Revue francaise de gynecologie et d'obstetrique最新文献

Today, the early diagnosis of ectopic pregnancy (EP) is made possible by the assay of plasmatic hCG and the improvement of trans-vaginal sonography. These different tests lead to diagnose the EP before the ruptured stage. Therefore, the medical treatment is today a logical alternative to the surgical one. The medical treatment is mainly based upon the use of methotrexate (MTX). The logical indications for EP medical treatment are: early EP without peritoneum effusion, with hCG < or = 5000 mUI/ml, without embryonic cardiac activity at sonography. The medical therapy by intramuscular injection of MTX at 1 mg/kg gives a success rate of 91.8% similar to the success rate of intra tubal injection of MTX under sonographic control.

A young woman with a history of in utero exposure to distilbestrol was diagnosed with vaginal clear-cell adenocarcinoma. Management consisted of limited excision of the tumor followed by brachytherapy after transposition of the ovaries. The patient had a successful pregnancy after reimplantation of the ovaries in their normal position and right adnexectomy for Chlamydia infection. The child was delivered by cesarean section. This is probably the first case with a pregnancy after repositioning of the ovaries in Europe and perhaps even in the world.

Struma ovarii is a rare ovarian tumor composed entirely or in part of thyroid tissue. Pathogenesis is unclear. Diagnosis rests on the histologic study. A case is reported. Specific features of struma ovarii are discussed based on a review of the literature. The treatment is surgical and the outcome generally favorable.

Compliance with hormone replacement therapy (HRT) in postmenopausal women is discussed. Although accurate quantitative evaluation is difficult, estimates in French women are provided. Thirty percent of postmenopausal women are under HRT, but data are lacking on the age groups in which HRT is most prevalent. Given the benefits of HRT in terms of public health, physicians should make every effort to educate their patients, in particular regarding differences between oral contraception and HRT. Other targets for HRT education include general practitioners, health insurance agencies, and the media. Better information provided by physicians and drug companies would allow to increase the use of HRT.

Vaginal sacro-spino-fixation or Richter's procedure is valuable for the treatment of posthysterectomy vaginal prolapse. Although technically difficult, this procedure is associated with minimal trauma and is effective in correcting pelvic static disorders. There seem to be few complications. Results are very promising. The functional and anatomic improvements induced by the operation persist over the long term. Although the main indication is treatment of prolapse of the vaginal vault, Richter's procedure is also useful for the prevention of prolapse. Based on the experience acquired by a surgical team, the technique, indications, complications, and results of Richter's procedure are discussed.

Four cases of struma ovarii were seen among 308 ovarian tumors removed surgically at the Salah Azaiz Institute, Tunis, Tunisia, between 1980 and 1989. This yields an occurrence rate of 1.3%, which is comparable to previously publishes rates (0.3% to 2%). One of the four tumors was malignant. Malignant transformation of struma ovarii is very rare (5% to 10%). The histologic diagnosis of malignancy is difficult, particularly in well-differentiated follicular forms. The prognosis is relatively favorable even in patients with metastases. Based on their personal experience and on a review of the literature, the authors discuss the diagnosis, management, and outcome of struma ovarii, in particular with malignant transformation.

Six cases of granulomatous mastitis are reported. Based on a review of the relevant literature, the clinical features, etiology, and management of this pathologic entity are discussed. The definition of granulomatous mastitis is given and the characteristics that distinguish this condition from other inflammatory breast diseases are pointed out.