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Resume Objectif Evaluer l’effet lymphostatique du combipatch TachoSil® dans la prevention des lymphoceles apres curage axillaire dans le cancer du sein localise. Patientes et methodes Etude retrospective, cas–temoin, realisee entre janvier 2007 et decembre 2009, dans deux services de gynecologie-obstetrique de l’AP–HP. Soixante-six patientes (45 dans le groupe temoin et 22 dans le groupe TachoSil®) ayant subi un curage axillaire seul, avec mise en place d’un redon ou associe a une tumorectomie, ont ete incluses. La quantite totale de lymphe drainee durant le sejour, le nombre de jours de drainage, la duree d’hospitalisation, le nombre de lymphoceles et le nombre de ponctions realisees au decours de l’hospitalisation ont ete recueillis. Resultats La population etait similaire concernant l’âge, l’indice de masse corporelle (IMC), les donnees cliniques et anatomopathologiques. Il n’existait pas de difference significative en termes de volume total de lymphe draine (268,2 ± 220,7 mL sans TachoSil® et 228,6 ± 128,8 mL avec TachoSil®, p = 0,89) et le nombre de jours de drainage (3,9 ± 1,6 j sans TachoSil® et 3,1 ± 0,9 j avec TachoSil®, p = 0,10). Par contre, la duree d’hospitalisation etait significativement plus elevee dans le groupe TachoSil® (5 ± 1,6 j avec TachoSil® et 3,8 ± 1,1 j sans TachoSil®, p = 0,006). Conclusion Cette etude ne demontre pas de benefice du combipatch (TachoSil®) dans la prevention des lymphoceles apres curage axillaire. Une etude randomisee avec de grands effectifs est desormais necessaire. more...

Resume Objectif Evaluer le degre de satisfaction des etudiants en medecine concernant leur enseignement de la gynecologie obstetrique a la faculte de medecine Paris-VII en 2008–2009. Le but est d’ameliorer la qualite de l’enseignement et des outils pedagogiques principalement dans une optique de preparation a l’epreuve classante nationale (ECN). Materiel et methode Il s’agit d’une etude observationnelle sur une cohorte de 116 etudiants inscrits en troisieme annee de deuxieme cycle des etudes medicales, a la faculte Denis-Diderot-Paris-VII, a qui il a ete demande de repondre de facon anonyme a un questionnaire de satisfaction comportant 13 questions. Resultats La participation aux cours organises par la faculte est de 62 %. Quatre-vingt-treize pour cent des etudiants sont inscrits a des cours prives preparant a l’examen national classant. Quatre-vingt et un pour cent des etudiants pensent que l’enseignement des cours prives est de meilleure qualite que les cours dispenses par la faculte. Soixante-deux pour cent des etudiants jugent qu’un support informatique (Internet ou CD-ROM) de qualite pourrait remplacer les supports traditionnels pour la partie theorique de l’enseignement. Quatre-vingt-dix pour cent des etudiants utilisent comme support principal de travail un meme livre vendu dans le commerce. Quatre-vingt-dix-huit pour cent d’entre eux, considerent que le stage d’externe est utile a la preparation de l’ECN. Discussion Il semble que l’enseignement traditionnel par cours theoriques magistraux de la gynecologie obstetrique ne soit plus la methode d’enseignement privilegiee des etudiants en cinquieme annee de medecine. Ils preferent l’enseignement dispense par les cours prives de preparation a l’ECN sous forme de cas cliniques, meme si l’enseignement dispense par la faculte Paris-VII tente depuis quelque temps de s’adapter a cette forme de cours. Le livre reste le principal support de travail mais de nombreux etudiants estiment qu’un support informatique pourrait remplacer ou completer ce support traditionnel. Le stage hospitalier dans les services de gynecologie obstetrique, obligatoire dans les textes reglementaires, leur semble utile dans l’apprentissage de la specialite, y compris dans l’optique de l’ECN. more...

