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Ovarian cancer is recognized by the immunological system of its host. Initially, it is effective to destroy and eliminate the cancer. But gradually, resistant tumor cells more aggressive and those able to protect themselves by inducing immune tolerance will be selected. Immunotherapy to be effective should consider both components of immune response with an action on cytotoxic immune effectors and action on tolerance mechanisms. The manipulations of the immune system should be cautious, because the immune effects are not isolated. A theoretically efficient handling may simultaneously cause an adverse effect which was not envisaged and could neutralize the benefits of treatment. Knowledge of tolerance mechanisms set up by the tumor is for the clinician a prerequisite before they prescribe these treatments. For each cancer, the knowledge of its immunological status is a prerequisite to propose adapted immunological therapies., Le cancer de l’ovaire est reconnu par le système immunitaire de son hôte. Dans un premier temps, il est efficace pour détruire et éliminer le cancer. Mais progressivement, seront sélectionnées les cellules tumorales résistantes, les plus agressives et celles capables de se protéger en induisant une tolérance immunitaire. L’immunothérapie pour être efficace devra envisager deux volets de la réponse immunitaire avec une action sur les effecteurs cytotoxiques de l’immunité et une action sur les mécanismes de tolérance. Les manipulations du système immunitaire doivent être prudentes, car les effets immunitaires ne sont pas isolés. Une manipulation théoriquement efficace peut entraîner simultanément un effet néfaste qui n’avait pas été envisagé et qui pourrait neutraliser les bénéfices du traitement. La connaissance des mécanismes de tolérance mis en place par la tumeur est pour le clinicien un préalable nécessaire avant qu’il ne prescrive ces traitements.

International audience; Ovarian cancer is recognized by the immunological system of its host. Initially, it is effective to destroy and eliminate the cancer. But gradually, resistant tumor cells more aggressive and those able to protect themselves by inducing immune tolerance will be selected. Immunotherapy to be effective should consider both components of immune response with an action on cytotoxic immune effectors and action on tolerance mechanisms. The manipulations of the immune system should be cautious, because the immune effects are not isolated. A theoretically efficient handling may simultaneously cause an adverse effect which was not envisaged and could neutralize the benefits of treatment. Knowledge of tolerance mechanisms set up by the tumor is for the clinician a prerequisite before they prescribe these treatments. For each cancer, the knowledge of its immunological status is a prerequisite to propose adapted immunological therapies.; Le cancer de l’ovaire est reconnu par le système immunitaire de son hôte. Dans un premier temps, il est efficace pour détruire et éliminer le cancer. Mais progressivement, seront sélectionnées les cellules tumorales résistantes, les plus agressives et celles capables de se protéger en induisant une tolérance immunitaire. L’immunothérapie pour être efficace devra envisager deux volets de la réponse immunitaire avec une action sur les effecteurs cytotoxiques de l’immunité et une action sur les mécanismes de tolérance. Les manipulations du système immunitaire doivent être prudentes, car les effets immunitaires ne sont pas isolés. Une manipulation théoriquement efficace peut entraîner simultanément un effet néfaste qui n’avait pas été envisagé et qui pourrait neutraliser les bénéfices du traitement. La connaissance des mécanismes de tolérance mis en place par la tumeur est pour le clinicien un préalable nécessaire avant qu’il ne prescrive ces traitements.

Resume Objectif Le but de l’etude a ete de comparer la bandelette de polyester enduite de silicone utilisee dans le LIFT ® (Cousin) par rapport a la bandelette de polypropylene utilisee dans le Tension-free Vaginal Tape (TVT ® , Gynecare), en termes de resultats et de complications a court et moyen terme. Materiels et methodes Il s’agit d’une etude retrospective portant sur 140 patientes entre 2000 et 2002 (71 LIFT ® et 69 TVT ® ) operees pour incontinence urinaire d’effort parfois associee a une chirurgie vaginale (prolapsus ou hysterectomie). Les complications per- et postoperatoires ont ete recherchees. Les patientes ont ete contactees afin d’evaluer les resultats a distance de l’intervention. Resultats L’âge moyen des patientes etait de 58,8 ± 11,3 ans dans le groupe LIFT ® et 57,2 ± 7,5 ans dans le groupe TVT ® . Plus de complications peroperatoires globales sont survenues dans le groupe TVT ® (six plaies vesicales et trois hemorragies ayant necessite un simple mechage versus deux dans le groupe LIFT ® , p ® et de 32,2 ± 11,3 mois pour le TVT ® . Parmi les patientes, 80 % etaient gueries dans le LIFT ® et 75,8 % dans le groupe TVT ® . Il n’existait pas de difference significative concernant le taux d’urgences mictionnelles de novo (18,3 versus 17,7 %) et de dysurie (10 versus 16 %). En revanche, quatre patientes (6,7 %) du groupe LIFT ® ont presente des troubles de cicatrisation avec parfois exposition de prothese ayant conduit dans tous les cas a une exerese partielle de bandelette. Nous n’avons releve aucun cas d’infection dans le groupe TVT ® . Conclusion Le LIFT ® semble tout aussi efficace que le TVT ® et possede un taux d’urgences mictionnelles de novo et de dysurie comparable au TVT ® et aux donnees de la litterature. Cependant, le taux de 6,7 % de troubles de la cicatrisation et de rejet de bandelette nous incite a ne plus utiliser ce type de bandelette polyester au regard de la faible incidence de ce type de complication avec le polypropylene.

