Congress book Livre du Congrès

Transcription

7th Congress of the
European Society
of Gynecology
OCTOBER 10-13,2007
PARIS - FRANCE
7ème Congrès de la
Société Européenne
de Gynécologie
10-13 OCTOBRE 2007
PARIS - FRANCE
Sous le haut patronage de Madame Roselyne Bachelot,
Ministre de la Santé, de la Jeunesse et des Sports
Avec le soutien de la Fédération Hospitalière de France
Congress book
Livre du Congrès
Congress Presidents - Présidents du Congrès
Dr. Clara Pélissier-Langbort
Dr. David Serfaty
Congress venue - Lieu du Congrès : Maison de la Chimie, 28 bis, Rue Saint-Dominique, 75007 Paris, France
Map of the Congress Venue / Plan du lieu du Congrès
Maison de la Chimie
28 bis, Rue Saint-Dominique
75007 Paris
France
Congress Secretariat - Secrétariat administratif du Congrès
Orga-Med Congress Office
Opalfeneweg 3
1740 Ternat - Belgium
T. +32 2 582 08 52
F. +32 2 582 55 15
[email protected]
7th Congress of the European Society of Gynecology
7ème Congrès de la Société Européenne de Gynécologie
OCTOBER 10-13,2007 - PARIS - FRANCE
10-13 OCTOBRE 2007 - PARIS - FRANCE
Congress Presidents
Présidents du Congrès
Dr. David Serfaty
Editorial
Dear Colleague,
The European Society of Gynecology organizes its seventh Congress in Paris,
at the “Maison de la Chimie” from the 10th to the 13th October 2007. This is
the Congress book of this relevant Congress which gathers more than 1000
European and non European, French and /or English speaking
gynaecologists.
We expect the 7th Congress to be a major scientific event at the level corresponding to the country and city which has given birth to our Society fourteen
years ago honouring the figure of our founder, Prof. Albert Netter.
We hope you will join us with your active participation in both the
socio-cultural and scientific programmes of this Congress.
Yours sincerely,
Pr. Joachim Calaf,
President of the ESG
Dr. Clara Pélissier-Langbort,
Secretary General of the ESG
President of the 7th ESG Congress
Dr. David Serfaty,
Vice-President of the ESG
President of the 7th ESG Congress
Editorial
Cher Collègue,
La Société Européenne de Gynécologie (SEG) organise son septième congrès
à Paris, à la Maison de la Chimie du 10 au 13 octobre 2007. Voici le livre du
congrès de cet important congrès qui réunie plus de 1000 gynécologues européens et non européens, francophones ou/et anglophones.
A titre indicatif, le précédent congrès (le 6ème) de la SEG, (Helsinki, 2-4 juin
2005) a réuni 1 200 congressistes provenant de 53 pays différents. Nous avons
l’ambition de faire du 7ème Congrès de notre société un évènement
scientifique majeur, digne du Pr. Albert NETTER, Président Fondateur de la
SEG, de Paris et du pays qui a vu naître la Société Européenne de Gynécologie
il y a 14 ans. Nous espérons pouvoir compter sur votre participation active au
programme scientifique et socio-culturel de ce congrès.
Cordialement,
Pr. Joachim Calaf,
Président de la SEG
Dr. Clara Pélissier-Langbort,
Secrétaire Générale de la SEG
Présidente du 7ème Congrès de la SEG
Dr. David Serfaty,
Vice-Président de la SEG
Président du 7ème Congrès de la SEG
7th ESG Congress Organisation
The Congress is organised by the European Society of Gynecology (ESG)
Board of the European Society of Gynecology
Founder Presidents
Prof. A. Netter (F) Dr. A. Lambert Netter (F) †
Honorary Presidents
Prof. Ph. Bouchard (F) Prof. A. de Almeida Santos (P)
Past Presidents
Prof. W. Kuhn (D) † Prof. K. Thomas (B)
President
Prof. J. Calaf (E)
Vice Presidents
Prof. G. Creatsas (GR)
Prof. J.M. Foidart (B)
Prof. A. Genazzani (I)
Prof. H. Meden (D)
Dr. D. Serfaty (F)
Prof. S.O. Skouby (DK)
Prof. O. Ylikorkala (FIN)
Prof. D. De Ziegler (CH)
General Secretary
Dr. C. Pélissier-Langbort (F)
Treasurer
Dr. A. Grimard (F)
Editor-in-Chief
Prof. Hoang Ngoc Minh (F)
Congress Presidents
Dr. Clara Pélissier-Langbort 72, rue d’Auteuil 75016 Paris
France
Tel.: +33 (0) 1 46 51 16 19
Fax: +33 (0) 1 47 27 32 61
[email protected]
Dr. David Serfaty
9, rue de Villersexel
75007 Paris
France
Tel: +33 (0) 1 45 48 31 32
Fax: +33 (0) 1 42 84 10 36
[email protected]
Organisation du 7ème Congrès de la SEG
Le congrès est organisé par la Société Européenne de Gynécologie (SEG)
Bureau de la Société Européenne de Gynécologie
Présidents fondateurs
Prof. A. Netter (F) Dr. A. Lambert Netter (F) †
Présidents d’Honneur
Prof. Ph. Bouchard (F)
Prof. A. de Almeida Santos (P)
Past-Présidents
Prof. W. Kuhn (D) †
Prof. K. Thomas (B)
Président
Prof. J. Calaf (E)
Vice-présidents
Prof. G. Creatsas (GR)
Prof. J.M. Foidart (B)
Prof. A. Genazzani (I)
Prof. H. Meden (D)
Dr. D. Serfaty (F)
Prof. S.O. Skouby (DK)
Prof. O. Ylikorkala (FIN)
Prof. D. De Ziegler (CH)
Secrétaire générale
Dr. C. Pélissier-Langbort (F)
Trésorière
Dr. A. Grimard (F)
Rédacteur en chef
Prof. Hoang Ngoc Minh (F)
Présidents du Congrès
72, rue d’Auteuil
75016 Paris
France
Tél.: +33 (0) 1 46 51 16 19
Fax: +33 (0) 1 47 27 32 61
[email protected]
Dr. David Serfaty
9, rue de Villersexel
75007 Paris
France
Tél: +33 (0) 1 45 48 31 32
Fax: +33 (0) 1 42 84 10 36
[email protected]
Organizing Committee
J. Calaf (E) J. M. Foidart (B) A. Genazzani (I) A. Grimard (F) Hoang Ngoc Minh (F)
G. Netter (F)
M. Nisolle (B)
C. Pélissier-Langbort (F)
E. Sedbon (F)
D. Serfaty (F)
O. Ylikorkala (FIN)
International Scientific Committee
A. de Almeida Santos (P) Th. de Almeida Santos (P) P. Barri (E) Ph. Bouchard (F) J. Calaf (E) G. Creatsas (GR) J.M. Foidart (B) A. Genazzani (I)
Th. Maudelonde (F)
H. Meden (D)
D. Serfaty (F)
S.O. Skouby (DK)
K. Thomas (B)
O. Ylikorkala (FIN)
Continuous Medical Education Committee
A. de Almeida Santos (P)
A. Grimard (F)
Evaluation of Professional Practices Committee
J.M. Foidart (B)
E. Sedbon (F)
D. Serfaty (F)
Scientifc societies “auspices”
- French Society of Gynecology (SFG)
- Francophone Society of Contraception (SFC)
- International Society of Gynecological Endocrinology (ISGE)
- Francophone Society for the Application of Ultrasound in
Medicine and Biology (SFAUMB)
- European Society of Contraception (ESC)
- European Society of Gynaecological Endoscopy (ESGE)
- National College of French Gynaecologists and Obstetricians (CNGOF)
- Association of French-speaking Gynaecologists and Obstetricians of
Belgium (GGOLFB)
- Spanish Society of Contraception (SEC)
- National Federation of the Medical Gynecology Colleges (FNCGM)
Comité d’organisation
J. Calaf (E) J. M. Foidart (B) A. Genazzani (I) A. Grimard (F) Hoang Ngoc Minh (F)
G. Netter (F)
M. Nisolle (B)
E. Sedbon (F)
D. Serfaty (F)
O. Ylikorkala (FIN)
Comité scientifique international
A. de Almeida Santos (P) Th. de Almeida Santos (P) P. Barri (E) Ph. Bouchard (F) J. Calaf (E) G. Creatsas (GR) J.M. Foidart (B) A. Genazzani (I)
Th. Maudelonde (F)
H. Meden (D)
D. Serfaty (F)
S.O. Skouby (DK)
K. Thomas (B)
O. Ylikorkala (FIN)
Comité de Formation Médicale Continue (FMC)
A. de Almeida Santos (P)
A. Grimard (F)
Comité d’Evaluation des Pratiques Professionelles (EPP)
J.M. Foidart (B)
E. Sedbon (F)
D. Serfaty (F)
Sociétés savantes “associées”
- Société Française de Gynécologie (SFG)
- Société Francophone de Contraception (SFC)
- Société Internationale d’Endocrinologie Gynécologique (ISGE)
- Société Francophone pour l’Application des Ultrasons en Médecine et en Biologie (SFAUMB)
- Société Européenne de Contraception (ESC)
- Société Européenne d’Endoscopie gynécologique (ESGE)
- Collège National des Gynécologues et Obstétriciens Français (CNGOF)
- Groupement des Gynécologues Obstétriciens de Langue Française de
Belgique (GGOLFB)
- Société Espagnole de Contraceptioon (SEC)
- Fédération Nationale des Collèges de Gynécologie Medicale (FNCGM)
Saturday / Samedi
13 October / octobre
Friday / Vendredi
Thursday / Jeudi
Wednesday / Mercredi
Synopsis
From 12:00 - A partir de 12:00 : Registration and poster mounting - Accueil des participants et installation des posters
13:00
Departure Visit of the Museum des Arts Premiers - Départ en bus au Musée des Arts Premiers
(first 250 registered participants - 250 premiers enregistrés)
16:45
Opening Ceremony - Séance d’Ouverture
Inauguration Symposium with the participation of Pfizer International
Symposium d’Inauguration avec la participation de Pfizer International
19:15
20:30
Recital, classical music : Ivry Gitlis - Récital de Musique Classique avec Ivry Gitlis
Wine and cheese
Grand Amphitéâtre
08:30 - 09:40
09:40 - 10:00
10:00 - 10:30
Plenary Session 1 - Session Plénière 1
Sponsored Lecture - Conférence Plénière Sponsorisée
Sanofi-Pasteur-MSD
Plenary Lecture 1 - Conférence Plénière 1
10:30 - 11:00
Break and visit of the exhibit - Pause et visit de l’exposition 11:00 - 11:30
11:30 - 11:50
11:50 - 13:15
13:25 - 14:25
Meet the Expert Sessions with lunch package - Sessions Meet the Expert avec collation
14:45 - 16:00
16:00 - 16:30
16:30 - 17:00
Break and visit of the exhibit - Pause et visit de l’exposition
17:00 - 17:30
17:30 - 18:50
08:30 - 09:55
09:55 - 10:15
10:15 - 10:40
Sponsored Lecture - Conférence Plénière sponsorisée : Conceptus
10:40 - 11:10
11:10 - 12:40
12:50 - 14:10
Meet the Expert Sessions with lunch package - Meet the Expert Sessions avec collation
14:15 - 15:45
15:45 - 16:15
16:15 - 16:45
16:45 - 17:15
17:15 - 18:45
20:30
Private night at the Orsay Museum and Cocktail - Soirée privée au Musée d’Orsay et cocktail
Grand Amphitéâtre
08:00 - 09:00
09:00 - 10:15
10:15 - 10:45
ESG General Assembly - Assemblée Générale de la SEG
09:00 - 11:00 Free communication session 1
Communications libres : Session 1
10:45 - 11:15
11:15 - 11:45
11:45 - 12:15
12:15 - 12:40
12:40 - 13:30
Closing Ceremony - Alice and Albert Netter Award Ceremony - Free communication and poster Prize
Remise du Prix de la Meilleure Communication Libre et du prix du Meilleur Poster
13:30
Wine and cheese
Room 7 / Salle 7
Cérémonie de clôture - Remise du Prix Alice et Albert Netter
Posters will be on display from 10 - 12 October (Room 101 + Foyer - First floor)
Les posters seront exposés du 10 au 12 octobre (Salle 101 + Foyer - 1er étage)
A jury will make a selection of 20 posters, Friday 12 October 2007.
The discussion (selection of 20 posters) for the Best Poster Prize will take place in the presence of the
presenting authors Saturday 13 October 2007 from 09:00 - 11:00
Une sélection de 20 posters sera faite par le jury, vendredi 12 octobre 2007, après midi.
La discussion des 20 posters selectionnés par le jury (en vue du Prix du Poster) aura lieu en présence des
auteurs, le samedi 13 octobre 2007 de 9:00 à 11:00.
Room 201 / Salle 201
09:00 - 10:45 Room 262 / Salle 262
Scientific Society Session 1 (ISGE)
Session des Sociétés Savantes 1 (ISGE)
11:00 - 12:00
14:30 - 16:00 17:00 - 18:45
09:00 - 10:30 Satellite Symposium 1 Pierre Fabre Lab.
Symposium Satellite 1 Pierre Fabre Lab.
Satellite Symposium 2 Bayer Schering Int.
Symposium Satellite 2 Bayer Schering Int.
Scientific Society Session 2 (GGOLFB)
Session des Sociétés Savantes 2 (GGOLFB)
Scientific Society Session 3 (ESGE)
Session des Sociétés Savantes 3 (ESGE)
11:10 - 12:40
14:15 - 15:15 15:30 - 17:00
17:15 - 18:45
Satellite Symposium 3 Grünenthal
Symposium Satellite 3 Grünenthal
Satellite symposium 4 Bayer Schering Int.
Symposium Satellite 4 Bayer Schering Int.
Scientific Society Session 4 (SEC)
Session des Sociétés Savantes 4 (SEC)
Scientific Society Session 5 (SFG)
Session des Sociétés Savantes 5 (SFG)
Room 69 / Salle 69
Room 33 / Salle 33
Foyer
09:00 - 11:00 Poster discussion
Communications libres : Session 2
Communication libres : Session 3
Discussion des 20
posters selectionnés
par le jury
Social programme
Additional tickets, if available, can be purchased at the registration desk.
Wednesday, 10 October 2007
13:00
Departure of the busses to the museum des Arts Premiers
Guided visit of the museum des Arts Premiers
This visit is foreseen for registered participants only
(the 250 first registered participants)
Return by shuttle bus at the ‘La Maison de la Chimie’
16:45
Opening Ceremony of the 7th ESG Congress
19:15
Recital, classical music with the violinist Ivry Gitlis
accompanied by the pianist Vahan Mardirossian
Wine and cheese
20:30
Friday, 12 October 2007
20:30
Private night at the Orsay Museum
with guided visit in French/English and cocktail
(limited number of tickets)
Your entrance ticket (one per person) will be requested at the entrance
of the museum
12
Saturday, 13 October 2007
12:40
Closing and Award Ceremony
13:30
Wine and cheese
Programme social
Vous pourrez acheter des cartons d’invitation supplémentaires (si disponibles) au guichet
d’enregistrement.
Mercredi 10 octobre 2007
13:00
Départ des bus de la Maison de la Chimie au Musée des Arts Premiers
Visite guidée du musée des Arts Premiers
Réservée aux inscrits enregistrés (les 250 premiers enregistrés)
Retour en bus à la Maison de la Chimie à la fin de la visite
Séance d’Ouverture du 7ème Congrès de la SEG
16:45
19:15
20:30
Récital de Musique Classique avec le violoniste Ivry Gitlis
accompagné au piano par Vahan Mardirossian
Wine and cheese
Vendredi 12 octobre 2007
20:30
Soirée privée au Musée d’Orsay avec visite guidée français/anglais et cocktail (places limitées)
Le carton d’invitation (un par personne) sera exigé à l’entrée du musée.
Samedi 13 octobre 2007
12:40
Clôture du 7ème Congrès de la SEG
13:30
Wine and cheese
13
Programme
Wednesday 10 October 2007
From 12:00
Registration and poster mounting
13:00
Departure of the shuttle bus from La Maison de la
Chimie to the Museum ‘des Arts Premiers’
Guided visit french/english - only for registered participants
(250 first registered participants)
Return by shuttle bus at the ‘La Maison de la Chimie’ to
attend the Inauguration Session of the 7th Congress of the ESG
16:45 - 20:30
Opening Ceremony
16:45
Presidential addresses
Prof. J. Calaf (E)
17:00
Opening lecture
New battle-front against cancer in Europe
Prof. David Khayat
Chief of Dept: Pitié-Salpétrière Hospital, Paris (F)
17:30
14
Inauguration Symposium
with the participation of Pfizer International
Emerging trends in endocrine treatment of breast cancer
Chairmen: J. Gligorov (F) - O. Ortmann (D)
Endocrine treatment developed over time
J. Gligorov (F)
Evidence Based and challenging data in adjuvant endocrine treatment of BC O. Ortmann (D)
IES: Key trial in endocrine treatment of BC
T. Delozier (F)
Endocrine treatment and QOL: What is important for our patients?
N. Harbeck (D)
Case discussion : From data to clinical practice. How would you decide?
A. Lesur (F)
Discussion / Conclusion
J. Gligorov - O. Ortmann (D)
19:00
Addresses of the Congress Presidents
Dr. C. Pélissier-Langbort (F), Dr. D. Serfaty (F)
19:15
20:30
Recital, Classical Music with the violinist Ivry Gitlis
accompanied by the pianist Vahan Mardirossian
Wine and Cheese
Programme
Mercredi 10 octobre 2007
Dès 12:00
Accueil des participants et installation des posters
13:00
Départ en bus de la Maison de la Chimie au
Musée des Arts Premiers
Visite guidée Français/Anglais - réservée aux inscrits enregistrés
(250 premiers participants enregistrés)
Retour en bus à la Maison de la Chimie pour la
Séance d’Inauguration du 7ème Congrès de la SEG
16:45 - 20:30
Séance d’Ouverture
16:45 17:00
Allocution du Prof. J. Calaf (E)
Président de la SEG
17:30
Symposium d’Inauguration
avec la participation de Pfizer International
Actualité et perspectives du traitement hormonal du cancer du sein
Présidents: J. Gligorov (F) - D. Ortmann ( D)
Evolution de l’hormonothérapie
J. Gligorov (F)
Evidence Based et données émergentes dans l’hormonothérapie adjuvante
O. Ortmann (D)
IES: Etude majeure pour l’hormonothérapie du cancer du sein
T. Delozier (F)
Hormonothérapie et qualité de vie : Ce qui compte pour nos patientes ? N. Harbeck (D)
Cas cliniques: des études à la pratique clinique. Quels choix thérapeutiques?
A. Lesur (F)
Discussion / Conclusion
J. Gligorov - O. Ortmann (D)
19:00
Allocution des Présidents du Congrès
Dr. C. Pélissier-Langbort (F), Dr. D. Serfaty (F)
19:15
20:30
Récital de Musique Classique avec le violoniste Ivry Gitlis
accompagné au piano par Vahan Mardirossian
Conférence inaugurale
Nouveau front de la lutte contre le cancer en Europe
Prof. David Khayat
Chef de Service : Hôpital Pitié-Salpétrière, Paris (F)
Wine and Cheese
15
Thursday 11 October 2007
08:30 - 09:40
Grand Amphitéâtre
Plenary Session 1 - Cervical cancer in Europe
Epidemiology of cervical cancer in Europe
Imaging and staging of cervical cancer
Interest of sentinel lymph node in cervical cancer
09:40 - 10:00 Grand Amphitéâtre
10:00 - 10:30
Grand Amphitéâtre
Sponsored Plenary Lecture
with the participation of Sanofi-Pasteur-MSD
Permanent Secretary of the Academy of Sciences
09:00 - 10:45
Room 201
A. Lesur (F)
M. Bazot (F)
F. Kridelka (B)
Chairman: G. Monsonego (F)
Anti-HPV vaccination: hope for women
N. Munoz (IARC, Lyon, F) - J. Monsonego (F)
Plenary Lecture 1 - Walter Kuhn Lecture
Chairman: Th. Maudelonde (F)
Immunology and Female Pathologies
J.F. Bach (F)
Scientific Society Session 1
International Society of Gynecological Endocrinology (ISGE)
“Gynecological Endocrinology: a challenge for basic
science and clinical practice”
Chairmen: A.R. Genazzani (I) - O. Ylikorkala (FIN)
Sex steroid signaling in cardiovascular system
T. Simoncini (I)
Sex steroids and the brain
A.R. Genazzani (I)
Antiprogestins and the uterus: facts and perspectives
Insulin resistance in women with PCOS
S. Angioni (I)
Genetic risks in ART
10:30 - 11:00
Coffee break and visit of the exhibit
Room 8
16
Chairmen: Ch. Quereux (F) - H. Meden (D)
Ph. Bouchard (F)
P.N. Barri (E)
Jeudi 11 octobre 2007
Session Plénière 1 - Cancer du col utérin en Europe
08:30 - 09:40
Grand Amphitéâtre
Présidents: Ch. Quereux (F) - H. Meden (D)
Epidémiologie du cancer du col en Europe
A. Lesur (F)
Imagerie et stadification du cancer du col
Intérêt du ganglion sentinelle dans le cancer du col
09:40 - 10:00
Grand Amphitéâtre
10:00 - 10:30
Grand Amphitéâtre
Conférence Plénière sponsorisée
avec la participation des Laboratoires Sanofi-Pasteur-MSD
M. Bazot (F)
F. Kridelka (B)
Président: G. Monsonego (F)
Vaccination anti-HPV: un espoir pour les femmes
N. Munoz (CIRC, Lyon, F) - J. Monsonego (F)
Conférence Plénière 1 - Conférence Walter Kuhn
Président: Th. Maudelonde (F)
Pathologies Immunologiques de la Femme
J.F. Bach (F)
Secrétaire Perpétuel de l’Académie des Sciences
09:00 - 10:45
Salle 201
Session des Sociétés Savantes 1
Société Internationale d’Endocrinologie Gynécologique (ISGE)
“La Gynécologie Endocrinienne: un défi pour la science
de base et la pratique clinique”
Les stéroïdes sexuels et le cerveau
L’insulino résistance chez les femmes atteintes d’Ovaires Polykystiques (PCO)
Les risques génétiques en Procréation Médicalement
Assistée (PMA)
10:30 - 11:00
Pause et visite de l’exposition pharmaceutique
Présidents: A.R. Genazzani (I) - O. Ylikorkala (FIN)
Les stéroïdes sexuels et le système cardiovasculaire
T. Simoncini (I)
A.R. Genazzani (I)
Progestatifs et l’Uterus: faits et perspectives
Ph. Bouchard (F)
S. Angioni (I)
P.N. Barri (E)
Salle 8
17
11:00 - 12:00
Satellite Symposium 1
Room 262
with the participation of Pierre Fabre Laboratories
“The unknown territories of iron deficiency”
New aspects in iron metabolism. Implication for iron deficiency without
anemia: an underrecognized, underdiagnosed and undertreated stage in iron deficiency
P. Nielsen (D)
Iron supplementation strategy during pregnancy and post-partum
11:00 - 11:30
Plenary Lecture 2
Grand Amphitéâtre
Chairman: S. Uzan (F)
Hormones and cancer
J.M. Foidart (B)
11:30 - 11:50
Grand Amphitéâtre
Plenary Lecture 3
J.P. Bourguignon (B)
11:50 - 13:15 Grand Amphitéâtre
Plenary Session 2
Gynaecological pathologies during adolescence
Puberty and its anomalies in Europe in 2007
Ch. Sultan (F)
18
C. Breymann (S)
Chairman: J. Belaisch (F)
Hypothalamo-hypophyso-gonadal maturation :
genetics and environmental determinants
Chairmen: D. Apter (Fin) - C. Sultan (F)
Breast and adolescence
M. Espié (F)
Sexual education and adolescence
D. Apter (Fin)
11:00 - 12:00
Symposium Satellite 1
Salle 262
avec la participation des Laboratoires Pierre Fabre
“Territoires inconnus de la carence en fer”
Aspects nouveaux du métabolisme du fer. Implication de la carence en fer sans Anémie : une étape de la carence en fer mal reconnue,
sous-diagnostiquée et insuffisamment traîtée.
P. Nielsen (D)
Stratégie de la supplémentation en fer durant la grossesse et le post-partum
11:00 - 11:30
Grand Amphitéâtre
Conférence Plénière 2
J.M. Foidart (B)
11:30 - 11:50
Grand Amphitéâtre
J.P. Bourguignon (B)
11:50 - 13:15
Grand Amphitéâtre
Session Plénière 2
Les pathologies gynécologiques de l’adolescente
La puberté et ses anomalies en Europe en 2007
Ch. Sultan (F)
Le sein de l’adolescente
M. Espié (F)
C. Breymann (S)
Président: S. Uzan (F)
Hormones et cancer
Président: J. Belaisch (F)
La maturation hypothalamo-hypophyso-gonadique :
les déterminants génétiques et environnementaux
Présidents: D. Apter (Fin) - C. Sultan (F)
Education sexuelle et adolescence
D. Apter (Fin)
19
13:25 - 14:25
Meet the Expert Sessions including lunch package
(preregistration obligatory, max 40 participants per session)
1
New treatments of osteoporosis
with the participation of Servier
2
Ovarian stimulations : simple and difficult (IVF excluded)
3
Non hormonal treatment of hot flushes
Out patient diagnostic and therapeutic hysteroscopy
4
J. Belaisch-Allart (F), J. Calaf (E), E. Sedbon (F)
A. Genazzani (I), P. Mares (F), C. Pélissier-Langbort (F)
E. Cicinelli (I), B. Blanc (F)
5
Turner and Klinefelter: practical approach
6
MRI in 2007 for gynecologists
7
Endometriosis: practical aspects
8
Follow up after breast cancer
Thrombophilia and the gynecologist
9
20
R. Levasseur (F)
D. Apter (Fin), Cl. Nahoul-Fékété (F), Ch. Sultan (F)
J.N. Buy (F), M. Bazot (F)
E. Daraï (F), Ph. Descamps (F), M. Nisolle (B)
M. Espié (F), H. Meden (D), P. Sismondi (I) , A. Lesur (F)
J. Conard (F)
13:25 - 14:25
Meet the Expert Sessions avec collations
(inscription préalable obligatoire, 40 inscrits maximum par session)
1
Les nouveaux traitements de l’ostéoporose
avec la participation des Laboratoires Servier
2
Stimulations ovariennes simples et difficiles hors FIV
J. Belaisch-Allart (F), J. Calaf (E), E. Sedbon (F)
3
Traitement non hormonal des bouffées de chaleur
A. Genazzani (I), P. Mares (F), C. Pélissier-Langbort (F)
4
Hystéroscopie diagnostique et thérapeutique en ambulatoire
E. Cicinelli (I), B. Blanc (F)
5
Turner et Klinefelter: approche pratique pour le gynécologue
R. Levasseur (F)
D. Apter (Fin), Cl. Nahoul-Fékété (F), Ch. Sultan (F)
L’IRM et le gynécologue en 2007
6
J.N. Buy (F), M. Bazot (F)
7
Endométriose: conduite pratique pour le gynécologue
E. Daraï (F), Ph. Descamps (F), M. Nisolle (B)
8
Surveillance après cancer du sein : le rôle du gynécologue médical
9
M. Espié (F), H. Meden (D), P. Sismondi (I) , A. Lesur (F)
La thrombophilie et le gynécologue
J. Conard (F)
21
14:45 - 16:00
Grand Amphitéâtre
Plenary Session 3 - Progestins in gynecology in 2007
“Progestatives by oral route after the age of 40 and breast cancer”: reflexions and comments on the E3N study
Control of enzymes involved in estrogen formation and
transformation in the mammary gland in situ
14:30 - 16:00
Room 201
Satellite Symposium 2 with the participation of
Bayer Schering Pharma International
Drospirenone for Contraception and Menopause: at the heart of women’s interests
User Satisfaction with Yasminelle
Women, Menopause, and HT
R. Arias (USA)
A different progestin in HT: drospirenone
J.M. Foidart (B)
Women’s heart: somethig to take care of
T. Simon (Fr)
16:00 - 16:30
Grand Amphitéâtre
Plenary Lecture 4
16:30 - 17:00
Chairman: C. Pélissier-Langbort (F)
J. Desreux (B)
J.R. Pasqualini (F)
Action of the progesterone on the brain after head injury: reflexions after the ProTect study
M. El-Etr (F)
Chairmen : M. Mendelsohn (USA)- J.M. Foidart (F)
M. Short (Ir)
Chairman: E. Daraï (F)
The gynaecologist of the future and robotics
M. Degueldre (B)
Room 8
17:00 - 17:30
Grand Amphitéâtre
Plenary Lecture 5
17:30 - 18:50
Grand Amphitéâtre Plenary Session 4 - Ageing and rejuvination
Urogynecology of the ageing woman
Will we be able to delay ageing tomorrow?
22
Chairman: J. Calaf (E)
Neuro endocrinology and ageing
Ph. Bouchard (F)
Chairmen: Ph. Bouchard (F) - K. Thomas (B)
Perspectives of European demography:
part of the centenarians
J.M. Robine
L. Cardozo (UK)
Th. Maudelonde (F)
14:45 - 16:00
Grand Amphitéâtre
Session Plénière 3 - Les Progestatifs en Gynécologie en 2007
Président: C. Pélissier-Langbort (F)
“Progestatifs par voie orale après 40 ans et cancer du sein”: réflexions et commentaires sur l’étude E3N
J. Desreux (B)
Contrôle des enzymes impliquées dans la formation et la transformation des oestrogènes dans la glande mammaire in situ
Action de la progesterone sur le cerveau apres traumatisme cranien :
reflexions apres l’etude protect
J.R. Pasqualini (F)
M. El-Etr (F)
14:30 - 16:00
Room 201 Symposium Satellite 2 avec la participation des
Laboratoires Bayer Schering Pharma International
La Drospirénone en Contraception et Ménopause :
au coeur des interêts des Femmes
Femmes, Ménopause et traitement de la ménopause
R. Arias (USA)
Un progestatif différent en ménopause: la drospirénone
J.M. Foidart (B)
Le coeur des femmes: attention, fragile
T. Simon (Fr)
16:00 - 16:30
Grand Amphitéâtre
Le gynécologue du futur et la robotique
16:30 - 17:00
Présidents : M. Mendelsohn (USA) - J.M. Foidart (F)
Satisfaction des femmes sous drospirénone 20 gamma
M. Short (Ir)
Président: E. Daraï (F)
M. Degueldre (B)
Salle 8
17:00 - 17:30
Grand Amphitéâtre
17:30 - 18:50
Président: J. Calaf (E)
Neuro-endocrinologie du vieillissement
Ph. Bouchard (F)
Session Plénière 4 - Vieillissement et rajeunissement
Grand Amphitéâtre
Présidents: Ph. Bouchard (F) - K. Thomas (B)
Perspectives de la démographie européenne :
place des Centenaires
J.M. Robine
Uro-gynécologie de la femme agée
Demain pourra-t-on retarder le vieillissement ?
L. Cardozo (UK)
Th. Maudelonde (F)
23
17:00 - 18:45
Room 201 Scientific Society Session 2
Association of French-speaking Gynaecologists-Obstetricians
of Belgium (GGOLFB)
General outline of the Belgian research: the throphoblastic
invasion - cryopreserved gonads: about 3 pregnancies
Chairmen: J.M. Foidart (B) - F. Kridelka (B)
HCG : not only a pregnancy-related hormone but also an angiogenic cytokine
S. Perrier d’Hauterive (B) - S. Berndt (B)
Placenta accreta: pathogenesis, diagnosis and conservative treatment
in 15 cases
F. Chantraine (B)
Regarding the seven cases of cryopreserved ovarian tissue transplantation
A.S. Van Eyck (B)
Two pregnancies following ovarian tissue grafting for premature ovarian failure after bone marrow transplantation
I. Demeestere (B)
Survival and proliferation of spermatogonia after cryopreservation of
immature humar testicular tissue
Ch. Wyns (B)
Direct and anonymoous oocyte donation: impact on clinical results
A. Delbaere (B)
24
17:00 - 18:45
Salle 201
Groupement des Gynécologues Obstétriciens de
Langue Française de Belgique (GGOLFB)
Aperçus de la recherche en Belgique: l’invasion trophoblastique cryopréservation des gonades: à propos de 3 grossesses
L’HCG: une hormone mais aussi une cytokine angiongène
S. Perrier d’Hauterive (B) - S. Berndt (B)
La placentation accreta et percreta - Pathogénie, diagnostic et traitement
conservateur de 15 cas
F. Chantraine (B)
A propos de 7 cas de greffe de tissu ovarien cryopréservé
A.S. Van Eyck (B)
Grossesses après transplantation de tissue ovarien pour défaillance ovarienne précoce suite à une transplantation de moelle
I. Demeestere (B)
Survie et prolifération des spermatogonies après cryopréservation de tissu
testiculaire immature
Ch. Wyns (B)
Don d’ovocyte direct et don croisé anonyme: impact sur les résultats cliniques
A. Delbaere (B)
Présidents: J.M. Foidart (B) - F. Kridelka (B)
25
Friday 12 October 2007
08:30 - 09:55
Grand Amphitéâtre
Plenary Session 5 - Contraception in Europe in 2007
Chairmen: R. Sitruk-Ware (USA) - S. Skouby (DK)
S. Skouby (DK)
Adolescent contraception in Europe
G. Creatsas (Gr)
Estetrol: a new natural estrogen for contraception
Contraception and ovarian cancer
09:55 - 10:15
Grand Amphitéâtre
Sponsored Plenary Lecture with the participation of
Conceptus
SUCCES french multicentric study : Are there any predictive failure factors of setting ESSURE system ?
10:15 - 10:40
Grand Amphitéâtre
Plenary Lecture 6
H.J.T. Coeingh Bennink (Nl)
D. Cibula (Czech Rep.)
P. Panel (F)
Chairman: D. Serfaty (F)
Research in contraception
09:00 - 10:30
Scientific Society Session 3
European Society for Gynecological Endoscopy (ESGE)
New advances in endoscopic surgery
Room 201 26
Contraception and metabolic and cardiovascular
consequences of PCOs
R. Sitruk-Ware (Population Council NY, USA)
Chairman: G.B. Melis (I)
The role of laparoscopic surgery in oncology
M. Canis (F)
Role of laparoscopy in the infertile woman
G.B. Melis (I)
Deep Endometriosis. Theraputical considerations.
S. Angioni (I)
Prevention of adherence formation after surgery
P. Koninckx (B)
Vendredi 12 octobre 2007
08:30 - 09:55
Session Plénière 5 - Contraception en Europe en 2007
Grand Amphitéâtre
Présidents: R. Sitruk-Ware (USA) - S. Skouby (DK)
Contraception des adolescents en Europe
G. Creatsas (Gr)
Estetrol: un nouveau estrogène naturel en contraception
H.J.T. Coelingh Bennink (Nl)
D. Cibula (Czech Rep.)
Contraception et conséquences métaboliques et cardiovasculaires du SOPK
S. Skouby (DK) 09:55 - 10:15
Grand Amphitéâtre
Contraception et le cancer de l’ovaire
Conférence Plénière sponsorisée avec la participation
des Laboratoires Conceptus
Etude multicentrique française SUCCES : Quels sont les facteurs prédictifs d’échec de pose du système ESSURE ?
P. Panel (F)
10:15 - 10:40
Grand Amphitéâtre
Président: D. Serfaty (F)
La recherche en contraception
R. Sitruk-Ware (Population Council NY, USA)
09:00 - 10:30
Salle 201 Session des Sociétés Savantes 3
La Société Européenne d’Endoscopie en Gynécologie (ESGE)
Nouveautés en chirurgie endoscopique
S. Angioni (I)
Présidents: G.B. Melis (I)
Place de la chirurgie laparoscopique chez les femmes infertiles
G.B. Melis (I)
Le rôle de la chirurgie laparoscopique en oncologie
M. Canis (F)
Endométriose profonde. Considérations thérapeutiques.
La prévention de la formation des adhérences après chirurgie
P. Koninckx (B)
27
10:40 - 11:10
Room 8
28
11:10 - 12:40
Salle 262
Satellite Symposium 3 with the participation of Grünenthal
Oral contraception and women’s wellbeing
Chairmen: J. Bitzer (CH) - C. Pélissier-Langbort (F)
Oral contraception and hyper androgenic disturbances of skin and hair
H. Wolff (D)
Cosmetic benefits of oral contraceptive – Relevance for
QoL and psychosocial health
CMA/EE – Improvement of women’s wellbeing
CMA/EE – Relief of dysmenorrhoea symptoms and mood
balancing effects
M. Kerscher (D)
R. Druckmann (F)
H.P. Zahradnik (D)
11:10 - 12:40
Plenary Session 6 - Sexual mutilations and repair
Grand Amphitéâtre
Chairmen: B.J. Paniel (F) - A. de Almeida Santos (P) The extent of the problem in Europe
O. Hussen (I)
Obstetrical consequences and repair of sexual mutilations
B.J. Paniel (F)
The fight against female sexual mutilations in France
H.J. Philippe (F)
10:40 - 11:10
Salle 8
11:10 - 12:40
Salle 262
Symposium Satellite 3 avec la participation de Grünenthal
Contraception orale et le bien-être de la femme
Présidents: J. Bitzer (CH) - C. Pélissier-Langbort (F)
Contraception orale et manifestations cutanées et
capillaires de l’hyperandrogénie
Avantages cosmétiques du contraceptif oral - Importance pour la qualité de vie et la santé psychosociale
ACM/EE – Amélioration du bien-être de la femme
11:10 - 12:40
Grand Amphitéâtre
ACM/EE – Soulagement des symptômes de la dysménorrhée
et effet régulateur de l’humeur
H. Wolff (D)
M. Kerscher (D)
R. Druckmann (F)
H.P. Zahradnik (D)
Session Plénière 6 - Les mutilations sexuelles et leur
réparation
Présidents: B.J. Paniel (F) - A. de Almeida Santos (P)
L’étendue du problème en Europe
O. Hussen (I)
Conséquences obstétricales et réparations des mutilations sexuelles
B.J. Paniel (F)
Lutte contre les mutilations sexuelles féminines en France
H.J. Philippe (F)
29
12:50 - 14:10
Meet the Experts Sessions
including lunch package
(preregistration obligatory, max 40 participants per session)
10
20 years experience of medical abortion in France: current status and perspectives for the future
with the participation of Exelgyn
N. Bajos (F), M.L. Brival (ANCIC, F), P. Lefebvre (F), E. Aubény (F)
11
Is there surgical treatment of myomas?
P. Madelenat (F), F. Zullo (I)
12
13
14
Post-Partum
M. Tournaire (F), J. L. Bénifla (F), J. Calaf (E)
Hyperprolactinemia : new approach in 2007
Ph. Touraine (F), D. Dewailly (F), M. Moreira (P)
Giving up smoking: pregnancy, contraception, menopause:
which particularities?
with the participation of Pfizer France, Section Cardiovasculaire
C. Jamin (F), M. Delcroix (F)
15
Colposcopy in 2007
J.L. Mergui (F), W. Prendiville (IRL), L. Pardal (P)
16
Dangerous treatments at the start of pregnancy
Th. de Almeida Santos (P), E. Eléphant (F)
17
Transexuality in 2007 and the gynecologist
B.J. Paniel (F), C. Meriggiola (I)
18
Vaginal route administration of hormonotherapy
D. Serfaty (F), L. Ulrich (DK)
19
Androgen therapy and female sexuality
with the participation of Procter & Gamble S. Christin-Maître (F), J. Bitzer (CH), M. Lachowsky (F)
30
12:50 - 14:10 Meet the Experts Sessions
avec collation
(inscription préalable obligatoire, 40 inscrits maximum par session)
10
20 ans d’IVG médicamenteuse en France: situation actuelle et perspectives d’avenir
avec la participation des Laboratoires Exelgyn
N. Bajos (F), M.L. Brival (ANCIC, F), P. Lefebvre (F), E. Aubény (F)
11
Que reste-t-il du traitement chirurgical des fibromes?
P. Madelenat (F), F. Zullo (I)
12
Le Post-Partum
M. Tournaire (F), J. L. Bénifla (F), J. Calaf (E)
13
Hyperprolactinémies: nouvelles approches en 2007
Ph. Touraine (F), D. Dewailly (F), M. Moreira (P)
14
Le sevrage tabagique: grossesse, contraception, ménopause:
quelles particularités?
avec la participation des Laboratoires Pfizer France,
Section Cardiovasculaire
C. Jamin (F), M. Delcroix (F)
15
16
17
18
19
Colposcopie en 2007
J.L. Mergui (F), W. Prendiville (IRL), L. Pardal (P)
Les traitements dangereux du début de la grossesse
Th. de Almeida Santos (P), E. Eléphant (F)
Transexualité en 2007 et le gynécologue
B.J. Paniel (F), C. Meriggiola (I)
Intérêt de la voie vaginale en hormonothérapie
D. Serfaty (F), L. Ulrich (DK)
Androgénothérapie et sexualité féminine
avec la participation des Laboratoires Procter & Gamble
S. Christin-Maître (F), J. Bitzer (CH), M. Lachowsky (F)
31
14:15 - 15:45
Grand Amphitéâtre
Plenary Session 7 - The bone and the gynaecologist:
from puberty till post-menopause
Chairmen: O. Ylikorkala (FIN) - P. Lopes (F)
The effect of the different methods of contraception on the bone
Pitfalls in osteodensitometry
The effect of menopause on osteoarticular system
The bone: how the gynecologist has to address osteoporosis?
14:15 - 15:15
Salle 201
Satellite symposium 4 with the participation of
Mirena 10 years later, new perspectives
Risk factors for IUD failure : results of a large multicentre case–control study
P. Thonneau (F)
New contraceptive strategy after abortion with the LNG-IUS
B. Letombe (F)
Strategy of treatment of menorraghia : new position of the LNG-IUS
J-L Brun (F)
15:45 - 16:15
Plenary Lecture 7
Grand Amphitéâtre
B. d’Arcangues (OMS/WHO – CH)
R. Levasseur (F)
B.C.M. Gambacciani (I)
O. Ylikorkala (FIN)
Chairmen : D. Serfaty (F) - A. Genazzani (I)
Chairman: A. Grimard (F)
Menopause in Europe and its treatment in 2007
16:15 - 16:45
A.R. Genazzani (I)
Room 8
16:45 - 17:15
Grand Amphitéâtre
32
Plenary Lecture 8
Chairman: G. Creatsas (Gr)
Limits of ambulatory gynaecological surgery
15:30 - 17:00
Spanish Society for Contraception (SEC)
P. Madelenat (F) 14:15 - 15:45
Grand Amphitéâtre
Session Plénière 7 - L’os et le gynécologue :
de la puberté à la post-ménopause
Présidents: O. Ylikorkala (FIN) - P. Lopes (F)
L’effet des différentes méthodes de contraception sur l’os
Les pièges de l’ostéodensitométrie
L’effet de la ménopause sur le système ostéo-articulaire
Comment le gynécologue doit-il prendre en charge une ostéoporose?
14:15 - 15:15
Salle 201 Symposium Satellite 4 avec la participation des
Laboratoires Bayer Schering Pharma International
Mirena 10 ans plus tard, les nouvelles perspectives
Facteurs de risque d’échec de la contraception intra-utérine : résultats d’une large étude multicentrique cas-témoins
Nouvelles attitudes dans la prise en charge contraceptive de l’après IVG avec le Système Intra-Utérin (SIU) hormonal
15:45 - 16:15
Grand Amphitéâtre
16:15 - 16:45
R. Levasseur (F)
B.C.M. Gambacciani (I)
O. Ylikorkala (FIN)
Présidents : D. Serfaty (F) - A. Genazzani (I)
P. Thonneau (F)
B. Letombe (F)
Prise en charge des hémorragies utérines fonctionnelles : place du système intra-utérin (SIU) hormonal Mirena.
J-L Brun (F)
Présidente: A. Grimard (F)
La ménopause en Europe et son traitement en 2007
A.R. Genazzani (I)
Salle 8
16:45 - 17:15
Grand Amphitéâtre
15:30 - 17:00
Salle 201 Session des Sociétés Savantes 4
Société Espagnole de Contraception (SEC)
Président: G. Creatsas (Gr)
Limites de la chirurgie ambulatoire en gynécologie
P. Madelenat (F) 33
17:15 - 18:45
Plenary Session 8 - Ovarian cancer in 2007
Grand Amphitéâtre
Chairmen: P. Madelenat (F) - Hoang Ngoc Minh (F)
Molecular biology and ovarian cancer
J. Prat (E)
Ovarian cancer and surgery
Ovarian cancer and chemotherapy
Fertility after ovarian cancer
34
G. Netter (F)
C. Poirot (F)
French Society for Gynecology (SFG)
20:30
Private night at the Orsay Museum with guided visit in French/English and cocktail
17:15 - 18:45
H. Meden (D)
17:15 - 18:45
Session Plénière 8 - Cancer de l’ovaire en 2007
Grand Amphitéâtre
Présidents: P. Madelenat (F) - Hoang Ngoc Minh (F)
Biologie moléculaire et cancer de l’ovaire
J. Prat (E)
Chirurgie du cancer ovarien
H. Meden (D)
Chimiothérapie du cancer de l’ovaire
G. Netter (F)
Fertilité après cancer de l’ovaire
C. Poirot (F)
17:15 - 18:45
Société Française de Gynécologie (SFG)
Salle 201
20:30
Soirée privée au Musée d’Orsay avec visite guidée
français/anglais et cocktail
35
Saturday 13 October 2007
08:00 - 09:00
General Assembly of the ESG
Grand Amphitéâtre
09:00 - 10:15
Plenary Session 9 - Evolution of PMA in European Societies
Grand Amphitéâtre
Chairmen: P. Barri (E) - G. Levy (F)
Gametes donation
Embryo donation
P. Barri (E)
J. Belaïsch-Allart (F)
Genetics and fertility: early fetal sex detection in maternal blood
PGD for genetic breast cancer in the UK and in Europe:
is it legal, is it ethical?
10:15 - 10:45
Grand Amphitéâtre
Plenary Lecture 9
09:00 - 11:00
Free communication session 1, 2 and 3 - Poster discussion
10:45 - 11:15
Th. de Almeida Santos (P)
F. Shenfield (UK)
Chairman: J. Belaïsch-Allart (F)
The future of infertility
J. Mandelbaum (F)
Room 8
11:15 - 11:45
Grand Amphitéâtre
11:45 - 12:15
Grand Amphitéâtre
12:15 - 12:40
36
Plenary Lecture 10
Chairman: P. Sismondi (I)
Do we need particular centres for women with high risk
for gynecological cancers?
S. Uzan (F)
Plenary Lecture 11
Chairman: D. Cibula (Czech Rep.)
Obesity and hormones in women
A. Basdevant (F)
Plenary Lecture 12
Grand Amphitéâtre
Chairman: G. Netter (F)
Gynecology and mirgrant women
12:40 - 13:30
Grand Amphitéâtre
Closing Ceremony of the 7th ESG Congress
Alice and Albert Netter Award ceremony
Best Free Communication Prize
Best Poster Prize
13:30
Wine and Cheese
D. De Ziegler (CH)
Samedi 13 octobre 2007
08:00 - 09:00
Assemblée Générale de la SEG
Grand Amphitéâtre
09:00 - 10:15
Grand Amphitéâtre
Session Plénière 9 - Evolution de l’AMP dans les
Sociétés Européennes
Don de gamètes
Accueil d’embryons
Présidents: P. Barri (E) - G. Levy (F)
P. Barri (E)
J. Belaïsch-Allart (F)
Génetique et Fertilité: détection précoce dans le sang maternel du sexe foetal
Le DPI pour les anomalies génétiques dont BRCA1/BRCA2 en Angleterre et en Europe
10:15 - 10:45
Grand Amphitéâtre
09:00 - 11:00
Session communications libres orales 1, 2 et 3 - Discussion des posters
10:45 - 11:15
Th. de Almeida Santos (P)
F. Shenfield (UK)
Président: J. Belaïsch-Allart (F)
Le futur de l’infertilité
J. Mandelbaum (F)
Salle 8
11:15 - 11:45
Grand Amphitéâtre
11:45 - 12:15
Grand Amphitéâtre
12:15 - 12:40
Grand Amphitéâtre
12:40 - 13:30
Grand Amphitéâtre
Président: P. Sismondi (I)
Faut-il des centres spécialisés dans la prise en charge des femmes à haut risque de cancers gynécologiques ?
S. Uzan (F)
Président: D. Cibula (Czech Rep.)
Obesité et hormones chez la femme
A. Basdevant (F)
Présidente: G. Netter (F)
La gynécologie des femmes migrantes
D. De Ziegler (CH)
Cérémonie de clôture du 7ème Congrès de la SEG
Remise du Prix Alice et Albert Netter
Remise du Prix de la Meilleure Communication Libre
Remise du Prix du Meilleur Poster
13:30
Wine and Cheese
37
Free communication sessions
Jury of the Best Free Communication Prize
Under the Chairmanship of Prof. K. Thomas (B)
N. Chabbert-Buffet (F) H. Meden (D) D. De Ziegler (S) K. Thomas (B) 09:00 - 11:00
Free communication session 1
Prevention of bone loss by add-back therapy with 6 months gonadotropin releasing hormone agonist in patients with endometriosis
Y. Choe (Kor)
Evaluation préopératoire de troubles mictionnels dans le cadre d’une
endométriose profonde sévère : à propos de 12 cas
C. de Lapasse (Fr)
Traitement cœlioscopique de l’endométriose profonde. À propos de 118 cas
C001
C002
C003
C004
Chairmen: S. Zervoudis (Gr) - K. Thomas (B)
P. Panel (Fr)
Management of recurrent endometriomas with ethanol sclerotherapy before assisted reproductive technologies
C. Yazbeck (Fr)
C005
Gynaecologic emergencies in a referral university hospital
A. Chavez Badiola (Mex)
Cure chirurgicale de l’incontinence urinaire d’effort par bandelette
sous-uretrale : analyse comparative à 3 ans des résultats fonctionnels
des voies retro pubienne et trans obturatrice
C. Bohec (Fr)
Traitement chirurgical du prolapsus du 4ème âge : serie de 43
patientes
P. Madelenat (Fr)
C008
Risk factors for antepartum stillbirth
C009
Sentinel lymph node biopsy in breast cancer a retrospective analysis
C010
Imagerie moderne du cancer du sein
Efficacy of magnetic resonance guided focused ultrasound surgery
of uterine leiomyomas: evaluation of morphological parameters
affecting the absorption of energy according to magnetic resonance
imaging
K. Liadov (Rus)
C006
C007
C011
C012
J.R. Garcia Flores (Sp)
S. Saleiro (P)
M. Suissa (Fr)
Magnetic resonance imaging for the preoperative diagnosis of deep pelvic endometriosis
M. Muñoz Muñiz (E)
38
A. Lesur (F)
S. Zervoudis (Gr)
Sessions des communications libres
Jury du Prix de la Meilleure Communication Libre
Sous la Présidence du Prof. K. Thomas (B)
N. Chabbert-Buffet (F) H. Meden (D) D. De Ziegler (S) K. Thomas (B) 09:00 - 11:00
Session des communications libres 1
Prevention of bone loss by add-back therapy with 6 months gonadotropin releasing hormone agonist in patients with endometriosis
Y. Choe (Kor)
Evaluation préopératoire de troubles mictionnels dans le cadre d’une
endométriose profonde sévère : à propos de 12 cas
C. de Lapasse (Fr)
C001
C002
C003
A. Lesur (F)
S. Zervoudis (Gr)
Présidents : S. Zervoudis (Gr) - K. Thomas (B)
C004
P. Panel (Fr)
C. Yazbeck (Fr)
C005
Gynaecologic emergencies in a referral university hospital
Cure chirurgicale de l’incontinence urinaire d’effort par bandelette
sous-uretrale : analyse comparative à 3 ans des résultats fonctionnels des voies retro pubienne et trans obturatrice
C. Bohec (Fr)
Traitement chirurgical du prolapsus du 4ème âge : serie de
43 patientes
P. Madelenat (Fr)
C008
C009
C010
efficacy of magnetic resonance guided focused ultrasound surgery
of uterine leiomyomas: evaluation of morphological parameters
affecting the absorption of energy according to magnetic resonance
imaging
K. Liadov (Rus)
M. Muñoz Muñiz (E)
C006
C007
C011
C012
A. Chavez Badiola (Mex)
J.R. Garcia Flores (Sp)
S. Saleiro (P)
M. Suissa (Fr)
39
09:00 - 11:00
Chairmen : A. Lesur (F) - H. Meden (D)
C013
Vaginoscopic Hysteroscopy in Postmenopausal Women
Prise en charge phytothérapique de la ménopause d’une femme
atteinte d’un cancer du sein
B. Arnal (F)
C015
Oral progestagens before menopause and breast cancer risk :
Bringing new data of the Mission Study
M. Espié
C014
C016
E. Atlantis (UK)
Clot Formation Assay in Postmenopausal Women Receiving Femarelle (DT56a), Oral or Transdermal Estrogens
L.E. Nachtigall (USA)
C017
Calcitonin and teriparatide for vertebral fracture pain
Evaluation of diagnostic usefulness of meassuring soluble receptors
TNF-alpha P55 and P75 concentraction in women with primary sterility
J. Buks (Pol)
Luteal estrogen supplementation in stimulated cycles may improve
the pregnancy rate in patients undergoing IVF/ICSI-ET
Peter Drakakis (G)
Aide médicale à la procréation chez les femmes infectées par le virus de l’immunodéficience humaine : possibilités et limites.
J. Guibert (F)
C021
Dysplasie ovarienne après stimulation de l’ovulation: mythe ou réalité?
C022
Comparison of cytogenetic abnormalities rates in couples investigated prior to ICSI and those explored after one or more unsuccessful
ICSI attempts
N. Abdelmoula (Tun)
Evaluation de l’intérêt du test HPV chez les femmes enceintes de plus de trente ans. Résultats intermédiaires d’une série de 333 patientes
(1000 patientes prévues au total)
E. Vaucel (F)
Human papillomavirus cervical infection and associated risk factors in two urban populations of mexico with high incidence of cervical
carcinoma
J.G. Rendón Maldonado (Mex)
40
Free communication session 2
C018
C019
C020
C023
C024 A. Bazarra-Fernandez (S)
G. Chene (F)
09:00 - 11:00
Présidents : A. Lesur (F) - H. Meden (D)
C013 Vaginoscopic Hysteroscopy in Postmenopausal Women
E. Atlantis (UK)
Prise en charge phytothérapique de la ménopause d’une femme
atteinte d’un cancer du sein
B. Arnal (F)
C015
Oral progestagens before menopause and breast cancer risk :
Bringing new data of the Mission Study
M. Espié
Clot Formation Assay in Postmenopausal Women Receiving Femarelle (DT56a), Oral or Transdermal Estrogens
L.E. Nachtigall (USA)
C017
Evaluation of diagnostic usefulness of meassuring soluble receptors
TNF-alpha P55 and P75 concentraction in women with primary sterility
J. Buks (Pol)
Luteal estrogen supplementation in stimulated cycles may improve
the pregnancy rate in patients undergoing IVF/ICSI-ET
Peter Drakakis (G)
C014
C016
C018
C019
Aide médicale à la procréation chez les femmes infectées par le virus de l’immunodéficience humaine : possibilités et limites
J. Guibert (F)
C021
Comparison of cytogenetic abnormalities rates in couples investigated
prior toICSI and those explored after one or more unsuccessful
ICSI attempts
N. Abdelmoula (Tun)
C020
A. Bazarra-Fernandez (S)
C022
Evaluation de l’intérêt du test HPV chez les femmes enceintes de plus
de trente ans. Résultats intermédiaires d’une série de 333 patientes
(1000 patientes prévues au total)
E. Vaucel (F)
Human papillomavirus cervical infection and associated risk factors in two urban populations of mexico with high incidence of cervical
carcinoma
J.G. Rendón Maldonado (Mex)
C023
G. Chene (F)
C024 41
09:00 - 11:00
Chairmen: N. Chabbert-Buffet (F) - D. De Ziegler (S)
C025
C026
Long term birth-control or sterilization?
L. Surtea (R)
C027
C028
C029
C030
C031
R. Wiborny (Aus)
Particularities of combined oral contraceptives interactions
in thrombophilia
Perseptive of indian acceptors of implanon r regarding contraceptive choices: an icmr task force study
L.N. Gaur (IN)
Ovulation inhibition with 4 different regimens of a 4-phasic estradiol valerate and dienogest oc
S. Parke (D)
Awareness and use of emergency contraception among women
requesting termination of pregnancy
E. Altanis (UK)
A review of reproductive disturbances accompanying pituitary adenomas
A. Lytras (G)
High dose testosterone traetment has no adverse effects on the
endometrium of female to male transsexuals
A. Perrone (I)
Expressions of the epidermal growth factor receptor, vascular endothelial growth factor and vascular endothelial growth factor
receptor on the human placenta in twins pregnancies without and with associate obstetrical pathology
Effect of supplementation with dehydroepiandrosterone on female sexual Function
V. Valentino (I)
C034
Thrombophilia and recurrent pregnancy complications
A. Makatsariya (RU)
C035
C036
Preventive and treatment the women with virus Hepatitis B, C and AIDS in during and outside pregnancy
V. Kuzmin (RU)
C032
C033
42
Free communications session 3
R. Stanculescu (R)
Prophylactic embolization of placental disorders
D. Henroteaux (B)
09:00 - 11:00
C025
C026
C027
L. Surtea (R)
Présidents: N. Chabbert-Buffet (F) - D. De Ziegler (S)
R. Wiborny (Aus)
Particularities of combined oral contraceptives interactions
in thrombophilia
Perseptive of indian acceptors of implanon r regarding contraceptive choices: an icmr task force study
C028
S. Parke (D)
Awareness and use of emergency contraception among women
requesting termination of pregnancy
A review of reproductive disturbances accompanying pituitary
adenomas
C029
L.N. Gaur (Ind)
C030
C031
C032
A. Lytras (G)
High dose testosterone traetment has no adverse effects on the
endometrium of female to male transsexuals
A. Perrone (I)
Expressions of the epidermal growth factor receptor, vascular
endothelial growth factor and vascular endothelial growth factor
receptor on the human placenta in twins pregnancies without and with
associate obstetrical pathology
R. Stanculescu (R)
V. Valentino (I)
C034
Thrombophilia and recurrent pregnancy complications
A. Makatsariya (RU)
C035
C036
Preventive and treatment the women with virus Hepatitis B, C and AIDS in during and outside pregnancy
V. Kuzmin (RU)
C033
E. Altanis (UK)
Prophylactic embolization of placental disorders
D. Henroteaux (B)
43
Abstracts of the oral presentations of the speakers - Résumés des
présentations des orateurs du congrès
Epidémiologie du cancer du col en Europe
A. Lesur, E. Desandes
Centre Alexis Vautrin, Vandoeuvre-les-nancy, France
1) Définition 1
La majorité des tumeurs épithéliales du col de l’utérus sont des carcinomes épidermoïdes (85%). Les adénocarcinomes sont moins fréquents. La plupart des carcinomes du col de l’utérus apparaissent à la jonction entre
l’épithélium cylindrique de l’endocol et l’épithélium squameux de l’exocol, site de changement métaplasique
continu, en particulier in utero, à la puberté et au cours d’une première grossesse.
2) Epidémiologie descriptive
Incidence
Le cancer du col de l’utérus est le deuxième cancer le plus fréquent chez la femme dans le monde, derrière le
cancer du sein ; environ 470 000 nouveaux cas sont diagnostiqués chaque année. Comme le montre la figure
n°1 ci dessous, 80% des cas de cancer du col de l’utérus surviennent dans les pays en développement 1.
Fig 1. Fardeau mondial du cancer du col de l’utérus (taux d’incidence/100 000 femmes).
< 9,3
< 16,2
< 26,2
< 32,6
< 87,3
Seulement 15% des cas surviennent chez les femmes européennes (68 000 nouveaux cas diagnostiqués par an
et un taux d’incidence standardisé de 12,8/100 000 femmes en 1995). Les taux d’incidence standardisés sont
plus élevés en Europe de l’Est (variant de 16 en Belarusse à 40/100 000 femmes en Roumanie) 2.
L’incidence du col de l’utérus commence à s’élever entre 20 et 29 ans, puis elle augmente rapidement pour atteindre un pic entre 45 et 49 ans dans la population européenne 1.
Au cours du temps, l’incidence a nettement décliné au cours des 40 dernières années dans la plupart des pays
européens, notamment dans l’Europe du Nord et l’Europe de l’Ouest avec une diminution annuelle de 4% par
an. Aucune variation de l’incidence n’a été observée dans les pays d’Europe de l’Est. Cette diminution est la
conséquence de la mise en place des programmes de dépistage de masse étendus fondés sur la cytologie
cervicale exfoliative, classiquement grâce au test de Papanicolaou. Néanmoins, pour certaines générations
féminines d’Europe du Nord nées en particulier après 1930, des augmentations du risque ont été observées
probablement en raison d’un changement de comportement sexuel 3.
Mortalité
En 1995, le taux de mortalité standardisé est de 4,4/100 000 femmes européennes. En Europe, ce ratio incidence/mortalité est approximativement de l’ordre de 3. Ce ratio reste stable pour l’ensemble des pays européens 2.
44
De 1960 à 1995, le taux de mortalité a diminué dans la plupart des pays européens à l’exception de l’Europe
de l’Est. Ceci est dû à l’adoption du dépistage de masse organisé, mis en place dès les années 60 dans les
pays européens nordiques et dès les années 80 dans les pays d’Europe de l’Ouest et du Sud. D’autres facteurs
peuvent faire varier le taux de mortalité, comme le changement de comportement sexuel exposant au virus du
papillome humain (HPV) observé en Europe du Nord (Royaume Uni et Irlande) dès les années 80 4.
Survie
Pour la période 1990-1994, l’étude EUROCARE 3 indique une survie relative moyenne en Europe pour les
cancers du col de l’utérus de 84% à 1 an, 68% à 3 ans et 63% à 5 ans. Les survies les plus élevées sont celles
observées en Suède, aux Pays-Bas, en Norvège, en Espagne et en Suisse où elles sont supérieures à 68% à
5 ans. La survie est moins bonne (<60% à 5 ans) dans les pays de l’Est où l’incidence est la plus élevée. Cela
reflète certainement des différences dans l’accès au dépistage 5, 6.
Entre 15 et 65 ans, la survie chez les femmes européennes ne varie guère (>60% à 5 ans). Seulement après 65
ans, la survie à 5 ans décline de façon plus marquée (48% pour les femmes âgées de 65 à 74 ans et 22% pour
les femmes de plus de 75 ans, ceci reflétant la dépendance hormonale 6.
En Europe, de 1983 à 1994, la survie à 5 ans des cancers col de l’utérus s’est améliorée de 2% passant de 62%
en 1983-1985 à 65% en 1992-1994. Cette amélioration est plus marquée chez les femmes âgées de moins
de 65 ans et pour les formes métastatiques, reflétant ainsi l’effet de la mise en place d’un dépistage de masse
organisé et de l’amélioration des traitements au cours du temps 7.
3) Epidémiologie étiologique
Des études épidémiologiques moléculaires ont montré que certains types de virus du papillome humain (HPV)
constituent la principale cause du cancer du col de l’utérus (carcinome épidermoïde et adénocarcinome) et de la
néoplasie cervicale intraépithéliale (CIN) 8, 9. Comme le montre le tableau n° I ci-dessous, les types 16, 18, 31,
33, 35, 39, 45, 51, 52, 56, 58, 59, 68, 73, et 82 d’HPV peuvent être considérés comme carcinogènes et à haut
risque et les types 26, 53, et 66 comme probablement carcinogènes.
Tableau I. Classification phylogénique et épidémiologique des types de HPV 9
Classification phylogénique
Classification épidémiologique
Haut risque
Haut risque
16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68, 82, 26*, 53*, 66*
Faible risque
73
Faible risque
70
6, 11, 40, 42, 43, 44,
54, 61, 72, 81, CP6108
* La classification épidémiologique de ces types comme types probables à risque élevé est fondée sur zéro
témoin et un à trois cas positifs.
Parmi les femmes européennes âgées de 15 à 74 ans, la prévalence d’HPV est de 5,2% (4,2%-6,2%),
s’échelonnant de 1,4% en Espagne à 9,2% en Italie. Parmi les types d’HPV à haut risque, les plus fréquents
en Europe sont : HPV 16 (21%), HPV31 (9%), HPV 42 (5%) et HPV 18 (5%). Les types d’HPV à faible risque
représentent 22% des infections à HPV 10.
D’autres études ont montré que le tabagisme et l’utilisation prolongée de contraceptifs oraux constituent des cofacteurs augmentant le risque de cancer du col de l’utérus. On étudie actuellement le rôle d’autres facteurs comme le virus herpès simplex type 2 (VHS-2), l’infection par Chlamydia trachomatis, le virus d’immunodéficience
humain (VIH) et d’autres causes d’immunodépression, certains déficits nutritionnels et une prédisposition génétique 1, 11.
4) Les mesures préventives
Le dépistage
L’efficacité du dépistage cytologique pour la prévention secondaire du cancer du col de l’utérus est basée sur
la détection des modifications précoces du col utérin, en particulier une néoplasie cervicale intraépithéliale, des
années avant qu’un cancer invasif ne se développe. Le problème d’un dépistage non-organisé ou opportuniste
est la non couverture de l’ensemble d’une population d’une zone géographique déterminée, délaissant le plus
souvent les individus à haut risque.
En Europe, les politiques d’organisation du dépistage cytologique de masse du col de l’utérus (test de Papanicolaou ou frottis cervico-vaginal) sont relativement différentes : selon l’année d’organisation du programme organisé (de « 1963 » en Finlande à « 2003 » en Slovénie), selon l’âge de la population cible (de « 15 ans » au Luxembourg à « plus de 85 ans » en Allemagne), selon la fréquence de dépistage (de « tous les ans » en République
Tchèque, au Luxembourg, et en Allemagne à « tous les 5 ans » en Lithuanie, aux Pays-Bas et en Finlande), selon
le coût (de « gratuit » dans la plupart des pays européens à « partiellement payant » en Icelande en Norvège, en
45
Suède et en Suisse), et selon le nombre de frottis par patiente (de « 7 » en Finlande, en Lithuanie, aux Pays-Bas
à « plus de 60 » au Luxembourg et en Allemagne) 12.
Les recommandations sur les bonnes pratiques du dépistage du cancer du col de l’utérus à l’échelon européen
sont régulièrement publiées 13-15.
La recherche de l’ADN de l’HPV est une alternative au dépistage primaire. Son exactitude et son bon rapport
coût-efficacité dans la détection des lésions cervicales précurseurs sont en cours d’étude 16, 17.
La vaccination contre le virus du papillome humain.
Les vaccins anti-HPV peuvent être prophylactiques (mesure de prévention primaire), thérapeutiques, ou une
combinaison des deux. Ils peuvent constituer un moyen sûr et efficace de prévention ou de lutte contre la maladie 18.
Récemment des essais de phase II et de phase III placebo versus vaccin monovalent (HPV 16), bivalent (HPV
16/18) ou quadrivalent (HPV 6/11/16/18) ont démontré une bonne tolérance et une protection complète contre
les infections aux différents types d’HPV 19-23.
Cependant les recommandations européennes soulignent la non protection des vaccins contre l’ensemble des
types d’HPV à haut risque et la nécessité de continuer le dépistage pour les générations de femmes qui sont
toujours infectées 24.
5) Conclusion
Le cancer du col de l’utérus reste un problème de Santé Publique de part sa fréquence (au second rang mondial
et au quatrième rang européen pour les cancers chez la femme), sa population cible (les femmes jeunes), ses
disparités géographiques de dépistage et de prise en charge. Les recommandations européennes tentent de
minimiser ces disparités.
6) Références bibliographiques
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2.
3.
4.
5.
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Stewart BW, Kleihues P. Les cancers de l’appareil génital féminin. In: Le cancer dans le monde. IARC Press, Editor. 2005: Lyon. p. 218-26.
Bray F, Sankila R, Ferlay J, Parkin DM. Estimates of cancer incidence and mortality in Europe in 1995. Eur J Cancer 2002; 38: 99-166.
Bray F, Loos AH, McCarron P, Weiderpass E, Arbyn M, Moller H, et al. Trends in cervical squamous cell carcinoma incidence in 13 European countries: changing risk and the effects of screening. Cancer Epidemiol Biomarkers Prev 2005; 14: 677-86.
Levi F, Lucchini F, Negri E, Franceschi S, la Vecchia C. Cervical cancer mortality in young women in
Europe: patterns and trends. Eur J Cancer 2000; 36: 2266-71.
Coleman MP, Gatta G, Verdecchia A, Esteve J, Sant M, Storm H, et al. EUROCARE-3 summary: cancer survival in Europe at the end of the 20th century. Ann Oncol 2003; 14 Suppl 5: v128-49.
Sant M, Aareleid T, Berrino F, Bielska Lasota M, Carli PM, Faivre J, et al. EUROCARE-3: survival of cancer patients diagnosed 1990-94--results and commentary. Ann Oncol 2003; 14 Suppl 5: v61-118.
Bielska-Lasota M, Inghelmann R, van de Poll-Franse L, Capocaccia R. Trends in cervical cancer survival in Europe, 1983-1994: a population-based study. Gynecol Oncol 2007; 105: 609-19.
