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« On ne se souvient pas de Flaubert », écrit Tiphaine Samoyault. Ce constat, qui est à entendre non comme une malencontreuse amnésie qui aurait frappé toutes les générations post-flaubertiennes, mais bien comme l’impossibilité – plutôt heureuse – de faire « sans » Flaubert pour tous ceux qui sont nés et naîtront après 1880, pourrait servir de préalable à la lecture de ce recueil d’Œuvres et Critiques consacré à la réception de Flaubert par des écrivains contemporains, de la seconde moitié du ...

« Je ne sais (et personne ne sait) ce que veulent dire ces deux mots : âme et corps, où l’une finit, où l’autre commence. » : « l’âme », « le corps », Flaubert ne cesse d’en parler dans toute son œuvre (romans, récits, écrits intimes ou correspondance) et toute sa vie durant. Ou plutôt, « l’âme », « le corps » ne cessent de s’exprimer dans l’ensemble de l’œuvre flaubertienne quel que soit l’apparent désintérêt que Flaubert semble accorder à ces deux notions, et plus précisément encore quelle ...

Dans le cadre d’une étude sur l’adaptation cinématographique d’une œuvre littéraire, il importe, certes, « de savoir ce qu’un film doit à un livre », mais peut-être tout autant, comme le souligne Morris Beja, « de découvrir ce qu’un livre doit à un film ». C’est ce que Mary Donaldson-Evans a choisi de faire en proposant un essai sur les adaptations de Madame Bovary au cinéma. Quatre œuvres filmiques sont à l’honneur : les versions cinématographiques, désormais canoniques, de Jean Renoir (1934...

Objective We aimed to evaluate the impact of the sentinel lymph node (SLN) biopsy on adjuvant therapy, recurrence and survival in early endometrial cancer (EC). Study design We retrospectively included all patients who underwent SLN biopsy for EC between February 2007 and March 2018. Results Of the 249 EC patients included, the overall SLN detection rate was 91 %. SLNs were positive in 36 (14.4 %) cases. Nine of the 13 preoperative low-risk patients with positive SLNs were re-operated and 22 % presented positive non-SLNs. No second surgery was required for the 10 patients upstaged to intermediate risk after negative SLN biopsy. Nine of the 11 preoperative intermediate-risk patients with positive SLNs were re-operated and 33 % presented positive non-SLNs. Eleven of the 24 preoperative high-risk patients with negative SLNs were re-operated and 27 % presented positive non-SLNs. For the whole population, 3-year overall survival was 99 % (CI 95 % (97−1)) and 3-year recurrence-free survival (RFS) was 92 % (CI 95 % (0.87−0.95)). Conclusion Our study supports the feasibility of the SLN procedure for assessing risk recurrence in patients with early-stage EC. SLN biopsy should lead to major reductions in secondary staging and better adaptation of adjuvant therapy.

International audience; In 2018, around 382,100 new cases of endometrial cancer (EC) were reported worldwide, accounting for about 4.4% of all new cases of cancer in women. In France, in 2018, the EC is the first gynecological cancer in incidence and the fourth cancer in women. The rationale for the therapeutic management of EC is based on the estimation of a theoretical risk of recurrence and lymph node metastasis using MRI and preoperative biopsy criteria. However, lymph node status remains the determining factor of adjuvant treatment. In order to reduce the morbidity of lymphadenectomy, the concept of sentinel lymph node biopsy (SLN) has been developed. The SLN technique has evolved in recent years, thanks to the advent of robotics and the creation of fluorescence detection cameras. It has been shown that detection of SLN with Indocyanine Green (ICG) allows for more frequent bilateral migration of 88 to 100% and better detection of pelvic GS in 97% of cases with a decrease in morbidity. Recently, in view of the absence of a therapeutic role of lymph node staging, the operational risks and the delay of adjuvant treatments, in case of pelvic lymph node metastasis on definitive histological examination, the question of secondarily performing paraaortic lymphadenectomy arises. The SLN procedure, extended to all early-stage endometrial cancers, should lead to a major reduction in the use of secondary staging and better adaptation of adjuvant therapy.

