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Objective: Many operative techniques have been proposed for urinary stress incontinence, a common finding in women. The goal of operating solely via a vaginal approach using autologous material has led to the development of a sling technique using a band of vaginal tissue., Methods: We described the operative technique and analyzed outcome in the first 35 patients operated with the new vaginal tissue sling technique., Results: Mean duration of the procedure was 35 minutes. The procedure was performed in two cases and thus could be used for prolapsus cure. We had no peroperative complications. Postoperative complications were mainly urine retention (50%) lasting a mean 4.4 days. Transfixation of the bladder was observed late in one case with resection of an intravesicular suture. At mean follow-up of 16.9 months, the success rate was 80% with 68.5% of the patients free of urine leakage. In case of sphincter insufficiency, the success rate was 85.7% (64.3% of the patients were free of leakage). Three of the four patients who had undergone prior Burch colpopexy were cured., Discussion: Our series demonstrated the feasibility of the new vaginal tissue sling technique. It appears to be an adapted procedure for urinary stress incontinence with sphincter insufficiency and particularly well adapted for low closure pressures and after failure of surgical cure. The final assessment of this technique will require longer follow-up and comparative studies with other methods.

Several studies have shown that estrogen replacement therapy protects postmenopausal women against coronary artery disease. This protective effect has been ascribed to the hormone's effect on serum lipids, as well as a direct action on the vascular wall. Concurrent administration of a progestin to protect women from the risk of endometrial hyperplasia may alter the protective effects of estrogen. The aim of this study was to assess the evolution of the endothelial function in postmenopausal women given a sequential combination of oral 2 mg estradiol valerate for 11 days, followed by 2 mg estradiol valerate associated with 1 mg cyproterone acetate for ten days (Climène). Each 21-day sequence was followed by a seven-day treatment-free interval. The women received a three-month treatment course. Thirty-one healthy postmenopausal women participated in the study (median age: 51 years; range: 45-59 years). Flow-mediated dilatation (FMD), a reflection of endothelium-dependent vasomotor function, increased from 8.47% at baseline (range: 4.57-11.02%) to 9.64% (range: 7.07-13.12%) at the end of the first treatment cycle; i.e., a 15% increase over baseline (P < 0.0001). FMD further increased after three treatment cycles to 10.59% (range: 8.09-15.22%); i.e., a 28.6% increase over baseline (P < 0.0001). FMD at the end of the first combined sequence or after the 11 days of estradiol only were similar (delta = 0.25%; range: -2.31-5.81%; not significant). In conclusion, in postmenopausal women, a three-month sequential treatment combining estradiol valerate and estradiol valerate plus cyproterone acetate (Climène) has beneficial effects on endothelial function as demonstrated by the evolution of the FMD. There was no decrease in the effect of estradiol on FMD when cyproterone acetate was added to estradiol.

Objective: Vaginal hysterectomy is an advantageous surgical technique as compared with abdominal hysterectomy: operating time is shorter, it is safer and hospitalization stay and recovery time are shorter. However in France, 2/3 of all hysterectomies are still performed by laparotomy. Would the vaginal approach be reasonable if a difficult hysterectomy is expected? The purpose of our study was to compare the per- and postoperative complications and the period following vaginal hysterectomy versus the abdominal route in patients with a large uterus., Patients and Methods: Forty-nine vaginal hysterectomies were compared retrospectively with 22 abdominal hysterectomies for fibroma during the period from 01.01.91 to 31.12.95. Uterine weight in all cases was between 500 to 1,000 g., Results: The average uterine weight was significantly different between the vaginal and the abdominal groups (644 g vs 747 g, p = 0.02). Operating time, pre- and postoperative complications and analgesic use were not significantly different between the two groups. Operative bleeding was significantly higher in the abdominal group than in the vaginal group (659 ml vs. 359 ml, p = 0.006), as well as hemoglobin loss (2.49 vs. 1.82, p = 0.04). There was also a statistical difference between the vaginal group and the abdominal groups in terms of hospital stay (4 d vs. 6 d respectively, p = 0.0002)., Conclusion: Vaginal hysterectomy with morcellation is advantageous in comparison with abdominal hysterectomy even when the uterine weight is over 500 g, since it offers better post-operative comfort than laparotomy without endangering the patients. The main contraindications for the vaginal route are uterus beyond the ombilicus and vaginal atresia. Excepting these cases, the indication for the vaginal approach depends on the patient's past surgical history, uterine mobility and vaginal access. In more difficult cases, these factors are assessed under anesthesia.

