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Background: Homeopathic medicines have a place among the non-hormonal therapies for the treatment of hot flashes during the menopause., Objective: The objective of this study was to evaluate the efficacy of the non-hormonal treatment BRN-01 in reducing hot flashes in menopausal women., Study Design: This was a multicenter, randomized, double-blind, placebo-controlled study carried out between June 2010 and July 2011., Setting: The study was conducted in 35 active centers in France (gynecologists in private practice)., Patients: One hundred and eight menopausal women, ≥ 50 years of age, were enrolled in the study. The eligibility criteria included menopause for <24 months and ≥ 5 hot flashes per day with a significant negative effect on the women's professional and/or personal life., Intervention: Treatment was either BRN-01 tablets, a registered homeopathic medicine containing Actaea racemosa (4 centesimal dilutions [4CH]), Arnica montana (4CH), Glonoinum (4CH), Lachesis mutus (5CH), and Sanguinaria canadensis (4CH), or identical placebo tablets, prepared by Laboratoires Boiron according to European Pharmacopoeia standards. Oral treatment (2 to 4 tablets per day) was started on day 3 after study enrollment and was continued for 12 weeks., Main Outcome Measure: The main outcome measure was the hot flash score (HFS) compared before, during, and after treatment. Secondary outcome criteria were the quality of life (QoL) [measured using the Hot Flash Related Daily Interference Scale (HFRDIS)], severity of symptoms (measured using the Menopause Rating Scale), evolution of the mean dosage, and compliance. All adverse events (AEs) were recorded., Results: One hundred and one women were included in the final analysis (intent-to-treat population: BRN-01, n = 50; placebo, n = 51). The global HFS over the 12 weeks, assessed as the area under the curve (AUC) adjusted for baseline values, was significantly lower in the BRN-01 group than in the placebo group (mean ± SD 88.2 ± 6.5 versus 107.2 ± 6.4; p = 0.0411). BRN-01 was well tolerated; the frequency of AEs was similar in the two treatment groups, and no serious AEs were attributable to BRN-01., Conclusion: BRN-01 seemed to have a significant effect on the HFS, compared with placebo. According to the results of this clinical trial, BRN-01 may be considered a new therapeutic option with a safe profile for hot flashes in menopausal women who do not want or are not able to take hormone replacement therapy or other recognized treatments for this indication. Trial registration number (EudraCT): 2009-016959-21.

Growing evidence indicates that androgens play a positive role in follicle proliferation and growth. Hence, many authors have assumed that androgen supplementation in women with poor ovarian reserve might improve the number of antral follicles available for ovarian stimulation. As androgen administration may become more frequently used in reproductive medicine, this study aimed at describing the histological changes observed in the genital tract and the breast of female-to-male (FTM) transsexuals. A pathological analysis of the genital tract of 112 FTM subjects who were given androgen for at least 6 months before hystero-salpingo-oophorectomy was performed. In addition, 100 bilateral mastectomies were performed, allowing a study of the breast tissue. Mean ovarian volume was increased, with histological characteristics of polycystic ovaries (PCO), defined as >12 antral follicles per ovary, observed in 89 patients (79.5%). Endometrial atrophy was observed in 45%. Breast examination revealed marked reduction of glandular tissue and increase of fibrous connective tissue in 93%, without atypical hyperplasia or carcinoma. The present data confirms and expands the putative associations between long-term androgen administration and abnormalities in ovarian architecture with macroscopic and microscopic characteristics of PCO, increased risk of endometrial atrophy and fibrotic breast tissue with marked glandular reduction., (Copyright (c) 2009 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.)

The association of Parkinson's disease and pregnancy is very rare. Some thirty cases are found in the literature. We report the case of a pregnancy in a 30-year-old patient with juvenile Parkinson's disease. During this pregnancy treated by levodopa and bromocriptine, no aggravation of the symptoms was been observed. However, the pregnancy was complicated by a premature delivery at 31 weeks of amenorrhoea.

The association SAPHO syndrome (Synovitis, Acne, Pustulosis, Hyperostosis, Osteitis) and pregnancy is very rare. Only one case is indexed in the literature. We report the case of a pregnancy in a 27-year-old patient with a SAPHO syndrome and we expose its history and its obstetrical, medical and anaesthetic following. Under this multi-field following, there was no evolutionary push of the disease neither during the pregnancy, nor in immediate postpartum. We will expose the different possible treatments during the pregnancy.

