[Impact of the mode of follow-up of preterm premature rupture of membranes before 36 weeks of gestation on the latency period]. / Impact du mode de suivi des ruptures prématurées des membranes avant 36 SA sur la durée de latence.

INTRODUCTION: Preterm premature rupture of membranes (PPROM) is the main cause of premature delivery, complicating 1-3% of all pregnancies. Conventional hospitalization (CH) is the most frequent mode of follow-up, but homecare (HC) seems to be an alternative. OBJECTIVES: Study of the impact of the monitoring mode on the duration of the latency period and on the latency ratio after PPROM, and analysis of the risk factors modifying this ratio. METHODS: This was a bicentric retrospective cohort study here-abouts including patients who presented a PPROM between 24 and 36weeks of gestation from 2016 to 2018. Patients had a follow-up in HC at Lille University Hospital center (UHC) and in CH at Nantes UHC according to two different follow-up protocols. The latency ratio corresponded to the real latency period divided by the latency period to theoretical term. RESULTS: We included 154 patients: 102 in HC and 52 in CH. The mean latency period was significantly higher in HC: 36.9±21.8 days, corresponding to an 85.5±23.7% latency ratio versus 20.2±12 days, corresponding to an 66.9±29.8% latency ratio in CH (P<0.001). The latency ratio in CH was correlated with term at PPROM (P=0.001). CONCLUSIONS: The duration of the latency period seems prolonged for PPROM followed by HC management versus CH in selected populations. This study suggests a benefit to HC in stable patients.

[Term Prelabor Rupture of Membranes: CNGOF Guidelines for Clinical Practice - Timing of Labor Induction]. / Rupture des membranes à terme avant travail. Recommandations pour la pratique clinique du CNGOF ­ Faut-il déclencher ?

OBJECTIVE: To assess the effect of immediate induction versus expectant management on maternal and neonatal outcomes in case of term prelabor rupture of membranes. METHODS: We searched Medline Database, Cochrane Library and consulted international guidelines. RESULTS: In case of term prelabor rupture of membranes, induction of labor is associated with shorter rupture of membranes to delivery intervals when compared to expectant management, if induction is conducted with oxytocin (LE2), prostaglandin E2 (LE2) or misoprostol (LE2), but not when induction is conducted with Foley® catheter (LE2), osmotic dilatator (LE2) or acupuncture (LE2). The strongest evidence to date comes from a large international randomized study, the TERMPROM study, which included over 5000 women between 1992 and 1995. This study compared immediate induction with oxytocin or prostaglandin E2 to expectant management up to 96hours, followed by induction by oxytocin or prostaglandin E2. Immediate induction was not associated with a decreased neonatal infection rate (LE1), even among women with a positive streptococcus B vaginal swab (LE2). Thus, expectant management can be offered without increasing the neonatal infection risk (Grade B). Induction with oxytocin was associated with a decreased risk of intra-uterine infection and postpartum fever in the TERMPROM study (LE2), however, this study had significant limitations concerning this outcome (unknown streptococcus B status and low rate of prophylactic antibiotics), and this association was not found in other smaller studies. This decrease was not observed with induction by prostaglandin E2. In the TERMPROM study, induction was not associated with an increase or decrease in the rate of cesarean section (LE2), whatever the parity (LE2) or Bishop score at admission (LE3). Induction can thus be proposed without increasing the cesarean section risk (Grade B). There is no study evaluating expectant management over 4 days. CONCLUSION: In case of term prelabor rupture of membranes, induction can be offered without increasing the cesarean section risk (Grade B). Expectant management can be offered without increasing the neonatal infection risk (Grade B), even among women with a positive streptococcus B vaginal swab (Professional consensus). The optimal moment of induction will therefore be guided by the maternity wards organization and women's preference after having informed them of the risks and benefits associated with induction and expectant management (Professional consensus). In case of meconial fluid or term prelabor rupture of membranes>4 days, induction must be offered (Professional consensus).

