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Patients with very high risk of cancer mutation may decide to undergo prophylactic surgery in order to avoid heavy clinical and radiological monitoring. This is a promising and nonetheless risky surgery because it is a complicated procedure and highly mutilating. Our goal was to improve the practice of this prophylactic surgery, to do so we assessed a postoperative satisfaction survey to cancer-free patients who have undergone this procedure.Single-center, cross-sectional descriptive study. Assessment of the primary efficacy endpoint using the BREAST-Q questionnaire. These results were compared to a control group representative of our sample of patients, those data came from the scientific literature using a single-sample Student's test. Several multivariate analyzes were also carried out in order to study the influence of certain factors on the patient's satisfaction.The averages obtained in the various questionnaires were 56.06/100 for "Satisfaction with breasts"; 66.94/100 for "Psychosocial well-being"; 50/100 for "Sexual well-being" and 59.22/100 for "Satisfaction with information". Postoperative satisfaction in our sample is comparable to the group control concerning the questionnaire "Satisfaction with breasts" (P=0.37) and "Psychosocial well-being" (P=0.18). Concerning the questionnaire "Sexual well-being" there is a significant statistical difference between our group and the control group (P=0.01).The post-operative satisfaction of our operated patients seems to be proportionally similar to the general population who have not undergone breast surgery except on the question of the quality of sexual life. The various analyzes of our study also allowed us to highlight the importance of preoperative information for postoperative well-being.

Los tratamientos farmacologicos de la endometriosis son hormonales convencionales (estrogenos-progestagenos, progestagenos, agonistas de la hormona liberadora de gonadotropinas [GnRH], danazol), hormonales innovadores (antiaromatasas, moduladores selectivos de los receptores de progesterona) o no hormonales (antiinflamatorios, inhibidores de las metaloproteasas o de la angiogenesis, estatinas y plantas medicinales chinas). De ellos, solo los estrogenos-progestagenos, los micro y macroprogestagenos, los agonistas de la GnRH y el danazol han demostrado su eficacia si se administraban durante el periodo adecuado. Dado que no existen ensayos terapeuticos sobre cada una de las clases, no es posible dar prioridad a una molecula sobre a las demas. Los (estrogenos)-progestagenos, que se toleran mejor que el danazol y los agonistas de la GnRH prescritos sin tratamiento hormonal sustitutivo, deben ser la opcion prioritaria como primera eleccion. En la endometriosis superficial no tratada o despues de su tratamiento quirurgico, esta indicado un tratamiento con estrogenos-progestagenos en modo continuo en lugar de secuencial o por macroprogestagenos. Si fracasa el tratamiento con (estrogenos)-progestagenos por via oral, en caso de mala observancia o de contraindicaciones, se puede plantear la colocacion de un dispositivo intrauterino con levonorgestrel, la inyeccion de agonistas de la GnRH o un tratamiento con danazol (sobre todo por via vaginal). En la endometriosis profunda, se propone un tratamiento medico preoperatorio si no se desea un embarazo de inmediato. Los agonistas de la GnRH se pueden utilizar de entrada, pero no han demostrado ser mas eficaces que los (estrogenos)-progestagenos. Despues de la cirugia de una endometriosis profunda o de un endometrioma, los estrogenos-progestagenos o los macroprogestagenos permiten disminuir el riesgo de recidiva. Todos estos tratamientos son anticonceptivos y deben continuarse si no se desea un embarazo, a excepcion de los agonistas de la GnRH, cuya prescripcion (sin tratamiento hormonal sustitutivo) se limita a 6 meses. Si se desea tener un embarazo, los antiinflamatorios no esteroideos son los unicos farmacos indicados en el tratamiento del dolor asociado a la endometriosis.

