C. Trastour

HIF‐1α and CA IX staining in invasive breast carcinomas: Prognosis and treatment outcome

Hypoxia stabilizes HIF‐1α (Hypoxia Inducible Factor‐1α), which then triggers the expression of several genes involved in many aspects of cancer progression, including metabolic adaptation, cell survival and angiogenesis. The aim of our study was to evaluate the impact of HIF‐1α and CA IX (carbonic anhydrase IX) (one of its target genes) expression on prognosis and treatment outcome of patients with breast cancer. Because of the extreme O2‐dependent instability of the protein, we first validated HIF‐1α staining using xenograft tumours that were subjected to experimental conditions mimicking surgical clamping or sitting at room temperature under normoxic conditions after surgical excision but before fixation. Afterwards, the immunohistochemical staining of HIF‐1α and CA IX was evaluated in 132 invasive breast carcinomas with a 10‐year follow‐up, and correlated to classical clinicopathological parameters and response to adjuvant therapy. No significant correlation was found between tumour size or nodal status and the expression of HIF‐1α or CA IX. Statistically significant association was found between HIF‐1α or CA IX staining and the grade, hormonal receptors loss and the presence of carcinoma in situ. Overexpression of HIF‐1α and CA IX correlates with a poor prognosis in breast cancer. We show that HIF‐1α is an independent prognostic factor for distant metastasis‐free survival and disease‐free survival in multivariate analysis. Furthermore, overexpression of HIF‐1α or CA IX correlates with a poor outcome after conventional adjuvant therapy. CA IX is, however, a weaker prognostic and predictive factor than HIF‐1α, and its association with HIF‐1α does not modify the survival curve neither response to therapy, compared to HIF‐1α alone.

Multifilament polypropylene mesh for urinary incontinence: 10 cases of infections requiring removal of the sling

One hundred and forty-nine women received a suburethral woven polypropylene mesh insertion for urodynamic stress incontinence. Eleven patients (7.5%) presented between 4 and 17 months after surgery (mean 10 months) with symptoms of retropubic infection. Ten patients required surgical exploration, drainage of the collection and removal of the tape either unilaterally (six) or bilaterally (four). Bacterial cultures were negative in nine women. Following removal of the tape, eight patients reported residual incontinence, either stress leakage (five) or de novo urge incontinence (three). Multifilament polypropylene meshes appear to be more at risk of infection, usually requiring sling removal, which may be related to pore size of the mesh. Our data reinforce the importance of proper evaluation of new surgical procedures by rigorously designed randomised trials with adequate follow up to identify rare but potentially serious complications.Sir, Proposed mechanism for polypropylene tape erosions Repair of damaged connective tissue with implanted mesh is a well-established technique in almost any form of surgery. Any implanted foreign body may cause a foreign body–tissue reaction. Indeed, all ‘tension-free’ vaginal tape operations are based on this principle. An implanted plastic tape irritates the tissues to create a longitudinal deposition of collagen to reinforce the posterior pubourethral ligament,1 the anchoring point for the three-directional muscle forces that facilitate the urethral and bladder neck closure mechanisms.2 Bafghi et al.’s clinical observations of sinus formation were reported in the original animal studies on which all ‘tensionfree tape’ operations are based.1 Woven Mersilene multifilament tapes were implanted as an inverted ‘U’, with both ends lying free in the vagina. Ten of 13 canines developed a suprapubic sinus. Like Bafghi’s patients, all remained afebrile and well, and no significant growth was noted on bacteriological examination. Radioactive Gallium studies showed no evidence of infection. In all cases, the sinus disappeared within 48 hours of vaginal removal of the tapes, accomplished by pulling on the vaginal end. In that study, macrophages were noted in the interstices of the tape. In subsequent human and animal studies on multifilament polypropylene tapes, macrophages were noted surrounding individual microfibrils in spaces less than 5 m.3 These data do not support the ‘pore’ hypothesis, which states that macrophages cannot enter spaces less than 10 m. The experience of the two first authors over 4000 clinical cases confirms this experience: it is unusual to grow significant bacteria in cases of tape rejection, even in cases where a skin sinus is present. Neither Bafghi et al. nor de Boer grew significant bacteria, and there is no mention of bacteria being

Perforation intestinale tardive après une opération de TVT

Resume Le tension free vaginal tape (TVT) est devenu le traitement de choix de l’incontinence urinaire (IU) de la femme. Les perforations intestinales sont rares et se manifestent generalement par des signes d’occlusion et/ou de peritonite en postoperatoire immediat. Nous rapportons un cas de perforation intestinale tardive (3 mois apres l’operation) chez une patiente operee en meme temps d’une cure de prolapsus par voie vaginale. L’apparition, meme tardive, de troubles digestifs apres une operation de TVT doit faire penser a la possibilite d’une plaie intestinale.

