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Publications in this journal

• [Vaginal sacral-spinal fixation or Richter's procedure. Experience of a surgical team with 54 cases]

  Authors: P Ko-Kivok-Yun, X Monrozies, J Ayoubi, A Elghaoui, J M Reme

  Revue française de gynécologie et d'obstétrique. 90(12):525-9.

  Vaginal sacro-spino-fixation or Richter's procedure is valuable for the treatment of posthysterectomy vaginal prolapse. Although technically difficult, this procedure is associated with minimalVaginal sacro-spino-fixation or Richter's procedure is valuable for the treatment of posthysterectomy vaginal prolapse. Although technically difficult, this procedure is associated with minimal trauma and is effective in correcting pelvic static disorders. There seem to be few complications. Results are very promising. The functional and anatomic improvements induced by the operation persist over the long term. Although the main indication is treatment of prolapse of the vaginal vault, Richter's procedure is also useful for the prevention of prolapse. Based on the experience acquired by a surgical team, the technique, indications, complications, and results of Richter's procedure are discussed.

• [Pregnancy after transposition and repositioning of the ovaries in a patient with clear-cell adenocarcinoma]

  Authors: A Gerbaulet, B Escaillet, Y Beral, F Fourika, G Yovo, D Houze, B Schneider, D Klopfenstein

  Revue française de gynécologie et d'obstétrique. 90(12):534-8.

  A young woman with a history of in utero exposure to distilbestrol was diagnosed with vaginal clear-cell adenocarcinoma. Management consisted of limited excision of the tumor followed byA young woman with a history of in utero exposure to distilbestrol was diagnosed with vaginal clear-cell adenocarcinoma. Management consisted of limited excision of the tumor followed by brachytherapy after transposition of the ovaries. The patient had a successful pregnancy after reimplantation of the ovaries in their normal position and right adnexectomy for Chlamydia infection. The child was delivered by cesarean section. This is probably the first case with a pregnancy after repositioning of the ovaries in Europe and perhaps even in the world.

• [Struma ovarii. Three malignant cases and one benign case]

  Authors: A Gamoudi, K Farhat, M Hechiche, R Kattech, O Khayat, K Rahal, K Ben Romdhane

  Revue française de gynécologie et d'obstétrique. 90(12):542-7.

  Four cases of struma ovarii were seen among 308 ovarian tumors removed surgically at the Salah Azaiz Institute, Tunis, Tunisia, between 1980 and 1989. This yields an occurrence rate of 1.3%, which isFour cases of struma ovarii were seen among 308 ovarian tumors removed surgically at the Salah Azaiz Institute, Tunis, Tunisia, between 1980 and 1989. This yields an occurrence rate of 1.3%, which is comparable to previously publishes rates (0.3% to 2%). One of the four tumors was malignant. Malignant transformation of struma ovarii is very rare (5% to 10%). The histologic diagnosis of malignancy is difficult, particularly in well-differentiated follicular forms. The prognosis is relatively favorable even in patients with metastases. Based on their personal experience and on a review of the literature, the authors discuss the diagnosis, management, and outcome of struma ovarii, in particular with malignant transformation.

• [Concerning the article: Simultaneous intrauterine and extrauterine pregnancy in the presence of an inert intrauterine device]

  Authors: T Delarue

  Revue française de gynécologie et d'obstétrique. 90(12):560.

• [Granulomatous mastitis]

  Authors: A Lafont, C Bailly, A Bremond

  Revue française de gynécologie et d'obstétrique. 90(12):530-3.

  Six cases of granulomatous mastitis are reported. Based on a review of the relevant literature, the clinical features, etiology, and management of this pathologic entity are discussed. The definitionSix cases of granulomatous mastitis are reported. Based on a review of the relevant literature, the clinical features, etiology, and management of this pathologic entity are discussed. The definition of granulomatous mastitis is given and the characteristics that distinguish this condition from other inflammatory breast diseases are pointed out.

• [Struma ovarii. A case report]

  Authors: R Barhmi, A Banani, M A Melhouf, S Nabil, D Ferhati, A Kharbach, M Achour, A Chaoui

  Revue française de gynécologie et d'obstétrique. 90(12):539-41.

