[Management of Chlamydia tracomatis pelvic infection]. / Prise en charge d'une infection pelvienne a Chlamydia trachomatis.

The infection by Chlamydia trachomatis is a serious infection that affects the male and female tractus, and that induces complications such as infertility and extrauterine pregnancy. The antibiotic treatment needed must necessarily reach the intracellular milieu to be efficient enough to eradicate the infection.

[Extended oestrogen-progestin contraceptive regimens: towards a contraception without menses]. / La contraception oestroprogestative continue: enfin sans les règles.

Women's attitude concerning menstruations is changing towards achieving extended cycles with few or even suppressed menses, in view of the unpleasant perimenstrual bleeding, pain and discomfort pattern that may accompany menstruation. Use of combined oral estrogen-progestin contraception in extended "cycles" of 3, 6 and 12 or more months is now under active study. Extended cycle contraception is abided by a better compliance than conventional cycle contraception with ensuing optimized contraceptive effectiveness. Hypothetically, transdermal or transvaginal combined contraception could be used in extended cycles. Tolerance is comparable for both methods and unpredicted bleeding, initially more frequent during long cycle treatment tends to become less frequent after about 6 months a compared with conventional cycles. Usual safety parameters appear to be similar under both contraceptive modalities. Comfort and well being brought by extended cycle use (5 to 10 times fewer days of bloating or perimenstrual pain) allow to estimate that, according to acceptability studies, 10 to 40 percent of women of reproductive age would currently choose extended cycle contraception.

[Adenomyosis: update on a frequent but difficult diagnosis]. / L'adénomyose: le point sur une pathologie méconnue.

Adenomyosis is a frequent entity, with difficult diagnosis, often obtained by pathological analysis performed after hysterectomy. This condition can cause abnormal uterine bleeding and dysmenorrhea, frequent reasons for consultation and hysterectomy. The development of ultrasonographic and magnetic resonance imaging techniques allow preoperative diagnosis. They also permit the use of hysteroscopic techniques for conservative uterine surgery, and have brought diagnosis and management of this disease to the front of the scene. This article reviews the pathological description of the disease, its epidemiology, clinical presentations, useful and necessary explorations, etiopathogeny and available therapies.

[Menopause-related risks and hormone therapy in diabetic women]. / Risques liés à la ménopause et traitement hormonal de la femme diabétique.

Prevalence of diabetes mellitus (types 1 and 2) in postmenopausal women is about 10-20% according to age. It can be associated with a metabolic syndrome in about 60% of cases, thereby severely increasing cardiovascular risk (among others) in these women. Estrogen or estrogen-progestin replacement therapy does not usually impair diabetes control. It will be submitted to the same indications/contraindications, in relation with the risk/benefit balance, as for all other postmenopausal women. However, increased risks inherent to diabetic subjects concerning metabolism, coagulation/hemostasis, and cardiovascular disease, should be considered. Therefore, estrogen in minimal effective dosages, eventually by transdermal route, as well as metabolically neutral progestins near to progesterone should be preferred. In case of pre-existing or occurring vascular problems, a careful approach or even suppression of replacement therapy should prevail.

[Contraception in young diabetic women]. / Contraception chez la jeune femme diabétique.

Contraception of the diabetic patient is an important matter. It allows to plan adequately the pregnancies, should respect carbohydrate metabolism and should consider the risk of diabetic complications. This review article describes the contraceptive techniques for diabetic patients.

[The first gynecological consultation in teens]. / La première consultation gynécologique chez l'adolescente.

The first gynecological consultation is particularly important for teens. It not only allows to answer the patient's questions, for instance, by prescribing a contraception, but also to provide an adequate information about some subjects, including sexuality, sexually transmitted diseases, and some life-style habits. This article will review the various important points of this first consultation.

[Risk of thromboembolism in contraception and hormone substitution: an update and recommendations]. / Risque thromboembolique en contraception et en hormonosubstitution: actualisation et recommandations.

Venous and arterial thromboembolism events are unfrequent but classical complications of sex steroid therapy, in contraception and menopause. The relative risks induced by these treatments have recently highlighted by the general press, in particular for the 2nd and 3rd generation progestins in oral contraception. In this article, we will review the risks of venous and arterial thromboembolism in patients treated with oral contraception or postmenopausal hormone replacement therapy. Practical guidelines will be defined.

[Medication of the month. Angeliq: new hormonal therapy of menopause, with antialdosterone and antiandrogenic properties]. / Le médicament du mois. Angeliq: nouvelle hormonothérapie de la ménopause comportant des propriétés antialdostérone et antiandrogéniques.

