[Female age - related fertility decline: Far from the myth of the "selfish working-girl" and the "right to have a child"]

OBJECTIVES

To study the social dimension of age-related female infertility through an analysis of three key themes: the personal life histories of infertile women over 40 years of age; representations of age and the desire to become pregnant after age 40; opinions of French legislations framing Assisted Reproductive Technologies, age limits, egg donation, and egg freezing for non-medical reasons.

METHODS

This qualitative sociological study was based on semi-structured interviews with infertile women over age 40 going through fertility treatments. The interviews contained three parts: personal and relationship histories; experiences related to age; opinions related to French legislation.

RESULTS

Twenty-three interviews were conducted; each lasting between 90 to 120minutes. Far from having similar life histories, the women interviewed had very different backgrounds leading to their desire for a pregnancy after 40 years of age. From the beginning of their fertility treatments, they perceived a "race against the clock". This feeling of urgency accompanied their experiences and was related to the desire to not be too old for their future child. The women interviewed were mainly in favor of loosening French bioethical laws in order to avoid the need to travel abroad to pursue fertility treatments.

CONCLUSION

The profiles studied attest to a growing gap between biological and biographical temporalities, as well as an inability of women to reduce their desire for a child. Faced with this disparity, egg donation and egg freezing were seen as practical solutions.

[Tomodensitometric semiology of Budd-Chiari syndromes]

Specific computed tomography findings in Budd-Chiari's syndromes are described, based on an analysis of images from five cases. Recognition of these signs assists diagnosis when little evidence of the disease exists or when atypical images are produced. The performance of an angioscan and the study of the changes on repeated imaging provides essential data for liver exploration: on the one hand these emphasize or even unmask the lesions (peripheral multi-lacunar images in the obstructed territory), and on the other hand they assess possible lesions of the inferior vena cava as well as lack of filling of the hepatic veins. Furthermore, they assist avoidance of the trap of pseudo-metastatic images by the particular kinetic of the attenuation of contrasts and the systematization of the lesions. The typical appearance of the liver in Budd-Chiari's syndromes probably results from the conjunction of histopathologic and hemodynamic modifications, notably localized inversions of portal flow and particular by-pass pathways. Computed tomography can be included in exploratory procedures as a non-invasive method capable of confirming the diagnosis of Budd-Chiari's syndrome and of orientating vascular explorations essential for pre-operative evaluation.

[Contribution of computed tomography to the exploration of aortic aneurysms (author's transl)]

A technique for exploring aortic aneurysms is described, and the results analysed in 50 cases (11 thoracic, 32 abdominal, 3 multiple, and 4 with both thoracic and abdominal aneurysms). The diagnostic value of this method appears evident for aneurysms in the thorax, and it can reduce the need for conventional radiological examinations. Results of examination of abdominal aneurysms were compared with those of ultrasonography and angiography. Angiography was more effective for studying collateral lesions, while ultrasonography is still a reliable, non-aggressive, low cost investigational procedure. Computed tomography, however, represents the most polyvalent, non-aggressive technique for evaluating the size of the aneurysm, its thrombotic components, and its extension to neighbouring organs.

[Diagnostic value of the CT scan in suppurative abdominal lesions (author's transl)]

Computed tomography, a relatively non-aggressive method of radiological investigation, can establish diagnosis, and, more particularly, define the site of suppurative lesions in the peritoneal cavity, the retroperitoneal space, and in solid organs (liver, kidneys, spleen). This method was employed to explore the abdomen in 52 patients. Intraperitoneal suppurations were diagnosed in 15 cases after demonstration of a low density mass, which may contain clear pockets of gas or be limited by a higher density wall. In 4 cases, a retroperitoneal lesion was detected (psoas or perinephric abscess). A parenchymatous abscess was present in 6 cases, 4 in the liver, one in the kidneys, and one in the spleen. Using the angioscan technique, after a bolus injection of an iodised contrast medium, improved definition of the limits of the abscess can be obtained. Differential diagnosis of intraperitoneal suppurative lesions in cases of developing haematomas, or in the presence of an intrahepatic abscess, which may be confused with necrotic metastases or post-traumatic ischaemic foci, may be difficult.

