[Clinical case of the month. Mild hemolytic disease of the newborn due to an anti-Wr(a) antibody]. / Maladie hémolytique néonatale modérê due à un anticorps anti-Wr(a).

A Caucasian woman, with a A+ CCD.ee K neg erythrocyte phenotype and no history of blood transfusion, delivered a first child who developed mild anemia. The direct antiglobulin test performed on the newborn red blood cells belonging to the A+ CCD.ee K neg group, was strongly positive for IgG. During the pregnancy and after the delivery, the woman had a negative irregular antibody screening test, using standard red blood cells. However, at birth, using a collection of thawed red blood cells with rare phenotypes (private antigens), the lab showed an antibody anti-Wr(a) in the maternal serum. The activity of the maternal antibody, with a titer of 16, was completely inhibited by dithiothreitol, indicating the nature IgM of the circulating antibody. The presence of the antigen Wr(a) on the surface of the newborn and its biological father red blood cells was confirmed. The concentration of IgG anti-Wr(a) on baby erythrocytes was demonstrated by the presence of the antibody anti-Wr(a) in the eluate. This case illustrates the difficulties to detect antibodies against private antigens on baby erythrocytes, responsible of hemolytic diseases of newborn. Indeed, standard red blood cell panels used for irregular antibodies screening test do not express generally those private antigens.

[Breast cancer in Belgium: why are we the first in Europe?]. / Le cancer du sein en Belgique: pourquoi sommes-nous les premiers en Europe?

Breast cancer incidence in Belgium is on the top of European countries, with 9.697 new cases in 2008 and 106/100.000 women/year. The explanation of this high incidence in our country is probably the accumulation of risk factors (many of them are linked to lifestyle), and the impact of screening and registration of cases. The relative impact of each of theses factors is less clear because we don't have powerful statistical studies. Belgium is slightly above the European mean for breast cancer mortality, with 19,4/100.000 women/year and an all stages 15-year survival of 75%. Breast cancers are responsible for around 3% of all-cause mortality in Belgian women. This article discusses the causes of this high Belgian incidence and of current decrease of incidence in western countries, and reviews known and less known risk factors of breast cancers, with a special focus on menopause hormonal treatments.

[Bilateral prophylactic mastectomy for women at very high risk for breast cancer: beyond the technique]. / Mastectomie bilatérale prophylactique chez les patientes à très haut risque de cancer mammaire: au-delà de la technique...

Bilateral prophylactic mastectomy is the most efficient risk management strategy for women at very high risk for breast cancer. Different methods can be used. The implementation of such a strategy must respond to the request of a well informed patient.

[Hormone therapy for breast cancer]. / Hormonothérapie du cancer du sein.

Following Beatson's publications in 1896, various modalities of endocrine therapy applied to breast cancer have been developed. Endocrine treatment has greatly contributed to the improvement of the disease's prognosis. Tamoxifen has established itself as a first choice adjuvant therapy for patients with tumors expressing hormone receptors. Over the last decade, third generation aromatase inhibitors have demonstrated their efficacy amongst menopausal patients, alone or in combination with tamoxifen. Efficacy of these medications is dependent on patient's compliance. This article proposes a synthesis of the main knowledges available in the field of breast cancer endocrine therapy.

[Management of estrogen deficiency after breast cancer]. / Prise en charge des conséquences de la carence oestrogénique après cancer du sein.

The prevention and the treatment of oestrogen deficiency induced by breast cancer treatments are crucial in the management of patients. The impacts of this deficiency must not be neglected: quality of life impairments inducing eventually premature withdrawal of hormonotherapies, and excess of bone and cardio-vascular morbidities and mortalities, especially in good prognosis young women. Management strategies of short and long term effects of this deficiency are reviewed and discussed here.

[Benefits and limitations of mammography]. / Intérêt et limites du dépistage de masse du cancer du sein par mammographie seule (mammotest).

