A plea for the creation of trophoblastic disease reference centers in France

Gestational trophoblastic diseases include partial and complete molar pregnancies together with trophoblastic tumors, namely invasive mole, choriocarcinoma and placental site trophoblastic tumor. Important advances continue to occur in both our understanding and management of these diseases. The general guidelines we display here are intended to standardize the essential current management of trophoblastic diseases and justify the creation of a reference center in France. The goal of such a center is to optimize the treatment of patients. The center can help in drawing and interpreting the human chorionic gonadotrophin regression curve and give the multidisciplinary current recommendations to the physician in charge of the patient. The aim is to diagnose and treat as soon as possible the malignant forms of the disease as the interval between the previous pregnancy and the initiation of treatment is a major prognostic factor.     

"Deep" figurate erythema

Deep figurate erythema is a rare dermatologic disease of unknown etiology. Early onset is exceptional. We report a clinical observation of neonatal onset, which serves to confirm the characteristic presentation of this disease, its benign nature and lack of response to different therapeutic attempts.     

Improving return-to-work after childbirth: design of the Mom@Work study,a randomised controlled trial and cohort study

Background  

Many women suffer from health problems after giving birth, which can lead to sick leave. About 30% of Dutch workers are on sick leave after maternity leave. Structural contact of supervisors with employees on maternity leave, supported by early medical advice of occupational physicians, may increase the chances of return-to-work after maternity leave. In addition, to understand the process of sick leave and return-to-work after childbirth it is important to gain insight into which factors hinder return-to-work after childbirth, as well, as which prognostic factors lead to the development of postpartum health complaints. In this paper, the design of the Mom@Work study is described.     

Seltene Varianten des Ekstrophie-Epispadie-Komplexes

Zusammenfassung Während die Blasenekstrophie keine sehr seltene Fehlbildung ist, sind die Variationen der Minimalformen äußerst ungewöhnlich und werden deshalb gelegentlich auch nicht erkannt. Prinzipiell werden 4 Formen der Ekstrophievarianten unterschieden: Die Pseudoekstrophie, die gedoppelte Ekstrophie, die obere vesikale Fissur oder obere Blasenspalte und die gedeckte Ekstrophie. Wir berichten über einen jungen Mann mit Pseudoekstrophie und über ein männliches Neugeborenes mit gedoppelter Ekstrophie. Embryogenese, Differentialdiagnose und Management dieser seltenen Fehlbildungen werden anhand der klinischen Fälle diskutiert. Abstract Although classic exstrophy of the bladder is not a rare anomaly, variants of exstrophy are extremely uncommon. Four entities of exstrophy variants are defined: the pseudoexstrophy, the duplicate exstrophy, the superior vesical fissure, and the covered exstrophy. We report on a young male patient with pseudoexstrophy and a male newborn with duplicate exstrophy. Embryogenesis, differential diagnosis, and management of these rare exstrophy variants are discussed.     

Psychosocial and psychosexual development in childhood and adolescence within the exstrophy-epispadias complex

PURPOSE: We report the psychosocial and psychosexual development of children and adolescents with the exstrophy-epispadias complex (EEC) after complete functional repair using the Erlangen single stage technique. MATERIALS AND METHODS: In a long-term retrospective followup of an average of 11.1 years 100 patients with EEC (76 boys and 24 girls, mean age 14.5 years) were evaluated with respect to medical history, and received a general questionnaire concerning their social and psychosocial situation. A total of 54 patients who were 15 years or older (mean age 18.5) received an additional questionnaire to assess detailed sexual history. RESULTS: Of the patients 81% returned the general questionnaire within 3 weeks. School education level and social integration were high. In about 25% of the patients impairment of daily life was significant, and in 58.7% peer relations were altered. Of the adolescent group 76% answered the special questionnaire. Genital satisfaction and genital touching were rated low, and avoidance of nudity in public areas was common. All patients expressed heterosexuality and 43.9% had engaged in sexual intercourse but 58.5% displayed anxiety about sexual activity. It is noteworthy that 93.9% expressed an interest in psychological assistance. CONCLUSIONS: Despite a high degree of social integration and adult adaptation, children and adolescents with EEC suffer from psychosocial and psychosexual dysfunction requiring special questionnaires for adequate assessment. Anxiety about genital appearance and sexual activity is a common phenomenon among adolescents with EEC, even when they present with nearly "normal" genitalia and participate with satisfaction in sexual activity. Further studies are needed to understand the exstrophy problem and supply all patients with EEC with the individual care they need.