Recurrent Mondor's breast disease -- Hormonal contraceptive involvement.

Mondor's disease can be a challenging diagnosis. The case we present is of a 29 year-old Brazilian woman, under combined hormonal contraception, who consulted for a painful lump on her right breast. She presented a complete resolution after a local treatment of heparinoid cream and a non-steroidal anti-inflammatory oral treatment, but relapsed 18 months later. Oral combined hormonal contraception was the only "risk factor" found, in this case, and the modification of the latter helped resolve the relapse clinical symptoms.

[Can medical treatment be the first-line treatment for most ectopic pregnancies? A series of 202 patients]. / Peut-on traiter 74 % des grossesses extra-utérines par un traitement médical ? A propos d'une série de 202 patientes.

OBJECTIVES: To assess the efficacy and safety of a liberal policy of medical treatment for ectopic pregnancies (EUP). MATERIAL AND METHODS: Retrospective study of EUP that received active management between January 1999 and December 2003. Patients with rupture or near-rupture and those who refused medical treatment received surgical treatment. Other patients were treated by methotrexate. RESULTS: Two hundred and two EUP were managed; 26 % were treated surgically, 74 % medically. The success rate of medical treatment was 83 %. A ss-hCG threshold of 2526 IU/l was selected. Under this level, the success rate was 90.7 % compared with 68 % when it was higher (p=0.001). Cardiac activity tripled the failure rate. Morbidity with medical treatment consisted of an augmentation in transaminases in 18.8 % and one case of severe dermatosis (0.7 %). Almost half of the patients treated medically required hospitalizations. CONCLUSION: The extension of medical treatment in our population to 74 % of all EUP yielded a high success rate, 83 %.

[Mid-term results of the grade 3-4 genital prolapse cure by vaginal route using a total hammock of porcine skin implant associated with bilateral sacro-spinofixation]. / Résultats à moyen terme du traitement par voie vaginale du prolapsus génital de grade 3 et 4 par hamac total de derme porcin associé à une sacro-spinofixation bilatérale.

OBJECTIVE: To evaluate the feasibility, morbidity and mid-term results of genital prolapse cure by vaginal route using a total hammock of porcine skin implant (Pelvicol) and bilateral sacro-spinofixation. PATIENTS AND METHODS: From May 2001 to June 2006, 101 patients with grade 3-4 genital prolapse, using the POPQ classification, were treated by vaginal route. One patient refused the use of porcine skin implant for religious reasons. Anterior fixation of the total hammock was performed by transobturator route and the posterior fixation was done on sacrospinous ligaments associated with a bilateral Richter operation. Intra- and postoperative complications, anatomical results, as well as global satisfaction, have been evaluated. RESULTS: The technique was always feasible. With a mean follow-up of 29 months, anatomical results were optimal in 73.3% while 16.8% of recurrences were observed. Mean operating time was 112+/-39 min (range: 40-310). Intraoperative complication rate was 4.9% (three bladder injuries, one rectal injury, one unfundibulo pelvic ligament injury during hysterectomy). Postoperative complication rate was 11.9% (four cases of urinary retention, one urethral plication and five pararectal haematomas including two cases requiring a second surgery complicated by an urethrovaginal fistula in one case and one urinary infection). With a mean follow-up of 29+/-12 months (74-12), optimal anatomical results and recurrence rate were 73.3 and 16.8%, respectively. Global satisfaction rate was 87.7%. This rate decreased to 60% for patients with a 4- to 6-year follow-up. CONCLUSION: Our results confirmed the feasibility of genital prolapse cure using a total hammock of porcine skin and bilateral sacro-spinofixation with a similar rate of complications to vaginal surgery without implant. However, anatomical results at mid-term raise the issue on the permanence of biological meshes.

[Guidelines for the follow-up of women treated for high-grade cervical neoplasia]. / Recommandations pour la surveillance des patientes traitées pour des lésions de haut grade du col utérin.

The women treated for CIN2-3 remain at a substantially increased risk of recurrences, which persists longer than 10 years. The women treated for a CIN2-3 are more likely to develop invasive cancer and the risk is two to five times greater than that of the general population. The main objective of the follow-up of patients treated for high-grade CIN is in one hand, to detect and treat the recurrences and on the other hand, to determine a subpopulation presenting a high risk of recurrence which should be followed-up more intensively. At present, frequent follow-up with cytology and colposcopic evaluation of the cervix is the preferred strategy recommended in France by Anaes. Both, the cytology and the colposcopy don't have a very good sensitivity. HPV test is more sensitive compared to cytology or colposcopy in detecting CIN treatment failures. It would be more prudent to use a strategy involving both the cytology and HPV test. Both the sensitivity and the negative predictive value of combined cytology and HPV testing in detecting a residual disease or recurrence are around 100%. Women presenting negative results of both tests, could, then be considered at a low risk of recurrence and their surveillance should be the same as that of the screening of the general population. In case of positivity a more intensive follow-up should be organized.