  Struma ovarii is a rare ovarian tumor composed entirely or in part of thyroid tissue. Pathogenesis is unclear. Diagnosis rests on the histologic study. A case is reported. Specific features of strumaStruma ovarii is a rare ovarian tumor composed entirely or in part of thyroid tissue. Pathogenesis is unclear. Diagnosis rests on the histologic study. A case is reported. Specific features of struma ovarii are discussed based on a review of the literature. The treatment is surgical and the outcome generally favorable.

• [Reflections on compliance in menopause hormone replacement therapy]

  Authors: J Berthet, J L Tabaste, F Vendittelli

  Revue française de gynécologie et d'obstétrique. 90(12):548-51.

  Compliance with hormone replacement therapy (HRT) in postmenopausal women is discussed. Although accurate quantitative evaluation is difficult, estimates in French women are provided. Thirty percentCompliance with hormone replacement therapy (HRT) in postmenopausal women is discussed. Although accurate quantitative evaluation is difficult, estimates in French women are provided. Thirty percent of postmenopausal women are under HRT, but data are lacking on the age groups in which HRT is most prevalent. Given the benefits of HRT in terms of public health, physicians should make every effort to educate their patients, in particular regarding differences between oral contraception and HRT. Other targets for HRT education include general practitioners, health insurance agencies, and the media. Better information provided by physicians and drug companies would allow to increase the use of HRT.

• [Schematic sections of the female pelvis]

  Authors: L C Lenck, G Vanneuville

  Revue française de gynécologie et d'obstétrique. 90(11):465-70.

  The anatomic complexity of the female pelvis is pointed out. The diagrammatic frontal and lateral sections through the female pelvis presented in this article are based on results of anatomic studiesThe anatomic complexity of the female pelvis is pointed out. The diagrammatic frontal and lateral sections through the female pelvis presented in this article are based on results of anatomic studies of cadavers of adults and fetuses and on pelvic ultrasonography and magnetic resonance imaging findings. The horizontal floor of the pelvis, the perineum, and the pelvic cavity are visible on both sections. Newly identified structures are the urogenital fossa, the pubosacral perineal cord, and the urethro-clitorido-vulvar erectile body. Special attention is devoted to the description of the ischiorectal fossa and its extensions and of the uro-genito-rectal mesentery. A study of the functional anatomy of the female pelvis would be feasible.

• [Does the incidence of premature labor vary according to the season?]

  Authors: C Posaci, U Saygili, Y E Erata, A Onvural, D Issever, U Yilmaz

  Revue française de gynécologie et d'obstétrique. 90(11):481-5.

  To investigate the epidemiology of premature delivery, in particular regarding potential seasonal influences, a retrospective medical-record study was conducted in 3345 women who deliveredTo investigate the epidemiology of premature delivery, in particular regarding potential seasonal influences, a retrospective medical-record study was conducted in 3345 women who delivered prematurely over a six-year period (1988-1993). The control group was composed of 53,162 women who carried their pregnancies to term. Each study subject had delivered at least one liveborn baby, prematurely or at full term. The premature delivery rate (ratio of premature over term deliveries) was highest in May through July and decreased significantly in January and February (p < 0.05). Premature delivery rates were similar in primiparas and multiparas (p > 0.05) and were not influenced by the gender of the fetus (p > 0.05). In conclusion, premature delivery rates vary across seasons, suggesting an influence of weather conditions.

• [Recurrent vulvovaginal mycoses]

  Authors: J Salvat, P Romand, A Vincent-Genod, B Younes, M Guilbert

  Revue française de gynécologie et d'obstétrique. 90(11):494-501.

  The treatment of recurrent vulvovaginal fungal infections is difficult. Pathogenic mechanisms are discussed. Available pharmacologic treatments and their mechanisms of action are reviewed. PatientsThe treatment of recurrent vulvovaginal fungal infections is difficult. Pathogenic mechanisms are discussed. Available pharmacologic treatments and their mechanisms of action are reviewed. Patients clearly prefer oral treatment. Ketoconazole is toxic. Only topical or nonabsorbed oral agents can be used during pregnancy. Agents absorbed via the digestive tract can be used in women who use effective contraceptive methods. Published data demonstrate that trifluconazole (which has not yet been granted a license in France) is potent and less toxic than ketoconazole, and that recurrences at discontinuation of this drug are less common. A few hypotheses for future research are presented.