La principal causa de utero cicatricial es la cesarea (en mas del 95% de los casos). En Francia, por ejemplo, cuando a las pacientes que tienen un utero cicatricial se les propone una prueba de trabajo de parto, el 75% da a luz por via vaginal. El riesgo de ruptura uterina aumenta de forma significativa durante una prueba de trabajo de parto, en comparacion con una cesarea programada. Sin embargo, un parto por via vaginal en caso de utero cicatricial reduce los riesgos vinculados a las cesareas multiples, sobre todo en lo que se refiere a la morbilidad materna del acto quirurgico a corto plazo y a las anomalias de insercion placentaria a largo plazo. Por esta razon, en caso de utero cicatricial es indispensable optar, de acuerdo con la paciente, por la solucion mas adecuada y con la mejor relacion beneficios/riesgos, teniendo en cuenta situaciones clinicas particulares, maternas o fetales, que podrian influir en la decision del modo de parto. La via vaginal es la opcion de preferencia en la gran mayoria de los casos, ya que pocas situaciones clinicas justifican por si solas una cesarea programada. Tres factores pronosticos principales correlacionan fuertemente con el exito de una prueba por via vaginal tras una cesarea y, en ausencia de contraindicacion, inducen a recomendar el nacimiento por via vaginal: un antecedente de parto por via vaginal, el inicio espontaneo del trabajo de parto y un cuello uterino considerado favorable al ingresar a la sala de trabajo de parto. Las dos posibilidades razonables de induccion (indicacion medica) en caso de utero unicicatricial, a pesar de un aumento moderado del riesgo de ruptura uterina, son el uso de oxitocina (cuello favorable) o el metodo mecanico con globo transcervical (cuello desfavorable). La cesarea programada por antecedente de cesarea sigue estando indicada de forma sistematica en caso de antecedente de cicatriz uterina corporal o de al menos tres cesareas.

This work was carried out under the aegis of the CNGOF (Collège national des gynécologues et obstétriciens français) and proposes guidelines based on the evidence available in the literature. The objective was to define the diagnostic and surgical management strategy, the fertility preservation and surveillance strategy in Borderline Ovarian Tumor (BOT). No screening modality can be proposed in the general population. An expert pathological review is recommended in case of doubt concerning the borderline nature, the histological subtype, the invasive nature of the implant, for all micropapillary/cribriform serous BOT or in the presence of peritoneal implants, and for all mucinous or clear cell tumors (grade C). Macroscopic MRI analysis should be performed to differentiate the different subtypes of BOT: serous, seromucinous and mucinous (intestinal type) (grade C). If preoperative biomarkers are normal, follow up of biomarkers is not recommended (grade C). In cases of bilateral early serous BOT with a desire to preserve fertility and/or endocrine function, it is recommended to perform a bilateral cystectomy if possible (grade B). In case of early mucinous BOT, with a desire to preserve fertility and/or endocrine function, it is recommended to perform a unilateral adnexectomy (grade C). Secondary surgical staging is recommended in case of serous BOT with micropapillary appearance and uncomplete inspection of the abdominal cavity during initial surgery (grade C). For early-stage serous or mucinous BOT, it is not recommended to perform a systematic hysterectomy (grade C). Follow up after BOT must be pursued for more than 5 years (grade B). Conservative treatment involving at least the conservation of the uterus and a fragment of the ovary in a patient wishing to conceive may be proposed in advanced stages of BOT (grade C). A new surgical treatment that preserves fertility after a first non-invasive recurrence may be proposed in women of childbearing age (grade C). It is recommended to offer a specialized consultation for Reproductive Medicine when diagnosing BOT in a woman of childbearing age. Hormonal contraceptive use after serous or mucinous BOT is not contraindicated (grade C).

To determine the procedures for follow-up and counselling of patients after pelvic inflammatory disease (PID).A search in the Cochrane database, PubMed, and Google was performed using keywords related to follow-up and PID to identify reports published between 1990 and 2018. All studies published in French and English relevant to the areas of focus were included. A level of evidence (LE) based on the quality of the data available was applied for each area of focus and used for the guidelines.The rate of recurrent PID is 15 to 21%. They are related to a recurrent sexually transmitted infection (STI) in 20 to 34% of cases. Recurrence PID increase the risk of infertility and chronic pelvic pain (LE2). Follow-up is recommended after PID (grade C). The rate of patients lost to follow-up is around 40%. Follow-up is improved by personalized text message reminders (grade B). Vaginal sampling for detection of N. gonorrhoeae, C. trachomatis, (and M. genitalium) by nucleic acid amplification techniques is recommended 3 to 6 months after treatment of PID associated with STI to rule out possible reinfections (grade C). The use of condoms after PID associated with STI is recommended to reduce the risk of recurrences (grade C). The systematic use of contraceptive pills after PID is not recommended to prevent subsequent infertility and chronic pelvic pain. Vaginal sampling for microbiological diagnosis is recommended before the insertion of an intrauterine device (grade B). The risk of ectopic pregnancy is high in these women and must be kept in mind.Patient counselling and microbiological testing after PID decrease the risk of STI and thus the recurrence of PID.