Resume Objectif L'hematome retroplacentaire (HRP) constitue l'une des grandes causes des metrorragies du troisieme trimestre de la grossesse d'une part, et d'autre part l'une des etiologies majeures de mortinatalite. Notre etude a pour but de determiner les differentes caracteristiques epidemiologiques, cliniques, paracliniques, therapeutiques et pronostiques des patientes prises en charge pour HRP dans notre maternite en vue de contribuer a la reduction de la mortalite et de la morbidite fœtomaternelles. Patientes et methodes Il s'agit d'une etude prospective, descriptive en serie continue, realisee a la maternite Issaka-Gazobi de Niamey, au Niger, du 1er janvier 2003 au 31 decembre 2003. Resultats Durant cette periode, 3255 accouchements ont ete realises. La frequence de l'HRP etait de 3,6 % avec un pic de frequence pendant la saison pluvieuse. L'âge, la parite moyenne etaient respectivement de 31 ans, cinquieme pare avec une predominance des grandes multipares (38,2 %). La majorite des patientes etait des transferts in utero (83,1 %) et avait parcouru une distance d'au moins dix kilometres (82,7 %). Cent onze patientes (94,1 %) avaient accouche par cesarienne, sept patientes (5,9 %) par voie basse. Le pronostic fœtal etait marque par une mortinatalite elevee (71,3 %), la frequence de l'hypotrophie fœtale (64,8 %) et la prematurite (23,8 %). La morbidite maternelle etait dominee par l'anemie (76,3 %) et la coagulation intravasculaire disseminee (CIVD) (5,9 %). Quatre-vingt-une patientes (68,7 %) avaient beneficie d'une transfusion sanguine. La mortalite maternelle etait de 5,1 %. Discussion et conclusion L'HRP, urgence medico-obstetricale par excellence, est une pathologie gravidique preoccupante dans notre pays du fait de la complexite de la prise en charge des patientes. Il doit etre particulierement craint chez les patientes ayant des facteurs de risque tels que l'hypertension arterielle (HTA), la toxemie gravidique, la multiparite. Le diagnostic precoce et la cesarienne ameliorent le pronostic maternofœtal.

The aim of our work was to objectify and quantify the mechanical benefits of healing with regards to tearing meshes off of tissues and maximal resistance after cicatrization. In vivo, we tested the mechanical gain in resistance by healing after implantation of a Prolene® mesh. We measured the value of forces when traction was exerted until mobilization at different stages of cicatrization. Resistance increased progressively at the beginning of tissue inclusion. A maximal plateau was reached around the 25th day. It is important to understand the role of sustaining and reinforcement we hope tissue integration of the mesh will play. We can thus adapt procedures to have the best kinetics and maximal resistance of montages. Study of the kinetics and maximal plateau allows us to make the best clinical recommendations.

Journal de Gynecologie Obstetrique et Biologie de la Reproduction - Vol. 36 - N° 1 - p. 83-86

Resume Objectifs Le principe de mise en place de protheses sans tension est largement diffuse dans la chirurgie des troubles de la statique pelvienne. Les resultats cliniques semblent favorables. Le but de notre travail est de quantifier les resistances transtissulaires objectives des protheses avant cicatrisation. Patientes et methodes Nous avons mesure les resistances tissulaires offertes a cinq types de prothese par quatre voies d'abord chirurgicales classiques. Nous avons egalement teste l'incidence de la modification de taille de la bandelette sur la resistance transtissulaire. Ce travail a ete realise sur cadavres congeles, par traction sur les protheses juste apres implantation. Les mesures sont effectuees a l'aide d'un dynamometre et les resultats obtenus sont exprimes en newtons. Resultats Au niveau du Retzius, la bandelette de TVT® offre une meilleure resistance a la traction par rapport au LIFT®, a l'IVS® et a la bandelette de Prolene® de 1 cm. Nous n'avons note de difference significative entre les quatre voies d'abord pour un meme type de prothese de 1 cm de large. En revanche, l'augmentation de largeur des bandelettes de Prolene® ameliore leur resistance dans les tissus et donc la qualite de leur fixation. Nous avons mis en evidence une meilleure resistance de la voie transligamentaire par rapport a un passage transmusculaire. Discussion et conclusion L'augmentation de resistance est liee a l'augmentation de la surface de contact entre la prothese et les tissus. Cette augmentation de resistance devrait etre prise en compte dans les cures de prolapsus dont les contraintes subies sont plus fortes que pour les cures d'incontinence. Les bras de protheses posterieurs doivent mesurer plus de 1 cm de large et etre mis en place au travers du ligament sacro-epineux plutot qu'au travers des muscles elevateurs. Le type de tricotage des protheses est important et influe sur la resistance dans les tissus en postoperatoire immediat. Les industriels devraient s'interesser a la fabrication de materiau prothetique concu specifiquement pour la pose sans fixation, sans suture.

