[Adenoid cystic carcinoma of the breast]. / Le carcinome adénoïde kystique du sein.

One the basis of personal observation and a review of recent literature (which is somewhat sparse), the authors describe the characteristics of adenoid cystic carcinoma of the breast which is a very unusual tumor. They stress the diagnostic difficulties which frequently make it necessary to use histochemical or immuno-histochemical diagnostic techniques which have been widely developed.

[Is peritoneal endometriosis painful?]. / L'endométriose péritonéale est-elle douloureuse?

Using a study of 306 coelioscopies as a basis, the authors try to define the relationship existing between the observation of lesions of peritoneal endometriosis and the symptom of pain. Certain observations raise the doubt of there being a cause/effect relationship (i.e. high incidence of peritoneal endometriosis in women without symptoms of pain, only 40% of cases of peritoneal endometriosis are associated with pain, very high incidence of associated lesions or psychiatric history in women with painful peritoneal endometriosis). While unable to rule out the responsibility of lesions of peritoneal endometriosis in the genesis of pelvic pain, they nevertheless believe that such an observation should lead the physician to be critical (is the pain psychogenic?) and thorough (investigation of genital or extra-genital associated lesions) before any conclusion is drawn. In certain cases, the reply will be given by the therapeutic test.

[Age, gynecologic status and urinary stress incontinence]. / Age, status gynécologique et incontinence urinaire d'effort.

Based on a series of 1,000 female patients examined in office practice, the authors of this study seek to define the incidence of USI according to the patient's age gynecological status. Concerning age, this factor only has a clear effect in patients over 35 years of age. No significant difference in the incidence of USI was observed between sexually active women over 35, women approaching the menopause or post menopausal women; for this reason, the authors believe that in these cases, USI is related more to concomitant factors than to trophic lesions which however certainly are also present. During pregnancy, USI frequently occurs during the 2nd and 3rd trimesters; in contrast, in the first trimester of pregnancy, frequently there is increased intraabdominal pressure thus explaining why the incidence of USI is less than in sexually active women.

[What lesions of the myometrium are responsible for hemorrhage?]. / Quelles sont les lésions du myomètre responsables d'hémorragies?

Based on a personal series of 54 cases of endo-uterine haemorrhage with normal endometrium, the authors show that lesions of the myometrium which may result in haemorrhages, consist mainly of interstitial or submucous myomas and adenomyosis, i.e. lesions on which medical treatments are ineffective. Ultrasonography, but mainly clinical data and hysterography very often demonstrate the lesions and are sufficient to indicate a hysterectomy or a myomectomy. The problem is more difficult when the clinical, ultrasonographic and hysterographic work-up is negative or barely evocative. In these cases, after ruling out certain functional haemorrhages or a haemorrhagic disease, it is useful to take an histological sample of the endometrium either by curettage or biopsy, on an ambulatory basis (using Inocurette for instance). If this examination is normal, hysterectomy is indicated, because, in their experience, there are such lesions of the myometrium, that recurrence of the haemorrhages is inevitable.

[Indications and contraindications of peridural anesthesia in obstetrics. Review of the literature]. / Indications et contre-indications de l'anesthésie péridurale en obstétrique. Revue de la littérature.

With the help of an extensive review of the french and foreign literature, and personal statistics concerning 500 peridural anesthesias (PDA), the authors analyze the indications and contraindications of this type of anesthesia, in 1987. It is possible to differentiate well accepted indications: caesarean section, inducement, labor test, dynamic dystocia, delivery of fragile fetus, desire of the patient; definite contraindications: patient's refusal, coagulation disorders, emergency situations, some cardiopathies; debatable indications: breech delivery, scarred uterus, twin delivery, maternal medical problem, where each particular case must be evaluated. In his study, the authors demonstrate that indications tend to become broader and contraindications to become more infrequent. They stress a necessary co-operation between obstetrician and anesthetist to make this decision.

