Unrecognized abdominal pregnancy with six months' evolution revealed by acute intestinal obstruction in women with PCOS.

Abdominal pregnancy is a rare form of ectopic pregnancy where implantation and development of the egg take place in the peritoneal cavity outside the tubo-uterine mucosa, in contact with intestinal loops. Diagnosis is most often difficult. We report the case of a 32-year-old woman (gravida 1, para 1), with a history of PCOS, diagnosed with abdominal pregnancy at 20 weeks of amenorrhea complicated by acute intestinal obstruction. Diagnosis was confirmed by abdomino-pelvic scan. Surgery was performed with the patient under general anesthesia. She presented a macerated fetus with an infiltration of the placenta causing a perforation of the sigmoid colon and uterus. Hartmann's procedure was performed and the perforation of the uterus was sutured. Abdominal pregnancy remains a rare variety of ectopic pregnancy. Preoperative diagnosis is difficult due to the presence of a variety of non-specific symptoms. This type of ectopic pregnancy remains challenging for gynecologists and radiologists.

Spontaneous bilateral tubal ectopic pregnancy: a gynecological challenge.

Bilateral ectopic pregnancy is very rare. Although the frequency of ectopic bilateral pregnancy has increased with the advent of medically assisted procreation, spontaneous bilateral tubal pregnancies remain rare. Early detection of this type of ectopic pregnancy is important to prevent maternal mortality and morbidity. Conservative surgery must also be considered, as preservation of both tubes is presumed to offer better fertility prospects. We report the case of a 35-year-old patient at five weeks of amenorrhea with bilateral ectopic pregnancy diagnosed based on ultrasound scans and confirmed during laparotomy. A 35-year-old woman with a history of three vaginal deliveries, non-smoker, on contraceptives (microprogestins), presented with pelvic pain and amenorrhea of five weeks. A beta HCG test came back positive. Pelvic ultrasound revealed a moderate hemoperitoneum and an empty uterus with hematometra. It also showed heterogeneous left and right adnexal masses measuring 3 cm and 4 cm, respectively. An emergency laparotomy was performed. Per-operatively, two bilateral tubal pregnancies of 3 cm and 4 cm were founded. The patient received conservative treatment with bilateral salpingotomy. Postoperative management was uneventful. The diagnosis of spontaneous bilateral tubal ectopic pregnancy is rare and often established at the time of surgery, hence the importance of a rigorous and vigilant examination of the two tubes during ultrasound examination and surgery, so as not to miss it and to better prevent maternal mortality. Conservative surgery must be carefully chosen.

Injectable bone cement containing carboxymethyl cellulose microparticles as a silver delivery system able to reduce implant-associated infection risk.

In the challenging quest for a solution to reduce the risk of implant-associated infections in bone substitution surgery, the use of silver ions is promising regarding its broad spectrum on planktonic, sessile as well as multiresistant bacteria. In view of controlling its delivery in situ at the desired dose, we investigated its encapsulation in carboxymethyl cellulose (CMC) microparticles by spray-drying and included the latter in the formulation of a self-setting calcium phosphate bone cement. We implemented an original step-by-step methodology starting from the in vitro study of the antibacterial properties and cytotoxicity of two silver salts of different solubility in aqueous medium and then in the cement to determine the range of silver loading able to confer anti-biofilm and non-cytotoxic properties to the biomaterial. A dose-dependent efficiency of silver was demonstrated on the main species involved in bone-implant infection (S. aureus and S. epidermidis). Loading silver in microspheres instead of loading it directly inside the cement permitted to avoid undesired silver-cement interactions during setting and led to a faster release of silver, i.e. to a higher dose released within the first days combining anti-biofilm activity and preserved cytocompatibility. In addition, a combined interest of the introduction of about 10% (w/w) silver-loaded CMC microspheres in the cement formulation was demonstrated leading to a fully injectable and highly porous (77%) cement, showing a compressive strength analogous to cancellous bone. This injectable silver-loaded biomimetic composite cement formulation constitutes a versatile bone substitute material with tunable drug delivery properties, able to fight against bone implant associated infection. STATEMENT OF SIGNIFICANCE: This study is based on two innovative scientific aspects regarding the literature: i) Choice of silver ions as antibacterial agent combined with their way of incorporation: Carboxymethylcellulose has never been tested into bone cement to control its drug loading and release properties. ii) Methodology to formulate an antibacterial and injectable bone cement: original and multidisciplinary step-by-step methodology to first define, through (micro)biological tests on two silver salts with different solubilities, the targeted range of silver dose to include in carboxymethylcellulose microspheres and, then optimization of silver-loaded microparticles processing to fulfill requirements (encapsulation efficiency and size). The obtained fully injectable composite controls the early delivery of active dose of silver (from 3 h and over 2 weeks) able to fight against bone implant-associated infections.

[Acute organophosphorus intoxications in pregnant women]. / Intoxications aigues aux organophosphores chez la femme enceinte.

Acute organophosphorus pesticides (OPs) poisoning during pregnancy are rare events, not well documented in the literature. We conducted a retrospective analysis of outcomes in seven cases of suicidal ingestion of OP in pregnant women. This intoxication was most often serious. Indeed, five of seven parturients had an initial Glasgow score < 9 and the POP score was ≥ 3 in all parturients. Five patients required mechanical ventilation for a mean duration of 3,4 days. All patients reported favorable outcomes but in more than half of the cases fetuses had unfavorable outcomes (fetal death in utero). Two mechanisms can explain these fetal complications. The first mechanism is fetal hypoxia, associated or not with a state of shock, which can be reflected in the Fetal Heart Rate (FHR) by tachycardia or decelerations and result in intrauterine fetal death. The second mechanism is the passage of these pesticides through the placental barrier representing a potential risk to the fetus due to the alteration of the microsomal enzyme systems.

[Clinical and therapeutic aspects of post-partum cerebral thrombophlebites]. / Les aspects cliniques et thérapeutiques des thrombophlébites cérébrales du post-partum.

Cerebral thrombophlebites are rare but life-threatening conditions (1/5000 births). Pregnancy and postpartum are predisposing factors: clinical presentation vary and may be misleading, dominated by headaches, convulsions and neurological deficits but showing no specific features. Physical examination often generates informations unavailable and misleading because cerebral thrombophlebites share symptoms with other affections. A definitive diagnosis can be made only neuroradiologically. Brain MRI is currently the reference method; it allows visualization of the venous thrombus and its evolution. The treatment of cerebral thrombophlebites is essentially medical based on anticoagulant drugs. We here report four cases with post partum cerebral thrombophlebites. The aim of our study and review of the literature is to highlight the importance of early diagnosis and adequate therapy.

Drug nano-domains in spray-dried ibuprofen-silica microspheres.

Silica microspheres encapsulating ibuprofen in separated domains at the nanometre scale are formed by spray-drying and sol-gel processes. A detailed (1)H and (13)C NMR study of these microspheres shows that ibuprofen molecules are mobile and are interacting through hydrogen bonds with other ibuprofen molecules. (1)H magnetisation exchange NMR experiments were employed to characterize the size of the ibuprofen domains at the nanometre scale. These domains are solely formed by ibuprofen, and their diameters are estimated to be ∼40 nm in agreement with TEM observations. The nature and formation of these particular texture and drug dispersion are discussed.