L'immunothérapie dans le cancer épithélial de l'ovaire : entre espoir et réalité [Immunotherapy in epithelial ovarian carcinoma: hope and reality]

National audienceLe cancer épithélial de l'ovaire (CEO) présente un pronostic sombre avec depuis deux décennies des progrès très modestes en terme de gain de survie. L'immunologie, longtemps négligée dans le CEO, apparait maintenant central dans l'histoire naturelle de cette maladie cancéreuse. L'objet de cette revue est une mise au point sur l'état des connaissances sur l'immunologie dans le CEO et la potentielle place de l'immunothérapie dans son traitement futur. Matériel et méthodes : Interrogation de la base de données MedLine en utilisant les mots clés : " Ovarian carinoma, immunotherapy, T lymphocyte, regulator T lymphocyte, dendritic cells, macrophage, antigen, chemotherapy, surgery, clinical trials ". Nous avons retenu les éléments pertinents pour la compréhension de l'immunologie du CEO, de la place des traitements conventionnels et des stratégies d'immunothérapie à partir des articles de langue anglaise et française. Résultats : L'infiltration intra-tumorale par des cellules immunitaires conditionnent de manière majeure le pronostic du CEO. Les traitements traditionnels du CEO que sont la chirurgie et la chimiothérapie diminuent l'immunosuppression de la patiente. L'immunologie est l'une des composantes de l'action thérapeutique de la chimiothérapie et de la chirurgie. L'immunothérapie après des résultats décevants est à l'aube d'une révolution thérapeutique en cancérologie par l'arrivée de drogue ciblant le microenvironnement tumoral tolérogène. Conclusion : L'immunologie conditionne l'histoire naturelle du CEO. La modulation de l'immunosuppression associée à une stimulation de l'immunité antitumorale est probablement l'une des prochaines révolutions thérapeutiques en cancérologie. Summary: Introduction: Epithelial ovarian carcinoma (EOC) has a worst prognosis with little progress in term of survival for the last two decades. Immunology received little interest in EOC in the past, but now appears very important in the natural history of this cancer. This review is an EOC immunology state of art and focuses on the place of immunotherapy in future. Material and methods: A systematic review of published studies was performed. Medline baseline interrogation was performed with the following keywords: " Ovarian carinoma, immunotherapy, T lymphocyte, regulator T lymphocyte, dendritic cells, macrophage, antigen, chemotherapy, surgery, clinical trials ". Identified publications (English or French) were assessed for the understanding of EOC immunology and the place of conventional treatment and immunotherapy strategy. Results: Intratumoral infiltration by immune cells is a strong prognosis factor in EOC. Surgery and chemotherapy in EOC decrease imunosuppression in patients. The antitumoral immunity is a part of the therapeutic action of surgery and chemotherapy. Until now, immunotherapy gave some disappointing results, but the new drugs that target the tolerogenic tumoral microenvironnement rise and give a new hope in the treatment of cancer. Conclusion: Immunology controls the EOC natural history. The modulation of immunosuppressive microenvironment associated with the stimulation of antitumoral immunity could be the next revolution in the treatment of cancer

Caesarean section at term: the relationship between neonatal respiratory morbidity and microviscosity in amniotic fluid.

None of the authors report any conflicts of interest.International audienceOBJECTIVES: The incidence of neonatal respiratory morbidity following an elective caesarean section is 2-3 times higher than after a vaginal delivery. The microviscosity of surfactant phospholipids, as measured with fluorescence polarisation, is linked with the functional characteristics of fetal surfactant and thus fetal lung maturity, but so far this point has received little attention in new-borns at term. The aim of the study is to evaluate the correlation between neonatal respiratory morbidity and amniotic microviscosity (Fluorescence Polarisation Index) in women undergoing caesarean section after 37 weeks' gestation. STUDY DESIGN: The files of 136 women who had undergone amniotic microviscosity studies during elective caesarean deliveries at term were anonymised. Amniotic fluid immaturity (AFI) was defined as a Fluorescence Polarisation Index higher than 0.335. RESULTS: Respiratory morbidity was observed in 10 babies (7.3%) and was independently associated with AFI (OR: 6.11 [95% CI, 1.20-31.1] with p=0.029) and maternal body mass index (OR: 1.12 [95% CI, 1.02-1.22] with p=0.019). Gestational age at the time of caesarean delivery was inversely associated with AFI (odds ratio, 0.46 [95% confidence interval, 0.29-0.71], p<0.001), especially before 39 weeks, and female gender was associated with an increased risk (odds ratio, 3.29 [95% confidence interval, 1.48-7.31], p=0.004). CONCLUSIONS: AFI assessed by amniotic microviscosity was significantly associated with respiratory morbidity and independently correlated with shorter gestational age especially before 39 weeks. This finding provides a physiological rationale for recommending delaying elective caesarean section delivery until 39 weeks of gestation to decrease the risk for respiratory morbidity

Etude prospective du devenir des fœtus porteurs d'hygroma colli vus au centre de diagnostic prénatal du chu d'Amiens entre avril 1993 et décembre 2002