Resume Objectifs Evaluer les complications maternelles et fœtales des extractions instrumentales par ventouse Kiwi ® par rapport aux forceps et spatules. Patientes et methodes Les patientes ayant beneficie d’une extraction instrumentale entre le 2 novembre 2006 et le 30 avril 2007 ont ete incluses dans cette etude retrospective unicentrique. Nous avons compare les complications survenant apres extraction par ventouse Kiwi ® a celles survenant avec les autres instruments. Resultats Cent soixante-neuf patientes ont ete incluses, dont 79 ont beneficie d’une extraction par ventouse Kiwi ® . Les deux populations (extraction par ventouse et autres instruments) etaient comparables sur le plan des caracteristiques maternelles, du deroulement du travail et des conditions de realisation de l’extraction instrumentale. Le taux d’episiotomie etait significativement moins eleve en cas d’extraction par ventouse (73,1 % versus 94,4 % ; p = 0,0001), ainsi que le taux d’hemorragie du postpartum (8,9 % versus 18,9 % ; p = 0,04). Aucune dechirure du deuxieme ou troisieme degre n’etait rapportee en cas d’extraction par ventouse. Le taux de difficulte aux epaules etait plus eleve en cas d’extraction par ventouse (12,8 % versus 6,7 % ; p = 0,16), sans que cela n’engendre une augmentation du taux de complications fœtales. Aucune complication fœtale grave n’etait rapportee. Le taux d’echec etait plus eleve en cas d’extraction instrumentale par ventouse (11,4 % versus 4,4 % ; p = 0,04), sans augmentation du taux de cesariennes realisees pour echec d’extraction instrumentale (1,3 % versus 4,4 %). Discussion et conclusion Cette etude est la premiere a comparer les complications consecutives aux extractions par ventouse Kiwi ® par rapport a celles survenant avec les autres instruments. Bien que les resultats soient limites par le caractere retrospectif de l’etude et son faible effectif, l’utilisation de la ventouse Kiwi ® est associee a une tendance a la diminution du taux de complications maternelles, pour des taux de complications fœtales similaires a ceux retrouves en cas d’extraction par forceps et spatules. Il est donc legitime de promouvoir cet instrument et de former les jeunes praticiens a son usage. Notre etude a mis par ailleurs en evidence un des taux d’echec d’extraction instrumentale et de dystocie des epaules plus eleves. Des etudes complementaires seraient necessaires afin de mieux evaluer les situations a risque d’engendrer ces evenements afin de permettre un usage optimal de la ventouse Kiwi ® . more...

The indication and extent of lymph node dissection in the surgical management of endometrial cancer remains controversial especially concerning the para-aortic lymph nodes. The therapeutic benefit of the lymph node dissection is criticized mainly for low-risk patients for extra-uterine spread. Surgically staging patients is the best method to predict node involvement and it allows an optimal decision for adjuvant therapy to be taken. The different prognostic factors for para-aortic lymph nodes metastasis are histological grade and size of the tumour, myometrial wall invasion and lymphovascular dissemination, as well as positive pelvic lymph nodes. However, these elements are not correctly evaluated before and during the surgery. Positive para-aortic lymph nodes can be found without a lymphatic spread to the pelvic area. Even though the prevalence of para-aortic node involvement is weak, it seems legitimate to propose in selected cases of important lymph node involvement, it's complete dissection if a pelvic lymphadenectomy is indicated and if it is surgically possible. more...

Radioguided occult lesion localisation (ROLL) is a new technique which allows identification of non palpable breast lesion in breast cancer using, on the model of sentinel node procedure, injection of a radiotracer over the tumour lesion. With a gamma detection probe, it is then possible during surgery to identify in the same time the lesion and the sentinel lymph nodes. Compared with the wire-guided localisation (WGL), ROLL seems easier to achieve for radiologists, the excision procedure seems to be simpler with a good lesions resection in sano rate and a good cosmetic result. more...

