[Peritoneal tuberculosis simulating advanced ovarian carcinoma: a case report]. / Tuberculose péritonéale disséminée simulant un cancer ovarien: à propos d'un cas.

Disseminated peritoneal tuberculosis accounts for 1-3% of tuberculosis disease, represented by high frequency of lung defects in endemic countries. The authors report one case in a 43-year-old woman, the initial interpretation of which, based on pleural and peritoneal exudate, showed suspected latero-uterine mass and significant elevated serum CA 125 level, mimicking disseminated ovarian carcinoma. Only after exploring laparotomy with biopsy was disseminated peritoneal tuberculosis identified, thus correcting the diagnosis. Symptomatology, X-ray defect, and cynetic of serum CA 125 level were left in totality after 3 months of antituberculosis multidrugs. This is a diagnostic trap, which presents a new interest for such pathology as tuberculosis, which is on the increase again in the West.

[Antepartum perineal massage: review of randomized trials]. / Le massage périnéal ante-partum: revue des essais randomisés.

OBJECTIVE: To assess the effectiveness of ante partum perineal massage to reduce the number of perineal injuries and episiotomies through a survey of the existing literature. MATERIAL AND METHODS: [corrected] A search both in English and French on randomized clinical trials using the Medline and Cochrane Library databases. The key words: "Perineum", "massage", "perineum injuries", "randomized controlled trial" were selected from the years 1966 to November 2000. RESULTS: Four randomized controlled trials were found. The definition of the selected issues, as well as the included and excluded criteria varied according to the authors. Perineal massages seemed to reduce the occurrence of perineal injuries and episiotomies, mostly among primipara: Labrecque et al. in 1999, noted an OR of 0.56; 95% CI: 0.61-1.31 and at the opposite an increased rate of intact perineum in the massage group (OR = 1.79; 95% CI 1.27-2.52]; and Shipman et al. in 1997 stressed among women of > or = 30 years old an augmentation of intact perineum in the intervention group (OR = 1.93; 95% CI 1.08-3.48), and in the logistic regression taking into account age and birth weight they found a reduction of episiotomies and important perineal injuries (p = 0.02). CONCLUSION: Ante partum perineal massages would seem valid but further studies would be necessary to evaluate the utility of this intervention in the avoidance of serious perineal injuries and the women's satisfaction.

Urethral cytology and diagnosis of the pregnancy term. About some observations on the use of this method in an hospital setting.

A retrospective study of routine urethrocytograms performed over a 10-year period in 3,478 pregnant women for the diagnosis of pregnancy term was carried out to determine the reliability of urethral cytology when two, three, or four successive urethral smears were performed at 2- or 3-day intervals, and to investigate the correlations between the cytological results and the neurological ages of newborns. Microscopical examination of the 3,478 routine smears demonstrated the existence of a before-term aspect, a near-term aspect, or an at-term aspect in 7.4%, 66.7%, and 22.1% of cases, respectively. The diagnosis of post-term was noted only in 1 smear. Repeated urethrocytograms (1, 2, or 3 smears after the firstone) in women with a previously diagnosed before-term aspect or a near-term aspect revealed the occurence of the at-term aspect over time. Concordant correlations between cytological results and the neurological ages of the newborns were noted in 98.1% of cases. Three developmental stages (beginning, middle, end) of the near-term aspect and three stages of the at-term aspect were described. Due to its interest, the urethral-smear method should be worth generalizing as the other laboratory examinations that are routinely used to determine the term of pregnancy.

[Reflections on compliance in menopause hormone replacement therapy]. / Réflexions sur l'observance du traitement substitutif de la ménopause.

Compliance with hormone replacement therapy (HRT) in postmenopausal women is discussed. Although accurate quantitative evaluation is difficult, estimates in French women are provided. Thirty percent of postmenopausal women are under HRT, but data are lacking on the age groups in which HRT is most prevalent. Given the benefits of HRT in terms of public health, physicians should make every effort to educate their patients, in particular regarding differences between oral contraception and HRT. Other targets for HRT education include general practitioners, health insurance agencies, and the media. Better information provided by physicians and drug companies would allow to increase the use of HRT.

[Traumatic lesions of the pregnant uterus and its contents: medico-legal aspects]. / Lésions traumatiques de l'utérus gravide et de son contenu: aspects médico-légaux.

