Sommeil et cancer du sein : existe-t-il un lien ?

The aim of this review is to evaluate the impact of sleep on breast cancer risk. Given the supposed protective role played by melatonin in breast cancer, it is interesting to study the effect of sleep, which is the moment of melatonin synthesis. Articles were extracted from the PUBMED database between 2000 and 2012 with the following keywords “sleep duration”, “sleep quality”, “breast cancer risk” and “melatonin”. In total, 10 articles were selected. Most prospective cohort studies found a decrease in the risk of breast cancer varying from 38 to 72% for “long sleepers”. Furthermore, a meta-analysis of the studies assessing the link between breast cancer risk and urinary concentration of 6-sulfatoxy-melatonin (6MT), which is melatonin's main metabolite, found a 34% decrease for patients with the highest 6MT concentration. Even though other studies are necessary to confirm these results, it seems already adequate to detect sleep disorders and to try to treat them.     

Suture péritonéale ou non au cours de la césarienne en 2008 ?

Non closure of the peritoneum at cesarean is still debatable, despite the national and international guidelines. This review aims at exposing risks and benefits of non closure of the peritoneum, focusing on the peritoneum adhesions. Many studies demonstrated no benefits at peritoneum closure in the duration of surgery, the immediate postoperative period and the short-term complications. Data about pelvic adhesion risk are more inconsistent. Different criteria were considered in the studies: adhesions incidence and density during subsequent cesareans or pelvic surgeries, duration of surgery and the delay between incision and birth during the subsequent cesarean and fertility known to be impaired by thick-pelvic adhesions. Most of the studies are exhibiting serious bias, leading to weak conclusions. However, two randomised controlled trials compared pelvic adhesion in the subsequent c-section, in step with closure or non closure of the parietal and visceral peritoneum at first caesarean. The results showed that non closure of the peritoneum does not increase or even reduce the adhesions risk. These results are consistent with results from three studies reporting no modification of patient fertility. As a conclusion, current data are supporting the national and international medical society recommendations about the benefits of the non closure of the peritoneum at caesarean section.     

Résection segmentaire pour endométriose colorectale : existe-t-il des alternatives ?

Colorectal surgery for endometriosis is increasingly performed, but its assessment is still incomplete, especially regarding its impact on quality of life, the recurrence rate and subsequent fertility. Segmental resection is the technique most often performed and best evaluated with a proven efficacy but associated with significant morbidity. Alternatives to segmental resection consisting of shaving rectal resection, discoid resection or superficial resection have recently been proposed to provide equivalent efficacy while decreasing morbidity. To date, data are insufficient to clarify the respective indications of segmental resection and alternatives. Only randomized trials will resolve the existing controversy.     

Intérêt des prélèvements bactériologiques endocervicaux en urgence ?

ObjectiveTo estimate the diagnosis profitability of endocervical specimen (ES) within the framework of a teaching gynecological emergency department by studying the circumstances of realization and its bacteriological results.Patients and methodsWe included in our study all the patients who had a gynecological exam with an ES during a consultation in our gynecological teaching emergency department of Tours between January 1st, 2012 and December 31st, 2012. We estimated the diagnosis profitability of realization of the ES (positivity rate within the population with ES, diagnosis correction in case of pelvic inflammatory disease).ResultsOver the study period, 614 (12.4%) women consulting in our emergency department had an ES, which was positive among 102 (16.6%) of them, and a diagnosis of pelvic inflammatory disease in 64 patients. ES had a higher pertinence in case of abdominal pain and a lesser one in case of pregnancy for whom ES realisation must be limited. The diagnosis correction due to ES was observed in 46.8% of pelvic inflammatory disease.ConclusionThe diagnostic profitability of the endocervical specimen in our emergency department was low, taking into account the whole cohort, but ES permitted to correct the diagnosis in about half of diagnosed pelvic inflammatory diseases. The endocervical specimens seem to have no profit in pregnant women.     

Lymphadénectomie lomboaortique dans les cancers du col de stade avancé : un standard en 2010 ?

