This review summarizes our knowledge on ovulation process. After gonadotropin surge or LH injection, 13 factors are involved in the follicular rupture. All of them plays a role since the inhibition of their synthesis or activity prevents the rupture of preovulatory follicles or reduces the number of ovulations. Most of them are involved in all inflammatory reactions. At the apex of the follicle, blood vessels constriction, free TNF alpha and probably factors from the ovarian epithelium cells are involved in the full dissociation of follicle layers and cell death, allowing the localized rupture of the follicle wall. Gonadotrophins and angiotensine II are the only factors able to induce both follicle rupture and meiotic resumption.
Sex determination relies on the translation of chromosomal sex established at fertilisation into gonadal sex (testis or ovary), and later into somatic sex (male or female) under the control of gonadal hormone secretions. The aim of the current review will be to highlight our knowledge of the key events which, in the presence of a Y chromosome, induce the organisation of the developing epithelial cells located inside the genital ridges into testicular cords. Many groups have tried to define the molecules relevant to this process, with a double goal: unravelling a molecular pathway which leads to cell fate decision (Sertoli cell in this particular case) during development; improving the establishment of a diagnosis and subsequent medical management in cases where chromosomal, gonadal and then somatic sexes are discordant. Recent progress made in this area will be depicted, with the introduction of several pieces to this developmental jigsaw puzzle.
Ovary seminomatous malignant germ cell tumours are a particular histopathologica entity. The presence of yolk salk tumor or choriocarcinoma is respectively correlated with elevation of alpha FP or beta hCG. This markers elevation permits to assess diagnosis, appreciate response to treatment, and detect relapses. The study of 64 patients registered in two successive S.F.O.P. protocols (TGM 85-TGM 90) precise indications of surgery, platin-based chemotherapy and results. Malignant non seminomatous germ cell tumors are separated in not secreting pure immature teratoma and secreting malignant germ cell tumours. Surgery is essential for treatment of not secreting pure immature teratoma. Secreting germ cell tumors are very chemosensitive and surgery must be as conservative as possible in all cases even metastatic tumour or relapse. If markers are normalized second-look surgery of secreting malignant germ cell tumours is only necessary in case of evident residual tumour. However in case of initial chemotherapy, resection of a pathological ovary is always performed at the end of treatment. These tumours have a good prognosis: 5-years overall survival and disease-free survival are 85%.
At the Tenon Hospital (Paris), 48 inflammatory or locally advanced breast cancers were treated by neoadjuvant chemotherapy (three different protocols), followed by surgery (mastectomy or tumorectomy and axillary dissection). The histological data of the specimens are analyzed with regard to the clinical and radiologic evolution. Twenty complete clinical responses (41%), 22 partial clinical responses (45%), and no response in six cases (14%) were observed. Histology demonstrated residual tumors in 42 cases (87.5%), even in the case of complete clinical response (14 cases), without notable change of the grade (SBR). Lymph node clearance demonstrated positive nodes in 38 cases (79%). Despite its great agreement with clinical examination, mammography does not predict the existence of histological residual tumors after initial chemotherapy. Chemotherapy allowed local treatment, but can rarely sterilize the tumor completely.
The objectives of our study are to assess the prevalence of STD agents in Tunisia and to validate the WHO algorithm of STD management. The most frequent STD agents are Trichomonas vaginalis and Chlamydiae trachomatis, respectively with a prevalence of 5.6% and 1.7%. The assessment of the syndromic approach shows that the sensitivity and specificity of the WHO algorithm can be improved by the introduction of risk factors. The training of health care service providers and the use of an algorithm including risk factors can improve this approach, which is useful when laboratories services are not available.
Preterm delivery is the leading cause of neonatal mortality. Thus predicting a preterm delivery is a major obstetrical problem. Endovaginal ultrasonography is a highly reliable and reproducible method of cervical examination. Unlike with a digital cervical examination the entire length of the endocervical canal can be measured. Using this tool, measuring the dilatation of the internal os does not require the examining finger to be placed inside the endocervical canal. Therefore, the internal os can be measured even if the external os is closed. While a digital examination assesses the "dilatability" of the internal os, an ultrasonography assesses the "true degree of dilatation". In a low-risk population endovaginal cervical ultrasonography helps rule out a preterm delivery if cervical length is long enough. It can also detect cervical incompetence. In a high-risk population, women whose cervix is longer than 30 millimeters can be identified. These women have over 80% chance to deliver on or after 36 weeks of pregnancy. Preliminary studies suggest that performing an endovaginal ultrasonography could decrease the number of false positive clinical diagnosis of modified cervix and thus, save long, expensive and inefficient hospital stays. Prospective randomized, controlled studies are needed to confirm these results.
We report a case of migration of an intrauterine contraceptive device (IUCD) detected during pregnancy one year after insertion. The advanced gestation of the pregnancy and the absence of symptoms lead to expectant management. There were no complications during the pregnancy or delivery. A CT Scan in the post-partum period suggested that the IUCD was located in the region of the small bowel. Laparoscopy confirmed that the IUCD was superficially embedded in the intestinal wall but with no mucosal lesion. The device was removed with the aid of a mini-laparotomy. The migration of an IUCD into the abdominal cavity is rare. A literature review spanning the past 18 years revealed 165 reported cases. The IUCD was located in the following sites: omentum 45, rectosigmoid 44, peritoneum 41, bladder 23, appendix eight, small bowel two, adnexa one, iliac vein one. The majority of the authors recommend removal of copper containing devices, because of the potential for inflammatory reactions that can cause bowel obstruction and perforation. Initial laparoscopy has mostly superceded laparotomy but conversion may be necessary if difficulties arise.
