[Evaluation of a proximity training program of nuchal translucency measurements and of self-scoring]. / Evaluation d'une formation de proximité à la mesure de la clarté nucale et à l'autoévaluation des clichés.

OBJECTIVE: Improvement in prenatal diagnosis of Down syndrome imposes to sonographers to realize good quality nuchal translucency measurements, which can be used for assessment of combined risk. The aim of our study was to evaluate a training program of 109 sonographers for measuring nuchal translucency and scoring their own image. STUDY DESIGN: After a proximity training program, trainees submitted 20 images scored by themselves with Herman image-scoring method. All images were reviewed by two experts. RESULTS: One hundred and nine sonographers have accomplished the training program (87.3%), collecting 2162 images. After reviewing, the mean score was 6.8+/-1.8. The rate of inacceptable scan (score< or =3) was in 6.0%. On the other hand, 48.1% of scans were excellent (score> or =8). Only 6.5% of scores were discordant for at least three points between self-scoring and reviewing. After the fourth scan, there was no significant scoring difference between self-scoring and reviewing. Finally, 84% of trainees were very satisfied of this program. CONCLUSION: As part of HAS evaluation of practitioners practices, it is possible to realize proximity training program for measuring nuchal translucency. Learning curve seems to be fast. Good handling of Herman scoring method by sonographers allows their accreditation after this kind of training program.

[Contribution of pure FSH in ovulation induction excluding fertilization in vitro]. / Apport de la FSH pure dans l'induction de l'ovulation hors fécondation in vitro.

The use of pure FSH reduces the likelihood of multifollicular development and increases the safety of ovulation induction without affecting the overall pregnancy rate. The authors propose a "slow" protocol, which is said to provide the same level of safety, but also to increase the number of pregnancies.

Purified follicle-stimulating hormone in polycystic ovary syndrome: slow administration is safer and more effective.

Twenty-seven infertile patients presenting with clomiphene citrate- (CC) resistant polycystic ovary syndrome (PCOS) were treated with purified urinary follicle-stimulating hormone (pFSH). We compared the conventional stepwise protocol with a slow protocol starting with 75 IU/d, not increased until 14 days, supplemented by human chorionic gonadotropins (hCG). The slow protocol was characterized by a slightly longer duration of stimulation but a more physiological ovarian response (mono- or biovulatory cycles in 70% versus 19% with the conventional protocol, less follicles, and a lower plasma estradiol [E2] resulting in significantly less discontinuation of treatment for risk of hyperstimulation or multiple birth). The pregnancy rate per cycle was higher with the slow protocol (23% versus 15%). The slow protocol could thus be the treatment of choice for CC-resistant PCOS, as it appeared safer and more effective.

A randomized trial of human chorionic gonadotropin support following in vitro fertilization and embryo transfer.

This article reports on the effects of human chorionic gonadotropin (hCG) on progesterone (P) and estradiol (E2), luteal phase length, and conception in 116 cycles treated by in vitro fertilization and embryo transfer (IVF-ET). In 60 cycles, the luteal phase was supported by hCG, 1500 IU three times at 2-day intervals from the day of ET. The remaining 56 cycles served as controls. hCG significantly increased the P level (93 +/- 53 versus 62 +/- 46 ng/ml), the P/E2 ratio, and the luteal phase length (17.4 +/- 1.3 versus 12.2 +/- 1.7 days). However, the total pregnancy rate did not significantly differ between the two groups, though the pregnancy rate after transfer of two or three embryos was slightly higher in the hCG group (26.9 versus 22% in the control group), as was the rate of implanted embryo per transferred embryo after transfer of two or three embryos (25 versus 15.3%). It was concluded that, while hCG increased the magnitude and duration of the luteal P secretion, it did not clearly improve the pregnancy rate.

[The diagnosis of adnexal masses of a gynaecological nature using ultrasound: an analysis of the specificity and reliability of the examination (author's transl)]. / Diagnostic des masses gynécologiques annexielles par l'ultrasonographie: analyse de la spécificité et de la fiabilité de l'examen.

A retrospective analysis has been carried out on 118 cases of gynaecological tumours of the adnexae. The reliability of ultrasound examination is about 90% for evaluating the existence, the size, the localisation and the structure of these masses. The principal mistakes occurred when the technique was poor, when the interpretation of the picture was faulty and when loops on intestine were in the way. It is possible to diagnose accurately simple ovarian cysts, dermoid cysts and adenocarcinomatous cysts. It is difficult to be specific as far as tubal pathology is concerned, and particularly in infections and ectopic pregnancies. Echotomography of the pelvis has become accepted among the battery of paraclinical gynaecological examinations. It has become of greatest importance in these examinations and particularly when exploring adnexal gynaecological masses. The purpose of this retrospective work has been to evaluate the reliability of ultrasound diagnosis of the nature and origin of masses.

[Parietal manifestations of thoracic actinomycosis. Results in five cases (author's transl)]. / Manifestations pariétales de l'actinomycose thoracique. A propos de cinq observations.

The authors review five cases of actinomycosis with thoracic involvement, and emphasize the importance of parietal manifestations and their radiological appearance in the diagnosis of such cases. They refer particulary to the bone locations of the disease and mention rare oesophageal lesions and the development of systemico-pulmonary shunts.