[The ovary and insulin resistance]. / L'ovaire de l'insulinorésistance.

Insulin resistance appears to be responsible of approximately half of the cases of polycystic ovaries, the other half being probably provoked by an anomaly of the stimulation of ovaries by an excess of LH. Nevertheless, it is likely that in most cases the two factors conjugate. The excess of androgen production by the ovarian stroma is one of the major symptoms of this disease. Today, however, the diagnosis is carried mainly with the assistance of ultra-sounds which, besides the increased ovarian volume, have permitted to discover an increased ovarian stromal vascularity. Two essential datas derive from the whole works: the increased frequency of ovarian hyperstimulation syndrome and the great number of metabolic complications which requires an endocrinological supervision. But the most recent works focus on the extension to all ages of this form of pathology: from the intra-uterine life to the post menopause; and on the hereditary character of this disease. The mystery remains concerning the mechanism of the favourable effect in clomifene resistant PCOS, of surgical and laparoscopic methods of ovulation induction to which it may be useful to resort after mature consideration. More recently the benefit at the administration of metformine has been confirmed by several works.

[Gynecologic infections and sterility]. / Infections gynécologiques et stérilité.

The authors consider all the mechanisms through which a genital infection is able to affect fertility and fecundity. They conclude that a strict diagnosis and treatment must complement accurate information of the public by physicians.

[Study of endometrial maturation under the influence of an oestrogen-progestin combination containing 30 mcg of EE and 150 mcg of desogestrel: the value of biopsy of the endometrium in assessing the efficacy of an oestrogen-progestin combination]. / Etude de la maturation de l'endometre sous l'influence d'un estro-progestatif contenant 30 mcg d'EE et 150 mcg de desogestrel: interet de la biopsie de l'endometre pour evaluer l'efficacite d'un estro-progestatif.

PIP: Endometrial biopsies were performed on 21 female volunteers aged 18-40 years to evaluate the inhibitory effects of a new contraceptive formulation and the influence of the steroid on 1 of the major target organs. The formulation contained 30 mcg of ethinyl estradiol and 150 mcg of the new progestin desogestrel. The 21 women had taken the OC for at least 3 months. The aspiration biopsies were performed during 3 different cycle phases in 3 different centers in Nice, Bordeaux, and Paris. 5 biopsies done during days 1-9, 5 during days 10-17, and 7 during days 18-23 were retained. Results from the 17 biopsies were remarkably homogeneous for all cycle dates. The endometrium was constantly hypotrophic, the glandular tubes were of small size, and signs of glandular secretion were present in 16 of 17 cases with intracellular vacuoles and a visible secretion. Mitosis was observed in the glandular cellule in only 1 case. The stroma were edematous in 9 of 17 cases. The results demonstrated a low estrogenic stimulation and a dominant progestagenic action due to the strong antigonadotrophic and progestagenic properties of desogestrel. The advantages of the new generation of progestins such as desogestrel are obvious from the study. The study also demonstrates the need for endometrial biopsies to characterize the overall effects and climate of combined OCs, since some of the most common markers can provide misleading results.^ieng

[Monitoring the induction of ovulation by HMG-hCG]. / Monitorage de l'induction de l'ovulation par HMG-hCG.

Despite correct management of HMG and hCG, the margin between effective dose and overdose is narrow. Surveillance must be clinical, biochemical and echographic. Biochemistry and echography give information on follicle maturation. Echography is a particularly valuable means of monitoring the effect of administration of hypophyseal hormones on the development of follicles.

[How does one confirm the definitive character of the menopause on a clinical basis]. / Comment affirmer le caractère définitif de la ménopause sur des bases cliniques?

The statement of the definitive character of the menopause is not easy, save in the case of surgical castration. In all other cases one has seen the reappearance of the menstrual periods after several months of amenorrhoea. Although, in principle, amenorrhoea of an entire year's duration corresponds to the menopause, there are exceptions. In the case of women who are undergoing contraceptive treatment, the only means of knowing if they are menopausal consists of interruption of the oestro-progestational contraception and of advising the use of a local contraceptive for a period of several months.

