Massive rectal bleeding distant from a blunt car trauma.

Mesenteric trauma is one of the possible injuries caused by the use of seat belts in case of motor vehicle crash. We report here a rare case of rectal bleeding by rupture of a mesosigmoid haematoma. An emergent laparotomy revealed a mesosigmoid haematoma with a centimetric rectal perforation. The wearing of safety belts added some specific blunt abdominal trauma, which directly depends on lap-and-sash belts. Mesenteric injuries are found out up to 5% of blunt abdominal traumas. "Seat belt mark" leads the surgical team to strongly suspect an intra-abdominal trauma. When "seat belt mark" sign is found, in patients with mild to severe blunt car injuries, CT-scan has to be realised to eliminate intra-abdominal complications, including mesenteric and mesosigmoid ones. In case of proved mesenteric haematoma associated to intestinal bleeding, a surgical treatment must be considered as first choice. Conservative approach remains possible in stable patients but surgical exploration remains necessary in unstable patients with active bleeding.

[Bariatric surgery and obstetrics]. / Chirurgie bariatrique et obstétrique.

Obesity poses a significant risk to reproductive-aged women. Weight reduction before conception is the best way to increasing fertility and reduces obesity associated morbidity. When medical interventions fail, bariatric surgery is the most successful method of weight loss, effective increasing fertility and reducing obstetrical complications and maternal and neonatal morbidity comparing obese women. Gastric banding and gastric bypass are the most increasingly utilized treatment option in France and should be offered to morbidly obese women of childbearing age. This literature review provides information about different techniques of bariatric surgery and about the multidisciplinary management of these pregnancies (monitoring, micronutrient supplementation) to promote maternal and fetal wellbeing in concert with continuing postoperative weight control.

[Primary upper urinary tract tumors and subsequent location in the bladder]. / Tumeur urothéliale primitive du haut appareil urinaire et seconde localisation ultérieure intravésicale.

The urothelium is the epithelium that lines the upper and lower urinary tract. Over 95% of urothelial carcinomas are derived from urothelium. They can be located in the lower tract (bladder, urethra) or upper tract (pyelocaliceal cavities, ureter). Urothelial carcinomas are the fourth most common tumours after prostate (or breast) cancer, lung cancer and colorectal cancer. On one hand, bladder tumours account for 90-95% of urothelial carcinomas. It is the most common malignancy of the urinary tract and the second most common malignancy of the urogenital tract after prostate cancer. It accounts for 5-10% of all cancers diagnosed each year in Europe. On the other hand, upper urinary tract urothelial cell carcinomas (UUT-UCC) are scarce and account for only 5-10% of urothelial carcinomas. Recurrence in the bladder after primary UUT-UCC occurs in 15-50% of UUT-UCC. Differences in treatment modalities of the primary UUT-UCC do not play a key role in the subsequent appearance of a bladder recurrence. However, others factors have been described such as stage and location in the upper tract of the primary tumour or upper tract tumour multifocality. Previous history of bladder tumour is also associated with the risk that another tumour arises in the bladder subsequently. However, it becomes difficult to distinguish between natural history of bladder tumour and evolution of UUT-UCC in these cases. In most cases, bladder cancer occurs in the first two years after UUT-UCC management. Surveillance protocol is based on cystoscopy and on urinary cytology during at least every three months for two years. Current surveillance regimen have a low level of evidence considering the paucity of UUT-UCC.

[Prevention of intrauterine adhesions after hysteroscopic surgery]. / Prévention des synéchies après hystéroscopie opératoire.

Intrauterine adhesions are the most frequent complications after hysteroscopic surgery in women of reproductive age. The prevalence of intrauterine adhesions after hysteroscopic surgery is correlated to intrauterine pathology (myoma, polyp, or adhesions). Few clinical trials have demonstrated the efficiency of barrier agents developed in order to prevent adhesions after operative hysteroscopy. Adhesion barriers are mechanic agent (intrauterine device), fluid agents (Seprafilm, Hyalobarrier) and postoperative systemic treatment (estroprogestative treatment). In this article, we evaluate the efficiency of these barrier agents for adhesion prevention in hysteroscopic surgery, undertaking a review of clinical trials published. The most frequent published studies evaluate the anatomic efficiency of antiadhesion agents after hysteroscopic surgery in order to evaluate the fertility. Data are still insufficient to evaluate them for clinical use. There is a need for other randomised controlled trials.

Uterine transplantation: Review in human research.

Uterine transplantation is the solution to treat absolute uterine fertility. In this review, we present the historical, medical, technical, psychological and ethical perspectives in human uterine transplantation research. We reviewed the PubMed database following PRISMA guidelines and added data presented by several research teams during the first international congress on uterine transplantation.

Obstetric outcome following laparoscopic adjustable gastric banding.

OBJECTIVE: To evaluate obstetric outcomes following laparoscopic adjustable gastric banding (LAGB) in obese women. METHODS: Obstetric outcomes were compared in a retrospective case-control study with 427 obese women, 13 who underwent LABG and 414 who did not. RESULTS: The mean weight gain during pregnancy was significantly lower in the LABG group than among controls (5.5 kg vs. 7.1 kg; P<0.05). The incidence of pre-eclampsia, gestational diabetes mellitus, low birth weight, and fetal macrosomia was less in the LABG group (P<0.05), and the incidence of cesarean deliveries during labor was half in the LAGB group (15.3% vs. 34.4%; P<0.01). Neonatal outcomes were not significantly different in the 2 groups. CONCLUSIONS: Among obese women, the incidence of adverse obstetric outcomes was less in those who underwent LABG than in those who did not. These results suggest that obese women who wish to become pregnant would decrease their risk of obstetric complications if they first underwent LAGB.

