emergent use of Cardiopulmonary bypass and extracorporeal membrane oxygenator in a child with sickle cell disease

The use of Cardiopulmonary bypass [CPB] and extracorporeal membrane oxygenator [ECMO] in patients suffering from Sickle cell disease [SCD] needs specific precautions. Whereas, no consensual protocols have been established to clarify therapeutic management

Case Report: A 7-year-old boy was admitted to the hospital for surgery of advanced endocarditis. Major dyspnea, hemodynamic distress and fever were noted on physical examination. Biological tests exploring anaemia revealed Haemoglobin [Hb] S levels of 39.1%. Echocardiography showed important right heart cavities dilation with multiple aortic vegetations. The child was accepted for emergent surgery. Ten minutes after anesthetic induction, serious hemodynamic distress was established. The patient was put on normothermic CPB when he received four packed red-blood-cell. After surgery, he was placed on ECMO support for 2 days than he succumbed

Conclusion: Urgent cardiac surgery in patients suffering from SCD poses a major therapeutic dilemma. Multiplying case reports and encouraging prospective studies are necessary to define the right place of cardio-pulmonary assistance in treatment protocols for better management

[ kuster Rokitansky Hauser syndrome]

The Mayer-Rokitansky-Kuster-Hauser syndrome is a congenital abnormality characterized by primary amenorrhea, vaginal hypoplasia, rudimentary uterus and normal ovaries. Surgical treatment may be proposed to allow normal sexual function. We report two cases of Rokitansky syndrome and we identify the characteristics of this syndrome and anlayse modalities of its management

[Postmenopausal uterine bleeding. Analytic study about 65 cases]

Postmenopausal uterine bleeding is frequent in gynecology. This symptom can reveal benign causes as well as cancers. So it's essential to rule out organic pathology. We propose a retrospective study of 65 postmenopausal women who had uterine bleeding for two years. To study the relative frequency of different causes of post-menopausal uterine bleeding.- To evaluate the different investigation procedures. In 65 cases of postmenopausal bleeding, we found:- 6 cases of cancer [9.2%]: 4 cases of cancer of uterine corpus and 2 cases of cancer of uterine cervix.- Benign pathology was more frequent [59 cases: 90.8%], essentially represented by endometrial atrophy [37 cases] and hyperplasia [11 cases].- Hysteroscopic aspect in the 4 cases of endometrial cancer:- Polypoid hypertrophy: 2 cases.- Simple hyperplasia: 2 cases. Despite the fact that benign pathology is more frequent than malignancy as a cause postmenopausal uterine bleeding, we must always rule out a cancer by oriented biopsy

[Breech presentation vaginal delivery or planned caesarean section?]

Breech delivery is a high risk situation because of its numerous dystocies. The most serious is the last head retention. The authors realized a retrospective study concerning 347 patients who had given birth to a newborn child in breech presentation during a period of 4 years

Results: The vaginal delivery was associated in a significant way to an excess of obstetric traumatisms [5.5%] versus caesarean section [0.5%] and this even after strict selection of vaginal delivery's conditions [P= 0.00453]. The rate of the newborn child having Apgar's score < 7 in 5 min was higherin case of vaginal delivery [17.39%] than caesarean section's birth [3.48%]. Corrected neonatal mortality is higher in the group of vaginal delivery than caesarean section's group [34% versus 0.49%, P= 0.02553] There is no significant difference of maternal morbidity between caesarean section and vaginal delivery group [P=4.65]. Vaginal delivery is associated to an excess of morbidity and neonatal mortality even after strict selection of the candidates of the vaginal delivery