Utérus malformé et Assistance médicale à la procréation : prévention du défaut d'implantation ?

The infertility in women with an abnormal uterus seems a subject of controversy. The prognosis of in vitro fertilization among these patients with such an anomaly is even less founded. The results of in vitro fertilization have been only studied with few patients and recently. Through the literature, we will focus step by step, on the impact of uterine anomalies on natural reproduction, then the impact of metroplasty on natural reproduction, the role of anomalies on the endometrium quality and lastly, the results of Assisted Rerpoductive Techniques with women with such an anomaly. It seems that the main risk is obstetric complications such as spontaneous abortion or premature delivery, not implantation failure. However, when infertility exists, surgical treatment tends to improve the pregnancy rate for some.     

Trauma périnéal à l'accouchement,intimité, ajustement dyadique et fonction sexuelle de nouveaux couples parentaux

Objective

This study focuses on perineal trauma during childbirth and its relationship to postnatal marital and sexual issues as expressed by the sexual function and perceived intimacy of new parent couples in Ontario.

Carcinomes canalaires in situ bilatéraux : événements indépendants ou maladie bilatérale ?

ObjectivesIn a retrospective study of bilateral Ductal Carcinoma In Situ (DCIS), cases were analysed to determine the relationship between the two events.Material and methodsFrom 1971 to 2001, among 812 patients with DCIS in Bergonie Institute, 78 suffering from bilateral DCIS and only19 were treated entirely in our institute. It was either synchronous DCIS or asynchronous (before 6 months). We realised a comparative study between, clinical and pathological characteristics of each DCIS.ResultsIn case of asynchronous DCIS, contra lateral DCIS occurred after a median 75-months period and until 22 years after the first event. We found at least for one histological subtype an agreement in 53% of cases. In 31% of cases, the grade was the same. For low plus intermediary grade versus high grade, the agreement was 53%. There was a subtype and grade agreement of 32% and a subtype or grade agreement in 63% of cases.ConclusionHistological agreement between the two lesions indicated the possible existence of in situ bilateral disease in these women. The local relapse rate was 20% and all of them were invasive. The risk of relapse in controlateral breast is high and patient needs a long follow up even in case of mastectomy.     

Comment décider avec justesse,justice et équité ? Réflexion sur la décision en situation d'extrême prématurité: Deuxième partie : comment tendre vers une décision optimale ? Définition des conditions d'exercice de la décision

Extreme premature child's long-term prognostic is getting better and better known, and if a resuscitation procedure is possible at birth, it won't guarantee survival or a survival free of disability. Incertitude toward individual prognosis and outcome for those children remains considerable. In this field, we are at the frontier of medical knowledge and the answer to the question, "how to decide the ante and postnatal care" is crucial. This work is focused on this problematic of decision-making in the context of extreme prematurity. It attempts to deconstruct this concept and to explicit its stakes. Thus, with the support of the medical sources and of philosophical debates, we tried to build a decision-making procedure that complies with the ethical requirements of medical care, accuracy, justice and equity. This decision-making procedure is primarily concerned with the singularity of each decision situation and it intends to link it closely to the notions of rationality and responsibility.     

Comment décider avec justesse,justice et équité ? Réflexion sur la décision en situation d'extrême prématurité: Première partie : problématique de la décision dans le contexte de la prématurité extrême

Extreme premature child's long-term prognostic is getting better and better known, and if a resuscitation procedure is possible at birth, it won't guarantee survival or a survival free of disability. Incertitude toward individual prognosis and outcome for those childs remains considerable. In this field, we are at the frontier of medical knowledge and the answer to the question, “how to decide the ante and postnatal care?” is crucial. This work is focused on this problematic of decision making in the context of extreme prematurity. It attempts to deconstruct this concept and to explicit its stakes. Thus, with the support of the medical sources and of philosophical debates, we tried to build a decision-making procedure that complies with the ethical requirements of medical care, accuracy, justice and equity. This decision-making procedure is primarily concerned with the singularity of each decision situation and it intends to link it closely to the notions of rationality and responsibility.     

Insémination intra-utérine : pourquoi continuer à stimuler l'ovulation ?

