La tumeur phyllode du sein se definit comme etant une tumeur fibro-epitheliale s'apparentant au fibro-adenome, mais dont la composante conjonctive est predominante. Le but de ce travail est de degager les particularites diagnostiques, therapeutiques et pronostiques de cette tumeur. Il s'agit d'un travail retrospectif portant sur 41 cas colliges dans le Service de Gynecologie-Obstetrique entre 1980 et 1991. L'analyse de cette serie a montre les particularites suivantes : l'incidence de la tumeur phyllode est de 0,46 % de toutes les tumeurs phyllodes, l'âge moyen est de 30 ans, dans 75,6 % il s'agit de femmes en periode d'activite genitale. Le delai moyen entre l'apparition des premiers signes et le diagnostic est de 20 mois. La taille moyenne est de 12 cm. Le diagnostic a ete confirme histologiquement dans tous les cas. La tumeur est classee grade 1 et 2 dans 65,9 % des cas, grade 3 dans 9,8 % et grade 4 dans 17,1 %. Le traitement est exclusivement chirurgical dans tous les cas a type de tumorectomie elargie (44 %), de mastectomie simple (29,2 %) et de mastectomie totale avec curage ganglionnaire (22 % Apres un recul de I a 7 ans, l'evolution est marquee par le deces (3 cas) et les recidives locales (11 cas) ayant justifie une reprise chirurgicale. Dans les cas restants, l'evolution est favorable sans recidive ni metastase. Ces resultats ont ete compares aux donnees de la litterature, il en ressort que le diagnostic des tumeurs phyllodes ne peut etre confirme qu'histologiquement. Le traitement est exclusivement chirurgical, l'exerese doit etre large et doit tenir compte du volume tumoral, de l'age de la patiente et surtout du grade histologique. Enfin, le pronostic depend des caracteristiques histologiques de la composante conjonctive de ces tumeurs.
L'objectif de cette etude est d'apprecier les roles respectifs des infections a PVH (papilloma virus humain) et de l'infection par le VIH (virus de l'immuno-deficience humaine) sur la survenue des lesions dysplasiques du col de l'uterus. Une etude transversale a ete realisee en Guyane Francaise incluant 91 patientes au centre hospitalier et au dispensaire anti-venerien de Cayenne (36 patientes VIH+, 55 patientes VIH-). Pour chaque patiente, un questionnaire standardise a ete recueilli, un frottis du col et un prelevement pour isolement de papillomavirus humain ont ete realises lors de l'inclusion dans l'etude. La prevalence des lesions dysplasiques du col etait de 18 % chez les patientes VIH-, elle etait de 22 % et 40 % chez les patientes VIH+ ayant respectivement plus de 500 lymphocytes T4/mm 3 et moins de 500 T4/mm 3 . La presence d'un papillomavirus humain est le seul facteur retrouve en analyse multivariable fortement associee aux lesions dysplasiques du col (Odds Ratio = 8,6 [2,2-34,3]). En Guyane Francaise, compte tenu de la transmission majoritairement heterosexuelle du VIH, la surveillance gynecologique des patientes doit etre systematique particulierement chez les patientes VIH et adaptee aux realites socio-culturelles.
La grossesse apres 40 ans est reputee etre a haut risque materno-fœtal. Les auteurs etudient ce risque au sein d'une population de 200 femmes âgees de 40 ans et plus, admises pour accouchements a la maternite universitaire des Orangers durant une periode allant du 1 er juillet 1994 au 1 er juillet 1996 sur un total de 10 050 accouchements. Le risque maternel est certain en raison de l'incidence importante des dysgravidies et du recours frequent a la cesarienne (16,6%) particulierement chez la primipare (37% ). Le risque foetal est incertain puisque le devenir des nouveau-nes transferes en pediatrie est inconnu. Aucune malformation par aberration chromosomique n'a ete notee.
La situation precaire correspond a un deficit humain, materiel ou a un environnement defavorable. La cesarienne est justifiee en situation precaire car c'est un facteur decisif de la qualite des soins en obstetrique et un moyen efficace de sauvetage maternel. Mais pour eviter ses complications il faut une veritable structure chirurgicale, des indications rigoureuses et une technique simple et bien codifiee. Les indications doivent etre restreintes et essentiellement maternelles. La cesarienne est donc une intervention de sauvetage maternel realisee le plus souvent en extreme urgence. En ce qui concerne la technique chirurgicale, la laparotomie mediane sous-ombilicale s'impose et l'hysterotomie doit toujours etre segmentaire et de preference transversale. Il faut egalement respecter les coutumes et s'adapter aux conditions locales. La cesarienne est souvent mal acceptee et parfois refusee alors que la mort neonatale est toleree si la fertilite maternelle ne fait pas de doute.