Laparoscopic discoid colorectal resection is a surgical option for bowel endometriosis, 1 of the most severe forms of endometriosis. However, no study has clearly analyzed the feasibility or the complication and recurrence rates of the procedure in a homogeneous population with specific criteria for discoid resection. The aims of this study were to evaluate the rate of conversion to segmental resection, the need for double discoid resection, and the complication and recurrence rates. We conducted a prospective study of 93 consecutive patients who underwent discoid resection in Tenon University Hospital, Paris, France. The median follow-up was 20 months. We included patients with colorectal endometriosis (≤3 cm long and90° of bowel circumference) experiencing failure of medical treatment or associated infertility. All the patients underwent a discoid colorectal resection using a transanal circular stapler. The primary end point was the rate of conversion to segmental resection (3.2%). The secondary end point was the rate of double discoid resection (6.5%). The overall complication rate was 24%, and the severe complication rate (i.e., Clavien-Dindo IIIB) was 3% (n = 4). Postoperative voiding dysfunction requiring bladder self-catheterization was observed in 16% (n = 15). The mean duration of bladder self-catherization was 30 days (range, 15-90) including 11 cases (74%) lasting less than 30 days and 4 cases lasting more than 30 days. No patients required bladder self-catheterization over 3 months. No difference in the complication rate or in voiding dysfunction was observed between double and single discoid resection. The low rate of conversion to radical resection confirms the satisfactory preoperative evaluation of bowel endometriosis. Few publications report the rate of conversion to radical surgery. This raises the crucial issue of the right indications for discoid resection. The present study confirms that discoid resection is probably the best option for small lesions because of its high feasibility and low complication rate. Further studies are required to evaluate the technique for larger colorectal endometriotic lesions.

International audience; Introduction: Surgical management of deep endometriosis with colorectal involvement remains an option after failure of medical treatments. Conventional laparoscopy is currently considered the standard approach for surgical treatment. Recently, assisted-robotic laparoscopy emerged as an alternative to conventional laparoscopy but with low evidence.Methods: From March 2019 to September 2019, we conducted a prospective cohort study of 48 patients undergoing a surgical treatment for colorectal endometriosis (rectal shaving, discoid excision or segmental resection). The interventions were either performed by robotic or conventional laparoscopy. Patients' characteristics, operative and post-operative data were compared between the robotic and the conventional laparoscopic group.Results: 48 patients were included, 25 in the conventional laparoscopy group and 23 in the robotic group. Patients' characteristics and operative findings were similar between the two groups, except for a trend in a higher incidence of associated surgical urinary or digestive procedures in the robotic group (p = 0.06). The mean total surgical room occupancy time and operating time were longer in the in the robotic group (281 ± 97 min vs 208 ± 85 min; p = 0.008) and (221 ± 94 min vs 163 ± 83 min (p = 0.03), respectively. The mean intra operative blood loss, the incidence of intra operative, post-operative complication (according to Clavien-Dindo classification) rates and voiding dysfunction were similar in the two groups. The rate of grade III complication was higher in the robotic group (13 % vs 0%) without reaching a significance (p = 0.17). The mean hospital stay was 8 ± 4.4 days in the robotic group and 6.5 ± 2.6 days in the conventional laparoscopy group (p = 0.18).Conclusion: Despite our initial experience in robotic surgery, our results support that robotic surgery is an adequate alternative to conventional laparoscopy for endometriosis colorectal resection.

