Journal de Gynecologie Obstetrique et Biologie de la Reproduction - Vol. 26 - N° 3 - p. 315

Objective Based on the 7-years results, assess the interest of organised cervical cancer screening on regional level (the EVE campaign).Organisation and method The screening relied on existing medical structures. The centralised data collection, with data from the cytopathology laboratories assessed the quality of screening and the participation of the women to the follow-up of abnormal smears. The campaign run by a local women's rights association and sponsored by National educational and health information funds (FNPEIS) and the local councils.Results To date, 814 649 smears in the Bas-Rhin and 62 227 in the Haut-Rhin have been collected. After 3 years, 72 % of women aged 25 to 64 in the year 1997, in the Bas-Rhin, had had at least one smear, and 82 % after 5 years. Inadequate smears represented less than 1 % of all smears of the region. Pathological smears represented around 4 % of the total and benefited from strict monitoring which could be improved. However this could be improved on since only 75 % of women in whom a low-grade lesion was suspected underwent a second examination within the year that followed. The rate was on 80 % for those with suspected high-grade lesions. Reminders made by the EVE association, in agreement with practitioners, permitted postponed follow-up and improved screening coverage.Conclusion The EVE programme clearly shows that organized screening is feasible in France because the results obtained are satisfactory in terms of screening coverage and quality of smears. Centralised data collection permits detection of possible weak points and contributes to the improvement in efficacy.(C) 2003, Masson, Paris.

Chronic pelvic pain (CPP) is a frequent and difficult problem because despite the quality and diversity of diagnostic procedures no relevant etiology will be found in 30 to 40% of all cases. Psychologic and psychotherapeutic counselling is than usually proposed and usually not well accepted. A different approach can now be proposed according to a new semeiologic overall. In many cases the pain dominant is not visceral but parietal. The pelvic envelope is actually more painfull than the pelvic content. In these cases one can evoke the diagnosis of pelvic fibromyalgia and this is quite similar to classic fibromyalgia. This pelvifibromyalgia can be quantified with an algometric index. This form of pain actually is the somatisation of a past and difficult issue which will be very slowly and progressively revealed in the realm of a multidisciplinary and simultaneous physical and psychological approach. In the majority of cases these women have occurred physical, moral or sexual trauma inflicted by family members or a third party. Taking in account the physical dimension of body pain at the same time as psychotherapy will considerably enhance the efficiency of treatment. In our experience 70% of all women will be cured using this new approach.

La douleur pelvienne chronique (DPC) est un problème fréquent et préoccupant car malgré la qualité et la diversité des examens secondaires réalisés, il n’est pas retrouvé de lésion accessible à un traitement spécifique dans 30 à 40 % des cas. Une prise en charge psychologique et psychothérapeutique est dès lors habituellement conseillée et habituellement mal acceptée… Un ensemble séméiologique simple permet pourtant dˈappréhender différemment ce problème. Très souvent en effet la dominante douloureuse n’est pas viscérale mais au contraire pariétale. Ce n’est pas le « contenu » du pelvis qui « fait mal » mais le « contenant ». Il est possible de parler dans ces cas de fibromyalgie pelvienne. La similitude avec les syndromes fibromyalgiques généraux est très grande. Cette fibromyalgie pelvienne peut être quantifiée par un bilan algométrique et elle illustre en fait la somatisation dˈune problématique lourde et difficile, progressivement révélée dans le cadre dˈune prise en charge multidisciplinaire et simultanée, physique et psychologique. Dans la très grande majorité des cas ces femmes ont été, dans le passé, la victime de violences physiques, morales ou sexuelles infligées par des proches ou des tiers. La prise en charge de la douleur du corps concomitante de la prise en charge psychothérapeutique libère beaucoup plus rapidement quˈil n’est habituel ces femmes de leur souffrance et permet la guérison dans 70 % des cas.

The cervical cancer screening campaign has been settled in 1990 in the french department of Bas-Rhin and has effectively started in 1994. The 1901 law association EVE, gathering the partners concerned by illness and screening, has been designed as responsible for organisation. In relation with the field actors, the main guidelines were to try and increase the women's participation in the screening, to insure the quality of the cytological interpretation and the follow-up of pathological smears. After a four and a health years campaign, 80.3% of 25 to 65 years old women had the benefit one smear at least. The quality of the cytological interpretation is quite good and the follow-up of pathological smears is acceptable. This experience indicates the screening by the existing medical structures is possible. Many laboratories of cytology have accepted to participate in the campaign and to respect the modalities, notably for the transfer of data and the process insurance-quality. The majority of the practioners (gynecologists and general practioners) takes part in collecting the information about the follow-up. However, there's no regulation from official texts about the screening modalities and that makes to come to an arrangement with the health professionals in order to obtain and maintain their participation.