To provide up-to-date guidelines on management of pelvic inflammatory disease (PID).An initial search of the Cochrane database, PubMed, and Embase was performed using keywords related to PID to identify reports in any language published between January 1990 and January 2012, with an update in 2018. All identified reports published in French and English relevant to the areas of focus were included. A level of evidence based on the quality of the data available was applied for each area of focus and used for the guidelines.PID must be suspected when spontaneous pelvic pain is associated with induced adnexal or uterine pain (grade B). Pelvic ultrasonography is necessary to exclude tubo-ovarian abscess (TOA) (grade C). Microbiological diagnosis requires endocervical and TOA sampling for molecular and bacteriological analysis (grade B). First-line treatment for uncomplicated PID combines ceftriaxone 1g, once, by intra-muscular (IM) or intra-venous (IV) route, doxycycline 100mg×2/d, and metronidazole 500mg×2/d oral (PO) for 10 days (grade A). First-line treatment for complicated PID combines IV ceftriaxone 1 to 2g/d until clinical improvement, doxycycline 100mg×2/d, IV or PO, and metronidazole 500mg×3/d, IV or PO for 14days (grade B). Drainage of TOA is indicated if the collection measures more than 3cm (grade B). Follow-up is required in women with sexually transmitted infections (STI) (grade C). The use of condoms is recommended (grade B). Vaginal sampling for microbiological diagnosis is recommended 3 to 6months after PID (grade C), before the insertion of an intra-uterine device (grade B), before elective termination of pregnancy or hysterosalpingography. Targeted antibiotics on identified bacteria are better than systematic antibioprophylaxis in those conditions.Current management of PID requires easily reproducible investigations and antibiotics adapted to STI and vaginal microbiota.

El cancer de cuello uterino es frecuente en las mujeres jovenes o entre la poblacion inmunodeprimida. Su carcinogenesis esta obligatoriamente inducida por el virus del papiloma humano (VPH) de tipo oncogenico. Existe una filiacion obligatoria entre las lesiones preinvasivas y el cancer invasivo. La evolucion de las lesiones intraepiteliales hacia la invasion requiere muchos anos, lo cual permite detectar estas anomalias preinvasivas y tratarlas. Todos los cofactores que favorecen el contagio del VPH o limitan el aclaramiento de este ultimo o favorecen su progresion constituyen riesgos de cancer de cuello. Sin embargo, solo el tabaquismo y la inmunodepresion han demostrado una relacion indiscutible como cofactor. El cancer de cuello puede prevenirse mediante la vacunacion y la deteccion precoz de las anomalias preinvasivas del cuello. Las vacunas del VPH son eficaces para prevenir las neoplasias intraepiteliales cervicales de grados 2 y 3 (NIC 2 y NIC 3) inducidas por los VPH 16, 18 y otros VPH oncogenos en las mujeres libres de infeccion en curso. Se toleran muy bien y no se ha senalado hasta el momento ningun aumento de la incidencia de enfermedades autoinmunes. La poblacion diana son las ninas de 11-14 anos, y la poblacion de recuperacion, las de 15-19 anos cumplidos. La cobertura vacunal es inferior al 40% en Francia, lo cual es insuficiente para inducir una inmunidad de grupo. La deteccion precoz se realiza cada 3 anos, entre los 25 y los 65 anos, tras dos frotis anuales normales. La deteccion precoz en Francia solo concierne al 57% de las mujeres de la poblacion diana. Un frotis anormal debe ir seguido de estudios diagnosticos complementarios. Aparte de las lesiones intraepiteliales de alto grado, estas anomalias a menudo se controlan, porque su porcentaje de regresion espontanea es elevado y casi siempre sigue al aclaramiento viral.

