[Epidemiological and therapeutic management of adnexal torsion in adolescent: retrospective study of 22 cases]

Adnexal torsion is a real surgical emergency. It may occur in girls and teenagers. It may involve the ovary, the fallopian tube or both. The main symptom is acute pelvic pain. Diagnosis is based on clinical examination and sonography. Prognosis depends on the rapidity of the surgical management. To analyse the clinical features and the management of adnexal torsion in teenagers. 22 observations of young patients, who underwent surgery for adnexal torsion in our department of obstetrics and gynaecology between January 2000 and December 2007, were retrospectively analysed. A review of literature is discussed. The mean age of the cohort was 16.3 years [range 13-19years]. Clinically, most children presented with a sudden onset of a low abdominal pain [19 cases], a low-grade fever [8 cases], nausea and vomiting [11 cases]. Ultrasound scans showed pelvic or pelvi-abdominal masses in all cases. Laparoscopy was realized in 54, 54 per cent of patients [12 cases]. Adnexal necrosis was occurred in 6 cases. Adnexal torsion was severe in 4 cases and slight in 12 cases. A Conservative treatment could be realized in 16 cases [72,72 per cent]. No major postoperative complication was noted. Histopathology concluded to benign tumour in 15 cases. Adnexal torsion is an uncommon cause of severe lower abdominal pain in young girls and teenagers. Accurate and early diagnosis is necessary after the onset of clinical symptoms in order to preserve the viability of the ovary. Ultrasound scans are useful in these situations. Surgical investigation either by laparotomy or by laparoscopy is necessary for the diagnosis and the treatment. A conservative treatment should be tried as possible in these young patients

[Medical interruption of pregnancy for severe Takayasu's disease, about two cases]

Takayasu's arteritis is a rare clinical entity characterized by a progressive obliteration of the aortic arch and the main vessels arising from it. The association with a pregnancy may lead to some maternal and fetal complications. Nevertheless, a normal outcome of pregnancy is not rare if a careful follow-up is provided. We report the observations of two patients who underwent a medical interruption of pregnancy in the department of obstetrics and gynecology "A" of Charles Nicolle hospital in Tunis because of a severe multi-visceral localization of Takayasu's arteritis. The aim of our study is to stress on the maternal and foetal prognostic factors of this association

118 cases of orogenital tuberculosis in the south of Tunisia

The authors had for aim to study the epidemiological, clinical, therapeutic, and evolving features of urogenital tuberculosis [UGT] in the south of Tunisia. 118 patients presenting with UGT were retrospectively studied from January 1982 to December 2007 in South and Central Tunisia. The diagnosis of UGT was confirmed in all cases by clinical, biological, radiological, and/or histological data. 81 male and 37 female patients [mean age 38 years] were included. The most common presentation was storage lower urinary tract symptoms [57.6%]. General signs were observed in 25.4% of cases. The diagnosis of UGT was proven by bacteriological evidence [49.2%], positive bladder biopsy [12.7%], and pathological analysis of a surgical exeresis piece [68.6%]. The treatment was anti-bacillary chemotherapy for all patients, associated to a surgical excision [70.3%], reconstructive procedures [18.6%], and/or endoscopic manoeuvres [13.6%]. 80% of patients were regularly followed up for an average of 6 years. Favourable evolution was observed in 85.3% of cases. UGT remains a current severe disease because of the multiple risks that can result, especially for the renal function

[Isolated torsion of fallopian tube managed laparoscopically - a case report]

Isolated torsion of the fallopian tube is an uncommon event. Its incidence is estimated at 1 per 1 500 000 among women in genital activity. We report a case of isolated torsion of fallopian tube caused by a paraovarian cyst in a 24 years old patient presenting an acute pelvic pain, nausea and vomiting. The clinical examination revealed a mass of 7cm. Pelvic ultrasound showed an adnexal mass. The laparoscopy performed revealed a severe torsion of the left fallopian tube caused by a paraovarian cyst. Based on this experience as well as on other similar reported cases, characteristics of isolated torsion of the Fallopian tubes are discussed. This pathology should be considered in the differential diagnosis of acute pelvic pain in the female patient. Prompt surgical intervention may allow preservation of the tube

[Medical treatment of ectopic pregnancy with methotrexate about 69 cases]

