[Transabdominal cervico-isthmic cerclage: 13 cases at Rouen University Hospital]. / Cerclage cervico-isthmique par voie abdominale : 13 cas au CHU de Rouen.

OBJECTIVE: The aim of this study was to describe our experience with cervico-isthmic cerclage by abdominal approach and to assess this efficacy. PATIENTS AND METHODS: A retrospective analysis of 13 transabdominal cerclages (eight by laparotomy and five by laparoscopy), seven cases performed before pregnancy and six cases between 12 and 14 weeks of gestation, between 2004 and 2009. We analyzed the previous obstetric accidents, the etiology of cervical incompetence and the patient outcome after cerclage. RESULTS: Median age of the patients was 35 years [27-42 years]. Patients had an average of pregnancy 4,2 [1-7], with 3,3 previous fetal losses or preterm delivery. Eighty percent had a prior failed transvaginal cerclage. The mean operative time of laparotomic cerclage was 100 minutes and 94 minutes by laparoscopy, with a mean hospitalization time respectively of seven and 2,5 days. No operative complication was reported. Eleven women were pregnant after cervico-isthmic cerclage: nine deliveries by caesarean section at term, and two preterm births between 34 and 37 weeks of gestation. Two patients are looking for being pregnant and one of those is currently doing a procedure of IVF. DISCUSSION AND CONCLUSION: Transabdominal cervico-isthmic cerclage is an alternative technique for the management of cervical incompetence after failed vaginal cerclage. Our data indicated that the cervico-isthmic cerclage placed laparoscopically compares favorably with the laparotomy approach in regard to operative technique and risk of complications.

Metastatic spread of gynaecological neoplasms to the adrenal gland: case reports with a review of the literature.

Metastatic involvement of the adrenal glands due to gynaecological neoplasms is a relatively rare condition. The aim of our study was to present four cases of metastases to the adrenal gland due to endometrial adenocarcinoma, ovarian and cervical cancer. These cases are correlated with a review of the literature. CT scan and MRI have been previously used in an attempt to define the nature of the adrenal mass but this approach is of limited value in diagnosis. Image-guided pathological confirmation of an adrenal lesion may significantly change the staging or management of the primary neoplasm. The authors suggest that isolated adrenal metastasis should be routinely considered for surgical management.

[Antibiotics at term. Questions about five severe allergic accidents]. / Antibiotiques en fin de grossesse. A propos de cinq réactions allergiques sévères.

We recently observed five cases of severe maternal allergic accident due to the administration of antibiotics near or at term in order to treat or prevent Early Onset Neonatal Group B Streptococcal Sepsis. We discuss the treatment of a severe maternal allergic reaction and these dramatic observations make us wonder about a reasonable use of antibiotics.

[Acute orthostatic intracranial hypotension]. / Hypotension intracrânienne aiguë orthostatique.

The case of a young female with an acute idiopathic low cerebrospinal fluid pressure is presented. Clinical-imaging manifestations were typical and two consecutive blood patches resulted in a complete and durable resolution of the symptomatology. We present a review of the various investigation and therapeutic techniques.