[Cancer mortality among reproductive age women in Tunisia]

Background: Cause-of-death data are critical to formulating good public health programs

In Tunisia, the mortality surveys of reproductive age women are specifically interested in maternal mortality and we do not have data on deaths from noncommunicable diseases including cancer

Aim: To identify the main cancers causing death among Tunisian women in reproductive age

Methods: A retrospective national RAMOS survey [Reproductive Age Mortality Study]. This survey was conducted in 2010 and included all deaths of women aged 15-49 years which occurred in 2008 and were due to cancer. Data collection was based on the verbal autopsy method

Results: In Tunisia, cancer is the leading cause of death among reproductive age women, especially breast cancer. The most exposed women are housewives [64.4%], aged 40-49 years [55.3%], living in urban areas [62.2%], belonging to the middle tercile classification of households [45.4%] and reaching a level of basic education [44.2%]

Conclusion: Cancer should receive priority funding of health care for this population in order to improve its diagnosis and treatment, with a special motion for breast cancer

[Comparison of two oxytocin administration protocols in elective cesarean section: 5 iu versus 10 iu]

Background: Although Oxytocin is used systematically during caesarean section, no recommendation precise optimal dose for this indication. The bolus administration of 10 IU intravenously after extraction of the newborn, is accompanied by side effects mainly hemodynamic

Objectives: To compare two Oxytocin protocols: 05 IU bolus Vs. 10 IU bolus during Cesarean section by studying their respective effectiveness [effects on uterine tone] and adverse effects

Methods: A prospective randomized double-blind study including 87 term parturients for undergoing a C-section under loco regional anesthesia. Parturients were randomized into two groups depending on the injected Oxytocine dose: - Group 1 [n = 43]: 10 IU + 25 IU IVD in 500 ml of serum / 3h - Group 2 [n = 44]: 5 IU IVD + 25 IU in 500 ml serum / 3h

Results: The variation of the heart rate and the incidence of low blood pressure were significantly greater for Group 1. No significant differences between the two groups regarding blood loss was noticed per or postoperatively. The type of digestive side effects were more common in the first group

Conclusion: Administration of 5 units of Oxytocin during the scheduled C-sections is effective for uterine tone without superimposed bleeding risk, guarantees better hemodynamic stability and less side effects than the 10 units dose

[Contribution of verbal autopsy in the study of cancer mortality among reproductive-age women in Tunisia]

Background: In Tunisia, the information system on medical causes of death is based on the use of standard death certificate model based on international model recommended by the World Organization started in January 2001. However, this system is still burdened with a major death causes of under-registration. Only specific surveys on mortality have FAR generate reliable mortality indicators

Objectives: to study the use of verbal autopsy in order to assess cancer mortality among Tunisian women in reproductive age [WRA]

Methods: A retrospective national RAMOS survey [Reproductive Age Mortality Study]. This survey was conducted in 2010 and included all deaths of women aged 15-49 years which occurred in 2008 and were due to cancer. Data were collected from civil status records and information gathered from families and from health institution's registers. For all deaths of women aged 15-49 years, the detailed circumstances and the sequence of events leading to death were grouped on a folder called "clinical record of verbal autopsy". Then; all folders were submitted to the independent expert

Results: During the study period, 1729 deaths among women of reproductive age [WRA] were the subject of a verbal autopsy against only 708 recorded by the National death information system [NDIS]. Cancer is the leading cause of death among WRA .The specific rate of cancer mortality is 17.83 per 100 000 WRA against only 7.91 per 100 000 WRA estimated by the NDIS. Breast cancer is the leading cause with 35% of all cancers and specific death rate of 6.3 per 100,000 WRA against 2.48 per 100,000 WRA recorded by the NDIS

Conclusion: Verbal autopsies Verbal autopsy remains an interesting method for measuring cancer mortality in women of a reproductive age especially in countries with a defective national death information system

[Elastography assessment of the cervix during cervical maturation]

The issue of cervical tissue imaging is to enable the provision of Obstetricians an objective tool for measuring cervical changes more accurate than the vaginal touch. Hitachi software "Real-time Tissue Elastography" allows an analysis of tissue elasticity, evaluated on a Young's modulus theory. This imagery evaluated for mammary tumors and liver changes elasticity, would objectively show changes in cervical consistency. The authors of the following work have attempted to: - Assess the usefulness of elastography in the uterine cervix examination. - Compare the modifications of the cervical module of elasticity before and during the maturation by prostaglandins indicated for medical reason with those raised in the clinical examination [score of Bishop]. It is about a non-interventional feasibility study with regulation of the machine, realized in forward-looking. We included 30 patients scheduled for a cervical maturation by prostaglandins for medical indication. We realized a measure of the cervical module of elasticity during an endo-vaginal ultrasound for measure of the cervix before the pose of prostaglandins, 6 hours then 12 hours after the stake in contact and we compared the measure every time with the score of bishop. All the patients who presented an index of high softening entered labor within the 3 hours following the examination. Furthermore, the modifications observed on the index of softening were correlated to those of the score of Bishop. The performance of the images of elastography with these regulations allowed a good confrontation of the results during the evaluation of the feasibility of the technique with the score of Bishop during cervical maturation. This promising technique remains a technique of research. Forward-looking studies on wide series of patients are going to be able to estimate the elastography as an additional and objective informer of the cervical maturation

First trimester diagnosis of Pallister-Killian syndrome in a fetus with suggestive abnormalities

Pallister-Killian Syndrome is a rare, sporadic chromosomal disorder characterized by a tetrasomy 12p often in mosaic. It is only in 2000 that the first case of PKS was diagnosed in the first trimester further to an increased nuchal translucency. Report a new case. To our knowledge, we present the first case of early prenatal diagnosis of Pallister Killian Syndrome due to the presence of an increased nuchal translucency, a diaphragmatic hernia, a typical facial dysmorphism and a micromelia of a predominantly rhizomelic type. A chorionic cells biopsy showed a normal karyotype. The diagnosis was revealed on cytogenetic analysis of amniotic fluid sampling. The main ultrasound indicators of PKS seem to be: Hydramnios, congenital diaphragmatic hernia [CDH] and a micromelia of a rhizomelic type. The hydrops fetalis, hygroma coli or increased nuchal translucency [INT], fetal overgrowth, ventriculomegaly and presence of a sacral appendix are less common. The amniocentesis with the study of the karyotype on amniotic cells is considered to be the gold standard for the diagnosis of PKS. A good morphological study during the first trimester in search of ultrasound abnormalities highly suggestive of PKS is able to direct the cytogenetic study

[Early diagnosis and management of cervical ectopic pregnancy]

Cervical pregnancy is the rarest of ectopic pregnancy. The classical treatment remains hysterectomy, in particular when diagnosis is made late. The possibilities of more and more premature diagnoses, sometimes before any clinical expression, let suspect the possibility of conservative treatments. We report two cases of medical treatment for early diagnosed cervical pregnancies. Through a review of the literature, we resume diagnostic criteria and various therapeutic possibilities. The two cases were diagnosed in the first trimester. The treatment consisted in intramuscular administration of methotrexate. The first patient had ultrasound-Guided feticide before the administration of methotrexate. Actually, vaginal ultrasound allows early diagnosis of cervical pregnancies, even before the beginning of vaginal bleeding. This advancement allowed conservative treatment. In this situation, current reference is the methotrexate to which can be associated an intracardiac potassium chloride injection in case of embryo positive heart activity

[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