Sensitivity and specificity of ultrasound indices of ovulation in spontaneous cycles.

OBJECTIVE: Evaluation of sensitivity and specificity of 4 ultrasound indices of ovulation. STUDY DESIGN: Multicenter collaborative study of 794 abdominal and transvaginal ultrasound scanning of ovaries performed during 271 cycles in 107 normally fertile women. Comparison of sensitivities and specificities of indices using McNemar test. RESULTS: The sensitivity and specificity of the indices were 84 and 89.2, respectively, for disappearance or sudden decrease in follicle size; 38.4 and 79.7 for appearance of ultrasonic echoes in the follicle; 61.6 and 87.1 for irregularity of follicular walls; 71.0 and 88.2 for appearance of free fluid in the cul-de-sac of Douglas. CONCLUSION: Ultrasonic echoes had a significantly lower sensitivity (P<0.001) and specificity (P<0.01) than other indices.

[Folic acid supplementation by 200 microgram per day during the periconceptional period: a necessary public health approach to reducing incidence of spina bifida]. / La supplémentation en acide folique à 200 micrograms/j pendant la période périconceptionnelle: un comportement de santé publique nécessaire pour réduire l'incidence du Spina-bifida.

The incidence of neural tube closure abnormalities, and particularly Spina-bifida is correlated with a low dietary intake of folic acid, for which the marker is the erythrocyte folate concentration. Initially, preventive policies concerned women treated with anticonvulsant agents and those with a known family history of Spina-bifida. This constituted secondary prevention. The objective of this study was to demonstrate the methods and respective role of secondary and primary prevention in 1998. The evolution away from secondary prevention towards primary prevention, i.e. aimed at all women who intend to conceive has been based upon the fundamental epidemiological estimate that 95% of cases of Spina-bifida occur in babies born to women without a known family history of this type of disorder. The idea that dietary measures alone may suffice to ensure effective prevention is invalid. However, if used in addition to a mean dietary intake of 200 micrograms folic acid a day, the only use of pharmacological or synthetic supplementation of 200 micrograms/day makes it possible to achieve the desired threshold of Dietary Folate Equivalents of 600 micrograms/day. The dose of 200 micrograms/day has been judged by the authors as being the most effective and safe for use on a large scale in the general population. Today, in 1998, the primary prevention of neural tube closure abnormalities is the subject of an international consensus which recommends folate supplementation of 100 to 200 micrograms/day during the periconceptional period. Implementation of this solution in the context of a health education campaign would meet the expectations of many women, in as much as 66% of them have declared that they would be ready to comply with such primary preventive measures.

Stenting small coronary arteries.

Stenting of small coronary arteries was long contra-indicated because of a high rate of subacute occlusion. We report a single-center registry including 190 patients stented with 2.5 mm balloons. Procedural success was 98% and subacute occlusion rate was 2.6%. Clinical follow-up showed a 24.5% repeat intervention rate. These results seemed acceptable, warranting stent implantation in small arteries in the case of acute or threatened closure. New stent designs and coatings may contribute to the improvement of outcomes and to the decrease in subacute occlusion and restenosis rates.

[Prenatal ultrasonographic diagnosis in the epileptic mother on valproic acid. Retrospective study of 161 cases in the central eastern France register of congenital malformations]. / Diagnostic anténatal échographique chez la mère épileptique sous acide valproïque. Etude rétrospective de 161 cas du Registre France/Centre-Est de malformations congénitales.

OBJECTIVE OF STUDY: To assess the reality and efficacy of antenatal ultrasound diagnosis in epileptic women on valproic acid. STUDY DESIGN: From the France/Central-Est registry of malformations we selected both fetuses and infants presenting with malformations born to epileptic women treated with valproic acid alone or in combination regimens. We studied the evolution in the number of cases diagnosed in utero according to the period, the nature of treatment and the type of malformation. RESULTS: Among the 161 women undergoing valproic acid treatment, 60% were valproic acid alone. This rate was about 100% during the years 1994-1996. About 30% of fetuses/newborns presented with at least one of the malformations usually associated with epilepsy, namely oral clefts and heart diseases. The improvement in the rate of ultrasound diagnosis was the most pronounced for these pathologies. Other major anomalies were specific of valproic acid, accounting for 30% approximately of the malformations observed: 35 spina bifida, 18 hypospadias and 6 limb reductions. CONCLUSION: Any ultrasound examination carried the monitoring of pregnant women should assess morphology and should in the future make it possible to diagnose most of the major malformations of fetus from epileptic women treated with valproic acid.

[Laparoscopic external iliac lymphadenectomy in the treatment of cancer of the cervix uteri]. / La lymphadénectomie iliaque externe per-coelioscopieque dans le traitement du cancer du col utérin.

OBJECTIVES: The aims of this study are to evaluate the feasibility of laparoscopic iliac external lymphadenectomy and to define current indications of this technique in pre-treatment staging of cervical carcinoma. MATERIAL AND METHOD: Forty seven patients with FIGO stages IA-IIIB invasive cervical cancer underwent transperitoneal laparoscopic iliac lateral lymphadenectomy prior to initiation of treatment. The mean length of operation was 115 min (35-180). An average of 14 nodes were retrieved from each patient (3-30). Percentage of complete removal was 96% in this study. The rate of complications was 6%, they were always minor. Today's most accepted indications concern: 1) FIGO IA2 stages with lymphovascular involvement or micro-invasion over 3mm, for which a simple resection of lesions can be performed if pN0. 2) Small FIGO IB stages where an exclusive vaginal enlarged colpo-hysterectomy can be performed for pN0. Other indications should not be performed for the moment except for therapeutical trials.