A species' Odyssey: evolution of obstetrical mechanics from Australopithecus Lucy to nowadays.

OBJECTIVE: Study of obstetrical mechanics of Australopithecus Lucy, Homo neanderthalensis and Homo erectus relative to modern Homo sapiens and the Catarrhines. STUDY DESIGN: The material comprised a total of 360 pelves: 3 fossil pelves reconstructed using casts (Australopithecus afarensis Lucy or AL 288-1, Homo erectus KNM-WT 15000, H. neanderthalensis or Kebara 2), 305 female modern adult pelves and 52 female Catarrhine pelves (29 gorillas, 18 chimpanzees, 5 orang-utans). All these pelves were reconstructed in order to carry out 11 pelvimetric measurements. Each measurement was carried out twice and by two different operators. RESULTS: The pelvis of Lucy was platypelloid at each pelvic plane. The pelvic inlet of H. neanderthalensis was anteroposteriorly oval whereas the midplane and the outlet were transversely oval. The pelvis of H. erectus was globally round. In modern women, the inlet was transversely oval. The pelvic midplane and outlet were anteroposteriorly oval. In the great apes, the shape of all three pelvic planes was anteroposteriorly oval. The discriminating value of the various pelvimetry measurements place Australopithecus Lucy, H. neanderthalensis Kebara 2, and H. erectus KNM-WT 15000 close to modern humans and less similar to the great apes. CONCLUSION: Obstetrical mechanics evolved from dystocic delivery with a transverse orientation in Australopithecus to delivery with a modern human-like rotational birth and an increase in the anteroposterior diameters in H. erectus, H. neanderthalensis and modern H. sapiens.

Morphological and immunohistochemical study of ovarian and tubal dysplasia associated with tamoxifen.

Ovarian epithelial dysplasia was initially described in material from prophylactic oophorectomies for BReast CAncer gene (BRCA) mutation. Similar histopathological abnormalities have been revealed after ovulation stimulation. Given that tamoxifen (TAM) has a clomid-like effect and is sometimes used to induce ovulation, we studied the morphological features and immunohistochemical expression patterns of neoplasia-associated markers in adnexectomies previously exposed to TAM for breast cancer. We blindly reviewed 173 histopathological slides of adnexectomies according to three groups - oophorectomie sassociated with TAM exposure (n=42), oophorectomies associated with clomiphene exposure (n=15) and a spontaneously fertile non cancerous control group (n=116). Morphological features (with an ovarian and tubal dysplasia scoring system) and immunohistochemical expression patterns of Ki-67, p53 and Aldehyde dehydrogenase 1 (ALDH1 is an enzyme significantly associated with earlystage ovarian cancer) were evaluated and correlated. Mean tubal dysplasia score was significantly higher in the TAM group and clomiphene group than in controls (respectively 7.8 vs 3.5, P<0.007 and 6.8 vs 3.5, P=0.008). There is no statistical difference for the ovarian score in TAM group in comparison with the control group whereas we found a significant score for clomiphen group (6.5, P=0.009). Increased ALDH1 expression was observed in the two exposed group whereas expression patterns of Ki67 and p53 were moderate. Interestingly, ALDH1 expression was low in non-dysplastic epithelium, high in dysplasia, and constantly low in the two carcinoma. Furthermore, we confirm our previous results showing that ALDH1 may be a useful tissue biomarker in the subtle histopathological diagnosis of tubo-ovarian dysplasia.

[Lucy's parturition, a way towards extinction?]. / La parturition de Lucy, chemin vers l'extinction ?

