Long-term functional stability of sacrospinous ligament-fixation repair of pelvic organ prolapse.

The objective of this study was to evaluate the variation over 5 years of functional discomfort associated with pelvic organ prolapse (POP) repaired by sacrospinous ligament fixation (SLF). A total of 178 women who had undergone SLF from 1992 to 2001. In 2002 and 2008, patients were sent a questionnaire including the pelvic floor distress inventory (PFDI-20); 79 responded and comparison of those data served to evaluate subjective signs at 5 years. This population was divided into two groups: ≤60 and >60 years old, and their 2002-2008 differences were compared. The outcomes were satisfaction, functional results and sexuality. Mean follow-up was 115 (72-173) months. Our results showed the long-term stability of SLF functional outcomes for women >60 years. However, for those≤60 years, functional outcomes and satisfaction had declined at 5 years.

[Cervical pregnancy: a rare case of reimplantation after abortion. A case report]. / La réimplantation cervicale de la grossesse, une complication méconnue des interruptions volontaires de grossesse. À propos d'un cas.

Cervical pregnancy is a rare form of ectopic pregnancy defined by the implantation of the blastocyst in the cervical canal. Most of the cervical pregnancies have been reported in patients with a history of vacuum curettage or caesarean section. The authors report a case of cervical pregnancy occurred after a failure of medical abortion. A literature review discusses the possibility of a cervical secondary implantation and describes the management of such pregnancies.

[Efficiency of the transobturator suburethral tape in the treatment of 61 patients presenting intrinsic sphincter deficiency]. / Efficacité de la voie trans-obturatrice dans le traitement de l'incontinence urinaire d'effort par insuffisance sphinctérienne urétrale: à propos de 61 cas.

OBJECTIVES: To evaluate the effectiveness of the transobturator route in the treatment of intrinsic sphincter deficiency in the stress urinary incontinence. PATIENTS AND METHODS: This is a retrospective multicenter study. Sixty-one patients with a low-uretral closure pressure were treated for stress urinary incontinence using the transobturator route. The intrinsic sphincter deficiency was defined according to criteria of the Société internationale francophone urodynamique (Sifud). The satisfaction of the patients was appreciated in postoperative consultation in the short run (six to 12 months) and by using the questionnaire "Contilife" evaluating the quality of postoperative life in the long run. The failure was defined when the patients declared themselves dissatisfied during the postoperative consultation and/or if their "Contilife" score was lower than seven (out of 10). RESULTS: The short-term evaluation reveals a rate of satisfaction of 92%. The questionnaire "Contilife" reveals 70% of very satisfied or satisfied patients. Eighteen percent of failure is noted. The majority of the patients in failure had urinary urgencies and/or overactive bladder. DISCUSSION AND CONCLUSION: Transobturator vaginal tape can be used in the treatment of patients having a low-uretral closure pressure. The patients must be informed of a success rate slightly lower than in women having a primary genuine stress incontinence.

[Screening and timing for the delivery of fetuses with intrauterine growth restriction of vascular origin]. / Dépistage et programmation de la naissance des foetus présentant un retard de croissance intra-utérin d'origine vasculaire.

The prenatal management of fetuses with intrauterine growth restriction (IUGR) has been a matter of perpetual evolving in obstetrics and has been the topic of numerous studies. The management of IUGR fetuses is currently available in tertiary centres using fetal heart monitoring, short term variability, or doppler investigation of the umbilical artery, ductus venosus and middle cerebral artery. The aim of the prenatal management is to detect anomalies that may predict severe fetal hypoxemia. On the other hand, any efforts should focus on the possibility to delay the time for delivery as gestational age at delivery together with birth weight appear to be essential parameters of the postnatal outcome.

Contribution of three-dimensional volume contrast imaging to the sonographic assessment of the fetal uterus.

OBJECTIVE: To investigate the contribution of volume contrast imaging (VCI) in assessing the fetal uterus in normally developed female fetuses. METHODS: The pelvis of 38 normal female fetuses was examined at 20-22 and 32-34 weeks' gestation using both conventional two-dimensional (2D) ultrasound and VCI on the same transverse or oblique longitudinal view of the fetal pelvis. Two experienced sonographers evaluated the ability of both techniques to image the fetal uterus. Results were compared by kappa index to evaluate the interobserver variability. RESULTS: A clear picture of the fetal uterus was obtained in 50% and 82-87% of the cases at 20-22 weeks' gestation and in 80-85% and 95-100% of the cases at 32-34 weeks' gestation using conventional 2D ultrasound and VCI, respectively. There was moderate to good agreement of uterus visualization between the two observers, with kappa values ranging from 0.43 to 0.65. The lower level of agreement was obtained for conventional 2D ultrasound during the second trimester. CONCLUSIONS: Our results suggest that VCI may be successfully applied to prenatal ultrasonography of the fetal pelvis anatomy. By enhancing the contrast between the intrapelvic organs, VCI provides a clearer picture of the fetal uterus.

