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Background American histoplasmosis is a mycosis caused by Histoplasma capsulatum. A variety of clinical features of histoplasmosis have been commonly described ranging from asymptomatic infections to severe pulmonary infections. In immunocompromised individuals, progressive disseminated forms are frequent, leading to fatal outcome if untreated. However, H. capsulatum sinusitis is unusual with a few cases documented over the last three decades and may be underdiagnosed or confused with other fungal aetiologies, especially outside endemic regions. Case presentation In this study, we report an atypical case of Histoplasma capsulatum sinus fungus ball-like in a patient with Acquired Immunodeficiency Syndrome due to Human Immunodeficiency Virus complicated by a disseminated histoplasmosis with a death ending. Diagnosis relied on CT-Scan imaging and on both direct examination of H. capsulatum yeast forms (Gomory methenamine Grocott) in the sinus specimen (aspirate, biopsy) and on positivity of the culture further confirmed by qPCR. Conclusions Since last few decades, among the eight reviewed patients, H. capsulatum sinusitis occurred mostly in HIV-immunocompromised patients and for three cases as a sinusitis with disseminated histoplasmosis. Even if this is a rare clinical presentation, its diagnosis is crucial as it could represent an early expression of an Histoplasma capsulatum exposure that can evolve into a disseminated fatal infection when immunity decreases.

International audience; From September 2013 to July 2014, several gold miners working in the tropical forest consulted the Maripasoula Health Center in French Guiana for edema and findings consistent with right cardiac failure. Of the 42 cases of beriberi that were diagnosed, one patient died. The laboratory and clinical investigation demonstrated vitamin B1 deficiency in most of the patients tested. Furthermore, 30 of 42 patients responded favorably to 500 mg of intravenous or intramuscular thiamine supplementation. In addition, dietary investigation showed insufficient thiamine intake in these patients. We concluded that patients had acquired beriberi because of diet restrictions, hard labor, and infectious diseases, notably malaria. In 2016, cases were still being reported. We recommend screening for compatible symptoms in gold miners, thiamine supplementation, and nutritional intervention

Every year, 20,000 mastectomy are realized. The most common complication of these surgical procedure is seroma, occurring in a range of 10 to 85% of the cases, which may be responsible for an increased morbidity by complications: disunity of surgical flap, infection, and delay in administrating adjuvant therapies.We focused on a post-mastectomy padding technique, aiming at decreasing incidence of postoperative seromas.We conducted a retrospective study of patients treated with mastectomy from January 2012 to March 2014 in Amiens University Hospital. Forty-two patients were included: 20 to the "padding's" group and 22 to the "control's" group.Drainage flow was significantly decreased at Day 1, Day 2, Day 3 and throughout hospitalization after padding (358.5mL versus 685mL; P=0.02). Hospital stays were significantly shortened by 2 days (5.3 versus 7.3 days; P0.05) for patients receiving padding surgery.Our results show a benefit in the mastectomy padding flap. However, the retrospective character of our study and its strength character imply bias and data not available such as complications in type of wound dehiscence, pain, necrosis, the period from the establishment of the adjuvant therapies and aesthetic evaluation of technique. As such, we initiated a prospective randomized multicenter study late 2013, named PRELYMCA, which should be able to answer the pending questions.

International audience; There are two ways of measuring the cell proliferation. The first one consists of quantifying the number of cycling cells with the help of antibodies directed against cells either in G1, S, G2 or M phase. The second way is to assess the cell cycle duration by the quantification of AgNOR proteins. Measuring both the features on the same slide represents an attractive way to tackle the proliferating activity of a cell culture or a tumor. Here, we propose a MIB-1 and AgNOR double staining method especially adapted to image cytometry measurement using MIB-1 antibody coupled to FITC in order to avoid the thresholding problems encountered with such a multilabeling technique. We have applied this new method on a series of 39 breast cancer cases, with at least 4 years follow-up, in order to determine the prognosis significance of this measurement. MIB-1 alone is not linked to prognosis, while the global mean AgNOR area is significantly linked to prognosis in terms of development of visceral metastasis or death. However, the global mean AgNOR area is insufficient to determine the time limit of appearance of metastasis or relapse. Our results clearly demonstrate that a high mean AgNOR area within a cell population having a high MIB-1 index can discern tumors with a high metastatic potential. By multiplying AgNOR area by the percentage of MIB-1 positive cells we calculate the proliferative activity, P, which brings very important information concerning the time limit of relapse.