Pregnant women are not free of the risk of trauma and any abnormality of pregnancy or the child is easily attributed to an accident occurring during the preceding days, weeks or ... months. This study reviews the traumatic complication of pregnancy and methods which can be used to attribute pathological events to the accident deemed responsible. Particularly stressed is the essential need for a meticulous and accurate approach when drafting the initial certificate, the only document available to an expert medical witness called upon to assist the judicial process in case of litigation.

[Current status of estrogen-progestational contraception]. / Le point actuel sur la contraception estroprogestative.

The final decade of the century confirms the importance of latest generation progestogens in terms of decreased risks associated with the use of doses of ethinyl estradiol of 50 gamma or more, equally effective in contraception of this type. These new combination very considerably limit the untoward effects seen in the past regarding carbohydrate and lipid metabolism, as well as cardiovascular disease. Concerning carcinogenesis, the long term protective effect against carcinomas of the endometrium and ovary is now accepted, while studies of breast cancer are not unanimous in their condemnation, the same applying to the risk of hepatocarcinoma. Regulation of cycles is satisfactory and the vaginal flora little affected. Moderate and stable fibroids seem to be well controlled, the same applying to mucosal hyperplasia. Pregnancy, particularly rare, is not influenced unfavourably and the effect on lactation appears to be nil. Provided that regular monitoring is ensured and contraindications are respected, age does not appear to be an absolute limiting factor to its use but the risk of concomitant smoking remains.

[Prevalence of HBs Ag in about 21,500 pregnant women. Survey at twelve French University Hospitals. The Muticentric Study Group]. / Prévalence de l'AgHBs chez près de 21,500 femmes enceintes. Enquête de douze CHU français. Le Groupe d'Etude Multicentrique.

The risk of perinatal B virus transmission is estimated in France on results of limited studies carried out during a long period and essentially in metropolitan area. Systematic screening for HBsAg in pregnancy was decided in February 1992 in France. In order to obtain national data on HBsAg prevalence of pregnant women, the authors have summarized the results obtained from twelve French university hospitals during one year. Among the 21,476 pregnant women studied (French: 16,351 and immigrant: 5,125), the total HBsAg prevalence was 0.72% and was significantly higher in the immigrant women group (2.56%) when compared to that of French women (0.15%). The HBsAg prevalence increased from Mediterranean area (1.75%) to SubSaharan Africa (4.61%) and South East Asia (5.45%). Important variations were observed between the centers (from 0.13 to 2.99%). Among the HBsAg carriers, 16.5% were HBeAg and/or HBV-DNA positive in their serum. The only means to prevent each year in France around 850 chronic HBV infections by vaccination of the neonates consist in systematic HBsAg screening.

[Uterine rupture in a prior cesarean section. Review of the literature and 2 case reports]. / Rupture utérine sur utérus antérieurement césarisé. Revue de littérature à propos de deux cas.

On the basis of two cases, the authors undertake a thorough review of rupture of the uterus affecting the uterus with cesarean section scarring. They evaluate etiological factors, monitoring methods and management. An extensive review of the literature is presented.

[Perineal rehabilitation of female urinary incontinence. Long term results]. / Rééducation périnéale au cours de l'incontinence urinaire féminine. Résultats à distance.

The results of perineal rehabilitation in 101 women with urinary incontinence are evaluated with a follow-up of 18 months (9-37 months). The authors try to precise the clinicals and urodynamicals initials factors of a bad pronostic.

[Prevalence of antibodies to the hepatitis C virus in pregnant foreign residents in France]. / Recherche des anticorps contre le virus de l'hépatite C chez les femmes enceintes d'origine étrangère vivant en France.

Blood transfusion and intravenous drug use are the two main modes of transmission of the hepatitis C virus (HCV). Sexual intercourse seems to play a less significant part in transmission of the HCV and data are still lacking on vertical mother-to-offspring transmission. HCV seroprevalence was determined in 1,084 pregnant foreign residents of France living in a single city (Limoges). Antibodies to the HCV were detected in sera using both the first and second generation Abbott ELISA kits. Sera yielding reproducible positive results with either kit were retested with a blocking test (HCV EIA Neutralization, Abbott) and a second generation RIBA (Ortho) for confirmation. For screening, use of tests detecting both nonstructural and structural antibodies improved results noticeably (5 of 16 sera). Use of confirmation tests was found to be indispensable. Overall seroprevalence was 1.47%. However, results varied across geographic regions or origin, ranging from 0% for Europe, 1.9% for North Africa and 1.78% for South-East Asia, to 4.76% for black Africa. These findings demonstrated the potential for mother-to-offspring transmission among women from high prevalence areas. A prospective study in African an Asian women is being considered to evaluate ineffectiveness and transmission using serial serologic tests and viral genome detection by polymerase chain reaction studies (PCR).