Délivrance de la contraception d’urgence aux mineures dans les pharmacies françaises

OBJECTIVE The goal of this work was to evaluate the application in French pharmacies of the decree n 2002-39 relating to the delivery of the emergency contraception to minors. PATIENTS AND METHODS Four selected minors carried out an anonymous investigation in 53 randomised pharmacies in the town of Nice (south of France). RESULTS The cost-free delivery of the emergency oral contraception was refused to minors by 37.7% of pharmacies. DISCUSSION AND CONCLUSION Our article highlights the remaining problems, five years after the decree, with the delivery of the emergency contraception. It seems necessary to explain to all the professionals of information, drugs delivery and treatments relating to the contraception or abortive methods the importance of their roles and the respect of their legal obligations.

Fistules entérogénitales d'origine digestive bénigne : À propos de trois cas

Journal de Gynecologie Obstetrique et Biologie de la Reproduction - Vol. 35 - N° 7 - p. 720-724Fistulas between the female genital tract and the digestive tract occur after obstetrical, oncological, or post-operative complications. We report herein 3 rare cases of enterogenital fistulas: one colouterine fistula and one colotubal fistula in a patient with diverticulitis, and one ileovaginal fistula in a patient with Crohns disease. Vaginal discharge was frequent and incited patients to consult a gynecologist. Better knowledge of enterogenital fistulas is necessary to enable earlier diagnosis and apply specific treatment. The incidence of colovaginal fistulas is increasing in diverticular disease because of increased prevalences of hysterectomies and diverticular disease.

État des lieux en France de la prise en charge des utérus cicatriciels

UNLABELLED Since many years, caesarean section rate has increased in France. The purpose of the study was to compare the different French obstetrical attitudes after a prior caesarean section. METHODS This retrospective study was performed between March 2008 and February 2010. We collected the answers of a majority of maternity centres contacted with an anonymous questionnaire sent by postal, electronic, fax mails. RESULTS Of the 194 maternity centres which have responded, there were 37 university hospitals and 312 obstetricians: 75.6% of them worked in public sector and 19.2% in private one. The use of a protocol is registered for 29.6% of questioned obstetricians (only 14% in private sector, P=0.002). Pelvimetry is consistently proposed by 44.4% of them. A trial of labour in case of breech presentation is proposed by 20% of questioned obstetricians, with twin pregnancies by 23.7%, with two prior low-transverse caesarean delivery by 12%, most in university hospitals, level III, with more than 1500 births per year. Induction of labour is allowed by 73.9% of questioned obstetricians, by ocytocics as a majority. Induction by Prostine(®) is underwent by 14.5% of them (24.6% in academic centres, P=0.01), by Propess(®) by 19.2% of them (30% in university hospitals, P=0.008). CONCLUSION These findings showed that the management of delivery after caesarean section is associated with statistically significant differences in France. These informations are relevant for counselling French obstetrical practices.

Le gynécologue face au mélanome : métastases mammaires et utérines, à propos de trois cas

Melanoma has an important metastatic potential and its incidence is greatly increasing. Even after many years of negative follow-up, gynecologists should be aware that a gynecological tumor might be a secondary location for a woman with a medical history of melanoma. Because of a poor prognosis and a reduced life expectancy, it is necessary to make a disease staging in order to offer a prompt diagnosis and a personalized strategy of treatment. Considering the increasing incidence of melanoma, gynecologists will face more frequently with this situation.

Un motif de consultation surprenant : la perception de fils sortant par l’anus: À propos d’une complication rare de la pose de DIU

Resume La perforation rectale par une migration de sterilet est une complication rare qui necessite d’etre parfaitement connue des praticiens du fait de ses particularites therapeutiques qui peuvent associer des examens endoscopiques a une prise en charge chirurgicale.

Évaluation selon l’âge de la technique TVT

OBJECTIVE: To compare efficacy and long-term morbidity of the TVT between patients younger than 70 years and patients older than 70 years. METHOD: Retrospective monocentric study from January 2000 to May 2001. A postal questionnaire was sent to patients to evaluate their satisfaction and their functional status after surgery. RESULTS: The study included 154 patients, and 137 (89%) answered the questionnaire. Seventy-two were less than 70 years old (52.5%) and 65 were more than 70 years old (47.5%). The satisfaction rate in the total population was 88.3%. Amongst the patients younger than 70 years, 97.5% were cured or improved, versus 78.5% of the oldest patients (p=0.001). The study within age groups showed that the satisfaction rate between 70-74 years was higher (92.6%) than in the total population and lower after 75 years (66.7%). This difference is linked to the rates of de novo and persistent urge incontinence, which increase after 75 years. CONCLUSION: The TVT seems to be a good treatment for urinary incontinence in women younger than 75 years. Patients should be warned that preoperative urge incontinence may persist after surgery.

Découverte fortuite d’une tumeur vésicale au cours d’une opération de TVT

Resume La generalisation du TVT ( tension-free vaginal tape ) lors de ces dix dernieres annees, nous mettra probablement face a des pathologies qui necessiteront un traitement par voie trans-uretrale. On rapporte un cas de tumeur vesicale decouvert pendant une cystoscopie peroperatoire d’une operation de TVT et qui a necessite plusieurs resections par voie trans-uretrale. Ces resections ne semblent pas influencer ni la qualite de la resection, ni l’efficacite de la bandelette.