In 10 to 15% of cases, breast cancer occurs in women under the age of 40. Thanks to the development of novel therapeutic approaches in the past few years, breast cancer prognosis is today far more acute than before and a pregnancy can be planned in these young women. They are expecting from their physician clear information about possibilities for pregnancy and specific risks after breast cancer. Several questions are raised in such situations: Does pregnancy modifies breast cancer prognosis? What is the influence of breast cancer for pregnancy? How do these young patients experience pregnancy and breast cancer? The goal of this paper, based upon literature review, was to clarify guidelines for the follow-up of young women experiencing pregnancy after breast cancer. more...

Sentinel lymph node biopsy is nowadays an accepted method of staging breast cancer patients. In case of an injection of radioactive colloid, preoperative lymphoscintigraphy is recommended to establish a lymphatic mapping and to predict the number of sentinel lymph nodes identified during surgery. Preoperative lymphoscintigraphy does not decrease the false-negative rate. However, positive preoperative lymphoscintigraphy significantly improves the identification rate of intraoperative sentinel nodes comparing with negative preoperative lymphoscintigraphy. Detecting extra-axillary sentinel lymph nodes, because of its minimal therapeutic consequences, does not appear to be an indication for preoperative lymphoscintigraphy. Given logistics and cost required, preoperative lymphoscintigraphy should be only performed for patients with a high risk of intraoperative failed localization. In case of negative preoperative lymphoscintigraphy, sentinel lymph node biopsy must be tried because sentinel nodes are still identified in the majority of these patients. Another possibility, with important cost and logistic, should consist in performing a later lymphoscintigraphy on the day after radioactive injection to ameliorate sentinel lymph nodes identification. more...

Journal de Gynecologie Obstetrique et Biologie de la Reproduction - Vol. 37 - N° HS2 - p. 69-75

Resume La mifepristone, steroide antagoniste des recepteurs de la progesterone, peut agir par differents mecanismes sur la croissance des fibromes uterins. De nombreuses etudes sur des patientes volontaires symptomatiques ont ete effectuees depuis plus de dix ans. Une administration journaliere de 5 mg par jour de mifepristone permet d’obtenir une reduction significative du volume uterin et fibromateux et une amelioration de la qualite de vie des patientes. L’efficacite de ce traitement est comparable a celle des agonistes de la GnRH. Les effets secondaires observes sont des bouffees de chaleur dans 38 % des cas, une elevation des enzymes hepatiques dans 4 % des cas et la survenue d’une hyperplasie simple de l’endometre dans 28 % des cas. La survenue de bouffees de chaleur ou d’hyperplasies endometriales n’est pas observee a la dose de 5 mg par jour. L’utilisation de mifepristone pourrait peut-etre permettre d’eviter ainsi un certain nombre de prises en charge invasive. Cependant, les etudes realisees ne portent que sur une duree de prise de trois a 12 mois, et d’autres etudes sur une plus longue periode et portant sur un plus grand nombre de patientes sont necessaires avant de pouvoir proposer ce traitement au long cours. more...

Since the advent of sentinel node biopsy, which made it possible to reduce the morbidity of axillary surgery, axillary lymph node dissection has been constituting the treatment of reference in certain cases of breast cancer. One of the most frequent complications in the immediate postoperative period is the lymphocele or seroma, the frequency of which is independent of the axillary technique of surgery. Following an analysis of the literature, some risk factors were isolated such as a high body mass index, the high volume of the first three days drainage and arterial hypertension. Some techniques seem to show a benefit in the reduction of the lymphocele: sentinel node biopsy, padding of the axilla and the axillary drainage. The majority of other techniques such as the use of fibrin sealant, hemolymphostatic sponges, various techniques of axillary dissection, external axillary compression, differed mobilization from the upper limb, axillary dissection by lipo-aspiration and endoscopic axillary dissection, have too contradictory results at the present time to be recommended in clinical practice. No consensus is clearly established to decrease the incidence and the volume of the seroma after axillary dissection in breast cancer. Today, two techniques can be nevertheless distinguished: sentinel node biopsy and padding of the axilla. more...

