[Hodgkin's disease, fertility and pregnancy]. / Maladie de hodgkin, fertilité et grossesse.

Hodgkin's disease, the most common cancer between 15 and 24 years, raises two problems in women in reproductive age: the preservation of fertility and the care during pregnancy. Chemotherapy and radiotherapy can destroy gonads and subsequently lead to a loss of fertility and premature ovarian failure. Many options are available today to maintain fertility in female patients treated for Hodgkin's disease, thanks to advances in assisted-reproduction technology. Chemotherapy and radiotherapy during the first trimester are associated with increased risk of congenital malformations and this risk diminishes as pregnancy advances. The management of this disease during pregnancy must be examined case by case.

Preoperative radiotherapy in breast cancer patients: 32 years of follow-up.

This study evaluates the long-term outcomes of a retrospective cohort of breast cancer (BC) patients who had received curatively intended premastectomy radiation therapy (RT). We analysed locoregional control, disease-free survival (DFS) and overall survival (OS), pathological complete remission (pCR), predictors thereof, and immediate safety. The series consisted of 187 patients with a median age of 49 years [43-60] and T2-T4 or N2 tumours. Between 1970 and 1984, they had received slightly hypofractionated RT to the whole breast, ipsilateral supraclavicular fossa and axilla ± the internal mammary chain (45-55 Gy/18 fractions of 2.5 Gy/34 days) systematically followed by a modified radical mastectomy with an axillary dissection. No other preoperative treatment was given. Among the 166 centrally reviewed tumour biopsy specimens, 22% had a triple-negative (TN) phenotype, 17% were HER2 3 + or amplified and 61% were ER+. The median follow-up was 32 years [23-35]. The 25-year locoregional control rate was 89% [93%-82%] and the 25-year DFS and OS rates were identical, 30% [24%-37%]. A pCR in the tumour and lymph nodes had been achieved in 18 among all patients (10%), but in 26% with TN disease. In the multivariate analysis, the TN status was the only predictive factor of pCR (OR = 5.49, 95% confidence interval [CI] 1.87-16.1, p = 0.002). Also, the pN status (HR = 1.69, [1.28-2.22], p = 0.0002) and TN subtype (HR = 1.80, [1.00-3.26], p = 0.05) exerted a significant prognostic impact on OS. The postoperative complication rate (grade >2) was 19% with 4.3% of localized skin necrosis. Preoperative RT followed by radical surgery is feasible and associated with good long-term locoregional control.

[Acute lymphoblastic leukemia and pregnancy. Apropos of a case]. / Leucémie aiguë lymphoblastique et grossesse. A propos d'un cas.

The authors report on a case of a woman with acute lymphoblastic leukemia treated with cortisone therapy during pregnancy. No problems were encountered during the gestational period or at parturition; and no maternal or neonatal complications were observed.

[Fertility after hysteroscopic treatment of intra-uterine adhesions]. / Fertilité après cure hystéroscopique de synéchie.

OBJECTIVE: The main aim of the study was to evaluate the efficacy of hysteroscopy in the treatment of intra-uterine adhesions with infertility. PATIENTS AND METHODS: This retrospective study of patients with uterine synechias treated exclusively hysteroscopically included 120 cases: 109 of them (90.8%) low fertility patients, 110 (91.7%) with menstrual disorders and 2 (1.7%) with no others symptoms. Mean age was 34 years (range: 21-45 years). Operative hysteroscopy was performed in 155 cases including electrosection in 124 cases (80%) and a collapse in 31 cases (20%). A single endoscopic procedure was performed in 96 patients, 2 procedures in 17 patients, 3 in 3 patients and 4 in 4 patients. Mean follow-up was 26.8 months (range: 6-52 months). RESULTS: Good anatomic results were achieved in 116 patients (96.7%) after 1, 2 or 3 hysteroscopic procedures. We obtained good results in 58.2% of the patients with menstrual disorders. One pregnancy was achieved in 49 of patients (44.9%) including: 35 childbirth, 13 abortions and 1 molar pregnancy. DISCUSSION AND CONCLUSION: Hysteroscopy, easy procedure, allowing reproducible treatment with low morbidity should be proposed as first intention treatment in all cases with synechia. Fertility prognosis is tightly related to the gravity of synechia and its topography.

[Hysteroscopic metroplasty of uterine septa]. / Les métroplasties hystéroscopiques des cloisons utérines.

A series of 23 patients with septate uteri who underwent hysteroscopic division of the septum between January 1990 and March 1992 were studied. Before operation 19 of the 23 patients had 50 pregnancies with 29 spontaneous abortions, 7 late abortions, 5 premature deliveries and 9 deliveries at term. Sixteen patients who were followed up for more than 6 months conceived 9 times. Six of these went to term with 4 normal deliveries and 2 caesarean sections for obstetrical indications. There are 2 pregnancies continuing at present (at 25 and 27 weeks of amenorrhoea) and one spontaneous abortion in the first trimester. Two patients had to be operated on again because a partial residual septum was found post-operatively.

Should BRCA2 mutation carriers avoid neoadjuvant chemotherapy?

