[Evaluation of different techniques for vaginoplasty in the treatment of the syndrome of Mayer-Rokitansky-Küster-Hauser]

Rokitansky syndrome is an utero-vaginal aplasia with a frequency of 1 / 5000 female births. To correct this anomaly whose prognosis is mainly functional and psychological numerous surgical techniques have been described. To report our experience about 13 patients with Rokitansky syndrome and having benefited from a vaginoplasty between 1993 and 2008 and to evaluate the results of the various anatomical techniques. This is a retrospective study of 13 patients who underwent a vaginoplasty in the center of maternity and neonatal units, over a period from December 1993 to April 2008. During this period, two operative techniques were used: the technique of Mac-Indoe and the technique of Davydov. The mean age at the time of surgery was 22 years [15 years-32 years]. In 6 patients operated using the technique of Davydov the average depth of neovagina was 6.83 cm, one treatment failure was noted. Among the 7 patients operated using the technique of Mac Indoe the average length of neovagina was 7 cm, 3 treatment failures were noted. It was noted that there was no failure of the anatomical results in patients who have had regular sex after surgery. It was noted that there was failure of the anatomical result in 4 of 9 patients who did not have sexual intercourse after the procedure regardless of the technique used, a failure rate of 44%.The choice of technique will be based on the experience of the teams as each technique has similar anatomical and functional results in the literature. Both anatomical and functional, the main factor that determines the success of treatment seems to be the motivation of the patient to have a married life and sexual relationship

[Obstetric Vesicovaginal fistulas, about 131 cases]

Vesicovaginal fistulas are the most frequent type of urogenital fistulas. Obstetrical cause remains the dominant etiology. They still represent a public health problem. to study epidemiological aspects of obstetric vesico-vaginal fistulas and their management. a retrospective multicentric study among 19 hospital departments from February 1982 to January 2007. 131 VVF [92% of urogenital fistulas]. The vaginal route for surgical repair was used in 2/3 cases. The mean diameter of the fistula was 11.35mm. In 122 cases [86.5%], the fistula was unique. IVU findings were normal in 83% cases. All patients had normal renal function apart one who had acute renal failure. 177 interventions were performed [1.37 intervention per patient]. Our findings suggest a regression in obstetrical VVF. However many efforts on institutional, socioeconomic and obstetrical levels have to be done in order to eradicate this pathology that is of major handicap for women regarding socioeconomic, functi6nal and psychological effects

Extralobar pulmonary sequestration revealed by prenatal hydrothorax

Pulmonary sequestration is a rare congenital pulmonary anomaly that can be diagnosed in utero. Report a New case: ln this case report of extralobar pulmonary sequestration, the authors report a case revealed by hydrothorax and describe this disease appearance in different imaging technique [Doppler ultrasonography, magnetic resonance imaging and postnatal multislice CT angiography]

[First trimester ultrasound: an early screening tool for fetal structural and chromosomic abnormalities]

Prenatal diagnosis has been greatly expanded in recent years. Many biological and sonographic criteria participated in the development of fetal medicine. Analyze the contribution of first trimester ultrasound in prenatal diagnosis of aneuploidy and early fetal malformations, and its impact on the strategy of prevention of disability. A prospective longitudinal descriptive study including all women who did a first trimester ultrasound during their pregnancy. We evaluated the detection rate of malformations and chromosomal abnormalities of the morphological embryonary study and nuchal translucency. These tests were then confronted with the results of fetal samples and the outcome of pregnancy. 593 ultrasound examinations were performed. The average age of pregnant women was 32.7 years. The mini-morphological ultrasound study revealed 26 abnormalities [3 major lethal malformations, 5 cystic hygroma and 18 increased nuchal translucency]. Chromosomal abnormalities were found in six cases. The first trimester ultrasound has ensured the detection of 2/3 of total aneuploidies of the study. The first trimester ultrasound allows early detection of a large number of aneuploidies and fetal malformations

[Prenatal ultrasound aspects of arthrogryposis multiplex congenita]

