[Smoking and ectopic pregnancy: is there a causal relationship?]. / Tabac et grossesse extra-utérine: y a-t-il un lien de causalité?

Tobacco smoking is often studied as a risk factor in epidemiology. The impact on fertility and pregnancy is significant. At conception, maternal smoking may have an effect on the occurrence of ectopic pregnancy. Experimental studies on hamsters show interactions between tobacco and the oviduct. These interactions may explain the role of tobacco in ectopic pregnancy. Eleven case-control studies compared smoking in two groups of women: a cases group with ectopic pregnancy, and a control group. Ten of them found a relationship between tobacco smoking and ectopic pregnancy (increased relative risk). Considering this results, we must encourage women to reduce or better to stop smoking.

[Operative termination of pregnancy between 12 and 14 weeks' gestation: influence of the operator's experience]. / Particularités techniques de l'IVG instrumentale entre 12 et 14 semaines d'aménorrhée: influence de l'expérience de l'opérateur.

OBJECTIVE: To assess the feasibility of operative termination of pregnancy between 12 and 14 weeks of gestation and the role of the operator's experience in physicians previously unfamiliar to this technique. MATERIALS AND METHODS: A prospective study of 251 operative terminations of pregnancy, from July 1st, 2001 to January 31st, 2002, and from May 1st, 2002 to October 31st, 2002, in order to assess the role of operator's experience. 104 terminations between 12 and 14 weeks were compared to 147 terminations at earlier gestational ages. All patients received cervical ripening with 400 mcg oral misoprostol 3-4 hours before operation performed under general anesthesia. Evaluation criteria were: duration of operation, need for use of forceps, and complications: uterine perforation, cervical laceration, bleeding > 500 ml and need for blood transfusion. RESULTS: There was no difference in the rate of operative complications between terminations before and after 12 weeks. The duration of operation was slightly longer after 12 weeks than before (12.9 +/- 6.7 min versus 11.1 +/- 2.8 min.; p < 0.05). Forceps use was 0.7% before 12 weeks, 20% between 12 and 13 weeks, and 59% between 13 and 14 weeks (p < 0.01). There was no difference in the complication rate or in the need for forceps according to the operator's experience. The perceived difficulty in cervical dilatation was higher in early experience than in experimented operators (19.6% versus 5.2%; p < 0.05). CONCLUSION: Operative termination of pregnancy is technically feasible beyond 12 weeks without dramatic increase in operative complications. Technical skill can be acquired in a short time interval.

[Atypical lipomatous tumour of the vulva. About one case]. / Tumeur adipeuse atypique de la vulve. A propos d'un cas.

Liposarcoma of the vulva is a rare entity. This unusual localization with atypical clinical and histological appearance may induce diagnostic and treatment delay. We report the 13th case shown in the literature in a 31-year-old woman initially treated for a vulvar lipoma. Arguments based on clinical short term recurrence, histological infiltrating adipocytes, and cytogenentical findings evoked well-differentiated liposarcoma. Even though cytogenetic abnormalities, involving MDM2 and CDK4 genes, have been found, a certainty in malignity diagnosis could be difficult. In these cases, treatment decision may be uneasy. This case report recalls difficulties encountered in uterine hypercellular leiomyomas.

[In utero treatment of fetal tachycardias with a digitalis-beta blocker combination. Apropos of 2 cases]. / Traitement in utero des tachycardies foetales par l'association digitalique-bêta-bloquant. A propos de deux cas.

The authors report two cases of fetal tachycardia treated in utero by digitalis (Digoxin) and a beta-blocker (Sotalol). The first case did well on treatment but the second case gave rise to difficulties in treatment both before and after delivery. A study of the literature and an analysis of our findings makes it possible for us to point out the following: echotomography is valuable in screening for fetal cardiac rhythm troubles and echocardiography is useful to work out the cause and to follow the progress of the case, this condition can be treated in utero and Sotalol, a beta-blocker, is valuable in overcoming the troubles of the rhythm, it is difficult to follow up the treatment by relying on maternal blood levels of the drugs used, finally the cause of the abnormal rhythm possibly alters the expectation of success from the treatment.

Laparoscopic management of borderline ovarian tumors: results of a French multicenter study.

BACKGROUND: Laparoscopy in the management of women with borderline ovarian tumors remains controversial. We therefore evaluated the adequacy of initial laparoscopic staging according to FIGO guidelines, by comparison with laparotomy. PATIENTS AND METHODS: In a French retrospective multicenter study of 358 women with borderline ovarian tumors, we compared epidemiological characteristics, sonographic findings, serum tumor marker levels, and surgical and histological parameters between women undergoing laparoscopy and women undergoing laparotomy. RESULTS: One hundred and forty-nine (41.6%) of the 358 women underwent laparoscopy. Mean age, mean gestity and parity, and mean tumor size were higher in the laparotomy group. Forty-two women (28.2%) underwent laparoconversion, mainly for suspected ovarian cancer or large tumor volume. Conservative treatment and cyst rupture were more frequent in the laparoscopy group than in the laparoconversion and laparotomy groups (P < 0.0001). The rate of complete staging was lower in the laparoscopy group than in the laparoconversion and laparotomy groups (P < 0.0001), with no difference between these latter two groups. No difference in the recurrence rate was noted between the groups, but a higher recurrence rate was observed after conservative treatment (P < 0.001). CONCLUSIONS: Laparoscopic management of borderline ovarian tumors is associated with a higher rate of cyst rupture and incomplete staging. Recurrence was more frequent after conservative treatment. Whatever the surgical route, the rate of complete initial staging was low, emphasizing the need to respect treatment guidelines for borderline ovarian tumors.

[Corneal toxicity of cytarabine. Apropos of a case]. / Toxicité cornéenne de la cytarabine. A propos d'un cas.

