[Pyoderma gangrenosum and breast cancer: a case report]. / Pyoderma gangrenosum et cancer du sein : à propos d'un cas.

The authors report a case of pyoderma gangrenosum (PG) following a breast lumpectomy for a relapse of a breast cancer. The treatment has associated a systemic corticosteroid therapy and local wound care with vacuum assisted closure Vacuum-Assisted Closure and skin graft.

[Pregnancy: a possible etiology of pyoderma gangrenosum. A case report and review of the literature]. / La grossesse: une étiologie possible du pyoderma gangrenosum. A propos d'un cas et revue de la littérature.

OBJECTIVE: We report an unusual case of pyoderma gangrenosum at 26 weeks gestation and review other cases reported in the literature in order to examine the underlying causes and determine the appropriate diagnostic and therapeutic approach to this uncommon skin disease. Patient and methods. The patient developed an acute abdominal syndrome at 26 weeks gestation (laparotomy was non contributive) followed by pyoderma gangrenosum of the abdominal wall. Seven other cases have been reported in the literature associating pyoderma gangrenosum with pregnancy. We analyzed the clinical findings in these cases. RESULTS: Corticosteroid therapy successfully controlled pyoderma gangrenosum in our patient. Pregnancy outcome was favorable with little effect on the newborn. Complete healing was achieved after several months of treatment. CONCLUSION: Histological lesions are nonspecific. Diagnosis of pyoderma gangrenosum is generally based on clinical signs. Systemic disease is associated in half the cases (inflammatory bowel disease, myelodysplastic syndrome, rheumatoid arthritis). The impact on pregnancy appears to be limited. Treatment is based on high-dose systemic corticosteroid therapy or cyclosporin. The two drugs may have to be combined. Search for an associated disease and appropriate treatment is particularly important for the outcome of pregnancy.

[Ovarian pregnancies: revaluation of diagnostic criteria]. / Grossesses ovariennes: réévaluation des critères diagnostiques.

OBJECTIVES: To clarify the clinical features of ovarian pregnancy and to show the incapacity of Spielberg's criteria to establish the diagnosis. MATERIAL AND METHOD: and method. Retrospective experience of ovarian pregnancies in a single maternity unit over seven years with comparison between new diagnostic criteria and those of Spiegelberg. RESULTS: Thirteen ovarian pregnancies identified (incidence=1 for 1400 deliveries). History of pelvic disease (one case), use of an IUCD (five cases), pelvic pain (all the cases), metrorrhagia (four cases), hemorrhagic shock (two cases). Diagnosis was evoked only once by ultrasound. Eleven patients were treated by laparoscopy. None of the ovarian pregnancies in the present series met the criteria of Spiegelberg's definition. CONCLUSION: Ovarian pregnancy is a rare form of ectopic pregnancy, but its incidence is certainly underestimated. Search for difficult to detect ultrasonographic features is essential. Criteria, other than those described by Spiegelberg, when present together confirm ovarian pregnancy: serum beta-hCG level > or = 1000 IU/l and uterine vacuity at vaginal ultrasonography; ovarian implication confirmed by surgical exploration, with bleeding, visualisation of chorionic villi or presence of an atypical cyst on the ovary; normal tubes; absence of serum beta-hCG after treatment of the ovary. Ovarian pregnancy does not compromise subsequent fertility of these patients. Recurrence is exceptional.

Adnexal torsion: a report on forty-five cases.

OBJECTIVES: To evaluate the clinical findings, evolution of treatment and ovarian function following conservative therapy. STUDY DESIGN: A case series of 45 patients presenting with adnexal torsion between January 1989 and June 1999. All patients were surgically treated, either conservatively or radically. Patients who had received conservative treatment, interviewed by phone and underwent ovarian sonographic examination. RESULTS: Adnexal torsion is more frequent in young women with adnexal pathology. Conservative therapy by laparoscopy has gained increasing preference as a surgical procedure. It is safe and preserves ovarian function. CONCLUSIONS: Conservative therapy by laparoscopy is recommended to preserve ovarian function in young women.

False aneurysm of the uterine pedicle: an uncommon cause of post-partum haemorrhage after caesarean section treated with selective arterial embolization.

We report three cases of post-partum haemorrhage following caesarean delivery attributed to a false aneurysm of the uterine pedicle and treated with artery embolization. These lesion were probably post-traumatic in origin related to hysterotomy. Angiographic study of the anterior division of hypogastric arteries confirmed the diagnosis and embolization of the false aneurysm was successful in controlling the haemorrhage.

