Revue francaise de gynecologie et d'obstetrique最新文献

Tissue-glue stands out by virtue of its ability to ensure non-traumatic tissue apposition and hemostasis, leading to a reduction in operative time. This explains the use of this technique in a wide range of indications in gynecological endoscopy. These include ovarian reconstruction after the extraction of cysts, tubal anastomoses and even closure of iatrogenic perforations of the uterus. In these indications, the application of tissue-glue can be considered as the method of choice because of its excellent long term results. In contrast, its effect in the sealing of peritoneal or serosal defects with the aim of avoiding adhesions has not yet been clearly demonstrated. Analysis of a sufficient number of cases with long follow-up is essential before any final assessment can be made. Among 75 instances of endoscopic use of tissue-glue up to now, we have never encountered any post-operative complications, nor during subsequent follow-up. In addition to its ability to stimulate tissue healing, tissue-glue offers a simple and non-traumatic alternative to the lengthy technique of endoscopic sutures, with a hemostatic action in parallel.

Variations in the vaginal environment that occur throughout the life span are described. The nature and cybernetics of factors involved in these variations are discussed.

Pregnancy duration was accurately determined using early ultrasonography in 21 patients prior to spontaneous abortion and in two successive pregnancies in each of 57 women prior to spontaneous delivery. Pregnancy durations before abortion or delivery approximated multiples of 14 days (14.4 and 13.3 days, respectively). In addition, in a given woman, the duration of two successive pregnancies carried to term was often identical; in a smaller number of cases, a difference of about 12 days (calculated value, 11.8 days) or, rarely, 24 days, was found. These values may correspond to the same functional period. These observations suggest that the duration of pregnancy (mean, 266 days) may be a multiple of the duration of the luteal phase of the menstrual cycle (12 to 14 days). Interindividual variations in luteal phase duration (standard deviation, 0.5 to 1 day) may explain inter-individual variations in pregnancy duration (standard deviation of about 15 days). The mean multiple may be 20. Thus, pregnancy duration may be determined both by fetal maturation and by a maternal time-counting mechanism. This hypothesis is discussed in the light of current data.

The anatomic complexity of the female pelvis is pointed out. The diagrammatic frontal and lateral sections through the female pelvis presented in this article are based on results of anatomic studies of cadavers of adults and fetuses and on pelvic ultrasonography and magnetic resonance imaging findings. The horizontal floor of the pelvis, the perineum, and the pelvic cavity are visible on both sections. Newly identified structures are the urogenital fossa, the pubosacral perineal cord, and the urethro-clitorido-vulvar erectile body. Special attention is devoted to the description of the ischiorectal fossa and its extensions and of the uro-genito-rectal mesentery. A study of the functional anatomy of the female pelvis would be feasible.

To investigate the epidemiology of premature delivery, in particular regarding potential seasonal influences, a retrospective medical-record study was conducted in 3345 women who delivered prematurely over a six-year period (1988-1993). The control group was composed of 53,162 women who carried their pregnancies to term. Each study subject had delivered at least one liveborn baby, prematurely or at full term. The premature delivery rate (ratio of premature over term deliveries) was highest in May through July and decreased significantly in January and February (p < 0.05). Premature delivery rates were similar in primiparas and multiparas (p > 0.05) and were not influenced by the gender of the fetus (p > 0.05). In conclusion, premature delivery rates vary across seasons, suggesting an influence of weather conditions.

The treatment of recurrent vulvovaginal fungal infections is difficult. Pathogenic mechanisms are discussed. Available pharmacologic treatments and their mechanisms of action are reviewed. Patients clearly prefer oral treatment. Ketoconazole is toxic. Only topical or nonabsorbed oral agents can be used during pregnancy. Agents absorbed via the digestive tract can be used in women who use effective contraceptive methods. Published data demonstrate that trifluconazole (which has not yet been granted a license in France) is potent and less toxic than ketoconazole, and that recurrences at discontinuation of this drug are less common. A few hypotheses for future research are presented.

This study involved 13 cases of patients fitted with intra-uterine contraceptive devices which migrated in the abdominal cavity. Laparoscopy enabled localization of the IUCD and full lesion assessment. It was removed by celio-surgery in all 13 cases. Difficulties encountered were due to parietoepiploic adhesions and IUCD impacted in the wall of the rectum.

Neuroradiologic and neuropathologic studies have revealed evidence of the existence of structural brain damage in schizophrenics, the ethiopathogenesis of which could include early neurodevelopmental disturbances. Exposure to obstetric complications could be an environmental risk factor predisposing to the later occurrence of schizophrenic disorder in adolescence. The majority of studies evaluating such an association have found an excess of obstetric complications in schizophrenia patients, tough without revealing the existence of a preferential link with a specific type of complications. These interpretation of these results in terms of cause-and-effect must remain cautious, because of the methodological limitations of the studies.

Management of a patient with a diagnosed choroid plexus cyst (CPC) is probably one of the most difficult of all prenatal diagnostic problems. Similarity between the risk of chromosomopathy due to the appearance of CPC only and the risk of fetal mortality due to amniocentesis (both being about 1/200) is such that an individual approach must be adopted in each case. The couple must be given a full explanation of all the details, which will enable them to finally decide whether a conservative attitude is appropriate or, on the contrary, if a specific diagnosis should be sought by amniocentesis.

Umbilical endometriosis is a rare site of the disease. The authors report a case of umbilical endometriosis only. Umbilical involvement is estimated at 0.5 to 1% of all site of the disease. This is a disorder affecting women of childbearing age, with a mean age of about 40. Medical treatment by progestogens or Danazol is inconstantly and partially effective regarding umbilical endometriosis. Surgical excision remains the only effective treatment: omphalectomy with wide removal of the tumor and reconstruction of an umbilicus. Surgery enables histologic study and, in the presence of suggestive symptomatology, search for and treatment of other genital sites.