[Balloon catheter for cervical ripening on scarred uterus with unfavorable cervix: multicenter retrospective study of 151 patients]. / Maturation du col utérin défavorable par ballonnet supra-cervical sur utérus cicatriciel : étude rétrospective multicentrique de 151 patientes.

OBJECTIVES: To evaluate safety and efficacy of balloon catheter for labor induction in women with previous cesarean section. MATERIAL AND METHODS: In a multicenter retrospective cohort study, 151 patients were included with the following criteria: pregnancy over 37 weeks, singleton, vertex presentation, previous caesarean section with unique transversal segmentary incision, medical indication for induction of labor, unfavorable cervix with Bishop score inferior to 7, no premature rupture of membranes. Balloon catheter used for cervix ripening, is inflated from 30 to 80 mL of sterile of NaCl and is left until 24 hours. RESULTS: Overall rate of vaginal delivery was 53.7% (81/151). Labor began before balloon catheter removal for 58 out of 151 (38.4%) with vaginal delivery for 75% (42/58). Best prognosis factors for vaginal delivery were spontaneous labor after balloon removal (P=0.004) and anterior vaginal delivery (P=0.03). Side effects were rare bleeding or PROM, but didn't prevent continuing ripening labor. Other morbidity consisted in two uterus ruptures (1.2%) without maternofetal incidence. CONCLUSION: Supracervical balloon is a safe and efficiency method for inducing labor on scarred uterus with unfavorable cervix with low side effects.

Anisotropic photo-induction in Rhodamine 6G dye-painted gelatin film.

A series of tests have been performed involving anisotropy photo-induction in Rhodamine 6G-dyed gelatin film. A film with photoinduced anisotropy has been shown to be characterized by photochromism. The dichroism of the dye molecule aggregates has been investigated.

[Maternal diaphragmatic hernia during pregnancy: report of two cases]. / Hernie diaphragmatique maternelle pendant la grossesse: a propos de 2 cas.

We report two cases of maternal diaphragmatic hernia during pregnancy. Diaphragmatic hernia is an unusual and severe disease. Maternal and fetal prognosis are threatened. Diagnosis is uncertain when confronted to respiratory and digestive symptoms without any specificity. The chest X ray is the first exam to perform. The objective of this work is to discuss the management of such a pathology in terms of ways of delivery and surgical cure of hernia.

Hartley's fractional crystallization and Weigert's effect.

In the course of slow evaporation of an azo-dye chrysophenine-saturated gelatin-water solution, dye crystals that developed two different interference colors were observed in the gelatin; the colors were yellow and blue. The crystals that produce a blue interference color undergo disintegration on exposure to non-polarized light from a mercury lamp.

Weigert's effect mechanism observed in dyes.

Anisotropic grains have been shown to be spontaneously induced in films that have been oversaturated and overcooled with dye in which Weigert's effect can be observed. Some of the grains exposed to active linearly polarized light are destroyed with the result that the film becomes anisotropic.

[Endocervical adenocarcinoma in situ. A histological entity to know]. / Adénocarcinome in situ de l'endocol. Une entité histologique à connaître.

We report diagnosis and treatment problems encountered in 4 cases of adenocarcinoma in situ (AIS) of the uterine cervix. The patients' ages ranged from 24 to 45 years. In 2 cases, Pap smears revealed strips of cells showing crowded nuclei and pseudostratification of AIS. In 3 cases, the diagnosis of AIS was confirmed from a colposcopically directed biopsy and, in the last case, from a surgical cone biopsy. In 3 cases, AIS was found to be associated with cervical squamous intraepithelial neoplasia. In all cases, it was difficult to rule out an early invasive adenocarcinoma. Three patients underwent total abdominal hysterectomy. The topographic data of lesions, notably the presence of endocervical AIS in hysterectomy specimen realised 4 years after conization, and a review of literature lead us to propose hysterectomy as a basic treatment. If conization is chosen, it should be cylindrical with adequate diameter and height.

[Rupture of a cerebral aneurysm and pregnancy: apropos of a case of neurosurgical intervention during pregnancy]. / Rupture d'anévrysme cérébral et grossesse: a propos d'une observation d'intervention neurochirurgicale en cours de grossesse.

The authors report a case of an aneurysm of the posterior cerebral artery that was operated on after 28 weeks of amenorrhoea without any sequelae for the mother or the fetus. The article gives precise details of the neurosurgical procedures carried out in this pregnant woman and how and what neurosurgical anaesthesia was administered while the aneurysm was cured and the pregnancy continued. Finally the obstetrical and neurosurgical care is discussed. The neurosurgeons decided on the operation in view of the neurological findings. Once the neurosurgical decision has been made, the obstetrical procedures depend practically on the length of amenorrhoea. Briefly, we would suggest the following: before 31 weeks of amenorrhoea: curing the aneurysm and going on with the pregnancy; after 32 weeks of amenorrhoea: first to carry out a caesarean section and during the same operation to treat the vascular malformation.

[Doppler examination of the umbilical arteries. Its role in the surveillance of pregnancy]. / L'examen Doppler des artères ombilicales. Sa place dans la surveillance de la grossesse.

Pregnancies with a high risk of fetal growth retardation are at present watched by using clinical observations and biological parameters including ultrasound and estimation of the fetal heart rate. The Doppler waveform in the umbilical arteries provides information about circulatory resistance in the placenta. An index of resistance "R" is evaluated on the Doppler trace. The purpose of this study is to describe the score (with its possibilities and limitations) for this parameter "R" to follow-up pregnancies with fetal growth retardation and to compare it with ultrasound, biological and clinical parameters that are commonly used. Two groups of pregnancies have been explored: pregnancies with hypertension and pregnancies with idiopathic fetal growth retardation. Abnormal values of "R" correlate well with failure of fetal growth. Furthermore pathological values of "R" do not correspond to the same population as abnormal values of the other parameters. In some cases "R" is disturbed before the others are. In conclusion, this study shows that the index increases the accuracy of detection and the follow-up of chronic fetal growth retardation, particularly in cases of pregnancies with vascular placental pathology.

