[Preventing of postmenopausal osteoporosis by hormone replacement therapy? Is the risk acceptable?]. / Prévention de l'ostéoporose postménopausique par traitement hormonal substitutif: les risques sont-ils encore acceptables?

Over the past two decades, multiple observational studies have suggested that hormone replacement therapy (HRT) reduced the risk of fracture, increased the quality of life and protected against the cardiovascular disease. HRT was often recommended, on the basis of this evidence, for that indications. But these recommendations were based entirely on observational evidence, which can sometimes be misleading. In the early 1990, several large randomized studies were initiated. The largest of these trials, the Women Health Initiative (WHI) was stopped prematurely last summer (only the group with estrogen plus progestin) because the disadvantages outweighted the advantages of treatment. The conclusions of that study were largely debated in the press and destabilised more than one patient or doctor. The Swiss menopausal society published some directive to precise the indications of HRT.

[Perinatal hemolytic disease. Part 2: Prevention and management]. / Maladie hémolytique périnatale. 2e Partie: Prévention et prise en charge.

There has been a dramatic reduction in the incidence of neonatal mortality due to fetal hemolytic disease since the introduction of Rhesus prophylaxis. Although routinely used since 1968, the exact mode of action of anti-D IgGs is still not fully understood. Notable advances have taken place in the screening and the management of fetal hemolytic disease. This article describes the antibody detection in the mother, and the fetal management with ultrasound amniocentesis, fetal blood sampling and intrauterine transfusions. Finally, the postnatal management is also considered.

[Perinatal hemolytic disease. Part 1: physiopathology]. / Maladie hémolytique périnatale. 1re Partie: Physiopathologie.

Perinatal hemolytic disease is characterized by the destruction of fetal red blood cells by maternal antibodies directed against membrane antigens and can lead to immune fetal hydrops. More than 250 blood group antigens have been described. After considering the particular situation of ABO incompatibility, this article describes the classification of red blood cells antigens, with particular reference to the Rhesus system. Other antigens such as Kell, Kidd, Duffy, MNSs, P and Lutheran are also considered.

Aorto-subclavian thromboembolism: a rare complication associated with moderate ovarian hyperstimulation syndrome.

The case of an arterial aorto-subclavian thromboembolism associated with a moderate ovarian hyperstimulation syndrome (OHSS) and following ovulation induction for in-vitro fertilization in a young woman is reported. Because of the lack of response to systemic thrombolysis, a left postero-lateral thoracotomy was performed on day 8 after embryo transfer. A fibrinocruoric embolus situated at the junction of the left subclavian artery from the aorta was removed through a left subclavian arteriotomy. The distal axillary embolus was removed by a retrograde balloon catheter embolectomy. A moderate OHSS was observed. The ovarian stimulation and OHSS-related risks of thromboembolism are discussed. We conclude that, in the absence of risk factors, counselling about possible complications resulting from stimulation must be emphasized.