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.