Maternal splenic cyst during pregnancy seems to be a rare disease whose treatment is not codified. The most feared complication of these cysts is the rupture. In case of rupture, 60% of cases occur during the third trimester of pregnancy and result in a significant maternal and fetal morbidity and mortality. We examine the two main modes of treatment used nowadays: surgical splenectomy or radiological drainage.

We evaluated prospectively our protocol for screening diabetes during pregnancy.We applied recommendations of the French National College for Obstetricians and Gynecologists with screening by O'Sullivan's test and HGPO with 100g when the result was greater than 1.40 g/l. This protocol was discussed and approved by our team including a neonatalogist.We included 780 patients delivered between the 1(st) January and the 1(st) October 2005. Between them, 628 were screened (80.5%) and 39 presented gestational diabetes (39/628=6.2%). Fetal ultrasound at 38 weeks of amenorrhea was included in our protocol but applied only for 25.8% of our patients. In the subgroup with gestational diabetes, the rate of induction of labor was 38.4% (15/39), with a cesarean delivery for 23% (9/39) and macrosomia for 20.5% (8/39) of the newborn.This study showed us that we have to improve the application of our protocol and to try to obtain a shorter time between the two test, O'Sullivan and HGPO, when performed.

To evaluate our clinical practice for Group B streptococcus (GBS) screening during pregnancy and antibiotic therapy during delivery.We performed a retrospective evaluation of our SBS screening protocol, by vaginal swab, for a period of two years, including 1,674 asymptotic patients. Intra partum antibiotic prophylaxis was administrated for GBS-positive women.The rate of GBS carriage was 6.9%. Antibiotics were administrated for 79.3% patients with GBS-positive culture. Of these women only 39% had an interval greater than four hours between antibiotic injection and delivery. In the group of patients with positive GBS culture, no newborn was infected and only 5% were colonised. In the GBS-negative group with 1.3% of the newborns were GBS positive.We were surprised by our low rate of GBS carriage and the non optimal application of antibiotics during labor. We reviewed our results with all our team and a prospective evaluation has been initiated.

Trophoblastic diseases correspond to a very heterogeneous group of rare pathology in young women which fertility should be preserved.We conducted a retrospective study from 1997 to 2003, including all patients with molar pregnancy or trophoblatic tumor in our department of Obstetrics and Gynecology.Fifteen patients were identified with 9 molar pregnancies, 5 trophoblastic tumors and 1 placental tumor of implantation site. The outcome was favorable for 14, and one patient died from her metastatic disease. For 4 patients we asked our university colleague for the optimal approach.Management of molar pregnancies is well established. Persistent gestational disease is more rare and problematic with potential metastatic dissemination. Multidisciplinary care is often needed.Persistent gestational disease should be managed in a highly specialized centre, as developed in the Lyon University Hospital.

We report two cases of moderate maternal poisoning during the third trimester. They underwent hyperbaric oxygen therapy at 2.5 atmospheres for 90 minutes and were delivered at term. In one case the newborn presented an antenatal ischemic cerebral lesion probably due to monoxide poisoning. Pathophysiology and treatment of such accidents are discussed.

Cryptococcosis and alternariosis are rare opportunistic infections often observed in immunocompromised patients. Because Cryptococcus and Alternaria are ubiquitous fungi found in soil, the presence of fungi in the dermis has to be observed on histological examination to confirm a real cutaneous, invasive, infection.We report the first case of concomitant cutaneous cryptococcosis and cutaneous alternariosis, in an immunocompromised patient treated for a metastatic thymoma.This observation underlines the fact that the possible co-existence of several rare infections in immunocompromised patients should take into consideration pathogen identification in order to adapt the therapy to individual patient requirements.

