Popliteal artery thrombosis complicating posterior tibial exostosis in a 35-year-old male.

Chronic popliteal artery thrombosis complicating tibial exostosis has never been described as far as we know. Here, we report the case of a 35-year-old male patient complaining of intermittent claudication over the previous 4 months, without history of trauma or hereditary multiple exostoses. Clinical examination found no popliteal or distal pulses. The diagnosis was confirmed based on CT angiography showing distinct blockage of the contrast product over an exostosis on the posterior side of the proximal tibia. Treatment consisted of removing the exostosis and then bypassing the popliteal artery with a reversed autogenous venous graft.

[Association between sperm abnormalities and occupational environment among male consulting for couple infertility]. / Association entre anomalies spermatiques et environnement professionnel chez les hommes consultant pour infertilité de couple.

Alteration of sperm parameters related to occupational exposures is the subject of several studies, often on a case-control approach. The study populations usually comprise men consulting in infertility clinics for couple infertility. The objective of this review is to identify, from these case-control studies, the main occupational factors that may be associated with altered sperm parameters. We selected 13 articles in the PubMed database. Participation in these studies varied from 61 to 2619 subjects, with great methodological heterogeneity, particularly in the characterization of exposure. The main occupations that appear significantly associated with a risk of altered sperm parameters are workmen, painters, farmers, welders, plumbers and technicians. When analysis focuses on occupational exposures, a significant result is reported for solvents, heavy metals, heat, vibrations and non-ionizing radiation. None of the selected studies has found a link with exposure to pesticides.

Application of Physiologically Based Pharmacokinetic (PBPK) Modeling to Support Dose Selection: Report of an FDA Public Workshop on PBPK.

The US Food and Drug Administration (FDA) public workshop, entitled "Application of Physiologically-based Pharmacokinetic (PBPK) Modeling to Support Dose Selection focused on the role of PBPK in drug development and regulation. Representatives from industry, academia, and regulatory agencies discussed the issues within plenary and panel discussions. This report summarizes the discussions and provides current perspectives on the application of PBPK in different areas, including its utility, predictive performance, and reporting for regulatory submissions.

Síndrome del túnel del tarso: secundario a insuficiencia venosa. Reporte de un caso / Tarsal tunnel syndrome secondary to venous insufficiency: Case report

El síndrome del túnel del tarso se define como una neuropatía compresiva extrínseca y/o intrínseca del nervio tibial posterior o de una de sus ramas siendo una de sus causas la insuficiencia vascular. Caso clínico: femenina de 51 años, originaria de León, Guanajuato. Hipertensa, síndrome de Guillain-Barré hace ocho años, insuficiencia vascular y obesidad. Inicia con dolor en tobillo y talón izquierdo, manejada con AINES y rehabilitación con mejoría parcial, se realizan radiografías y resonancia magnética nuclear del tobillo izquierdo con datos de pinzamiento posterior, se realiza artroscopía y mejora un mes presentándose dolor intenso en el tobillo y la planta del pie y disestesias, se hace electromiografía con datos de lesión del tibial posterior. Cuenta con historia clínica, perfil prequirúrgico, dorsoplantar y lateral, se realiza una artroscopía encontrándose una tendinitis del Flexor Hallucis Longus (FHL), sinovitis y un pinzamiento posterior del tobillo, se hace sinovectomía, descompresión y un peinado del FHL. Mala evolución, se realiza electromiografía con axonotmesis de la rama plantar medial. Se realiza la liberación del nervio encontrándose el plexo venoso de Lazhortes tortuoso comprimiendo en todo su trayecto. Una de las causas es por la compresión intrínseca secundaria a tumores, modificaciones de la anatomía del túnel del tarso; sin embargo, menos frecuente, las várices pueden confundir el diagnóstico y llegar a producir un daño irreparable para el paciente si no se trata a tiempo. La paciente se encuentra actualmente sin dolor que le posibilita la marcha, con disestesias leves del primer dedo y movilidad limitada para su flexión.

