Diagnosis of post-partum ovarian vein thrombophlebitis by color Doppler ultrasonography: about 10 cases.

BACKGROUND: Post-partum ovarian vein thrombosis is often overlooked or mistaken for other complications such as endometritis. Color Doppler ultrasonography is a very good diagnostic method when properly indicated and correctly interpreted according to clinical data. METHODS: This study reports ten cases that were retrospectively studied, during which color Doppler ultrasonography was used. The clinical signs and the results are reviewed. RESULTS: The lesions were clearly visualized in eight of the ten cases; one of the two failures resulted from a methodological fault (uninterpretable result); the other one was due to the lack of experience of the operator and nonrecognition of the clinical signs. Thrombosis appears as a hypoechogenic and tubular image. This type of examination is particularly indicated in the presence of certain clinical signs that were observed in our cases: fever and iliac pain are the main precursor signs, often associated with abdominal meteorism and slow digestive transit; provoked cul-de-sac pain during vaginal probing was the only constant sign, sometimes associated with painful swelling.

Selective intrapartum anti-bioprophylaxy of group B streptococci infection of neonates: a prospective study in 2454 subsequent deliveries.

OBJECTIVE: To investigate the efficacy of a selective intrapartum prophylaxy of group B streptococci (GBS) infection of the neonates. STUDY DESIGN: A prospective protocol of universal antepartum screening of GBS and selective intrapartum treatment from the 1st February 1994 to the 31st December 1995, on 2454 subsequent deliveries was designed. Our policy included: (1) antepartum screening as soon as possible after 28 weeks by a single vaginal and perianal sample for culture; (2) intrapartum recognition of one condition of high risk of fetal contamination during labor (these conditions included: a temperature of 38 degrees C during labor, rupture of membranes for more than 12 h or prolonged labor for more than 12 h with rupture of membranes, prematurity, twins, maternal diabetes, previous pregnancy with GBS infection of the neonate); and (3) intrapartum anti-bioprophylaxy (amoxicillin) for women with positive screening during pregnancy and one condition of high risk of fetal contamination during labor. We studied the outcome of neonates during this period to look for immediate GBS severe infection of the neonates in the form of bacteraemia or meningitis and compared the results with the rate of neonatal infection before this protocol (4.5/1000 live births in 1993). RESULTS: We noted that 11% of pregnant women were carriers, 25% of which led to antibiotic chemoprophylaxis during the labor. We noticed four cases of neonatal bacteraemia of GBS. One case arose from the group of carriers (but no condition of risk of fetal contamination during the labor and no chemoprophylaxy). The three other cases were from women with a negative antepartum screening. There was no case of meningitis and all four babies were in good health at day 10 of life. Comparing with results prior to the study, we noticed that the rate of neonatal bacteraemia dropped from 4.5 to 1.6 per 1000 livebirths (P < 0.0001). CONCLUSION: This protocol of intrapartum anti-bioprophylaxy significantly decreases the rate of GBS neonatal sepsis. We propose to improve the efficacy of this prevention program, especially with regard to the method of antepartum screening of pregnant women colonized with GBS.

[Value of screening for cervical intraepithelial neoplasia in women treated for adnexitis]. / Intérêt de la recherche des néoplasies intra-épithéliales du col utérin chez les femmes traitées pour annexite.

OBJECTIVE: To demonstrate that women treated for PID constitute a population with a specially high incidence of cervical intraepithelial neoplasia (CIN) and who should be screened for CIN. POPULATIONS AND METHODS: Retrospective, non-comparative study of 260 patients treated for PID in the Gynecology-Obstetrics Department of Hôtel-Dieu hospital in Rennes (France) from December 1st, 1989 to May 31st, 1996. CIN screening was performed by smear tests and colposcopy. RESULTS: Cervical lesions were detected in 39 patients (15%): five CIN 3 (including one early-stage microinvasion), twelve CIN 2 and 22 CIN 1 and/or condylomas, i.e., 6.5% high grade and 8.5% low grade lesions. Colposcopy in this case proved to be more effective than smears for screening. DISCUSSION: According to epidemiological studies, sexual behavior is a major risk factor of CIN, due to the role played by sexually transmissible human papillomavirus in their pathogenesis. Because the main risk factor of PID is sexual activity, it is likely that CIN are more frequent in women with PID. Our study clearly established that fact because the prevalence of CIN in the general population is only 0.5 to 4% according to literature reports. CONCLUSION: We are in favor of CIN screening in women treated for PID, and in our view colposcopy is the preferred method.

