Contraception, fertilite, sexualite (1992)最新文献

Study objective: To investigate the alternative routes for hysterectomy for benign disease and the appropriate role of laparoscopic surgery.

Design: Retrospective study of hysterectomies performed between August 1991 and July 1997.

Setting: University hospital.

Patients: Hysterectomy for benign disease without prolapse, pelvic floor relaxation.

Intervention: 359 hysterectomies: vaginal (n = 211), laparoscopically-assisted vaginal (n = 56), and abdominal (n = 92).

Measurements and main results: Uterine volume was the principal indication for laparotomy. Laparoscopy was required only in cases of adnexal disorders or when the vaginal access was limited or associated with extensive adhesions. The rate of laparotomies and laparoscopies dropped steadily over the six-year study period: during the last two years, 75% of all hysterectomies were vaginal, and 90% of those for patients without a previous vaginal birth.

Conclusion: With experienced surgeons, the number of cases in which there appears to be poor vaginal accessibility experience decreases, and indications for vaginal hysterectomies increase.

Our objective was to determine, in a retrospective study of 352 operative hysteroscopies: (a) the rates and the types of complications and (b) the risk factors of peroperative perforations. The most important complications represented 1.7% including two haemorrhage, one symptomatic metabolic abnormalities and three uterine perforations with bowel injuries (0.8%). Furthermore, minor complications were observed in 9.3% including non symptomatic metabolic abnormalities (5.5%) and uterine perforations without visceral injury. Among mechanical complications, the majority were uterine perforations (4%). No relation was found between menopausal status of the patients and the occurrence of uterine perforation. In contrast, the perforation rate was statistically greater in patients treated for synechia than those found for myoma (p < 0.0001). Furthermore, the perforation rate was statistically higher for resection of myomas as compared with endometrial resection (p < 0.0001) or polyp resection (p < 0.0008). Moreover, in our experience, the perforation rate depended on hysteroscopic experience of surgical operators.

The fine mechanisms involved in human follicular growth in the ovary are not completely elucidated yet. The morphometric parameters are, by far, better understood than the metabolic ones. However, new data on the steroidogenic follicular human activity and their ability to respond to endogenous and exogenous gonadotropins lead to a better understanding of the results of our different therapeutic schemes. On the other hand, the selection criteria of patients have been modified, dealing now with the ovarian age much more than the real age. A precise determination of the ovarian age allows us to better drive our stimulation protocols and helps us to switch to other alternatives rather than multiplying useless and ineffective stimulations. This is of major importance in term of psychological aspects as well as in term of public health costs for the society.

Nowadays there are more and more empirical studies of sexual fantasies. Fewer are researches on sexual dreams. Even less common are the data on the relation between sexual fantasies and sexual dreams. A lot of questions can be brought up. Is there a correlation between the frequency in fantasies and sexual dreams? Is there a concordancy or discrepancy between these two? What would be the differences between the persons whom sexual fantasies and dreams concord from those who don't concord? Finally is there an interaction between fantasies and sexual dreams? Based on our preliminary results, we present our mains hypothesis and few illustrations.

More than 30 years after the legalization of contraception in France (Neuwirth law) it was interesting to access the sexual behavior and the practice of contraception of French female teenagers. It is with this purpose that this survey has been done in the city of Nantes in Loire Atlantique. 467 female teenagers, 13 to 21 years old, were concerned. Results point out that more of 75% of young girls who replied to this survey used one contraceptive method during the first sexual intercourse and condom is predominantly used. A few ambivalences stake out this life period, so preventive strategies have to be very specific in order to fight sexual transmitted diseases (STD) and AIDS.

Objectives: Evaluation of amnioinfusion results during labour in case of thick meconial amniotic fluid or in case of oligo-hydramnios associated with variable deceleration of the fetal heart response.

Patients and methods: Prospective non randomized study. Amnioinfusion was applied to 47 cases of thick meconial amniotic fluid and to 18 cases of variable fetal heart decelerations associated with oligo-hydramnios. Obstetrical and neonatal data were compared with a similar group without amnioinfusion (n = 32).

Results: Comparing both groups shows that amnioinfusion offers a better fetal well-being during labour, according to Kreb's fetal heart evaluation during labour (8.53 +/- 1.06 vs 6.56 +/- 0.35--p < 0.01), lows the cesarean section rate (8.5% vs 31.2%--p < 0.01). Amnioinfusion is also associated with a higher Apgar's score at one minute after delivery (9.4 +/- 0.8 vs 8.7 +/- 1.7--p = 0.01) and a lower rate of thick meconium inhalation (13.7% vs 40.7%--p < 0.01). There was no difference for children's first days of life. We found no serious complication following amnioinfusion.

Conclusion: We confirm general agreement about amnioinfusion, according to international literature. Amnioinfusion needs an acute care to prevent classically described complications. In case of thick meconial amniotic fluid or variable decelerations associated with oligo-hydramnios, amnioinfusion during labour offers a better fetal well-being.

The incidence of neural tube closure abnormalities, and particularly Spina-bifida is correlated with a low dietary intake of folic acid, for which the marker is the erythrocyte folate concentration. Initially, preventive policies concerned women treated with anticonvulsant agents and those with a known family history of Spina-bifida. This constituted secondary prevention. The objective of this study was to demonstrate the methods and respective role of secondary and primary prevention in 1998. The evolution away from secondary prevention towards primary prevention, i.e. aimed at all women who intend to conceive has been based upon the fundamental epidemiological estimate that 95% of cases of Spina-bifida occur in babies born to women without a known family history of this type of disorder. The idea that dietary measures alone may suffice to ensure effective prevention is invalid. However, if used in addition to a mean dietary intake of 200 micrograms folic acid a day, the only use of pharmacological or synthetic supplementation of 200 micrograms/day makes it possible to achieve the desired threshold of Dietary Folate Equivalents of 600 micrograms/day. The dose of 200 micrograms/day has been judged by the authors as being the most effective and safe for use on a large scale in the general population. Today, in 1998, the primary prevention of neural tube closure abnormalities is the subject of an international consensus which recommends folate supplementation of 100 to 200 micrograms/day during the periconceptional period. Implementation of this solution in the context of a health education campaign would meet the expectations of many women, in as much as 66% of them have declared that they would be ready to comply with such primary preventive measures.