Endométriose : pourquoi se développe-telle ?

peer reviewedL’endométriose est une maladie œstrogéno-dépendante responsable d’une morbidité importante liée notamment aux opérations multiples et aux phénomènes douloureux. De nouvelles données sur les facteurs génétiques, le rôle possible de l’environnement, du système immunitaire, de l’inflammation offrent des nouvelles perspectives concernant la physiopathogénie de cette affection permettant ainsi de nouvelles approches thérapeutiques et d’autres voies pour un diagnostic moins invasif que la cœlioscopie exploratrice.Endometriosis is an estrogen-dependent disorder that can result in substantial morbidity, including multiple operations, and pelvic pain. New findings on the genetics, the possible roles of the environment, the immune system, and the inflammation have given insight into the pathogenesis of this disorder and serve as the background for new treatments and new diagnostic approach

An unusual diagnosis of a bicornuate unicollis uterus

We present a case of an unusual diagnosis of a bicornuate unicollis uterus mimicking a uterus didelphys with blind hemivagina. Few cases of a bicornuate uterus have been reported with the primary symptom of a paracervical pyocolpos. The difficulties involved in the diagnosis and management of this particular congenital malformation are described in detail. The role of imaging techniques and adequate preoperative preparation is emphasised with a review of recent literatur

Prise en charge des pathologies gynécologiques bénignes par chirurgie robotique

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Reprint of: Peritoneal endometriosis, ovarian endometriosis, and adenomyotic nodules of the rectovaginal septum are three different entities.

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MIRROR SYNDROME : A CASE REPORT IN FETAL MEDICINE

peer reviewedMirror syndrome is a rare entity describing the association of foetal hydrops and maternal symptoms as general oedema and excessive weight gain mimicking preec- lampsia. We report the case of a patient who developed symptoms of oedema, weight gain, headache and biological hemodilution associated with foetal hydrops due to a com- plex congenital heart defect. This symptomatology spontane- ously resolved after foetal expulsion. Mirror or Ballantyne’s syndrome needs to be identified on time and well differenti- ated from preeclampsia. Its consequences may involve the maternal and foetal prognosis.Le syndrome miroir est une entité rare associant un fœtus en anasarque et une symptomatologie maternelle faisant évoquer une pré-éclampsie étant donné l’œdème et la prise de poids. Nous rapportons le cas d’une patiente présentant des céphalées, des œdèmes et une prise de poids avec une hémo- dilution biologique associés à un anasarque fœto-placentaire en relation avec une malformation cardiaque complexe. Cette symptomatologie s’est résolue spontanément après l’accouche- ment. Le syndrome miroir ou syndrome de Ballantyne doit être bien différencié de la pré-éclampsie. Il mérite d’être identifié à temps car ses conséquences peuvent mettre en jeu le pronostic fœtal et maternel

Pharmacological inhibition of the PI3K/PTEN/Akt and mTOR signalling pathways limits follicle activation induced by ovarian cryopreservation and in vitro culture

BACKGROUND: Cryopreservation and transplantation of ovarian tissue (OTCTP) represent a promising fertility preservation technique for prepubertal patients or for patients requiring urgent oncological management. However, a major obstacle of this technique is follicle loss due to, among others, accelerated recruitment of primordial follicles during the transplantation process, leading to follicular reserve loss in the graft and thereby potentially reducing its lifespan. This study aimed to assess how cryopreservation itself impacts follicle activation. RESULTS: Western blot analysis of the PI3K/PTEN/Akt and mTOR signalling pathways showed that they were activated in mature or juvenile slow-frozen murine ovaries compared to control fresh ovaries. The use of pharmacological inhibitors of follicle signalling pathways during the cryopreservation process decreased cryopreservation-induced follicle recruitment. The second aim of this study was to use in vitro organotypic culture of cryopreserved ovaries and to test pharmacological inhibitors of the PI3K/PTEN/Akt and mTOR pathways. In vitro organotypic culture-induced activation of the PI3K/PTEN/Akt pathway is counteracted by cryopreservation with rapamycin and in vitro culture in the presence of LY294002. These results were confirmed by follicle density quantifications. Indeed, follicle development is affected by in vitro organotypic culture, and PI3K/PTEN/Akt and mTOR pharmacological inhibitors preserve primordial follicle reserve. CONCLUSIONS: Our findings support the hypothesis that inhibitors of mTOR and PI3K might be an attractive tool to delay primordial follicle activation induced by cryopreservation and culture, thus preserving the ovarian reserve while retaining follicles in a functionally integrated state

Image of the Month. Asherman Syndrome

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A Bilateral Dysgerminoma: A Rare Presentation of the Swyer Syndrome

peer reviewedSwyer syndrome is a pure gonad dysgenesis associating 46 XY karyotype, primary amenorrhea, presence of female internal genital tract and bilateral streak gonads in a phenotypic female. The diagnosis is usually made at adolescence when the primary amenorrhea is investigated. We report the case of a 25-year-old XY woman who developed a bilateral dysgerminoma from undifferentiated gonads

How I Treat: An Ectopic Pregnancy

peer reviewedNowadays, the management of ectopic pregnancy should be codified as often as possible. Two types of treatment are possible. One surgical and the other medical. Our study is concerned with a series of 97 patients hospitalized for suspicion of ectopic pregnancy for whom the risk factors and treatment were analyzed. Our conclusion is that the medical treatment should be more frequently proposed and surgery should prefer the conservative treatment whenever it is still possible

A reversible posterior leucoencephalopathy syndrome including blindness caused by preeclampsia.

Complications of (pre)eclampsia may involve multiple systems and organs. Neurological symptoms may occur. Visual symptoms concern up to 25% the of patients with severe preeclampsia and 50% of the patients with eclampsia. An uncommon effect of severe preeclampsia is sudden blindness. Blindness may be part of a clinical and radiological presentation named Posterior Reversible Encephalopathy Syndrome (PRES). PRES may lead to permanent neurological deficit, recurrences or death. We report the case of a 24-year-old Caucasian patient, gravida 5 para 2 who developed preeclampsia and PRES complicated with blindness at 32 weeks of gestation. Optimal care allowed visual symptoms to resolve within 24 hours and a favourable maternal outcome and no long- term sequelae. We describe different causes and manifestations of PRES and highlight the need for immediate care in order to optimize the chance of symptoms reversibility