Journal de Gynecologie Obstetrique et Biologie de la Reproduction - Vol. 35 - N° 8 - p. 778-784

Resume Les malformations arterio-veineuses intra-uterines sont une etiologie possible de metrorragies persistantes notamment en cas d’antecedent de fausses couches, de grossesse cornuale, de grossesse molaire ou de maladies trophoblastiques gravidiques. Nous rapportons 4 cas de patientes presentant une malformation arterio-veineuse intra-uterine. Le diagnostic de telles lesions fait appel a l’echographie Doppler en premiere intention. Ce diagnostic est par la suite confirme par angiographie. Le traitement de premiere intention est l’embolisation qui est la plupart du temps realisee dans le meme temps que l’angiographie. Ce traitement est rapide et definitif, permettant aux patientes d’avoir d’autres grossesses ulterieurement. Un suivi echographique, dont le rythme reste a definir, est necessaire afin de verifier la bonne involution de ce type de malformation vasculaire.

Resume Objectif Determiner la frequence, les indications, et les difficultes de prise en charge des hemorragies graves du post-partum avec hysterectomie d'hemostase dans un pays en voie de developpement. Le deuxieme objectif etait d'evaluer le pronostic maternel, de proposer des conduites a tenir appropriees et d'evaluer les moyens materiels et humains necessaires afin de reduire l'incidence de cette intervention. Patientes et methodes Etude prospective monocentrique realisee a la maternite Issaka-Gazobi de Niamey, entre le 1 er janvier 2003 et le 31 decembre 2003. Resultats Trois mille deux cent cinquante-cinq accouchements ont eu lieu, 41 hysterectomies d'hemostase pour hemorragie grave de la delivrance ont ete realisees, soit 1,25 %. La moyenne d'âge de nos patientes etait de 32,76. Les grandes multipares (plus de cinq enfants) etaient les plus souvent concernees (24 patientes). La majorite des patientes avait beneficie d'un transfert in utero (23 patientes provenaient des maternites peripheriques de la communaute urbaine de Niamey et 13 patientes des autres formations sanitaires du pays). Trente et une patientes presentaient une hemorragie active, 11 etaient en etat de choc lors de l'admission. Les principales indications de l'hysterectomie etaient representees par un HRP (21 patientes), une atonie uterine (11 patientes), une rupture uterine (trois patientes), une plaie de la filiere genitale (trois patientes) et un cas de placenta accreta avec inversion uterine. Dans un tiers des cas une CIVD etait associee au tableau clinique. L'hysterectomie a ete subtotale dans la plupart des cas (27 patientes). Enfin, les taux de deces maternel (neuf patientes) et perinatal (31 nouveau-nes) sont eleves dans notre serie, consecutifs aux conditions d'admission des patientes comme aux moyens de reanimation insuffisants dont dispose notre service. Discussion et conclusion Une prevention de l'hemorragie de la delivrance et des nouvelles strategies therapeutiques s'imposent pour ameliorer la prise en charge de l'hemorragie grave du post-partum dans nos regions. C'est cependant la maitrise technique du geste chirurgical vital qui est indispensable.

Nous envisageons successivement la description des complications des implants de renfort vaginaux, leur symptomatologie, leur prevention et leur traitement specifique. Nous nous sommes attaches a definir et decrire precisement ces complications afin de proposer une classification rationnelle et claire qui pourra etre retenue ulterieurement dans les futures publications sur ce sujet. Nous distinguerons ainsi les complications: Type 1: Defaut de cicatrisation vaginale – 1 A: Exposition vaginale de prothese; – 1 B: Troubles de la cicatrisation; polypes, synechies. Type 2: Infection du materiau; diffusion le long de l’implant favorisee par la densite du materiau – 2 A: Erosions vaginales; – 2 B: Infection diffusant le long de la bandelette; – 2 C: Erosion cutanee; – 2 D: Abces de contact; – 2 E: Abces a distance; – 2 F: Fistules; – 2 G: Infection aigues: cellulite pelvienne. Type 3: Retractions prothetiques – Grade 1: Implant de renfort palpable; – Grade 2: Retraction moderee et/ou peu symptomatique; – Grade 3: Retraction importante et/ou symptomatique; – Grade 4: Implant douloureux ++ au contact. Type 4: Erosions par l’implant – 4 A: Erosions vaginales; cul-de-sac vaginal; – 4 B: Erosions uretrales; – 4 C: Erosions vesicales; – 4 D: Erosions rectales; – 4 E: Autres erosions a distance. Cette classification ne peut malheureusement qu’etre provisoire mais a l’avantage de mieux individualiser les differentes categories de complications qui sont le plus souvent confondues dans les publications. Les implants de renfort vaginaux mis en place pour une cure d’incontinence urinaire ou de prolapsus genital sont bien responsables de complications specifiques dont la frequence peut etre diminuee par des mesures de prevention. Leur prise en charge fait l’objet de strategies specifiques que tout chirurgien utilisant ces produits devrait connaitre, notamment pour eviter un retard prejudiciable a la patiente.