Female genital mutilation (FGM) is considered as the most dangerous custom still ritually practiced and 2 million girls undergo the ordeal each year. This practice is anchored and fixed firmly in numerous African people's culture and Western countries are confronted to it through African immigrants. In order to understand the justifications and the consequences of FGM we interviewed 14 genitally mutilated African women living in France. Unfortunately and despite the conscious knowledge of consequences and absurd side of such practice, yet it seems to be perpetuated over the descendants. Educational approach is the best solution to fight female genital mutilation fixed firmly in numerous African people's culture.

Amniotic fluid leakage and premature rupture of membranes following amniocentesis is uncommon.We reviewed the literature. Thirteen recent studies including 17 186 amniocenteses and 280 cases of amniotic fluid leakage were analyzed.Risk increases when early amniocentesis is performed prior to 15 weeks gestation and when the needle is inserted far from the placenta. Significant loss of amniotic fluid compromises pregnancy. Conservative management with bed rest seems to give good results. When amniotic leakage persists for more than two weeks, there is little spontaneous resolution. The risk of pursuing the pregnancy should be discussed with the couple in this case. Risks include respiratory disorders, skeletal malformations and premature birth.New techniques such as 'amniopatch' may play an important role in the near future.

To determine if the presence of cells having a DNA content5c and occurring at very low frequency is related to breast cancer outcome.Feulgen-stained imprints of fresh tumors used for routine standard DNA image cytometry were reanalyzed, with the aim of detecting hyperploid (5c) cells or minor stemlines. Specially adapted software was used.The new DNA analysis showed discordance of 47.3% with standard DNA cytometry. Minor stemline or rarely occurring 5c exceeding cells were found. These were not detected by the first DNA analysis. The presence of both DNA hyperploid cells occurring as rare events and a DNA hyperploid stemline was related to outcome.The detection of DNA hyperploid cells, even in very small numbers, appears essential to outcome, particularly in diploid or single DNA aneuploid breast cancers.

This communication aims at illustrating ultrasound diagnostic difficulties in early pregnancy with acardiac fetus. Our case concerns a spontaneously conceived triplet pregnancy. It was diagnosed as a twin pregnancy at 11 weeks of amenorrhea. One and a half months later the patient was referred to our center for spontaneous premature rupture of membranes with the diagnosis of a fetal demise in a triplet pregnancy. The definite diagnosis of acardia was assessed sonographically by the presence of a reverse blood flow through the umbilical cord, reflex movements, limbs anomalies and discordance between femoral and crown-rump length. Two days after admission, the patient developed chorioamnionitis and the three fetuses were expelled.

Delivery of viable fetus with a long interval delay is an unusual occurrence. There is no clear attitude among obstetricians for such cases. We report a case of retention of the second and the third triplet after the delivery of the first one at 24 weeks of amenorrhea and 3 days. The duration of the retention was 6 days. Only the third infant survived. We attempt to outline the difficulties in managing such pregnancies.

to evaluate the results of superovulation, protocol hMG-hCG, associated to IUI for treatment of infertility.this prospective study, includes 77 couples who underwent 204 consecutive cycles of homologous IUI. The same protocol was applied for all the couples. hMG was administrated from cycle days 2 to 5 (3 then 2 ampuls per day). Patients were monitored daily, by evaluation of serum oestradiol. Insemination was done 36 to 38 hours after hCG injection.2.6 cycles were done per couple. We observed 16.2% pregnancy per cycle. The best results were obtained in female indications, in the first cycle, with more than 500,000 spermatozoide and with a level of E2 between 500 and 1500 pg/ml. Multiple pregnancy was observed in 18.2%.controlled ovarian stimulation should be associated to all IUI.