With tumour size, node involvement is the most important prognosis factor in advanced stage cervical cancer. Para-aortic (PA) disease is observed in 15 to 30% of these patients. CT scan and magnetic resonance imaging (MRI) are not efficient enough to detect these lesions and PET CT have false negatives. Surgical staging is useful to detect carcinosis associated and to adapt therapy (radiotherapy fields are extended if PA nodes are involved). Laparoscopy was crucial to develop this staging because its morbidity associated to chemoradiotherapy is limited. If prognosis impact of PA lymphadenectomy is well established, therapeutic impact is still discussed. The systematic extension of this staging to pelvic nodes that are included in the basic radiotherapy fields is debated because it does not modify therapeutic management and is morbid. Radiotherapy progress, especially with boost and combination to MRI (MRIT), will impact on future therapeutic management.     

Vitamine D et cancer du sein : y a-t-il un lien ?

ObjectiveThe aim of this review is to know the relationship between breast cancer and vitamin D, synthesised by skin or brought by food or supplementation.Material and methodsThe selected articles were extracted from the Pubmed database between 1998 and 2012. The keywords used were: “25-hydroxyvitamin D”, “breast cancer recurrence”, “breast cancer risk”, “serum levels of vitamin D”, “vitamin D intake”. A total of 37 articles were selected.ResultsThe sun exposure, via the skin vitamin D synthesis, is associated with a decreased risk of breast cancer. This decrease seems also likely for food contributions and an over 400 IU per day vitamin D supplementation. An inverse relationship between plasma 25-hydroxyvitamin D (25-OH-D) level and breast cancer risk has been suggested. An increased 25-OH-D level seems associated with a decreased risk of breast cancer recurrence.ConclusionRecommendations concerning a vitamin D supplementation could be established, but should be supported by additional studies.     

Prise en charge de l’accouchement des patientes ayant un antécédent de césarienne

The authors announce their own experience and data of the literature to clarify their policy in cases of pregnancy after a previous caesarean section. For obstetricians, the question is to accept a trial of labor for vaginal birth or to decide an elective caesarean section. We particularly explain our conclusions in cases of breech deliveries, twin pregnancies, fetal pelvic disproportion, maternal diabetes, and labor inductions. In cases of previous caesarean, a trial of labor can be successfully tempted in numerous situations. Nevertheless, there are some limits not to be crossed.     

Varicocèle et infertilité : où en sommes-nous en 2013 ?

While the incidence of clinical varicocele is common in infertile men (about 40%), the reasons why varicocele may affect sperm parameters is still unclear. In addition, the improvement of fertility after treatment of varicocele is also a subject of debate. The purpose of this review is to get new insight into the physiopathology of varicocele, its impact on sperm parameters and the effectiveness of varicocele treatment on fertility. Treatment is likely to be effective in infertile men with clinical varicocele and impaired spermatogenesis. Even if it does not systematically lead to an improvement in sperm parameters, it may prevent further sperm degradation. In case of non-obstructive azoospermia, few studies reported a slight improvement in the process of spermatogenesis. The critical role of an adequate methodology in order to establish clinical guidelines needs to be stressed. Indeed, the huge intra-individual variability in sperm production makes the usual analysis of sperm parameters inadequate to measure treatment effectiveness. Regarding the assessment of conception, it requires not only well designed and properly sized studies but also a multivariate analysis for weighing predictive factors of success. Thus, an active scientific research is needed to better identify pathogenic agents and appropriately assess the impact of varicocele treatment.     

Cirugía histeroscópica del istmocele: ¿solución a un viejo problema?

The increase in cesarean sections in developed countries in recent years has led to the possibility of a parallel increase in the problems associated with this procedure. The best known are obstetric problems, while gynecological complications are less frequent. A cesarean scar defect can sometimes be found at the incision of a previous cesarean section, consisting of a sacculation of isthmic localization where residual menstrual blood accumulates, causing post-menstrual bleeding, abdominal pain and secondary infertility. We present a review of the topic with the evidence available to date.