Contraception, fertilite, sexualite (1992)最新文献

Thirteen cases of genital tuberculosis are reported to make emphasis onto the difficulties of diagnosis, management and prognosis of the disease. The average age of the patients is 31 years. Most of them were under 30. The circumstances of diagnosis were variable. The diagnosis was essentially made thanks to histology. The evolution was favorable under antibiotics. But clinical sequels as amenorrhea and infertility are frequent.

Objective: To assess the frequency, histological grade and time interval of residual and recurrent lesions after loop electrosurgical excision procedure and to analyse their associated risk factors.

Methods: 288 patients treated by loop electrosurgical excision procedure between February 1991 and July 1995 were prospectively included in this study. They agreed to a postoperative cytological and colposcopic follow-up with a first visit between 3 and 6 months after excision, a second one between 9 and 15 months and a third one between 24 and 36 months. We used univariate and multivariate analyses to evaluate the association between clinical variables and residual or recurrent lesions.

Results: The pathologic diagnosis of the specimens included 21 normal cervices (7.3%), 35 CIN 1 (12.2%), 43 CIN 2 (14.9%), 180 CIN 3 (62.5%), 1 adenocarcinoma in situ (0.3%) and 8 microinvasive cancers (2.8%). The pathologist considered the excision complete in 244 cases (85%). Among the other 44 patients, 27 had involved endocervical margins, 17 involved exocervical margins but none had both margins involved. The mean postoperative follow-up +/- standard deviation was 39 +/- 13 months (range 24-68 months). Treatment failure, defined as the persistence or recurrence of a cervical lesion, was observed in 20 patients (6.9%) having a squamous cancer stage IB (n = 1), a CIN 3 (n = 15), an adenocarcinoma in situ (n = 1) or a CIN 1 (n = 1). In 6 cases the second treatment was performed before the first cytological and colposcopic visit because of an excision considered incomplete by the pathologist. Overall 19 out of the 20 treatment failures were diagnosed within the first two years of the follow-up. The endocervical localisation of the initial lesion (adjusted RR 13.7; 95% CI 1.3, 150.1; P < 0.05) and incomplete excision (adjusted RR 9.1; 95% CI 3.0, 27.3; P < 0.001) were the only independent risk factors for treatment failure.

Conclusion: Residual or recurrent lesions occurs rarely after loop electrosurgical excision procedure. They are favoured by totally endocervical lesion and an incomplete excision. With the association of cytology and colposcopy, 95% of treatment failures can be detected in the first 2 postoperative years.

Ovary seminomatous malignant germ cell tumours are a particular histopathologica entity. The presence of yolk salk tumor or choriocarcinoma is respectively correlated with elevation of alpha FP or beta hCG. This markers elevation permits to assess diagnosis, appreciate response to treatment, and detect relapses. The study of 64 patients registered in two successive S.F.O.P. protocols (TGM 85-TGM 90) precise indications of surgery, platin-based chemotherapy and results. Malignant non seminomatous germ cell tumors are separated in not secreting pure immature teratoma and secreting malignant germ cell tumours. Surgery is essential for treatment of not secreting pure immature teratoma. Secreting germ cell tumors are very chemosensitive and surgery must be as conservative as possible in all cases even metastatic tumour or relapse. If markers are normalized second-look surgery of secreting malignant germ cell tumours is only necessary in case of evident residual tumour. However in case of initial chemotherapy, resection of a pathological ovary is always performed at the end of treatment. These tumours have a good prognosis: 5-years overall survival and disease-free survival are 85%.

The subcutaneous implants from the levonorgestrel (Norplant) has been introduced in Burkina Faso in September 1992 within the context of a project assisted by a non-governmental organization (the Population Council). The aim was to reinforce the family planning programme in Burkina Faso by increasing the number of family planning methods available for the clients. 4 years after its introduction, we propose to make a report of our experience in terms of the contraception through subcutaneous implants in order to better set up an IEC campaign on this method. Within 4 years, 1,660 users benefitted from that contraceptive method. They were housewives in 65% of the cases. The age-group of 30-34 years old most used this method with 28.6%. Multipares most benefitted from this method with 64.3%. In 72% of the cases, the insertion was made during the premenstrual period. On the whole, 247 withdrawals have been made before the fourth years for various reasons. Among those reasons are cycle disorders (60 withdrawals), medical reasons (53 withdrawals), personal conveniences (47 withdrawals), weight gaining (14 withdrawals), failures (2 withdrawals). Regarding the side effects, they were mainly represented by the menstrual cycle disorders such as amenorrhoea, spotting, hypermenorrhoea in 51% of the cases. A good information and sensitization campaign should reduce the number of implants withdrawals before the fourth year of use. Moreover, a perfect knowledge of contraindications is indispensable before any prescription.

Object: we attempt to determine the usefulness of uterine re-assessment by hysteroscopy in women with two unsuccessful IVF-ET attempts.

Material and method: This retrospective study concerns seventy-three infertile women who have had a repeat uterine hysteroscopy after two implantation failures in IVF.

Results: In half the cases, an abnormality was diagnosed. Cervical abnormalities (synechia, polyp, false passage) and hormono-dependent abnormalities (polyp, hyperplasia, submucous myoma) were the most frequent findings. The rate of pregnant women raises to twenty-two percent after treatment of these abnormalities.

Conclusion: Regarding our experience, it seems legitimate to perform hysteroscopy in women who have had two IVF-ET failures before attempting a third procedure.

Preterm delivery is the leading cause of neonatal mortality. Thus predicting a preterm delivery is a major obstetrical problem. Endovaginal ultrasonography is a highly reliable and reproducible method of cervical examination. Unlike with a digital cervical examination the entire length of the endocervical canal can be measured. Using this tool, measuring the dilatation of the internal os does not require the examining finger to be placed inside the endocervical canal. Therefore, the internal os can be measured even if the external os is closed. While a digital examination assesses the "dilatability" of the internal os, an ultrasonography assesses the "true degree of dilatation". In a low-risk population endovaginal cervical ultrasonography helps rule out a preterm delivery if cervical length is long enough. It can also detect cervical incompetence. In a high-risk population, women whose cervix is longer than 30 millimeters can be identified. These women have over 80% chance to deliver on or after 36 weeks of pregnancy. Preliminary studies suggest that performing an endovaginal ultrasonography could decrease the number of false positive clinical diagnosis of modified cervix and thus, save long, expensive and inefficient hospital stays. Prospective randomized, controlled studies are needed to confirm these results.