[Ectopic pregnancy on tubal obstruction by bilharzia eggs at Meaux medical center (France)]. / Grossesse extra uterine et bilharziose genitale au centre hospitalier de Meaux (France).

Bilharzia is the world's second parasitic endemic and its genito-urinary lesions are well described. Ectopic pregnancies on tubal obstruction by bilharzia eggs are reported in African populations. Through a case of clinical observation we report an exceptional case of tubal erythema tubal bilharziasis in a French woman of origin but particularly affectionate by the African woman Africa south of the sahara. where she carries out humanitarian activities in countries in conflits (Democratic Republic Of Congo, Ivory Coast, and Mali).

La bilharziose est la seconde endémie parasitaire mondiale et ses atteintes génito-urinaires sont bien décrites. Les grossesses ectopiques sur salpingite bilharziennes ont rapportées dans les populations Africaines. Nous vous rapportons un cas exceptionnel. de grossesse extra-utérine sur bilharziose tubaire chez une française d'origine mais particulièrement affectionnée par l'Afrique au sud du saharienne où elle mène des activités humanitaires dans les pays Africains en conflits armées (République Démocratique Congo, Côte d'Ivoire, et Mali).

Sepsis due to Clostridium perfringens after pregnancy termination with feticide by cordocentesis: a case report.

We report a case of sepsis due to Clostridium perfringens after termination of pregnancy at 22 weeks with feticide by cordocentesis. Three weeks earlier, the 41-year-old patient had undergone an amniocentesis and a full trisomy 13 karyotype had been discovered. Feticide was performed by injection of thiopental and potassium chloride after percutaneous umbilical foetal blood sampling through the same needle. The patient delivered vaginally with signs of chorioamnionitis and septicaemia. She recovered under broad-spectrum antibiotherapy. C. perfringens was present in maternal blood cultures, placental smears and foetal organs. We discuss the possible mechanisms of infection by C. perfringens, including inoculation of intestinal germs.

Traceability of measurements of radioactivity and of amount of substance

Comparability of measurement results in space and time are highly desirable to observe whether differences are real, whether concordance of results is real and whether trends over time of the quantity measured, are significant. The metrological way to achieve this, is to make results 'traceable' to a common 'stated reference' (definition in the Vocabulaire International de Metrologie-VIM). This 'stated reference' should be (the value of) the relevant SI unit wherever and whenever possible. The latest traceability concepts for results of measurements of radioactivity and amount of substance are presented and critically compared for their similarity. Transparent and simple pictures of traceability chains are given, respecting the VIM definition.

Comparative performance study of ICP mass spectrometers by means of U "isotopic measurements".

The performance of four commercially available ICPMS instruments of three different types was compared by means of uranium "isotopic measurements". Examined were two quadrupole sector (different generation, different manufacturer), one single detector double focusing magnetic sector and one multiple collector double focusing magnetic sector instruments. The same samples of the IRMM-072 series were used under routine conditions to measure the 233U/235U and the 233U/238U ratios which, in these samples, vary over almost three orders of magnitude from approximately 1 to approximately 2 x 10(-3). Within expanded (k = 2) uncertainties, good agreement was observed between the certified values and the data internally corrected for mass-discrimination effects. The magnitude of the evaluated uncertainties was different for each type of instrument. With the multiple collector instrument, expanded uncertainties varied from +/- 0.04% to +/- 0.24% for the 233U/235U ratio, and from +/- 0.08% to +/- 0.27% for the 233U/238U ratio. They were approximately 1 to 5 times larger with the single detector magnetic sector instrument, and approximately 10 to 25 times larger with both quadrupole sector instruments. With the multiple collector instrument, repeatability of the measurements seemed to be limited by the difficulty of correcting properly for instrumental background, whereas with the single detector magnetic sector instrument the counting statistics was the only limitation (on smallest ratios). Apparent mass-discrimination was clearly found to be larger but more reproducible (and hence easier to correct for) in the case of magnetic sector instruments than for both quadrupole sector instruments. If space charge effects were the main source of mass-discrimination for all instruments, these results are in contradiction with the hypothesis of the size of mass-discrimination decreasing with the acceleration voltage. With the single detector magnetic sector instrument in particular (when operated by changing the ion energy only), our results pointed at more than only one major source of mass-discrimination, with variable size depending on the ratios measured.

"Demonstration" vs. "designation" of measurement competence: the need to link accreditation to metrology.