Tarsal tunnel syndrome is defined as an extrinsic and/or intrinsic compressive neuropathy of the posterior tibial nerve or one of its branches. Its causes include venous insufficiency. Clinical case: 51 year-old female patient from León, Guanajuato. Hypertensive, with Guillain-Barré syndrome for eight years, vascular insufficiency and obesity. Her condition started with left ankle and heel pain; she was treated with NSAIDs and rehabilitation and achieved partial improvement. X-rays and MRI of the left ankle showed posterior impingement. She underwent arthroscopy and improved but one month later she presented with severe pain in the left ankle and sole and dysesthesias. Electromyography showed a lesion of the posterior tibial nerve. We had the patient's case history, preoperative tests, and dorsoplantar and lateral X-ray views. The arthroscopic diagnosis was flexor hallucis longus (FHL) tendinitis, synovitis and posterior ankle impingement. Synovectomy, decompression and smoothening of the FHL tendon were performed. The patient did poorly and underwent electromyography with axonotmesis of the medial plantar branch. After the nerve was released, Lazorthes venous plexus was found to be tortuous and compressing the entire nerve tract. The possible causes for this include intrinsic compression secondary to tumors, and anatomical changes of the tarsal tunnel. However, less often varices may confound the diagnosis and cause irreversible damage if not treated timely. The patient is currently pain free and can walk, has mild dysesthesias of the first toe and limited flexion.

[Elective single embryo transfer policy at 48/72 h: which results after fresh transfers and frozen/thawed transfers?]. / Politique de transfert électif d'un embryon à 48/72h: quels résultats après transferts frais et transferts d'embryons congelés ?

OBJECTIVES: To evaluate our elective single embryo transfer policy performed at 48/72h and define predictive factors of pregnancy after frozen/thawed embryo transfer. METHODS: Analysis of 289 elective single embryo transfers (eSET) performed in a selected population in the ART center of Marseille University Hospital from January 2005 to December 2011, as well as the 325 following frozen/thawed embryo transfers performed in this population between May 2005 and December 2012. RESULTS: Cumulative pregnancy rate/oocyte retrieval was of 62.6%; 45% of the couples obtained the birth of at least one child. During this studied period, cumulative pregnancy and delivery rates in the whole population remained stable while multiple delivery rate/delivery clearly decreased. Elective single embryo after frozen/thawed transfer gave satisfying results (24.6% pregnancy/transfer) only in the lack of lysis or in case of mild lysis (1-25%) of the transferred embryo. CONCLUSION: The implementation of an eSET policy gives satisfying results, depending largely on embryo quality. By proposing eSET to a well-targeted population, chosen both on clinical and biological criteria, a clear reduction of cumulative multiple delivery rate/delivery was obtained in our center over this period, without any global decrease of cumulative pregnancy rate/attempt. Embryo quality is a major factor of success, especially in frozen/thawed cycles. The elective single embryo frozen/thawed transfer should be carried out only if embryo lysis after thawing does not exceed 25%.

[Tarsal tunnel syndrome secondary to venous insufficiency. Case report]. / Síndrome del túnel del tarso: secundario a insuficiencia venosa. Reporte de un caso.

Tarsal tunnel syndrome is defined as an extrinsic and/or intrinsic compressive neuropathy of the posterior tibial nerve or one of its branches. Its causes include venous insufficiency. Clinical case: 51 year-old female patient from León, Guanajuato. Hypertensive, with Guillain-Barré syndrome for eight years, vascular insufficiency and obesity. Her condition started with left ankle and heel pain; she was treated with NSAIDs and rehabilitation and achieved partial improvement. X-rays and MRI of the left ankle showed posterior impingement. She underwent arthroscopy and improved but one month later she presented with severe pain in the left ankle and sole and dysesthesias. Electromyography showed a lesion of the posterior tibial nerve. We had the patient's case history, preoperative tests, and dorsoplantar and lateral X-ray views. The arthroscopic diagnosis was Flexor Hallucis Longus (FHL) tendinitis, synovitis and posterior ankle impingement. Synovectomy, decompression and smoothening of the FHL tendon were performed. The patient did poorly and underwent electromyography with axonotmesis of the medial plantar branch. After the nerve was released, Lazorthes venous plexus was found to be tortuous and compressing the entire nerve tract. The possible causes for this include intrinsic compression secondary to tumors, and anatomical changes of the tarsal tunnel. However, less often varices may confound the diagnosis and cause irreversible damage if not treated timely. The patient is currently pain free and can walk, has mild dysesthesias of the first toe and limited flexion.

