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In 2009, the Critical Care Network of the American College of Chest Physicians (ACCP) in partnership with La Sociéte de Reanimation de Langue Française selected a panel of experts to characterize competence in critical care ultrasonography. The task force developed a consensus and made recommendations concerning the qualifications in ultrasonography. Experts have identified specific skills that intensivit should acquire, by setting a minimum standard for the realisation and control of ultrasound. Last year, we published in the present journal the results of this consensus conference concerning the "basic echocardiography" for intensivit. This year, we summarize here the results of the consensus conference and its conclusions on the assessment of advanced level skills to practice echocardiography in intensive care.

In critical care patients, microvascular alterations and perfusion heterogeneity play an important role in the persistence of cellular hypoxia despite a satisfactory functioning of the macrocirculation. Advance in the knowledge of microcirculatory pathophysiology, and its relation with the macrocirculation could be in the future a way to improve the outcome of critically ill patients. Moreover, the evolution of clinical practice towards microcirculation monitoring as a standard of care, with new therapeutic targets aimed to increase tissue perfusion, could be a revolution in critical care practice.

Microcirculation represents a complex system devoted to provide optimal tissue substrates and oxygen. Therefore, pathophysiological and technological knowledge developments tailored for capillary circulation analysis should generate major advances for critically ill patients' management. In the future, microcirculatory monitoring in several critical care situations will allow recognition of macro-microcirculatory decoupling, and, hopefully, it will promote the use of treatments aimed at preserving tissue oxygenation and substrate delivery.

To demonstrate that women treated for PID constitute a population with a specially high incidence of cervical intraepithelial neoplasia (CIN) and who should be screened for CIN.Retrospective, non-comparative study of 260 patients treated for PID in the Gynecology-Obstetrics Department of Hôtel-Dieu hospital in Rennes (France) from December 1st, 1989 to May 31st, 1996. CIN screening was performed by smear tests and colposcopy.Cervical lesions were detected in 39 patients (15%): five CIN 3 (including one early-stage microinvasion), twelve CIN 2 and 22 CIN 1 and/or condylomas, i.e., 6.5% high grade and 8.5% low grade lesions. Colposcopy in this case proved to be more effective than smears for screening.According to epidemiological studies, sexual behavior is a major risk factor of CIN, due to the role played by sexually transmissible human papillomavirus in their pathogenesis. Because the main risk factor of PID is sexual activity, it is likely that CIN are more frequent in women with PID. Our study clearly established that fact because the prevalence of CIN in the general population is only 0.5 to 4% according to literature reports.We are in favor of CIN screening in women treated for PID, and in our view colposcopy is the preferred method.

To assess the means to diagnose grade 3 cervical intraepithelial neoplasia (CIN 3) during pregnancy, with special consideration to the risk of overlooking invasive lesions.a retrospective study on 16 cases of CIN 3 over 4 years and a literature review.Smear tests were indicative of low-grade lesions in 8 cases. Colposcopy always was suggestive and accompanied by biopsy. No conisations were performed during pregnancy but one was performed after delivery in 15 of 16 cases. After delivery, comparing conisation results with those of recent biopsies revealed that some lesions were less severe and others more severe than during pregnancy. So, a CIN 3 and a microinvasive carcinoma observed during pregnancy changed into CIN 2 and CIN 3, respectively, after delivery. In contrast, two pregnancy CIN 2 were seen as CIN 3 in post-partum and three CIN 3 as MIC. Such variations have been described in the literature and have several causes. In particular, improvements may sometimes reach "normalisation" in post partum although, recurrences remain possible.when the smear tests performed during pregnancy are indicative of cervical intra-epithalial lesions, whatever the severity, colposcopy with biopsies are mandatory. If a CIN 3 is detected, early MIC should be removed, which may require specific treatment according to the invasive degree. Colposcopy with guided biopsies is a safe and reliable diagnostic means. After delivery, the cervix should always be reexamined, preferably by conisation, even if smears or colposcopy were normal.