[Epidemiology, risk factors and child prognosis: CNGOF Preterm Premature Rupture of Membranes Guidelines]. / Épidémiologie, facteurs de risque et pronostic de l'enfant. RPC : rupture prématurée des membranes avant terme CNGOF.

OBJECTIVES: To synthetize the available evidence regarding the incidence and risk factors of preterm premature rupture of membranes (PPROM). To describe the evolution of pregnancy, neonatal outcomes and the prognosis of infants born in a context of PPROM, according to the existence of an associated intrauterine infection and to the latency duration. METHOD: Consultation of the Medline database, from 1980 to February 2018. RESULTS: PPROM before 37 and before 34 weeks' gestation occur in 2-3% and <1% of pregnancies, respectively (LE2). Although many risk factors are identified, few are modifiable, and the vast majority of patients have no risk factors (LE2). Consequently, individual prediction of the risk of PPROM and primary prevention measures have not been shown to be effective and are not recommended in clinical practice (Grade B). Most women give birth within the week following PPROM (LE2). The main complications of PPROM are prematurity, intrauterine infection and obstetric and maternal complications (LE2). Latency duration and the frequency of complications decrease with increasing gestational age at PPROM (LE2). Neonatal prognosis is largely conditioned by gestational age at birth, with no apparent over-risk of poor outcomes linked to PPROM compared to other causes of preterm birth (LE2). In contrast, intrauterine infection is associated with an increased risk of in utero fetal death (LE3), necrotizing enterocolitis (LE1) and early-onset sepsis (LE2). The association of intrauterine infection with neurological morbidity remains controversial. Prolongation of latency, from gestational age at PPROM, is beneficial for the child (LE2). CONCLUSION: PPROM is a major cause of prematurity and short- and long-term mortality and morbidity. Antenatal care is an important issue for obstetric and pediatric teams, aiming to reduce complications and adverse consequences for both mother and child.

[Modalities of birth in case of uncomplicated preterm premature rupture of membranes: CNGOF Preterm Premature Rupture of Membranes Guidelines]. / Modalités de naissance en cas de rupture des membranes avant terme non compliquée. RPC Rupture prématurée des membranes avant terme CNGOF.

OBJECTIVE: To identify the ideal gestational age at delivery for preterm premature rupture of membranes and modalities of birth. METHOD: To identify studies, research was conducted using Pub-Med, Embase and Cochrane databases. RESULTS: Prolonged latency duration after pPROM does not worsen neonatal prognosis (NP3). Therefore, it is recommended not to deliver before 34 weeks of gestation for patient with uncomplicated preterm rupture of membranes (pPROM) (Grade C). After 34 weeks of gestation, expectant management for pPROM is not associated with neonatal sepsis (NP1) but is associated to intra-uterine infection (NP2). Early delivery is associated with higher risk of respiratory distress syndrome (NP2), higher risk of cesarean section (NP2) and longer duration of NICU hospitalization (NP2). Before 37 weeks of gestation, expectant management is recommended for uncomplicated pPROM (Grade A), even if vaginal group B streptococcus is positive, as long as antibiotics are used at the time of membranes rupture (Professional consensus). Elective cesarean section is reserved for usual obstetrical indications. Oxytocin and prostaglandins are reasonable options for inducing labor (Professional consensus). Data are too scarce to establish recommendation regarding intra-cervical balloons in case of pPROM (Professional consensus). CONCLUSION: Expectant management is recommended for uncomplicated pPROM before 37 weeks of gestation.

The latency complex: the dead hand of anti-development.

It is common knowledge that the same phenomena can be viewed in a variety of ways. This paper considers the implications of a constellation observed in some adult patients who have increasingly reminded the author of some of the children of latency age with whom he has also worked. In the literature these patients may also have been thought about in terms of 'defences of the self' (Fordham), patients who are 'difficult to reach' (Joseph), 'psychic retreats' (Steiner), and those who make 'attacks on linking' (Bion). They may equally be considered in terms of schizoid, narcissistic or borderline personalities, or as showing features on the autistic spectrum, such as mindlessness and extreme obsessionality. Writers such as Helene Deutsch with her concept of an 'as-if personality', Winnicott with his 'false self', and Rosenfeld, discussing the split-off parts of the personality in narcissistic patients, have also offered much to think about in their consideration of some of these phenomena. This paper proposes yet another vertex - the author's own imaginative conjecture - that is by no means mutually exclusive of any of these others.