[Menorrhagia, metrorrhagia and the endometrium. Apropos of 300 cases]. / Ménorragies, métrorragies et endomètre. A propos de 300 cas.

The authors report on the different aspects they have observed when they studied 300 case histories of patients who had a histological examination of the endometrium for menorrhagia or metrorrhagia. In 9.9% of the cases the endometrium was normal. In those cases there was an associated lesion particularly of the myometrium. Whatever the type of bleeding, the most common finding was hyperplasia. The authors emphasize that this can evolve to dysplasia (4% of their cases) and to carcinoma of the endometrium (3% of the cases).

[Contribution of celioscopy to the diagnosis and treatment of female sterility]. / Apport de la coelioscopie dans le diagnostic et le traitement des stérilités féminines.

After having specified the current place of celioscopy in the study of female sterility, the authors try to specify, with the use of a short personal series of 64 cases and a large review of the literature, the diagnostic and therapeutic advantage of celioscopy. It is a particularly performing examination for the etiological diagnosis of tubal and peritoneal sterilities, contradicting sometimes the data provided by hysterography. In their experience, it enables to offer a suitable therapeutic strategy in 81% of the cases, whether it is abstention, medical treatment, immediate surgical treatment (per celioscopy, laser or laparotomy) or secondary surgical treatment. Thus, the authors obtain 48 pregnancies in 35 patients (60%). Although it concerns a subjective element, the relationship between celioscopy and the occurrence of pregnancy is discussed.

[An ultrasonic trap: pseudocystic degeneration of uterine myomas]. / Un piège échographique: la dégénérescence pseudokystique des myomes utérins.

The authors present a rare case of pseudocystic degeneration of fibroids for which they had used an ultrasound scan before the operation. They point out that the ultrasound pictures they found were very similar indeed to those shown by patients with multiloculated ovarian cysts. They emphasize that ultrasound does have its limits in the diagnosis of pelvic tumours.

[Etiology of perimenopausal organic hemorrhages of uterine origin]. / Etiologies des hémorragies organiques périménopausiques d'origine utérine.

The authors study the etiologies of organic uterine bleeding during the menopause in 66 of their own cases. Benign lesions of the endometrium and of the myometrium are, of course, the most common, but the possibility of pregnancy and particularly that of malignant lesions must not be forgotten. The authors emphasize the importance of obtaining endometrial samplings, in particular using the Inocurette, and of the importance of making a histological diagnosis. They seem to be able to define a population at increased risk for cancer, which should be followed more closely.

[A case of a well-tolerated spontaneous post partum uterine inversion]. / Un cas d'inversion utérine spontanée du post-partum très bien tolérée.

The authors report the unusual case of spontaneous inversion of the uterus that occurred three days after a normal delivery. Clinically this was very well tolerated. There did not seem to be a constriction ring which normally occurs in there cases. The authors were therefore able to wait until it was quite safe to give the patient an anaesthetic. Manual replacement was easy bu inversion recurred immediately. A pack was therefore put inside the uterus, and the uterus closed down satisfactorily on it in the right position. When the pack removed under anaesthesia 48 hours later inversion did not recur.

[Supraventricular tachycardia in utero. Apropos of a personal case, review of the literature]. / La tachycardie supraventriculaire in utero (TSVF). A propos d'un cas personnel, revue de la littérture.