Bosch FX, Lorincz A, Munoz N, Meijer CJ, Shah KV. The causal relation between human papillomavirus and cervical cancer. J Clin Pathol 2002; 55: 244-65.
Munoz N, Bosch FX, de Sanjose S, Herrero R, Castellsague X, Shah KV, et al. Epidemiologic classification of human papillomavirus types associated with cervical cancer. N Engl J Med 2003; 348: 518-27.
Clifford GM, Gallus S, Herrero R, Munoz N, Snijders PJ, Vaccarella S, et al. Worldwide distribution of hu
man papillomavirus types in cytologically normal women in the International Agency for Research on Cancer HPV prevalence surveys: a pooled analysis. Lancet 2005; 366: 991-8.
Matos A, Moutinho J, Pinto D, Medeiros R. The influence of smoking and other cofactors on the time
to onset to cervical cancer in a southern European population. Eur J Cancer Prev 2005; 14: 485-91.
Anttila A, Ronco G, Clifford G, Bray F, Hakama M, Arbyn M, et al. Cervical cancer screening programmes and policies in 18 European countries. Br J Cancer 2004; 91: 935-41.
Arbyn M, Herbert A, Schenck U, Nieminen P, Jordan J, McGoogan E, et al. European guidelines for quality assurance in cervical cancer screening: recommendations for collecting samples for conventional and liquid-based cytology. Cytopathology 2007; 18: 133-9.
Herbert A, Bergeron C, Wiener H, Schenck U, Klinkhamer P, Bulten J, et al. European guidelines for
quality assurance in cervical cancer screening: recommendations for cervical cytology terminology.
Cytopathology 2007; 18: 213-219.
Wiener HG, Klinkhamer P, Schenck U, Arbyn M, Bulten J, Bergeron C, et al. European guidelines for quality
assurance in cervical cancer screening: recommendations for cytology laboratories. Cytopathology 2007; 18: 67-78.
Cuzick J, Clavel C, Petry KU, Meijer CJ, Hoyer H, Ratnam S, et al. Overview of the European and North American studies on HPV testing in primary cervical cancer screening. Int J Cancer 2006; 119: 1095-101.
Stewart BW, Kleihues P. Dépistage du cancer du col de l’utérus. In: Le cancer dans le monde. IARC Press, Editor. 2005: Lyon. p. 169-73.
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Stewart BW, Kleihues P. Vaccination contre le virus du papillome humain. In: Le cancer dans le monde. IARC Press, Editor. 2005: Lyon. p. 150-52.
Villa LL, Costa RL, Petta CA, Andrade RP, Ault KA, Giuliano AR, et al. Prophylactic quadrivalent human papillomavirus (types 6, 11, 16, and 18) L1 virus-like particle vaccine in young women: a randomised double-blind placebo-controlled multicentre phase II efficacy trial. Lancet Oncol 2005; 6: 271-8.
Mao C, Koutsky LA, Ault KA, Wheeler CM, Brown DR, Wiley DJ, et al. Efficacy of human papillomavirus-16 vaccine to prevent cervical intraepithelial neoplasia: a randomized controlled trial. Obstet Gynecol 2006; 107: 18-27.
Garland SM, Hernandez-Avila M, Wheeler CM, Perez G, Harper DM, Leodolter S, et al. Quadrivalent
vaccine against human papillomavirus to prevent anogenital diseases. N Engl J Med 2007; 356: 1928-43.
Koutsky LA, Ault KA, Wheeler CM, Brown DR, Barr E, Alvarez FB, et al. A controlled trial of a human papillomavirus type 16 vaccine. N Engl J Med 2002; 347: 1645-51.
Harper DM, Franco EL, Wheeler C, Ferris DG, Jenkins D, Schuind A, et al. Efficacy of a bivalent L1
virus-like particle vaccine in prevention of infection with human papillomavirus types 16 and 18 in young women: a randomised controlled trial. Lancet 2004; 364: 1757-65.
Arbyn M, Dillner J. Review of current knowledge on HPV vaccination: an appendix to the European Guidelines for Quality Assurance in Cervical Cancer Screening. J Clin Virol 2007; 38: 189-97.
Stadification des cancers invasifs du col utérin
M. Bazot, M. Gibeault, I. Thomassin-Naggara, C. Lafont, E. Daraï
Services de Radiologie et Gynécologie-Obstétrique, Hôpital Tenon, Paris, France
Le bilan d’extension d’un cancer du col est envisagé après qu’une biopsie dirigée est fournie un diagnostic
positif de cancer invasif du col utérin. Ce bilan d’extension repose sur l’établissement d’une classification FIGO
ou TNM. Elle doit permettre d’évaluer les principaux facteurs pronostiques et thérapeutiques représentés par le
volume tumoral, les extensions paramétriales et ganglionnaires. Le cancer du col utérin est le seul cancer gynécologique bénéficiant encore d’une stadification clinique reposant sur des examens simples et reproductibles à
l’échelle mondiale ; Examen clinique +/- sous anesthésie générale, radio pulmonaire, UIV, opacifications digestives, cystoscopie et rectoscopie. La classification FIGO génère d’importantes sous et sur-estimations, aussi la
valeur des diverses techniques d’imagerie en coupes, et en particulier de l’IRM pelvienne a été démontrée. Le
but de cette présentation sera de rappeler le rôle des diverses modalités d’imagerie pour établir un diagnostic
pré-thérapeutique le plus adéquat possible.
Pathologies Immunologiques de la Femme
J.F. Bach (F)
L’immunité de la femme diffère sensiblement de celle de l’homme. La femme produit plus d’anticorps que
l’homme en réponse à une stimulation antigénique identique. Le niveau des anticorps naturels contre les antigènes de groupe sanguin est plus élevé chez la femme que chez l’homme. Cela ne signifie pas, pour autant,
qu’il existe une différence claire dans la sensibilité aux infections entre la femme et l’homme, dans la mesure où
la défense anti-infectieuse est multifactorielle, faisant intervenir plusieurs types cellulaires dont le niveau de la
fonction n’est pas toujours différent dans les deux sexes. En fait, d’un point de vue opérationnel, la différence
essentielle entre les systèmes immunitaires de la femme et de l’homme concerne la survenue des maladies autoimmunes. La plupart de ces maladies sont plus fréquentes chez la femme. La différence est particulièrement
nette pour les maladies thyroïdiennes et le lupus érythémateux disséminé. Les rares exceptions à cette règle,
comme le diabète insulino-dépendant dans sa forme habituelle, sont probablement liées à l’engagement du processus auto-immun avant la puberté. De fait les différences immunitaires observées entre la femme et l’homme
sont pour l’essentiel exclusivement dues à la différence des effets des hormones sexuelles sur les cellules de
l’immunité. Des informations précieuses ont été recueillies sur ces effets dans les modèles expérimentaux de
maladies auto-immunes mais beaucoup reste à apprendre sur les mécanismes de la régulation des systèmes
immunitaires par les hormones chez l’homme et la femme.
Les principaux résultats obtenus soulignent l’action immunosuppressive des andogènes. L’effet des oestrogènes
et des progestatifs est plus complexe. Un autre problème important concerne les modifications des réponses
immunitaires observées pendant la grossesse indépendamment du sujet fascinant, mais encore largement
mystérieux, de la tolérance de la mère vis-à-vis du « fœtus allogreffe » et de la transmission foeto-maternelle des
maladies dues à des auto ou allo-anticorps.
Hypothalamo-hypophyso-gonadal maturation : genetics and environmental determinants
J-P. Bourguignon, F. Dominé, A-S. Parent, G. Rasier, A. Gérard, M-C. Lebrethon
47
Division of Pediatric Endocrinology and Adolescent Medicine, Department of Pediatrics, and Center of Cellular
and Molecular Neurobiology, University of Liège, University Hospital (CHU), Liège, Belgium
During the past decades, children migrating for international adoption have increased in number, creating an
original condition of dramatic environmental change during development. In several countries, cohorts of these
subjects have been shown to experience a global advancement in age at onset of puberty and sexual precocity
is seen much more frequently than in other conditions, particularly in girls. The pathophysiological mechanisms
leading to advancement of puberty in migrating girls possibly involve several factors. While genetic factors
usually account for 2/3 of the variance in pubertal age, they are unlikely to play the major role in this condition
involving girls with different ethnic origins. Sexual precocity in children migrating for international adoption could
represent a developmentally programmed disorder resulting from cumulative anomalies in early remodelling of
the central nervous system (CNS) by psycho-social, nutritional and hormonal inputs. Deviations in those inputs
can involve early exposure to endocrine disruptors and can result in intrauterine growth retardation, two conditions associated with an increased risk of sexual precocity. It is possible that such environmental determinants of
pubertal timing are ultimately translated into genetic factors through epigenetic effects.
(supported by the FRSM (grants 3.4515.01 and 3.4573.05), the European Commission (EDEN project, contract
QLRT-2001-00269) and the Belgian Study Group for Pediatric Endocrinology)
Sexuality education and adolescence
D. Apter
The Sexual Health Clinic, Family Federation of Finland, Helsinki, Finland
Sexual health for adolescents is based on three fundamental components:
1. Recognizing sexual rights. 2. Sexuality education and counselling 3. Confidential high quality services. These
components all need to be considered together. The closer sexuality education programs and sexual health
services work together, the better are the results.
The sexuality education provided should be adapted to the developmental stage. Three kinds of guidance are
needed: 1. Counselling, which occurs in direct interpersonal relationship and is based on recognizing individual
needs. 2. Sexuality education is typically given in schools or other social situations, where a group of young persons of similar age listen to lectures, see educational material and can discuss. Individual needs are not possible
to consider. 3. A third approach is information campaigns about sexual health through e.g. mass media.
According to WHO, countries providing extensive sexuality education have better succeeded in limiting unintended adolescent pregnancies as well as sexually transmitted infections. The programs need to be comprehensive in order to work. In some studies, it has been difficult to demonstrate an effect of individual sexuality
education programs. The Family Federation of Finland performed in 2006 an extensive study of sexuality education in schools in Finland. Teachers from more than 500 schools answered questions about sexuality education
provided, and 34 000 grade 8 students filled in a questionnaire testing their knowledge about sexual health. The
extent of sexuality education provided correlated well with the level of knowledge of the students, particularly for
boys.
In conclusion, when adolescent sexuality is not condemned but sexuality education and sexual health services
instead are provided, it is possible to profoundly improve adolescent sexual health with comparatively small
costs. But each year new groups of young people mature, requiring new efforts. Education, counselling and
services are all needed.
Meet the Expert Sessions
1. New treatments in osteoporosis
R. Levasseur
Rheumatology Department and Inserm EMI 335, Angers Teaching Hospital, France
Osteoporosis is a widespread disease which will affect around 40% of women aged over 50 in the Caucasian
population. The fractured bones are mostly the wrist, the vertebrae and the femur, inducing an altered quality of
life and reduced mobility, even causing mortality in old people with numerous comorbidities. To date osteoporosis is clinically defined either by a low trauma fracture or by a T-score ≤-2.5, measured by DXA in the lumbar
spine and in the femur. We have known since the consensus conference in 1993 that osteoporosis is due to a
quantitative and a qualitative defect of bone, leading to bone fragility and increased fracture risk. At the cellular
level, the postmenopausal state with oestrogen depletion induces a high bone turnover with increase in both
bone resorption by osteoclasts and bone formation by osteoblasts. However, the increase in bone formation is
not sufficient to compensate for the loss of bone, which is high in the postmenopausal period. Hence, from a
therapeutic point of view, it would be valuable to have a drug which can slow down bone resorption and enhance
bone formation. Classically, the therapeutic approach was to inhibit bone resorption with bisphosphonates such
as risedronate, alendronate, and ibandronate which have proved their antifracture efficacy concerning vertebrae
and femur except ibandronate which has only proved for vertebrae. Beside this antiresorptive approach, new
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therapeutics have emerged with anabolic agents (such as PTH1-34 and PTH1-84) which increase bone formation and bone resorption , with a net balance favoring bone formation and antifracture efficacy (mostly vertebral).
A third option has been offered by strontium ranelate which is able to reduce bone resorption and enhance bone
formation. This double effect has proved its action on both bone quantity and bone quality in rodents and humans. The antifracture efficacy has been showed by the SOTI (Spinal Osteoporosis Therapeutic Intervention) and
TROPOS (Treatment of Peripheral Osteoporosis) studies in women with osteoporosis. In the SOTI trial, 3 years’
treatment with strontium ranelate led to a 41% reduction in vertebral fracture risk (RR=0.59; 95% CI: 0.48-0.73;
P<0.001), while in the TROPOS study there was a 16% reduction in nonvertebral fractures (RR=0.84; 95% CI
0.702-0.995; P=0.04) and a 36% reduction in hip fracture in patients with a high risk of hip fracture. The antifracture efficacy has also been proven in younger patients between 50 and 65 years old. This new therapy is a new
opportunity for clinicians to treat osteoporosis efficiently in postmenopausal women, whatever the age.
3. Non hormonal treatment of hot flushes
A.R. Genazzani
Department Of Obstetrics and Gynecology, Pisa University Hospital, Italy
Estrogen-containing HRT is the most effective treatment for menopausal symptoms in healthy women but is contraindicated for some women and avoided by many others. However, after the publication and the misinterpretation of the WHI results an increasing number of women are requesting non-hormonal treatments for menopausal
symptoms. Concerns regarding the adverse effects of HRT have led to demand for other options. However, the
efficacy and adverse effects of nonhormonal therapies are unclear. Few good quality studies have addressed
this issue, almost all have only addressed the short term treatment of hot flushes and there are a smaller number
of long-term data. The number of daily hot flashes decreased compared with placebo in meta-analyses of 7
comparisons of selective serotonin reuptake inhibitors (SSRIs) or serotonin norepinephrine reuptake inhibitors
(SNRIs). Hot flushes frequency was not reduced in meta-analysis of trials of red clover isoflavone extracts and
results were mixed for soy isoflavone extracts. Evidence of the efficacy of other therapies is limited due to the
small number of trials and their deficiencies. Trials do not compare different therapies head-to-head and relative
efficacy cannot be determined. The SSRIs or SNRIs, clonidine, and gabapentin trials provide evidence for efficacy; however, effects are less than for estrogen. Few trials have been published and most have methodological deficiencies, generalizability is limited, and adverse effects and cost may restrict use for many women. These
therapies may be most useful for highly symptomatic women who cannot take estrogen. However, these nonhormonal preparations are not the most favourable choice for the most part of normal postmenopausal women.
7. Endométriose pour le gynécologue
Emile Daraï, Vincent Lavoué, Roman Rouzier, Marc Bazot, Gil Dubernard
Services de Gynécologie et Obstétrique, Hôpital Tenon, AP-HP, Université Pierre et Marie Curie Paris VI, France
L’endométriose est une pathologie fréquente affectant de 10 à 20% de la population féminine en âge de procréer. Elle pose avant tout un problème de diagnostic devant une symptomatologie qui peut être considérée
comme banale telle que l’existence d’une dysménorrhée ou une infertilité dite inexpliquée. Diverses publications
telles que les recommandations pour la pratique clinique publiées par le CNGOF en 2007 et celles de l’AFFSAPP
en 2005 permettent d’apporter une aide précieuse pour le praticien tant en terme de diagnostic clinique et para
clinique qu’en terme de traitement médical et chirurgical.
Dans une première étape, nous rappellerons les symptômes devant faire évoquer le diagnostic ainsi que leur
valeur pour préciser la localisation des lésions. La place de l’imagerie ainsi que les limites seront précisés.
Nous analyserons l’intérêt de l’imagerie principalement l’échographie qui reste l’examen de première intention
mais dont la normalité ne permet pas d’exclure le diagnostic d’endométriose. Le recours à une coelioscopie
s’avère parfois nécessaire pour affirmer le diagnostic qui doit être confirmé par un examen histologique. Chez
les femmes non désireuses de grossesse, le traitement médical vise à faire disparaître les symptômes et repose
principalement sur l’utilisation des progestatifs et les oestro-progestatifs. Les analogues de la GnRH doivent
être utilisés dans des situations précises du fait de leurs effets secondaires même si l’add-back thérapie permet
de les limiter. D’autres thérapeutiques sont en cours d’évaluation telles que les anti-aromatases, l’implanon ou
encore des facteurs anti-angiogéniques. Dans les formes de découverte fortuite lors d’un bilan d’infertilité, une
méta-analyse souligne l’intérêt de la chirurgie pour améliorer le taux de grossesse chez les patientes ayant une
endométriose de stade I et II de la classification internationale rAFS.
Dans une deuxième étape, nous évoquerons la place du traitement chirurgical. Le traitement des endométriomes ovariens est standardisé et repose sur la kystectomie validée par une méta-analyse. Il n’existe pas
d’argument pour associer en pré ou en post-opératoire un traitement par analogues de la GnRH qui ne simplifie
pas la chirurgie ni ne réduit le risque de récidive. Seule l’utilisation avant FIV est efficace en augmentant le taux
de grossesse. Dans les formes récidivantes d’endométriome, la stratégie est moins consensuelle. Cependant,
l’indication d’une chirurgie itérative semble peu légitime dans le cadre des patientes infertiles chez qui l’AMP
a prouvé sa supériorité. Dans les formes profondes, se posent plusieurs problèmes. Le premier réside dans
l’intérêt du traitement pré-opératoire par analogues de la GnRH. A ce jour, peu de données soutiennent leur
utilisation. Seul un essai semble prouver leur intérêt en permettant une chirurgie optimale et en limitant le risque
49
d’adhérences. Le deuxième problème réside dans la reconnaissance des patientes ayant un bénéfice à une
chirurgie qui peut exposer les patientes à des complications majeures. Nous avons développé un algorithme
basé sur un questionnaire validé évaluant la qualité de vie des patientes (SF36) pour identifier les bonnes candidates à la chirurgie. Outre l’identification de ces patientes, la chirurgie des formes profondes nécessite une
connaissance non seulement de la chirurgie gynécologiques mais également urologiques et digestive ce qui
souligne bien que non unanimement reconnu la notion de centre spécialisés.
Mais nombreuses sont les questions non encore résolues pour la prise en charge des patientes endométriosiques. Chez les patientes présentant une endométriose profonde désireuse de grossesse, faut-il faire appel à la
chirurgie de première intention ou à une AMP ? Après échec d’une AMP, une chirurgie permet-elle d’améliorer la
fertilité ? Quelle place pour le traitement médical pour les formes récidivées ?
8. Follow-up after Breast cancer
P. Sismondi
Despite improvements in breast cancer management, about one third of the women with operable disease will
relapse. Both local and distant recurrences can occur at any time during the lifespan of the patient, although the
risk is higher during the initial five years after surgery. For this reason regular surveillance is advised to all women
that are apparently free-of disease. In the past, a few randomised trials have addressed different follow-up policies, including systematic use of diagnostic imaging (mammography, chest x-ray, liver ultrasonography, computed tomography and bone scans) and laboratory tests (liver enzymes, tumour markers). Newer imaging modalities like magnetic resonance imaging and positron-emission tomography are also being investigated in order to
assess their performance in the early prediction of disease recurrence. The current evidence does not support
the routine use of most of these diagnostic tests in an otherwise asymptomatic woman after local treatments.
Regular history, breast examination and annual mammography remain the cornerstone of appropriate breast
cancer follow-up. Opposite to this “minimalistic” approach, a more aggressive follow-up policy has not resulted
in significant improvements in disease outcomes and is associated with unnecessary expenditures.
Progestatifs par voie orale après 40 ans et cancer du sein : réflexions et commentaires sur l’étude E3N.
J. Desreux1, A. Fabre2,A. Fournier2, S. Mesrine2, A. Gompel3, M.-C. Boutron-Ruault2, F. Clavel-Chapelon2
1 Service de sénologie, département universitaire de gynécologie-obstétrique, CHR Citadelle, Liège, Belgique
2 INSERM, ERI 20, Institut Gustave Roussy, Villejuif, France
3 Unité de gynécologie Hôtel-Dieu de Paris, Université Paris V, Paris, France
De nombreuses études observationnelles et prospectives randomisées mettent en évidence un effet délétère
des progestatifs sur le risque de cancer du sein lorsqu’ils sont ajoutés aux oestrogènes dans le cadre d’une
hormonothérapie substitutive de la ménopause. Cependant, l’impact des progestatifs prescrits seuls en préménopause a été jusqu’ici peu étudié.
L’équipe de l’étude E3N a récemment focalisé ses recherches sur la sous-population préménopausée âgée de
plus de 40 ans (73 664 patientes, suivi moyen de 9,1 ans) et a constaté 2390 cas de cancers du sein. Leurs observations montrent une augmentation significative du risque si l’utilisation d’un progestatif dure plus de 4,5 ans
(RR = 1,44 ; IC 95% 1,03 – 2,00) et une annulation de cet excès de risque après l’arrêt du traitement, suggérant
un effet promoteur sur des tumeurs pré-existantes. Il n’y avait pas de différence significative entre progestatifs
anti-gonadotropes et non anti-gonadotropes1.
Ces données très importantes alimentent les connaissances sur les effets des progestatifs sur le sein, seuls
ou associés avec des oestrogènes, et mettent en exergue les différences entre femmes préménopausées et
femmes postménopausées.
1 Fabre A, Fournier A, Mestrine S et al. Oral progestagens before menopause and breast cancer risk. British
Journal of Cancer (2007), 1 – 4.
Control of enzymes involved in estrogen formation and transformation in the mammary gland in situ
J.R. Pasqualini
Hormones and Cancer Research Unit, Institut de Puériculture et de Périnatalogie, Paris, France
Estradiol (E2) is considered one of the main factors in breast carcinogenesis. However, a ‘direct effect’ of E2 in
breast cancerization has not yet been demonstrated. The estrogen receptor complex can mediate the activation
of oncogens, proto-oncogens, nuclear proteins and other target genes that can be involved in the transformation of normal to cancerous cells. The breast contains all the enzymes responsible for this local biosynthesis
of E2 from circulating precursors. Two principal pathways are implicated in the last steps of E2 formation : the
‘aromatase pathway’ which transformas androgens into estrogens, and the ‘sulfatase pathway’ which converts
estrone sulfate (E1S) into estrone (E1) by the activity of the sulfatase. The treatment of breast cancer patients
50
with anti-aromatases is largely developed with very positive results. However, the formation of E2 via the ‘sulfatase pathway’ is very important in the breast cancer tissue. In recent years it was found that anti-estrogens (e.g.
tamoxifen, 4-hydroxytamoxifen), various progestins (e.g. promegestone, nomegestrol acetate, medrogestone,
dydrogesterone, norelgestromin), tibolone and its metabolites, as well as other steroidal (e.g. sulfamates) and
non-steroidal compounds are potent sulfatase inhibitors. In another series of studies it was found that E2 itself
has a strong anti-sulfatase action. It was observed that anti-sulfatase agents correlate with an anti-growth effect
in breast tissues. Using a breast cancer cell rich in aromatase expression (MCF-7aro) it was demonstrated that
the progestin nomegestrol acetate, as well as E2 itself, can block aromatase activity. These paradoxical effects
of E2 add a new biological response of this hormone and could be related to estrogen replacement therapy
in which it was observed to have either no effect or to decrease breast cancer mortality in post-menopausal
women. Recently, it was also observed that androstenedione (the main circulatory androgen in post-menopausal
women) can act as an anti-aromatase agent in breast cancer cells.
Interesting information is that the evaluation in breast tissues of the messenger sulfatase mRNA and of 17ß-hydroxysteroid dehydrogenase (17ß-HSD) mRNA can be used as prognostic factors of this disease.
In conclusion, the blockage in the formation of E2 via sulfatase or 17ß-HSD Type I, or the stimulatory effect on
sulfotransferase activity in combination with anti-aromatases, can open interesting and new possibilities in clinical applications for breast cancer treatment.
Action de la progesterone sur le cerveau après traumatismes crâniens: réflexions après l’étude ProTect
M. El-Etr
INSERM UMR 788, France
Malgré une meilleure connaissance de leur physiopathologie, les traumatismes cérébraux constituent toujours
un problème universel de santé publique. La plupart des mesures visent à maintenir une perfusion cérébrale
adéquate en évitant l’hypoxie mais aucun des traitements plus spécifiques n’a formellement fait la preuve
de son efficacité: la méthylprednisolone, longtemps utilisée, est peu efficace et peut même être dangereuse,
l’hypothermie a des effets aléatoires, voire néfastes après 45 ans, le mannitol et les barbituriques ne diminuent
pas non plus la morbi-mortalité de façon significative.
En dehors de son rôle dans la régulation de la reproduction, la progestérone exerce sur le cerveau des effets
neurotrophiques et neuroprotecteurs (réduction de l’œdème cérébral après traumatisme et ischémie ; prévention
de la toxicité du glutamate in vitro ; réduction de la mort neuronale après lésion ; régulation de gènes de facteurs
de croissance et diminution de la peroxydation des lipides induite par les radicaux libres), et des effets anti-inflammatoires (inhibition de la prolifération des cellules microgliales, macrophages du système nerveux central
; diminution de la production de cytokines pro-inflammtoires TNFα et IL12, par la microglie activée in vitro ;
diminution de la gliose astrocytaire, également productrice de cytokines pro-inflammatoires, TNFα et IL1β, après
lésion cérébrale). Ses effets bénéfiques observés dans des modèles animaux de traumatisme cérébral, ont conduit l’équipe de Donald Stein à entreprendre l’essai clinique ProTECT (1), étude randomisée en double aveugle
contre placebo, visant à limiter les conséquences d’un traumatisme cranien, par l’administration de progestérone intraveineuse dans un délai maximum de 11 heures après l’accident. Les effets indésirables se sont révélés
identiques dans les deux groupes. La progestérone a divisé par 2 la mortalité à 30 jours parmi les patients dont
le coma était sévère, et assuré une bien meilleure récupération fonctionnelle à 30 jours chez les patients dont le
coma était modéré. Une étude de phase III est maintenant en cours, incluant un plus grand nombre de traumatisés, un nombre identique de patients traités par progestérone et placebo (perfusés le plus précocement possible
après le traumatisme), avec un suivi d’un an.
La progestérone, administrée dans les plus brefs délais après un traumatisme cranien, pourrait ainsi offrir des
perspectives thérapeutiques intéressantes avec en particulier une limitation de l’œdème et une prévention de la
mort neuronale secondaire.
(1) Wright DW et coll. ProTECT : a randomized clinical trial of progesterone for acute traumatic brain injury. Ann Emerg Med
2007;49:391-402.
Urogynecology of the ageing woman
L. Cardozo (UK)
King’s College Hospital London UK
Urogenital ageing is a common problem which is becoming more prevalent with the increasing life expectancy
of women. Changes in the urogenital tract relate not only to age but also to the effects of decreased oestrogens.
Oestrogen is known to have an important role in the function of the lower urinary tract throughout adult life with
oestrogen and progesterone receptors have been demonstrated in the vagina, urethra, bladder and pelvic floor
musculature. After the menopause women become increasingly oestrogen deficient and this leads to changes
in the urogenital tract and overall physiology. This is supported by the fact that oestrogen deficiency occurring
following the menopause is known to cause atrophic changes within the urogenital tract and is associated with
urinary symptoms such as frequency, urgency, nocturia, incontinence and recurrent infection. These may also
co-exist with symptoms of vaginal atrophy such as dyspareunia, itching, burning and dryness. Lack of oestrogen
51
also has effects on physical and emotional aspects of a women’s life.
Few studies have looked into the incidence of these problems. Epidemiological studies have implicated oestrogen deficiency in
the aetiology of lower urinary tract symptoms. Oestrogen preparations have been used for many years in the treatment of urinary
incontinence although their precise role remains controversial. Low dose vaginal oestrogens have been shown to be have a role in
the treatment of urogenital atrophy in postmenopausal women and would appear to be as effective as systemic preparations.
This lecture gives an insight into the magnitude of the problem and evidence based
approach to the understanding and treatment of various uro-gynaecological symptoms affecting postmenopausal women.
Will we be able to delay ageing tomorrow?
Th. Maudelonde
CHU of Montpellier, France
There is an obvious relation between the age and the incidence of cancers. The profile of the genes which are expressed in the
cells of the subjects presenting a premature ageing such as the syndrome of Werner presents a great similarity with that of the
senescent cells (Kying KJ, 2003) and these subjects present a high incidence of epithelial cancers (Martin G, 1970). The knowledge gradually acquired on the mechanisms responsible for the installation of cellular ageing and those of carcinogenesis makes
it possible to consider assumptions which could explain the increased frequency of cancers beyond of a certain age.
What is carcinogenesis?
Cancer is a disease of genes. Two great families of genes are implied in cancer: - the oncogenes which are normally present in
the cell but whose expression is normally repressed or controlled. Appearance of a deregulation of their expression induced of the
cellular alterations found in the cancerous cells; -the process of cancer development is repressed by the gene products called
tumor suppressors. One can define two main categories of them: the proteins which prevent or repair genetic damages (caretakers) and protect the genome from acquired changes; - those which prevent the development of the potentially cancerous cells
(gatekeepers) within the framework of a regulation at cell, tissue or organism level by a definitive arrest of the proliferation or by
inducing cellular death (apoptosis).
What is cellular senescence?
Cellular ageing can be defined like a program leading to the irreversible arrest of the cellular proliferation. It is accompanied by
modifications of the morphology and the functions of the cell. Cellular ageing is closely related to the size of the ends of the DNA
which are called telomeres. The structure of the telomeres protects the degradation of the final end of the chromosomes (Makarov,
1997). The size of the DNA can be maintained constant by the telomerase which allows, during the duplication of the ADN (replication), to recognize the end of the telomeres. In human being, this enzyme is expressed in germinal cells and in stem cells but it
is not expressed any more in the majority of the somatic cells (Kim NW, 1994). Size of the telomere thus shortened to each cellular
multiplication. When the telomere reaches a critical size called limit of Hayflick, the DNA becomes instable and the cell definitively
stops multiplying and has morphological modifications and a deterioration of a certain number of biological functions which one
calls cellular senescence. The arrest of proliferation is on the control of the P53 tumor suppressor. In cellular culture of fibroblasts,
such a process involves the secretion of enzymes of degradation of the extra cellular matrix, the inflammatory cytokines and the
growth factors (Campisi, 1996). In fact the P53 and RB tumor suppressors control the ways which will lead to the arrest of the cellular cycle or to the apoptosis (Kohn, 1999).
Mechanisms common to ageing and cancer
Genetic instability
Genetic instability triggers the senescence but it supports also carcinogenesis. There are in vitro and pathological arguments. In
culture of human cells there is a progressive shortening of the telomeres (Al, 1995). On the contrary, a shortening of the telomeres
is not observed in the cultures of murine cells and, in vivo, in the rodent (Sherr, 2000). However if one inactive the telomerase in
the mouse, we observe in some generations a shortening of the telomeres. When their size approaches that of the human cells,
the mice develop cancers very similar to those of human (Artandi, 2000). Certain human pathologies as the congenital dyskeratosis which presents a deficit in one of the components of the telomerase are partially overdrawn in telomerase and have an increased frequency of cancer (Mitchell, 1999). Of another with dimensions, the people suffering from this pathology have biological
anomalies normally associated the age (ageing immunizing, hair are grey and rare, delay with the cicatrisation) (Rudolph, 1999).
The P53 and RB tumor suppressor
The answer “ageing” requires a correct function of P53 and RB on the level of the regulation of the cellular cycle and repair of
the DNA damaged. The cell can then stop to proliferate or can die by apoptosis. In the event of deterioration of the regulations
ensured by these 2 gene suppressor a genomic instability appears (Campisi, 2004). The genome instability very often induces the
cellular death. But in some case, the cell can, by an epigenetic event or by mutation, stabilize its telomeres and then to become
cancerous. The more frequent means to stabilize is to express the telomerase (Kim et al., 1994). The cell then becomes immortal
by maintaining the size of these telomeres. This was shown perfectly in the transgenic mouse for the catalytic unit of the telomerase which presents a frequency higher of breast cancers than in the mice controls (Artandi SE, 2002). Genomic instability helping, the cell quickly becomes cancerous. Thus the association of anomalies of genes suppressors and the re-expression of the
telomerase could allow the cancerous transformation of a cell. The telomerase is found in almost all the human tumors but not in
the adjacent normal cells (Shay JW, 1997, 2004)
The INK4a/ARF locus
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The INK4a/ARF locus encodes two critical tumor suppressors, p16INK4 and ARF. Whereas p16INK4a is an inhibitor of the cyclindependent kinases CDK4 and CDK6 and acts by imposing a G1 cell cycle arrest, ARF regulates P53 stability through inactivation
of the p53 degrading ubiquitin ligase MDM2 (Gil and Peters, 2006). These proteins then inhibit the proliferation and stimulate the
apoptosis. This locus is normally expressed at very low levels in most tissues of young organisms but becomes derepressed with
ageing (Krishnamurty, 2004). Their high expression in ageing might be a protector mechanism against carcinogenenesis.
Scenario according to the age
The arrest of the growth associated with a cellular ageing can be a mechanism of protection in a young organization. Senescent
cell isolated in the middle of young cells has probably negligible effects. On the other hand, in an old organization, the senescent
cells are numerous and their abnormal secretions can disturb the physiology and the integrity of the tissues (Krtolica A, 2001).
The old cells perhaps will create a micro environment around the cancerous cells supporting their proliferation and their migration
(Park, 2000). The age could thus support the emergence of cancer by 2 mechanisms:-the accumulation of changes which can
lead to the inactivation of tumor suppressor gene;- the reduction of the controls normally ensured by the tissue micro environment
caused by the ageing of the cells.
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Shay JW and Roninson IB. (2004) Hallmarks off senescence in carcinogenesis and cancer therapy. Oncogene, 23, 2919-2933.
Sherr CJ and DePinho RA. (2000). Cellular linen senescence: mitotic clock gold culture shock? Concealment, 102, 407-410.
Adolescent contraception in Europe
G. Creatsas (Gr)
Pregnancy and abortions still remain a problem during adolescence, especially in the developing world. For this reason proper
consultation to young people is advised. Adolescent contraception includes almost all contraceptive methods currently available.
Oral contraceptives, in addition to their contraceptive efficacy, also provide other beneficial effects. However the use of condoms
is advised for the prevention of sexually transmitted diseases. Emergency contraception is also in use with very good efficacy and
results.
Although there are no recent mulitcentric studies in Europe, the above methods are the most commonly used during adolescence.
In any case, our goal is the proper sexual education through our Adolescent and Family Planning Centers to preserve the young
woman’s reproductive health.
Estetrol: a new natural estrogen for contraception
Herjan J.T. Coelingh Bennink 1, Sven Skouby 2, Philippe Bouchard 3 , Monique Visser 1, Christian F. Holinka 4
1 Pantarhei Bioscience, Zeist, The Netherlands,
2 Department of Obstetrics and Gynecology, Frederiksberg Hospital, University of Copenhagen, Denmark,
3 Service d”Endocrinologie, Hopital Saint-Antoine, Paris, France,
4 PharmConsult®, New York, NY, USA
Combined oral contraceptives (COCs) or “the pill” contain an estrogen (E) and a progestin (P). Since the introduction of the pill,
efforts have been made to improve the P component. However the E component has been unchanged for decades and today all
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COCs contain ethinylestradiol (EE) after initial use of the EE precursor mestranol.
Estetrol (E4) is a steroid hormone produced by the human fetal liver during pregnancy only. It was discovered by Egon Diczfalusy
at the Karolinska Institute in Stockholm in 1965.
Pharmacological and clinical data obtained by Pantarhei have shown that E4 is an estrogen for the vagina, the uterus including
the endometrium, bone and brain (effect on hot flushes). Surprisingly E4 appeared to act pharmacologically in several in vitro and
in vivo models as an estrogen antagonist in the presence of estradiol with comparable potency to tamoxifen and ovariectomy.
Administration of E4 effectively inhibits ovulation in cycling rats. The effect is dose-dependent. The relative potency of E4 is about
18 times less compared to that of EE.
At present a feasibility study on the contraceptive effect of E4 alone or combined with either progesterone or desogestel is ongoing in human volunteers.
Data suggest that advantages of E4 over EE may be fewer subjective side effects, less interaction with liver function, a lower
incidence of cardiovascular and gallbladder disease and protection of the breast against breast cancer. When clinically significant
advantages can be proven indeed, the human fetal estrogenic steroid E4 is a potential candidate to replace EE in combined oral
contraceptives.
Sponsored Plenary Lecture - Conférence Plénière sponsorisée
La pratique francaise de la pose des implants de sterilisation tubaire Essure®
I. Grosdemouge 1, J.B. Engrand 2, C. Dhainault 3, H. Martigny 4, J. Thevenot 5, V. Villefranque 6, P. Lopes 7, P. Panel 1
1.CH de Versailles, 78150 Le Chesnay.
2.Maternité des Bazennes, 59431 Saint Paul sur Mer.
3.CHU Bichat, 75018 Paris.
4.Polyclinique de l’Atlantique, 45819 Saint Herblain Cedex.
5.Clinique Ambroise Paré, 31083 Toulouse Cedex 1.
6.CH René Dubos, 95300 Pontoise.
7.CHU Nantes, 49093 Nantes Cedex.
La loi du 4 juillet 2001 a libéralisé la pratique de la stérilisation tubaire en France. Dans le même temps est apparue une nouvelle méthode de stérilisation féminine par voie hystéroscopique. Cette méthode se développe d’autant plus qu’elle ne nécessite
pas toujours d’analgésie, ne laisse pas de cicatrice, réduit la durée d’hospitalisation et diminue les coûts. Le but de l’étude est
d’analyser la faisabilité et le succès de pose des implants en France. Nous avons réalisé une étude multicentrique sur 7 centres
français de janvier 2004 à juin 2006. La parité, l’aspect de la cavité, la présence d’un geste associé, la visibilité des ostiums, le type
d’anesthésie et le succès de pose uni ou bilatéral ont été répertoriés. Cette étude a concerné 1061 tentatives de pose d’implants
Essure® commercialisés par le laboratoire Conceptus (France). 1054 tentatives de pose d’implants Essure® ont été réalisées et
analysées. L’âge moyen des patientes était de 41,1 ans. La parité moyenne des femmes demandant la pose des implants Essure®
était de 2.5 enfants. 26 patientes étaient nullipares (2.9 % de la population).
Le mode d’analgésie était très variable en fonction des opérateurs, du désir de la patiente et de la réalisation ou non d’un geste
chirurgical associé. Aucune analgésie n’a été nécessaire dans 510 cas (48 %). 83 patientes ont eu une analgésie locale à la xylocaïne. Moins de la moitié des patientes ont eu une anesthésie soit par rachianesthésie (n = 10) soit par sédation intra veineuse (n
= 239) ou anesthésie générale (n = 212). Par ailleurs, il a été observé un moindre recours à une analgésie au cours du temps. Un
geste chirurgical a été associé dans 6.2 % des cas (n = 65). Dans 992 cas (94.1 %), la première tentative de pose s’est révélée être
un succès. Lorsqu’une deuxième tentative de pose par voie hystéroscopique a été tentée, le taux de succès était de 47 % (n =
23). Au final, le taux d’échec de stérilisation a été de 3 %.
Les patientes se déclaraient satisfaites ou très satisfaites dans 94.5 % des cas. La stérilisation tubaire par les implants Essure® est
une méthode de plus en plus répandue en France, largement plébiscitée par les femmes. Dans les centres où cette pratique est
bien rôdée, on observe un faible taux d’échec de pose et un recours de moins en moins fréquent à une technique analgésique. A
l’avenir, la voie hystéroscopique est amenée à remplacer la voie coelioscopique.
Research in contraception
Regine Sitruk-Ware
Rockefeller University and Population Council New York, NY, USA
New methods have been developed to meet the objectives of expanding contraceptive choices for both women and men and, of
answering an unmet need for contraceptives with long-term action that meet the expectations of consumers. Men now tend to
accept the concept of taking responsibility for the control of the couple’s fertility, leading to a growth in requests for male contraceptives, an emerging area of research.
Future contraceptive research will build upon advances in biomedical research, which have created new opportunities for studying the basic biology of reproduction. Basic research could, in turn, lead to the discovery of novel targets for contraception. The
technologies of genomics, proteomics, lipidomics, and glycomics, has great potential in the identification of protein targets and
their regulatory genes. As an example, the identification of proteins involved exclusively in the maturation of sperm, the motility
of spermatozoids, or in the fusion between the spermatozoid and the female oocyte could prove useful. If such proteins could
be identified and small molecule antagonists for these proteins could also be found, these discoveries would provide a way to
stop the fertilization process without disrupting the hormonal environment or other body systems. Thanks to new high throughput
screening methods that can screen existing libraries of thousands of molecules in a relatively short time frame, the identification of
unique proteins and their antagonists may be possible and research is ongoing in that direction.
The extraordinary progress made in the drug delivery area may also facilitate the development of superior contraceptive systems
in the future. Long-acting systems would be preferred to improve compliance and easiness of use. The first revolution in drug
delivery systems was spearheaded by the first-generation, long-acting systems developed by the Population Council. Both IUDs
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and implants, fruits of this research, are now widely available; transdermal gels and sprays are in early stages of research and a
one-year contraceptive vaginal ring is in the last stages of development. All these delivery systems are based on the use of steroidal hormones delivered continuously at very low doses, which suppresses ovulation in cycling women. Dual-protection methods
which join contraceptives to microbicides or antiviral agents to protect women against both unwanted pregnancy and sexually
transmitted infection, especially with human immunodeficiency virus (HIV), would meet a major need.
In other cases, the provision of an extra health benefit may increase compliance with contraceptive use. Current contraceptive
methods do have many benefits: some improve menstrual bleeding patterns, alleviate dysmenorrhea and acne, and sometimes
pre-menstrual syndrome. Others can produce amenorrhea. The protective effect of the COC on ovarian and endometrial cancer is
perceived as an advantage by providers and this additional medical benefit may enhance continuation rates among well-informed
women. Contraceptive methods that would also provide additional protection against breast or ovarian cancer would also have
wide appeal. Above all, new contraceptives, which are designed to be used by healthy men and women, should be very safe.
Development of easy to use, reversible, and inexpensive methods is warranted.
Lutte contre les mutilations sexuelles féminines en France
HJ Philippe 1, V. Carton 2, S. Lebihannic 2, N. Jarrousse 2, F. Mortagne 2
1 Président de Gynécologie Sans Frontières, 2 UGOMPS, CHU Nantes 38 bd Jean Monet 44093 Cedex
En 2006, dans le cadre du programme de lutte contre les violences faites aux femmes, plusieurs institutions ont choisi de
s’attaquer à l’une des formes extrêmes de violence faite aux femmes, les mutilations sexuelles féminines. A cette fin, le 4 décembre, un colloque national a permis de lancer une campagne d’informations et de sensibilisation auprès des professionnels de la
santé et du secteur social, dans 9 régions prioritaires françaises.
Gynécologie Sans Frontières a été missionné pour :
- organiser avec les DRASS, les services de gynécologie-obstétrique des CHU concernés et le GAMS, 9 colloques
régionaux : à Nantes, en Île-de-France, à Lille, à Amiens, à Rouen, à Poitiers, à Marseille, à Lyon et à Reims.
- la coordination d’un ouvrage : le praticien face aux mutilations sexuelles féminines
- la participation à une enquête avec l’INED et l’université de Paris I sur les conséquences des MSF
- la réalisation d’un Cdrom à destinations des enseignants des facultés de médecine, des écoles de sages-femmes
et des IFSI
- la participation à des sessions de formations pour les acteurs du secteur social
- impulser la mise en place de centre pluridisciplinaire pour la réparation des MSF.
A Nantes, l’Unité de Gynécologie Obstétrique Médico-Psycho-Sociale (UGOMPS) a pris en charge les 4 dimensions du projet
national : informer les femmes pour elles et leurs enfants, former les professionnels (Faculté, ESF, IFSI), créer des centres experts
pluridisciplinaires et mettre en place un réseau avec les associations
Cette unité a organisé le 1er colloque régional de sensibilisation des professionnels de santé sur les MSF, a intégré un enseignement initial en faculté de médecine, au niveau de l’école de sages-femmes et de l’I.F.S.I. depuis deux ans.
Depuis deux ans, nous avons mis en place une prise en charge pluridisciplinaire pour les femmes souhaitant une réparation
chirurgicale ; elle comporte plusieurs étapes :
• premier contact : informations, explications,
• ensuite, entretiens :
o avec un psychologue (=> évaluation du traumatisme),
o avec un sexologue (=> évaluation des attentes sexuelles),
o avec un chirurgien et un anesthésiste,
• puis, intervention chirurgicale éventuelle
• et surtout réalisation d’un suivi médical, psychologique et sexuel.
Nous organisons une fois par mois une réunion d’échanges en collaboration avec l’ASAMLA.
L’ensemble des ces actions sont abordées à l’occasion d’un staff mensuel sur les Violences faites aux femmes (orienté actuellement sur les Mutilations sexuelles).
Meet the Expert Sessions
10. Nouvelles perspectives pour faciliter le protocole de l’IVG medicamenteuse
Elisabeth Aubény
Gynécologue, Paris - Fiapac
Les perspectives d’amélioration de l’IVG médicamenteuse portent à la fois sur l’amélioration de la technique et sur un allègement
du protocole.
- Amélioration de la technique
Le dosage des BHCG dans les 15 jours qui suivent l’IVG permet d’affirmer l’efficacité de la méthode à 99,5 % de confiance. Ce
dosage doit avoir chuté de 80 % par rapport au dosage pré-IVG.
Le dosage sanguin des BHCG pourrait d’ailleurs être remplacé par un test urinaire à faible sensibilité (1000 mIU /ml) que la femme
réaliserait elle-même dans les 15 jours suivant l’IVG.
La prise du misoprostol par voie orale pourrait être remplacée par la voie buccale qui semble plus efficace.
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- Allègement du protocole
Le protocole comporte 3 visites actuellement, 2 visites sont remises en question.
La visite pour la prise du misoprostol. Elle ne semble pas justifiée, en particulier en ville, où cette prise n’est suivie d’aucune
surveillance médicale. En effet le misoprostol agissant très rapidement, la patiente peut avoir des douleurs et peut même expulser
sur le chemin du retour après avoir quitté le cabinet médical.
La visite de contrôle est aussi remise en question d’autant que 20 à 40 % des patientes ne l’effectuent pas, ce pourcentage augmentant avec la pratique du contrôle de la méthode par le dosage des BHCG. Cette visite pourrait être optionnelle si les BHCG
ont chuté et s’il n’existe aucun symptôme fonctionnel. Une seule visite pourrait être requise : la visite de prise de la mifépristone.
- Remarque : La visite pré-IVG. Elle ne peut être remise en question dans notre pays car elle est légalement requise.
Au total des possibilités d’amélioration de l’IVG médicamenteuse se dessinent. Elles permettront aux femmes d’avoir une IVG
médicamenteuse toujours aussi sûre mais moins contraignante.
12. Le Post-Partum
M. Tournaire (F), J.L. Bénifla (F), J. Calaf (E)
La période du post-partum sera envisagée sous trois aspects :
- insertion immédiate d’un stérilet après la délivrance,
- inhibition de la lactation,
- mise en place de la contraception lors de l’hospitalisation post-partum.
16. Dangerous treatments at the start of pregnancy
Teresa Almeida Santos (1) and Cristina Rama (2)
(1) Medical Genetics Service – Department of Maternal Fetal Medicina, Genetics and Human Reproduction, Coimbra University
Hospital, Portugal, (2) SIMED – Coimbra University Hospital, Portugal
The consumption of therapeutic agents by women during their reproductive life span has raised new problems concerning possible effects of such chemical agents both occasionally or chronically for the treatment of pre-existing diseases.
Possible teratogenic effects of such drugs may cause anxiety in the couples as the obstetrician often does not have an evidence
based answer. Since some years ago, the University Hospital of Coimbra has had a new department concerned with supplying
the physicians with information about pharmacologic agents trying to help them with the questions raised by the clinical practice.
Several possibilities can occur and impose a systematic approach, this is: the exposition to drugs whose teratogenic effect is
unknown and that may occur before or after conception; the question of which agent is the ideal one to treat an acute or chronic
disease coexisting with pregnancy or even the use of drugs for fetal therapy. In such situations we may observe effects of the disease in the pregnancy or influence of the pregnant status in the pre-existing disease which may also influence fetal development.
The discovery at birth of fetal abnormalities that may have been caused by the treatment (whether expected or not) and the
transmission of genetic of infeccious diseases to the fetus also deserves considering. The latter may also concern the father that
may contribute for fetal development if he is exposed t drugs or toxics, even before conception. Most of the problems that our
team had to deal with concern the use of drugs by the pregnant women both in an acute episode of disease or for the treatment
of previous disease. The analysis of the pharmacotherapeutic groups more often involved in these questions revealed that the
majority of the cases are related to the use of antibiotics for perianal infections, anti-fungic drugs for dermatologie use in cases of
seborrheic dermatitis and anti-viral agents and interferon for chronic hepatitis B.
However, the inflammatory diseases of the bowel are also associated with pregnancy and often need systemic treatment, the
same occurring with systemic lupus erithematosus and epileptic patients that need to keep a prophylactic approach to prevent
seizures.
16. Les traitements dangereux du début de la grossesse
E. Éléfant
Centre de Référence sur les Agents Tératogènes , Hôpital Trousseau, Paris, France
L’exposition par mégarde ou délibérée à un traitement médicamenteux en début de grossesse, génère toujours une vive inquiétude au sein du corps médical et du public. Celle-ci trouve sa source dans la catastrophe du thalidomide, exemple typique d’un
effet tératogène médicamenteux. Pour autant, dans la pratique courante, cette crainte est loin d’être toujours justifiée ou appropriée aux conditions dans lesquelles chaque grossesse a été précisément exposée. Après une vague d’études assez alarmistes
qui a fait suite à ce drame, les études plus récentes, qui répondent à des critères méthodologiques de meilleure qualité, ont
permis de réduire cette inquiétude généralisée. Il n’en demeure pas moins que pour quelques médicaments, la preuve d’un effet
malformatif est faite dans l’espèce humaine. Ils sont heureusement peu nombreux. Si le tableau malformatif qu’ils provoquent est
assez bien cerné, leur fréquence n’est pas toujours déterminée. Par ailleurs, certains d’entre eux sont des médicaments d’utilité
thérapeutique incontournable et donc difficilement remplaçables par des produits proches. Ceci met en exergue la nécessaire
appréciation de la balance bénéfice/risque pour les patientes qui, faute de traitement approprié, risquent de voir leur pathologie
décompenser en cours de grossesse. Dans ces situations cliniques délicates, le diagnostic prénatal peut s’avérer une aide très
précieuse à la poursuite d’un traitement dangereux en début de grossesse. Enfin, il est nécessaire de rappeler l’importance d’un
conseil pré-conceptionnel chez les patientes recevant de façon chronique un traitement tératogène. Ceci permet de réévaluer
avec tous les prescripteurs concernés le bien-fondé de la poursuite, et éventuellement un changement, du traitement en vu d’une
grossesse.
17.Transexuality in 2007 and the gynecologist
MC Meriggiola, F Armillotta, A Costantino, S Cerpolini, M Perrone, F De Musso, G Pelusi
Center for Sexual Health, 1° Clinic of Ob Gyn, University of Bologna, S. Orsola Hospital
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The gynecologist plays an important role in various phases of the transition of the transsexual people and in their long term
healthcare. The medical treatment of transsexuals is based on cross-hormone administration and sex reassignment surgery.
Transsexuals require cross-hormones to induce the phenotypic characteristics of the opposite sex to which they feel they belong.
Although organizations such as the Harry Benjamin International Gender Dysphoria Association have provided recommendations
for treatment of these people, evidence-based guidelines are lacking. Medical risks of these treatments have to be balanced with
the psychological needs of adapting the body to the desired sex. Standard cross-sex hormone treatments will be discussed in the
light of the most recent literature.
The gynecologist is also required to perform hystero-annessiectomy in the FtM transsexuals in preparation for reconstructive
surgery. Abdominal or laparoscopic hystero-annessiectomy can be performed and the pros and cons of both these routes will be
discussed.
After surgery both FtM and MtF subjects have to continue hormonal treatment for the rest of their lives in order to maintain hormone–dependent physiological functions and the phenotypic characteristics of the acquired sex. The long-term safety of crosssex hormone administration is unknown and morbidity and mortality data is almost non-existent for these patients. Cardiovascular
risk assessment, bone density monitoring, liver, prostate and breast checks should be included in the follow-up of transsexual
people. Appropriate life style changes, such as exercise, diet, weight reduction and smoking cessation are important topics which
the gynecologist must discuss with these patients in order to minimize the long-term side effects of hormone administration and
improve safety.
18. Vaginal route administration of hormone therapy
Lian Ulrich (DK)
Like other drugs, hormones can be administered as oral tablets or non-orally as transdermal patches or gels, nasal sprays, sublingual tablets, intrauterine devices, vaginal pellets and creams, rectal suppositories or by injection. All of these non-oral ways of
administration avoid the hepatic first pass effect. The systemic distribution of the administered hormone and its metabolites differ
between oral and non oral application, whereas the various non-oral ways of administration differ mainly with respect to total
systemic bioavailability.
Hormones are readily absorbed over the vaginal wall to the systemic circulation, and thus estrogens as well as progestogens for
menopausal hormone therapy and contraceptive purposes can be administered via the vaginal route. The extent of absorption is
influenced by the type of hormone, dosage and particle size as well as by the pharmaceutical formulation. In general a lower dosage of hormone is required to achieve the same serum level when administered via the vaginal compared to the oral route. This
may be advantageous but the acceptability among women of this way of administration has been discussed.
The extent of absorption as well as the form of the absorption curve is dependent on pharmaceutical formulation, and thus it is
also possible to formulate drugs intended for local treatment of atrophic vaginitis almost without systemic absorption. However as
the absorption is also dependent on the thickness of the vaginal wall, some absorption is seen even with preparations intended
for local treatment until the thickness of an atrophic vaginal epithelium is restored.
Whether vaginal estrogen treatment is acceptable when systemic estrogen is contraindicated i.e. to women with a history of
breast cancer can be discussed, whereas it is generally agreed that there is no need for endometrial protection by progestogen
addition to low dose vaginal estrogen for the treatment of atrophic vaginitis.
19. Androgenes & sexualite feminine
Michèle Lachowsky (F)
Appétits et désirs, voilà sans doute une des définitions de la vie. Perdre le désir embellit le passé, ces « années folles » toujours
regrettées, mais obscurcit présent et avenir, en dépit ou à cause de notre fameuse longévité. Quantité certes, mais où en est
l’intérêt sans qualité ?
.Comme dans toute recherche diagnostique, mais plus encore si la sexualité est en cause, deux étapes peuvent et doivent nous
guider : repérer la plainte et le trouble. En effet c’est bien entendre et décrypter l’expression de la plainte qui nous amène au diagnostic du trouble.
Les femmes n’ont pas toujours les mots pour nous parler de leur souffrance, elles n’en ont pas toujours le courage ni même la
volonté, persuadées qu’elles sont de leur responsabilité et de notre inefficacité en ce domaine. A nous de leur rouvrir la voie, de
redorer leur image du corps, d’atténuer puis de guérir leur souffrance en les rendant -par notre écoute active et nos traitements- à
nouveau désirantes et désirées.
N’oublions pas que selon une enquête européenne récente, si les Français détiennent le record des rapports sexuels en semaine,
ils se plaignent cependant d’une grande insatisfaction.
« Que veut la femme ? » se demandait Freud, pour qui la sexualité féminine restait un continent noir. Ce que veulent tous nos
patients, le désir et l’amour tout simplement !
19. Androgénothérapie et sexualité féminine
J. Bitzer (CH)
Le rôle important des androgènes dans la santé sexuelle de la femme a été reconnu il y a peu de temps seulement. Les androgènes sont des précurseurs essentiels pour la synthèse des estrogènes et l’équilibre intrafolliculaire entre les deux stéroïdes
joue un rôle fondamental dans la maturation folliculaire. De plus les androgènes semblent importants pour l’équilibre affectif, la
fonction cognitive, la masse musculaire, l’homéostasie sqelettique et avant tout le désir sexuel.
Chez la femme en âge reproductif le taux de téstostérone est 400 +/-30 pg/ml ; chez la femme en ménopause naturelle on trouve
une réduction de 50% à 200 +/-20 pg/ml et chez la femme ovarectomisée le taux est 100+/- pg/ml, une réduction de 75%.
Il est compréhensible que cette réduction massive chez les femmes après ovarectomie peut se manifester par une perte du désir
sexuel (Hypoactive Sexual Desire Disorder HSDD), ce qu’on a pu observer dans des études comparatives. Ces études ont pu
démontrer que la détresse invidivuelle causée par le HSDD est plus grave chez les femmes après ovarectomie que chez celles du
même age non-operées.
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Dans des études comparatives le traitement par estrogènes (avec ou sans progestérone) était inférieur au traitement oestrogénique plus testostérone dans l’ensemble des aspects de la sexualité féminine.
Le développement d’un patch avec 300 ug de testostérone donne au médecin un moyen de remplacer les androgènes chez les
femmes ovarectomisées qui souffrent d’une perte du désir sexuel. 2 grandes études cliniques qui comparant ce patch au placebo, ont montré une amélioration significative du nombre total des rapports sexuels satisfaisants, une augmentation du désir
sexuel, une baisse de la souffrance due au faible désir sexuel et une amélioration dans tous les domaines de la PFSF, un questionnaire international validé pour mésurer les differents aspects de la HSDD.
L’effet des différentes méthodes de contraception sur l’os
Les contraceptifs hormonaux stéroïdiens, y compris les contraceptifs oraux, les contraceptifs injectables et les implants, sont extrêmement efficaces et largement utilisés. Ces contraceptifs ont des avantages importants pour la santé, liés ou non à la contraception, ainsi que certains risques, entre autres ont un impact sur l’état osseux.
L’état de l’os peut être modifié par un grand nombre de facteurs, y compris grossesse, allaitement et contraception hormonale. Le
critère clinique principal concernant l’état de l’os est la survenue de fractures. La densité minérale osseuse (DMO) sert de mesure
pour évaluer le risque de fracture, mais l’exactitude de la mesure peut varier avec la composition corporelle, et notamment les
variations de la masse maigre et de la masse grasse. De plus, le risque de fracture est associé à un grand nombre de facteurs,
la DMO n’étant que l’un d’eux. La relation entre la diminution de la DMO et l’augmentation du risque de fracture a été particulièrement bien étudiée chez la femme ménopausée, chez laquelle le risque de fracture quelle qu’il soit, est multiplié par environ
1,5 chaque fois que la DMO diminue d’un écart type. Les données concernant l’impact des modifications de la DMO chez les
personnes jeunes sur le risque de fracture ultérieur sont peu nombreuses.
L’emploi des contraceptifs estro-progestatifs oraux actuels a des effets peu importants sur la DMO, très probablement sans
signification clinique. Les adolescentes qui utilisent ces contraceptifs paraissent avoir une DMO plus faible que les adolescentes non utilisatrices, tandis qu’ en périménopause, la DMO est généralement plus élevée chez les utilisatrices que chez les non
utilisatrices. Un certain nombre d’études ont examiné le risque de fracture après la ménopause, en relation avec la prise antérieure
de contraceptifs oraux estro-progestatifs, mais leurs résultats ne concordent pas. Les données concernant d’autres contraceptifs
hormonaux estro-progestatifs sont rares.
Concernant la contraception par progestatifs seuls, les données relatives aux implants contenant du lévonorgestrel indiquent une
absence d’effet indésirable sur la DMO. D’autres contraceptifs progestatifs faiblement dosés, pilules, autres implants et dispositifs intra-utérins libérant du lévonorgestrel ne semblent pas avoir d’effet sur la DMO; les données concernant ces méthodes sont
cependant limitées.
L’utilisation de l’acétate de médroxyprogestérone retard (AMPR) en contraception entraîne une hypoestrogénie chez la femme;
certaines études ont montré que celle-ci est associée à une diminution de la DMO. L’utilisation de l’AMPR diminue la DMO chez
les femmes qui ont atteint leur capital osseux maximal, et empêche l’acquisition de la charge minérale osseuse maximale chez
celles qui n’y sont pas encore parvenues. L’amplitude des effets sur la DMO est comparable dans diverses études. Des études
transversales mettent en évidence une DMO inférieure d’environ 0,5 écart type au niveau de la hanche et des vertèbres lombaires
en cas de longue utilisation de l’AMPR comparé à l’absence d’utilisation. Dans des études longitudinales, des groupes d’adultes
(>18 ans) et d’adolescentes (de la ménarche jusqu’à <18 ans) ont perdu tous deux de 5 à 7% de la DMO (environ 0,5 écart type)
mesurée dans ces mêmes sites, après deux années d’utilisation continue de l’AMPR. La vitesse de cette perte osseuse semble
diminuer avec le temps.
En cas d’arrêt de l’AMPR, la DMO augmente de nouveau quel que soit l’âge de la femme, sauf chez les femmes ayant atteint la
ménopause. Chez l’adulte, la DMO semble retrouver un niveau comparable à celui des non utilisatrices de l’AMPR en 2 à 3 ans.
On ignore si la perte de DMO chez l’adolescente utilisatrice de l’AMPR l’empêche d’atteindre son pic potentiel de masse osseuse. Il reste une question préoccupante, à savoir que la femme plus âgée qui atteint la ménopause en étant encore utilisatrice de
l’AMPR n’a plus la possibilité de reconstituer sa DMO avant d’entrer dans la phase de perte osseuse normalement associée à la
ménopause.
Le risque absolu de fracture est faible chez la femme en âge de procréer et les données existantes ne permettent pas d’estimer si
l’AMPR modifie ce risque. De même, les données ne sont pas assez nombreuses pour dire si l’emploi de l’AMPR pendant la période de procréation modifie le risque de fracture après la ménopause. Dans la mesure où l’effet sur la DMO est en grande partie
réversible, toute augmentation du risque de fracture au cours de la vie est probablement faible.
Les données concernant l’utilisation de l’autre contraceptif injectable à progestatif seul, l’énantate de noréthistérone (EN-NET) ne
sont pas suffisantes pour pouvoir déterminer si ce progestatif a un effet quelconque sur l’état de l’os. En l’absence de données,
les préoccupations concernant l’AMPR s’appliquent également à l’EN-NET.
Pitfalls in osteodensitometry
R. Levasseur
Rheumatology Department and Inserm EMI 335, Angers Teaching Hospital, France
Osteodensitometry (DXA) is a powerful tool to appreciate risk fracture by analysing bone mineral density (BMD, g/cm²) and
diagnoses osteoporosis when the T-score ≤ -2.5. The quality control of devices realising BMD analysis is necessary by using
phantoms (i. e. analysis of accuracy and precision) allowing clinicians to interpret correctly the T-score in the clinical context. Also,
the T-score is calculated according the peak bone mass of the reference curve defined for a specific patient (race, age, sex). An
appropriate reference curve should be used by clinicians. The main T-score measures concern lumbar spine (L1 to L4 or L2 to
L4), total hip and femoral neck. Clinicians need to know if the measure has been correctly done by cheeking parameters who are
known to influence the value of BMD: position of the evaluated bone, soft tissue area, fractures, osteoarthritis, obesity, calcification of the lumbar aorta, surgery in lumbar spine… Hence, T-score can be measured and defined: T-score > -1 = normal; -2.5 <
T-score ≤ -1 = osteopenia; T-score ≤ -2.5 = osteoporosis. Clinicians have de facto a parameter to evaluate the risk of fracture of
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their patient in a clinical context. Then, one should keep in mind that the sensibility of DXA to detect osteoporosis is around 30 to
40%. In fact, the majority of low energy fractured people are osteopenic. It means that DXA is not able to correctly evaluate bone
quality (since the BMD measures some grams per cm²). DXA is a useful tool to evaluate quickly a level of fracture risk in patients
when the good rules of use are respected.
The effect of menopause on osteoarticular system
Gambacciani M, Pepe A., Cappagli B, AR Genazzani
The role of estrogen on bone health is based on biology, epidemiology, animal and preclinical data, observational studies and
randomized clinical trials. The reduction of clinical consequences of estrogen deficiency is statistically significant, clinically relevant and, last but not the least, biologically plausible. The Women’s Health Initiative (WHI) study clearly confirms overwhelming
evidence accumulated in previous studies, showing that HRT reduces the relative risk of hip, spine and total fractures by 33%,
35% and 24% respectively. In different studies we evaluated bone status by Dual Energy X-ray absorptiometry (DXA) and Quantitative Ultrasound (QUS) technique QUS in eumenorrhoic and oligomenorrhoic perimenopausal women, and assess the effects of
different low dose oral contraceptives(OC) on bone metabolism and bone density. OC preparations exert a bone sparing effect
on perimenopausal women. After menopause low dose HRT (as 1 mg/day of 17β-estradiol) minimizes the side effects and is likely
to improve compliance to the treatment. The osteoporosis prevention can be actually considered as a major additional effect of
HRT. In addition menoapuse can affect collagen metabolism. Ageing and menopause may affect the height of intervertebral discs
evaluated measuring the intervertebral disk space (IDS), by DXA. DS values are stable from age 20 to 50 years, while thereafter
show a decrease, negatively correlated with both age and YSM. After menopause IDS shows a progressive decrease that almost
entirely occurs in the first 5-10 YSM, suggesting that the estrogen decrease may rapidly change collagen metabolism in the intervertebral disks. The HRT treated women show IDS similar to the premenopausal subjects, while postmenopausal osteoporotic
women treated with other antiresorptive agents (as bisphosphonates) have IDS significantly lower than normal women. The estrogenic milieu is relevant for the effects on the metabolism of collagen, elastin and hydrophilic glycosaminoglycans, as well as the
water content of the intervertebral discs. The maintenance of sufficient estrogenic milieu seems to be relevant to preserve not only
BMD but also physiological intervertebral discs maintaining their shape and viscoelastic functions, protecting spinal architecture
from vertebral body compression fractures. All these data further support the protective effect of estrogen on bone health.
The bone: How gynecologists should address osteoporosis?
Olavi Ylikorkala
Helsinki University Central Hospital, Helsinki, Finland
Gynecologists are often the only physicians who see healthy postmenopausal women on regular basis. These visits are often
made to exclude a gynecological cancer the risk of which amounts only to 3.8 % among women of 50-85 years. Yet the risk of
osteoporotic fractures is 50 % in the same population. It is established that if gynecologists would actively screen for and treat
osteoporosis on time, a large part of these fractures would be prevented.
In screening of osteoporosis, a good clinical skill is essential. A number of clinical features ( e.g. petite body composition, periods
of amenorrhea, early menopause, insufficient intake of calcium or vitamin D, physical inactivity, heavy smoking, use of heparin,
glucorticoids antiepileptics or aromatase inhibitors, thyroid disease, history of bone fracture ( even in family) and no use of hormone therapy ( HT ) indicate a need of bone density assessment ( BMD ). The interpretation of BMD- scores ( osteopenia-porosis)
needs careful, individual consideration to optimize a bone-preserving treatment, and to avoid unnecessary treatments; gynecologists can easily learn this interpretation.
In treatment of osteoporosis we gynecologists can use the following options. 1. Postmenopausal HT which increases low BMD
by 4-6 %/y both in spine and femoral neck in osteoporotic women. The HT- associated increase in BMD and other benefits (
improved balance and reduced risk of falls ) explain the reduction of osteoporotic fractures in women with longterm use of HT;
this reduction ( 40-60 % ) is seen both in spine and femoral neck. HT is a primary treatment for women with osteopenia ( or mild
osteoporosis ) especially if the woman also complains of hot flushes or other climacteric symptoms. Recent data indicate that
even very small dose of estrogen ( estradiol 0.25 mg orally or 14 ug transdermally ) can protect against osteoporosis in elderly
women. 2. SERMs increase BMD and prevent fractures without having any adverse effect on breasts. They may, however, trigger
or worsen hot flushes, and some SERMs may lead to vaginal atrophy while some others improve vaginal health.( e.g. ospemiphene ) . 3.Bisphosphonates protect bone effectively. They are easily administered ( weekly, monthly ) and they cause no serious
adverse effects but mild gastrointestinal complaints are common. Bisphosphonates are usually given up to 5 years . A addition
of HT to bisphosphonates does not increase the therapeutic efficacy. 4. Calcitonin , given as nasal spray, also protects against
osteoporosis and bone fractures. 5. Other bone specific treatments ( e.g strontium ranelate, teriparatide ) or some iv treatments (
e.g. tsoledronate ) are effective but not often used in outpatient practice.
Gynecologists should emphasize that adequate physical activity ( minimum 30- 60 min walking 3 times a week ), nonsmoking
and intake of calcium ( > 1200 mg/day ) and vitamin D ( 400-800IU/day ) form a basis for bone health in any age group. HT, given
for the control of hot flushes, concomitantly strengthens bone,and this aspect should be stressed in clinical practice.