Are electrophysiological features related to disability in patients with anti-MAG neuropathy?

OBJECTIVES: To explore clinical-neurophysiological correlations in anti-myelin-associated glycoprotein (anti-MAG) neuropathy. METHODS: Clinical and electrophysiological data of 42 patients with anti-MAG neuropathy were retrospectively analysed. Disability was evaluated using the Overall Neuropathy Limitation Scale (ONLS), motor impairment through MRC sum score and sensory deficiency through INCAT sensory score. Compound motor action potential (CMAP) sum score was calculated adding the distal CMAP amplitude of the median, ulnar, tibial and fibular nerves of both sides. RESULTS: In multivariate analysis, motor impairment was associated with CMAP sum score (r=0.35, P=0.047) and distal motor latency in the median nerves (r=-0.45 P=0.012), sensory deficiency was related to motor conduction velocity in the median nerve (r=-0.65. P=0.02). Disability was correlated with CMAP sum score (r=-0.37, P=0.022). CONCLUSION: Electrophysiological features are associated with clinical involvement in anti-MAG neuropathy. Reduction of CMAP amplitudes reflects distal motor latency delay and is mainly due to axonal loss. Since it is related to muscle weakness and disability, CMAP sum score may be a good marker in the evaluation of patients with anti-MAG neuropathy.

Age Differences in Reaction Times and a Neurophysiological Marker of Cholinergic Activity.

RÉSUMÉ La détérioration du système cholinergique lors du vieillissement normal semble contribuer au déclin de l'attention avec l'âge. Nous avons examiné l'effet potentiel de l'âge sur la performance au « Attention Network Test ¼ (ANT) ainsi que sur la variabilité intra-individuelle dans la vitesse des réponses à une tâche go/no-go et à une tâche de temps de réaction (TR) à choix multiples chez un groupe de jeunes adultes et de personnes âgées en santé. Nous avons ensuite examiné si un marqueur neurophysiologique de l'activité cholinergique dérivé de la stimulation magnétique transcrânienne (i.e., inhibition afférente à courte latence; IACL) était associé à la performance. Les personnes âgées montraient un ralentissement au ANT ainsi qu'une plus grande variabilité intra-individuelle que les jeunes adultes à la tâche de TR à choix multiples, mais il n'y avait pas de différence liée à l'âge dans les scores reflétant les réseaux attentionnels du ANT (vigilance, orientation aux stimuli et contrôle exécutif). Les niveaux de IACL étaient diminués chez les personnes âgées, mais ils n'étaient pas associés à la performance. Il est possible que des relations entre le marqueur de l'activité cholinergique et l'attention émergent seulement en cas de déficits de neurotransmission sévères. D'autres mécanismes corticaux pourraient aussi être plus fortement associés aux fonctions liées à l'attention.

Specific brainstem and cortico-spinal reflex abnormalities in coexisting essential tremor and Parkinson's disease (ET-PD).

OBJECTIVE: We aimed to analyze functional changes at brainstem and spinal levels in essential tremor (ET), Parkinson's disease (PD) and coexisting essential tremor and Parkinson's disease (ET-PD). PATIENTS AND METHOD: Age- and gender-matched patients with tremor (15 ET, 7 ET with resting tremor, 25 ET-PD and 10 PD) and 12 healthy subjects were enrolled in the study. Diagnosis was established according to standardized clinical criteria. Electrophysiological studies included blink reflex (BR), auditory startle reaction (ASR) and long latency reflex (LLR). RESULTS: Blink reflex was normal and similar in all groups. Probability of ASR was significantly lower in ET-PD group whereas it was similar to healthy subjects in ET and PD (P<0.001). LLR was recorded during voluntary activity in all three groups. LLR II was more common in ET, PD and ET-PD groups. LLR III was far more common in the PD group (n=3, 13.6% in ET; n=4, 16.0% in ET-PD and n=7, 46.7% in PD; p=0.037). CONCLUSIONS: Despite the integrity of BR pathways, ASR and LLR show distinctive abnormalities in ET-PD. In our opinion, our electrophysiological findings support the hypothesis that ET-PD is a distinct entity.

