[Traumatic lesions of the pregnant uterus and its contents: medico-legal aspects]

Pregnant women are not free of the risk of trauma and any abnormality of pregnancy or the child is easily attributed to an accident occurring during the preceding days, weeks or ... months. This study reviews the traumatic complication of pregnancy and methods which can be used to attribute pathological events to the accident deemed responsible. Particularly stressed is the essential need for a meticulous and accurate approach when drafting the initial certificate, the only document available to an expert medical witness called upon to assist the judicial process in case of litigation.

[Doctor Pascal Rougon. An imaginary predecessor]

Through the Rougon-Macquart series and the cases described in the last volume (Le Docteur Pascal, 1893), clinical analysis of the 58 characters identifies only seven neurotics and six alcoholics (only three of whom were Rougon-Macquart by birth). All the other illness described are unrelated to hysteria in the family. It remains true, however, that Zola's interpretation of hereditary degeneracy follows that of contemporary medical teaching, as witnessed by the genealogics published by Charcot in 1893. Through the voice of Dr. Pascal, however, Zola does challenge the concepts of heredity advanced by his medical advisors: he envisages the concepts of dominance and recessiveness without devising any general scheme for the transmission of hereditary characteristics, but eight years before Vries he advanced the idea of mutations, which he interprets as accidents occurring at the beginning of the ovum's development. When faced by the lack of success of his opotherapy of degenerative diseases, Pascal initiates trials versus a placebo and puts forward a highly coherent theory of what we would now call the placebo effect. It appears, therefore, that contrary to the opinion of most commentators, Emile Zola was in fact capable of a remarkable subtleness when he ventured into medicine. Through Dr Pascal Rougon, and notwithstanding the mockery of Flaubert, Goncourt and France (and of many others), he was a brilliant trail-blazer in the fields of genetics and therapeutics. Six years later he was to strike again with Dr Boutan, who invented what we now know as the prophylactic care of mothers and children (Fécondité, 1898).

[Acute idiopathic dilatation of the right colon or Ogilvie's syndrome. Apropos of a case encountered after cesarean section]

The syndrome of acute colectasia of the right colon following a caesarean section is a rare disease observed and described for the first time by Ogilvie in 1948. Many etiopathological hypotheses have been formulated but recent studies demonstrate the role of the neuro-vegetative nervous system, causing the functional obstacle responsible for the idiopathic right colon dilatation. The clinical picture of low obstruction is seldom typical, as in our case; however, the abdominal X-Ray easily confirms the diagnosis, since the caecal distention may exceed 10 cm in diameter. Most of the time, the prognosis is favorable after aspiration via colonoscopy; caecal perforation is always the spontaneous outcome, due to the "vicious cycle" perpetuating the functional obstruction.

[Ecology of vaginal discharges]

If the word "opportunism" is recent, gynaecologists at the beginning of the century were already wondering all "vaginal saprophyte" hosts were able to become pathogens. An accurate knowledge of the cause disturbing the ecological balance, should prevent the progression of this opportunism, if, too often; people did not turn a deaf ear to medical advice.

[Vaginal cesarean sections]

Vaginal caesarean section, or Durhssen's procedure, is seldom performed in France. Although its indications are exceptional, it enables to rapidly deliver a small fetus minimal maternal trauma without compromising the future of the mother.

[Death in utero of a twin during the 2d and 3d trimester of pregnancy]

The study of a series of 9 cases of monofetal death during the last trimester of a twin pregnancy, permits to emphasize the relative frequency of this accident (7.14% in our series, markedly higher than those noted in the literature). An early diagnosis, essentially on ultrasonography, of monofetal death, enables monitoring of the mother and the surviving fetus for whom there is a non negligible risk. It is often necessary to deliver this fetus as soon as it is mature. Systematic and repeated clinical and ultrasonographic monitoring of any twin pregnancy during the third trimester ensures, in a large number of cases, prophylaxis of this accident.

[Can zinc deficiency in the mother be responsible for the occurrence of spina bifida aperta in the fetus?]

The occurrence in the fetus of closure defects of the neural tube and especially spina bifida aperta (SBA) has been related, by some authors, to nutritional deficiencies of the mother, in addition to well-known genetic factors: a folic acid deficiency and more recently a zinc deficiency have been evoked. The retrospective study of 23 couples mother/newborn selected from the presence of a SBA in the child, and 14 reference couples, shows that the mothers of children with SBA have a zinc blood level lower than that of the reference group; this result is confirmed by the alkaline phosphatases and zinc enzymes which are markedly decreased. Measurement of the incorporation of radioactive zinc in the skin fibroblasts shows, in case of SBA, in the mother, an increased incorporation rate, and in the newborn a decrease of that rate in relation to the reference group. We believe that the results of our study which confirm those from other authors, demonstrate that the administration of zinc during pregnancy is at least as important as the administration of folic acid to prevent recurrence of neurulation abnormalities.

[Efficacy and clinical and biological tolerability of the long-term administration of veralipride. Apropos of 74 cases]

Veralipride was given to 74 women with menopausal disorders. Clinical tolerance proved excellent and no abnormal variations were recorded in monitored biological parameters. Effectiveness is very satisfactory, all the more so that disorders are more specific and severe.

[Value and limits of estrioluria in cases of retarded fetal growth]

On the basis of personal experience of 56 cases of retarded intra-uterine growth (RIUG) followed during the course of pregnancy by means of repeated estriol determinations (213 values), the authors note that : In 2/3 of the cases the urinary estriol level was higher than the lower limit of normality. The urinary estriol levels were not related to the severity of the RIUG. The estriol level has a limited value in the diagnosis of RIUG. The authors emphasize the prognostic value of the curves of estrioluria in this pathology and propose a course of obstetrical management based on interpretation of the curves.