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Sonohysterography versus hysteroscopy: the assessment of the uterine cavity: a series of 84 cases. We study indications, advantages, limits of a technic of investigation of uterine cavity: sonohysterography. Our results show that sonohysterography is as effective as hysteroscopy in the diagnosis of intrauterine conditions. It is painless, no time consuming. There is no adverse effects and it is helpful in the diagnosis of intrauterine abnormality as a complement of transvaginal scanning.

Autosomal dominant polycystic kidney disease (ADPKD) is the most common hereditary disease. Genetic molecular methods can make the diagnosis of at least three different types of ADPKD. ADPKD concerns young people and complications such as hypertension and decreased renal function occur more frequently if onset is early, if it is a type 1, and if the patient is a woman. The pregnant woman with autosomal dominant cystic disease is at particular high risk of obstetrical complications. Prenatal diagnosis is possible.

A prospective study was conducted in three maternity wards to compare the medical outcomes and the costs of two screening strategies for the detection of fetal/neonatal alloimmune thrombocytopenia (FMAIT). A total of 2066 primiparas and 6081 newborns were included. Fifty-two primiparous women with HPA-1b phenotype were found, and 45 were followed during pregnancy. Four women developed antibodies, and two fetuses exhibited FMAIT; therefore, the prevalence of anti-HPA-1a was 2 per 1000, and the prevalence of FMAIT 1 per 1000. Forty-eight thrombocytopenic newborns were found out of a total of 5632 blood samples. Five were HPA-1a children whose mothers were HPA-1b. The cost-effectiveness of screening all primiparous women was $45,000 and of screening all newborns is $18,000-per anti-HPA-1a alloimmunization diagnosed. Costs per fetal death or disability averted were $500,000 for the primiparous strategy and $225,000 for the newborn strategy. In conclusion, screening newborns for neonatal alloimmune thrombocytopenia is more cost-effective than screening primiparous women.

Tamoxifen is a nonsteroidal anti-estrogen frequently used in breast cancer therapy. Side effects to tamoxifen are uncommon (2%) but should be recognized and detected early by careful follow-up. Tamoxifen adjuvant therapy is absolutely indicated in postmenopausal breast cancer with estrogen-receptor--positive nodes. Recently, this indication has been extended to negative-node postmenopausal breast cancer. Mild acute side effects are the most frequent: hot flushes, menstrual irregularity, nausea, headache, vertigo, minimal modifications in blood cell counts. However, more serious accidents can occur. Increased risk of thromboembolism is linked to a fall in the level of antithrombin III. Ocular toxicity can occur. If such ocular lesions are diagnosed early enough, they can be cured by promptly withdrawing treatment. For patients given tamoxifen, there appears to be a small increase in risk of endometrial carcinoma, especially if the daily dose is30 mg. This over-risk requires adequate detection based on sufficient knowledge of the usual tamoxifen-related modifications in the endometrium. Physicians should also be aware of two favorable effects. Tamoxifen therapy leads to decreased cardiovascular morbidity and mortality in postmenopausal women and is associated with a significant increase in lumbar bone density. Risk of interaction with oral anticoagulants has been reported. We discuss here practical steps in the follow-up of women treated with tamoxifen.