[CIN and pregnancy. Apropos of 16 cases and review of the literature]. / CIN 3 et grossesse. A propos de 16 observations et revue de la littérature.

AIM: To assess the means to diagnose grade 3 cervical intraepithelial neoplasia (CIN 3) during pregnancy, with special consideration to the risk of overlooking invasive lesions. STUDY DESIGN: a retrospective study on 16 cases of CIN 3 over 4 years and a literature review. RESULTS: Smear tests were indicative of low-grade lesions in 8 cases. Colposcopy always was suggestive and accompanied by biopsy. No conisations were performed during pregnancy but one was performed after delivery in 15 of 16 cases. After delivery, comparing conisation results with those of recent biopsies revealed that some lesions were less severe and others more severe than during pregnancy. So, a CIN 3 and a microinvasive carcinoma observed during pregnancy changed into CIN 2 and CIN 3, respectively, after delivery. In contrast, two pregnancy CIN 2 were seen as CIN 3 in post-partum and three CIN 3 as MIC. Such variations have been described in the literature and have several causes. In particular, improvements may sometimes reach "normalisation" in post partum although, recurrences remain possible. CONCLUSIONS: when the smear tests performed during pregnancy are indicative of cervical intra-epithalial lesions, whatever the severity, colposcopy with biopsies are mandatory. If a CIN 3 is detected, early MIC should be removed, which may require specific treatment according to the invasive degree. Colposcopy with guided biopsies is a safe and reliable diagnostic means. After delivery, the cervix should always be reexamined, preferably by conisation, even if smears or colposcopy were normal.

[Müllerian mixed tumors. Experience of the Rennes Regional University Hospital]. / Les tumeurs mixtes mullériennes. Expérience du C.H.R.U. de Rennes.

Seventeen cases of mixed Muller tumours (tumours of the uterus with malignant epithelial and mesenchymal components) are presented. These recently described tumours are rare and occur in menopaused women. Bloody discharge is the usual clinical manifestation, together with an increase of the volume of the uterus. Pathology examination of the surgical specimen is required for diagnosis using immunolabeling to distinguish between homologous tumours (the sarcomatous component occurs in the primary mesenchyma) and heterologous tumours (the mesenchymatous component results from a metastasis). Prognosis, usually poor, depends on the stage of the tumour. Overall survival at 5 years is about 30%. Survival in early stage I and state II tumours is no greater than 50% at 5 years. Treatment is based on radiosurgical techniques in less advanced tumours and requires radiochemotherapy in more advanced stage tumours. Recurrence is usually seen within 2 years, involving the pelvis alone in 10% of the cases and metastasis in most of the others. Because of their rapid development and poor prognosis, these tumours should be identified separately as a separate entity within a larger group of mixed mesodermic tumours.

[Postpartal ovarian thrombophlebitis. Value of Doppler ultrasonograph y]. / Thrombophlébites ovariennes dans le post-partum. Intérèt de l'échographie Doppler.

Thrombophlebitis of the ovarian vein is a well recognized but uncommon complication during the postpartum period. We report a small series and emphasize the contribution of color Doppler and the basic therapeutic measures.

[Socioeconomic approach to the practice of in vitro fertilization in the Brittany region in 1993]. / Approche socio-économique de la pratique de la fécondation in vitro en région Bretagne en 1993.

AIM OF THE STUDY: to estimate the social and economical point of view of the practice of in vitro fertilization (IVF) in Brittany in 1993. METHODS: we made a prospective study of 152 cases of IVF. We studied the medical history of sterility of the patients, treatments during IVF, hormonal and ultrasound monitoring, oocytes retrieval and embryo transfer, and the screening until beta-hCG > 1,000 UI or evidence of pregnancy with ultrasound scan. After analysing results of IVF, we studied the cost of all these steps, including hospitalization, transports and stoppage. RESULTS: we estimated the mean price of one IVF cycle at 11,084 francs. We analysed the portion of each step in the total cost and discussed with the view of literature. CONCLUSION: the cost of IVF seems reasonable in this context.

[Borderline ovarian tumors. A review and 11 cases]. / Tumeurs borderline de l'ovaire. Mise au point, à propos de 11 cas.