Resume Description d’une entite clinique : les grossesses gemellaires monochoriales sont connues pour leur risque specifique de syndrome transfuseur transfuse, pathologie d’evolution chronique, survenant au cours du deuxieme trimestre de la grossesse. Les cas de transfusion aigue per-partum sont plus rares et sont tres peu decrits dans la litterature. Nous presentons deux cas cliniques de transfusion fœto-fœtale aigue per-partum. Le risque de transfusion fœto-fœtale aigue per-partum semble imprevisible malgre un suivi regulier de la grossesse. Ce risque doit etre envisage lors de la prise en charge de la mere et des nouveau-nes issus de grossesse gemellaire monochoriale en salle de naissance. Une numeration systematique aux cordons des deux jumeaux permettrait d’en faire le diagnostic immediat et de depister des formes passees inapercues cliniquement.

Resume Objectif. – Nous rapportons 143 cas de grossesse extra-uterine (GEU) traites a la maternite Issaka-Gazobi de Niamey entre le 1er janvier 1999 et le 30 avril 2001 (28 mois). L'objectif de l'etude etait d'evaluer les aspects epidemiologiques, diagnostiques et therapeutiques afin de proposer des actions qui pourraient conduire a l'amelioration du pronostic de la GEU dans les pays en voie de developpement. Patientes et methode. – La frequence de la GEU est de 2,32 % dans notre serie, les patientes sont jeunes (30 ans), paucipares (deuxieme et troisieme pares), avec des antecedents d'infections sexuellement transmissibles (IST) et/ou d'avortements. Plus de 70 % des patientes etaient admises au stade de complications (rupture). Resultats. – La culdocentese a permis d'evoquer le diagnostic dans plus de 80 % des cas. C'est un geste simple qui permet a peu de frais de faire le diagnostic de GEU et qui devrait etre enseigne et pratique dans les maternites des pays en developpement. L'echographie pelvienne et la cœlioscopie ont permis le diagnostic dans les autres cas. La localisation tubaire est la plus frequente, une grossesse cervicale et une grossesse abdominale ont ete retrouvees. Le traitement chirurgical par laparotomie a ete conservateur dans 11,9 % et radical dans 87,4 % des cas. Le taux de mortalite est encore de 0,7 %. Discussion et conclusion. – Une prevention des IST et une prise en charge des avortements non medicalises s'imposent pour reduire les risques de GEU. Une sensibilisation des patientes, domiciliees loin de la maternite, est egalement necessaire pour obtenir qu'elles consultent plus precocement en cas de metrorragies en debut de grossesse afin d'ameliorer le pronostic de la GEU.

In spite of the fact that there are many articles considering that intrauterine depressed skull fractures are caused essentially by instrumental extraction, literature is scarce about spontaneous foetal head injuries. Here, we report the case of two depressed skull fractures and one of linear fracture not associated with any known trauma during the pregnancy or delivery. The etiological process leading to the idiopathic character of such lesions, the aetiology, the treatment and the prognostic will be discussed. The forensic problem raised by such cases is very important.

Resume Objectifs. – Les echelles d’evaluation sont utilisees afin d’analyser l’incontinence urinaire. Leur nombre important rend difficile l’analyse et la comparaison des etudes concernant ce symptome. Nous proposons d’evaluer et de comparer entre elles les echelles d’evaluation specifiques de l’incontinence urinaire de la femme. Patientes et methode. – Nous avons effectue une analyse bibliographique des differentes echelles d’evaluation developpees dans la litterature. Chaque echelle a ete evaluee selon quatre criteres : principales caracteristiques : (reference, nombre d’items, modalites de cotation, langue), objectifs (type, severite et qualite de vie), validation psychometrique (validite, fidelite et sensibilite aux changements) et validation linguistique. Resultats. – Treize echelles ont pu etre repertoriees. Deux groupes sont individualisables : (1) les classifications et (2) les questionnaires. Les classifications sont peu precises et ne sont pas scientifiquement validees. Les questionnaires sont plus elabores et plus detailles ; neanmoins l’etude de leur validite psychometrique est souvent incomplete. Discussion et conclusion. – Les classifications sont insuffisantes pour analyser l’incontinence urinaire. Le questionnaire « type » devra repondre aux trois objectifs d’analyse de l’incontinence urinaire avec une validite psychometrique validee. Le choix dependra d’une utilisation en pratique clinique ou dans le cadre de protocoles de recherche clinique.