Formal acceptance of the results of chemical laboratories is increasingly organized through a) accreditation of measuring laboratories nationally and b) mutual recognition of accreditation internationally (through formal Multilateral Recognition Agreements, MRAs). However, real comparability of results of measurements is realized by using common (internationally agreed) measurement scales which make these results traceable to this scale, i.e. "traceable" to the same (internationally agreed) value of the unit of that scale. In addition, the criterion against which the evaluation is done, should be "external" to the measurement laboratories which are being evaluated. This is realized in IRMM's International Measurement Evaluation Programme (IMEP) where evaluation is performed against values which are anchored using "metrology", the science of measurement with its own rules, which offers a sound foundation for measurement in all scientific disciplines. It is argued in this paper that the demonstration of measurement capability against values on such scales provides a result-oriented rather than a procedure-oriented evaluation. Thus, competence can be "demonstrated" rather than just "designated" and this can be shown to both customers and regulators. It inspires more confidence.

[Use of ultrasonography as a first-line investigation of the uterus. Results of a prospective study]. / Utilisation de l'échographie avec accentuation de contraste comme examen de première intention dans l'exploration de la cavité utérine. Résultats d'une enquête prospective.

OBJECTIVE: To assess the effectiveness of hysterosonography as a first line investigation for uterine bleeding in perimenopausal women. METHODS: 185 women were enrolled in a prospective study. They underwent a hysterosonography indicated for abnormal uterine bleeding or follow-up of a treatment with tamoxifene. Patients with a normal cavity or atrophia were scheduled for a diagnostic hysteroscopy or a hormonal therapy. Patients with uterine cavity abnormalities were scheduled for surgery (operative hysteroscopy or hysterectomy). All the patients were clinically followed after the hysterosonography or the surgery. Results of hysterosonography were compared to data issued from the clinical follow-up or to pathological results when available. RESULTS: Hysterosonography was achieved in 179 patients. In all but 1 case, hysterosonography was well tolerated by the patients. We had no complication during or after the examination. Hysterosonography had a high sensitivity and specificity in the discrimination of women with normal cavity or atrophia from the ones with intrauterine lesions (respectively 96.4% and 98.3%). Hysterosonography was also accurate in the distinction of polyps from sub-mucosal myomas (sensitivity 88.2 à 90.3%, specificity: 98.6 à 95%). The measurement and localization of the lesions were accurate in an equal manner with both procedures. Hysterosonography had similar results in women treated with tamoxifene, but the failure frequency was significantly higher (13% vs 1.8%) (p < 0.05). CONCLUSIONS: Hysterosonography appears as a reliable tool for the investigation of abnormal uterine bleeding in perimenopausal women. It can distinguish women who just need a medical therapy from the ones who will require a surgical exploration. It is easy to learn, and well tolerated by the women. Hysterosonography is more sensitive and specific than transvaginal sonography in the follow-up of patients treated with Tamoxifene.

Stability studies and purification procedure for nitrite solutions in view of the preparation of isotopic reference materials.

The lack of reference materials, accurately certified for nitrite, is a problem in view of the importance of this species for environmental and medical reasons. This work outlines a plan for the preparation of nitrite isotopic reference materials (IRMs) in the form of high purity solutions, certified for their nitrite-nitrogen isotopic composition and nitrite concentration. To achieve the desired accuracy (expanded uncertainty U with a coverage factor k=2 of

Microscale Synthesis of Fe(PF(3))(5) for Gas Source Mass Spectrometry.

Down-scaling of a cocondensation method to produce volatile pentakis(trifluorophosphine)iron(0) for measuring isotope ratios by gas source mass spectrometry is described. Starting from 10 mg of iron, this method allows synthesis of a sufficient amount of Fe(PF(3))(5) that can be used to measure iron content and/or isotope ratios in real-life samples. The advantage over thermal ionisation mass spectrometry is that more precise determinations of ratios/amounts are possible. Reproducibilities for n((54)Fe)/n((56)Fe) and n((57)Fe)/n((56)Fe) are (1-3) × 10(-4), while those obtained by thermal ionization mass spectrometry are at the 10(-3) level.

Saline contrast sonohysterography as first-line investigation for women with uterine bleeding.

The objective of this study was to assess the effectiveness of saline contrast sonohysterography (SCSH) as a first-line investigation for perimenopausal women with uterine bleeding. A total of 162 women were enrolled in a prospective study. They underwent SCSH indicated for abnormal uterine bleeding. Patients with normal or atrophic endometrium were scheduled for diagnostic hysteroscopy or hormone therapy. Patients with uterine cavity abnormalities were scheduled for surgery (operative hysteroscopy or hysterectomy). A clinical follow-up was obtained for all the patients after SCSH. Sonohysterographic findings were compared with pathological results. SCSH was carried out in 159 patients. In all but one case, the procedure was well tolerated by the patients. There were no complications either during or after the examination. Surgical and pathological results were available in 109 cases. SCSH was highly sensitive and specific in the differentiation between women with intrauterine lesions and those with normal or atrophic endometrium (98.9% and 76.4%, respectively). SCSH was also accurate in the diagnosis of polyps and submucosal myomas (sensitivity 87.8 and 89.6%, specifically 90.7 and 95%). SCSH and surgery displayed the same reliability in the measurement and the localization of the lesions. SCSH recognized endometrial cancer in only 40% of cases. However, all these patients had abnormalities at sonohysterography which indicated a surgical exploration, leading to a zero false-negative rate. Saline contrast sonohysterography appears to be a reliable tool for the investigation of abnormal uterine bleeding in perimenopausal women. It can distinguish women who only require medical therapy from those who require surgery. The method is easy to learn, and is well tolerated by the patients.