Seventeen cases of mixed Muller tumours (tumours of the uterus with malignant epithelial and mesenchymal components) are presented. These recently described tumours are rare and occur in menopaused women. Bloody discharge is the usual clinical manifestation, together with an increase of the volume of the uterus. Pathology examination of the surgical specimen is required for diagnosis using immunolabeling to distinguish between homologous tumours (the sarcomatous component occurs in the primary mesenchyma) and heterologous tumours (the mesenchymatous component results from a metastasis). Prognosis, usually poor, depends on the stage of the tumour. Overall survival at 5 years is about 30%. Survival in early stage I and state II tumours is no greater than 50% at 5 years. Treatment is based on radiosurgical techniques in less advanced tumours and requires radiochemotherapy in more advanced stage tumours. Recurrence is usually seen within 2 years, involving the pelvis alone in 10% of the cases and metastasis in most of the others. Because of their rapid development and poor prognosis, these tumours should be identified separately as a separate entity within a larger group of mixed mesodermic tumours.

to estimate the social and economical point of view of the practice of in vitro fertilization (IVF) in Brittany in 1993.we made a prospective study of 152 cases of IVF. We studied the medical history of sterility of the patients, treatments during IVF, hormonal and ultrasound monitoring, oocytes retrieval and embryo transfer, and the screening until beta-hCG1,000 UI or evidence of pregnancy with ultrasound scan. After analysing results of IVF, we studied the cost of all these steps, including hospitalization, transports and stoppage.we estimated the mean price of one IVF cycle at 11,084 francs. We analysed the portion of each step in the total cost and discussed with the view of literature.the cost of IVF seems reasonable in this context.

Report the diagnosis and therapeutic approach in two cases of primary malignant melanoma of the vagina.Malignant melanoma is rarely localized in the vagina, resulting from the malignant transformation of an ectopic melanocyte during menopause. The clinical diagnosis is often made in an advanced stage with a variable degree of pigmentation, usually on the anterior aspect of the vagina. Surgical exeresis should be extensive with a 1-cm safety margin. Radiotherapy may be effective as a complementary treatment for limited surgery or as first intention therapy aimed as improving local control before surgery.Locoregional relapse occurs in 60% of the cases, emphasizing the importance of local treatment. The prognosis is unfavourable with a 23 month mean survival. Total survival at 5 years is only 17%.

To clarify and classify the still debated diagnostic and prognostic elements of borderline tumours of the ovary and analyze the data obtained in our series.Develop an adapted management scheme, integrating relatively good prognosis and known or suspected factors of poor prognosis. SIEGE: Department of Gynaecology-Obstetrics, Hôtel-Dieu (CHU) Rennes, France.Eleven patients with borderline tumour of the ovary diagnosed and managed over the last 5 years.Current morphology and macroscopy examinations of the tumour do not provide data capable of predicting malignancy. The borderline nature of the tumour is not a histological diagnosis. The problems encountered lead to a search for new techniques such as digitalized nuclear morphology. Some progress has been made in classifying prognosis factors. Other than stage, important factors appear to be age, histological type, mitotic index, atypical cells and invasive peritoneal implants. Management decisions depend on prognosis factors but should especially take into account parity. Methods include cystectomy and total hysterectomy with annexectomy. Evaluation of chemotherapy and radiotherapy is still to preliminary.The slow clinical course, allowing good mid-term prognosis, is still the best reason for a moderated therapeutic approach relying on conservative or more aggressive surgery alone.

Review of primary seropapillary carcinoma of the peritoneum.Retrospective.Department of Gynaecology and Oncology, University Hospital, Rennes.16 patients who underwent chemotherapy and surgery.Mean age at onset was 62 years with a late clinical diagnosis at an advanced stage. Macroscopically, peritoneal miliary was often associated with a predominant tumoural formation on the epiploon. Treatment included surgical exeresis with endoxan-cisplatin chemotherapy. The prognosis was equivalent to ovarian tumours at similar stages.Primary seropapillary carcinosis of the peritoneum is a separate group of peritoneal carcinosis distinguishable from peritoneal mesotheliomas and which have a prognosis similar to ovarian tumours. These tumours should be classed as part of the large group of mullerian tumours.

We have noted in a group of oligospermic patients with normal FSH levels and normal sized testes that there can be a significant drop in the LH levels estimated by IRMA, compared with a control group of fertile men. On the other hand, there is no correlation between IRMA and RIA levels of LH in oligospermic men when there is such a correlation in the control group. As oligospermia is usually testicular in origin preliminary results suggest that there may be a disturbance of gonadotrophin secretion in one type of oligospermia and we intend to continue this preliminary study.

