[A new perspective in adolescent contraception--why prescribe an IUD first?]. / Un nouveau regard sur la contraception des adolescentes: pourquoi prescrire un dispositif intra-utérin en première intention?

Adolescent girls are very fertile and therefore need a reliable contraceptive strategy in order to prevent unwanted pregnancies. Although highly recommended by international gynecological and adolescent societies and in spite of its high efficiency, good tolerance and ease of use, only minority of adolescents use IUD as a contraceptive method. This article will focus on available IUDs suitable for adolescents and will address misconceptions and barriers to use of IUDs in this age group. We believe this information will encourage physicians in recommending IUD use to adolescents during their most vulnerable years.

[Contraception and bone health in adolescence]. / Contraception chez les adolescentes et santé osseuse.

Adolescents' access to contraception has improved and indication for their use have been extended beyond pregnancy prevention. For adolescents, this implies the use of hormonal contraception before the accrual of peak bone mass. Sexual hormones, notably estrogens, play a major role in skeletal development, growth and acquisition of maximal bone mass density (BMD). This article will review different contraceptive methods and their impact on BMD, with particular attention to low-dose pills and medroxyprogesterone acetate, both of which seem to alter peak bone mass acquisition. Nevertheless, benefits from appropriate contraception should be weighed against safety concerns, and recommended on an individual basis.

[Which contraception for women with increased risk of venous thromboembolism?]. / Ouelle contraception pour la femme a risque de maladie thromboembolique veineuse?

Women presenting an increased risk of venous thromboembolism can present quite a challenge when it comes to choosing a contraceptive method. Taking a complete personal and familial history is mandatory for the correct identification of these women and of contraceptives for which there is a formal contraindication. Combined hormonal contraceptive methods containing estrogens and a progestogens increase the risk of venous thrombosis and their use is contra-indicated in women at risk for thromboembolism. Non hormonal contraceptives are good options but can present with other inconveniences. Progesterone only contraceptives can all be used by these women and can present specific advantages and disadvantages.

[Gynecology/Obstetrics. Magnesium sulfate for fetal neuroprotection in preterm delivery. Latest advances in contraception.]. / Gynécologie - obstétrique.

Morbidity of neonates born before 32 weeks remains significant. Cerebral palsy is found in up to 8 to 10% of survivors. Three randomized controlled trials evaluated the effectiveness of magnesium sulphate given to mothers with a risk of imminent very preterm delivery to prevent perinatal death or cerebral palsy in children. These studies suggest a reduction of the risk of cerebral palsy by magnesium sulphate from 6.5% to 4.8% (relative risk 0.71, 95% CI 0.55-0.91). These results remain controversial, but warrant information to the parents and the implementation of treatments protocols for selected cases.

A multicenter study assessing uterine cavity width in over 400 nulliparous women seeking IUD insertion using 2D and 3D sonography.

BACKGROUND: In the selection of an appropriate IUD little consideration is placed on device size or adequacy of fit. Properly fitting IUDs will likely lead to less adverse effects or patient discomfort resulting in enhanced continuation of use. METHODS: A multicenter study conducted at 7 centers in 410 nulliparous women, to measure the width of the uterine cavity using 2D and 3D ultrasound. RESULTS: Measurements of maximal fundal cavity width was performed by either 2D or 3D ultrasound by experienced sonographists. The mean width of the uterine cavity in the fundus was 22.2mm (range 6.0-41.1mm). There was no statistical difference in the values whether determined by 2D (n=258) or 3D (n=152) measurements having a median value of 22.5mm and 21.6mm, respectively, 79% of women had a uterine cavity width between 15mm and 28mm, 32%<20mm and 6.8%<15mm, respectively. DISCUSSION: Uterine cavities in nulliparous women are narrow and rarely wide enough to fit conventional IUDs. Gross discrepancy between the IUD and the uterine cavity leads to side effect (e.g., expulsion, embedment, bleeding, pain) and early discontinuation. Historically, devices too large for the uterine cavity have been routinely inserted which may account for their 5-year continuation rates being only 40 to 50%. Our study suggests that preprocedural 2D or 3D sonography to measure the width of the uterine cavity may result in the selection of a suitable IUD to maximize continuation of use. Measurement of the cavity width is not necessary with a frameless IUD.

Primary breast lymphomas.

The diagnosis, prognostic factors, and optimal management of primary breast lymphomas (PBL) is difficult. Seven patients recorded at the Geneva Cancer Registry between 1973-1998 were reviewed. Five patient had diffuse large B-cell lymphoma, one a follicular lymphoma and one a MALT-lymphoma. All patients had clinical and radiological findings consistent with breast cancer and underwent mastectomy, which is not indicated in PBL. Diagnosis should be established prior to operative interventions, as fine needle aspiration missed the diagnosis for one patient and intra-operative frozen sections for 3 patients in our study. Five-year and 10-year overall survivals were 57% and 15%, respectively. Of the 3 patients who died from PBL, 2 had tumors that were Bcl-2 positive but Bcl-6 negative. All 3 surviving patients have positive Bcl-2 and Bcl-6 immunostaining, which could be important prognostic factors if confirmed by a larger study.