[Correlation between the perineal-to-skull measurement by tranperineal ultrasound, failure of vaginal operative delivery and maternal-fetal morbidity]. / Corrélation entre la mesure de la distance périnée-crâne à l'échographie transpérinéale, les échecs d'extraction instrumentale et la morbidité materno-fœtale.

OBJECTIVES: To assess the influence of the perineal-to-skull measurement by tranperineal ultrasound (TPU) on the outcome of vaginal operative extraction together with maternal and fetal morbidity. MATERIALS AND METHODS: Retrospective, monocentric and descriptive study was done on 272 patients, from 2009 January 1st to 2009 December 31st. It compares the failure rate of instrumental extraction, total caesarean section rate together with the maternal morbidity (type of perineal tears and post-partum hemorrhage rate) and fetal morbidity (5' Apgar score, arterial pH, transfer in neonatal intensive care unit) to the values obtained with TPU. RESULTS: There is a correlation between the perineal-to-skull measurements higher or equal to 50mm at TPU and the instrumental failure rate (<50mm 0.8% vs. ≥50mm 11.9%; P<0.0001), caesarean (0.9% vs. 33.3%; P<0.0001), post-partum haemorrhage (3% vs. 11.9%; P=0.02), et paediatric intervention (16.7% vs. 31%; P=0.03). CONCLUSION: Perineal-to-skull distance measured with TPU higher or equal to 50mm is at risk of instrumental failure and maternal morbidity. Associated with clinical examination and usual obstetrical risk factors, TPU could be useful to the decision between operative vaginal delivery and prophylactic caesarean section.

[Plication of suburethral slings as treatment of persisting or recurring stress urinary incontinence]. / Plicature de la bandelette sous-urétrale comme traitement de l'incontinence urinaire d'effort persistante ou récidivante.

OBJECTIVE OF THE STUDY: Feasibility and efficiency study of mesh readjustment in suburethral slings by overcoat plication in case of persisting of recurring stress urinary incontinence in patients with suburethral slings. METHODS: Retrospective and monocentric study including patients that present with a failure or recurring incontinency after suburethral slings surgery. The eligibility was evaluated after a complete clinical and paraclinical statement, proving the recurrence of the incontinence and its mechanism. Surgery consisted in a plication in an overcoat. RESULTS: Nineteen patients were included. The medium delay between initial surgery and the plication was 23.4months (ds=25.5). Results were evaluated subjectively by the MHU questionnaire and objectively by the urodynamic appraisal. The medium survey was 27.2months (ds=37.3). The procedure lasts about 30minutes. According to MHU, 73.7% of patients were cured and for 10.3% the symptoms were lessened. The difference in the MHU score of stress urinary incontinence before and after mesh readjustment was significant (P=0.0005) and get down from 2.31 (ds=0.75) to 0.56 (ds=0.92) as an average. There was no complication during surgery. There were two cases of postoperative acute urinary retention which were reoperated by simply cutting a thread allowing the sling to relax without losing the benefit of the plicature. There was no significant increase in urge incontinence or dysuria. CONCLUSION: The results of this study confirmed the feasibility, the efficiency and the low morbidity of mesh readjustment for the suburethral sling.

The cutaneous form of adult T-cell leukemia/lymphoma in a woman from the Ivory Coast. Clinical, immunovirologic studies and a review of the African adult T-cell leukemia/lymphoma cases.

A 36-year-old woman from Ivory Coast, who has lived in France since 1976, had multiple cutaneous nodules and tumors in 1988. Histopathologic studies showed a massive infiltration of the dermis and hypodermis by a diffuse proliferation of mature activated T-cells (CD4-positive, CD25-positive, HLA-DR-positive) with irregular nuclei. The patient did not present with a leukemic picture and only few lymphoid cells with abnormally shaped nuclei were present in the blood. Human T leukemia/lymphoma virus type I (HTLV-I) antibodies were present in the serum and specific HTLV-I pol sequences were detected in the DNA extracted from the tumor nodules and peripheral blood mononuclear cells (PBMC) using the polymerase chain reaction technique. Whereas only a polyclonal integration of HTLV-I provirus was detectable in the PBMC, a clonal integration of three HTLV-I proviruses was demonstrated in the tumor nodules DNA, establishing with certainty the diagnosis of HTLV-I-induced adult T-cell leukemia/lymphoma (ATL). This case illustrates the need for molecular studies to differentiate without ambiguity an ATL from any other type of cutaneous lymphoproliferation, even when it occurs in a HTLV-I-seropositive individual. The situation of HTLV-I-associated ATL in Africa is reviewed.

[Acquired syphilis during human immunodeficiency virus infection. 6 cases]. / Syphilis acquise au cours de l'infection par le virus de l'immunodéficience humaine. Six cas.

We retrospectively studied the clinical, serological, bacteriological and histopathological data obtained in 6 HIV seropositive patients seen in our department from 1986 to 1989 for secondary syphilis. The clinical presentation was atypical in 4 of the 6 patients, with 2 palmoplantar keratodermas and 2 ulcerative syphilids. The diagnosis was made on darkfield examination in 2 patients, high titers of antibodies in 6 and histopathological examination (numerous plasma cells) in 4. All were cured with the classical penicillin therapy recommended for early syphilis.

Amyloïdose associée à un myélome à IGD (lambda), chez un hansénien / Amyloidosis associated with IGD (lambda) myeloma in a Hansen's disease patient

M. F.., 56 nos, portugais présentant comme antécédent une lèpre lépromateuse traitée par les sulfones de 1948 à 1958 nus est adressé pour le bilan d'une amyloidose généralisée.