Objective: To evaluate the management of urinary tract infections in women by general practitioners and compare it with official French guidelines., Methods: This survey enrolled 1587 general practitioners in France and 7916 adult women. Exclusion criteria for patients included: pregnancy, diabetes, neurogenic bladder, or urinary catheters. During the visit at which the diagnosis was made, physicians completed a questionnaire that included diagnostic and management details, in particular, prescription of further examinations., Results: According to the French guidelines, 37% of women had an upper or complicated urinary tract infection, although one third of the complicated infections were so defined only by the patient's age (>65 years). Additional testing was prescribed for 36% of the women with acute uncomplicated cystitis., Conclusion: This study shows that the management of urinary tract infections in women does not comply with current guidelines, especially in cases of acute uncomplicated cystitis. The use of age alone as a complicating factor should be reconsidered.

Objective: To assess the acceptability, ease of insertion, tolerance and associated bleeding of a novel intrauterine progestogen-releasing system, combined with transdermal estradiol, in postmenopausal women., Design: An open non-comparative study of 294 postmenopausal women with an intact uterus at 27 centers in six countries., Method: All subjects had requested treatment for menopausal symptoms and had received transdermal estradiol 50 microg/day by patch and an experimental intrauterine system (MLS) releasing levonorgestrel 10 microg/day. Details of the insertion were recorded and subsequent bleeding, side-effects and adverse events were documented on a daily diary. Endometrial thickness was measured by transvaginal ultrasound scan prior to insertion of the MLS and after 12 months. The study is of 3 years duration. This report summarizes the results after the first year., Results: The median age of the subjects was 52.6 years (range 41.7-59.6 years), 90% were within 3-5 years of menopause and 78% had previously used hormone therapy (HT). The MLS was inserted at the first attempt in 297/294 (94%) subjects and was facilitated by dilatation of the cervical canal in 65 (22%) subjects. Local anesthesia was given to 30 (10%) subjects. Of the 17 with a failed first insertion, two subjects did not want a second attempt, in 14 a second attempt succeeded, facilitated by cervical dilatation in seven and local anesthetic in three subjects. There was one failed insertion. Investigators rated 80% of first insertions as easy, 14% as slightly difficult and 6% as very difficult. The second insertion was easy in 9/15 subjects, slightly difficult in 4/15 and very difficult in one (data from one subject missing). During insertion, 34% subjects had no pain, 49% said it was mild, in 15% it was moderate and in 2% the pain was severe. At 12 months, one MLS had been expelled. Spotting was the most common form of bleeding and this decreased from a median of 9 to 0 days at 4 months, although 10% of subjects continued to report spotting up to 12 months. Bleeding days were few and mainly in the first 2 months. At the end of month 11, 66.8% were amenorrheic and 87% non-bleeding. Only nine subjects discontinued because of bleeding. There was no correlation between the bleeding profiles and number of years since menopause, previous HT use or body mass index. The median endometrial thickness at entry to the study (without HT) was 2.6 mm and 3.4 mm at 12 months. Of the adverse events, after the pain associated with insertion, headache was the next most common at 13.3% and mastalgia was experienced by 7.8% of subjects. Overall, the dropout rate was low at 28 subjects (9.5%). There were favorable changes in the serum lipid profile consistent with the effects of estradiol and suggesting minimal attenuation by the intrauterine progestogen. Conclusion This interim report of a 3-year study has confirmed that the menopausal levonorgestrel intrauterine system is easy to insert and is well tolerated by postmenopausal women.