In this review we aimed to update the possibilities of adenomyosis treatment in women excluding those with a desire for pregnancy. Adenomyosis is defined as the presence of endometrial tissue within the myometrium and frequently underestimated. Over the last decades, its pathophysiology has been better known. The diagnosis is essentially based on clinical symptoms like menorrhagia and dysmenorrhea. Transvaginal ultrasound and magnetic resonance imaging are the main tools of the radiologic diagnosis. However, the definitive diagnosis is histological. The most effective treatment remains hysterectomy; however it is expensive, radical and at risk of morbidity compared with medical or surgical conservative management. The literature has reported several series of patients undergoing various treatments, thus allowing different therapeutic options. The levonorgestrel-releasing intrauterine device showed its efficacy alone or in combination with hysteroscopic treatment. Oral progestins, GnRH agonists are useful at short term or in preoperative condition. Some conservative treatments like focused ultrasound therapies or uterus-sparing operative treatment stay under evaluation and seems to be effective. Embolization has been the subject of several studies and must be outlined. Furthermore, several molecules, such as modulators of progesterone receptors and the aromatase inhibitors have been recently studied and are perhaps future treatments.

The Collège national des gynécologues obstétriciens français (CNGOF), in agreement with the Société de chirurgie gynécologique et pelvienne (SCGP), has set up a commission in 2017 to define endometriosis expert centres, with the aim of optimizing endometriosis care in France.The committee included members from university and general hospitals as well as private facilities, representing medical, surgical and radiological aspects of endometriosis care. Opinion of endometriosis patients' associations was obtained prior to writing this work. The final text was presented and unanimously validated by the members of the CNGOF Board of Directors at its meeting of October 13, 2017.Based on analysis of current management of endometriosis and the last ten years opportunities in France, the committee has been able to define the contours of endometriosis expert centres. The objectives, production specifications, mode of operation, missions and funding for these centres were described. The following missions have been specifically defined: territorial organization, global and referral care, communication and teaching as well as research and evaluation.Because of its daily impact for women and its economic burden in France, endometriosis justifies launching of expert centres throughout the country with formal accreditation by health authorities, ideally as part of the National Health Plan.

3 pags., In this letter, we show that it is possible to unravel both the physical origin of the Landau’s consistence criterion and the specific and subtle meaning of interpenetration of the “two fluids” if one takes into account that in the hydrodynamic regime one needs a coarse-graining in time to bring the system into local equilibrium. That is, the fuzziness in time is relevant for the phenomenological Landau’s consistency criterion and the meaning of interpenetration. Note also that we are not questioning the validity of the “Two-Fluid” Model., We gratefully thank Prof. C.F. Barenghi, Prof. T. Kodama and Prof. A.J. Leggett for correspondence exchange and Prof. A. Cruz for very illuminating discussions. In addition, Prof. Kodama has helped us to complete our knowledge about the hydrodynamic regime and without the help of Prof. Barenghi we would not have got all the content of his works, essential for the discussion in Section 3. We also acknowledge the referee's recommendations. This work was supported by Diputacion General de Aragon (Spain)-FSE Grants E24/2 and E24/3 and by Ministerio de Economia y Competitividad (Spain) Grants FIS2017-82426-P and FPA2015-65745-P. FA is supported by the DGA/European Social Fund Grant C070/2014.

La adenomiosis se define por la presencia de islotes de tejido endometrial en el espesor del miometrio. Esto suele provocar una hipertrofia difusa o localizada del utero. La etiologia y la patogenia no se han definido con precision: invaginacion endometrial provocada por traumatismos uterinos (cesarea, raspado, miomectomia) o metaplasia mulleriana. Los factores hormonales facilitarian el desarrollo de estas lesiones. Su papel en la infertilidad no se ha dilucidado con claridad, pero la adenomiosis podria perjudicar la implantacion por fenomenos mecanicos, inflamatorios o inmunologicos. La prevalencia de la adenomiosis varia entre el 5 y el 70%, con un promedio de un 40%. Afecta sobre todo a mujeres de 35-50 anos. Provoca dolores pelvicos y menorragias, pero es asintomatica en alrededor de un tercio de los casos. El diagnostico de certeza es anatomopatologico. Sin embargo, la ecografia endovaginal y la resonancia magnetica permiten orientar el diagnostico con una sensibilidad y especificidad adecuadas. Los criterios diagnosticos son la heterogeneidad miometrial difusa o localizada (adenomioma) y la presencia de quistes intramiometriales. En la resonancia magnetica, un engrosamiento de la zona de union superior a 12 mm tambien es un dato a favor del diagnostico. Las otras pruebas de laboratorio o endoscopicas no aportan nada.

