[Show abstract][Hide abstract] ABSTRACT: We describe a case of uterine necrosis, following Gelitaspon® embolization for postpartum hemorrhage resulting from vaginal laceration. Previous cases published help to improve the safety of this effective method by showing the risk factors, as particles sizes, ultraselective embolization, prevention of infection. Controlling bleeding by surgery is the priority when hemorragy is due to laceration without uterin atony. In case of failure, embolization is an option which should be proposed without delay. Uterine necrosis should be suspected in case of postembolization septic syndrome.
Journal de Gynécologie Obstétrique et Biologie de la Reproduction 05/2014; 43(5):401–406. DOI:10.1016/j.jgyn.2013.03.017 · 0.56 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Une femme de 53 ans s’est présentée aux urgences pour une rétention aiguë d’urines. L’examen clinique objective la présence
d’un très volumineux fibrome pédiculé qui entraînait une occlusion complète de l’introïtus. Une échographie abdominopelvienne
ne montra aucune autre cause de rétention urinaire. Les douleurs présentées par la patiente étaient très importantes (EVA:
9/10). L’insertion d’une sonde de Foley fut impossible. Une anesthésie a dû être réalisée afin de sonder la patiente et de
procéder à l’exérèse du fibrome pédiculé par myomectomie vaginale. Aucune complication peropératoire n’est survenue. L’examen
histologique confirma le diagnostic de lésion léiomyomateuse bénigne. Le cathéter de Foley a été retiré le lendemain de l’intervention,
et la patiente est rentrée à son domicile le surlendemain compte tenu du fait que sa miction était complément normalisé. Les
très volumineux fibromes intracavitaires pédiculés peuvent être expulsés à la vulve et entraîner une rétention aiguë d’urines.
Celle-ci peut nécessiter une intervention en urgence sous anesthésie générale s’il est impossible de réduire l’extériorisation
Both acute urinary retention and impacted pelvic mass are rare events in women. The objective of the current study was to
report a case of complete urinary retention caused by impaction of a large uterine pedunculated myoma. A 53-year-old woman
presented to the hospital (emergency department) for urinary retention. Clinical examination showed a large pedunculated impacted
myoma. Abdominal sonography revealed no other aetiology for urinary retention. The patient reported high-level painful (VAS:
9/10) and was unable to void. Insertions of Foley catheter have failed. General anesthesia was required to insert Foley catheter
and remove the pedunculated impacted myoma. Myomectomy was performed. No peroperative complication was noted. Pathology confirmed
the diagnosis of benign myoma. The Foley catheter was removed one day after surgery and the patient was discharged two days
after surgery since complete spontaneous voiding was observed. Urinary retention is a potential complication of large pedunculated
[Show abstract][Hide abstract] ABSTRACT: We describe the findings on computed tomography (CT) in a prenatally diagnosed case of bladder exstrophy, and compare them with the findings on two- and three-dimensional sonography. The CT data of the affected fetus were compared with the CT findings of 14 fetuses with normal bony pelvises. The CT images showed differences in the structure of the bony pelvis in the case of bladder exstrophy, with a wide gap between the iliopubic and ischiopubic rami and a widening of the iliac bones. CT scanning was useful in confirming the sonographic diagnosis of bladder exstrophy, and it may also be helpful for planning early surgery following delivery.
Ultrasound in Obstetrics and Gynecology 06/2009; 33(6):716-9. DOI:10.1002/uog.6409 · 3.85 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Patent urachus cyst is a rare umbilical anomaly, which is poorly detected prenatally and frequently confounded with pseudo bladder exstrophy or omphalocele. A 27-year-old woman was referred to our prenatal diagnosis centre at 18 weeks of gestation after diagnosis of a megabladder and 2 umbilical cord cysts. Subsequent 2D, 3D and 4D ultrasound examinations and fetal magnetic resonance imaging (MRI) revealed a typical umbilical cyst and an extra-abdominal cyst, communicating with the vertex of the fetal bladder through a small channel that increased in size when the fetus voided urine. Termination of pregnancy occured at 31 weeks because of associated cerebral septal agenesis, and autopsy confirmed the prenatal diagnosis of urachus cyst. Few cases of urachus cyst diagnosed prenatally are reported in literature, but none were associated with other extra-abdominal disorders and none used 3D, 4D and fetal MRI. Our case illustrated the efficiency in prenatal diagnosis of 3D and 4D ultrasound examinations. This could help pediatrician surgeons to explain to a couple about neonatal surgical repair and plastic reconstruction in the prenatal period.