Journal de Gynecologie Obstetrique et Biologie de la Reproduction - Vol. 35 - N° 8 - p. 826-828

Because a power generation facility is made up of structures that contain a large number of welds, the reliability of weld joints is important to ensure the safety of power plants. Surveys and research are conducted on special weld joints to verify the reliability of power plants. The results of the investigation to verify the relation between the welding conditions and quality of small-diameter socket joints are described. Some defects are observed in the roots of socket-pipe joints of carbon steel in this project. The authors investigate experimentally the effect of the welding parameters on the generation of defects. The defects of the root are found experimentally to be solidification cracking (hot cracking). It is also revealed that a higher heat input and lower wire feed rate generate more hot cracking at the root of a weld. The authors also give a hypothesis that explains the generation mechanism of hot cracks at the root of a socket-pipe joint, based on finite element modelling analysis and other information.

(1995). Toughness of electron beam weld metal in heavy‐gauge low‐alloy steel. Welding International: Vol. 9, No. 4, pp. 278-285.

This study analyzes maternal deaths in a tertiary maternity in Niamey, Niger.This is a retrospective study covering the period of one year, from January 1 to December 31 2007. The setting for this study was the Maternity Issaka Gazobi, a tertiary maternity referral centre in the city of Niamey, Niger. Data encompasses all hospital maternal deaths attributable to obstetric causes. The data were abstracted from emergency room, delivery rooms and hospitalization units' patient files.During the study period a total of 4,582 live births were registered with a total count of 121 maternal deaths, yielding a maternal mortality ratio of 2,640/100,000 live births. The mean age of deceased mothers was 26 years with a range of 15 to 43 years, and 46% of them were 15-24 years old. The most common risk factors for maternal death were primiparity (33%), haemorrhage (30%) and anaemia (22%). Most of the maternal deaths occurred post-partum (70%), 24 died peripartum, 6 died from miscarriage or abortion in association with excessive bleeding or septic complications, and one died from etopic pregnancy. Among most deaths, the burden of morbidity was important, with 57.9% of patients admitted in a state of shock from eclampsia or acute cerebral malaria.The high rate of mortality in this hospital testifies to the high morbidity of the patients, with anemia as an important risk factor. Maternal mortality in Niger remains high due to socio-economic factors, lack of access to quality care, and insufficient number of qualified health personnel.

The aim of this study is to identify the epidemiological and histological aspects of gynaecologic and breast cancer for a best care of patients.A restropective and descriptive study have been realised in the Histopathologic laboratory of Niamey's Health faculty department, Niger. During 9 years (01 January 1992 to 31 December 2000), we brought up all cases of gynaecological and breast cancer. We analysed epidemiologic characteristics of patients, the histological type of cancer.Gynaecologic and breast cancer reprensented 54.3% of woman cancer and 33.1% of diagnosed cancer of both sex. Patients mean age was 36.5 years (extreme 9 to 79 years). The most frequent site was breast (40.4%) follow by cervix (26%). The distribution according to histoloigical group have detected a neat predominance of epitheliale tumours (87%). Sarcoma represents 7.9% of case and 5.1% for the other histological types.Despite the results, suggestions have been formulated for epidemiological and histological follow up of gynecologic and breast cancer in Niger.

Placental abruption is a syndrome, which occurs in the third trimester of the pregnancy or during labour. It is the main cause of pregnancy last term bleeding and is also responsible for a high stillbirth rate. The objective is to describe the epidemiological, clinical, paraclinical and therapeutic characteristics in order to decrease the fetal and maternal mortality and morbidity.It is a prospective and descriptive study in continuous series, over a twelve-month period, from 1st January 2003 to 31st December 2003, at Issaka Gazobi maternity of Niamey, Niger.During the study period, 3255 deliveries have been done. One hundred and eighteen placental abruptions have been observed, which corresponds to a frequency of 3.6% with the highest rate during raining season. The average age and parity were: 31 years and 5th with a predominance of grand multiparous (38.2%). The majority of the patients were in-utero transfers (83,1%) and had done at least 10 km before arriving. One hundred and eleven patients had a caesarean section (94,1%) and 7 delivered through the vaginal route (5.9%). The fetal prognosis was characterized by a high stillbirth rate of 71.3% (87/122), fetal hypotrophy (64.8%) and prematurity (23.8%). The main cause of maternal morbidity was anaemia (76.3%) and Disseminated Intravascular Coagulation (5.9%). Further, 81 patients have been transfused (68.7%). The maternal mortality was 5.1% (6/118).Placental abruption, a medical and obstetrical emergency, is a serious obstetric condition, especially in our country. Physicians must be aware that patients with high blood pressure, preeclampsia, eclampsia, particularly in case of multiparity are at increased risk of placental abruption. Early diagnosis, prenatal follow-up and caesarean section improve the maternal and fetal prognosis.

Bicornuate uterus with rudimentary horn is a rare disability. Pregnancy can accidentally settle inside the rudimentary horn; in this case, it becomes apparent by uterine rupture generally in the second trimester. Bicornuate uterus should be diagnosed early, before pregnancy if possible. Abdominal pain of unknown origin occurring during the second trimester of pregnancy is the most frequent sign.