Preeclampsia is characterized by maternal hypercoagulable state and intravascular coagulation, microthromboses in several organs, and impairment of uteroplacental circulation. Excessive fibrin deposition occurs in the placenta, suggesting that disorders of placental coagulation and fibrinolysis physiologic systems may have a role in hemostasis activation. Term placentas were collected from 17 hypertensive/preeclamptic women and from 17 healthy pregnant women, and processed for both histologic and hemostasis studies. Placental fibrinoid deposition was visualized by cresyl-violet staining and quantified by histomorphometric analysis. The content in hemostasis factors was measured on extracts from homogenized placentas treated by a nonionic detergent. The percentage of villi with fibrinoid deposits was higher in the diseased placentas than in controls: 13.2 +/- 11.2 versus 6.75 +/- 2.7% (p0.001) for the total amount of deposits; 4.8 +/- 6.7 versus 1.5 +/- 1.0% (p = 0.04) for perivillous fibrinoid deposits, which are considered as histologic markers of intraplacental fibrin. The content in type 2 plasminogen activator inhibitor (PAI-2) antigen was higher in the diseased placentas than in controls: 124 +/- 8 versus 104 +/- 6 ng/mg placental protein (p = 0.046); there was a negative correlation between PAI-2 antigen and thrombomodulin activity (r = -0.57, p = 0.02) in the diseased placentas. No significant differences were found between the two groups for placental procoagulant tissue factor and anticoagulant thrombomodulin activities, and for the content in plasminogen activators and PAI-1 antigens. Placental antifibrinolytic potential is increased in pregnancy-induced hypertension and preeclampsia. This change, and the association of the highest PAI-2 placental concentrations with the lowest concentrations of thrombomodulin, may contribute to the prethrombotic state and to the excessive placental perivillous fibrin deposition observed in these situations.

Among a series of 100 cases of retroplacental hematomas we performed vaginal cesareans in 15 and present here the technical difficulties, solutions and indications of this procedure in case of in utero fetal death. Criteria for choosing vaginal cesarean were: term les than 32 weeks, biparietal diameter80 mm, fetal weight2500 g. The main difficulty was the disproportion between the size of the fetus and the cervical orifice due to insufficient anterior trachelotomy. Possible solutions are posterior trachelotomy or craniotomy. This procedure is rapid and causes little blood loss and important advantage in case of impaired hemostasis.

Several trials have been published about the usefulness of early uterine Doppler waveform in the prediction of pre-eclampsia and intrauterine growth retardation in nulliparous or low risk patients. We reviewed 3 trials introducing aspirin therapy in patients selected by an early abnormal uterine Doppler waveform. In one trial, serum alpha fetoprotein above 2.5 median at 16 weeks was used as a first selection criterion. In two studies, the incidence of pre-eclampsia was significantly decreased in aspirin treated groups: McParland's trial (odds ratio: 0.08; 95% CI:0.01-0.63) and Campbell's preliminary report (odds ratio: 0.15; 95% CI:0.02-0.91). In contrast, the rate of intra-uterine growth retardation was found similar in aspirin and placebo treated patients. To clarify the usefulness of aspirin therapy in patients with early abnormal uterine Doppler in improving maternal and fetal outcome, other prospective large studies are needed.

There were 5503 deliveries between 1989 and 1991 in the Guy de Lorier Maternity Unit (Pr Salat-Baroux) of Tenon Hospital, Paris. These included 81 women testing HIV+ in the department with 33 asymptomatic black African women among 781 deliveries. Africans account for 14% of women delivered in the department but for 40% of seropositives in the unit, with a predilection for women from Zaïre (central Africa), accounting for 17 seropositives. They only represent 50% of all cases of African HIV+ and 20% of the unit, while they account for only 6% of the black African community and 0.8% of the maternity unit. Women from west Africa accounted for 45.5% of African seropositive cases, with Ivory Coast in first place with 24.3% while only 9% of women from Mali, accounting for 40% of African patients and 5% the units, tested positive (3 cases out of 309 patients). The mean age of seropositive patients was 23 +/- 4, pregnancies proceeded normally and there were 4 therapeutic abortions. There were 9 births by cesarean section, with no evidence of neonatal contamination, the same applying in the other 20 vaginal deliveries. Routine testing (informed consent) for HIV in these high-risk (endemic zone, drug addiction) or unrecognised seropositive patients is important whenever the opportunity presents itself (prenuptial examinations, prenatal visits, family planning, preoperative assessment) in order to attempt to lower infection rates and ensure the best possible care for mother and child when there is a wish to continue the pregnancy, but also to protect hospital staff from the risks to which they may be exposed.