Objectives: In order to further improve its prevention program entitled "Maternity childhood follow-up", the Paris region health insurance program for independent workers carried out a survey among female participants. The survey was designed to assess women's smoking behavior and evaluate reception of information concerning smoking-related risks and support available to stop smoking. The women's suggestions were also collected., Materials and Methods: A questionnaire was sent by the physicians in charge of the Ile de France region to the 3525 women who had reported a pregnancy., Results: 1099 answers were received (31%) The mean age of responders was 34.3 4.7 years. Their educational level was high (76% had a university degree). Before pregnancy, 37% were smokers. At the first trimester of pregnancy, 17% were smokers, 15% at the second trimester and 14% at the third trimester. Two years after childbirth, 20.5% were smokers. The proportion of women who stopped smoking was higher for those with a low Fagerström score. 29% of women said they did not receive any information about the harmful consequences of smoking. To cease smoking during pregnancy, 70% are helped by family and friends, 20% by health professionals; 3.5% took nicotine substitutes., Conclusion: This survey emphasises the need for improving information to pregnant women for alerting them to the dangers of smoking and for training the relevant health professionals.

Lower urinary tract infections (UTI) more readily evolve towards acute pyelonephritis (AP) during pregnancy. It should thus be considered as a serious situation. UTI screening is not routinely achieved but appears advisable because the treatment notably reduces the occurrence AP. The effectiveness of urinary testing by dipstick is good even though it can't compete with the sensitivity and specificity of urine culture. AP mainly increases the risk of prematurity. Prompt therapy should be carried out since renal function could be compromised by parenchymal infection. Unfavourable outcome mainly occurs in complicated UTI that it may reveal but that can often be drawn out form the patient's medical history.

Dyslipidemia is a cardiovascular risk factor which commonly develops during forty. In Europe, progestins are frequently prescribed for treatment of perimenopausal symptoms in women in this age group, as well as in combination with estrogen replacement therapy in non hysterectomised postmenopausal women. Their complete metabolic tolerance is an important, even if non exclusive, factor to take in consideration for cardiovascular protection. Our aim was to review available data on the effects of a 19-norprogesterone derivative, nomegestrol acetate, on lipid tolerability. In healthy or at risk premenopausal women, clinical studies found no significant changes in lipid parameters (total, HDL and LDL cholesterol, triglycerides, apoprotein B, Lp(a) and LpA-I) with nomegestrol acetate administered in antigonadotropic sequence, alone or combined with estrogen in inverse sequence, during 6 to 9 cycles; there was only a small statistically significant decrease in apoprotein A1, probably due to the induced hypoestrogeny. In clinical studies carried out in postmenopausal women, nomegestrol acetate combined with estrogen replacement therapy in a sequential or continuous combined regimen, did not alter the beneficial estrogen-induced lipid profile: reductions in total and LDL cholesterol, apoprotein B and Lp(a); HDL cholesterol was unchanged and an increase in triglycerides occurred only with oral estrogens. A decrease in apoprotein A1 was found after six months of a cyclic sequential hormone replacement therapy but was associated with a beneficial increase in LpA-I. Nomegestrol acetate has proven its neutral effects on lipid metabolism and does not alter the beneficial estrogen-induced lipid effects.

Objectives: To determine the number of times women failed to take their oral contraceptive medication and their behavior in response to a missed pill. Another objective was to determine the potential benefit provided by a continuously administered oral contraceptive compared with an oral contraceptive involving a pill-free interval during a 6-month period., Methods: Healthy women were enrolled in a cohort study; their contraceptive practices were followed by their gynecologists. Data were collected at inclusion using cross-sectional method with retrospective data collection for the previous 6 months and, more specifically, on their previous or their current menstrual cycle. Women on the pill were asked to specify the number of times and precise time at which they missed one or more pills and what they did in response to missing a pill., Results: A total of 617 gynecologists enrolled and followed 3316 patients from six geographic areas throughout France. The mean age of patients was 30 years. Duration of oral contraceptive use was 8 years. During their previous cycle, 23% of women (n = 737) missed a pill at least once. Among women on the pill involving a treatment-free interval, 42% of instances of missing a pill occurred during the first week following the treatment-free interval. In response to missing a pill, patients read the product information leaflet (39%) or asked someone's advice (28%), mainly their gynecologist (63%) or their family physician (18%). Almost one-third of women did not take any specific measures., Conclusions: Patients on a discontinuous oral contraceptive regimen tended to miss a pill during the first week of treatment. Prescription of a continuous regimen without a treatment-free interval may improve compliance.