[Show abstract][Hide abstract] ABSTRACT: B.-D. Grigoriu, F.-M. Jacobs, A.-E. Mas, D. Prat, S. Prévot, F.-G. Brivet
Tuberculosis is the most common infectious complication in HIV infected patients. The incidence of tuberculosis and the proportion of disseminated disease increase with more severe immuno-suppression. Septic shock and multiple organ failure are uncommon but are of markedly bad prognostic significance.
A forty-four year old HIV seropositive man was admitted to the intensive care unit (ICU) with acute respiratory distress. The patient had been febrile for the previous two weeks. His thoracic radiograph showed a discrete interstitial infiltrate and at bronchoscopy small whitish granulations were observed in the main bronchi. All bacteriological investigations remained negative at the time of ICU admission. The patient died sixteen hours later due to multiple organ failure. Mycobacteria were identified after patient’s death on the smear from BAL, from blood cultures, and in a postmortem liver biopsy.
Septic shock is an infrequent complication of disseminated tuberculosis. Mortality is very high. Treatment should be started early in cases with a high diagnostic suspicion
[Show abstract][Hide abstract] ABSTRACT: An important subset of implantation defects/early abortion seems to be linked with a deregulation of the interleukin (IL)-12/IL-15/IL-18 system as well as tumor necrosis factor (TNF)- and natural killer (NK)-controlled/mediated networks at the decidual placental interface, both in case of deficient or excess expression. The presence of TNF in high amounts in the pre/peri-implantation uterus and its pivotal role during pregnancy are difficult to reconcile with its abortive effects in ongoing pregnancy. We therefore searched for regulators of the IL-12/IL-18 family of cytokines as well as for antagonist(s) of TNF with potentially selective effects on implantation.
We first used Swiss mice to verify the presence in the murine reproductive tract of 'new members' of the IL-12 family of cytokines, IL-23 and IL-27, as well as of tumor necrosis factor-like WEAK inducer of apoptosis (TWEAK), described as acting with TNF as Yin and Yang of innate immunity in murine placenta/ decidua at days 0-12.5. We then compared expression by RT-PCR in the CBA x DBA/2, and CBA x BALB/c murine mating combinations. Finally, we performed in vivo neutralization experiments of TWEAK and IL-27.
Immunohistochemistry (IHC) studies showed that IL-23, IL-27, and TWEAK were expressed at the interface. For RT-PCR, IL-23 expression peaked at day 9.5 in the non-aborting mating combination, a peak absent in the aborting one, and thus difficult to explain except by invoking a feed back on EB13 (Epstein-Barr virus-induced gene 3 cytokine). Most important, an immediate post-mating IL-27 hyper expression was seen in the CBA x DBA/2 mating compared to CBA x BALB/c one. The difference in expression resurged and was statistically very significant by days 6.5-9.5, compatible with an early activation of inflammation on day 0.5 which would then peak again in the 'resorption window' where takes place the early NK/mph activation described by Baines et al. A significant TWEAK expression was present in both strains from days 0.5 to 4.5 peaking in both cases in the first days when it is known that intra uterine TNF also reaches high levels as a component of post-mating inflammation. However, it was lower from day 1.5 in the abortion-prone CBA x DBA/2 mating combination, and almost absent by days 6.5-9.5 when compared to the non-aborting CBA x BALB/c mating combination. In both mating combinations, neutralization of TWEAK-enhanced resorption rates, but surprisingly so did IL-27 neutralization.
TWEAK is likely offering protection against the deleterious effects of TNF in implantation explaining embryo survival in a TNF-rich environment, and equal number of implants in both strains. However, there is a clear difference of protection in abortion-prone mating peaking in the abortion/resorption window but starting early, and therefore possible links with the prevention of abortion in CBA x DBA/2 matings by interfering with complement activation as recently described by Girardi et al. are discussed, as well as consequences for our current view of feto-maternal 'seed and soil' interplay. The apparently paradoxical effects of IL-27 neutralization are also discussed.
American journal of reproductive immunology (New York, N.Y.: 1989) 05/2008; 59(4):323-38. DOI:10.1111/j.1600-0897.2007.00567.x · 2.44 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: This article explains why we have had to come to a central role for innate immunity rather than the threat of maternal rejection of the foetal allograft. We encompass briefly the role of inflammation in implantation, not only for invasion adhesion, but also to prepare future “tolerance”. In this context, we envisage the role of TWEAK and complement.