Re-visitando a latência: reflexões teórico-clínicas sobre os caminhos da sexualidade / Re-visiting the latency: Clinical and theoretical reflections about the ways of the sexuality / Revisiter la latence: réflexions cliniques et théoriques sur les chemins de la sexualité / Re-visitando la latencia: reflexiones teóricas y clínicas sobre los caminos de la sexualidad

A proposta deste trabalho é revisitar o período do desenvolvimento psicossexual denominado por Freud de latência. Pretendemos demonstrar a partir de reflexões teórico-clínicas que, longe de ser um momento de parada caracterizado pela ausência da sexualidade, este é um momento-chave para a organização psíquica do adolescente e do adulto, que exige um grande trabalho psíquico e que leva a grandes conquistas intelectuais, a um reordenamento da personalidade e a uma abertura para o mundo. Pretendemos também apontar como dificuldades na vivência desta fase de desenvolvimento aparecem em manifestações clínicas.(AU)

The purpose of this work is to revisit the psychosexual development period that Freud called latency. We intend to demonstrate based on clinical and theoretical reflections that, far from being a stop-time characterized by the absence of sexuality, this is a key moment for the teenager and adult psychological organization, which requires a great psychic work and leads to great intellectual achievements, a reordering of the personality and an openness to the world. We also intend to point out how the difficulties on the experience of this stage of development appear in clinical manifestations.(AU)

Ce travail revisite la période du développement psychosexuel que Freud appelle la latence. À partir de réflexions cliniques et théoriques, nous cherchons à démontrer que, loin d'être un temps d'arrêt caractérisé par l'absence de sexualité, il s'agit d'un moment-clé pour l'organisation psychique des adolescents et des adultes. Il nécessite un grand travail psychique et il conduira à grandes réalisations intellectuelles, puisque c'est une réorganisation de la personnalité et une ouverture sur le monde. Nous soulignions aussi comment les difficultés à vivre ce moment du développement apparaissent comme des manifestations cliniques.(AU)

Re-visitando a latência: reflexões teórico-clínicas sobre os caminhos da sexualidade / Re-visiting the latency: Clinical and theoretical reflections about the ways of the sexuality / Revisiter la latence: réflexions cliniques et théoriques sur les chemins de la sexualité / Re-visitando la latencia: reflexiones teóricas y clínicas sobre los caminos de la sexualidad

A proposta deste trabalho é revisitar o período do desenvolvimento psicossexual denominado por Freud de latência. Pretendemos demonstrar a partir de reflexões teórico-clínicas que, longe de ser um momento de parada caracterizado pela ausência da sexualidade, este é um momento-chave para a organização psíquica do adolescente e do adulto, que exige um grande trabalho psíquico e que leva a grandes conquistas intelectuais, a um reordenamento da personalidade e a uma abertura para o mundo. Pretendemos também apontar como dificuldades na vivência desta fase de desenvolvimento aparecem em manifestações clínicas...

The purpose of this work is to revisit the psychosexual development period that Freud called latency. We intend to demonstrate based on clinical and theoretical reflections that, far from being a stop-time characterized by the absence of sexuality, this is a key moment for the teenager and adult psychological organization, which requires a great psychic work and leads to great intellectual achievements, a reordering of the personality and an openness to the world. We also intend to point out how the difficulties on the experience of this stage of development appear in clinical manifestations...