[Anatomical variants of the medial calcaneal nerve and the Baxter nerve in the tarsal tunnel]. / Variantes anatómicas del nervio calcáneo medial y nervio de Baxter en el túnel del tarso.

The tarsal tunnel is composed of the posterior border of the medial malleoulus, the posterior aspect of the talus and the medial aspect of the calcaneus. The medial calcaneal nerve emerges from the posterior aspect of the posterior tibial nerve in 75% of cases and from the lateral plantar nerve in the remaining 25%. Finally, the medial calcaneal nerve ends as a single terminal branch in 79% of cases and in numerous terminal branches in the remaining 21%. To describe the anatomical variants of the posterior tibial nerve and its terminal branches. To describe the steps for tarsal tunnel release. To describe Baxter nerve release. The anatomical variants of the posterior tibial nerve and its terminal branches within the tarsal tunnel were studied. Then the Lam technique was performed; it consists of: 1) opening of the laciniate ligament, 2) opening of the fascia over the abductor hallucis muscle, 3) exoneurolysis of the posterior tibial nerve and its terminal branches, identifying the emergence and pathway of the medial calcaneal branch, the lateral plantar nerve and its Baxter nerve branch and the medial plantar nerve. Baxter nerve was found in 100% of cases. In 100% of cases in our series the nerve going to the abductor digiti minimi muscle of the foot was found; 87.5% of cases had two terminal branches. The dissections proved that a crucial step was the release of the distal tarsal tunnel.

[Morel-Lavallee syndrome of the lower leg]. / Syndrome de Morel-Lavallée du membre inférieur.

BACKGROUND: Morel-Lavallée syndrome, which appears after tangential trauma of highly vascularised tissues, is characterized by closed internal degloving injuries resulting in subcutaneous fluid collection. It can cause many complications. A 42-year-old man presented with open wounds after a violent right lower extremity trauma; the wounds were sutured. One month after the trauma, the patient complained of painful edema of the lower limb and fluid discharge from the previously sutured wounds. Local examination showed fluctuating fluid collection. Serum inflammatory markers were within the normal range. Ultrasound investigation of the right lower limb confirmed an extended fluid collection from the lower third of the thigh to the upper third of the leg, and CT scan delineated a surrounding capsule. The clinical and radiological data supported a diagnosis of post-traumatic Morel-Lavallée syndrome. Local surgical debridement and drainage associated with systemic antibiotic therapy (the fluid was found to be infected with oxacillin-resistant Staphylococcus epidermidis) resulted in rapid improvement. DISCUSSION: Morel-Lavallée syndrome commonly appear after tangential trauma of highly vascularised tissues. The skin and the subcutaneous fat tissue are abruptly torn from the underlying muscle fascia, shearing the lymphatic vessels, rendering lymphostasis impossible. The local inflammatory reaction can cause the formation of a fibrous capsule resulting in a fluid collection. The clinical signs are not specific. When examining a soft-tissue collection or slow-healing wounds, the dermatologist should always rule out previous soft-tissue trauma; simple imaging studies will confirm the diagnosis if Morel-Lavallée injuries are suspected. CONCLUSION: All dermatologists consulted by young patients without vascular disease for an unusual swelling and/or for slow-healing wounds should be mindful of this syndrome.

Sperm cryopreservation before cancer treatment: a 15-year monocentric experience.