The reasons for 186 medically indicated terminations of pregnancy, 178 stillbirths, and 126 neo-natal deaths were analysed by a multi-disciplinary team after a thorough enquiry into the social and medical context for the deaths or for the decision to interrupt the pregnancies. This was undertaken on the initiative of the regional technical consultative commission for enquiring into births, and according to a protocol that had already been partly used by a group studying the neonatal period in Ille and Vilaine. A comparison of the causes according to the type of death shows the value of following up these three indicators to the plan and appropriate policy for three weeks following delivery. A certain number of questions about definitions and classifications still have arisen.

Different aspects of the relationship between dermatopolymyositis and cancer of the ovary are emphasised here. A clinical case support these aspects. In the incidence of cancer of the ovary it is remarkable that there is often a relationship between the two conditions. Usually the diagnosis of the dermatopolymyositis comes before the cancer is discovered. This means that decisions have to be taken as to how far investigations for the cancer should be carried out when dermatopolymyositis has been diagnosed.

We report the case of acute adrenal gland failure which occurred one hour after cesarian section for the delivery of a child after 31 weeks of amenorrhoea. The clinical picture of the mother was immediately severe and was dominated by neurological features: profound coma with a bilateral Babinski's sign. The laboratory tests however only revealed severe hypoglycaemia among the classical signs of adrenal gland failure. It was extremely difficult to correct the blood glucose level without concomitant administration of corticosteroids.

Fibroadenomas occupy the first place, in terms of prevalence, among benign breast disorders in adolescent girls. Juvenile giant fibroadenoma is a special though rare form, which must be recognised in terms of differential diagnosis from virginal hyperplasia in its asymmetrical early form and phylloid tumours, the prognosis of which is different. The authors describe the clinical and pathological features necessary for diagnosis and report the results of breast reconstruction after excision via a lateral radial approach in a 14-year-old adolescent girl.

The authors have evaluated the risk of neonatal infection (NNI) by materno-fetal contamination when a rise in temperature occurs in labour and they have worked out the prophylactic measures that should be taken. This has been the results of a prospective study carried out on 6305 deliveries. Any significant conditions associated with NNI are stained liquor and a low Apgar score at birth. When high temperature develops in labour it is important to deliver the infant as quickly as possible particularly if the labour is a premature one. Prevention carried out by very early diagnosis of amniotic fluid infection in pregnancy and by careful attention to the high risk conditions of: early rupture of the membranes, a high level of vaginal infection particularly with Beta streptococci.

The authors report nine personal cases in a review of the literature concerning cancers of the breast associated with pregnancy and lactation (until a year post-partum). The diagnosis of the illness is reported to be difficult in pregnant women and it is necessary to use fully all the diagnostic procedures available and in particular cytology and histology. Surgery is urgent. It is classical practice to carry out a mastectomy with axillary clearance. Nevertheless more conservative treatments are now being suggested. The principal problem of therapy is linked to the effects of adjuvant therapy on the fetus be they radiotherapy or chemotherapy, particularly because it is very important that treatments should be thorough and start early in the pregnancy. The overall prognosis is bad because pregnancy seems above all to aggravate serious forms of the disease.

Perinatal mortality for infants born to diabetic mothers has dropped in the years from the 1950's when it was 20% to less than 3% by the end of the 1980's. In spite of this considerable reduction which is due to careful observation and multidisciplinary management in this type of pregnancy, the congenital malformation rate is 4 times greater than with the general population (3%) and the rate of spontaneous abortions is double (13%). The caesarean section rate is 5 times higher (18%). In bringing out a retrospective study we have attempted to analyse the endocrinological and obstetrical features of the cases.

The authors report a case of familial Mediterranean fever in a pregnant woman treated with Colchicine. She delivered normally at term. A review of the literature shows that colchicine does not have a teratogenic effect which it was long thought to have. All the same it is best to carry out fetal karyotype examination using early amniocentesis. Furthermore, colchicine improves fertility which is disturbed in these patients and pregnancy has a good effect on the disease.

A retrospective study of the notes of 253 deliveries was carried out in the two maternity units attached to the University of Rennes between 1980 and 1985. This followed a review of the literature on delivery of babies presenting with a persistent occipito posterior position. Tarnier's forceps were used in each case with full rotation of the presenting part carried out or else delivery in the occipito posterior position. There were five cases of failed forceps. We have not been able to show that there was a significant statistical difference as far as the neonatal state of the babies was, because to the methods of delivery. On the other hand, there was a greater frequency of urinary-vaginal lesions after full rotation. We therefore suggest that a trial of forceps delivery should be carried out in the operating theatre when the optimal obstetrical conditions have been fulfilled, so long as the manoeuvres are carried out technically easily and so long as Caesarean section is resorted to if all the obstetrical conditions are not fulfilled, or if it seems difficult to deliver the baby with a forceps.