[Parenteral nutrition for Crohn disease in the third trimester of pregnancy. Apropos of a case]. / La nutrition parentérale pour maladie de Crohn au troisième trimestre de la grossesse. A propos d'un cas.

The authors report a case of Crohn's disease in pregnancy where complications made it necessary to give the digestive system a complete rest by using parenteral nutrition. A review of the literature shows that it is possible to use this technique in pregnancy.

[Postoperative vaginal pseudosarcoma. Apropos of a case]. / Pseudosarcome vaginal post-opératoire. A propos d'un cas.

We report a case of a pseudosarcoma in the scar of an anterior repair operation. The possibility that the lesion could be sarcomatous was raised by the histologists and by the appearance on the hysterogram of a filling defect in the fundus of the uterus which resembled a sarcomatous lesion. The patient was treated by external irradiation and total hysterectomy and colpectomy. The tumour belonged to that entity that is known under the name of "post-operative pseudosarcomatous nodule". The characteristics, clinical and histological, should be better known so that this mistake is not repeated. The treatment is just simple excision.

[Effect of the etiology of sterility on the results of tubal microsurgery]. / Influence de l'étiologie de la stérilité sur les résultats de la microchirurgie tubaire.

The authors have carried out a prospective study from the 1 January 1977 to the 31 December 1981 on 168 women, 89.3% of whom (150/168) had pure distal tubal microsurgery and 10.7% (18/168) had mixed surgery. The results were studied in relationship to the aetiological reason for tubal sterility, which was: salpingitis in 60 cases = 35.7%; appendicitis in 23 cases = 13.7%, endometriosis in 29 cases = 17.3%, termination of pregnancy in 22 cases = 13.1% and unknown causes in 34 cases = 20.2%. The figures for intra-uterine pregnancies were 32.74% after 24 months using a classical method of determining it and 31% using an actuarial method. There was a significant difference between endometriosis and the four other aetiologies. These latter could not be differentiated between one another. The level of ectopic pregnancies was 5.3% at 24 months, or 6.3% using an actuarial method. It was higher after endometriosis. It would therefore appear from the results of this study that endometriosis seems to be poor from a prognostic point of view when compared with the other aetiological causes and the results shown in the literature. Finally the authors discuss in cases of endometriosis whether it is correct to carry out a second operation after the first or to resort to the other possibility, namely in vitro fertilisation.

[Tubal choriocarcinoma: a case]. / Choriocarcinome tubaire: un cas.

The authors report a case history of a tubal choriocarcinoma occurring in a woman of 38 years of age. This was 6 years after her second and last pregnancy and was diagnosed before operation. A summary of the complementary examinations is presented: An ultrasound showing a non-specific mass whose value therefore was somewhat limited; A hysterosalpingogram which showed an irregular tubal image suggestive of a cancer of the tube; Pelvic arteriography that made the signs of choriocarcinoma fairly clear. Discussion then developed in looking at the literature of those diagnostic features that are usually made. Most often this is by laparatomy when a ruptured extra-uterine pregnancy is suspected or when suspicion rests on a twisted ovarian cyst, a uterine fibroid, a tubo-ovarian abscess or blood in the peritoneal cavity in the third trimester of pregnancy, treatment, which is best given as a combination of surgery and chemotherapy, and pathogenic aetiology. It does seem that there are two principal mechanisms, the first being a malignant transformation of a tubal pregnancy, or a choriocarcinoma arising de novo without an ectopic pregnancy.

[Importance of arteriography in complicated trophoblastic disease]. / Intérêt de l'artériographie dans la maladie trophoblastique compliquée.

Sixty two patients with gestational trophoblastic disease were investigated and treated between January 1977-December 1983. The value of pelvic arteriography was examined. The cases included: 45 moles with a simple outcome. 14 cases of invasive trophoblastic neoplasia after evacuation of the mole. 3 choriocarcinomas after full term pregnancy. Pelvic arteriography was performed in 14 patients. 9 of the 14 patients presented with persistent HCG secretion 6 to 8 weeks after evacuation of the mole. Before chemotherapy was begun, we looked for unfavourable prognostic features such as extra-pelvic metastases, multiple pulmonary metastases, high HCG secretion, delay between the initial event and starting chemotherapy of more than six months. The Ishizuka score was calculated. Six arteriography type I readings suggested choriocarcinoma with an Ishizuka score above five. Double chemotherapy (oncovin-methotrexate) was started successfully (with a one year follow up). Only two patients had unfavourable factors. Two arteriography type III suggested persistent moles, with an Ishizuka score below five. Chemotherapy (only methotrexate) was successful). It was not possible to classify the last arteriography, so the patient was treated successfully with double chemotherapy. Three patients failed to recover with chemotherapy. Arteriography was indicated to determine the site of HCG secretion. Three hysterectomies were performed. Tissue choriocarcinoma was found. Two diagnoses of choriocarcinoma were confirmed by arteriography: In one case an unexplained pleurisy appeared six months after full term. HCG was then positive. In the other case, extrauterine pregnancy was first suspected, but the woman had not had intercourse for six months. Arteriography demonstrated tubal choriocarcinoma. So pelvic arteriography is useful for managing complicated gestational trophoblastic disease.