Changing trends in pregnancy outcome among HIV-infected women between 1985 and 1997 in two southern French university hospitals.

OBJECTIVES: To analyze risk factors for pregnancy outcome among HIV-infected women before and after introduction of AZT prophylaxis in 1994. STUDY DESIGN: A prospective, two-center observational study conducted from 1 January 1985 to 31 December 1997. PATIENTS: Pregnant HIV-infected women followed in one of the obstetrics units during the study period. MAIN OUTCOME MEASURES: pregnancy outcome (normal delivery, ectopic pregnancy, spontaneous abortion, voluntary termination of pregnancy (TOP) according to year of pregnancy, age at pregnancy professional status, marital status, ethnic origin, mode of contamination, stage of disease, partner's human immunodeficiency virus (HIV) status and prior pregnancy. RESULTS: One thousand one hundred and three pregnancies among 937 HIV-infected women were studied. Mean age of patients was 28.1 +/- 4.9 years. Pregnancy outcomes were distributed as follows: 473 normal deliveries, 589 TOP, 9 ectopic pregnancies and 32 spontaneous abortions. The proportion of TOP decreased from 59.4% before 1994 to 37.5% from 1994 (P < 0.001). In univariate analysis, mode of transmission, marital status, ethnic origin, partner's HIV status and prior pregnancy were also significantly correlated with pregnancy outcome. However, after adjustment by logistic regression for each period (before and after 1994), mode of transmission no longer appeared to influence pregnancy outcome. CONCLUSION: Effective prevention of mother-to-child transmission of HIV infection appears to have influenced HIV-infected women's decisions on continuing their pregnancy to term. Incidence of voluntary TOP has decreased significantly after introduction of AZT.

Intra-uterine fetal death following maternal varicella infection.

The association of varicella and pregnancy is very rare since 90% of women of reproductive age are immune. In the literature, a fetal varicella syndrome has been described characterized by multiple congenital malformations. We report here a case of intrauterine fetal death following maternal varicella at 17 weeks amenorrhea, with virological proof of fetal contamination. Because of the rarity of this association and by the same token of the fetal contamination during maternal varicella, the management during pregnancy rests essentially on a valid ultrasonic surveillance.

[Acute myocardial infarction in myocardial bridge treated by coronary stent]. / Infarctus du myocarde aigu sur pont myocardique traité par l'implantation d'endoprothèses. Résultats immédiats et suivi à long terme.

The authors report the case of a symptomatic myocardial bridge treated in the acute phase of anterior wall myocardial infarction by classical stenting of the mid and distal left anterior descending artery. One and a half months later, intrastent restenosis at the two dilated sites, led to another angioplasty procedure with implantation of sirolimus-eluding stents. The outcome was good with no recurrence of angina at 16 months and control coronary angiography was totally normal at the 8th month.

[Desmoid tumors of the anterior abdominal wall. Apropos of a case]. / Tumeurs desmoïdes de la paroi abdominale antérieure. A propos d'une observation.

The authors describe a case of a desmoid tumor of the anterior abdominal wall. From a review of the world literature, the main characteristics of these tumors are detailed, and the various pathophysiological hypotheses, demonstrating the necessity of exclusively surgical treatment, are presented.

[Treatment of pain due to unwanted lactation with a homeopathic preparation given in the immediate post-partum period]. / Traitement de la douleur de la montée laiteuse non souhaitée par homéopathie dans le post-partum immédiat.

Dopaminergic agonists, such as Parlodel((R)), are now widely used to inhibit lactation. However, some countries, such as the United States, no longer use these drugs in this indication because of their sometimes serious adverse effects. In this context, the authors tested a homeopathic treatment designed for parturients unable or not wanting to breastfeed. The APIS MELLIFICA 9 CH and BRYONIA 9 CH combination was chosen for its anti-inflammatory and analgesic effects. 71 patients were included in this double-blind placebo-controlled study. All received basic treatment comprising naproxen and fluid restriction. A significant improvement of lactation pain (main criterion of the study) was observed in parturients treated with homeopathy (p<0.02 on D2 and p<0.01 on D4). A similar effect (p<0.05 on D4) was observed for breast tension and spontaneous milk flow. No significant difference was observed for the other criteria of the study. The homeopathic combination studied was therefore effective on the pain of lactation and should be integrated into the therapeutic armamentarium.

[Association of Bologna-type cervicocystopexy and Richter-type sacro-spinal fixation in low approach treatment of genital prolapse. Apropos of 18 cases]. / Association de la cervicocystopexie de type Bologna à la fixation sacro-spinale de type Richter dans le traitement par voie basse des prolapsus génitaux. A propos de 18 cas.

We report our experience with Richter spinofixation in association with Bologna cervicocystopexy. Eighteen patients underwent surgery for voluminous prolapse. Spinofixation did not lead to complications. This technique allows a vaginal approach in cases where only an abdominal operation was possible before. Incontinence results were similar to those with the Bologna procedure alone with the additional improvement of allowing a permeable vagina. Currently mean follow-up is 13 months, but these encouraging results suggest that this association should be continued in the future.