Revue francaise de gynecologie et d'obstetrique最新文献

In a 13-year old girl, an ovarian tumor was suspected of being responsible for causing amenorrhea-galatorrhea. In the absence of any abnormality of the medial umbilical folds, hormonal assessment indicated a high level of prolactin, which was restored to normal after exeresis of the mass. This was an ovarian tumor of the sexual cords with annelated tubules (SCTAT de Scully).

One the basis of personal observation and a review of recent literature (which is somewhat sparse), the authors describe the characteristics of adenoid cystic carcinoma of the breast which is a very unusual tumor. They stress the diagnostic difficulties which frequently make it necessary to use histochemical or immuno-histochemical diagnostic techniques which have been widely developed.

Gelatinous degeneration of the peritoin is an unusual disorder which inevitably takes the surgeon by surprise during laparotomy. Three cases are reported. The diagnosis, pathogenesis, prognosis and possible therapies are discussed. The tumoral pathogenesis usually appears to be non-malignant and to originate in the ovaries or appendix. However, gelatinous degeneration of the peritoin must be viewed as a disease with attenuated malignancy. The pattern of development is slow, with repeated peritoneal recurrences. The survival time is long. Treatment is essentially surgical even when recurrences occur.

The authors report the case of a degenerative Buschke-Löwenstein tumor located on the vulva. The authors stress the unusual nature of this disorder, recall its etiopathogenic factors and insist on the necessity for surgery to avoid a transition to malignancy.

A case of persistent permeability of the medial umbilical fold identified by the ultrasound detection of an enlarged umbilical cord. The ultrasound characteristics of this cord are described. A review of the literature made it possible to survey the diagnostic conditions of this disorder and to envisage the mechanisms involved.

Coculture techniques on monolayers cells increase the rate of human blastocysts development. The selection of these heavier and more expensive methods should be reserved for cases which this work specifies. The rate of achieved pregnancies seems increased, embryo quality being, at this stage of later development, better estimated, from which a more objective selection. The window of endometrial receptivity to blastocysts implantation seems later than the one defined by the 2/8 cells stage. Last but not least, the cryopreservation of high quality blastocysts favours a high rate of recovery on defreezing.

One-hundred-and-four cases of histopathologically confirmed hydatiform moles were subjected to ultrasound examination at the Hung Vuong Hospital, Ho-Chi-Minh-ville (Vietnam) over a period of 16 months (1988-1989). The diagnosis was confirmed only in some cases on clinical grounds (18%) or by laboratory tests (52%). In contrast, typical ultrasound signs were found in 82% of cases; in the other 18% of cases, other aspects had suggested disorders calling for aspiration (partial mole, clear ovum, pregnancy terminated). Some ultrasound images, highly suggestive of mole, were found in occasional cases of mucoid ovarian cyst, endometrial cancer or cystic necrobiosis of fibroma (HCG tests negative). Despite its limitations in Vietnam ultrasound constitutes the primary method of detecting hydatiform mole, the acquisition of practical experience is facilitated by the high number of cases and the concentration of cases reported.

This study involved an analysis of 25 cases of sarcoma of the uterine body collected at the Gynecology and Obstetrics Clinic of the Ibn Rochd CHU teaching hospital, Casablanca (Morocco) during a 15-year period (1977-1992). These are unusual malignant tumours (accounting for only 0.9% of uterine cancers) which occur after the menopause and have an appalling prognosis. Metrorrhagia was the most common alerting symptom. Presurgical diagnosis was difficult and uterine sarcoma was usually identified during surgery. The most common histological type encountered was leiomyosarcoma. Treatment was primarily surgical: total hysterectomy combined with bilateral appendectomy (20 cases), with radiotherapy (5 cases) or with adjuvant chemotherapy (1 case). Radiotherapy was the only treatment in 2 patients. The survival rate was low: 10% after 2 years, 5% after 5 years. Age, histological type, extent of the tumor and method of treatment were all recognised as prognostic factors. One interest of this work is to recall the existence and the severity of this pathology in those periods of endoscopic games and excessive conservative treatments.

In this study, the authors raise the question of the morbidity related to Asherman's syndrome and demonstrate that hysterectomy is the best method for diagnosis and treatment. In a group of 15 patients, secondary sterility and secondary amenorrhea were the main reasons for consultation, 11 patients underwent surgical hysteroscopy and the other fourteen received conventional treatment. The main etiological factors identified were curettage and cesarian section. A normal cavity was successfully reconstructed in 12 cases (80%) after between one and three treatments. Normal menstruation was restored in all patients. In the obstetric field, there were 7 pregnancies, resulting in 6 deliveries and one miscarriage. Hysteroscopy therefore constitutes a real step forward in the diagnosis and treatment of Asherman's syndrome; it may be possible to extend its advantage to all forms of endouterine neoformations.

The origins of the Cesarian section date back to the Classical era, and possible even earlier. Ancient India, the Hebrews, the Grecks and the Romans were all familiar with post-mortem Cesarian section. The operation marked time during the Middle Ages. The name "Cesarian section" was first used to designate this operation during the Renaissance period, when it was first carried out in live women. However, until the middle of XIX th century, a Cesarian remained a last chance option which was cautioned against by most obstetricians. It was only after the advent of the "surgical golden tripod" that the Cesarian was gradually rehabilitated through the work of Poro, Kherer and Sanger and the German School. In the XIXth century, segmental incision became the norm and fetal indications for a Cesarian emerged.