• [Current indications for medical treatment of ectopic pregnancy]

  Authors: E Darai, D Sitbon, J L Benifla, E Sebban, C Renolleau, P Madelenat

  Revue française de gynécologie et d'obstétrique. 90(12):552-7.

  Today, the early diagnosis of ectopic pregnancy (EP) is made possible by the assay of plasmatic hCG and the improvement of trans-vaginal sonography. These different tests lead to diagnose the EPToday, the early diagnosis of ectopic pregnancy (EP) is made possible by the assay of plasmatic hCG and the improvement of trans-vaginal sonography. These different tests lead to diagnose the EP before the ruptured stage. Therefore, the medical treatment is today a logical alternative to the surgical one. The medical treatment is mainly based upon the use of methotrexate (MTX). The logical indications for EP medical treatment are: early EP without peritoneum effusion, with hCG < or = 5000 mUI/ml, without embryonic cardiac activity at sonography. The medical therapy by intramuscular injection of MTX at 1 mg/kg gives a success rate of 91.8% similar to the success rate of intra tubal injection of MTX under sonographic control.

• [Tissue glue in endoscopic surgery]

  Authors: D Wallviener, S Rimbach, D Pollman, W Solt, J Gauwerky, A Depierreux, G Bastert

  Revue française de gynécologie et d'obstétrique. 90(11):461-4.

  Tissue-glue stands out by virtue of its ability to ensure non-traumatic tissue apposition and hemostasis, leading to a reduction in operative time. This explains the use of this technique in a wideTissue-glue stands out by virtue of its ability to ensure non-traumatic tissue apposition and hemostasis, leading to a reduction in operative time. This explains the use of this technique in a wide range of indications in gynecological endoscopy. These include ovarian reconstruction after the extraction of cysts, tubal anastomoses and even closure of iatrogenic perforations of the uterus. In these indications, the application of tissue-glue can be considered as the method of choice because of its excellent long term results. In contrast, its effect in the sealing of peritoneal or serosal defects with the aim of avoiding adhesions has not yet been clearly demonstrated. Analysis of a sufficient number of cases with long follow-up is essential before any final assessment can be made. Among 75 instances of endoscopic use of tissue-glue up to now, we have never encountered any post-operative complications, nor during subsequent follow-up. In addition to its ability to stimulate tissue healing, tissue-glue offers a simple and non-traumatic alternative to the lengthy technique of endoscopic sutures, with a hemostatic action in parallel.

• [Vaginal environment. The vaginal climate and its variations]

  Authors: J M Nicoli, R M Nicoli

  Revue française de gynécologie et d'obstétrique. 90(11):471-80.

  Variations in the vaginal environment that occur throughout the life span are described. The nature and cybernetics of factors involved in these variations are discussed.

• [Is the length of gestation a multiple of a fundamental cycle?]

  Authors: J Kotoujansky, G Hedelin, B Canguilhem

  Revue française de gynécologie et d'obstétrique. 90(11):486-93.

  Pregnancy duration was accurately determined using early ultrasonography in 21 patients prior to spontaneous abortion and in two successive pregnancies in each of 57 women prior to spontaneousPregnancy duration was accurately determined using early ultrasonography in 21 patients prior to spontaneous abortion and in two successive pregnancies in each of 57 women prior to spontaneous delivery. Pregnancy durations before abortion or delivery approximated multiples of 14 days (14.4 and 13.3 days, respectively). In addition, in a given woman, the duration of two successive pregnancies carried to term was often identical; in a smaller number of cases, a difference of about 12 days (calculated value, 11.8 days) or, rarely, 24 days, was found. These values may correspond to the same functional period. These observations suggest that the duration of pregnancy (mean, 266 days) may be a multiple of the duration of the luteal phase of the menstrual cycle (12 to 14 days). Interindividual variations in luteal phase duration (standard deviation, 0.5 to 1 day) may explain inter-individual variations in pregnancy duration (standard deviation of about 15 days). The mean multiple may be 20. Thus, pregnancy duration may be determined both by fetal maturation and by a maternal time-counting mechanism. This hypothesis is discussed in the light of current data.