The vulvar intraepithelial neoplasia has been identified as one of the 12 neoplasias whose incidence increases in the developed countries. The vulvar intraepithelial neoplasia (VIN) and invasive vulvar cancer incidence increases by 2.4% per annum; and this principally in young women. The VIN account for 57% of the vulvar neoplasias and are actually more frequent than invasive carcinomas. In the United States, between 1973 and 2000, the incidence of the VIN increased by 411% against 20% for invasive cancers. Similar figures were reported from Norwegian registers. The VIN have a different age distribution than invasive cancers: the incidence of the VIN increases until the age of 40-49 years then decreases while the incidence of invasive cancers increases after 50 years without real peak of incidence. The increase in the incidence of VIN could be followed by an increase in the incidence of invasive cancers but the unknowns on the natural history of the VIN and the impact of the treatments make any extrapolation hazardous. The association between the VIN and the human papillomavirus (HPV) has been well established. It should be noted that, contrary to the cervical neoplasia that are related for nearly 100% to the HPV, only 30-40% of invasive cancers of the vulva are related to HPV, while the other carcinomas are related to the evolution of a vulvar lichen sclerous. The HPV induce various types of anogenital lesion according to their genotype. These lesions can be benign for the HPV6 and 11 and preneoplastic or neoplastic for the HPV16 and 18. The presence of HPV16 and 18 is found in 70 to 80% of the VIN suggesting that HPV vaccines could decrease the incidence VIN and HPV related invasive vulvar cancer. more...

Parvovirus B19 infection during pregnancy is at risk of adverse fetal outcome. The risk is increased if maternal infection occurs during the first two trimesters, but may also happen during the third trimester. Adverse first and third trimester fetal outcome were recently highlighted by polymerase chain reaction (PCR) viral DNA detection. Parvovirus does not seem to be a significant teratogen. Infection during pregnancy can cause severe fetal anaemia and nonimmune hydrops fetalis. Cardiac tropism of the virus can cause myocarditis and aggravate the cardiac failure. Follow up of in utero anaemia is based upon the middle cerebral artery peak systolic flow velocity evaluation and treatment is based upon cordocentesis transfusion. more...

Metabolic acidemia may cause cerebral palsy or perinatal death. Its detection is the major goal of perpartum fetal evaluation. Sensitivity of continuous fetal heart rate analysis is excellent, but the lack of specificity of this test can lead to inadequate intervention during labour. Fetal scalp pH is directly reliable to fetal acid-base status. In every situation where fetal heart rate displays ominous pattern, a potential acidemia can be detected with fetal scalp pH analysis. Intervention is recommended in the next 30min when fetal scalp pH is bellow 7.20. Complete analysis of fetal acid-base status parameters, including base excess and lactatemia allows a more precise detection of metabolic acidemia. Described since 1962, the place of fetal scalp pH analysis is still central in our daily practice. more...

Journal de Gynecologie Obstetrique et Biologie de la Reproduction - Vol. 36 - N° 6 - p. 567-576

Journal de Gynecologie Obstetrique et Biologie de la Reproduction - Vol. 36 - N° 4 - p. 389-392

Fresh mechanically harvested cuphea seed from the Midwest contains more than 50% moisture. Such high moisture leads to challenging drying problems. Cuphea seeds must be dried immediately to reduce moisture before destructive seed mold and material-clumping develop. A method had to be developed to batch dry large quantities of cuphea seeds. The freshly harvested, wet, uncleaned seeds were dried using a Grain Technology 245XL Dryer. Drier conditions were optimized over a 2 year period to yield a procedure for a batch drying process. In this process, the grain dryer was modified to help meet the demands of a small seed that has greater than 50% moisture at harvest. The seed moisture data was collected on a low-cost, commercially available G-7 Grain Moisture Meter, which can be used for different crops. The meter showed a strong correlation between the soybean setting and actual cuphea moisture content (%) measured in the lab when seed moisture was less than 20%. The cuphea seeds were dried to about 12% for storage. more...

