[Juvenile Parkinson's disease and recurring prematurity. Case report]. / Maladie de Parkinson juvénile et prématurité récidivante. A propos d'un cas.

The association of Parkinson's disease and pregnancy is very rare. Some thirty cases are found in the literature. We report the case of a pregnancy in a 30-year-old patient with juvenile Parkinson's disease. During this pregnancy treated by levodopa and bromocriptine, no aggravation of the symptoms was been observed. However, the pregnancy was complicated by a premature delivery at 31 weeks of amenorrhoea.

[A pregnant woman with a SAPHO syndrome]. / Grossesse chez une patiente présentant un syndrome de SAPHO.

The association SAPHO syndrome (Synovitis, Acne, Pustulosis, Hyperostosis, Osteitis) and pregnancy is very rare. Only one case is indexed in the literature. We report the case of a pregnancy in a 27-year-old patient with a SAPHO syndrome and we expose its history and its obstetrical, medical and anaesthetic following. Under this multi-field following, there was no evolutionary push of the disease neither during the pregnancy, nor in immediate postpartum. We will expose the different possible treatments during the pregnancy.

Concentration of benzydamine in vaginal mucosa following local application: an experimental and clinical study.

The results of an experimental and clinical study on the benzydamine binding and distribution in vaginal mucosa are presented, employing benzydamine solution for gynaecological use. When applied first to rats, the mean amount of the drug in their vaginal mucosa became 3.65 +/- 2.99 micrograms/g of fresh tissue with a significant difference between control and treated animals, without detectable amounts in the plasma. When applied to humans, the mean amount of benzydamine assayed in 17 specimens of vaginal mucosa was 9.72 +/- 6.24 micrograms/g. It was greater than the range of animal anti-inflammatory concentration (2-8 micrograms/g) established by pharmacological studies on this drug and justified the local benefits from benzydamine treatment of vaginal inflammation. Benzydamine assayed in seven volunteers with healthy vaginas showed that the drug cannot be detected in the plasma.

[Controlled trial of preventive treatment of preeclampsia. Preliminary results]. / Essai contrôle d'un traitement préventif de la prééclampsie. Résultats préliminaires.

We selected 100 patients at high risk for having preeclampsia and/or intrauterine growth retardation, on the basis of their past obstetrical history. At three months, they were randomly allocated to treatment group (group A) receiving dipyridamole (300 mg/day) and low dose aspirin (150 mg/day) until delivery, or control group (group B). Age and parity were similar in both groups. 90 patients have delivered at this time. The pregnancy was normal in 54% of patients in group A and 23% in group B (p less than 0.01). Preeclampsia occurred in 6 patients in group A, none in group B (p less than 0.01). Fetal loss occurred in 5 patients in group B, none in group A (p less than 0.01). Duration of pregnancy, as well as fetal and placental weights were significantly higher in group A, and IUGR significantly less frequent. It is concluded that inhibition of platelet aggregation, when used early in pregnancy, may have a significant protective effect against preeclampsia and IUGR in high risk subjects.

[Compliance with hormone replacement therapy in menopause: effect of an original education program. The COMET study]. / Observance du traitement hormonal substitutif de la ménopause: effet d'un programme d'éducation original. L'étude COMET.

OBJECTIVE: To study the impact of an original education program on compliance to hormone replacement therapy (HRT) in post-menopausal women. METHODS: Data were obtained from 1,192 post-menopausal women (age: 53 +/- 5 years) included in the study with an onset less than six months: E2 gel (n = 791) or patch (n = 401) + progestins, and randomized in either educational program (Ep = 600) or regular verbal counselling (VC = 592). A patient is considered bad compliant with HRT when she prematurely stopped the study, whatever the reason of the cessation. The groups EP and VC are homogeneous for the age distribution, the HRT regimen, the date of onset and the climateric symptoms scores. RESULTS: There is a significant difference between EP and VC groups in compliance, respectively 86 and 81% (p < 0.027). This difference is partially explained by the significant improvement in the patch subgroups (EP: 86% versus VC: 77%, p = 0.028). The trend observed in the gel group is not significant (EP: 85% and VC: 82%) due to the high level of compliance usually noticed in women treated with the gel and the verbal counselling. The significative difference in the compliance observed during the verbal counselling between the continuous (76%) and the sequential (86%, p = 0.001) HRT regimen disappears with the educational program (continuous: 84% and sequential: 87%, NS). CONCLUSION: This first large study on the HRT compliance in France, using a patient educational material, validates its efficacy to reach a better compliance than with regular verbal counselling. Even though in the daily practice, about 40% of the patients discontinue the treatment during the first year, 81% of the women followed in this study continue to receive the HRT after nine months of use. The original educational program of the COMET study improves significatively this high compliance (+ 5% from the verbal counselling). Thus, the combination of the doctor verbal counselling and an educational material is desirable to obtain a good compliance with HRT.

