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This study was carried out to compare ultrasonographic findings on patients after transobturator tape (TOT) and tension-free vaginal tape (TVT) procedures to evaluate displacement of tapes up to a 2-year follow-up and to test the correlation between bladder outlet obstruction and the tape position. Forty-nine patients had a transvaginal ultrasonographic evaluation after TOT (n=31) or TVT (n=18) procedures. Twenty-one patients from the TOT group and 12 from the TVT group had ultrasonographic evaluation both at 1 and 2 years follow-up. Tape position was evaluated with a complete sagittal view, and the width of the tape and the distance between the middle of the tape and the bladder neck were measured. Statistical analysis was performed using a t test. After clinical evaluation, stress test, and uroflowmetry with residual measurement, the tapes were compared on ultrasound with regard to clinical and urodynamic results: success in stress incontinence vs failure, bladder outlet obstruction vs no obstruction, and de novo urgencies vs no urgencies. No difference was found between TOT and TVT in the midurethral tape placement. The distance between the middle of the tape and the bladder neck at rest was similar at both 1 and 2 years after both TOT and TVT and was unchanged after coughing or Valsalva. The width of the tape was similar after TOT and TVT at both 1 and 2 years after the procedure. There was no difference in the distance between the middle of the tape and the bladder neck between cured patients, failure, bladder outlet obstruction, and de novo urgencies after both TOT and TVT. Transvaginal ultrasound examination showed no significant difference in the tape position between TOT and TVT. No correlation was found between ultrasonographic findings and postoperative voiding troubles for both techniques.

Aim and Methods: The diagnostic algorithms of ectopic pregnancy (EP) include sonographic procedures. Diagnostic sensitivity is low because the procedure is operator-dependent and each clinical aspect of EP is variable. We analyzed results of standardized ultrasound procedures performed within the framework of a detailed analysis of clinical findings., Results: The sonographic procedure must be performed within the framework of an overall analysis including laboratory results (hCG level), examination of the decidua, localization of the corpus luteum, and careful detailed examination of adnexa. Hematosalpinx is pathognomonic of EP and is observed in 80% of cases. When diagnosis is doubtful, a second ultrasound procedure should be performed 48 hours later before undertaking laparoscopic diagnosis., Conclusion: The diagnostic sensitivity of ultrasonography has been consistently high in published series, undoubtedly because the studies were performed in referral centers highly experienced in diagnostic ultrasound.

Objective: To evaluate the reproductive performance after hysteroscopic metroplasty performed for hypoplastic uterus., Design: Crossover study (15 patients) and descriptive analysis (14 patients)., Setting: Tertiary care university hospital., Population: Twenty-nine women (mean age: 31.4 years; range: 27-38.5 years) with a hypoplastic malformed uterus and a history of primary infertility and/or recurrent abortion and/or preterm delivery were included in this study. Fourteen women suffered from primary infertility and 15 women had previous pregnancies. Twenty-three women had been exposed to diethylstilboestrol in utero., Methods: Women underwent hysteroscopic metroplasty between January 1996 and May 1999., Main Outcome Measures: Rate of pregnancies and live births, anatomical results., Results: The mean follow up was 40 months (range: 13-67 months). Twenty-one women (72.4%) experienced 30 pregnancies. Thirteen women gave birth to 16 live infants. At the time of the follow up, four women were pregnant in the second trimester. Compared with previous pregnancies, the rate of deliveries increased from 3.8% to 63.2%. No complications occurred during metroplasty. The hysteroscopic anatomical results were good in all cases., Conclusions: Our results suggest that hysteroscopic metroplasty, with its simplicity and minimal post-operative sequelae, seems to be an operation of choice in women with a hypoplastic malformed uterus and a history of severe infertility and/or recurrent pregnancy loss.

Objective: To describe selective embryo reduction of two triplet pregnancies with a monozygotic twin., Design: Case reports., Setting: Infertility unit of a Department of Obstetrics and Gynecology., Patient(s): Two patients treated with IVF-ET who had triplet pregnancies., Intervention(s): Selective embryo reduction of monozygotic twins., Main Outcome Measure(s): Fetal heart beat., Result(s): During intracardiac injection of potassium chloride plus midazolam in one of the monozygotic twin fetuses, we observed an immediate diminution of the cardiac pulse rate of the second twin. This phenomenon was observed in both patients., Conclusion(s): These observations clearly indicate the presence of vascular anastomosis between the two fetuses of these monozygotic twins. Thus, use of toxic substance to reduce one of the two fetuses of a monozygotic twin pregnancy is contraindicated. In cases of triplets that include a monozygotic twin, it is safest to interrupt the evolution of the twin if selective reduction is desired.

