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Didier Oberweis,1 Patrick Madelenat,2 Michelle Nisolle,3 Etienne Demanet4 1Department of Gynecology and Obstetrics, CHU de Charleroi, Hôpital André Vésale, Montigny-le-Tilleul, Belgium; 2Private Consultation, Paris, France; 3Department of Gynecology and Obstetrics, CHR Citadelle, Liège, 4Clinical Research Unit, Charleroi, Belgium Abstract: Endometriosis is one of the most common benign gynecological disorders, affecting almost 10%–15% of all women of reproductive age and >30% of infertile women. The pathology is associated with various distressing symptoms, particularly pelvic pain, which adversely affect patients' quality of life. It is an estrogen-dependent disease. There is evidence both in animals and in humans that metal ions can activate the estrogen receptors. They are defined as a variety of xenoestrogens, called metalloestrogens, which could act as endocrine disruptors. Therefore, it could be considered to act on this gynecological disorder using food supplements containing trace elements (ie, nutripuncture). The assumption is that they could modulate estrogen receptors and thus influence the tropism and the survival of cells involved in endometriosis. By a modulation of the antioxidant system, they might also interact with various parameters influencing tissue biochemistry. The objective of this article is to describe and discuss the design and methodology of an ongoing double-blind, randomized, placebo-controlled study aiming to evaluate the efficacy of metal trace elements on the reduction of pain and improvement of quality of life, in patients with a revised American Fertility Society Score Stages II–IV endometriosis, combined or not with adenomyosis, during a treatment period of 4 months. Trace elements or placebo is proposed in the absence of any other treatment or as an add-on to current therapies, such as sexual hormones, nonsteroidal anti-inflammatory drugs, and surgery. A placebo run-in period of one menstrual cycle or 30 days for women in amenorrhea has been scheduled to eliminate the patients who are responding too much to the placebo. After a 1:1 ratio randomization on Day 0, the treatment with trace elements or placebo will last for 4 months (120 days). Keywords: endometriosis, trace elements, randomized, placebo-controlled study, pain, quality of life

Necrotizing fasciitis (NF) is a rare infection (0,2 to 0,4/100,000 adults) of the dermis and hypodermis extending along muscular fascia1. The absence of pathognomonic symptoms makes its diagnosis difficult. Rapidly progressive, it is a life-threatening emergency whose prognosis is letal in 30 % of cases. Treatment of necrotizing fasciitis is mixed and involves aggressive surgical debridement and medical treatment with antibiotics and supportive agents. This article is presenting the case of a young woman who developed abdominal necrotizing fasciitis following a caesarean section. In forty-eight hours, the patient developed septic shock with an extensive and rapid destruction of her abdominal wall. After hysterectomy and multiple surgical debridements, evolution was favorable. After one month, a reconstruction of the abdominal wall could be performed.

Raloxifene (RLX), a selective oestrogen receptor modulator, has oestrogen-agonist effects on bone, lipoproteins, and homocysteine and oestrogen-antagonist activity in the breast and uterus, positioning it as a potential drug for long-term prevention of coronary heart disease in postmenopausal women. To further evaluate its influence on cardiovascular risk factors, we studied the effects of 60 mg/day RLX on serum lipid levels, inflammatory (high-sensitivity C-reactive protein, and coagulation (fibrinogen) markers, monocytes, and fibrinolysis in 15 healthy postmenopausal women. Markers were measured at baseline, after 1 month without treatment, and after 3 months of treatment. Fibrinolysis was evaluated using the euglobulin clot lysis time (ECLT) determined with a new semiautomatic optical method. Monocyte phenotype was determined by measurement of the expression of the antigens CD14, HLA-DR, and CD62-L using flow cytometry. After 3 months of RLX treatment, we observed a decrease in total cholesterol (p = 0.002), in low-density lipoprotein cholesterol (p <0.001), and in lipoprotein A (p = 0.01). Fibrinogen (p = 0.002) decreased significantly, and high-sensitivity C-reactive protein had a tendency to decrease, but this did not reach statistical significance (p = 0.06). RLX treatment had no effect on ECLT (p = 0.223) or on white blood cell, lymphocyte, and total monocyte counts (p = 0.313). Monocyte expression of HLA-DR, CD14, and CD62-L was not modified by the treatment. In conclusion, we confirm that RLX has beneficial short-term effects on levels of lipids and inflammatory markers, with no effect on fibrinolysis or monocyte phenotype.

The study reports blood velocity and blood flow in the descending aorta and the umbilical vein of 20 normal human fetuses by application of combined B-mode ultrasound and pulsed Doppler technique. All pregnancies and newborns were clinically normal. The echographic examination was performed between 37 and 40 weeks' gestation by an ADR real-time linear scanner 2130 coupled with the Kranzb uhler pulsed Doppler system 8105. The diameter of the vessels was measured by B-mode echogram, and the Doppler beam was directed to form an incident angle between 30 and 65 degrees with the axis of the vessel. The Doppler shift frequency was measured electronically with a spectrum analyzer 8106. Fetal blood velocity waveforms were calculated following the Doppler equation. In the descending aorta, the calculated velocity was 27.7 +/- 6.7 cm/second (mean +/- SD) and the blood flow was 679 +/- 106 ml/minute or 216 ml/kg/minute. In the umbilical vein, the same parameters were 18.3 +/- 4.0 cm/second, 366 +/- 65 ml/minute, and 117 +/- 16 ml/kg/minute, respectively. The average umbilical flow: aortic flow ratio was 0.54 +/- 0.07.

18 cases of trisomies 13, 18, or 21 were diagnosed either by examining the caryotype or on clinical criteria. When the placenta was examined in 60% of cases there was a marked retardation of villous maturation with frequent persistence of embryonic forms of villi. The authors suggest that the failure of the villi to mature was often a reflection of pathology in the oocyte which started to show itself at the beginning of the pregnancy.

The authors have studied a series of 2,292 pregnancies that were unselected and have calculated from this the risks of spontaneous abortion before the 28th week of the pregnancy that patients have when they come for ultrasonography for the first time in the pregnancy. They have been able to work out the risks of spontaneous abortion even when the ultrasound was normal for the time of pregnancy. The risks diminish as the pregnancy progresses and rise with the mother's age.