ACTH (110 and 180 ng/ml). All three steroids were suppressed by dexamethasone. Androgen and estrogen levels were at or below the lower limit for normal women. The sex steroid levels obtained by radioimmunoassay in plasma and a follicular cyst fluid were confirmed by isotope dilution-mass spectrometry. We suggest that the sexual ambiguousness resulted from an excessive production of gestagenic steroids during fetal life, and that the enzyme defect is either a partial 17 alpha-hydroxylase defect combined with a peripheral production of 17-hydroxyprogesterone, or else a partial 17-20-desmolase defect with a secondary 21-hydroxylase defect limited to the cortisol pathway.