[Lymphatic drainage of the uterus. Preliminary results of an experimental study]. / Drainage lymphatique de l'utérus. Résultats préliminaires d'une etude expérimentale.

We carried out an experimental study on the lymphatic drainage of the uterus in 11 female cadavers. We performed 5 injections of a colored fluid in the corpus uterinum and 6 in the cervix. We observed 2 main routes along the external iliac vessels. The first was anterior and drains the lower limb. The second is medial and posterior to the external iliac vessels and drained the uterus (2.4 lymph nodes/side). The number and location of the lymph nodes varied between subjects but also in the same subject (45.5% of cases). The cervix was essentially drained to lymph nodes located on the posterior aspect of the external iliac vein, especially near the hypogastric artery origin. We did not observe any direct connexion between the cervix and the para-aortic area. The corpus uterinum was drained to the lymph nodes located in the lateral part of the parametrium and or under the external iliac vein. One other main route ran along the infudibulo-pelvic ligament. These findings confirm that the first lymph nodes metastases of the cervical carcinoma are under the external iliac vein. and particularly near the hypogastric artery. On the other hand, endometrial carcinomas spread along two lymphatic connections: one extending to the external iliac area and another to the para-aortic area. These results have to be considered in order to define lymphadenectomy margins for these cancers.

Microinvasive carcinoma of the cervix. Rationale for conservative treatment in early squamous cell carcinoma.

Numerous definitions of microinvasive carcinoma (MIC) have been proposed. Taking into account that a classification must be a guide for the evaluation of prognosis and treatment, the authors reviewed the risk of spread in MIC. Two major prognostic factors can be identified in the literature: the volume of the lesion and the presence of capillary-like space involvement (LVI). The former item is generally assessed by the depth of invasion. Two kinds of MIC can be distinguished. Those with stromal invasion under 3 mm and without LVI, and those with invasion over 3.1 mm depth or LVI. The former have little risk of parametrial and nodal involvement and a high rate of survival. The latter have a greater risk of spread beyond the cervix and many authors now consider them as true invasive cancers. The Society of Gynaecologic Oncologists (SGO) definition seems more reliable. For lesions invading the stroma within 3 mm, treatment can be limited to a standard hysterectomy with good results. Some authors have proposed more conservative therapy such as conization. This procedure could be desirable for young women who want to preserve their anatomical integrity, fertility and sexual function. In selected cases, short term results are similar to those of hysterectomy but there is a lack of controlled studies with long term follow-up.

Traceable values for nitrate in water samples by isotope dilution analysis using a small thermionic quadrupole mass spectrometer.

An isotope dilution mass spectrometric procedure was developed for the determination of nitrate in water samples. The isotope dilution experiments were carried out using the Institute for Reference Materials and Measurements's 15N-enriched nitrate spike reference material IRMM-627. Nitrate was isolated from the matrix by precipitating it as nitron nitrate, from which emission of negative thermal NO2-ions was found to be best. The ions were produced in the ion source of a small, low-cost, easy-to-handle thermionic quadrupole mass spectrometer equipped with a secondary electron multiplier coupled to an ion counter. The procedure developed was applied to the measurement of nitrate in a certified reference material (stimulated rainwater, CRM 409 from Community Bureau of Reference), in sparkling mineral water, and in tap water. Results were compared with those obtained using ion chromatography. Good agreement (within 1%) was found between the concentration determined by isotope dilution mass spectrometry, the values from ion chromatography, and the certified value. The procedure developed allowed accurate and traceable determinations of nitrate in water samples, with an expanded uncertainty (coverage factor k = 2) of 2-5%, and the detection limit was found to be 2 mumol kg-1.

Varicella and pregnancy.