The literature on screening mammography provides ample opportunity for doubt (the sceptics) and dogma (the screening zealots), and can be interpreted to prove both benefit and harm. The benefit of mammography screening, if any, is modest and the balance between beneficial (potentially, a 20% relative reduction in breast cancer mortality with no significant benefit on all-cause mortality) and harmful (physical and psychological morbidity related to the 15-40% missed cancers and the 80-90% false-positive diagnoses) effects is still delicate. The mammogram alone is a modest weapon. Concurrent clinical breast examination is mandatory. Women that are concerned about breast cancer should be fully informed of the potential benefits and risks of screening mammography. These women should benefit from mammography with concurrent clinical breast examination, and possible whole-breast ultrasound in heterogeneously dense and extremely dense breast patterns.

[Organization of a post-partum home care service. Five years' experience of the university service of the Gynecology, Obstetrics and Mastology Center of the Forest of Abbaye and Hesbaye Hospital]. / A propos de l'organisation d'un service de post-partum à domicile. Cinq années d'expérience du Service universitaire de Gynécologie, d'Obstétrique et de Sénologie du Centre hospitalier du Bois de l'Abbaye et de Hesbaye.

In compliance with new ministerial directives, maternity clinics had no choice but to reduce the average stay of mothers and their newborns. This change also reflected the preference of young parents. In order to respond to these organisational and educational challenges and to ensure the optimal medical attention for mothers and infants--our Obstetrics Service decided to create a Post-partum Service for the outpatients at home. Carried out in tandem with the family doctors the service began in August 1994. This paper describes our past 5 year experience.

[Prevention of prematurity in the French community at the approach of the year 2000]. / La prévention de la prématurité en Communauté française à l'approche de l'an 2000.

The actual results confirm the dominating influence of psychosocial factors on prematurity and low birth weight. The study performed in Liège indicates that these factors must be taken into account for better care of the future mother. The systematic use of a prenatal questionnaire on psychosocial factors draws attention towards the personal situation of the future mother. Detection of some organic or psychosocial risk factors must prompt prophylactic measures even in the absence of any sign of pathologies. Prevention of prematurity has, over the last 30 years, been the primary objective of prenatal follow-up. Its importance must be further emphasized.

[Concerning some important sexual problems]. / A propos de quelques grands problèmes sexologiques.

Sexology is the study of normal and abnormal sexual phenomena, as well as the treatment of sexual dysfunctions. Sexual science is at the dawn of its history, with many of its aspects--be they physiological or sociological--still awaiting investigations. It appears that about three-quarters of all cases of sexual dysfunctions can be handled by the general practitioner or by the gynecologist. As for the remaining patients, they should be referred to a psychologist-sexologist or a psychiatrist specialized in sexual therapy. The practitioner has to be careful not to allow himself to be drawn in a situation of uncontrolled psychotherapy. First of all, he must begin with a full and systematic gynecological examination of the patient.

[Perimenstrual dermatoses: a comment fact of chronobiology]. / Les dermatoses cataméniales: une facette fréquente de la chronobiologie.

More than 15 common or specific dermatoses may be worsened during the premenstrual phase. Acne, herpes simplex and the autoimmune progesterone dermatitis represent typical examples.

Circadian and seasonal variations of hematopoiesis in cord blood.

Cord blood hematopoietic progenitors undergo circadian and seasonal variations. The lowest values are obtained between 4:00 and 12:00, as well as between May and August. This represents the first observation of such rhythms before birth.

[Treatment of epithelial ovarian cancer]. / Le traitement du cancer épithélial de l'ovaire.

Cancer of the ovary is much less frequent than breast cancer. Nevertheless, it hits 12 women out of 1,000,000 every year. The majority of patients are diagnosed with the disease in their fifties. The usual prognosis for ovarian cancer is back. Indeed, in 70 percent of all cases, it is, unfortunately, discovered at an advanced stage. This article will discuss the medical therapeutic approaches to ovary cancer, while stressing that major surgery is the basic treatment. If hormonotherapy and immunotherapy have not so far proven their efficacy, chemotherapy treatment has shown its ability to combat this affliction.