Tamoxifen is an antioestrogen widely used in the breast cancer treatment. Its paradoxical antioestrogenic action on breast and its oestrogenic action on the endometer is well-known. Since 1988, few cases of malignant mixed mullerian tumors following tamoxifen were described. We report a new case of uterine malignant mixed mullerian tumor four years after the end of tamoxifen for breast cancer. more...

To evaluate maternal and fetal complications resulting from the use of the Kiwi vacuum extractor and to compare them with those resulting from the use of forceps or spatula.Patients who had instrumental extraction between November 2006 and April 2007 were included in a unicentric retrospective study. Complications resulting from the use of Kiwi vacuum extractor and those of other instruments were compared.One hundred and sixty-nine patients where included, 79 had extraction with Kiwi vacuum extractor. The two populations (women having extraction with Kiwi and woman having extraction with spatula or forceps) were similar in terms of maternal characteristics, progress of labour and delivery. The rate of episiotomies was significantly lower with KIWI (73.1% versus 94.4%; P=0.0001), as well as was postpartum haemorrhage rate (8.9 % versus 18.9%; P=0.04). No perineal tear of second or third degree occurred with Kiwi. Kiwi vacuum extractor was associated with a higher rate of shoulder dystocia (12.8% versus 6.7%, NS), but related fetal complication rates were similar in the two groups. The extraction failure rate was significantly higher with Kiwi (11.4% versus 4.4%; P=0.04), but cesarean section rate was similar for the two groups (1.3 % versus 4.4%).This study is the first comparing complications occurring after extraction with KIWI vacuum extractor to those occurring with other instruments. Although the results are limited by the retrospective nature of the study and the small size of the workforce, our study suggests that Kiwi vacuum extractor is associated with a lower rate of maternal complications and a rate of fetal complication similar to other kind of instruments. This instrument should be promoted and taught to younger patricians. Our study also revealed higher failure and shoulder dystocia rates. Larger studies are needed to better evaluate risks factor concerning these two complications in order to optimise the use of Kiwi vacuum extractor. more...

Assess the degree of satisfaction of medical students regarding their teaching of gynaecology and obstetrics at the medical faculty of Paris-VII in 2008-2009. The aim is to improve the quality of teaching and learning tools mainly with a view to preparing for the national examination competition.This is an observational study on a cohort of 116 students enrolled in 3rd year of graduate medical education, Faculty Paris-VII Denis-Diderot, who was asked to respond anonymously to a questionnaire of satisfaction comprising 13 questions.Participation in course organized by the faculty is 62%. Ninety-three percent of students are enrolled in private lessons to prepare the national examination competition. Eighty-one percent of students believe that teaching private courses is better than the courses offered by the faculty. Sixty-two percent of students consider a medium (Internet or CD-ROM). Quality could replace traditional media's theory of education. Ninety percent of students use as a main working the same book sold in commerce. Among them, 98.2% considered that the external training is useful in the preparation of the national examination competition.It seems that teaching traditional academic lectures of gynaecology and obstetrics is not the preferred method of teaching students in 5th year of medicine. They prefer the education provided by the private preparedness at national examination competition, in the form of clinical cases, even if the courses offered by the faculty try to adapt in this form. The book remains the primary medium of work, but many students believe that a computer could replace or supplement the traditional media. The internship hospital services in gynaecology and obstetrics compulsory Paris-VII seems helpful in learning the specialty including in the context of the national examination class. more...