Menopause in Europe and its treatment in 2007
AR Genazzani
The rapid ageing of societies. is a worldwide phenomena, rising a series of problems for health care providers. In Europe a vast
proportion of women is over 50 and the long term consequences of ovarian hormone deprivation will increase inevitably with the
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increase of postmenopausal years. The rates of cardiovascular disease, osteoporosis, dementia, and the decline of quality of life
among elderly women in the near future will be greatly determined by the success of possible preventing measures. Menopause
is a critical and emblematic event in the woman life.The menopausal state is, of course, a natural condition, but as the number of
postmenopausal women has increased, it has become apparent that the decline in estrogen production, which characterizes the
menopause, has serious short- and long-term health implications. The biological transformations that take place can jeopardize
the women health and quality of life. Symptoms usually occur in a typical sequence and frequently continue for 2–5 years after
the menopause, persisting in some cases for as long as 10 years. During the climacteric, as many as 80% of women experience symptoms, and in a number of cases these are sufficiently unpleasant to significantly impair the quality of life. The decline
in estrogen production has more threatening long-term health implications in that it is closely associated with the development of
osteoporosis and the increased risk of cardiovascular disease seen in postmenopausal women. The vast majority of perimenopausal women refer to their general practitioner or to their gynecologist to asses the individual risk for long term consequences of
menopause (and ageing) in each individual woman. The use of different HRT products also in Europe was affected by the misinterpretation of WHI results, although the vast majority of European women had always been treated with different preparation and
with more personalized schedules than the American women. The use of new combinations, transdermal estrogens and lower
doses can offer better choices. The role of general practitioner, as well as the role of cardiologists and other Specialists is complementary. The emerging Menopause Specialist must play a central role in the management of climacteric years in order to prevent
medicalization of normal postmenopausal women and coordinate the interventions when they are needed.
Chirurgie ambulatoire en gynécologie
M. Koskas, O. Chanelles, A. Thoury, P. Madelenat
La Chirurgie ambulatoire peut être définie comme l’ensemble des actes chirurgicaux qui autorisent le retour du patient à son domicile le jour de l’intervention. Elle s’inscrit dans l’évolution de l’organisation des soins pour au moins 4 raisons ;
Demande des patientes, diminution des infections nosocomiales, amélioration de l’accès aux soins, réduction des coûts
d’hospitalisation.
L’éventail législatif qui encadre son exercice et en précise les modalités d’organisation existe depuis 15 ans. Cependant, on peut
regretter le retard pris par la France (dans le secteur publique en particulier), notamment concernant l’activité gynécologique qui
possède un large potentiel de développement avec l’avènement des techniques chirurgicales mini-invasives.
Afin de garantir la sécurité et la satisfaction des patientes, la pratique de la chirurgie ambulatoire doit répondre à certains principes de bon sens (recommandations à respecter en pré opératoire, pendant l’hospitalisation et en post opératoire). En particulier,
l’information de la patiente et son adhésion à la prise en charge en ambulatoire doivent être aussi clairs que possible.
La chirurgie ambulatoire suppose aussi la participation des anesthésistes avec l’utilisation de protocoles spécifiques et le recours
à l’anesthésie multimodale.
Dès lors, outres les interventions classiquement réalisées en ambulatoire (AMP, IVG, aspiration, hystéroscopie, sein, cœlioscopie)
les innovations chirurgicales récentes permettent d’en élargir les indications (stérilisation tubaire, cure d’incontinence urinaire,
ganglion sentinelle). Cependant, on peut regretter que le développement de la chirurgie ambulatoire se heurte à une tarification
peu incitative.
Ovarian cancer and surgery
H. Meden (D)
Department of Obstetrics and Gynecology, Diacony Hospital,Academic Teaching Hospital of the University of Göttingen, Elise-Averdieck-Str. 17, D-27356 Rotenburg / W., Germany, E-mail: [email protected]
Ovarian cancer is the most lethal gynecologic cancer. Based on results from large, random-ized trials conducted over the last 25
years, the current standard of care for newly diagnosed advanced (FIGO stage III-IV) ovarian carcinoma is surgical bulk reduction followed by six cycles of paclitaxel plus carboplatin. This approach has resulted in an enhanced response rate and clinical
complete response rate, an improved progression-free survival, an increase in survival, and more long-term survivors. Despite
these results, the overall frequency of relapse and hence need for second-line therapy is 62%. Ongoing and future studies focus
or will focus on four major themes: dose intensity through the use of intraperitoneal chemotherapy in se-lected patients, addition
of a third cytotoxic agent to front line therapy, addition of a targeted or biologic agent to front-line therapy, and the development
of effective maintenance or con-solidation therapy. The current standard of care for patients who present with limited (FIGO stage
I-II) ovarian carcinoma is the use of prognostic factors to classify the patient as at low risk or high risk for recurrence. High risk
features include: grade 2 or 3 disease, disease on the surface of the ovary, disease outside the ovary, positive peritoneal cytology,
or the presence of ascites. Any one high risk feature makes the patient high risk for recurrence. Patients at low risk require surgical resection only, whereas those at high risk for recurrence require adjuvant therapy. Ongoing studies evaluate the duration of
therapy and the potential value of anti-angiogenic agents in those patients at high risk for recurrence.
Chimiothérapie des cancers de l’ovaire
G. Netter
Pendant cette dernière décennie, le traitement des cancers de l’ovaire a nettement évolué.
Bien que la plupart des malades qui se présentent à un stade avancé de la maladie meurent encore de la progression de leur cancer, la survie globale a augmenté. Le rôle de la chirurgie est majeur, car ce sont les femmes qui ont des résidus intrapéritoneaux
microscopiques inférieurs au centimètre qui ont une survie améliorée avec la chimiothérapie.
Des phases III randomisées ont montré que la meilleure chimiothérapie, qui est devenue le standard, est l’association d’un sel de
platine et d’une taxane pour une durée de 6 cycles. L’administration intra péritonéale de la chimiothérapie dans certaines indica-
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tions peut améliorer la survie, mais n’est pas sans inconvénients. Des essais de phases III ont également montré que dans les
stades précoces à haut risque (stade II et stade I de haut grade), la chimiothérapie par un sel de platine augmente la survie.
De nouvelles molécules ont récemment vu le jour en oncologie. Ces molécules ciblent les facteurs de croissance (EGF) et de survie (VEGF) des cellules ovariennes tumorales. Des études sont en cours avec ces agents biologiques couplés à la chimiothérapie
ou en traitement de consolidation pour appréhender leurs indications dans le cancer de l’ovaire.
Fertilité après cancer de l’ovaire
C Poirot, M Prades, G Lefebvre.
Groupe Hospitalier Pitié-Salpêtrière, France
La fertilité future des patientes présentant une tumeur de l’ovaire est une dimension importante à prendre en compte.
Dans l’absolu, il existe trois principales techniques de préservation de la fertilité : la stimulation de l’ovulation soit en vue d’une
cryoconservation embryonnaire ou d’une cryoconservation d’ovocyte mature et, enfin, la cryoconservation de cortex ovarien.
La faisabilité de ces techniques sera discutée. Il sera pris en compte, entre autre, le type de la tumeur ovarienne, son hormonosensibilité, l’instauration d’une possible chimiothérapie et de ses caractéristiques (type de molécules utilisées, doses, durée),
l’age de la patiente, son statut marital, l’estimation de la profondeur de l’infertilité engendrée par les traitements et les résultats en
terme de grossesses des différentes techniques biologiques de préservation de la fertilité.
La prise en décision se fera, au moins, avec le chirurgien, le biologiste de la reproduction et la patiente, afin de proposer la technique la plus efficace et la moins délétère.
D’autre part, il ne faut pas négliger le fait de laisser en place du tissu ovarien sain lorsque cela est possible.
Les différentes techniques de préservation de la fertilité seront abordées avec leurs avantages et leurs inconvénients ainsi que
leurs indications potentielles dans le cadre des tumeurs ovariennes.
Gametes donation
P.N. Barri, B. Coroleu, E. Clua, M. Luna, M. Boada
Service of Reproductive Medicine, Department of Obstetrics, Gynecology and Reproduction
Donation of sperm or of oocytes is a common practice in modern Reproductive Medicine. Apart from the simplicity and high efficacy of these treatments different aspects should be taken into consideration.
Legal reasons exclude many people from treatment with gamete donation in some European countries. This situation induces a
growing phenomenon known as “reproductive tourism” or “cross-border reproductive care” with a difficult equitable access to all
citizens.
We will present our experience with sperm and/or oocyte donation during the last years considering both efficacy and safety. Likewise we have analyzed the countries of origin of donor and recipients as well as their motivation to undergo these treatments.
We can’t forget that doctors, biologists and nurses working in this field should be aware about the ethical risks of these procedures and of their responsibilities of good clinical practice.
L’accueil d’embryon
Joëlle Belaisch-Allart
Service de Gynécologie Obstétrique et Reproduction Humaine, Centre Hospitalier des Quatre Villes,Site de Sèvres, Sèvres, France
Après les tentatives de FIV ou d’ICSI couronnées de succès, certains couples ont la chance (ou la malchance) d’avoir encore des
embryons congelés alors qu’ils ont obtenu tous les enfants souhaités. Se pose alors le problème du devenir de ces embryons.
En France, la loi dite de Bioéthique de 2004 nous autorise à mettre fin à leur conservation (autrement dit à les destruire), mais
il est également possible aux couples de les donner à la recherche ou à un couple infertile. Bien que les décrets relatifs au don
d’embryon (appelé par la loi « accueil d’embryon ») datent de 1999, peu de centres en France se sont lancés dans cette aventure puisque l’enquête du BLEFCO de novembre 2006 avait recensé …8 centres le pratiquant sur les 18… centres ayant obtenu
l’agrément.
L’accueil d’embryon peut se définir comme une sorte d’adoption pré natale avec par rapport à l’adoption, pour la femme receveuse, l’opportunité de vivre une grossesse et un accouchement et donc de nouer des liens pré natals avec son enfant et d’être la
mère au sens légal du terme puisque selon la loi française, la femme qui accouche est la mère. Alors que l’on manque de donneuses d’ovocytes, ces embryons congelés disponibles semblaient donc une alternative extrêmement séduisante. Après un début
enthousiaste, il est difficile de ne pas se poser des questions sur la pratique de l’accueil d’embryon. Les couples, qui donnent
leurs embryons, sont clairement des couples exceptionnels dans tous les sens du terme. Tout le problème est que pour nous,
médecins, ces embryons sont certes un humain potentiel mais ne sont en fait que quelques cellules, , tandis que dans
l’imaginaire des patients qui donnent cet embryon congelé est le petit frère ou la petite sœur des enfants qu’ils ont déjà.
Nous ne sommes pas loin du fameux film « La vie est un long fleuve tranquille ». A défaut d’échanger un enfant à la naissance,
c’est aux embryons que nous faisons connaître une vie différente de celle pour laquelle ils ont été conçus. A quoi jouons nous …
On peut rétorquer que dans l’adoption la situation est identique. En fait, dans l’adoption, une femme, qui ne peut assumer son
enfant, a le courage de le donner à un couple adoptant pour qu’il connaisse une vie meilleure que celle quelle aurait pu lui donner.
Dans l’accueil d’embryon, les couples qui ont déjà deux ou trois enfants, et n’ont plus de projet d’enfant, donnent leurs embryons
congelés restant, mais ils voudraient, comme le montrent les entretiens avec ces couples, pouvoir continuer à le protéger de loin.
Comme le disent certains, si les parents d’accueil meurent, nous aimerions être là pour pouvoir nous en occuper.
Bien entendu, au 1er degré l’appariement social des embryons est profondément choquant, mais en y réfléchissant bien, il
nous faut nous interroger. Le nombre de couples, qui donnent leurs embryons, est extrêmement restreint. Il est évident que les
couples donneurs voudraient une qualité de vie pour l’enfant potentiel qu’ils donnent égale à celle qu’ils offrent à leurs enfants.
Bien entendu, en France, nous vivons dans le dogme de l’anonymat et de la gratuité. Mais si ,inquiets du sort de ces embryons
sur lesquels aucune assurance ne peut leur être donnée, plus aucun couple ne donne leurs embryons. l’accueil d’embryon va
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s’arrêter. Est-ce réellement le but du législateur ?
L’accueil d’embryon est une alternative fantastique à l’adoption. Pour le préserver, ne doit-on pas accepter l’idée de pouvoir assurer aux couples donneurs un appariement autre que physique ?
La question n’est pas « politiquement « correcte mais il serait hypocrite de ne pas se la poser en 2007.
Evolution of PMA in the European Societies Genetics and fertility: early sex detection in maternal blood
Teresa Almeida Santos (1) And Margarida Veiera (2)
(1)Medical Genetics Service – Department of Maternal Fetal Medicine, Genetics and Human Reproduction, Coimbra University
Hospital, Portugal.
(2)Genelab
Background : The discovery of cell free DNA in maternal peripheral circulation has provided a new possibility for the non-invasive
assessment of fetal genetic material, as well as a diagnostic tool for monitoring a number of pregnancy related disorders. In fact,
several studies have shown that elevated concentrations of fetal DNA in maternal plasma are associated with certain aneuploidies
as well as with anomalies of placentation like pre-eclampsia, intra-uterine growth restriction or invasive placenta. Additionally, it is
possible to determine the fetal gender, which is useful for the prenatal investigation of sex-linked disorders. The aim of this study
was to quantify fetal DNA levels and identify the presence of the SRY gene in the maternal plasma of pregnant women to determine fetal gender from the 8th week of pregnancy.
Methods : Peripheral blood was collected from pregnant women, starting at 8th week of gestation. After contrifugation the
plasma was separated for the fetal DNA extraction. The DNA was analyzed by conventional PCR as well as real-time PCR, for
two genomic regions of the Y cromosome.
Amplification of the Y chromosome from maternal plasma was indicative of a male fetus.
Results : A total of 107 samples were tested and the results were compared to fetal gender after delivery. When using conventional PCR followed by agarose gel electrophoresis, the accuracy of the test was around 94%. On the other hand, when performing the test with a more sensitive technique, as real-time PCR, the accuracy was almost 100% (106 out of 107 cases)
Conclusions : Real-time PCR for detection of fetal gender in maternal plasma is feasible and reliable and should be made available to women at risk for X-linked disorders, as the use of this technology can reduce the need for invasive procedures.
DPI pour cancers genetiques et Brac1/2, problemes juridiques et ethiques
Francoise Shenfield, LRCP, MRCS, MA (medical law and ethics)
Reproductive medicine unit, UCLH, London, UK
Les questions éthiques concernant le DPN et le DPI, ainsi que l’interruption médicale de grossesse sont deja fort complexes
dans le cas d’une anomalie probable de l’enfant a venir qui serait grave et presente lors de sa naissance.
Elles le sont encore plus quand il s’agit d’une prédisposition génétiques aux cancers de l’adulte, comme le cancer dun sein Brac
1 ou 2. Comparant l’attitude face a ce cas de figure entre la France et la GB, nous analyserons la pratique, le droit et les aspects
ethiques de ce probleme. Le respect de l’autonomie des patients dépend d’abord de la qualité de l’information qui leur est donnée, avec un support psychologique essentiel dans ce domaine très complexe, touchant à la reproduction et la transmission en
général. L’analyse du quotient bénéfice / risques est souvent technique, mais comprend également le coût psychologique de la
démarche ; dans ce cas précis, l’analyse concerne surtout celui les risques supplémentaires qu’apporte la FIV au DPI, comparés
aux avantages de la procréation « naturelle » mais au risque d’un recours éventuel à l’interruption médicale de grossesse. Enfin, la
justice et l’acces aux soins couteux est a prendre en consideration, ainsi que la question de l’eugenisme.
Premier centre de suivi AP HP : Les femmes à haut risque de cancer du sein et de l’Ovaire
S.Uzan, et toute l’équipe du centre
Les patientes à haut risque soulèvent plusieurs questions :
•
Qui intégrer dans cette catégorie ?
•
Comment quantifier le risque ?
•
Quel type de décision adopter après évaluation du dossier de la patiente : consultation clinique, consultation d’oncogénétique, bilan complémentaire ou parfois pas d’inscription au centre
•
Comment surveiller ces patientes ?
•
Quelle prévention leur proposer : chirurgie radicale, mastectomie, annexectomie bilatérale, ou prévention médicale
créer un environnement psychologique permettant d’aborder ces différentes annonces et le suivi sans un stress majeur
•
Apporter des conseils en cas de grossesse et lors de la survenue de ménopause.
•
Etre un centre de ressources et d’informations pour les médecins et les patientes
•
Constituer des cohortes de patientes permettant d’effectuer une recherche clinique et fondamentale efficace dans les domaines de la génétique, de la clinique, de l’imagerie et des traitements
Il apparaissait donc utile de réunir l’ensemble des acteurs susceptibles de répondre à ces différentes questions sur le même site.
Actuellement notre groupe comporte des chirurgiens, des gynécologues, des oncogénéticiens, des radiologues, des cytologistes,
des endocrinologues, et une équipe d’infirmières d’accueil incluant une infirmière et un secrétariat. L’objectif de ce groupe est
par le biais de réunions de concertation pluridisciplinaire d’établir des protocoles et une évaluation de chaque dossier avec une
proposition de stratégie de suivi. Notre centre a été constitué par une collaboration entre l’AP-HP, l’Institut National du Cancer,
l’Institut Lilly et l’Université Pierre et Marie CURIE.
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Sont prises en charge dans ce centre les patientes porteuses d’une mutation délétère de BRCA 1 ou BRCA 2, les femmes dont
les familles présentent des cas multiples de cancer du sein et de l’ovaire sans mutation identifiée mais avec une forte probabilité
(supérieure à 20%) et les femmes présentant des lésions prolifératives bénignes mais comportant des atypies.
Seul un médecin par demande écrite accompagnée d’un dossier médical peut adresser une femme déjà identifiée comme personne à haut risque au niveau du centre. Le dossier est ensuite examiné par le comité pluridisciplinaire qui prend une décision.
Un plan personnalisé d’exploration et de suivi est proposé à chaque patiente.
Le résumé du fonctionnement de notre centre est figuré sur le tableau suivant
Obésité et hormone chez la femme
Arnaud Basdevant,
Pôle d’Endocrinologie, Pitié Salpêtrière, Université Paris 6, France
L’obésité connaît un développement épidémique. Les déterminants de l’obésité sont multiple comportementaux, environnementaux et biologiques. Les « événements hormonaux » sont des circonstances classiques de prise de poids chez la femme, singulièrement la grossesse et certains traitements hormonaux. L’inflation du tissu adipeux est responsable de désordres hormonaux
avec des conséquences fonctionnelles sur la fertilité et des conséquences préoccupantes sur le plan carcinologique. Le tissu
adipeux est en réalité un organe endocrine qui participe à la physiologie hormonale tout autant qu’à la physiopathologie des désordres de la reproduction.
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Scientific Society Session - Session des Sociétés Savantes
Scientific Society Session 1 ISGE - Session des Sociétés Savantes 1 ISGE
Sex steroid signaling in the cardiovascular system
T. Simoncini
Molecular and Cellular Gynecological Endocrinology Laboratory (MCGEL), Dept. of Reproductive Medicine and Child Development, University of Pisa, Italy
In the last two decades, several studies have unveiled a series of original signaling mechanisms through which so-called “nuclear”
receptors can mediate rapid actions of steroid hormones. These rapid signaling actions are independent by the synthesis of
mRNA or protein, and are therefore known as “non-transcriptional” or “nongenomic” as opposed to the classical genomic mechanisms. Nongenomic signaling of estrogens plays a prominent role in non-reproductive tissues, and between these is the vascular
wall. At this level, estrogen triggers rapid vasodilation, exerts anti-inflammatory effects, stimulates endothelial growth and migration and protects the vessels from atherosclerotic degeneration. Nongenomic signaling mechanisms have been involved in many
of these actions and are more and more considered to be of importance for vascular function in physiological and pathophysiological conditions. Rapid actions of steroid hormones have been implicated with vascular as well as with myocardial protection in animal experimental models. Moreover, the nongenomic signaling of estrogens are tightly interconnected with the nuclear
pathways, and there are several indications that, through nongenomic modulation of signaling cascades, estrogens are also able
to modulate the expression of several relevant genes in endothelial cells. In conclusion, while we are still in an early phase of the
investigations of the non-transcriptional actions of steroid hormone receptors, it is clear that this newly recognized category of
signaling mechanisms is responsible for critical steroid actions in non-reproductive tissues.
Sex steroids and the brain
A.R. Genazzani, N. Pluchino
Department of Reproductive medicine and child development, Division of Obstetrics and Gynecology, University of Pisa, Italy
Starting from the fetal life sex steroids are crucial in determining central gender dimorphism and an estrogen-induced synaptic
plasticity is well evident during puberty and seasonal changes as well as during the ovarian cycle. Sex steroids act on central
nervous system (CNS) both through genomic mechanisms, modulating synthesis, release and metabolism of neurotransmitters,
neuropeptides and neurosteroids, and through non genomic mechanisms, influencing electrical excitability, synaptic function, and
morphological features. Therefore, estrogen neuroprotective effects are multifaced and encompass system that range from the
chemical to the biochemical to the genomic mechanisms, protecting against a wide range of neurotoxic insults. Clinical evidences show that during the climacteric period, estrogen withdrawal at limbic gives rise to modifications in mood, behavior and
cognition and that estrogen administration is able to improve mood and cognitive efficiency in postmenopause. The decline of
ovarian and adrenal androgens deeply affects symptoms like decrease libido, loss of energy and cognitive vitality. Evidences from
randomized controlled trials and from cross-sectional and longitudinal studies shows that estrogen-replacement therapy preferentially protects against the age-related cognitive impairment in healthy postmenopausal women and decreases the risk of dementia. Although results are not constant across studies, they indicate that treatment with estrogens during the early postmenopausal
years might attenuate cognitive aging in women during the latter part of their life: a critical window of time may exist around the
menopause when hormone therapy may delay or decrease cognitive changes. Additional studies are needed to understand the
external generalizability of these data to define how individual variability, type of regimen used (estrogen or estrogen¬+androgen)
and timing of initiation of treatment affect the role of HRT in neuroprotection.
Insulin resistance in women with PCOS
S. Angioni, A.M. Fulghesu, G.B. Melis
Division of Gynecology, Obstetrics and Pathophysiology of Human Reproduction, Department of Surgery, Maternal-Fetal Medicine, and Imaging, University of Cagliari, Cagliari, Italy
Polycystic ovary syndrome (PCOS) is characterized by chronic anovulation and hyperandrogenism and it is the most common
endocrine disorder in women of reproductive age. This syndrome is strongly associated with insulin resistance that seems to play
an important role in the pathogenesis. Defective insulin activity has been shown in many target tissue in PCOS, while the activity
of insulin receptors in the ovary induces an over production of ovarian androgens. Beside obesity, the most common underlying
cause, many other factors are presumed to play a role. In particular tumour necrosis factor α, adiponectin, leptin, IL-6 and some
other adipokines seem involved. Hyperinsulinemia is associated to insulin resistance but it can be present per se. It is implicated
in the development of many pathological states, such hypertension and cardiovascular disease. The diagnosis of insulin resistance and hyperinsulinemia is important and many tests have been proposed. The insulin response after oral glucose test and the
fasting models (HOMA and QUICKI) seem simple and accurate tools but their results should be evaluated according to the age
and the ethnicity of the population studied. Life style modifications and the use of insulin sensitizer appear promising in the management of patients with PCOS and could be important in the prevention of its metabolic complications.
Genetic risks in art
P.N. Barri, J.M. Vendrell, F. Martinez, B. Coroleu, M. Boada, A. Veiga
Service of Reproductive Medicine, Department of Obstetrics, Gynecology and Reproduction. Càtedra d’Investigación en Obstetrícia I Ginecologia (CIOG). Institut Universitari Dexeus. Barcelona, Spain
Genetic aspects of male infertility and the possible risks of new assisted reproduction and their influence on the development of
zygotes and children born after intracytoplasmic sperm injection (ICSI) need further research. These patients have an increased
risk of diploidy, and disomies are frequent in their spermatozoa. Meiotic disorders are more common in testicular biopsies of
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patients with severe oligoasthenozoospermia. For these reasons, a detailed andrological study is absolutely mandatory before
accepting a couple with these characteristics into an IVF-ICSI programme. When an andrological patient has plasma FSH values
>10 IU/l and/or very low total motile sperm count <1 x 10(6), despite a normal karyotype, they clearly need a testicular biopsy and
a meiotic study in order to rule out meiotic arrest or synaptic anomalies. Another important aspect to be considered is the possible
benefit of applying preimplantation genetic diagnosis in these cases because they normally have a high percentage of chromosomally abnormal embryos, although in the present study this was not evident. More recently several studies have been published
on the potential risks of imprinting disorders in babies born after ART. All studies agree on the necessity of conducting follow-up
studies in the population of children born after IVF-ICSI. In this way, it will be possible to find out if these infertile patients and their
offspring have a higher risk of suffering epigenetic errors and imprinting disorders.
Scientific Society Session 2 GGOLFB - Session des Sociétés Savantes 2 GGOLFB
L’HCG : une hormone mais aussi une cytokine angiogène
Sophie Perrier d’Hauterive 1,2 S. Berndt 3, M. Tsampalas 2, C. Charlet-Renard 2, V. Geenen 2 and J.-M. Foidart 1,3
1.Université de Liège, Département de gynécologie-Obstétrique, Centre de Procréation médicalement assistée-CHR de la Citadelle, Liège, Belgique
2. Université de Liège, CIL, laboratoire de Neuroimmuno-Endocrinologie et d’Embryologie, CHU B-23, Liège, Belgique
3. Université de Liège, CRCE, LBTD, CHU-B23, Liège, Belgique
Ces recherches sont soutenues par le Fonds National de la Recherche Scientifique de Belgique, la Fondation Léon Frederiq.
Le succès de l’implantation nécessite un dialogue synchronisé entre tissus embryonnaires et maternels. Alors que l’implantation
peut se produire dans n’importe quel tissu du corps humain, l’endomètre est un des rares dans lequel l’embryon ne peut
s’implanter qu’au cours d’une période limité, appelée fenêtre implantatoire. L’existence de cette fenêtre d’implantation permet
l’établissement du dialogue paracrine complexe entre mère et embryon. Ces dernières années, l’importance fonctionnelle des
interactions paracrines entre les cellules embryonnaires et maternelles est largement étudiée. Parmis les signaux primordiaux envoyés précocement par l’embryon en voie d’implantation, l’hCG est le plus spécifique. Par l’intermédiaire de cette hormone interagissant avec son récepteur, le LH/hCGR présent dans l’ovaire et les tissus extra-gonadiques, l’embryon favorise son implantation
et le maintien de la grossesse. L’hCG est un facteur lutéotrope qui relaie le soutien inadéquat fourni par les taux réduits de LH. Via
le système hCG/ LH-hCG-R, l’embryon participe activement à son implantation, sa tolérance, sa placentation et l’angiogenèse qui
l’accompagne.
L’angiogenèse et la vasculogenèse sont des étapes cruciales de l’implantation embryonnaire et du développement normal du
placenta. Des perturbations précoces de la circulation sanguine endométrial, au moment de l’implantation conduit à des déficits
de la placentation pouvant provoquer des fausses-couches ou, plus loin dans la grossesse, un retard de croissance intra-utérin
ou une pré-éclampsie. Les résultats obtenus au CIL et au CRCE de l’Université de Liège ont permis de mettre en évidence des
propriétés pro-angiogéniques nouvelles pour hCG, au travers une interaction directe avec les cellules endothéliales maternelles
induisant leur prolifération et leur migration. Nos résultats suggèrent également une stimulation indirecte de la production de
VEGF, un facteur pro-angiogène puissant, par les cellules épithéliales de l’endomètre humain sous l’action de l’hCG. Ces effets
biologiques nouveaux de l’hCG sont régis par l’interaction de l’hormone à son récepteur, le LH/hCG-R, mis en évidence au niveau
de l’ARNmessager et de la protéine, dans l’épithélium endométrial au cours du cycle et l’endothélium vasculaire. Nous avons
quantifié l’expression de ce LH/hCG-R dans l’endomètre humain et murin et avons observé une expression accrue au moment de
l’implantation embryonnaire, permettant d’évaluer un possible rôle pour le LH/hCG-R en tant que marqueur de la fenêtre implantatoire.
L’évaluation de la réceptivité utérine, de l’impact de l’embryon au moment de l’implantation, des interconnexions entre mère et
embryon demeurent, en 2007, des challenges, en pratique clinique.
La placentation accreta et percreta – Pathogénie, diagnostic et traitement conservateur
Frédéric Chantraine,
Université de Liège, Liège, Belgique
Le placenta accreta se définit par une infiltration trop importante des villosités trophoblastiques dans le myomètre dû à une
absence de la décidua. En fonction de la profondeur de cette invasion sont décrits trois stades (a-, in- et percreta). Dans le
troisième stade (percreta), on note une infiltration du muscle utérin jusqu’à la séreuse et même des organes pelviens du voisinage.
L’incidence du placenta accreta varie fortement d’une étude à l’autre. En général, on peut retenir qu’elle est de 1/1000 naissances pour les formes légères. En 1950, cette placentation anormale était encore très rare (1/30 000 naissances dans une étude
américaine).
Cette croissance de l’incidence s’explique facilement par l’augmentation des actes chirurgicaux qui sont réalisés sur et dans la
cavité utérine. Le premier facteur de risque est principalement la césarienne (20-25% selon les différents hôpitaux).
Le diagnostique peut se faire en anténatal par ultrason si l’examinateur cherche chez les patientes à risques (placenta prævia,
antécédents de césariennes ou de curettage,…) les signes échographiques connus (p.ex. absence de myomètre entre placenta et
vessie, disparition de l’espace hyper-échogène retro-placentaire). L’ajout du Doppler couleur augmente le taux de détection et la
résonance magnétique apporte une information importante sur l’extension générale du placenta percreta, surtout s’il se trouve sur
la face postérieure de l’utérus.
La prise en charge était pendant longtemps l’hystérectomie en post-partum immédiat. Mais cette opération peut être sur des
placentas percretas importants très difficile avec une très grande morbidité. Une autre technique est celle où on garde après la
naissance de l’enfant le placenta en place en attendant la délivrance spontanée. Durant l’exposé, notre série de ce traitement
conservateur de placenta percreta est présentée et discutée.
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A propos de 7 cas de greffe de tissu ovarien cryopréservé
Anne-Sophie Van Eyck, Anne Van Langendonckt, Marie-Madeleine Dolmans, Jacques Donnez
Université Catholique de Louvain, Bruxelles, Belgique, Service de Gynécologie.
La cryopréservation de tissu ovarien est couramment proposée aux jeunes patientes atteintes d’un cancer afin de préserver leur
fertilité. En effet, une des complications des traitements chimio et/ou radiothérapiques reste une défaillance ovarienne précoce,
entraînant une ménopause et une stérilité.
Au sein de notre équipe, 7 cas de greffe de tissu ovarien cryopréservé ont fait l’objet d’une étude de la fonction ovarienne. Cette
étude clinique prospective porte sur un suivi maximal de 4 ans post-transplantation.
Cinq patientes ont bénéficié d’une biopsie d’ovaire par laparoscopie et d’une cryopréservation du cortex ovarien prélevé. La
biopsie a été réalisée avant la chimiothérapie pour 3 patientes et après une cure de chimiothérapie pour 2 patientes. Après une ou
deux cures de chimiothérapie, toutes les patientes étaient en aménorrhée, suite à une défaillance ovarienne précoce.
Dans le cadre d’un désir de grossesse, les fragments ovariens décongelés ont été greffés en site orthotopique. Deux patientes
(2/5) ont subi une deuxième greffe.
La restauration de la fonction ovarienne a été évaluée par dosage hormonal, suivi échographique de la croissance folliculaire et
présence de cycles menstruels.
Les premiers signes de restauration de la fonction ovarienne (pic d’oestradiol, décroissance de la FSH et développement folliculaire objectivé à l’échographie) ont été observés entre 4 et 6 mois ½ post-greffes. Une patiente a présenté une grossesse spontanée.
Cette grossesse à terme a mené à la première naissance après greffe orthotopique de tissu ovarien cryopréservé.
Les patientes ont présenté des épisodes d’élévation de la FSH alternant avec des cycles ovulatoires réguliers, suggérant une
faible réserve ovarienne.
Aucun signe de récidive de néoplasie n’a été observé chez les patientes initialement atteintes de pathologies malignes.
En conclusion, ces 7 cas de greffe orthotopique ont permis une restauration de la fonction ovarienne endocrine. Actuellement,
les greffons restent fonctionnels chez les 5 patientes greffées, sans signe de récidive de pathologie maligne. La naissance obtenue par cette technique constitue un réel espoir de restauration de la fertilité pour ces jeunes patientes.
Grossesses après transplantation de tissue ovarien pour défaillance ovarienne précoce suite à une transplantation de
moelle
I. Demeestere (B)
Laboratoire de Recherche en Reproduction Humaine, Hôpital Erasme, ULB
Introduction: La cryopréservation de tissu ovarien est considérée à l’heure actuelle comme une procédure expérimentale recommandée afin de préserver la fertilité des jeunes patientes nécéssitant un traitement anticancéreux gonadotoxiques. Bien qu’il ait
été clairement montré que la transplantation de tissu ovarien permettait de restaurer la fonction ovarienne chez la femme, encore
peu de grossesses ont été obtenues à ce jour suite à cette procédure. Dans cette communication, nous décrivons et analysons le
cas d’une patiente chez qui deux grossesses spontanées, dont une évolutive, ont été obtenues suite à cette procédure.
Patiente: En 1999, la patiente a bénéficié d’une cryopréservation de tissu ovarien (ovariectomie unilatérale) à 24 ans avant un
traitement par greffe allogénique de moelle pour traitement d’une maladie d’Hodgkin. Après son traitement, la patiente était en
aménorrhée et n’a plus jamais présenté de cycle spontané.
Méthodes: En novembre 2004, 18 fragments sont transplantés par laparoscopie en deux temps au niveau de sites orthotopiques
(ovarien et péritonéal) et hétérotopique (sous-cutané abdominal). Une deuxième transplantation orthotopique et hétérotopique de
4 fragments décongelés est réalisée en mai 2006.
Résultats : Suite à la première transplantation, les valeurs de la FSH basale ainsi que de l’inhibine B sont progressivement revenues à la normale. Cinq mois après l’intervention, une première ovulation a été observée. Après 6 cycles spontanés, une grossesse spontanée a été obtenue mais s’est achevée par une fausse-couche à 7 semaines d’âge gestationnel. Au vue de l’altération
progressive de la fonction ovarienne, une deuxième transplantation est réalisée avec succès et une grossesse spontanée évolutive est obtenue 5 mois après. La patiente a accouché à terme d’une petite fille en juin 2007.
Au niveau des sites de transplantation, les follicules dominants sont observés principalement au niveau ovarien. Un délai de plus
d’un an a été observés avant d’obtenir des follicules dominants en sous-cutané. Au total, 3 ovocytes ont été récoltés au niveau du
site sous-cutané dont deux dégénérés et un fécondé ayant conduit au transfert d’un embryon 3 cellules sans succès.
Conclusion : Cette seconde grossesse spontanée à terme confirme l’efficacité de la procédure pour restaurer la fonction ovarienne et la fertilité des jeunes patientes nécéssitant un traitement à haut risque de défaillance ovarienne précoce. L’analyse des
cycles permet également une meilleure compréhension du fonctionnement ovarien post-greffe et de l’influence des sites de
transplantation sur la folliculogénèse.
Survie et prolifération des spermatogonies après cryopréservation de tissu testiculaire immature
Christine Wyns, Mara Curaba, Belen Martinez-Madrid, Anne Van Langendonckt, Wese François-Xavier and Jacques Donnez
Université Catholique de Louvain, 1200 Brussels, Belgium
Introduction. La préservation de la fertilité des garçons prépubères devant bénéficier d’un traitement gonadotoxique devient une
nécessité clinique urgente. Etant donné que ces patients ne produisent pas encore de spermatozoïdes qui pourraient être cryopréservés, seul le tissu testiculaire immature contenant des cellules diploïdes est disponible pour cryopréservation. Nous avons
étudié la survie et la prolifération des spermatogonies et des cellules de Sertoli après cryopréservation et xénogreffe de tissu
testiculaire cryptorchide immature.Matériel et méthodes. Des fragments de tissu cryptorchide provenant de garçons de 2 à 12 ans
ont été cryopréservés, décongelés et transplantés dans le scrotum de souris nudes. Des analyses morphométriques et immunohistochimiques ont permis d’évaluer l’intégrité tissulaire ainsi que la survie et l’activité proliférative des spermatogonies et des
cellules de Sertoli avant et après la procédure de congélation,décongélation et greffe. Le tissu cryopréservé et greffé a été analysé
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après 3 semaines.La plupart des tubules (88.3%) étaient intacts et nous n’avons pas observé de fibrose ou sclérose.14.5% de la
population spermatogoniale initiale identifiée par immunomarquage MAGE A4 était préservée et 32% de ces cellules montraient
une activité proliférative mise en évidence par le Ki67, comparativement à 17.8% avant congélation et greffe.Le nombre de cellules de Sertoli était inchangé et 5.1% étaient positives pour le Ki67.Conclusion. Notre modèle de xénogreffe orthotopique a permis de démontrer la survie et l’activité proliférative des spermatogonies et des cellules de Sertoli dans le tissu testiculaire immature humain cryptorchide cryopréservé.La congélation de ce tissu semble donc une technique prometteuse pour la préservation
de la fertilité des garçons prépubères devant subir un traitement oncologique.Etant donné que la niche de la cellule souche est
maintenue, le tissu cryopréservé pourrait être utilisé pour une auto-transplantation future.En outre, la congélation des fragments
tissulaires entiers n’exclut pas d’autres alternatives d’utilisation clinique telle que la transplantation de cellules isolées après dissociation tissulaire. Néanmoins ce travail ayant été réalisé sur du tissu cryptorchide, des études sur du tissu testiculaire immature
normal sur une période prolongée sont nécessaires afin de démontrer la capacité de différenciation des cellules préservées.
Direct and anonymous oocyte donation: impact on clinical results
A Delbaere, I Demeestere, S Emiliani, Y Englert.
Fertility Clinic, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
Two types of oocyte donation programs are proposed at the Fertility Clinic of Hôpital Erasme: anonymous oocyte donation which
is based on permutation of related donors with oocyte sharing between different recipients, and direct, non anonymous oocyte
donation. In both programs, donors are voluntary and unpaid. All oocyte donation cycles from 1990 to 2007 were retrospectively
analysed. Clinical results of the two types of programs were compared.
Results:
Direct oocyte donation program:
105 oocyte donors (mean age, 31.9 ± 4.5) provided a total of 1180 oocytes to 97 recipients in 125 cycles (mean number of oocytes retrieved: 9.7 ± 5.4). 710 embryos were obtained from which 228 were replaced (32% of embryos) in 116 cycles (mean number of embryos replaced: 2.0 ± 0.6) resulting in 30 clinical pregnancies. 213 embryos were frozen (30% of embryos) from which
126 were thawed and 66 replaced in 47 cycles resulting in 8 clinical pregnancies.
Anonymous oocyte donation program:
210 oocyte donors (mean age, 30.1 ± 4.0) provided a total of 3015 oocytes to 343 recipients in 218 cycles (mean number of oocytes retrieved: 13.8 ± 7.9). 1979 embryos were obtained from which 1227 were replaced (62% of embryos) in 666 cycles (mean
number of embryos replaced: 1.8 ± 0.7) resulting in 194 clinical pregnancies. 330 embryos were frozen (17% of embryos) from
which 205 were thawed and 113 replaced in 80 cycles resulting in 17 clinical pregnancies.
Conclusions: The anonymous oocyte donation program with oocyte sharing between different recipients led to a clinical pregnancy rate per operated donor more than 3 times higher than the direct oocyte donation program (97% versus 30%). This is
largely due to the oocyte sharing between different recipients which maximizes the use of the oocytes by reducing the proportion
of supernumerary embryos, which are either frozen or destroyed.
Scientific Society Session 3 ESGE - Session des Sociétés Savantes 3 ESGE
The role of laparoscopic surgery in oncology
M. Canis, K. Jardon, N. Bourdel, B. Rabischong, S. Matsuzaki, R. Botchorishvili, J.L. Pouly, G. Mage
University of Auvergne Clermont and Department of Obstetrics Gynecology and Reproductive Medicine. Polyclinique CHU Bd
Léon Malfreyt Clermont Ferrand, France
All the surgical procedures, which may be required to treat a gynecologic cancer, have been performed endoscopically. However prospective randomized studies required to confirm the oncologic efficacy of the technique are still lacking in gynecology,
whereas such studies are available in digestive surgery.
Animal studies suggested that the risk of tumor dissemination in non traumatized peritoneum is higher after a pneumoperitoneum
than after a laparotomy. Experimental studies also emphasized two points.
The surgeon and the surgical technique are essential. All the parameters of the pneumoperitoneum may influence the postoperative dissemination. Changing these parameters we may, in the future, be able to create a peritoneal environment adapted to
oncologic patients in order to prevent or to decrease the risks of peritoneal dissemination and/or of postoperative tumor growth.
Until the results of prospective randomized studies become available, the preoperative selection of the patients and the surgical technique should be very strict. In patients with endometrial cancer, the laparoscopic approach should be reserved to clinical
stage I disease, if the vaginal extraction is anticipated to be easy accounting for the volume of the uterus and the local conditions.
In cervical cancer, the laparoscopic approach should be reserved to patients with favorable prognostic factors : stage IB of less
than 2 cm in diameter. Laparoscopy is the gold standard for the surgical diagnosis of adnexal masses. But the puncture should be
avoided whenever possible. The surgical treatment of invasive ovarian cancer should be performed by laparotomy whatever the
stage. In contrast restaging of an early ovarian cancer initially managed as a benign mass, is a good indication of the laparoscopic
approach. The laparoscopic management of low malignant potential tumors should include a complete staging of the peritoneum.
Knowledge of the principles of endoscopy and of oncologic surgery is required. Teaching and diffusion of endoscopic oncological
techniques are among the major challenges of gynecologic surgery within the next few years.
Deep Endometriosis. Theraputical considerations.
S. Angioni, G.B. Melis
Division of Gynecology, Obstetrics and Pathophysiology of Human Reproduction, Department of Surgery, Maternal-Fetal Medicine, and Imaging, University of Cagliari, Cagliari, Italy.
Deep endometriosis is defined as a lesion penetrating the retroperitoneal space to a depth of 5 mm or more. These lesions are
responsible of painful functional symptoms, the intensity of which is proportional to the depth of penetration. Bowel or bladder
infiltration is a special form of presentation of deep invasive endometriosis. In addition to the classic symptoms, patients may
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present with bowel obstruction, voiding problems, rectal bleeding and hematuria. Patients with endometriosis associated pain
have a wide range of therapeutical options. Non surgical treatments includes hormonal approaches with progestagenes, Danazol
and GnRH agonists which can have several side effects or provide relief only for a limited period of time. Laparoscopic complete
excision of all endometriotic implants seems to be the best treatment achieving long term results in term of pain. However, only
few centres have the surgical expertise to perform this kind of surgery and consequently limiting the potential severe complications. The difficulty of surgery and the difficulty of understand the extent of the disease result in many incomplete surgeries and
recurrences. These patients are candidates to repeated surgery or medical approaches.
Another issue is whether to treat intestinal lesions if they do not result in obstructive symptoms. Although, the results in term of
pain seems promising the complications of intestinal resections (fistula, leakage, bowel obstruction) may be very high.
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Satellite Symposium - Symposium Satellite
Satellite Symposium 1 Pierre Fabre Lab. - Symposium Satellite 1 Pierre Fabre Lab.
New aspects in iron metabolism. Implication for iron deficiency Without anemia: an underrecognized, underdiagnosed and
undertreated stage in iron deficiency
P. Nielsen
Department of Molecular Cell Biology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
In quantitative terms, iron is the most important trace element in the organism and is indispensable for maintaining cellular life.
In the last 10 years, the complex regulation of normal and pathologic iron homeostasis has been elucidated extensively at the
molecular level. The identification of new hormones and transporters such as hepcidin, DMT1, ferroportin, or transferrin receptor
2. It gave us a better understanding of the pathology, diagnostics of both iron overload and iron deficiency and may in the future
even help to optimize the treatment in affected patients.
Iron deficiency anaemia (IDA) is still the most common nutritional deficiency worldwide affecting mostly women and children in
developing countries. In economically strong countries, the predominant form of iron deficiency (ID) is a milder form - iron deficiency without anaemia (IDWA) - in which a slightly negative iron balance reduces the individual iron stores, but the haemoglobin
concentration is still normal. Whereas the medical impact of IDA and the benefit of iron supplementation in subjects with IDA are
well established, there are conflicting reports in the literature about symptoms, consequences and treatment of IDWA. In the last
20 years, guidelines for the management of ID were based on the opinion that mild ID had only subtle health consequences in
individuals, and that preventive iron therapy in risk groups had no important clinical benefits.
However, mounting evidence suggests that even mild ID (serum-ferritin <20-35 µg/l) can result in symptoms such as fatigue,
altered cognitive functions, decreased aerobic performance, restless legs syndrome and reduced quality of sleep. Individuals,
especially from the well-known risk groups such as growing children, menstruating and pregnant women, but also endurance
athletes and elderly, frequently develop mild forms of ID. Current evidence strongly indicates that to ensure optimal health and
development, it is important to prevent and treat even mild ID by iron supplementation, not only in growing individuals, menstruating and pregnant women but also in endurance athletes, and the elderly.
Iron supplementation strategy during pregnancy and post-partum
C. Breymann
Feto Maternal Haematology Research Group, University of Zurich, Switzerland
The increased iron requirement in pregnancy and the puerperium carry with it an increased susceptibility to iron deficiency and
iron-deficiency anemia and perioperative or peripartal blood transfusion. Prevention and correction presuppose reliable laboratory
parameters and a thorough understanding of the mechanisms of iron therapy. In order to correctly diagnose the type and degree
of anemia, a prerequisite for selection of the proper therapy, one must first of all correctly differentiate between the “relative”(the
physiological anaemia due to the normal plasma volume increase during pregnancy), and “real” anemias with various different
pathophysiological causes. When defining the haemoglobin (Hb) cut-off value for anemia in pregnancy, the extent of the plasma
volume must be taken into consideration. It has been found that Hb values <11.0 g/dL in the first and third trimesters, and <10.5
g/dL in the second trimester may point to an anemic situation which should be further clarified. Postpartum Hb values below
10.0 g/dL define anemia and should be treated with higher iron doses. A considerable number of postpartum women show iron
deficiency without anemia, especially those who were iron deficient at term before delivery. These women benefit from routine iron
supplementation after birth. The first important steps for diagnosing anemia in a pregnant patient include a thorough check of her
medical history and a medical examination. The current gold standard to detect iron deficiency remains the serum ferritin value.
To be reliable, this requires the ruling out of an infection (chronic or acute) as a cause of the anemia. We recommend a complete
laboratory test for the exact haemotological status as well as the assessment of specific chemical laboratory parameters. The
Hb level alone is insufficient to guide management. After correct diagnosis, major emphasis should be put on safe and effective
treatment of anemia which depends on the severity of anemia, time for restoration, and patient characteristics. Besides oral iron
or blood transfusion, parenteral iron complexes and in selected cases also recombinant erythropoietin have been investigated and
show promising results concerning effective treatment of anemia during pregnancy and postpartum.
Satellite Symposium 3 Grünenthal - Symposium Satellite 3 Grünenthal
Oral contraception and hyper androgenic disorders of skin and hair
H. Wolff (D)
Hyper androgenic diseases are based on an endocrine dysfunction characterised by ex¬cessive androgen production or increased end-organ sensitivity towards androgens in women. The clinical manifestations are hir¬sutism, androgenic alopecia, acne,
sebor¬rhoea, menstrual bleeding disorders and infertility, accompanied by polymetabolic dys¬functions such as obesity, hypertension and diabetes type 2. Hyper androgenic symp¬toms can range in severity from a subtle cosmetic im¬pairment to true virilisation, de¬pending on genetic differences in the target tissue to an¬drogens. Androgens bind to an¬drogen receptors within the
cell, they are precursors for estrogen production in the ovary and they are controlled by a feedback mechanism which is mediated
by cortisol-feed¬back on the hypothalamic-pituitary-adrenal axis. Hy¬per androgenic disorders may be due to increased number or function of androgen-secret¬ing cells, increased peripheral me¬tabolism, increased sensitivity of the androgen-recep¬tor,
low levels of sex hormone binding globulin (SHBG) leading to elevated levels of free tes¬tosterone. Especially in PCOS-patients
significant morbid conditions are associated with endometrial hyperpla¬sia, insulin resistance, diabetes mellitus type 2, and probably in¬creased risk for cardio¬vascular disease. Available treatment options are life style inter¬ventions, anti diabetic treatment
and endocrine anti androgenic treatment including oral contraceptives with ethinyl estradiol in combination with anti androgenic
progestogens. CMA is a 17-OH-progesterone derivative (pregnan group) with such anti androgenic properties due to competitive
inhibition of the androgenic receptor, inhibition of 5-α-re¬ductase, reduction of androgenic receptor development and inhibition
69
of adrenal and ovarian testosterone production. CMA has a higher progestogene activity than natu¬ral progesterone, resulting in
an endometrial transformation dos¬age of 1.5 to 2 mg/day. CMA has no androgenic or clinically relevant mineral corticoid activity.
On oral admini¬stration CMA is rapidly and completely absorbed. After multiple administrations the mean t½ is 36-39 h. CMA has
no clinically relevant effects on haemostasis and has been used for decades in France for HRT and contraception in women with
cardiovas¬cular risk factors. It has a favourable influence on the LDL/HDL ratio and no clinically relevant effect on carbohydrate
metabo¬lism, haemostasis or other relevant laboratory parameters.
Cosmetic benefits of oral contraceptives – Relevance for QoL and psy¬chosocial health
M. Kerscher (D)
Especially in western societies a clear and immaculate skin symbolises health, attrac¬tiveness and youth. Not fulfilling this ideal
may cause considerable psychosocial stress for those affected and distinctly impair quality of life. Especially for adolescent women greasy hair and impured skin is a common problem (Kerscher et al. 2004). Clinically the severity of impured skin may vary considerably, and there is no clear-cut transition to acne vulgaris. In women of reproductive age, acne and seborrhoea can often be
treated successfully by taking combined oral contraceptives containing a potent antiandrogenic progestogen. Chlormadinone acetate is a progestogen showing comparable antiandro¬genic properties to cyproterone acetate in a dosage range suitable for contraceptive use (Terouanne et al. 2002). Comparing the clinical efficacy of the progesterone derivative chlormadinone acetate (2mg
CMA/ 0.03mg EE (Belara®)) to the testosterone derivative levonorgestrel (0.15mg LNG/0.03mg EE (Mikrogynon®)), both in combination with 0.03 mg ethinyl estradiol, in reducing moderate papulopustular acne, 59.4% of women using CMA/EE vs. 45.9% of
women using LNG/EE were responders (n=199 female acne pa¬tients). Complete resolution of acne was seen in 16.5% of women
receiving CMA/EE and 4.3% receiving LNG/EE (Worret et al. 2001). In a pla¬cebo controlled study by Cunliffe et al. 2007 (in publication) 64.1% (161/251) of women with acne responded with CMA/EE vs. 43.7% (55/126) of those taking placebo (p=0.0001). In
a self-assessment rating 70.5% of the CMA/EE users vs. 41.3% of the placebo users reported at least a satisfactory improvement
of their acne. Due to its efficacy in acne and seborrhoea CMA/EE provides excellent cosmetic and dermatological benefits even in
women, who do not suffer from pathological skin and hair disorders. In an open monocentric, non-controlled phase IV study in 50
women with acne-prone, impured skin, the appearance of the skin using CMA/EE dur¬ing a 6-month treatment phase improved
significantly (p<0.01) by reducing the number of comedo¬nes, papulopustules and the activity of the sebaceous glands. The size
of the pores generally decreased, whereas the water con¬tent of the skin increased and barrier function improved. More than 85%
of women stated very satisfactory improvement of the skin after 6 treatment cycles. This study clearly demonstrates the cosmetic
benefit even for those women, who do not suffer from clinically relevant acne, but from impured, seborrhoeic skin with enlarged
pores. The demonstrated effects can be important for the psychosocial well being and quality of life, not only for young women
but also for women up to 35 years.
CMA/EE – Improvement in women’s well-being
R. Druckmann (F)
Modern oral hormonal contraceptives are safe and low in side-effects. Only a few con¬traindications restrict their use. Nevertheless, compliance is sometimes less than ideal for various reasons. To prevent unwanted pregnancies and insufficient therapeutic
out¬comes it is absolutely necessary to ensure acceptable compliance in contraceptive use. Compliance can only be guaranteed by the acceptance of a contraceptive in an informed consent. For the doctor it is therefore essential to offer a contraceptive
method, adapted to the individual needs of the woman. The combination of 2 mg chlormadinone acetate and 0.03 mg ethinyl
estradiol (Belara®) is one such possibility in contraception. The ex¬cellent compliance rate of CMA/EE above 90%, reflecting a
good acceptance and toler¬ability profile in clinical use (Schramm et al. 2002, Schramm et al 2003), is derived from an impressive Pearl index: unadjusted: 0.44 (95% CI 0.2 – 0.8), adjusted: 0.04 (95% CI, 0.002 – 0.2), a low rate of intermenstrual bleeding:
about 8 per cent up to the third cycle and be¬low 2 per cent from the twelfth cycle, a high cycle stability: in about 98% from
the sixth cycle onwards, good weight stability: unchanged or decreased in about 84% from the twelfth cycle, a very low rate of
side-effects: below 2% after twelve cycles, a very low rate of thromboembolic events: 2.07 VTE/10,000 women years, very good
cycle stability, the absence of clinically relevant metabolic effects, no disturbance of libido and mood. However, the concomitant
benefits of CMA/EE also contribute to the good compliance, these include an almost 70% improvement or complete remission of
increased sebor¬rhoea after twelve months, almost 90% improvement or cure of acne symptoms after twelve months due to the
antiandrogenic properties of CMA/EE. Significant remission of dysmenorrhoea after twelve months in 79%, after 4 cycles in 95%
a significant reduction of pre-existing dysmenorrhoea after switching to CMA/EE from another OC. Therefore CMA/EE (Belara®) is
an excellent oral hormonal contraceptive providing high contracep¬tive efficacy and safety in combination with considerable additional benefits for health and beauty.
CMA/EE – Relief of dysmenorrhoea symptoms and mood balancing effects
H.P. Zahradnik (D)
In clinical practice dysmenorrhoea and mood changes are important factors in diminish¬ing woman’s quality of life and well-being.
Both symptoms are to be taken into consid¬eration, when prescribing hormonal contraceptives. The prevalence of dysmenorrhoea, inexplicable by anatomic pathology is highest in adoles¬cent women, with estimates ranging from 20 to 90%, depending
on the psychological analytical instruments used (Davis et al. 2001, Bani¬karim et al. 2000, Strinic et al. 2003). 10% of the 24year-olds reported pain that interfered with days work. Over 9% of women are absent from work once a month. 20% of all affected women require medical treatment. Oral contraceptives in general can have a beneficial effect on dysmenorrhoea symp¬toms,
but in a particular impressive manner, a reduction of dysmenor¬rhoea symptoms is seen in large observa¬tional studies for
chlormadinone acetate (CMA) in combination with ethinyl estradiol (EE) (Schramm et al 2002 and 2003). CMA is a derivative of
the natu¬rally secreted hormone progesterone. Even women who were still suffer¬ing from dys¬menorrhoea while taking other
OCs experienced a significant improvement in the num¬ber of painful menstrual periods after switching to CMA/EE (Schramm,
Heckes 2007). As expected, the use of CMA/EE, like that of other OC`s, causes a significant reduc¬tion in endometrial thickness
and reduces total endometrial production of the uter¬ine contract¬ing prostaglandin F2α. Since a further reduction in endometrial
thickness is unlikely, CMA must be assumed to have a special pharmacological action in relation to endometrial phosphol¬ipid /
70
arachi¬donic acid metabolism. Should this prove to be the case, CMA would be of particular therapeutic relevance not only for
dysmenorrhoea but also for a variety of other thera¬peutic indications. Dysmenorrhoea and mood changes in women go hand
in hand be¬com¬ing subjectively intensified. A great number of women of reproductive age suffer from sudden mood swings,
irritability, nervousness, excitability and anxiety asso¬ciated with a consider¬able decrease in quality of life. Endogenous steroid
hormones may inter¬act with the central nervous system. Among them progesterone and its metabolite allo¬pregnanolone have
been demonstrated to produce mood-balancing and anxiolytic ef¬fects via activation of the GABAA receptor, a major regulator
of mood function in the brain. When oral contra¬ception is considered, it has to be taken into account that the various synthetic
pro¬gestogens used may dif¬fer in their influence on mental state. For CMA large observational studies for at least 12 cycles,
including 50,000 women have shown that the combination of 0.03mg EE and 2mg CMA has prompt and distinct mood balancing effects (Schramm et al. 2002 and 2003). Based on a similar molecular struc¬ture initial research suggests that CMA has an
allopreg¬nanolone-like activity upon the GABAA receptor, a major regulator of mood in the brain, hav¬ing the ability to stabilise
mood and reduce depressive mood swings.
Satellite Symposium 4 Bayer Schering International - Symposium Satellite 4 Bayer Schering International
Facteurs de risque d’échec de la contraception par stérilet : résultats d’une large étude multicentrique cas-témoins
P. Thonneau (F)
CONTEXTE : La contraception par stérilet est, dans le monde, une des premières méthodes de planification familiale et elle
représente, en France, la seconde méthode contraceptive. Selon l’OMS, le taux d’échec de cette méthode se situe entre 0.5 et
3%. Plusieurs études ont tenté d’identifier les facteurs de risque d’échec du stérilet mais sans résultat très probant . Cette étude
a été conduite afin d’identifier les facteurs de risque du dispositif intra-utérin (DIU) et aussi afin de confirmer, ou non, l’hypothèse
d’un rôle délétère des anti-inflammatoires.
METHODE : Une étude rétrospective de type cas-témoins a été menée auprès des gynécologues : les cas (femmes ayant un DIU
avec une grossesse confirmée) et les témoins (femmes ayant un DIU et n’étant pas enceintes) ont été recrutés entre 1999 et 2002.
RESULTATS : 216 cas ont été comparés à 657 témoins. L’âge de la femme était significativement associé au risque d’échec du
DIU, avec une diminution du risque au delà de 35 ans. Une association significative a été observée entre « avoir eu un antécédent
d’expulsion de DIU » et le risque d’échec du DIU (OR ajusté égal à 3,31 ; IC : 1,40 – 7,81). Aucune relation n‘a été observée entre
le risque d’échec du DIU et les antécédents gynécologiques et reproductifs de la femme (fibrome, polype, fausses-couche), ni
avec un traitement médicamenteux, quel qu’il soit. Concernant l’efficacité relative des différents types de stérilet (lévonorgestrel,
cuivre, autres), un taux d’échec significativement plus bas a été retrouvé pour les femmes ayant utilisé un stérilet à la progestérone (Miréna®).
CONCLUSION : Cette étude est clairement rassurante en montrant que ni les anti-inflammatoires ni aucun autre type de
traitement pris par la patiente ne constituent des facteurs de risque d’échec de la contraception par DIU. Seul, l’antécédent
d’expulsion du DIU a été trouvé comme facteur de risque d’échec, résultat devant inciter les praticiens à proposer à ces patientes
un suivi médical et échographique régulier. Par ailleurs, la comparaison de l’efficacité des différents types de DIU fait ressortir un
net avantage pour le DIU à la progestérone (Miréna®).
Nouvelles attitudes dans la prise en charge contraceptive de l’après IVG avec le SIU hormonal
Brigitte Letombe
Praticien hospitalier, CHR LILLE, Lille, France
En dépit d’une forte acceptation de la contraception en France, avec des méthodes de contraceptions disponibles simples et
fiables, l’IVG reste actuellement un problème de santé publique : plus de 200 000 IVG annuellement déclarées en France.La
contraception intra utérine est une méthode contraceptive fiable et indépendante de la femme, encore trop peu utilisée en post
abortum. L’analyse de la Cochrane Review de 2005 sur ce sujet concluait que l’utilisation des DIU dans ces circonstances était
pratique et fiable. Les recommandations de l’ANAES de décembre 2004 et celles de l’OMS en 2005 confirment que cette méthode peut être utilisée sans restriction après un avortement non compliqué du premier trimestre. Le Système Intra Utérin au levonorgestrel (SIU-LNG) Mirena s’était révélé dès 1982 lors des études préalables d’Heikkila une excellente alternative contraceptive
de l’après IVG avec une tolérance générale ainsi qu’un taux de continuation comparables à ceux observés dans une utilisation
contraceptive habituelle. La publication de Pakarinen portant sur plus de 300 femmes suivies pendant 5 ans et comparative
avec NovaT200 montre un profil de saignements plus favorable pour le SIU hormonal et un taux de retrait et d’expulsion moindre
qu’avec NovaT (NS).Le taux cumulé de grossesses à 5ans y est particulièrement faible de 0,8 %. Deux analyses rétrospectives
et une étude prospective ont été réalisées dans des centres d’orthogénie en France et ont fait l’objet de thèses récentes : l’étude
prospective porte sur 56 femmes ayant reçu le SIU hormonal en post abortum immédiat et suivies régulièrement pendant 1 an.
L’effectif le plus important concerne 620 femmes ayant bénéficié d’une contraception de longue durée d’action après leur IVG :
DIU cuivre, SIU-LNG ou implant progestatif . Environ la moitié de ces femmes soit 286 ont rempli un questionnaire permettant
d’apprécier, avec un recul supérieur à 1 an, la tolérance de chacune de ces méthodes. Le SIU-LNG s’est avéré la méthode de
contraception ayant les taux de continuation et de satisfaction les plus élevés.Une autre analyse portant sur 119 nullipares ayant
bénéficié de la pose immédiate d’un SIU-LNG au décours d’une IVG et dont 53 ont rempli un questionnaire dans un délai de 6
mois à 3 ans après la pose, confirme ces données positives. Ainsi, après une IVG cette méthode de contraception s’avère une
alternative contraceptive efficace et bien tolérée.
Prise en charge des hémorragies utérines fonctionnelles : place du système intra-utérin (SIU) hormonal Mirena
Jean-Luc Brun
Hôpital Pellegrin, Service de gynécologie obstétrique, Bordeaux, France
Les ménorragies concernent 25% des femmes de plus de 40 ans et représentent 25% des hystérectomies pratiquées en France.
Leur caractère fonctionnel n’est affirmé qu’après avoir éliminé une cause organique. L’abondance des hémorragies, leur répercussion, et le contexte dans lequel elles surviennent sont ensuite évaluées.
Des traitements médicaux sont classiquement proposés en première intention : anti-fibrinolytiques si ménorragies essentielles
71
isolées, progestatifs si troubles du cycle associés. Les anti-fibrinolytiques bien tolérés réduisent en 3 mois les saignements excessifs dans 40 à 50% des cas. Les progestatifs (norstéroïdes évalués dans les essais) sont efficaces dans environ 85% des cas,
mais s’accompagnent d’effets secondaires androgéniques invalidants qui limitent la prescription à long terme.
Le SIU délivrant du levonorgestrel (SIU-LNG) efficace chez plus de 90% des femmes est bien toléré, et son observance est excellente. Il agit par atrophie endométriale et inhibition de la fibrinolyse locale. Son action contraceptive se prolonge pendant 5 ans.
L’efficacité clinique et biologique (correction de l’anémie) du SIU-LNG l’a amené à être comparé aux traitements chirurgicaux classiquement proposés en cas d’échec du traitement médical (endométrectomie, hystérectomie). Le taux de réduction des saignements est identique un an après traitement par SIU-LNG ou résection/réduction endométriale. Le volume des pertes menstruelles
serait même significativement diminué au delà d’un an chez les femmes ayant un SIU-LNG par rapport à celles traitées par thermocoagulation endométriale par ballonnet. Chez des femmes programmées pour une hystérectomie après échec d’un traitement
per os, la mise en place d’un SIU-LNG a permis de les faire renoncer à la chirurgie dans plus de 2/3 des cas au bout d’un an.
Dans une étude randomisée comparant SIU-LNG et hystérectomie, la qualité de vie des femmes n’était pas significativement différente et le rapport coût-bénéfice était en faveur du SIU-LNG avec un recul de 5 ans.
Au total, par son efficacité à long terme et sa bonne tolérance, le SIU-LNG est devenu le traitement médical de première intention
des hémorragies utérines fonctionnelles selon les experts du NICE (National Institute for Clinical Excellence, UK, Janvier 2007).
72
Free communication sessions - Sessions des communications libres
Free communication session 1 - Session des communications libres orales 1
Prevention of bone loss by add-back therapy with 6 months gonadotropin releasing hormone agonist in patients with
endometriosis.
Y Choe, M Jung, C Huh, Kyung Hee
Medical center, Korea, Republic of
Objective: To assess the effects of 6 months gonadotropin releasing hormone (GnRH) agonists treatment on lumbar bone mineral
density (BMD) and bone metabolism with and without add-back therapy in patients with laparoscopic proven endometriosis.
Design & Methods: This is an analysis of a prospective, randomized study. We studied one hundred-six women who had been
given a laparoscopic proven diagnosis of endometriosis. Patients received leuprorelin acetate 3.75mg subcutaneously monthly for
6 months, at which time add-back therapy was initiated along with the GnRH agonist. Add-back therapy was given to 52 patients,
and not to 54 patients (control group). The add-back therapy regimen was tibolone 2.5mg daily for 6 months. The bone mineral
density (BMD) of the lumbar spine (L2-L4) was measured by dual energy X-ray absorptiometry (DEXA) two times: at baseline, after
6 months. The serum concentrations of sex steroids (estradiol, follicular stimulating hormone;FSH, luteinizing hormone;LH) and
bone metabolic markers (serum alkaline phosphatase, calcium, phosphorus, osteocalcin and urinary deoxypyridinoline) were measured at the same times as BMD. The data were stastically analyzed with SPSS 13.0 for windows (SPSS Inc, Chicago, Ill., USA).
The statistical significance of differences between groups was determined by student t-test, and that of within group differences
was evaluated by one way ANOVA. Confidence intervals (CI) were calculated 95% level.
Results: After 6 months, BMD decreased significantly in both group (p<0.05). The mean decrease of t-score of BMD after 6 month
with add-back group and without add-back group was 0.32 and 0.43, respectively. The difference between groups was significant
in the reduction in mean BMD of lumbar spine after 6 months (p=0.002). There was significant difference between groups in LH
(p=0.016), and not in the rest of sex steroids and bone metabolic markers.
Conclusion: BMD loss occurs during GnRH agonist treatment for 6 months and add-back therapy may be an effective prevention
of BMD loss. On basis of this study, Add-back therapy using tibolone seems to be able to preserve bone mineral density, especially in initial low BMD women.
Evaluation préopératoire de troubles mictionnels dans le cadre d’une endométriose profonde sévère : à propos de 12 cas
C. de Lapasse, F. Renouvel, C. Chis, I. Grosdemouge, P. Panel
Hôpital André Mignot, Centre hospitalier de Versailles, France
La chirurgie coelioscopique de l’endométriose profonde atteignant les ligaments utéro-sacrés et le rectum induit classiquement
des troubles mictionnels post opératoires imputables aux lésions nerveuses du plexus pré-sacré dont les terminaisons nerveuses
peuvent être lésées en per opératoire. Cependant, les patientes consultant pour ce type de pathologie décrivent fréquemment des
signes fonctionnels urinaires avant toute intervention chirurgicale.
Objectif : Cette étude a pour but d’évaluer l’existence de troubles mictionnels préexistants par un bilan urodynamique préopératoire.
Matériel et méthodes : Il s’agit d’une étude prospective descriptive non comparative chez douze patientes consécutives venues
consulter pour prise en charge chirurgicale d’une endométriose profonde atteignant cliniquement et radiologiquement les ligaments utéro-sacrés, le torus utérin et/ou le rectum.
Résultats : L’âge moyen de ces patientes est de 34,6 ± 5,3 ans [24-42] au moment de la prise en charge. La parité moyenne est
de 0,5 ± 0,8 enfants [0-2].
Ces patientes sont atteintes d’une endométriose profonde évaluée par un examen clinique soigneux et par une imagerie de
type échographie abdominopelvienne sus pubienne et endovaginale associée à une imagerie par résonance magnétique. A
l’interrogatoire, quatre patientes ne présentent aucun signe fonctionnel urinaire (30 %). Les 8 autres ont au moins un signe parmi
les suivants : pollakiurie, incontinence urinaire, dysurie, lever nocturne, impériosité, brûlures mictionnelles, crampes vésicales,
diminution de la sensation de réplétion vésicale (Une infection urinaire a systématiquement été éliminée). Le bilan d’imagerie retrouve une atteinte annexielle dans 3 cas (25 % cas), de l’adénomyose dans 3 cas (25 %), de l’endométriose au niveau rectal dans
8 cas (66,7 %), au niveau du torus utérin dans 9 cas (75 %), au niveau des ligaments utérosacrés dans 10 cas (83,3 %). Aucune
atteinte vésicale n’a été mise en évidence.
Le bilan urodynamique réalisé en pré opératoire est strictement normal pour deux patientes seulement (16,7 %). Trois patientes présentent un résidu post mictionnel significatif (25 %). La pression moyenne de clôture urétrale est de 87,8 ± 33,5 cm H20
[38-150]. Quatre patientes présentent une hypertonie urétrale (30 %), 3 patientes une instabilité urétrale (25 %), 3 patientes une
dysurie (25 %), 2 patientes une vessie hypersensible (16,7 %), 2 patientes une insuffisance sphinctérienne (16,7 %), 1 patiente
une incontinence urinaire mixte (8,3 %) et enfin 1 patiente une petite capacité vésicale.