BRCA2 mutation carriers typically develop luminal B breast cancers. Data on the effectiveness of neoadjuvant chemotherapy in these patients are limited because of small patient numbers and lack of prospective studies. We used our 15-year genetic clinic database to compare retrospectively the pathological complete response rates (pCR) and rates of post-chemotherapy nodal involvement among BRCA2 carriers and BRCA1/2-negative (WT) patients with luminal B tumours, all treated with neoadjuvant anthracyclines±taxanes-based chemotherapy. Twenty-nine BRCA2 carriers and 67 WT patients fulfilled the inclusion criteria and were analysed. Patients and treatment characteristics were represented. A pCR occurred in 3 (10%) BRCA2 patients and 13 (19%) WT patients (p=0.43). Twenty (69%) BRCA2 carriers and 34 (51%) WT patients remained node-positive at surgery (p=0.17). BRCA2 germline mutations are associated with a low probability of pCR and a high risk of axillary invasion. Alternative treatments are highly expected, and clinical trials are needed to set the best treatment regimen in this population.

[Conformal accelerated partial breast irradiation: state of the art]. / Irradiation partielle accélérée conformationnelle du sein : état des lieux.

Breast conserving treatment (breast conserving surgery followed by whole breast irradiation) has commonly been used in early breast cancer since many years. New radiation modalities have been recently developed in early breast cancers, particularly accelerated partial breast irradiation. Three-dimensional conformal accelerated partial breast irradiation is the most commonly used modality of radiotherapy. Other techniques are currently being developed, such as intensity-modulated radiotherapy, arctherapy, and tomotherapy. The present article reviews the indications, treatment modalities and side effects of accelerated partial breast irradiation.

[The myofibroblastic inflammatory tumours: A fortuitous association or an unknown postpartum complication]. / Les tumeurs myofibroblastiques inflammatoires : association fortuite ou complication peu connue du post-partum ?

The inflammatory myofibroblastic tumour has clinical, biological or histological features sometimes misleading with a septic condition. Presenting symptoms are variable and arising circumstances remain obscure. We report three cases occurring in a postpartum context. The first patient, a 28-year-old female, had left psoitis with a sepsis the first day postpartum in relation with an inflammatory myofibroblastic tumour of the meso-ovary. The second patient, a 40-year-old woman, had a hepatic inflammatory myofibroblastic tumour revealed by a ruptured sub-capsular haematoma of the liver in the forth day postpartum. The third patient, a 32-year-old woman, had a pulmonary inflammatory myofibroblastic tumour, diagnosed 5 months after a delivery and which recurred 10 years after surgical treatment. These cases illustrate the difficulty to diagnose inflammatory myofibroblastic tumour, particularly in postpartum.

[Hysteroscopy and hysterosalpingography. Which examination to chose?]. / Hystéroscopie et hystérosalpingographie. Quel examen choisir?

The authors report 58 patients undergoing hysterosalpingography (HSG) then hysteroscopy (HC) for investigation of the uterine cavity. Comparison of HSG and HC findings revealed the following: In 26.9 per cent of cases HC disproved or rectified the result of HSG. Results of the two investigations were in agreement in 74.1 per cent of cases. In the light of our results, and after a review of the literature, HSG is indicated as the first line investigation for exploration of the uterine cavity and/or the tuboperitoneal level. HC alone is sufficient for exploration of the cervical canal and of the uterine cavity.

[Acardiac malformation: ultrasonographic diagnosis. A case report]. / Le monstre acardiaque: diagnostic échographique. A propos d'un cas.

Acardia is an extremely rare malformation which is seen in less than 1 per cent of monozygous twin pregnancies. Pathological aspects and etiopathogenic theories concerning this malformation are reviewed on the basis of a case diagnosed in utero at 24 weeks. The value of the antenatal diagnosis of this malformation is that of monitoring the progression of the pregnancy and predicting the fate of the healthy twin.

[Uterine fixation to the promontory and the Orr-Loygue operation in associated genital and rectal prolapse]. / La promonto-fixation utérine et l'intervention d'Orr-Loygue dans l'association prolapsus génital et prolapsus rectal.

The association of genital prolapse and rectal prolapse is rare. The authors report six cases of simultaneous mixed prolapse treated surgically via an abdominal approach. The latter technique enables the treatment of genital prolapse by uterine fixation to the promontory and rectal prolapse by rectopexy using the Orr-Loygue technique. Chronic constipation and obstetric trauma are constantly found among etiological factors. Four of our patients had urinary stress incontinence. There were no preoperative complications. One patient reported worsening of her constipation. Mean follow-up is only 20 months (2 months to 3 years), but no recurrences have occurred. Review of the literature and of series with more than fifteen years follow-up shows that the Orr-Loygue operation is reliable with a low complication rate and only rare recurrences.

[Laparoscopic surgery of an intraperitoneal intrauterine device]. / Traitement coelio-chirurgical du stérilet intrapéritonéal.

This study involved 13 cases of patients fitted with intra-uterine contraceptive devices which migrated in the abdominal cavity. Laparoscopy enabled localization of the IUCD and full lesion assessment. It was removed by celio-surgery in all 13 cases. Difficulties encountered were due to parietoepiploic adhesions and IUCD impacted in the wall of the rectum.

[Bologna operation]. / L'intervention de Bologna.

Thirty cases of urinary incontinence and genital prolapse have been treated using Bologna's method. The authors describe this operation. The post-operative controls were based on the clinical state of the patient and in ten cases on the urodynamic tests. Anatomical result was very satisfactory. In all but one case the abdominal pressure transmission defect to the upper urethral was corrected without deterioration of maximal urethral pressure.