Conflicting results have been published about intra-uterine insemination efficacy. In many studies, success rates is due to ovarian stimulation and number of follicles. In the present fight against multiple pregnancies, ovarian stimulation is discussed and present pregnancy rates are weak. Our aim is to demonstrate that there is a place for the association controlled ovarian hyperstimulation and intra-uterine insemination in the field of infertility treatments. It is possible to try and recognise women at high risk of multiple pregnancies, keeping the benefit of ovarian stimulation.     

Le kit prothétique dans la cure des prolapsus génitaux : est-ce un gadget ?

ObjectiveTo search if the prosthetic kits bring an interest, other that financier.Materials and methodAuthors have counted 5 firms presenting the varied kits. The Prolift™ kit with synthetic pre- cut mesh made of polypropylene, standardized needle, cannulas and protective devices of recovery of mesh arms in 3 versions, anterior, posterior and total. Perigee™ and Apogee™ systems in a synthetic version (IntePro™) and a biological version (InteXen ++LP™) matched of specific needles for the different obturator passages and infra coccygeus. The Avaulta™ kit declines in a biosynthetic version and a hybrid version with a specific needle for its anterior kit and an other for its posterior kit. The Biomesh^® Soft system presents a polypropylène mesh posed on a multi pattern sheet to carve following dots with a share of 3 needles according to the type of arm passage ended by a recuperator thread. The Nazca POP Repair System, in its anterior version claims to be able to correct in the same time a urinary incontinence by pre-pubic arms. The polypropylene mesh is perforated and is had with the help a needle for its anterior and posterior kit. Authors have been interested in the research of studies on prosthesis with and without kit.ResultsThe Prolift™ kit contains the alone prosthesis having been evaluated without (TVM) and with kit. Authors remind results of two studies, understanding 684 cases without kit and 110 cases with kit. The rate of early per and postoperative complications has been decreased half, the rate of mesh exposure decreased from 11,3 to 4,7%. Studies on Perigee and Apogee IntePro™ kits, whose meshe and the procedure are similar to the Prolift™ seem to obtain from results equal. The Biological version has not made the object of study. For the Avauta™ kit, alone the mesh in plate not pre-cut has been well studied as for its tolerance for the biosynthetic version. Nothing on the hybrid version. No study is found for the Biomesh^® Soft kit and Nazca POP repair system.DiscussionThe cost of these kits, varying 1 to 4, is to take in consideration and to put in scale with the returned service. Alone TVM/Prolift™ allows to advance in a reply. The utilization of needles, presents in all the kits, but especially devices facilitating the passage and the recovery of prosthesis arms, presents solely in the Prolift™ kit, reduce the utilization of valves and the risk of tear tissues during their job. The improvement of techniques by elements of the kit make that the surgical procedure become mini invasive.ConclusionThe full kits allow a best security of procedures, facilitate the surgical gesture and limit complications. It is necessary to remain vigilant in the evaluation of these new materials "ready to wear" and to require pre clinic and clinic studies before their distribution.     

Désir d’enfant et VIH : le préservatif est-il dépassé ?

With antiretroviral therapy, the risk of HIV transmission from an infected person to a stable heterosexual partner is very low when a sustained undetectable viral load is achieved, in the absence of associated genital tract infections. However, epidemiological data do not prove that there is no risk at all. Virological data confirm that when the blood viral load is undetectable for several months, the viral load in semen usually becomes undetectable, but viral shedding can persist in some cases. Two different issues are involved: 1): Can we do without assisted reproductive in HIV sero-different couples who want to have a child? and; 2): can couples in which one or both members are HIV positive entirely stop using condoms? The current French guidelines consider natural conception to be a reasonable option for these couples, recommending self-insemination when the woman is HIV positive and timed unprotected intercourse when the man is HIV positive. Preconceptional care should be available, including viral load monitoring, detection of genital infections and an estimation of the couple's potential fertility. On the other hand, we must strongly discourage unprotected sex in high-risk situations. The best prevention of risk behavior is to offer complete information and appropriate support to people with HIV who wish to conceive.