We present a case of a rare condition of nasopharyngeal cancer and pregnancy occurring together. We review the unusual epidemiological, clinical and prognostic features of this type of cancer. Because of the immunological changes that occur in pregnancy and because of the potential oncogenic role of Epstein Barr virus we consider that pregnancy worsens the prognosis for nasopharyngeal cancer. After having pointed out the risks of radiotherapy and particularly of chemotherapy in pregnancy, we discuss the need to carry out a therapeutic abortion because of the effect that pregnancy will have if it is allowed to go on to term.

In situ canalicular carcinomas are defined as malignant, galactophoric epithelial cells, do not invade the basal membrane. The author saw 21 cases of in situ canalicular carcinomas which were treated surgically at the University Hospital of Rennes. It is possible from these cases to include certain themes: there is a pathology of an early carcinoma of the breast which will go on growing. It concerns patients in the menopausal age who 1 in 3 have a family history of neoplasia. Medical examination is important because in 1 out 2 cases leads to complimentary examinations which help to make the diagnosis. Mammography is essential because it leads to the diagnosis of a finding of suspicious microcalcifications as well as arranges an outline. The histology will indicate what the therapy should be. Comedocarcinomas (cellular proliferation with central necrosis) has to be considered as separate from other better differentiated types (solid, cribriform, papillary and clinging carcinomas). In fact comedocarcinomas often have a poor prognosis and the factors are: the size, the mitotic activity, the poor cellular differentiation, perigalactoriphic reaction, and stromal and multi centre micro-invasion. Treatment has to be adapted to features of this pathology. Mastectomy which used to be routine in these cases because of the high incidence of multiple centres, are to be reserved for cases with a poor prognosis. At present conservative treatment is being evaluated, but it seems logical to recommend it in non-invasive cancers with a good prognosis when a large lumpectomy followed up by radiotherapy to the whole breast can be used, particularly because this form of treatment is now given to invasive tumours. It is very important to follow-up these patients regularly and for a long time, clinically and with mammography if conservative treatment is carried out, in any case when the opposite breast is at risk. Conclusion. Now that treatments have become varied the improvement in prognosis will depend on early diagnosis. This means that mammography screening will proceed to an increasing number of non-invasive cancers of the breast that are discovered, and to a need to work out acceptable and effective treatment for these cancers.

We report a case of abdomino-thoracic oesophageal duplication revealed by prenatal ultrasonography as a liquid mass in the posterior mediastinum, responsible for a major chylothorax. Tow our knowledge, this is the first thoroughly documented case occurring in the prenatal period. The various possible ultrasonographic diagnoses and the possibility of therapeutic drainage of pleural effusions are discussed in the light of anatomy, embryogenesis and ultrasonographic images of the lesion.

The authors present their results as far as successful vaginal delivery (in 39.9% of cases) carried out in 884 cases with a scar in the uterus. They also give the morbidity and maternal and fetal mortality as well as those that developed a rupture of the uterus. No mother died in their series and there was no fetal death that could be ascribed to a complete rupture or a uterine dehiscence. Both fetal and maternal mortality was considerably higher when the trial of scar failed or when a Caesarean section was carried out prophylactically, as compared with the results from vaginal delivery. 2.17% of all the 884 patients with a uterine scar had a complete or incomplete rupture of the scar. Finally the describe their criteria for selecting patients for attempts at vaginal delivery and they show that it is necessary to test the ability of the fetus to pass through the pelvis after looking very carefully at the partogram made for the previous Caesarean operation. In this way they were able to use a trial of labour in slightly contracted pelves or where the fetus was big in such a manner as to obtain a vaginal delivery in, respectively, 68 and 72% of cases.

The authors report 5 cases of intestinal endometriosis which required resection. They review the pathological characteristics and attempt to define the while accepting that the indications for resection should be extremely limited from both gynecological and intestinal viewpoints.