We report three cases of caudal regression syndrome diagnosed in utero. Caudal regression syndrome (CRS) is a rare condition associating vertebral agenesia and urinary and digestive tract malformations. Pathogenesis is not clear but, as in our three cases, the CRS is often associated with poorly controlled maternal diabetes. Antenatal ultrasound examinations may reveal the disease in major forms with a non-viable foetus. In our 3 cases, a femoral "V" was associated with sudden interruption of the spine. Minor forms may not be recognized until childhood. Prognosis depends essentially on the extent of spinal involvement and associated malformations. Sirenomelus was considered for many years to be the most severe form of caudal regression, but recently acquired evidence suggests that these two conditions are separate entities.

Objective: Our purpose was to assess etiological factors in enterocele and to compare abdominal sacral colpopexy with mesh and resection of the cul-de-sac of Douglas to transvaginal sacrospinous colpopexy., Methods: A retrospective study, for 20 years, concerned 134 patients clinically proved enterocele confirmed during the operation., Results: Etiological factors were: multiparity, perineal tear, foetal macrosomia, instrumental extractions, antecedents of gynaecologic operations, tissular and constitutional factors. The analysis of the anatomical and functional results did not distinguish between the two surgical procedures, each with its proper indications., Conclusion: For patients 60 years old or older, we propose the transvaginal sacrospinous colpopexy. Before 50 years, we prefer abdominal sacral colpopexy with mesh. Between 50 and 60 years, each case must be examined with the health status of the patients.

A clustering of radiologic signs is associated with the presence of ovarian and/or peritoneal endometriosis: some indicate fibrosis of utero-sacral ligaments (isthmic dissection of the uterus, fixed retroversion); others are linked to pathology of the tube (ampullar retention of dye after evacuation, sometimes inducing false aspects of hydrosalpinx); the last ones suggesting peritoneal adhesions (incomplete peritoneal diffusion). All these signs have been systematically studied, independently of the diagnosis, on 154 hysterosalpingograms of infertile patients known to have patent tubes at laparoscopy: in 107 out of these cases endometriosis was diagnosed at laparoscopy; the 47 last cases constituted the control group. The results confirm that all the signs described are significantly more frequent in cases of endometriosis, although non-specific for this condition. On the contrary, neither adenomyosis, tubal diverticulosis, nor intramural polyps are significantly linked to external endometriosis. In conclusion, some radiologic signs suggest the presence of peritoneo-ovarian endometriosis. Their detection is possible only on high quality pictures, including a last one taken after 10 to 20 minutes walking, to feature the anomalies of tubal evacuation and peritoneal diffusion. The clustering of these signs allows the clinician to propose an early laparoscopy in the work-up of an infertility case. Furthermore, some of these salpingograms provide evidence of a functional disorder of tubal motility in endometriosis, possibly responsible for the low fertility associated with the disease.

Our group provided in 1981 evidence of a transmission of external voices, particularly the mother's voice, into the pregnant uterus in the human. The present study was carried out in order to investigate the actual perception and memorisation of this particular feature of the fetal environment. 25 infant newborns, 20 within the first hour of life and 5 during the second hour, with no post-natal experience of the mother's voice, were submitted to five females voices. The mother's voice rank was determined by randomization. The stimulus consisted in the first name of the newborn, repeated three times, with no associated visual or tactile perception. The behavior of the newborn was studied on videotapes by three of the investigators, without knowledge of the rank of the mother. Three levels of response were determined: no reaction, weak response (segmental movement) and complete response (orienting movement). The behavioral responses to the mother's voice were significantly different (p less than 0.01). The mother induced 36% of complete responses, when the unknown voices induced only 12% (p less than 0.001). Because the intonation of the mother was found, as expected, significantly warmer, this factor had to be controlled. After exclusion of cold voices, a significant difference persisted (45% of complete responses to the mother versus 16% to the other women, p less than 0.02). A fetal perception of external sounds in demonstrated. Moreover, evidence of a prenatal experience of the mother's voice, possibly involved in the process of attachment, is provided.

The tracings of intra-uterine pressure changes that are made during normal labours in primiparous patients, whether the labours were normal or accelerated with oxytocin, were analysed using a semi-automatic time-lag with the help of system of 25 parameters. The classical data of pressures and of time have been made up with a study of the minima and maxima of pressure measurements and the drawing up of new indices to characterise the pressure wave form. A study of the correlations between the different groups of parameters made it possible to make a summary of the information from a smaller number of data which were identical for the two groups of delivery. In particular working out the surfaces dose not seem to give extra information over and above that derived from a simple calculation of the length and intensity of the contractions. A comparative statistical study confirms that in accelerated labour there is a rise in the basal tone, in the maximum pressure and in the frequency of contractions, and shows a minimal scatter of the values obtained which demonstrated that oxytocin has a regulating effect. Using parameters for the shape of contractions, quite independently of the units chosen to measure, has made it possible to design a typical form for the graph for each group of labours.