After describing a case of early hydrops fetalis in a fetus demonstrating supraventricular tachycardia (TSVF) the authors review the literature: First they note the increase in the number of cases of TSVF published in the last few years, thanks to better means of monitoring pregnancies and to the place taken by TSVF among the different other troubles of fetal heart rhythm than can occur. The second section enumerates and analyses the pathological associations and the complications that have been observed in cases of TSVF that have been indexed. All have a poor prognosis: as far as those cases where there are faults in the rhythm which are associated with or alternate with TSVF, congestive heart failure occurs in 50% of cases, and organic heart pathological conditions in 20% of cases. 19.1% die. The third section analyses the means available for diagnosis and prognosis and the value of these means. Diagnosis rests on screening by clinical observation (careful auscultation in every pregnancy, observation of the raised height of the uterine fundus and a lessening in active fetal movements) and by monitoring. Only the ECG can confirm the diagnosis. Congestive heart failure is diagnosed by using ultrasound. A cardiac malformation should be searched for thoroughly by ultrasound. Monitoring in labour has no use as a prognostic indicator. Only repeated measurements of pH can demonstrate fetal distress in labour. The last section is concerned with management: digitalisation is strongly to be recommended before the fetus is mature. Propranolol should be reserved for resistant and severe cases: when there is no congestive heart failure a wait and see policy under strict observation can be followed. If there is congestive heart failure, caesarean section must be carried out. After delivery resuscitation with vagal stimulation is often sufficient, but when it is not digitalisation can be used and very rarely electric cardioversion is needed. Relapses are frequent and treatment must be followed for a year.

[Prognosis for delivery in women with previous cesarean section. Apropos of 209 cases]. / Pronostic de l'accouchement chez la femme antérieurement césarisée. A propos de 209 cas.

The authors have attempted to show the following with the help of 209 cases of delivery in women who had previously had Caesarean sections: Vaginal delivery is possible in approximately one out of every two cases, providing certain precautions have been taken and these are: Maternal morbidity rises to about 12% when a woman is delivered after a previous Caesarean section, whether the delivery is vaginal or, a repeat Caesarean. Furthermore, morbidity rises greatly after a failure of a trial of labour for which the indications should be very carefully considered. The outlook for the fetus is better after a vaginal delivery. In fact, this result seems to be allied to pathology which results from the surgical procedure itself. All the same, respiratory distress in the newborn is more frequent after Caesarean operation, which exposes the fetus to the risks of a uterine rupture and also of increased incidence of instrumental delivery following a previous Caesarean.

[Prevention of rupture of the uterus before or during birth in women with previous caesarian sections: report on 14 cases (author's transl)]. / Prévention des ruptures et prérupture des utérus antérieurement césarisés. A propos de 14 observations.

Based on 14 cases observed during 230 deliveries of women with previous caesarian sections, the authors attempt in define those factors that may weaken hysterotomy scars and provoke uterine rupture. Factors at risk are defined, and can be assessed from the medical history (parity, number of previous caesarians, period since last section, postoperative fever, placenta praevia as the indication for a caesarian, curettage after the operation), and the clinical findings during the present pregnancy (height of the uterus, placenta praevia). Hysterography is an excellent means of evaluating the state of cicatrisation, but this investigational method is rarely available. These elements are employed the define the attitude of the authors towards the end of a previous caesarian. They emphasize the need for early diagnosis of a rupture, and the validity of early emergency caesarian section. Any delay can considerably after fetal and maternal prognosis, which remains goods in the authors' experience.

[A consideration of "avoidable deaths". A study on early neonatal mortality in Ille-et-Vilaine from 1972 to 1977 (author's transl)]. / A propos des "morts évitables". Une étude sur la mortalité néo-natale précoce en Ille-et-Vilaine, de 1972 à 1977.

The authors have made a study of 514 case notes of early neonatal deaths that occurred in Ille-et-Viliane from the 1st January 1972 to the 1st January 1977 among a total of 61,400 deliveries. They had 3 objects in mind: 1. To know what mechanisms had produced these deaths. In order to do this they divided their observations into 4 groups according to what seemed to them at the time to be the primary cause of the death, namely a lethal congenital malformation, a complication occurring in pregnancy, an accident that happened during the delivery, prematurity and dysmaturity. 2. To establish the importance of what is now called "avoidable deaths" and the conditions under which they were produced. 3. To show the means and methods that might eventually reduce this mortality after studying these results. On the conclusion of this study it seems to them that this improvement can here and now be obtained not so much by new procedures as by better monitoring of the state of pregnancy and the puerperium, and by more attention to the classical rules and more sensible use of the numerous techniques that already exist today.