OBJECTIVES: To compare pelvic cavities in australopithecines, modern humans and non-hominid primates in order to discuss the obstetrical mechanisms in australopithecines MATERIAL AND METHODS: Bony pelves from fossil material (Australopithecus afarensis AL 288-1, Australopithecus africanus Sts14, Australopithecus Stw 431 and Mh2), 133 modern humans (82 adult females and 51 adult males) and 67 anthropoid primates (36 gorilla, 26 Pan troglodytes, 5 Pongo pygmaeus) were reconstructed and compared (shape and morphometric analysis) using 16 pelvimetric mesasurements. RESULTS: Pelves of australopithecines were characterized by lower anteroposterior (AP) and transverse (TRV) diameters in inlet pelvis than in other species. Index (AP/TRV) of pelvic inlet, midpelvis and pelvic outlet in the australopithecines were the lowest (<100) and the pelvic shape was platypelloid. A logarithmic factorial analysis showed that the pelvic morphology of australopithecines was different from humans and non-hominid primates but nearer the humans. DISCUSSION AND CONCLUSION: In contrast with apes where obstetrical mechanics seem to be easier, and because of platypelloidy, mechanism of birth in australopithecines was as difficult as in modern homo sapiens. Birth without cesarean was probably possible in an asynclitic TRV orientation.

[Anthropometric analysis of obstetrical pelvis from Neolithic area: obstetrical consequences. Preliminary study]. / Analyse anthropométrique du bassin obstétrical datant du Néolithique : conséquences obstétricales. Étude préliminaire.

OBJECTIVES: To study female pelves from Neolithic area (5000 years AD) in order to better understand the evolution of obstetrical mecanisms. MATERIALS AND METHODS: The fossil material comprised 73 Homo sapiens pelves: we reconstructed all the 20 adult female bony pelves. We realised the shape and morphometric analysis of the pelvic cavity. Changes in pelvic neolithic morphology were compared with pelvic modern morphology. RESULTS: The pelves of prehistoric female were similar in shape with modern female. However, they differ in relative dimensions (transversal diameter of the pelvis inlet: respectively 118 mm vs 125 mm, p=0.02). DISCUSSION AND CONCLUSION: Reconstructions based on Neolithic hominin fossils suggest that obstetrical mechanisms were probably common to Neolithic and modern humans: childbirth would probably require social adaptations and risks of perinatal and obstetric complications were undoubtedly high. However, the differences in morphometric analysis could suggest a change of human pelvis and raise the question of the evolution in obstetrical mechanisms in the future.

[Health-related quality of life in women operated on by surgical anti-incontinence procedures: comparison of three techniques]. / Qualité de vie après cure d'incontinence urinaire d'effort: comparaison de trois techniques.

OBJECTIVES: To assess the health-related quality of life (Contilife) after three surgical anti-incontinence procedures (Tension-Free Vaginal Tape [TVT], Transobturator Vaginal Tape [TOT], and Transobturator Vaginal Tape [TVT-O]). PATIENTS AND METHODS: We performed a prospective analysis of 90 women (30 TVT, 30 TOT, 30 TVT-0) with genuine stress incontinence pre- and postoperatively at 18 months. The objective cure rate was determined by clinical and urodynamic examination and the subjective cure rate by the Contilife questionnaire. RESULTS: Prior to surgery, patients complained more of effort activities, followed by global well-being. Postoperatively, all domains improved significantly without statistical difference between the three groups and 90% of the patients would advise the intervention to one of their friends. DISCUSSION AND CONCLUSION: Surgical outcomes vary greatly depending on the methodology of the study. Health-related quality of life seems paramount to decide time of surgery and to evaluate postoperatory results. We have chosen the Contilife questionnaire because of its scientific and clinical validity, reliability, responsiveness and linguistic validation. These results confirm that TVT/TOT/TVT-O procedures are a safe and effective surgical method and that they significantly improved health-related quality of life.

[Ovarian epithelial dysplasia: myth or reality? Review]. / Dysplasie épithéliale ovarienne: mythe ou réalité? Revue de la littérature.

Ovarian epithelial dysplasia has been described in the ovarian surface epithelium by histologic, morphometric and nuclear profile studies. It could represent a potential precursor of ovarian malignancy in patients with genetic risk of ovarian cancer, although its natural history and progression to carcinoma are unpredictable. Diagnosis and identification of ovarian dysplasia would certainly be useful to understand the early steps of ovarian carcinogenesis. However, dysplasia in relation with ovulation induction seems to have a different pattern. We report dysplasia definitions and the current clinical management.