Sperm banking is an important procedure to preserve fertility before cancer therapy. The aim of this study was to comprehensively analyse cryopreservation activity retrospectively for 1080 patients referred to the sperm bank for sperm cryopreservation before cancer treatment. This study included 1007 patients diagnosed with testicular cancer (TC) (41.7%), lymphoma (26%), other haematological cancers (9.4%) or other types of cancer (22.8%); of these, 29 patients did not produce any semen sample and cryopreservation was impossible for 67 patients. Semen characteristics before treatment were within normal ranges, except moderate asthenospermia. Sperm concentration was significantly lower in TC than in non-TC. Straws from 57 patients (6.3%) were used in assisted reproductive technologies, which led to a 46.8% cumulative birth rate. Straws were destroyed for 170 patients (18.7%) and 140 patients performed semen analyses after cancer therapy. After an average delay of 22.5 months after the end of therapy, 43 patients (30.7%) exhibited azoospermia. This study of a large population of cancer patients revealed a high level of successful sperm storage. Utilization of cryopreserved spermatozoa led to good chances of fatherhood. Nevertheless, sperm banks should be aware of the low rates of straw use and straw destruction by cancer patients.

[Do couples who procreate through sperm donation inform their children?]. / Les couples qui procréent par don de sperme en informent-ils leurs enfants ?

OBJECTIVES: An amendment to the French bioethics law allowing children conceived by gamete donation to know the identity of donors is proposed, while no study can assess the proportion of parents in France that disclose the nature of conception to their donor conceived offspring. The aim of our study was to know whether couples who wish to inform their offspring actually did it. PATIENTS AND METHODS: We sent a questionnaire to parents who had expressed an intention to disclose the nature of conception to their future offspring conceived by sperm donation. This allowed us to evaluate the number of couples who inform their offspring, and the couple and offspring feelings when information was given. RESULTS: Among 38 questionnaires sent, 20 couples answered. Fourteen informed their offspring about the nature of conception, most having lived serenely this moment. 47% of offspring have reacted with indifference. While 19 couples informed their friends or family, six couples did not inform their offspring, and two of them no longer want to disclose anymore. CONCLUSION: Careful thought before the beginning of assisted reproductive technology and support after birth are needed to help couples communicate information to their offspring. Without this communication, any policy of openness to know donor related data seems vain.

[Initial results of a novel technique for sperm retrieval in male infertility due to refractory retrograde ejaculation]. / Résultats préliminaires d'une nouvelle technique de recueil du sperme vésical en présence d'éjaculation rétrograde réfractaire au traitement médical.

AIMS: To describe and evaluate a novel technique of spermatozoa retrieval from patients suffering from infertility secondary to refractory retrograde ejaculation. METHOD: Prospective study to compare mobility and vitality of spermatozoa obtained from urine (U) after oral modification of chemical parameter (PH, Osmolarity) versus from endovesical instillation of sterile spermatozoa culture medium before ejaculation (F). Patients were their own controls. Twelve month prospective follow-up was achieved to document the results of assisted procreation. RESULTS: Eight patients were included and mobility and vitality were improved in all patients after F technique was compared to U technique. With U technique, eight patients on eight had negative defrost test; after F technique, seven patients on eight had a positive defrost test and could therefore have access to assisted reproduction techniques. Four couples had five ICSI and obtained three pregnancies leading to five births. CONCLUSION: Endovesical instillation of sterile spermatozoa culture medium before ejaculation was a safe and effective technique to improve spermatozoa quality in male infertility related to refractory retrograde ejaculation.

Applications of physiologically based pharmacokinetic (PBPK) modeling and simulation during regulatory review.

Physiologically based pharmacokinetic (PBPK) modeling and simulation is a tool that can help predict the pharmacokinetics of drugs in humans and evaluate the effects of intrinsic (e.g., organ dysfunction, age, genetics) and extrinsic (e.g., drug-drug interactions) factors, alone or in combinations, on drug exposure. The use of this tool is increasing at all stages of the drug development process. This report reviews recent instances of the use of PBPK in decision-making during regulatory review. The examples are based on Center for Drug Evaluation and Research reviews of several submissions for investigational new drugs (INDs) and new drug applications (NDAs) received between July 2008 and June 2010. The use of PBPK modeling and simulation facilitated the following types of decisions: the need to conduct specific clinical pharmacology studies, specific study designs, and appropriate labeling language. The report also discusses the challenges encountered when PBPK modeling and simulation were used in these cases and recommends approaches to facilitating full utilization of this tool.