Parkinson's disease is a neurological condition associated with neuronal degeneration in the corpora nigra with a drop in the level of dopamine in the striatum. It is rarely encountered in women of reproductive age. Treatment is by giving levodopa. We report a case of pregnancy in a woman of 34 years of age who was suffering from severe Parkinson's disease treated with levodopa. We have assessed this case in the light of viewing the literature which confirms that there is no effect on the pregnancy or on the fetus although the symptoms of Parkinson's disease are made worse. Levodopa seems to be quite innocuous as far as the fetus is concerned. There is no teratogenicity although in animal experiments high doses teratogenic effects have been noted.

In 28 couples with spontaneous abortions, data of immunological investigations revealed an elevated frequency of HLA DR compatibility and immunological characteristics defining distinct patterns of immune responsiveness. In the half of women with recurrent spontaneous abortion (RSA) we observed a failure to develop a recognition response to paternal inherited fetal antigens expressed by the lack of classical evidence of in vivo allo-immunization such as antipaternal antibodies, and the absence of the inhibitors of cell-mediated immunity found in maternal blood during pregnancy. In few cases, the paternal cells are inefficient to elicit in vitro maternal cell-mediated lympholysis. In most women with a normal pregnancy occurring after spontaneous abortions or prior to RSA, an immune recognition response was evidenced by the presence of antipaternal antibodies and/or blocking factor acting on in vitro cell-mediated lympholysis. These observations support the hypothesis that immunological process could be the cause of some fetal losses of unknown etiology, through a defective or unsuitable maternal immune response.

Janz and Fuchs, in 1964, started the question of the teratogenicity of anti-epileptic drugs by their publications. In Poitiers we have carried out a retrospective study on 56 epileptic women who gave birth to 85 children. We found that 12 of these children (14.4%) had malformations. These results confirm that there is a risk of malformation in the use of anti-epileptic measures, a conclusion which corresponds with those of the majority of authors. The hydantoins and the barbiturates seem to have an equal role to play but they do so by different mechanisms. The most common malformations are hare-lips or cleft palates and cardiopathies. The most obvious ones are the facial deformities and skeletal abnormalities; none of these are lethal. In spite of this risk all authors state that it is important to carry on with anti-epileptic treatment for the mothers' sake.

Von Recklinghausen's neurofibromatosis is an illness that quite often has visceral and neurological side-effects (the former in turn as its side-effects on the blood vessels). Although the patients' fertility is maintained the numbers of spontaneous abortions, of premature births and of perinatal mortality are raised. In fact one of the principal effects of this disease on pregnancy is on the blood vessels, giving rise to hypertension and to a drop in the circulation through the placenta, which in turn has well-known consequences. These are: intra-uterine growth retardation, chronic fetal distress and premature labour. As far as vascular aneurysms are concerned, they constitute an indication for termination of pregnancy. We here give a case history of the condition drawing attention yet once more to the need for a multidisciplinary care of the pregnancy in women who have neurofibromatosis.

Having studied perinatal mortality in Ille-et-Vilaine from 1972 onwards, the authors have come to realise how out of date the present method of working out perinatal mortality is because it only takes account of late intra-uterine death and early neonatal mortality of infants weighing at least 1 kilogram. The old method does not take notice of the changes that have occurred because of the progress that has taken place in obstetrics and neonatology such as the survival of an increasing number of newborn that weigh less than 1,000 grams or of the fact that the distinction between early and late neonatal death seems to be less and less valid. It does not add up to the total of "lost pregnancies". Furthermore, it does not make it possible to compare our figures with those published in foreign countries. The authors therefore feel that a new definition of perinatal mortality should be made, and this should satisfy the four following requirements: It should include on the one hand all fetuses and newborn that weigh at least 500 grams and on the other hand it should include early and late mortality and even mortality that occurs after the neonatal period. It should take into account the problem of false still-births. It should take into account fetal malformations and abnormalities that have called for therapeutic abortions because they are among the principal causes of perinatal mortality. It should study all the statistics and publications on this subject.

Considering the difficulties involved in treating chronic pharyngitis and the frequent failure of therapies, the authors tried Manganese-Copper-Oligosol. The study involves 148 ambulatory patients who were given the drug twice daily in the morning and at midday, for a period varying from 1 to 3 months. The following informations were noted; the symptoms; the aspect of the mucous membrane; associated diseases, if any; predisposing factors; hygienic and alimentary habits. Global results: 46,5% good and very good results; 32,5% quite good results; 21% no result. The authors considered as good and very good the cases in which they noted both an objective aspect of the mucous membrane and a subjective improvement, the results were considered when the improvement was only objective. No intolerance or side effects were noted.