Following American randomised controlled epidemiologic studies (HERS, WHI), regulatory authorities have advised that postmenopausal hormone therapy, using minimal effective dosages, is indicated for the first line treatment of climacteric symptoms during a limited, and problem-related period of time, and for second line prevention of osteoporosis when a non-hormonal treatment cannot be used. Observation of a discrete increase in cardiovascular and breast cancer risk in hormone users currently appears to partly justify this rather strict attitude. We report here results of studies concerning a new continuous combination regimen (Angeliq), associating a "half-dose" estrogen (estradiol 1 mg/d) with potentially less thrombogenic impact than a standard (2 mg) dose, and the new progestin drospirenone (2 mg/d). The latter demonstrates a high level of endometrial safety as well as unique antialdosterone properties (reduction of symptoms related to water retention; potential cardioprotective effects) and consistent antiandrogenic properties, useful for both metabolic and clinical issues. Accordingly, Angeliq constitutes a new therapeutic approach, in good agreement with updated guidelines related to hormone replacement therapy.

[Peritoneal closure in abdominopelvic surgery: useful or not?]. / Fermeture du péritoine en chirurgie abdominopelvienne : utile ou non?

Peritoneal closure is a classical technique in abdominopelvic surgery. However, numerous studies demonstrated that omission of this surgical procedure did not lead to increased rate of short-term postoperative complications, and shortened the operative times. As a consequence, numerous surgeons deliberately choosed not to perform peritoneal closure. This manuscript updates about this topic.

[Prostate carcinoma cell lines and apoptosis: a review]. / Lignées de carcinome prostatique et apoptose: état de la question.

Prostate cancer is a major pathology in industrialized countries. Tumor growth usually results from increased cell proliferation, conjugated with an inhibition of programmed cell death (apoptosis). In this paper, after a short description of the apoptotic mechanisms and their methods of investigation, we review the present knowledge of the implication of different molecular actors in the regulation of apoptosis in prostate cancer cells. This review notably summarizes the present knowledge of the (de)regulation of the effects of androgens, p53, Bcl-2, Bcl-xL, Bax, Akt, PTEN, Par-4, clusterine, caspases and NF-kappaB in prostate adenocarcinoma cell lines and provides an appraisal of their therapeutic potential. A better knowledge of the apoptotic pathways in these cells could indeed allow the development of new selective and effective anti-cancer strategies.

[Hormone replacement therapy one year after the results of the Women's Health Initiative]. / Place du traitement substitutif de la ménopause 1 an après la publication des résultats de l'étude WHI (Women's Health Initiative).

The currently reported data concerning the large WHI randomized controlled trial compare the impact of continuous combined conjugated estrogens + medroxyprogesterone acetate vs placebo in postmenopausal women. These results appear largely pessimistic. After 5.2 years of hormone replacement, an excess of coronary heart disease, cerebrovascular disease, venous thromboembolism, breast cancer incidence and extension, mild cognitive impairment and dementia is recorded. By contrast, osteoporotic fracture risk and colorectal cancer are decreased during hormone replacement. Accordingly, this hormonal treatment can no longer be recommended on a long term basis, except after extensive risk-benefit balance evaluation. It should no longer be prescribed for prevention of chronic diseases. It remains indicated during 4-5 years for relief of vasomotor symptoms, genital atrophy and, potentially, for some aspects of quality of life. HRT should probably be prescribed in minimal-effective dosages; new regimens, routes of administration, new compounds and associations should be envisaged in order to avoid cardiovascular or breast problems. However these new approaches ask for thorough validation studies.

[Postmenopausal hormone replacement therapy and breast cancer risk: an update]. / Hormonosubstitution postménopausique et risque de cancer mammaire: une mise à jour.

Numerous studies have examined the risk of breast cancer in patients with postmenopausal hormone substitution. Most of these studies are retrospective, and a few recent studies are prospective. The observed results present with weak variations from baseline and major heterogeneity. Some studies highlight a slightly increased relative risk of breast cancer. A reanalysis of 51 studies demonstrates a relative risk of 1.35 for developing breast cancer during hormone substitution, with a 2.3% increased risk per year of use. Recently, the results of the WHI study have shown a slight increase of some risks of disease, including breast cancer (relative risk, 1.26). These results have induced the interruption of one of the 3 arms of the study (that of the patients treated with an estrogen-progestin combination), and have provoked a new discussion about the benefits and risks associated with hormone substitution. These facts have been largely related and commented in the general press. In this article, we review the important studies concerning this topic.