[An MRI study of the normal pelvis in the immediate postpartum period]. / Etude IRM du pelvis normal en post-partum immédiat.

PURPOSE: To describe the MR findings of the pelvis in the early post-partum period, after vaginal delivery or cesarean section. MATERIALS AND METHODS: Fifteen asymptomatic patients were imaged using a 1.5 Tesla MR unit between 1 and 7 days following delivery. Eight patients had a vaginal delivery, and seven patients had a cesarean section. RESULTS: The following items were evaluated: uterus size, architecture, and contents; uterine and abdominal wall scars; parametrium; peritoneal cavity; ovarian veins. CONCLUSION: MRI provided a good evaluation of the pelvic changes related to pregnancy and delivery. Knowledge of the normal findings should improve diagnosis of early post-partum complications.

[Causes, diagnosis and treatment of uterine perforations by intrauterine devices]. / Causes, diagnostic et traitement des perforations utérines par dispositifs intra-utérins.

Perforations of the uterus by intra-uterine devices (I.U.D.) are still at present serious complications. Their incidence is very varied and diverse because they are often asymptomatic. Pregnancy of a frequent circumstance under which they are discovered, as well as the more general way, which is the disappearance of the strings, which should always give rise to the suspicion that perforation has happened. There are two types to be distinguished from one another: Immediate perforation due to a faulty technique in insertion, secondary perforation due to gradual wearing down of the uterine wall. The factors predisposing to the occurrence of these accidents are numerous but notable among them are the date in the cycle when the insertion was done and above all the time in relationship to the last pregnancy, parity, the position of the uterus and the experience of the operator. Diagnosis of perforation is not always easy and may require not only radiological investigation without preliminary preparation but also hysterography, ultrasound examination and hysteroscopy. Withdrawal of a device that has perforated the uterus is advisable even if its migration has not given rise to any clinical symptoms. The technique for removing it varies often from case to cause between laparoscopy, laparotomy and culdotomy. Prevention of perforations should not only take into account the contra-indications to insertion but also knowledge of favourable factors, of a rigorous technique for insertion as well as clinical supervision in order to screen for secondary perforations.

[Ovarian tumors and cysts after 50 years of age. Retrospective study from 1979 to 1989 at the Foch hospital]. / Tumeurs et kystes ovariens après 50 ans. Etude rétrospective des années 1979 à 1989 au C.M.C. Foch.

This is a retrospective study carried out between the years 1979 and 1989 to look at the anatomopathology of tumours and ovarian cysts occurring in women over 50 years of age who had operations in our department. We found a raised incidence of malignant tumours (30%) when a late diagnosis is made (70% diagnosed at stages 3 and 4). There was a higher incidence of fibrothecomas (10%) along with the nine tumours. This is an important finding because functional cysts have only been found in non-menopausal women or in women who have recently had their menopause who have been taking hormone replacement therapy. Ovarian cysts in menopausal women are therefore primarily organic. This result makes it possible to outline a therapeutic regime specifically designed for the menopausal women. In effect the proposed treatment would either be laparoscopic surgery or laparotomy because it is very doubtful whether ultrasound puncture should be carried out because one cannot be sure that it is not a malignant cyst. The authors take the occasion of this study to view the complimentary tests that can be carried out for ovarian cysts. These are mainly ultrasounds and estimations of CA125. The therapeutic methods that are available are then transparietal cystectomy or intraperitoneal cystectomy or intraperitoneal cystectomy which means laparotomy with removal of the cyst.