Upper urinary tract calculi can be difficult to diagnose and to treat. One has to be aware that there is a risk for the mother which is often not recognized in the long term. The authors describe 17 cases of pregnant women aged between 20 and 33 who were treated for calculi in the Urological Service in Poitiers. They were diagnosed at different stages of pregnancy and a few had a previous urological history. The women presented in different ways, several of them with urinary colic and 10 with urinary colic and fever. Urinary tract infection and septicaemia also occurred. Six patients passed the stones spontaneously. The rest had to be treated by some form of operation, either during the pregnancy or afterwards, including one case of a patient who had to have her kidney and ureter removed and another who had to have a kidney removed. One patient had to have an emergency caesarean section for fetal distress although she had had stone removed at the 20th week of pregnancy. It is not possible to know from this series the incidence of stones in the tract. Various theories of the formation of the stones, including the anatomical changes that occur in the urinary tract in pregnancy, are suggested and these include the hormonal theory of dilatation of the ureters as well as the mechanical theory of changes in the course of the ureters. There are also likely to be changes in the phosphocalcium metabolism. Pain in the lumbar and lower abdominal region is the most frequent symptom occurring in 90-100% of cases and urinary tract infection is common.(ABSTRACT TRUNCATED AT 250 WORDS)

In France, 7,000 women die yearly of cancer of the breast, and 25,000 new cases are registered. The seriousness of the illness and its frequency show how important it is to diagnose it early at a stage before invasion or in situ (where 95 to 100% can be cured). In 4 years, at the University Hospital of Rennes, 90 out of 446 patients who were operated on for breast lesions had invasive cancer of the breast, i.e. 20%. 12 had a carcinoma in situ of the breast (C.I.S.E.), constituting 2.6%, of which 9 were in situ duct carcinomas and 3 in situ lobular carcinomas. In situ carcinoma of the breast can take almost any clinical form (a nodule, pain in the breast, mastitis, blood stained discharge from the nipple or Paget's disease). This means that lobular carcinoma in situ is always a surprise when diagnosed histologically in a lesion that is clinically benign. Since the anatomo-pathological diagnosis is difficult, a simple examination of the breast is not to be relied on in cases of carcinoma in situ of the breast. Mammography is the only truly valuable investigation in early diagnosis of C.I.S.E.

The authors report a case of ovarian hyperstimulation leading to 6 endo-uterine pregnancies and one extra-uterine pregnancy. After embryonic reduction, and salpingectomy, a twin pregnancy was carried through, in a bifid uterus. Review of the literature enables to emphasize the difficulties in diagnosing heterotopic pregnancies, and to discuss the indications and techniques of selective embryonic reduction, along with the ethical and legal problems it raises.

The authors carried out a prospective study and also looked at the literature in order to assess the contribution ultrasound makes in the diagnosis of the aetiology of upper urinary tract infections in pregnancy. They studied two matched series (patients and controls). They note that ultrasound is reliable in the aetiological diagnosis of upper urinary tract infections without complications and they discuss its place and the contribution it can make as compared with more invasive investigations of infections of the upper urinary tract in pregnancy (such as I.V.U. and C.T. scanning).

In this retrospective study, 91 neonates were born from 89 patients with high temperature (T. greater than 37.9 degrees C) during labor. This group is distinguished by the high frequency of premature rupture of membranes (44%), low gestational age (25%), and instrumental extractions (30%) or cesarean section (30%). 53 newborns were transferred to pediatric hospitals (58%) for investigations: bacterial infections of neonates were noted in 30 of them (32%). The responsible germ was noted in 21 observations: 7 group B Streptococci (23%), other cocci (3), E. coli (4), other gram negative germ (7). One premature 1420 g. neonate died; four neonates presented a septicemia (group B streptococcus: 3; Staphylococcus aureus: 1). Five neonates had neurological abnormalities. We tried to detect some predictive signs of neonatal infections in labour and delivery. Three factors seemed significant: temperature greater than 38.4 degrees C, fetus cardiac frequency greater than 160, and Apgar score at 1 minute lower.