Use of an intrauterine levonorgestrel (SIU-LNG) delivery system (Mirena 52mg has become popular in recent years, particularly among younger women. Mirena is currently the contraceptive method of choice used as an alternative to classical copper-containing intrauterine devices after oral contraception. The purpose of this study was to evaluate patient satisfaction among young women during the first year of use of the intrauterine hormonal system.This multicentric phase IV trial with a non-comparative methodology was conducted among 211 young women aged 25-35 years. The SIU-LNG was prescribed for women who wanted to change their contraception after oral estrogen progesterone taken for at least three months prior to inclusion in the study. A total of 211 patients were included and review was planned at one year: 197 patients (93.36%) were reviewed.Mean patient age was 31.48+/-3.25 years. The SIU-LNG was inserted successfully at the first attempt in 99.05% of women. The continuation rate ws 85.65% at one year. Evaluation of cycle characteristics showed less voluminous blood loss and fewer dysmenorrheal phenomena as well as, in 40%, the development of amenorrhea. At the last visit, 85% of women were satisfied or very satisfied with this method of contraception.As has been demonstrated in earlier studies, Mirena offers a contraception with a reliability equivalent to that of oral estrogen progesterone (IP: 0 - 0.2), with very few hormonal side effects due to the low plasma passage of levonorgestrel. Mirena is particularly well adapted for young women who desire a reliable long-term easty-to-use contraception after taking oral contraception.

Intra-uterine arteriovenous malformations are a possible etiology of persistent metrorrhagia especially in the event of a history of miscarriages, cornuale pregnancy, molar pregnancy or gravidic trophoblastic diseases. We report 4 cases of patients having an intra-uterine arteriovenous malformation. The diagnosis of such lesions calls upon first intention Doppler echography. This diagnosis is confirmed thereafter by angiography. The first intention treatment is embolization which can save time if carried out at the same time as the angiography. This treatment is rapid and final, enabling the patients to have other pregnancies later on. An echographic follow-up, according to a schedule which remains to be defined, is necessary in order to check the good involution of this type of vascular malformation.

The purpose is to quantify objective tissue resistances before healing of prostheses used in pelvic floor surgery.We measured tissue resistances offered to five types of meshes by four classical surgical routes. We also tested the incidence of the modification of the width of meshes on tissue resistance. This study was realized on frozen cadavers, by pull on prostheses just after implantation. Tests are realized with a dynamometer and results obtained in Newton.In the Retzius space, TVT offers a better resistance than IVS or LIFT meshes. We did not bring to the fore a significant difference between four routes for 1 cm wide prosthesis. The increase of width of Prolene meshes improves their resistance in tissues and thus quality of their fixation. We underscore a better resistance of the trans sacrospinous route with regard to the trans muscular one.The increase of resistance is bound to the increase of the contact area between the prosthesis and the tissues. This increase of resistance should be taken into account in prolapse surgery: constraints are stronger than for stress incontinence. The posterior arms of meshes have to measure more than 1 cm wide and be set up through the sacrospinous ligament rather than through the elevator muscles. The type of knitting of prostheses is important and influences the resistance in tissues in the immediate postoperative time. Manufacturers should be interested in conceiving specific meshes for the tension-free fixation, with special and adapted mechanical properties.

Description of acute per-partum feto-fetal transfusion. The risk of twin-twin transfusion syndrome in monochorionic twin pregnancies is well known. This pathology starts in the second trimester and has a chronic course. Acute per-partum feto-fetal transfusion seems to be less frequent and has not been studied. In the study, we described two cases of acute per-partum feto-fetal transfusion. The outcomes of the pregnancies were as follows: following a successful delivery, the first set of twins presented hypovolemic shock at birth due to an acute anemia. The second set of twins was polyglobulic, but otherwise healthy at birth. The risk of hypovolemic shock seems to be unpredictable, even if the pregnancy is monitored. Obstetricians and pediatricians must keep this pathology in mind when dealing with this kind of pregnancy. Moreover, it would be interesting to obtain systematically a full blood count of each set of twins of monochorionic pregnancies, in order to detect every case of feto-oetal transfusion.

The authors describe a case report of a tubal choriocarcinoma occurring in women of 32 years old, 2 years after her last pregnancy. The patient was treated by laparoscopic salpingectomy and polychemotherapy. Metastatic pulmonary micronodules were diagnosed at thoraco-abdomino-pelvic tomodensitometry. Patient's recovery was complete with an uneventfull follow-up at 3 years. The association of surgical treatment and chemotherapy used under the guidelines of the FIGO score improves patient's outcome.

