Clinical Characteristics and Management of Adnexal Torsion.

Adnexal torsion is a gynaecologic surgical emergency. Misdiagnosis or delay may lead to loss of the adnexa and may compromise fertility. Aim: To determine the most relevant findings for the diagnosis of adnexal torsion and the results of laparoscopic surgery. Methodology: A retrospective cohort study of 266 patients who underwent surgical treatment for adnexal torsion in our department from January 1994 to January 2014. Clinical, biological, ultasonographic, therapeutic and histological findings were analysed as well as risk factors and prognosis. Results: The mean age of patients was 33.1 years. Adnexal torsion occurred during pregnancy in 21 patients (7.8%). Abdominal pain was present in 91.7%, vomiting in 63.9% and fever in 19.1% of the cases. Ultrasonographic findings were: ovarian cysts (54.1%), complex mixed echogenicity masses (40.2%) and ovarian enlargement (5.6%). The pain-to-surgery interval varied from 4 hours to 26 hours. At surgery, the mean number of spiral turns was 2. Treatment was carried out by laparotomy in 87 patients (32.7%). The mean size of the adnexa treated by laparotomy was 10.7 cm. Laparoscopic surgery was performed in 137 patients (51.5%). The mean size of the adnexa treated by laparoscopy was 6.9 cm. Laparoscopic treatment was conservative in 77.3% of the cases. Conclusion: Adnexal torsion is a common gynaecologic emergency. Prompt diagnosis of adnexal torsion requires a combination of clinical, biological and sonographic investigation. The prognosis of adnexal torsion was potentially increased by the interval period before surgery. Laparoscopic treatment is the gold standard if possible.

[Medical treatment of endometriosis]

Prerequisites: Pathogenesis and pathophysiology of endometriosis, pharmacodynamics of oral contraceptives, progestagens, antiprogestagens, danazol, GnRh agonist and non-steroidal antiinflammatory

Purpose of review: The aim of this paper is to systematically review the literature evidence of medical treatments for endometriosis and to summarize recently published recommendations

Methods:Literature and recently published recommendations review via bibliographic research using Pubmed/Medline, Google scholar and Cochrane database

Results:Endometriosis is an estrogen-dependent gynecological disease. Medical treatement of endometriosis induce an estrogen deprivation situation. The Oral contraceptives reduce the rate of postoperative endometrioma recurrence and should be considered an essential part of long-term therapeutic strategies.New agents promise a distinct perspective in endometriosis treatment

Conclusions: The effectiveness of medical treatment is well established in the management pelvic pain and infertility associated with endometriosis and constitutes an important alternative or complement to surgery

[Medical treatment of ectopic pregnancy]

The ectopic pregnancy [EP] is a public health problem and its frequency has doubled in most industrialized countries in 20 years. To evaluate the effectiveness of medical treatment of ectopic pregnancy with methotrexate [MTX] intramuscularly [IM]. prospective study supported between October 2006 and December 2010. The selected patients received methotrexate IM [1 mg per kg]. The monitoring was based on: the kinetics of plasma HCG, clinical examination and ultrasound. A second injection was performed if hCG on day 4 was increased by more than 25% or J7> the initial rate. Healing corresponded to obtain a zero rate of HCG in a stable manner. We used the first-line medical treatment in 122 patients. The average age of patients was 31.94 years. A haematosalpinx was found in 87.70% of cases. The initial rate of HCG plasma varied between 40 lU/ml and 4088 IU / ml, with an average of 805.88 m IU / ml. The primary success rate obtained after a single injection of intramuscular MTX was 67%. The high success rate obtained after two injections of MTX was 27%. The overall success rate after 1 or 2 injections of MTX was 82%. 17 patients underwent surgical treatment after a first injection of methotrexate. 5 patients underwent surgery after receiving two doses of methotrexate. The period of normalization of plasma levels of h CG was 24 days on average, with extremes ranging from 4 to 43 days for 67 patients cured after a single injection of MTX. This period was 33 days on average, with extremes ranging from 8 to 62 days for patients healed after two injections of MTX. Medical treatment applied to 38% of ectopic pregnancies diagnosed in our department is effective in 82% of cases if the inclusion criteria are strictly adhered to. Successful treatment is limited by patient compliance and demanding nature of monitoring