Conclusion : Les patientes atteintes d’endométriose profonde dont la localisation touche les ligaments utéro-sacrés et/ou la face
antérieure du rectum présentent très fréquemment une symptomatologie fonctionnelle urinaire préopératoire. L’interrogatoire est
fondamental dans l’évaluation de celle-ci mais seul le bilan urodynamique permet de préciser l’atteinte réelle et de la quantifier.
L’atteinte mise en évidence est une atteinte de type neurologique, et vraisemblablement une atteinte du plexus hypogastrique
inférieur, il ne s’agit pas d’une atteinte vésicale. Dans cette étude, il n’existe pas de corrélation entre les troubles pré opératoires
et post opératoires qui semblent davantage liés au geste chirurgical. Une étude sur un plus grand nombre de patientes pourrait
préciser les améliorations et complications éventuelles imputables à la chirurgie.
Mots clés : endométriose – bilan urodynamique – troubles urinaires.
73
P. Panel, C. Chis, S. Gaudin, A. Letohic, P. Raynal, M. Mikhayelyan, B. Fraleu, G. Sangana, C. Almeras, C. Dufour, F. Foidart
Hôpital André-Mignot, centre hospitalier de Versailles, France
Objectifs - Évaluer les risques et les bénéfices du traitement cœliochirurgical de l’endométriose profonde, notamment intestinale,
afin de pouvoir en informer clairement les patientes et décider en accord avec elles d’une prise en charge adaptée.
Patientes et méthodes - Série prospective de 118 patientes atteintes d’endométriose profonde (48 endométrioses digestives) traitées par cœliochirurgie. Résultats - 95,6 % patientes ont eu une évolution favorable sur la douleur et 93,7 % sur la dyspareunie.
Parmi les 29 patientes infertiles désireuses de grossesse, 21 grossesses (72 %) ont été obtenues après chirurgie dont 14 (66 %)
spontanément. Au cours de la période peropératoire trois laparoconversions ont été nécessaires dont deux pour hémorragie. La
période postopératoire a été marquée par des complications majeures (deux fistules rectales et deux nécroses urétérales) et des
complications mineures (rétentions urinaires et hématomes du cul-de-sac de Douglas).
Discussion et conclusions - Nos données confirment l’efficacité du traitement cœliochirurgical sur la symptomatologie douloureuse et la fertilité des patientes. Les complications de cette chirurgie sont peu fréquentes mais potentiellement graves. Une
information claire, loyale et appropriée apportée aux patientes est nécessaire avant d’envisager cette prise en charge.
Mots clés: Endométriose profonde; Cœlioscopie; Fertilité; Douleur; Dyspareunie; Fistule; Consentement éclairé
C. Yazbeck, P. Madelenat, Jp. Ayel, L. Jacquesson, P. Solal, A. Hazout
Bichat Claude Bernard Hospital, France
Background: In past years, lots of surgical treatment modalities had been described in cases of isolated or multiple ovarian
endometriotic cysts. The aim of this preliminary study is to investigate and test the efficacy of ethanol sclerotherapy for recurrent
endometriotic cysts, before controlled ovarian hyperstimulation in infertile patients with an adequate ovarian status.
Methods: Ethanol sclerotherapy was used in 29 infertile patients with recurrence of ovarian endometriomas before inclusion in
assisted reproductive technology (ART) cycles. Efficacy was evaluated by the recurrence rate. Reproductive outcome was also
compared to that of a previous series with conventional surgical treatment of endometriomas.
Results: The mean size of endometriomas was 38.4 ± 10.8 mm in diameter. Eight patients
(28.6%) had multiple cysts which were bilateral in four cases (14.3%). Ovarian cysts recurred in 13.6 % of cases, at a mean time
of 15 months after EST. The clinical and cumulated pregnancy rates were 44.4 % and 59.3% respectively. These rates were significantly higher than those of the control group (p=0.004).
Conclusions: Despite the lack of randomization, these results suggest that ethanol sclerotherapy is safe, efficient and relevant for
adequately selected infertile patients with recurrent ovarian endometriotic cysts before ART.
Gynaecologic Emergencies in a Referral University Hospital
A. Chavez Badiola, M. Ayala Castellanos, V. Sanchez Gonzalez
Hospital Civil de Guadalajara, Guadalajara, Mexico
Objective: To assess emergency calls in a large referral University Hospital.
Material and methods: Data from gynaecologic emergencies was prospectively registered over four months in the largest referral University Hospital in Western Mexico. Information was collected by the gynecology resident attending the call immediately
after first examination and reviewed for diagnosis and management by the chief resident a consultant gynaecologist. Calls from
departments other that the Emergency Room were also considered for the study.
Results: 70 emergency calls were made to the Gynaecology Department, 83% made by Emergency Departments and 17% from
other Departments (e.g. Hematology, Psychiatry). Abnormal bleedings (45%) and genital tract infections, including pelvic inflammatory disease (15%) were the most common final diagnoses. Most frequently prescribed treatment were high-dose oral contraceptives (21%). Ten patients required surgical interventions but only eight were admitted to the Gynaecology ward, representing
0.26% from the total number of admissions via Emergency Departments over four months for that hospital.
Conclusion: Almost half of gynaecological emergencies were related with menstrual disorders rather than genital tract infections,
as generally reported in literature. The high prevalence of abnormal uterine bleedings demands from clinicians a high degree of
familiarity with diagnostic and therapeutic alternatives.
Cure chirurgicale de l’incontinence urinaire d’effort par bandelette sous-uretrale : analyse comparative à 3 ans des résultats fonctionnels des voies retro pubienne et trans obturatrice.
Bohec C., Delaporte V., Fournier G., Collet M.
CHU Brest, Brest, France
Objectif de l’étude : déterminer la supériorité de l’une des deux voies d’abord chirurgical de la cure d’incontinence urinaire à
l’effort (IUE) par bandelette sous-urétrale.
Matériels et Méthodes : Nous avons comparé deux séries rétrospectives de 26 voies obturatrices (Monarc©) avec 21 voies rétropubiennes (TVT©) à 3 mois puis 3 ans. 47 patientes ont bénéficié d’une cure chirurgicale d’IUE entre mars 2002 et mai 2004 par
un opérateur unique sous anesthésie locale. L’anesthésie locale consistait en une infiltration cutanée suivant le trajet des bandelettes de deux ampoules de ropivacaïne (Naropeïne®) diluées dans 100mL de sérum physiologique. Le bilan fonctionnel pré
opératoire comprenait : un examen clinique, un bilan urodynamique (débitmétrie, profilométrie et urétrocystomanométrie) et un
auto-questionnaire intégrant les questionnaires validés que sont le SSI (Symptom Severity of Index), l’UDI-6 (Urogenital Distress
Inventory) et l’IIQ-7 (Incontinence Impact Questionnaire). Les résultats fonctionnels de 21 voies rétro pubiennes consécutives puis
26 voies trans obturatrices consécutives ont été évalués : à 3 mois par le même auto-questionnaire et un bilan uro-dynamique,
puis à 3 ans par l’auto-questionnaire.
Résultats : L’évaluation pré opératoire est équivalente entre les 2 groupes de patientes. Les temps opératoires, l’évaluation
analogique de la douleur et les complications per-opératoires ne sont pas statistiquement différents. A 3 mois post-opératoires
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25% des patientes ont répondu avoir eu des fuites urinaires depuis l’intervention dans le groupe voie obturatrice versus 41%
dans le groupe TVT©. Seulement 18% des patientes étaient non à peu satisfaites après TVT© versus 10% par voie trans-obturatrice. 18% et 10% des patientes présentaient des douleurs périnéales non systématisées après une chirurgie par voie trans-obturatrice et rétro-pubienne respectivement. Les résultats à 3 ans étaient comparables : seulement 63,6% des patientes n’ont eu
aucune fuite après TOT versus 60% après TVT ; cepandant 95% des patientes étaient satisfaites à 3 ans après TOT versus 87%
après TVT sans aucune différence significative.
Conclusion : Nous n’avons pas mis en évidence de supériorité d’une voie rétro pubienne par rapport à la voie trans obturatrice.
Ces 2 techniques sont techniquement réalisables sous anesthésie locale avec la satisfaction de 9 femmes sur 10 à 3 ans. Ces
résultats sont concordant avec les données de la littérature.
Traitement chirurgical du prolapsus du 4ème âge : serie de 43 patientes
G. Rathat, C. Yazbeck, M. Ebrard, J. Gulielminotti, C. Dhainaut, P. Madelenat
Hôpital Bichat, France
INTRODUCTION : La population française vieillit. Les troubles de la statique pelvienne sont corrélés à l’âge. Les progrès réalisés
en anesthésie permettent de proposer aux patientes du quatrième âge une prise en charge chirurgicale de leur prolapsus.
BUT : Evaluation de la prise en charge chirurgicale du prolapsus génital chez les patientes âgées de 75 ans et plus.
MATERIEL ET METHODE : Entre mars 2001 et octobre 2006, 43 patientes de 75 ans ou plus ont bénéficié d’une intervention
chirurgicale pour un prolapsus intéressant les étages antérieur, moyen et/ou postérieur. L’étude rétrospective de ces dossiers
évalue la pertinence des options chirurgicales en étudiant la morbidité post-opératoire et les résultats anatomiques, dans ce
groupe particulier de patientes.
RESULTATS : 43 patientes, dont la moyenne d’âge à la prise en charge est de 81 ans ([80,5 +/- 3,98 ](extrêmes : 75-92)) ont
bénéficié d’une cure chirurgicale pour prolapsus, exclusivement par voie vaginale. 23 patientes (53,5%) se sont vues proposer
une intervention de Rouhier. Les 20 autres ont été prises en charge en conservant la perméabilité vaginale : l’étage antérieur a été
traité soit par plicature sous urétro-vésicale (n = 5, 25% des patientes de ce groupe) soit par mise en place d’un hamac sous vésical (n = 11, 55% des patientes de ce groupe). Pour l’étage moyen, 8 sacrospinofixations (40% des patientes de ce groupe) ont été
pratiquées. 9 hystérectomies (45% de ces 20 interventions) ont été effectuées. A l’étage postérieur ont été réalisés une cure isolée
d’élytrocèle, et 12 myorraphies des releveurs dont 5 associées à une plicature du fascia pré-rectal. 7 BSU ont été associées à la
chirurgie conservant la perméabilité vaginale et 10 à la chirurgie oblitérante. Si une incontinence urinaire d’effort (IUE) préexistait à
l’intervention, une BSU a été associée au geste dans 76,5% des cas (13 patientes sur 17 avec IUE préopératoire). Si les patientes
étaient continentes avant l’intervention, elles ont bénéficiée dans 9,5% des cas d’une BSU à visée préventive (2 patientes sur 21
sans IUE préopératoire). Dans 6 cas (dont 2 avec pose de BSU), l’existence ou non d’une IUE préopératoire n’a pu être précisée
rétrospectivement.
9/43 (18,6%) des interventions ont été réalisée sous anesthésie locorégionale, 35 sous anesthésie générale (81,4%) (ASA moyen
= 2). La durée moyenne de séjour post-opératoire est de 5 jours (extrêmes [2-17]). La cause principale des hospitalisations prolongées est la mauvaise vidange vésicale, on relève en effet 12 anomalies de résidu post-mictionnel post-opératoire (12/41, 2 datas
manquantes (29,3%)).
Une transfusion per-opératoire et deux transfusions post-opératoires ont du être faites. Un cas d’érosion sur prothèse et une plaie
vésicale sont survenus. Aucune suite opératoire n’a été compliquée d’un évènement thromboembolique. Aucun décès per-opératoire ou secondaire à l’intervention n’est survenu. Les consultations à distance de l’intervention retrouve un résultat anatomique
satisfaisant dans 97,1% % (34/35) des cas (8 perdues de vue), avec un délai moyen d’évaluation à (50 jours (+/- 48; 13/242).
L’évaluation de la continence post opératoire a pu être étudiée sur 33 dossiers : sur 15 patientes incontinentes en préopératoire,
11 (73,3%) sont guéries, 2 (13,3%) sont améliorées, et 2 autres (13,3%) sont équivalentes. 2 des patientes continentes en préopératoire (15,8%) présentent une incontinence urinaire démasquée de novo.
19 patientes (44,2%) ont pu être recontactées par téléphone à distance de l’intervention. 84,2% d’entre elles estiment que le résultat de la cure de prolapsus est satisfaisant ou très satisfaisant. 68,4% n’ont pas d’incontinence urinaire (61,5% de celles-ci ont
vu leur continence urinaire améliorée par l’intervention). Seulement 1 patiente (5,3%) présente une incontinence aux gaz de novo.
78,9% jugent que leur intervention a amélioré leur qualité de vie.
CONCLUSION : La prise en charge par chirurgie vaginale des prolapsus chez les patientes âgées de plus de 75 ans semble être
une option thérapeutique raisonnable. Sur cette série, la mortalité liée au geste est nulle, et la morbidité faible. L’évaluation postopératoire montre un bon résultat anatomique et fonctionnel dans la grande majorité des cas.
JR. García Flores, M. Espada Vaquero, A. Bermejo de la Calzada, F. M. Dans, A. González González
Hospital La Paz, Madrid, Spain
Introduction : Stillbirth is an infrequent phenomenon, and its ethiology remains unexplained in most cases. In this study we make a
complete description of the main risk factors and its prevalency in the population analyzed.
Design and methods : Retrospective study of registered stillbirth cases at Hospital Universitario La Paz (Madrid) from January
2004 to June 2006. Clinical data were collected from medical records as well as fetal autopsy.
Results : 113 cases of stillbirth were registered during the analyzed period, with similar distribution over the three years. Stillbirth
rate is around 4,46 deaths per 1000 births. Mean maternal age was 31,65 (SD +/- 6,29). Maternal age >35 years was 26,2% and
>40 years 7,5%.
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Multiple pregnancies constitute approximately 11,5% of all stillbirths. In this group, the most common finding was the death of
one of the fetuses (92%), when a cesarean section was performed. Three cases of twin-twin transfusion were diagnosed during
the second trimester.
In 4,4% of the cases there was no prenatal care. Maternal medical and obstetrical complications identified were pregestational
diabetes (0,8%), gestational diabetes (3,5%) and hypertension diseases during pregnancy (14,2%). Congenital defects or malformations were described in 12,4% of cases.
Table 1 shows symptoms at the moment of diagnosis. Ultrasound findings before or at the moment of the diagnosis of the stillbirth
are described in Table 2.
Table 1. Symptoms
No symptoms (casual diagnosis)
No fetal movements
Uterine activity
Rupture of Membranes
Hemorrhage
Abdominal pain
37,2%
24,7%
18,8%
9,7%
6,2%
3,5%
Table 2. Ultrasound findings
Fetal growth restriction
Macrosomia
Polyhydramnios
Oligohydramnios
Hydrops
8%
3,5%
5,3%
4,4%
5,3%
A substantial proportion of stillbirths is attributed to umbilical cord accidents, thought to occur because of cord occlusion from
true knots, nuchal cords or cord compression. Table 3 shows umbilical cord findings. Placental pathologies are circumstances
also related with stillbirths. In Table 4 we summarize the conditions observed in our study.
Table 3. Umbilical cord findings
Prolapse
Constricting loop or knot
Velamentous insertion
Other
4,4%
41,4%
7,9%
9,4%
Table 4. Placental pathology
Abruptio
Placental infarction
Other
11,5%
11,5%
2,7%
For the evaluation of stillbirth the most useful diagnostic test is the fetal autopsy. In addition to the identification of birth defects
and morphologic abnormalities suggesting genetic or developmental abnormalities, necropsy can determine and confirm other
causes of stillbirth like infection, anemia, hypoxia and metabolic abnormalities. Necropsical fetal findings, in our cases related to
hypoxia and chorioamnionitis, are similar in pregnancies of 27 weeks or more, but in those of less than 27 weeks we find more
cases of infection (18,8%). Findings of fetal autopsy are shown In Table 5.
Table 5. Necropsical fetal findings
<27 weeks
27-34 weeks
34-37 weeks
>37 weeks
Hypoxia
75%
89,3%
86,4%
89,4%
Chorioamnionitis
18,8%
10,7%
13,6%
14,9%
Conclusion: Stillbirth is an infrequent event of multifactorial and complex ethiology. It may not be possible to precisely determine
which disorder was directly responsible for the loss. Indeed, it is likely that some cases of stillbirth are due to contributions from
multiple factors. Finally, conditions may be associated with stillbirth without directly causing them.
There are no definitive conclusions about the actual value of different tests used in the evaluation of stillbirth. In summary, we think
that autopsy, placental evaluation, karyothype, Kleihauer-Betke test and serologic test are useful in all cases. Other tests should
be considered in selected cases, depending on clinic and risk factors.
Knowledge on timing of stillbirth specific risk factors may help clinicians in decreasing stillbirth risks through monitoring and timely
interventions.
Sofia Saleiro, Ana Rodrigues, Cristina Frutuoso, Natalia Amaral, Carlos Guerra, Arlete Manarte, Carlos Oliveira
University Hospital of Coimbra, Coimbra Portugal
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Introduction: The most important prognostic indicator in patients with invasive breast cancer is the axillary node status, which
must also be known for correct staging and influences the selection of adjuvant therapies. The increased use of radiologic screening contributed to a significant rise in early stage breast cancer and with negative lymph nodes. Other staging procedures have
been evaluated for patients with clinically negative axillary lymph nodes. Sentinel lymph node (SLN) biopsy is revolutionizing
breast cancer surgery.
Objectives: Analysis of results of the breast cancer sentinel lymph node (SLN) research in the Gyneacology Department of the
University Hospital of Coimbra. More specifically, analysis of identification rates, technique security and factors affecting success
rates.
Material e methods: A retrospective study was performed on 174 patients with breast cancer submitted to SLN technique
between August 2003 and December 2006. All patients with breast cancer T1 and T2 smaller than 3 cm and with In Situ Ductal
Carcinoma were included.
Results: Average age at the time of diagnosis was 57.0 years (24 – 85). Identification rate of SLN by preoperative lymphoscintigraphy was 96%. The SLN was not identified in patients submited previosly to excisional biopsy. The peroperatory identification of
SLN was performed with blue dye and radiocolloid. SLN identification rates are shown in the table bellow.
Identification rate of SLN
Lymphoscintigraphy
Peroperatory identification (blue dye and radiocolloid)
Lymphoscintigraphy
and peroperatory identification
Blue dye and radiocolloid Radiocolloid
Blue dyeTotal
96% 77%
19%
2%
98% 93,7%
The combined technique of preoperative lymphoscintigraphy, blue dye and radiocolloid increased the SLN identification rates.
The medium number of SLN removed during surgery was 2.30. SLN was detected and removed in 163 patients and histological
examination showed macrometastasis in 19%, micrometastasis in 7% and no metastasis in 74%. There were no complications in
the patients submited to SLN biopsy.
Conclusions: SLN biopsy is an advance in breast conserving surgery showing excellent identification rates. Since the SLN is submitted to a more detailed histological examination it allows a better staging.
Mickael Suissa
IRP, Paris, France
L’imagerie sénologique, aujourd’hui quasi-exclusivement ciblée sur le diagnostic et la surveillance du cancer du sein, bénéficie
profondément des avancées nouvelles. Au premier rang d’entre-elles et véritable pivot central du diagnostic, la mammographie
est le premier outil à utiliser les avantages du monde numérique : qualité du détecteur sans cesse améliorée, aide automatisée
à la détection, archivage numérique des images avec rappel automatique des antériorités, angiographie de contraste et très bientôt…la tomosynthèse. Elle s’appuie sur les données de l’échographie et sur celles de l’IRM dans le cadre du bilan de caractérisation de la lésion et de multifocalité. Ces données sont utiles désormais avant la réalisation des prélèvements qui s’effectuent
sous contrôle échographique, mammographique voire IRM. La spectro-IRM, après des débuts prometteurs, cherche encore sa
place en routine.
Dans le cadre du bilan général d’extension, l’actualité est au scanner avec reconstructions multiplanaires, à l’IRM, au PET-Scanner avant l’utilisation en routine de l’IRM corps entier et de l’imagerie scannographique de perfusion ( dans le cadre des suivis de
chimiothérapie).
Efficacy of magnetic resonance guided focused ultrasound surgery of uterine leiomyomas: evaluation of morphological
parameters affecting the absorption of energy according to magnetic resonance imaging
Liadov Konstantin, Kurashvili Julia, Stepanov Alexandr, Bogomazova Svetlana, Vishninsky Alexandr, Lazutkina Victoria, Zelenin
Guerman
FGU “Clinical and Rehabilitation Centre of ROSZDRAV”, Moscow, Russia
Objective: Efficacy of noninvasive ablation of uterine leiomyomas (UL) by MRI-guided focused ultrasound (MRgFUS) depends on
UL capability to absorb ultrasound energy. Purposes of study: to determine MRI characteristics of UL affecting energy absorption, to assess possibility to forecast the efficacy of MRgFUS depending on UL MRI-type. Methods: used data of 360 symptomatic UL patients. In 315 cases MRgFUS ware performed using ExAblate-2000 with GE 1,5T MRI. In 122 patients MRI findings
were compared with histological examinations: 68 patients underwent needle biopsy before MRgFUS; 9 patients - myomectomy
after MRgFUSt; 14 patients – myomectomy, 31 patients - hysterectomy. In 68 patients immunohistochemical examinations were
performed to evaluate UL proliferation activity. In 30 patients UL blood perfusion was assessed before and after MRgFUS by color
Doppler ultrasound. Efficacy of MRgFUS was determined as ratio of non-perfused volume (NPV) to the UL volume after T1W
contrast enhanced MRI. Results: outcome of the study is correlation between UL morphology, MRI characteristics and MRgFUS
efficacy. Basic UL histological types - simple and proliferating differ in proportion of muscular and fibrous tissue. The study determined ratio of UL MRI-types: “Dark” (hypo-intensive in comparison with myometrium on T2W MRI) was found in 80% of patients;
“Grey” (iso-intensive) in 12%; “White” (hyper-intensive) in 8%. The study determined that each MRI-type of UL corresponds to
certain histological variant. “Dark” UL corresponds to “simple UL without edema of stroma”. The efficacy of MRgFUS of “Dark”
UL was 60-90% of NPV. “Grey” UL corresponds to ”proliferating UL” or “simple UL with edema of stroma”. The MRgFUS efficacy
of “Grey” UL was 20-90%. In ”proliferating UL” using of energy up to 4000J enabled to reach 80-90% efficacy. Even using higher
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energy efficacy in “Grey” UL of the second variant was 20-30%. “White” UL corresponds to histological variant ”proliferating UL”
or “simple UL with strong edema of stroma”. MRgFUS of “White” UL were always technically hard, using energy up to 4500J and
resulted in 10-25%. Conclusion: MRI evaluation of UL morphology is necessary for UL treatment planning and forecast of MRgFUS result. The study outcome is significant because definition of MRI-types of UL enables to forecast the efficacy of MRgFUS
and either to use standard or especial protocol of MRgFUS or to prescribe alternative treatment of UL.
M. Muñoz Muñiz, A. Hernández Gutiérrez, R. Savirón Cornudella, J. Fernández Cuadrado, J. Ordás Santo Tomás
Introduction : Endometriosis is defined as the presence of endometrial tissue outside the endometrium and myometrium. The
most common locations of endometriosis are the ovaries and the pelvic peritoneum, followed in order of decreasing frequency by
deep lesions of the pelvic subperitoneal space, the intestinal and the urinary system. Deep pelvic endometriosis, also called deep
infiltrating endometriosis, is defined as infiltration of the implant of endometriosis under the surface of the peritoneum more than 5
mm. Physical examination and laparoscopic exploration may not allow diagnosis or prediction of the extension of deep pelvic endometriosis in all cases, especially in pelvic subperitoneal sites. The purpose of our study is to evaluate the accuracy of magnetic
resonance imaging (MRI) for the preoperative diagnosis of deep pelvic endometriosis and location and extension of the disease.
Materials and Methods : Prospective evaluation of patients, suspected of having pelvic endometriosis, from January 2005 to
December 2006 in La Paz Hospital (Madrid, Spain). The inclusion criteria were: clinical symptoms of endometriosis (pelvic pain,
infertility, nodules, dysuria, dispareunia or dysquezia) and/or sonographic signs (bilateral cysts, multilocularity or masses in specific subperitoneal locations). These cases were evaluated using the MRI with jelly method.
Before the MRI, a mild laxative extract was orally administered daily for 3 days to empty the rectum. Then, ultrasonography jelly
was injected into the vagina, and jelly diluted 50% with water was administered into the rectum. The protocol included sagittal
and axial fast spin-echo T2-weighted images, axial spin-echo T1-weighted or gradient echo T1-weighted images with and without
fat suppression.
The following criteria were analysed for each patient when reading the MRI: size of the lesion; description of its contour, exact
location relative to neighboring organs and existence or absence of any suggestion of rectal adhesions. All the MR images results
were compared with the findings at surgery and the pathological results.
Results : 50 patients were studied by MRI to detect the presence of inclusion criteria. The most frequent symptoms associated
were: severe dysmenorrhoea (81%), dyspareunia (50%) and chronic pelvic pain (34%). After gynaecological exploration we found
rectovaginal septum nodule (13,7%), rectovaginal septum fibrosis (18,2%) and severe pelvic fibrosis (27,2%).
Using transvaginal echography we identified endometriotic ovarian cysts in 84% and adenomyosis foci in 21%. Ultrasounds demonstrated a sensitivity of 24,1%.
MRI shows lesions in different localizations: Douglas 100%, Ovary 75%, Rectovaginal septum 58%, Uterosacral ligaments 50%,
Adenomyosis 33,3%, Bladder 25%, Rectosigma 25% and Ureter 8,3%.
Surgery confirms the existence of suspected lesions in 43 patients. MRI sensitivity for detecting deep endometriotic lesions in our
study is 93,8%. There are differences in sensitivity depending on the localization of lesions. These sensitivities are summarized in
Table 1.
Localizations
Uterosacral ligaments
Vagina
Rectovaginal septum
Rectosigma
Bladder
TOTAL
Sensitivity
81%
77,8%
68,4%
80%
42,9%
93,8%
Conclusion : The high sensitivity (93,8%) of MRI compared to the poor results of routine clinical examination and low sensitivity
of ultrasounds in our patients (24,1%) leads us to consider MRI the best image technique to determine the extension, localization
and severity of deep infiltrating endometriosis with a high precision, in order to programme surgical procedures correctly.
Vaginoscopic hysteroscopy in postmenopausal women
E Altanis, V Gahlot, T Dada
Stoke Mandeville Hospital, United Kingdom
Introduction: Vaginoscopic hysteroscopy obviates the need to use speculum or tenaculum and has been associated with less pain
during the procedure. Our aim was to evaluate the feasibility and tolerability of this approach in postmenopausal women.
Methods: Prospective observational study. Hysteroscopy was performed in 127 unselected postmenopausal women in an outpatient setting and using a “no-touch” technique. A rigid 3.2mm hysteroscope with operating channel was used. Normal saline was
the medium for distention.118 women were referred because of postmenopausal bleeding and 9 because of incidental finding of
thickened endometrium on ultrasound scan. The main outcome measures that were studied were rate of successful completion of
the procedure, requirement of local anaesthesia and degree of pain during the procedure. Pain was defined arbitrarily as mild if the
patient was aware of discomfort only, moderate if the issue of anaesthesia was discussed and severe if the pain was significant
enough to warrant cessation of the procedure.
Results: Median age was 58 years and mean parity was 2.3. Ninety per cent of women had at least one vaginal delivery in the
past. Successful introduction and view achieved in 125 out of 127 (98.4%) cases. Examination was well tolerated (absent or mild
pain) in 109 out of 125 (87.2%) successful cases. Sixteen women developed moderate pain. Local anaesthesia was administered
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in nine cases and cervical dilatation was performed in four of them.
Conclusions: Vaginoscopic Hysteroscopy can be performed successfully in parous postmenopausal women in whom cervical
stenosis can be a possible impediment to endometrial assessment. The procedure was well tolerated by the majority of women
and requirements for local anaesthesia were relatively infrequent.
Prise en charge phytothérapique de la ménopause d’une femme atteinte d’un cancer du sein
B. Arnal (F)
Faculté de Médecine , Paris 13, France
Le traitement phytothérapique de la ménopause chez une femme atteinte d’un cancer du sein résulte d’une prescription individualisée, modulable dans le temps, prenant en charge la globalité de la patiente, dans son histoire au quotidien. Les plantes
médicinales sont de véritables phyto-médicaments avec des indications, des contre-indications, des risques d’effets secondaires
ou d’interférences médicamenteuses. Elles relèvent de la prescription médicale par un thérapeute averti.
Nous avons été les premiers en France à appeler à la prudence en juin 99 par voie de presse et à imposer à tous les phyto-oestrogènes qu’il s’agisse d’isoflavones de soja, de sauge, de kudzu, de cimificuga .. les mêmes contre-indications que celles relatives
à la prescription d’ oestrogènes de synthèse. En l’occurrence le cancer du sein qu’il soit hormono-dépendant ou pas est une
contre-indication à la prescription de tout phyto-oestrogène. Mais on peut se poser la question de savoir si la présence dans la
tumeur de récepteurs à la progestérone ne doit pas imposer la prudence quant aux dilutions homéopathiques basses de progestérone et quant à la prescription de phytoprogestérones dans le traitement naturel de la ménopause.
Le traitement phytothérapique de la ménopause ne se résume pas au simple traitement des bouffées de chaleur. Il impose une
réelle connaissance et pratique de la prescription de la plante médicinale. Il veut participer, associé à des conseils nutritionnels
incontournables, à la recherche d’un meilleur être, dans les suites de cette pathologie lourde et à la prévention du vieillissement
général, dans le cadre d’une réflexion générale sur la prévention de la récidive et des métastases.
Oral progestagens before menopause and breast cancer risk : Bringing new data of the mission Study
P. De Reilhac 1, M. Espié 2, T. Chevallier 3, M.C. Micheletti 4, D. Postrucnick 4, P. Mares 5
1 3 Place Ladmirault, Nantes, France, 2 Hôpital Saint-Louis, Paris, France, 3 Laboratoire de Biostatistique, d’Epidémiologie et de
Recherche Clinique, Montpellier, France, 4 Laboratoire Théramex, Société de la Division Merck Serono, Monaco, Monaco, 5 Service
de Gynécologie Obstétrique, CHU Hôpital Caremeau, Nimes, France
Introduction : To determine breast cancer incidence in women before menopause and after the age of 40 years with or without oral
progestagens exposure during this period.
Methods : Historical-prospective study with random patient selection. One period was studied : before menopause and after the
age of 40 years. Two groups were defined : “Exposed Group”: women on oral progestagens prescribed alone (except for mini-pills)
during this period ; “Unexposed Group”: women who never received oral progestagens during this period.
Results: 4333 patients was evaluated : 1527 Exposed Group, 2806 Unexposed Group. The Exposed Group was younger and less
overweight than the Unexposed Group. The mean duration of oral progestagens exposure in the Exposed Group was 3.15 years
+/- 2.48. During the period studied, the incidence of breast cancer cases was 1.31 % in the Exposed Group and 1.78% in the
Unexposed Group (Relative Risk Exposed/Unexposed 0.732, 95% CI [0.434; 1.234]). In the Exposed Group, the mean duration of
oral progestagens exposure was not significantly different in the subgroup with breast cancer comparatively to that without breast
cancer (respectively 3.15 years +/- 2.48 vs 3.11+/- 2.43).
Discussion: The results of this part of MISSION Study found no evidence for an increased risk of breast cancer in women exposed to
oral progestagens between before menopause and after the age of 40 years (after an average of 3.15 years of exposure) compared
with non-exposed women.
Clot formation assay in postmenopausal women receiving Femarelle (dt56a), oral or transdermal estrogens
L. Nachtigall1, R. Nachtigall1, M. Nachtigall1, LB Nachtigall2, R. Flaumenhaft2
New York University School of Medicine, New York, New York, United States (1) Harvard University, Boston, Mass, United States (2)
PURPOSE: Femarelle (DT56a) is a standardized phytoSERM for the treatment of menopausal symptoms. The Effect of Femarelle
on the clotting time of blood was assessed using the Platelet Function Analyzer-100 (PFA-100; Dade Behring,) and compared to
the results following transdermal and oral estrogen therapy.
METHODS: The PFA-100 instrument measures clotting time of blood under flow, yielding normal clotting time values of 61125 seconds. 84 menopausal women, not on estrogen therapy (ET) had blood analyzed on the PFA-100. Patients with under 61
seconds were not given ET. Both normal women( > 66 sec.) or “borderline” (61-66 sec.) received 8 weeks of oral or transdermal
ET. A subset of 25 patients received Femarelle. Clotting times were reanalyzed following 8 weeks of treatment. Patients < 60 sec
were placed on Femarelle & investigated for genetic factors as the cause of rapid clotting time.
RESULTS: Women, normal at baseline (n=71) demonstrated no significant change after 8 weeks of oral (n=29) or transdermal
estrogens (n=42). Women considered “borderline” (61-66 seconds) (n=13), showed a significant decrease (p=.001) after a trial
of oral estrogen (-6.8 sec), (n=5), but no significant change after a trial of transdermal estrogen (-1.1 sec), (n=8).The Femarelle
group (n=25) showed no change. Preliminary results of 7 patients, who were primarily excluded from the Estrogen arm, showed
no change in clotting time following 8 weeks of treatment with Femarelle. 6 of the 7patients were found to have hereditary thrombophilia. Data on more patients is currently under investigation. CONSLUSION: Neither oral, transdermal ET nor Femarelle affect
clotting times in women with normal baseline values as measured by the PFA-100. Patients with “borderline” values demonstrated a further increase in clotting potential after oral but not transdermal ET (p-.001). Patients with clotting times outside of normal
with genetic abnormalities placed on Femarelle had no change from baseline in their clotting times. These findings may place
Femarelle as a new therapeutic approach to symptomatic menopausal women with clotting problems and add an important safety
aspect of Femarelle for the “normal” ones. The study on Femarelle in high risk patients is currently extended to larger numbers.
The role of the PFA-100 in clinical management of menopausal women merits further study.
79
Antonio Bazarra-Fernández, Juan Canalejo
University Hospital Trust, Spain
Background: Fractures, especially vertebral fractures, are a common complication of osteoporosis, leading to significant pain.
Aim: To compare the pain release induced by osteoporotic vertebral fracture, through teriparatide and teriparatide plus calcitonine.
Methods: We performed a study to compare the analgesic effect of 20 mcg teriparatide versus 20 mcg teriparatide plus metered
dose intranasal spray 200IU/activation calcitonin in two groups between postmenopausal women undergoing osteoporosis with
vertebral fracture. A 10-point visual analog pain scale (1 = least to 10 = most painful) and a four-point pain grade (grade 1 = least
to grade 4 = most painful) were used to measure the pain perception.
Results: The mean pain scores for the teriparatide and teriparatide plus calcitonin were 2.3 ± 1.1 and 8.5 ± 1.1, respectively
(P<0.05), while the pain grades for teriparatide and teriparatide plus calcitonin were 1.5 ± 0.3 and 3.5 ± 0.4, respectively (P<0.05).
In teriparatide group, analgesics were requested, but in teriparatide plus calcitonin group no analgesics were requested (P<0.001).
Conclusion: Using teriparatide is more expensive than other osteoporosis treatment. Studies show that taking a bisphosphonate
with hormone replacement therapy (HRT), results in increased bone mass when compared to taking either a bisphosphonate or
estrogen alone. Besides, calcitonin is better for osteoporotic vertebral fracture pain release than HRT. However, a larger investigation will be needed to achieve more significant case number.
Evaluation of diagnostic usefulness of meassuring soluble receptors TNF-alpha P55 and P75 concentraction in women
with primary sterility
J. Buks (2), M. Wilczak (1), P. Rzymski (1), T. Opala (1)
Department of Mother`s and Child`s Health in the Poznan University of Medical Sciences, Poznan, Poland (1)
Student Scientific Society of the Gynaecology and Obstetric in the Poznan University of Medical Sciences, Poznan, Poland (2)
Introduction: In modern medicine the cause of infertility is believed to be immune mechnism disorders as well as immune over-reactivity. Aim: Objective of this thesis is evaluation of diagnostic usefulness of measuring soluble receptors TNFa p55 and p75 concentration in women with primary infertility. Materials and methods: Examination: 41 female patients (age 17 to 42) with primary
sterility undertreatment in the Department of Mother`s and Child`s Health of the Poznan University of Medical Sciences in a period
between January- September 2005. Control group consisted of 13 female patients. For identification of soluble receptors’ p55 and
p75 TNFa concentration were used commercial sets ELISA. For identification of TNFa-R1 and TNFa-R2 were used Quantakine
set. Quantitative in vitro method of hormone indentification in blood serum of plasma (ECLIA) has been used to estimate hormone
concentration. Results have been analyzed with t-Student test, Wilcoxon`s test, Fisher`s test and Spaerman`s test. P value <0.05
was considered significant. Results: There is no significant statistical relation between concentration of soluble p55 and p75 TNFa
receptors and age or BMI index, as well as length of periods. In case of soluble p75 TNFa receptor it has been proven the statistical correlation to length of period (p=0,004). From the statistical point of view, the most advantageous relation has been shown
in case of p75 TNFa soluble receptor and gauge of endometrium (p=0,007) as well as correlation of p55/p75 soluble receptors
(p=0,05). Similar results were obtained for relation of p55/p75 to size of rising vesicle (p=0,04). Conducted statistical analysis of
correlations between TNFR1 and TNFR2 receptors and concentration of hormones FSH, LH, PRL, E2, testosterone showed no
dependence of TNFR1 and TNFR2 receptors’ concentration and concentration of examined hormones. Analyzing statistical relations between the relation of TNFR1/TNFR2 receptors’ concentration a significant relation between abovementioned receptors
and concentration of LH was obtained (p=0,05). Conclusions: Correlation between endometrium gauge, size of dominating vesicle
and concentration of LH compared to soluble receptors’ p55 and p75 TNFa concentration, and their proportion might condition
time of survival of the vesicle or lead to excessive expression of its atresion-leading conditions.
Luteal estrogen supplementation in stimulated cycles may improve the pregnancy rate in patients undergoing IVF/ICSI-ET
Drakakis Peter, Loutradis Dimitris, Vomvolaki Eleftheria, Stefanidis Konstantinos, Kiapekou Erasmia, Antsaklis Aris
University Of Athens, “Alexandra” Maternity Hospital, Ivf Unit, Athens, Greece
Introduction: To evaluate the effect of estradiol (E2) addition to progesterone supplementation during the luteal phase on pregnancy and implantation rates in patients undergoing IVF/ICSI-ET cycles.
Methods: Prospective, randomized study. Patients who were undergoing IVF/ICSI with controlled ovarian hyperstimulation using a
GnRH analog/hMG long or short protocol. Patients were divided randomly in two groups according to the protocol used. The first
group took estrogen and progesterone supplementation from the day of oocyte retrieval and the second group took only progesterone supplementation during the luteal phase.
Results: Our results suggest a higher pregnancy and implantation rate in IVF/ICSI cycles with the supplementation of E2 in the
luteal phase (Table)
Discussion: E2 supplementation during luteal phase in women undergoing IVF/ICSI has a beneficial effect on the outcome without
having, as it seems, at least from this study, any adverse effects. Increasing pregnancy rates in IVF-ET is a difficult task and it is
worthwhile to continue investigations in this area to confirm our findings and to find the best possible results with variations in
dosage, administration time or estrogen compound.
80
Table .
I V F outcomes i n the two groups
G roup 1
(supp lem entati on w ith E2)
G roup 2
(N o supp lemen tatio n)
N o of subjec ts
39
38
N o of tra nsfe rs
176
150.0
N o of oocy tes retri eved
Fertli zati on rat e (%)
N o of emb ryos tra nsfe rred
N o of pregn an cies
7.2 (±1.8) *
76. 2
4.5 (± 0.9 )*
46. 2%
Imp la ntati on rat e (%)
10 .2%
Spon ta ne ou s abo rti on rat e (%)
71.7
3.9 (± 1.2 )*
18
Pr egn ancy rat e (%)
Ectop ic pregn ancy rat e (%)
6.5 (±2.2) *
a
a
p valu e
(< 0.05)
NS
NS
NS
6
15.8%
4.0%
a
a
5.6%
0.0 %
22.2%
16.7%
NS
NS
*M ean (±SD)
a: stati stically sign ificant (p valu e: 0.003< 0. 05)
Aide médicale à la procréation chez les femmes infectées par le virus de l’immunodéficience humaine : possibilités et
limites
J Guibert (1), E Dulioust (2), M Leruez-Ville (3), O Launay (4), R Leandri (2), Ph Sogni (5), E Charlemaine (6), C Rouzioux (3), P
Jouannet (2)
Unité de Médecine de la Reproduction. Service de Gynécologie-Obstétrique II. Hôpital Cochin-Saint-Vincent-de-Paul, Paris,
France (1)
Service de Biologie de la Reproduction. Hôpital Cochin, Paris, France (2)
Service de Virologie. Hôpital Necker-Enfants-Malades, Paris, France (3)
Service de Médecine Interne. Hôpital Cochin, Paris, France (4)
Service d’Hépato-Gastro-Entérologie. Hôpital Cochin, Paris, France (5)
Maternité Port-Royal. Service de Gynécologie-Obstétrique I. Hôpital Cochin, Paris, France (6)
Objectifs : Cette étude compare la réserve ovarienne des femmes infectées par le virus de l’immunodéficience humaine (VIH) à
celle de femmes non infectées et rapporte la faisabilité et les résultats de l’aide médicale à la procréation (AMP) chez les femmes
infectées qui souhaitent avoir un enfant.
Méthodes : La réserve ovarienne a été évaluée chez 167 femmes infectées par le VIH par la mesure du taux de FSH et d’œstradiol
plasmatiques au 3ème jour du cycle et comparée à celle d’une population contrôle de 334 femmes infertiles non infectées appariées sur l’âge. Les résultats de l’AMP ont pu être analysés pour 97 couples dont la femme était infectée par le VIH ayant bénéficié
de 72 tentatives de fécondation in-vitro (FIV) et de 231 cycles d’insémination intra-utérine (IIU) selon les paramètres du bilan de
fertilité du couple : taux d’annulation des cycles en FIV, taux de grossesse clinique en FIV et en IIU, taux de fausse-couche global,
taux d’accouchement global, taux de gémellité, nombre d’enfants nés, taux de transmission du VIH.
Résultats : La réserve ovarienne était significativement altérée chez les femmes infectées par le VIH par rapport aux femmes
non infectées (FSH : 10.9 ± 9.8 UI/L versus 6.7 ± 2.4 UI/L dans une population à œstradiol normal (<60 pg/L), p=0.001). Le taux
d’annulation en FIV était de 37%. Le taux de grossesse clinique était de 12% par cycle en IIU et de 22% par cycle en FIV et le
taux de fausse-couche du premier trimestre de 41%. 28% des femmes ont accouché et 21% des grossesses étaient gémellaires.
Il n’y a eu aucun cas de transmission du VIH de la mère à l’enfant sur les 34 enfants nés.
Conclusion : L’augmentation du taux basal de FSH suggère que la réserve ovarienne des femmes infectées par le VIH est souvent altérée, ce qui conduit à un taux d’annulation plus élevé en FIV du fait d’une réponse ovarienne souvent trop faible. Quand la
réserve ovarienne est normale, l’AMP semble efficace et sûre malgré un taux élevé de fausses-couches du 1er trimestre qui n’est
pas explicable par l’âge des femmes.
G Chene (1), MM Dauplat (2), F Mishellany (3), G Le Bouedec (4), P Jaffeux (5), B Aublet-Cuvelier (6), F Penault-Llorca (7), P Déchelotte (8), JL Pouly (9), J Dauplat (10)
Service De Gynécologie-obstetrique, Chu, St Etienne, France (1)
Service D’anatomopathologie, Hotel Dieu, Chu, Clermont Ferrand, France (2)
Service D’anatomopathologie, Centre Jean Perrin, Clermont Ferrand, France (3)
81
Service De Chirurgie, Centre Jean Perrin, Clermont Ferrand, France (4)
Département D’information Médicale, Chu, Clermont Ferrand, France (5)
Département D’information Médicale, Chu, Clermont Ferrand, France (6)
Service D’anatomopathologie, Centre Jean Perrin, Clermont Ferrand, France (7)
Service D’anatomopathologie, Hotel Dieu, Chu, Clermont Ferrand, France (8)
Service De Gynecologie Obstetrique, La Polyclinique, Hotel Dieu, Chu, Clermont Ferrand, France (9)
Service De Chirurgie, Centre Jean Perrin, Clermont Ferrand, France (10)
Introduction: La dysplasie ovarienne a été définie lors de l’analyse des pièces d’ovariectomis prophylactiques pour risque génétique de cancer de l’ovaire. Comme la stimulation de l’ovulation est considérée comme facteur de risque de cancer de l’ovaire,
nous avons étudié le risque de dysplasie après stimulation de l’ovulation.
Méthode: Dans cette étude de cohorte rétrospective, nous avons revu 125 pièces d’ovariectomies divisées en 3 bras: 35 patientes aux antécédents de fécondation in vitro, 28 présentant une mutation des gênes BRCA, 62 témoins spontanément fertiles et
sans risque génétique de cancer de l’ovaire.Ces ovaires ont été réexaminés en aveugle par 4 pathologistes: 11 critères épithéliaux, cytologiques et architecturaux (habituellement observés dans les tumeurs ovariennes épithéliales) ont été définis et un score
de dysplasie a été calculé pour chaque patiente afin de quantifier la sévérité des anomalies ovariennes épithéliales.
Résultats: Le score moyen de dysplasie est significativement plus élevé dans le groupe stimulé que chez les témoins (7.64 vs
3.62, p<0.0002). En plus, nous avons établi une corrélation entre le nombre de cycles d’ovulation et la sévérité de la dysplasie
(“effet-dose”), ainsi qu’une relation significative entre la durée après la fin des stimulations et la sévérité de la dysplasie (au-delà
de 7 ans, “effet-temps”). Le score de dysplasie est aussi significativement plus élevé dans le groupe à risque génétique par rapport au groupe stimulé (11.26 vs 7.64, p=0.02), et au groupe témoin (11.26 vs 3.62, p<0.0001).
Conclusions: On ne peut pas affirmer que le risque de cancer de l’ovaire soit augmenté par la stimulation de l’ovulation. Cependant, il y aurait probablement une relation entre dysplasie ovarienne et stimulation.En raison du risque cancéreux reconnu et de
la présence démontrée ici de dysplasie chez les porteurs des mutations BRCA, la dysplasie pourrait être le précurseur du cancer
de l’ovaire (phénotype prénéoplasique?). D’autre part, différentes études ont relié stimulation et tumeur border-line de l’ovaire: les
différents aspects histopathologiques et la gradation dans la dysplasie entre stimulées et risque génétique confirmeraient cette
association. Quoiqu’il en soit, la stimulation de l’ovulation doit conduire à une surveillance ovarienne attentive et à long terme.
Comparison of cytogenetic abnormalities rates in couples investigated prior to ICSI and those explored after one or more
unsuccessful ICSI attempts
Nouha Abdelmoula1, Mounira Meddeb3, Ahlem Amouri4, Lyess Mokaddem2, Faouzi Bouzid2, Abdelwaheb Belhadj2, Mourad Kammoun2, Abdelhamid Ammous2, Tarek Rebai1
1 university Of Medicine, Tunisia, 2 private Sector, Tunisia, 3 private Sector, Tunisia, 4 pasteur Institute, Tunisia
Genetic testing before ICSI is always limited to chromosome analysis of male infertility (oligospermia and azoospermia) since
recommendations for genetic counselling and screening are not well understood. Here we present results of cytogenetic investigations performed in 181 couples prior to ICSI or after unsuccessful attempts. This study objective was to compare the frequency
of chromosomal aberrations in couples undergoing ICSI for the first time and those failing to conceive after one or more ICSI
attempts. Couples were classified according to the ICSI indications as: Group 1: 99 couples undergoing ICSI for the first time
indicated because (1-1) male oligoasthenoteratozoospermia (OAT) (n= 42), (1-2) male azoospermia (n=13), (1-3) male asthenoteratospermia (n= 14) and (1-4) others indications with normospermic men (n= 30). Group 2: 82 couples failing to conceive by ICSI
indicated because (2-1) male OAT (n=41), (2-2) male azoospermia (n=5), (2-3) male asthenoteratospermia (n= 13) and (2-4) others
indications with normospermic men (n=23).
Out of these 362 patients, sixteen had an abnormal karyotype (4,42 per cent patients and 8,84 per cent couples); fourteen men
(14/181: 7,73 per cent) and two women (2/181: 1,10 percent). We have considered inversions of chromosome 9 and chromosome 12 as major abnormalities. Frequencies of chromosome abnormalities are estimated to 6,06 per cent in group 1 and 12,2
per cent in group 2. If we consider inversions as minor abnormalities frequencies became respectively 5,05 per cent and 8,53 per
cent. Most chromosomal abnormalities detected were structural rearrangements. Our results combined with those of the literature stress the importance of karyotyping both male and female partners before ICSI is started to ovoid couples, unsuccessful
attempts. Adequate genetic counselling, followed by preimplantation or prenatal diagnosis, should be offered if a chromosomal
abnormality is detected.
Thus, much greater overlap between reproductive medicine and genetics is necessary and a close collaboration between professionals working in these two fields is imperative in treating patients with infertility in the best possible way.
Evaluation de l’intérêt du test HPV chez les femmes enceintes de plus de trente ans. Résultats intermédiaires d’une série
de 333 patientes (1000 patientes prévues au total)
E Vaucel1, M Coste-Burel2, H Pigeau3, C Laboisse4, P Lopes3, Hj Philippe4, Hj Philippe1
1 CIC 0004 Chu Nantes, France, 2 service De Virologie Chu Nantes, France, 3 service De Gynécologie Obstétrique Chu Nantes,
France, 4 service De Cytologie Et Anatomo-Pathologie Chu Nantes, France
Introduction : Nous proposons la réalisation d’un test HPV aux femmes enceintes de plus de trente ans. En effet, les difficultés du
dépistage par le FCV sont la sensibilité médiocre du test et un taux de couverture trop faible. En cours de grossesse, les obstétriciens et les sages femmes ne voient leurs patientes le plus souvent qu’au 3ème trimestre, à ce moment le FCV n’est que très
rarement fait. Méthode : Il s’agit d’une étude prospective avec recherche et génotypage du virus HPV sur brossage de l’endocol
par PCR chez les femmes enceintes de plus de trente ans. Il était recommandé une vigilance particulière dans le contrôle du
dernier FCV, et le FCV était réalisé selon les habitudes de l’investigateur. Les patientes HPV HR positives étaient revues dans le
post-partum (3 à 6 mois) pour un contrôle de l’HPV, un FCV et la réalisation d’une colposcopie. Nous proposons une analyse intermédiaire avec analyse critique du dépisatge par FCV en cours de grossesse. Résultats : Le test HPV a été réalisé chez 333 patientes au terme moyen de 33 SA+5J (IC 95%: 33-34SA+3J). Le prélèvement était fait le plus souvent dans le même temps que la
recherche de streptocoque B. Nous ne notions pas de problème dans la réalisation pratique du geste à ce terme, et raportons une
bonne faisabilité. La prévalence de HPV HR était de 9.91%, avec une distribution des génotypes habituelle (HPV 16: 33.3%, HPV
82
18: 2.78%, la prévalence des principaux génotypes -16, 18, 31, 33, 45- étaient 66.7%). Chez 30.7% des patientes HPV négative
et 36.4% des patientes HPV positives nous n’avons pas de FCV. Ce qui nous laisse à penser que le clinicien ne peut pas identifier
à priori les patiente à risque pour qui la recherche ou la réalisation d’un FCV paraît indispensable. Nous présentons la description
de la population HPV positive (le tabagisme >10PA est plus élévé dans le groupe HPV positif, OR=3.14, p<0.01), et les résultats
du contrôle dans le post partum : Infection HPV persistante (69.2%), corrélation viro-cyto-histologique (23% de CIN2 dans ce
groupe). Conclusion : La grossesse pourrait être un point de dépistage systématique par l’utilisation du test HPV sensible, simple
dans sa réalisation et son interprétation. La réalisation du test HPV en cours de grossesse lors des consultations à la maternité est
faisable, et permet d’identifier des patientes à risque qui doivent avoir une surveillance dans le post partum.
Human papillomavirus cervical infection and associated risk factors in two urban populations of mexico with high incidence of cervical carcinoma
J.G. Rendón Maldonado1, H.S. López Moreno1, F. Morgan Ortiz2, I. Osuna Ramírez1, S.P. Díaz Camacho1
1 Unidad de Investigaciones en Salud Púlica “louis Pasteur”, Facultad deCiencias Químico-Biológicas-Universidad Autónoma de
Sinaloa, Mexico, 2 Hospital Civil de Culiacán, Mexico
Cervico-uterine cancer (CUC) is the main cause of cancer in women worldwide and Mexico is not the exception, where is an
important health problem and occupies the first places as cause of morbi-mortality in women in productive and reproductive age.
Several clinical, epidemiological and molecular studies shown that more than 90% of women with CUC and their high-grade precursor lesions have high risk human papillomavirus (HPV) mainly genotypes-16 and 18. The aim of the present work was to study
the frequency of oncogenic HPV in two urban populations of women from Sinaloa, Mexico.
Two hundred and fifty six vaginal samples of women between 15 and 65 years old that attendant to the clinic of dysplasias of two
regional hospitals from the state of Sinaloa were studied. With previous consent, a survey was applied to each patient to get information about factors risk. 256 samples of exocervix and endocervix were collected, which was incubated 2 hr to 50 ºC with digestion buffer containing 0,1 mg/ml proteinase K. DNA was purified by extractions with phenol-chlorophorm-isoamyl alcohol and the
PCR run out in 30 μl final volume. Primers for a fragment of human beta-globin were used as an internal control. The genotyping
of HPV 16, 18, 31 and 35 was made using MY09/MY11 consensus primers and later by RFLP’s. Preliminary results shown that
92% of the patients begun their sexual life before 24 years old; nevertheless, 46% did it before the 18 years. 60% of them have
used contraceptive oral as prenatal control. Almost a half of the studied women (44%) had her first childbirth before the 19 years.
Respect to the pathological background, 52% of women referred previous sexually transmitted infections: 37% HPV, 25% condylomes and 38% did not specify the aetiology. Additionally 52% of the studied women had cysts mainly in ovary and in 36% of
the cases the diagnosis was malignant. The vaginal cytology study shown that around 50% of the patients had a NIC II and 38%
NIC I with unspecific inflammation. Preliminary results of the molecular diagnosis of HPV using MY09/MY11 primers agree with
the cytological diagnosis amplifying a fragment of 450 bp by PCR; nevertheless, some samples with diagnostic of NIC I and NIC II
only, amplified also the 450 bp fragment. Although this work is still in developing, it determines that PCR is a very sensible method
to establish the diagnosis and genotyping of HPV.
R. Wiborny
Praxisgemeinschaft gsundinhorn, Horn, Austria
Objectives: the intention of this study was to show the side effects of tubal ligation and to point out the alternatives.
Materials and Methods: Own experiences lead to a literatur research on psychological, surgical,gynecological and anaesthesiological aspects.We looked at Cochrane database and medline for the last 30 years .
Results: Up to now tubal ligation has been the first choice for a guaranteed contraception. Now, after developing methods for a
long-term birth control, this has changed.
Neither a Medroxyprogesterone injection nor a subcutaneous Etonogestrel-implant had as little side effects, or other disadvantages, as the levonorgestrel-releasing intrauterine system, which therefore proved as the best alternative.
The benefits of a reversible long-term birth control are obvious.
The reasons of sterilisation regrets are various .There are neither the psychological problems due to the sudden impossibility to
reproduce, nor are there the risks of surgery or anaesthesia.
Since the CREST-study has been released in 1999 the cumulative rate of pregnancies after a tubal ligation presents itself in a different light. The average of 18 pregnacies in ten years of 1000 women,who had different surgical procedures for sterilisation, was
astonishing.
The PTL (post tubal ligation syndrome), which contains abnormal bleedings, is still discussed controversally.
There are additional benefits of the LNG-implants in cases of endometriosis, dysmenorrhoea, menorrhagia and posthemorrhagic
anaemia.
Conclusion: the Levonorgestrel IUD „Mirena“ seems to be the best alternative to tubal ligation until now.
Particularities of combined oral contraceptives interactions in thrombophilia
Leontina Surtea 1, Alice Gavrila 2, Magda Manolea 2, Paul Lucian Surtea 1
1 University of Medicine, Romania,
2 Clinical Municipal Hospital Filantropia, Romania
Combined oral contraception (COC) has an procoagulative effect (raising prothrombine, the VII,VIII,X factors and decreases the
V-th factor) and an anticoagulative effect (decreases the S protein, increases resistance to reactivated C protein) but the predominant cumulative effect is procoagulative. These effects were attributed to the estrogens. The progestative component was not
considered to contribute to the raise of thrombosis for its users but the third generation progestatives were established to have an
intrinsic prothrombotical activity, although positive effects on HDL-cholesterol, generating the decrease of the coronary thrombosis risk. Objectives: Our paper represents an extensive study over the relation between COC and the thrombo-embolism disease, in order to prevent the appearance of these complications during the contraceptive treatment. Materials and methods: The
patients following the treatment with oral contraceptives are in general young women without pathological antecedents; therefore
83
the anamnesis is eloquent only in the field of hereditary antecedents. Results: From 325 patients attending contraception methods and selected for COC prescription we identified 27 cases with positive hereditary antecedents of thrombophilia selected for a
first group of tests (PT, INR, APTT) in order to identify the thrombotic risk. From this group, 11 patients had normal results, which
allowed the administration of COC under careful surveillance with good results. In 16 cases, the modified results of the blood
tests imposed specific tests for diagnosis of congenital thrombophilia (determination of antigens components connected to the
activity of AT III of C and S proteins, evaluation of resistance to activated C protein, determination of the activity of tPa and PAI-1,
test for the hyperhomocystinemia, mutations at the 20210 - prothrombine level. The results for this tests indicating thrombophilia
determined us to advise those patients for other contraceptive methods (POP, IUD).Conclusions: we consider as necessary the
investigation of hereditary antecedents of hypercoagulation before COC administration, in order to avoid deep venous/arterial
thrombosis. If the antecedents are positive, coagulation tests are necessary. If the tests indicate the tendency of hyper coagulation, specific tests for thrombophilia are required. The diagnosis of thrombophilia indicates another contraceptive method than
COC. particular for each case.
Perseptive of indian acceptors of implanon R regarding contraceptive choices: an icmr task force study
L. N. Gaur, Malabika Roy, Chander Shekhar
Indian Council of Medical Research, New Delhi, India
Objectives: To assess the acceptors perspectives and relative choice of ImplanonR – a single Rod contraceptive implant.
Design and Method: A study on Implanon with the above objectives has been initiated at 17 Human Reproductive Research
Centers (HRRCs) located in the Deptt. Of Obst. & Gynae of Medical Colleges in different parts of the country. After obtaining
clearance from Drug Controller General of India (DGCI) and institutional review Board, the study was initiated. The subjects were
enrolled after screening inclusion /exclusion criteria as per protocol. A balance presentation was given to all eligible subjects
about new and the available contraceptive methods in National Family Planning Program. The perception of acceptors was noted
after insertion of Implant by the staff not involved in this study.
Results: A total of 2745 women opted the method through cafeteria approach ranging from 20 to 38 years of age. Of which 2727
(99.3%) women informed that they were briefed about all the available methods (IUD/OC/Condom/Sterilization/Implation etc.). Out
of 7227 women, 1957 (71.8%) could understand what was explained to them and 756 (27.7%) could understand partially about all
contraceptive methods. Out of total women enrolled 93% had Implanon as their first choice, 3.2% for injectables & 2% had IUD
as their Ist choice.The reasons for opting this method by the women were long effectiveness–46%, safe–13%,ease in insertion11%, and insertion in arm–7%. Of the total accepters, 97.5% desired to use this method for 36 months. In order to assess the results of counseling, women were asked to elicit the advantage & disadvantage of the method. The response related to advantage
of the method stated were as -long acting method-47%, safe–15%, insertion in arm–11%, less side effect–13% and new method
(no need of daily interference)–8% and the related disadvantage were menstrual abnormalities – 65%, weight change–16% and
headache-5% as stated by women.
Conclusions: The results of the study indicate that women accepted the method for its long effectiveness, ease in insertion,
insertion in arm, safety and minimal side effects. The side effects in terms of menstrual disturbances, weight gain, headache were
agreeable to them prior to accept the method. The relative acceptance of this method is very high.
Jan Endrikat1, Susanne Parke2, Ingrid Duijkers3, Christine Klipping3
1 Bayer HealthCare, Canada, 2 Bayer Schering Pharma AG, Germany, 3 Dinox Medical Investigations, Netherlands
Background: There have been several attempts in the past to increase tolerability of OC, one was to substitute ethinyl-estradiol
(EE) by 17beta-estradiol (E2) or its valerate ester (E2V). However, these approaches were unsatisfying with respect to ovulation inhibition and cycle control. To optimize cycle control we combined E2V with the progestin dienogest (DNG) that has strong
endometrial activity, and evaluated different four-phasic regimens, instead of monophasic regimen. We present the results of two
dose-finding studies on ovulation inhibition. Methods: We performed two open-label, randomized studies at a single center. The
full-analysis set comprised 192 and 203 subjects, respectively. Study 1 compared two regimens (1A and 2A) with similar dosages
but different daily application. Study 2 compared two regimens (2B and 2C) with similar daily application but different dosages.
The primary efficacy variable was the proportion of subjects with Hoogland score of 5-6 (LUF or ovulation) during cycle 2. Results:
In study-1, 10 subjects (10.9%) and 6 subjects (6.4%) had Hoogland scores 5–6 in regimen 1A and 2A, respectively. In study-2, 3
subjects (3.13%) and 1 subject (1.03%) had Hoogland score 5–6 in regimen 2B and 2C, respectively. There was no safety concern
with any of the formulations. Conclusion: Regimen 2B (2 days E2V-3mg, 5 days E2V-2mg/DNG-2mg, 17 days E2V-2mg/DNG3mg, 2 days E2V-1mg and 2 days placebo) contains the lowest effective dose for efficient ovulation inhibition and is currently
investigated in phase-III studies. This approach is expected to become the first globally available OC containing E2 instead of EE.
Awareness and use of emergency contraception among women requesting termination of pregnancy
Efstathios Altanis, Wesley McCullough
Northampton General Hospital, Northampton, Northamptonshire, United Kingdom
Objectives: To assess the knowledge and use of emergency contraception among women who attend a gynaecological outpatient’s clinic requesting termination of pregnancy.
Background: Emergency contraception is a safe and effective way of preventing unwanted pregnancies and therefore it can reduce terminations of unplanned pregnancies.
Materials/ Methods: A prospective questionnaire survey, including 179 women who were referred during the period January-September 2006.
Results: 179 women attended the clinic and completed questionnaires were returned in 175 cases. All but two pregnancies were
unplanned. Current contraception failed in seven out of ten women. Half of these women were using barrier methods for contraception and one third was taking the common oral contraceptive pill. One out of five women had undergone termination of
pregnancy in the past. Seventy five per cent of women were aware of emergency contraception. Fifty per cent had used hormonal
emergency contraception previously.
Eighteen women had used emergency contraception, exclusively hormonal forms, to try to prevent this current pregnancy. There
was no case where an intrauterine coil had been used as emergency contraception. The majority of women (60%) who knew that
their contraception could fail and were aware of the emergency contraception, did not use it because they did not consider the
possibility of pregnancy.
84
Conclusions: The level of knowledge of emergency contraception in this group of women is similar to the level that has been
quoted in studies conducted in other regions of the United Kingdom over the past decade. In comparison to previous studies
there has been an increase in the reported use of emergency contraception. Cases suitable for consideration of post coital contraception demonstrated a low uptake rate in the current pregnancy. It is apparent that a significant number of women do not seek
post-coital contraception although they know about it and possibly even have experience of taking hormonal forms of post-coital
contraception. The commonest contributing factor for the low uptake is the fact that women do not consider the possibility of
pregnancy.
A review of reproductive disturbances accompanying pituitary adenomas
Aristides Lytras, George Tolis
Hippokrateion General Hospital, Athens, Greece
Pituitary adenomas are usually sporadic but also appear as part of mutliple endocrine tumor syndromes. Concurrent with pituitary
adenomas, reproductive abnormalities may occur via different mechanisms: (a) Hyperprolactinemia due to (i) direct production
by prolactinomas or mixed somatolactotroph tumors or (ii) pressure of the optic chiasm by a pituitary tumor resulting in abruption of the tonic ihibition of lactotrophs by dopamine (b) Hypogonadotrophic hypogonadism due to mechanical pressure on
gonadotrophs by the pituitary tumor (c) Hypercortisolism due to Cushing’s disease (ACTH adenoma) (d) Hyperthyroidism due to
a TSH producing tumor (e) gonadotrophin hypersecretion by a LH/FSH producing tumor (f) tumors or functional disturbances in
reproductive organs in the context of a multiple endocrine syndrome. McCune-Albright syndrome is accompanied by GH excess,
hyperprolactinemia and hyperthyroidism. Sexual precocity (part of the characteristic triad of this syndrom) is very frequent, associated with episodic increases in serum estrogen, a parallel reduction in gonadotropin secretion and large ovarian cysts. Autonomous ovarian function persists during puberty and early adult life (J Pediatr Endocrinol Metab 19 Suppl 2:607-17, 2006). In CNC
somatotropinomas and occasionally prolactinomas (Br J Dermatol 126:367-7, 1992) occur. Reproductive organ manifestations
include breast ductal adenomas, large-cell calcifying Sertoli cell tumors (LCCSCT), Leyding cell tumors (LCT) or adrenocortical
rest tumors of the testes, and ovarian tumors (such as serus cystadenomas). LCCSCT and LCT have been associated with sexual
precocity (J Clin Endocrinol Metab 86: 4041–4046, 2001). Myxoid uterine leiomyomas are also observed quite frequently while an
atypical mesenchymal neoplasm of the uterine cervix has been reported (Am J Med Genet 73:369-77, 1997). In MEN1, anterior
pituitary adenomas include prolactinomas, somatotropinomas and ACTH secreting tumors, while a gonadotroph tumor has been
also reported (J Clin Endocrinol Metab 90:570-4, 2005). An ovarian gastrinoma and carcinoids of the ovary have been reported in
patients with MEN 1 (Am J Obstet Gynecol 184:237-8, 2001; Int J Gynecol Cancer 12:337-47, 2002) while uterine smooth muscle
tumors have been linked with loss of heterozygosity in 11q13 i.e. the locus that contains the MEN 1 gene (Am J Pathol 159:11217, 2001).
High dose testosterone traetment has no adverse effects on the endometrium of female to male transsexuals
Anna Myriam Perrone1, Francesca Armillotta 1, Antonietta Costantino 1, Silvia Cerpolini1, Guido Formelli 1, Paolo Casadio 1, Nunzio CM Salfi 2, Lucilla Badiali De Giorgi 2, Francesca De Musso1, Barbara Di Marcoberardino 1, Giuseppe Pelusi 1, Maria Cristina
Meriggiola 1
University of Bologna, Center for Reproductive Health, Obstetrics and Gynecology Clinic, Bologna, Italy (1) University of
Bologna,Pathology Clinic, University of Bologna, Bologna, Italy, Bologna, Italy (2)
Objects: Testosterone (T) patches have been recently approved in Europe for replacement therapy in surgical menopausal women
who complain of low sexual desire. Long term safety of T administration in women is still unknown. In particular no data exists on
the effects of T on the endometrium. The aim of this study is to evaluate the effect of high dose T administered for at least one
year on the endometrium.
Methods
Endometrial biopsies from nine Female to Male transsexuals (FtM) treated with T (i.m. injection of 100 mg Testoviron Depot /10
days for least one year), 7 postmenopausal women undergoing vaginal hysterectomy and 5 premenopausal women undergoing
hysteroscopy for infertility problems were collected. Endometrial proliferation was evaluated on the basis of histopathology and
expression of the proliferation marker Ki-67. Both postmenopausal (M) and premenopausal (PrM) women had not received any
hormonal treatment for at least one year.
Results
All FtM subjects had received T for 32.7+12.4 months (range 22-48 months) and had stopped treatment at least 7 days before
surgery. At histological analysis, atrophic, proliferative and polipoid endometrium were reported in 6, 3 and 0 subjects respectively.
All M women had healthy atrophic endometrium and all PrM women had healthy proliferative endometrium. The mean of Ki-67
expression was similar in the endometrium of FtM and M women.
n
Age (years) BMI
(kg2/h)
FtM
M
PrM
32 + 12.4
60 + 4.8*
38 + 5.9 24.4 + 0.2
28.2 + 4.4*
21.7 + 0.9*
9
7
5
T (ng/dl) Ki-67
(%)
Hystology
Atrophic Proliferative Polipoid
4.7 + 3.0
n.a.