A 4 1/2 year old girl with acute lymphoblastic leukemia developed corneal toxicity while receiving courses of chemotherapy once a month (standard doses of vincristine, cyclophosphamide or teniposide, always associated with cytarabine and asparaginase). Symptoms began after 18 courses of treatment and consisted of ocular pain, foreign body sensation, blurred vision, bilateral conjunctival hyperemia. The symptoms appeared during the course of chemotherapy and decreased before the following course. Symptomatic treatment appeared to be effective. Ocular toxicity of antineoplastic agents and particularly cytarabine is discussed.

Serum insulin-like growth factor 1 and serum growth-promoting activity during the first postnatal year in infants with intrauterine growth retardation.

Follow-up from birth to age 12 months was obtained in 21 infants born with intrauterine growth retardation. Serum insulin-like growth factor 1 was measured by radioimmunoassay. The bioassayable growth-promoting activity of the serum was measured as the "thymidine activity" on lectin-activated lymphocytes at 5 days and 1, 3, 6, 9, and 12 months, and was compared with control values. Depending on their length at age 12 months, the intrauterine growth retardation infants were divided into three groups: at or above the average (n = 8, group A), between the mean and -2 SD (n = 7, group B), or less than -2 SD (n = 6, group C). No differences in nutritional indexes or in head circumference were found between the three groups. Insulin-like growth factor 1 was significantly lower at age 5 days in intrauterine growth retardation than in control infants. It increased slowly in groups A and B to reach the control values at age 9 and 12 months. In group C it remained significantly subnormal at 1 yr of age. Thymidine activity was also significantly lower at age 5 days in intrauterine growth retardation compared with control infants. It increased sharply at age 1-3 months in groups A and B but remained significantly lower in group C up to 1 yr of age. Although individual values of insulin-like growth factor 1 and thymidine activity were closely correlated, the increase of length during the first postnatal year correlated significantly with the thymidine activity levels at 1 and 3 months but not with the insulin-like growth factor 1 levels at 1, 3, and 6 months.(ABSTRACT TRUNCATED AT 250 WORDS)

[Candida meningitis, in a premature infant, treated with liposomal amphotericin B and flucytosine]. / Méningite à Candida, chez un prématuré, traité par amphotéricine B liposomale et flucytosine.

BACKGROUND: Candida meningitis in infancy is becoming more common. Its treatment is difficult and may benefit from liposomal amphotericin B. CASE REPORT: A preterm infant developed necrotizing enterocolitis on day 4. Antibiotic therapy included cefotaxime, gentamicin, vancomycin and metronidazole; a central catheter was inserted for nutrition. An acute meningitis developed on day 17 and CT scan showed several brain abscesses. Candida albicans was recovered from the feces, urine and gastric fluid on day 19 and the infant was treated with fluconazole. This drug was replaced by amphotericin B and fluorocytosin when CSF studies a few days later showed persistent meningitis and the presence of Candida albicans. There was no sign of endocarditis. 3 days later, amphotericin B was replaced by liposomal amphotericin B at a dose of 3 mg/kg/day, while the initial catheter was removed. The CSF values and CT scan images gradually improved on this treatment. Liposomal amphotericin B and fluorocytosin treatment was interrupted on day 94, and replaced by oral fluconazole for 5 weeks. These drugs were very well tolerated and further studies at 6 months of age showed that the infant was normal, with no sign of immune deficiency. CONCLUSION: This infant showed several indications of a bad prognosis. But treatment of Candida meningitis liposomal amphotericin B seemed to greatly improve the management of this severe infection.

Erythroblastic and/or megakaryoblastic leukemia in Down syndrome: treatment with low-dose arabinosyl cytosine.

PURPOSE: We report here the clinical response to low-dose arabinosyl cytosine (Ara-C) in seven children with Down syndrome (DS) and acute leukemia in which blast cells express markers of erythroid and/or megakaryoblastic lineages. Following an initial course of treatment with Ara-C, complete remission was obtained in all seven patients. Maintenance therapy with Ara-C was continued during complete remission. Four patients subsequently relapsed; the three others are disease-free. Based on these data, we suggest that when conventional therapy is contraindicated by associated malformations, low-dose Ara-C can be used for treating DS patients with erythroblastic or megakaryoblastic leukemia. The aim of this study was to assess the efficacy of low-dose Ara-C in treating megakaryoblastic and/or erythroblastic leukemia associated with DS. PATIENTS AND METHODS: Seven patients with DS presented with leukemia in which blast cells displayed early markers of the erythroblastic and/or megakaryoblastic lineage. Low-dose subcutaneous Ara-C (10 mg/m2 two times per day) was given for 21 days as induction therapy, followed by a 5-10-day course each month for 2 years as a maintenance treatment. RESULTS: Low-dose Ara-C treatment resulted in complete remission in all seven patients and in long-term disease-free survival in three patients. CONCLUSION: In cases in which conventional chemotherapy is contraindicated, low-dose Ara-C should be considered as a therapeutic alternative for treatment of DS-associated erythroblastic or megakaryocytic leukemia.

[Neonatal herpes: recurrence after treatment with acyclovir]. / Herpès néonatal: rechute après traitement par acyclovir.

A case of cutaneous herpes relapse with meningitis is reported in a 1.5 month-old infant treated during the first three weeks of life with acyclovir (ACV) for a neonatal herpes infection. Such a relapse has previously been described in older children as well as in adults. In this case report, there was immunological response to herpes virus infection, 2.5 months after the onset of the infection. The relapse is discussed taking into account the mechanism of action of ACV, the age of the patient and the immunological response profile. Because of the high risk of neurological involvement, we suggest that the relapse should be treated with ACV for a period of time longer than actually recommended.