Evaluate the different quality of life parameters in treated breast cancer patients.Retrospective analysis from 1977 to 1987.Bichat, Lariboisière and Tenon Hospitals.239 operated patients, with or without irradiation following or before chemotherapy, with or without hormonotherapy. Patients were divided into 4 groups according to age. STUDY PARAMETERS: Essentially, gynaecologic consequences of treatments (flush, menstrual cycles, fertility, vaginal dryness, breast reconstruction), effect of tamoxifen on genital organs and osteopenia.Tamoxifen acts as an oestrogen both on genital organs and bones.The impact of substitutive hormone therapy on quality of life should be evaluated in randomized studies.

Repeated screening for asymptomatic bacteriuria using a reagent strip-test was conducted in a population of 859 pregnant women. The women performed 4,125 tests at home, and 2,867 tests were performed by the nursing staff at the antenatal clinics. The tests done by the women at home had a higher predictive value than the tests done in the antenatal clinics (24% versus 10%). The sensitivity was 47%, specificity 90% and negative predictive value 98.8%. The tests performed by the women at home were well accepted and detected.

Our understanding of the pathophysiology underlying the hypertensive diseases of pregnancy has clearly progressed during the past ten years. The key phenomenon is an early defect of placentation occurring at the end of the first trimester and associated with a more widespread endothelial disorder. This results in early activation of the coagulation cascade and imbalance between prostacyclin and thromboxanes. Hypertension and proteinuria only occur after several weeks or months of placental dysfunction. This explains why antihypertensive treatments are ineffective in improving the prognosis of such pregnancies. In contrast, early preventive treatments, such as antiplatelet therapy, seem to be very promising for these patients. In this respect, early prediction of the risk associated with pregnancy has become a key goal.

Pathophysiologic understanding of the hypertensive diseases of pregnancy has largely progressed in the past 10 years. The key phenomenon is an early defect of placentation, occurring at the end of first trimester. It is associated with a more global endothelial disorder. This results in early activation of coagulation, and an imbalance between prostacyclin and thromboxanes. Hypertension and proteinuria only occur after several weeks or months of placental dysfunction. This explains why antihypertensive treatments are ineffective in improving the prognosis of such pregnancies. On the contrary, early preventive treatments, such as antiplatelet therapy, seem very promising for those patients.

This report analyses the efficacy and tolerance of percutaneous mitral commissurotomy (PMC) in 10 pregnant women with severe mitral stenosis. Pregnancy was the cause of decompensation of the mitral stenosis and surgery was not considered because of the foetal risk. PMC was undertaken after an average of 26 +/- 4 weeks of gestation (range 23-33 weeks). The average age of the patients was 28 +/- 6 years (range 20-41 years). Six patients were in NYHA Class III and 4 in Class IV despite medical treatment. Five patients had mild mitral regurgitation. Foetal protection was ensured by covering the mother's abdomen with a lead apron. The double balloon technique was used in 4 cases and Inoue's balloon in 6 patients. The average duration of fluoroscopy was 17 +/- 10 minutes (range 6-37 minutes). After PMC, the mean pulmonary artery pressure decreased from 47 +/- 12 mmHg to 31 +/- 11 mmHg (p = 0.005); two dimensional echocardiography showed an increase in mitral valve surface area from 1 +/- 0.2 cm2 to 2 +/- 0.3 cm2 (p = 0.005). There were no complications related to the procedure. The foetal heart rate was monitored continuously and no significant modification suggestive of foetal distress was recorded. The abdominal cutaneous dose of irradiation was less than 0.2 millisievert, which was minimal. All patients experienced a functional improvement after PMC. Nine delivered after an average gestation of 38 +/- 2 weeks (range 36-42 weeks) without cardiac decompensation. The average birth weight of the babies was 3.1 +/- 0.3 kg (range 2.9-3.7 kg).(ABSTRACT TRUNCATED AT 250 WORDS)

In the early treatment of schizophrenia, insight and cognitive disorders are key components in the observance and the functional prognosis of patients.This study aims to evaluate the impact of neurocognitive rehabilitation and psycho information programs on the quality of insight in a population of 20 schizophrenic patients.Results show a correlation between the extent of cognitive disorders and the quality of insight as well as with the efficiency of specific treatment programs.The study emphasizes close links between improvement of cognitive skills and the quality of insight in this population.