• [Laparoscopic surgery of an intraperitoneal intrauterine device]

  Authors: M Ferchiou, F Zhioua, M Hasnaoui, S Sghaier, A Jedoui, S Meriah

  Revue française de gynécologie et d'obstétrique. 90(10):409-11.

  This study involved 13 cases of patients fitted with intra-uterine contraceptive devices which migrated in the abdominal cavity. Laparoscopy enabled localization of the IUCD and full lesionThis study involved 13 cases of patients fitted with intra-uterine contraceptive devices which migrated in the abdominal cavity. Laparoscopy enabled localization of the IUCD and full lesion assessment. It was removed by celio-surgery in all 13 cases. Difficulties encountered were due to parietoepiploic adhesions and IUCD impacted in the wall of the rectum.

• [Possible implication of obstetric risk factors in the etiopathogenesis of schizophrenia]

  Authors: H Verdoux, M Bourgeois

  Revue française de gynécologie et d'obstétrique. 90(10):417-22.

  Neuroradiologic and neuropathologic studies have revealed evidence of the existence of structural brain damage in schizophrenics, the ethiopathogenesis of which could include early neurodevelopmentalNeuroradiologic and neuropathologic studies have revealed evidence of the existence of structural brain damage in schizophrenics, the ethiopathogenesis of which could include early neurodevelopmental disturbances. Exposure to obstetric complications could be an environmental risk factor predisposing to the later occurrence of schizophrenic disorder in adolescence. The majority of studies evaluating such an association have found an excess of obstetric complications in schizophrenia patients, tough without revealing the existence of a preferential link with a specific type of complications. These interpretation of these results in terms of cause-and-effect must remain cautious, because of the methodological limitations of the studies.

• [Peripartum hysterectomy. Report of eleven cases]

  Authors: F Gardeil, S Daly, M J Turner

  Revue française de gynécologie et d'obstétrique. 90(10):431-4.

  A series of hysterectomies performed during labor or shortly after delivery, all as emergencies is reported. The study covered the ten years 1982-1991, during which 65,488 deliveries resulted inA series of hysterectomies performed during labor or shortly after delivery, all as emergencies is reported. The study covered the ten years 1982-1991, during which 65,488 deliveries resulted in infants with a birth weight of 500 g or more. There were no hysterectomies among the 21,998 primipara, the incidence in multipara being 1 per 3,954 deliveries. Five operations were performed for rupture of the uterus and six for cataclysmic bleeding. Seven of the 11 patients had history of caesarean section. In multipara, the existence of a caesarean scar multiplied the risk of emergency hysterectomy by a factor of 18. There were no maternal deaths but all patients required transfusion with more than 6 units of packed cells. These results emphasize the fact that a history of caesarean is the principal etiologic factor in patients experiencing complications of pregnancy which require emergency peri-partum hysterectomy.

• [Umbilical endometriosis. A case report]

  Authors: K Daoudi, A Bongain, V Isnard, J M Castillon, J F Michiels, J Y Gillet

  Revue française de gynécologie et d'obstétrique. 90(10):442-3.

  Umbilical endometriosis is a rare site of the disease. The authors report a case of umbilical endometriosis only. Umbilical involvement is estimated at 0.5 to 1% of all site of the disease. This is aUmbilical endometriosis is a rare site of the disease. The authors report a case of umbilical endometriosis only. Umbilical involvement is estimated at 0.5 to 1% of all site of the disease. This is a disorder affecting women of childbearing age, with a mean age of about 40. Medical treatment by progestogens or Danazol is inconstantly and partially effective regarding umbilical endometriosis. Surgical excision remains the only effective treatment: omphalectomy with wide removal of the tumor and reconstruction of an umbilicus. Surgery enables histologic study and, in the presence of suggestive symptomatology, search for and treatment of other genital sites.

• [Critical study of the characterization of hyperandrogenism in a group of obese women]

  Authors: J P Cordray, R E Merceron, P Nys, X Guillerd, P Reboul, M Rainaut

  Revue française de gynécologie et d'obstétrique. 90(10):403-8.

