[Prospective evaluation of an intravaginal electrical stimulation in the treatment of women with pure genuine stress urinary incontinence]. / Évaluation prospective d'un dispositif de rééducation périnéale à domicile dans l'incontinence urinaire d'effort féminine.

OBJECTIVES: To study the objective and subjective effectiveness of transvaginal electrical stimulation for treatment of female pure genuine stress incontinence. PATIENTS AND METHODS: This was a multicenter prospective trial including 207 patients with genuine stress incontinence who used the stimulator for 10 weeks. Similar pre-treatment and post-treatment assessments included both validated symptom severity index and health-related quality of life. RESULTS: Objective evaluation showed a significant improvement in 65.7% of subjects with stress incontinence. All domains of quality of life improved significantly after treatment (P=0.0001) and rate of satisfactory was 84.7%. There were no statistical differences between the two stimulators. DISCUSSION AND CONCLUSION: Pelvic floor electrical stimulation seems to be effective in treating female genuine stress incontinence and could be considered first-line therapy.

[Uterine transplantation: animal and human studies]. / Transplantation de l'utérus : expériences animales et humaines.

Many cases of not life saving transplanted organs were described with the aim of improving quality of life. Uterus graft could be an alternative solution to adoption or surrogacy for women who have uterine factor infertility. Different animals' studies with mouse, sheep or monkey showed feasibility of the surgical technique with large vessels patch. One case of human uterine transplant has been reported but failed. Cold storage of the uterus in protective solution has been explored with mouse, sheep and human. Only pregnancy after uterus graft by syngenic mouse has been published. Results about pregnancy after allograft with sheep or monkey are necessary before pregnancy after human uterus graft becomes a reality.

Concomitant intensive chemoradiotherapy induction in non-metastatic inflammatory breast cancer: long-term follow-up.

The aim of this study was to evaluate with a long follow-up the efficacy of concomitant chemoradiotherapy in non-metastatic inflammatory breast cancer (IBC) and to evaluate the breast conservation rate. Between 1990 and 2000, 66 non-metastatic patients with IBC were treated with chemotherapy and concomitant irradiation. The induction chemotherapy consisted of epirubicine, cyclophosphamide and vindesine, in association with split-course bi-fractionated irradiation to a total dose of 65 Gy with concomitant cisplatin and 5-fluorouracil. Maintenance chemotherapy consisted of high-dose methotrexate and six cycles of epirubicine, cyclophosphamide and fluorouracil. Hormonal treatment was given if indicated. Mastectomy was not systemic. Among 65 evaluable patients, 57 (87.6%) achieved a complete clinical response and had a breast conservation. Only six loco regional relapses were noted in six patients with a delay of 20 months and with concomitant metastatic dissemination in four cases. Median disease-free survival (DFS) was 28 months. Median overall survival (OS) was 63 months and median follow-up was 55.5 months. Induction chemotherapy and concomitant irradiation is feasible in patients with IBC, permitting a breast conservation with a high rate of local control with an OS comparable to that of the best recent series.

Detection of the sentinel lymph node under local anaesthesia in early-stage breast cancer: feasibility study in a series of 78 unselected patients.

AIMS: To evaluate the feasibility of excision of the sentinel lymph node under local anaesthesia in early-stage breast cancer. METHODS: Sentinel lymph node detection under local anaesthesia was carried out on all patients presenting with breast cancer at Stage T0, T1 or T2 < 3 cm and N0, M0. The lymph node was mapped using a radioisotope and patent blue dye and lymphoscintigraphy was routinely performed. No premedication was given, and local anaesthesia was carried out with xylocaine. The patients underwent tumorectomy one week later under general anaesthesia, with or without complete axillary dissection, depending on the results of the definitive histopathological examination of the sentinel lymph node. RESULTS: 78 patients underwent this procedure over a period of 20 months. The procedure was successful in 76 out of the 78 patients, with one failure in mapping and one failure in detection (detection rate = 97.4%). The mean time to detection was 21 min (range: 6-45). It was unnecessary to interrupt the procedure due to patient discomfort in any of the cases. One allergic reaction to patent blue dye was noted and required corticosteroid therapy without interruption of the procedure. The time to detection was correlated with the experience of the surgeon carrying of the procedure, the patient's body mass index and the number of labelled lymph nodes found at lymphoscintigraphy. CONCLUSION: We have shown that it is feasible to detect the sentinel lymph node under local anaesthesia in an unselected population. Using this procedure, patients can undergo surgery with the knowledge of their axillary lymph node status while at the same time avoiding the uncertainties of an intraoperative examination of the sentinel lymph node--a source of many false negatives, particularly in the event of micrometastases.