Objective Endometriosis affects 10% of women in reproductive age and alters fertility. Its management is still debated notably the timing of surgery and ART in infertility. Several tools have been created to guide the practitioner and the couple yet many limitations persist. The objective is to create a nomogram to predict the likelihood of a live birth after surgery followed by assisted reproductive technology (ART) for patients with endometriosis-related infertility. Study design All women in a public university hospital who attempted to conceive by ART after surgery for endometriosis-related infertility from 2004 to 2016 were included. We created a model using multivariable linear regression based on a retrospective database. Result Of the 297 women included, 171 (57.6%) obtained a live birth. Age, duration of infertility, number of ICSI-IVF cycles, ovarian reserve and the revised American Fertility Society (rAFS) score were included in the nomogram. The predictive model had an area under the curve (AUC) of 0.77 (95% CI, 0.75–0.79) and was well calibrated. The external validation of the model was achieved with an AUC of 0.71 (95% CI, 0.69–0.73) and calibration was good. The staging accuracy according to AUC criteria for the nomogram compared to the currently used Endometriosis Infertility Index to predict live births were 0.77 (95% CI, 0.75–0.79) and 0.60 (95% CI: 0.57–0.63), respectively. Conclusion This simple tool appears to accurately predict the likelihood of a live birth for a patient undergoing ART after surgery for endometriosis-related infertility. It could be used to counsel patients in their choice between spontaneous versus ART conception, or oocyte donation.

The garment industry—the second most polluting industry worldwide—called for a global transition to a circular economy at the Copenhagen Fashion Summit (2017). This led us to study how modularity could contribute to reconcile extended clothes life span with the pleasure of fashion renewal. While the history of garments has been familiar with removable and reversible systems, contemporary clothing seems to resist the reusable spare parts concept developed in sustainable object designs. Consequently, sewn garments, preponderant since the Paleolithic, needed to be questioned. Transposing to clothing G. Simondon’s open object philosophy through practice-based prospective, we propose, in response to the fabless system of fast fashion, a local and on-demand production—inspired by fablabs—of seamless modular clothing, thus opening up new avenues to digital pattern trade in light of computer numerical control (CNC) technologies. Such a systemic approach led us to rethink the roles of both the user and the fashion designer.

In 2018, around 382,100 new cases of endometrial cancer (EC) were reported worldwide, accounting for about 4.4% of all new cases of cancer in women. In France, in 2018, the EC is the first gynecological cancer in incidence and the fourth cancer in women. The rationale for the therapeutic management of EC is based on the estimation of a theoretical risk of recurrence and lymph node metastasis using MRI and preoperative biopsy criteria. However, lymph node status remains the determining factor of adjuvant treatment. In order to reduce the morbidity of lymphadenectomy, the concept of sentinel lymph node biopsy (SLN) has been developed. The SLN technique has evolved in recent years, thanks to the advent of robotics and the creation of fluorescence detection cameras. It has been shown that detection of SLN with Indocyanine Green (ICG) allows for more frequent bilateral migration of 88 to 100% and better detection of pelvic GS in 97% of cases with a decrease in morbidity. Recently, in view of the absence of a therapeutic role of lymph node staging, the operational risks and the delay of adjuvant treatments, in case of pelvic lymph node metastasis on definitive histological examination, the question of secondarily performing paraaortic lymphadenectomy arises. The SLN procedure, extended to all early-stage endometrial cancers, should lead to a major reduction in the use of secondary staging and better adaptation of adjuvant therapy.

