[Cryoconservation of ovarian tissue: indications and outcome of the patients]. / Cryoconservation du tissu ovarien: indications et devenir des patientes.

OBJECTIVES: Ovarian Tissue Cryopreservation (OTC) is a very promising approach of fertility preservation for women and young patients who have to follow gonadotoxic treatments (chemotherapy, radiotherapy…). The aim of this study was to analyse the indications and the outcomes of the patients who had OTC in our center during the last 17 years. PATIENTS AND METHODS: The study is retrospective. Forty-six patients, who underwent OTC in the Laboratory of Reproductive Biology of the University Hospital of Clermont-Ferrand, between January 1997 and December 2009, were included. RESULTS: The average age on the day of ovarian tissue harvesting was 19.5 years. Fifty-two percent of the patients were minor. In order of decreasing frequency, the diseases for which OTC has been proposed were hematologic, ovarian tumors, sarcoma ou PNET and breast neoplasia. In 93.5 %, the harvesting of ovarian cortex was performed by laparoscopy. After OTC, 82.6 % of the patients were treated by chemotherapy. A bone marrow transplant was performed for 48 % of the study patients. At the time of data collection, 57 % of the patients who had evaluation of their ovarian function presented premature ovarian failure. Eight patients had one or more pregnancies after treatment. It was a natural pregnancy for five of them. The three others were obtained by medically assisted procreation (in vitro fertilization and oocyte donation). DISCUSSION AND CONCLUSION: We report a long-term follow-up of patients treated in our center for OTC. The originality of our study is to evaluate all aspects of OTC from the decision to propose the patients an OTC to their outcomes several years after the ovarian tissue harvesting. It is therefore a multidisciplinary approach both oncology, gynecological and pediatric whereas OTC is often considered restrictively in the literature. Finally, it seems to be essential to establish a specific medical care for these patients. This monitoring will allow an adequate assessment of pubertal development and ovarian function, management of estrogen deficiency and secondary infertility, supporting patients in their desire for motherhood.

[Prenatal diagnosis of cerebral tumors and differential diagnosis]. / Diagnostic anténatal des tumeurs cérébrales fœtales et diagnostics différentiels.

Fetal brain tumors are rare and have different histologies. Although the definitive diagnosis relies on the histopathology of the tumor, it is useful to distinguish the tumors potentially curable from the tumors rapidly fatal after birth. Nevertheless, some intracranial masses are not tumors. We report four cases of intracerebral masses diagnosed prenatally corresponding to different histological lesions: teratoma, fetus-in-fetu, chraniopharyngioma, hemangioma. We discuss the elements of the differential diagnosis, which can be identified prenatally.

[Information and facilities recommendations concerning trial of labour in the context of scarred womb]. / Quelles sont les recommandations d'organisation et d'information en cas de proposition de tentative de voie basse pour utérus cicatriciel ?

OBJECTIVES: To precise key elements concerning facilities and patient information prior to trial of labour in the context of scarred womb. METHOD: Bibliographic search restricted to French and English languages using Medline database and recommendations of medical societies. RESULTS: Only expert's opinions are available. Patient information should present both trial of labour and elective cesarean section. Counselling should be influenced by individual risk of failed vaginal birth and uterine rupture. Mode of delivery should be planned the latest at 8 months of gestation. Patient should be aware of obstetrical and anesthetic facilities. Trial of labour should be presented as the first option for patients with no additional risk factors. Immediate presence of obstetrician and anesthesiologist is not required except in the context of increased risk for failed trial of labour or uterine rupture. Elective cesarean section on maternal request is acceptable after extensive counselling and delay of reflexion. CONCLUSION: Individual patient information should be initiated early and mode of delivery should be planned at 8 months of gestation. Resources and facilities recommendations aim to facilitate prompt cesarean section.

[Ballantyne syndrome caused by materno-fetal Parvovirus B19 infection: about two cases]. / Syndrome de Ballantyne secondaire à une infection maternofœtale à Parvovirus B19: à propos de deux cas.

Ballantyne's syndrome also known as Mirror syndrome is the association of fetal hydrops and maternal hydric retention. The maternal condition is often misdiagnosed as preeclampsia. We report two cases of Ballantyne syndrome associated with materno-fetal Parvovirus B19 infection. In the first case, the syndrome occurred at 26GW in a context of premature rupture of membranes. Parents and medical staff opted for termination of pregnancy because of the poor fetal prognosis. Maternal symptoms regressed after delivery. In the second case, the patient presented a Ballantyne's syndrome at 25GW. Intrauterine transfusions reversed symptomatology. Fetal hydrops of any etiology can be associated with this syndrome. Specific treatment of the fetus can avoid maternal complication allowing continuation of the pregnancy.