Gravidic hypertension remains one of the most frequent causes of perinatal mortality and morbidity. There are two aims when investigating this disease: evaluate the gravity, try to find early signs of a risk of pre-eclampsia. This last point has become particularly important over the past few years because of the development of preventive treatment (platelet anti-agregates). Mother and fetal blood velocimetry play a more and more important role. Three measurement sites appear to have different and complementary importance: for long-term prediction, measuring the velocimetric index of the uterin artery seems the most interesting because it schematically explores the type of placentations; for mid-term, measuring the ombilical artery evaluates placenta resistance, an essential factor in chronic fetal suffering; at short-term, measuring the fetal cerebral and carotid vessels explores the hemodynamic reactions of fetal adaptation to fetal suffering.

The origin of pre-eclampsia lies in uteroplacental ischemia due to an anomaly of the "vascular insertion" of the placenta. Although the cause of this anomaly remains unknown, it would appear to include both a genetic and an immunological origin possibly favourised by special underlying conditions and certain obstetric circumstances. Prostaglandin imbalance (in particular prostacyclins and Thromboxane A2) appears to be one of the chief factors governing these anomalies. One of the consequences of these mechanisms is the onset of hypertension but other disturbances are essential features. In particular, disseminated intravascular coagulation may occur leading to the release of numerous microthrombi which cause placental (leading to chronic fetal distress), renal, hepatic and cerebral lesions.

Objectifs Connaitre une nouvelle procedure de biopsie percutanee. Definir ses particularites, ses avantages et inconvenients. Connaitre sa place dans le diagnostic et la therapeutique. Points cles La biopsie percutanee Breast Lesion Excision System (BLES) permet une exerese monobloc par radiofrequence sous guidage stereotaxique et echographique. La duree et le vecu par la patiente de la procedure semblent equivalents aux macrobiopsies. La sous-estimation des HCA et CIC semblent moindres. Une exerese en marges saines de petite lesion est possible. Resume Les biopsies percutanees utilisees couramment generent au pathologiste une information « morcelee » puisqu’il integre les donnees de plusieurs biopsies pour son diagnostic. Un nouveau materiel Breast Lesion Excision System permettant une exerese monobloc par radiofrequence sous guidage stereotaxique et echographique est apparu. Des specimens de 10 a 30 mm de diametre sont obtenus en ambulatoire pour une duree de procedure equivalente aux macrobiopsies. Les sous-estimations des lesions HCA et de CCIS semblent moindres. Le pathologiste peut determiner les marges entre tissu sain et lesionnel. Une exerese curatrice en marges saines d’une lesion est possible sans chirurgie complementaire. Le BLES est une nouvelle technique de biopsie diagnostique mais elle ouvre la possibilite d’etre utilisee a visee therapeutique.

Objectifs Correler les donnees IRM et histologiques de patientes ayant un antecedent de cancer du sein et secondairement explorees pour masses annexielles en IRM. Materiels et methodes Une recherche sur base de donnees a identifie 41 patientes avec cancer du sein traite puis operees pour masse annexielle. Criteres morphologiques et vasculaires furent revus retrospectivement (bilateralite, taille, type tumoral, portion tissulaire, ascite et prise de contraste). Une analyse statistique fut effectuee. Resultats En histologie, des masses benignes et malignes etaient presentes chez 20 (48,8 %) et 21 (51,2 %) patientes (11 primitives et 10 metastases). En IRM, la taille moyenne (± SD) des tumeurs benignes et malignes etaient de 55 mm ± 39 and 63,7 mm ± 32,5. Des lesions bilaterales etaient presentes chez 3/20 lesions benignes et 14/21 malignes (p Conclusion Chez des patientes avec antecedent de cancer du sein, la presence de lesions annexielles bilaterales a predominance solide suggerent la malignite. La presence de vegetations suggere une origine ovarienne primitive.

