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Background: The incidence of atypical ductal hyperplasia (ADH) is increasing due to mass screening. Because of the underestimation risk of malignancy, the management remains controversial. Our goal was to analyze clinicopathologic features of patients with ADH diagnosed on directional vacuum-assisted biopsy (DVAB). The objectives of this continuous retrospective study were to evaluate the underestimation rate of malignancy and to identify predictors of upgrade to carcinoma. Methods: Between 2003 and 2010, 3159 patients underwent stereotactic DVAB in our institute. We retrospectively evaluate clinical, mammographic and pathological features of 298 cases of ADH who underwent surgical excision in our center (93.1%). Patients with concurrent history of breast cancer, intraductal carcinoma (DCIS) associated, or with no follow-up or surgical excision on place were excluded. Histological scar of macrobiopsy was systematically searched in surgical specimens. A pathologic upgrade was defined by presence of invasive cancer or DCIS on surgical specimen. Statistical tests used were the chi-square or Fisher's exact test. Results: Among the 298 studied DVAB, 224 ADH were isolated (75.2%), 46 associated to flat epithelial atypia (15.4%) and 28 to lobular neoplasia (9.4%). 98.4% patients presented microcalcifications at diagnosis. In 52 cases, lesions were upgraded to DCIS (n = 38) or invasive cancer (n = 14). The underestimated rate was 17.5%. In 67.3% cases, upgrade lesions were low or intermediate grade DCIS. Only the history of contralateral breast cancer was significantly correlated with the underestimated rate (p = 0.04). There was no statistical difference between these 52 cases and the 246 others for: family history, size of calcification, sampling number, histological lesion, and quality of calcifications removal. Conclusions: In this study, DVAB may not be considered a therapeutic procedure in case of ADH, even in the case of complete removal of microcalcifications. It is still challenging to identify a subgroup of ADH cases with a low upgrade rate. [ABSTRACT FROM AUTHOR]

Introduction and Hypothesis: The objective was to evaluate the ewe as an animal model for teaching and training in vaginal surgery., Methods: Twenty-nine postgraduate surgeons attended a training course on vaginal prolapse surgery. After a review of human and sheep anatomy, the participants performed transvaginal meshes, vaginal hysterectomy, SSLF (Richter), and OAS repair in ewes and human cadavers. Participants completed questionnaires on the whole course., Results: Questionnaires showed the significant superiority of ewes over human cadavers for all items evaluated regarding surgical dissections. Only identification of the sacrospinous ligament and the spine were judged to be similar in ewes and human cadavers. Participants noticed that ewe model is appropriate for vaginal prolapse surgery training for resident and for postgraduate surgeons. Two vaginal hysterectomies were also performed. Operating time, surgery, and anatomy were nearly identical to that of humans. The same conclusions were made while performing sacrospinous ligament fixation (Richter) and obstetric anal sphincter injury repair., Conclusion: This series indicates that the ewe is a useful animal model for teaching vaginal surgery.

Objective: Post-term pregnancy is frequently associated with higher fetal and maternal morbidity and mortality. Its management essentially depends on clinical cervical characteristics as evaluated by the Bishop score (BS). However, BS is poorly predictive of the delivery outcome. We sought to demonstrate that ultrasound measurement of cervical length and evaluation of fetal height could predict the outcome in post-term pregnancies., Methods: A prospective single center study was undertaken between the 21st of January and the 1st of June 2013. Fetal height was measured using a transperineal technique and cervical length was evaluated by a vaginal ultrasound on patients consulting and their term date. C-section rates were considered to be the primary judgment criteria., Results: A total of 136 patients were included. C-section rates in this population was 19%. Fetal height and cervical length were not different between the C-section group and the vaginal delivery group., Conclusion: Our study demonstrates that ultrasound measurement of cervical length and fetal height do not show better results than BS in predicting the outcome of post-term pregnancy. Combining these ultrasound measurements has already been suggested in other studies and promising results have been shown. More studies are necessary to further these results., (Copyright © 2016 Elsevier Masson SAS. All rights reserved.)

