[ newborns from epileptic women about 13 cases]

We report a study of 13 pregnant women with epilepsy over a 5-year period The mean age was 28 years [Range :20-36 years].Eight women had grand mal seizures [generalized tonic-clonic seizures]. All women were receiving anticonvulsivant therapy before pregnancy, whose 08 under monotherapy and 05 under bitherapy. Phenobarbital is largely the must used for 10 women. During pregnancy, an increase in seizure frequency was noticed in 07 cases and antiepileptic doses were increased to the clinic in 05 cases and 02 patients required the association of other anticonvulsivants. Thirty babies were born at term of which 03 by forceps and 02 by caesarean section. There where no cases of neonatal hemorrhage or per natal death. Symptoms of drug impregnation were found in 04 cases. pregnancy doesn't have a catastrophic effect on the course of epilepsy apart from the risk of an increase in the frequency of the fits. This risk must be reduced thanks to an optimal use of an anticonvulsive therapy before and during pregnancy

[Conservative treament for a post trumatic uterine rupture in the 3rd trimester of pregnancy]

We report the case of a woman in her 38[th] week of pregnancy who was brought by the SAMU in a state of shock following a car accident. She was a multiple trauma case with lesions over the face, the abdomen, a left femur fracture and metrorrhagia. The abdominal ultrasound revealed the presence of an important hemoperitoneum and absence of the fetal heart sounds. The surgical exploration found a ruptured uterus and an intra peritoneal dead fetus. A conservative treatment was done in this primipara and the post surgical evolution was good

[ haemolytic anaemia of child and adolescent. Study of 21 observations]

The auto-immune haemolytic anaemia [AHAI] is a scare entity in child. So the positive diagnosis is in easy rule. The therapeutically treatment remains the mainly difficulty because of the less age of some patients and often because of the unforeseenable variability of the diseases evolution. The prognosis is regularly different according to the forms if they are acute with a good prognosis or chronic with unfavourable evolution owing to the fact that a subjacent pathology is often associated. We report the results of a retrospective study of 21 child and teenagers affected by AHAI collected in a period of 16 years old [1986 - 2001]. The average age of these patients was 7 years 4 months [extreme 5 months and 18 years]. So 8 are aged less than 4 years. The outset was Brutal in 4 cases [19 per cent] and progressive in 17 cases [81 percent]. So the anaemic syndrome associating cutano-mucous pallor and asthenia, the haemolytic syndrome developed by icterus and dark urine constituted the most frequently consultation motives respectively observed in 76, 2 per cent and 42, 8 per cent of cases. However digestive signs [abdominal pain and/or diarrhea and/or vomiting] and signs linked to the associated disease [arthralgia, purpura] are revealing of AIHA in respectively 28, 6 and 1 9per cent of cases. The clinical triad of haemolytic anaemia [pallor, icterus and SMG] was noted in 47, 6 percent of cases. An haemogram revealed severe anemia in 17 cases [81 per cent], normochrome anaemia in 95, 2 per cent and macrocytary in the half of cases relating to an important hyper reticulosytosis. So it was regenerative in 20 cases and aregenerative in only one child relating with fierce appearing severe haemolysis. The anaemia has been associated with a thrombopenia in 9 cases and with leucooenia in 2 cases. The direct combs test was positive in 19 cases [90, 5 percent] in the two others cases, where it was negative the cold agglutinin research was positive [> 1/32]. The etiologic balance permitted to place the AIHA in 17 cases of secondary AIHA [81 percent] and in 4 cases of AIHA probably idiopathic [19 percent]. So the viral infections, the systemic diseases and the immunitary deficiency constitute the most frequently associated affections in our series found respectively in 23, 8 per cent, 33, 3 percent and 19 percent of cases. The prescribed corticoid treatment in 19 child permitted the obtainment an initial remission in 13 cases. The splenectomy realized in 4 child was effective in two cases. The prescribed immuno-suppresseur treatment in 4 child was effective in only one case. After a middle recession of 1 year and 9 months, the evolution was favorable [recovery] in 5 cases [23,8per cent]. Six infants were dead and 10 were lost sight

Generalized enchondromatosis associated with angiomas case report

The authors report a case of generalised enchondromatosis associated with a cutaneous angiomatosis realising the syndrome of MAFUCCI or type 11 of the classification of enchondromatosis of SPRANGER and A1. [1978]. This observation constitutes the first tunisian case. It is a rare entity, non familial, of unknown pathogeny discovered more often than not after the second year of life, because, of the shortening of lower limb or of the refraction of finger or a toe. The particular lesion of the disease is chondroma with often anarchic repartition about the skeleton. Its radiological aspect is that of homogeneous and transparent image with clear limits of oval or lengthened shape parrallel to the bone axis. The prognosis is reserved because of the evolutive tendances and the risk of degenerescence