[Outcome of malignant vulvar tumors]

Vulva anatomy - FIGO classification- Vulva tumors anatomopathology - Treatments of vulva cancers. Our study is a retrospective, longitudinal and continuous one. It concerns 11 malignant vulva tumors which were treated in the d‚partement "C" of the centre of maternity of Tunis. The period of study is fifty four months [2002-2006]. The aim of our study is to analyse the characteristics of the vulva cancer and to compare our results to litterature. Mean age of our patients is 67 years old. They are all menaused. The principal signs are vulva tum‚faction in 72,7% of the cases, vulva pruritis in 27,3% of the cases and genital bleeding in 27,3% of the cases. The mean period of consultation is of 14 months. We have ten cases of vulvar epidermoid carcinoma and one melanoma. The treatment was surgical in the eleven cases [10 total vulvectomy and one hemivulvectomy] They all benefited of an inguinal bilateral curage. The adjuvant radioth‚rapie was indicated in 3 cases. A patient was classed stage lb of FIGO, 7 stage II, one stage III and one stage IVA. Nine patients are in remission, 3 are dead: 2 because of their cancer and one due to a pulmonar embolism. The survival of 6 month is 72, 2%.The prevention of this cancer passes by the close follow of dystrophic states and viral pathologies of the vulva

Usefulness of colposcopy in inflammatory vagin frottis

The cervical cancer is the second most frequent cancer of the woman in Tunisia. It is considered as a sexual transmissive desease due to the involvement of the HPV. The purpose of our study is to proove that an inflammatory cervical smear should be considered as a positive test and must lead to other investigations. It is a prospective study over 140 cases of inflammatory cervical smears [without atypical cells] diagnosed during a year period from June 2001 to June 2002. These patients had a systematic colposcopy with the biopsy of suspicious lesions. The mean age of our patients is 42 years. 68.57% of them are in active genital period. The colposcopy was normal in 10% of our patients. It showed benign lesions such as: ectropion in 22.85%, colpitis in 14.28%, cervical polypus in 5%, normal transformation zone in 8.57%, but also suspicious lesions such as: atypical transformations grade I [ATGI] in 25.71% and atypical transformations grade II [ATGII] in 13.57%. The biopsies made on 89 patients showed dysplasia and carcinoma in 18.57% of them. A case of in situ carcinoma, a microinvasif epidermoid carcinoma and an invasif glandular carcinoma were diagnosed. Colposcopy is an ambulatory investigation. It makes a minutious study of the cervix and diminishes the rate of false negative made by the cervical smear

[Fetal and maternal prognosis of breech presentation at term]

Introduction: Breech presentation is associated with increased fetal, neonatal and maternal risk. The purpose of this study was to assess the prognosis of this presentation near or at term

Patients and methods: This retrospective study included all deliveries with a breech presentation and a gestational age over 34 weeks in our service between January 2000 and December 2005

Results: 243 deliveries were indexed throughout the study period.141 patients delivered by prelabor planned cesarean section and 47 by cesarean section during labor. 2 cord prolapses were found [0.8%]. 8 babies [3,3%] had a 5 minute Apgar scores < 7 and we observed 5 admissions to the neonatal unit. There were 2 birth trauma and 2 perinatal deaths

Conclusion: Breech delivery is a risk for mother and newborns. Development of measures and standards for obstetric practice would help improve its prognosis

[Pregnancy and fetal autcomes in macrosomic delivery about 400 cases]

Fetal macrosomy represents a materno-fetal high-risk pathology in front of which obstetricians face diagnostic, therapeutic and prognostic problems. We report a retrospective analytical study of 400 deliveries of macrosomes brought together in the gynaecology and obstetrics C departement of the maternity center of Tunis over a period of 4 years from 1997 till 2001. The aim of our study is to stress on the materno-fetal risk factors of macrosomy. The frequency the macrosomy was of 7, 11%. The average maternal age was of 30, 9 years. Pathologies associated with pregnancy were dominated by gestational diabetes in 19% of cases and by toxemia in 17% of cases. The antecedents of big baby were noted in 23% of cases. Screening of macrosomy was based on excessive uterine height [>35 cm] found in 43 % of cases and near term ultrasounds, which suspected macrosomy in 21, 8% of the cases. Delivery was made naturally in 68 % of the cases, with instrumental help in 5, 25% of cases and by cesarian section in 32% of cases. The mean weight of macrosomes was of 4233g. Maternal complications were dominated by delivery hemorrage in 2% of cases and obstetrical trauma in 2, 75% of the cases. Fetal complications were dominated by shoulder dystocia in 2, 25% of the cases, respiratory distress 2, 75% of cases and hypoglycemia in 2% of the cases

[Inaugural diabetic acido-ketosis during pregnancy]

Ketoacidosic decompensation is still an important cause of morbidity, and mortality in diabetic patients. This complication may inaugurate the disease and its occurrence in pregnancy is a medical and obstetrical emergency that puts both mother's and foetus' life at risk. We report two cases of inaugural ketoacidosis in patients 27 and 14 years old, at 36 and 25 weeks of amenorrhea [WA]. With reanimation and insulinotherapy, evolution was favorable with a cesarean section delivrery at 36WA+3d and 35WA+3d of healthy children who weighed 2900g and 1970g. Persistance of high glucose values in postpartum required continuance of insulinotherapy for one patient and oral antidiabetic agents for the second