[Polymyositis, dermatomyositis and pregnancy: high-risk pregnancy. A further case report and review of the literature]. / Polymyosites, dermatomyosites et grossesse: grossesse à haut risque. Nouvelle observation et revue de la littérature.

The authors report a new case where polymyositis/dermatomyositis and pregnancy were associated. The polymyositis and dermatomyositis appeared in the last third of the pregnancy. A caesarean operation had to be performed for fetal distress after 37 weeks of amenorrhoea. An apparently dead small-for-dates baby was born. Progress, however, after resuscitation of the baby was good. At 20 months after delivery the polymyositis and dermatomyositis also were improved. Two and a half years later there was no recurrence. In the light of cases that have previously been reported in the literature, it has been established that on the one hand pregnancy may trigger off the condition and worsen the PM/DM and on the other hand the condition has a bad effect on the progress of the pregnancy. 50% of the babies are born dead or die in the week after delivery and 55% are born prematurely. We discuss the possibility that PM/DM is of viral origin. A confirmation of this is the presence of viral inclusion bodies on electron microscopy found in the muscle cells of the patients who have PM/DM. However, in the previous history of these patients an acute viral myositis in childhood is a troublesome factor. Pregnancy, because it involves alterations in the immune responses of the patients, may lead to a recrudescence of a "sleeping" virus and so be responsible for the appearance or aggravation of polymyositis and dermatomyositis.

[Surgical treatment of vulvar stenosis. Technic description]. / Traitement chirurgical des sténoses vulvaires. Description technique.

A surgical technique for the treatment of vulvar stenosis is described. The recto-vaginal space is approached by the cutaneous route, starting with incisions for resection of 2 skin triangles arranged as butterfly wings on either side of the midline. The sclerous cicatricial tissue between rectum and vagina is widely exposed and incised so that the lower part of the posterior vaginal surface can be dissected and mobilized without any risk of damaging the mucosa, since the tractions required for cleavage are exerted on the cutaneous side of the bridle. It is only at this stage that a median sagittal cutaneo-mucosal incision of the bridle is carried out, followed by a transverse suture without tension. This easily performed technique has been used in 11 cases without complication and with satisfactory long-term functional results.

[Surgical treatment of genital prolapse by vesicovaginal interposition of the myometrium]. / Cure chirurgicale des prolapsus génitaux par interposition vésico-vaginale du myomètre.

The authors propose a new technique for the surgical treatment of uterine prolapse. The technique consists of placing the myometrium between the bladder and the vagina after amputation of the cervix uteri and total excision of the endometrium. The bladder is then supported by a strong and well vascularized muscular tissue. Anterior transposition of the cervical pedicles and fixation of the myometrium to the anterior vagina ensure that the fitting is solid and in the correct direction. These modifications of the old technique of vesico-vaginal uterine interposition suppress the drawbacks which have gradually led to the rejection of the Wertheim-Schauta operation.

[Haemostatic circling suture during conisation of the uterine cervix (author's transl)]. / Cerclage hémostatique lors des conisations du col utérin.

The insertion of a cervical circling suture before conisation, with tightening around an endo-uterine sound after excision of the specimen, ensures effective haemostasis of the cervical remnant. In addition, this circling suture may be used to apply the necessary traction to the cervix away from the pathological zone, without causing any lesion of the epithelium to be studied.

[Epithelialisation of a neovagina by nymphoplasty (author's transl)]. / Epithélialisation d'un néo-vagin par nymphoplastie.

The walls of the artificial cavity created by recto-vesical cleavage in the surgical treatment of congenital absence of the vagina never become covered with epidermis and this lack of epithelialisation is the source of progressive stenosis. The use of pediculated mucosal flaps with a broad, well vascularised base, obtained by cleavage and folding of the labia minora, makes it possible to appropriately and durably cover the first centimeters of the neovagina.

[Hysteroplasty for septate uterus by cleavage and mobilisation of the septum (author's transl)]. / Utérus cloisonné: hystéroplastie par clivage et mobilisation de l'éperon.

A new technique of hysteroplasty is proposed for the septate uterus. The uterine incision is anterior medline, leaving the posterior wall of the uterus untouched. The septum is split into two hemi-septa which are increased in such a way as to obtain two pediculated flaps, covered by endometrium. Anterior and posterior distribution of the flaps makes it possible to recreate a spacious single cavity.

[Spontaneous rupture of the spleen in relation to a splenic pregnancy. Apropos of a case]. / Rupture spontanée de rate en rapport avec une grossesse splénique. A propos d'un cas.

