How to make a LLETZ simulator: LLETZ Simulator

Large loop excision of the transformation zone (LLETZ) of the uterine cervix is a surgical procedure very frequently performed. Simulation of LLETZ under colposcopic guidance has a major role in training practitioners. The objective was to present an ex vivo model of LLETZ.

The impact of using electrical impedance spectroscopy (ZedScan) on the performance of colposcopy in diagnosing high grade squamous lesions of the cervix

OBJECTIVES

To determine the efficacy of colposcopy plus ZedScan, which measures changes in tissue electrical impedance, for detecting intraepithelial high-grade lesions compared to colposcopy alone.

METHODS

A prospective study conducted at a university hospital colposcopy clinic. Patients referred following abnormal cervical cytology or colposcopic follow up were examined by colposcopy plus ZedScan to assess the cervix. The results of ZedScan directed and colposcopically directed biopsies were compared.

RESULTS

Ninety-one patients were included in this study. The median age was 33 years. Eighty (88%) were referred with abnormal cytology; LSIL 45%, ASCUS 27%, ACS-H 8%, HSIL 7%, AGC 1% and 12% follow-up postconisation or colposcopic follow up. Colposcopy alone detected 18 high-grade lesions with 64 women undergoing biopsy with a total of 115 biopsies being taken with a sensitivity of 60% and NPV estimated at 81.7%. ZedScan with colposcopy increased the detection of high-grade lesions by 47.3%, identifying 27 high-grade lesions and one case of invasive cancer. Sensitivity was 93.1% and NPV estimated at 91.3%. A combination of normal colposcopy practice and ZedScan had a sensitivity and NPV of 100%.

CONCLUSION

ZedScan used in conjunction with the colposcopy improves sensitivity in detecting high-grade lesions at the expense of a moderate increase in the number of biopsies.

[How far can we go to oocyte donation? Debates on the risks of late pregnancies]

In France, there is a decline in first-time motherhood influenced by many sociocultural factors thus leading to a reproductive age where fertility decreases and which increase the risks associated with late pregnancy. The oocyte donation in France is subject to The Bioethic law granting no support in infertility beyond past 43 years. Thus, to satisfy their need for maternity, the French use a gift abroad. Then we will report the case of a pregnancy obtained by an oocyte donation, after 42 years, which was complicated. We will discuss the importance of taking into account the risk factors before a support to ART, and the ethical issues raised by this case. After a brief review of French legislative framework governing the practice of oocyte donation, we will evoke ways to improve the coverage needs of it in France.

[Early home abortion and immediate contraception with Evra® patch]

AIM

To propose a new home safe abortion protocol and effective immediate contraception.

PATIENTS AND METHODS

Four hundred women undergoing home safe abortion with RU 486. Hundred accepted to start contraception with Evra® patch.

RESULTS

Concerning home abortion, the failure rate of the protocol was only 3% (12 cases). Concerning contraception, the continuation rate was 50% (50 cases).

CONCLUSION

Early home abortion is a promising method to propose an immediate contraception. The Evra® patch is well accepted and appears to be a first line contraceptive choice.

[Intrauterine fetal death in a woman with a gastric banding]

Obesity defined by a Body Mass Index (BMI) over 30 is a major public health problem. Its correction may require surgical treatment in case of failure of adequate medical care. A pregnancy achieved in the aftermath of this surgery must be planned and monitored as a high-risk pregnancy, in fact it can complicate. We report here the occurrence of fetal death in a patient with a gastric banding.

[Coasting and ovarian stimulation protocols in high-responder patients undergoing assisted conception]

Over-responsive patients are at risk of ovarian hyperstimulation, which may lead to severe complications. The choice of ovarian stimulation protocol or the use of a coasting (gonadotrophins suspension) with its associated risk of too strong ovarian response will be discussed herein. As for in vitro fertilization stimulation protocols, the best are probably those which use steadily increasing low doses of gonadotrophins, associated to GnRH agonists (low-dose protocols) or those which complete a double hypophyseal inhibition (estro-progestative association and GnRH agonists). GnRH antagonists may also reduce the risk of ovarian hyperstimulation, by estradiol drop. Outside the context of in vitro fertilization GnRH continuous administration or low -dose gonadotrophin stimulation are the best options. A coasting will be performed when an excess follicle response is documented. Under strict hormonal follow-up and within four days it allows achieving a high rate of pregnancy with a lower risk of hyperstimulation. Compared to other therapies of hyperstimulation syndrome, the coasting allows to avoid cycle cancellation or freezing of all embryos.

Faut-il poursuivre les frottis de dépistage après hystérectomie ?

OBJECTIVE

To precise the risk of cancer of the vagina after hysterectomy.

PATIENTS AND METHODS

In our file of cervicovaginal and vulvar pathology, we looked for all VAIN and invasive cancers of the vagina on a 10-year period.

RESULTS

Out of 2152 patients, we found but 45 cases, 13 of which only after total or radical hysterectomy: 4 cases of invasive cancer of the vagina (1 after radical hysterectomy for invasive cancer of the cervix, and 3 after total hysterectomy for CIN); 9 cases of VAIN (5 after total hysterectomy for CIN; and 4 VAIN (3 after radical hysterectomy for cervical invasion).

DISCUSSION AND CONCLUSIONS

In our series, we did not observe precancerous or invasive lesion of the vagina after hysterectomy for benign lesion. Indeed, the 13 cases of invasive or in situ cancers of the vagina we found had undergone simple or radical hysterectomy for cervical lesion. We think that the cytological follow-up of the vaginal vault after hysterectomy for benign lesion can be, if not stopped, at least quite spaced out. On the other hand, the follow-up must be imperatively maintained in the event of hysterectomy for precancerous lesion or cancer of cervix.