International audience; Objective: To evaluate the risk of rectovaginal fistula after en bloc hysterectomy and colorectal resection (H-CR) for endometriosis using prevesical peritoneum interposition.Study design: A retrospective study conducted at Tenon University Hospital, expert center in endometriosis, from June 2016 to June 2018. Patients undergoing H-CR with prevesical peritoneum interposition without protective defunctioning stoma were included.Results: Of the 160 patients who underwent surgery with colorectal resection for endometriosis during the study period, 27 had H-CR (15 with segmental and 12 with discoïd colorectal resection) and were included. The median age (range) was 45 years (41-47.5). Eight patients (13 %) were nulliparous. All procedures were performed by laparoscopy. Parametrial resection was performed in 14 cases (52 %). Associated bowel procedures were ileocecal resection (n = 5) and appendectomy (n = 2). Median follow-up (range) was 14.6 months (10.5-20.2). Nine (33.3 %) patients experienced intra- or postoperative complications including one grade I, four grade II, two grade IIIA and two grade IIIB complications (Clavien-Dindo classification). Seven patients (26 %) experienced postoperative voiding dysfunction. One suspicion of rectovaginal fistula associated with pelvic abscess was diagnosed 4 weeks after surgery but not confirmed during a second operation.Conclusion: Despite the small sample size, the present pilot study supports the practice of prevesical peritoneum interposition to limit the risk of rectovaginal fistula in patients who undergo H-CR for deep endometriosis.

AIM Using a prospective database of discoid resection performed in two tertiary referral centres, the aim of this study is to assess the feasibility, short-term complication rates and clinical outcomes, including voiding dysfunction, of the procedure. METHOD A retrospective analysis of a prospective cohort database was conducted from February 2010 to October 2017 in two tertiary referral centres. One hundred and forty-eight consecutive patients scheduled for colorectal endometriosis by discoid resection were enrolled. The median follow-up was 21 months. All the women underwent complete preoperative assessment (MRI, transvaginal ultrasonography and rectal echo-endoscopy) before the removal of colorectal endometriosis. Postoperative complications were classified according to the Clavien-Dindo classification system as minor (grades I and II) or major (grades IIIA, IIIB and IV). Cases of voiding dysfunction were also noted. RESULTS The procedure was abandoned in seven patients. In 91 (64.5%) of the remaining 141 patients, the diameter of discoid resection removed was ≥ 30 mm. Surgery was performed by laparoscopy in 137/141 cases (92.7%). Grade I-III complications were observed in 37 patients (26.2%) with 11 grade IIIb (7.8%). Postoperative voiding dysfunction occurred in 16 patients (11.3%), 11 of whom required self-catheterization for

Aim To study the evolution in cesarean section (CS) categories in a single center from 2002 to 2012. Methods We performed a retrospective study on all live births from 2002, 2007, and 2012 using a modified Robson classification accounting for cervical ripening in the induction groups, post-term pregnancies, and the number of uterine scars. Results We recorded 2162, 2105 and 2380 deliveries with caesarean delivery rates of 23.2%, 24.9%, and 30.4% in 2002, 2007, and 2012 respectively. Nulliparous women in spontaneous labor (group 1) decreased from 36.3% to 27.4% of the total population, but CS rates in this group increased from 14.1% to 19.5% (P < 0.05). Labor induction and CS before labor in nulliparous women category (group 2) increased from 6.7% to 14.2% but with stable CS rates. Induction of labor and cervical ripening in this group increased from 91 and nine in 2002 to 119 and 240 in 2012, respectively. In the same period, maternal pathology increased from 11% to 33%. Scarred uterus remained the major source of CS (almost 30% of all CS in 2012). Conclusion CS rates increased throughout the studied period, associated with an increase in rates of maternal pathology, induction by cervical ripening, and scarred uterus.

La notion centrale de bovarysme retenue comme outil d'analyse a permis de mettre en relief, au-delà de ressemblances thématiques, une interrogation récurrente du texte littéraire sur le rôle de la lecture dans la définition de sa propre identité. Le roman de Flaubert et son héroïne constituent alors plus qu'une référence, une véritable déclaration de connivence entre auteur et lecteur / lectrice qui situe le roman au coeur d'un incessant processus de création/recréation, plus tard explicité par Umberto Eco comme celui de « œuvre ouverte ». A l'intertextualité affirmée se joint une dimension métatextuelle donnant au roman une portée autocritique qui dépasse le niveau du simple divertissement, sans pourtant nier la nécessaire facette Iudique. Ce que les études ici réunies ont montré, c'est que la critique littéraire la plus contemporaine n'est pas une construction in abstracto, mais bien une théorisation s'appuyant sur la trame même du. Récit romanesque, au-delà des modes, des époques ou des limites géographiques.