Spontaneous rupture of the spleen related to an ectopic pregnancy is exceptional but must be kept in mind. The clinical picture is dominated by signs of haemoperitoneum and shock. Except in an emergency, the plasma BhCG titration, abdominal ultrasonography and CT-Scan, offer a major contribution. If the exploration through a Pfannenstiel incision is normal, the surgeon should not hesitate to extend it through the mid-line. The diagnosis is almost always made on pathological examination.

[Treatment of severe rhesus isoimmunization by repeated transfusions in utero]. / Traitement des iso-immunisations rhésus graves par transfusions in utéro itératives.

Repeated transfusions in utero by umbilical cord puncture enable the treatment of severe forms of rhesus incompatibility. The two cases reported, including one involving seven transfusions between twenty and thirty seven weeks since the LMP, form the basis of a review of the literature defining the advantages and results of this technique.

[Spontaneous abortion with an IUD and Candida chorioamnionitis]. / Avortement spontané d'une grossesse sur DIU par chorioamniotite à Candida.

Interruption and expulsion of a stillborn fetus in patients with an IUD Candida albicans chorioamniotic infection is a very rare obstetrical event. Generally, the diagnosis is established in retrospect by the routine histological examination of the products of expulsion and the demonstration of a specific chorioamniotic infection. This infection occurs by upward dissemination in a pregnancy where the amniotic membrane is unbroken, with the IUD being the facilitating factor of infection. Prevention appears to be the withdrawal of an IUD at the beginning of pregnancy.

[Retroplacental hematoma and factor XI deficiency]. / Hématome rétroplacentaire et déficit en facteur XI.

The authors report a case of premature separation of a normally located placenta at 28 weeks, associated with factor XI deficiency. The deficiency became known 6 weeks before the acute episode. In this particular case the deficiency did not occur in the context of congenital abnormalities, hepatocellular insufficiency nor any autoimmune disease. This rare case raises the problem of the role of a coagulation disorder in the etiopathogenesis of retroplacental hematoma.

[Neonatal death following injuries in utero, in the absence of maternal lesions]. / Mort néonatale dans les suites d'un traumatisme in utéro, en l'absence de lésions maternelles.

The authors report a case of neonatal death at 24 hours following maternal trauma during a traffic accident. The abdominal trauma did not result in any maternal injury. Caesarean delivery was justified by fetal rhythm disorders. A wide variety of fetal injuries, in the absence of maternal injuries, are reported in the literature. Some benefit from an early diagnosis, improving therefore the fetal prognosis.

[Epithelialization of a new vagina after nymphoplasty and salpingoplasty]. / Epithélialisation d'un néovagin par nymphoplastie et salpingoplastie.

The association of salpingoplasty to the previously described nymphoplasty improves the result of the vaginoplasty of the Rokitansky-Kuster-Hauser syndrome. The pediculate mucous flaps obtained by cleavage of the labium minus are linked with the vascularized tubal flaps from the lumbo-ovarian ligament. In the present observation, this dressing up technique of the new vagina has enabled a quick and complete epithelialization, avoiding a progressive obturation from inwards towards the surface, without the use of a mandrin in the long run.

Value of examination of the gastric aspirate for the diagnosis of neonatal infection.

To evaluate the interest of examination of the gastric aspirate (GA) as a contribution to decision making of initial antimicrobial therapy, all 3,989 neonates delivered in Orléans Maternity Hospital in 1990 have been studied. Microscopic examination: polymorphonuclear leukocytes (PMN) were, respectively, absent/present/abundant in 180/130/25 treated (T) and in 2,567/1,032/90 untreated (NT) newborns. PMN were demonstrated in 2/5 documented, 4/6 obvious, 2/2 suspected and 34/58 possible infections. Bacteria were, respectively, absent/present/abundant in 201/109/46 T newborns and in 2,722/877/56 NT newborns. Bacteria were demonstrated in 3/5 documented, 4/6 obvious, 2/2 suspected and 32/58 possible infections. Culture: the number of initially T and NT newborns was, respectively, for each bacterial species: Enterobacteriaceae 33/294, streptococci B (GBS), D and alpha-hemolytic 60/107, 12/110 and 18/70, Streptococcus pneumoniae 2/2, anaerobes 12/402, Listeria 3/0, Haemophilus species 4/4, Staphylococcus aureus 5/7, coagulase-negative staphylococci 25/1335, Lactobacillus 14/345, corynebacteria 10/196. In the 5 newborns with documented early onset meningitis and/or septicemia, 3 grew with GBS, Escherichia coli and Listeria. In the 4 newborns (2 meningitis and 2 urinary tract infections) with late-onset infection, no positive GA could be demonstrated. Although microscopic examination and cultures were statistically more frequently positive in T newborns, with variations dependent on the species of bacteria, more newborns without infection were colonized whatever the bacteria. Thus, bacteriological results of GA, if considered out of the clinical context, cannot be an argument for treatment.