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.
Proximal tubal desobstuction by selective salpingography: through a study of eight cases, the authors give their first results about tubal desobstruction by selective salpingography. (C) 1999 Editions scientifiques et medicales Elsevier SAS.
Object : we attempt to determine the usefulness of uterine re-assessment by hysteroscopy in women with two unsuccessful IVF-ET attempts. Material and method, this retrospective study concerns seventy-three infertile women who have had a repeat uterine hysteroscopy after two implantation failures in IVF: Results, in half the cases, an abnormality was diagnosed. Cervical abnormalities (synechia, polyp, false passage) and hormono-dependant abnormalities (polyp, hyperplasia, submucous myoma) were the most frequent findings, The rate of pregnant women raises to twenty-two percent after treatment of these abnormalities. Conclusion, regarding our experience, if seems legitimate to perform hysteroscopy in women who have had two IVF-ET failures before attempting a third procedure.
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 during the first trimester of pregnancy (50% in this series) was insufficient. This fact is perhaps due to the confusion, for many practicioners, with gestational diabetes, which is a very mediatized affection, though much less severe for the fetus and mother. (C) 1999 Editions scientifiques et medicales Elsevier SAS.
Objectivs : 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 litterature, Amnioinfusion needs an acute care to prevent classicaly discribed complications. In case of thick meconial amniotic fluid or variable decelerations associated with oligo-hydramnios, amnioinfusion during labour offers a better fetal well-being.
After the diagnosis of breast epithelial hyperplasia or carcinoma in situ, the clinical follow-up must take into account several parameters. First, the adequacy of the diagnostic and the therapeutic approach is to be evaluated. Second, the patient must be informed of her risk of subsequent breast cancer. In such a protocol, one can recommend a program of close follow-up in an attempt at early defection. An annual clinical examination combined with a mammographic and a sonographic exam is considered as the method of choice. In between annual check-ups, clinical exam is encouraged. The potential benefits of magnetic-resonance imaging in these circumstances is currently evaluated. In rare instances, the absolute risk of breast cancer is so high that a prophylactic mastectomy can be considered.
We report on the preliminary results of a series of 111,292 patients who benefited from a liquid medium sample (CytoRich(R)) for cervical cancer screening. The number of dubious or limited smears was reduced by 0.03% and 0.53% respectively. The junction rone 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. If 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(R) II. (C) 1999 Editions scientifiques et medicales Elsevier SAS.
The pipelle has become the sampling tool of choice for histological detection of endometrial adenocarcinoma. Some practitioners still prefer cytological sampling. The distal extremity of the pipelle has been modified to allow removal of both types of samples simultaneously The aim of this preliminary study was to evaluate the feasibility of this method. A positive agreement between histological and cytological results was found in 10 out of the 12 cases examined, among which an adenocarcinoma was positively defected. A prospective study on larger size must confirm these first findings. The new modified pipelle (Pipelle Mark II) offers a possible approach for reduction of false negatives.
Objective : to appreciate the real sexual practice among students. Population and methods : from 29th April to 10th May 1997, 1 867 students from lower and upper schools have accepted to fake part in the investigation being carried on their practice of sexuality. Results : 1 333 students, that is 72 % of the group, have already had sexual intercourse. The average age of the very first sexual intercourse was 17 years and the extreme ages range from 8 to 24 years. 72.7 % of the students have already had sexual intercourse less once a month, mostly it is by love in 68.6 % or by desire in 21.1 %. Among more than half of the girl students, that is 59.5 %, their partnere was students. 31.3 % were at least once pregnant. Conclusion : the outcome of this study revealed that sexual activity among students is rare and sporadic. If is motivated by love.