Hyperhomocysteinemia and pregnancy--review of our present understanding and therapeutic implications.

Homocysteine results from the transmethylation of methionine. Its metabolism depends primarily on three enzymes and several vitamin cofactors. Genetic abnormality in these enzymes or deficiency of these vitamins lead to hyperhomocysteinemia (HHCh). HHCh is usually biologically defined by a fasting value >15 micromol/l. HHCh belongs among the congenital hypercoagulable states and is a long-known vascular disease risk factor. The discovery that HHCh may also be responsible for several pregnancy complications has only recently been made. Studies in this area are still scarce and report on limited numbers of patients. It nevertheless appears clear that HHCh is associated with the syndromes of repeated miscarriage, pre-eclampsia, placenta abruptio, thromboembolic events, neural tube defects, and perhaps with fetal death-in-utero and intra-uterine growth retardation. Supplementation with vitamin B9 can reduce plasma HC levels, and is thus recommended in patients with HHCh. The prevention of thromboembolic events during pregnancy by anticoagulant treatment is also desirable in these patients.

[Hyperhomocysteinemia and pregnancy: a dangerous association]. / Hyperhomocystéinémie et grossesse : une association dangereuse.

Homocysteine results from the demethylation of the essential amino acid methionine. Its metabolism depends primarily on three enzymes and several vitamin cofactors (vit. B6, B9 and B12). Genetic abnormality in these enzymes or deficiency of these vitamins lead to Hyperhomocysteinemia. Hyperhomocysteinemia belongs among the congenital thrombophilies and is a long-known vascular disease risk factor. The discovery that hyperhomocysteinemia may also be responsible for several pregnancy complications has only recently been made. Studies in this area are still scarce and report on limited numbers of patients. It nevertheless appears clear that HHCh is associated with the syndromes of repeated miscarriage, pre-eclampsia, placenta abruptio, thromboembolic events, neural tube defects, and perhaps with fetal death-in-utero and intra-uterine growth retardation. Supplementation with vitamin B9 can reduce plasma HC levels, and is thus recommended in patients with HHCh. The prevention of thromboembolic events during pregnancy by anticoagulant treatment is also desirable in these patients.

[Folates and the neural tube. Review of the literature]. / Folates et tube neural. Revue de la littérature.

There are two types of neural tube fusion abnormality (NTFA)--craniorachischisis and rachischisis--with a prevalence of 11.2/10,000 in continental Europe. Their prevalence varies widely and is influenced by many factors, including geographical, racial and seasonal components. The transmission of NTFAs is usually polygenic and affected by many factors, and far more rarely of the mendelian monogenic type. The occurrence of NTFAs has been shown to be due to folic acid (FA) deficiency. First suspected in 1965, FA deficiency was proved to be a cause of NTFAs both occurring and recurring in the 1980s. FA deficiency might act by preventing the remethylation of homocysteine to methionine, the latter is known to play an essential role in fusion of the neural tube in animals. Primary prevention of NTFAs therefore requires that FA supplementation be given to women planning a pregnancy and after conception. Two possible ways of preventing FA deficiency can be envisaged, ie. via folic acid supplementation or systemic enrichment of the basic diet. Neither of the two alternatives is sufficient by itself and probably a combination of the two would provide the best means of preventing neural tube defects.

[The history of cesarean section]. / Histoire de l'opération césarienne.

The origins of the Cesarian section date back to the Classical era, and possible even earlier. Ancient India, the Hebrews, the Grecks and the Romans were all familiar with post-mortem Cesarian section. The operation marked time during the Middle Ages. The name "Cesarian section" was first used to designate this operation during the Renaissance period, when it was first carried out in live women. However, until the middle of XIX th century, a Cesarian remained a last chance option which was cautioned against by most obstetricians. It was only after the advent of the "surgical golden tripod" that the Cesarian was gradually rehabilitated through the work of Poro, Kherer and Sanger and the German School. In the XIXth century, segmental incision became the norm and fetal indications for a Cesarian emerged.