Study Objective To evaluate efficacy of a 3 months course of ulipristal acetate on abnormal uterine bleeding in adenomyosis Design A multicenter randomized trial with a 3:1 ratio. Setting In five different teaching hospitals Patients or Participants Women with adenomyosis confirmed on MRI or sonography and abnormal uterine bleeding with PBAC score more than 100 Interventions Women were randomly assigned for a 3 months course of either 10mg Ulipristal acetate or a placebo Measurements and Main Results Main objective was the rate of women with a PBAC score under 75 after 3 months of treatment. The secondary objectives included rate of PBAC score under 75 at 6 months, rate of amenorrhea at 3 and 6 months, evolution of the pain and of the quality of life at 3 and 6 months and finally, tolerance. Forty women were included, 30 in the UPA group and 10 in the placebo group. The two groups were comparable particularly for PBAC score and analgesic consumption before the treatment. At 3 months, a significant difference was observed between UPA group and placebo group for the rate of PBAC score under 75 (0 versus 95.2%), p Conclusion Ulipristal acetate seems to stop abnormal uterine bleeding due to adenomyosis but also pain during a three months course but both of these symptoms reappeared at the stop of the medication. Other studies are needed to conclude and to try different doses.

La tuberculose genitale est rare. L’absence de specificite clinique fait la difficulte d’evoquer cette infection et le diagnostic est souvent tardif. Nous rapportons deux cas observes chez des femmes jeunes, de 22 et de 33 ans, consultant pour infertilite primaire et amenorrhee. Le diagnostic a ete porte par l’examen anatomopathologique d’une biopsie de peritoine et d’epiploon pour le premier cas et le produit de curetage biopsique de l’endometre pour la deuxieme patiente. Les deux examens revelaient des granulomes gigantocellulaires et des necroses caseeuses, qui sont des lesions pathognomoniques de la tuberculose. La tuberculose doit etre evoquee et recherchee chez toute femme presentant une amenorrhee secondaire, mais surtout il faut penser a l’inclure dans le bilan d’infertilite particulierement dans les pays ou la tuberculose est encore endemique comme Madagascar.

Journal de Gynecologie Obstetrique et Biologie de la Reproduction - Vol. 42 - N° 8 - p. 752-759

El cancer del ovario representa alrededor del 4% de los canceres femeninos y es responsable de mas del 5% de los fallecimientos por cancer. Las mujeres de raza blanca o que viven en los paises desarrollados son las mas expuestas. Los indices de incidencia y de mortalidad, estables entre 1980 y 2000, tienden a disminuir gracias al empleo de la anticoncepcion oral y a los adelantos terapeuticos. Las formas hereditarias de los canceres del ovario representan el 5-10% de los casos: carcinomas epiteliales solos o asociados a canceres mamarios (mutaciones BRCA1 y 2) o sindrome de Lynch con asociacion de cancer ovarico y de colon o endometrio. Mas del 90% de los canceres epiteliales ovaricos son esporadicos. Todas las situaciones que permiten disminuir el numero de ovulaciones durante la vida reproductiva hormonal y ginecologica desempenan un papel protector. Asi, varios embarazos, la lactancia materna y la anticoncepcion oral prolongada reducen el riesgo de cancer ovarico. Por el contrario, los factores de riesgo suelen asociarse al hiperestrogenismo relativo: tratamiento hormonal de la menopausia, endometriosis, infertilidad, sindrome de los ovarios poliquisticos, obesidad y diabetes. En el plano ambiental y toxico, la exposicion profesional a algunos compuestos aromaticos ejerce un efecto perjudicial, pero tambien se ha senalado el efecto protector de la exposicion solar y de las vitaminas A y D. Es probable que existan otros factores con una influencia positiva o negativa sobre el riesgo de cancer ovarico, pero todavia se discuten.

