Confirmation of the systematic presence of tin particles in fallopian tubes or uterine horns of Essure implant explanted patients: A study of 18 cases with the same pathological process.

OBJECTIVE: To examine associations between local and systemic symptoms and the wear of the tin weld of Essure implants. DESIGN: study of a series of cases. SETTINGS: Two French hospitals. PARTICIPANTS: Eighteen patients explanted by hysterectomy and salpingectomy for removal of their Essure implants between September 2019 and July 2020, have had a common anatomopathological process. MAIN OUTCOME MEASURES: anatomopathological examination by optical microscopy and mineralogical analysis of the fallopian tube or uterine horn with scanning electron microscopy coupled with energy dispersive X-ray (SEM-EDX). Evaluation of local and systemic symptoms with a questionnaire. Examination of blood metal assays (nickel, chromium, and tin). RESULTS: anatomopathological examination highlights foreign body granulomas, fibrosis, adenomyosis, nonspecific inflammation, cysts and myomas in the Fallopian tubes, uterine horns, or both and mentions the presence of foreign bodies in seven cases. SEM-EDX analyses showed, systematically, the presence of tin particles integrated in the wall near the weld, generally in clusters, and with a size ranging from about one micron to several dozen microns. The questionnaire shows that the most frequent local symptoms were pelvic pain, urinary disorders, bleeding, and pains during intercourse. The most common systemic symptoms were: asthenia, visual disturbances, amnesia, giddiness, dorsal pains, headaches, and joint pains. The majority of local and systemic symptoms decreased after explantation, but sometimes incompletely. Before explantation, high levels of nickel, tin and chromium were observed in 11/17, 1/7 and 2/17 patients. After explantation, tin levels were high in 3/11 patients. CONCLUSIONS: our new anatomopathological process systematically demonstrates the presence of tin particles in tissue near the weld. These particles could be responsible for granulomatous inflammations as well as local symptoms. Many of the systemic symptoms are consistent with chronic organotin poisoning but further studies are needed to find out whether tin from the solder can be converted to organotin in the patients' bodies.

[Evaluation of 100 autopsies performed in the maternity service of the Hôtel-Dieu in Lyon during an 18 month period]. / Bilan de 100 autopsies pratiquées dans le service de maternité de l'Hôtel-Dieu de Lyon sur une période de 18 mois.

100 Necropsies have been performed from January 1983 to June 1984, on 53 abortus and stillborn and 47 therapeutic terminations of pregnancy. All fetuses came from the same obstetric unit. Half spontaneous fetal deaths remained of unknown aetiology; in 18 cases (34%) placental, maternal or pregnancy pathology existed; fetal abnormalities were discovered in 10 (18%). As for therapeutic interruptions of pregnancy (the indications of which are detailed) the importance of ultrasonography emphasized since this technique allowed 25 of the 47 prenatal diagnosis. The importance of necropsy to help precise diagnosis and subsequent counselling is also recalled.

[Water intoxication following oxytocin perfusion]. / Intoxication à l'eau après perfusion d'ocytocine.

The authors report a case of water intoxication in a woman who received 140 I.U. of oxytocin in 3 litres of glucose serum in 15 hours to induce a therapeutic abortion. This water intoxication led to loss of consciousness with increase in weight and hyponatraemia. The treatment consisted in restricting fluid intake, giving sodium and 20% Mannitol. A short review of the literature with an explanation of the physiopathology is given. This is the antidiuretic action of oxytocin when it is given with too much fluid without electrolytes.

[Ultrasonography and alpha fetoprotein determination: two complementary tests in the prenatal diagnosis of anencephaly]. / Echographie et alpha-foetoproteine: deux examens complementaires, a propos d'un diagnostic precoce d'anencephalie.

From an observation, authors underline the interest of two complementary tests: ultrasonography and amniotic fluid AFP determination. About the reported case, the chronology of facts is unusual: ultrasonography led initially to suspect anomaly, then elevated AFP result confirmed the malformation.

[Trophoblastic tissue pulmonary embolus in a molar pregnancy (author's transl)]. / Embolie pulmonaire de tissu trophoblastique au cours d'une grossesse molaire.

We report a case of pulmonary embolus which is presumed to have been of trophoblastic tissue in a woman in her second pregnancy who had a hyperactive hydatidiform mole. (The size of the uterus was 27 cm after thirteen weeks of amenorrhoea. The level of urinary H.C.G. was greater than 2 million international units per litre.) One hour after the uterus had been evacuated under chemotherapy a picture of acute dyspnoea appeared, and this made it necessary to transfer the patient to an intensive care unit and to incubate her and ventilate her. The analysis of the blood gas showed desaturation and hypoxaemia leading to a diagnosis of massive pulmonary embolus. These complications were resolved in 72 hours and the levels of H.C.G. went down later under the influence of chemotherapy which was started one month after the evacuation and continued for fourteen weeks (for six weeks after the plasma H.C.G. levels had become negative).