Objective: To study the impact of an original education program on compliance to hormone replacement therapy (HRT) in post-menopausal women., Methods: Data were obtained from 1,192 post-menopausal women (age: 53 +/- 5 years) included in the study with an onset less than six months: E2 gel (n = 791) or patch (n = 401) + progestins, and randomized in either educational program (Ep = 600) or regular verbal counselling (VC = 592). A patient is considered bad compliant with HRT when she prematurely stopped the study, whatever the reason of the cessation. The groups EP and VC are homogeneous for the age distribution, the HRT regimen, the date of onset and the climateric symptoms scores., Results: There is a significant difference between EP and VC groups in compliance, respectively 86 and 81% (p < 0.027). This difference is partially explained by the significant improvement in the patch subgroups (EP: 86% versus VC: 77%, p = 0.028). The trend observed in the gel group is not significant (EP: 85% and VC: 82%) due to the high level of compliance usually noticed in women treated with the gel and the verbal counselling. The significative difference in the compliance observed during the verbal counselling between the continuous (76%) and the sequential (86%, p = 0.001) HRT regimen disappears with the educational program (continuous: 84% and sequential: 87%, NS)., Conclusion: This first large study on the HRT compliance in France, using a patient educational material, validates its efficacy to reach a better compliance than with regular verbal counselling. Even though in the daily practice, about 40% of the patients discontinue the treatment during the first year, 81% of the women followed in this study continue to receive the HRT after nine months of use. The original educational program of the COMET study improves significatively this high compliance (+ 5% from the verbal counselling). Thus, the combination of the doctor verbal counselling and an educational material is desirable to obtain a good compliance with HRT.

Acute pelvic pains in women can reflect highly diverse disorders of varying severity, sometimes requiring surgery. It thus is clearly a part of abdominal emergencies in the adult. Good knowledge of underlying gynaecological disorders usually avoids unnecessary surgery. The use of echography has greatly contributed to reducing coelioscopy for diagnosis.

Objective: The aim of this study was to demonstrate clinical equivalence between a novel intranasal estradiol formulation and a reference oral drug., Study Design: In this multinational, double-blind, parallel-group study 659 postmenopausal women with moderate to severe postmenopausal symptoms were randomly assigned to receive either 300 microg/d intranasal 17beta-estradiol (S21400) or 2 mg/d oral micronized estradiol, plus the appropriate placebo, for 24 weeks. All patients also received 10 mg/d dydrogesterone for 14 days per 28-day cycle. Adjustment of intranasal dosage was permitted from week 14 on. The primary efficacy criterion was the Kupperman index at week 14, with a predefined limit of equivalence of 4., Results: Kupperman index scores improved similarly in the 2 groups, from 28.4 +/- 6.2 to 10.0 +/- 8.6 (mean +/- SD) for S21400 and from 28.1 +/- 6.0 to 8.9 +/- 8.0 for oral therapy, with a difference between groups at week 14 of 1.1 +/- 0.6 (90% confidence interval, 0. 0 to 2.2). This was below the predefined equivalence limit of +4 for statistical noninferiority (P <.001). The daily number and intensity of hot flushes decreased similarly in the two treatment groups. Withdrawal bleeding was 20% less frequent with intranasal therapy (90% confidence interval, 12.5 to 27.6). Severe mastalgia was less frequent in the S21400 group (1.0%) than in the group with oral therapy (5.2%; P <.01). Triglyceride and angiotensinogen levels increased significantly with oral therapy but not with S21400. The same number of patients required dose adaptation in the 2 groups (approximately 20%)., Conclusion: Intranasal administration of 300 microg/d estradiol was at least as effective as oral administration of 2 mg/d estradiol in alleviating postmenopausal symptoms, with less frequent mastalgia and uterine bleeding and without the metabolic consequences of the first-pass effect.

Objective: To evaluate comparatively the acceptability and safety of a new pharmaceutical form of benzalkonium chloride, the vaginal capsule, with the pessary form., Methods: Eighty-nine women were randomized to receive either a benzalkonium chloride vaginal capsule or a benzalkonium chloride pessary prior to sexual intercourse according to an open cross-over design over a 2-month study period., Results: The discomfort caused by delayed leakage or discharge was mild. The mean scores for subjective signs (burning, itching, vulvar pruritus) were also mild and were comparable for the two formulations. The capsule appeared to be slightly superior to the pessary regarding discomfort caused by immediate discharge or leakage, ease of use and acceptance by the woman's partner. Local safety was generally good. Adverse events consisted chiefly of vulvar pruritus and a vaginal or vulvar burning sensation, with a higher incidence being associated with the pessary than the capsule. All symptoms regressed spontaneously after the end of treatment., Conclusions: This study demonstrated good acceptability and good local safety for the benzalkonium chloride vaginal capsule. It is essential to take these parameters into consideration in the evaluation of any local spermicidal contraceptive, since they play a large part in compliance with, and thus in the efficacy of, the product under assessment.

