Peripartum cardiomyopathy

To analyze the clinical characteristics and to evaluate the different factors that influences the prognosis of the peripartum cardiomyopathy [PPCM]. A retrospective review was undertaken on records of women who were diagnosed with peripartum cardiomyopathy at Farhat Hached Hospital [Sousse] between January 1992 and December 2004. Clinically, PPCM shows pulmonary symptoms such as dyspnea and tachypnea. The diagnosis is established by echocardiography that showed decreased systolic function of the left ventricular. Both gynecologist and cardiologist must check the patients regularly. No patient died. Three preterm pregnancies occured with 9 health newborns [2 sets of twins]. One miscarriage took place. PPCM is often undetected or misdiagnosed because of the low incidence and the unspecific symptoms. The treatment is also unspecific and similar to dilated cardiomyopathy or acute cardiac failure. Early diagnosis of the peripartum cardiomyopathy is extremely important. Pregnancy in patients with dilated cardiomyopathy is associated with maternal and fetal morbidity. Left ventricular function is a prognostic factor and must be the most parameter when conseling patients with peripartum cardiomyopathy about a new pregnancy

[Ovary teratoma_Report of 91 cases]

To analyse the clinical and anatomic aspects of cystic treatomas of the ovary, carcteristics of patients having cystic teratomas and the masnagement trends at our institution. Retrospective study of 91 cases of cystic teratomas of the ovary diagnosed and treated at Farhat-Hached Hospital [Sousse] between 1 january 1995 and 30 june 2003. Cystic teratomas constituted 12.13% of all ovarian tumors diagnosed and treated at our institutation during the study period. The median of age was 33.35 ans. Abdominal or pelvic pain was the most frequent symptoms for presentation in 67% of the cases. In addition; incidental finding was noted in 25.3% of the cases and swelling in 23% of the cases. The mean tumor diameter was 10 cm. The rate of bilateral cystic teratomas of the ovary was 14.3%. 19.8% of cystic teratomas has occurred in pregnancy. The operative video-laparoscopy was employed in 9 cases, laparotomy was employed in 82 cases. Histopathological evaluation has detected 96.7% cases of mature teratomas, and 3.3% cases of immature teratomas. Cystic teratomas are the most common ovarian neoplasm, that occurs most commonly during the reproduce years. The operative laporoscopy is the most common modiality of treatment of mature cystic teratomas. Immature teratomas must be treated by laparotomy associated if necessary to chimiotherapiy

[Lobular idiopathic granulomatos mastitis About 10 cases]

Our retrospective study was performed on 10 cases of granulo-matous mastitis registered in Obstetric Gynaecology Department and Pathology Department of CHU F. Hached Sousse, during 8 years period. The mean age was 36.4 years [range 32-59]. Among these 10 cases, 8 were observed in reproductive-age women and 2 were noted in menopausal women. Clinical findings showed unilateral breast nodule associated with inflammatory signis in 4 cases, mammelonary retraction in 2 cases and serous or sero-purulent mamelonnary flow in 4 cases. Mammographic examination suggested a malignant tumor in 5 patients. In all cases, the diagnosis is made by histopathology. Surgical treatment consisted in wide excision with drainage or radical mastectomy, eventually with combination with antibiotic therapy and non steroid anti-inflammatory drugs. Prognostic features showed a good cicatrisation in 4 cases, local recurrence and cutanonus fistulization in one patient. Granulomatous mastitis aetiology is still unclear, auto-immune aetio-pathologenesis appears more interesting and should be clarified

[Recurrent hydatidiform mole. About a case with 9 sucessive molar pregnancies]

The recurrent hydatiform mole is rare, its frequency is lower to 1%. We report the observation of a 28 years old women, without antecedents of molar pregnancy in the family and without considerable pathological antecedents. She had 9 successive molar pregnancies, without inset normal pregnancy and without living chilfren. The delay of at least 1 year between the gestations has been respected in 6 pregnancies. The etiologic balance in particular the caryotypes of parents is normal. The aurthors debate the etiopathogenic and prognostic factors of this pathology

[Pronostic factors in squamous cell carcinoma of the vulva. about 35 cases]

To evaluate the pronostic factors of the vulvar cancer. This is a retrospective study, of 35 cases of squamous cell carcinoma of the vulva diagnosed and treated at Farhat Hached Hospital [Sousse] between January 1991 and December 2002. The study of the pronostic factors is based on analysis of the following parameters obtained after a period varying from 6 months to 5 years: clinical data, pre-therapeutique and therapeutic evaluation, pathologic data, outcome and survival rate. The diagnostis was often late with a delay for consultation superior to 6 months in 60% of cases. 80% of the patient were in stages III and IV of FIGO with an average tumorous size of 3.8 cm and palpable lymph node in 74.2% of the cases. 22 patient underwent vulvectomy with bilateral inguinal node dissection. Adjuvant therapy was carried out in 8 cases. The rate of relapses was 22.7%. The global survival at 5 years of the operated patients was of 40%. The main prognostic factors were: the size tumorale, the degrees of stromal invasion and the lymph node invasion. Early detection fo vulvar cancer by regular gynecologic examinations and a biopsy of all suspect lesions, allows an early treatment consequenlly a better prognosis