Use of the SF-36 questionnaire to predict quality-of-life improvement after laparoscopic colorectal resection for endometriosis.

BACKGROUND: Laparoscopic colorectal resection for endometriosis can improve quality of life (QOL), but the results vary widely from one woman to another. The aim of this study was to determine whether the preoperative results on the Physical Component Summary (PCS) and Mental Component Summary (MCS) subscales of the SF-36 questionnaire could predict the improvement in QOL after surgery. METHODS: The predictive value of the subscales was first evaluated on a training set of 57 patients. A mathematical model, quantified with respect to discrimination and calibration was then applied to the validation set of 36 patients. RESULTS: Women with preoperative PCS and MCS scores below 37.5 and 44.5, respectively, had 80.7% and 84.2% probabilities of seeing their scores improve after surgery, whereas women with preoperative scores above 46.5 and 47.5, respectively, had probabilities of 0% and 10.7% to improve their scores. CONCLUSIONS: With our mathematical model, the postoperative improvement in QOL can be reliably predicted. This model should help to identify those women who are most likely to benefit from this major surgery.

Surgical routes and complications of hysterectomy for benign disorders: a prospective observational study in French university hospitals.

BACKGROUND: Despite the advantages of the vaginal and laparoscopic approaches, most hysterectomies carried out involve laparotomy. The objective of this prospective observational multicentre study was to examine the routes and complications of hysterectomy for benign disorders. METHODS: Of the 15 university hospitals belonging to Collégiale de Gynécologie-Obstétrique de Paris-Ile de France, 12 participated in this study that took place between June and December 2004. We analysed the characteristics of the patients, the indications for hysterectomy and intra- and post-operative complications (and their determinants) according to the surgical approach. RESULTS: In total, 634 women underwent hysterectomy for benign disorders during the study period. The patients' mean age (+/-SD), BMI, parity and previous Caesarean sections were 51.4 +/- 10.3 years, 25 +/- 5.7 kg/m(2), 2 +/- 1.6 children and 0.2 +/- 0.6, respectively. Hysterectomy was performed by the laparoscopic, laparoscopically assisted vaginal hysterectomy (LAVH), laparotomic and vaginal routes in 19.1, 8.2, 24.4 and 48.3% of cases, respectively. The operating time was shorter with the vaginal route than with laparoscopy, laparotomy and LAVH (P < 0.0001). Intra- and post-operative complications were significantly more frequent in the laparotomic group (18%) compared with the vaginal group (8.2%), the laparoscopic group (5.8%) and the LAVH group (8.2%) (P < 0.0001). In a multivariate logistic regression model, obesity [odds ratio (OR): 2.84, 95% confidence interval (CI): 1.53-5.27, P = 0.001], history of pelvic surgery (OR: 2.47, 95% CI: 1.39-4.39, P = 0.002) and history of Caesarean section (OR: 2.04, 95% CI: 1.01-4.1, P = 0.046) were significantly associated with intra- and post-operative complications. Laparoconversion was necessary in 36 cases (7.5%) overall and was more frequent with laparoscopy and LAVH than with the vaginal route (P < 0.0001). CONCLUSIONS: This study confirms that the vaginal route is increasingly used for hysterectomy in France and that it is the route of choice for benign disorders.

[Accuracy of MR imaging combined with sonography for the diagnosis of persistent adnexal masses during pregnancy: about nine cases]. / Intérêt de l'IRM associée à l'échographie pour la caractérisation des masses annexielles persistantes au cours de la grossesse: à propos de neuf cas.

OBJECTIVE: To evaluate the accuracy of MR imaging combined with sonography for the diagnosis of persistent adnexal masses during pregnancy. PATIENTS AND METHODS: From January 1999 to November 2003, nine patients with a persistent adnexal masse were included in this retrospective study. All patients underwent both transvaginal and transabdominal sonography combined with MR imaging. Accuracy of imaging techniques was evaluated by comparison with histology. RESULTS: Adnexal masse was detected by systematic sonography in six women whereas three patients were symptomatic. Mean gestational age at the diagnosis was 17 weeks of amenorrhea (range 5-36). Mean tumor size was 96 mm (range 2-15). Two patients underwent a surgery during pregnancy; one for acute abdominal pain related to an adnexal torsion and the second for suspicion of malignancy. One patient underwent a caesarean delivery for obstetrical reasons. In all patients, benign ovarian tumours were found. For eight patients the diagnosis suspected by imaging techniques was confirmed by histology. DISCUSSION AND CONCLUSION: The combination of sonography and MR imaging allows diagnosing accurately adnexal masses during pregnancy.