Que le terme de bovarysme soit évocateur, tient sans aucun doute davantage au succès de l’œuvre de Flaubert, qu’à celui de l’œuvre théorique qui le sous-tend. Il n’est point besoin de connaître aujourd’hui Jules de Gaultier pour entendre le mot « bovarysme », pour qu’il prenne un certain sens. Il est même une acception générale du terme, qui veut que le bovarysme concerne le personnage d’Emma Bovary. Ce n’est pas une pirouette tautologique. C’est la condition première de l’existence du bovary...

Study Objective Our primary endpoint was to compare the intra- and postoperative complications, whereas secondary endpoints were the occurrence of voiding dysfunction and evaluation of the quality or life of segmental and discoid resection in patients with colorectal endometriosis. Design Retrospective study (Canadian Task Force classification II-2). Setting Tenon University Hospital in Paris. Patients Thirty-one 31 patients who underwent a conservative surgery and 31 patients who underwent. Interventions The 2 groups were compared using propensity score matching (PSM) analysis, with a median follow-up of 247 days (8.2 months). Measurements and Main Results Discoid colorectal resection was associated with a shorter operating time (155 vs 180 minutes, p = .03) and hospital stay (7 vs 8 days, p = .002) than segmental colorectal resection; however, a similar intra- and postoperative complication rate was found. A higher rate of postoperative voiding dysfunction was observed in the segmental resection group (19% vs 45%, p = .03) as well as duration of voiding dysfunction requiring bladder self-catheterization longer than 30 days (0 vs 22%, p = .005). Conclusion Our PSM analysis suggests the advantages of discoid resection because it results in a similar surgical complication rate to segmental resection but with advantages in operating time, hospital stay, and voiding dysfunction.

Background: The Doppler measurement of middle cerebral artery peak systolic velocity (MCA-PSV) is considered the gold standard for the noninvasive detection of moderate to severe anemia. However, the accuracy of this test has not been evaluated so far, specifically beyond 34 weeks. Objectives: To assess the accuracy of MCA-PSV to detect moderate to severe fetal anemia and to identify risk factors associated with false-positive and false-negative MCA-PSV values after 34 weeks. Study Design: We studied a retrospective cohort of 150 pregnant women with severe alloimmunization who delivered between 2010 and 2014 and correlated MCA-PSV and fetal or neonatal hemoglobin levels. Results: Sensitivity to predict severe anemia was 69%, with a false-negative rate of 3.6%. When MCA Doppler assessment was normal, the identification of serosal effusions increased the detection rate of severe fetal anemia to 94%, with a false-negative rate of 0.8%. False-positive MCA-PSV measurements were more frequent in fetuses with 1 previous intrauterine transfusion (p = 0.0002), but were not associated with MCA resistance index, intrauterine growth restriction and fetal heart rate. Conclusions: Between 34 and 37 weeks, sensitivity of MCA-PSV Doppler assessment alone is 69% and increases to 94% when also considering signs of hydrops. False-positive MCA-PSV measurements are more frequent in case of former fetal transfusion.

To study the evolution in cesarean section (CS) categories in a single center from 2002 to 2012.We performed a retrospective study on all live births from 2002, 2007, and 2012 using a modified Robson classification accounting for cervical ripening in the induction groups, post-term pregnancies, and the number of uterine scars.We recorded 2162, 2105 and 2380 deliveries with caesarean delivery rates of 23.2%, 24.9%, and 30.4% in 2002, 2007, and 2012 respectively. Nulliparous women in spontaneous labor (group 1) decreased from 36.3% to 27.4% of the total population, but CS rates in this group increased from 14.1% to 19.5% (P0.05). Labor induction and CS before labor in nulliparous women category (group 2) increased from 6.7% to 14.2% but with stable CS rates. Induction of labor and cervical ripening in this group increased from 91 and nine in 2002 to 119 and 240 in 2012, respectively. In the same period, maternal pathology increased from 11% to 33%. Scarred uterus remained the major source of CS (almost 30% of all CS in 2012).CS rates increased throughout the studied period, associated with an increase in rates of maternal pathology, induction by cervical ripening, and scarred uterus.