Purpose: To describe the MR findings of the pelvis in the early post-partum period, after vaginal delivery or cesarean section., Materials and Methods: Fifteen asymptomatic patients were imaged using a 1.5 Tesla MR unit between 1 and 7 days following delivery. Eight patients had a vaginal delivery, and seven patients had a cesarean section., Results: The following items were evaluated: uterus size, architecture, and contents; uterine and abdominal wall scars; parametrium; peritoneal cavity; ovarian veins., Conclusion: MRI provided a good evaluation of the pelvic changes related to pregnancy and delivery. Knowledge of the normal findings should improve diagnosis of early post-partum complications.

Estrogen replacement therapy in postmenopausal women is followed by several benefits including a prompt improvement of quality of life. Due to uterine proliferation induced by prolonged estrogen intake, progestogens are usually associated, on a cyclical basis, in hormonal replacement therapy prescribed to non-hysterectomized women. Persistence of the beneficial effect of estrogen on quality of life, during progestogens intake, was never investigated. We evaluated, through a specific and previously validated questionnaire, the changes in quality of life observed in 351 women recently menopaused, after 6 months of hormonal replacement therapy associating 24 days of estrogens and 12 days of administration of a non androgenic progestogen: nomegestrol acetate. Patients were randomized within two therapeutic groups in which evaluation of quality of life was performed either during the administration of estrogen alone or during administration of estrogen and progestogen. In the two groups, hormonal replacement therapy was followed by a significant improvement (P < 0,001) in quality of life and no significant difference was observed between the changes observed during estrogen or estrogen-progestogen administration. Quality of life indices measured after 6 months of hormonal replacement therapy are within the same range than values previously described in eugonadal women. We conclude that improvement of quality of life induced by estrogen replacement therapy remains unchanged during cyclical administration of nomegestrol acetate.

Objective: Our purpose was to study the correlation between maternal serum human chorionic gonadotropin levels measured at 15 to 18 weeks of amenorrhea and pregnancy-induced hypertension, preeclampsia, and small-for-gestational-age neonates., Study Design: Prospective trisomy 21 human chorionic gonadotropin screening data from 5776 patients were examined in a retrospective investigation of the relationship between human chorionic gonadotropin and pregnancy-induced hypertension (234 cases), preeclampsia (34 cases), and small-for-gestational-age neonates (238 cases)., Results: Maternal serum human chorionic gonadotropin (multiples of the median) was higher in the three populations with pathologic disorders. This difference was statistically significant in patients with small-for-gestational-age neonates (p < 0.0163) and preeclampsia (p < 0.0001) but not in those with pregnancy-induced hypertension. In the preeclampsia subgroup, with a cutoff value of 2 multiples of the median, specificity was 32% and sensitivity was 10%; with a cutoff value of 1 multiples of the median, specificity was 100% and sensitivity was 50%., Conclusion: High maternal serum human chorionic gonadotropin levels at 15 weeks are related to a risk for preeclampsia. Depending on the human chorionic gonadotropin cutoff value, 32% or 100% of preeclampsia patients would be selected. The usefulness of preventive aspirin treatment from the fifteenth week needs more investigation in a larger multicenter study of preeclampsia.

A 15 item-questionnaire designed and weighted by experts has been validated in terms of acceptability, validity, reproducibility and responsiveness. This French original tool allows a precise clinical evaluation of quality of life in menopausal women and of its changes with hormonal therapy.