0.4 + 0.3*
1.2 + 1.0
1.0 + 1.4
42.6 + 17.1*
6
7
0
3
0
5
0
0
0
*= P<0.05 vs. FtM
Conclusions
Our preliminary data suggest that long term, high dose T treatment does not stimulate endometrial proliferation in FtM subjects.
Exogenous T administration appears to have no adverse effects on the endometrium.
Expressions of the epidermal growth factor receptor, vascular endothelial growth factor and vascular endothelial growth
factor receptor on the human placenta in twins pregnancies without and with associate obstetrical pathology
Ruxandra Stanculescu, Florina Vasilescu, Carmen Ardeleanu, Teodora Vladescu, Carmen Predoi
University of Medicine “Carol Davila”, Bucharest, Romania (1), Natinal Institute of Pathology “Victor Babes”, Bucharest, Romania
(2), Natinal Institute of Pathology “Victor Babes”, Bucharest, Romania (3), “St. Pantelimon” Hospital, Bucharest, Romania (4), University of Medicine “Carol Davila”, Bucharest, Romania (5)
85
Objective The purpose of the study is to asses the expressions of angiogenic factors represented by the epidermal growth factor
receptor (EGFR), the vascular endothelial growth factor (VEGF) and the vascular endothelial growth factor receptor (VEGF-R1) in
human monochorionic and dichorionic twins placentae without and with associate obstetrical pathology in the third trimester of
gestation. Material and Methods The analysis was performed for twins pregnancies without associate pathology (controls) and
with intrauterine growth retardation (IUGR) or pre-eclampsia (cases). Immunohistochemistry study was effectuated on 24 different
human placentae: 12 monochorionic, 12 dichorionic; of them eight cases were with IUGR, eight cases were with pre-eclampsia
and eight missed any pathology. The monoclonal antibody used was EGFR [Sigma 1:1000], VEGF- R [Santa Cruz 1:50], VEGFR1 [Santa Cruz 1:50]. We used the observational method for the interpretation of the results. Results The Immunohistochemistry
study on the placental tissue samples revealed a negative expression of EGFR in all situations. Expression of the VEGF and
VEGF- R1 was positive on all analysed samples. VEGF was lower in syncytiotrophoblast for monochorionic placentae than for dichorionic placentae during all the third trimester of gestation. However, VEGF and VEGF- R1 expressions inside of the dichorionic
placentae were not significantly different between normal twins pregnancies and cases associated with IUGR or pre-eclampsia.
Furthermore, we did not observe any differences in VEGF and VEGF-R1 expression inside cytotrophoblast and syncytiotrophoblast. Conclusion This research deduced that the expression for VEGF and VEGF- R1 in placentae provided from twins pregnancies during the third trimester is constantly elevated. All our processed slides identified the same expressions for these angiogenic
factors both in pre-eclampsia or IUGR cases. As a consequence of hypoxia in all situations their expressions were increased.
In the same tissue samples EGFR was constantly absent. In conclusion the elevated expressions for both VEGF and VEGR- R1
support the idea of the impairement of placental angiogenesis in twins pregnancies; for obtaining useful results about obstetrical
pathology forecast, the above expressions will be correlated with maternal serum analysis.
V. Valentino, G. Simi, C. Nanini, A. Riccardo Genazzani
University of Pisa, Italy
OBJECTIVE: Dehydroepiandrosterone (DHEA) and its esther dehydroepiandrosterone sulfate (DHEAS) are produced by the adrenal glands and in minimal percent by fertile ovaries. These hormones are inactive precursors that are transformed into active sex
steroids in peripheral target tissues, where they are thought to affect mood and well-being. After reaching a peak in early adulthood, plasma concentrations of this steroid show a progressive decrease throughout adult life. Starting from thirty to thirty-five
years we observe a progressive decline in the function of the adrenal gland reticular zone and consequent reduced Δ5-androgen
synthesis. Postmenopausal and aging females also exhibit a decreased synthesis of DHEA and Δ4-androstenedione on behalf
of the ovaries, and this may be associated in reduction of libido, well-being as well as fatigue. This constellation of symptoms
constitutes the Androgen Insufficiency Syndrome (AIS), an important biological substrate of female sexual dysfunction. In women,
the increased DHEAS levels facilitate additional production of downstream androgens, testosterone, dihydrotestosterone, androstenedione.
The aim of our study was to evaluate the effects of supplementation with dehydroepiandrosterone (DHEA) oral administration on
androgens circulating levels in postmenopausal and aging women and a correlation between the DHEA oral supplementation and
female sexual function.
DESIGNS and METHODS: 15 postmenopausal women, aged 50-55 years, were treated with 25 or 50 mg/day of DHEA orally
(based on basal DHEA-S serum levels). All patients underwent hormonal evaluation before and at 3, 6 months of therapy. We have
dosed circulating DHEA, DHEAS, androstenedione, dihydrotestosterone, testosterone, dehydroepiandrosterone. We have evaluated their sexual function by Female sexual Function Index questionnaire (FSFI).
RESULTS: Levels of DHEA, DHEAS, androstenedione, testosterone and dihydrotestosterone increased progressively already from
the third month of treatment. With the improved female androgenic profile, we observed an improvement in sexual thoughts and
fantasies as well as an enhancement in mood and well-being.
CONCLUSIONS: The female adrenal androgen deficiency syndrome, characterized low serum DHEAS levels, may be corrected by
DHEA supplements that increase levels of DHEAS and downstream androgens of importance to female sexuality.
Thrombophilia and Recurrent Pregnancy Complications
A. Makatsariya, V. Bitsadze, S. Baimuradova, S. Akinshina
I. M. Sechenov Moscow Medical Academy, Moscow, Russia
Introduction: To determine genetic thrombophilia and to evaluate the preconception treatment efficiency in women with pregnancy
complications. Methods: 56 patients with preeclampsia, 150 patients with fetal loss syndrome and 32 patients with metabolic
syndrome (MS) and obstetric complications in anamnesis were tested to have genetic thrombophilia, antiphospholipid antibodies
(APA) and received treatment in the preconception period and during pregnancy. The preconception treatment included LMWH,
aspirin in low doses, antioxidants, vitamins of B group, folic acid. The basic therapy during pregnancy was LMWH guided by Ddimer. Control group: 55 patients with preeclampsia, 155 patents with fetal loss syndrome and 45 patients with MS receiving this
therapy since II or III trimester. Results: Thrombophilia was detected in 96,4% women with recurrent preeclamsia, 82% patients
with fetal loss syndrome, 93,5% (mainly 4G/5G PAI-1 polymorphism) patients with MS. In the study group nobody had moderate
or severe preeclampsia, mild preeclampsia was observed in 16%. Preconception therapy allowed preventing recurrent fetal loss
syndrome in 66%; 96% were delivered after 37 weeks. The therapy started since II or III trimester was not so effective: 32,7%
patients with preeclampsia were delivered prematurely, babies did not survive in 27,2%; 52% patients with previous fetal loss
were delivered prematurely, babies were alive in 44% (p<0,05 for all comparisions). Discussion: Thrombophilia might be the main
pathogenetic mechanism of recurrent pregnancy complications. Due to thrombophilia involvement in trophoblast invasion and placentation, early treatment is essential. Preconception treatment with LMWH allows preventing recurrent pregnancy complications
in most cases.
Preventive and treatment the women with Virus Hepatitis B, C and AIDS in during and outside pregnancy
Vladimir Kuzmin
Moscow State University of Medicine and Dentestry, Moscow, Russia
Study of features of current and outcomes at virus hepatitis B, C and HIV at the women, development of rational tactics of running of pregnancy, delivery, postpartum period at the women and newborn with virus hepatitis B, C and HIV. There is urgent need
86
to develop the tactics of running the pregnant women and to work out preventive measures of newborns as the growth of virus
hepatitis B, C and AIDS illnesses and the number of pregnant women carriers is increasing. We have revealed 345 women with
virus hepatitis B, 175 women with virus hepatitis C, 275 women with HIV infection and followed them during pregnancy. The
given quota of the women was directed from Female advice Dispensaries to Hepatological Centre, where they were given a highly
skilled advice and carried out laboratory-diagnostic examination; and if necessary, they got medical help. The ultrasonic examination and dopplerography during pregnancy, as well as, computer cardiotocography of fetus were carried out to reveal the pathology of fetus. The women were followed up during the time of pregnancy and they were admitted for delivery to the maternity
home of Clinical Infections Hospital № 1. The medical therapy directed on removal of symptoms most frequently to an observed
pathology, with the account thus of a degree of weight and stage virus hepatitis, has allowed to keep pregnancy at all women. To
prevent development of virus hepatitis B all newborns were introduced vaccine during the first hours after delivery. The following vaccination of children were carried out at the age of 1, 2 and 12 months of life. With the purpose of preventive maintenance
virus hepatitis C applied immunoglobulin. The vaccination was the extremely effective measure and it was allowed to exclude the
occurrence of virus hepatitis B with children. Chemoprophylaxis HIV infection by azidothymidine at pregnant women descend
frequency transmission HIV to newborn with 50% to 5%. Realization hemostatic cesarean section permit descend frequency
transmission HIV to newborn with 10% to 2%. Thus, the creation of women dispensary system and organisation of newborn help
and the choice of optimum obstetrics tactics with the virus hepatitis B, C and HIV pregnant women are the necessary condition
for the decrease of perinatal mortality and morbidity.
Prophylactic embolisation of placental disorders
Denis Henroteaux, Malek Tebache, Frederic Chantraine, Xavier Chapelle, Adrienne Henroteaux, Jean-pierre Schaaps
CHR de la Citadelle, Liège, Belgium
Purpose:
To evaluate the efficiency of prophylactic uterine arteries embolization in case of placental disorder to prevent severe haemorrhage.
Material and method:
From 1997 to 2005, 6 patients were admitted for placental disorder : 2 placenta accreta, 1 placenta percreta, 1 cervical pregnancy,
1 trophoblastic disease and 1 post-molar uterine arterio-veinous fistula. Patients undergo prophylactic embolization. In 5 patients,
both uterine arteries were selectively catheterised and embolized by gelfoam + microparticles 3, gelfoam + coils 1, gelfoam only
1.One patient need only a right uterine artery embolisation with particles.
Discussion:
Placental disorder like placenta accreta, or percreta, cervical pregnancy, trophoblastic disease and post-molar uterine arterio-veinous fistula are associated with a high risk of hemorrhage and hysterectomy.
Only one patient bleed after embolization and need a second succesfull embolization.
No bleeding occur in the other patients. Embolization were followed by pregnancy ending and medical treatment in 4 patients.
Two patients don’t need any other treatment.
Conclusion:
Prophylatic embolisation of placental disorder is efficient and safe to prevent the risk of major bleeding and to avoid hysterectomy.
87
Abstracts of the posters - Résumés des Posters
Jury of the Best Poster Prize - Jury du Prix des Posters
Under the Chairmanship of Prof. A. de Almeida Santos (P)
Sous la Présidence du Prof. A. de Almeida Santos (P)
J. Bitzer (S) M. Moreira (P)
A. Grimard (F)
E. Sedbon (F)
Adolescence and gynaecology – Adolescence et gynécologie
P001
Timely examination under anaesthesia is vital in evaluating acute painful vulval lesions of uncertain aetiology in adolescent
girls-A case report
B Deval, K Bhal
Worthing Hospital, Worthing, West Sussex, United Kingdom
Background- Evaluation of vulval lesions in adolescent girls is a challenging problem. The differential diagnosis includes a spectrum
of traumatic, infectious, neoplastic and genetic disorders. Possibility of sexual abuse should always be excluded. A timely examination under anaesthesia is vital in evaluation of acute vulval lesions in adolescent girls. Based on a Medline search using the keywords
‘vulva’, ‘hair’, ‘strangulation’, ‘children’, ‘paediatric’; we report the first case of painful vulval lesion caused by strangulation from
loops of pubic hair.
Case- A 14-year-old girl was referred by her family doctor to the paediatric department for evaluation of an extremely painful left
labial swelling. The swelling developed insidiously over 3 days, gradually increasing in size with another smaller lump developing just
above it. There was no history of any abnormal discharge, bleeding, pruritus, trauma, sexual contact, previous sexually transmitted
infections and urinary infections. There were no systemic signs or symptoms. Local examination revealed two red, pappilomatous,
extremely tender and tense lesions at the middle of the left labia minora, one on top of the other. The dermatologist thought it to
be an adnexal swelling secondary to blockage/ infection of sebaceous glands or hair follicles or Bartholin’s gland. Because of the
diagnostic dilemma and extreme pain being experienced by the girl, an examination under anesthesia was decided, at which loops
of pubic hair were found to be strangulating part of left labia minora. These were divided and released. The skin had been actually
cut through at three places which was repaired with vicryl no.4-0. The patient made a complete recovery.
Discussion-Vulval skin lesions in adolescent girls are a diagnostic challenge. In our case, the vulval lesion was more of a warty appearance. But, the acute onset and severe pain made it distinct from other lesions of warty appearance. If the strangulation caused
by the loops of hair were not released timely, necrosis of the vulval skin could have occurred with resultant protracted suffering to the
young girl. Our case highlights the importance of timely examination under anaesthesia which is a useful diagnostic and therapeutic
modality in management of painful vulval lesions of unexplained aetiology in adolescent girls.
References1. Anogenital skin diseases of childhood- Elaine C Siegfried, Lori D. Frasier. Paediatric Annals 26:5/May1997, 321-331.
P002
Are youth reproductive health care services in Serbia in line with the needs of young people?
M. Rasevic, K. Sedlecki
1 Institute of Social Sciences, Belgrade, Serbia, 2 Mother and Child Health Care Institute, Belgrade, Serbia
Objective: To explore if the needs of young people have been encountered in the design of the youth reproductive health care services in Serbia (YRHS). The hypothesis was that the current model of YRHS has been adjusted to the requirements of young people
in Serbia.
Design & Methods: Surveys conducted in Serbia from 1997 to 2007 on young peoples’ sexual behavior were collected, and data
concerning YRHS were selected. These data were compared with the YRHS model created in 1999. The analysis was performed
by the means of descriptive statistics.
Results: The YRHS in Serbia have been developed within primary health care institutions, offering various services, like comprehensive sex education through workshops carried out by health care professionals as well as peer educators, individual counseling,
gynecological examination, and diagnosis and treatment of reproductive health disorders. The working staff of YRHS consisted of
pediatrician, gynecologist, psychologist and nurse, thus enabling comprehensive approach to preventive and therapeutic aspects of
young people’s health care, which has been age and developmentally appropriate, respecting their right to confidentiality. According
to investigations the majority of young people, insufficient for relevant knowledge, named peers as the main source of information. In
the same time, they were opened for new knowledge conducted by interactive way and cited physician as desirable educator. The
most of the interviewed adolescents wanted patience, more time and friendly approach from YRHS staff. More than half of surveyed
girls were uneasy to have the first gynecological examination postponing it till pregnancy and STIs fear occurred.
Conclusion: Although the hypothesis of this investigation was confirmed in indirect way, the main elements of the YRHS model in
Serbia have been in line with young people needs. Two results should be underlined. The first has been the significance of individual
counseling, and the second one the involvement of physicians as well as peer educators in sex education workshops. It seems that
the involvement of pediatricians as adolescent’s primary health care givers in Serbia as YRHS team members could alleviate the
barriers of young people toward gynecologists.
88
P003
Improving sexual education in adolescent age – solution for improving their reproductive health
A. Kapamadzija, J. Vukelic, A. Bjelica
Clinical center Vojvodina, Dept, of Obstetrics and Gynecology, Novi Sad, Serbia
Objectives: The aim of the study was to establish attitudes, knowledge and prejudices of adolescent towards sexuality in order
to improve their sexual education and reproductive health. It is estimated that adolescents have lack of knowledge resulting in
prejudices in this field because of insufficient sexual education which could result in improper behavior with consequences to their
sexual, emotional and reproductive health.
Design: Anonym survey was conducted in four high schools among 823 adolescents aged 15-19 years. Questions asked included
their attitudes towards sexuality and contraception, earliest possible age for the beginning of sexual life on their opinion, which
moments impact the first sexual intercourse, who is more interested in sex, male or female, and some questions which included
knowledge of contraception and sexually transmitted infections (STI). Students were asked to say if they needed more education
and to suggest the way of performing it, where and by whom they would like to gather more knowledge. Various statistical analyses
were made to compare differences between male and female students. Results: Among high school adolescents, 43% male and
30% female students had sexual intercourse. Reasons for beginning with sexual life were significantly different between the two
sexes - love was the reason for 54,5% male and 75% female students and sexual desire for 45,4% male and for only 21,4% female
sexually active students More female students claim they are not interested in sex matters or are too shy to admit it. Attitudes and
knowledge on contraception had differed between male and female students. Both male and female showed lack of knowledge
in STI. Almost half of the students said they would like to get more education in the fields of sexuality, contraception and STI, in
schools, performed by an expert.
Conclusions: Some problems in the domain of adolescent sexuality are still not solved in our country. Lack of knowledge in the field
of contraception and sexually transmitted infections result in high number of adolescent pregnancies and STI. Ministry of health in
our country, Expert group for health of adolescents has developed National strategy for healthy growing up of adolescents whom
we hope will bring benefit for them in the upcoming years.
P004
Consultation de gynécologie d´ adolescent - expérience de la maternité Bissaya Barreto
M. Inês Marques, A. Cruz, N. Pereira, J. Bello, H. Leite
Maternité Bissaya Barreto, coimbra, Portugal
Résumé : Objectif : Évaluer les caractéristiques épidémiologiques et cliniques des adolescents qui fréquentent la consultation
de gynécologie d´ adolescent, bien comme son impact dans la garantie de la qualité de la santé. Matériel et méthode : Analyse
rétrospective de 1580 procès informatisés, se procédant à la révision des paramètres suivants : l´âge de la première consultation,
provenance, scolarité et métier, raison de la consultation, pathologie chronique, antécédents gynécologue / obstétrical, pathologie
gynécologue, début de láctivité sexuelle, et contraception.
Résultas : La plupart des adolescents vont à la consultation pour la première fois après l´âge de 15 ans et l´âge en moyenne de la
première consultation est à 17 ans. Quant au niveau de la scolarité, nous avons remarqué que 67% fréquente le primaire et 32% la
Faculté. Les principales raisons de la consultation sont la contraception, cycle menstruel irrégulier et dysménorrhée. Relativement
aux adolescents qui utilisent déjà une méthode de contraception, on a vérifié que 53% faisait la double protection. Conclusion :
L´âge tardif de la première consultation gynécologue, superposable à l´âge du début de láctivité sexuelle, la principal raison de la
consultation fut le désir de la contraception, un pourcentage significatif de jeunes associe lútilisation du préservatif à la pilule, ce
qui indique un considérable niveau de responsabilité des adolescents.
Mot-clef: consultation gynécologue des adolescents
P005
Youth Space – 13 years of young people´s assistance
S. Fraga Marantes, M. Teixeira, H. Bachu, M. Fernandes, T. Oliveira
Maternidade de Júlio Dinis, Oporto, Portugal
Objective: The first law of sexual education approved by the Portuguese parliament was in 1984. Based on this legislation, was
created in March 1994, a youth attendance centre called Youth Space (YS). Formed by gynecologist and psychologist, provides
counselling on reproductive health, sexuality and provides contraceptives for young pleople up to 25 years. It has high clinical standards and the qualities that adolescents seek: it is confidential, accessible and comprehensive. The aim of this study was to analyse
the adolescents assisted in this centre during the past 13 years, according to their age, sex, education, concerns and reason for
acceptance.
Design and Methods: Retrospective analysis of all cases observed in YS between March 1994 and March 2007.
Results: 48 892 youth were observed, being 10 523 (21,5%) first acceptance. Since 2001 the number of assistance has ranged 800
cases per year. The majority were girls (87,3%). 41,3% had ages between 20 and 24 years. All residents in our city, they knew our
centre mostly from friends and family relatives; few cases came from media or sexual education at school (3,4%). The reasons for
attendance were mostly for sexual and contraception information, free contraceptive methods (65%), and gynecological complaints
(22,3%); emergency contraception was requested in 0,6% of the cases.
Conclusions: The World Health Organization (WHO) assumed in 2002 the need of adolescent friendly health services and recommends that they must be accessible, equitable, acceptable, appropriate, comprehensive, efficient and affordable. YS, since 1994,
seems to fullfill this purpose, promoting a sexual and reproductive health among youth population.
89
P006
Adolescents: connaissance sur la sexualité
S. Maia, S. Soares, A. Ferreira, M. Sobral, C. Santos
Hospital Distrital De Faro, Faro, Algarve, Portugal
Objectifs: Etudier les connaissance sur la sexualité des adolescents de l’enseignement secondaire.
Méthodes: Réalisation dúne étude transversal autour d’un questionnaire anonyme auto appliqué en Janvier de 2007 à 722 étudiants
dún lycée de lénseignement publique.
Resultats : Des 421 élèves qui ont répondus au questionnaire, 57% sont du sexe féminin et 41% du sexe masculin. La moyenne
dáge est de 17 ans (entre 14 et 22 ans). En relation aux connaissances sur les méthodes de contraception, 97% des adolescents
ont indiqués la pilule et le préservatif, 81% le DIU, 44% le diaphragme, 27% les spermicides et <20% les autres méthodes.
Relativement aux maladies sexuellement transmissibles (DST), 97% connaissent le HIV, 57% l´hépatite, 56% l´herpes, 48% la syphilis, 42% la gonorrhée et <1% les autres maladies. 88% des adolescents ont indiqués le préservatif comme méthode de prévention
contre les DST. Sur le sujet des relations sexuelles, 37% des adolescents ont initiés leur activité sexuelle, aillant 76% d’entre eux
utilisés le préservatif. L´école est la principale source dínformation sur la sexualité pour 66.5% des adolescents et la famille pour
24%. 30% des adolescentes sont allés à une consultation de gynécologie, desquelles 53% avant leur première relation sexuelle.
Conclusions: lánalyse des résultats révèle que les adolescents étudiés ont une bonne connaissance sur la sexualité. Cela peut être
du au fait que ce lycée possède un cabinet dáide aux adolescents et organise régulièrement des conférences sur ce thème.
En conclusion, il est très important léxistence de programmes dínformations pour pouvoir éduquer les adolescents et éviter les
comportements de risques.
P007
Premature Ovarian Failure In A 16 Year-old Girl
M. Sobral, O. Viseu
Hospital Distrital de Faro, Faro, Algarve, Portugal
Introduction : Ovarian failure is a normal occurrence during menopause, and this event is determined by genetic inheritance. Ovarian failure occurs before 40 years of age in 1% to 5% of women and is considered pathologic – premature ovarian failure. If ovarian
failure occurs before puberty, the patient`s breasts will not develop and gonadal agenesis results. Despite the array of causes of
ovarian failure, in most cases the etiology cannot be determined.We present a case of premature ovarian failure in a 16 year-old girl
and discuss the possible etiology, treatment and follow-up in these cases.
Methods and Results : D.P.B.G., 16 years old, is sent by her doctor to our appointment because of primary amenorrhea. Her
pubarche was at 14 years of age but she had no axilar hair, and the breast development was Tanner stage 2. She had no signs of
hirsutism or galactorrhea. She had not iniciated sexual intercurse. There was no history of infeccions, autoimmune disorders, radiation or chemoterapy. The ginecological exame revealed genital atrophy, with a apparentely normal vagina. Her pelvic ultrasound
revelead a small tubular uterus and the ovaries had a volume of 2.35 cc and 2.44 cc. The thyroid function was normal, as well as the
prolactina, cortisol and SO4-DHEA (dehydroepiandrosterone sulfate). She had high levels of FSH (follicle-stimulating hormone) and
LH (luteinizing hormone) and low estrogen and progestin levels. The karyotype was determined – 46,XX.
Discussion: This 16 year-old girl had a normal karyotype, a parcial development of secondary sexual characteristics and hypergonadotropic hypogonadism. This case is compatible with premature ovarian failure, probably a gonadotropin resistance, also referred
to as Savage Syndrome, likely due to FSH receptor dysfunction. Biopsy is not adviced because diagnosing resistant ovarian failure
will not affect management. We iniciated in this case, as indicated in individuals with primary amenorrhea associated with all forms
of gonadal failure and hypergonadotropic hypogonadism, cyclic estrogen and progestin therapy to initiate, mature and maintain
secondary sexual characteristics, with good results. Prevention of osteoporose is an additional benefit of estrogen therapy.
P008
Management of uterine didelphys with obstructed hemivagina and ipsilateral renal agenesis
J.-S. Park, M.-R. Kim, K.-J. Hwang
Ajou University School of Medicine, Suwon, Korea, Republic of
Introduction: Uterine malformations are the result of major disturbances in the development, formation or fusion of the Mullerian or
paramesonephric ducts during fetal life. And these anomalies may be associated with numerous congenital anomalies, especially
ipsilateral renal agenesis are the most common. The aim of this study was to retrospective review our experience with 7 cases of
uterine didelphys, obstructed hemivagina and ipsilateral renal agenesis, highlighting the clinical presentation, natural history and
clinical outcome.
Methods: Between 1994 and 2006, we carried out a retrospective study of patients with uterine didelphys, obstructed hemivagina
and ipsilateral renal agenesis who were treated in our hospital. Only 7 patients who visited hospital with chief complaints and symptoms related to obstructed hemivagina were included. Patient demographics, presenting symptoms, clinical course, preoperative
radiologic investigations, intraoperative findings, operative management, and follow-up were assessed.
Results: The mean age at diagnosis was 21 years (12-30 years). Dysmenorrhea or noncyclic abdominal pain and pelvic mass were
major complaints. Endometriosis was noted with hematometra and hematosalpinx in 5 of 7 patients at the time of laparoscopy. All
patients were sufficiently treated by vaginal septectomy with marsupialization and drainage. All patients did not presented recurrent
symptoms or complication during follow-up period. A patient who complained of infertility was pregnant naturally after 8 months
postoperatively.
Discussion: Early accurate diagnosis followed by excision and marsupialization of the vaginal septum offers complete relief of symptoms and preserves reproductive potential. Uterine malformations should be considered when the adolescent girls visit the hospital
with abdominal pain, increasing severity of dysmenorrhea after menarche or pelvic mass as the chief complaints.
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P009
Non contraceptive benefits of two combined oral contraceptives with anti androgenic properties among adolescents
R. Sabatini, G. Loverro, L. Digiacomantonio
University of Bari, General Hospital Policlinico, Dept. of Obstetrics and Gynecology, Bari, Italy
Objective: Many adolescent girls are sexually active at earlier age than in past, before they are cognitively able to develop a responsible sexual behaviour. In spite of the evident need of effective contraception, non compliance is still an issue among teenagers.
Moreover, during the post-men¬arche years several kinds of menstrual irregularity and dysmenorrhoea may occur. Yet, androgenrelated skin and hair disorders, arising from hormonal imbalance, are common problems in young women. These conditions can
lead to relevant emotional and psychological disorders affect¬ing teen’s self image. The aim of our study was to assess the non
contraceptive benefits of two com¬bined oral contraceptives (COC s) containing different anti androgenic progestogens. Methods: In this prospective, observational study the non contraceptives effects of 2 mg chlormadinone ace¬tate (CMA), derived from
progesterone and 3 mg drospirenone (DRSP), derived from spironolac¬tone, both combined with 30 µg ethinyl estradiol (EE) were
compared. Condom use was been re¬quired, in each group for protection against STDs. Within a treatment period of 6 months,
156 sexu¬ally active adolescents, requiring contraception were evaluated with regards to intermenstrual bleeding, dys¬menorrhoea,
hair and skin disorders as well as to sexual interest, intercourse frequency and sexual satisfaction. Results: Body weight and blood
pressure did not change in either group. Although, at cycle 3, irregular bleeding and dysmenorrhoea decreased significantly in both
groups, only for CMA/ EE group, the significant reduction continued until the end of the study. A reduction in skin and hair disorders, such as acne, greasy hair and hair growth excess, was also seen in both groups, but there was a significant higher benefit in
the CMA/EE group compared to the DRSP/EE at the end of the study-period. Similarly, the adolescent girls who were allocated to
CMA/EE use reported the best results as sexual interest and sexual satisfaction. In the DRSP group there were 16 mild ad¬verse
effects versus 9 in the CMA group. Conclusion: Both contraceptives used offered safety and effectiveness; even though the best
results were obtained with the formulation containing CMA/EE for all considered parameters. The resulting adherence of CMA/EE to
teenager expecta¬tions led to elusive goal of adolescent’s pill continuation.
Endometriosis - Endométriose
P010
Axillary localization of endometriosis in teeneage girl
M. Bogavac1, S. Miloševic1, G. Relic2, D. Katanic3
1 Clinical centre Vojvodina, Department of Obstetrics and Gynaecology, Novi Sad, Novi Sad, Serbia,
2 Medical faculty, Priština Health Center Kosovska Monrovia, KMitrovica, Serbia,
3 Institute of Child and Youth Health Care, Novi Sad, Novi Sad, Serbia
Introduction: Endometriosis is a condition in which endometrial tissue occurs aberrantly, implanting or infiltrating various locations
including extragenital ones. Some of the authors reported very high incidence of endometriosis in adolescent patients. The genesis
could be explained by the retrograde flow of menstruating blood from the fimbriated end of the tube and its vascular or lymphatic
transport to the distant sites.
Case report: An obese girl age 19 presented with a painful nodule 10 mm of size in the right axilla that was bothering her from time
to time. The patient was not sexually active. The menstrual cycle was shorter (21-23 days) and dysmenorrhoea was common. Her
mother was suffering from dysmenorrhoea as well.
The girl has already undergone various consultants’ check-up, the nodule being recorded as a lymph node, a post – traumatic lesion,
tumour, adenovirus infection or a part of the fibrocystic dysplasia.
The history revealed its cyclic appearance and strong association with menstruation. On needle aspiration biopsy a chocolate – like
content was obtained, proved to be blood material.
She refused surgical intervention and started a short-term danazol treatment, with moderate effects.
Conclusion: The axillary localization of extragenital endometriosis is extremely rare. It could be easily confirmed after history taking
and the needle aspiration biopsy. Surgical intervention is a method of choice although medicaments can help in the meantime.
P011
Surgical management of endometriomas in an IVF setting. A review of literature
A. Chavez Badiola, A. Drakeley, R. Gazvani
Hewitt Centre for Reproductive Medicine, Liverpool, United Kingdom
Introduction: Endometriosis is frequently encountered in subfertile patients. It is the primary indication for up to 14% of IVF cycles.
There are controversies about the impact of laparoscopic surgery for endometriomas in an IVF setting. Discussion includes ideal
surgical approach, impact of surgery in final outcomes and the potential risks of conservative management. Material and Methods:
A systematic review in PubMed, the Cochrane Database for Systematic Reviews and Aditus was carried out. Important references
from papers obtained, background articles, guidelines and reviews by experts in the subject were also analysed. Discussion: Increasing evidence in literature support conservative management of endometriosis prior to IVF. Regarding the laparoscopic management of endometriomas three approaches have been described: cystectomy, fenestration with vaporisation and ultrasoundguided drainage, with or without sclerotherapy, each with its own benefits and down-sides. On the other hand, ultrasound guided
drainage is, in the short term, the least expensive option, but has the highest recurrence rates. With respect to the outcomes it
appears that skills of the surgeon are more important than the technique employed. Using appropriate surgical techniques, the
damage to healthy ovarian tissue can be kept to a minimal and without impact on IVF outcomes. Lack of evidence showing clear
benefits with intervention, the known potential risks, delay in treatment and financial implications associated with surgery would
seem to incline the balance towards the conservative management of endometriomas. Unfortunately most studies also fail to take
into consideration the potential risks associated with the conservative management and these risks in themselves may justify surgi-
91
cal intervention. Conclusion: Meticulous surgical techniques for the management of endometriomas are of paramount importance
to avoid damage of healthy ovarian tissue. There is not strong enough evidence upon which to base a recommendation regarding
the optimal approach in the management of endometriomas in an IVF setting. However, before further guidelines are issued, both
the potential benefits and risks associated with different management options, including conservative approaches, must be evaluated and taken into account in the equation.
P012
Recent changes in the operation methods of ovarian endometriomas for twelve years
M.-R. Kim, J.-Y. Song, Y.-T. Lim, J.-H. Kim, J.-W. Lee, J.-H. Kim
Dept. of OB/GYN, The catholic university of Korea, Seoul, Korea, Republic of
Objective: to study of changes in the method of operation for ovarian endometrioma for recent twelve years, and to compare advantages of laparoscopy versus laparotomy
Design: a retrospective study
Setting: a tertiary university hospital.
Patient(s): nine hundred twenty five ovarian endometriosis patients operated by laparotomy and 747 patients by laparoscopy were
subjected to ovarian endometriosis operation from january 1995 through may 2007.
Measurements ; proportion of laparoscopic surgery of each operators were reviewed and operating time, total hospital stay days,
postoperative hospital stay days were compared between laparotomy and laparoscopy
Results: the proportion of laparoscopy is dramatically increased (p=0.00005 ~ 0.03) In each faculty members except one gynecologic endocrinologist. Because she has initial high rate of laparoscopic surgery from the beginning of this study (p= 0.06). Total
hospital stay days (5.50 ± 1.68 Day) and postoperative hospital stay days (3.19 ± 1.46 Day) in laparoscopy group were shorter than
those in laparotomy group , which were 7.89 ± 3.25 Day, 5.48 ± 2.73 Day , respectively (p < 0.05).
There were no difference on operating time (141.69 ± 50.49. Min. Vs 143.78 ± 49.37 Min., P = 0.20 ) Between the two kinds of operation.
Conclusions: laparoscopic operation became primary choice of operation method for ovarian endometriosis in gynecologist regardless their subspeciality and had shorter hospital stay.
P013
Rare localization of endometriosis in the episiotomy scar
S. Miloševic, M. Bogavac
Centre Vojvodina, Department of Obstetrics and Gynaecology, Novi Sad, Novi Sad, Serbia
Introduction: More now than ever before, endometriosis has stimulated discussion about the possible localization, the best methods
of recognition and treatment.
Aim: To present patients with endometriosis in the episiotomy scar, method of treatment, follow up and recurrence rate.
Material and method: The retrospective research included 12 patients with endometriosis in the episiotomy scar, where diagnosis
was made preoperatively, based on pathognomonic symptoms and where surgical excision was the only therapeutic modality. Epidemiological, clinical - important parameter and literature data were analyzed.
Results and conclusion: Incidence is 0,034%. Average age of the patients was 29,5, 5 for primiparas and 7 for multiparas. Mean
value of endometrial diameter was 3,25 cm (1,5 - 6cm), with occurrence of symptoms 5 months till 9 th year after delivery. All patients were chirurgically treated and, in all patients, pathologic diagnosis was endometriosis. There were no serious complication.
Dehiscence in 2 cases and superficial inflammation of injury in 1 case were the easiest complication. Average duration of hospitalisation was 7,25 days (2-15). Postoperative follow up lasted from 2 to 5 year, average duration was 3,59 year. There were no recurrence in that period.
Conclusion: The appropriate treatment of endometriosis is based on an accurate diagnosis and surgical treatment.
P014
Increased mRNA aromatase expression in eutopic endometrium among women with endometriosis compared to healthy
controls
P Zubor1, S Galo1, J Hatok2, P Racay2, E Babusikova2, J Visnovsky1, J Danko1
1 Department of Obstetrics and Gynecology, Jessenius Faculty of Medicine, Comenius University, Martin, Slovakia,
2 Department of Biochemistry, Jessenius Faculty of Medicine, Comenius University, Martin, Slovakia
Introduction: Endometriosis is estrogen dependent disease. Estrogen is the most important factor that stimulates its growth. Aromatase is a key enzyme of estrogen biosynthesis. Endometrial tissue from uterine disease-free women does not exhibit aromatase
activity. In contrast, mRNA levels are steadily detectable in endometriotic lesions. We aimed to provide a clinically useful result illustrating molecular aberrations affecting estrogen biosynthesis and metabolism in patients with endometriosis and to point on the
therapeutic role of aromatase inhibitors. Methods: In this prospective study investigated subjects were women of reproductive age
(mean 43.4). Tissue biopsies were obtained from eutopic and ectopic endometrium. Final inclusion criteria matched 63 women (46
healthy controls, 17 patients). Disease was staged according to revised American Fertility Society classification (rAFS). All biopsies
were obtained in early proliferative phase of menstrual cycle, and stored at –80˚C until subsequent RNA isolation. The mRNA aromatase expression was detected by reverse transcription PCR using actin as control. The level of aromatase was calculated using
aromatase/ actin ratio (A R). Results: A significantly increased mRNA aromatase was found in eutopic endometrium of women with
endometriosis compared to healthy controls (p<0.01). The mean value of aromatase in controls was 0.43 (interval 0-1.79) compared
to patients with endometriosis grade I-II and grade III-IV (0.65; interval 0.13-2.55) and (1.67; interval 0.70-3.52), respectively. These
results point on the highest (3.9-fold) difference in aromatase expression in patients with endometriosis grade III-IV compared to
controls (p<0.0001), whereas in women with disease stage I-II this difference was „only“ 1.5-fold increased. This gradual increase of
92
mRNA aromatase expression was confirmed by significant difference in A R when we compared patients with disease stage I-II to
III-IV (2.6-fold,p<0.05). Discussion: A significant increased level of mRNA aromatase expression is present in eutopic endometrium
in women with endometriosis. This expression follows disease stage with highest levels in patients of stages III-IV. Successful treatment of unusually aggressive cases with aromatase inhibitors in some previous trials confirmed the clinical significance of our study,
which brings results that may serve as a diagnostic marker for therapeutic intervention in women suffering from endometriosis.
P015
Antiapoptotic and proapoptotic gene expression evaluated from autologous uterine endometrium in women with endometriosis and healthy controls
J Hatok1, P Zubor2, S Galo2, J Danko2, D Dobrota1, P Racay1
1Department of Biochemistry, Jessenius Faculty of Medicine, Comenius University, Martin, Slovakia,
2Department of Obstetrics and Gynecology, Jessenius Faculty of Medicine, Comenius University, Martin, Slovakia
Introduction: Endometriosis is estrogen-dependent disease. Its etiology and pathogenesis are controversial. Abnormalities of p53
gene, and bcl-2 family genes, which are involved in regulation of apoptosis, have been considered to play role in tumorigenesis.
We hypothesized that apoptotic gene expression evaluated in autologous endometrium is impaired in women with endometriosis,
and this imbalance may be related to disease occurrence and severity. Thus, we investigated molecular mechanisms underlying
expression of proapoptotic and antiapoptotic genes in eutopic endometrium from women with endometriosis and healthy controls.
Methods: A prospective study in women of reproductive age (mean 41.5) undergoing laparoscopy for pelvic pain was conducted.
Tissue biopsies from autologous endometrium and ectopic lesions were obtained. Inclusion criteria matched 45 women (30 healthy
controls, 15 patients). Disease was staged accordingly revised American Fertility Society classification. All biopsies were obtained
in early proliferative phase of menstrual cycle and stored in TRIzol Reagent for subsequent RNA isolation. The mRNA expression
of apoptotic genes (p53, Bcl-XL,S and Bax) was detected by RT-PCR using β-actin as control. Results: A significant difference in
increased mRNA p53 expression (p<0.05), and Bcl-XS (p=0.0006) was found in eutopic endometrium of women with endometriosis
compared to controls. Increased, however insignificant expression was found also for Bax (1.22 vs 1.15), whereas antiapoptotic
Bcl-XL was nearly the same (1.08 vs 1.07), respectively. The Bcl-XL/Bcl-XS ratio from eutopic endometrium was two-fold higher
(5.63 vs 2.63) in controls. Stratifying patients by disease stage we have revealed an increased mRNA expression for all observed
apoptotic genes in patients of grade III-IV compared to patients with disease grade I-II. However, difference was significant only for
Bcl-XS expression (p<0.01). Discussion: Increased transcription of proapoptotic genes (p53 and Bcl-XS) in eutipic endometrium
is significantly associated with endometriosis. Our work indicated dysregulation of apoptotic genes transcription associated with
endometriosis. Identification of selected genes may contribute to uncovering pathomechanism in disease progression/persistence,
and serve as a potential diagnostic markers or target for therapeutic intervention in women with endometriosis.
P016
Cutaneous endometriosis
S. Maia, F. Albergaria, C. Santos
Hospital Distrital de Faro, Faro, Algarve, Portugal
Introduction: Endometriosis affect 15% of women of reproductive age, but cutaneous endometriosis is not a common condition.
Cutaneous endometriosis can be associated with surgical scars (like in episiotomy, hysterectomy, laparoscopy and caesarean section) or spontaneous occurrence. Common presentations include palpable mass, cyclic pain, bleeding and discharge. Preoperative
diagnosis can be easily mistaken for a lipoma, suture granuloma, abscess, hernia or cyst.
Methods: We report the cases of women with cutaneous endometriosis, treated at our institution from 2000 to 2006. The diagnosis
was made after surgical excision, by histological examination that revealled ectopic endometrial glands with surrounding cellular
stroma. Conclusions: Management of cutaneous endometriosis can include surgery and hormone suppression. Only short term
success in alleviation of symptoms has been achieved with hormone suppression. Extensive surgical excision is the treatment of
choice, and local recurrence after adequate surgical excision is not common.
P017
Endometriosis of the extraperitoneal portion of round ligament: description of this entity based on two clinical cases
G. Chalouhi, M. Sabra, F. Golfier
Hotel-Dieu de Lyon, Lyon, France
Endometriosis is a common gynecologic pathology characterized by the development of ectopic endometrial glands and stroma.
Although it is most frequently located in the pelvis, many extrapelvic and extraperitoneal localizations have been reported. Endometriosis of the groin is a rare condition; lesions are usually located in the extraperitoneal portion of the round ligament. We report two
cases diagnosed, investigated and operated in our department. They offer an interesting description of the pathogenesis, presentation, diagnosis, imaging, treatment and prognosis of inguinal endometriosis.
Case 1: A twenty-three-year-old-female presented an inguinal tumefaction which increased in bulk and became painful around
menses. The ultrasound showed a complex mass of 2.5 cm. On examination, there was a roughly roundish mobile irreducible tender
right lump covered by intact skin in the inguinal region. She underwent a total surgical excision of this mass. No hernial sac was
detected. Macroscopically (3x2x1.5 cm), it had a heterogeneous whitish fibrous aspect with dark brown inclusions. Microscopically,
it consisted.of endometriosis without cytonuclear atypia. Thirty months after surgery the patient presented no signs or symptoms
of a relapse.
Case 2: A thirty-one-year-old-female presented the same symptomatology. Her symptoms diminished while taking oral contraceptives, and resolved completely during a pregnancy and six months of breast-feeding. They reappeared as soon as she resumed her
menstruations. A pre-operative ultrasound and MRI were performed before the surgery. The excision of this inguinal tumefaction
proved the diagnosis of endometriosis of the extraperitoneal portion of the round ligament. A diagnostic laparoscopy showed mini-
93
mal pelvic endometriosis graded I (score ASRM=1).
Inguinal endometriosis is a rare pathology. It is often associated with hernias, pelvic endometriosis imposing a laparoscopy (especially in case of pelvic symptomatolgy). Ultrasonography (with color doppler) is the examination of choice although MRI brings interesting information. Surgical excision is curative. The lesion must be removed en bloc to avoid cellular dissemination and subsequent
recurrence which can infiltrate adjacent muscles. Malignant degeneration has been described.
P018
Use of proteomic analysis of thioredoxin reductase and effect of gonadotropin releasing hormone agonist in eutopic endometrium with endometriosis
J. Park1, J. Lee2, M. Kim1, K. Hwnag1
1 Department of Obstetrics and Gynecology, Ajou University School of Medicine, Suwon, Korea, Republic of,
2 Department of Biological Science, College of Natural Science, Ajou University, Suwon, Korea, Republic of
Introduction: None the less of numerous efforts of investigation, little is known about the aetiology of endometriosis. Thioredoxin(Trx)
and thioredoxin reductase (TrxR) comprise a thioredoxin system which exists in nearly all living cells. TrxR enzyme displays remarkable broad substrate specificity but are also targets for existing chemotherapeutic drugs. Recently, TrxR is essential for the
carcinogenic process and invasive phenotype of cancer. The purpose of this study, using proteomic techniques, is to evaluate the
expression of thioredoxin reductase-1 (TrxR-1) and effect of gonadotropin releasing hormone (GnRH) agonist (most common medical treatment drug for endometriois) in the eutopic endometrium in patients with endometriosis.
Methods: Endometrial tissues were obtained by endometrial biopsy from 2 groups of women (eutopic endometrium with endometriosis versus without endometriosis). Expressions of TrxR-1 were investigated by 2-dimensional electrophoresis, mass spectrometry,
immunohistochemical staining, and Western blot, After endometrial cells were cultured in the presence of GnRH agonist (Lucrin®)
for 72hrs, we compare the degree of cellular proliferation and of TrxR-1 expression between 2 groups.
Results: In the eutopic endometrium with endometriosis group, especially during proliferative phase, the expression of TrxR-1 was
significantly higher than the control group. But there was no difference with the control group during secretory phase. The expression of TrxR-1 was significantly decreased in cultured endometrium with GnRH agonist.
Discussion: We firstly suggested that TrxR-1 play an important role in developing endometriosis and GnRH agonist had a negative
effect on TrxR-1.
Benign pathology - Pathologie gynécologique bénigne
P019
Retrospective analysis of surgical therapy in vaginal vault prolapse after hysterectomy using the abdominal technique from
Williams-Richardson in 62 cases
M. Butterwegge
Marienhospital, Osnabrueck, Germany
Symptomatic vaginal vault prolapse after hysterectomy requires special surgery to restore or preserve the ability to have intercourse.
Vaginal repair often results in a narrowed and shortened vagina with diminished function or pain. Pelvic organ prolapse surgery with
biologic graft or synthetic mesh is not free of side effects like mesh-related infections, erosion of the vagina, granulation tissue or
draining sinus tracts.
Abdominal fixation with an external oblique aponeurosis attaches the vaginal apex to the abdominal wall and restores the physiological position of the vagina.
All patients were operated on by one surgeon. Preoperative evaluation consisted of physical examination, age, parity, body mass
index, history of previous pelvic surgery and hormonal status. The cure rate and complications were evaluated in follow-up.
Using original tissue an abdominal colposuspension with retroperitoneal strips were performed on 62 patients with fixation of the
vaginal vault. No serious intraoperative complications occurred. Postoperative complications occurred in 4 cases (three urgent and
one stress urinary incontinence).
Using a standardized questionnaire and a gynecological examination all patients were evaluated next two years after surgery. The
complications were resolved and the patients were free of negative postoperative symptoms in the time of the last follow-up visit.
92% patients expressed satisfaction with the 24 month therapeutic results. In 8 cases postoperative hernia of the posterior vaginal
wall occurred. To prevent the persistence or development of an rectocele, a culdoplasty according to McCall might possibly be
helpful.
Those complaints were resolved after surgery. No re-operations were performed.
The technique by Williams-Richardson is an effective, safe and efficacious treatment surgical procedure of the post hysterectomy
vaginal vault prolapse avoiding mesh technology. All patients mentioned a considerable and nearly complete freedom from subjective complaints, and obviously also a low likelihood of relapse.
P020
Anatomical and functional assessment of vaginal prolapse treatment in women undergoing transvaginal synthetic mesh
implantation (Gynecare Prolift®)
A.J. Jakimiuk (1,2), W. Borucki, J. Beta
1 Department of Obstetrics and Gynecology, Central Clinical Hospital of Ministry of Interior and Administration, Warsaw, Poland,
2 Polish Academy of Sciences, Medical Research Center, Warsaw, Poland
INTRODUCTION: The study was undertaken to assess the anatomical and functional outcomes of the transvaginal surgery. METHODS: Forty women evaluated preoperatively and after 6 month follow – up using the POPQ classification and HRQOL specific
questionnaires (PFDI-20 and PFIQ-7). All of them underwent the transvaginal synthetic mesh implantation (Prolift Gynacare, Ethicon,
94
Poland). RESULTS: Significant anatomical improvement in the prolapse measured by the POPQ classification was observed (anterior vaginal wall: median POPQIII vs POPQ0 postoperatively, p< 0,001; posterior vaginal wall: median POPQIII vs POPQ0 postoperatively, p< 0,001 ). No life – threatening complications were noted. One patient suffered from urinary retention and one from the
lumbar postoperative pain. No single case of mesh erosion was observed. At follow – up the 100% efficacy of the method was assessed in 34/37 of cases. Only in three cases the recurrence of the prolapse (POPQI) was observed. Significant improvement in the
quality of life in PFDI-20 and PFIQ-7 questionnaires was observed (PFDI – 20: 139 ± 33 vs 56 ± 39 postoperatively, p<0,0001; PFIQ
– 7 143 ± 41 vs 47 ± 46 postoperatively, p < 0,0001). All three scales of the PFDI-20 and PFIQ-7 demonstrated excellent postoperative responsiveness (SRM: 1.44 – 1.90, ES: 0.77 – 2.27 and SRM: 0.98 – 1.94, ES: 1.17 – 2.21 respectively, p<0.001 in each case).
DISCUSSION: Transvaginal synthetic mesh implantation is an effective, safe and quality-of-life-improving treatment method.
P021
Benign serous cyst adenoma of the fallopian tube, a case report
Sandadura de Silva, Venkataraman Chandra, Sanjeev Sharma
Southport and Ormskirk NHS Trust, Merseyside, United Kingdom
Objective: To describe a rare tumour pathology occurring in a novel (fallopian tube) site.
Design and Methods: Setting: Gynaecology unit in a secondary referral unit in the UK. Method: A case of a 32 year old female who
was diagnosed to have a benign serous cyst adenoma of the fallopian tube is discussed with a review of published literature. The
review of literature was performed by means of MEDLINE and CINHAL search from 1950 to date using keywords – benign serous
cyst adenoma fallopian tube, adenoma fallopian tube and tumours fallopian tube.
Results: Our patient presented to the emergency room with an acute exacerbation of right iliac fossa pain of 6 months duration.
9 years previously she had a right sided tubo-ovarian abscess drained as an emergency. During her current admission, a vaginal
scan revealed 8cm mass in the right adenexae. Consequently she underwent laparotomy and right salphingectomy. The histology
revealed a benign serous cyst adenoma of the right fallopian tube.
Conclusions: Benign serous cyst adenomas are known to occur in a variety of endocrine organs including the ovaries. To our knowledge, this is the first report of a benign serous cyst adenoma occurring in the fallopian tube.
P022
Is Hysteroscopy diagnosis in dysfunctional uterine bleeding useful? Experience at Temuco Clinical hospital Chile 20042006
R. Celis1, N. Barria1, J. Cabrera1, F. Gallardo2
1 University La Frontera, Temuco, Chile, 2 Temuco Clinical Hospital, Temuco, Chile
Objective To determine the diagnostic value of hysteroscopy study fro endometrial and uterine abnormalities in patients with abnormal uterine bleeding.
During two years period 2004 -2006 Two hundred and seventeen patients were submitted to hysteroscopy uterine cavity study and
direct endometrial biopsy al Temuco Universitary Hospital in Chile . Hysteroscopical procedure was performed under ambulatory services with 4 mm Hamou optic and 30 º oblique views. A 5mm Karl Storz exam sheet was used.CO2 provided by automatic
hysteroflator and 150 watts cold light power K Storz too.
Dysfunctional uterine bleeding (DUB) is one the most frequent motives to consult a gynaecologist .For many years the principal
diagnosis tool was dilatation and curettage (D&C) In this procedure 70-80% is removed so histopatological results are unsatisfactory in defining the diagnosis and explanation for bleeding. The last year’s transvaginal ultrasonography study provided new
alternatives. So transvaginal study not permits possibilities for direct endometrial biopsy. The gold standard in these studies was
endometrial samples for histological study.
Results We find a sensitivity (sens) near to 88 % and specificity (spec) of 98% in atrophic endometrial with Positive predictive values
(PPV) of 83% and negative predictive values (NPV) of 98%. With endometrial hyperplasia sensitivity was 99% and specificity 95 %
and negative Predictive value of 95 %. Endometrial cancer hysteroscopy sensitivity was 93% and specificity of 99% with negative
predictive value of 99%. Hysteroscopy study in patients under therapy with tamoxifen is useful, is related to sub endometrial quistical hyperplasia of endometrial. The first hysteroscopical diagnosis in postmenopausal uterine bleeding is atrophic endometrial and
histopatological study was unsatisfactory in many cases, performed under direct view.
Conclusions Our results provided support for hysteroscopical exploration in postmenopausal patients with uterine bleeding, endometrial cancer study and endocavitary lesions, sub mucosal uterine myopmas in example.
P023
Microwave endometrial ablation (MEA): A safe and effective way of treating dysfunctional uterine bleeding
M. Nikolaou, N. Oikonomopoulos, D. Daglas, I. Vervitas, G. Kourounis
Univercity Hospital Of Patras, Patra, Greece
Objectives: Microwave endometrial ablation is a minimal invasive procedure for the safe treatment of menorrhagia due to benign
causes in pre-menopausal women. It is designed to ablate the endometrial lining of the uterus. The aim of our study was to investigate the safety, efficacy and acceptability of MEA, as a way of treating pre-menopausal women with dysfunctional uterine bleeding
(DUB).
Design and Methods: Twenty-five women underwent MEA for the treatment of DUB. The mean age at treatment was 46.6 years
and the average treatment time was around 3 minutes. These women suffered from menorrhagia, had failed to respond to the
medical treatment and all had completed their families. In all women normal endometrial hystology was confirmed before ablation.
95
Endometrial preperation was not undertaken by using gonadotropin-releasing hormone analogue. Intra-operative antibiotics were
recommended in all cases as a prophylaxis against infection. MEA utilizes magnetic energy, which has a shallow penetration and
produces a maximum 6 mm of ablation. All cases were performed under general anesthesia as day cases.
Results: Our preliminary results from this ongoing study suggest success rate 92% in the form of amenorrhea and menstrual flow
reduction at 1 year of follow up and women’s satisfaction rate 90%. There were few postoperative complications in the group studied. In general women report minimal discomfort and fast recovery enabling them to quickly resume their daily activities. Two women
who underwent hysterectomy due to failure of ablation, had uterine pathology in the form of fibroid uterus. Initial results of MEA were
encouraging, with active treatment times less than 3 minutes and high satisfaction rates, acceptability and improved quality of life
1 year after ablation.
Conclusion: Menorrhagia affects 10% of women and is a significant healthcare problem since it can have an adverse impact on
their quality of life. If MEA follows surgical principles, it will prove to be easier accepted by women carrying a high rate of safety and
effectiveness.
P024
Atypical Demons-Meigs’ syndrome – a case report
I. E. Blidaru1, R. Pintilie1, D. Socolov1, C. Ciolpan2, C. Terinte3, M. Iordache4, M. Mictariu1, M. Mosneagu1, A. Luchian1
1 Department of Obstetrics & Gynecology, “Gr. T. Popa” University of Medicine & Pharmacy , Iasi, Romania
2 Department of Radiology, C.F. Hospital, Iasi, Romania,
3 Department of Pathology, Cuza-Voda, Maternity Hospital, Iasi, Romania,
4 Intensive Care Unit, Cuza-Voda, Maternity Hospital, Iasi, Romania
The existence of an ovarian fibroma, causing hydrothorax and ascites represents the Demons-Meigs’ syndrome. Atypical DemonsMeigs’ syndrome, a rare condition also known as pseudo-Meigs’ syndrome, is a peculiar clinical entity defined by the presence of a
pelvic mass, other than an ovarian benign solid tumor, also coexisting with hydrothorax and ascites. The authors report the case of
a 42-year-old woman who was diagnosed and surgically treated in the 4-th Department of Obstetrics and Gynecology for an atypical
Demons-Meigs’ syndrome consisting of right hydrothorax, ascites and a large uterine myoma. Preoperatively, the patient was fully
investigated through routine blood and urine tests, chest X-ray, serum CA 125 serial levels, abdominal ultrasound and computed
tomography. Postoperatively, the diagnosis was confirmed on the pathological specimen. In conclusion, these syndromes should
be considered in any woman presenting a pelvic mass, hydrothorax and ascites. Even the distinction between them could seem
unimportant, as the removal of the tumor is the only treatment in both cases, the correct diagnosis could sometimes represent a
problem.
P025
Transobturator tape: a minimally-invasive procedure in the treatment of female urinary incontinence
M. Brandao, A. Lebre, M. Montalvão, M. Rodrigues, B. Candoso
Maternidade Julio Dinis, Porto, Portugal
Objective:
To assess the efficacy and safety of the minimally invasive surgical procedure using the transobturator tape in the treatment of female urinary incontinence.
Patients and methods:
Retrospective study in wich we reviewed the charts of 260 patients, with stress or mixed urinary incontinence, that underwent the
minimally invasive surgical procedure using the transobturator tape, from March 2004 through December 2006. All patients were
assessed before surgery by clinical and urodynamic examination.
Results:
Mean age was 52 years (29-83).
The medium follow-up was 11 months (range 1-24 months). 9 (3,46%) patients were previously operated by different techniques for
incontinence. 45 (17,31%) patients had mixed urinary incontinence. 16 (6,15%) patients were operated at the same time for their
genital prolapse. No intraoperative complications were recorded. At the end of the follow-up considered, of the 260 patients, 255
(98,08%) were completed cured from their stress urinary incontinence. Persistence of symptoms were found in 5 (1,92%) patients.
No patient felt that their situation had deteriorated.
Conclusion:
It seems that transobturator tape is a minimal invasive, highly effective and safe technique for the treatment of female urinary incontinence in our institution. We have done it in carefully selected women, with a low rate of complications and a high successful rate.
Evaluation of the results after a longer follow-up period is needed to validate this technique.
P026
Is the cough-stress test possible during spinal anesthesia for the Tension Free Vaginal Tape (TVT) procedure?
K. Spanopoulos1, E. Goutziomitrou1, F. Pournaropoulos2, A. Douvantzi1, I. Bontis2, P. Petropoulou1
1 Department of Anaesthesiology, ‘Papageorgiou’ general hospital, Thessaloniki, Greece,
2 1st department of Gynecology and Obstetrics, Aristotelian University, Thessaloniki, Greece
Women who undergo a tension-free vaginal tape (TVT) procedure show greater improvements in incontinence severity when the TVT
is placed using the cough-stress test. The aim of this study was to evaluate the effect of spinal anaesthesia on the patients’ ability
to cough effectively during the TVT procedure.
Methods: 25 patients received intrathecally 8mg of the local anaesthetic Levobupivacaine 0.5% combined with 0.02mg fentanyl.
Cough-stress test was performed before and 20min after the onset of spinal anaesthesia by measuring the volume of leakage in a
scale (0-3), after administration of 250ml normal saline with a catheter in bladder and asking the patient to cough vigorously. We also
96
recorded maximal dermatomal sensory block level using the loss of cold to ice technique and maximal motor block achieved using
the modified Bromage scale (0= no block, 1= hip movement block, 2= hip and knee block and 3= complete block in hip, knee, and
ankle). Data were analyzed using paired samples t-test. Results:
Cough-stress test
Pre-
2.2±0.4
20min
2±0.5
p-value
NS
Patients had a maximal sensory block level in T12 (T10-L1) dermatome and a maximal motor block of Bromage score 2 (unable to
move hip and knee), 20 min after the onset of spinal block.
There were no side effects during anesthesia (nausea, vomiting or shivering).
Conclusion: Spinal anesthesia did not impair the patients’ ability to cough effectively during surgery, when this was necessary for
the adjustment of tape tension although all the patients had an effective sensory and motor block.
P027
Implant sheets from a porcine source used in anteroposterior vaginal suturing in women with cystorectocele
S. Dimitrakopoulos, F. Plevria, E. Papathoma, A. Sidiropoulou, I. Mavropoulos, S. Koliantazaki, K. Gioni, E. Papageorgiou, A. Saltamavros, N. Sidiropoulos
General Hospital, Pyrgos/ilias, Greece
Objective: to evaluate the use of implant sheets from a porcine source in the procedure of anteroposterior vaginal suturing in cystorectocele.
Methods: the study group was consisted of 18 aged between 55 and 82, who were subjected to vaginal hysterectomy followed by
anteroposterior vaginal suturing and to which implant sheets from a porcine source was used. The grafts used were surgisistm . This
product has been sterilized with ethylene oxide. Surgisistm sheets have a microscopically rough and a smooth side. The functional
difference between the two sides is minimal, but cell culture studies suggest that epithelial cell growth is moderately favored on the
smooth side. By the use of aseptic technique the surgisistm sheet is placed into the sterile container and 50 ml of rehydration fluid
per sheet is added for 3 min. The graft site is prepared using the standard surgical technique of anteroposterior vaginal suturing.
Then, the surgisistm sheet is transferred to the site and is sutured into place with close tissue approximation, avoiding excess tension. Single layer surgisistm sheets and surgisistm es (enhanced strength) sheets are designed to tolerate the mechanical stresses
associated with low-stress and high-stress body systems, respectively. Note that the product is derived from a porcine source and
should not be used in patients with known sensitivity to porcine material.
Results: the suture retention strength of single layer surgisistm is 303+/- 51. The nominal thickness is 0.20 And the burst force is
23.1+/-1.8. The potential complications are: a) infection, b) acute or chronic inflammation (initial application of surgical graft materials may be associated with transient, mild, localized inflammation), c) allergic reaction. If any of the above conditions occur, the
product should be removed.
The results of using the graft were statistically important. Only 1 patient developed localized acute inflammation.
Conclusions: the clinical importance of the implant sheets of a porcine source used in anteroposterior vaginal suturing in women
with cystorectocele was statistically important. The use of these implant sheets actually improved the results of this surgical procedure.
P028
Frequency and Treatment of Menorrhagia
A. Mladenovic Mihailovic, G. Obradovic, N. Vulic
KBC Zvezdara, Belgrade, Serbia
Our aim was to find the best way in treating women who suffer from prolonged and heavy menstrual bleeding in various age groups.
Methods We retrospectively analysed patients who had that problem in period from the beginning of 2005 to April 2007. and compared two groups where menorrhagia was caused by different causes: ovarian dysfunction on one side and some organic disease (
myoma, polypus, inflammation ). We also compared frequency in different age groups and their treating.
Results There were 150 women with abnormal bleeding from uterus in that period. 58 of them had menorrhagia ( 38,6% ). Among
them 18 ( 31% ) were between 18-45 years old, 35 ( 60,3% ) between 45-50, and 5 ( 8,6% ) over 50 years.
Organic cause had 28 ( 48,3% ) patients, 7 ( 25% ) had polypus cerv. 3 ( 10,7% ) polypus endometr. 12 ( 42,9% ) myoma uteri and 6
( 21,4% ) inflammation. The rest of them, 30 patients had ovarian dysfunction and most of them belonged to group between 45-50
years. 42 patients had a heavy bleeding and we did curettage expl. And 16 patients were treated with medicaments ( gestagenes,
ergometrin ). Connected with cause of bleeding as well as with the age, we continued with various Th: 9 of them were treated with
oral contraceptives, 10 with gestagens, 8 were operated, and we applicated IUD with gestagen to 11 women. Only 7 patients were
bleeding using hormonal Th in inappropriate way and we had to do expl. Curetage again.
Discussion and conclusions Most of our patients who had menorrhag. were 45-50 years of age. It is understandable, because that is
the period of perimenopause and as well the period with frequent organic causes for bleeding. We also recommended therapy IUD
with gestagene as more convenient for women because they are not obliged to think about taking pills.
97
P029
Adhesion prophylaxis after laparoscopic myomectomy using a novel resorbable membrane consisting of D,L-Polylactid
(Supraseal®)
B. Kraemer, M. Wallwiener, C. Wallwiener, C. Brochhausen, H. Planck, D. Wallwiener, T. Konrad Rajab
University of Tuebingen, Tuebingen, Germany
Introduction / Purpose
Post-operative adhesions constitute an important clinical problem. As a result, a number of liquid and solid barrier agents are being
developed. However, there is no consensus on which strategy (liquid or solid) is more suitable.
Here we present data about Supraseal®, a novel resorbable membrane designed to prevent adhesions and compare it to the liquid
adhesion barrier Adept ®, the efficacy of which has been verified in the literature.
Methods
30 patients admitted for laparoscopic myomectomy were randomised to receive adhesion prophylaxis with either Supraseal ®
(n=15), a solid adhesion barrier consisting of D,L-polylactid or Adept® (n=15), a liquid barrier consisting of icodextrin 4% solution.
Efficacy of the respective barrier was analysed according to the following parameters: Visual Analogue Scale for pain, requirement
for further operations, fever, constipation, nausea, dysparunia and dysmenorrhoea after 1, 2, 3, 7 and 14 days as well as 3 months
after surgery. Moreover, handling of the respective barrier was analysed using a questionnaire for the surgeons.
Results
There was no evidence for a significant difference in the post-operative outcome between patients receiving Adept® or Supraseal®.
However, intra-operatively Supraseal was considerably more difficult to use (p<0.05) because of its texture.
In a separate animal study we show with second look after 14 days that the adhesion scores of female Wistar rats receiving Supraseal® were significantly improved compared to control (p<0.01).
Conclusions
The clinical efficacy of Supraseal® is equal to Adept, yet the handling of Supraseal® is more time-consuming. We envision the routine application of Supraseal® for adhesion prophylaxis after further modifications of the material characteristics.
P030
An audit on the practice of second-generation endometrial ablation techniques (balloon and microwave endometrial ablation)
C. Madhu, J. Nattey, T. Naeem
Calderdale and Huddersfield NHS Trust, Halifax, West Yorkshire, United Kingdom
Objective(s): To audit the practice and effectiveness of two second generation ablation techniques (microwave and thermal balloon
endometrial ablation) in heavy and/or irregular menstrual blood loss.
Design & Methods: Women who underwent either microwave or balloon endometrial ablation for heavy and/or irregular periods during a three year period were followed up for at least one year following the procedure. This audit was conducted by the Department
of Obs and Gynae in 2 district hospitals of Calderdale and Huddersfield NHS Trust, UK.
Results: 136 and 59 women underwent Balloon and Microwave endometrial ablation respectively (Total=195). Majority of the women
were aged over 40 (72%) and almost all of them had heavy periods. Endometrium was evaluated by either hysteroscopy and/or
endometrial biopsy, with no significant abnormality detected. Fibroid uterus was one of the common abnormalities noted on ultrasound scanning.
66% of women were symptomatically better at 3 to 6 months follow up. Symptoms were better in 80 % of women at 12 months
follow up and were happy with the procedures. At nearly five years 15% of women had had a hysterectomy, with no statistically
significant difference in the endometrial ablation technique. Histopathological examination of the specimens showed no abnormalities in 59% specimens. Adenomyosis (24%) and fibroid uterus (14%) were the most common abnormalities noted. There was no
significant effect of age, Body mass index, uterocervical length or operator grade on the results or the hysterectomy rates. Another
satisfaction survey done during the same period showed more than 75% women felt better after the procedure and the same number would also recommend it to a close friend.
Conclusions: Second generation ablation techniques are an effective method of treating heavy and irregular menstrual blood loss.
They are easier and safer than the first generation techniques and reduce the incidence of hysterectomies. This not only has an
effect on the long-term health of women but also has financial implications on healthcare providers. They should be offered to all
eligible women seeking treatment for period problems.
P031
The acute leukemia should be included in the list of differential - diagnosis of hemoperitoneum
T. Pop, D. Craiut, R. Herczegh, S. Lacziko, M. Veres
University of Oradea, Oradea, Romania
Normal hematopoiesis requires tightly regulated proliferation and differentiation of pluripotent hematopoietic stem cells that become
mature peripheral blood cells. Acute leukemia is the result of a malignant event or events occurring in an early hematopoietic precursor. Instead of proliferating and differentiating normally, the affected cell gives rise to progeny that fail to differentiate and instead
continue to proliferate in an uncontrolled fashion. Immature myeloid cells (in acute myeloid leukemia [AML]) or lymphoid cells (in
acute lymphoblastic leukemia [ALL]), often called blasts , rapidly accumulate and progressively replace the bone marrow; diminished
production of normal red cells, white cells, and platelets ensues. This loss of normal marrow function in turn gives rise to the common clinical complications of leukemia: anemia, infection, and bleeding. If untreated, acute leukemia is rapidly fatal; most patients
die within several months of diagnosis. The signs and symptoms of acute leukemia result from decreased normal marrow function
and invasion of normal organs by leukemic blasts. Anemia is present at diagnosis in most patients and causes fatigue, pallor, and
headache and, in predisposed patients, angina or heart failure. Thrombocytopenia is usually present, and approximately one third
98
of patients have clinically evident bleeding at diagnosis, usually in the form of petechiae, ecchymoses, bleeding gums, epistaxis, or
hemorrhage. Most patients with acute leukemia are significantly granulocytopenic at diagnosis. As a result, approximately one third
of patients with AML and slightly fewer patients with ALL have significant or life-threatening infections when initially seen, most of
which are bacterial in origin. Some times, unfortunately, the ALL could be diagnosed first time after an emergency intervention for
hemoperitoneum. Regarding this statement we present a case report.
P032
Current vaginal surgery in treatment of the genital prolapse in our hospital
M.J. Martínez Payá, M. R. Espejo Catena, F. G. Naranjo De la Puerta
Hospital de la Ribera, Alzira-Valencia, Spain
Objective: -to communicate our procedures used in the correction of the genital prolapse present in the woman with different current
devices. The period go from july of the 2.004 To may of the 2.007.