OBJECTIVES:Evaluation of amnioinfusion results during labour in case of thick meconial amniotic fluid or in case of oligo-hydramnios associated with variable deceleration of the fetal heart response.PATIENTS AND METHODS:Prospective non randomized study. Amnioinfusion was applied to 47 cases of thick meconial amniotic fluid and to 18 cases of variable fetal heart decelerations associated with oligo-hydramnios. Obstetrical and neonatal data were compared with a similar group without amnioinfusion (n = 32).RESULTS:Comparing both groups shows that amnioinfusion offers a better fetal well-being during labour, according to Kreb's fetal heart evaluation during labour (8.53 +/- 1.06 vs 6.56 +/- 0.35--p < 0.01), lows the cesarean section rate (8.5% vs 31.2%--p < 0.01). Amnioinfusion is also associated with a higher Apgar's score at one minute after delivery (9.4 +/- 0.8 vs 8.7 +/- 1.7--p = 0.01) and a lower rate of thick meconium inhalation (13.7% vs 40.7%--p < 0.01). There was no difference for children's first days of life. We found no serious complication following amnioinfusion.CONCLUSION:We confirm general agreement about amnioinfusion, according to international literature. Amnioinfusion needs an acute care to prevent classically described complications. In case of thick meconial amniotic fluid or variable decelerations associated with oligo-hydramnios, amnioinfusion during labour offers a better fetal well-being.
To advance in their strategies to manage patients, clinicians need new research results. To be accessible, medical research must be published. Writing and publishing medical articles should respect principles that are described in this article. Good writing is based on a logical organization and the application of scientific style. Organization according to the IMRD structure (Introduction, Methods, Results, Discussion) allows one to present the reasons for and objectives of the study (Introduction), details on whatever has been done to answer the question (Methods), data on the actual study population and answers to the main question (Results), and a critical appraisal of these results, given the limits of the study and current knowledge (Discussion). The main elements of scientific style are precision, clarity, fluidity and concision. Finally, submitting a paper to a scientific journal implies presenting the work in a covering letter and respecting rules for formatting a manuscript (order of presentation, typography, etc.).
The relevance and efficacy of long-term estrogen therapy is well established, though some undesirable side effects and contraindications persist. Raloxifene, the first selective estrogen receptive modulator (SERM) tested in phase III trials, offers a choice alternative. It increases bone mineral density, lowers serum lipid concentrations and reduces vertebral fractures.
This is an epidemiological study of 1,498 patients who underwent laparoscopic surgery for different reasons. Between 1989 and 1996, 308 cases of endometriosis were identified among 1,498 patients who underwent laparoscopic surgery. One hundred and five patients were admitted for pelvic pain, 794 for infertility, 319 patients had both on admission, and 280 were admitted for non-gynecologic complaints. The incidence of endometriosis is related to the chief complaint on admission. This disease has different clinical manifestations, different locations and different stages. The mean age in our series is greater than that reported by the literature. The symptoms are related to the location of the lesions but not the stage of the disease. Unlike pelvic pain, infertility is correlated to the stages of the disease.
Proximal tubal desobstuction by selective salpingography: through a study of eight cases, the authors give their first results about tubal desobstruction by selective salpingography.
We report on the preliminary results of a series of 111,292 patients who benefited from a liquid medium sample (CytoRich) for cervical cancer screening. The number of dubious or limited smears was reduced by 0.03% and 0.53% respectively. The junction zone was better explored, and metaplastic changes were observed in 35.71% of the cases. This method improved the identification of low-grade lesions by +56% (2751/111,292; 2.47%) and of high-grade lesions by +75% (860/111,292; 0.77%), with a reduction in the number of ASCUS/AGUS by -44% (2065/111,292; 1.85%). This preliminary study confirms the results already published. The results demonstrating cytohistological correlation should prove to be a decisive factor, enabling the testing of the sensitivity and specificity of this technique. It will then be possible to envisage a future 'new paradigm' for screening cervical cancer as the result of a liquid medium sample, computer-assisted screening and HPV viral identification by Hybrid capture II.
OBJECTIVE The authors want to appraise the management of diabetes prior to pregnancy in a local population treated in the Lille University Hospital. METHOD This is a retrospective study of 143 pregnancies occurring in 111 patients with diabetes prior to pregnancy, between 1987 and 1997, in the Obstetrics Department at the Lille University Hospital. RESULTS Only one-third of the patients benefited from preconception management; the stability of diabetes during the first trimester was satisfactory in 50% of the cases. The maternal complications are represented by preeclampsia (20%), metabolic complications specific to diabetes (hypoglycemia, ketoacidosis), the aggravation or the emergence of a retinopathy (10%) and polyhydramnios (19%). Concerning the termination of the pregnancies, of the 147 fetuses (four twin pregnancies), 140 newborns in good health, two neonatal deaths, three in-utero deaths and two therapeutic terminations of pregnancy were observed. The fetal malformation rate was 9.5% (14 cases/147). The cesarean section rate was 63%, whereas the fetal macrosomatia rate was 35%, with dystocia in 26% of the deliveries (outside of planned cesareans). Three shoulder dystocia were observed (two requiring the Jacquemier's maneuver and one with transitory plexus brachial palsy for a newborn weighing 5,650 g). CONCLUSION The authors conclude that preconception management (one-third of the patients in this series) and management of during the first trimester of pregnancy (50% in this series) was insufficient. This fact is perhaps due to the confusion, for many practitioners, with gestational diabetes, which is a very mediatized affection, though much less severe for the fetus and mother.