[Gynecology and obstetrics in ancient Egypt]. / La gynécologie et l'obstétrique en Egypte antique.

We analyzed scriptural and archeologic sources of information concerning gynaecology and obstetrics as practiced in ancient Egypt. Knowledge of anatomy was rudimentary but precocious diagnosis of pregnancy was practiced. An obstetrical chair had been used since the VIth dynasty. The Egyptians were the first to describe prolapsus of the genital organs. The pessary was a known treatment. Spermicidal mixtures were used for contraception.

[Effects of a 19-norprogesterone derivative, the fourth decade nomegestrol acetate, on lipids]. / Effets sur les lipides d'un progestatif 19-norprégnane. Le nomégestrol acétate.

Dyslipidemia is a cardiovascular risk factor which commonly develops during forty. In Europe, progestins are frequently prescribed for treatment of perimenopausal symptoms in women in this age group, as well as in combination with estrogen replacement therapy in non hysterectomised postmenopausal women. Their complete metabolic tolerance is an important, even if non exclusive, factor to take in consideration for cardiovascular protection. Our aim was to review available data on the effects of a 19-norprogesterone derivative, nomegestrol acetate, on lipid tolerability. In healthy or at risk premenopausal women, clinical studies found no significant changes in lipid parameters (total, HDL and LDL cholesterol, triglycerides, apoprotein B, Lp(a) and LpA-I) with nomegestrol acetate administered in antigonadotropic sequence, alone or combined with estrogen in inverse sequence, during 6 to 9 cycles; there was only a small statistically significant decrease in apoprotein A1, probably due to the induced hypoestrogeny. In clinical studies carried out in postmenopausal women, nomegestrol acetate combined with estrogen replacement therapy in a sequential or continuous combined regimen, did not alter the beneficial estrogen-induced lipid profile: reductions in total and LDL cholesterol, apoprotein B and Lp(a); HDL cholesterol was unchanged and an increase in triglycerides occurred only with oral estrogens. A decrease in apoprotein A1 was found after six months of a cyclic sequential hormone replacement therapy but was associated with a beneficial increase in LpA-I. Nomegestrol acetate has proven its neutral effects on lipid metabolism and does not alter the beneficial estrogen-induced lipid effects.

[Acardiac twins]. / Les jumeaux acardiaques.

An acardiac twin in a multiple pregnancy initially develops normally and is a specific complication of monozygous multiple pregnancies. Development results from arterio-arterial and veno-venous anastomoses leading to predominance of one of the twins. The haemodynamic abnormalities in the dominated twin lead to the disappearance of the heart and major morphologic malformations. Outcome is generally unfavourable in 50% of the pregnancies with an acardiac twin. Complications in the healthy twin include heart failure, then hydramnios, and finally premature delivery which is the cause of most of the deaths. Proposed treatment currently relies on treating the heart failure in the healthy twin or interrupting vascularization between the two twins leading to in utero death of the acardiac twin. Antenatal diagnosis is made by echography and is useful for evaluating the prognosis for the pregnancy according to the growth of the acardiac twin.

[Parvovirus B19 infection and pregnancy]. / Infection à parvovirus B19 et grossesse.

Parvovirus B19 was identified in 1975. It causes infections megalerythemia in adults associated with skin eruptions and joint pain (about 50% of the adult population is immunized). The risk of contamination in case of an epidemia is high in school teachers and school personnel. In 1984, the parvovirus B19 was implicated as the cause of fetal anasarca. The risk of transplacental contamination is estimated at 33% in case of maternal infection. Pregnant women with parvovirus B19 infection and confirmed serology should have an echography every 15 days. Fetal anasarca can be complicated by in utero fetal death related to erythroid stem-cell anaemia. The diagnosis of fetal infection is based on PCR techniques on fetal blood. Symptomatic antenatal treatment with in utero transfusion was proposed as early as 1988. This method does not however appear to be necessary in all cases as the outcome in several reports of untreated fetuses was delivery of a normal child. There is the possibility of myocardial damage caused by parvovirus B19 which would make in utero transfusion difficult and limit its beneficial effect. Finally associated thrombopenia is often severe and increased fetal risk.