Introduction: To assess ultrasonic data in the context of repeated failure of implantation in assisted reproduction medicine., Materials and Methods: We reviewed ultrasonic data (uterine score at follicular and luteal phase). The same ultrasound exploration was repeated for two consecutive cycles to assess the changes in abnormalities observed and compare findings in 16 patients with repeated failure of implantation and in 14 controls. The controls were women who became pregnant within the three months following the exploration. We then introduced acetylsalicylic acid and prednisolone as first line treatment and nitroglycerin as second line treatment to measure the effects induced in 14 pathological uterine scores., Results: The score obtained under hormonal treatment was representative of other cycles (r = 0.812, p < 0.0014). The score was significantly lower and the luteal uterine artery pulsatility index was significantly higher in the repeated failure group than in the control group (p < 0.0001 and p = 0.008 respectively). For the 14 patients, treatment improved the uterine score in 8 with acetylsalicylic acid and prednisolone and in 4 with nitroglycerin. Two patients did not respond to treatment. Concerning the effect of therapy, of 14 patients, 8 had an improved uterine score with A + P, and with T; 2 patients did not respond to any treatment., Conclusion: The uterine score and luteal artery pulsatility index may be valuable tools for patients with implantation failure who all do not respond to the same therapy.

We describe a case of early bilateral tubal pregnancy diagnosed by transvaginal ultrasonography after intracytoplasmic sperm injection (ICSI) and embryo transfer (ET). A follow-up by transvaginal sonography was done with a systematic second scan (5 days) after the first diagnosis of left tubal ectopic pregnancy in case of assisted conception procedure. This follow-up sonographic strategy permitted us to perform a conservative treatment for this case of spontaneous bilateral tubal pregnancy by two consecutive (left then right) in-situ methotrexate injections under vaginal ultrasonographic guidance without any complications.

Background: Thrombocytopenia occurred in a woman given alpha interferon for chronic hepatitis C without cirrhosis. Both central thrombocytopenia, clearly demonstrated, and peripheral thrombocytopenia, probably of autoimunne origin, were involved., Case Report: A 55-year-old woman with active chronic hepatitis C (Metavir score A2, F2) was given alpha interferon. One month after treatment onset, she developed thrombocytopenia (32 G/L). A second bone marrow aspirate and osteomedullary biopsy evidenced megalokaryocytes and the platelet count responded to polyvalent immunoglobulins. Five months after discontinuing interferon, the platelet count progressively returned to normal., Discussion: Central thrombocytopenia is classically described in patients given interferon and usually appears during the first weeks of treatment. In our case, the central mechanism was clearly demonstrated by the bone marrow aspirate and osteomedullary biopsy findings at a time when the platelet count was 32 G/L. A peripheral immunological participation was more difficult to prove but was strongly suggested by the persistence of thrombocytopenia despite the interruption of the interferon and the efficacy of immunoglobulins.

Objective: to compare methotrexate (MTX) to laparoscopic salpingotomy for conservative management of ectopic pregnancy (EP)., Design: prospective randomized study., Patients: eighty-nine patients were randomized into 2 groups using a random number table. Inclusion criteria were an EP visualized by ultrasound with a pretherapeutic score < or = 13 as assessed by 6 criteria graded from 1 to 3: gestational age, hCG level, P level, abdominal pain, volume of the hemoperitoneum, and diameter of the hematosalpinx., Interventions: 1 mg/kg of MTX injected transvaginally into the ectopic pregnancy without anaesthesia or IM administration (1.5 mg/kg) when EP cannot be safely or easily punctured (group 1) versus laparoscopic salpingotomy (group 2)., Results: the success rates defined by hCG levels returned to normal (< 10 mlU/mL) were 43 out of 46 in group 1 and 40 out of 43 in group 2. Medical treatment was significantly associated with shorter post-operative stay (24 vs 46 hours). hCG return to normal was quicker after laparoscopic treatment (13 vs 29 days). Reproductive performances were similar in both groups., Conclusions: in selected cases of EP with a pretherapeutic score < or = 13, MTX treatment appeared to be as safe and efficient as was conservative treatment by laparoscopy, an expectant management should be offered as a treatment option only in women fulfilling the criteria for a good prognostic.