Une etude statistique d'evaluation de la pertinence des marqueurs cliniques classiques de la trophicite foetale que sont la hauteur uterine et la prise de poids maternelle, a ete realisee sur une serie homogene continue de 500 couples mere-enfant. La correlation statistique entre d'une part hauteur uterine et poids de naissance et d'autre part entre prise de poids maternelle et poids de naissance a ete forte. La valeur decisionnelle de la hauteur uterine quant a la prediction de la macrosomie s'est par contre averee tres mauvaise sur cette serie. Il en est de meme en ce qui concerne la prise de poids maternelle. Il est apparu impossible de se baser sur ces parametres pour depister la macrosomie. Ils ne peuvent etre que des elements a prendre en compte, eventuellement, parmi d'autres, cliniques et para-cliniques.
Les auteurs ont procede a une etude comparee retrospective ayant pour objectif d'analyser l'evolution des hysterectomies par voie abdominale realisees dans le service de gynecologie des Hopitaux de l'universite de Coimbra sur une duree de 24 ans (1968-1991). Ils ont utilise comme parametres fondamentaux d'evaluation la conservation/excision des annexes, l'âge des malades a la date des interventions, les indications chirurgicales, les accidents chirurgicaux, les complications post-operatoires (immediates et tardives). Ils ont informatise les dossiers cliniques sur le programme StatView et ils ont utilise la distribution de frequences, la liste de contingences a une ou deux variables, x 2 ainsi que des tests d'adherence. La fibroleiomyomatose s'est maintenue au fil du temps, comme l'indication chirurgicale principale (58,2 % en 1991). Au cours des 24 ans ils ont constate une diminution significative du nombre d'hysterectomies avec conservation des annexes (p < 0,001) et une augmentation significative du nombre d'hysterectomies totales avec annexectomie bilaterale (p < 0,001). Entre les 40 et les 45 ans, ils ont constate de veritables bouleversements dans l'attitude chirurgicale en ce qui concerne la conservation/excision des annexes en l'absence de pathologie annexielle. Les accidents chirurgicaux et les complications post-operatoires n'ont pas presente de variations significatives.
Struma ovarii is a rare ovarian tumor composed entirely or in part of thyroid tissue. Pathogenesis is unclear. Diagnosis rests on the histologic study. A case is reported. Specific features of struma ovarii are discussed based on a review of the literature. The treatment is surgical and the outcome generally favorable.
One the basis of personal observation and a review of recent literature (which is somewhat sparse), the authors describe the characteristics of adenoid cystic carcinoma of the breast which is a very unusual tumor. They stress the diagnostic difficulties which frequently make it necessary to use histochemical or immuno-histochemical diagnostic techniques which have been widely developed.
On the basis of a series of 600 deliveries between January 1 and May 1 1993, the authors analyze cases of unrecognized delivery-related hemorrhage. Hemorrhage of this type, defined retrospectively on the basis of a difference of at least 3g/100 ml in hemoglobin levels at the time of admission to the labor ward and on the 2nd day post-partum, were found in 3.83% of deliveries and were responsible for 51.11% of falls in hemoglobin of 3g/100 ml or more. Primiparity, induced labor (oxytocics), episiotomy, forceps extractions and cesarean section are their etiologic factors. Particular care should be taken in the presence of any of these factors and induced labor may be useful in the prophylaxis of these unrecognized hemorrhages.
One-hundred-and-four cases of histopathologically confirmed hydatiform moles were subjected to ultrasound examination at the Hung Vuong Hospital, Ho-Chi-Minh-ville (Vietnam) over a period of 16 months (1988-1989). The diagnosis was confirmed only in some cases on clinical grounds (18%) or by laboratory tests (52%). In contrast, typical ultrasound signs were found in 82% of cases; in the other 18% of cases, other aspects had suggested disorders calling for aspiration (partial mole, clear ovum, pregnancy terminated). Some ultrasound images, highly suggestive of mole, were found in occasional cases of mucoid ovarian cyst, endometrial cancer or cystic necrobiosis of fibroma (HCG tests negative). Despite its limitations in Vietnam ultrasound constitutes the primary method of detecting hydatiform mole, the acquisition of practical experience is facilitated by the high number of cases and the concentration of cases reported.