This statistical enquiry carried out in a region of France by the University Hospital Services in Obstetrics and voluntarily devoid of bibliographical references, deals with a group that are particularly pathological and thus probably explains the seriousness of the prognosis for the newborn and the frequency of maternal morbidity following these early operations. 15% of serious maternal complications with severe neonatal pathology which was often heavy and responsible for the death of the fetus in 22.4% of the cases and the late sequelae in the newborn in more than 10% of cases, mad it important to seek for the inevitable link between the pathology and the length of gestation at the time of the operation. Only one in three children were alive without any sequelae after Caesarean carried out between 28 and 31 weeks, but more than 80% were alive when the operation was performed at 34 weeks. In view of these findings the authors suggest that each case should be considered very carefully before early Caesarean section is carried out, both from the advantages and disadvantages of this means of delivery for the baby as well as for the mother. Caesarean section before 30 weeks of amenorrhoea on an infant with an estimated weight of less than 1 000 grams is seldom to be recommended in view of the poor results for the newborn and in the absence of severe maternal pathology which requires immediate evacuation of the uterus. In view of the poor statistical results that have been analysed, early Caesarean section for fetal pathology and particularly for fetal distress when there is no adequate sophisticated means of resuscitating the baby should be lowered to the minimum possible figure. The comparative study of the notes shows that pathological conditions apparently similar to one another lead to occasions for carrying out very early Caesarean section, and also show that the outlook is different from the point of view of the immediate prognosis and a late prognosis for the newborn infant in view of the delay that has occurred before extracting the baby and of the facilities available to resuscitate the baby.

The authors approach the question of the risk of fetal and neonatal hypothyroidism when intravenous pyelography is carried out in the pregnant woman. They looked at a continuous series of 15 cases in 7 years, of which 8 were studied retrospectively and 7 prospectively. They did not find any clinical or biological signs of hypothyroidism when the children were from 10 months to 9 years of age at review. The authors approached the reaction of the fetal thyroid to this excess dose of iodine considering what is known about the physiology of this gland in utero and the publications concerning hypothyroidism occurring after prolonged administration of iodine or amniofetography. They conclude that there is probably a temporary disturbance of fetal thyroid function but it does not continue into the neonatal period. All the same, caution is advocated because intravenous urography during pregnancy should be carried out only for very tight indications and the newborn should be carefully examined.

The authors report their diagnostic and therapeutic approach to four recent cases. While ultrasound is an excellent diagnostic aid, only simplified intravenous urography can establish the nature and localization of the obstacle. As regards management, surgery, when it is possible, allows removal of the obstacle and the repair of the excretory tract. In pregnant women, as in other cases when surgery is not feasable, the drainage of the infected and retained urine is achieved endoscopically. The J ureteral catheter offers a sure and comfortable method. When retrograde catheterization is unsuccessful, percutaneous nephrostomy can be used as a temporary measure to tide over the pregnancy.

The authors explain the particular nature of these multifocal tumors: absence of node involvement, difficulties of diagnosis, relatively favorable prognosis and a therapeutic dilemma: limited procedure with strict surveillance, subcutaneous bilateral mastectomy.

The authors have made the census of all the Medical Terminations of Pregnancy (MTP) which have been carried out in the Department of Ille et Vilaine from 1982 to 1986, i.e. 222 cases, in order to precise the different indications and the diagnosis tools which were used. 132 MTP concern women who live in the Department of Ille et Vilaine. By referring this figure to the total number of pregnancies in this area, one can see that the average incidence is of 1.9%; MTP account for 1% of the total number of Terminations of Pregnancies. Foetal indications are more frequent (188 cases; i.e. 84.7%) than maternal ones (34 cases, 15.3%); these figures remained stable over the 5-year period of study. Chromosomal aberrations and closing defects of the neural tubule are the main causes of MTP (22.9% of foetal indications). Among the 43 chromosomal aberrations, trisomies are the most frequent ones (34.9%) because all women aged 38 or more are proposed a detection. The diagnosis of trisomy was made in 24 cases after tests were programmed either because of the age of the mother or because of family antecedents (amniocentesis: 22 times, punction of foetal blood: once, biopsy of chorion villosities: once), in 6 cases after tests were carried out on the basis of suspect clinical signs amniocentesis: once, punction of foetal blood: 5 times), and in 13 cases after the echography had revealed a major syndrome. Closing defects of the central nervous system mainly concern anencephaly (17.6% of foetal indications) since the echography enables an easy diagnosis. All anencephaly have actually been detected during the reference period of pregnancy.(ABSTRACT TRUNCATED AT 250 WORDS)