  The authors report the hormonologic characteristics of 20 obese and hirsute women meeting the criteria for adrenaltype hyperandrogenism, suppressible by dexamethasone, without hyperprolactinemia andThe authors report the hormonologic characteristics of 20 obese and hirsute women meeting the criteria for adrenaltype hyperandrogenism, suppressible by dexamethasone, without hyperprolactinemia and without any late developing partial enzyme block appearance. The laboratory profile of these women differed from that of a group of women with type 1 polycystic ovaries syndrome. In this same group obese women in whom LH/FSH ratio was below 1, there was evidence under baseline conditions of a moderate increase in testosterone and delta 4-androstenedione in relation to increased plasma levels of DHA and SDHA, plasma delta 4 and delta 5-androgen levels falling precipitalely during the dexamethasone suppression test. The ACTH stimulation test revealed greater reactivity for 17 hydroxy-pregnenolone (p < 0.001) and less for 21-deoxycortisol than in the control group of normal women (p < 0.01). The essentially adrenal origin of plasma hyperandrogenism in certain cases of obesity is discussed. Insulin could increase adrenal sensitivity to ACTH and its possible action in vivo on the activity of adrenal enzymes requires clarification. The accumulation of certain androgens in the adrenal cortex could also be responsible for dysregulation of 3 beta ol-dehydrogenase and 11-hydroxylase.

• [Amniocentesis and single choroid plexus cyst. Current status]

  Authors: J Morales-Roselló, J A Martin Jurado

  Revue française de gynécologie et d'obstétrique. 90(10):412-6.

  Management of a patient with a diagnosed choroid plexus cyst (CPC) is probably one of the most difficult of all prenatal diagnostic problems. Similarity between the risk of chromosomopathy due to theManagement of a patient with a diagnosed choroid plexus cyst (CPC) is probably one of the most difficult of all prenatal diagnostic problems. Similarity between the risk of chromosomopathy due to the appearance of CPC only and the risk of fetal mortality due to amniocentesis (both being about 1/200) is such that an individual approach must be adopted in each case. The couple must be given a full explanation of all the details, which will enable them to finally decide whether a conservative attitude is appropriate or, on the contrary, if a specific diagnosis should be sought by amniocentesis.

• [Are there still indications for cerclage in 1995?]

  Authors: P Dufour, J Bérard, P Ernoult, N Tordjeman, D Vinatier, J C Monnier

  Revue française de gynécologie et d'obstétrique. 90(10):423-30.

  AIM: In order to assess their undertook a retrospective study in their department over a 4 year period: from January 1991 to December 1994. METHOD: the study concerned 129 patients who were treatedAIM: In order to assess their undertook a retrospective study in their department over a 4 year period: from January 1991 to December 1994. METHOD: the study concerned 129 patients who were treated by cerclage. This procedure was performed prophylactically in the great majority of them (97), while it was carried out as an emergency in 32 (25%). RESULTS: the authors drew a distinction between two groups (prophylactic and emergency suture) when analyzing the various results: complications due to suture, mean age of pregnancy at delivery, threatened premature labor, mean length of prolongation obtained. These personal data formed the basis of a review of the literature, in order to specify the indications for suture adopted by various authors at the present time. CONCLUSION: the authors found themselves to be in agreement with data from the literature, considering a history of at least two obstetric accidents (late abortions) and/or the existence of a severe uterine malformation to be the principal indication for prophylactic suture. "Emergency" suture should be performed whenever there is a serious threat of early premature labor in the presence of cervical changes such that suture offers the only chance of prolonging the pregnancy.

• [Breast angiosarcoma. Five case reports]

  Authors: A Gamoudi, K Farhat, S Derouiche, M Hechiche, R Khattech, K Rahal, K Ben Romdhane

  Revue française de gynécologie et d'obstétrique. 90(10):435-41.