In this study, the authors raise the question of the morbidity related to Asherman's syndrome and demonstrate that hysterectomy is the best method for diagnosis and treatment. In a group of 15 patients, secondary sterility and secondary amenorrhea were the main reasons for consultation, 11 patients underwent surgical hysteroscopy and the other fourteen received conventional treatment. The main etiological factors identified were curettage and cesarian section. A normal cavity was successfully reconstructed in 12 cases (80%) after between one and three treatments. Normal menstruation was restored in all patients. In the obstetric field, there were 7 pregnancies, resulting in 6 deliveries and one miscarriage. Hysteroscopy therefore constitutes a real step forward in the diagnosis and treatment of Asherman's syndrome; it may be possible to extend its advantage to all forms of endouterine neoformations.
One the basis of personal observation and a review of recent literature (which is somewhat sparse), the authors describe the characteristics of adenoid cystic carcinoma of the breast which is a very unusual tumor. They stress the diagnostic difficulties which frequently make it necessary to use histochemical or immuno-histochemical diagnostic techniques which have been widely developed.
The epidemiological characteristics of iron deficiency anemia after radioimmunoassay of serum and erythrocyte ferritin were evaluated in 209 Malian women at the time of delivery in a maternity unit in Bamako, Mali. The incidence of iron deficiency anemia was high (36.8%). This incidence did not reflect socio-economic status, nor even any particular obstetric history, but was significantly higher in younger mothers (aged under 26). The severity of anemia was such that 2.4% of women would require a blood transfusion post-partum. It looks therefore desirable, in Mali, to screen routinely and to ensure the prevention of iron deficiency in adolescent girls and to include, in the prevention of anemia of pregnant women, routine iron supplements from the beginning of pregnancy.
A retrospective study enabled us to evaluate the "wait-and-see" attitude adopted in our department in case of premature rupture of the membranes at term. The series included 88 patients (9.74%) who delivered spontaneously or after induction. The following maternal parameters were studied:time between rupture and delivery, pyrexia and chorioamnionitis number of vaginal digital examinations, histology and placental bacteriology. Neonatal criteria were based upon an infection assessment. Our results showed that approximately 80% of patients were in labor within 24 hours following rupture. Cesarean section rate remained stable (13%) in comparison with the overall rate for the department. Neonatal infectious morbidity (5.7%) showed no increase. The incidence of chorioamniotitis did not vary (7 cases) but appeared to be related to the number of vaginal examinations before labor. In conclusion, our attitude of temporization did not result in any increase in the number of cesarean sections nor of neonatal infections in comparison with the general population in the department. Prostaglandins might be useful in unfavorable obstetric situations.
Our intentions were to determine the incidence of the association of anemia and pregnancy, to evaluate maternal and fetal prognosis and to offer some recommendations regarding national health care policies. This prospective study lasting 30 months included all cases of anemia and pregnancy detected by clinical and laboratory examinations. Thus 13,191 women were enrolled in the study but only 1408 cases of anemia and pregnancy (10.67%). Primipara and grand multipara were particularly at risk. Severe forms of anemia and pregnancy were encountered often (51.71%). Maternal and fetal prognoses were very poor. Maternal mortality was 852/100,000, accounting for 65% of the maternal mortality of the department. The stillborn rate was 50 per thousand. This is a serious health problem which needs to be dealt with by a national health education programme.
Contraception during breast feeding must take two points into account: the first physiological contraception due to anovulation which disappears at around the 9th week of lactation); the second pharmacological: any substance ingested by the mother during breast feeding is excreted in milk, chiefly by passive diffusion. All pharmacokinetic studies have shown that the transfer of progesterone or of estrogen when taking a contraceptive pill is extremely slight, being of the same order as that of natural hormones. When it is decided to use hormonal contraception, this should be started after the 6th week of lactation, when lipid profile has returned to normal and thromboembolic risk is identical to that of the population in general. As with all prescription during lactation, the drug should be taken as far as possible from the next feed. Barrier techniques (combining condoms and spermicides) are an elegant alternative to drug methods.
Six cases of granulomatous mastitis are reported. Based on a review of the relevant literature, the clinical features, etiology, and management of this pathologic entity are discussed. The definition of granulomatous mastitis is given and the characteristics that distinguish this condition from other inflammatory breast diseases are pointed out.