[The effect and consequences of inflammation on urethral cytology in the 9th month of pregnancy]. / Les effets et les conséquences de l'inflammation sur la cytologie urétrale au cours du neuvième mois de la grossesse.

Qualitative and quantitative modifications were observed in urethral smears made from week 37 to week 41 of amenorrhoea and showing leucocytes in the desquamation. The number of cell clusters decreased; the numbers of false clusters and of isolated cells with rounded borders increased. Columnar cells and degenerating isolated nuclei are often seen in these inflammatory smears. The quantitative fluctuations of epithelial clusters and of columnar cells are connected with the number of weeks of amenorrhoea on the one hand, and the quantity of leucocytes on the other. The presence of an inflammatory process can alter the diagnosis as far as the term of the pregnancy is concerned; and therefore limits the use of urethral cytology.

[Prevalence of hepatitis B (Hbs Ag, Hbe Ag, DNA) and delta virus markers, in about 10,000 pregnant women in Limoges (France)]. / Prévalence des marqueurs des virus des hépatites B (Ag HBs, Ag HBe, ADN) et delta, Chez près de dix mille femmes enceintes à Limoges (France).

The risk of perinatal B virus transmission is well known, but is estimated in France on results obtained from blood donors or from urban populations. In the present study, the screening of HBs Ag was carried out during five years (1984-1988), within a sample population of pregnant women (french women: 8,364, immigrant women: 1,206) seen in the university hospital of Limoges. Positive sera for HBs Ag were also tested for the other markers of B virus including specific DNA, and markers of the delta virus. The total seroprevalence of HBs Ag among these women was 0.54%, and was significantly higher in the immigrant women group (2.57%) when compared to that of french women (0.25%). During the same period (1984-1988), the seroprevalence among females blood donor was 0.03%. Among the HBs Ag chronic carrier pregnant women (n = 52), 27% were HBe Ag positive and four of them (31%) had viral DNA in their serum. Viral DNA was found in three women who were HBe Ag negative. Thirteen per cent of the HBs Ag positive pregnant women were infected by the delta virus.

[Urethral cytology and diagnosis of the term of pregnancy. Changes in the morphological aspects during the last trimester]. / Cytologie urétrale et diagnostic du terme de la grossesse. Evolution des aspects morphologiques au cours du dernier trimestre.

Urethrocytograms were made by brushing in women during the last quarter of their pregnancy, from week 28 of amenorrhea to week 38. Two different cell patterns were present in these smears. The A-pattern is composed by round squamous cells, often in clumps. The B-one is characterized by small clusters of more irregular polygonal squamous cells. The A-pattern was more frequent until week 32; the B-pattern was predominant in further smears until week 38. The presence of the A- and B-patterns in the smears may cause confusion for the cytologist respectively with the at-term- and near-term-patterns. The authors emphasize the interest of these studies in the early deliveries.

[Pregnancy and delivery after the age of 40]. / Grossesse et accouchement après 40 ans.

When pregnancy occurs in a woman who is more than 40 years of age there are certain risks, ranging from the risks of chromosome abnormalities to those associated with grand multiparity and the syndrome of "the precious baby", when it is a first pregnancy. We have looked at the case notes of 52 patients who delivered after the age of 40. This was a total of 59 pregnancies which occurred in our service between the 1st January 1981 and the 31st December 1986. Of these patients 6 were primiparous, which was 1.17% of all those women delivered in the service. 83% delivered vaginally, with or without the help of forceps. In this group hypertension as well as vein troubles and fatness are more common. Prematurity was of a low order (3.4%), as was perinatal mortality as compared with other series in the literature. We only had one case of trisomy and this was very upsetting for us because we could not get across to our patients the importance of antenatal screening in more than one third of all cases.

[Longitudinal study of the changes in glycosylated hemoglobin in normal pregnancy]. / Etude longitudinale des variations de l'hémoglobine glycosylée au cours de la grossesse normale.

A longitudinal study of HbA1c levels during normal pregnancy was carried out on 54 women. Three measurements were systematically performed around the 14th, the 24th and the 33rd weeks of gestation. On average, an initial decrease was observed in the first period, followed by a significant increase in the second period. The latter increase was negatively related to age (r = -0.33; p less than 0.05) and to prepregnancy weight (r = -0.26; p = 0.06), but neither to the birth weight of the offspring nor to total weight gain. The variation of HbA1c in the first period was not related to any of these four factors.