  The authors report 5 cases of breast angiosarcoma collected in the Salah Azaiz Institute of Tunis, the only oncology center in this country, between 1969 and 1990. They enumerated 4,000 malignantThe authors report 5 cases of breast angiosarcoma collected in the Salah Azaiz Institute of Tunis, the only oncology center in this country, between 1969 and 1990. They enumerated 4,000 malignant breast tumors during this period; i.e. an incidence of 1.25%, higher than that in the world literature (0.4%). The mean age of patients was 44. Three were post-menopausal, and two were of childbearing age, one of whom was pregnant. This rare tumor is virtually limited to women. Affection is scarce, it affect's almost exclusively women. It generally present as a painless, ill-defined mass, without regional lymphadenopathy. The diagnosis of angiosarcoma is difficult since the histologic appearance is sometimes identical to that of a hemangioma. Hence the value of very thorough histologic examination of the entire operative specimen. Treatment is based upon mastectomy. The usefulness of adjuvant chemotherapy and/or radiotherapy is uncertain. The prognosis remains gloomy despite early diagnosis and treatment. The authors attempt in this study to identify the various features of this serious and uncommon condition, based upon the rare published cases in the world literature.

• [Postpartum depression: too often neglected!]

  Authors: I O Godfroid, A Charlot

  Revue française de gynécologie et d'obstétrique. 90(10):444.

• [HIV seropositive pregnant women from black Africa seen at the Guy de Lorier maternity unit of Tenon hospital. Report of 33 cases]

  Authors: O Pambou, F Hervé, S Uzan, M L Dupuis, J Salat-Baroux

  Revue française de gynécologie et d'obstétrique. 90(3):129-33.

  There were 5503 deliveries between 1989 and 1991 in the Guy de Lorier Maternity Unit (Pr Salat-Baroux) of Tenon Hospital, Paris. These included 81 women testing HIV+ in the department with 33There were 5503 deliveries between 1989 and 1991 in the Guy de Lorier Maternity Unit (Pr Salat-Baroux) of Tenon Hospital, Paris. These included 81 women testing HIV+ in the department with 33 asymptomatic black African women among 781 deliveries. Africans account for 14% of women delivered in the department but for 40% of seropositives in the unit, with a predilection for women from Zaïre (central Africa), accounting for 17 seropositives. They only represent 50% of all cases of African HIV+ and 20% of the unit, while they account for only 6% of the black African community and 0.8% of the maternity unit. Women from west Africa accounted for 45.5% of African seropositive cases, with Ivory Coast in first place with 24.3% while only 9% of women from Mali, accounting for 40% of African patients and 5% the units, tested positive (3 cases out of 309 patients). The mean age of seropositive patients was 23 +/- 4, pregnancies proceeded normally and there were 4 therapeutic abortions. There were 9 births by cesarean section, with no evidence of neonatal contamination, the same applying in the other 20 vaginal deliveries. Routine testing (informed consent) for HIV in these high-risk (endemic zone, drug addiction) or unrecognised seropositive patients is important whenever the opportunity presents itself (prenuptial examinations, prenatal visits, family planning, preoperative assessment) in order to attempt to lower infection rates and ensure the best possible care for mother and child when there is a wish to continue the pregnancy, but also to protect hospital staff from the risks to which they may be exposed.

• [Anemia and pregnancy. Epidemiologic, clinical and prognostic study at the university clinic of the Ignace Deen Hospital, Conakry (Guinee)]

  Authors: M S Diallo, T S Diallo, F B Diallo, Y Diallo, A Y Camara, G Onivogui, N Keita, S A Diawo

  Revue française de gynécologie et d'obstétrique. 90(3):138-41.

  Our intentions were to determine the incidence of the association of anemia and pregnancy, to evaluate maternal and fetal prognosis and to offer some recommendations regarding national health careOur intentions were to determine the incidence of the association of anemia and pregnancy, to evaluate maternal and fetal prognosis and to offer some recommendations regarding national health care policies. This prospective study lasting 30 months included all cases of anemia and pregnancy detected by clinical and laboratory examinations. Thus 13,191 women were enrolled in the study but only 1408 cases of anemia and pregnancy (10.67%). Primipara and grand multipara were particularly at risk. Severe forms of anemia and pregnancy were encountered often (51.71%). Maternal and fetal prognoses were very poor. Maternal mortality was 852/100,000, accounting for 65% of the maternal mortality of the department. The stillborn rate was 50 per thousand. This is a serious health problem which needs to be dealt with by a national health education programme.

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