We report a retrospective series of 28 patients with Krukenberg tumors treated at the Gustave Roussy Institute from 1973 to 1990. Mean age of these women was 42 years. The patients were classed into two groups: depending on whether the ovarian metastasis (group 1) or the primary cancer (group 2) was discovered first. The primary tumor was identified in 20 cases (18 cases of linitis, 1 tumor of the cecum, 1 tumor of the appendix). The primary tumor remained unknown in 8 cases. Twenty-seven patients underwent radical total hysterectomy or bilateral adnexectomy. Gastrectomy was possible for 11 of the 18 cases of linitis; hemicolectomy and appendectomy were performed for the cecal and appendicular tumors respectively. Diagnosis of a primary tumor of the appendix was made after systematic appendectomy and of two Krukenberg tumors after systematic bilateral adnexectomy. In the first group of patients, both localizations were treated in 6 cases, one in 12 including 4 because gastrectomy was not initially possible and in 8 because the primary tumor was unknown. In the second group, the two localizations were treated in 7 cases, and one in 2 cases because gastrectomy was not possible. Surgery was not performed in one patient due to diffuse carcinosis. Bilateral ovarian metastases were seen in 26 out of the 28 cases and 26/28 had chemotherapy without any appreciable effect. Bone metastasis predominated (9 cases), followed by pleuropulmonary (5 cases) and liver (3 cases) metastasis. Overall median survival was 20 months; 14 months in the first group and 29 months in the second. Appendectomy and exploration of the colon and the stomach were performed in all cases in which the Krukenberg tumor was discovered intraoperatively. An endosonographic exploration of the stomach is recommended if the primary tumor is not localized. Bilateral adnexectomy should always be performed in patients with linitis whatever the age. Surgical treatment of the two localizations is not always sufficient for cure.

Menopause is a probability diagnosis. Menopause does not mean permanent infertility, particularly in the case of premature menopause. We have realised a national enquiry in order to precise the pregnancy phenomenon after diagnosis of menopause. We found 116 pregnancy cases, which occurred 2.4 years (average) after menopause diagnosis. Pregnancies occur more often in the case of premature menopause and seem to be favoured by hormonal replacement therapy.

The problem of the treatment of premature labor has not yet been resolved. The positive effect of using sympathomimetics is not as significant as was initially thought and they are not free of side-effects. A review of the literature forms the basis of a comparison of sympathomimetics with nifedipine and indomethacin. The latter sometimes offer a better alternative but must be used with care. The potential benefits of oxytocin antagonists are still being evaluated.

Objective: To determine the relationship between bacterial colonization of the amniotic fluid sampled by amniocentesis and premature rupture of the membranes., Methods: A prospective multicentric study conducted over a one year period in 6 maternity wards in the suburban area of Paris. Thirty-six women with premature rupture of the membranes were studied., Results: There were 11 patients (30%) with contaminated fluid at the first amniocentesis. Twenty-five patients had sterile fluid. In 7 patients with prolonged rupture for more than one week, repeated amniocentesis. Twenty-five patients had sterile fluid. In 7 patients with prolonged rupture for more than one week, repeated amniocenteses were used to follow bacterial colonization. In one patient, Proteus mirabilis in the amniotic fluid was eradicated by adapted antibiotic therapy. In patients with sterile amniotic fluid, there was no secondary colonization. In the 11 cases with colonized liquid, the vaginal swab could only be considered as positive in 4 cases. Amniocentesis was able to discover 7 bacterial colonizations of the amniotic fluid in patients with an indeterminant vaginal swab. Likewise, C-reactive protein levels were raised only in 26% of the cases with a colonized amniotic fluid.

Parvovirus B19 was identified in 1975. It causes infections megalerythemia in adults associated with skin eruptions and joint pain (about 50% of the adult population is immunized). The risk of contamination in case of an epidemia is high in school teachers and school personnel. In 1984, the parvovirus B19 was implicated as the cause of fetal anasarca. The risk of transplacental contamination is estimated at 33% in case of maternal infection. Pregnant women with parvovirus B19 infection and confirmed serology should have an echography every 15 days. Fetal anasarca can be complicated by in utero fetal death related to erythroid stem-cell anaemia. The diagnosis of fetal infection is based on PCR techniques on fetal blood. Symptomatic antenatal treatment with in utero transfusion was proposed as early as 1988. This method does not however appear to be necessary in all cases as the outcome in several reports of untreated fetuses was delivery of a normal child. There is the possibility of myocardial damage caused by parvovirus B19 which would make in utero transfusion difficult and limit its beneficial effect. Finally associated thrombopenia is often severe and increased fetal risk.