Journal de Gynecologie Obstetrique et Biologie de la Reproduction - Vol. 40 - N° 8 - p. 875-884

Journal de Gynecologie Obstetrique et Biologie de la Reproduction - Vol. 40 - N° 8 - p. 885-901

Resume Cette etude retrospective monocentrique s’est interessee aux anomalies chromosomiques limitees au placenta (ACLP) a priori d’origine meiotique (i.e. anomalies chromosomiques limitees au placenta de type 3 homogenes). A partir d’une serie de 14 967 biopsies de trophoblaste effectuees dans notre centre de medecine fœtale, dix ACLP de type 3 homogenes ont ete mises en evidence. Ces anomalies impliquaient uniquement les chromosomes 15, 16 ou 22. Les grossesses compliquees d’une ACLP de type 3 homogene etaient associees a des termes de naissance prematures et des hypotrophies neonatales. Ainsi, lorsqu’une anomalie chromosomique limitee au placenta est suspectee, cette etude souligne la necessite de bien caracteriser son type afin de prevenir un tres probable retard de croissance intra-uterin associe aux ACLP de type 3 homogenes et adapter la prise en charge obstetricale le cas echeant.

Post-term pregnancy in the broad ligament is rarely described in the literature. A 33-year-old woman, grava 2 para 1, not followed-up during gestation was admitted at 44 weeks of gestation. The fetus was dead and in transversal position, as shown by ultrasound. A cesarean section was performed and the fetus was extracted from the right broad ligament. The placenta was inserted on the surface of the posterior wall of the uterus. Blood loss was estimated at 1200 mL and the patient received isogroup total blood. There was no major complication.

Please cite this paper as: Rouzier R, Bergzoll C, Brun J, Dubernard G, Selle F, Uzan S, Pomel C, Darai E. The role of lymph node resection in ovarian cancer: analysis of the surveillance, epidemiology, and end results (SEER) database. BJOG 2010;117:1451–1458. Objective The therapeutic role of lymphadenectomy on the survival in patients with ovarian cancer is controversial. The aim of this study was to evaluate the survival impact of lymphadenectomy, depending on the disease stage and extent of the surgery. Design The surveillance, epidemiology, and end results (SEER) registry provided ovarian cancer data from 17 registries. Setting Surveillance, Epidemiology, and End Results database. Population The study population comprised 49 783 patients. Methods Survival was studied according to the number of lymph nodes removed, with stratifications on disease stage and extent of surgery. Main outcome measure The 5-year cause-specific survival rate. Results The median follow up for patients alive at the last follow-up visit was 39 months. The five-year cause-specific survival rates were 37, 62, and 71% for the groups in which no lymph nodes were examined, in which between one and nine nodes were examined, and in which ten or more nodes were examined, respectively (P

In this paper we select a small element of fluid of a given mass and follow it as it moves about in space under the influence of the external forces exerted by the rest of the fluid and by gravity, using only ideas contained in any classical mechanics textbook. Then, without the need to consult a fluid mechanics textbook, we obtain the conditions for the energy conservation in a fluid and, from these conditions, we derive the standard form of Bernoulli's theorem.

Journal de Gynecologie Obstetrique et Biologie de la Reproduction - Vol. 37 - N° 8S1 - p. 368-383

Any curve derived from a parabola by shearing is a potential in which the anharmonic vibrations are isochronous, with a period independent of the energy.

Journal de Gynecologie Obstetrique et Biologie de la Reproduction - Vol. 37 - N° 1S - p. 155-166

Human papillomavirus is a necessary cause for the development of cervical cancer. Cervical cancer is attributed to 15 high-risk oncogenic HPV among the 120 genotypes present in human. The infection affects about 3 out of 4 women and is often transient thanks to immunological modulators leading to viral clearance. This characteristic made it possible to develop vaccines. Prophylactic vaccines are made of virus-like particles L1, non infectious, well tolerated and highly immunogenic. They prevent from viral infection by producing antibodies, which are secreted throughout the genital mucosa (humoral immunity). High-risk oncogenic HPV-16 and 18, responsible for 70% of cervical cancer, are included in Gardasil and Cervarix. Both vaccines prevent from HPV infection and related cervical and perineal lesions in more than 90% of the cases. Therapeutic vaccines are made of epitope peptides, recombinant proteins and bacteria, plasmid DNA or dendritic cells. All sensitize immunocompetent cells (cellular immunity). Ineffective in cervical cancers, they induce the regression of cervical dysplasia in about 50% of the cases. They are still under research and development, in opposition to prophylactic vaccines, which are available.

I find that students have difficulty with Hamilton's principle, at least the first time they come into contact with it, and therefore it is worth designing some examples to help students grasp its complex meaning. This paper supplies the simplest example to consolidate the learning of the quoted principle: that of a free particle moving along a line. Next, students are challenged to add gravity to reinforce the argument and, finally, a two-dimensional motion in a vertical plane is considered. Furthermore these examples force us to be very clear about such an abstract principle.