Intrauterine underdevelopment is a frequent complication in pregnancies associated with high blood pressure. It can also happen in the absence of this symptom but in a similar context. During these pregnancies, homeostasis problems were often shown to be at the root of placental abnormalities responsible for the development problems. This is why the authors of this article have tried to prevent intrauterine underdevelopment by prescribing antiplatelet drugs as from the start of the 2nd trimester of pregnancy. They compare their encouraging results with those of other teams and conclude that a larger prospective trial is necessary.

The authors studied 165 patients, 161 of them having been examined at least once for their umbilical diastolic index, uterine diastolic index and carotid diastolic index (CDI) during pregnancy. Four patients have been examined only for the umbilical and carotid indexes. These patients presented either a pathological pregnancy (37% of arterial hypertension; 34% of intrauterine growth retardation; 8% other causes) or previous pathological gestations (21%). Particular emphasis was given to the study of the prediction of CDI with respect to fetal heart rate (FHR) abnormalities or an intrauterine fetal death (IUFD). A mean of 1.4 measurements of CDI per patient were performed, ranging from 1 to 5. The average time lag of the first CDI measurement was of 30 weeks of pregnancy, ranging from 21 to 36.5 weeks. The mean time lag of the children's deliveries was of 35 weeks, ranging from 27 to 40 weeks of pregnancy. The mean time lag of the last CDI measurement with respect to delivery was of 15 days (1 day to 15 weeks). The CDI (CDI = D/S; D = residual diastolic velocity; S = maximal systolic velocity) was considered as pathological when exceeding 22% up to 30 weeks of pregnancy and when exceeding 26% after 30 weeks. 50% of the children born in this series were hypotrophic. When presenting identical umbilical and uterine indexes, the percentage of hypotrophic offspring was the same, whether the carotid index was normal or pathological.(ABSTRACT TRUNCATED AT 250 WORDS)

The obstetrical outcome of 305 pregnancies obtained by in vitro fertilization were reviewed: out of 275 pregnancies following fresh embryo transfers, 205 (74.5%) were single, 64 (23.3%) double and 6 (2.2%) triple). We observed increased frequencies of high blood pressure linked to older maternal age, bleeding in the late pregnancy and breech presentation, which could be associated to abnormal insertion of umbilical cord and/or placenta. Multiple pregnancies, especially the triple ones, are of the highest risk (intra-uterine growth retardation, low birth weight). Nevertheless the total fetal mortality remains low in our experience. Data about 22 pregnancies following cryopreserved embryo transfer, 5 after oocyte donation and 3 therapeutic abortions are also given.

We followed 325 pregnancies in 131 patients with known renal disease. Perinatal death was of increased frequency (8–10 %), contrary to growth retardation and spontaneous abortion. Pre-existing blood pressure and serum creatinin were the main determinants of pregnancy outcome.

Umblical blood flow velocity was studied in 55 pregnant, chronically hypertensive patients, during variations of beta-blocking therapy. There was a highly significant positive correlation between in SBP and variations in diastolic flow velocity.

941 patients were evaluated at least 3 months after an hypertensive pregnancy. 318 of them (34 %) were hypertensive and 183 were treated at once. 142 patients normotensive at first evaluation were followed up for 1 to 14 years, 12,6 % of them became hypertensive within this time.

Of 221 patients with « pure preeclampsia , 137 had at least one subsequent pregnancy. This one was normal in only 28% of patients, and this did not improve in further pregnancies. Fetal growth retardation occured in 11% of second pregnancies and fetal death in 6%. 28% of patients appeared in the few subsequent years to have either hypertension or renal disease.

The application technique of a newly developed tissue pH electrode designed for continuous pH monitoring is described. Some parameters are described as criteria of technically accurate records.

A newly developed tissue pH electrode designed for continuous pH monitoring was evaluated in 61 fetuses during labor. The results obtained in this series confirm the reliability of this method. The correlation coefficient between tissular pH and capillary blood pH is 0.94. The correlation coefficient between the last intrapartum tissue pH and the umbilical arterial blood pH is 0.84.