OBJECTIVE: To clarify and classify the still debated diagnostic and prognostic elements of borderline tumours of the ovary and analyze the data obtained in our series. AIM: Develop an adapted management scheme, integrating relatively good prognosis and known or suspected factors of poor prognosis. SIEGE: Department of Gynaecology-Obstetrics, Hôtel-Dieu (CHU) Rennes, France. SUBJECTS: Eleven patients with borderline tumour of the ovary diagnosed and managed over the last 5 years. RESULTS: Current morphology and macroscopy examinations of the tumour do not provide data capable of predicting malignancy. The borderline nature of the tumour is not a histological diagnosis. The problems encountered lead to a search for new techniques such as digitalized nuclear morphology. Some progress has been made in classifying prognosis factors. Other than stage, important factors appear to be age, histological type, mitotic index, atypical cells and invasive peritoneal implants. Management decisions depend on prognosis factors but should especially take into account parity. Methods include cystectomy and total hysterectomy with annexectomy. Evaluation of chemotherapy and radiotherapy is still to preliminary. CONCLUSION: The slow clinical course, allowing good mid-term prognosis, is still the best reason for a moderated therapeutic approach relying on conservative or more aggressive surgery alone.

[Malignant melanoma of the vagina. Two case reports. Review of the literature]. / Mélanome malin du vagin. A propos de deux observations. Revue de la littérature.

OBJECTIVE: Report the diagnosis and therapeutic approach in two cases of primary malignant melanoma of the vagina. RESULTS: Malignant melanoma is rarely localized in the vagina, resulting from the malignant transformation of an ectopic melanocyte during menopause. The clinical diagnosis is often made in an advanced stage with a variable degree of pigmentation, usually on the anterior aspect of the vagina. Surgical exeresis should be extensive with a 1-cm safety margin. Radiotherapy may be effective as a complementary treatment for limited surgery or as first intention therapy aimed as improving local control before surgery. CONCLUSION: Locoregional relapse occurs in 60% of the cases, emphasizing the importance of local treatment. The prognosis is unfavourable with a 23 month mean survival. Total survival at 5 years is only 17%.

Remarks about the prognosis in case of antenatal diagnosis of gastroschisis.

We report our experience of 15 cases of gastroschisis which occurred between 1981 and 1993. All but one were diagnosed antenatally by ultrasound between 16 and 32 weeks of pregnancy. We made a termination of the pregnancy in 3 cases, for multiple malformations in 2 cases and one case of very early premature rupture of the membranes (PROM). When checked (11 cases), the karyotype was normal. We made a cesarean section in 11 cases: the indication was a complication for 6 (fetal distress, PROM, polyhydramnios, large dilatation of the gut). We noted growth retardation in 7 newborns and prematurity in 5/12 (mean gestational age of 36.8 weeks). The preoperative study of the gut noted 5 cases with intestinal damage and one case of complete necrosis of the gut. The global prognosis is not as good as usual, with a perinatal mortality of 41.6% (5/12). We discuss this latter point and examine the literature.

Absent end diastolic flow of umbilical artery Doppler: pregnancy outcome in 62 cases.

We retrospectively studied the outcome of pregnancy in 62 cases of absent end diastolic flow (AEDF) of umbilical artery Doppler flow velocity waveform. The history of pregnancies revealed that nearly all were of high risk. Many cases presented cerebral (65%) or uterine (55.5%) Doppler flow abnormalities, or both (38%). We noted 10 fetal deaths and decided 7 pregnancy terminations. Malformation and chromosomal defect rate was 16%. We noted 44 (71%) live-births, a very high rate of cesarean section (86%), prematurity (75%), small for gestational age (39%). Forty-five percent of the neonates had a 1-min Apgar score under 7, which dropped to 27% at 5 min. Neonate mortality rate was 6.9% and the total mortality rate was 34% (21/62). Morbidity was significant (7 cases with severe morbidity, 2 cases with chromosomal abnormality of poor prognosis). We compared different sub-groups with a view to looking for some prenatal factors which predict poor neonatal outcome in case of AEDF.

[Primary seropapillary peritoneal carcinoma. 16 case reports. Review of the literature]. / Carcinome séropapillaire primitif du péritoine. A propos de 16 observations. Revue de la littérature.