[Recording expulsive forces during childbirth using intercostal muscle electromyogram: a pilot study]. / Monitorage des efforts expulsifs pendant l'accouchement par l'électromyogramme des muscles intercostaux: étude pilote.

OBJECTIVE: The expulsive forces of childbirth can be included among the many potential risk factors implicated in the subsequent development of perineal disorders. The objective of this study was to devise a non-invasive way to measure abdominal pushing that would accurately represent the expulsive forces during childbirth. PATIENTS AND METHODS: By means of intravesical and intrauterine manometry, and electromyography (EMG) of intercostal muscles, we quantified these forces in 21 women during vaginal delivery. RESULTS: A mixed Ancova model showed the integral of intravesical pressure to be significantly associated (P<0.001) with the integral of intercostal muscle electrical activity during the first 6 uterine contractions during the phase of fetal expulsion. DISCUSSION AND CONCLUSION: Electromyography is a non-invasive measurement that can replace intravesical determinations to quantify these forces as it reflects the real intra-abdominal pressure.

[Preterm corticosteroid therapy and fetal immobility. Case report]. / Diminution des mouvements actifs foetaux et cure de corticoïdes. A propos d'un cas.

We report a case of fetal immobility following antenatal corticosteroid therapy administered to women in thirty weeks at risk of preterm labor. The short-term side effect of corticosteroid, a decrease in fetal heart rate variation are well known. This case report presents the difficulty of therapy choice in front of fetal immobility and acute fetal distress. We chose a medical supervision. A review of the literature suggests other criteria, such as Doppler of umbilical artery, which could help therapeutical choice.

Prospective 3D ultrasonographic evaluation of immediate postpartum urine retention volume in 100 women who delivered vaginally.

Our objective was to determine the reproducibility and validity of urine retention volumes measured by 3D ultrasonography (3D-US) 2 h postpartum. This was a longitudinal prospective study of 100 women who delivered vaginally. Each woman underwent five successive urine retention measurements with the Bladder Scan 2 h after vaginal delivery, followed by transurethral catheterization to determine the real volume. The reproducibility of only the last four scan values was analyzed with an intraclass correlation coefficient, and that of determinations 4 and 5 with a Bland-Altman plot. The validity of the device was similarly evaluated using the mean four-scan and real values. Pearson's correlation coefficient was calculated and a least-trimmed squares robust linear-regression model was used. All tests were two-sided with a 5% alpha risk. Results showed that 3D-US measurements were highly reproducible, with an intraclass correlation coefficient of 0.974 (95% CI:0.964-0.981). 3D-US also accurately estimated the real urine volume (intraclass correlation coefficient 0.924; 95% CI:0.888-0.949), but tended to underestimate by about 6.8%. The between-technique Pearson correlation coefficient was 0.94 (P < 0.0001) and the regression analysis gave an R2 of 0.914. Urine retention volumes exceeded 500 ml in 55 women, and 11 in 7. We concluded that 3D-US was reliably able to measure postpartum urine retention volume.

[Mother-to-child transmission of hepatitis C virus: recent news about the benefit of caesarean sections]. / La transmission materno-foetale du virus de l'hépatite C : actualités sur l'intérêt de la césarienne.

The rate of mother-to-infant transmission for hepatitis C virus is estimated to be around 5% of viraemic mothers and represents an important route of HCV infection among children. Transmission is possible in utero but the highest risk of infection is at or near the time of delivery because of an important blood transmission of hepatitis C virus. Mothers with high levels of HCV-RNA and co-infected for human immunodeficiency virus are documented to have risk factors for vertical transmission of HCV. Thus, for these, the mode of delivery must be discussed even if there are no precise recommendations. Among obstetrical risk factors, the results of literature fail to prove a benefit of elective caesarean delivery in the aim to reduce the vertical transmission of HCV. However, obstetrical situations with a high risk of blood contact between mother and foetus must be considered and if possible evicted.

[Osteochondrodysplasia: nosologic assessment and report of 6 clinical cases]. / Osteocondrodisplasie: inquadramento nosologico e descrizione di sei casi clinici.