[Post-menopausal bleeding. Comparison between ultrasonography, hysteroscopy and histology's results]

Post-menopausal bleeding are frequently found in gynaecological consultations and requires the search of an organic cause. To value the profit and the performances of the transvaginal ultrasonography and the hysteroscopy in the determination of the causes of post-menopausal bleeding. 80 patients presenting abnormal uterine bleeding in post menopause period have been explored in our department with transvaginal ultrasonography and hysteroscopy. The findings have been evaluated on the basis of specimens obtained from either endometrial biopsy, hysterectomy or operative hysteroscopy. We have calculated in our study the sensitivity, the specificity, the positive and negative predictive values of transvaginal ultrasonography and hysteroscopy. The sensitivity, the specificity, the positive and negative values predictive of the transvaginal ultrasonography is respectively 93, 75%, 87, 5%, 83, 3% and 95, 45%. In the other part, hysteroscopy seems more performant in the diagnosis of intrauterine abnormalities with the respective values: 100%, 95, 83%, 94, 11% and 100%. The initial investigation in front of all mennorhagic patients must be the transvaginal ultrasonography but we also need the hysteroscopy because its highly accurate means in the diagnosis of the causes of excessive uterine bleeding in post menopausal period

[Ultrasound diagnosis of ectopic pregnancy: prospective study about 200 cases]

The ectopic pregnancy is responsible for 10% of maternal mortality in the first quarter. Progress in transvaginal ultrasound; have revolutionized the diagnosis of ectopic pregnancy, allowing her diagnosis earlier. To evaluate the contribution of ultrasonography in the diagnosis of ectopic pregnancy. A prospective study about 200 patients hospitalized for ectopic pregnancy between July 2009 and July 2011. All patients underwent a transvaginal ultrasound. The average age was 25.4 years. The study of the endometrium showed an endometrial thickness of 10.1mm in 152 cases. An haematosalpinx was observed in 71% of cases. The average size was 30.5mm. Hemoperitoneum was observed in 64.5% of cases. An ectopic gestational sac with embryo was found in 9 cases [4.5%]. In 51 cases no pathological sonographic signs were noted. The transvaginal ultrasound is the method of choice in the diagnosis of ectopic pregnancy. However the use of BHCG is still necessary

[Correlation between vital signs and hemoperitoneum in ruptured ectopic pregnancy]

Ectopic pregnancy [EP] is a medical-surgical emergency. Rupture of an ectopic pregnancy is a serious complication and may develop severe life-threatening to the patient. To determine correlation between vital signs and hemoperitoneum in ruptured ectopic pregnancy and the association between abnormal vital signs and tubal rupture. Via a retrospective study we have considered a sample of 32 patients of ruptured ectopic pregnancy. All patients were diagnosed at the Gynecology and Obstetrics Unit A at Charles Nicole Hospital, Tunisia. Mean minimum systolic [SBP] 109 mmHg [range 70-150], mean maximum [HR] 81.5 beats/min [range 70-140]. Mean volume of hemoperitoneum 693.75 mL [range 100 -2000 mL].Correlation between vital signs and volume of hemoperitoneum was poor [R 2 = 0.279 for HR, R 2= 0.267 for SBP]. Hypotension was associated with blood loss of at least 1280 ml. Association of tachycardia with hypotension was observed in only 2 cases. Correlation between HR and SBP was not significant and poor [p=0.23, R 2= 0.05] Normal vital signs alone are poor predictors of ruptured ectopic pregnancy and do not correlate well with volumes of hemoperitonieum