[Placental chorioangioma. Echographic diagnosis in the 19th week]. / Chorio-angiome placentaire. Diagnostic échographique à la 19e semaine.

Systematic ultrasound examination made it possible to discover a placental angioma measuring 50 mm in diameter and situated in contact with the feral plaque. This angioma had reached 78 mm in size across its largest diameter by the 23rd week and appeared to become stable thereafter, getting in size towards the 35th week. This state of involution was confirmed when the placenta was examined and it was found there was a second angioma present, and that is was functional, and that there were several microangiomata. The pregnancy, clinically and biologically, was normal throughout and ended with the birth of a healthy girl, who in particular had no enlargement of her heart.

[Complete genital prolapse repaired per vaginam with preserved vaginal permeability (author's transl)]. / Prolapsus génital extériorisé. Cure par voie basse avec conservation de la perméabilité vaginale.

A procedure of total vaginal hysterectomy without vaginectomy with a vaginal vault suspension to the anterior abdominal wall-- without laparotomy--is presented. The patient for whom this operation is indicated is the old sexually active women.

[Abdominal pregnancy with a malformed uterus (author's transl)]. / Grossesse abdominale et utérus malformé.

The author reports a case of abdominal pregnancy in a woman with a malformed uterus after 30 weeks of amenorrhoes. The several different clinical abnormal features are detailed: threatened early labour, death in utero, inability to induce labour by several different methods, sub-acute obstruction and "rupture" of the membranes. Diagnosis was made only on laparotomy. Rupture of the uterine cornu had occurred in a bicornuate uterus with single cervix with secondary implantation of the oocyte in the abdominal cavity. The ruptured cornu was removed.

[IUD and nulliparae (author's transl)]. / Sterilet et nulliparite.

PIP: Contraception with the IUD is definitely on the increase in France where, in January 1978, there were about 850,000 users. According to the authors of this article the IUD is an excellent contraceptive method, except in the case of nulliparous women, who seem more susceptible to complications caused by IUDs. A survey of the published literature shows that uterine perforation is easier in nulliparous women, and that expulsion is more frequent, as is removal for reasons of bleeding and pain, and as unwanted pregnancy resulting from IUD failure. More importantly, frequency of infection is higher among nulliparous IUD wearers; it must be remembered that serious infection often leads to sterility. As a result of such findings nulliparity must be regarded as an absolute contraindication to the use of an IUD unless no other contraceptive choice is possible.^ieng

Tubal sterilization by a combined laparoscopic and external technique: preliminary report on 75 cases.

A preliminary report is given on a new laparoscopic sterilization procedure. By a double-puncture method, a loop of tube is brought out of the abdomen through the suprapubic incision. The loop is then resected by a modified Pomeroy method. Between Octorber 1976 and June 1978, 75 sterilizations were performed without any major problem. Sterilization failed in one case when one tube could not be seen. All recoveries were uneventful. Safety, effectiveness, simplicity, and potential reversibility seem to be the qualities of this method.

[Indication and technic of tubal sterilization by vaginal route. Posterior transverse colpotomy]. / Indication et technique de la stérilisation tubaire par voie vaginale. Colpotomie transversale postérieure.

40 tubal sterilisations have been carried out in 5 years. The indications most often are for grand parity. The anatomical criteria for effective sterilisation by the vaginal route should be sought by gynaecological examination under general anaesthetic. The date for the operation, the technique and its difficulties have been described. The operation lasted on an average 30 minutes. The average stay in hospital was 8.2 days. Only one local complication using this techinque was noted. On one occasion the authors had to abandon the vaginal route to reach the tubes. This simple procedure without any aesthetic inconvenience seems to them to be the ideal route for tubal sterilisation.