Analyse des stratégies thérapeutiques dans la maladie de Behçet (étude retrospective monocentrique de 98 patients)

La maladie de Behçet est une vascularite qui expose à des complications sévères. Nous avons mené une étude rétrospective pour décrire les patients atteints de la maladie de Behçet satisfaisant les critères ICBD 2013 et les stratégies thérapeutiques qui leur sont proposées. L'étude a inclus 98 patients suivis entre 2000 et 2012 au CHU de Montpellier. Il s'agissait de 56 hommes et 42 femmes sex ratio 1,33. L'âge moyen est de 42,3 ans. L'âge moyen des premières manifestations était de 22.6 ans et le retard diagnostic moyen était de 10,2 ans. L' origine des patients était à 50% européenne. Les principales manifestations étaient : aphtose orale 100%, aphtose génitale 67,3%. uvéite 68,4% (surtout postérieure ou totale 78%, cécité 13%), atteinte articulaire 59,2%, neurologiques 58,2% dont 27 patients (51 ,9%) avec atteintes psychiatriques, vasculaire 34%, digestive 33%. cardiaque 7,1 %, testiculaire 23% des hommes et pulmonaire 4,1%. Une prédominance masculine était trouvée pour l'atteinte ophtalmologique (OR à 2,43) et féminine pour l'atteinte articulaire (OR à 0,33). Les traitements sont décrits ainsi que leur tolérance. Vingt et un patients ont été traités par anti-TNF a Les anti-TNF a ont permis de baisser significativement le seuil de cortico-dépendance des patients réfractaires au moins 1 autre immunosuppresseur et de diminuer le nombre de poussées de la maladie. Sous anti-TNF a. l'acuité visuelle augmentait significativement (p=0.001). Dans la discussion, le protil clinique de notre série est comparé à ceux de la littérature. Les données thérapeutiques actuellement publiées sont présentées. La place des anti-TNF a dans le schéma thérapeutique est discutéeMONTPELLIER-BU Médecine UPM (341722108) / SudocMONTPELLIER-BU Médecine (341722104) / SudocSudocFranceF

Ovarian torsion in a twin pregnancy at 32 weeks and 6 days: A case-report

BACKGROUND: Ovarian torsion during pregnancy is a rare event and occurs mostly during the first trimester. This is the first case describing the diagnosis and management of an ovarian torsion at 33 weeks in a twin pregnancy with a normal term delivery. CASE SUMMARY: The patient presented with irregular uterine contraction due to an acute abdominal pain in the right iliac fossa. A cyst was discovered during the ultrasound scan on the right ovary and a torsion was highly suspected. A small laparotomy facing the ovarian mass after an ultrasound guidance was chosen. The patient finally delivered at 37 weeks. CONCLUSION: The clinic holds a preponderant place in the diagnosis of ovarian torsion. Our surgical approach by laparotomy under ultrasound guidance was less risky than by laparoscopy

Comparison of Oral Dydrogesterone with a Micronized Vaginal Progesterone in Fresh Embryo Transfer in IVF ± ICSI

Abstract Introduction: Luteal insufficiency corresponds to a progesterone deficiency affecting women who receive treatment for in vitro fertilization (IVF). Different routes of progesterone administration exist and have varying degrees of acceptability to patients. The aim of this study was to compare two luteal phase support (LPS) treatments: oral dydrogesterone versus micronized vaginal progesterone on the clinical pregnancy rates after fresh embryo transfert. Material and Methods: This study was a retrospective, monocentric and observational study carried out in the reproductive medicine department at the University Hospital, Femme Mère Enfant in Lyon. 580 consecutive women between 18 and 43 years old, who completed an IVF cycle with or without ICSI, followed by fresh embryo transfer on the second or third day after oocyte retrieval (D2 or D3) or at the blastocyst stage (D5 or D6) between July 2019 and July 2020 were included.Results: In the univariate analysis, the clinical pregnancy rate per transfer was comparable between the MVP and OD groups (29.7% and 27.6% respectively with p = 0.6460). In the multivariate analysis, OD also appeared to be associated with a similar pregnancy rate compared to MVP, with a non-significant difference (p &gt; 0.05) (OR [95% CI]): 0.922 [0.626; 1,358] with p = 0.6817. The use of OD compared to MVP did not significantly influence the clinical pregnancy rate in any age group (p &gt; 0.05) (OR [95% CI]): 0.954 [0.657; 1.386] with p = 0.8057. There was no significant difference between the two groups in the clinical pregnancy rate, whether the patients belonged to the reference population of the center or not (p &gt; 0.05) (OR [95% CI]): 2.367 [0.568; 3.568] with p &lt; 0.0001. Conclusion: This is the largest retrospective study comparing these two routes of progestogens in LPS during IVF and it reinforces the use of the oral form to improve patients’ comfort.</jats:p