[A pregnant woman with a SAPHO syndrome]. / Grossesse chez une patiente présentant un syndrome de SAPHO.

The association SAPHO syndrome (Synovitis, Acne, Pustulosis, Hyperostosis, Osteitis) and pregnancy is very rare. Only one case is indexed in the literature. We report the case of a pregnancy in a 27-year-old patient with a SAPHO syndrome and we expose its history and its obstetrical, medical and anaesthetic following. Under this multi-field following, there was no evolutionary push of the disease neither during the pregnancy, nor in immediate postpartum. We will expose the different possible treatments during the pregnancy.

Single-port approach to benign gynecologic pathology. A review.

Laparoscopy is the gold standard in gynecological surgery. Single-port laparoscopic surgery, has been developed in order to improve minimally invasive surgery. We analyzed single-port approach in benign gynecologic pathology and made a bibliographic research on Pubmed and Medline from January 2000 to January 2015. From what emerges from the papers taken into consideration, single-port laparoscopy can be used for salpingostomy or salpingectomy to treat tubal ectopic pregnancy, benign adnexal disease (ovarian cystectomy, salpingo-oophorectomy), and for hysterectomy. We do not have enough data for complex procedures like myomectomy or hysteropexy. Robotic single-port laparoscopy seems to be a very attractive perspective and its use in benign gynecology surgery is expanding. More and more ergonomic limitations of single-port laparoscopy are corrected by development of articulated or flexible instruments and camera. Beyond these preliminary results, more ample prospective studies with an adapted and standardized instrumentation are thus essential to highlight real profits.

[Obstetric and neonatal outcomes of adolescent pregnancies: a cohort study in a hospital in Seine-Saint-Denis France]. / Devenir obstétrical et néonatal des grossesses chez les adolescentes : cohorte de patientes en Seine-Saint-Denis.

OBJECTIVES: The aim of this study was to describe the characteristics, monitoring, obstetrical complications, childbirth and neonatal outcomes of pregnancies among minors in a cohort of adolescents from Seine-Saint-Denis (France). PATIENTS AND METHODS: This is a retrospective, cohort, comparative study, conducted from January 1, 1996 to July 31, 2011, made from the database of Jean-Verdier hospital in Seine-Saint-Denis. Three groups were established: patients aged less than 16 years old, patients aged over 16 years old and under 18 years old compared to a group consisting of older primiparas from 18 to 25 years old. The criteria considered were the characteristics of pregnancy, terms of delivery, neonatal outcome and conduct of post-partum. RESULTS: Minor patients were statistically more likely to be single, student, smoking and anemia compared to young adults. The obstetrical care was lower for minor compared to the control group with a number of consultations and ultrasounds lower (P < 0.001). Obstetrical complications were similar in the three groups outside of preterm labor. Adolescentes under 16 years old had a higher preterm delivery risk in multivariate analysis (RR = 0.33 CI 95% [0.12; 0.90] P = 0.03). Adolescents had fewer cesarean and instrumental deliveries (P < 0.05). DISCUSSION AND CONCLUSION: Teenage pregnancy remains an important managing issue for maternities, particularly from a social standpoint. On the medical side, one preterm delivery appears to be more common among these adolescents.

[Delays in treatment of breast cancer: experience of an expert center of the Assistance Publique-Hôpitaux de Paris (AP-HP)]. / Délais au traitement du cancer du sein : expérience d'un centre expert (CEX) de l'Assistance Publique des Hôpitaux de Paris (AP-HP).

OBJECTIVES: The National Institute of the Cancer (INCA) recently published a study over the deadlines of medical care of breast cancers. We compared our delay within the framework of our expert center with their results. PATIENTS AND METHODS: Our work is a retrospective unicentric non-interventional study. We included all the patients taken care for a breast cancer to the hospital Tenon in Paris. The criteria of inclusion were a primitive breast cancer, having accepted a care for a first cancer operated over a period of three months. We recovered 9 key deadlines to study the care of our patients. RESULTS: Sixty-six patients were included. The mean age was of 55.6 years. The deadline of access to the hospital Tenon was 8.7 ± 7.7 days for the meetings of gynecology and 4.3 ± 4 days for those of radiology. The deadline of access to the diagnosis was 31.8 ± 26 days. The deadlines of access to the meeting of multidisciplinary dialogue pre-therapeutic was 13 ± 11 days. The access to the first management time was 18.5 days for the neoadjuvant chemotherapy and 13.5 days for surgery. The deadline of access to the postoperative therapeutic proposal was on average 20 ± 8 days. The deadline of access to the postoperative radiotherapy was of 197 days in case of postoperative chemotherapy vs 47.5 days without chemotherapy. The global deadline mammography-radiotherapy was of 188 days. DISCUSSION AND CONCLUSION: The deadline of access to the diagnosis, to the postoperative therapeutic proposal and the global deadline mammography-radiotherapy with adjuvant chemotherapy or neoadjuvant were longer in our center compared with the results of the INCA. The deadlines of access to the surgery and access to the radiotherapy without postoperative chemotherapy were shorter on the other hand. The contribution of the diagnosis in one day for breast cancer is probably going to allow us to improve the deadlines of care in our structure.