BACKGROUND: When administered in the late follicular phase to prevent an LH surge, GnRH antagonists induce a sharp decrease in serum LH levels that may be detrimental for assisted reproductive technology cycle outcome. Therefore, a prospective study was designed to assess the effects of recombinant human (r)LH supplementation during GnRH antagonist (cetrorelix) administration. METHODS: The protocol consisted of cycle programming with oral contraceptive pill, ovarian stimulation with rFSH and flexible administration of a single dose of cetrorelix (3 mg). A total of 218 patients from three IVF centres were randomized (by sealed envelops or according to woman's birth date) to receive (n = 114) or not (n = 104) a daily injection of rLH 75 IU from GnRH antagonist initiation to hCG injection. RESULTS: The only significant difference was a higher serum peak E 2 level in patients treated with rLH (1476 ± 787 versus 1012 ± 659 pg/ml, P < 0.001) whereas the numbers of oocytes and embryos as well as the delivery rate (25.2 versus 24%) and the implantation rate per embryo (19.1 versus 17.4%) were similar in both groups. CONCLUSIONS: These results show that in an unselected group of patients, there is no evident benefit to supplement GnRH antagonist-treated cycles with rLH.

Resume Objectif. – Verifier la capacite des antagonistes de la GnRH de supprimer les decharges intempestives de LH au cours des protocoles de stimulation « classique » pour FIV-ET associant clomiphene et gonadotrophines. Patientes et methodes. – Cinquante-huit patientes ont suivi un protocole de stimulation par clomiphene (100 mg pendant 5 jours a partir de j2) et gonadotrophines (225 UI HMG les jours 5, 7 et 9) avec debut du monitorage a j10. L’administration d’une dose quotidienne de 0,25 mg de cetrorelix a ete initiee des que le diametre du follicule dominant atteignait 18 mm et/ou le taux plasmatique d’estradiol 800 pg/ml. Resultats. – Aucune decharge prematuree de LH n’a ete observee au cours des 48 cycles de stimulation complets. Ce protocole a permis d’enregistrer un taux de grossesses evolutives de 20,8 % par ponction et de 25,6 % par transfert. Il n’y a pas eu d’hyperstimulation clinique dans cette serie. Conclusions. – L’utilisation du cetrorelix 0,25 permet d’optimiser le protocole de stimulation classique clomiphene–HMG en supprimant les abandons motives par les pics de LH. Les resultats conceptionnels obtenus avec relativement peu d’hormones rehabilitent ce protocole a un moment ou un retour vers des stimulations pour FIV plus moderees devient souhaitable.

La grande école de Sèvres en photographie est marquée par la personnalité du physicien chimiste et membre de l'Académie des Sciences Victor Regnault. Elle est exempte de toute influence des écoles de peinture et met en scène, outre les porcelaines de Sèvres, les paysages de Sèvres ou de ses environs ; elle utilise les divers procédés photographiques avec une dilection pour la calotypie. Elle s'achève vers 1871 lorsque Regnault quitte la présidence de la Société française de la photographie ; lui succède alors la Petite école de Sèvres, dirigée par les peintres et les artistes de la Manufacture., Jayot Franz. L'École de Sèvres. In: La Gazette des archives, n°180-181, 1998. Le patrimoine photographique (journées de la section des Archives municipales, Douai, 3-5 juin 1998) pp. 19-23.