[Residual ovarian function after minidoses of estroprogestative agents]. / Etude de la fonction ovarienne résiduelle sous estroprogestatifs minidosés.

Levels of plasma 17 beta oestradiol, FSH and LH, were carried out on the 7th, 14th, 21st and 28th day of the cycle in three studies in order to evaluate the residual ovarian secretions under the influence of low-dose pills (30 micrograms of ethinyl-oestradiol and 150 micrograms of levonorgestrel). The studies consisted of: a preliminary study involving 5 women under the oestrogen/progestogen pills over more than 1 year; a comparative study of the three first cycles on the same preparation against a control cycle (5 women); a comparative crossover study of one cycle of the minidose oestrogen/progestogen preparation and one cycle of oestrogen/progestogen preparation with 50 micrograms of ethinyl-oestradiol (10 women). The results of these trials show that minidose oestrogen/progestogen preparations have a braking effect on the hypophysio-ovarian axis similar to that exerted by the higher dose pills.

[Smoking and pregnancy: survey among women enrolled in an independent worker insurance program]. / Tabac et grossesse. Etude de l'Assurance maladie des professions indépendantes en Ile-de-France.

OBJECTIVES: In order to further improve its prevention program entitled "Maternity childhood follow-up", the Paris region health insurance program for independent workers carried out a survey among female participants. The survey was designed to assess women's smoking behavior and evaluate reception of information concerning smoking-related risks and support available to stop smoking. The women's suggestions were also collected. MATERIALS AND METHODS: A questionnaire was sent by the physicians in charge of the Ile de France region to the 3525 women who had reported a pregnancy. RESULTS: 1099 answers were received (31%) The mean age of responders was 34.3 4.7 years. Their educational level was high (76% had a university degree). Before pregnancy, 37% were smokers. At the first trimester of pregnancy, 17% were smokers, 15% at the second trimester and 14% at the third trimester. Two years after childbirth, 20.5% were smokers. The proportion of women who stopped smoking was higher for those with a low Fagerström score. 29% of women said they did not receive any information about the harmful consequences of smoking. To cease smoking during pregnancy, 70% are helped by family and friends, 20% by health professionals; 3.5% took nicotine substitutes. CONCLUSION: This survey emphasises the need for improving information to pregnant women for alerting them to the dangers of smoking and for training the relevant health professionals.

[Study of amniotic fluid bacterial colonization sampled by amniocentesis in cases with premature rupture of membranes. Prospective multicenter study]. / Etude de la colonisation bactérienne du liquide amniotique prélevé par amniocentèse en cas de rupture prématurée des membranes. Etude prospective multicentrique.

OBJECTIVE: To determine the relationship between bacterial colonization of the amniotic fluid sampled by amniocentesis and premature rupture of the membranes. METHODS: A prospective multicentric study conducted over a one year period in 6 maternity wards in the suburban area of Paris. Thirty-six women with premature rupture of the membranes were studied. RESULTS: There were 11 patients (30%) with contaminated fluid at the first amniocentesis. Twenty-five patients had sterile fluid. In 7 patients with prolonged rupture for more than one week, repeated amniocentesis. Twenty-five patients had sterile fluid. In 7 patients with prolonged rupture for more than one week, repeated amniocenteses were used to follow bacterial colonization. In one patient, Proteus mirabilis in the amniotic fluid was eradicated by adapted antibiotic therapy. In patients with sterile amniotic fluid, there was no secondary colonization. In the 11 cases with colonized liquid, the vaginal swab could only be considered as positive in 4 cases. Amniocentesis was able to discover 7 bacterial colonizations of the amniotic fluid in patients with an indeterminant vaginal swab. Likewise, C-reactive protein levels were raised only in 26% of the cases with a colonized amniotic fluid.

[Risk of neonatal Streptococcus B infection]. / Risque infectieux néo-natal à streptocoque B.