Osteochondrodysplasias represent an important group of disease affecting cartilage and/or bone. The clinical evidence of disarmoniuous low stature, of a disproportion between trunk and limbs length, of a big skull can suggest this diagnosis and the necessity to carry out all the instrumental investigations. The diagnostic suspect can be placed, some time, already in the neonatal period. The complexity of problems regarding the osteochondrodysplasias bearer child and his family requires a multidisciplinary approach. The Authors present a personal experience of six cases of osteochondrodysplasias observed in a period of fifteen years.

[Lead concentrations in breast milk of women living in urban areas compared with women living in rural areas]. / Concentrazione del piombo nel latte materno di donne residenti in aree urbane rispetto a donne residenti in aree rurali.

In the last twenty years a great interest has grown up about the accumulation of lead in the environment, because many studies have found relationship between exposure to low lead doses and neuropsychological impairment of children. The Authors have measured and then compared the lead content of milk from women living in city-areas and women living in rural areas, not having professional lead exposure. 34 samples of women milk from the rural areas and 20 samples from the city areas were examined: the lead mean concentration of the rural areas milk samples was 45.62 microgr/l with a range from 0 to 425 microgr/l; the mean concentration of the city areas samples was 126.55 microgr/l with a range from 1 to 472 microgr/l. The data were compared with the Student t-test and the difference was statistically significant at p = 0.01. The Authors examine the correlations between environmental lead accumulation and increased lead concentration in woman milk, laying stress on the possible hazard to health and neuropsychological development of children, mostly of those living in urban areas with heavy road traffic and industrial activity.

[Clinical and diagnostic approach to children of low stature. Evaluation of a 24-month hGH treatment of patients with growth impairment of diverse etiopathogenesis]. / Approccio clinico-diagnostico al bambino con bassa statura. Valutazione della terapia con hGH a 24 mesi in soggetti con deficit dell'accrescimento di diversa eziopatogenesi.

Growth retardation represents a frequent reason of consultation of Clinical Centers interested in Pediatric Endocrinology. Short stature is a problem especially considered by patients and their families, either because of fear of organic pathologies possibly underlying growth retardation, or because of psychological implications, frequently related to growth retardation and short stature. The Authors describe their clinical and diagnostic approach to short stature; general data from 302 patients followed and treated for growth delay are presented. Clinical experience with recombinant growth hormone (hGH) is discussed in detail: a total of 61 prepuberal children (9 with classic GH deficiency, 26 with partial GH deficiency, 18 with neurosecretory deficit, 6 "short normals", one patient with Turner's syndrome and one case of skeletal dysplasia) have been treated with hGH for a period ranging from 12 to 24 months. Height velocity (expressed as cm/year) increased significantly in all considered groups during the first and the second year of treatment, while considering standard deviation values for chronological age, all treated subjects increased significantly their stature after one year of therapy, but only patients with total GH deficiency appeared to obtain a significant gain after a 2-year course with hGH. No significant adverse effects attributable to hGH administration were observed.

[Effects of ovarian and peritoneal endometriosis on fertility. Experimental study]. / Effetti dell'endometriosi ovarica e peritoneale sulla fertilità. Studio sperimentale.

Fertility after ovarian and peritoneal endometriosis experimentally induced has been studied. The fertility rate in the animals with ovarian endometriosis was decreased of 40% and the same reduction was found in the animals with peritoneal endometriosis. Not only the direct effect from adhesion formation, but also changes in the peritoneal fluid or its constituents are proposed as causes of endometriosis-associated infertility.

[Morpho-functional study of the rabbit ovary after cauterization]. / Studio morfo-funzionale dell'ovaio di coniglio dopo cauterizzazione.

The authors investigated the lower incidence of post-operative adhesion formation after cauterization in comparison with microsurgical wedge resection in rabbit ovaries. Microscopic examination of cauterized ovaries did not show extensive necrosis in the depth of ovarian tissue. Electrocautery seems to be an effective alternative to ovarian wedge resection.

[Use of prostheses made of ePTFE in anastomoses of the rat uterine horn]. / Impiego di protesi in ePTFE nell'anastomosi di corno uterino di ratto.

ePTFE prostheses were used in the microsurgical anastomosis of the rat uterine horn. Handling characteristics of this synthetic material during the performance of anastomosis were tested. Patency rates, infections and local tissue reaction were evaluated after thirty and sixty days. Connective tissue infiltration and incomplete endothelialization by normal endometrial elements were observed on the luminal surface of the prosthesis.

[Althesin in "continuous perfusion" in urologic surgery; a preliminary note]. / L'althesin in "perfusione continua" nella chirurgia urologica; nota preliminare.

Althesin was used as the main anaesthetic in 44 urological operations. The "continuous perfusion" technique is described and an account is given of the main biological parameters, the features of the return to consciousness, and the secondary effects that make althesin particularly useful in lengthy operations on high-risk aged subjects.