Purification, expansion, and multiple fluorochrome labeling of cord blood hemopoietic precursors: preliminary results.

CD34-positive cells were isolated from a total of 23 cords using CellPro Ceprate columns. AIS MicroCellector flasks, and panning. The cells were (1) expanded in serum-free culture supplemented with a variety of combinations of cytokines and (2) immunophenotyped using multiple fluorochrome labeling. The results indicated that the avidin column produced the highest purity of CD34-positive cells, and that immature blast cells could be expanded in serum-free culture. Preliminary results suggested that the four fluorochrome labeling technique may provide useful information on the lineage commitment of cord blood precursor and blast cells.

[Hormonal contraception]. / La contraception hormonale.

PIP: The forms of administration, mechanisms of action, side effects and complications, and other aspects of female hormonal contraception are set forth in this "lesson" for medical students. Female hormonal contraception has been in use for over 30 years and is used by more than 150 million women worldwide. Oral contraceptives suppress the preovulatory peak of follicle stimulating hormone and luteinizing hormone, preventing ovulation and follicular maturation. Progestins render the cervical mucus impermeable to sperm and modify the endometrium so that it will no longer support implantation. The synthetic estrogen ethinyl estradiol is used in most combined oral contraceptives (OCs). Among the numerous progestins in use are the newer desogestrel, gestodene, and norgestimate, which have fewer androgenic and metabolic effects than did the 1st generation. the different forms of administration of hormonal methods include combined OCs, oral preparations containing low doses of progestin continuously administered or high doses continuously or discontinuously administered. Intramuscular injection of progestins and the so-called "morning after" postcoital pills are less often prescribed. The combined preparations may be monophasic, biphasic, triphasic, or sequential. Sequential preparations should be avoided because of the hyperestrogenic climate they induce. The low-dose progestin preparations are indicated for women with contraindications to synthetic estrogen. They must be taken at the same time each day and have a relatively high rate of side effects, especially ovarian and breast cysts and irregular bleeding. High-dose progestin preparations have significant metabolic effects and are indicated primarily for patients with gynecological problems such as fibromas and endometriosis. Intramuscular injection of medroxyprogesterone acetate every 3 months is effective but has the same side effects as high-dose progestins. It is indicated primarily for patients unable to control their own behavior. The hormonal methods are all highly effective in preventing pregnancy when correctly administered. Side effects may be minor problems, such as nervousness and nausea, that are usually of short duration. the more serious side effects, including modifications of lipid or carbohydrate metabolism, hemostasis, blood pressure, or hepatic functioning and cardiovascular effects, have been reduced with the new lower dosed formulations. Absolute contraindications to hormonal contraception include undiagnosed vaginal bleeding or amenorrhea, history of thromboembolic or cerebral vascular accidents, severe cardiopathy or hypertension, hyperlipidemia, hepatopathy, hormonodependent cancer, pituitary tumors, porphyria, and severe mental problems. Relative contraindications impose the need for careful monitoring and follow-up. The practitioner should be aware of the possibility of interactions between OCs and certain other drugs.^ieng

[Results of a policy of conservative treatment of breast cancer (146 cases)]. / Résultats d'une politique de traitement conservateur du cancer du sein (146 cas).

Tumorectomy and irradiation for small cancer of the breast. Tumorectomy followed by breast irradiation and a single course of chemotherapy is the most accurate treatment for small cancer of the breast. The 5 and 10 years survival are 92.5% and 85% respectively: this demonstrates the efficacy of the conservative treatment in the control of most of the small breast cancer provided a strict selection of the cases was done. Patients who develop local recurrence have the same life expectancy than the other cases when they are soon treated by mastectomy.