Abnormal connexion of the umbilical vein in the inferior vena cava was diagnosed in a fetus at 18 weeks' gestation. Associated anomalies included nuchal and axillary lymphangiectasia, hypertrophic cardiomyopathy and hepatomegaly. Neonatal death occurred after spontaneous vaginal delivery at 25 weeks. A review of the literature summarizes the diagnostic criteria and associated anomalies.

Objective: To compare local injection of methotrexate (MTX) under sonographic control to laparoscopic salpingotomy for conservative management of ectopic pregnancy (EP)., Design: Prospective randomized study., Patients: Forty patients were randomized into two groups using a random number table. Inclusion criteria were an EP visualized by ultrasound with a pretherapeutic score < or = 13 as assessed by six criteria graded from 1 to 3: gestational age, hCG level, P level, abdominal pain, volume of the hemoperitoneum, and diameter of the hematosalpinx., Interventions: Group 1 patients injected transvaginally with 1 mg/kg MTX into the EP without anesthesia versus group 2 patients undergoing laparoscopic salpingotomy., Main Outcome Measures: Postoperative hospital stay, decrease of hCG levels, success rate., Results: The success rates, defined by hCG levels returned to normal (< 10 mIU/mL [conversion factor to SI units, 1.00]), were 19 of 20 in both groups. Medical treatment was associated significantly with shorter postoperative stay (24 versus 46 hours) and a higher initial hCG level. Human chorionic gonadotropin returned to normal more quickly after laparoscopic treatment (14 versus 28 days)., Conclusions: In selected cases of EP with a pretherapeutic score < or = 13, MTX treatment appeared to be as safe and efficient as was conservative treatment by laparoscopy.

Objective: To evaluate nonsurgical management of heterotopic pregnancy., Design: Retrospective case series., Setting: Department of Obstetrics and Gynecology (Antoine Béclère Hospital, Clamart, France, Paris-Sud University)., Patients: Six women with heterotopic pregnancy who conceived in four cases after ovulation induction., Intervention: Transvaginal ultrasound (US)-guided aspiration/injection of potassium chloride (KCl) was performed in three cornual pregnancies with alive embryo. Expectant management was realized in three other cases. The regression was followed by serial US examination., Main Outcome Measures: Early and late complications related to the procedure, outcome of intrauterine pregnancy (IUP)., Results: Five of six patients were treated successfully (3 with KCl and 2 after expectant management). Three of these five patients had a spontaneous vaginal delivery, and two abortions occurred in the remaining two patients. Salpingectomy had to be performed in one case 10 days after medical treatment. This twin pregnancy ended with an abortion at 23 weeks of amenorrhea. Four cornual heterotopic pregnancies were treated successfully. No complication occurred after the initial management., Conclusion: Ultrasound permits a reliable and early diagnosis of heterotopic pregnancy. In such cases nonsurgical management is an efficient alternative with a good IUP prognosis.

Currently two genetic pulmonary disorders can be diagnosed before birth: alpha-1-antitrypsin deficiency and mucoviscidosis. For the latter there are two possible diagnostic techniques: first a study of the intestinal enzymes of the amniotic fluid, a reliable method only at the 18th week, and also a study of DNA markers (ADN) of the trophoblastic cells using molecular biological techniques: this can be performed from the 10th to 11th week of pregnancy but presupposes a family study in which there is already a subject suffering from the disorder. Foetal echocardiography enables various pulmonary abnormalities to be detected: pleural effusion, cyst, pulmonary hypoplasia and other disorders. This technique however has some limits, at least at present. Most often these severe malformations are revealed at birth such as respiratory distress or stillbirth. Adenomatous cystic malformations or congenital lobar emphysema, a posterior diaphragmatic hernia, and oesophageal atresia with oesophagotracheal fistula are the most frequent and are curable surgically.

A double-blind trial comparing isoprinosine with a placebo was conducted in 36 subjects. Improvement of skin lesions was significantly better in the treatment group (p less than or equal to 0.01). Before entering the trial, patients in the treatment group had significantly more severe pain than those in the placebo group (p less than or equal to 0.01), the difference disappeared after treatment. Healing of skin lesions was more rapid in patients treated before the 5th day of the disease (p less than or equal to 0.03). None of the subjects developed post-zoster neuralgia. The clinical effects of the drugs were accompanied by a decrease in serum rosette activity. We consider isoprinosine as an innocuous and effective treatment of herpes zoster.