Method. - We are collected all the interventions made for correction of genital prolapse, as much anterior as posterior compartment
or both. Also we are taken if associated to vaginal hysterectomy and population caracteristics. We are used epiinfo programme for
the statistical analysis.
Results. – In 2.004 We are performed 8 procedures about posterior compartment. In 2.005 We are performed 59 procedures, posterior compartment 25 and anterior compartment 34.In 2.006 We are maked 80 procedures, posterior compartment 47 and anterior
compartment 33. In 2.007 Up to 31 of may we have made 28 procedures, posterior compartment 13 and anterior compartment 16,
altogether, are gathered 175 procedures from july of the 2.004 To may of the 2.007.
According to our protocol we have gathered intraoperating, postoperating the complications immediate (first week). Intraoperative
complications(175).- Vesical injuries; 3 (1,7%); hemorrhages; 3 (1,7%).Short term complications (1ª week) (175).- Pelvic hematoma;
3 (1.7%), Buttock hematoma; 17 (9,7%). Postoperative complications (1º month) (172).- A) vaginal expositions; anterior 3 (1.7%);
Posterior 4 (2.3%); B) pelvic pain; 8 (4.6%); C) recurrence prolapse: compartment nontreated 3 (1.7%); Failure procedure 1
(0.6%), D) urinary incontinence; sui (required surgery treatment) 2 (1.2%); Urge incontinence new 7 (4.1%),; Urge incontinence
previous 22 (12,8 %) and e) granulomas; 7 (4,1%).
Discussion. - We have follow-up of up to 32 months. In general, the results are good. The complications are not serious and usually
are solved with local and ambulatory treatment, except those of new appearance like the stress urinary incontinence that have not
appeared in previous the urodinamic study with pessary to the operation and the recurrences of prolapse.
Contraception - Contraception
P033
Effect of Ruta graveolens L. Aqueous Extract on Human Sperm Motility: A Promising Female and Male Contraceptive
J. Naghibi Harat1, M. Reza Sadeghi2, H. Reza Sadeghipour1, M. Kamalinejad3, M. Reza Eshraghian4
1 Physiology Department, School of Medicine, Medical Sciences/University of Tehran, Iran, 2 Reproductive Biotechnology Research
Center, Avesina Research Institute, Tehran, Iran, 3 Pharmacognosy Department, School of Pharmacy, Shahid Beheshti University,
Tehran, Iran, 4 Biostatics Department, School of Public Health, Medical Sciences/University of Tehran, Tehran, Iran
Background: One of the contraceptive plants which have been introduced in Iranian traditional medicine for both men and women
is Ruta graveolens L. (rue). Abortive and anti-implantation effects of this plant had been established, but there is no data about
its effect on men fertility, so we experienced its effects on human sperm in vitro. Methods: Different concentrations of lyophilized
aqueous (from 6.25 to 200 mg/ml) and boiled extract (100 mg/ml) were added to different aliquots of fresh semen, containing 10 6
cells. Motility, viability, morphology of cells, and sperm revival tests were assessed according to WHO criteria. Osmolarity and ph of
extracts were also figured out. Results: The sperm immobilization effects of the aqueous extract appeared immediately in a doesdependent manner and 100% of the sperms became immotile at a concentration of 100 mg/ml, but viability of cells was intact.
After washing the sperm, motility returned in 30.8 ± 3.2 of the spermatozoa, besides coiled tails in 38.6 ± 5.5% of them (p=0.001).
The part of the extract, responsible for immobilization was stable upon boiling. The extract which had acidic pH, was hyperosmolar
before and nearly iso-osmolar after boiling. Discussion: Ruta graveolens L. aqueous extract contains some thermostable chemical
compounds that could immobilize human spermatozoa in a dose dependent manner, without being toxic for spermatozoa and making them coiled. High Osmolarity and acidic pH are another motility inhibitors, so it seems that immobilization effect of this extract
is multifactorial. Besides rue is an anti-microbial, anti-fungal and anti-inflammatory agent. Considering all these properties it could
be promising as a new natural vaginal or even male contraceptive factor.
Test material mg/ml
PBS
6.25
12.5
25
50
100
200
100boiled
pH
7.34
6.62
6.17
5.85
5.24
5.18
5.10
5.10
Osmolarity
286
293
301
374
377
725
1405
344
Motility%
74.1±3.3
70.6±6.2
72.4±3.8
65.5±2.4
53.2±4.7
0
0
0
P034
Former methods of contraception
S. Dimitrakopoulos, B. Karmi, A. Saltamavros, A. Bonas, A. Sidiropoulou, I. Mavropoulos, E. Papageorgiou, S. Koliantzaki, K. Sorras,
N. Sidiropoulos
General Hospital, Pyrgos/ilias, Greece
AIM: The study and the promotion/publicity of former methods of contraception dating from antiquity until the making/formation of
a condom made of latex in earlier years.
99
MATERIAL-METHOD: Data from Greek as well as foreign writings were researched.
RESULTS: Long time ago, man tried to find ways to avoid an unwanted pregnancy. In ancient Egyptians papyrus called Ebers
(1500bc) a recipe of vaginal suppository made of a mixture/blend of honey and acacia pins which kills spermatozoa is mentioned. In
the Minoic civilization, it is mentioned that Prokris, the wife of Kefalous, used the urinary bladder of a goat as a means of contraception. Aristotle refers to cedar oil endovaginally as a means of contraception. At Roman times, Sorranos suggests the obliteration of
the cervix uteri with cotton-wool or fabric soppy of spermicidal or fatty substances. During Middle Ages, Aetius suggests the use of
stryptic/astringent substances endovaginally. He suggests the “ekvolia” (abortion) or “atokia” (medicine/drugs that deter/prevent
conception). Afterwards, the English Condon uses a contraceptive made of enterozoa. In 1884, the tyre company Goodyear first
produces/makes the first condom made of rubber which has both protective/preventive and contraceptive use.
CONCLUSION: Hence, we find out that from antiquity till the earlier years, the activity with methods of contraception-protection has
led humankind to the discovery of more secure/safer methods. It is evident then, that the progress in the field of contraception is not
only based in the know-how but in medical knowledge of the past too.
P035
Chlamydia trachomatis and iud as a more up-to-date method of contraception
M. Bogavac1, G. Relic2, S. Miloševic1
1 Clinical centre Vojvodina, Department of Obstetrics and Gynaecology, Novi Sad,, Novi Sad, Serbia,
2 Medical faculty, Priština Health Center Kosovska Mitrovica, KMitrovica, Serbia
Introduction: Chlamydia trachomatis (CT) infection, like other pelvic inflammatory diseases, has been associated with the use of
intrauterine devices (IUD) ever since they were introduced as a method of contraception. Out of hypothetic risk factors the low
socioeconomic status, history of sexual contacts with multiple partners and use of intrauterine devices (IUD), were significantly associated with CT infections.
Aim of this study: To investigate incidence of chlamydial infections in
IUD users.
Study design: The chosen sample underwent testing by a direct immunoflorescence method of determining the Chlamydia trachomatis antigens in endocervical smear.
Results: Three years investigation comprised a sample of 16.792 women’s, including 893 - IUD users. Most of the patients with
positive chlamydial infection were at the age of 21-30. The Chlamydia trachomatis infection was recorded in all age groups. These
infections were significantly more frequent in IUD users 233 of 893 (26.04%).
Conclusion: The role of IUD use in the pathogenesis of chlamydia trachomatis infection and the other pelvic inflammatory disease
remains unclear and continual research on this topic is important. The testing of chlamydia trachomatis should be recommended as
a routine method before the IUD insertion.
P036
Efficacy of using “once a month combined injectable contraceptive cyclofem” among indian women
S. Kumar, C. Shekhar, M. Roy, N.K. Gupta
Objectives : To evaluate the contraceptive efficacy, side effects and continuation rate for the monthly contraceptive injection
“Cyclofem” in Indian women.
Methodology : The study was carried out at 16 centres. A total of 1275 women were enrolled in the study. All family. planning
seekers were given balanced presentation of the advantages & disadvantages of the currently available methods in the clinic
namely IUD, OC, Condom, Sterilisation and Cyclofem. A thorough systemic and pelvic examination was done to exclude subjects
as per exclusion criteria. Haemoglobin estimation, urine for albumin, sugar, B.P. and weight were also recorded at the time of
registration and subsequently at every three month till the completion of the study.
Results: A total of 63792 women attended family planning clinics, 42.1% accepted Tubectomy, 0.2% couples opted for the Vasectomy, 24.9% accepted condoms, 15.8 accepted IUD, 14.7% accepted oral pills and only 2.0% opted for Cyclofem of total family
planning seekers. Mean age of acceptors was 26.0±4.1 years and mean parity of 1.8±1.0. Mean weight and height of acceptors
was recorded as 48.2±10.9 kgs and 152.3±17.7cms respectively. 87% of the acceptors were literate and 17.8% were employed.
These women were observed for a total of 10934 women months of use. 791 women completed one year of use i.e. have used 12
injections. The continuation rates at 6, 9 and 12 months was 74.3, 66.7 and 63.2 per 100 users respectively. Majority of the users
discontinued the method due to personnel reasons. Discontinuation rate due to ammenorrhoea was 2.7 at 12 months, discontinuation due to heavy and prolonged bleeding was 2.7 and discontinuation rate due to other medical reasons was 3.8 at 12 months.
Few women discontinued due to personal reasons. 33 acceptors were late for followup due to various reasons and were not given
injection.
Conclusion: The results of the study indicate that the method is highly efficacious as no pregnancy is reported in the study and the
method is acceptable to women desiring spacing (continuation rate 63.2%) at the end of 1 year. In contrast to progestin only methods. Discontinuation rates due to menstrual irregularities was very less i.e. 9.2 per 100 users at one year.
P037
Introduction of emergency contraceptive services through paramedics in India
N. K. Gupta, C. Shekhar, M. Roy
Objective: To evaluate the effectiveness of delivery services of ECP (Emergency Contraceptive Pill) by the trained paramedics and
thus could the awareness be increased among potential users.
100
Design and Method: In spite of wide range of modern contraceptives available in National Family Welfare Programme (NFWP) of
India 21% pregnancies are unplanned resulting in 6.5 million induced abortions every year. The situation like unprotected sex, improper use of regular contraceptives, failure of barrier methods and sexual violence often lead to an unwanted pregnancy. The unwanted pregnancies can be prevented by using Emergency Contraceptive Pill (ECP). In 2001, Govt of India included EC pill in NFWP.
But only Medics/Paramedics know about ECP as a method to prevent unwanted pregnancy after intercourse. Even among those
who are aware of ECP, very few know how to use it correctly. To make ECP easily available and effective in preventing unwanted
pregnancies, it is important that paramedics/potential users be made aware of correct use of ECP and the sources from where it
could be easily obtained. Keeping this in view, Indian Council of Medical research and Frontier carried out a collaborative study to
know whether paramedics could be trained to provide ECP and deliver the services effectively and correctly. The study was carried
out in one district each from 4 states of India. From each of the selected districts six Community Health Centre (CHC) areas were
selected at random. These CHC areas were then randomly allocated to the two delivery models and one control group. In each state
about 1, 80,000 population was covered. Before, initiating the study training were organized with the focus on: what is ECP, who
should provided with ECP, dose interval, side effects and how to counsel potential ECP uses etc. Result: The data indicates that
before training, knowledge about ECP was quite low among paramedics 23%, which increases to 86% post training .The training
aids and educational package developed for ECP training was useful and effective Conclusion: The study showed that paramedics
can easily be trained in providing ECP correctly and increase awareness in masses by training and counseling them.
P038
Original method for second trimester medical termination of pregnancy
J. Vukelic, A. Kapamadzija, S. Milosevic, Z. Grujic
Clinical center Vojvodina, Dept.of Obstetrics and Gynecology, Novi Sad, Serbia
Objectives: The aim of the study was to evaluate efficacy of original method for second trimester medical termination of pregnancy
with double dose of dinoprostone (PGE2) gel for ripening of the cervix before intramuscular administration of carboprost tromethamine (PGF2 alpha) which had been previously established at our Department.
Design: A randomized study had been performed at our Department, during the period from 1995-1999 which included 100 primigravidas who underwent second trimester pregnancy termination with double endocervical application of dinoprostone gel for
ripening of the cervix before intramuscular administration of carboprost tromethamine every two hours until the expulsion of the
foetus. Since this method proved to be more effective compared to administration of single dose of dinoproston gel, from year 2000
till now all medical second trimester abortions had beeen performed in this way (413 women).
Results: Endocervical administration of double dose of dinoproston gel (1mg) for cervical ripening before intramuscular administration of PGF2 alpha was performed in 413 women and resulted in: 1. significantly shorter abortion interval x=5,55 hours (SD=3,48),
(p<0,01), 2. less amount of used PGF2 alpha and 3. more effective dilatation of the cervix measured with Hegar dilatators x=13,48mm
(SD=2,49) compared with patients who received single dose (0,5mg) of dinoprostone gel followed by intramuscular administration
of PGF2 alpha. This method failed in 5 (1,21%) women and hysterotomy – Sectio parva, had to be done.
Conclusions: The method for second trimester medical pregnancy termination using double dose of dinoprostone gel intracervicaly
before intramuscular administration of carboprost tromethamine resulted in significantly shorter abortion interval compared to single
dose of dinoprostone gel. Shortened abortion interval with this method significantly decreases the rate of immediate, early and late
complications of pregnancy termination. Significantly decreased amount of used prostaglandins (PGF2 alpha) decreases the rate of
undesirable systemic effects resulting also in reduced costs of the procedure. On the basis of presented results it can be concluded
that this original method is a method of choice for legal medical pregnancy termination in the second trimester.
P039
Emergency Contraception: Health Care provider’s Knowledge and Awareness in India
S. C. Yadav, A. K. Mathur, Neeru Gupta
Objectives: To assess knowledge and awareness of Emergency Contraception among Health Care Providers.
Design and Methods: The study was carried out with the above objectives, in Hospital settings through 10 Human Reproduction
Research Centres (HRRCs) of Indian Council of Medical Research (ICMR), located in Department of Obst. & Gynae. of Medical
Colleges in the country. All the staff members of Department of Obst. & Gynae. of above 10 Medical colleges, Gynecologist, other
specialists and health staff working in the selected District Hospitals, were given the pre designed questionnaire and the filled-up
questionnaire were collected on the same day by the concerned HRRC staff.
Results: A total of 635 health care providers were enrolled in the study with 40% Medicos and 60% Para-medicals. Overall, 50.5%
of the providers knew about Emergency Contraception (EC). The doctors - 82%, and Para-medicals –30% (p < 0.001) had knowledge of EC. Of the total 315 providers who knew about EC, 89.6% said that EC couldn’t substitute regular contraceptives. Of these
only 29% knew which method of contraception can serve as EC. The Doctors – 86%, Para-medicals - 77% said that EC couldn’t
be administered after the pregnancy is confirmed and this was found to be statistically significant (p < 0.05). Of the providers who
had knowledge about EC, 95% said that effectiveness of EC method is higher if it is taken as early as possible after the unprotected
sexual intercourse (USI). Whereas, 89.7% of the providers said that to avoid pregnancy even after the use of EC, the use of another
contraceptive is required for further sexual intercourse (SI). As regards time elapsed between USI and the use of EC, 54% providers
said it should be taken within 48 to 72 hours and 43% said as soon as possible.
Conclusions: The Medicos and Para-medicals need to be trained regarding knowledge and awareness of EC as to update them
to counsel the beneficiaries.
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P040
Therapeutic attitude for treatment of the morphologic changes of the cervical cytology at the monogamous IUD users
R. Stanculescu1, Teodora Vladescu2, Cecilia Tihoan2, Rodica Chirculescu2, Florina Vasilescu3
1 University of Medicine “Carol Davila”, Bucharest, Romania
2 St Pantelimon Hospital, Bucharest, Romania,
3 National Institute for Pathology, Victor Babes, Bucharest, Romania
Objective The purpose of the study is to analyse the cervical cytology at the IUD user from monogamous couples targeting to
investigate if there are cytological changes and to check the efficiency of a supplemental therapy. Material and method The study
registered 1256 IUD user women. The Pap test was firstly made before the insertion of the IUD and then every year during 10 years.
After one year 780 women recorded changes of the morphologic aspects in the cytologic smears characteristic for inflammation and
476 women did not present morphologic changes. Following the first year analysis, we decided to divide, for analysis reasons, the
subjects thus: Group A (containing the cases) - formed by n= 548 IUD users who accepted anti COX2 therapy during the menstrual
period for five days monthly during at least one year; Group B (holding the controls) – formed by n=310 IUD users with cytologic
changes who did not receive any anti-inflammatory therapy (controls). The Group A enclosed the subgroup A1 (268 cases without cellular inflammation) and subgroup A2 (280 cases with cytologic changes). We examined the data by using the case-control
method. Results The study revealed that after one year 62% of the IUD users had morphologic changes of the cytologic smear; the
encountered morphological issues were intracitoplasmatic vacuolisations, slight augmentation of nuclei, perinuclear hallo, inflammatory changes and presence of neutrophil polymorphs, histiocytes and sometimes the presence of actionomyces. In the Group
A with anti COX 2 treatment these changes disappeared at the next Pap test or never appeared. The incidence of inflammation
in the Pap test increased to 88% after three years at the IUD users with initially normal cervical smear, which did not receive anti
COX2 treatment. In group B we observed a yearly increase of morphological changes: slight to moderate cellular alterations (30% of
group B) and metaplastic and severe inflammatory lesions (14% of group B). Conclusion Our study concluded that the presence of
the inflammation in the cervical smear at the IUD users can lead to cytopathologic changes in epithelial cells and this justifies short
period anti COX 2 treatment, annual Pap test and do not require the IUD removal. The anti-inflammatory treatment associated with
Pap test creates the possibility to prolong the IUD usage duration for more then ten years.
P041
Counseling and compliance for contraception with intrauterin sistem with progestins
L. Lote Surtea, M. Manolea, A. Gavrila
University of Medicine, Craiova, Romania
Introduction: From the women`s perspective, she has used a contraceptive method successfully if she is able to prevent an undesired pregnancy and to continue the method for as long as she desires contraception. Oral contraceptives are the most popular
form of reversible contraception used in Europe, but the efficacy depends on their consistent and proper use. The above-mentioned
aspects initiated the development of alternative contraceptive method using different routes of administration and controlled released formulations.
Objectives: This study examines the supposition that effective contraception actually has the potential to contribute to better maternal health beyond simply reducing the proportion of birth that are unwanted.
Methods: In our study we used intrauterine system (IUS) with 52 mg levonorgestrel which delivers 20 µg / day during 12 -60 months
(Mirena) for 56 women. We do not find unintended pregnancies.The only procedure considered essential in that circumstance for
safe use of the contraceptive method is adequate initial counseling that covers the major issues in compliance, side effects, fear and
concerns. We also emphasize that transient side effects are expected, but we encourage to continue to use these reliably methods,
even if side effects do occur.To measure acceptability, women were asked if they would like to continue the regimen and if they
would accept renewal of the intrauterine system.
Results: Endometrial safety was evaluated by transvaginal ultrasound examination and by endometrial biopsy in a subset of 8
women prior to replacement of the IUS. Ultrasound was taken dynamically every twelve cycles. The endometrial thickness according to ultrasound data was : starting 36 mm; after 6 months 30 mm; after 12 months 24 mm, in correlation with a favorable
bleeding pattern with very law incidence of hypermenorrhea or methrorragia (1.04%).
The histological examination conducted after an average period of use of the method of 60 months in 8 cases, showed predominantly inactive endometrium characterized by pseudo-decidual reaction of the endometrial stroma with endometrial atrophy, that
makes endometrium improper to implantation.
Conclusions: Our data support the evidence that the IUS is safe, well tolerated, well accepted and effective in preventing undesired
pregnancies. The IUS is a locally acting method which should be regarded as fundamentally advantageous to systemically applied
medications which may have potentially inherent ill side effects.
P043
Frequency and determinants of emergency contraception use in young women
M Teixeira, S Fraga, C Pina, M Fernandes, H Bachu, D Leite, J Santos, T Oliveira
Maternidade Julio Dinis, Porto, Portugal
Introduction: Emergency contraception (EC) is the reason for seeking our youth friendly service -Youth Space- in about 1% of all
appointments throughout the year. EC has been available free of prescription in hospitals, health centres and pharmacies in the last
years, as a last resource after unprotected intercourse, and there is no “real world” knowledge of its use among adolescent and
young adult population. The aim of this study was to evaluate the use of EC among female attendants of Youth Space.
Methods: All 403 female attendants of Youth Space between 1st December 2006 and 31st January 2007 were asked about their
education level, job, age at first intercourse, usual contraceptive method, use of EC, type of EC, who prescribed it and occurrence
of pregnancy afterwards.
102
Results: Mean age of the studied group was 20.4±2.5 years, and most of the attendants were students (79.9%). Of the 375 sexually active attendants, 89.9% (n=341) reported regular use of contraceptive method and 42.7% (n=160) had already used EC, most
(65%) only once. In 72.5% of cases EC was prescribed by a pharmaceutical/ pharmacy and there were only 4 (2.5%) pregnancies
reported after EC use. Mean age at first intercourse was significantly lower in attendants that reported use of EC (17.0 vs. 17.4 years
in non-users, p=0.02). Use of EC was more frequent in girls who used condom, and the risk of using EC was significantly reduced
by 70% in attendants who used hormonal methods compared with those who reported condom use (OR: 0.30, 95%CI 0.16-0.54).
No significant differences were found in EC use according to education level (43.7% in college attendants vs. 41.5% in undergraduate girls).
Conclusions: Almost half of the attendants in this period had already used EC, despite the regular use of a contraceptive method.
In most cases it was prescribed by a pharmaceutical, being impossible to evaluate the adequacy of its prescription. Education level
was not related to EC use but young age at first intercourse and use of non-hormonal methods increased the risk of its use.
P044
Experience in the use of Mirena - Critical Analysis
Mario Pommier, Mauricio Pommier
Clinica URBARI, Santa Cruz, Bolivia
Objective: To determine the overall efficacy of Mirena over a six-year period by establishing the indications for its use, the symptoms
that resulted, and the impact of these symptoms on the normal duration of its use.
Methodology: The report is based on the medical records of 233 patients, presenting a total of 362 indications, who had Mirena
inserted between December 2000 and December 2006. It presents and analyzes data gathered from successive patient clinical
controls in which we identified indications, recorded symptoms associated with Mirena, and determined whether or not we should
extract the contraceptive prematurely.
Results: Contraception was the reason for half of all Mirena use, with the remaining indications split between pre-menopause, c-section, birth or D/C, menorrhagia, fibroids, and menopause. The full five-year term of use was reached by 75.90% of those patients
who had Mirena inserted in 2001 or 2002. And of those patients who began using Mirena between 2003 and 2006, 78.26% still have
it inserted. The most frequent symptoms associated with the use of Mirena were amenorrhea, vaginal infection, spotting, bleeding,
chloasma, acne, and depression. The most common reasons for extraction involved patients who presented more than one hormonal reaction, i.e. some combination of chloasma, acne, hair loss, or libido reduction. Other reasons for extraction included bleeding and persistent spotting, depression, abnormalities in the breasts, weight gain (when exceeding 2kg/yr), and hysterectomy.
Discussion : The report compares these results with Backman’s national study of Finland (BJOG 2000), concluding similarly that
the continuation rate of Mirena remains high despite adverse symptoms and complications. We further conclude that Mirena is an
effective contraceptive method – especially during premenopause, after giving birth, or after c-sections – and that it is also a viable
alternative to hysterectomy in cases of menorrhagia and fibroids.
P045
The evaluation of the rate of major depression in those who use norplant at Shiraz Hafez Hospital
S. Habibollah Kavari, M. Helyani, V. Dehghani
Islamic Azad university-Drab branch, Darab,fars, Iran, Islamic Republic of
The aim of this research study, is to investigate the rate of server depression in those who use propellant. In order to achieve this
objective, 260 patients volunteered to participate in this investigation and They were referred to the family planning clinic at Hafez
hospital, and were planted capsule of Norplant.
In order to further fulfill selection process of patients suitable for this project, 200 of the most suitable candidates who suffered
from even minor depression but had no history of congenital and familial major depression were selected and considered fit for this
research work.
The next stage of this work involved, the interviews of these selected patients based on regular intervals of every six months and
they were asked to complete a series of questionnaires. These questionnaires were set out according to DSM-IV standard, in order
to monitor the patient’s condition by putting direct questions to them.
This stage was also meant to give them the opportunity to express and discuss their progress on their different aspects of life such
as social, career and familial problems. This investigative project continued for two years, and the experimental data were collected
during the period Dec/2002 to Dec/2004.
The conclusions drawn from this investigative study can be summarized as follows;
1- The relationships between progesterone in anti pregnancy compound tablets, major depression and anxiety were recognized
from many years ago. Norplant which is progestin itself can also be regarded as the cause of these conditions.
2- This investigation concluded that, among those patients studied, only 0.5% started having major depression as a result of the
plantation. Therefore, Norplant was removed from their body.
3- Based on the finding in this research, using Norplant had no serious limitation and consequences because, depression can stop
and disappears as soon as the Norplant has been removed.
4- This study also showed that although the rate of depression caused by Norplant was very little and that depression is not a prevalence common complication, but it is important and advisable to be aware of tempers and other side effect.
5- A good consultation, awareness, correct guidance and efficient method of educating people before using Norplant, seeking
prompt referral advice and future follow ups, will result in an effective way of preventing, diagnosis and treatment of these side
effect conditions.
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P046
The survey of an effective factors on different practical failure methods of family planning in women refers to health centres
S. Habibollah Kavari, A. Keshtkaran
Shiraz Medical University, Shiraz,fars, Iran, Islamic Republic Of
One the spite of the proportional access to means of family planning, the rate of unwanted pregnancy is very high. That is because
of failure in using different methods of family planning or they do not use any methods that are for different methods of family planning or they do not use any methods that are for different reasons. In this research 938 cases of unwanted pregnancy from the view
point of prevention method, how to use different means of family planning and the reason of not using family planning methods were
checked. On the whole 88.6 percent of women used one of the methods of family planning in month of pregnancy. 37.2 percent
used prevention tablets and, 5.9 percent of pregnancy cases was because of careless using tablets. About other means of family
planning, an important factors of failure was using irregularly with different forms. Using confident methods irregularly.
The use of those method that are not confident and having wrong belief about different prevention method was the most important
practical factor’s of failure which have related directly or indirectly with family planning education. Correct education of family planning is one of the important prevention factors in unwanted pregnancy.
Key words: Family planning methods, unwanted pregnancy.
P047
The choice of Essure microinserts placement – success rate and women`s opinion
J. Faria, R. Condeço, F. Sousa, N. Assunção
Hospital Dona Estefânia, Lisbon, Portugal
Introduction: Hysteroscopic flexible micro-insert (Essure) is as ambulatory improvement of fallopian tube sterilization, approved for
use by the European Health Office in November 2001 and by the U.S.Food and Drug Administration in November 2002.
Objective: To present our initial experience in the use of Essure permanent birth control (PBC) micro-insert device in an outpatient
setting and evaluate procedure feasibility without general anesthesia, device placement success rate, incidence of complications,
post-operative adverse events and women global satisfaction.
Methods: It is a retrospective study, carried out between July 2002 and March 2007 in a tertiary level hospital, with includes fortyseven women in reproductive age and proven fertility that requested for permanent contraception and accepted hysteroscopic
sterilization with the Essure micro-insert, which was done under manufacturer recommendations.
Results: In 8,5% (4 cases) of women proposed for hysteroscopic sterilization, the insertion was not performed because of technical
difficulties or intracavitary pathology. No intraoperative complications were detected. The device placement success rate at three
months was 79,1%. It was possible to evaluate patient´s satisfaction in thirty-four cases (72,3%): perioperatory discomfort 1,97(110); 20,6% reported pelvic pain during the fist 24-hour and there was no cases of persistent pelvic pain six weeks after placement.
One case of pregnancy was reported. Women global satisfaction was 9,23(1-10).
Discussion: Essure is safe and a minimally invasive option for proximal tubal occlusion. The transcervical route avoids the need for
hospitalization, general anesthesia and incisions. It is associated with minimal postoperative pain, and allows faster recovery and
resumption of normal activities with very satisfactory patient acceptance. It seems to be a good alternative to laparoscopic tubal
sterilization. As with all surgical procedures, a high rate of successful placement of devices shows to benefit of surgeon experience.
The one case of pregnancy after apparently successful placement is discussed.
P048
Knowledge and use of emergency contraception among students in state schools in Morelos Mexico
D. Ramirez Villalobos
Instituto Nacional de Salud Publica, Ceurnavaca, Morelos, Mexico
Objective: To evaluate Knowledge and use of that students have about emergency contraception (EC), in state schools, in Morelos
Mexico. Methods. The present study is based of the third measurement of one cohort study of students age 14-24 years state
schools from of Morelos, Mexico. Between 2003-2004 the study enrolled 1549 students who signed and answered previous informant consent and questionnaire. Results. The age average of the students was of 19+2 years. Of the 1549 students, only 61,07%
(946 students) had knowledge about EC. The women showed greater knowledge on EC than the men, (63,95% vs. 36,05% %;
p=0.003).Of the students who had sexual relations for the first time (17 years +2), only 1,13% used EC. Finally, the students that
had sexual relations for the first time almost half (47%) knew about EC. The factors associated to the EC knowledge were: to have
had sexual relations (RM=1.83; CI=1.43-2.34); to be woman (RM=, 1.86;CI 1.48-2.33;); and age (RM=0.613;CI0.43-0.86). Conclusions. The results show that the women have more Knowledge of EC. However, it is important conduce future studies that identifies barriers and use of this contraceptive method in diverse Mexican students. The previous, because, it is very important that not
only Morelos state but also in the Mexico country exist more knowledge EC about, in students of all levels, and with these increase
campaigns to promote responsible attitudes before and after they initiate his active sexual life.
Gynaecological imaging - Imagerie en gynécologie
P049
Polycystic ovarian syndrome: morphological criteria diagnosed by ultrasound
A. Radulovic1, M. Bogavac2
1 Health Center, General Hospital, Subotica, Subotica, Serbia, 2 Clinical Center, Department of Obstetrics and Gynaecology, Novi
Sad, Novi Sad, Serbia
104
Introduction: The Polycyistic ovary syndrome (PCOS) (Polycyistic ovary disease - PCOD) is the most frequent endocrine disorder
associated with infertility and esthetic problems in the women of reproductive age. Aim of the study was to analyze morphological
criteria diagnosed by ultrasound and hormonal findings in PCOS. Results and conclusions: The levels of LH increases relative to the
number of microcysts whereas the ratio of LH/FSH in all PCO patients and the normal weight patients is significantly increased in
relation to all other subgroups. The lowest value of FSH in normal weight patients was recorded in the subgroup C and the highest
values of testosterone were also recorded in the subgroup C. The volume of ovaries was in significant positive correlation with the
levels of LH in obese patients and with the levels of testosterone in normal weight patients with PCO. The investigated patients with
increased density of the stroma had significantly increased levels of testosterone than these with normal stromal echogenity.
P050
T.V. sonographic assessment in postmenopausal women with bleeding
P. Tsikouras, G. Galazios, T. Sibbas, E. Skyfta, I. Nikas, S. Zervoudis, A. Tobias Teichmann, V. Liberis
Democriyus University of Thrace, Alexandroupolis,Thrace, Greece
Aim: The aim of this study was to evaluate retrospectively the usefulness of transvaginal sonography for the detection of endometrial
disease in postmenopausal women with bleeding. Methods:This study was conducted from 1.1.1998 to 31.12.2006 in the Departments
of Obstetrics and Gynecology of the Democritus University of Thrace,Greece and the Akademic Hospital of Aschaffenburg,Germany
, Lito Maternity Hospital ,Athens and Department of Obstetrics and Gynecology,Hospital Ddimoticho,Greece This study involved
155 postmenopausal women aged 55 - 81 years (Median 68). None of them were on hormone replacement therapy and all had
amenorrhea for more than 3 years.Results: Concerning the age in the study patients , we confirm that endometrial cancer occurs
at any age, but more commonly in ages above 60 years. Transvaginal sonography was performed in 155 women .About 91,2% of
the malignant diseases were discovered in study-women, whose endometrial thickness was above 6 mm,but we found endometrial
cancer in 8,8% of the cases, in women, whose endometrial thickness was below 6 mm.Conclusion: In postmenopausal symptomatic women premalignancy or malignancy causes of bleeding can not be excluded with just transvaginal ultrasound.
P051
Doppler assessment of endometrial carcinoma
C. Iavazzo, F. Ntziora, K. Kalmantis, N. Balakitsas, D. Paschalinopoulos
Vougiouklakeion, Athens, Greece
Background: Angiogenesis is an important factor occurring in the neoplastic process of endometrial carcinoma for both tumor
growth and progression. Color and pulsed Doppler can be useful diagnostic tools in the detection of endometrial pathology, as
several cases of endometrial carcinoma have abnormal blood flow with low impedance.
Case report: We present a case of a 61-year-old woman with known history of per vaginam bleeding. The transvaginal sonography
showed a large uterus measuring 50x37x43 mm with a heterogeneous mass which measured 23x20 mm in the endometrial cavity. The color Doppler revealed areas of increased endometrial blood flow and the pulsed Doppler showed a low resistance index
(RI=0.31) in selected endometrial vessels. The patient underwent a total abdominal hysterectomy with bilateral oophorectomies and
the histology showed an endometroid carcinoma of the uterus stage Ic grade 2-3. Lymph node biopsies were negative.
Discussion: The presence of a very thick endometrium (more than 20 mm) and intra- and/or peritumoral blood flow with a low resistance index (RI=0.37+/-0.07) increases the risk for endometrial carcinoma. The uterine artery is too large to show hemodynamic
disturbances caused by small areas of neovascularization in the early stages of endometrial carcinoma. However, in the advanced
stages, a significant reduction in RI of uterine and intramyometrial arteries is showed. Greater depth of invasion and higher tumor
grade are related with increased angiogenesis which makes it more likely for the color and/or the pulsed Doppler to detect it. Routine use of the color and pulse Doppler in the study of increased endometrial thickness can be a first line investigation, necessary
adjunct to the B-mode.
Key words: endometrial carcinoma, angiogenesis, color, pulsed Doppler
P052
Abnormal placentation: echography and magnetis resonance imaging diagnosis
M. Tebache, D. Henroteaux, F. Chantraine, X. Chapelle, L. Tebache, J.-P. Schaaps
Chr, Citadelle, Belgium
Purpose: to compare ultrasound (US) and MRI aspects of normal and pathologic placentation.
Method and materials: during an observation period of 45 months, 11 patients presented with abnormal placentation underwent
high-resolution ultrasound with doppler flow study and multiplanar MR study with T2 and T1 weighted sequences. Both techniques
were compared retrospectively. Mean maternal age was 32.6 years old. The number of cesarean sections ranged from 0 to 4 in each
patient. Gestational age ranged from 17 to 34 weeks old. Specific diagnoses included placenta percreta (n=6) and accreta (n = 5).
Results: All abnormal placentation cases were diagnosed before delivery. US demonstrated the disorder in all cases with a deficit
of accuracy in the definition of potential invasion of peri-uterine tissues and bladder wall. T1 MR slices do not provide sufficient
contrast information for correct diagnosis or adequate abnormality evaluation. An adequate analysis of placenta can be achieved
with T2 thin slices because of excellent soft tissue contrast. The transmural extension of placenta percreta was easily defined with
MRI but it failed to confirm 1 case of placenta accreta. MR examination provided additional informations, facilitating diagnosis of
bladder wall invasion in 2 cases. Post partum pelvic infection (endometritis) occurred in 1 case. Hysterectomy was necessary in 2
patients for persistent bleeding in one and pelvic sepsis in the other. Conclusions: In gravid patients with risk factors for abnormal
placentation, US and MRI should search for potential placental invasion of the myometrium. So that the treatment can be planned
and tailored to the patient situation, avoiding postpartum life-threatening hemorrhage and preserving fertility. MRI appeared superior
to define adjacent organs invasion.
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P053
Antibiotic, single–dose versus triple–dose prophylaxis of infection in abdominal hysterectomies
P. Tsikouras, S. Zervoudis, V. Liberis, A. Savidis, K. Giagloglou, X. Grapsas, A. Tobias Teichmann, G. Galazios
Democritus University of Thrace,Department of Obstetrics and Gynecology, Alexandroupolis,Thrace, Greece
Aim:The purpose of this retrospective study was the evaluation of the prophylactic efficacy from postoperative infections that offers the use of the antibiotic-therapy in patients who had undergone abdominal hysterectomy, concerning the reduction in peri-and
postoperative morbidity. Methods:This study was conducted from 1.1.1996 to 31.12.2005 in the Departments of Obstetrics and
Gynecology of the Democritus University of Thrace,Greece and the Akademic Hospital of Aschaffenburg,Germany and Lito Maternity Hospital ,Athens and included 594 that had undergone abdominal hysterectomy for various causes.In these women ,who
underwent elective hysterectomy for non-malignant pathology ( mainly dysfunctional bleeding and fibromas ) were given a single
intraoperative dose of cephalosporin first-generation ( evaluable 105 patients=Group A ) or three postoperative doses of the same
medication ( evaluable 125 patients=Group B) over an eight –hour period as antibiotic prophylaxis.Results: The mean age for the
A- women was 50.0±1.9 years (range 48-52 years) while the mean age for the B-group was 48.0 ±2.0years(range 46-50 years)The
efficacy of the perioperative antibiotic prophylaxis was assessed clinically and on the basis of laboratory parameters. The good tolerability of the drugs administered was proven in 98% of the patients (Group A) and in 97% of the patients (Group B ). In both groups
5 patients developed nausea and/or vomiting, respectively, due to the antibiotic prophylaxis There was no statistically significant
difference in febrile morbidity and in the frequency of postoperative infections between the two groups
Conclusion: We did not observe any essential therapeutic differences between single dose monotherapy and triple dose antibiotic
treatment in postoperative prophylaxis. However ,more prospective studies with greater number of patients are required,for better
evaluation regarding the efficacy of single dose antibiotic prevention.
P054
Traitement chirurgical des tumeurs bénignes de l’ovaire: a propos de 299 patientes
S. Figueiredo, C. Silva, J. Almeida, M. Helena Barros Leite
Maternite Bissaya-barreto, Coimbra, Portugal
Objectifs : Recueil des caractéristiques cliniques, échographiques et histologiques des tumeurs bénignes de l’ovaire et évaluation
de leur prise en charge chirurgicale
Patientes et méthodes : Nous avons effectué une étude rétrospective du 1er Janvier 2000 au 31 Décembre 2005 portant sur 299
patientes opérées pour une tumeur bénigne de l’ovaire.
Résultats : Nous avons établi une analyse descriptive de nôtre population en étudiant plusieurs paramètres : l’âge des patientes au
moment du diagnostic, l’existence d’antécédent de chirurgie ovarienne, un contexte de stérilité ou d’infertilité, une éventuelle prescription préopératoire de traitements suppressifs, la parité et la gestité. Les variables suivantes ont été évaluées et colligées : les
circonstances de découverte, les caractéristiques échographiques de la masse annexielle, le dosage du marqueur tumoral CA125,
la voie d’abord chirurgicale, le geste opératoire effectué, la durée de l’intervention et de l’hospitalisation, l’existence de complications chirurgicales ou post-opératoires, la taille tumorale, le résultat anatomo-pathologique et la survenue de récidive. Dans un
contexte de stérilité, la fertilité postopératoire a été étudiée.
Conclusion : Nos résultats sont comparables à ceux de la littérature.
Unusual pregnancies - Grossesses atypiques
P055
Spontaneous heterotopic pregnancy with uncommon symptomatology, a case report and literature review
S. De Silva, V. Chandra, S. Sharma
Southport and Ormskirk NHS Trust, Merseyside, United Kingdom
Objective; To analyze the incidence, symptomatology, diagnosis and management of heterotopic pregnancy.
Design and Methods: Setting: Gynaecology unit in a secondary referral hospital in the United Kingdom. Method: A case report of
a 28 year old female with a heterotopic pregnancy is presented with a review of published literature. The review of literature was
performed by means of MEDLINE search from 1950 to date using keywords – heterotopic pregnancy, combined pregnancy and
ectopic pregnancy.
Results: We report a case of 28 yr old female who presented to the gynaecology unit with minimal vaginal bleeding and abdominal
pain. She gave a history of amenorrhoea for 6 weeks and the pregnancy test was positive. A vaginal scan confirmed a non viable
single intrauterine pregnancy and the diagnosis of a missed miscarriage was made. While the patient was on the conservative management, she presented again 6 days later with continuing abdominal pains and rising serum beta human chorionic gonadotrophin.
A repeat scan revealed a complete miscarriage together with a right adenexal mass suggestive of an ectopic pregnancy. Subsequent laparoscopic surgery confirmed a non ruptured ectopic pregnancy.
Conclusions: Spontaneous heterotopic pregnancy is a rare entity with an estimated incidence of one per 30,000 pregnancies. However, the incidence is much greater with the use of assisted reproductive techniques. The diagnosis of the condition could sometimes be challenging due to the misleading nature of the symptoms. Therefore, it is important for the clinicians to keep a high index
of suspicion to prevent potential dangers to the patients.
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P056
Coexistence of endometrial and ectopic pregnancy. Presentation of case.
S. Dimitrakopoulos, B. Karmi, A. Sidiropoulou, E. Papageorgiou, M. Anastasopoulou, I. Mavropoulos, S. Koliantzaki, A. Bonas, K.
Gioni, N. Sidiropoulos
General hospital, Pyrgos/Ilias, Greece
AIM: This paper aims at presenting a rare case of endometrial and ectopic pregnancy, diagnosed in a 16-year-old female gypsy,
patient of the Gynecology clinic of the General Hospital of Pyrgos.
MATERIAL-METHOD: A 16-year-old female gypsy got operated in the Gynecology clinic of the General Hospital Of Pyrgos.
RESULT: Once the 16-year-old gypsy arrived, she was examined in the one stop cleaning of the Gynecology clinic of Pyrgos Hospital
with main trouble ache in the minor pelvis and additional symptoms such as fainting and tachycardia. During the ultrasound scanning of the minor pelvis, 9-week endometrial pregnancy was diagnosed as well as cystic tumor of mixed audiogenicity in the right
fallopian tube and fluid of mixed audiogenicity in the Douglas pouch. During the diagnostic laparotomy, ectopic pregnancy in the
ampulla of the right fallopian tube was found. The product of the operation was sent for pathologoanatomic examination. The result
of the histological examination was ectopic pregnancy in the ampulla of the right fallopian tube.
CONCLUSION: Despite the fact that it is a very rare case, the clinical importance of the coexistence of the endometrial and ectopic
pregnancy in the 16-year-old gypsy patient, is indeed a fact.
P057
Cervical pregnancy, conservative management with methotrexate
J. Lourenço Reis, P. Ventura, P. Condeço, C. Barros, D. Rosa
Maternidade Dr. Alfredo da Costa, Lisboa, Portugal
Introduction: The incidence of cervical pregnancy ranges from 1 in 2,400 to 1 in 50,000 pregnancies. Delayed diagnosis can be associated with significant morbidity and maternal death from haemorrhage. The authors present a case report of a cervical ectopic
pregnancy, in a patient without risk factors, diagnosed at five gestational weeks and successfully managed with a single administration of systemic methotrexate (MTX).
Case report: A 26 year-old secundigravid woman, with no relevant past obstetrical history, was referred to the hospital five weeks
after her last menstrual period, with diffuse pains in the lower pelvis, spotting and positive pregnancy test. Transvaginal ultrasound
examination revealed a normal endometrial stripe, absent intrauterine pregnancy and a gestational sac within the cervix, below the
internal os. At this time the embryo or yolk sac were not identified. The h-CG value was 2208 mUI/mL. After 48 hours the gestational
sac remains intracervical, with visible yolk sac. The h-CG level increased for 3512 mUI/mL. The diagnosis of viable ectopic cervical
pregnancy was placed and the authors proceeded with the administration of 70 mg intramuscular MTX (1 mg/kg). After MTX a successive reduction of h-CG levels and, in the follow-up scan, a significant shrink of the gestational sac, replaced by a small echogenic
structure, were observed.
Comment: In a stable patient, with an early gestation, chemotherapy with methotrexate is the treatment of choice in cervical pregnancy management. The selection of methotrexate administration routes lacked uniform criteria and essentially depended on physician preference.
The authors present this case, as one more example of success in conservative management of ectopic cervical pregnancy, using
a single administration of systemic MTX. No toxic effects were related to MTX.
Conclusion: In young women who desire future pregnancy, conservative treatment with MTX could be an acceptable option in the
management of early ectopic cervical pregnancies.
P058
Investigation Incidence and outcome of molar pregnancy in samples referring to pathologic center from Shabihkhani maternity hospital in Kashan, IRAN 1999-2003
Z. Sadat, Z. Tabasi, M. Barati
Khashan University Of Medical Science, Kashan, Iran
Objective: molar pregnancy is one of the high risk pregnancy which considering its frequency and important and its side effect if it is
not diagnosed, requires extensive investigation. The present study was carried out in order to determine prevalence and pathologic
result and outcome of hydatidiform mole on the patients hospitalized in Shabih Khani hospital.
Disign and methods: A descriptive study (existing data) was performed. In during study, all of molar patient based on pathologic
finding and sonogrophy was selected in shabihkhani hospital. Data collected by medical records and pathologic results. Informations contain pathologic finding hydatidiform mole outcome, patient’s demographic factors, and clinical signs.
Results: Incidence of molar pregnancy was nearly 0/002 based on number of delivery In during study and there was 37 hydatidiform
mole. From 37 patients, 28 cases (%75/7) was complete mole and 9 cases (%24/3) was incomplete mole. %10/8
Of patients needed to curettage more than once time. After six months control by BHCG test: there was three cases invasive mole,
one cases choriocarcinoma and 33 cases were with ought complications. %28/8 patients were lesser than 20 years and %35 patients were primigravida and primary sign was vaginal bleeding(%86/4).
conclusion: prevalence was not higher than others studies .due to large number of patients had vaginal bleeding; all of pregnant
women with vaginal bleeding specially primigravida and younger 20 years old should investigation exactly. Further studies are require to determine the epidemiology and treatment of the disease
Key words: Hydatidiform mole, invasive mole, choriocarcinoma, vaginal bleeding
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P059
The role of recombinant human erythropoietin in the treatment of iron deficiency anemia of pregnancy
S. Dimitrakopoulos, A. Saltamavros, A. Sidiropoulou, P. Tseliou, A. Bonas, I. Mavropoulos, K. Sorras, E. Papageorgiou, S. Koliantzaki,
N. Sidiropoulos
General hospital, Pyrgos/Ilias, Greece
Introduction: the purpose of this study is the evaluation and management of iron deficiency anemia in pregnancy using recombinant
human erythropoietin combined with oral iron in severely anemic pregnant. It is followed the practice of some centers which have
chosen to use slightly lower hb values (<11gr/dl) to define anemia during pregnancy remembering to obtain a follow up hem gram.
Method-material: eighteen (23) pregnants were diagnosed as suffering from severe iron deficiency anemia at the maternity clinic of
pyrgos, the last two years. These women were treated with recombinant human erythropoietin (10000 iu given sc every other day
that means three times weekly) in combination with oral iron. The dose was 1600 mg of proteinsuccinylate iron daily. The therapy
lasted four weeks and was initiated at the end of second trimester or alternatively in the third trimester. The inclusion criteria are
described below: hem globulin (hb) below 8,5 gr/dl, hematocrit (hct) <26%, low serum ferritin levels (<10μg/dl), red used total iron
–binding capacity (<216 μg/dl) and abnormal erythroid rbc indices (mcv, mch, mchc). A second group of seventeen (17) severely
anemic pregnants were treated with blood transfusion. The mean value of transfused units was four (4) per woman per month. All
women were matched for age and parity and signed informed consent. The results were collected and evaluated according the
mean elevation of hb and hct values. The two groups were compared using the student’s t-test.
Results: the majority of iron deficient anemic pregnants reacted promptly in the combined erythropoietin and supplemental oral iron
treatment in the first two weeks of therapy. The mean elevation of hb value was 2,7 gr/dl and hct value was 8,1%. Two pregnants
did not respond to treatment and needed the transfusion of two blood units each. The groups of pregnants who treated with blood
transfusion raised hb at a mean value of 2,9 gr/dl and hct 8,7% respectively. Additionally one pregnant presented anaphylactic
reaction in the transfusion group and was treated with prednisolone iv. The statistical analysis of the results of the two groups did
not disclose any statistically significant differences in the elevation of hb and hct. For the statistical assessment the student’s t-test
was used.
Conclusion: the use of erythropoietin in severe iron deficiency anemia during pregnancy is not considered to be a standard treatment. In our study proved to be very effective with limited adverse effects. The effective combination of recombinant human erythropoietin sc and elemental iron orally in the severely iron deficient anemic pregnants may also assist in the dramatic reduction of the
need in blood transfusion during pregnancy.
P060
Hrt and pathologies in the first three months’ pregnancy : epidemiologic data
L. Tossichetti, A. Palagiano
private, p.s.giorgio(ap), Italy
Object of the Study : The diagnosis of a pregnancy, whichever its site may be, is an interesting part of gynaecologic echographia.
It is effected by using an E.V. probe as the emission high frequency of probes, along with the minimization of the tissue interposed
between the probe and the organs that are being examined, allows a better diagnostic sensitivity versus the organs examined.
The routine examination in the first control, after HHCG beta positivization, is executed between the first and seventh weeks when
the ovular sac, the embryo with heartbeat, and the ovular sac insertion site, can be better detected. The most accurate method to
date a pregnancy is to measure the embryo cranial-caudal length (CRL) in the 10°weeks.
Material and Methods: We carried out an epidemiologic study at our centre of assisted reproduction centre Using a 6.5 mHz Ansaldo
E.V. probe in 325 patients with a three months’ pregnancy, sub-diving them on the basis of their gestational period, age and number
of embryos transferred. The pathologies mostly found in the firsts three months were:
Abortion ( embrionat, whitout cardiac impulse, blighted-ovum, decidual haematoma )
GEU, multiple pregnancies (dicorial-tricorial amniotic), vesicular mole.
Results: The pathologies studied gave the following results: Decidual haematoma (213) 65.54%, blighted-ovum (80) 24.62%, vesicular mole (2) 0.62%, GEU (2) 0.62%, embryonate abortion (25) 7.70%, multiple pregnancies (3) 0.90%.
Conclusions The results obtained can be superimposed on the tricorialtriamniotic pathologies in the first three months’ spontaneous pregnancies, excluding, of course, tricorialtriamniotic pregnancies. Therefore we can consider opmistically the use of HRT
techniques, in a pregnancy test.
P061
Rubéola et toxoplasme gondii: séroprévalence d’anticorps dans les femmes enceintes d’une consultation multi-ethnique
A. Ramírez
ASSIR. Hospital del Mar, Barcelona, Spain
Objectifs: Connaître l’état sérologique pour la rubéole et le toxoplasme gondii des femmes enceintes visitées dans la consultation
obstétrique d’un quartier avec un très haut tas de femmes immigrées et estimer l’existence de différences entre les européennes et
celles d’autres continents.
Méthodes: Étude rétrospective de toutes les femmes enceintes qui sont venues pour contrôler leur grossesse du janvier 2005 à
l’avril 2007. Dans la première visite on sollicite sérologie pour rubéole et toxoplasme. Le diagnostic vient fait par quimioluminiscence.
Les variables considérées sont l’état immunitaire, le continent d’origine, les semaines de gestation où on effectue le diagnostic et
l’âge de la femme. Les variables qualitatives sont exprimées avec sa fréquence absolue et son pourcentage correspondant et les
variables continues avec leur moyenne et leur déviation standard.
Résultats: Le nombre de femmes enceintes: de l’Asie, 39; de l’Afrique, 33; de l’Europe, 137; de l’Amérique latine, 75. L’immunité
dans ces femmes, en pourcentage ; semaines gestation et âge - moyenne (déviation standard) est, respectivement: Pour la rubéole:
de l’Asie [76,92; 12,17 (4,95) y 28,07 (4,12)], de l’Áfrique [84,38;10,74 (5,09) y 28,18 (5,36)], de l’Europe [92,91; 9,64 (4,21) y 30,92
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(5,98)] et de l’Amérique latine [90,41; 10,33 (5,57) et 29,73, (6,66)]. Pour la toxoplasmose: de l’Asie (13,51; 11,22 (2,41) y 32 (5,15)],
de l’Áfrique [39,39; 10,74 (3,56) y 29,46 (5,72), de l’Europe [24,63; 9,58 (3,69) y 31,36 (6,6) et de l’Amérique latine [35,14; 10,83
(4,07) y 27,64 (6,82)].
Conclusions: Parmi nous, pour ce qui est rubéole, les femmes enceintes européennes et celles de l’Amérique latine sont celles
les plus immunisées, le diagnostic est effectué avant dans les Européens mais son âge est supérieur. Pour la toxoplasmose le
pourcentage de femmes immunisées de l’Asie est bas; on diagnostique avant les femmes de l’Europe, tandis que l’âge est supérieur
dans celles-ci et celles de l’Asie que au reste. Connaître cettes particularités nous permet de faire attention à la vaccine puerpérale
dans les femmes rubeóla_non_inmunes -puisqu’à cet moment ci c’est difficile d’établir des visites préconception pou la pluspart
des femmes immigrées-, et insister sur les mesures préventives pendat la grossesse pour la rubéola et la toxoplasmose à celles
non_inmunes.
Endocrinology and reproduction - Endocrinologie de la reproduction
P062
What your abandoned cycle rates should be
A. Chavez Badiola, S. Papadopoulos, A. Drakeley
Hewitt Centre for Reproductive Medicine, Liverpool, United Kingdom
Introduction: Success of assisted reproductive technologies is largely determined by ovarian response to gonadotrophins. Despite
all efforts inadequate responses still constitute a major concern leading to cycle cancellations. There is poor evidence in literature
about what cancelled cycles rates should be, with rates reported ranging from 6 to 71%.
Methodology: Retrospective analysis of 12 consecutive months of IVF treatment cycles was performed at the Liverpool Women’s
Hospital to assess rate of abandoned cycles and reason for cancellation. Total gonadotrophin dose, age, FSH, and outcome in previous and immediate next cycle were analysed in relation to the cause of cancellation for that specific cycle. Student’s T was used
for analysis (p <0.05 was considered significant). Results are presented as percentages and mean (M) with standard deviations. Cost
of abandoned cycles was estimated in GBP.
Results: 1116 IVF/ICSI cycles were included for analysis. 8.5% resulted in cancelled cycles (M- age: 34 years; M-FSH: 7.6IU). Poor
responses represented 74.7% of cancellations (M-age: 33.8; M-FSH: 7.82IU); over responses accounted for 22.9% (M-age: 34.7;
M-FSH: 7.05IU) and 2.4% were cancelled for other reasons. 25% had an immediate previous cycle abandoned and 13.7% had an
immediate next cycle cancelled. The overall cost of abandoned cycles was £61,440 GBP.
Conclusions: It was not possible to evaluate whether our abandoned cycle rate falls within national standards due to a lack of parameter to compare against. National surveys are needed to identify rate of abandoned cycles: A standard to compare against. Poor
responses were the cause of two thirds of cancelled cycles and were more frequently related to a previous abandoned cycle (31%)
in compare to over responders. However, this audit was not designed to evaluate future responses.
P063
Predictive power of clomiphene citrate challenge test in IVF treatment outcome in infertility patients of Mirza Koochak Khan
Hospital, infertility clinic from 2004-2006
A. Ghaseminejad, Z. Rezaee, E. Nikkhah
Tehran University of Medical Sciences, Tehran, Iran
Female fecundity is related to the total number of primordial follicles within the ovaries, referred to as ovarian reserve. The aim of
this study was to assess the accuracy of ovarian reserve tests, namely basal and clomiphene stimulated follicle stimulating hormone
(FSH) concentrations.
We prepared a prospective cohort study, including patients with infertility referred to Mirza Koochak Khan Hospital during 20042006. The whole patients went under clomiphene citrate challenge test (CCCT) and then in vitro fertilization was obtained. SPSS
(Statistical software) was used to analyze the data of the patients.
IVF success rate was 11.7% and showed that CCCT sensitivity and specificity was 30.2% and 92.9% while its positive and negative
predictive values were 14.9% and 97%, respectively.
We believe that CCCT may help us to estimate the ovarian reserve better. Negative predictive value of this test was so high, thus the
chance of pregnancy is lowered in the cases with abnormal test results.
P064
Intracytoplasmic Glutathione level in MII oocyte during in vitro maturation of germinal vesicle: Effect of Cysteamine
P. Pasbakhsh1, A. Mohammadi Roushandeh2, M. Hossein Noori Mooghahi3, M. Abdolvahhab1, M. Akbari1, M. Ali Shokrgozar4, A.
Sobhani1
1 Department of Anatomy, Medical school, Medical sciences, University of Tehran, Iran, 2 Department of Anatomy, Medical school
Tabriz university of medical sciences, Tabriz, Iran, 3 Khoramshahr university, Khoramshahr, Iran, 4 National Cell Bank of Iran (NCBI),
pasteure Institute of Iran, Tehran, Iran
Objective:The present study examined the kinetics of glutathione (GSH) concentration during in vitro maturation in presence of
Cysteamine in culture medium. Also we examined effects of different doses of Cysteamine on Germinal Vesicle Breakdown (GVBD)
and MetaphaseII (MII) development.
Method: Germinal vesicle (GV) oocytes was obtained from ICR mouse and cultured in Tissue culture medium (TCM199) supplemented with 0, 50, 100, 200 and 500 µM cysteamine. Number of GVBD and MII oocytes was recorded 4 and 24 hours after culture
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respectively. For GSH assay 5, 5’-dithio-bis (2-nitrobenzoic acid)-glutathione disulfide (DTNB-GSSG) reductase recycling assay
was employed.
Result: Our results showed that 100 µm cysteamine can improve GVBD and MII development significantly higher than control group
(P<0.05). Also all Cysteamine groups increased GVBD and MII development compared to control group exept 500 µm cysteamine
groups. Developmental competence in 500 µm group was significantly lower than control group (P<0.05). GSH assay indicated
that glutathione concentration in In vivo MII oocyte is significantly higher than GV stage and In vitro maturation MII oocytes. Also
our results showed that 100 µm cysteamine in culture medium increased GSH level in MII oocyte significantly compared to control
(P<0.05). GSH level in 500 µm Cysteamine was lower than control group but not significantly. Presence of cysteamine in culture
medium can affects on oocyte development competence in vitro is dose dependent.
Conclusion: Cysteamine as a thiole is able to improve development of GVBD and MII via synthesis of gluthathione as a major antioxidane in the mammalian cells.
Key words: In vitro maturation of oocyte, Cysteamine, Glutathione, Germinal Vesicle
P065
Changes of ovarian reserve after conservative ovarian surgery by serial measurement of Antimullerian hormone
S. Hoon Han1, B. Ick Lee2
1 Seoul National University Bundang Hospital, Seongnam, Gyeonggido, Korea, Republic of, 2 College of Medicine, In ha University,
Incheon, Korea, Republic of
Objective: To evaluate whether ovarian reserve changes after conservative ovarian surgery. We prospectively checked preoperative
1 week and postoperative 1 week, 1 month, 3 month serum levels of anti-mullerian hormone (AMH).
Design and Methods: Twenty women with a benign ovarian mass (either unilateral or bilateral) participated (mean±SD: 34.3±9.4 year
old, range: 21-45 years) after providing informed consent. Ovarian masses were removed after conserving normal ovarian tissue.
Four patients had bilateral ovarian masses. Ovarian reserve (serum values of AMH) were measured four times; before 1 week operation, and at one week, one month, three month period after operation. Changes of ovarian reserve (serum values of AMH) were
compared by paired t-test according to periods.
Results: Mean AMH level was 2.92±1.94 ng/mL before operation but reduced to 1.18±1.07 ng/mL, at one week postoperatively
(P<0.001) and then slightly increased to 1.61 ± 1.43 ng/mL after one month period (P=0.001) and 1.76 ± 1.91 ng/mL after three
months period (P=0.016). However, it subsequently failed to increase to the preoperative level (P=0.023). AMH values were reduced
in all 18 patients at 1 week postoperatively, and then increased at one to three month postoperatively. The two patients that did not
show a postoperative AMH level increase were 44 and 45 years old, respectively.
Conclusions: Conservative ovarian surgery of benign ovarian tumors may be associated with a reduced ovarian reserve in terms of
AMH. However, AMH levels increased slightly over the first postoperative month and similar t postoperative third month. This pilot
study suggests that ovarian reserve can be restored after ovarian surgery in reproductive women.
Figure 1. Serial measuremet of AMH level before and after conservative ovarian surgery
*, **, *** : statistically significant
P066
Frequency of Metabolic Syndrome and Its Features in Females with Hyperplastic Processes of Uteri and Mammary Glands
B. Tkeshelashvili1, D. Virsaladze2, L. Javashvili2, N. Kajaia2, M. Jugeli1, D. Tananashvili3
1 D.Tatishvili Medical Center, Tbilisi, Georgia, 2 Tbilisi State Medical University, Tbilisi, Georgia, 3 E.Andronikashvili Institute of Physics, Tbilisi, Georgia
Objectives: There are less data about the influence of metabolic syndrome (MS) and its features on hyperplastic processes (HP) of
endomyometrium, endocervix and mammary glands (MG) in literature. The aim of our investigation was the evaluation of frequency
of MS and its features in patients with HP in above mentioned organs. Design & Methods: 72 patients with HP in endomyometrium
(hyperplasia, polyposis, myoma), endocervix (hyperplasia, polyposis) and MG (adenomatosis, fibroadenomas) were selected in main
110
group. Control group consisted of 16 patients without any HP of reproductive organs. The incidence of MS was assessed by WHO
definition (2002). All metabolic and anthropometric characteristics of MS features have been investigated. Results: In main group
MS was confirmed in 28% of cases, in control group - 18,8% (X2=3,95, p=0,047); insulin resistance - 37,5% and 18,7% (X2=4,59,
p=0,033), respectively; obesity – 52,8% and 25,0% (X2=4,05, p=0,045), respectively; dyslipidemia – 52,8% and 0,0%; hypertension
– 26,4% and 12,5% (X2=1,88, p=NS), respectively. Blood leptin level in main group was 13,7±10,9 ng/ml, and in control – 5,0±2,9
ng/ml (p=0,005). Conclusions: Our results suggest that MS and its features significantly influence on the formation of HP of reproductive organs. Blood leptin level is significantly increased in patients with hyperplastic processes.
P067
Quality of life and marital sexual functioning in women with polycystic ovary syndrome
V. Skrzypulec, A. Drosdzol, K. Nowosielski, R. Kowalczyk
Woman’s Health Chair, Department of Women’s Health Prophylaxis and Sexology, Medical University of Silesia, Katowice, Poland
Background. Polycystic ovary syndrome affects 5-10% of women in the developed world, making it the most common endocrine
disorder among women of reproductive age. The symptoms typically associated with polycystic ovary syndrome: amenorrhea, oligomenorrhea, hirsutism, obesity, subfertility, anovulation and acne can lead to a significant reduction in female quality of life.
Objective. The aim of the study was to evaluate the effect of polycystic ovary syndrome on quality of life and marital sexual satisfaction.
Design and Methods. 50 women with polycystic ovary syndrome were qualified to the study as the research group. The control
group consisted of 40 healthy women. A specific questionnaire was used as a research tool in this study. It included the socio-demographic aspect, polycystic ovary syndrome’s symptomatology and validated scales: Short Form-36 Health Survey (SF-36) and
Index of Sexual Satisfaction (ISS). STATISTICA 6.0 for Windows was used in the statistical analysis. Differences among parameters
were considered significant at the level of 0.05. The statistical analysis made use of: t-Student test, Mann-Whitney U test, CHI2 and
CHI2 with Yates’ continuity correction tests.
Results. The mean age of researched women was 28.9±5.6 years, and in the control group – 30.5±5.3 years (p>0.05). Quality of life
parameters for women with polycystic ovary syndrome were lower than for the controls in the aspect of: general health (p<0.01),
limitations due to physical health (p<0.05), limitations due to emotional problems (p<0.001), social functioning (p<0.01), energy/fatigue (p<0.001) and emotional well-being (p<0.01). Studied women showed worse marital sexual functioning (p<0.05). Marital sexual
dysfunctions were diagnosed in 28.6% of women with polycystic ovary syndrome and in 10.5% of healthy women (p<0.05).
Conclusions. Polycystic ovary syndrome decreases quality of life and marital sexual functioning among women. A negative effect of
hirsutism severity on general well-being and marital sexual life is also observed.
Gynaecological oncology : Cervical carcinoma - Oncologie gynécologique : Cancer du col
P068
Colposcopy important diagnostic method for early detection of cervical carcinoma
G. Relic1, M. Bogavac2, B. Petrovic1
1 Medical faculty, Priština Health Center Kosovska Mitrovica, KMitrovica, Serbia, 2 Clinical centre Vojvodina, Department of Obstetrics and Gynaecology, Novi Sad, Novi Sad, Serbia
Introduction:Discovering uterus cervix cancer at an early stage has been possible by the use of Papanicolau test as well as by
the use of colposcopy. With all patients with suspected cytologic or colposcopic findings,the final diagnosis is made by doing the
biopsy on the cervix of the uterus. The aim of the paper: to determine the correlation between colposcopic findings which tell us
about a severe case of dysplasia and biopsy as an independent method of uterus cervix cancer diagnosis.
Materials and methods used:A retrospective study was done in1998. on 130 patients who reported themselves to the early detection of uterus cervix cancer department of Clinics for gynecology and obstetrics in Pristina. All women were examined by using
colposcopy and were observed in the department for a long time, and on some of them a biopsy was performed due to suspected
findings on the cervix of the uterus.
The results obtained:Pathological colposcopic findings, are more likely to be found in women of the Orthodix confession.Out of 130
women who participated in the research 70 women ( 53, 85% ) were Orthodox and 60 women ( 46,15% ) were Muslim.The greatest
number of pathological changes proven by colposcopic findings referred to leukoplakia 53 women ( 40, 77% ), mosaic – 39 women
( 30, 00%), the puncture basis 22 women ( 16, 92% ), atypical vascularization 15 women ( 11, 54% ) a change which would lead to
suspect of an invasive cancer 1 ( 0, 77% ). Hystopathological diagnosis of the total of 130 women who participated was in most
cases chronical cervicitis 79 women ( 60, 76% ), CIN I 23 women (17, 69% ), CIN II 10 women ( 7, 69% ), CIN III 3 women ( 2, 31%
), microinvasive cancer 2 women ( 1, 45% ), adenocarcinoma 1 woman ( 0, 77% ), planocellular invasive cancer 5 women( 3, 85%
)and normal findings 7 women( 5, 35% ).
Discussion: There is an early detection of uterus cervix cancer department at the Clinics of gynaecology and obstetrics in Pristina
where routine gynaecological examintaion and Papanicolau test are obligatorily accompanied by colposcopy and if necessary by
biopsy on the cervix of the uterus to make the final diagnosis. Due to low level of health knowledge a large number of women ask
for help when uterus cervics cancer has already reached a very progressive stage.
Conclusion: Based on the results given the following conclusions could be made:The greatest number of atypical colposcopic findings are found in women between 31-40. There is no significant difference in cancer diagnosis by using PVO with Orthodox and
Muslim patients, considering that the latter are less likely to subject themselves to examination.The most common colposcopic
findings is leukoplakia which has in most cases been diagnosed as cancer based on HP findings.Cancers diagnosed are in most
cases planocellulare invasive cancer type.
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P069
Association radiochimiothérapie concomitante en néoadjuvant une chirurgie simple dans le traitement du cancer du col
utérin stade Ib, IIa
R. Benhabib
CHU Tlemcen, Tlemcen, Algeria
Le cancer du col utérin constitue un problème majeur de santé publique dans le monde par sa fréquence et sa gravité. La radiochimiothérapie néo-adjuvante est considérée actuellement comme le traitement de référence dans la prise en charge des cancers du
col localement avancés. Nous avons procédé à une étude prospective multicentrique réalisée sur 60 patientes atteintes du cancer
du col au stade IB, IIA de la classification de la FIGO, avec pour objectif d’étudier le profil épidémiologique des patientes atteintes
du cancer du col utérin et de déterminer l’impact thérapeutique du protocole radio-chimiothérapie chirurgie simple par rapport aux
autres protocoles du cancer du col stade IB, IIA.
L’âge moyen de nos patientes est de 49,8 ans, le délai écoulé entre les premiers symptômes et le diagnostic était plus de 08 mois.
L’apport de la biopsie du col utérin a été déterminant dans le diagnostic du cancer du col.
Le scanner abdomino-pelvien a joué un rôle important dans le bilan d’extension chez nos patientes et qui a permis de révéler une
atteinte ganglionnaire pelvienne et lombo-aortique.
Notre protocole thérapeutique composé d’une chimio-radiothérapie concomitante utilisant Gemcitabine + Cisplatine (03 cycles)
associé à une radiothérapie externe (45 Grays) suivie 04 à 06 semaines plus tard d’une colpohystérectomie extrafasciale avec annextomie bilatérale.