OBJECTIVE: Review of primary seropapillary carcinoma of the peritoneum. TYPE OF STUDY: Retrospective. PLACE: Department of Gynaecology and Oncology, University Hospital, Rennes. SUBJECT: 16 patients who underwent chemotherapy and surgery. RESULTS: Mean age at onset was 62 years with a late clinical diagnosis at an advanced stage. Macroscopically, peritoneal miliary was often associated with a predominant tumoural formation on the epiploon. Treatment included surgical exeresis with endoxan-cisplatin chemotherapy. The prognosis was equivalent to ovarian tumours at similar stages. CONCLUSION: Primary seropapillary carcinosis of the peritoneum is a separate group of peritoneal carcinosis distinguishable from peritoneal mesotheliomas and which have a prognosis similar to ovarian tumours. These tumours should be classed as part of the large group of mullerian tumours.

[Fever during labor. Evaluation of the risk of maternal-fetal infection and reflections concerning prophylactic measures based on a prospective study of 6,305 deliveries]. / Fièvre au cours du travail. Evaluation du risque d'infection materno-foetale et réflexions à propos de mesures prophylactiques à partir d'une étude prospective sur 6.305 accouchements.

The authors have evaluated the risk of neonatal infection (NNI) by materno-fetal contamination when a rise in temperature occurs in labour and they have worked out the prophylactic measures that should be taken. This has been the results of a prospective study carried out on 6305 deliveries. Any significant conditions associated with NNI are stained liquor and a low Apgar score at birth. When high temperature develops in labour it is important to deliver the infant as quickly as possible particularly if the labour is a premature one. Prevention carried out by very early diagnosis of amniotic fluid infection in pregnancy and by careful attention to the high risk conditions of: early rupture of the membranes, a high level of vaginal infection particularly with Beta streptococci.

[Severe oligospermia with normal FSH. Comparison between radioimmunologically and immunoradiometrically determined levels of LH]. / Oligospermies sévères à FSH normale. Comparaison entre les dosages radio-immunologiques et immuno-radiométriques de la LH.

We have noted in a group of oligospermic patients with normal FSH levels and normal sized testes that there can be a significant drop in the LH levels estimated by IRMA, compared with a control group of fertile men. On the other hand, there is no correlation between IRMA and RIA levels of LH in oligospermic men when there is such a correlation in the control group. As oligospermia is usually testicular in origin preliminary results suggest that there may be a disturbance of gonadotrophin secretion in one type of oligospermia and we intend to continue this preliminary study.

[Study of the reasons for therapeutic abortions, stillbirth and neonatal mortality in the Brittany region in 1991]. / Etude des causes des interruptions thérapeutiques de grossesse, de mortinatalité et de mortalité néonatale en région Bretagne, année 1991.

The reasons for 186 medically indicated terminations of pregnancy, 178 stillbirths, and 126 neo-natal deaths were analysed by a multi-disciplinary team after a thorough enquiry into the social and medical context for the deaths or for the decision to interrupt the pregnancies. This was undertaken on the initiative of the regional technical consultative commission for enquiring into births, and according to a protocol that had already been partly used by a group studying the neonatal period in Ille and Vilaine. A comparison of the causes according to the type of death shows the value of following up these three indicators to the plan and appropriate policy for three weeks following delivery. A certain number of questions about definitions and classifications still have arisen.

[Acute adrenal gland decompensation in the immediate postpartum]. / Décompensation surrénalienne aiguë dans le post-partum immédiat.

We report the case of acute adrenal gland failure which occurred one hour after cesarian section for the delivery of a child after 31 weeks of amenorrhoea. The clinical picture of the mother was immediately severe and was dominated by neurological features: profound coma with a bilateral Babinski's sign. The laboratory tests however only revealed severe hypoglycaemia among the classical signs of adrenal gland failure. It was extremely difficult to correct the blood glucose level without concomitant administration of corticosteroids.

[Giant juvenile fibroadenoma in an adolescent. A case report]. / Le fibroadénome géant juvénile chez l'adolescente. A propos d'un cas.

Fibroadenomas occupy the first place, in terms of prevalence, among benign breast disorders in adolescent girls. Juvenile giant fibroadenoma is a special though rare form, which must be recognised in terms of differential diagnosis from virginal hyperplasia in its asymmetrical early form and phylloid tumours, the prognosis of which is different. The authors describe the clinical and pathological features necessary for diagnosis and report the results of breast reconstruction after excision via a lateral radial approach in a 14-year-old adolescent girl.