Définition : L'hygroma colli est une malformation du système lymphatique cervical fœtal apparaissant comme une masse liquidienne rétro cervicale avec extension latérale symétrique, dont le diagnostic se fait par l'échographie anténatale, souvent entre 10 et 14 semaines d'aménorrhée. Il se distingue de la clarté nucale par la présence d'au moins une cloison (antéro-postérieure ou " ligamentum nucae "). Objectifs : Connaître les étiologies et apprécier le devenir des fœtus porteurs d'un hygroma colli au premier trimestre de grossesse.(...) Conclusions : L'hygroma colli est associé à une anomalie chromosomique dans 52,3 % des cas. Même lorsque le caryotype fœtal est normal, le risque de voir apparaître une mort fœtale in utero, une mort néonatale ou d'autres malformations associées est important. Seuls 24,2 % des enfants sont vivants, avec pour la majorité un développement normal mais pour certains, l'apparition d'une pathologie identifiée : syndrome de Noonan, nanisme, syndrome de BOR ?AMIENS-BU Santé (800212102) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Devenir obstétrical et néonatal après métrorragies du 2ème trimestre de grossesse

Les métrorragies au cours de la grossesse sont un motif fréquent de consultation aux urgences. Le pronostic des grossesses après métrorragies varie selon le terme et l'étiologie. Au 2ème trimestre de grossesse, quelques études ont rapporté une augmentation des complications obstétricales et néonatales, en particulier de l'accouchement prématuré. La prématurité est à l'origine d'une importante morbidité et mortalité. La prise en charge de ses facteurs de risque devrait permettre de diminuer le nombre de naissance avant 37 semaines d'aménorrhées. Objectif: Evaluer le devenir obstétrical et néonatal des grossesses compliquées de métrorragies au 2ème trimestre. Matériels et méthode: Etude de cohorte rétrospective comparant deux groupes de patientes, l'un constitué de 76 patientes ayant consulté aux urgences gynécologiques pour des métrorragies au 2ème trimestre et l'autre composé de 80 patientes tirées au sort qui n'ont pas eu de métrorragies au 2ème trimestre. Variables analysées: l'accouchement prématuré, la rupture prématurée des membranes avant terme, la chorioamniotite, l'Apgar à 5 minutes de vie, le transfert en réanimation, l'infection materno-foetale et l'endométrite. Analyse des caractéristiques des métrorragies et risque d'accouchement prématuré avant 37 semaines d'aménorrhées en fonction de ces caractéristiques. Résultats: La prévalence des métrorragies du 2ème trimestre est de 0,37 %. Le risque d'accouchement prématuré, de rupture des membranes avant terme, de chorioamniotite et de transfert en réanimation est significativement augmenté après métrorragies du 2ème trimestre. Le risque de rupture prématuré des membranes est également associé aux métrorragies du 1er trimestre. Le risque d'accouchement prématuré est corrélé à l'intensité des métrorragies: il est augmenté en cas de métrorragies de moyenne ou de forte abondance. Les placentas recouvrant, les placentas accreta et les hématomes marginaux sont plus à risque d'accouchement prématuré. Conclusion: Le risque d'accouchement prématuré, de rupture prématuré des membranes avant 37 SA, de chorioamniotite et de transfert en réanimation néonatale est augmenté après métrorragies du 2ème trimestre. Le risque de prématurité dépend de l'intensité et de l'étiologie des métrorragies.RENNES1-BU Santé (352382103) / SudocSudocFranceF

Activité des urgences gynécologiques , entre le 1er Juillet et le 30 Septembre 2005, dans le département d'obstétrique, gynécologie et médecine de la reproduction de l'Hôpital Sud de Rennes

RENNES1-BU Hôpital Sud (352382126) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Tumeur adénomatoïde multinodulaire de l'utérus chez une patiente avec allogreffe rénale. [Multinodular-adenomatoid tumor of the uterus in a patient with a renal allograft]

International audienceA case of diffuse-adenomatoid tumor of the uterus occurring in a 43-year-old patient with a renal-allograft transplant is reported. Grossly, the lesions were thought to be multiple leiomyomas. The diagnosis was supported by the adenomatoid and angiomatoid histologic patterns and the mesothelial immunophenotype. Diffuse-adenomatoid tumor of the uterus is a rare and benign lesion, usually reported in patients with immunodeficiency and renal transplant

[Acquired uterine arteriovenous malformations].