El tratamiento de la adenomiosis depende de la sintomatologia y del deseo de embarazo que tenga la mujer. Si la paciente no quiere tener mas hijos, las hemorragias se tratan en primer lugar con metodos farmacologicos del tipo de gestagenos orales o intrauterinos o agonistas de la hormona liberadora de gonadotropinas (GnRH). A menudo se prefiere el tratamiento con levonorgestrel intrauterino a los gestagenos orales, debido a su mayor eficacia y a que sus efectos secundarios son menos importantes, lo que hace que el cumplimiento sea mejor. Si este metodo fracasa, esta indicado el tratamiento quirurgico, con reduccion endometrial si la adenomiosis es superficial o con histerectomia si es profunda. Los dolores relacionados con los adenomiomas pueden tratarse con cirugia electiva (reseccion, radiofrecuencia) precedida o no de un tratamiento con agonistas de la GnRH. Si la paciente quiere tener hijos, el tratamiento sera medico en el caso de la adenomiosis difusa (gestagenos intrauterinos) o quirurgico si es focal (reseccion). Si existe una endometriosis externa asociada es preferible recurrir a los agonistas de la GnRH. No se han establecido recomendaciones concretas para las mujeres esteriles con adenomiosis que necesitan recurrir a la fecundacion asistida.

As is well known, the existence of geometrically similar orbits for a particle moving under a central conservative force is a consequence of the fact that the corresponding potential energy is a homogeneous function of the co-ordinates. In this paper, we consider a particular non-homogeneous potential of the form V = U + W, where U and W are homogenous functions of degrees −1 and −2, respectively, because, for this potential, the search of closed orbits, for discrete values of the angular momentum, is straightforward. We focus our attention on these daisy-like charming orbits and graphically show the consequences of the impossibility of geometrical similarity.

Endometrial hyperplasias can be divided into two categories based on the presence or absence of cytological atypia and further classified as simple or complex according to the extent of architectural abnormalities. They are usually diagnosed because of irregular bleeding in perimenopause. Hysteroscopy with a biopsy gives a more accurate diagnosis than transvaginal ultrasonography, sonohysterography, or blind curettage. Endometrial hyperplasias with no cytological atypia, regarded as a response to unopposed endogenous estrogenic stimulation, are normally treated with progestins. The intra-uterine route (levonorgestrel intra-uterine system) is more effective and better tolerated than the oral route. Either conservative surgery (endometrial resection, thermal ablation) or radical surgery (hysterectomy) in the case of other genital diseases is performed on women who did not respond to medical treatment. Endometrial hyperplasias with cytological atypia, considered as intra-epithelial neoplasias, are traditionally treated by hysterectomy. The absence of management protocols in the literature offers various treatment options and indications. Gonadotropin-releasing hormone agonists, danazol, or aromatase inhibitor are effective, but have adverse effects and are expensive. Endometrial ablation can be performed as a first line therapy in women suffering from bleeding related to hyperplasia without cytological atypia. Medical treatment may be offered to young women suffered from hyperplasias with cytological atypia and desiring pregnancy.

Rockets not subjected to gravitational forces are often considered in mechanics textbooks as an example of the use of the momentum conservation equation for an isolated system. We consider in this paper the momentum conservation in the motion of a trolley moving horizontally and powered by a tennis player with a racket and a given number of tennis balls. The energy supplied by the player is discussed as a way of deepening students' understanding of the work done by internal forces.

The problem of particles falling under gravity allows us to relate Hamiltonian mechanics to such different subjects as elasticity and fluid mechanics. It is with this in mind that mechanics gives us the opportunity of introducing, in a rather simple and unusual form, some concepts such as vorticity, the incompressibility condition or simple shear strain to physics students at the undergraduate level.

We analyse qualitatively and quantitatively the terminology referring to the forces experienced by an astronaut in an orbiting spacecraft. We emphasize that the use of some quite common terms is unfortunate.

When the concept of scattering differential cross-section is introduced in classical mechanics textbooks, usually it is first supposed that the target is a fixed, hard sphere. In this paper we calculate the scattering differential cross-section in the case of the hard target being a fixed figure of revolution of any shape. When the target is a paraboloid of revolution, we find the well-known formula corresponding to Rutherford's scattering. In addition, we analyse the inverse problem, i.e. given a differential cross-section, what is the profile of the corresponding hard target?

