[Comparison of breast cancers diagnosed in and outside the large scale mammography program of L'Ariana state in Tunisia]

To report the anatomoclinical comparison of BC issued from the large scale mammography program in Ariana state of Tunisia to those of the cases "classically" diagnosed in patients consulting for breast symptoms. This retrospective study was done between April 2004 and June 2007. We have included 58 women issued from the large scale mammographic program of the state of Ariana in Tunisia [Group I] and 100 symptomatic women who came to our patient clinic [Group 2]. We have compared epidemiological characters [age, delay of diagnosis...], tumoral size, histological sue and type, grade, hormonal receptors and therapeutic protocols. In the large scale mammographic program, BC are insitu carcinomas in 11.1% and invasive carcinomas in 88.9% of the cases. The mean age was 48 years old in the group I versus 46 years in group 2. In the first group, the mean clinical and histological tumoral size was 20mm and 22 mm versus 45mm and 36 mm for the group 2. The invasive canalar carcinoma was the most frequent histological type in both groups. The lymph nodes were negative in 58.1% of the cases in group I versus 34% in group 2.80% of the patients in group 2 had mastectomy versus 42.8% in the first one. The mortality was 10% in the screened women versus 6.8% in the other group2. The results of large scale mammographic BC program were favourable for the management of breast cancer in terms of clinical and histological tumoral size, number of positive nodes, number of mastectomies and the survival rates

[Satisfaction inquiry within women involved in the pilot program of large scale mammography in the Ariana state in Tunisia]

Evaluate the degree of satisfaction of women included in the large scale mammography program of breast cancer screening in the state of Ariana in Tunisia. Within the women explored by mammography, we have contaced 112 patients who had a positive screening requiring histological checking. We have established a questionnaire concerning: the invitation, the clinical examination, the result announcement and the therapeutic management. The average age of patients was 49 years. 64% had a primary education level. 80 women or 71.4% were satisfied with the process of screening and the method of announcement. The main cause of dissatisfaction for patients with cancer diagnosis was delay and difficult access to adjuvant treatments. Among patients who had histological diagnosis: 47.3% had a malignant disease [53 cases] against 37.5% of benign [42 cases]. 100% of patients who had a pathological result reassuring are satisfied at the end of the screening program. The psychosocial impact of screening must be considered for the development of new programs. The waiting and announcement of results are essential factors that allow us to judge the success of the project, because of patient satisfaction will depend the quality of monitoring and adherence to screening

[Fetal and maternal prognosis of breech presentation at term]

Introduction: Breech presentation is associated with increased fetal, neonatal and maternal risk. The purpose of this study was to assess the prognosis of this presentation near or at term

Patients and methods: This retrospective study included all deliveries with a breech presentation and a gestational age over 34 weeks in our service between January 2000 and December 2005

Results: 243 deliveries were indexed throughout the study period.141 patients delivered by prelabor planned cesarean section and 47 by cesarean section during labor. 2 cord prolapses were found [0.8%]. 8 babies [3,3%] had a 5 minute Apgar scores < 7 and we observed 5 admissions to the neonatal unit. There were 2 birth trauma and 2 perinatal deaths

Conclusion: Breech delivery is a risk for mother and newborns. Development of measures and standards for obstetric practice would help improve its prognosis

Usefulness of colposcopy in inflammatory vagin frottis

The cervical cancer is the second most frequent cancer of the woman in Tunisia. It is considered as a sexual transmissive desease due to the involvement of the HPV. The purpose of our study is to proove that an inflammatory cervical smear should be considered as a positive test and must lead to other investigations. It is a prospective study over 140 cases of inflammatory cervical smears [without atypical cells] diagnosed during a year period from June 2001 to June 2002. These patients had a systematic colposcopy with the biopsy of suspicious lesions. The mean age of our patients is 42 years. 68.57% of them are in active genital period. The colposcopy was normal in 10% of our patients. It showed benign lesions such as: ectropion in 22.85%, colpitis in 14.28%, cervical polypus in 5%, normal transformation zone in 8.57%, but also suspicious lesions such as: atypical transformations grade I [ATGI] in 25.71% and atypical transformations grade II [ATGII] in 13.57%. The biopsies made on 89 patients showed dysplasia and carcinoma in 18.57% of them. A case of in situ carcinoma, a microinvasif epidermoid carcinoma and an invasif glandular carcinoma were diagnosed. Colposcopy is an ambulatory investigation. It makes a minutious study of the cervix and diminishes the rate of false negative made by the cervical smear

[Pregnancy and fetal autcomes in macrosomic delivery about 400 cases]

Fetal macrosomy represents a materno-fetal high-risk pathology in front of which obstetricians face diagnostic, therapeutic and prognostic problems. We report a retrospective analytical study of 400 deliveries of macrosomes brought together in the gynaecology and obstetrics C departement of the maternity center of Tunis over a period of 4 years from 1997 till 2001. The aim of our study is to stress on the materno-fetal risk factors of macrosomy. The frequency the macrosomy was of 7, 11%. The average maternal age was of 30, 9 years. Pathologies associated with pregnancy were dominated by gestational diabetes in 19% of cases and by toxemia in 17% of cases. The antecedents of big baby were noted in 23% of cases. Screening of macrosomy was based on excessive uterine height [>35 cm] found in 43 % of cases and near term ultrasounds, which suspected macrosomy in 21, 8% of the cases. Delivery was made naturally in 68 % of the cases, with instrumental help in 5, 25% of cases and by cesarian section in 32% of cases. The mean weight of macrosomes was of 4233g. Maternal complications were dominated by delivery hemorrage in 2% of cases and obstetrical trauma in 2, 75% of the cases. Fetal complications were dominated by shoulder dystocia in 2, 25% of the cases, respiratory distress 2, 75% of cases and hypoglycemia in 2% of the cases

[Inaugural diabetic acido-ketosis during pregnancy]

Ketoacidosic decompensation is still an important cause of morbidity, and mortality in diabetic patients. This complication may inaugurate the disease and its occurrence in pregnancy is a medical and obstetrical emergency that puts both mother's and foetus' life at risk. We report two cases of inaugural ketoacidosis in patients 27 and 14 years old, at 36 and 25 weeks of amenorrhea [WA]. With reanimation and insulinotherapy, evolution was favorable with a cesarean section delivrery at 36WA+3d and 35WA+3d of healthy children who weighed 2900g and 1970g. Persistance of high glucose values in postpartum required continuance of insulinotherapy for one patient and oral antidiabetic agents for the second

[Hormonal contraception with depo-provera about 930 cases]

In this study, D‚po-Prov‚ra [R] was evaluated in 930 women. It is a retrospective longitudinal bicentric study: We revealed the following The average age is 30,8 years. 66,6% the women have between 1 and 3 children. The nulliparous represent 17%. In 84,3%, it is the first used contraceptive method. The first injection was done in the post abortion in 65,3% of the cases. Pearl index is 0,46. Thus, the efficacy level is 99,54%. Amenorrhea is the most frequent trouble; its incidence within a year is 52,3%. It the first cause of abandon. The other troubles of the cycle disappear within 12 months. The acceptability is 34,8% year women