Analysis of medical treatment of ectopic pregnancy with methotrexate. Via a retrospective study we have considered a sample of 69 patients having ectopic pregnancy treated with methotrexate [1mg/Kg IM]. All patients were diagnosed at the Gynecology and Obstetrics Unit A at Charles Nicole Hospital, Tunisia. the average age is around 32.8 years [19-43 years]. We have noted amenorrhea in 76.81%of cases while pelvic pain and vaginal bleeding were observed respectively in 68.11%and 75 .36%of the cases. The ultrasound examination highlighted an adenexal mass in 95.65%of cases. The average size was around 20.66 +/- 7.3 mm. The average level of beta HCG was around 1067.97mtJlJml with extremes between 42 and 4163 mUI/ml. A second MTX injection was necessary for 24 patients, while a third one was compulsory only for one patient. A success rate of 58%was observed after a single dose of MTX. The same rate goes up to 88.4%with a second dose and to 89.85%with a third one. We have observed a failure in 7 cases through a symptomatic hemoperitoneum. We have conducted an operative laparoscopy in five cases out of seven and laparotomy for the two other patients. The medical treatment with MTX is considered to be a pillar in the management of ectopic pregnancy. The variety and heterogeneity of the research studies available has Led to the absence of consensus over the proposed treatment

[Recurrent omphalocele a case report]

Abdominal wall defects include a broad spectrum of structural malformations with variable severity and prognosis. The purpose of prenatal ultrasound examination is to correctly diagnose and classify these malformations according to their localization [paincularly their relation to the umbilical cord insertion], their contents, their size and associated malformations or karyotypic abnormalities. We report one case of recurrent omphalocele which happened three times in the same patient

[Laparoscopic management of ectopic pregnancy about 166 cases]

The ectopic pregnancy [EP] is a frequent and serious pathology. It represents a medical and surgical emergency. To study the epidemiologic profile and to evaluate the laparoscopic management of ectopic pregnancy by comparing our results with those of the literature. Retrospective study of 166 cases of ectopic pregnancies treated by laparoscopy in the department of obstetric and gynaecology of the Charles Nicolle Hospital, over one period of five years [January 2002-December 2006]. The mean age of the patients was 32.07 years [21-41]. The mean parity was 1, 42 [27.71%when nulliparous]. 9.03%of our patients had a history of ER Clinical symptomatology was dominated by the pelvic pains and the bleeding in 90%of the cases. The amenorrhoea missed in 32 patients. The rate of beta HCG was superior to 1500 at 47.61%of the patients. The pelvic ultrasonography carried out in all the patients, objectified a pelvic mass in 81.92%of the cases. Serology of chlamydiaewas positive at 9.03%of the patients. The laparoscopy was initially indicated in 155 patients; a medical treatment with methotrexate was begun in the six other patients. A laparoconversion was indicated in 16 cases, 9 times for operational difficulties and 7 times for a hemorrhagic complication. A salpingectomy was practised in 79.72%of the cases. The treatment was conservative in 20.27%of the cases. The laparoscopic treatment at best conservative should be the gold standard in the treatment of EP in order to preserve the fertility of the patients. who are generally young

[Prenatal diagnosis of hemoglobinopathy: seria of 37 cases]

Objectives: to determine the main hemoglobinopathies in order to act for the reduction of the cases of homozygosis and this, by an early prenatal diagnosis

Methods: It is a retrospective study of 37 cases of antenatal diagnosis for hemoglobinopathies during a 5 years period and having detected 8 homozygous fetus

Results: The mean age of the patients was 32 years. 62 per cent of the patients were originating in the North-West of the country. 56.7 per cent of the patients had a marriage between blood relations. A family antecedent of hemoglobinopathy was noted in all of the cases. The age of the pregnancy at the time of the realization of the prenatal diagnosis was 15 weeks of amenorrhoea and 6 days. 75.7 percent of the patients had an amniocentesis and 24.3 per cent a chorionic villus sample. The detected homozygous fetus accounted for 12.6 per cent of the cases for which a medical interruption of pregnancy was practiced

Conclusion: Because of the frequency and gravity of the hemoglobinopathies in our country, of the recommendations to improve quality of tracking are in particular proposed the preferential recourse to the biopsy of the placental villi and, if necessary with the other methods of taking away when the request of the prenatal diagnosis is late