[Biomarkers and uterine cervical cancer. Are they useful for prognosis of cancer and triage of precancerous lesions?]

Biomarkers are "keys" of oncogenesis. Many applications are soon possible as gene therapy and vaccination. Authors have reviewed different aspects of classical prognosis factors and examined new possibilities of prognosis and selection of precancerous lesions as ASCUS by biomarkers. Ag SCCTA4, HPV typing, microangiogenesis, are the main biomarkers in cervical cancers.

[Is systematic clinical breast examination in women still indicated?]

Screening for breast cancer is not generalized in France. In order to evaluate any change in clinical practice, we reviewed three cohorts of one hundred successive breast cancers diagnosed in a geographical area without a breast screening campaign, starting in 1978, 1999 and 1996. The proportion of T1 (UICC) shifted from 32% to 50% and the rate of positive nodes among these T1 patients from 63% to 26% from the 1978 cohort to the 1996 cohort. There was an unchanged proportion (20%) of T4 patients in all three cohorts. Conservative treatment improved from 32% to 78% (p > 0.001). Systematic clinical breast examination should be strongly encouraged to lower the high proportion of T4 patients.

[Mixed endoscopic colposuspension (retroperitoneal and vaginal) for the treatment of female stress urinary incontinence: technique and preliminary results]

Preliminary results of a mixed technique of cervical bladder suspension by retroperitoneal laparoscopy and vaginal route. 35 patients, average age 55 years with stress incontinence. Every patients had positive Bonney test. Associated lesions were prolapse (72%). In this retrospective study, we give technique in details. Average operative time: 65 minutes. Average hospital stay: 5.4 days. Success rate: 89%. Retzius hematoma were treated by laparoscopy. Average lapse of time: 10.5 months. Interesting technique in associated prolapse.

[Ultrasound abnormalities of the placenta during triploidy with pre-eclampsia in the 2nd trimester]

A documented case of triploidism which developed to 20 weeks gestation underlines the importance of early ultrasonographic assessment of the trophoblast. Large placentas, especially when pre-eclampsia occurs, should lead to assay of beta-hCG and search for chromosome anomalies. Paternal genomic origin was suggested based on the large volume of the placenta.

Endoscopic exploration and lymph node sampling of the axilla. Preliminary findings of a randomized pilot study comparing clinical and anatomo-pathologic results of endoscopic axillary lymph node sampling with traditional surgical treatment

OBJECTIVE

To describe the technique of endoscopic exploration of the axilla. To compare this technique to open surgical treatment by comparing the following variables: operative time, peri-operative complications, duration of hospital stay, node's histology and morphologic aspects and esthetic results.

MATERIALS

Standard instruments for traditional operative laparoscopy plus a lipo-aspirator (0.8 Bar).

PATIENTS

Forty patients, 20 (group A) undergoing open surgery and 20 (group B) undergoing axilloscopy. All patients with early invasive breast cancer are eligible for conservative operative treatment.

METHOD

Randomized study. The technique is described and preliminary results are presented.

RESULTS

The operative time for axilloscopy is approximately double that for open surgery. A comparable number of lymph nodes is collected by axilloscopy and open surgery. The nodes collected by axilloscopy are more likely to be fractured. What is the clinical consequence? Two loco-regional relapses are observed in the endoscopic group.

DISCUSSION

Axillary sampling by endoscopic procedure gives the same pathologic information than surgical axillary sampling. Anatomo-pathologic aspects of nodes and possibilities of relapses were two drawbacks of this procedure.

CONCLUSION

Operative time is increased for axilloscopy compared with open surgery. The techniques yield comparable anatomo-pathologic results. It is still unknown whether this endoscopic technique is as effective as traditional surgery or if the frequency or severity of lymphedema is decreased by the endoscopic approach.

Sacrospinous ligament fixation by palpation: variation of the Richter procedure

OBJECTIVE

To present our method of sacro-spinous ligament fixation by palpation and compare it to the classical approach described by Richter.

MATERIAL

In addition to the standard instruments needed for vaginal surgery, we use a Rasemond dissector, a small O'Shaugnessy dissector with smooth branches. We also use a Bengolea forceps and a monothread-nylon (Ethilon), decimal 4 suture loaded on a needle with a 30-mm curve.

PATIENTS

Twenty patients underwent this procedure from 03/15/1978 to 05/19/1995. Their ages ranged from 46 to 86 years with a mean age of 64.7 years.

METHOD

This was a retrospective study of the indications, results and complications associated with this technique.

RESULTS

With an average follow-up of 7 years, we observed 90% success, 10% recurrences, and no complication directly attributable to this technique. This technique is valuable because of its effectiveness and simplicity.

CONCLUSIONS

Sacrospinous fixation by palpation is more simple and provides the same results as the classic exposure technique. We describe the technique in this text. The efficacy of sacro-spinous ligament fixation by palpation would be improved by its systematic and bilateral use. Its value must be confirmed by a controlled prospective study to confirm our impression that our technique carries fewer risks.

[Recurrent vulvovaginal mycoses]

The treatment of recurrent vulvovaginal fungal infections is difficult. Pathogenic mechanisms are discussed. Available pharmacologic treatments and their mechanisms of action are reviewed. Patients clearly prefer oral treatment. Ketoconazole is toxic. Only topical or nonabsorbed oral agents can be used during pregnancy. Agents absorbed via the digestive tract can be used in women who use effective contraceptive methods. Published data demonstrate that trifluconazole (which has not yet been granted a license in France) is potent and less toxic than ketoconazole, and that recurrences at discontinuation of this drug are less common. A few hypotheses for future research are presented.