[Contribution of computed tomography to radiological investigation of the adrenals (author's transl)]

Computed tomography examinations of the liver, kidneys, and pancreas were conducted in 466 patients over a period of one year, and both adrenals were visualized in 94 p. cent of cases. The adrenals were investigated during examination of the posterior submediastinal space in certain types of cancer, and clinically silent adrenal metastases were demonstrated in 14 patients with bronchial or pancreatic cancer. When computed tomography is employed for specific investigation of the adrenals (22 cases), the technique varies (5 mm thick sections, "angioscan"), and results are comparable with those of early renal tomography, ultrasonography, and scintigraphy. Computed tomography provides clearer evidence of small tumors (less than 2 mm in diameter) and hyperplasia, and can provide images that are perfectly correlated with operative findings, but not always with the histology of the lesions. A method for exploring the adrenals radiologically, including the use of computed tomography, is proposed as a function of the biological nature and size of the tumors.

[Contribution of computed tomography to the diagnosis of benign tumors of the liver]

Computed tomography is a recently introduced, nonaggressive method of radiological investigation that can contribute to the study of hepatic tumors. Information obtained by using a third generation apparatus in six cases of benign hepatic tumor is reported, and compared with operative findings in five cases. The principal aspects, common to both ultrasonography and computed tomography examinations, are compared within the context of the pathological findings. Computed tomography is of value as a complementary investigation to reduce any possible insufficiency of ultrasonography examinations or to supply supplementary information during pre-operative tests.

[Computer tomography examination of the diaphragmatic pillars. Value during the study of the postero-inferior mediastinum (author's transl)]

The authors review the results of 100 computer tomography examinations of the normal thoraco-abdominal region and define the radiological anatomy of the posterior submediastinal space limited by the pillars of the diaphragm, which can almost always be investigated by computer tomography. Study of this posterior submediastinal space in 276 cases, by means of a strictly defined procedure, was used to illustrate the elementary signs encountered: effacement of the pillars, loose appearance of the pillars with absence of the median arcate ligament, presence of an abnormally sized structure in the middle of the space. The main indications for computer tomography examination of this region are for diagnosis of an opaque tumor of the postero-inferior mediastinum, and the investigation of extensions of bronchial cancers, regionally located neoplasms and lymphomas.

[The provoked hypercalciuria test. Significance and limitations]

The calcium tolerance test is of diagnostic importance only in osteomalacia, which it helps to identify before bone biopsy when the static phosphocalcic parameters are not a deciding factor. However, the test does not make it possible to distinguish an osteoporosis from a cortisone osteopathy or an idiopathic hypercalciuria. In the first two diseases, the rates of urinary calcium elimination are comparable to that of normal individuals. It seems that the rate of urinary elimination of I.V. administered calcium is, approximately, all the more elevated as the level of iPTH is low; and, when the level of iPTH is low, the osteoid tissue seems less calcified than normally.

[The role of early nephrotomography in renal insufficiency (author's transl)]

The use of early nephrotomography has added a supplementary functional dimension to intravenous urography films, made after the rapid injection of 60 ml of contrast media in the form of an embolus. This method enables the corticomedullary junction to be visualized in the nephrography, which is an important point in differential diagnosis. An analysis is made of the results obtained from early nephrotomographies in 50 patients with acute or chronic renal insufficiency. Satisfactory nephrographies were obtained in all cases and the position and size of the kidneys could be established. Certain nephrotomographic abnormalities appear more frequently during the course of some types of chronic nephropathies, and this can assist aetiological classification. The existence of dilated secretory cavities in the superior part of the kidney can be established very quickly. In this way it is possible to differentiate clearly between parenchymatous nephropathies and those due to obstruction, such as when oliguria or anuria is present. The presence of a persistent homogenous nephrography would evoke, under these same conditions, an acute medical nephropathy.