The indication and extent of lymph node dissection in the surgical management of endometrial cancer remains controversial especially concerning the para-aortic lymph nodes. The therapeutic benefit of the lymph node dissection is criticized mainly for low-risk patients for extra-uterine spread. Surgically staging patients is the best method to predict node involvement and it allows an optimal decision for adjuvant therapy to be taken. The different prognostic factors for para-aortic lymph nodes metastasis are histological grade and size of the tumour, myometrial wall invasion and lymphovascular dissemination, as well as positive pelvic lymph nodes. However, these elements are not correctly evaluated before and during the surgery. Positive para-aortic lymph nodes can be found without a lymphatic spread to the pelvic area. Even though the prevalence of para-aortic node involvement is weak, it seems legitimate to propose in selected cases of important lymph node involvement, it's complete dissection if a pelvic lymphadenectomy is indicated and if it is surgically possible. more...

Radioguided occult lesion localisation (ROLL) is a new technique which allows identification of non palpable breast lesion in breast cancer using, on the model of sentinel node procedure, injection of a radiotracer over the tumour lesion. With a gamma detection probe, it is then possible during surgery to identify in the same time the lesion and the sentinel lymph nodes. Compared with the wire-guided localisation (WGL), ROLL seems easier to achieve for radiologists, the excision procedure seems to be simpler with a good lesions resection in sano rate and a good cosmetic result. more...

In 10 to 15% of cases, breast cancer occurs in women under the age of 40. Thanks to the development of novel therapeutic approaches in the past few years, breast cancer prognosis is today far more acute than before and a pregnancy can be planned in these young women. They are expecting from their physician clear information about possibilities for pregnancy and specific risks after breast cancer. Several questions are raised in such situations: Does pregnancy modifies breast cancer prognosis? What is the influence of breast cancer for pregnancy? How do these young patients experience pregnancy and breast cancer? The goal of this paper, based upon literature review, was to clarify guidelines for the follow-up of young women experiencing pregnancy after breast cancer. more...

Sentinel lymph node biopsy is nowadays an accepted method of staging breast cancer patients. In case of an injection of radioactive colloid, preoperative lymphoscintigraphy is recommended to establish a lymphatic mapping and to predict the number of sentinel lymph nodes identified during surgery. Preoperative lymphoscintigraphy does not decrease the false-negative rate. However, positive preoperative lymphoscintigraphy significantly improves the identification rate of intraoperative sentinel nodes comparing with negative preoperative lymphoscintigraphy. Detecting extra-axillary sentinel lymph nodes, because of its minimal therapeutic consequences, does not appear to be an indication for preoperative lymphoscintigraphy. Given logistics and cost required, preoperative lymphoscintigraphy should be only performed for patients with a high risk of intraoperative failed localization. In case of negative preoperative lymphoscintigraphy, sentinel lymph node biopsy must be tried because sentinel nodes are still identified in the majority of these patients. Another possibility, with important cost and logistic, should consist in performing a later lymphoscintigraphy on the day after radioactive injection to ameliorate sentinel lymph nodes identification. more...

Mifepristone, a progesterone receptor antagonist steroid, can reduce uterine fibroid tumours' growth by several pathways. Its efficiency has been widely evaluated in symptomatic patients for more than 10 years. A significant decrease in fibroid tumours and uterine volume concomitant with better quality of life scores can be obtained with a daily administration of Mifepristone 5mg. Mifepristone can be compared with GnRH agonists in terms of efficiency. Observed adverse outcomes are hot flushes (38%), elevated hepatic enzymes (4%) and benign endometrial hyperplasia (28%). Hot flushes and endometrial hyperplasia are not observed with 5mg daily doses. Data suggest that many invasive procedures could be avoided with the routine use of Mifepristone for fibroid tumours care. However, published study periods are only three to 12 months: long lasting evaluation in larger groups of patients seems necessary before this treatment could be proposed as routine care. more...

Tamoxifen is an antioestrogen widely used in the breast cancer treatment. Its paradoxical antioestrogenic action on breast and its oestrogenic action on the endometer is well-known. Since 1988, few cases of malignant mixed müllerian tumors following tamoxifen were described. We report a new case of uterine malignant mixed müllerian tumor four years after the end of tamoxifen for breast cancer. more...