The purpose of the study was to compare a polyester mesh coated with silicone (LIFT, Cousin) to a polypropylene mesh (TVT, Gynecare), in terms of results, and short and middle term complications.We have performed a retrospective study concerning 140 patients between 2000 and 2002 (71 LIFT and 69 TVT operated for stress incontinence with or without vaginal surgery (prolapse surgery or hysterectomy). We noticed per- and postoperative complications. The patients were contacted by phone to evaluate the middle and long-term results.The mean age of the patients were of 58.8+/-11.3 years in LIFT group and 57.2+/-7.5 years in TVT group. More intraoperative complications arose in the TVT group (six bladder injuries and three haemorrhages versus two in LIFT group, p0.05). There was no difference for the postoperative time. The mean follow-up was 16.6+/-5.7 months for the LIFT and 32.2+/-11.3 months for the TVT. 80% of the patients were dry in the LIFT and 75.8% in the TVT group. There was no significant difference concerning the rate of de novo urge incontinence (18.3 versus 17.7%) and voiding difficulties (10 versus 16%). On the other hand, 6.7% of the patients of the group LIFT presented bad healing with prosthesis exposure, in every case a partial resection of the mesh was performed. We did not observe any case of exposure in the TVT group.The LIFT seems as effective as the TVT with a rate of de novo urge incontinence and voiding difficulties similar to the TVT and to the literature's data. However the rate of 6.7% of exposure leads us to prefer polypropylene meshes.

The purpose of our prospective study was to determine the frequency, the main indications and difficulties of coverage of the peripartum haemostatic hysterectomy in a developing country. The secondary purpose was to assess the maternal forecast and suggest suited management and to estimate the necessary material and human means to reduce the incidence of this surgery.We realized a forward-looking monocentric study in the Issaka Gazobi maternity of Niamey, between January 1st, 2003 and December 31st, 2003.3255 deliveries took place, and 41 peripartum haemostatic hysterectomies for post-partum haemorrhage were realized (ie 1.26%). The mean age of our patients was 32.76. The multiparous (more than 5 children) were most often concerned. The majority of patients had benefited from an in utero transfer. 31 patients presented an active bleeding, 11 were in a state of shock during the admittance. The main indications of hysterectomies were represented by an abruptio haematoma, uterine inertia, a rupture of the uterus, a wound of the genital field, 1 placenta accreta with uterine inversion. In a third part of the cases a disseminated intravascular coagulation was associated to the clinical picture. The hysterectomy was subtotal in most of the cases. Finally, the rate of maternal death is high in our series.Prevention of post-partum haemostatic haemorrhage and new therapeutic strategies are essential to reduce the rate of haemostatic hysterectomy in our regions, and improve the coverage of this pathology. However, it is a vital surgery which must be technically mastered.

We report 143 cases of ectopic pregnancy (EP) treated in the Issaka-Gazobi maternity of Niamey between January 1st, 1999 and April 30th, 2001 (28 months). The objective of this study was to estimate the epidemiological, diagnostic and therapeutic aspects to propose actions, which could lead to the improvement of the prognosis of EP.The frequency of ectopic pregnancy was 2.32% in our study. The patients were young and pregnant for the second or third time. Frequently we observed previous sexually contagious infections and/or abortions. More than 70% of the patients were admitted for a complicated stage of EP.The culdocentesis allowed to evoke the diagnosis in more than 80% of the cases. It is a simple gesture, which makes it possible to make the diagnosis of EP and which should be taught and practised in maternities of the developing countries. The pelvic ultrasonography and the laparoscopy allowed the diagnosis in the other cases. The tubal localization was the most frequent, cervical and abdominal pregnancies were found. The surgical treatment conducted by laparotomy was conservative in 11.9% and radical in 87.4% of the cases. The mortality rate was still 0.70%.Prevention of the sexually contagious infections and medical management of abortions are important to reduce the risks of ectopic pregnancies. Education of the patients, living far from the maternity, is also necessary to obtain more precocious consultation in case of pregnancy in order to improve the prognosis of EP.

In spite of the fact that there are many articles considering that intrauterine depressed skull fractures are caused essentially by instrumental extraction, literature is scarce about spontaneous foetal head injuries. Here, we report the case of two depressed skull fractures and one of linear fracture not associated with any known trauma during the pregnancy or delivery. The etiological process leading to the idiopathic character of such lesions, the aetiology, the treatment and the prognostic will be discussed. The forensic problem raised by such cases is very important.

Description and evaluation of ligamentopexy techniques using strings and spiral staples.We first describe the ligamentopexy procedure using non-absorbable sutures before comparing this technique to the use of Tacker type staples. We describe the advantages and disadvantages of this procedure in terms of surgical technique, secondary complications and biomechanical strength.For our team, recommendable attitude is to use non-absorbable sutures for the fixation to the prevertebral ligament. The main advantages of the use of staples are the ease and facility for learning the technique. The risk of spondylodiscitis is rare but enhanced by the deeper penetration of the staples into the intervertebral discs. In terms of resistanc, promontofixation using sutures is much stronger compared to staples.The use of sutures for promontofixation, in laparoscopy, is preferred to the utilization of staples type Tacker. These staples should be used when there is a risk of needle stitches for the patient.