[The spinal cord injured patient: semen quality and management by Assisted Reproductive Technology]. / Le blessé médullaire: quel sperme et quelle prise en charge en Assistance médicale à la procréation?

Men with spinal cord injury present a unique infertile population. Only 10 % of them can father children without medical assistance, owing to potential impairments in erection, ejaculation and semen quality. The algorithm typically followed is to retrieve semen by Penile Vibratory Stimulation, in case of failure by Electro Ejaculation. Most of these patients have normal sperm concentrations but abnormally low sperm motility and vitality in the ejaculate. The reasons for poor semen quality in spinal cord injured men are reviewed. If semen cannot be obtained by Electro Ejaculation, or if the ejaculate from Penile Vibratory Stimulation or Electro Ejaculation contains an insufficient quantity or quality of sperm for in vitro fertilization with intracytoplasmic sperm injection, then retrieval of sperm from reproductive tissues is attempted. Despite abnormal semen quality, successful pregnancies with sperm from spinal cord injured male partners have occurred by intravaginal insemination, intrauterine insemination, and in vitro fertilization with intracytoplasmic sperm injection. The prevailing pregnancy and fecundity rates in couples with a spinal cord injured male partner are reviewed.

Do tantalum components provide adequate primary fixation in all acetabular revisions?

INTRODUCTION: A number of studies have reported favorable results of cementless fixation in acetabular revisions. Nevertheless, the implant bearing on more than 50% of the patient's bone and good primary stability are required. The objective of this study was to determine whether the use of tantalum implants could provide stable reconstruction for any type of acetabular revision. PATIENTS AND METHODS: This study investigated 72 hips (71 patients) implanted with tantalum cups, some with augments, and morselized graft material. The mean age was 60 years (range, 34-84 years). There were 30 males and 41 females. The mean weight was 71 kg (range, 52-102 kg), the mean height was 1.68 m (range, 1.52-1.84 m). Twenty-five revisions were bipolar. Six revisions were performed for infected acetabular loosening. The mean follow-up was 4 years (range, 2-6 years). RESULTS: The mean Merle d'Aubigné score at follow-up was 15.8 points (range, 9-18 points). According to the Paprosky classification of acetabular bone defects, there were 13 type 1 (18%), 14 type 2A (19.5%), 14 type 2B (19.4%), 23 type 3A (31.9%), and eight type 3B (11.2%) acetabular defects, four of which had pelvic discontinuity. Postoperatively, the position of the hip's center of rotation in relation to Köhler's teardrop was 22 mm (range, 5-41 mm) vertically (normal, < 25 mm) and 39 mm (range, 13-55 mm) horizontally (normal, < 35 mm). The mean acetabular inclination was 40 degrees (range, 20 degrees -63 degrees ). The radiographic analysis found no radiolucent line after 1 year and up to the last follow-up. None of the patients required revision for acetabular loosening. Three hips were revised for instability. Two retentive liners and a dual-mobility cup were cemented in the cups that were left in place. DISCUSSION AND CONCLUSION: Given their mechanical properties (coefficient of friction, porosity), tantalum implants provide a stable primary cementless fixation without compromising the center of rotation and without necessarily requiring a structural graft. A single implant range can therefore be used for any type and severity of bone loss and for all types of acetabular reconstruction. Longer follow-up is nevertheless necessary to confirm these encouraging results. LEVEL OF EVIDENCE: Level IV, historical series.

Ultrasound monitoring in patients undergoing in-vitro fertilization after methotrexate treatment for ectopic pregnancy.