Metabolic acidemia may cause cerebral palsy or perinatal death. Its detection is the major goal of perpartum fetal evaluation. Sensitivity of continuous fetal heart rate analysis is excellent, but the lack of specificity of this test can lead to inadequate intervention during labour. Fetal scalp pH is directly reliable to fetal acid-base status. In every situation where fetal heart rate displays ominous pattern, a potential acidemia can be detected with fetal scalp pH analysis. Intervention is recommended in the next 30min when fetal scalp pH is bellow 7.20. Complete analysis of fetal acid-base status parameters, including base excess and lactatemia allows a more precise detection of metabolic acidemia. Described since 1962, the place of fetal scalp pH analysis is still central in our daily practice. more...

Since the advent of sentinel node biopsy, which made it possible to reduce the morbidity of axillary surgery, axillary lymph node dissection has been constituting the treatment of reference in certain cases of breast cancer. One of the most frequent complications in the immediate postoperative period is the lymphocele or seroma, the frequency of which is independent of the axillary technique of surgery. Following an analysis of the literature, some risk factors were isolated such as a high body mass index, the high volume of the first three days drainage and arterial hypertension. Some techniques seem to show a benefit in the reduction of the lymphocele: sentinel node biopsy, padding of the axilla and the axillary drainage. The majority of other techniques such as the use of fibrin sealant, hemolymphostatic sponges, various techniques of axillary dissection, external axillary compression, differed mobilization from the upper limb, axillary dissection by lipo-aspiration and endoscopic axillary dissection, have too contradictory results at the present time to be recommended in clinical practice. No consensus is clearly established to decrease the incidence and the volume of the seroma after axillary dissection in breast cancer. Today, two techniques can be nevertheless distinguished: sentinel node biopsy and padding of the axilla. more...

Parvovirus B19 infection during pregnancy is at risk of adverse fetal outcome. The risk is increased if maternal infection occurs during the first two trimesters, but may also happen during the third trimester. Adverse first and third trimester fetal outcome were recently highlighted by polymerase chain reaction (PCR) viral DNA detection. Parvovirus does not seem to be a significant teratogen. Infection during pregnancy can cause severe fetal anaemia and nonimmune hydrops fetalis. Cardiac tropism of the virus can cause myocarditis and aggravate the cardiac failure. Follow up of in utero anaemia is based upon the middle cerebral artery peak systolic flow velocity evaluation and treatment is based upon cordocentesis transfusion. more...

With fifteen years of development, laparoscopy for myomectomy has proven its advantages. However, this technique remains controversial concerning its feasibility and the quality of uterine scar obtained. Laparoscopic myomectomy (LM) is usually indicated when number of myomas is less than 3 to 4 with a 8 to 9 cm maximal size. Surgical technique is standardized and intervention time becomes acceptable. Risk of conversion ranges between 1 to 3% when technique is realized by trained surgeon. Bleeding is less important compared with laparotomy and immediate postoperative complications are exceptional. Results concerning fertility are positive with more than 50% of infertile patient conceiving after surgery, this rate rising up to 61 to 76% for myomas isolated cause for infertility; these values can be compared with myomectomy realized by laparotomy. Postoperative adhesions seem to be less important after laparoscopy when compared with laparotomy but this point needs to be confirmed. Risk of uterine rupture is estimated between 0 to 1%, but this point needs for larger series evaluation and needs to be compared with pregnancies after laparotomy. Laparoscopic myomectomy is a feasible technique, safe for patients waiting for conception and has proven its interest in case of infertility. more...

Calcium channel blockers of the dihydropyridin's family have been associated with the onset of an acute pulmonary edema when they are used as a treatment of preterm labor. We report here four cases of pulmonary edema in pregnant women treated with nicardipine (Loxen) for preterm labor. The physiopathology of pulmonary edema, the pharmacology of calcium channel blockers of dihydropyridin's family and the detailed analysis of our cases and those of the literature make us discuss of the role of these agents and associated population and risk factors in such complication. more...

