Locally advanced adenocarcinoma of the cervix on uterus didelphys: a case report.

In November 2013, a woman with Herlyn-Werner-Wunderlich (HWW) syndrome was diagnosed with a locally advanced left cervical adenocarcinoma. The patient's malformation consisted of two uteri with two cervixes, a obstructed vagina, and a left renal agenesis. Classification FIGO: stage IIIa because of infiltration of the inferior third of the vagina wall. Locoregional management comprised an infrarenal lateral aortic lymphadenectomy followed by concomitant radio-chemotherapy to the pelvic (inguinal, pelvic, and infrarenal para aortic nodes) volumes. A total of 50.4 Gy were delivered (1.8 Gy/fraction/day) to the node (inguinal, pelvic, and aortic infrarenal) and pelvic volume; a concomitant boost to the primary cervical tumor and macroscopic nodes to 59.92 Gy (2.14 Gy/fraction/day) was performed. 20 Gy were delivered with intracavitary brachytherapy boost with mold technique and a pulsed-dose-rate technique due to the rarity of this uterine malformation. After 30 months of follow-up, there was no evidence of locoregional or distant recurrence.

[Pelvic and abdominal actinomycosis presenting as a parietal mass]. / Actinomycose abdominopelvienne révélée par des abcès pariétaux.

INTRODUCTION: Actinomycosis is a rare disease. It has a highly varied clinical picture and may simulate genital or gastrointestinal neoplasms. CASE: This 45-year-old woman was referred for suspected ovarian cancer, with secondary lesions of the liver and pelvic wall. Pelvic actinomycosis was first suggested by the presence of an intrauterine device (IUD), which had been in place for several years without any follow-up. The final diagnosis was based upon histological examination of a biopsy sample of the parietal mass. COMMENTS: The association of apparent pelvic tumors with infection and inflammation together with the presence of an IUD must suggest genital actinomycosis and lead to the rejection of any immediate surgical resection. The diagnosis is usually histological, with samples obtained either surgically or by percutaneous stereotactic biopsy. The treatment is essentially medical and consists of long-term antibiotics (penicillin). The prognosis is usually good.

[Maternal pancytopenia during antenatal treatment of congenital toxoplasmosis]. / Pancytopénie maternelle au cours du traitement anténatal d'une toxoplasmose congénitale.

INTRODUCTION: The treatment of reference of congenital toxoplasmosis combines two folate synthesis inhibitors, pyrimethamine and an antibacterial sulfamide (sulfadiazine or sulfadoxine). Despite the efficacy of this combination, the possibility of eventually severe side effects must also be taken into account. OBSERVATION: A pancytopenia occurred at 37 weeks of amenorrhea during antenatal treatment for congenital toxoplasmosis in a tripara. The outcome was positive following administration of strong doses of parenteral folinic acid combined with platelet transfusion and broad-spectrum antibiotics. DISCUSSION: Each of the molecules (pyrimethamine and antibacterial sulfamide) used for the treatment of congenital toxoplasmosis can lead to acute haematological problems. The occurrence of maternal pancytopenia however remains exceptional. It is principally related to pyrimethamine and is usually observed in the presence of factors enhancing folate deficiency.

[Surgical cure of stress urinary incontinence with vaginal tissue sling: technique, results, indications]. / Cure chirurgicale de l'incontinence urinaire d'effort par fronde de tissu vaginal: technique, résultats, indications.

OBJECTIVES: Describe a new surgical technique of sling procedure using a vaginal sling and report complications and mid-term functional results. According to these results, it's necessary to discuss the best indications. MATERIAL AND METHODS: Retrospective study of the first 75 patients operated for urinary stress incontinence. RESULTS: The average age of patients was 56 (30-90). Preoperative complications have been rare with only one bladder injury (1.3%). Postoperative complications have been more frequent and the most of them was caused by 76% of urine retention lasting a mean of 14 days and 44% of urinary infections. 20% of the patients have presented secondary dysuria and/or urinary urgency. 4 patients (5.3%) have presented a vaginal mucocele between 9 and 32 months after the operation. At mean follow-up of 25.1 months, the success rate was 70.6%, with 61.3% of patients who have been cured and 9.3% which was improved. In case of severe sphincter insufficiency, the success rate was 80%. Success rate was 30% when the vaginal sling was the only procedure and 66.1% when it was associated to another vaginal procedure (p = 0.006) as vaginal hysterectomy or sacro-spinous suspension. CONCLUSION: This original surgical technique for cure of urinary stress incontinence is inexpensive and easy to learn. It can be associated to other operations by vaginal way. The realization of this procedure under regional anaesthesia should enable to warn urine retention which is the mean postoperative complication. The success rate of this series is cheerful because it takes into account any patients no selected and operated on the learning phase of the technique. The best results of this technique are urinary stress incontinence associated with vaginal surgery for genital prolapse. The final assessment of this surgical technique will be require longer follow-up and comparative studies with other procedures on an elevated number of patients.