[Pelvic actinomycosis abscess and intrauterine device]. / Abcès actinomycosique pelvien et stérilet.

A case of association between IUD and a left tubal actinomycotic abscess is presented. The 45 year old patient was wearing an IUD for five years. The symptomatology was mainly that of pelvic pain with an associated mass in the left iliac fossa. The working diagnosis was that of a digestive tumor or an adnexal mass. The surgical procedure allowed to identify an inflammatory reaction with a pseudotumoral abscess formation in the left fallopian tube. The etiology was confirmed by the pathology and bacteriology reports. Treatment consists in surgical extirpation of the infected structures and long term antibacterial therapy. Actinomycosis is a rare but potentially serious pelvic disease. It may involve various organs and readily takes on the aspect of tumor formation.

[Screening for trisomy 21 by measuring nuchal translucency during the first trimester of pregnancy]. / Dépistage de la trisomie 21 par mesure de la clarté nucale au premier trimestre de la grossesse.

The purpose of the present literature review is to assess the screening value of trisomy 21 by measurement of fetal nuchal translucency (NT) thickness in the first trimester. NT is a subcutaneous translucency between the skin and the soft tissues overlying the cervical spine, which disappears in the second trimester. Ultrasound examination was used to image a sagittal section of the fetus to measure the maximum thickness of the subcutaneous translucency. NT is physiological for a measurement < 3 mm but the incidence of chromosomal abnormalities (essentially trisomies 21, 18 and 13) increases when NT > or = 3 mm. Differential diagnoses include cystic hygroma and fetal hydrops. For screening purposes, a cut-off threshold value of > or = 3 mm, with a standardized technique, gave a sensitivity > or = 50%, a false positive rate < 5% and a positive predictive value > 1%. In the chromosomally normal group, prognosis was good, but incidence of structural defects and fetal loss increased, with a sharp rise in these complications for fetal translucency thickness > or = 5 mm.

[Short-term outcome of infants from triplet pregnancies. A series of 45 pregnancies]. / Devenir à court terme des enfants issus de grossesses triples. A propos d'une série de 45 grossesses.

OBJECTIVE: To evaluate outcome of triplets pregnancies. METHODS: A retrospective study about children of 45 triplet pregnancies which occurred spontaneously or after assisted reproductive technologies. All were managed by the same obstetrical and pediatric team. RESULTS: Mean birth weight was 1800 g and 26% of children were very low birth weights (< 1500 g). There was no difference in the mean Apgar score of pH between first, second and third infant. Neonatal and perinatal mortality rate were respectively 60 and 75%. Incidence of respiratory distress syndrome was 29%, hyaline membrane disease 11%, intraventricular hemorrhage (grade 4) 1.3%, necrotizing enterocolitis 10.5% and bronchopulmonary dysplasia 4%. Only 10% of the infants were not hospitalized and were kept by their mother. 38% of the newborns had to be hospitalized in a Neonatal Intensive Care Unit, with a mean stay of 6 days. At birth, 34% of the babies required intubation for artificial ventilation. CONCLUSIONS: The main problem of triplet pregnancies is high prematurity.

[Obstetrical management of triplets. A series of forty five cases]. / Prise en charge obstétricale des grossesses triples. A propos d'une série de 45 cas.

OBJECTIVE: To evaluate management of triplet pregnancies. METHODS: A retrospective study of 45 triplet pregnancies which occurred spontaneously or after assisted reproductive technologies. All were managed by the same obstetrical and pediatric team. Obstetrical data were collected. RESULTS: Major etiologies were fertility drugs and in vitro methods (66%). Mean maternal age as 30 years, higher with assisted reproductive technologies (p < 0.05). Risks of chorioamniotitis, preeclampsia and anemia were respectively 4.4%, 13.3% and 70%. Triplets had a 100% prematurity rate and mean gestational age was 33.6 weeks; 22.2%, 51.1% and 64.4% delivered before respectively 32, 34 and 35 weeks of gestation. Triplet had a 91% cesarean section rate. CONCLUSION: Triplet pregnancies present a high risk of prematurity and infertility specialists have to be vigilant in the use of fertility drugs. Their management requires early reduced maternal physical activity.

[Hemorrhage during the 3d trimester of pregnancy]. / Les hémorragies du troisième trimestre de la grossesse.

Bleeding during the final three months is a serious event. Mortality is very slight in developed countries but morbidity remains considerable. Fetal mortality and morbidity are notable, linked to resultant pathology or prematurity. Their existence requires hospitalisation in a department of gynecology/obstetrics, with a team including an obstetrician, anesthetist/intensive care specialist, and pediatrician. Bleeding is due to placental separation involving the inter-villous chamber (basal decidual hematoma) or the marginal region (marginal decidual hematoma). Precise diagnosis of refractory bleeding is essential and must be obtained simultaneously with treatment. Maternal and fetal prognosis can only be improved by early and appropriate management. The treatment of serious cases is based upon intensive therapy including the replacement of losses, the correction of possible hemostasis problems and fetal extraction. Delivery is a critical phase, with the risk of extremely heavy bleeding and decompensation. This stage of labour requires careful monitoring and intensive therapy without delay.

[Tamoxifen and cervico-vaginal cytology]. / Tamoxifène et frottis cervico-vaginal.

The impact of tamoxifen on the genital tract was assessed by cervico-vaginal cytology. Fifty two post-menopausal patients treated with tamoxifen for breast cancer were regularly monitored, with a pre-treatment reference smear showing a profoundly menopausal status, followed by an anual smear. Smears returned to a functional status in 44% of patients after 2 to 5 years treatment. The agonist effect of tamoxifen appears to be beyond any doubt, and responsible for certain adverse reactions. This should not bring into question the usefulness of the drug, but indicates the need for regular monitoring and, in the presence of a functional smear, further investigation by vaginal ultrasonography is essential in order to evaluate the status of the endometrium.

[Surgical treatment of hidradenitis and Fox-Fordyce disease of the nipples]. / Traitement chirurgical de l'hidrosadénite et de la maladie de Fox-Fordyce aréolaires.

Hidradenitis suppurativa and Fox-Fordyce disease are apocrine sweat gland diseases, characterized by chronic and recurrent forms, with frequently unsatisfactory management and physical discomfort. The localisation to the breast areola is well known but infrequent. A new surgical treatment of areolar involvement is presented. This technique includes: dermal detachment of the areola safeguarding the nipple, excision of the underlying apocrine sweat glands, areola fixation like a flap-total skin graft. This very simple procedure allows definitive treatment without aesthetic impairment. Two cases of areolar involvement are presented.