High-resolution $K$-shell photodetachment measurements of ${\mathrm{He}}^{\ensuremath{-}}$ giving rise to ${\mathrm{He}}^{+}$ ions have been performed using a merged synchrotron vacuum ultraviolet photon-ion beam technique. The measurements on this fundamental negative ion display dramatic structure differing substantially, qualitatively and quantitatively, from the corresponding process in neutral atoms and positive ions, owing to the dominance of correlation in both initial and final states of ${\mathrm{He}}^{\ensuremath{-}}$. In addition, this experimental investigation provides an unambiguous test of two independent theoretical calculations that report serious discrepancies and shows excellent agreement with one of them. more...

High-resolution K-shell photodetachment measurements of He- giving rise to He+ ions have been performed using a merged synchrotron vacuum ultraviolet photon-ion beam technique. The measurements on this fundamental negative ion display dramatic structure differing substantially, qualitatively and quantitatively, from the corresponding process in neutral atoms and positive ions, owing to the dominance of correlation in both initial and final states of He-. In addition, this experimental investigation provides an unambiguous test of two independent theoretical calculations that report serious discrepancies and shows excellent agreement with one of them. more...

An experimental K-shell photodetachment study of Li(-) giving rise to doubly photoionized Li(+) ions has been carried out at the Advanced Light Source, using a collinear photon-ion beam apparatus. The experiment reveals dramatic structure, differing substantially both qualitatively and quantitatively from the corresponding processes above the 1s ionization threshold in Li and Li(+), as predicted by our enhanced R-matrix calculation. The experimental/theoretical comparison shows good agreement over some of the photon energy range, and also reveals some puzzling discrepancies. more...

The steady state expression of glutathione S-transferases (GSTs) at both the protein and mRNA level is reported for the 60 tumor cell lines that are used for the National Cancer Institute Drug Screening Program. Individual GST isozymes were separated, identified, and quantified (with reverse-phase calibration curves) through a novel high performance liquid chromatographic procedure. GSTP1 was the predominant isozyme and was found at quantifiable levels in all but two of the cell lines. This isozyme ranged from 0.03% to 2.7% of the total cytosolic protein. For the mu family, 90% of the lines had GSTM2, 68% had GSTM3, but only 28% were positive for the M1 phenotype. The M1 proportion is lower than would be expected from the standard M1 null phenotype for human populations. Isozymes of the alpha family were detected only at very low levels in 35% of the lines. Significant quantitative correlations among enzyme activity, total enzyme protein, and mRNA were shown for GSTP1. However, such relationships were not apparent for the mu or alpha families. Levels of glutathione (GSH), and the transcript levels of other enzymes involved in GSH homeostasis were determined. gamma-Glutamyl cysteine synthetase (gamma-GCS) was present in all cell lines, but did not correlate with levels of intracellular GSH. Glyoxalase-I and gamma-glutamyl transpeptidase, both involved in GSH salvage, were found in 100% and 70% of the cell lines, respectively. Using a pattern-matching computer program, COMPARE, we compared and correlated the arrays of mRNA and protein levels with the pattern of chemosensitivity or chemoresistance of the 60 cell lines with 175 agents constituting a standard agent database. This database is composed of compounds to which a putative mechanism of action has been assigned. Although Pearson correlation coefficients relating the target and drug patterns were generally modest, when the patterns for the enzyme protein and mRNA levels for GST pi were correlated to drug sensitivity patterns, the list of 30 agents most closely matching (for which P0.05) was enriched with alkylating agents. gamma-GCS also showed an enrichment of alkylating agents in the COMPARE correlations, indicating that high levels of gamma-GCS may be an important determinant of resistance. In contrast, none of the other enzymes or GSH had patterns of expression that resulted in an obvious correlation to the sensitivity or resistance of alkylating agents. more...