The vaginal route is routinely used for surgical cure of exersion-induced urinary incontinence. This technique has the advantage of being rapid and easily performed during a short hospital stay. Long-term results however, have been debated. Certain factors have been identified in the literature which would affect long-term failure. These factors indicate that the "ideal" vaginal route should be based on the Burch operation starting at the upper portion and working downwardly. Finally, sphincter failure or detrusor instability must be eliminated before an operation for exertion-induced incontinence can be indicated since such a combination would modify the procedure.

Unlabelled: Retrospective study from january 1991 to May 1993 of 49 patients undergoing transvaginal colposuspension (TVC) for urinary stress incontinence (USI)., Surgical Technique: 14 TVC performed using Raz's technique, including 11 with non absorbable suture material. 35 TVC were performed by longitudinal incision, including 26 with non-absorbable suture material., Results: Peroperative complications: 3 accidental bladder lesions (6.1%), 2 hemorrhages during detachment of Retzius (4%). Postoperative complications: temperature over 38 degrees in 10 cases (17%), 3 urinary tract infections (5.1%), 1 phlebitis (post sacro-spino-fixation). Functional results: 3 early failures at 2 months (93.9% good results). TVC is a simple technique for dealing with USI but longer follow-up is necessary for its invalidation.

An acardiac twin in a multiple pregnancy initially develops normally and is a specific complication of monozygous multiple pregnancies. Development results from arterio-arterial and veno-venous anastomoses leading to predominance of one of the twins. The haemodynamic abnormalities in the dominated twin lead to the disappearance of the heart and major morphologic malformations. Outcome is generally unfavourable in 50% of the pregnancies with an acardiac twin. Complications in the healthy twin include heart failure, then hydramnios, and finally premature delivery which is the cause of most of the deaths. Proposed treatment currently relies on treating the heart failure in the healthy twin or interrupting vascularization between the two twins leading to in utero death of the acardiac twin. Antenatal diagnosis is made by echography and is useful for evaluating the prognosis for the pregnancy according to the growth of the acardiac twin.

We analyzed scriptural and archeologic sources of information concerning gynaecology and obstetrics as practiced in ancient Egypt. Knowledge of anatomy was rudimentary but precocious diagnosis of pregnancy was practiced. An obstetrical chair had been used since the VIth dynasty. The Egyptians were the first to describe prolapsus of the genital organs. The pessary was a known treatment. Spermicidal mixtures were used for contraception.

Acute fatty infiltration of the liver in pregnancy (AFILP) is a rare disorder with a severe prognosis, improved by diagnosis of the minimally symptomatic form. AFILP is classically considered to be non-recurrent. We nevertheless report the fourth case of the recurrent form.

This article on pyelonephritis of pregnancy is based on data from the literature and on a retrospective study of 64 patients followed up from 1987 to 1991. Pregnancy is the cause of a more frequent progression from lower urinary tract infection to pyelonephritis. The clinical features and course of the disease are not specific of pregnancy. Cure is the rule in young pregnant or non-pregnant women, provided the urinary tract itself is healthy. Repercussions on the foetus (weight and size retardation or prematurity) seem to have been overestimated; they are very light when pyelonephritis is successfully treated. Studies in neonates have shown no increase in the infection rate. Treatment is based on a 3-week course of antibiotics, the nature and use of which are discussed here. Prevention relies on detection and treatment of lower urinary tract infections which are known to respond readily.

This multicentre, open, randomized trial, involving 482 patients and conducted by private practitioners, compared the effectiveness and safety of a single 800 mg dose of pefloxacin and of a 10 days' course of norfloxacin 400 mg bid. in the treatment of uncomplicated acute cystitis in women aged over 50 years. Clinical effectiveness was evaluated on days 17-19 and 28-32 respectively, and bacteriological effectiveness on days 15-17 and 26-28 respectively. The median time taken for the symptoms to disappear was 2 days with pefloxacin and 3 days with norfloxacin (P < 0.001). Irrespective of the nature of cystitis and the patients' age, no significant difference could be found in eradication of the pathogens. Undesirable side-effects were recorded in 7.8 percent of patients under pefloxacin and in 8.8 percent of those under norfloxacin (P = 0.68); gastrointestinal disorders were predominant. The acceptability of treatment, as judged by the patients themselves, was regarded as excellent by 55 percent of women treated with single dose pefloxacin and by 37.6 percent of those treated with norfloxacin (P = 0.001).