EVE is a pilot project for cervical cancer screening whose aim is to test the feasibility of organized screening in the French liberal health system with a consensus of medical participants. After three and a half years, 74.8% of women aged 25 to 64 had had at least one smear. Coverage varies with age, from 89% between 25 and 29 to 56% between 55 and 60. Only 8% of smears are taken by General Practitioners. There is a tendency to space out smears because only 14% of women had had a second smear within one year and 41.1% within 2 years. On the other hand more then 20% percent of women do not return after 3 years. Pathological smears represent 1.94% of all smears. For these, a questionnaire is sent to the physician in order to get information on follow-up. This enables cytologic/histologic correlation. The histologic exam reveals a pathological lesion in 95% of cytologies consistent with invasive cancer, 91% of those consistent with high grade lesions and 70% of those consistent with low grade lesions.

The aim of this study was to determine the feasibility and safety of hysteroscopic metroplasty in cases of diethylstilboestrol-exposed and hypoplastic malformed uterus. Twenty-four patients were referred for primary infertility (n = 9), secondary infertility (n = 1) or infecundity (n 14), Fifteen had been exposed to diethylstilboestrol in utero, All patients had a hypoplastic uterus and/or uterine deformity as seen by hysterosalpingography and each served as their own control. All patients underwent hysteroscopic metroplasty. Outcome measures included postoperative hysterosalpingography and the ability to conceive and to carry pregnancy to live birth, Postoperative hysterosalpingograms revealed improvement in 23 cases; the final result was considered excellent in 15 cases and 11 pregnancies occurred. The abortion rate decreased from 88% in previous pregnancies to 12.5%, and the rate of term deliveries increased from 3% to 87.5%. Ten patients were delivered after 30 weeks' gestation of healthy infants and one delivered more prematurely. Six deliveries were normal and four required a Caesarean section. We conclude that hysteroscopic metroplasty gives good results. This technique can be used in women with diethylstilboestrol-exposed or hypoplastic malformed uterus, suffering from severe infertility, recurrent pregnancy loss or implantation failures in an in-vitro fertilization programme.

Indications of transcervical metroplasty are uterine septa, synechia, DES-exposed and hypoplastic malformed uterus. These operative procedures give good anatomic and functional results. The pregnancies obtained must be considered as high risk.

Percutaneous testicular sperm aspiration and ICSI were performed in 5 cases of excretory azoospermia. Usable sperm have always been obtained, two pregnancies were initiated.

Aggressive fibromatosis of the breast is an uncommon benign disease. The clinical and X-Ray findings can simulate breast cancer. The diagnosis relies on histology. The typical feature of this disease is a locally aggressive but non metastasizing lesion with high recurrence rate. Treatment consists in wide excision. The role of radiation and drug therapy including antiestrogens has not been clearly established. Colonoscopy is indicated to research for an association with Gardner syndrome.

s of the 13th Annual Meeting of the ESHRE, Edinburgh 1997 patients from subgroup 1 with a sperm morphology score ;0.4%, cycle fecundity and baby take home rate per couple were 13.6 (9/66) and 21.8% (7/32) respectively, comparable with the results of subgroups 2, 3 and 4. The incidence of multiple (twin) pregnancies was only 2.5% (2/79).Conclusion: In a selected group of patients with an absence of clomiphene citrate resistance and a normal ovarian response following clomiphene citrate, lUI combined with clomiphene citrate-HCG can be offered as a safe, non-expensive first-line treatment, at least with an IMC of > I X 10 6 /ml or < I X 10 6 / ml if the morphology score is >4%.

Percutaneous testicular sperm aspiration and ICSI were performed in 5 cases of excretory azoospermia. Usable sperm have always been obtained, two pregnancies were initiated.

Indications of transcervical metroplasty are uterine septa, synechia, DES-exposed and hypoplastic malformed uterus. These operative procedures give good anatomic and functional results. The pregnancies obtained must be considered as high risk.