Long-term results of tension-free vaginal tape (TVT) for the treatment of female urinary stress incontinence.

OBJECTIVES: Prospective evaluation of outcome and complications over a 5-year period post-treatment of urinary stress incontinence by TVT, and comparison of our results with the reference studies. MATERIALS AND METHODS: About 94 patients were treated for urinary stress incontinence only by one TVT procedure (single surgical procedure), between April 1997 and December 1998; 68% of patients presented pure urinary stress incontinence and 32% mixed incontinence. We found also a 25.5% rate of sphincter deficiency (UCP < 20 cm H(2)O) in this cohort. Patients were evaluated after 5 years: 52 complete evaluations (clinical, flow measurement with measurement of post-mictional residue, 24h PAD-test, quality of life questionnaire), 30 complete telephone interviews, 12 lost to follow-up (2 patients deceased). RESULTS: About 87% of the patients had a 5-year follow-up. The success rate was 79.2% overall (84.5% for the pure urinary stress incontinence and 67% for the mixed incontinence cases), and 72.2% for the cases of associated sphincter deficiency. We had only a 13% rate of patients lost to follow-up. More than half of the urinary urgency cases were treated successfully, however with a less satisfactory outcome in cases of bladder instability. The urodynamic exploration appeared to reveal that TVT caused dysuria: 52% of patients had a maximum flowrate below 15 ml/s, but the quality of life was improved, with a 95% rate of satisfaction without functional problems. We observed no late complications such as vaginal erosion or rejection of the prolene; the de novo syndrome was rare, with 8.5% of urinary frequency, 6% of urinary urgency and only 5.7% of invalidating dysuria. We saw no cases of pelvic floor disease after TVT treatment. DISCUSSION: Our casuistry results are comparable with the reference studies by Scandinavian authors, Rezapour and Ulmsten, confirming the long-term success of the TVT procedure. Concerning the apparently elevated rates of post-TVT dysuria found by urodynamic exploration, a distinction has to be drawn between post-TVT urinary problems (frequent but oligosymptomatic), and true, severe dysuria (rare). However, "dysuria" in the broad sense did not affect the patients' quality of life, and is a reminder of the absolute necessity of meticulous compliance with the correct surgical techniques. CONCLUSION: Treatment of urinary incontinence by TVT is a reliable, mini-invasive, reproducible technique, almost suitable for outpatients, with no serious complications; it is inexpensive and very successful, including in complicated cases such as sphincter deficiency. All the recent data confirms, with this 5-year follow-up, that the TVT procedure is comparable to the previously gold standard, the Burch colposuspension.

[Colorectal cancer discovered during pregnancy]. / Cancer colique découvert pendant la grossesse.

Colorectal carcinoma during pregnancy is very rare. Prognosis is severe because of the advanced stage due to delay in diagnosis and the aggressiveness of this widespread metastatic disease. We report the case of colon metaststic adenocarcinoma during a twin pregnancy with a good outcome. In the light of epidemiology, pathogeny and immunology, the diagnostic challenge for clinicians is distinguishing pregnancy symptoms from the warning signs of colorectal cancer and, we describe recommended medical and surgical management.

[Postoperative complications of Bartholin's duct abscess. About two cases]. / Complications postopératoires des bartholinites aiguës. A propos de deux cas.

Bartholinitis is the most common infectious vulvar disease and develops in approximately 2% of all women. The choice concerning treatment may be uneasy between medical or surgical modalities, and we have to be cautious because of the risk of severe complications associated with the procedure. We report two cases: one case of sepsis and the other one of bacterial cellulitis after Bartholin's duct abscess marsupialization. In the light of epidemiological and bacteriological date referring to Bartholinitis, we recommend a safe and effective management (particularly the use of broad-spectrum antibiotics) that we will describe.