[Management of deep pelvic endometriosis]. / Endométriose pelvienne profonde: quelle attitude adopter?

No symptom is pathognomonic for deep pelvic endometriosis. It presents essentially in the form of a painful syndrome dominated by deep dyspareunia and painful functional symptoms that recur according to the menstrual cycle. It is essential to investigate deep endometriosis lesions and draw up a precise map, which is the only way to be sure that exeresis will be complete. The treatment of first intention remains surgery, and medical treatment is only palliative in the majority of cases. Success of treatment depends on how radical surgical exeresis is. Patients should be aware of these specific major complications. Rating scales are recommended in diagnosis and therapeutic follow up. It is advisable to explain that pain improves, either partially or completely, in about 80% of patients.

[Hodgkin's disease, fertility and pregnancy]. / Maladie de hodgkin, fertilité et grossesse.

Hodgkin's disease, the most common cancer between 15 and 24 years, raises two problems in women in reproductive age: the preservation of fertility and the care during pregnancy. Chemotherapy and radiotherapy can destroy gonads and subsequently lead to a loss of fertility and premature ovarian failure. Many options are available today to maintain fertility in female patients treated for Hodgkin's disease, thanks to advances in assisted-reproduction technology. Chemotherapy and radiotherapy during the first trimester are associated with increased risk of congenital malformations and this risk diminishes as pregnancy advances. The management of this disease during pregnancy must be examined case by case.

[Malignant keratoma: Harlequin fetus]. / Keratome malin: foetus Arlequin.

Harlequin fetus, with an incidence of about 1 in 300.000 births, is an extremely severe form of congenital ichtyosis. We report a case of malignant keratoma: a male infant was born at 40 weeks' gestational age. The parents were first cousins. This infant was covered with massive thick, waxy, plate-like scales and deep fissures. There was striking facial distortion including severe eclabium and ectropion. The baby was transferred to the Neonatal Intensive Care Unit but he died at 2 days of age. There is limited information regarding the course and prognosis of neonates affected with Harlequin ichthyosis because most affected patients die within the first days or weeks of life. However, it is now evident that these infants, may have extended survival potential with intensive supportive measures as well as the addition of retinoids. Prenatal diagnosis for malignant keratoma had been performed by fetal skin biopsy and electron microscopic observation at 19-23 weeks estimated gestational age. In 2005, ABCA12 was identified as the causative gene for this disease. It has now become possible to make DNA-based prenatal diagnosis for Harlequin ichthyosis by chorionic villus or amniotic fluid sampling procedures in the earlier stages of pregnancy with a lower risk to fetal health and with a reduced burden on the mothers.