Le staging préopératoire a objectivé une disparition des signes cliniques dans plus de 80 % des cas, une fonte tumorale complète
chez 31 patientes, des résidus tumoraux microscopiques chez 18 patientes et des résidus macroscopiques chez 10 patientes.
Le suivi médian était de 32,4 mois. Nous avons observé 2 cas de récidives vaginales et aucune complication notable après chirurgie.
Les effets secondaires de la chimiothérapie étaient mineurs et facilement jugulés.
Cette étude nous a montré un taux particulièrement élevé d’efficacité estimée à 95 % de nos patientes n’ont pas présenté de récidive. Nous savons maintenant qu’une chirurgie simple est suffisante après une radio-chimiothérapie concomitante pour assurer la
guérison pour cette pathologie aux stades précoces.
P070
Confrontation histologique et cytologique des lesions du col uterin
N. Ounaies, H. Tounsi, E. Jerbi, S. Kassar, T. Assili, E. Haouet, S. Boubaker
Institut Pasteur De Tunis, Tunisia
Objectif : Notre étude consiste à une confrontation des résultats cytologiques et histologiques des lésions cervicales observées et
d’essayer de mettre le point sur l’intérêt du dépistage précoce du cancer du col par la cytologie conventionnelle.
Matériels et méthodes : 32 patientes ont eu 32 frottis suivis de 32 biopsies colligées d’Avril 2002 à Mai 2007.
Les frottis ont été colorés par PAP et les biopsies fixées au formol et incluses en paraffine.
Résultats : l’âge moyen de nos patientes est de 41.4 ans avec des extrêmes de 28 ans à 75 ans.
Les frottis ont été répartis comme suit : inflammatoire, ASCUS, bas grade, carcinome infiltrant et haut grade.
L’étude histologique montre une concordance de 100% pour les frottis de haut grade, de 100% pour les frottis trouvant un carcinome infiltrant, de 82% pour les frottis de bas grade, et de 75% pour les frottis inflammatoires. Pour les frottis de type ASCUS,
l’histologie a révélé que les 2/3 correspondaient à des lésions de bas grade et le 1/3 restant correspondait à un ectropion.
Nous discuterons l’intérêt du frottis cervico-vaginal qui reste un examen de dépistage simple, rapide et non coûteux, présentant une
spécificité et une sensibilité excellentes.
Même avec l’avènement de la cytologie en milieu liquide et du test HPV, le frottis reste un examen de référence des infections à HPV
et des lésions pré-cancéreuses du col
P071
Lymphoepithelioma-like carcinoma of the uterine cervix
M. Espada Vaquero, A. Martinez Rodriguez-Marin, J.R. Garcia Flores, M. Muñoz Muñiz, A. Armas Serra
Introduction: Lymphoepithelioma-like carcinoma (LELC) has been reported outside the nasopharynx in many sites, including the
uterine cervix. Although the association between LELC and Epstein-Barr virus (EBV) is clear, when this appears in cervix it is still
controversed. To date, EBV genome has only been demonstrated in Asian patients. We present a 39-year-old white woman with a
IVb staged LELC, in which Human Papillomavirus (HPV) was not detected by polymerase chain reaction.
Case report: We present a 39-year-old woman who consulted at our Hospital because of continuous intermenstrual bleeding. Gynecologic examination revealed an exophytic lesion of 3 cm that occupied the posterior lip of the cervix. Colposcopy showed an
ulcerated mass with abnormal vascularization and budding. Cervical biopsy was performed and the following histopathological diagnosis was shown: poorly differentiated carcinoma with mucoid differentiation . Carcinoma-suggesting images were also observed
in the cytological study. A complete extension study was also performed. The Computerized Tomography showed a methastasic
suggestive hepatic nodule, which was confirmed by punction biopsy. The rest of results of extension study were negative. According
to these data the patient was clinically staged as FIGO stage IVb.
The patient underwent paliative surgery in order to stop bleeding, a hysterectomy and ovarian transposition by laparoscopy being
practised.
The final histopathological diagnosis was a lymphoepitelioma-like carcinoma of the uterine cervix. Epstein-Barr virus and Human
Papillomavirus were tested for by in situ hybridization and polymerase chain reaction. The results of both techiques were negative.
Postsurgical treatment included chemotherapy. Our patient had a favourable evolution.
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Discussion: Lymphoepitelioma-like carcinoma of the uterine cervix is an uncommon neoplasy, and it accounts for only 0,7-1% of all
primary uterine cervix malignant neoplasies in western countries. In Asia the incidence of this tumor is higher, representing 5,5% of
all cervical carcinomas. It usually has better prognosis than squamous cervical carcinoma, as well as LELC arising in other organs.
The role of EBV or HPV in the pathogenesis of this kind of tumours still remains unknown. EBV may be involved in the pathogenesis
of LELC in Asian women, while in Western women the virus genome has not been identified, as occurs in our case. HPV relationship
to this entity remains unclear and needs to be determined.
P072
Cannabinoid receptor cb2 and 2-arachidonoylglycerol expression as a new prognostic factor marker in endometrial cancer
M Guida1, F Tarsitano1, A Di Spiezio Sardo1, D De Filippis2, L Insabato3, A Somma3, S Sparice1, G Bifulco1, D Canzaniello1, T
Iuvone2, C Nappi1
1 Department of Obstetrics and Gynecology, University of Naples, Federico II, Naples, Italy, 2 Department of Experimental Pharmacology, University of Naples Federico II, Naples, Italy, 3 Department of Biomorphological and Functional Sciences, Pathology Section, University of Naples Federico II, Naples, Italy
Introduction : In recent studies it has been provided evidence that the inflammation is involved, with or in addition to estrogen exposure, in the development of endometrial cancer. In fact the endometrial neoplastic cells are surrounded by inflammatory cells, such
as lymphocytes, neutrophiles, mast cells and macrophages that produce nitric oxide (NO).
In addition, a considerable amount of experiments suggested that the cannabinoids from Cannabis Sativa L. have a protective effect
during the inflammatory process. In this study, we determine the expression of two tipes of receptor for cannabinoid: CB1 receptor and its ligand (anandamide - AEA) and CB2 receptor and its ligand (2-arachidonoylglycerol- 2-AG) in biopsies of endometrial
carcinoma.
Matherials and methods : We have selected ten postmenopausal patients undergoing surgical treatment for endometrial cancer
(Group A) and ten patient, used as controls, which matched for age, BMI and parity undergoing an office hysteroscopic biopsy
for benign conditions (Group B). We performed, for each patient, two target hysteriscopic biopsies of the endometrial lesions and
determined the CB1 and CB2 expression by immuno-blotting analysis.
Results: We found that the patients of the Group A showed increased espression levels of CB2 receptor protein and 2AG compared
with the patients of Group B. Interestingly the CB1 receptor protein expression levels didn’t modify between the two groups.
Conclusion: Our data suggest that the upregolation of CB2 receptor and 2AG could be considered as prognostic factor in endometrial cancer.
P073
Pap smear’s pattern and it’s barriers among women in Kashan city 2005-2006
F. Saberi, Z. Sadat, M. Abedzadeh
University of Medical Sciences, Kashan, Iran
Background: With respect to importance use of Pap smear for diagnosis cervical cancer and lack of enough information in this context, this study performed to find of Pap smear’s pattern and causes of lack or irregular use of this test among in eligible Kashanian
women and base on determined barriers be act to use of this important health behavior.
Materials and Methods: This is descriptive Epidemiological study performed on 1000 women by cluster sampling. Any unit study
was an Iranian and inhabitant of Kashan woman that aged 15-75, at least one time had got married and passed one year of her
marriage. Data collected by fill of questioner by interview with woman and then analyzed by statistical tests.
Results: Findings showed mean age women was 36.3±10.4, level education of the most of them were elementary(44/2%), 92.7%
were housekeeper, the most of them had got married at the age of 15-19(61.5%). 800 of 1000 women performed at least one time
Pap smear and the most of them reported the first of Pap smear at the age of 25-29(28.9±8.9), 20.7% was performed Pap smear
for the first time 3-5 years after marriage. In addition the first cause of irregular or lack of Pap smear screening in 39.9% was lack of
knowledge of importance and necessity of screening and the second cause was feeling shame and shyness when they go to clinic
(26.3%).
Conclusion: In base on results this study, to seem the Kashanian women need to education and consultation for screening on time
and standard interval.
Key words: Pap smear, cervical cancer, screening, barriers.
Gynaecological oncology : Uterine cancer - Oncologie gynécologique : Cancer de l’Uterus
P074
Dermatofibrosarcoma protuberans Darier-Ferrand: à propos d’un cas gynécologique
J.-D. Bettex
Cabinet médical du Dr. Bettex, Berne, Switzerland
Le dermatofibrosarcome est une tumeur fibrohistiocytère de la peau de malignité moyenne ne produisant que rarement des métastases mais tendant à récidiver localement. Cette tumeur est rare (1/100’000 personnes par an). Il est d’autant plus rare qu’une
patiente se présente chez son gynécologue avec une manifestation du dermatofibrosarcome de la vulve.
Casuistique: Une patiente de 52 ans (165 cm, 94.5 kg, BMI 35) en bon état général, se présente avec une tumeur visible de 10 cm x
5 cm de la grande lèvre vulvaire droite. La tumeur est rougeâtre, non ulcérée, de consistance ferme et polycistique. Elle semble bien
délimitée. La patiente présente en outre un oedem lymphatique de la jambe droite d’étiologie incertaine. Il s’agit vraisemblablement
d’une récidive, une tumeur de
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3 cm x 3 cm «en forme de champignon» ayant déjà été excisée il y a 15 ans.
Thérapie et évolution: L’excision primaire se fait avec une marge de sécurité de 1 cm au minimum dans le tissu d’apparence sain,
ce qui équivaut à une hémivulvectomie du coté droit. L’histologie confirme le diagnostic. Malheureusement la tumeur n’est pas
excisée dans sa totalité conformément à la tendance de cette néoplasie d’infiltrer le tissu cutané et sous-cutané horizontalement
parfois jusqu’à plusieurs cm de la tumeur sans que ce soit cliniquement apparent. Une deuxième opération est nécessaire avec des
excisions successives jusqu’à ce que les coupes histologiques ne montrent plus de tissu cancéreux. Une plastique abdominale est
nécessaire pour couvrir la plaie opératoire. L’histologie révèle 10 ganglions lymphatiques, tous négatifs. Il s’agit donc d’un dermatofibrosarcoma protuberans Darier-Ferrand probablement du stade II (récidive loco-régionale) avec une résection R0 et 10 ganglions
lymphatiques négatifs. Après l’opération, il se développe une fistule lymphatique dans l’aine droite. Parallèlement l’œdème de la
jambe droite se résorbe. La fistule étant résistante à toute autre thérapie, nous nous voyons obligés à procéder à un pansement
V.A.C.® (vacuum-assisted wound closure). La fistule se referme en 33 jours. La littérature ne recommande ni chimiothérapie, ni
radiothérapie.
P075
Several risk factors in relation to endometrial adenocarcinoma diagnosis features
I.E. Blidaru1, S. Musca2, A. Luchian1, L. Mosneagu1, M. Mictariu1
1 Department of Obstetrics & Gynecology, Gr. T. Popa, University of Medicine and Pharmacy, Iasi, Romania, 2 Department of Pathology, Cuza-Voda, Maternity Hospital, Iasi, Romania
Both endogenous and exogenous estrogen high levels and the events inducing or counteracting these have been related to endometrial cancer risk; nevertheless their relationship to certain aspects of the endometrial cancer diagnosis features could still
be debated. The aim of this study is to investigate the relationship between some clinical signs having risk factor significance, as
duration of the abnormal uterine bleeding, age at menarche, menopausal age, parity degree and certain diagnostic aspects as age
at diagnosis, FIGO stage of disease, histological grade. Our population-based study included 20 patients aged 40-78 years (average 58.9 years) diagnosed and surgical treated between 2003 - 2006 for endometrial adenocarcinoma in the 4-th Department of
Obstetrics and Gynecology. 5 patients were not menopaused. Data from the medical files was used. The statistical analysis used
the calculation of the correlation coefficient (r). Our results showed the existence of a strong correlation between the parity degree
and the patients’ age at the moment of the diagnosis (r=0.80), a medium correlation between the duration of the abnormal uterine
bleeding and both FIGO surgical stage (r=0.52) and histological grade (r=0.61), as well as between the age at menarche and the
patients’ age at diagnosis (r=0.59). We found no correlation between the menopausal age and the patients’ age at the moment of
the diagnosis (r=0.18). The results are consistent with the idea that the accepted risk factors are of different importance that must
be carefully assessed together with the prognostic factors.
P076
Clinical and therapeutics outcomes of uterine sarcomas: Results from eight years of experience
M. Nikolaou, N. Georgopoulos, G. Adonakis, V. Tsapanos, G. Decavalas, G. Kourounis
University Hospital of Patras, Patra, Achaia, Greece
Objectives: Uterine sarcomas are relative rare tumous characterized by poor prognosis. Aim of this study was to review the clinical
characteristics, prognostic factors and therapeutics results in patients with uterine sarcoma treated in our University Hospital from
1998 until now.
Design & Methods: Ten patients with histologically proven uterine sarcoma were evaluated in this retrospective study. Cases were
distributed into groups based on definitive diagnosis of uterine sarcoma.
Results: The median age of patients at presentation was 55.8 years (range, 36-80). Six-patients were diagnosed with leiomyosarcoma, three- patients with malignant mixed mullerian tumour and one-patient with endometrial stromal sarcoma. Six- patients
(60%) were postmenopausal and abnormal uterine bleeding was the most common manifestation. Preoperative diagnosis of uterine
sarcoma was established in 4 patients (40%). Total abdominal hysterectomy with bilateral salpingo-oophorectomy was preformed in
80% of the patients. Postoperative adjuvant chemotherapy was delivered in 7 patients. Radiation therapy used in combination with
surgery in 3 patients and in one case only for palliation. Survival rates was 60 % in all groups until now.
Conclusions: Uterine sarcomas are relative rare malignant tumours and they constitute 2% to 4% of all invasive uterine malignant
tumours. Preoperative diagnosis of uterine sarcomas were diffuclt. The diagnosis is usually accidental and postoperative. In our
analysis of the factors affecting survival, aggressive surgery with no residual disease and histologic tumor grade were the most
important contributed to disease-free survival.
P077
Laparoscopic management of stage I endometrial cancer
A. Martínez, R. Curiel, A. Hernandez, M. Muñoz, A. Armas, J. De Santiago
Hospital Universitario La Paz, Madrid, Spain
Introduction: Endometrial carcinoma is the most commonly reported gynaecologic malignancy in industrialized countries. The development of new diagnostic and surgical methods has brought a differentiated approach to the surgery of endometrial cancer. The
aim of this study was to assess the technical feasibility and surgical outcome of total laparoscopic hysterectomy (TLH) in the treatment of clinical FIGO stage I endometrial cancer.
Design and methods: Retrospective case-control study carried out at Universitary La Paz Hospital. Patients with stage I endometrial
cancer undergoing TLH with those having total abdominal hysterectomy (TAH) from January 2004 through December 2006 were
compared. Patients with uterine sarcoma were excluded from the study. The operative and clinical records were investigated in all
treated patients.
Results: In the study period, a total of 130 patients were treated for endometrial cancer stage I. Of these, 50 were scheduled for TAH,
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while 80 were scheduled for TLH. Patients within both groups were comparable with respect to age age, body mass index, parity,
previous abdominal surgery, ASA, pathology grade or tumor size. 4 out of 80 patients initially approached by laparoscopy were
converted to laparotomy (5 %). Compared with TAH, TLH had fewer intraoperative complications (p<0.05), higher median number
of nodes removed (p<0.05) and a shorter hospital stay. Differences in postoperative complications among the two groups did not
reach statistical meaning.
Discussion: Primary management of early stage endometrial carcinoma is changing to include an increased use of laparoscopy. Our
findings suggest TLH gives correct staging of endometrial disease, like TAH, with more lymph nodes yelded, less morbidity, and
shorter hospital stay.
P079
Noninvasive diagnostic tools for endometrial cancer: clinical-sonography scoring system vs. transvaginal ultrasonography
A. Mandic1, M. Zivaljevic1, D. Nincic1, D. Zikic1, S. Bulatovic2
1 Institute of oncology Vojvodina, Sremska Kamenica, Serbia, 2 Clinical Center Novi Sad, Novi Sad, Serbia
Background. Endometrial cancer is the leading type of gynecological cancer in developed countries. In a region of Vojvodina, part
of Republic of Serbia, incidence of endometrial cancer is 15-20/100.000. Approximately 75% of women with endometrial cancer are
postmenopausal. The main goal of this study was to examine statistical significance of clinical-sonography scoring systems ONCO1
vs. transvaginal ultrasonography score (TVS) as a noninvasive diagnostic tools .
Material and methods. A 122 patients with postmenopausal vaginal bleeding were included. Transvaginal sonography was performed before curettage. After final histopathological findings obtained by curettage patients were divided into a group A (without
malignancy) and B (with endometrial cancer), Scoring systems were created. Using test for diagnostic accuracy and receiver operating characteristic (ROC) curve evaluations for scoring systems were performed.
Results.; Average value of clinical-sonography scoring system ONCO 1 in group A was 7.13, SD ± 3.07 and in group B was 9.14,
SD ± 2.32. with statistically significant difference. Average value of TVS score in group A was 2.35, SD+/-1.05 and in group B; 2.53,
SD +/-0.75 without any statistically significant difference. The area under the ROC curve for ONCO 1 scoring system was 0.69 and
for TVS 0.52.
Conclusion. Postmenopausal bleeding caused by endometrial cancer is usually diagnosed in older patients. It was possible to distinguish high-risk patients with suspect neoplasia from those with benign changes of endometrium using the clinical-sonography
systems ONCO 1. TVS had less sensitivity and no statistically differences among these two groups. Nevertheless, histopathological
examination is still unavoidable in final diagnosis of endometrial cancer.
Key words: Endometrial cancer; scoring system, diagnosis
P080
Selective embolization for the control of life-threatening pelvic hemorrhage due to locally advanced cervical carcinoma
M. Nikolaou, N. Georgopoulos, G. Adonakis, V. Tsapanos, G. Decavalas, G. Kourounis
University Hospital Of Patras, Greece
Objectives: This study was undertaken to evaluate the safety and efficacy of arterial embolization for the management of massive
vaginal bleeding due to locally advanced cervical carcinoma.
Design & Methods: Three women with median age at presentation 45.3 years with locally advanced cervical carcinoma, have been
referred to our clinic for the diagnosis and treatment of life-threatening vaginal hemorrhage. In all cases patients suffered from locally
advanced cervical carcinoma. They presented with a compromised hemodynamic status. All the patients required blood transfusions due to extensive blood loss and they were embolized under emergency conditions. Embolization of branches of internal iliac
arteries was performed by transfemoral access using stainless microcoils.
Results: All the embolization procedures have been performed successfully and stabilized the hemodynamic condition of the patients. Recurrent vaginal bleeding occurred in one case and was performed second embolization session on a short term. No major
complications of embolization treatment was observed.
Conclusion: Massive pelvic hemorrhage due to cervical carcinoma is a acute life-threatening situation. Percutaneous transcatheter
selective arterial embolization is a safe and effective treatment option in these patients. In our institution we preferred the embolization as a primary treatment for controlling massive vaginal bleeding due to advanced cervical carcinoma.
Gynaecological oncology : Ovarian cancer - Oncologie gynécologique : Cancer des ovaries
P081
Leydig cell tumour of the ovary – clinical case
S. Saleiro, S. Gonçalves, C. Marinho, A. Manarte, C. F. Oliveira
University Hospital of Coimbra, Coimbra, Portugal
Ovarian Leydig cell tumours are a type of steroid cell tumours. According to WHO they are classified in the group of sex cord stromal
tumours. They are rare tumours and account for 0.1% of the ovarian tumours. The clinical presentation is a hyperandrogenic state,
with signs of virilization, but occasionally may exibit a hyperestrogenic state. Ovarian Leydig cell tumour show a benign behaviour,
with an execelent prognosis and reversion of symptoms after treatment.
The authors present a clinical case of a 61 year-old woman with signs of virilization on a 8 month follow-up. The abdomino-pelvic
computerized tomography showed an enlarged left ovary and laboratory hormone analisys demostrated increased levels of testosterone, androstenedione and 17-OH progesterone. The patient was subjected to laparoscopic bilateral oophorectomy for suspicion
of virilizing tumour of the left ovary.
Histological examination showed Leydig cell tumour of the left ovary.
After surgery there was complete regression of symptomatology and normalization of sex hormone levels.
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P082
Preclinical antitumor activity of the intraperitoneal combination carboplatin/topotecan in vivo against human ovarian cancer xenografts
J. Dowaji1, A. Donner2, W. Rath1
1 Department of Obstetrics and Gynaecology, University of Aachen, School of Medicine, Aachen, Germany, 2 Department of Pathology, University of Aachen, School of Medicine, Aachen, Germany
Objective: To evaluate the antitumor activity of the combination Carboplatin/Topotecan administered intrapertoneally to mice bearing human ovarian cancer xenografts. Design & Methods: Forty female mice (SCID-typ) at the age of 6 weeks were randomized into
four groups. On day 0 a suspension of 6x106 ovarian cancer cells (SKOV3ip) was injected intraperitoneally (i.p). Onset of intraperitoneal chemotherapy was on day 10 as follows: Group I: Topotecan (Hycamtin) i.p 3 µg/g body weight (bw) once per week for 8 weeks.
Group II: Carboplatin i.p 32.5 µg/g bw q3d 5x. Group III: Topotecan i.p and Carboplatin ip (the previous doses). Group IV: Control
group (mice with ovarian cancer, no chemotherapy). Mice were checked daily for any adverse clinical reactions and weighed three
times per week throughout the study. Acute toxicity was determined by loss of body weight. After death the abdominal cavity was
opened and the tumor growth inhibition was assessed and compared with other groups. Statistical analysis was performed using
the x2 -test. P values were considered to be significant when less than 0.05. Results: Data obtained showed that combined intraperitoneal treatment with Carboplatin/Topotecan produced a significant enhancement of antitumor activity compared with monotherapy
at the same doses of these agents. The majority of xenograft-bearing animals receiving this combination therapy demonstrated a
massive tumor regression at the end of the study with no additive toxicity. Conclusions: These results encourage clinical trials to
prove the advantages of this intraperitoneal combination therapy.
P083
Who has endometrial cancer?
A. Lebre, S. Carvalho, M. Brandão, N. Nunes, M. Rodrigues
Maternidade de Júlio Dinis, Porto, Portugal
Objective: We sought to characterize the population of women who were diagnosed endometrial adenocarcinoma in our institution
during a period of 5 years.
Design and Methods: Retrospective study of the clinical charts of the patients who were diagnosed endometrial adenocarcinoma in
our institution from January 2002 to December 2006, with evaluation of age, parity, hormonal status and other risk factors, clinical
presentation, diagnostic procedures, histological type and stage.
Results: We found 115 cases of endometrial adenocarcinoma, with a median patient age of 63. 61% of women were overweight
or obese, 59% had hypertension and 26% were diabetic. 21% were nulliparous women. Only 8% of the patients were in a premenopausal status, while 92% had already reached menopause. In 77% of cases they presented with postmenopausal uterine
bleeding and endometrial thickening. In 54% of the patients the diagnosis was made histologically from endometrial tissue obtained
after “blind” endometrial biopsy, while in 41% it was obtained from hysteroscopy-directed biopsy. 80% of the adenocarcinomas
were of the endometrioid type and, after surgical staging in an oncology referral hospital, 47% of patients were classified as stage
I (FIGO).
Conclusions: The demographic characteristics and the risk factors present in our population are similar to those described in literature. The appearance of symptoms early in the course explains why most women with endometrial cancer have early-stage disease
at presentation, being an early diagnosis a fundamental step for a good prognosis for the patient.
P084
Potentiation of antitumor activity by intraperitoneal combination treatment with Topotecan and Bevacizumab in vivo against
human ovarian cancer xenografts
J Dowaji1, A Donner2, W Rath1
1 Department of Obstetrics and Gynaecology, University of Aachen, School of Medicine, Aachen, Germany, 2 Department of Pathology, University of Aachen, School of Medicine, Aachen, Germany
Objective: To evaluate the antitumor activity of the combination Topotecan (Hycamtin) / Bevacizumab (anti-VEGF) administered
intrapertoneally to mice bearing human ovarian cancer xenografts. Design & Methods: Forty female mice (SCID-typ) at the age of
6 weeks were randomized into four groups. On day 0 a suspension of 6x106 ovarian cancer cells (SKOV3ip) was injected intraperitoneally (i.p). Onset of intraperitoneal chemotherapy was on day 10 as follows: Group I: Topotecan (Hycamtin) i.p 3 µg/g body
weight (bw) once per week for 8 weeks. Group II: Bevacizumab i.p 5 µg/g bw. q3d 12x. Group III: Topotecan i.p and Bevacizumab
ip (the previous doses). Group IV: Control group (mice with ovarian cancer, no chemotherapy). Mice were checked daily for any
adverse clinical reactions and weighed three times per week throughout the study. Acute toxicity was determined by loss of body
weight. After death the abdominal cavity was opened and the tumor growth inhibition and the volume of malignant ascites were
assessed and compared with the other groups. Statistical analysis was performed using the x2 -test. P values were considered to
be significant when less than 0.05. Results: Data obtained showed that combined intraperitoneal treatment with Topotecan/Bevacizumab produced the most significant tumor growth inhibition compared with monotherapy at the same doses of these agents. All
xenograft-bearing animals receiving this combination therapy demonstrated a significant tumor regression at the end of the study
with no additive toxicity. Conclusions: These results encourage clinical trials and may provide a novel and effective approach to the
treatment of human ovarian cancer intraperitoneally.
P085
Evaluation of presenting symptoms of ovarian cancer in comparison with other abdominal-pelvic cancer
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Z Sarraf1, E Anvari2, A Eshraghian2, S Skandari2, M Tangestani2, S Sohrabi3, A Karimpour3
1 OB/GYN department of Shiraz university of medical science, Shiraz,Fars, Iran, Islamic Republic of, 2 Jahrom university of medical
science, Jahrom,Fars, Iran, Islamic Republic of, 3 Shiraz medical school, Shiraz, Fars, Iran, Islamic Republic of
INTRODUCTION: Many of ovarian tumors can not be detected early in their development, so they account for a disproportionate
number of fatal cancers in women. To evaluate primary clinical symptoms of ovarian cancer to find a group of symptoms which are
best alarms for developing ovarian cancer.
METHODS: We reviewed the medical records of all women with abdominal-pelvic cancer diagnosed in hospitals between March
2003 and March 2005.The patients divided into ovarian cancer and non ovarian cancer groups. Then the presenting symptoms were
compared between these two groups of patients.
RESULTS: of 168 patients, ovarian cancer was diagnosed for 22 women (SatgeI: 0, StageII: 2, Stage III: 10, Stage IV: 7 and 3 patients without staging. The sensation of abdominal mass was more common among women with ovarian cancer in comparison
with other abdominal-pelvic cancer. (P=0.001).Constipation was more common in patients with colon cancer comparing to ovarian
cancer patients (P=0.012).Abdominal pain and defecation problems were more common in ovarian cancer patients in comparison
with other cancers (P=0.05). Patients with bladder cancer complained from urinary problems such as hematuria and dribbling more
than those with ovarian cancer (P=0.004).
DISCUSSION: Ovarian cancer is presented with wide varieties of symptoms. Sensation of abdominal mass, abdominal pain, urinary
and defecation problems can be associated with this cancer.
P086
Ovarian cancer: UbcH10 gene expression as new marker for diagnosis and prognosis
M Guida1, MT Berlingieri2, P Pallante2, F Tarsitano1, F Sorrentino1, D Canzaniello1, R Ciccarelli1, A Fusco2, C Nappi1
1 Department of Obstetrics and Gynecology, University of Naples, Federico II, Naples, Italy, 2 Department of Sperimental Endocrinology and Oncology, University of Naples Federico II, Naples, Italy
Introduction : Work done by several laboratories provide evidence that the expression of UbcH10 is an indicator of the proliferative
and aggressive status of thyroid cancer. We have analyzed the expression of UbcH10 in ovarian carcinoma to study the involvement
of this gene in the process of ovarian carcinogenesis, and to find new diagnostic markers of this neoplasia.
Materials and Methods
To analyze the UbcH10 expression pattern in ovarian cancers cell lines and in the respective normal tissue and cells. We performed
an RT-PCR and Western Blot analysis. UbcH10 immunoreactivity has been determined in two tissue micro-arrays (TMA).
Results : We showed that the UbcH10 was abundantly exspressed in all carcinoma cell lines and was present in very small amounts
in the normal tissues. To obtain evidence that UbcH10 overexpression had a role in the process of ovarian carcinogenesis, we
evaluated the growth rate of one ovarian carcinoma cell line, in which UbcH10 protein synthesis was suppressed by RNA interference. In vitro data indicated that the presence or absence of the UbcH10 siRNA duplexes determined a different cell growth of
these cell lines. In fact the block of the UbcH10 protein synthesis significantly inhibited ovarian carcinoma cell growth. These results
suggests a specific role of UbcH10 in neoplastic ovarian cell proliferation.
Discussion : This study is in according to the other functional studies demonstrating that the suppression of UbcH10 by RNA
interference reduced the growth of two ovarian carcinoma cell lines. We suggest the possibility to use this gene like a marker for
diagnosis and prognosis of this carcinoma.
Gynaecological oncology : Breast cancer - Oncologie gynécologique : Cancer des seins
P087
Expressions of Her-2/neu and Tp53 in infiltrative ductal breast carcinomas: correlations with clinicopathologic characteristics
A. Moghaddam, P. Mahsoni
Isfahan University of Medical Sciences, Isfahan, Iran, Islamic Republic of
Objective: To review HER-2/neu and Tp53 status and its correlation with all other prognostic histopathological features of infiltrative ductal breast carcinomas diagnosed between May 2000 and March2006 at the surgery and pathology departments of Alzahra
Hospital, Isfahan,Iran.
Method: Immunostaining for Tp53 and HER2/neu was performed on formalin-fixed, paraffin-embedded tissues based on an avidin-biotin-peroxidase complex technique. nuclear staining for Tp53 and cytoplasmic staining for Her-2. Cases were considered
negative for a specific marker if 10% or less of the malignant cells stained for the antibody. The positive results of Her-2 were scored
in three grades:1+,2+ and 3+. The relationship of these markers with clinicopathologic parameters including age, axillary’s lymph
nodes status, tumor size and histological grade were evaluated.
Results: The study included 139 patients with infiltrative ductal carcinomas of berast. The total number HER2/neu-positive cases
was greater among metastatic lymph nodes (55 cases) than in patients without metastases (39 cases). However statistically no
significant difference was observed (p=0.1). A significant association was observed between HER2/neu status and tumor grading
(p=0.01). On the contrary, no association was evidenced with other clinicalpathological parameters, such as tumor dimension and
menopausal status. In this study Tp53 was present significantly more often in carcinomas with high-grade or poorly differentiated
nuclear grade than in lowgrade tumors(p=0.03). A significant association was also observed between Tp53 and tumor size (P =0.01).
On the contrary, no association was evidenced with menopausal status. TP53 is seen in node-positive cases (37 cases) more than
node-negative patients (25 cases).
Conclusion: This information will help to identify those patients who are at greater risk of local failure and therefore may warrant more
aggressive local management. However long-term prospective studies are necessary to validate these findings and also, there is a
great need for the standardization of these biomarker assay and slide-scoring procedures.
Key words: Her-2/neu, Tp53, Ductal breast carcinomas, Clinicopathology.
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P088
High grade malignancy neuroendocrine carcinoma of the uterine corpus: report of two cases and the literature review
A.J. Jakimiuk (1,2), M. Nowicka, J. Beta
1 Department of Obstetrics and Gynecology, Central Clinical Hospital of Ministry of Interior and Administration, Warsaw, Poland, 2
Polish Academy of Sciences, Medical Research Center, Warsaw, Poland
INTRODUCTION: The neuroendocrine carcinoma of the endometrium is a very rare and aggressive neoplasm with poor final prognosis. The literature data are based most often on case reports. Cited incidence of the tumor is approximately 1% of all endometrial
carcinomas. The microscopic criteria for the recognition are poorly differentiated, small tumor cells with barely visible cytoplasm and
darkly staining nuclei. Additionally, tumor cells present neuroendocrine features that can be revealed using immunohistochemical
markers such as synatpophysin, chromogranin or neuron – specific enolase. This is a report of two cases of high grade malignancy
neuroendocrine carcinoma of the uterine corpus with the review of the literature data. CASES: Two women admitted to hospital
due to uterine bleeding after menopause without any additional symptoms and complaints. Both patients underwent endometrial
biopsy, that revealed the low-differentiated endometrium carcinoma, followed by total abdominal hysterectomy with bilateral oophorectomy and bilateral pelvic lymphadenectomy. Due to interpreting vagueness, the specimens were immunohistochemically stained
with the use of standard techniques. Carcinoma cells were positive for synaptophysin and chromogranin A in each case. One of
the patients had the disease progression and died despite the therapy due to disseminated disease. The evaluation of the disease
progression was made in the second case with use of the somatostatin receptors mapping. Patient underwent the post-surgical
Somatostatin Receptor Scintigraphy (SRS) examination (Tc-99m NeoSPECT 460MBq) that revealed the active pathology within the
mediastinal and hilar lymph nodes. She had the combined chemotherapy course (Paclitaxel and Carboplatin) and is still alive with no
signs of regrowth evaluated by the CT scans and control SRS examinations. DISCUSSION: The neuroendocrine carcinoma of the
endometrium is extremely rare, and therefore, there is still a need for close cooperation of the surgeon, pathologist and oncologist
to improve the prognosis and survival period.
Immunology and genetics - Apports de l’immunologie et de la génétique
P089
The leukemia inhibitory factor gene mutations are significantly more frequent in the population of infertile women but the
heterozygote transition G to A on the position 3400 does not affect the outcome of the infertility treatment – a pilot study
Z. Rokyta1, M. Kralickova1, Z. Ulcova-Gallova1, R. Sima2, T. Vanecek2, P. Martinek2, P. Sima3, J. Krizan3, P. Uher4
1 Department of Obstetrics and Gynecology, University Hospital, Faculty of Medicine, Charles University, Plzen, Czech Republic,
2 Department of Pathology, University Hospital, Faculty of Medicine, Charles University, Plzen, Czech Republic, 3 Department of
Immunology and Gnothobiology, Institute of Microbiology, Czech Republic, Prague, Czech Republic, 4 Institute of Reproductive
Medicine and Endocrinology, Plzen, Czech Republic
Introduction: The leukemia inhibitory factor (LIF) is one of the most important signaling factors in the embryo-maternal cross talk
during the embryo implantation. We investigated the prevalence of the LIF gene mutations in the population of infertile women and
their impact on infertility treatment. Design and methods: A cohort study. The population to screen consisted of 399 infertile women.
The control population was comprised of 202 healthy fertile subjects. For the mutational analysis, the temperature gradient gel electrophoresis (TGGE) followed by subsequent sequencing of the positive samples, had been used. The groups of fertile controls and
infertile patients were compared for statistically significant difference using the Fisher´s 2 by 2 Exact test. Results: Twelve potentially
functional LIF gene mutations, the G to A transversions at the position 3400 leading to the valin to methionin exchange at codon 64
(V64M) were detected in the group of infertile women. Four of the positive women were diagnosed by idiopathic infertility, three of
them by endometriosis, three of them by polycystic ovary syndrome, one by andrological factor and one by hyperprolactinemia. No
mutations were identified in the control group, which means that the frequency of functionally relevant mutations of the LIF gene in
infertile women is significantly enhanced in comparison with controls (P = 0.01, Fisher´s 2 by 2 Exact test). Five of these twelve positive patients were successfully treated by in vitro fertilization (IVF) by first embryo transfer which is a common pregnancy rate. It is
interesting that in the group of successfully treated there were no patients with idiopathic infertility and only one with endometriosis.
Conclusion: The results suggest that the LIF gene mutation, the heterozygote G to A transition on the position 3400, affects fertility
but the infertility treatment can succeed. We suppose that the probability of success depends on the cause of infertility. Idiopathic
infertility and endometriosis that are frequently accompanied by various immunopathologies (autoimmune antibodies, embryotoxic
cytokines and so on) decrease the pregnancy rates in the population of lif gene mutation positive women. We are aware of the fact
that we will have to confirm this hypothesis by larger study. The study was supported by grant GA CR 301/05/0078.
P090
The concentrations of soluble CD40L antigen and the surface expressions of CD40L on T CD4+ lymphocytes in normal
pregnancy and pre-eclampsia
Dorota Darmochwal-Kolarz1, Bogdan Kolarz2, Jacek Rolinski3, Bozena Leszczynska-Gorzelak1, Jan Oleszczuk1
1 Department of Obstetrics and Perinatology, Medical University of Lublin, Lublin, Poland, 2 Department of Reumathology and Connective Tissue Diseases, Medical University of Lublin, Lublin, Poland, 3 Department of Clinical Immunology, Medical University of
Lublin, Lublin, Poland
Purpose: The objective of the study was to test the hypothesis that innate immunity is activated in pre-eclampsia. We investigated
the surface expressions of CD154 antigen (CD40L) on peripheral blood T CD4+ lymphocytes and the sera concentrations of soluble
CD40L antigen (sCD40L) in normal pregnancy and pre-eclampsia.
Methods of study: Blood samples were taken from 25 patients with pre-eclampsia, 18 healthy pregnant women in their first, second
and third trimesters and 10 healthy non pregnant women. Mononuclear cells were isolated from peripheral blood and stained with
118
monoclonal antibodies against surface markers (CD 4, CD 154). The expressions of CD154 antigen on T CD4+ lymphocytes were
determined using flow cytometry. The concentrations of soluble CD40L antigen in sera of normal pregnant patients and pre-eclampsia were measured using ELISA method. Statistical analysis was performed using U Mann-Whitney test.
Results: We found that the expressions of CD154 antigen on T CD4+ lymphocytes and the sera concentrations of sCD40L were
significantly higher in pre-eclampsia when compared to normal third trimester pregnant women. There was a positive correlation between the percentage of CD154+CD4+ cells and sCD40L concentrations in pre-eclampsia. The concentrations of sCD40L and the
percentage of CD154+CD4+ lymphocytes did not differ in first, second and third trimesters of normal pregnancy. In the first trimester
of normal pregnancy the concentrations of sCD40L were significantly lower when compared to non-pregnant women.
Conclusion: These results suggest that there is an activation of innate immunity in pre-eclampsia. Furthermore, they suggest that T
CD4+ lymphocytes are the important source of soluble CD40L antigen in pre-eclampsia.The results do not confirm the hypothesis
that normal pregnancy is associated with moderate activation of innate immunity.
P091
Identification d’une activité de pinocytose au niveau des pinopodes de l’endomètre humain
A. Zhioua1, A. Amouri2, A. Ben Ammar2, A. Chaker1, M. Habib Jaafoura1
1 Hôpital Aziza Othmana Tunis– Dept de Gynécologie et Biologie de la Reproduction, Tunis, Tunisia, 2 Département de Microscopie
Électronique, Faculté de Médecine, Tunis, Tunisia
Pendant la période d’implantation, des protrusions cytoplasmiques appelées pinopodes apparaissent au niveau du pôle apical des
cellules endométriales. Ces structures seraient impliquées dans le processus d’implantation. Néanmoins, leur rôle biologique précis
est encore discuté.
Le but de cette étude est d’analyser en microscopie électronique à transmission (MET) l’ultrastructure de ces formations pendant la
période de la fenêtre d’implantation.
Des biopsies de l’endomètre ont été effectuées chez des femmes bien portantes suivies pour des problèmes d’infertilité d’origine
uniquement masculine. Ces biopsies ont été pratiquées pendant la période présumée d’implantation. Sur ces biopsies, nous avons
effectué à la fois une étude en microscopie optique sur coupes semi fines suivie d’une analyse ultrastructurale en MET.
Nous avons alors pu démontrer l’existence d’une activité d’endocytose évidente, aussi bien au niveau des pinopodes de l’épithélium
de surface, qu’au niveau des pinopodes des glandes endométriales. Ainsi, des images incluant les différentes phases d’endocytose
ont été visualisées sur plusieurs séries d’images.
Ces résultats confirment, pour la première fois à notre connaissance, l’existence d’une endocytose au niveau des pinopodes de
l’endomètre humain. En effet, cette fonction n’a été démontrée que chez l’animal et contribuerait à expliquer l’implication probablement directe des pinopodes dans le phénomène d’implantation.
Infections in gynecology - Infection en gynécologie
P092
Study on frequency of chief complaint for postpartum fever in referral to Dr.Shabihkhani gynecology hospital
M. Kafaei Atrian, Z. Tabasi
University Of Sciences, Kashan, Iran
Background: concerning to prevalence of postpartum fever and proposed contradictions and importance of subject and lake of
information for postpartum fever , the research is done in the maternity hospital of Dr. Shabihkhani in kashan
Materials & Methods : The research was done according to explanatory methods and or the form of existing data . then by reference
to archive of medical records affiliated to the department , the information derived and inserted to questionnaire .
Results : 43 cases with postpartum fever detected amonge 43012 delivery (0.3%) during 2000 to 2003 .
The most chief complaint was shaking with 44.2% ,pain (16.3%) , discharge ( 2.3%) , shaking and pain (9.3%) , and discharge and
pain(4.6%) .
Conclusion : Frequency of postpartumfever was 0.3% and the most chief complaint was shaking , pain and discharge.
Keywords : Postpartum fever , postpartum infection .
P093
Interceed® and Its Effects on the Inflammatory Response after Laparoscopic Gynecologic Surgery
H. Jung1, Y. Hye Kim1, S. Ah Kim1, K. Kee2
1chosun University Hospital, Gwangju, Korea, 2 Gwangju Christian Hospital, Gwangju, Korea
Objective: Adhesions resulting from surgery are the most significant iatrogenic factor contributing to postoperative infertility and
pelvic pain. Adhesion prevention barriers are commonly used to mechanically separate opposing surfaces during tissue healing.
In general, the postoperative peritoneal cavity is an inflammatory environment. This study investigated whether Interceed® would
enhance the postoperative inflammatory reaction or immune response to foreign materials when left in the pelvic cavity.
Methods: This prospective study included 207 patients who underwent laparoscopic surgery in the Department of Obstetrics and
Gynecology, Chosun University Hospital from January 2002 through December 2004. Of the 207 patients studied, 102 patients underwent laparoscopic surgery followed by application of Interceed® (Group 1, Treatment) and 105 patients underwent laparoscopic
surgery without Interceed® (Group 2, Control). Blood was collected to quantify WBC (white blood cell), ESR (erythrocyte sedimentation rate) and CRP (C-reactive protein) concentrations. In addition, body temperature was measured before operation (Day 0) and
at the 4th, 10th, and 21st days after operation.
Results: The two groups did not show any significant differences in medical examinations prior to operation. The same surgical
119
methodology was employed during the surgical procedures for the two groups. There were no significant differences in hematological findings, clinical symptoms, or body temperature at anytime following surgery.
Conclusions: Interceed® use did not enhance the postoperative inflammatory reaction as measured by standard clinical parameters of immune response when used in the pelvic cavity after surgery. Accordingly, Interceed® may not further increase the inflammatory nature of the postoperative peritoneal cavity.
Keywords: Interceed®, Adhesions, Inflammation, Laparoscopy
P094
Optimization of diagnostics of cervical chlamydia-mycoplasmatic infections in women
B. Tkeshelashvili1, M. Jugeli1, T. Bukia2, L. Shanidze2
1 D.Tatishvili Medical Center, Tbilisi, Georgia, 2 Georgian State Medical Academy, Tbilisi, Georgia
Objectives. Frequency of chlamydia-mycoplasmatic genital infections still remains stable high in the world. The aim of our investigation was to evaluate the diagnostic significance of colposcopic signs in patients with cervical chlamydia-mycoplasmatic infections (CMGI). Design & Methods. Colposcopic examination was performed in 952 women (age - from 16 to 67). In I group unified
805 patients with colposcopic signs of CMGI, in II group – 147 patients without colposcopic signs of CMGI. Specific colposcopic
features of chlamydia-mycoplastic genital infections – lymphatic follicles and “vessel starlets” were revealed, which were compared
with results obtained from “gold standard” method – direct immunofluorescence (DIF) of cervical smears. Results. In I group in 725
cases lymphatic follicles have been revealed (90%), in 80 cases (10%) – “vessel starlets”. In 29 cases colposcopy data was not
confirmed by DIF. In II group CMGI were diagnosed in 36 patients (24,5%). High specificity (0,79), sensitivity (0,96) and diagnostic
effectiveness (0,93) of colposcopy were established. Conclusions. Our findings suggest that the colposcopy should be implemented
as initial method for examination of patients with STD, for optimization of diagnostic process and decrease of economic costs.
P095
Clinical-morphological changes of cervix uteri and vesica urinaria associated to HPV
I. Ivanova1, V. Brykov1, L. Isakova2
1 Main clinical military hospital of Ukraine, Kiev, Ukraine, 2 Institute of hematology and transfusiology of the Academy of medical
sciences of Ukraine, Kiev, Ukraine
Research objective: assessment of vesica urinaria urothelial of women with abnormal colposcopic findings on cervix uteri associated to HPV. Materials and methods: complex examination of 123 (100%) patients aged 27-48. Identification of HPV DNA with
genetic typing of 12 types of oncogenic HPV conducted by polymerase chain reaction method. Colposcopy discovered acetowhite
epithelium, fine punctation, coarse mosaic, iodine negativity, condylomata, keratosis. For all patients bacteriological, Pap-test, and
pathomorphological assessment of material was conducted. CIN I, II, and III were discovered in 10.2%, 28.6%, and 13.8% cases
respectively. Other pathologies of cervix uteri were discovered in 47.4% of cases. Concomitant genital infection was sanitized after
diagnosing. Cystoscopy of Lieutaud’s triangle of vesica urinaria discovered that 57.7% of patients had whitish spotted fimbriated
excrescences clearly limited from and raised over the level of normal mucous. Occurrence of chronic cystitis of cervix vesicae urinariae was discovered for 17.9% of patients; polyps combined with signs of chronic cystitis for 3.2%; whitish spotted fimbriated
excrescences combined with papillary affections of cervix vesicae urinariae for 32.5%. For 21.2% pathological changes were not
discovered. Pathomorphological examination of 68 biopsy materials taken from affected area of urothelial discovered leukoplakia
for 47%. Metaplasia with focuses of dysplasia and parakeratosis was discovered for 42.6%; chronic inflammation for 5.8%; uninformative material constituted 4.4%. Conclusion: in the presence of changes on cervix uteri associated to HPV the changes on
vesica urinaria urothelial of different intensity also take place. This must be taken into account when selecting individual strategy for
medical supervision and complex treatment of such patients.
P096
Early hospital discharge and puerperal complications and use of Family Planning Methods in a cohort of 893 women at
Mexico, City General Hospital
D. Ramirez Villalobos
Centro de Investigacion en Salud Poblacional, Cuernavaca, Morelos, Mexico
Background: The objective of this study was to evaluate the association between time of postpartum discharge and reported symptoms indicative of complications during the first week postpartum and the association between the use of family planning methods
in the immediate postpartum period, in women who had eutocic delivery at the Mexico City General Hospital. Methods Women who
underwent uncomplicated spontaneous vaginal deliveries at a Mexico City public hospital and who agreed to participate were included. Interviews and medical record reviews were used to collect sociodemographic and obstetric data. Seven days after delivery
women were asked about symptoms related to the following complications: urinary tract infection, episiotomy infection/breakdown,
and endometritis, and whether they had sought medical care. The dependent variable was defined as the occurrence and severity
of puerperal complication symptoms, and use of family planning methods. The exposure variable was the length of stay in hospital,
classified as early or late early hospital discharge. Results Out of 762 studied women, 501 (64%) were discharged early after delivery.
In the whole sample, no association was found between early discharge and the severity of complication symptoms reported during the first week post-partum. However, in those women who were discharged early the risk of suffering more severe complication
symptoms was greater when they had received an enema prior to the delivery or when they had had inadequate prenatal care. Respect use of family planning methods we found a 23% prevalence of use, found a positive and significant association of use during
immediate postpartum with multiparity (OR 1.52, 95% CI 1.04-2.21). Conclusions The results of this study show that, although there
was no association between early discharge and the severity of complications during the mid puerperium in all mothers, the severity
of complications increased for those who had an enema prior to the delivery or whose prenatal care was inadequate and A longer
duration of postpartum hospital stay was positively associated with the use of family planning methods.
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Menopause – Ménopause
P097
Syndrome “burn out” and menopause
S. Dimitrakopoulos1,3, A. Bonas, K. Goula2, F. Plevria1, A. Sidiropoulou2, I. Mavropoulos1, K. Sorras2, A. Saltamavros2, E. Papageorgiou, N. Sidiropoulos1
1 Obstetrics-Gynecology Department, General Hospital of Pyrgos, 2 Department of Medicine, Saint Andrew Hospital, Patras, 3 Occupational Health Centre West of Greece
AIM: Our aim was to study the repercussion of syndrome “Burn out” in working women in the period of menopause. The women
worked in labour spaces as is the Education, Hospitals, beneficial enterprises to the wider Public and Private sector.
Material-method: The first team was 80 women in the menopause and in the second team 80 women in productive age. The study
became with qualitative analysis of results based on questionnaire Burn-out test of Jerabek I. that was given in concrete working
and natural examination of these.
RESULT: In the particular social team of metemenopause workers was observed statistically important increase of syndrome “Burn
out” concerning the population. This professional pathology is characterized by fast consumption of psychosomatic reserves and
reduction of professional records. It is mainly owed to the negative consequences of chronic labour Stress in t health, but also in
psychosocial factors. With result the sentimental exhaustion, the bodily exhaustion, the lack of professional satisfaction and depersonalization. There is disturbance of behavior as concern, stress, depression, pugnacity, tendency of isolation, use of psychotropic
substances and impact to the psychology of working women.
Burn - out test Jerabek I
Sentimental exhaustion Bodily exhaustion Depersonalization
Lack of professional Satisfaction Mean
A
B
75,2 67,6 67,6 61,0 68,2 58,7 71,0 56,7 71,5
61,0
CONCLUSION: With the present study we realized that metemenopause working women are more prone in the syndrome “Burn
out”.
P098
Differentiated approach to menopausal disorders treatment depending on metabolism parameters
I. Kuznetsova, M. Yakokutova
Russian Medical academy of postgraduate education, Moscow, Russia
Introduction: Medical actions which will be carried out in perimenopause, should take into account not only the gynecologic status,
but also features of metabolism. Objective: to optimize a choice of hormone replacement therapy (HRT) for treatment women with
clinical features of age deficiency estrogens depending on metabolic parameters.
Methods: 125 patients with clinical symptoms of estrogen deficiency were examined during for 9 months. The age of women ranged
between 45-51 years. Serum total cholesterol, triglyceride, high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL)
cholesterol, index of HOME and anthropometrical qualities (BMI, ‘‘waist/hip’’ ratio) were measured before and one week after
therapy. The choice of a preparation for HRT was carried out depending on preliminary research results.
Results: In all groups the positive effect of therapy resulting in significant reduction of quantity and expressiveness of hot flashes,
night sweats and their full disappearance was noted. In the 1-st group (n=50) of women with normal body mass index, combination
of 17-b estradiol with levonorgestrel showed beneficial effect on a fatty and carbohydrate exchange. In the 2-nd group (n=45) of
women, with excessive body weight and low level HDL, the tendency of body weight decrease at the expense of abdominal fat was
marked. In result we noted ‘‘waist/hip’’ ratio reduction, LDL/HDL ratio (p<0,001) and index of HOME (p<0,001) decrease. The 3-rd
group of women, suffered from adiposity or increased level of triglyceride, was administered 17-b estradiol in transdermal patches
and levonorgestrel-releasing intrauterine system. Metabolic factors did not change after treatment, except for TG level decrease
(p<0,05).
Discussion: Metabolism parameters can be used as one of the choice criteria for HRT. It will provide for safety and positive drug
effects. Combination of 17-b estradiol and levonorgestrel are indicated for women with normal metabolic factors; 17-b estradiol with
dydrogesterone is preferable for patients with excessive body weight; patients with adiposity require parenteral use of hormonal
preparations.
P099
Diagnostic hysteroscopy in postmenopausal women with endometrial thickening
S. Carvalho, A. Lebre, R. Patricia, E. Fernandes, M. Areias, M. Rodrigues, M. Leal
Maternidade De Julio Dinis, Oporto, Portugal
Objective: Evaluate endometrial pathology in postmenopausal women with endometrial thickness > 4 mm in transvaginal ultrasound.
Materials and methods: Retrospective study of 192 postmenopausal women ( age 46-84; mean age 61,9), during a period of 19
months. After detection of endometrial thickness (>4mm) in transvaginal ultrasound they were presented to our department in order
to evaluate possible endometrial lesions. Of these women 91(47,4%) were symptomatic (postmenopausal bleeding) and the others 101(52,6%) were asymptomatic. All of these patients underwent diagnostic or surgical hysteroscopy followed by histological
endometrial sampling.
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Results: We considered four groups: symptomatic postmenopausal women with endometrial thickness ≤6mm-Group A(5,7%; n=11);
asymptomatic women with endometrial thickness ≤6mm- Group B (3,1%, n=6); symptomatic postmenopausal women with endometrial thickness >6mm-Group C (41,7%; n=80); asymptomatic women with endometrial thickness >6mm- Group D (49,5%, n=95).
In group A the histeroscopic findings were atrophic endometrium in 5 cases, endometrial polyps in 3 cases, and in the other 3 cases
a submucous myoma, a sinequia and an uterine septum were diagnosed. In group B we found 3 polyps, 2 sinequias and one case of
atrophic endometrium. In group C the endometrial lesions diagnosed were 52 endometrial polyps, 10 sinequias; 9 endometrial carcinomas; 7 submucous myomas, 1 endometrial hyperplasia and 1 mucous polyp. In group D were diagnosed 80 endometrial polyps,
6 cases of atrophic endometrium, 4 mucous leyomiomas, 3 cases of sinequias and 1 adenomyoma. Ressectoscopy was performed
in 70 cases (36,5%)and hysteroscopic polypectomy was performed in 68 cases ( 35,5%)without any major complications.
Conclusion: Hysteroscopic evaluation of postmenopausal endometrial thickening is a safe and accurate procedure. The most
frequent endometrial pathology found in postmenopausal women with endometrial thickness >4 mm were endometrial polyps.
Endometrial carcinoma was found in 4,5% (n=9) of all patients, and in all endometrial thickness was > 6mm with postmenopausal
bleeding.
P100
Manifestationes of somatic disturbences in early post menopause in women after physiological and surgical menopause
D. Nincic, M. Zivaljevic, A. Mandic, M. Davidovic, D. Zikic
Institute of Oncology Vojvodina, Novi Sad, Vojvodina, Serbia
Objectives: Major purpose of the study was to provide information about the most common symptoms of early menopause after
surgical removing of the ovaria. Design and Methods: Study is designed as a prospective study and enclosed 120 women age
41-55, divided into two groups: physiological and induced menopause. Every subject checked special evidence list consisted of
disease history questions, physical and gynecology examination and data about physiological variables and laboratory examination.
Results: The most frequently symptoms in both group were vasomotor symptoms. Headache is more intensive sign in group after
induced menopause. Extrasistolic heart excursion represents common symptom in both group. Arterial tension, no matter of type of
menopause, was in physiological frame. Frequent organic signs of menopause, more intensive in group after induced menopause,
were genitourinary and skin atrophy. Analysis of Body Mass Index marks subjects in both groups as fatigue. Lipids analysis confirmed predomination of hyperlipoproteinemia type IIa in group with physiologic menopause and type IIb after induced menopause.
Conclusion: Dominant signs of menopausal syndrome are vasomotor and bone-joint symptoms, more frequent in group after induced menopause. There are no statistic significant differences between study groups according to the signs of aging. Menopausal
hormonal changes, no matter the way of menopause developing, increase the risk for hyperlipoprotenemia. Frequency of somatic
signs in early post menopause is typically higher after induced menopause.
P101
DT56a (Femarelle): A natural selective estrogen receptor modulator (SERM) for the management of menopause
I. Yoles1, D. Somjen2
1 Sheba Medical Center, Tel Hashomer, Israel, 2 Sourasky Medical Center, Tel Aviv, Israel
Introduction: DT56a (Femarelle) is a standardized compound for the treatment of menopausal symptoms and bone loss. In clinical
studies, Femarelle was shown to relieve menopausal symptoms and to increase bone mineral density with no effect on sex steroid
hormone levels or endometrial thickness. DT56a, similarly to estradiol-17 (E2), stimulated the specific activity of Creatine Kinase
(CK, a marker of estrogen receptor activation) in skeletal and vascular tissues of female rats. However, in the uterus CK was activated only by E2 but not by DT56a. DT56a also stimulated human cultured female derived osteoblasts. Moreover, DT56a had no
estrogenic effect on the MCF-7 breast cancer cell line. In the present study, we examined the mutual interaction between DT56a
and E2 in different models, when administered simultaneously. Methods: DT56a and E2 were administered simultaneously to intact
or ovariectomized female rats. Additionally, human-derived cultured osteoblasts and human umbilical artery smooth muscle cells
where treated by DT56a and E2. Results: Administration of DT56a or E2 stimulated CK in all tissues tested. When given simultaneously the following results were found; in intact immature female rats, DT56a completely abolished E2 stimulation of CK in all organs
except in diaphyseal bone where the inhibition was only partial. In ovariectomized female rats, DT56a abolished E2 stimulation of
CK in epiphyseal cartilage, diaphyseal bone, thymus, pituitary gland and in the uterus. Partial inhibition was found in the aorta and
in the left ventricle. DT56a abolished E2 stimulation in cultured osteoblasts. In human vascular cells, DNA synthesis was completely
inhibited but CK was only partially inhibited.
Discussion: Our findings suggest that DT56a works as a selective estrogen receptor modulator (SERM); it acted as an agonist is
different tissues but when given simultaneously with E2 it antagonized E2’s effect. The exact mechanism of this effect and potential
clinical applications are currently under investigation.
P102
Transdermal estrogens and vaginal micronized progesterone compared to oral route of Hormone Therapy in the first years
of in menopause. Two years of lipid profile monitoring
Manuela Russu1, D Hudita1, S Nastasia1, N. Mubarak2
1 Carol Davila University of Medicine &Pharmacy, Bucharest, Romania, 2 Titan Center of Diagnosis & Treatment, Bucharest, Romania
Objective. Lipid profile assessment after transdermal estrogens and vaginal progesterone administration vs oral hormone therapy
(HT) in the first 5 years of menopause
Material and methods. Were analyzed during January 1, 2002- December 31, 2003, total -, LDL-, HDL-cholesterol, and triglycerides
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at 50 postmenopausal women after 6, 12, 24 months on 5 types of secquential HT [different by route for estrogens- oral/transdermal, and progestogen/progesterone - oral/vaginal, duration of progestogen/progesterone - 12/14 days/month and cycle 14 days
at 3 months] and 10 postmenopausal controls, who refused HT. Total cholesterol <200mg/dl, LDL-c <130mg/dl, HDL-c >65mg/dl,
triglycerides <150mg/dl appreciated as protective for atherosclerosis.
Statistical analysis: each non-oral(NO) group compared to control and oral(O) groups, by pair Student’s test (ANOVA).
Results. After 6 months: increased total cholesterol: 7 (3NO+ 4O) (14%) treated, 4 (40%) controls; reduced total cholesterol: 18(11NO+
7O) (36%) treated, 1(10%)control; HDL-c in normal range: 12 (8NO+ 4O) (2.4%) treated, no control; HDL-c of 50-64 mg/dl: 34
(20NO+14O) (68%) studied, 8(80%) controls; HDL-c <50mg/dl: 4(2NO+2O) (8%) studied, 2(20%) controls; triglycerides >150mg/
dl: 10(2NO+8O)(20%) treated, 6(60%) controls. After 12 months of HT: total cholesterol >200mg/dl: 5(3NO+2O)(10%) treated,
4(40%) controls; increased LDL-cholesterol: 4(3NO+1O) (8%) treated, 8(80%) controls; high triglycerides: 10(2NO+8O)(20%) studied, 6(60%) controls. Were registered reduction of: total cholesterol (with 12%, 15-18%, and 18% at 6, 12, 24 months), LDL-c (with
20%, 25% at 6, 12 months, unchanged values at 24 months) in all treated groups, triglycerides (only with transdermal estrogens:
with 14%, 15% at 6, 12 months, unchanged values at 24 months), increase of HDL-c (with 8-10%, 14-18% at 6, 12, 24 months,
best values after 24 months being on micronized progesterone vaginally monthly vs control –P<0.05 and cycle administered at 3
months vs oral progestogen/dydrogesteron- p<0.05).
Conclusions. Lipid profile was mostly positively influenced after first 12 months, less changes after 24 months; oral estrogens induced a light raise of triglycerides; vaginally monthly and cycle at 3 months associated micronized progesterone induced the most
antiatherogenic levels (P<0.05). Medroxyprogesterone acetate had the worst effect even associated to transdermal estrogen.
Key words: lipid profile, menopause, transdermal/oral estrogen, oral progestogen/vaginal micronized progesterone
P103
Postmenopausal osteoporosis, weight loss and HRT
A. Bazarra-Fernández
Juan Canalejo University Hospital Trust, La Coruña, Spain
Background: Recent studies have found weight gained during menopause increase the risk of high blood pressure, the diabetes,
heart disease, and has been strongly linked to increased incidence of breast and other hormone-related postmenopausal malignancies. These healthcare concerns have led to the conception of specific products that target menopausal weight gain.
Aim: Looking over weight gain and osteoporosis treatment in climacteric.
Material and methods: 20 women who were 44 to 58 years old have been recruited. BMI was increased to age. Those with an intact
uterus have moderate to severe vasomotor symptoms associated with the menopause, moderate to severe symptoms of vulvar
and vaginal atrophy and risk of postmenopausal osteoporosis. They were ascribed to equal two 10 women groups. One group was
assigned to 2 mg drospirenone /1 mg 17 beta- estradiol hemihydrate. The other group treated with. 40 mg soybean.
Results: in the women on 2 mg drospirenone /1 mg 17 beta- estradiol hemihydrate medication decreased, moderate to severe
symptoms of vulvar and vaginal atrophy vasomotor symptoms associated with the menopause in regard to the other group treated
with 40 mg soy bean. They had weight main loss of 3 kg in one year, (P < 0.05).
Conclusions: Human HRT is in relation to decrease osteoporosis. It is not noted 17 beta- estradiol is in relation to breast cancer. Estradiol is the same oestrogen produced by the ovaries before menopause. Drospirenone has the unique property of reducing water
retention often associated with the use of oestrogen and other synthetic gestagenic steroids. The only one with this added advantage. The impact of obesity on hormone replacement therapy is due to many women associate hormones with weight gain. This late
medication formula can be beneficial in minimizing uncomfortable symptoms, such as weight gain, hot flashes, night sweats, and
mood swings, associated with the natural progression of a woman’s life cycle. So, it is due to conduct one greater trail to make clear
and more comprehensible these points.
P104
Effects of hormone replacement therapy, tibolone or raloxiphene monotherapy on the parenchymal mammographic density
in postmenopausal women
P. Petropoulos, V. Palapelas, D. Russo, V. Petropoulou, I. Tsibanakos, V. Karayiannis
3th dep of Obstet Gynecol Aristotl Univesity of Thessaloniki, Thessaloniki, Greece
Objectives: The determination of the changes in the parenchymal mammographic density of postmenopausal women during the
administration of different regimens aiming to prevent menopausal osteoporosis. Methods: The mammographies of 268 women
(47 – 62y) on hormone replacement therapy (HRT), Tibolone or Raloxiphene monotherapy to prevent osteoporosis, were examined
and evaluated. The women were allocated to 5 groups. Group I (n=46) comprised of women who had undergone hysterectomy and
were administered a monotherapy of transdermal 50μg E2. Group II (n=52) received continuous combined E2 and norethisterone
(E2 2mg + NETA 1mg). Group III (n=56) received the same regimen as group II with the dosage adjusted to half (E2 1mg + NETA
0.5mg). Group IV (n=54) received 2,5mg/d Tibolone monotherapy and finally group V (n=60) received 60mg/d Raloxiphene. The
evaluation of the change in the mammographic density was performed according to the Wolfe classification before the commencement of therapy and one year later. Statistical analysis was performed with x2. Results: In group I an increase in the mammographic
density was observed in 2 patients (2/46 - 4,3%). In group II an observed increase was documented for more than 1/3 of the patients
(18/52 – 34.6% ). An increase in the mammographic density was observed in 8 patients (8/56 – 14.2%) in group III. This percentage is statistically lower in comparison to group II. In group IV, 5 patients (5/54 - 9.2%) revealed an increase in the mammographic
density, while a decrease in the parenchymal breast density was observed in 6 out of the 54 women (11.1%). Finally in group V no
change in the mammographic density was observed, except in two women (2/60 – 3.3%), who exhibited a small decrease in the
parenchymal breast density. Conclusions: The continuous combined E2 + NETA (group II) affects the parenchymal mammographic
density to a greater extent. It is obvious that the dose reduction in this regimen results in a diminution of the observed increase in the
mammographic density (group III), the latter becoming comparable to group II. Additionally, the mammographic density increases in
a small percentage of women and decreases in a larger percentage of women, who were administered Tibolone. In the women who
received Raloxiphene no important changes were observed in the parenchymal brest density.
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Sexuality - Sexualité
P105
The assesment of prevalence and related factors on female sexual dysfunction (FSD) in married women, babol, 2006
F. Bakouei, S. Omidvar, F. Nasiri
Medical University, Babol, Iran
Introduction: sexual dysfunction in women is very common and occurs in every age, cultural , social and economical status. That
can have major impact on quality of life, self- steam, mood and relationship with partner. Fsd is a multi factorial set of condition
associated with biological, psychological and social factors. This study investigated the prevalence and related factors for fsd on
married women.
Material and methods: this research is an analytical- descriptive study that are assessed 318 married women refered to selected
therapeutic and health centers by questionnaire. The analysis of obtained findings were done by statistical software spss and statistical tests. Findings: in this study 318 woman 18-53 years with mean age 28 year were assessed. From this women, %80.8 Were
in normal group, %13.2 Were in mild fsd group and %6 were in sever fsd . Actually 19.2% Of them have fsd. Findings showed that
prevalence of each subgroups was as follows: desire disorders(48.4%), Arousal disorders(40.3%), Pain disorders(19.8%), Orgasm
disorders(18.6%), Lubrication problem(12%) and sexual satisfaction problem(11.3%).In this study there were significant relationship among fsd and woman educational status, partner’s job,
Conclusion: according to the finding, the mental and educational factors have the most affect on educational status. In result, using
of mental and educational consulting and applying
Workshops for planning and method of study is necessary.
Keywords: female sexual dysfunction, prevalence, related factors
P106
Is there a role of Rho-kinase (ROK) related proteins in the control of the function of human subepithelial vaginal arteries?
S. Ückert1, E. Waldkirch1, M. Seidler1, W. Kauffels2, U. Jonas1, P. Hedlund3
1 Hannover Medical School, Dept. of Urology, Hannover, Germany, 2 Klinikum Hildesheim GmbH, Dept. of Gynecology & Obstetrics,
Hildesheim, Germany, 3 Lund University Hospital, Dept. of Experimental Pharmacology, Lund, Sweden
Objectives: Rho-associated kinase (ROK) causes calcium-independent contraction of smooth muscle and has been demonstrated
in male genital tissue, such as the corpus cavernosum penis. Up until now, it is not known if ROK or related proteins are involved in
the control of vaginal blood flow. Thus, we evaluated the ROK pathway in human vaginal vessels by means of functional experiments
and immunohistochemistry.
Design & Methods: By means of the organ bath technique, the effects of the Rho-kinase inhbitor Y 27632 on the concentrationresponse curve to phenylephrine (PE) of isolated human subepithelial vaginal arteries (diameter < 100 µm) were investigated. The
distribution of ROK-1, ROK-2, RhoA and RhoGDI in sections of full wall specimens of the human vagina was elucidated by means
of immunohistochemistry (IHC).
Results: PE caused concentration-dependent contractions of isolated vaginal arterial segments amounting to a maximum determined 120 ± 16% that of 124 mM K+. The contractile response to PE was significantly reduced in the presence of 0.1 µM and 1
µM of Y 27632. The cumulative addition of Y 27632 (10 nM - 10 µM) produced relaxant responses with a mean -log IC50 of 6.4
and a relaxation of 91% at a concentration of 10 µM. IHC revealed a dense mesh-work of alpha-actin immunoreactive arterioles in
the subepithelium of the vaginal specimens. Immunoreactions specific for ROK-1, ROK-2, RhoA and RhoGDI were observed in the
smooth musculature of these vessels.
Conclusion: alpha1-adrenoceptor activation contracts subepithelial human vaginal arteries via ROK-sensitive mechanisms. Based
on our findings, a role for this signalling pathway in the control of vaginal blood flow might be considered.
