[Before surgery predictability of malignant ovarian tumors based on ADNEX model and its use in clinical practice]. / Prédictibilité préopératoire de la malignité des tumeurs ovariennes à partir du score ADNEX et utilisation en pratique clinique.

OBJECTIVE: The principal aim of this study was the predictability of malignant ovarian tumors and to determine a cut-off value for this score to indicate the risk of malignancy that would be easy to use in clinical practice. METHODS: We retrospectively calculated the ADNEX score for all patients who underwent surgery for ovarian tumours in two Burgundy hospitals (Dijon University Hospital and Chalon-sur-Saône Hospital). We used the nine criteria of the ADNEX model. The inclusion criteria were the presence of all of the ADNEX criteria and a histology result. We analysed the sensitivity, specificity, PPV and PNV of four cut-offs (3%, 5%, 10% and 15%) for the entire pool then by age groups; from 14 to 42 (group 1) and 43 and more (group 2) RESULTS: Two hundred and eighty-four patients managed for an ovarian tumour were included between the 1st January 2013 and the 31st December 2015. Our AUC was of 0.94 (95% CI [0.903-0.977]) for discrimination between benign and malignant ovarian tumors. For a cut-off of 10%, sensitivity was 90%, specificity was 81.1%, PPV was 34.6% and PNV 98.5%. Results were lower for young women than for the second group. For a cut-off of 10%, group 1 had a sensitivity of 77.7% and specificity of 89.6%, PPV of 46.6% and PNV 97.5%. For the group 2, sensitivity was 95.2%, specificity was 76.6%, PPV was 33.8% and PNV was 99.2%. The most reasonable cut-off for the whole pool was 10%. For group 1 a cut-off of 5% was retained due to the less satisfying detection of "borderline" tumours more frequent in younger patients. For group 2 the cut-off of 10% gave the best results. CONCLUSION: In our study, a lower cut-off for younger women seemed better suited to discriminate borderline tumours. In practice, the ADNEX score associated with the peroperative laparoscopic examination seems to be the best way to use the ADNEX model. Our study showed that the ADNEX model allows a good predictability of malignant ovarian tumours. The predictability becomes less satisfying for the youngest patients. A cut-off malignity value allowing surgical treatment of patients in a specialised facility was reached for two age groups: a cut-off of 5% for women under 42 years old and a cut-off of 10% for women over 43 years old.

[Acute puerperal uterine inversion: two cases]. / Inversion utérine puerpérale aiguë: à propos de deux cas.

Acute puerperal inversion is both rare and serious (1/20000 deliveries in France) and may lead to significant morbidity and mortality. Outcome depends on the degree of uterine bleeding and the presence or not of a state of shock. Acute puerperal inversion occurs at the time of placental delivery. Four stages are usually described by degree of exteriorization of the uterus. The diagnosis is essentially clinical. The predisposing factors are hypotonic uterus, fundal implantation of the placenta and placental acretas. 60% of all cases are caused by precipitous manoeuvres including traction on the cord or improper fundal pressure. Once a diagnosis is made immediate measures must be undertaken to assure clinical stability of the mother. Manuel reinversion of the uterus must be done quickly to avoid a cervical stricture that may form within thirty minutes of the inversion making successful manipulation very difficult. Failure or reoccurrence requires surgical treatment either by abdominal or vaginal approach. We report on two cases: one of complete inversion leading to a hysterectomy in order to control bleeding and a second case of incomplete inversion where repositioning was successful.

[Premature rupture of the membranes between 28 and 34 weeks of amenorrhea. Retrospective study apropos of 71 cases]. / Rupture prématurée des membranes entre 28 et 34 semaines d'aménorrhée. Etude rétrospective à propos de 71 cas.

OBJECTIVE: The aim of our study is to compare the outcome of infants born after preterm premature rupture of the membranes (PPROM) between 28 and 34 weeks gestation. We compare two groups of infants: group A, infants born in hospitals without neonatal intensive care unit, after PPROM with long tocolysis, no maternal prophylactic antibiotic therapy and no systematic maternal steroid therapy. Group B with systematic maternal steroid therapy, maternal prophylactic antibiotic therapy, short tocolysis and born in an hospital with neonatal intensive care unit. The latency period (time from rupture of membranes to the onset of labor) authorized was 15 days in the group B and not limited in the group A. RESULTS: Death (13.8% vs 0%; p=0.022), neonatal infection (66.6% vs 28.6%; p=0.0013), and respiratory distress (63.8% vs 34.3%; p=0.0144) were less frequent in the group B. The group A infants passed more than ten days in intensive care unit (61.1% vs 37.1%; p=0.043). Neonatal infection was not higher in the corticosteroïd therapy group (41.2% vs 70.3%; p=0.0135). There is more neonatal infection in the group A with long latency period (61.7% vs 24.3%; p=0.0014) and more chorioamnionitis (70.6% vs 24.3%; p<0.0001). CONCLUSION: The association maternal steroid and antibiotic therapy, short latency period, and hospitalization of the pregnant woman close to a neonatal intensive care unit reduce significantly the neonatal morbidity after preterm premature rupture of the membranes.

[Infraclinical breast lesions: apropos of a retrospective study of 261 cases]. / Les lésions mammaires infracliniques. A propos d'une étude rétrospective de 261 cas.

OBJECTIVE: To determinate the rate of malignant lesions discovered after surgery for nonpalpable breast lesions diagnosed by radiology. TOOLS AND METHODS: We performed a retrospective study of 261 patients who underwent surgery for nonpalpable breast lesions at the Saint-Etienne University Hospital between 1991 and 1998. We included women who did not have any palpable breast lesion. We excluded bilateral lesions and nonpalpable lesions associated with a palpable lesion in the same breast. We grouped outcome by alarming signs, those of complementary exams such as mammography, ultrasound, fine-needle aspiration biopsy and setreotaxis core needle breast biopsy in their sensitivity, specificity and predictive values, and classed results by pathology and type of surgery performed. All nonpalpable lesions were localized by stereotaxis maneuvers. RESULTS: In our series, 61.7% of the patients were seen for individual detection, 3% had participated in mass screening programs and 35.3% were referred for suspected conditions. The predictive value of malignant lesions on mammography, analyzed in all cases and interpreted in 275, was 42.2%. The sensitivity and specificity of ultrasound exams performed in 50.2% of the cases were 85% and 91% respectively. Fine-needle aspiration biopsy and core needle biopsy were performed in 45 (18%) and 23 (9%) cases respectively. Twelve patients underwent total mastectomy with axillary dissections, 58 had tumorectomy with axillary dissections, and 191 had simple tumorectomy. Benign lesions were found in 128 (49.1%) cases, atypical hyperplasia in 10.7%, carcinoma in situ in 57 (cases 21.8%). The rate of malignant lesions was 38.6%. I was 50.9% when borderline lesions (atypical hyperplasia and in situ lobular carcinoma) were included. CONCLUSION: In our series, 38.6% of all nonpalpable operated breast lesions were cancers. Ultrasound, fine-needle aspiration and needle core biopsy showed high sensitivity and specificity allowing good biopsy outcome.