The design of a wall, as insulating as possible with respect to heat transfer, is discussed. Several materials are considered and evaluated with respect to conduction, convection and radiation, which are the three heat transfer modes.

Objectives To analyse the management of pregnancy after prenatal diagnosis of sex chromosome aneuploidy (SCA) and the factors influencing genetic counselling and parental decision. Methods Between 1991 and 2001, 73 non-mosaic fetal SCA were diagnosed in our centre and 25 were referred to us from outside institutions. The same geneticist carried out genetic counselling. The outcome of pregnancies and the termination trend over time were determined according to the type of SCA. Clinical parental data were analysed in order to assess whether they influenced genetic counselling. Results 45,X was diagnosed in 41 fetuses. The main indication for karyotyping was abnormal ultrasound (83%). The termination rate was 93%. Sex chromosome polysomies (SCP) including 47,XXY, 47,XXX, and 47,XYY were diagnosed in 31, 16, and 10 fetuses respectively. The main indication for karyotyping was advanced maternal age (60%). The termination rate was 32, 25, and 20% respectively. The difference between the termination rate for local cases (25%) and referred cases (33%) was not significant. The termination rate for pregnancies with SCP was 38% in 1991 to 1994, 34% in 1995 to 1998, and 12% in 1999 to 2001. The parents' characteristics did not influence the outcome of pregnancy. Conclusions The relatively low termination rate (28%) in pregnancies where the fetus was affected by SCP and the decreasing termination trend over time in our centre suggest an improved knowledge of the pathological conditions associated with SCP, influencing genetic counselling. Copyright © 2004 John Wiley & Sons, Ltd.

SummaryThe synthetic pentasaccharide, fondaparinux, is the first of a new antithrombotic class: selective factor Xa inhibitors. Comparative clinical trials of fondaparinux versus heparins in prevention and treatment of venous thromboembolism are ongoing. Little is known about fondaparinux during pregnancy, as women of child-bearing potential were excluded from clinical trials. No particular safety issue, for either mother or fetus, has been reported for heparins. The objective of this study was to compare in vitro the steady state placental transfer of fondaparinux and enoxaparin at the plasma concentrations reached during acute treatment of venous thromboembolism (1.75 µg/mL and 1 anti- Xa IU/mL respectively), using antipyrine (20 mg/L) as reference. No biological activity was detectable in the fetal venous effluent during perfusion of enoxaparin-antipyrine, fondaparinux-antipyrine or control media. Furthermore, fetal venous samples did not differ significantly from fetal arterial samples. This apparent absence of placental transfer supports further evaluation of fondaparinux in pregnant women.

In this review we aimed to update the possibilities of adenomyosis treatment in women excluding those with a desire for pregnancy. Adenomyosis is defined as the presence of endometrial tissue within the myometrium and frequently underestimated. Over the last decades, its pathophysiology has been better known. The diagnosis is essentially based on clinical symptoms like menorrhagia and dysmenorrhea. Transvaginal ultrasound and magnetic resonance imaging are the main tools of the radiologic diagnosis. However, the definitive diagnosis is histological. The most effective treatment remains hysterectomy; however it is expensive, radical and at risk of morbidity compared with medical or surgical conservative management. The literature has reported several series of patients undergoing various treatments, thus allowing different therapeutic options. The levonorgestrel-releasing intrauterine device showed its efficacy alone or in combination with hysteroscopic treatment. Oral progestins, GnRH agonists are useful at short term or in preoperative condition. Some conservative treatments like focused ultrasound therapies or uterus-sparing operative treatment stay under evaluation and seems to be effective. Embolization has been the subject of several studies and must be outlined. Furthermore, several molecules, such as modulators of progesterone receptors and the aromatase inhibitors have been recently studied and are perhaps future treatments.

The present paper deals with systems which can be characterized by a single variable executing anharmonic oscillations. An algorithmic procedure is given for calculating the period of these nonlinear vibrators as a power series of the energy, E. Any potential energy function V(x) which has a minimum with non-vanishing second derivative can be used. Computer assistance is provided through an interactive applet, whose Internet address is given.