OSNA (one-step nucleic acid amplification) sentinel lymph node intraoperative molecular analysis in breast cancer: a cost-benefit analysis.

The aim of the study was to analyze the medical and economic interest of OSNA molecular technique, compared to conventional postoperative histopathologic evaluation for sentinel lymph node exploration in breast cancer patients. This retrospective cost-benefit study was conducted in the French Universitary Hospital of Saint Etienne on patients who received sentinel lymph node exploration between July 1, 2007 and December 31, 2009. Lymph nodes were analyzed by conventional postoperative histological evaluation in group 1 (82 patients) and OSNA in group 2 (86 patients).

[Lucy's parturition, a way towards extinction?].

Objectives: To compare pelvic cavities in australopithecines, modern humans and non-hominid primates in order to discuss the obstetrical mechanisms in australopithecines

Material And Methods: Bony pelves from fossil material (Australopithecus afarensis AL 288-1, Australopithecus africanus Sts14, Australopithecus Stw 431 and Mh2), 133 modern humans (82 adult females and 51 adult males) and 67 anthropoid primates (36 gorilla, 26 Pan troglodytes, 5 Pongo pygmaeus) were reconstructed and compared (shape and morphometric analysis) using 16 pelvimetric mesasurements.

Results: Pelves of australopithecines were characterized by lower anteroposterior (AP) and transverse (TRV) diameters in inlet pelvis than in other species. Index (AP/TRV) of pelvic inlet, midpelvis and pelvic outlet in the australopithecines were the lowest (<100) and the pelvic shape was platypelloid.

Female urinary incontinence and intravaginal electrical stimulation: an observational prospective study.

Objective: To assess the efficacy of intravaginal electrical stimulation in the management of female urinary incontinence.

Study Design: 359 Women with urinary incontinence (207 with stress incontinence [group A], 33 with urge incontinence [group B] and 119 with mixed urinary incontinence [group C]) were included in this multicenter prospective observational study. Patients were managed by home intravaginal electrical stimulation of the pelvic floor for 20-30 min per day, 5 days a week, for a period of 10 weeks.

Reduction of the use of antimicrobial drugs following the rapid detection of Streptococcus agalactiae in the vagina at delivery by real-time PCR assay.

Objective: To assess whether the determination of the presence of group B streptococci (GBS) in the vagina using a rapid polymerase chain reaction (PCR) assay at delivery was able to spare useless antimicrobial treatments, as compared with conventional culture at 34-38 weeks of gestation.

Design: Practical evaluation and prospective cost-effectiveness analysis.

Setting: A university hospital in France.

[Acute urinary retention and retroverted uterus during pregnancy].

Acute urinary retention at first trimester of pregnancy are uncommon, but have to alert the physician on the possibility of an incarcerated retroverted uterus. Through the management of iterative acute urinary retention before 18weeks of gestation with an incarcerated uterus and a review of the literature, we are going to see the various aetiologies, particularly gravid incarcerated uterus. Acute urinary retention during pregnancy is an emergency.

[Single-dose intraincisional levobupivacaine infiltration in caesarean postoperative analgesia: a placebo-controlled double-blind randomized trial].

Objectives: The efficacy of single-dose intraincisional infiltration with levobupivacaine in postoperative analgesia and chronic pain after caesarean sections is unknown.

Study: A placebo-controlled double-blind randomized trial.

Patients And Methods: After ethical approval, and written inform consent, 140 women scheduled for a caesarean section were randomly assigned and received 30mL of levobupivacaine 0.

[Preliminary study of fetal head engagement diagnosis by transperineal ultrasound before operative vaginal delivery].

Objectives: Estimate the predictive value of perineum-fetal head distance obtained by transperineal ultrasound on results of an operative vaginal delivery.

Patients And Method: A prospective preliminary monocentric study has been conducted on 28 patients between the 18th of April and the 31st of July 2011. Three successive perineum-fetal head distance have been measured before realization of an operative vaginal delivery.

[A new low-cost webcam-based laparoscopic training model].

Objectives: To validate a new laparoscopy home training model (GYN Trainer®) in order to practise and learn basic laparoscopic surgery.

Patients And Method: Ten junior surgical residents and six experienced operators were timed and assessed during six laparoscopic exercises performed on the home training model.

Results: Acquisition of skill was 35%.

[Latest developments on risk factors and prophylaxis of thromboembolic disease in obstetrics].

Venous thromboembolic disease and placental vascular pathology are responsible for an important maternal and foetal morbi-mortality with a modification of the hemostasis parameters. As these biological factors combined with particular clinical features can increase or reduce the risk of occurrence of these diseases, knowing the risk factors would help to prevent problems during the pregnancy. Several antithrombotic therapies exist, including very recent ones.

[Prospective evaluation of an intravaginal electrical stimulation in the treatment of women with pure genuine stress urinary incontinence].

Objectives: To study the objective and subjective effectiveness of transvaginal electrical stimulation for treatment of female pure genuine stress incontinence.

Patients And Methods: This was a multicenter prospective trial including 207 patients with genuine stress incontinence who used the stimulator for 10 weeks. Similar pre-treatment and post-treatment assessments included both validated symptom severity index and health-related quality of life.

[Prospective randomised study of long versus short agonist protocol with poor responder patients during in vitro fertilization].

Objectives: Different ovarian stimulation protocols are used for in vitro fertilization (IVF) in "poor responder" patients. Our work aims at comparing two ovarian stimulation protocols (long agonist half-dose protocol versus short agonist protocol without pretreatment) in this population of women.

Patients And Methods: This prospective, randomized study was realized at the University Hospital of Saint-Étienne and concerns "poor responder" patients (age between 38 and 42 years and FSH at day 3 more than 9.

