[Sensitivity and specificity of meta-iodobenzylguanidine (mIBG) scintigraphy in the evaluation of neuroblastoma: analysis of 115 cases]. / Sensibilité et spécificité de la scintigraphie à la méta-iodobenzylguanidine (mIBG) dans l'exploration des neuroblastomes: analyse de 115 examens.

Seventy children (3.7 +/- 3.3 y) with definitely confirmed diagnosis of neuroblastoma had 115 whole body scans carried out 24 h after injection of 3.7 MBq/kg of I-123 mIBG (83 scans) or 0.7 MBq/kg of I-131 mIBG (17 scans) or 0.9 to 4.5 GBq of I-131 mIBG (15 post-therapeutic scans). The scans were interpreted as positive in the presence of any non-physiological uptake area or of any bone uptake of the tracer, even at the level of the metaphyseal complex. For the primary tumour, the sensitivity of mIBG scans was 73%. Ten false negative patients had an overlap of the tumour with the bladder or heart images (4 cases) or with positive metastatic images (6 cases: liver, spine). Three false negative patients had neuroblastomas which did not secrete catecholamines. The specificity of mIBG was 94%. In our opinion, mIBG scans have a complementary role to assess the activity of post-therapeutic remnants. For the detection of hepatic and lymph node metastases, the sensitivity was about 50% and the specificity was 100%. The standard used for the detection of bone marrow metastases was the cytological and histological examination of 10 bone marrow aspirations and one or more biopsies (CHBMS). The sensitivity of mIBG scans was 90% and the specificity 68%. However, reviewing the data from the 16 false positive scans, we found 11 definitely proven bone metastases, 3 biological relapses and 2 cases of delayed abnormal CHBMS supporting the positivity of the mIBG scans, raising the specificity to 100%. Tc-99m diphosphonate bone scans had a sensitivity of 78% and a specificity of 51%. We suggest that positive mIBG scans may save other procedures since our data do not support false positive detection of bone or bone marrow metastases. In contrast, patients with negative mIBG findings should be further explored.

Can the number of cesarean sections be reduced without risk? An analysis of rates and indications in a university clinic.

This study concerns women followed from the first trimester of pregnancy, in a university clinic in Paris in 1977, 1979 and 1981. The cesarean section rate was separately analysed for primiparas, and multiparas with and without previous cesarean section. The overall rate of cesarean section was 11.4% in 1977, 17.2% in 1979 and 21.1% in 1981. The 9.6% increase observed between 1977 and 1981 is mainly attributable to an increase in primary cesarean section, particularly among primiparas, between 1977 and 1979. This does not seem to have arisen from sample variations. There is a change in obstetrical attitude and more cesarean sections are performed in cases of hypertension, breech presentation or intrauterine growth retardation. The greater number of previously sectioned women explains the increase in the rate between 1979 and 1981. The main fact among primiparas is the 18.8% increase in diagnosis of dynamic dystocia between 1979 and 1981. Three key areas allow us to envisage a reduction in cesarean section rate: obstetrical attitude towards previous cesarean section, breech presentation, and management of labor, whose perturbations lead to diagnosis of dynamic dystocia.

[Fetal hypotrophy. Statistical analysis of placental changes]. / L'hypotrophie foetale. Analyse statistique des modifications placentaires.

The purpose of this research was to study the relationship between placental characteristics and the degree of failure of growth between 37 and 41 weeks of pregnancy. The cases of severe small-for-dates (percentiles of 1 to 5) and moderate small-for-dates (percentiles of 6 to 10) were compared with a control series (percentiles of 11 to 90) with an equivalent gestational age. In both groups of small-for-dates babies one could find that the chorionic arteries and their trunks were of a lower diameter than those of the villi that were small and that there were sub- chorial deposits of fibrin in both groups. The greater number of placental abnormalities were found in those babies who were severely small-for-dates at a gestational age of between 37 and 39 weeks. The relationship between acute fetal distress and small for dates was analysed. There was little difference in the likelihood of fetal distress between the two groups of small-for-dates babies, but there were differences between both groups and the control group.