23 cases of contamination with streptococcus group B have been seen after premature rupture of the membranes. Mothers and fetuses have been affected. The systematic study of swabs or liquor or cervical discharge carried out on the mother since the time her membranes had ruptured show that in 74 per cent of cases studied contamination existed within the first 24 hours. Giving antibiotics to the mother before delivery gave very variable results. These multiple tests, before and around the time of birth, made it possible to detect the children at risk of infection and to start antibiotic therapy with a narrow spectrum antibiotic of the type Penicillin G. The clinical progress of these children, which is usually favourable, gives no reason for postponing prophylactic cover antibiotic treatment when the membranes have ruptured prematurely.

[Morphine analgesia by the intrathecal route]. / Analgésie morphinique par voie intrathécale au cours de l'accouchement.

30 patients for whom an epidural injection using local anaesthesia was hazardous (deformed spine) or contra-indicated (allergic to local anaesthetic agents) received an injection of 0.008 mg cm-1 of morphine chlorhydrate intrathecally. Residual pain scored from 0 to 5 was 2.5 after 10 minutes and 1.5 after 25 minutes. Thereafter there was only a simple ache which was well tolerated right up to the time of delivery. Uterine action was not changed, which allowed 27 labours to be completed vaginally, of which 23 were without forceps. There was no haemodynamic change or respiratory depression, either immediately of later, in the mother nor in the infant (there were 26 Apgar scores of 9 or more). The ratio of plasma concentrations of morphine between the mother and the fetus using radio-immunological assays was inverted as time passed. These were at 6 mg ml-1 or less, which explains the medullary characteristic of the analgesia and the absence of general repercussions. The safety that is offered by the poor diffusion of substance between the fetus and the mother and the ability to prevent secondary effects (pruritus and headache) are features that make intrathecal analgesia and interesting alternative to a conduction block in labour.

[Antenatal diagnosis. 601 chromosome examinations (author's transl)]. / Diagnostic prénatal. 601 examens chromosomiques.

601 antenatal chromosome tests were carried out by culturing amniotic liquor. The fetal caryotype was abnormal in 18 cases (3.1 per cent). Most of the examinations were carried out because of advanced maternal age and they gave rise to the diagnosis of 15 abnormalities (3.3 per cent). It should be possible to carry out this kind of screening of patients over the age of 38.

[Acute cystitis in women over 50 years of age. Efficacy of pefloxacin with single dose and norfloxacin for 10 days]. / Cystite aiguë chez la femme de plus de 50 ans. Efficacité de la péfloxacine en dose unique et de la norfloxacine prescrite pendant 10 jours.

This multicentre, open, randomized trial, involving 482 patients and conducted by private practitioners, compared the effectiveness and safety of a single 800 mg dose of pefloxacin and of a 10 days' course of norfloxacin 400 mg bid. in the treatment of uncomplicated acute cystitis in women aged over 50 years. Clinical effectiveness was evaluated on days 17-19 and 28-32 respectively, and bacteriological effectiveness on days 15-17 and 26-28 respectively. The median time taken for the symptoms to disappear was 2 days with pefloxacin and 3 days with norfloxacin (P < 0.001). Irrespective of the nature of cystitis and the patients' age, no significant difference could be found in eradication of the pathogens. Undesirable side-effects were recorded in 7.8 percent of patients under pefloxacin and in 8.8 percent of those under norfloxacin (P = 0.68); gastrointestinal disorders were predominant. The acceptability of treatment, as judged by the patients themselves, was regarded as excellent by 55 percent of women treated with single dose pefloxacin and by 37.6 percent of those treated with norfloxacin (P = 0.001).

[Treatment of urinary incontinence by vaginal approach]. / Traitement de l'incontinence urinaire par voie vaginale.

The vaginal route is routinely used for surgical cure of exersion-induced urinary incontinence. This technique has the advantage of being rapid and easily performed during a short hospital stay. Long-term results however, have been debated. Certain factors have been identified in the literature which would affect long-term failure. These factors indicate that the "ideal" vaginal route should be based on the Burch operation starting at the upper portion and working downwardly. Finally, sphincter failure or detrusor instability must be eliminated before an operation for exertion-induced incontinence can be indicated since such a combination would modify the procedure.