[Management of breast cancers detected by screening mammography program of L'Ariana state in Tunisia]

To report the epidemiological and anatomoclinical features of breast cancers referred to a department of gynecology from the screening program of l'Ariana state in Tunisia. A longitudinal retrospective Study was done over a period of 4 years [2004 - 2006] at the Unit "A' gynecology department of the maternity of Tunis. We collected all the cases with histologically confirmed breast cancer diagnosed within the mammography screening program of l'Ariana state, referred to our unit for treatment. 10 patients with histologically confirmed breast cancer were collected during the study period, treated at our unit. Mean age of patients was of 48.8 years. Clinical examination was initially negative in 50% of cases. Mean clinical tumor size was 18 mm, while invasive ductual carcinoma represents the most frequent histological type. One patient [10%] had histological axillary involvement. Conservative surgery was performed for 8 [80%] of the 10 patients. This pilot study of mammography screening confined to a Tunisian state, precludes to the future profile of BC In Tunisia, showing that an early diagnosis can lead to a dramatic reduction of mean clinical tumor size, less histological poor prognostic features, more conservative surgery and a slight improvement of survival. A structured extended screening program must be installed to achieve these goals but requires an important financial and human investment

[Surgical treatment of infraclinical breast lesions: preliminary results of the screening program of L'Ariana state]

To report clinical, radiological and histological characteristics of the infraclinical breast lesions patients recruited via the large scale mammography breast cancer screening of l'Ariana state in Tunisia. Retrospective study over a period of 2 years. The recruitment of patients made on the occasion of the program of breast cancer screening. During this period, 22 patients in our unity had a surgical excision after wire localization. Ten patients were recruited by means of systematic breast cancer screening. In these cases, the mammographic findings were classified B.I.R.A.D.S 4 in 7 cases and BIRADS type 5 in 3 cases. Definitive histology concluded to benign disease in 4 cases and malignancy 6 cases. This collaboration enables the diagnosis an invasive ductal carcinoma in three cases. The surgical excision after wire localization for non palpable breast lesions allows diagnosis of high-risk benign lesions and low-stage breast cancer. It is a reliable technique which indications have to be based on clinical and radiological strict criteria. This procedure is at present, and in developed countries, widely outstripped with the stereotactic core needle biopsy

[Postpartum foot drop a case report]

Postpartum foot drop is the clinical manifestation of lumbosacral plexus radiculopathy [LPR] which is a neurological maternal complication in obstetrics. It is mainly due to cephalopelvic disproportion. Occurring also in the third trimester of the pregnancy, this pathology includes motor and sensitive disorders interesting the lumbosacral plexus territory. Its diagnosis and physiopathology are based on electromyographic data. The prognosis is commonly favourable after a physical therapy program. The prevention is primarily based on the management of mechanic dystocia

[Placenta percreta: a rare aetiology of metrorrhagies in the first and second trimesters of pregnancy about two cases and review literature]

The placenta percreta is an abnormal placentar adhesion with invasion of all the uterine wall with sometimes an extension to the organs bordering the womb by chorial villiosities. It is a pathology rarely diagnosed during the first trimester of pregnancy. We report in this work two cases of placenta percreta diagnosed in the first trimester of pregnancy in the A service of the centre of maternity and of neonatology of Tunis. After a review of the literature we tried to make lignt on risk factors inherent to this pathology and to propose a practical behaviour. The first patient of the study was 28 years old, with bicicatricial uterus. She was admitted in urgency for abundant metrorragies in the tenth week of pregnancy, A molar pregnancy was suspected and an attempt of uterin evacuation failed. In front of the importance of bleeding an haemostais hysterctomy was made. The second patient was 39 years old, and had as antecedents of cures of uterine synechy. She was admitted in the 19[th] week of pregnancy, for a late abortion. In front of the complete placentar retention and the aggravation of bleeding, the diagnosis of placenta accreta was evoked and a haemostasis hysterectomy was realized. In both cases histological exam confirmed peroperative discoveries and concluded the diagnosis of placenta percreta. The difficulty of the management of the placenta percreta is due to the fact that this pathology is almost always met in a unexpected way in an urgent context. Antenatal diagnosis is recently described as possible in the first trimester of pregnancy

[Placental chorioangioma and ultrasound diagnosis - case report and review]

Placental chorioangioma is the most frequent benign vascular placental tumor. Its prenatal diagnosis can be made by ultrasound. After analysing our case, we describe clinical and sonographic features of this kind of tumor, maternal and fetal complications and finally, therapic issues. Chorioangioma can be identified by ultrasound as a well-circumscribed solid mass. Its vascular origin can be established by use of color Doppler imaging. Fetal complications are caused by arteriovenous shunting. Maternal complications are polyhydramnios, preeclampsia and placental hematoma. Therapeutic possibilities are reduced. Ultrasound is helpful for diagnosis and follow-up of these tumors who are associated with severe consequences

[Gestational pemphigoid - about two cases and review of the literature]

Gestational pemphigoid is the most clearly characterized dermatosis of pregnancy. It is a rare vesiculo-bullous eruption that develops during the last trimester or even in postpartum and causes severe pruritus.The objective of this work is to study the clinical aspects and especially the materno-foetal involvement of this pathology. We report the case of a 35 years old patient who was admitted on a term of 32 weeks of pregnancy for generalized bullous eruption. The diagnosis of gestational pemphigoid was confirmed on clinical and histological arguments. The patient had a caesarian section for acute foetal suffering. Evolution in post partum was characterized by a progressive disappearance of lesions. The patient presented a recurrence of this dermatosis during the second pregnancy. Gestational pemphigoid is a rare dermatosis during the pregnancy. Materno-foetal transmission is possible and expose to a higher risk of prematurity and hypotrophy of the newborn child