Fetal growth retardation in gestational hypertension: relationships with blood pressure levels and the time of onset of hypertension.

To evaluate the effects of gestational hypertension on fetal growth, we studied the standardized records of 2996 single live-birth pregnancies. Mothers all had documented diastolic blood pressure of less than 85 mmHg before the 16th wk of amenorrhea and no history of pre-pregnancy hypertension or kidney disease. Diastolic blood pressure readings exceeding 84 mmHg were found later in pregnancy in 38.4% of the mothers, and were associated with an increased number of small-for gestational-age infants: 3.2% in mothers whose diastolic blood pressure had never reached 85 mmHg, 6.3% when peak diastolic blood pressure had been in the 85-94 mmHg range, and 8.5% when it had exceeded 94 mmHg (p less than 0.01). In mothers who had had one or more diastolic readings of more than 84 mmHg, and for all peak diastolic pressures, the rate of small-for-gestational-age infants was higher when hypertension had begun early in third trimester (between the 27th and 36th wk), than in the second trimester or later than the 35th wk (10.2% compared to 5.6 and 6.1% respectively, p = 0.02). This temporal reinforcement of the adverse fetal effects of hypertension when it began in the early third trimester was not explained by differences in the incidence of proteinuria or in maternal age, parity, obstetric history or smoking habits.

[Incidence and fetal impact of hypertension in pregnancy: study of 2996 pregnancies]. / Incidence et conséquences foetales de l'hypertension gravidique: étude de 2996 grossesses.

To evaluate the incidence and the foetal effects of gestational hypertension, we studied 2 996 pregnancies with a single live birth in mothers selected on the basis of 1) a documented diastolic blood pressure (DBP) less than 90 mmHg before the 16th week of amenorrhea and 2) no history of hypertension or kidney disease. In 38,4% of the gravidas, the highest DBP during pregnancy was greater than or equal to 90 mmHg, and in 15,4% this level was reached twice or more. Gestational hypertension (two DBP readings greater than or equal to 90 mmHg) was more frequent in nullipara than in mothers with previous pregnancies (17,9 versus 12,4%, p less than 0,01) and its incidence tended to decrease with increasing maternal age. Irrespective of parity or maternal age, a significant increase in the percentage of small for gestational age infants was associated with increasing DBP levels: 3,2, 6,4 and 8,5% when the highest recorded DBP was less than 90 mmHg, equal to 90 mmHg (even at one single reading), or greater than or equal to 100 mmHg respectively (p less than 0,001). Very similar percentages were obtained in non-proteinuric pregnancies: 3,3, 6,5 and 7,8 respectively (p less than 0.001). Non-proteinuric gestational hypertension, even mild or transitory, is indicative of a high risk pregnancy and requires close medical supervision.

[A study of the prognosis at one year after restorative tubal surgery in the treatment of sterility (author's transl)]. / Etude du pronostic à un an de la chirurgie tubaire restauratrice dans le traitement de la stérilité.

A cooperative study has been carried out on 301 women who were operated on for tubal sterility in 9 centres in different countries between 1969 and 1974. 19 per cent of these started an intra-uterine pregnancy and 4 per cent an extra-uterine pregnancy during the first year they were followed up. The results reaffirm the poor prognosis of genital tuberculosis, of tubal blocks found on hysterosalpingography and of adhesions discovered on laparoscopy. If the type of operation has little relationship to the results, these do change according to the treatment given around the time of operation. There were more intra-uterine pregnancies in women who had treatment systemically with corticoids and with antibiotics than in those who only had corticotherapy locally. This result has been confirmed when results have been compared taking into account the Centre where the operation was carried out and the type of lesions that were discovered on hysterosalpingography and on laparoscopy.

[The evolution of perinatal pathology and its prevention in France. The national enquiries by INSERM in 1972-1976 (author's transl)]. / Evolution de la pathologie périnatale et de la prévention en France. Enquêtes nationales INSERM 1972-1976.