To analyze the contribution of prenatal ultrasound in the diagnosis of arthrogryposis multiplex congenital according to its type and antenatal expression. Retrospective study led between January 1993 and November 2007. We studied the cases of arthrogryposis suspected or diagnosed by antenatal ultrasound while analyzing the circumstances of discovery, the profile of the pregnant women and the abnormal scan findings. 16 Observations have been collected. We recovered one multiple pterigium syndrome and five observations of severe fetal akinesia sequences diagnosed in the second trimester. The arthrogryposis was part of different syndromes in other cases. Four distal arthrogryposis had been diagnosed in the second trimester. All cases suspected during the third trimester were associated to an anomaly of the amniotic fluid, mainly to a polyhydramnios. The abnormal scan findings were less specific to this term. Arthrogryposis multiplex congenital is rare. It has several morphological aspects. Some ultrasound aspects are specific in the first and second trimesters. The diagnosis is more difficult at the third trimester

[Prenatal diagnosis of ectopia cordis. Case report]

Ectopia cordis is a rare and impressive malformation presenting as an isolated lesion or as part of the Cantrell's pentology syndrom. It is defined as an anomaly in which the fetal heart lies outside the thoracic cavity. The aim of the study is to report the prenatal diagnostic features and management of ectopia cordis. We report a prenatal diagnosis case of ectopia cordis using two-dimensional ultrasound at 19 weeks of gestation. Multiple congenital anomalies were found. The most important one was the presence of a ventral thoraco-abdominal wall defect with exstrophy of the heart, liver, stomach and intestines. Histopathological examination confirmed the ultrasound findings. Due to severity of the malformations, termination of pregnancy was made

Prise en charge en reanimation des pathologies obstetricales graves

We report a retrospective study over a period of 4 years and half and bearing on 59 patients that require an intensive care. The number of childbirth during this period was 22237 with 8.97% of Caesareans. The main obstetrical diseases were: gravidic toxaemia 75.5%, uterine inertia 7%, cardiopathy 5% of the cases. The reasons for the transfer were: eclamptic state in 27% of the cases, hemostasis disorder 22% of the cases, and acute pulmonary oedema 18.6% of the cases. Average duration of hospitalization was 3-18 days. Five cases of death were noted

Place du sulprostone dans la prise en charge des inerties uterines. A propos de 60 cas

The serious haemorrhages of the delivery still one of the'first causes of maternal mortality. We report an analytical study over a period of 18 months and gathering 60 cases of haemorrhage of the delivery by uterine inertia having imposed the recourse to the sulprostone. The average age of the patients was 31 years, the average parity was L9, the rate of childbirth per Caesarean was 65%. The uterine surdistension was fhe principal etiology of the uterine inertia. The average time of administration of the sulprostone was 10 mn. No complication related to the product was noted. The effectiveness of the treatment was observed in 93.3% of the cases, with 4 cases of failure

[Aspects foetopathologiques de 97 cas d'anencephalie: etude du CMNR Tunis]

So, the epidemiologic study done for 8 years at CMNR Tunis has shown that the incidence is 1,15%o births [between 0,52 and 1,66%o per year]. This anomaly is more frequent in Female sex [sex linked = 0,59]. The antenatal echographic diagnosis is efficient in 90,5%. This anomaly is more shown at low socio-economic group. The improvement of the socio-economic level and specially the daily uptake of acid folic in periconceptionnel time decrease the frequency of this congenital malformation

[Foetopathology study: 88 cases of spina bifida]

Letal spina bifida continue to be frequent in Tunisia; we report 88 cases of letal spina bifida 1,05 per thousand births. This pathology was more frequent with women. The up letal spina bifida situated is predominant with female and the dow spina bifida situated is frequent with male. We have noted an association with anencephalia [46 cases] and hydrocephaly [21 cases]. Prevention is based on obstetric health care and hygieno dietetic advices to avoid alimentary deficit

Gonadectomie per-coelioscopique dans le syndrome de porris a propos d'un cas

Prophylactic gonadectomy is widely accepted in male poseudohermaphrodism because of the possible malignant conversion of the gonads. Here, we report our management of a patient with complete testicular feminisation by laparoscopy, this procedure has permitted the diagnosis and the removal of the dysgenetic gonads

Le fibrome du ligament rond chez une femme menopause

Round ligament myoma constitute an exceptional pathology. We report one case of round ligament myoma with intra abdominal d‚veloppement. The diagnosis was only done during surgery