[Urgent contraception [Norlevo]-Experience of the service ''A'' CMNT-About 14 cases]

Urgent contraception [naming recognized by the WHO] is a contraceptive method that can be used after a non protected or badly protected sexual act. It is about a retrospective preliminiary study concerning 14 young women, having opted voluntarily for the post coital contraception with the levonorgestrel further to a not protected sexual act. Urgent contraception is indicaed for a delay of 72 hours after a sexual intercourse not protected or in case of failure of a contraceptive method. The average age of our candidates was of 24.4 years with extremes going from 16 to 33 years. 50% of our consultants were single. A pregnancy test had been realized at all our candidates before the intake of the norelevo. It was negative in every case. Average time sold between the report and the ingestion of Norlevo was 15.27 hours without never exceeding 24 hours. The rate of success was 100%. this non-expensive contraception, is easy to implement; it is so much less expensive than an pregnancy interruption [IVG] to which the women often have appeal in case of not wished pregnancy. Urgent contraception is now well codified. Its efficiency approaches 75 to 85%

[Uterine synechias treated exclusively hysteroscopically - about 127 cases]

This retrospective study of 127 patients with uterine synechias treated exclusively hysteroscopically included 84 [66.25%] low fertility patients, 36[28.5%] with menstrual disorders and 7 [4%] with no other symptoms. About ninety three patients [73.8%] had a past history of trauma on a gravid uterus. Operative hysteroscopy was performed in all cases, including sections with scissors in 8 cases [13.3%] between 1995 and 1996, and electrosection between 1997 and 2003. A single endoscopic procedure was efficient in 70% of cases and second procedure were required in 6 cases [7.5% of the patients]. No complications due to infection, bleeding or metabolic disorders occurred, but perforations were seen in 2 patients [2.5%] both with complexe synechia. Good anatomic results were achieved after 1 hysteroscopic procedure [70%]. Clinical results were less satisfactory, particularly in cases with low fertility in which another pathology was often associated [31.42%]. We obtained good results in 78.57% of the patients with amenorrhea. However, 49 pregnancies were achieved including 12 normal deliveries

[Laparoscopic treatment of adnexal abscess - about 86 cases]

To Specify the epidemiological profile of the patients presenting an adnexal abscess the therapeutic modes and the ulterior fertility. Retrospective clinic survey about 86 cases of adnexal abscess collected in the Service A of the Center of Motherhood and Neonatology the Rabta Turns during a period of 7 years going from January 1996 to December 2002 A laparoscopic drainage has been achieved in all patients; 35 patients underwent a second laparoscopy 3 to 6 months later. The clinic symptomatology was dominated by the pelvic pain [97% and the fever in 65% of cases A latero - uterine adnexal mass has been discerned m 56% of patients. The echography practiced in all cases evoked the diagnosis in 49 cases. The exclusive laparoscopy permitted a conservative treatment in 52% of the cases. No new immediate operation was necessary in the first two months after the initial surgery. At the time of the control laparoscopy an adhesiolysis was made in any case necessary. A distal tuboplasty has been achieved in 17 patients and 6 patients were sent in IVF. Thereafter, 12 patients out of 19 that didn't use a contraceptive mean had a spontaneous intra-uterine pregnancy [63%]. Conclusion this survey confirms that the laparoscopic surgery is a sure and efficient technique for the treatment of the adnexal abscesses The anatomical results observed at the time of the control suggests that this second surgical phase is essential for the patients who want a future pregnancy

[Hysteroscopic myomectomy - about 90 cases]

We conducted a retrospective study of 90 cases of fibroma electroresections performed by hysteroscopy. Mean follow-up was 21 months. Clinical manifestations disappeared totally [80%] or nearly so in 93.5% of the patients. No predictive factor for functional success was observed. Seven of the 20 infertile patients became pregnant. Four gave birth at full term, in 74% of the cases the uterine cavity was found to be satisfactory at follow-up examination. The size and depth of the fibroma within the uterine wall were factors which predicted anatomical success

[Complications of the diagnostic and operational coelioscopies in gynaecology, about 5049 cases]

To present and compare with the literature, the complications which have occurred during 10 years of coelioscopic experiment. Material and processes: 5049 diagnostic and operational coelioscopies were practiced between January 1990 and December 2003 in the obstetric service of gynaecology "A" of the center of maternity and neonatology of Tunis. The major or advanced acts accounted for 28.5% of the practiced ccelioscopies. The rate of complications related to the phase of installation of the coelioscopy was 6.45%. 93.6% of our complications occurred at the time of major or advanced coelioscopies. 32 complications having imposed the immediate or differed laparoconversion. The most frequent complications were in connection with difficulties of hemostase accounting for 59.4%. The digestive, urinary, anaesthetic and infectious complications respectively accounted for 21.8%, 9.4%, 6.25%, and 3.1% of the accidents. The respect of against indications, the preoperative digestive preparation, the vesical survey as well as the rigour in the operational gestures should reduce the risk of complications related to this technique