Contraception, fertilite, sexualite (1992)最新文献

Proximal tubal desobstuction by selective salpingography: through a study of eight cases, the authors give their first results about tubal desobstruction by selective salpingography.

We report on the preliminary results of a series of 111,292 patients who benefited from a liquid medium sample (CytoRich) for cervical cancer screening. The number of dubious or limited smears was reduced by 0.03% and 0.53% respectively. The junction zone was better explored, and metaplastic changes were observed in 35.71% of the cases. This method improved the identification of low-grade lesions by +56% (2751/111,292; 2.47%) and of high-grade lesions by +75% (860/111,292; 0.77%), with a reduction in the number of ASCUS/AGUS by -44% (2065/111,292; 1.85%). This preliminary study confirms the results already published. The results demonstrating cytohistological correlation should prove to be a decisive factor, enabling the testing of the sensitivity and specificity of this technique. It will then be possible to envisage a future 'new paradigm' for screening cervical cancer as the result of a liquid medium sample, computer-assisted screening and HPV viral identification by Hybrid capture II.

This is an epidemiological study of 1,498 patients who underwent laparoscopic surgery for different reasons. Between 1989 and 1996, 308 cases of endometriosis were identified among 1,498 patients who underwent laparoscopic surgery. One hundred and five patients were admitted for pelvic pain, 794 for infertility, 319 patients had both on admission, and 280 were admitted for non-gynecologic complaints. The incidence of endometriosis is related to the chief complaint on admission. This disease has different clinical manifestations, different locations and different stages. The mean age in our series is greater than that reported by the literature. The symptoms are related to the location of the lesions but not the stage of the disease. Unlike pelvic pain, infertility is correlated to the stages of the disease.

At the Tenon Hospital (Paris), 48 inflammatory or locally advanced breast cancers were treated by neoadjuvant chemotherapy (three different protocols), followed by surgery (mastectomy or tumorectomy and axillary dissection). The histological data of the specimens are analyzed with regard to the clinical and radiologic evolution. Twenty complete clinical responses (41%), 22 partial clinical responses (45%), and no response in six cases (14%) were observed. Histology demonstrated residual tumors in 42 cases (87.5%), even in the case of complete clinical response (14 cases), without notable change of the grade (SBR). Lymph node clearance demonstrated positive nodes in 38 cases (79%). Despite its great agreement with clinical examination, mammography does not predict the existence of histological residual tumors after initial chemotherapy. Chemotherapy allowed local treatment, but can rarely sterilize the tumor completely.

The relevance and efficacy of long-term estrogen therapy is well established, though some undesirable side effects and contraindications persist. Raloxifene, the first selective estrogen receptive modulator (SERM) tested in phase III trials, offers a choice alternative. It increases bone mineral density, lowers serum lipid concentrations and reduces vertebral fractures.

Objective: The authors want to appraise the management of diabetes prior to pregnancy in a local population treated in the Lille University Hospital.

Method: This is a retrospective study of 143 pregnancies occurring in 111 patients with diabetes prior to pregnancy, between 1987 and 1997, in the Obstetrics Department at the Lille University Hospital.

Results: Only one-third of the patients benefited from preconception management; the stability of diabetes during the first trimester was satisfactory in 50% of the cases. The maternal complications are represented by preeclampsia (20%), metabolic complications specific to diabetes (hypoglycemia, ketoacidosis), the aggravation or the emergence of a retinopathy (10%) and polyhydramnios (19%). Concerning the termination of the pregnancies, of the 147 fetuses (four twin pregnancies), 140 newborns in good health, two neonatal deaths, three in-utero deaths and two therapeutic terminations of pregnancy were observed. The fetal malformation rate was 9.5% (14 cases/147). The cesarean section rate was 63%, whereas the fetal macrosomatia rate was 35%, with dystocia in 26% of the deliveries (outside of planned cesareans). Three shoulder dystocia were observed (two requiring the Jacquemier's maneuver and one with transitory plexus brachial palsy for a newborn weighing 5,650 g).

Conclusion: The authors conclude that preconception management (one-third of the patients in this series) and management of during the first trimester of pregnancy (50% in this series) was insufficient. This fact is perhaps due to the confusion, for many practitioners, with gestational diabetes, which is a very mediatized affection, though much less severe for the fetus and mother.