The authors report a case of disseminated peritoneal leiomyomatosis (DPL) occurring in a post-menopausal woman not using hormone replacement therapy. Her past history included a subtotal hysterectomy, with preservation of the adnexae, for metromenorrhagia due to a leiomyomatous uterus. This case confirms data in the literature concerning presentation, symptomatology, macroscopic appearance and histology. No electron microscopy study was undertaken, nor were hormonal receptors evaluated. The originality of this case lies in the onset of DPL in a post-menopausal (with laboratory confirmation) woman with very slow progression over several decades confirming the hormone-dependent nature and the good prognosis of this rare condition.

Uterine rupture affecting the pregnant uterus has become rare. It occurs essentially in the presence of scarring. The cases reported here described rupture following evacuation curettage which had caused an unrecognized uterine perforation. While such perforations often have no serious consequences, this explaining the usual abstention from treatment, it is nevertheless important that acute complications (intestinal or vascular trauma) or long term (uterine rupture of pregnant uterus) should not pass unrecognized.

The diagnosis of molar pregnancy is now easy based upon a triple clinical, laboratory and ultrasonographic approach. Histology provides final confirmation. However treatment is more difficult since uterine evacuation may be very hemorrhagic or traumatic. A clinical case forms the basis here for a review of the main features concerning the diagnosis and treatment of hydatidiform mole.

This is a retrospective study carried out between the years 1979 and 1989 to look at the anatomopathology of tumours and ovarian cysts occurring in women over 50 years of age who had operations in our department. We found a raised incidence of malignant tumours (30%) when a late diagnosis is made (70% diagnosed at stages 3 and 4). There was a higher incidence of fibrothecomas (10%) along with the nine tumours. This is an important finding because functional cysts have only been found in non-menopausal women or in women who have recently had their menopause who have been taking hormone replacement therapy. Ovarian cysts in menopausal women are therefore primarily organic. This result makes it possible to outline a therapeutic regime specifically designed for the menopausal women. In effect the proposed treatment would either be laparoscopic surgery or laparotomy because it is very doubtful whether ultrasound puncture should be carried out because one cannot be sure that it is not a malignant cyst. The authors take the occasion of this study to view the complimentary tests that can be carried out for ovarian cysts. These are mainly ultrasounds and estimations of CA125. The therapeutic methods that are available are then transparietal cystectomy or intraperitoneal cystectomy or intraperitoneal cystectomy which means laparotomy with removal of the cyst.

This was a retrospective study for the years 1979 to 1989 involving histological examination of ovarian cysts in women over 50 years who underwent surgery in our Department. A higher incidence of malignant tumours was found (32%), associated with a late diagnosis (70%) diagnosed stage III or IV). There was a higher incidence of fibrothecomas (10%) among benign tumours and functional cysts were only found in non menopausal or recently menopausal women taking hormone replacement therapy. There results allow a more specific therapeutic attitude in menopausal women i.e. laparoscopic surgery or laparotomy. Ultrasound puncture is very debatable, since this is inappropriate for an organic cyst. The authors review the complementary investigations performed for ovarian cyst, these include essentially ultrasound and Ca 125. Possible therapies include transparietal cystectomy, intraperitoneal cystectomy or laparotomy and excision.

Inversion of the uterus is a rare condition, basically described in old treatises on obstetrics. On the basis of one recent case, the authors recall details of the diagnosis, treatment and prognosis, while referring to previous older works. The usual description is given of the three anatomical degrees of inversion of the uterus, depending on the extent of invagination of the fundus of the uterus. The aetiology of this event is not always very clear, but faulty manoeuvres at the time of delivery may help to promote its occurrence. Diagnosis is relatively easy, except in cases which are not exteriorized. Treatment relies on reduction of the inversion, which should take place as early as possible, and prevention of a relapse. The prognosis was formerly catastrophic, but has currently been transformed by the progress made in improving intensive care.