Plasma progesterone kinetics following surgical treatment of ectopic pregnancies.

OBJECTIVES: Comparative study of plasma progesterone and betaHCG kinetics following surgical treatment of ectopic pregnancy. STUDY DESIGN: Prospective study involving 62 patients with tubal ectopic pregnancies. Study of the kinetics of plasma progesterone and betaHCG, and the correlation coefficient between plasma progesterone and betaHCG levels during post-operative follow-up. RESULTS: Thirty-nine patients were treated by salpingostomy and 23 by salpingectomy. Analyzing the betaHCG kinetics according to treatment revealed that both curves were convergent on day 2. Progesterone kinetics differed greatly in that they appeared "parallel and confused". Analyzing the correlation between betaHCG and progesterone levels proved the absence of a significant link. CONCLUSIONS: Studying the kinetics of plasma progesterone after surgical treatment of ectopic pregnancies revealed a fast decrease in progesterone. Statistical analysis of the progesterone concentration showed that post-operative kinetics is fully independent from that of betaHCG. Progesterone therefore cannot be substituted to betaHCG for post-operative follow-up.

[Influence of the type of breech presentation on delivery in selected primiparous women at term]. / Influence du mode de la présentation dans l'accouchement du siège chez la primipare à terme sélectionnée.

OBJECTIVE: Study the effect of the type of breech presentation on the prognosis of delivery in selected primiparous women at term. PATIENTS AND METHODS: We reviewed retrospectively 146 breech presentations seen between January 1, 1993 and December 12, 1999 in our unit. We limited our study to primiparous mothers at term (> or = 37 weeks gestation) who had had a normal single fetus pregnancy and who had accepted a trial of labor. We analyzed the mode of labor termination, and maternal, fetal, ovular, obstetrical and neonatal features by type of breech presentation and by type of delivery. We collected data by manual search of the patients' registered files (AUDIPOG). The chi-squared and Fisher's tests were used as appropriate for statistical analysis. RESULTS: Spontaneous vaginal delivery was achieved in 10.3% of the cases and non-spontaneous vaginal delivery in 56.2%. Cesarean section during labor was required in 33.5%. There was no significant difference between frank breech presentation (27.4%) and incomplete breech presentation (72.6%). Maternal, fetal, ovular, obstetrical and neonatal features were not significantly different. CONCLUSIONS: Unlike data reported by others, our series did not demonstrate any significant feature predictive of obstetrical and neonatal prognosis irrespective of the type of breech presentation in selected primiparous women at term who had had a normal pregnancy.

[Missed diagnosis of postpartum hemorrhage]. / Les hémorragies non-diagnostiquées du post-partum.

OBJECTIVE: The purpose of this work was to search for the reasons why the diagnosis of post-partum hemorrhage may be missed. PATIENTS AND METHODS: We reviewed retrospectively the files 5,517 vaginal delivery patients cared for in our Gynecology and Obstetrics Unit at the Rouen University Hospital between January 1, 1997 and September 30, 1999. Among these patients, 90 (1.63%) developed anemia during the post-partum period with a 10-point fall in the hematocrit from the pre-delivery level, which corresponds to a 1 liter loss of blood, but for whom no diagnosis of hemorrhage was made. We compared this group with the population of patients who had had a diagnosis of hemorrhage. The chi-squared or Fischer's exact text were used where appropriate to compare means and calculate z. RESULTS: Significant risk factors were: primiparity, anemia before delivery, labor induction, locorregional anesthesia, use of ocytocin, long labor with a long active phase, fever during labor, episiotomy and prolonged delay between delivery and onset of suture. CONCLUSIONS: Missed diagnosis appeared to be related to use of visual assessment to determine the degree of bleeding, a very mediocre indicator, particularly when no means of blood collection or quantification is used. In addition, factors having an impact on the development of hemorrhage should be revisited with particular attention given to primiparous patients.

Small for gestational age infant in association with maternal prothrombin gene variant (nt 20210A).

Most of disproportionate infants born small for gestational age (SGA) have an history of placental dysfunction with no explained cause. We report a case of an unexplained SGA infant with placental infarctions and thrombosis. Maternal thrombophilic disorder tests revealed that the patient was heterozygous for the A20210 prothrombin gene variant a newly identified thrombotic risk factor. It may be suggest that prothrombin gene variant, as factor V Leiden, could be a genetic risk factor for placental insufficiency.