OBJECTIVES: To compare sonographic characteristics of the endometrium and follicles during in-vitro fertilization (IVF) before and after methotrexate (MTX) treatment for ectopic pregnancy. METHODS: This retrospective study, conducted at Conception Hospital from January 2000 to July 2007, included all patients diagnosed with an ectopic pregnancy resulting from IVF treatment that was treated with MTX and who then underwent another IVF cycle. We compared the number and size of follicles and the endometrial thickness and quality on the day of human chorionic gonadotropin injection in the cycles before and after the MTX treatment to determine whether MTX had any effect. RESULTS: Eleven patients were included in the study. The median interval between the IVF cycle resulting in ectopic pregnancy and the first IVF cycle after MTX therapy was 180 (range, 150-900) days. There was no statistically significant difference between the before and after MTX treatment groups with respect to number of follicles (14 (3-20) vs. 9 (4-16), P = 0.12), follicle size (16.5 (14.7-21.7) mm vs. 17.8 (14.9-19.8) mm, P = 0.37), endometrial thickness (10.0 (9.5-12.0) mm vs. 10.0 (7.5-14.0) mm, P = 0.31) or endometrial quality (P = 0.32). Four women became pregnant during the IVF cycle following MTX treatment. CONCLUSIONS: Ultrasound monitoring showed no modification of the characteristics of the endometrium or follicles during IVF after MTX treatment for ectopic pregnancy.

[Bone remodeling around cementless tantalum cups]. / Etude du remodelage osseux autour de cupules non cimentées en tantale.

PURPOSE OF THE STUDY: Most studies have reported a significant decrease in periacetabular bone stock one year after implantation of a cementless cup. The purpose of this work was to study the bone-implant interface of the tantalum cup using plain X-rays and dual-energy X-ray absorptiometry (DEXA). MATERIAL AND METHODS: This retrospective analysis concerned 42 patients with a tantalum cup, Trabecular Metaltrade mark (Zimmer, Warsaw, IN, USA). All hips had primary implantations, performed by one surgeon via the same approach and with the same postoperative rehabilitation protocol. Minimum follow-up was two years. The Harris clinical score, and radiographic (lucent lines and acetabular position) and densitometric (analysis of 3.3mm of periacetabular bone in the three DeLee and Charnley zones) were recorded. RESULTS: At follow-up, the mean Harris score was 81. There were no implant malpositions (horizontal, vertical, inclination). Lucent lines were noted for 14% of the cups. Bone mineral density (BMD) was higher than generally observed with cementless cups (1.290+/-0.309g/cm(2)). DISCUSSION: The clinical and radiographic results are similar to data in the literature regarding correct implant position. The higher rate of lucent lines around the tantalum cup is also reported in the literature and is the result of the pressfit, resolving at one year. The greater BMD in zone 1 might reflect better force transfer to the weight-bearing zone. CONCLUSION: As biomaterial recently introduced in orthopedic surgery, tantalum appears to provide a better force transfer to the central part of the iliac bone and thus possibly better preservation of pelvic bone stock.

[What are at present the real hopes of pregnancy after ovarian cryopreservation?]. / Quels sont actuellement les espoirs réels de grossesse après cryoconservation ovarienne?

Survival rates for cancers that occur in childhood and adolescence have improved over the last decades, and preservation of future fertility in these patients has become a relevant issue. Premature ovarian failure is a consequence of exposing women to chemotherapeutic drugs and ionizing radiation. Ovarian cryopreservation is an alternative to cryopreservation of embryos or oocytes for theses patients. Ovarian cryopreservation aims to reimplant ovarian tissue after complete remission into the pelvic cavity (orthotopique site) or a heterotopic site like the abdominal wall or the forearm. In vitro folliculogenesis, that aims at the maturation of ovarian cortex primordial follicles cryopreserved for a FIV, is still in an experimental research stage. In this review, the objective was to evaluate the real hopes of pregnancy after ovarian cryopreservation. Indeed, many teams offer ovarian cryopreservation at present time, although only two pregnancies have been achieved to date. In both cases, it can be discussed whether the fertilized oocyte originated from the transplant or from the native ovary. Furthermore, the potential for reintroduction of cancerous cells may limit this technique in cancers that are known to have a risk of ovarian dissemination. The hopes engendered by ovarian cryopreservation, but also its limits, must be explained to the patients before an ovarian surgery for cryopreservation.