Introduction and Hypothesis: Pelvic organ prolapse (POP) affects one third of women of all ages and is a major concern for gynecological surgeons. In pelvic reconstructive surgery, native ligaments are widely used as a corrective support, while their biomechanical properties are unknown. We hypothesized differences in the strength of various pelvic ligaments and therefore, aimed to evaluate and compare their biomechanical properties., Materials and Methods: Samples from the left and right broad, round, and uterosacral ligaments from 13 fresh female cadavers without pelvic organ prolapse were collected. Uniaxial tension tests at a constant rate of deformation were performed and stress-strain curves were obtained., Results: We observed a non-linear stress-strain relationship and a hyperelastic mechanical behavior of the tissues. The uterosacral ligaments were the most rigid whether at low or high deformation, while the round ligament was more rigid than the broad ligament., Conclusion: Pelvic ligaments differ in their biomechanical properties and there is fairly good evidence that the uterosacral ligaments play an important role in the maintenance of pelvic support from a biomechanical point of view.

Objective: To assess anatomical and functional preliminary results, and safety of a new surgical approach for a combined treatment of pelvic organ prolapse (POP) of anterior and medium compartments, using a mesh attached through the sacrospinous ligaments with the UpHold(®) system (Boston Scientific) and the Capio(®)., Material and Methods: A longitudinal case series of 59 consecutive patients operated between October 2009 and January 2012, by five senior surgeons in a single tertiary unit., Results: Mean age was 66.9 years. Ten patients (17%) had previous pelvic organ prolapse (POP) surgery. There was no intraoperative complication. Mean follow-up was 12 months. Anatomical success for both anterior and apical compartments, i.e. Ba and C/D point<1, was 93% (52/56). Anatomical results shown correction of cystocele with a mean Ba point from+0.79 cm (range -3 to +8) to -2.35 cm (range -3 to 0), correction of uterine/vaul prolapse with a mean C/D point from+0.14 cm (range -6 to+8) to -7.29 cm (range -9 to -1), and correction of rectocele with a mean Bp point from -0.68 cm (range -3 to 7) to -2.77 cm (range -3 to -1). Two patients required further surgery for mesh exposure (3.5%). One patient had a unilateral pudendal neuropathic pain postoperatively., Conclusion: In the current series, utero-vaginal suspension using a bilateral vaginal anterior sacrospinous fixation with mesh was associated with good anatomical success rates. Prospective, comparative and long-term data are needed., (Copyright © 2012 Elsevier Masson SAS. All rights reserved.)

Objective: Assessment of fetal head engagement by digital examination is highly subjective even though this method remains the gold standard. Ultrasonography could be helpful to determine fetal head engagement during the second stage of labor., Patients and Methods: Prospective unicentric study to compare the diagnostic of fetal head orientation and engagement between digital examination and ultrasonography. One hundred measurements were performed in 100 patients at complete cervical dilatation., Results: In 80 % of patients, abdominal ultrasound assessments were consistent with digital examinations in depicting fetal head position. We were not able to evaluate engagement by abdominal ultrasonography. Perineum to fetal head distance was measured between 12 and 83mm by translabial ultrasonography. When the head was not engaged (-1), the mean distance was 66.4±7.53mm. The measure was 56.15±10.86mm when the head was at the upper part of the birth canal (+1), 46.47±12.49mm at the middle part (+2) and 35.81±10.42mm at the lower part (+3; +4). A threshold of 55mm was associated with a sensibility and a negative predictive value of 100 % for vaginal birth., Discussion and Conclusion: Abdominal intrapartum ultrasound increases the accuracy of fetal head position assessment. Translabial ultrasound is a simple and easy method to define fetal head engagement by measuring the distance between perineum and fetal head. Ultrasound during the second stage of labor may serve as an educational tool for physicians in training., (Copyright © 2011 Elsevier Masson SAS. All rights reserved.)