[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

[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%

[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