To emphasize the importance of follow-up after birth of infants with an antenatal diagnosis of congenital toxoplasmosis.Retrospective study from July 1987 through January 31 1995 on 211 women (214 fetuses) who had undergone ovular biopsy for toxoplasmosis seroconversion during pregnancy.Antenatal diagnosis was positive in 13 patients (6.2%). Four pregnancies were terminated during the second trimester. Delivery was triggered at 37 weeks gestation in one woman and in 8 others pregnancy was continued with Fansidar. All infants were born live with infraclinic disease. Two fetal deaths related to biopsy technique occurred (0.95%) and one pregnancy was terminated before the results had been obtained. Only 21.3% of the patients were delivered in our unit. A total of 197 infants were delivered with a negative antenatal diagnosis: 93 were healthy, 5 had congenital toxoplasmosis, 1 died at 3 months and 98 had no or incomplete follow-up.Incomplete post-natal follow-up is in contradiction with the excellent performance of antenatal diagnosis of congenital toxoplasmosis. Greater care is needed, especially since now only an amniocentisis is required to detect the parasite genome with polymerase chain reaction.

We report a case of inflammatory tuberculosis of the breast in a 83-year-old French Caucasian woman. She presented with a diffuse inflammatory tuberculosis of the breast and an axillary enlarged lymph node but no tumor was palpable in the breast. A carcinoma was firstly suspected. The diagnosis was accessed after repeat punction of a lymph node, as a Mycobacterium tuberculosis was identified after culture. A medical treatment was sufficient in our case.

Our aim is to evaluate the efficacity of intrauterine insemination in male infertility after controlled ovarian hyperstimulation. 96 cycles were carried out. 16 pregnancies were achieved, the pregnancy rate per cycle is 16.7% (43.3% per couple) and 12.5% ongoing pregnancies. Six cycles were proposed and the higher cumulative probability of pregnancy is obtained at the 4th cycle. The best pregnancy rate per cycle is obtained with 5.10(6) to 10.10(6) inseminated. The success rate is not associated with the number of sperm abnormalities in our study.

We report two cases of pregnancy in patients with Crohn's disease. For the first woman, non-exclusive ambulatory parenteral nutrition was given during the entire duration of gestation in a patient with short bowel syndrome, maintaining good nutritional status and normal delivery at term of an eutrophic infant; Crohn's disease relapsed one month post partum. In the second patient, Crohn's disease was less severe and remission occurred without treatment. Prophylactic cesarean was required due to multiple perineal scars resulting from surgical treatment of Crohn-related fistulae. The main problems with pregnancy in patients with Crohn's disease are discussed.

The authors report a case of pulmonary tuberculosis during pregnancy. They point out that the pregnancy does not change the natural course of the disease, congenital tuberculosis is rare but with a high rate of mortality, and the three most important antituberculosis (isoniazid, ethambutol and rifampicin) are safety during pregnancy.

Evaluate the frequency and discuss the mechanisms and the prognostic value of sonographic anomalies observed during the surveillance of seroconversion for toxoplasmosis during pregnancy.Cases of seroconversion during pregnancy were collected from 6 teams working with similar protocols. There were 2,168 seroconversions. We focused on ultrasound anomalies reported.Ultrasound anomalies were reported in 48 cases including the 168 fetuses with proven contamination (fetal blood or amniotic fluid sample), i.e. 2.2% (48 cases out of 2,168) of the seroconversions and 28% (48 cases out of 168) of the contaminated fetuses. There were multiple lesions in 44% of the cases. Brain calcifications had been found in utero in 44% of the newborns with such anomalies. No case of microcephalia was reported. Isolated hepatomegalia (4 cases) was not an indication for medical abortion. Isolated ascitis can regress after antiparasite treatment (2 cases). Medical abortions were performed in 51% of the cases (34 cases out of 66) on the basis of ultrasound findings.Ultrasound examination is reliable but can only detect late, constituted and often irreversible lesions. Nevertheless, this examination can help in deciding on medical abortion.

The authors report a case of pregnancy in a rudimentary horn diagnosed by laparotomy. The location could not be suspected by any clinical sign. This pregnancy stopped at 19 weeks of amenorrhoea. Any attempts of induction of labour failed. Laparotomy was necessary to assess the diagnosis and to allow the resection of the uterine horn. The authors present a review of literature.