Evolution of DNA strand-breaks in cultured spermatocytes: the Comet Assay reveals differences in normal and gamma-irradiated germ cells.

In reproductive toxicity assessment, in vitro systems can be used to determine mechanisms of action of toxicants. However, they generally investigate the immediate effects of toxicants, on isolated germ cells or spermatozoa. We report here the usefulness of in vitro cultures of rat spermatocytes and Sertoli cells, in conjunction with the Comet Assay to analyze the evolution of DNA strand-breaks and thus to determine DNA damage in germ cells. We compared cultures of normal and gamma-irradiated germ cells. In non-irradiated spermatocytes, the Comet Assay revealed the presence of DNA strand-breaks, which numbers decreased with the duration of the culture, suggesting the involvement of DNA repair mechanisms related to the meiotic recombination. In irradiated cells, the evolution of DNA strand-breaks was strongly modified. Thus our model is able to detect genotoxic lesions and/or DNA repair impairment in cultured spermatocytes. We propose this model as an in vitro tool for the study of genotoxic injuries on spermatocytes.

[Ovarian cryopreservation: clinical and ethical problems arisen further to study on cases of ovarian cryopreservation]. / Cryoconservation ovarienne: problèmes cliniques et éthiques. A propos d'une série de cas d'autoconservation de tissu ovarien.

OBJECTIVE: An early ovarian failure and sterility, on patients often still young, may result from some of the anticancerous treatments. Ovarian cryopreservation is a research way for fertility restoration on patients who will have gonadotoxic treatment. The aim of our work was to study the cases of ovarian tissue preserved in our Department, enabling us to assess the clinical and ethical problems of this technique. PATIENTS AND METHODS: A retrospective study was conducted from January 2001 onwards up to October 2005, on 14 patients, whose ovarian cortex was frozen our the University Fertility Center (Hôpital de la Conception, Marseille, France). RESULTS: In our study, the patients' average age was 17+/-5.5 and the median was 14 years [13-24]. Eight patients were under 18 (11+/-3-years-old). The cryopreservation indications were especially haematological (N = 9). More than half of the patients (N = 8) had undergone a gonadotoxic treatment before ovarian cryopreservation. DISCUSSION AND CONCLUSION: Ovarian cryopreservation is still a recent technology in reproductive medicine. The future of ovarian tissue after thawing, with its different techniques of autograft, is still not consensual. Experimental research remains essential to improve the freezing protocols and ovarian transplant in human medicine.

[Optimization of artificial inseminations with donor semen: a four-year experience]. / Optimisation des résultats d'inséminations intra-utérines uniques avec sperme de donneur: bilan de quatre ans d'activité.

OBJECTIVE: Our aim was to analyse the results of a donor insemination program using ovarian stimulation, swim-up sperm preparation and intrauterine insemination proposed to women with a maximum age of 39. Incidence of several clinical and biological parameters on success rates was investigated. PATIENTS AND METHODS: Retrospective analysis of the results of 249 cycles performed in 106 couples during a four-year period is reported. RESULTS: Overall pregnancy rate of 28.1% and delivery rate of 22% per cycle were achieved, with a multiple pregnancy rate of 11.4%. Most of the pregnancies (84%) were obtained before the fourth insemination. Among the different parameters studied the total number of motile sperm inseminated was found to be the most important factor for success rate: pregnancy rate per cycle reached 40.4% if more than 1.5 million progressive sperm were inseminated vs. 24.7% if they were less than 1.5 million (P<0.05). DISCUSSION AND CONCLUSION: In precise conditions, outcome of inseminations with donor semen can reach satisfying pregnancy rates, being a valuable help for couples suffering of long-time infertility.