International audienceUterine arteriovenous malformations (AVM) may be responsible for vaginal bleeding potentially life-threatening. They are most often acquired following uterine trauma (curettage, cesarean section, artificial delivery/uterus examination) in association with pregnancy or gestational trophoblastic disease. We report three cases of patients having uterine AVM after curettage. The diagnostic management is important to avoid differential diagnoses (intra-uterine retention, hemangioma, gestational trophoblastic disease). It is based on serum hCG measurement and Doppler ultrasound, then confirmed on dynamic angio-MRI, which tends to replace angiography as first-line. The therapeutic management in cases of symptomatic AVMs is mostly embolization which offers the possibility for childbearing. Current data on subsequent pregnancies is reassuring even if they remain limited

Surgical management of isthmocele symptom relief and fertility

International audienceObjective: To describe symptoms and fertility and quality of life outcomes after isthmocele surgery.Study design: We conducted a retrospective study on from January 2012 to December 2017 in two tertiary referral centers in Rennes (France). All the patients diagnosed with isthmocele and operated were included. They all underwent isthmocele surgery by hysteroscopy, vaginal way or laparotomy.Results: The following data were collected: surgical procedure, symptoms and fertility before and after surgery, patient satisfaction about the surgery, and quality of life after surgery. Eighteen patients were included. The mean duration of follow-up was 15 months. Surgical procedures consisted of hysteroscopy (n = 5/18, 27.8%), vaginal surgery(n = 8/18, 44.4%) and laparotomy (n = 5/18, 27.8%). Surgical indications were: secondary infertility (n = 10/18, 55 %), pelvic pain (n = 5/18, 28%) and abnormal uterine bleeding (n = 3/18, 17%). Among patients with abnormal uterine bleeding, improvement was obtained after hysteroscopy, laparotomy and vaginal surgery for 83.3%, 75% and 50%, respectively. Among those with pelvic pain, improvement was obtained after hysteroscopy, laparotomy and vaginal surgery for 80%, 81% and 66%, respectively. One patient (1/18, 5.5%) had post-operative complication. Of the 12 patients who wished to conceive eleven pregnancies were obtained (91.7%). Of the 10 patients with secondary infertility, six became pregnant (60%). Five pregnancies (5/11, 45.4%) were carried to full term, including four in patients whose surgical indication was infertility. Among these, one patient had a vaginal delivery (after vaginal surgery) without obstetric complication. All patients operated on by hysteroscopy would recommend this surgery versus 75% of patients with vaginal surgery and 60% of patients with laparotomy (p = 0.24). Pain and quality-of-life scores were comparable between the three groups.Conclusion: Isthmocele surgery is effective for abnormal uterine bleeding, pain and infertility regardless of the surgical route

Screening for Chlamydia trachomatis Using Self-Collected Vaginal Swabs at a Public Pregnancy Termination Clinic in France: Results of a Screen-and-Treat Policy.

International audienceOBJECTIVE: : To assess the prevalence of Chlamydia trachomatis (CT) infection and the risk factors for CT infection among women presenting for abortion at a clinic in France. METHODS: : Women seeking surgically induced abortions were systematically screened by PCR on self-collected vaginal swabs between January 1, 2010, and September 30, 2010. CT-positive women were treated with oral azithromycin (1 g) before the surgical procedure. RESULTS: : Of the 978 women included in the study, 66 were CT positive. The prevalence was 6.7% (95% confidence intervals [CI] 5.1%-8.3%). The risk factors for CT infection were the following: age <30 years (Odds ratio [OR]: 2.0 [95% CI: 1.2-3.5]), a relationship status of single (OR: 2.2 [95% CI: 1.2-4.0]), having 0 or 1 child (OR: 5.2 [95% CI: 2.0-13.0]), not using contraception (OR: 2.4 [95% CI: 1.4-4.1]), and completing 11 weeks or more of gestation (OR: 2.1 [95% CI: 1.3-3.6]). Multiple logistic regression indicated that 4 factors-having 0 or 1 child, a single relationship status, no contraceptive use, and a gestation of 11 weeks or more-were independently associated with CT infection. The rate of postabortion infection among all patients was 0.4% (4/978). CONCLUSIONS: : These results reveal a high prevalence (6.7%) of CT-positive patients among French women seeking induced abortions. Because it is not common practice to screen the general population for CT, screening before induced abortions seems relevant. A cost-effectiveness study is required to evaluate this screen-and-treat policy

L'interruption volontaire de grossesse médicamenteuse de 12 à 14 semaines d'aménorrhée : étude rétrospective portant sur 126 patientes. [Medical abortion from 12 through 14 weeks' gestation: a retrospective study with 126 patients].

International audienceOBJECTIVE: To assess the efficacy of medical abortion performed according to a single protocol from 12 through 14 weeks. STUDY DESIGN: Retrospective observational study of medical abortions from 12 through 14 weeks performed from January 2007 through March 2009. The protocol combined 600 mg de mifepristone orally, followed 48 h later by 400 μg of misoprostol, administered orally, and repeated after 3h, four times a day (during two days), if patient did not begin to abort. Outcome measures were the abortion rate, the rate of complication, the rate of manual uterine revision or vacuum aspiration, the time of expulsion and the misoprostol dose. RESULTS: The study included 126 medical abortions. The abortion rate was 98% and the secondary manual revision or vacuum aspiration rate was 41%. The mean time to expulsion was 10.4 (±8.8)h, and the mean misoprostol dose 1040 (±420) μg. Higher parity was significantly correlated with shorter time to expulsion (P=0.02). CONCLUSION: Medical abortion was consistently effective from 12 through 14 weeks but with high rate of secondary manual revision or vacuum aspiration