Two national enquiries were carried out in France by INSERM in 1972 and in 1975-76 in order to review the efficiency of using medical discoveries and health programmes. The first was carried out on a representative sample of 11,254 deliveries and the second on a representative sample of 4,685 deliveries. The perinatal mortality rate and the prematurity rate have gone down quite definitely, while on the other hand the birth weight has stayed more or less identically the same and the number of small-for-dates babies has not become less and in fact there is a slight tendency for a rise in the number. Antenatal care has improved considerably for most women, without the idea of high risk factors having really become integrated. The number of maternity units with fewer than 15 beds has considerably dropped, especially in the private sector. Monitoring of labour and of the newborn has shown a certain progress. These changes exist in a family context which is evolving with more planned pregnancies and a slight improvement in the social and cultural conditions of parents.

[Feto-infantile births and deaths. Statistical data]. / Naissances et morts foeto-infantiles Données statistiques

After a period of stability between 1968 and 1971 the birth-rate was lowered slightly in 1972-1973. The first projections worked out by INSEE lead us to predict that there will be a considerable drop in the number of births in 1974 (800, 000 as against 855,000 in 1973). Perinatal mortality has dropped rapidly since 1969. The rate for France is now better than that for Scotland or the Federal German Republic and is catching up on England. It is however still far behind the rates for the Scandinavian countries and Holland and Belgium.

[Study of surveillance of women using contraception]. / Enquete de surveillance de femmes sous contraception.

PIP: The results of contraceptive prescription for 1666 French women by 10 physicians are compiled from files covering 1969-1971. 736 women began in 1969-1970; 242 used the same method 1 year or more; 414 discontinued; 80 changed their method in the first 11 months. Comparing those starting in 1971 with the others, there were few significant differences: the 1971 groups more often tended to be married, housewives, recently delivered, and to choose pills. In general the group using pills were young, students or professional women, while those choosing IUDs were multiparas, married and housewives. 1030 chose pills, of whom 201 had side effects or complications such as: bleeding (27), nausea (17), liver disorders (19), weight gain (33), nervousness (27) and decreased libido (16). 442 women received 8 types of IUDs. Th ere were 59 expulsions, 49 with spotting and 25 with pain. Overall there were 359 dropouts, no accidental pregnancies in pill users, 9 pregnancies with IUDs, 6 pregnancies after expulsion of IUDs and 9 pregnancies with diaphrahms.^ieng

[Follow-up survey of women under contraception]. / Enquete de surveillance de femmes sous contraception.

PIP: Records of 908 patients of 10 Parisian gynecologists are included in these preliminary results of an ongoing 3-year survey of patient characteristics and consequences of contraception in France. The population averaged 26.8 years, parity 1.1; 39% were single, 21% not working, 15% students, the rest working. These characteristics, and the methods chosen, differed widely among patients of different physicians. 55.5% first chose pills, 26% IUDs, 18.5% chose diaphragm; of these, 28 pill patients, 11 IUD patients and 13 diaphragm patients then chose another method. The second choices were pills by 17, IUDs by 15, and diaphragms by 20. Those who chose pills tended to be single, working, nulliparas, and without previous contraceptive history. IUD and diaphragm users were similar in these characteristics. 7 types of IUDs (61% Corolle, 25% Saf-T-Coil, 16% Omega, 11% Trefle, 10% Sterilem, 6% Lippes loop, 1% Canel) resulted in 23 (9.7%) patients with bleeding side effects and 17 (7.1%) expulsions. 75% of pill patients took Stediril, 25% took 12 other types. Chief complications were weight gain in 11 (1%), nervousness or depression in 11, bleeding in 7, and nausea in 7. There were 7 accidental pregnancies, 2 with IUDs in place, 1 after expulsion (3.5% Pearl index), 4 pregnancies with diaphragm (11.06% Pearl index), and 2 unplanned pregnancies after the women stopped their pill and diaphragm because of their partner's objections.^ieng