[Failed forceps extraction: risk factors and maternal and neonatal morbidity].

Objectives: To evaluate risk factors associated with failed forceps delivery and to compare the maternal and neonatal morbidity.

Patients And Methods: In this retrospective case-control study, all failed forceps delivery cases were analyzed from January 2005 to June 2008 and were compared to a successful forceps delivery cohort.

Results: The rate of failed forceps extraction was 4.

[Is the socioeconomic deprivation EPICES score useful in obstetrics?].

Objectives: To describe a validated and multifactorial deprivation score to study the relationship between socioeconomic deprivation and perinatal risks.

Patients And Methods: The index of deprivation EPICES (Evaluation of Precarity and Inequalities in Health Examination Centers) was used to characterize the deprivation status of 234 women in post-partum in comparison with perinatal morbidity. The cutoff value of 30.

[News on antithrombotic therapy and pregnancy].

Objectives: State of the art of antithrombotics and their use recommendations during pregnancy.

Methods: A review

Results: Aspirin and heparins remain the safest molecules during pregnancy, and oral anticoagulants are still used for mechanical valves. Heparinoids are the methods of choice in case of heparin-induced thrombopenia but other molecules could find their place: fondaparinux at first and possibly the direct thrombin inhibitors.

[Anthropometric analysis of obstetrical pelvis from Neolithic area: obstetrical consequences. Preliminary study].

Objectives: To study female pelves from Neolithic area (5000 years AD) in order to better understand the evolution of obstetrical mecanisms.

Materials And Methods: The fossil material comprised 73 Homo sapiens pelves: we reconstructed all the 20 adult female bony pelves. We realised the shape and morphometric analysis of the pelvic cavity.

Diagnostic performance of one-step nucleic acid amplification for intraoperative sentinel node metastasis detection in breast cancer patients.

The purpose of this prospective multicenter study was to assess one-step nucleic acid amplification (OSNA) for intraoperative sentinel lymph node (SLN) metastasis detection in breast cancer patients, using final histology as the reference standard. OSNA results were also compared to intraoperative histology SLN evaluation and to standard clinicopathological risk markers. For this study, fresh SLNs were cut in four blocks, and alternate blocks were used for OSNA and histology.

[Computerized cardiotocography and short-term variation in management of obstetric cholestasis: a useful tool?].

Objective: To evaluate active management of obstetric cholestasis by comparing correlation between bile acid concentrations and computerized cardiotocography (Short-term variation [STV]).

Patients And Methods: Retrospective analytic study about 51 obstetric cholestasis between January 2001 and August 2009. Demographic characteristics, bile acid concentrations and STV data were recorded since diagnosis to pregnancy with evaluation of fetal outcome.

[Ovarian carcinogenesis: recent and past hypotheses].

Ovarian carcinogenesis and the early stages of malignant transformation are limited because of the lack of a candidate precursor. There have been several proposed hypotheses: first, ovary and the ovarian surface epithelium and more recently observations have increasingly focused attention of the Fallopian tube. Moreover, molecular genetic analysis has designed two main pathways of tumorogenesis.

Implementation of molecular intra-operative assessment of sentinel lymph node in breast cancer.

Background: Sentinel lymph node (SLN) biopsy is used as a staging procedure in early breast cancer, however, histology based intra-operative assessment of the SLN status has a low sensitivity. The one-step nucleic acid amplification (OSNA) method was developed to detect metastases by amplification of cytokeratin (CK) 19 mRNA. Experience with OSNA during a French multi-centric prospective study, as well as intra-operative clinical routine use, is reported.

[Prenatal diagnosis and management of isolated bladder exstrophy].

The isolated bladder extrophy is a major congenital malformation which prenatal diagnosis is essential. It is based on the non-visualization of the bladder during the first trimester ultrasound but in most cases, it is confirmed by the morphological ultrasound of the second trimester. For the baby, the prognosis of life quality depends on the accurate identification of the malformation, the foetal sex and the associated pathologies.

Three-dimensional sonographic diagnosis of abdominal wall endometriosis: a useful tool?

Objective: To report the usefulness of three-dimensional (3D) ultrasonography for the assessment of parietal endometriosis.

Design: Case report.

Setting: Academic research hospital.

Identification of factors influencing the decision-to-delivery interval in emergency caesarean sections.

Background: In a life-threatening context, the American College of Obstetrics and Gynecology and the Royal College of Obstetrics and Gynaecology recommend a maximum delay of 30 min between the decision to perform an emergency caesarean and the infant's birth. Our objectives were to estimate the rate of prolonged intervals and identify the factors influencing the decision-to-delivery interval.

Methods: All women who had given birth at Saint-Etienne University Hospital by a non-prophylactic caesarean section between September 1 and November 1, 2007 were included in a prospective cohort study.

[Risk factors of mesh exposure after transvaginal repair of genital prolapse].

Objectives: We analysed the risk factors of vaginal surgery of pelvic organ prolapse with non resobable prothesis.

Patients And Methods: This is a continuous, retrospective study of the 208 patients who had surgery between 2003 and 2007. Depending on the localisation of the prolapse, they had a prothesis under the bladder and/or a posterior tape through the sacrospinous ligament.

Neonatal outcomes and four-year follow-up after spontaneous or iatrogenic preterm prelabor rupture of membranes before 24 weeks.

Objective: To assess the neonatal outcome and four-year follow-up of pregnancies complicated by preterm prelabor rupture of membranes (PPROM) before 24 weeks.

Design: Retrospective study.

Setting: University Hospital of Saint Etienne, tertiary level center, France.