[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

[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

[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

Place of the sulprostone in therapeutic interruptions of the pregnancy

Therapeutic interruption of the pregnancies of the 2-nd and 3-rd quarter is often badly accepted by the patients and it is original that his realization is easy, effective and the less traumatic possible. In this indication, the sulprostone [Nalador] is a big contribution. The purpose of our study is to review this product, to describe our experience concerning its use in the therapeutic interruptions of pregnancies and to study alternatives in case of failure or of against indication in its use. It is about a forward-looking study opened from the 01-07-02 led in the service [A] of the CMNT. We brought together 30 women where a therapeutic interruption of the pregnancy was put and who did'nt present of against indications to the sulprostone. The average age was of 27 years with extremes from 18 to 39 years50% of our patients were nullipares. The terms of pregnancy varied from 16 to 28 LIMITED COMPANIES with an average of 20 LIMITED COMPANIES. The indications of these terminations of pregnancy were maternal in 33.33% of cases and foetal in 66.66% of cases. The average number of light bulbs of Nalador used by the women was of 2,25 with extremes going from 1 to 4. The delay of eviction from the beginning of the induction was on average of 21 hours, with a rate of success of 90%. We did not regret any break uterine Delivery was incomplete requiring a uterine revision under general anesthetic in 5 cases. Tolerance was good in general In case of failure alternatives were: the misoprostol [cytotec], the Probe extra amniotic dries and the wet Probe. The sulprostone by intravenous way constitutes an effective method of medical interruption of the pregnancy in the 2-nd and 3-rd quarter with a satisfactory tolerance and a rate of success of 90%

[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

Sciatica as a rare symptom of recurrent uterine carcinoma. About four cases and literature review

The occurrence of inflammatory sciatica needs a special attention because it is often related to malignant, infectious or inflammatory affections. However, rare pelvic affections and especially gynecological conditions can also cause sciatic pain. We report four observations of sciatic neuropathy caused by compression of the sacral plexus by metastases of uterine carcinoma. A literature revue is also undertaken to emphasize on the importance of recent complementary exams for the etiological diagnosis of sciatica

[Krukenberg's tumor- about 5 cases]

KRUKENBERG's tumor is an ovarian metastasis of a digestive neoplasm. It is a rare tumor. We realized a retrospective study over 5 years, in the service "A" of the CMNT. We listed 5 cases of KRUKENBERG's tumors. The average age of our patients was of 47 years. The main motive for consultation are pelvic pains. Clinical exam finds an abdominal mass in 4 cases. The treatment is surgical associated to the chemotherapy. The primitive tumor was found in 4 cases, it was gastric in three patients. KRUKENBERG's tumor is a rare tumor, it touches the young woman. The prognosis of this tumor remains dark. The surgical treatment and the chemotherapy improve little the survival

[Thrombocytopenia in pregnant women- about 148 cases]

Thrombocytopenia in pregnant women is a common finding. We report a retrospective study of 148 cases over a period of two years. The average age was 30 years. 17% had antecedents of haemorrhagic accidents. Pathologies associated to the thrombocytopenia were dominated by the anaemia and the preeclampsia. The average term of discovery was of 33 weeks of gestation and 4 days. 102 cases were diagnosed in the third trimester. Thrombocytopenia was light in more than half of cases. Only 14 patients [95%] had rates of plaques < 50 000 /mm[3]. Causes of thrombocytopenia were dominated by the gestational thrombocytopenia. It was the etiology in 89 patients [60%]. Preeclampsia and its complications were in second position. Gestational thrombocytopenia was followed in a regular way by platelet counts. Thrombocytopenia in complications of the preeclampsia [HELLP syndrome] impose an interruption of the pregnancy. The immune thrombocytopenia < 30 000 / mm[3] and the one that was symptomatic benefited from corticosteroids. Haemorrhagic complications were observed in 43 patients [31,5%]. 15 patients [10%] were transferred in a unity of intensive care. No case of maternal mortality was recorded. Delivery was by natural way in 69% of cases, instrumental in 7,4% of cases and by caesarean section in 23,6% of cases. General anesthesia was realized in 95% of cases. Percutaneous umbilical blood sampling was not realized at any patient. No neonatal haemorrhagic complication was observed. The association thrombocytopenia and pregnancy is of high risk. It can be at the origin of haemorrhagic complications involving maternal and fetal vital preview. The coverage requires a multidisciplinary cooperation between obstetrician, haematologist, pediatrician and anaesthesist

[Amelia - about two cases]

Amelia is a rare syndrome characterized by complete absence of one or all four limbs. We reported two cases of amelia observed in service A of the CMNT during 2002. The purpose of this article is to discuss the different etiologies of this malformation and to underline the contribution of the ultrasound done early [12 weeks of gestation]. Amelia is the result of toxic, mechanic or genetic causes. The antenatal diagnosis by ultrasonography is very useful

[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