Ce travail revisite la période du développement psychosexuel que Freud appelle la latence. À partir de réflexions cliniques et théoriques, nous cherchons à démontrer que, loin d'être un temps d'arrêt caractérisé par l'absence de sexualité, il s'agit d'un moment-clé pour l'organisation psychique des adolescents et des adultes. Il nécessite un grand travail psychique et il conduira à grandes réalisations intellectuelles, puisque c'est une réorganisation de la personnalité et une ouverture sur le monde. Nous soulignions aussi comment les difficultés à vivre ce moment du développement apparaissent comme des manifestations cliniques...

Separation, dependance et depression a l'adolescence / Separation, addiction and depression has adolescence

La dépendance est une étape, provisoire mais nécessaire pour la constitution psychique du sujet. C›est une des figures du lien sans laquelle il ne saurait y avoir d›autonomie. Mais la dépendance traduit aussi un état pathologique dans le processus d'adolescence où la capacité à jouer avec l'objet est rabattue au besoin de trouver un objet qui comble, qui masque aussi la détresse du sujet et sa difficulté à se séparer. Nous faisons l›hypothèse que la dépendance pathologique est une façon de lutter contre la dépression et l›angoisse d›effondrement qui lui est sous-jacente.

Separation, dependence and depression in adolescence. Addiction is a step, provisional but necessary for the psychological constitution of the subject. This is one of the forms of relation without which there can be no autonomy. But dependency also reflects a pathological condition in the process of adolescence where the ability to play with the object is replaced by the need to find an object which fills, as well as masks the distress of the subject and its difficulty to be separated. We establish the hypothesis that the pathological dependency is a way to fight against depression and its underlying anxiety of collapse.

Separation, dependance et depression a l'adolescence

La dépendance est une étape, provisoire mais nécessaire pour la constitution psychique du sujet. C›est une des figures du lien sans laquelle il ne saurait y avoir d›autonomie. Mais la dépendance traduit aussi un état pathologique dans le processus d'adolescence où la capacité à jouer avec l'objet est rabattue au besoin de trouver un objet qui comble, qui masque aussi la détresse du sujet et sa difficulté à se séparer. Nous faisons l›hypothèse que la dépendance pathologique est une façon de lutter contre la dépression et l›angoisse d›effondrement qui lui est sous-jacente(AU)

Separation, dependence and depression in adolescence. Addiction is a step, provisional but necessary for the psychological constitution of the subject. This is one of the forms of relation without which there can be no autonomy. But dependency also reflects a pathological condition in the process of adolescence where the ability to play with the object is replaced by the need to find an object which fills, as well as masks the distress of the subject and its difficulty to be separated. We establish the hypothesis that the pathological dependency is a way to fight against depression and its underlying anxiety of collapse(AU)

Construção narrativa: o processo interpretativo diante de uma situação traumática / The narrative construction: the interpretative process within a traumatic situation

Neste trabalho descrevo um recorte da análise de Joaquim, um menino de oito anos, que, embora cronologicamente na latência, iniciou o processo analítico num estado muito imaturo e perturbado. Procuro mostrar como a participação da analista na construção narrativa das temáticas inconscientes das sessões permitiu tanto a elaboração de uma situação traumática com uma progressiva possibilidade de representar compartilhado, quanto a reconstituição do tecido psíquico.

This paper describes a fragment of Joaquim’s analysis, an eight year-old boy who, although chronologically in latence, has initiated the analytical process in a very immature and disturbed condition. My attempt is to show how the analyst‘s participation in the narrative construction of unsconscious themes in his sessions, has allowed him to work through a traumatic situation with an increasing possibility of shared representation as well as the reconstruction of the psychic fabric.

En este trabajo describo un recorte del análisis de Joaquim, un niño de ocho años, que, a pesar de estar cronologicamente en la latencia, inició el proceso analítico en un estado inmaduro y perturbado. Trato de mostrar como la participación de la analista en la construcción narrativa de las temáticas inconscientes de las sesiones permitió tanto la elaboración de una situación traumática con una progresiva posibilidad de representar lo compartido, cuanto la reconstrucción del tejido psíquico.