[Adenosarcoma uterine]

This cancer is composed of a benign glandular component and sacromatous stroma. It is characterized by its rarity, difficulties in both diagnostic and therapeutic care. Patient aged 65 years old, complaining of a post-menopausal bleeding, the gynecological examination showed a collar - like benign polyp, both the ultrasound examination info showed an endometrial hypertrophy and the endometrial biopsy examination were negative. The positive diagnosis was based on the biopsy anatomopathological examination, after a subtotal hysterectomy with bilateral ovarian excision operation. This operation was ended by a neck -isthmectomy. Uretine adenosarcoma represents only 8% of all sarcomatous period. Its clinical symptoms are highly polymorphic dominated by the presence of metrorrhagia. Only the anatomo-pathological examination allows for the positive diagnosis by demonstrating the presence of malignant mesenchymal elements and benign epithelial components. Surgery is the main treatment the radio or chemotherapy were instituted in the advanced cases but their usefulness in terms of survival benefit remains controversial. The treatment involves a multidisciplinary team to establish a diagnostic and therapeutic proper conduct especially in advanced cases

[Delivery of macrosomic]

Management of fetal macrosomia is a situation that obstetricians are often faced. Independently of its etiology, the macrosomian exposed to major complications, dominated during delivery by the risk of shoulder dystocia, which is rare but dramatic situation, requiring the presence of a trained obstetrician ready to cope. We describe results of a retrospective study of 438 cases of confinement of newborn weighing 4000g or more, in our department trough one year period, from 1 January till 31 December 2007. Frequency was of 6.5%, maternal age >30 years old in 59% of cases, mothers average weight was over 80 kg in 56%. A family history of diabetes was found in 18.7%, primiparous was 31% while multiparity was 35%. The diagnosis of macrosomia has been suspected and identified only prior to work in 15.75%. Caesarean section was licited in 30% cases. The complications following vaginal delivery were shoulder dystocia in 22 cases. The neonatal complications were noted in 44 cases, they were represented by: hypoglycemia at birth [7%], 6 cases of acute foetal and one case of neonatal Jaundice. 17 cases were transferred to different pediatrics departments. The main observed maternal complications were represented by: 6 cases of postpartum hemorrhage, cervical tears in 12 cases, 21 vaginal tears and 16 cases of perineal tears, no case of uterine rupture or maternal death has been reported. By an appropriate management during macrosomic vaginal delivery, close monitoring and directed the work with a good command of obstetric maneuvers, we can reduce the risky associated with this delivery and woke it as a mangeable delivery of a non-macrosomic newborn

[Sertoli-Leydig tumor of UC]

It represents 1% only of all malignancies that mostly affects young women. Its histological diagnosis is difficult and unpredictable. Trough this observation and literature review, we will outline the difficulties of management of this tumour. Mrs. I.R 28 years old had a secondary amenorrhea of 4 months with a huge abdominopelvic mass. CT examination described a mars occupying the right adnexa of 23 cm diameter orienting suspected teratoma or other tumours of ovarian origin. During surgery, we discovered an enormous fibrocyotic necrotic and friable mass, at the expense of the right ovary, so a right ophorectomy was done. The pathological examination confirmed the diagnosis. The patient was clinically manifested by an abdominal distension, with signs of hyperandrogenism and or hyperestrogenism. So a hormonal examination was essential in case of virilization to eliminate abnormal adrenal anomaly. The imaging and macroscopie study showed a solid avarian mass with some well-demarcated intra mural cysts of varying size. Histological examination defines the tumour grade. There are six sub-types that are valued by the degree of tubular differentiation of the Sertoli cell component and the abundance of primitive gonadal stroma. Recurrences are early. The reported prognostic factors are: histologic grade, tumor rupture and the presence of a heterologous mesenchymal elements. The differential diagnosis poses a problem with other ovarian tumours. Treatment consists of a lumpectomy or unilateral oophorectomy for the benign forms than a bilateral oophorectomy and hysterectomy if the tumour is poorly differentiated or greater than the stage of IFGO. This tumour is characterized by its rarity and difficulty of diagnosis. It occurs in a nulliparous or paucipare, young women. The unpredictable evolution causes a radical problem in the management of this entity

[Prophylactic caesarean deliveries]

The rate of caesarean deliveries has increased in recent years. Among the major problems of the practitioners in this regard we find the choice of indications. The overall objective of this study is to profile information and compare with the practices of some teams described in the literature, while assessing the value of the programming of these cesarean vis- a- vis the maternal and fetal prognosis. This study aims to profile the indications of prophylactic caesarean deliveries and to assess the value of their programming in terms of maternal-foetal morbidity. 290 prophylactic cesareans were performed at the teaching maternity between January, 1[st] and December 31[st] 2007, divided into programmed prophylactic caesarean and prophylactic caesareans carried out urgently. The rate of caesarean sections was 17%. 26% of these caesarean sections were prophylactic, and were spread in 55% of programmed ones and 45% of urgent ones. The scarreduterus and the foetal-pelvic disproportion were two thirds of the indications in our series. The average gestational age of achievement of the prophylactic caesareans was 39 weeks. When the type of anaesthesia used, 2/3 o the programmed ones were done under spinal anaesthesia, while 86% of the urgent ones were under general anaesthesia. Wound infection was the prophylactic caesareans in two thirds of cases. The best conditions for programmed prophylactic caesareans compared to the prophylactic caesareans carried out urgently show the interest of programming, and justify the need for proper monitoring of all pregnanciesintensive care unit