P107
Phosphodiesterase type 5 inhibitors enhance the nitrinergic relaxation of isolated human vaginal arteries
P. Hedlund1, Stefan Ückert2, Eginhard Waldkirch2, Michael Seidler2, Wolfgang Kauffels3, Udo Jonas2
1 Lund University Hospital, Dept. of Clinical Pharmacology, Lund, Sweden, 2 Hannover Medical School, Dept. of Urology, Hannnover,
Germany, 3 Klinikum Hildesheim GmbH, Dept. of Gynecology & Obstetrics, Hildesheim, Germany
Objectives: An increase in vaginal bloodflow is considered a key event in the initiation of lubrication in response to sexual arousal.
Although a significance of the nitric oxide (NO) - cyclic GMP (cGMP) signaling in this mechanism has been assumed, up till now, no
study have addressed the functional effects of compounds interfering with the cGMP-pathway on vaginal vascular tissue. The aim
of the present study was to evaluate the effects of the PDE5 inhibitors sildenafil, vardenafil and tadalafil, as well as the NO-independent guanylyl cyclase activator YC-1 on isolated subepithelial vaginal arteries. Design & Methods: Subepithelial vaginal arteries
were dissected from full wall specimens of the human vagina obtained from five women (mean age: 56 y). Circular segments were
mounted in an organ bath and challenged by the addition of phenylephrine (PE, 1 µM). Once a stable tension had been reached,
the muscarinic agonist carbachol (1 nM - 100 µM) was added in a cumulative manner and relaxant responses of the tissue were
recorded. Dose-response curves were also generated following pre-exposure of the tissue to sildenafil, vardenafil, tadalafil (10 nM
and 100 nM), and YC-1 (1 µM). Results: The tension induced by PE was dose-dependently reversed by carbachol, starting at a concentration of 100 nM. Preincubation with the threshold concentrations of the PDE5 inhibitors shifted the carbachol dose-response
curve significantly to the left, with sildenafil and tadalafil (100 nM) being the most effective drugs. EC50-values were calculated to
0.5 µM and 0.09 µM, respectively. YC-1 also induced a left-shift in the carbachol dose-response curve which was not as prominent
as the responses caused by the PDE inhibitors.
Conclusion: Our findings are in favour of a role for cyclic GMP and PDE5 in the control of vaginal vascular responses.
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P108
A statistical report regarding the possible affection of sexual appetite at the oral contraceptive users
T. Pop, D. Craiut, S. Lacziko, M. Veres, R. Herczegh, P. Pop
University of Oradea, Oradea, Rwanda
In the last three decades a lot of significant progress was made in development and promotion of the new contraceptive technologies, including the obvious extension of usage of classical oral contraceptives and the combined ones, with reduced dosage.
The medical corporation has the deontological duty to offer to COC user adequate and correct information regarding indications,
contraindications, contraceptive efficiency (pearl index), side effects, giving them this way the possibility to make a well informed
and self-willed choice of the medication. In the last years we noticed during the periodical screening of our patients, the fact that
some of them complain of the affection/lowering of the sexual appetite. This was the reason why we found useful to elaborate a set
of questions regarding the possibility of emergence of sexual disorders at COC users, particularly to be able to quantify this side
effect, which ones set, can negatively influence the well-being of women and in the same time to try to ameliorate it. Analyzing the
questionnaire allowed us to assume some pertinent findings, which yet needs the scientific support of further studies (some of them
already active) on bigger batch of women.
P109
Sexuality and sexual behaviors of women using oral contraceptives containing different doses of ethinyloestradiol – the
preliminary study
V. Skrzypulec, K. Nowosielski, A. Drosdzol, O. Lindert
Medical University of Silesia, Katowice, Poland
Objective. The purpose of this study was to assess the relationship between dose of ethinyloestradiol (EE) in oral contraceptive pills
(OCP) and the quality of sexual life and sexual behavior of women.
Design and Methods. 80 women aged 16-45 using OCP were eligible for the study. The research was based on self-prepared questionnaire “Sexuality of woman” and the Mell-Krat scale.
Results. Mean age of sexual initiation in the studied group was 19. Women taking high dose EE OCP’s assessed sexual satisfaction
as the best.
Conclusions. Dose of ethinyloestradiol (EE) in oral contraceptive pills (OCP) may influence the quality of sexual life. Sexuality of
women is multfactorial. This investigation should be expanded on the larger population.
Infertility and MAP - Infertilité et PMA
P110
Effet de la periode de preincubation ovocytaire sur les resultats de l’icsi
A. Zhioua1, H. Elloumi1, M. Meftah1, A. Amouri2, F. Zhioua1
1 Hôpital Aziza Othmana Tunis– Dept de Gynécologie et Biologie de la Reproduction, Tunis, Tunisia, 2 Faculté de Médecine, Tunis,
Tunisia
Dans le but d’étudier l’effet de la préincubation ovocytaire qui précède la technique d’ ICSI sur la qualité des embryons, le taux
d’implantation et le taux de grossesse nous avons comparé les résultats de cette technique pour différentes durées de préincubation.
Ainsi, 162 cycles d’ICSI (108 cycles longs, 46 cycles courts et 8 cycles antagonistes) ont été pratiqués au centre de PMA de l’hôpital
Aziza Othmana de Tunis chez des patientes ayant un âge moyen de 36 ans.
Le recueil des ovocytes a été réalisé 36 h après le déclenchement de l’ovulation. Nous avons obtenu :
- 704 ovocytes matures qui ont été microinjectés par le sperme du conjoint après une incubation variant de 1 h à 5 h,
- et 378 embryons dont 308 ont été transférés 48h après la fécondation.
Nous avons essayé d’évaluer la qualité embryonnaire et le taux d’implantation en fonction de la durée de préincubation ovocytaire.
La morphologie des embryons ne semble pas être affectée par la durée de préincubation. En effet, la régularité des blastomères
et la présence de fragments cytoplasmiques sont similaires quelque soit le temps écoulé avant l’ICSI. Le pourcentage d’embryons
comportant au moins 4 blastomères lors du transfert est de 62% (≤ 2,5 h) comparativement à 51,9%(> 2,5 h).
Les taux d’implantation et de grossesse sont significativement plus élevés quand le temps de préincubation ≤ 2,5 h.
Conclusion : Le temps de préincubation durant lequel s’accomplit la maturité cytoplasmique et nucléaire de l’ovocyte est un
paramètre très important qui influence de manière significative les résultats de l’ICSI. Un délai ≤ 2,5h semble être la période idéale
de microinjection pour avoir les meilleurs résultats.
P111
Testicular expression of testis specific gene A10 (TSGA10) mRNA in patients with non-obstructive Azoospermia
M. Aarabi1, H. Soltanghoraee2, N. Amirjannati2, M. Reza Sadeghi1, H. Sadri Ardekani1, M. Akhondi3, M. Hossein Modarressi4
1 Reproductive Biotechnology Research Center, Avesina Research Institute, Tehran, Iran, 2 Avesina Infertility Clinic, Avesina Research Institute, Tehran, Iran, 3 Monoclonal Antibody Research Center, Avesina Research Institute, Tehran, Iran, 4 Department of
Medical Genetics, Tehran University of Medical Science, Tehran, Iran
Introduction: Genetic defects could be an important cause of male infertility and non-obstructive azoospermia which lead to
low sperm numbers, low numbers of morphologically normal sperm, and low numbers of motile sperm. Testis specific gene A10
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(TSGA10), located on chromosome 2, encodes a protein as the structural component of sperm tail in mice and human. Methods: We
investigated TSGA10 mRNA expression in testicular samples of 84 patients with non-obstructive azoospermia in Avesina Infertility
clinic, Tehran, Iran, during 2006. Semi-quantitative nested reverse transcriptase PCR was performed in order to find the strength
of gene expression. We also evaluated the expression stage of TSGA10 during spermatogenesis using the Johnsen’s method for
histopathological scoring of all samples. Results: Testicular expression of TSGA10 mRNA was observed in 31/84 (36.9%) patients.
The expression level correlated with the degree of spermatogenic failure (p<0.0001). While it was expressed in patients with higher
Johnsen’s scores of spermatogenesis, a lack of expression was seen in all of those with Johnsen’s score less than 4.5. Conclusion:
These data indicate that TSGA10 expression is expressed in testis and its expression is restricted to germ cells. Lack of TSGA10
expression is suspected to have negative correlation with spermatogenesis and male fertility. The gene expression in a specific level
of spermatogenesis can also help histopathological findings in detection of level of spermatogenesis.
P112
Perinatal outcome of twin pregnancies after assisted reproduction andspontaneous conception
N. Bogoje, L. Dragan, C. Ivanela
Medical Faculty, University of Kragujevac, Kragujevac, Kragujevac, Serbia
Objective: The retrospective study was conducted at Gynecologic-obstetric clinic of Medical faculty, Kragujevac, and its aim was
to compare perinatal outcomes of twin pregnancies achieved after in vitro ferilization (IVF) and artificial insemination (AI) on one
side,and twin pregnancies after IVF and AI demand greater care than twin pregnancies after spontaneous conceptions.
Design & Methods: Statistic evaluation of perinatal outcomes between a group of 67 twin pregnancies after assisted reproduction
(10 IVF and 57 AI) and a groupof 68 twin pregnancies after spontaneous conceptions delivered from january 2001 and january 2005.
The fallowing parameters were investigated: symptoms of imminent abortion and preterm delivery, bleeding during pregnancy,
preterm rupture of membranes, performed cerclages, and occurrence of pre-eclampsia and maternal gestational diabetes. We also
evaluated pathologic ultrasound findings (fetal growth irregularities and amniotic fluid amount) and analyzed the delivery methods,
delivery week, birthweight, Appgar score in newborns, differentiation of birthweight in sublings, and perinatal mortality.
Results: There was a significant difference in the method of delivery ending between the group of twin pregnancies after IVF and
AI and the group of twin pregnancies after spontaneous conceptions: there were more cesarean sections in thw group of the group
of IVF (100%) and AI (74%) than in the group with spontaneous conceptions (45%). Besides, it is important to note the difference
in cerclage frequency between the studied groups. Amnong the twin pregnacies after IVF, cerclages were performed in all cases
(100%) and in 35 (61%) of AI cases, and 25 (37%) women from the group of twin pregnancies after spontaneous conceptions had
cerclages performed. All ceclages, in bouth studied groups, were performed between 16 and 20 weeks of gestation. Therefore, there
were no differences in gestational age at the time of cerclage. Mean Appgar score was 8/9 in IVF/AI group and 7/8 in spontaneous
conception group.
Conclusion: The retrospective analysis of pregnancies and deliveries and neonatal outcomes found a difference in mode of pregnacy anding. Besides, Appgar score was greater in the group of IVF and AI in comparison to the group of spontaneous conceptions.
Key words: in vitro fertilization, artifitial insemination, twin pregnancy
P113
The influences of different concentrations of glucose and pyruvate on in vitro development of mouse preimplantation embryos in medium with glutamine
Ki-Hwan Lee, Sung-Kyong Son, Min-Ah Lee, Young-Bok Koh, Kil-Chun Kang
Chungnam National University Hospital, Daejeon, Korea
Introduction: The purpose of this study was to examine the effects on in vitro development of early preimplantation mouse embryos
in DMEM medium with glutamine which was controlled by different concentrations of glucose and pyruvate.
Metheds: Four hundred and nineteen mouse 2-cell embryos were cultured in four different concentrations of glucose and pyruvate
in DMEM with (DMEM-GGP) or without (DMEM-G) glucose and pyruvate for 96 hours. The DMEM-G was used for control group.
Group Ⅰ was cultured in three volume of DMEM-G and one volume of DMEM-GGP, and group Ⅱ was cultured in same volume of
DMEM-G and DMEM-GGP, and group Ⅲ was cultured in DMEM-GGP.
Results: At 24 hours, the development into ≥ 3-cell was significantly higher (p<0.05) in group Ⅰ (93.3%) than control (84.6%). The
development into ≥ 8-cell was significantly higher in group Ⅰ (73.1%) than control (44.2%), group Ⅱ (59.6%) and Ⅲ (45.8%), and also
group Ⅱ was significantly higher than control and group Ⅲ. At 48 hours, the development into ≥ morula was significantly higher in group
Ⅰ (90.4%) and Ⅱ (86.5%) than control (73.0%). However, the development into blastocyst, in group Ⅲ (15.0%) was significantly lower
than control, group Ⅰ and Ⅱ. At 72 hours, the development into ≥ expanded blastocyst was significantly higher in group Ⅰ (69.2%)
than group Ⅲ (47.7%), and total blastocyst was significantly higher in group Ⅰ (80.8%) than control (66.3%) and group Ⅲ (67.3%). At
96 hours, the development into ≥ hatching blastocyst was significantly higher in group Ⅰ (78.8%) than control (61.5%) and group Ⅲ
(57.9%), and also, total blastocyst was significantly higher in group Ⅰ (85.6%) than control (69.2%) and group Ⅲ (72.0%).
Discussion: The cleavage rate of early preimplantation mouse embryos cultured in three volume of DMEM without glucose and pyruvate and one volume of DMEM with glucose and pyruvate showed higher than other groups during entire culture period.
P114
Testicular expression of NYD-SP5 mRNA in patients with non-obstructive azoospermia
M. Aarabi1, H. Soltanghoraee2, N. Amirjannati2, M. Reza Sadeghi1, H. Sadri Ardekani3, M. Akhondi4
1 Reproductive Biotechnology Research Center, Avesina Research Institute, Tehran, Iran, 2 Avesina Infertility Clinic, Avesina Research Institute, Tehran, Iran, 3 Monoclonal Antibody Research Center, Avesina Research Institute, Tehran, Iran, 4 Department of
Medical Genetics, Tehran University of Medical Science, Tehran, Iran
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Introduction: It is becoming clear that a significant proportion of azoospermia is associated with problems in expression of testis
specific genes. NYD-SP5 gene, located on Chromosome 15 q22, has been discovered recently and is speculated to be involved in
spermatogenesis. It is observed that NYD-SP5 mRNA is expressed only in seminiferous tubules.Methods: We investigated NYDSP5 mRNA expression in testicular samples of 87 patients with non-obstructive azoospermia in Avesina Infertility clinic, Tehran,
Iran during 2006. Semi-quantitative nested reverse transcriptase PCR was performed to find the strength of gene expression. We
also evaluated the expression stage of NYD-SP5 during spermatogenesis using the Johnsen’s histopathological scoring. Results:
Testicular NYD-SP5 mRNA expression was observed in all patients including hypospermatogenesis, maturation arrest and Sertoli
Cell-only Syndrome. The strength of mRNA expression correlated with the degree of spermatogenic failure and Johnsen’s scores
(p<0.0001). While high expression was observed in patients with higher Johnsen’s scores, it was weakly expressed in patients with
lower scores. Conclusion: These data indicate that NYD-SP5 mRNA is expressed in human testis. Expression in patients with Sertoli
Cell-only Syndrome and lower Johnsen’s scores is probably explained by very high level of the expression in germ cells, that is observed even in a few number of germ cells in biopsy samples. In addition, NYD-SP5 could be a Sertoli cell specific gene. Therefore,
production of monoclonal antibody and immunohistochemistry is suggested for further investigations.
P115
Y a-t-il une correlation entre la morphologie ovocytaire et le taux de fecondation, la qualite embryonnaire et le taux de grossesse ?
A. Zhioua, O. Kilani, B. Zouari, F. Zhioua, A. Amouri
Hôpital Aziza Othmana Tunis– Dept De Gynécologie Et Biologie De La Reproduction, Tunis, Tunisia
Le but de cette étude prospective est d’évaluer, dans le cadre d’un programme d’ICSI, l’influence d’une dysmorphie ovocytaire sur
le taux de fécondation, la qualité des embryons obtenus et sur le taux de grossesse.
L’étude a porté sur 1618 ovocytes matures ponctionnés chez 320 femmes devant subir une ICSI pour stérilité d’origine masculine.
Après décoronisation des ovocyte ; nous avons analysé : l’aspect du cytoplasme, du globule polaire, de l’espace périvitellin et de
la zone pellucide. Le lendemain de la microinjection, nous avons calculé le taux de fécondation et évalué la qualité des embryons
à j2 et à j3.
Résultats : Sur les 1618 ovocytes matures ponctionnés, 34 (2,2%) n’avaient aucune anomalie morphologique et 1584 (97,8%)
présentaient au moins une dysmorphie. Les anomalies du cytoplasme prédominaient (95,6%), suivies par celles de l’espace périvitellin (51,4%) ; les dysmorphies du globule polaire occupaient 19,9% et celles de la zone pellucide 5,4%. Le taux de fécondation
ainsi que la qualité des embryons à j2 et à j3 ne sont pas influencés par les dysmorphies ovocytaires sauf en cas d’anomalies du
globule polaire, nous avons noté une baisse significative du taux de fécondation (45,8% vs 34,8%).
Sur les 320 transferts, nous avons obtenu 56 grossesses soit un taux de 21,21%. Les embryons dérivant d’ovocytes sans aucune
anomalie morphologique (correspondant à 14 transferts) ont abouti à un taux de grossesse de 14,28%. Ceux dérivant d’ovocytes
ayant une anomalie cytoplasmique isolée (81 transferts) ont abouti à un taux de grossesse de 13,58%.
Les 90 transferts correspondant à des embryons provenant d’ovocytes comportant à la fois une anomalie cytoplasmique et une
anomalie du globule polaire, ou une association d’une anomalie cytoplasmique et d’une anomalie de l’espace périvitellin n’ont
donné lieu qu’à 10% de taux de grossesse. Chez 31 patientes, tous les embryons transférés provenaient d’ovocytes comportant
plus de 2 anomalies morphologiques. Dans ce dernier groupe, le taux de grossesse avait chuté à 3,22%.
Conclusion : Seule la dysmorphie du globule polaire semble agir significativement sur le taux de fécondation. La qualité des embryons n’est pas influencée par les anomalies morphologiques ovocytaires. Le taux de grossesse diminue en présence de 2 anomalies
dans la morphologie des ovocytes et devient très faible s’il y a plus de 2 anomalies.
P116
Effects of cysteamine on in vitro maturation of mouse oocytes (ivm) in two media
P. Pasbakhsh1, A. Mohammadi Roushandeh2, M. Hosein Noori Mooghahi3, M. Abdolvahhabi1, M. Akbari1, M. Ali Shokrgozar1, A.
Sobhani1
1 Department of Anatomy/School of medicine/Medical sciences/Tehran university, Tehran, Iran 2 Department of Anatomy/School of
medicine/Tabriz university of Medical school, Tabriz, Iran 3 university of khoramshahr, Khoramshahr, Iran
Introduction:Low rate of in vitro maturation of oocytes is one of the challenges of assisted reproductive techniques. A suboptimal
environment for maturation in vitro is one of the many factors that could account for the low IVM rates. In this study we investigated
effects of supplementation of different dose of cysteamine on in vitro maturation of oocytes in two different media.
Method: Germinal vesicle oocytes were collected from immature mouse ovary. Germinal vesicle oocytes were cultured in two media
(TCM199 and MEME) with 0, 50, 100, 200, 500 µM/ml cysteamine. Number of germinal vesicle breakdown (GVBD) and metaphase
II (MII) oocytes were recorded 4 and 12 hours after culture respectively. Result:The results showed that, rate of IVM in 100 µM cysteamine was high significantly compare to control groups in two media (p<0.05). Comparsion of two media showed that TCM199
improved rate of IVM and oocyte maturation better than MEME, however this difference was not significant.
Conclusion: These findings indicated that presence of cysteamine in culture medium can affect the rate of maturation of oocyte.
Key word: In vitro maturation of oocyte, Cysteamine, Glutathione, MEME, TCM199
P117
Increased Sperm ubiquitination correlate with abnormal chromatin integrity
M. Hodjat, M. Reza Sadeghi, M. Ahmad Akhondi, M. Mobaraki
Avesina Research Institute, Tehran, Iran, Islamic Republic of
Introduction: Ubiquitin, an 8.5kDa peptide that marks other proteins for proteasomal degradation, tags defective sperm during epididymal passage. Thus sperm ubiquitination seems to be a universal marker for sperm defects. It is not known how such spermatozoa are recognized by epididymal ubiquitination pathway and whether there is a selection against certain type of sperm defects. In
127
order to find the main trigger for sperm ubiquitination, the present study examined the relationships between sperm ubiquitination,
sperm chromatin integrity and clinical sperm parameters.
Methods: Semen samples from 63 couples attending Avesina infertility clinic, were collected and analyzed according to WHO
criteria. Each sample was evaluated for sperm surface ubiquitination, by direct immunofluorescence method using FITC-labeled
anti-ubiquitin antibodies. Chromatin integrity of the same semen samples were analyzed using Acridine orange and Toluidin blue
staining test.
Results: Based on the clinical sperm analysis, subjects were divided in to following five groups; Normozoospermia(N),Teratozoospe
rmia(T),Asthenozoospermia(A),Asthenoteratozoospermia(AT),Oligoasthenoteratozoospermia(OAT). The percentage of ubiquitinated
sperm in the respective groups was 10.9±7 (OAT), 2.7±2 (T), 4.08±4 (AT), 5.8±5 (A) and 2.7±2 (N). There was a positive and significant
correlation between ubiquitinated sperm and the percentage of sperm with abnormal chromatin (AO: r = 0.58, p= 0.000 and TB: r
=0.48, p=0.000). Negative correlations were obtained between sperm ubiquitination and: sperm count (r = -0.2, p=0.048), sperm
concentration (r = - 0.33, p= 0.007), sperm morphology (r = - 0.36, p= 0.003), rapidly progressive motility (a) (r = - 0.25, p= 0.044)
and slow progressive motility (b) (r = -0.28, p=0.022). Also sperm ubiquitination positively correlated to the percentage of immotile
sperm (r= -0.38, p= 0.002).
Discussion: A positive correlation obtained between sperm ubiquitination and sperm chromatin integrity suggests that ubiquitin-dependent sperm quality control has the ability to detect sperm with abnormal chromatin integrity and targeting such Ubiquitin-labeled
sperm for epididimal degradation. However in some cases increased sperm ubiquitination was not accompanied by an increased
abnormality of sperm chromatin. A possible explanation may be the fact that, DNA integrity is not the only signal, targeting sperms
for ubiquitination.
P118
A study on relation between time of clomiphene citrate administration and pregnancy rate in patients with unexplainable
infertility
Z. Rezaei, F. Akbari asbagh, T. Mir Boolook, A. Ghaseminejad, O. Azmoodeh
Tehran University of Medical Sciences, Tehran, Tehran, Iran, Islamic Republic of
Introduction: there are many methods for treatment of patients with unexplained infertility. The easiest method is induction of ovulation and the most commonly used drug for induction of ovulation is clomiphene citrate.
Objective: this study was carried out to compare the efficacy of different methods of clomiphene citrate administration for induction
of ovulation.
Materials and methods: this is a randomized clinical trial performed on 60 cases with unexplained infertility in Mirza Koochak Khan
Hospital of Tehran from Sep. 23, 2001 to March 20, 2003.
Patients were divided into three groups with 20 cases in each group. All three groups were treated with clomiphene citrate 100 mg/d.
In group A, 100 mg of clomiphene citrate was given for the first 5 days of the cycle and in group B on days 3-7 and in group C on
days 5-9.
Results: the results showed no significant differences in age, parity, duration of infertility, weight or endometrial pattern in three
groups.
The mean follicle number in group A was 2±0.85, in group B 2.25±0.9 and in group C 1.1±0.8. There was significant difference between three groups. We observed 2 pregnant cases in group A, 4 in group B, and 1 in group C.
No differences in the mean serum progesterone levels in mid-luteal phase were detected between the three groups.
Conclusion: considering the results obtained, it appears that administration of clomiphene citrate on days 3-7 exert the best impact
on the follicle number and pregnancy rate.
P119
Experience of screening for cytogenetic abnormalities in infertile Tunisian men in the era of ICSI
N. Ounaies - Boutrif1, N. Bouayed- Abdelmoula1, O. Kilani1, I. El Kamel1, H. Guermani1, F. Zhioua1, A. Zhioua2, A. Amouri1
1 Laboratoire de Cytogénétique,Institut Pasteur, Tunis, Tunisia, 2 Département de Gynécologie Obstétrique, Unité de PMA, Hopital
Aziza Othmana, Tunis, Tunisia, 3 Département d’Histologie Embryologie, Faculté de Médecine, Sfax, Tunisia
Introduction. Children born after intracytoplasmic sperm injection (ICSI) performed for male factor infertility seem at increased risk
of congenital malformations and chromosome aberrations. These anomalies seem to be related to the underlying spermatogenic
damage of the father, that frequently is caused by genetic alterations. Methods. Chromosomal analysis of 350 infertile men candidates for ICSI was performed during the last 4 years in our laboratory. All patients underwent evaluation, consisting of a complete
history, semen analysis, hormone testing, and karyotype from peripheral blood lymphocytes using RHG, C banding, fluorescent in
situ hybridization (FISH). All men with chromosomal abnormality were referred for genetic counseling.
Results. A total of 33 chromosomal aberrations were diagnosed, corresponding to a frequency of 9,6%. They were in most cases
alterations of the sex chromosomes. Numerical sex chromosome abnormalities were more frequent than structural chromosomal
rearrangements.
Discussion. Genetic alterations represent a major cause of severe spermatogenic impairment leading to male infertility. The risk of
transmission of chromosomal and genetic diseases by ICSI is therefore very high. Genetic tests and counselling are highly recommended in men candidates for in vitro fertilisation techniques, to avoid transmission, persistence, or even an increase of genetic
defects in future generations.
P120
Management of tuboperitoneal factor infertility by laparoscopic surgery
L. Tasic, M. Vasiljevic, Ž. Perisic
Gynecology and Obstetric Clinic Narodni Front, Belgrade, Serbia
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Objective: To determine does laparoscopic surgery offers better results in comparison with classical laparotomy tehnics in menagement of tuboperitoneal factor infertility.
Design: Prospective observational study.
Methods: 200 patients aged up to 38 years were operated because of the presens of tuboperitoneal factor infertility diagnosed by
laparoscopy. First group of 100 patients who were operated by laparoscopy, consisted 23 patients with only tuboperitoneal adhesions withought tubal opstruction, 23 patients with partial tubal opstruction and 54 patients with hydrosalpinx under 30 mm.
Second group of 100 patient who were operated by classical laparotomy, consisted 25 patients with tuboperitoneal adhesions withought opstruction, 30 patients with partial opstruction and 45 patients with hydrosalpinx under 30 mm.
Operative tehnics used in both groups of patients were adhesiolysis, fimbrioplasty and salpingoneostomy with adhesiolysis.
Results: In first group of patients operated by laparoscopy, the operation was of a shorter duration, hospitality stay and recovery
period were shorter and antibiotic and analgetic doses after operation were smaller. There were not any sirious complication. 32
patients (32%) became pregnant after 18 months.
In second group of patients operated by classical laparotomy two patients had some sirious complication. 21 patients (21%) became pregnant after 18 months.
Conclusion: Laparoscopic surgery offers better results in treating infertile patients with tuboperitoneal factor infertility in comparison
with classical laparotomy.
P121
Non invasive procedures of the management of infertility in women with polycystic ovary syndrome
L. Canelas, M. Estrela, D. Vaz, A. Vicente, P. Rocha, É. Fernandes
Department of Gynecology and Obstetrics, Santarém Hospital, Santarém, Portugal
Polycyctic ovary syndrome (POCS) is the most common endocrinopathy among women of reproductive age, accounting for 75%
of anovulatory infertility.
Successful non-pharmacological and pharmacological treatment of infertility in these patients can be extremely rewarding to patients and physicians alike.
The authors present a retrospective analysis in a two years period, from January 2005 to December 2006, of the management of
infertility in women with POCS with non invasive procedures (lifestyle modification, clomiphene citrate, metformin, gonadotrophin
treatment). The main purpose of this study is to evaluate the successfully and failure of this management.
P122
Cytogenetic abnormalities related to male infertility
N. Abdelmoula1, F. Bouzid2, D. Sallemi2, A. Amouri3, M. Meddeb1, A. Belhadj2, A. Ammous2, M. Trifa2, M. Kammoun2, H. Midassi2, L. Mokaddem2, H. Khmiri1, T. Rebai1
1 University of Medicine, Sfax, Tunisia, 2 Private sector, Sfax, Tunisia, 3 Pasteur Institute, Tunis, Tunisia, 4 Private Sector, Tunis, Tunisia
To assess the frequency of chromosomal aberrations in reduced male fertility, three hundred and seventy one males with nonobstructive oligozoospermia (n=200), azoospermia (n=140) or teratospermia (n=31) were included in this study. Peripheral blood
cultures were set up according to standard protocols and 15 RHG banded metaphases were analyzed in each case. A total of
forty three aberrant karyotypes was diagnosed, corresponding to an abnormality frequency of 11.6% (43/371). The following frequencies of abnormalities according to spermatogenetic impairment were observed: 21.4% (30/140) for azoospermic men, 5.5%
(11/200) for oligozoospermic men and 6.4% (2/31) for teratospermic men. Among the azoospermic group of patients, sex chromosome abnormalities were predominant, 76.6% (27/30): 47,XXY (n = 23), 46,XX (n = 1), 47,XYY (n = 2) and idic(Y) (n = 1). There was
three other autosomal abnormalities: trob(14;21) (n = 1) and trob(13;14) (n = 2). For oligospermic men, reciprocal translocations
were the major abnormalities, 45,5% (5/11): trcp(4,9)(p15.3;p21), trcp(11;22)(q24;q11), trcp(16;22)(q13;q12), trcp(2;3)(p24;q26) and
trcp(11;21)(q13;p11). Robertsonian translocations were found in 3 cases: trob(14;21) (n = 1) and trob(13;14) (n = 2). One patient has
a mosaicism for numerical sex chromosome: 46,XY[16]/47,XXY[14] and two patients have cytogenetically Y deletion. Finally, a familial trcp(1;18)(p21,q12) was detected for two men who have a teratospermia. Chromosomal abnormalities related to male infertility
need to be considered particularly before ICSI attempts.
P123
Apport de la cytogénétique dans l’exploration de l’infertilité féminine
A. Amouri1, O. Kilani1, O. Kacem1, N Abdelmoula2, F Zhiwa3, A Zhiwa3
1 Institut Pasteur, Tunis, Tunisia, 2 Faculté de Médecine, Sfax, Tunisia, 3 Unité de PMA Aziza Othmana, Tunis, Tunisia
Selon l’OMS 10 à 15 % environ des couples en âge de procréer consultent pour infertilité. Les étiologies de l’infertilité féminine
peuvent être regroupées en quatre catégories principales: anomalies ovulatoires ou hormonales, anomalies génétiques, anomalies
anatomiques et autres causes inexpliquées (idiopathiques).
Dans ce travail, nous rapportons une étude rétrospective portant sur 146 patientes explorées dans le cadre dune infertilité féminine,
colligées sur une période de 4 ans et pour les quelles le caryotype a été réalisé dans le laboratoire d’Histologie et de Cytogénétique
de l’Institut Pasteur de Tunis.
Des anomalies chromosomiques ont été retrouvées chez environ 9% des cas (n =15).
Ces anomalies chromosomiques correspondent des dysgonosomies, touchant le chromosome X avec un cas de triple X (47,XXX/
46,XX), un Syndrome de Turner en mosaïque dans 6 cas et un iso chromosome pour le bras long de l’X chez une patiente.
A coté des anomalies des chromosomes sexuels, des anomalies de structure autosomiques ont été décelées chez 5 de nos patientes. Il s’agissait d’une translocation robertsonienne et de 4 translocations réciproques apparemment équilibrées.
Nous nous proposons de préciser à travers cette étude, la prévalence et la nature des anomalies chromosomiques au cours de
l’infertilité féminine et en fonction des indications et des tableaux cliniques évocateurs.
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Nous comparons nos résultats avec ceux de la littérature afin de montrer l’intérêt de l’étude cytogénétique dans une meilleure prise
en charge thérapeutique de ces infertilté féminines.
P124
Cytogenetic abnormalities in couples with recurrent spontaneous abortion
A. Amouri1, N. Ounais1, N Abdelmoula2, F. Zhiwa3, A. Zhiwa3
1 Pasteur Institute, Tunis, Tunisia, 2 university of Medicine, Sfax, Tunisia, 3 PMA unity Aziza Othmana, Tunis, Tunisia
Recurrent spontaneous abortion is defined as the occurrence of two or more consecutive foetal losses. Recurrent spontaneous
abortions concern 1 to 2% of couples wishing pregnancy. Couples suffering from recurrent spontaneous abortions are at increased
risk of either of the partners carrying a structural chromosome abnormality. The incidence of carrier status increases from approximately 0.7% in the general population to 2.2% after one miscarriage, 4.8% after two miscarriages, and 5.2% after three miscarriages.
If one of the partners carries a structural chromosome abnormality, products of conception can have a normal karyotype, the same
balanced karyotype as the carrier parent, or an unbalanced karyotype. The last of these can lead to miscarriage, stillbirth, or the birth
of a child with major congenital impairments. Prenatal diagnosis is therefore offere to carrier couples in subsequent pregnancies.
The paper presents the results of cytogenetic investigations in 116 couples referred to us for chromosomal analysis and genetic
counselling because of at least 2 spontaneous abortions. 15 chromosomal abnormalities were detected for 4% of males and 8% of
females. Chromosomal translocations predominate with frequency of 53%. The other abnormalities were various types of X aneuploidy mosaicism and inversions.
Theses results will be discussed and compared with those of literature.
Other - Autres
P125
Détection des facteurs des risques potentiels avec le lipometer, un appareil patenté de mesure du tissu adipeux sous-cutané
A. Giuliani1, R. Horejsi2, R. Moeller2, E. Tafeit2, H. Mangge2
1 Service de Gynécologie – Obstétrique, Université de Médecine, Graz, Austria, 2 Institut de Chimie, Université de Médecine, Graz,
Austria
Objectifs: une série de travaux de recherche démontrent le lien entre l’obésité et une tendance morbide ainsi que la réduction de
l’espérance de vie. La répartition du tissu adipeux sous-cutané joue un rôle particulièrement décisif dans l’apparition des maladies
cardio-vasculaires et le diabète de type II. Par l’intermédiaire de méthodes de mesure diverses, il est possible de mesurer la répartition individuelle du tissu adipeux.
Méthodes : Le Lipometer est un nouveau système patenté (Europ Patenté N° EP 0516251) de mesure non invasif du tissu adipeux
sous-cutané. La mesure est d’une haute précision comme il a pu l’être confirmé par l’intermédiaire de la tomographie. Ce nouveau
système est exempt de rayonnements et la mesure est rapide et absolument indolore. La détermination de l’épaisseur du tissu
adipeux sous-cutané est réalisée à 15 endroits du corps différents et pré- définis. Un programme informatisé calcule la répartition
exacte du tissu adipeux et celle-ci est comparée à celle de la population normale. Jusqu’à présent, ces mesures ont été réalisées
chez plus de 20.000 participants, population saine et patients confondus.
Résultats : Les mesures montrent que des personnes ayant une taille et un Body-Mass-Index identiques peuvent néanmoins
présenter une répartition différente du tissu adipeux sous-cutané déterminant un risque corrélatif en ce qui concerne les maladies
cardio-vasculaires.
Des exemples typiques sont le syndrome polycystique des ovaires ou le diabète de type II qui montrent une répartition du tissu
adipeux stéréotypique, caractérisée par une augmentation de la quantité du tissue adipeux dans la région abdominale.
Conclusions : Cette nouvelle méthode de mesure du tissu adipeux sous-cutané par l’intermédiaire du Lipometer permet une détermination rapide du profil adipeux. Grâce à elle il est possible d’identifier les personnes présentant un profil anormal et grâce à une
intervention d’aide adéquate comme par exemple un changement du style de vie et l’administration de soins médicaux de prévenir
l’évolution vers les conséquences à long terme ou du moins de les retarder.
P126
Postoperative analgesia following intrathecal hyperbaric levobupivacaine and clonidine after caesarean section
I. Touroundous1, N. Vasilas2, M. Tagara2, K. Kosmas1, X. Maxairiotis1
1 Department of Gynaecology, Thriassion General Hospital, Attiki, Greece, 2 Department of Anaesthesiology, Thriassion General
Hospital, Attiki, Greece
Background: We investigate in spinal anaesthesia for Caesarean section, the effect of the addition of clonidine to hyperbaric levobupivacaine plus fentanyl on postoperative consumption of morphine.
Methods:52 women received spinal anaesthesia using a 25-gauge pencil point needle.
The group (A), 26 patients, received 10mg hyperbaric levobupivacaine , 15y fentanyl and 30 μy clonidine. The group (B), 26 patients,
received 10mg hyperbaric levobupivacaine plus 15y fentanyl. Total morphine consumption during 24h after surgery, duration of
postoperative analgesia, cardiovascular effects, were compared between the groups.
Results: Total morphine consumption was similar in both groups. The mean time of first analgesic request in group A was 143min
compared with 68min in group B.
In group A 13 patients (50%) had a complete motor block 60min after surgery compared with 2 patients in group B. Not detected
side effects of clonidine.
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Conclusions: The addition of clonidine does not reduce the postoperative morphine consumption during the first 24h but prolongs
spinal anaesthesia.
References: 1) Filos KS, Goudas L, Patroni O, Polyzou V. Anaesth. 1992,77:267-74.
2)I.Van Tuijl, W,Klei, V.Merf, C.Kalkman. BJA 2006 97:365-70.
P127
The relationship between Candida & Lactobacilli flora in vaginal smears using methenamine silver staining method
A. Moghaddam, P. Rajabi
Isfahan University of Medical Sciences, Isfahan, Iran, Islamic Republic of
Background : The aim of this study is to determine whether there is a relationship between the presence of Lactobacilli and the
growth of Candida.
Material and methods : For this purpose, 3762 vaginal smears were examined cytologically in Al-Zahra hospital of Isfahan from 2001
to 2006 and 242 patients were diagnosed as having Candida (64.33 per 1000), among them 215 satisfactory smears of patients who
were normally menstruating were subsequently selected for evaluation. The originally Papanicolaou – stained smears were stained
with Methenamine silver method. The relationship between the type of Lactobacillus flora and the presence of Candida was determined. The mean maturation index was also determined. Statistical analysis was performed with chi 2 test using SPSS package
programme.
Result : One hundred and ninety-four patients (90.2%) showed Lactobacillus flora. The frequency of different type of Lactobacillus
flora included:Lactobacillus overgrowth;18 cases(9.3%), Lactobacillus flora;;163 cases(84%),Mixed;13 cases(6.7%).
There was also a significant correlation between the presence of Lactobacilli and the growth of Candida (p < 0.001). The most prevalent maturation index,was belonged to intermediate cells.
Conclusion : We can suggest that In silver stained slides, there is a relationship between the type of vaginal microbial flora and the
presence of Candida. The specific roles of estrogen and progesterone hormones in Candidial infections are not clear.
Key words: Candidia , Lactobacillus flora,Vaginal smears,Methenamine silver
P128
Randomized double blind placebo controlled trial of outpatient cervical ripening with isosorbidemononitrate (imn) prior to
induction of labour
Parisa Moghtadaei
Iran University of Medical Sciences, Tehran, Iran
Objective: our aim was to examine the efficasy ,safety of imn for cervical ripening and labour induction.
Study design: two hundred and fourty pregnant women of at least 41 week”s gestation with bishop score <5 were selected,double,
blind, randomly to receive vaginally either 60 mg imn or placebo.
Result: fifty-four percent who treated with imn went to active phase of labour compared to therty-one percent in placebo group(p<0.01).
Mean interval to active phase of labour had statisial difference between two groups(p<0.01).Ninty-eight women in study group had
vaginal delivery compared eighty-two women in placebo group.Headacke was the common side effect with moderate intensity in
imn group. Conclusion: outpatient cervical ripening and labour induction with imn seems to be an effective ,safe, and well tolerated
procedure.Although some of women experienced side effect, no serious clinical maternal or fetal adverse effect were diagnosed.
The definitive clinical efficasy and saftey needs to be elevated in larger series of patients.
Key words: cervical ripening - induction of labour - isosorbide mononitrate
P129
Investigation of relative factors women waist circumference
M. Taebi1, M. Noroozi2, Zam zam Paknahad3
1 Kashan medical Science university, Kashan, Iran, 2 Isfahan medical Science university, Isfahan, Iran, 3 Isfahan Medical Science
university, Isfahan, Iran
Introduction: Evaluating body fat distribution is done through various methods.
Today a close consideration is given to Waist Circumference (WC) assessment in order to evaluate physical health in epidemiological
studies. Waist Circumference depends on various environmental factors. Identifying these factors can be used in health programs
to promote women health. The present research was aimed at determining relative factors in WC in women.
Methods: This research is a cross – sectional one. The samples included 740 women in Isfahan who were selected through cluster
sampling and were invited to 10 health centres. In this research data were collected through questionnaire and standard meter.
Test-re-test was employed to determine the questionnaire reliability and content validity was used to determine its validity. Descriptive and analytical statistics (Pearson correlation coefficient, Independent student t-test and one way ANOVA) were used for data
analysis.
Results: The results showed that there was a significant relationship between age
(p<0.001), occupation (p=0.046), education degree (p<0.001), first delivery age (p=0.001), the number of pregnancy (p<0.001), parity
(p<0.001) and consuming oral contraceptive pills (LD) with WC (p=0.009).
Discussion: This study demonstrated that various factors are related to Waist Circumference. Therefore by controlling these factors
we can prevent the abnormal body fat distribution as well as the related dangers in women.
Key Word: Fat Distribution, Waist Circumference.
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P130
Estimation of fetal weight by symphsio fundal height measurement
Nahid Sarafraz, Mahbubeh Kafaei, Azam Bagheri
University of Medical Science, Kashan, Iran
Background: Among the neonatal health indexes, weight is the best one indicating the rate of neonatal survival and future developrnent and growth. Moreover, birth weight is significant for determining the societies health status.
One of the main intervention at the time of admission for delivery is estimation of fetal weight. The association of uterine height with
birth weight has been investigated in this study in accordance with the geographical status of considered region. This method can
be used as a criterion for estimating birth weight.
Materials and methods : The current study was carried out descriptively on 384 full term , normal, singletone parturients with the
head presentation of a fetus, intact amnion , and emptied bladder. The weight and height of studied women was less than 90 kg
and more than 150 cm; respectively. The needed criteria were obtained by conducting interview , direct observation and by using
tape measure and scale.
Results : There was a direct and significant correlation between birth weight and uterine height. The following equation was obtained
from drawing the regression line of these variables.
Birth weight = 12.82 + (95.67×height of uterine) for obtaining more definite estimation of birth weight and also given that some factors such as mother’s weight, age and the gravity were correlated with the weight of a fetus.
Various equations were given to determine the rate of their role in this regard.
Conclusion : considering the height of uterine and its measuring can be a simple and inexpensive method for predicting birth
weight.
Keyword: uterine height, fetus weight
P131
Study on frequency of postpartum fever clinical sign in referral to shabihkhani gynecology hospital during 2000-2003
M. Kafaei Atrian, Z. Tabasi
1 Kashan Sciences University, Kashan, Iran
Background: Concerning to prevalence of post partum fever and proposed contradictions and importance of subject and lack of
information for postpartum fever the research is done in the maternity hospital of shabihkhani in kashan during 2000-2003
Materials and methods: The research was done according to explanatory method and or the form of existing data. Then by reference
to archive of medical records affiliated to the department the information derived and inserted to questionnaire.
Results: 43 cases with postpartum fever detected during 2000-2003. in these cases 83.6% had and 16.4% hadn’t clinical signs. chill
had the highest frequency rate in clinical signs (44.2%) and then pain (16.3%) discharge (2.3%) were at subsequent frequencies.
Conclusion: The results showed that the frequency of postpartum fever was 0.3% and the highest frequency for clinical signs was
chill and subsequently pain and discharge. Key word: postpartum fever, puerperal fever, postpartum fever.
P132
Salting used to take care of the newborn. Sorranus and empirical medicine
S. Dimitrakopoulos, B. karmi, A. Bonas, P. Foteini, A. Sidiropoulou, S. Koliantzaki, M. Anastasopoulou, G. Allagiannis, N. Sidiropoulos
General Hospital of Pyrgos, Pyrgos, Greece
Aim: the comparison between sorranus of ephesus and the empirical’s opinions dealing with the health/sanitary habit of salting the
newborn.
Material-method: the research was functioned/performed/conducted through the study and the analysis of women a- b of sorranus
of ephesus as well as modern analysts of our folklore.
Results: salting the newborn, which is considered a primary care given to the newborn, is an old habit practiced/applied/implemented from skithes and greeks. After the sprinkle of the newborn with salt, the ligation of the umbilical cord followed. This was
done mainly because the salt contains antiseptic properties suitable for dermal diseases that threatened the newborn. Sorranus
of ephesus has done some research on the topic. He concerned salting to be necessary for the newbrorn’s care in order for the
crust formulated/formed by the blood’s viscosity in the newborn’s body and for the skin to brisken and get in the formation of the
exanthemas. He recommended fine-grained salt (flour) and salting of the entire body apart from the eyes and the mouth. He also
suggests the addition of honey, oil, barley water or mallow for reducing/constricting the causticity/acerbity of the salt. After salting
once, he suggests the wash of the newborn with water and the application of salt for the second time. Reports on salting can also
be found in oreivasius as well. Salting is found in greece used in the empirical medicine until the beginnings of the 20th century.
After delivery, the midwife salts the baby and gives it to the parents. It is applied for the reasons mentioned above and, as folklore
says, not for the baby to be “tasteless” when s/he grows up. Folklore associates the adjective “salty” from doris with the habit of
salting/adding salt.
Conclusion: it appears that this habit was maintained and affected the folk medicine almost until our days.
P133
Analysis of the use of episiotomy in instrumental deliveries
D. Marín, A.F. Lumsden, I. Juarez
Hospital de Fuenlabrada, Fuenlabrada, Madrid, Spain
Introduction : Different systematic revisions have shown that there is no evidence to support routine use of episiotomy to reduce
perineal morbidity. With respect to instrumental delivery, Cochrane systematic review concludes that vacuum extraction instead of
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forceps delivery reduces maternal morbidity, although it may increase the risk of neonatal morbidity.
Use of episiotomy in instrumental delivery may be associated with increased pelvic floor injury and perineal tears. Vacuum extraction is related to fewer episiotomies.
Design and methods : Retrospective correlational design. 2568 deliveries from January 2006 to May 2007 in a Spanish hospital.
2061 (80.26%) spontaneous deliveries and 507 (19.74%) instrumental deliveries. 1709 deliveries without episiotomy (66.55%) and
859 deliveries with episiotomy (33.45%) Of the 507 instrumental deliveries, 415 with episiotomy (81.5%), 92 without episiotomy
(18.15%).
Results : A significant relationship was found between the mode of delivery and use of episiotomy (Chi-Square 664.87, p=0.000)
A significant difference was found between nulliparous and multiparous women in relation to the use episiotomy with instrumental
deliveries (Chi-Square 4.66, p=0.031). There were no differences with respect to perineal complications between nulliparous or multiparous women with instrumental delivery in the immediate puerperium.
Discussion : Further research is needed to investigate the use of routine episiotomy in instrumental delivery. Reducing episiotomy
rates would help diminish perineal morbidity in women. It is important, in order to reduce perineal injuries, to choose the most appropriate instrumental delivery technique.
P134
Experimental models to induce standardised adhaesions in the rat
M. Wallwiener, T. Konrad Rajab, C. Wallwiener, C. Brochhausen, D. Wallwiener, B. Kraemer
University of Tuebingen, Tuebingen, Germany
Introduction : Easily reproducable animal models are pivotal for research into the pathogenesis and prophylaxis of post-operative
adhaesions. Here we compare and contrast four different models to induce standardised peritoneal adhesions in the rat.
Methods :
Model 1: Bipolar electrocautery (40-60W) of a standardised area of the parietal peritoneum and/or visceral peritoneum
Model 2: Monopolar electrocautery (50W) as for model 1.
The peritoneal defects in models 1 and 2 were either closed with 5 interrupted 3-0 vicryl sutures or left open.
Model 3: Peritoneal traumatisation using a cyto-brush
Model 4: Peritoneal traumatisation by punch-biopsy (8mm)
Tissue preparation for histomorphological analysis was performed according to a standardised method. In tissue samples without
adhesions representative areas of the peritoneum were analysed. In those samples with detectable adhesions, areas of maximal
adhesion formation with the transition zone to the normal peritoneum were analysed.
Results :
Model 1 with closure of the peritoneal defect caused objectively and quantitatively scorable adhesions in all animals. Histologically,
samples from this model were characterised by a rich vascularized connective tissue and moderate acute unspecific inflammation
without foreign body reaction. There were no significant differences between animals treated with different electrocautery. We observed weaker adhesions in models 3 and 4. These could be scored semi-quantitatively. Here, the histology showed florid unspecific
and fibrotic peritonitis, partially with abscesses in the submesothelial muscularis. Moreover, exact standardisation between different
surgeons was relatively difficult in model 3.
Conclusions
Model 1 is best suited to induce standardised adhesions and is therefore employed by our group for further analysis of post-operative adhesions and different adhesion barriers.
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accès à toutes les séances scientifiques
accès à l’exposition de l’industrie pharmaceutique européenne
accès à la visite du musée des Arts Premiers (mercredi 10 octobre) pour les 250 premiers enregistrés
accès à à la cérémonie d’ouverture et au concert de musique classique (mercredi 10
octobre)
accès à la réception d’accueil ‘wine and cheese’ (mercredi 10 octobre)
accès à la réception de clôture ‘wine and cheese’ (samedi 13 octobre)
un exemplaire du programme final incluant le livre des abstracts
un certificat de présence
les pauses café pendant toute la durée du Congrès
collation pendant les “Meet the Experts’ (inscription préalable obligatoire)
Pour les personnes accompagnantes à jour de leur inscription:
-
-
-
-
-
accès à l’exposition de l’industrie pharmaceutique européenne
accès à à la cérémonie d’ouverture, à la visite du musée des Arts Premiers (pour les 250
premiers enregistrés) et au concert de musique classique (mercredi 10 octobre)
accès à la réception d’accueil ‘wine and cheese’ (mercredi 10 octobre)
accès à la réception de clôture ‘wine and cheese’ (samedi 13 octobre)
les pauses café pendant toute la durée du Congrès
Pour les inscriptions prises par les laboratoires:
Les médecins participants doivent prendre en charge le coût du programme social = 50 EUR (15 EUR
pour leur participation au programme social du mercredi 10 octobre 2007 et 35 EUR pour la soirée
privée au Musée d’Orsay, vendredi 12 octobre 2007)
Inscriptions sur place
Droits d’inscription
Participant Membre de la Société Européenne de Gynécologie (SEG) Participant Non-membre de la Société Européenne de Gynécologie (SEG)
Interne des hôpitaux (joindre un justificatif)
Accompagnant(e)(s)
Soirée privée (vendredi, 12 octobre 2007)
450 €
550 €
200 €
150 €
35 €
Heures d’ouverture du comptoir d’enregistrement
Mercredi, 10 octobre
Jeudi, 11 octobre
Vendredi, 12 octobre
Samedi, 13 octobre
12:00 - 20:00
07:30 - 19:00
08:00 - 19:00
07:30 - 14:00
Badges
Vous devez être muni de ce badge à toute occasion durant le congrès. Les participants ne
peuvent rentrer dans les salles qu’après verification de leur badge.
135
Prizes
The Alice and Albert Netter Award, the best Free Communication Prize and the best Poster Prize will be validated
during the Closing Ceremony on Saturday, 13 October 2007 (12:40 - 13:30).
THE ALICE AND ALBERT NETTER AWARD
The Alice et Albert Netter Award of 10.000 EUR is awarded to a young scientific researcher, unique in the field of
gynecology. This researcher has been selected out of several European candidates.
Best free communication prize and best poster prize
The best Free Communication Prize and the best Poster Prize consists of an invitation (registration + travel + accommodation) for the 8th Congress of the European Society of Gynecology (8 – 11 octobre 2009, Rome, Italy).
The best Free Communication Prize is selected by the chairmen of the free communication sessions.
Certificate of attendance
A certificate of attendance will be available in your registration package which you can collect at the registration
desk.
Insurance
The organizing committee cannot accept any liability. Please check the validity of your own travel and personal
insurance. The congress organizers cannot accept liability for personal injuries sustained or loss of, or damage to
property belonging to congress delegates or their accompanying persons either during or as a result of the congress.
Preview room (Room 103)
Speakers are kindly invited to submit their slides - either on CD-rom or memory stick - at least 1 hour before their
presentation to the preview room (room 103) and before their session starts. Last minute preview facilities will be
available.
Exhibition (Room 8)
The organizers invite all participants to visit the congress exhibition in the Exhibition Hall. The exhibition
floor plan can be found at the end of this congress book.
Opening hours exhibition area
Wednesday, 10 October Thursday, 11 October Friday, 12 October
Saturday, 13 October
12:00 - 20:00
07:30 - 19:00
08:00 - 18:00
07:30 - 14:00
Translation
The official languages of the Congress are English and French. Simultaneous translation French-English
will be available in all plenary rooms.
Eating and drinking
Coffee/tea is served daily free of charge during the breaks mentioned in the programme.
Lunchboxes are included in the ‘Meet the experts sessions’.
136
Les prix
Le Prix Alice et Albert Netter, les prix pour la meilleure Communication Libre et pour le meilleur Poster seront
remis pendant la Cérémonie de clôture, le samedi, 13 Octobre 2007 (12:40 - 13:30).
LE PRIX ALICE ET ALBERT NETTER
Le PRIX Alice et Albert Netter de 10.000 EUR est remis à un jeune chercheur qui à soumis au Jury un
travail scientifique de très haut niveau et qui a été selectionné parmis plusieurs candidats Européens.
Le Prix de la meilleure Communication Libre et du meilleur Poster
Le Prix du meilleur Poster comprend une invitation (inscription + voyage + séjour) au 8ème Congrès de la Société
Européenne de Gynécologie (8-11 octobre 2009, Rome, Italie).
Le Prix de la meilleure Communication Libre comprend une invitation (inscription + voyage + séjour) au 8ème
Congrès de la Société Européenne de Gynécologie (8-11 octobre 2009, Rome, Italie)
Certificat de présence
Un certificat de présence est inclus dans votre enregistrement (comptoir d’enregistrement).
Assurance
Veuillez vérifier la validité de vos assurances personnelles et assurance-voyage. Les organisateurs du Congrès
ne peuvent être tenus responsables en cas d’accidents, de dommages ou de perte de biens acquis durant ou à
l’issue du Congrès soit par les délégués du Congrès soit par les personnes accompagnantes.
Salle de préprojection (Salle 103)
Veuillez remettre vos supports informatiques (CD-rom ou clé mémoire) à la salle de pré-projection au plus tard 1
heure avant le début de la séance d’atelier dans laquelle vous intervenez. Une personne prévue à cet effet vous
aidera à charger vos aides visuelles informatiques et en assurera la transmission dans les ateliers. Vous devrez
vous rendre dans votre salle au moins 10 minutes avant le début de la séance.
Exposition (Salle 8)
Les organisateurs invitent tous les participants à se rendre à l’exposition du Congrès dans le Hall des
Expositions. Le plan de l’etage des expositions se trouve à la fin de ce livre du congrès.
Heures d’ouverture de la salle d’exposition pharmaceutique
Mercredi, 10 octobre
Jeudi, 11 octobre
Vendredi, 12 octobre
Samedi, 13 octobre
12:00 - 20:00
07:30 - 19:00
08:00 - 18:00
07:30 - 14:00
Traduction
Les langues officielles du 7ème Congrès sont le Français et l’Anglais.
Il y aura une traduction simultanée Français-Anglais dans toutes les salles plénières.
Déjeuner et café
Café/thé vous seront servis gratuitement chaque jour durant les pauses mentionnées dans le programme. Les inscrits qui participent aux meet the experts sessions recevront une collation.
137
Local Information
Various means enable you to reach Paris Downtown
- By plane: There are many possibilities of joining Paris by train (RER), buses and coaches
from Paris - Charles de Gaulle or Paris - Orly. Note that the Air France coaches connecting
Paris - Orly to Paris arrive in Invalides Station, located 500 m from the Maison de la Chimie.
- By train: Paris railway stations are connected to the RER and subway networks, more practical with luggage than the network of buses.
- By car: Parking in the neighbourhoods of the Maison de la Chimie is difficult. There is
however a car park near from Invalides Square, approximately 500 m from the Maison de la
Chimie.
- Coaches: Many companies serve Paris, the terminus being the International road station of
Paris-Galliéni, connected to the subway (line 3, Galliéni stop).
To go to the Maison de la Chimie
The Maison de la Chimie is easily accessible:
- by the RER, line B (Invalides station)
- by the subway, lines 8 and 13 (Invalides station) and line 12, (Assemblée Nationale station)
- by bus, lines 63, 69, 83, 84, 93. The closest stops are on line 69 (“Esplanade des Invalides” or “Bourgogne”, in direction of the East). It is advised to buy a daily fixed price
Mobilis ticket or Paris Visite pass.
Accommodation / tours reservation secretariat
C.F.E. Express France SARL
58, avenue de Wagram
75017 Paris, France
T +33 1 47 31 16 54
F +33 1 47 31 32 27
[email protected]
www.cfe-express.com
138
Information locale
Maison de la Chimie
Différents moyens vous permettent d’accéder à Paris intra muros:
-
-
-
-
En avion: il existe de nombreuses possibilités de rejoindre Paris intra muros par train
(RER), autobus et cars depuis Paris - Charles de Gaulle ou Paris - Orly. Notez que les cars
Air France reliant Orly à Paris arrivent en Gare des Invalides, située à 500 m de la Maison
de la Chimie.
En train: les gares parisiennes sont connectées aux réseaux RER et métro plus pratiques
avec des bagages que le réseau d’autobus.
En voiture: le stationnement en surface aux alentours de la Maison de la Chimie est difficile. Il existe toutefois un parking au niveau de la place des Invalides, à environ 500 m de
la Maison de la Chimie.
Autocars: de nombreuses compagnies d’autocars desservent Paris, le terminus étant la
gare routière internationale de Paris-Galliéni reliée au métro (ligne 3, station Galliéni).
Se rendre à la Maison de la Chimie
La Maison de la Chimie est facilement accessible :
- par le RER, ligne B (station Invalides),
- par le métro, lignes 8 et 13 (station Invalides) et ligne 12, (station Assemblée Nationale),
- par autobus, lignes 63, 69, 83, 84, 93. Les arrêts les plus proches sont sur la ligne 69
(Esplanade des Invalides ou Bourgogne, en direction de l’Est).Il est conseillé d’acheter
un forfait journalier Mobilis ou Paris Visite pour la durée du congrès.
Réservations hôtelières
C.F.E. Express France SARL
58, avenue de Wagram
75017 Paris, France
T +33 1 47 31 16 54
F +33 1 47 31 32 27
[email protected]
www.cfe-express.com
139
FORMULAIRE D’ADHESION SEG POUR 2007
ESG MEMBERSHIP APPLICATION FORM FOR 2007
European Society of Gynecology / Société Européenne de Gynécologie
www.seg-web.org
Nom/Name: .................................................................................................
Prénom/Surname: .......................................................................................
Titre/Title: ....................................................................................................
Adresse/Address:.........................................................................................
Tel: ...............................................................................................................
Fax: . ............................................................................................................
E-mail: .........................................................................................................
Spécialité/Speciality: ...................................................................................
Hôpital/Hospital: .........................................................................................
Sujets d’intérêt/area of interest: ..................................................................
Sociétés savantes/society memberships: . .................................................
COTISATION/SUBSCRIPTION FEE: 80 euro
Paiement/payment:
- Par cheque bancaire joint établi à l’ordre de la Société Européenne de
Gynécologie / By enclosing a bankers draft payable to the European
Society of Gynecology
- Par carte de crédit / by credit card (VISA)
o N° . ................................................................................................
o Validité/Exp date: . ....................... (mois/année – month/year)
- Par transfert bancaire/by bank transfer
o Bank: Société Générale
o IBAN: FR76 30003 03450 00050655612 54
o BIC: SOGEFRPP
Date:
Signature:
Cette fiche doit être envoyée à / Please return this form to:
Docteur Anne Grimard, 35 avenue Ferdinand Buisson, 75016 Paris (France)
140
List of exhibitors - Liste des exposants
Stand nr 14. Stand nr 15. Stand nr 16. Stand nr 17. Stand nr 18. Stand nr 19. Stand nr 20. Stand nr 21. Stand nr 22. Stand nr 23. Stand nr 24. Stand nr 25. Stand nr 26/27. Stand nr 28. Stand nr 29. Stand nr 30. Stand nr 31. Stand nr 32. Stand nr 33. Stand nr 34. Stand nr 35. Pierre Fabre
Théramex
Pfizer International
Karl Storz
Organon France
Siemens Medical Solutions
Bayer Schering Pharma
Medgyn Products International
GlaxoSmithKline France
Codepharma (Wyeth)
Microsulis Medical Limited
Procter & Gamble Pharmaceuticals France
Grünenthal
ExelGyn
Richard Wolf
Lilly France
Conceptus
Novartis Pharma
Servier France
Sanofi Pasteur MSD
Wisepress Online Bookshop
141
The Congress Presidents and the Organizing Committee of the 7th Congress of the
European Society of Gynecology, acknowledge and recognize the valuable support of
the following companies who participate in realizing this Congress:
Les Présidents du Congrès et le Comité d’Organisation du 7ème Congrès de la Société Européenne de Gynécologie, remercient tout particulièrement les Laboratoires et
les Etablissements qui les ont aidés à réaliser ce Congrès:
AstraZeneca (F)
Bayer Santé Familiale (F)
Bayer Schering Pharma (F)
Boiron (F)
Codepharma (F)
Conceptus
Exelgyn (F)
Gedeon Richter (H)
GlaxoSmithKline (F)
Grünenthal (International)
Karl Storz (International)
Lilly (F)
Medgyn Products International
Microsulis Medical (International)
Novartis Pharma (F)
Organon (F)
Pfizer, section Cardio-Vasculaire (F)
Pfizer International, section Oncology - Oncologie
Pierre Fabre (F)
Procter and Gamble Pharmaceuticals (F)
Richard Wolf (International)
Sanofi Pasteur MSD (F)
Siemens Medical Solutions (International)
Servier (F)
Theramex - Merck (Monaco)
Wisepress Online Bookshop (International)
For your agenda
Les Journées Albert Netter
of the European Society of Gynecology
October 30 - November 1, 2008
Algarve (Portugal)
Organizer: Prof. Theresa de Almeida Santos
E-mail: [email protected]
8th Congress of the European Society of Gynecology
October 8 - 11, 2009
Roma (Italy)
Organizer: Prof. A. Genazzani
E-mail: [email protected]
Pour votre agenda
Les Journées Albert Netter de la
Société Européenne de Gynécologie
30 octobre – 1 novembre 2008
Algarve (Portugal)
Organisateur: Prof. Theresa de Almeida Santos
Courriel: [email protected]
8ème Congrès de la Société Européenne de Gynécologie
8 – 11 octobre 2009
Rome (Italy)
Organisateur: Prof. A. Genazzani
Courriel: [email protected]
Maison de la Chimie
2ème ETAGE
2nd FLOOR
Grand Amphithéâtre
101
1er ETAGE
1st FLOOR
Poster area
L’espace poster
Preview room
Salle de préprojection
Garden / Jardin
8
Exhibition area
Salle d’exposition
REZ DE
CHAUSSEE
GROUND
FLOOR
Registration area
L’espace d’enregistrement
Notes
Notes
30 µg ethinyl estradiol + 2 mg chlormadinone acetate
oral hormonal contraceptive
0.03 mg ethinyl estradiol
2 mg chlormadinone acetate
1 x 21 film-coated tablets for oral use
21 tablets per blister
The unique antiandrogenic progesterone derivative
• Benefit for skin and hair 1, 2, 3 • Stable weight 3
• Improvement of dysmenorrhoea symptoms 4
BELARA® - prescription-only. Composition: 1) active ingredients: one pack of BELARA contains 21 film-coated tablets each of 0.03 mg ethinyl estradiol and 2 mg chlormadinone
acetate. 2) Other ingredients: lactose monohydrate, macrogol 6000, magnesium stearate, maize starch, hypromellose, povidone K 30, propylene glycol, talc, titanium dioxide (E
171); red iron oxide (E 172). Indications: hormonal contraception. Contraindications: pregnancy; lactation only after careful consideration of the benefit/risk ratio; acute and
chronic progressive liver diseases; Dubin-Johnson syndrome; Rotor syndrome; disorders of biliary secretion; cholestasis, history of idiopathic jaundice and severe pruritus during
pregnancy; viral hepatitis until liver function values become normal; previous or existing liver tumours; previous or existing thrombo-embolic disorders and conditions that increase
susceptibility to these disorders; arterial hypertension requiring therapeutic intervention; severe diabetes (mellitus) with associated vascular abnormalities; sickle-cell anaemia; severe
disorders of lipid metabolism; diagnosed or suspected uterine or mammary hormone-dependent tumours (also after treatment); endometrial hyperplasia; history of gestational
herpes; otosclerosis with deterioration in previous pregnancies; severe obesity; migraine accompanied by sensory, perceptual and/or motorial disorders; undiagnosed genital
bleeding, hypersensitivity to one of the ingredients of BELARA. Reasons for immediate discontinuation: pregnancy; thrombophlebitis or thrombo-embolic manifestations;
scheduled surgery (six weeks beforehand); prolonged immobilisation (e.g. after accidents); first occurrence of migraine-like or increased frequency of unusually severe headache;
acute sensory deficits (visual, auditory disorders etc.), motorial disorders; severe upper abdominal complaints; hepatomegaly or signs of intraabdominal bleeding; pronounced rise
in blood pressure; jaundice; hepatitis; generalised pruritus; cholestasis; abnormal liver function tests; increase in epileptic seizures; first onset or recurrence of porphyria, acute
decompensation of diabetes mellitus. Conditions requiring special medical supervision: cardiac and renal diseases; migraine; epilepsy; asthma; history of phlebitis; marked
tendency to varicose veins; multiple sclerosis; Sydenham's chorea; tetany; diabetes mellitus and a tendency to this disorder; previous liver diseases; lipid metabolism disorders;
obesity; hypertension; endometriosis; mastopathy; otosclerosis; myomatous uterus. Adverse reactions: intracyclic bleeding; amenorrhoea; headache, also migraine-like; breast
tension; nausea, emesis; gastric symptoms; weight variations; depression; changes in libido; certain vaginal infections such as candidiasis; reduced tolerance to contact lenses;
chloasma; skin rash; erythema nodosum; upper abdominal complaints; possibly, abnormal laboratory tests; effect on mammary tissue (see Summary of Product Characteristics);
increased risk of venous and arterial thrombo-embolic diseases, this risk can be further increased by additional factors (smoking, hypertension, blood coagulation or lipid metabolism
disorders, obesity, varicose veins, history of phlebitis and thrombosis). Warnings: factors promoting thrombo-embolic events (e.g. varicose veins, history of phlebitis and thrombosis
and cardiac diseases, obesity, blood coagulation disorders) are to be carefully identified. Smokers taking hormonal contraceptives have an increased risk of developing sometimes
serious complications of vascular changes. The risk increases with age and rising cigarette consumption. Women over 30 years of age should therefore refrain from smoking if
they are taking hormonal contraceptives since there is an increased risk of developing sometimes serious complications of vascular changes. The occurrence of thrombo-embolic
diseases among relatives at an early age may indicate the presence of disorders of the coagulation system; in these cases the coagulation status should be determined. Women
over 40 years of age require special supervision. Interactions with other drugs: contraceptive effectiveness may be impaired by the simultaneous use of other drugs and
substances such as barbiturates, griseofulvin, phenylbutazone, anti-epileptics, activated charcoal, rifampicin and other antibiotics. Effects on some laboratory tests. Insulin or oral
antidiabetic requirements may be changed. The elimination of theophylline or caffeine is reduced, which increases and prolongs the action of these substances. Spotting has been
reported in women taking concomitantly preparations containing St-John's-Wort. Dosage: 1 tablet daily. For detailed information see Summary of Product Characteristics.
Grünenthal GmbH, 52099 Aachen, Germany, Date of information: April 2005
References
1. H.P. Zahradnik, J. Goldberg and J.-O. Andreas, “Efficacy and safety of the new antiandrogenic oral ontraceptive Belara“, Contraception, 1998, 57:103-109
2. I. Worret, H.P. Zahradnik, J.-O. Andreas, N. Binder, “Acne Resolution Rates: Results of a Single-Blind, Randomized, Controlled, Parallel Phase III Trial with EE/CMA (Belara) and EE/LNG (Microgynon)“,
Dermatology, 2001, 203: 38-44
3. G. Schramm, D. Steffens, “A 12-month evaluation of the CMA-containing oral contraceptive Belara: efficacy, tolerability and anti-androgenic properties“, Contraception, 2003, 67:305 -312
4. KUSS (Switch)-Study, Clinical report, Grünenthal GmbH, 2003 (accepted by 'Contraception' for publication)
Grünenthal GmbH - 52099 Aachen, Germany - www.grunenthal.com - www.belara.com
30 µg ethinyl estradiol + 2 mg chlormadinone acetate
oral hormonal contraceptive
Highly reliable
contraceptive pill with
chlormadinone acetate
The unique antiandrogenic
progesterone derivative
• Benefit for skin and hair 1, 2, 3
• Stable weight 3
• Improvement of
dysmenorrhoea symptoms 4

Congress book Livre du Congrès

Transcription

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