OBJECTIVE: To appreciate the risk of embryo-foetopathy in case of maternal varicella occurring before 20 weeks of gestation, as well as the maternal complication risk (notably pulmonary) in case of maternal varicella occurring the third trimester of pregnancy. METHOD: Over the period from January 1987 to February 1995, 20 patients were managed for maternal varicella confirmed during the pregnancy. From these observations, the authors, by studying the literature, attempt to better specify the real fetal and/or maternal complication risk in case of maternal varicella. RESULTS: In their personal series of 20 cases, including 17 before 20 weeks of gestation, the authors have noted no embryo-foetopathy. Similarly, no maternal complication (notably pulmonary complication), has been found. Careful study of the literature allows to specify some points. In case of varicella before 20 weeks, one observes an identical frequency of spontaneous abortions, as compared to the general population and a moderated increase of the frequency of premature delivery. The risk of congenital varicella syndrome reaches about 1.3%. Finally the risk of neonatal varicella consists in a maternal infection which occurs during the perinatal period and which is source of a high perinatal morbidity. The prenatal diagnosis is based essentially and currently, on the amniocentesis with viral research by polymerase chain reaction (PCR) in the amniotic fluid, completed by a ultrasound supervision. CONCLUSION: The occurrence of maternal varicella during the pregnancy is rare (0.7/1000) because more than 90% of women are immunized. The risk of congenital varicella syndrome is limited to the 20 first weeks and seems very weak, authorizing therapists to reassure patients presenting a varicella during their pregnancy. Nevertheless, the risk of pulmonary complications for the mother, in case of varicella during the third trimester, does exist and requires appropriated treatment.

The IRMM--International Measurement Evaluation Program (IMEP). IMEP-3--trace elements in synthetic and natural water.

The aim of the IRMM--International Measurement Evaluation Program (IMEP) is to test out a possible realization of international measurement comparability for field laboratories through traceability of their measurements to the SI Unit for amount of substance: the mole. In IMEP-3, 10 different trace elements, B, Ca, Cd, Cu, Fe, K, Li, Pb, Rb, and Zn, were determined in a synthetic and a natural water by participating laboratories using their routine methods and graphically compared (in coded form) to certified values, established by IRMM and NIST using an isotope-specific method (Isotope Dilution Mass Spectrometry, Neutron Activation Analysis). The number of participants was 70; 64 laboratories have reported results. The results show a spread of more than 50% asymmetrically around the certified value. The Youden graphs allow evaluation of the overall performance of the laboratories in the IMEP-3 round.

[The "hazards" of using a Gore-Tex sling in the treatment of stress urinary incontinence]. / Les "aléas" de l'utilisation d'une fronde de Gore-Tex dans le traitement de l'incontinence urinaire d'effort.

OBJECTIVE: To analyze the use of the Gore-Tex in the treatment of exertion incontinence. METHODS: During 1991, two gynecology units used the Mouchel technique and a Goebell-Stoeckel type technique in 72 patients with exertion incontinence, alone in 36 and in combination with a cure for prolapsus in 36 others. Results were analyzed with the chi 2 squared test and the Student's test for paired series. RESULTS: The rate of incontinence was 65% with a range from 60 to 66.7% according to the type of technique used and whether a cure for prolapsus was also performed. Gore-Tex was not well tolerated in 23/72 cases. Rejection was seen in 20 to 37.5% according to the type of vaginal suture and the type of protection. CONCLUSION: The high rate of rejection suggests prudence in using Gore-Tex.

[Prenatal diagnosis of hepatic hemangioendothelioma. Apropos of a case]. / Diagnostic anténatal d'un hémangioendothéliome hépatique. A propos d'une observation.

An antenatal echography performed at 32 weeks of amenorrhoea revealed a formation in the liver. Other tests during the antenatal period were unable to provide an exact diagnosis which was only established after exploratory laparotomy after birth. A review of the literature showed that this hepatic tumour has been diagnosed in 3 reported cases antenatally. Haemangioendothelioma occurring during the antenatal period is difficult to diagnose and the severe forms discovered by echography have a poor prognosis.

Letter to the Editor: New Values for Silicon Reference Materials, Certified for Isotope Abundance Ratios.

New isotope abundance and relative atomic mass (atomic weight) values - with low, hitherto unattained uncertainty - are reported for two previously described silicon reference materials using a well-known method with an improved isotope-ratio mass spectrometer. These new values are directly traceable to the SI, more specifically to the unit for amount of substance, the mole, and independent of the SI unit of mass and of the Avogadro constant. Besides the residual mass-spectrometric uncertainties, these new values depend in effect only on a recently published direct comparison of the cyclotron frequency in a Penning trap of 28Si+ with that of 12C+.

Letter to the Editor: Silicon Reference Materials Certified for Isotope Abundances.

In a series of gas mass-spectrometric measurements performed near the highest attainable accuracy, samples from two highly homogeneous batches of silicon crystals and silica powder were compared directly with a synthetic mixture of the three stable isotopes of silicon. Thereby, this work not only established the "absolute" atomic weight of these batches, but also makes portions of these batches available as an Isotopie Reference Material for accurate isotopic abundance measurements in geochemical and other isotope-abundance studies of silicon.