Rate scales are used to analyse urinary incontinence. There are many scales making it difficult to compare the different studies of urinary incontinence. The purpose of this study was to evaluate and compare the rate scales pertaining specifically to urinary incontinence.A review of the literature was performed for publications specifically addressing rate scales of urinary incontinence. Each scale was evaluated using the following four criteria: principal characteristics (reference source, number of items addressed, scoring method, language), objectives (type of incontinence, severity and quality of life measures), psychometric properties (scientific validity, reliability and responsiveness) and linguistic validation.Thirteen scales were identified. These were divided into two groups: (1) those based on "classifications" and (2) those based on specific questionnaires. Scales based on classifications were not precise and are never scientifically validated. Scales based on questionnaires were more elaborate and more detailed; nevertheless, the study of their psychometric properties was often incomplete.Classification-based rate scales are inadequate to analyse urinary incontinence. Questionnaire-based rate scales are superior, but at minimum, they should address the previously stated objective and psychometric criteria. The choice of questionnaire should depend on whether it is to be used in clinical practice or for research protocol.

We describe a case of dystocia by excess of fetal abdominal part related to giant polycystic renal disease. We list the fetal malformations leading to dystocia and discuss the choice between embryotomy and cesarean section, particularly in countries were no prenatal diagnosis can be made.

Objectifs : Cette etude se propose d'evaluer la frequence de la mortalite maternelle a la maternite Issaka Gazoby de Niamey du 1er aout 1999 au 28 fevrier 2001, d'identifier les causes et les facteurs contribuant a ces deces aux fins d'une prevention en ameliorant la prise en charge. Methodologie : Il s'agit d'une etude prospective a propos de 104 cas de deces enregistres durant la periode correspondante au niveau de cette maternite de reference. Elle repose sur le recueil des informations a partir d'un questionnaire rempli suivant la technique de l'autopsie verbale. Resultats: Le taux de la mortalite maternelle est de 3063 pour 100.000NV. Les facteurs de risque etaient: la femme jeune, la primipare et la grande multipare, les sans profession et les analphabetes. La prise en charge a ete systematique sans pour autant ecarter l'issue fatale a cause du retard dans le diagnostic et l'evacuation des patientes. Les causes obstetricales directes (84,6 %) a l'origine des deces des patientes etaient dominees par l'hemorragie (29,8 %) les infections (23,1 %), les complications hypertensives (19,2 %). Conclusion: Ce taux dramatique de la mortalite maternelle nous interpelle tous. Sa reduction significative est possible si tous les acteurs du systeme de sante agissent en synergie, avec competence et motivation.

Type 316 stainless steel was electron beam welded with titanium foil insertion. The concentration of introduced titanium in the weld metal was 0.1, 0.3 and 0.6 wt% corresponding to the inserted foil thickness of 10, 30 and 60 μm, respectively. All the weld joint showed good mechanical performance. The swelling resistance of the weld metal is effectively improved by the introduced titanium. Although inhomogeneous distribution of titanium makes it difficult to estimate the extent of the improvement quantitatively, the results suggest the applicability of this method to Ti-modified 316 stainless steel, where weld metal is already reported to show reduced swelling resistance.

A guard limiter concept with graphite brazed to a stainless steel base plate has been proposed in FER. The bonding of graphite and stainless steel was successfully done by vacuum brazing with an interlayer material of Mo or Cu. Mechanical strengths were measured by tensile and shear tests. Fatigue tests up to approximately 107 cycles were done. Heat load experiments were performed with electron beam equipment. Brazed materials with a Mo interlayer were subjected to a heat load up to 60 MJ/m2 (6 kJ/cm2). No complete failures were observed in every condition, but cracks were generated by heat loads greater than 40 MJ/m2 (4 kJ/cm2). The failures were generated in graphite near to the interface. Mechanical strength and thermal shock resistance were improved by the change from 1 to 3 mm in thickness of Mo interlayer. Residual stresses due to brazing and cool-down were analyzed with an FEM code, and the results were compared with strain measurements on the test specimen. A comparison study on interlayer materials is continuing, and heat load cycle tests are now underway for 10 MJ/m2(1 kJ/cm2), which is a target value based on the FER design.

Schistosomiasis represents the second most endemic diseases following malaria. It is now endemic in 76 countries of the world, and it is estimated that more than 200 million persons are infected. The objective of this work is to help in the improvement of knowledge about Female Genital Schistosomiasis (FSG) effects on the women reproductive. A transversal prospective survey during six months, on women consulting for infertility in the health reproductive center of Niamey. The women included (109 persons) have been asked and consulted in gynecology, cervical smears urine pathology, urine ragent strips test, vesico-renal and gynecologic trans-abdominal ultrasound, hysterosalpingography (HSG) and cervical biopsy on infected patients. The infestation prevalence at S.haematobium was 38,5%. The infected persons have presented more gyneco-obstétrical symptomatology than the non infested ones. The proportion of exocervicite was 31,0% by clinical examination. The cervical biopsy done on 26 bilharziosis patients confirmed the frequence of highs chronic exocervicites (50%) and leucoplasia (11,5%). Echography and HSG noticed that the bilharzios patients can let develop other annexiel pathologies such as: ovary cyst, peri-tuboovary adhesions and wide ovaries. The symptomatology felt by infested women showed the parasitose consequence on women in endemic area. The treatment in o large schaddle by the national program allows to reduce morbidity caused by that infection in Niger.