[An unusual cause of sciatica: soft tissue desmoid tumor. Apropos of 2 cases]. / Une cause exceptionnelle de sciatique: la tumeur desmoïde des tissus mous. A propos de 2 observations.

The authors report 2 cases of sciatica resulting from nervous compression by a desmoid tumour in women aged 33 and 27 years. In each case, careful exeresis did not prevent recurrence as shown by tomodensitometry. Eight other well-documented cases were found in the literature. The desmoid tumour penetrates the buttock and thigh muscles and presses the sciatic nerve. The patients often suffer from previous and persistent sciatica which can combine with hip restriction. The responsible tumour made up of abundant bundles of collagenous fibers, a small number of fusiform cells without mitosis or atypics and on the periphery degenerative and dissociated muscle fibers is usually discovered late. Tomodensitometry is the best means of detection, evaluation of the extent, adhesions and recurrence during the observation period. Treatment is usually surgical and success depends on the quality of the exeresis. Other methods, corticoid, anti-oestrogen and radiotherapy, sometimes effective in desmoid tumours of the abdominal wall, do not prevent recurrence in the buttocks or thighs which are of sciatic derivation.

[An urethromanometric study using micro-pressures gauges for female urinary incontinence. A definition of the index of continence. Applications (author's transl)]. / Etude urétromanométrique par microcapteurs de l'incontinence urinaire féminine. Définition d'un indice de continence. Applications.

The study has resulted from comparing urethral pressure curves measured with the use of a catheter with two micropressure gauges in 34 continent and 100 incontinent women. Two types of tracing were obtained: first of all at rest and then with the woman coughing repeatedly. Of the different parameters that were measured at rest only one seems to be advantageous over the others. That is the pressure at the maximum closure which becomes less with incontinence and with ageing. The curves that have been produced with effort make it possible to analyse what happens to this pressure when maximum closure is effected. This always rises in patients who are continent and always lessens in patients who are incontinent. The ratio of these two values, Pc with maximum effort over Pc at maximum rest, allows an index of continence (IC) to be drawn; and which conveys the ability of the sphincter apparatus to adapt itself, and which gives a quantitative value to female continence. Its practical application makes if possible to confirm the diagnosis and adapt the therapy to be used in many incontinent patients in whom other tests have been unrevealing, and to unmask incontinences that have been masked by prolapse and to identify possible future incontinent patients.

[Residual slowing of the heart in the first stage of labour. The interpretation and the prognostic value of this sign (author's transl)]. / Les ralentissements résiduels pendant la dilatation. Interprétation et signification pronostique.

117 deliveries in which fetal heart slowing was accompanied by residual bradycardia where at least one measure of the fetal pH was undertaken (212 measures were carried out in the whole series) allowed the authors to analyse the maximum and residual amplitudes, the regular or irregular morphology. The frequency of the slowing and its relationship to uterine contractions (regular or variable) and the number of episodes of slowing were recorded before any measures of the fetal pH in utero were undertaken. The regular morphology and the size of the residual degree of bradycardia beyond 30 Bpm are of great diagnostic importance. In fact, while slowing with residual bradycardia below 30 Bpm is tolerable, beyond this 19% of cases show fetal acidosis when slowing is irregular or variable, and 76% when slowing is regular (53 of these had severe acidosis with a pH of less than 7.20). In this last group, which is by far the most dangerous, acidosis appeared after 5 episodes of slowing and became constant after more than 10 episodes. Because of this, measuring pH in the presence of residual slowing would seem to be only useful in irregular types of slowing.

[Perinatal mortality in twin pregnancy. 576 case histories (author's transl)]. / La mortalité périnatale dans la grossesse gémellaire. Etude de 576 observations.

The authors report on the result of a retrospective survey which they carried out in 8 Hospital Centres in the West of France between 1975 and 1978 and these were concerned with 576 twin pregnancies. This study confirms that the fetal prognosis in twins is precarious. The perinatal mortality is high and is made up at the same time of a stillbirth rate of 5 per cent and a neo-natal mortality rate of 6 per cent, which is mainly due to prematurity (49.6 per cent) and to intra-uterine growth retardation in 19.3 per cent. Studying these results and the figures given in the literature, the authors analyse the ways in which this mortality can be reduced: early diagnosis, rest, screening for fetal low growth and a sensible broadening of the indications for Caesarean section. This broadening appears to them to merit consideration especially in three circumstances: intra-uterine growth retardation, premature labour between the 31 and 33 week after the last period and transverse presentation of the second twin that cannot be turned.