[Role of the hysteroscopy and laparoscopy in managementof the female infertility: about 200 cases]

Infertility is a common disease which affects nearly 10% of women at reproductive age. The hysteroscopy and laparoscopy are becoming very important in the management of this pathology. We tried to assess the current results of both hysteroscopy and laparoscopy, to study the prognosis factors as well as operating techniques and to clarify their contribution in comparison with other therapeutic techniques. This is a retrospective study about 200 cases of hysterolaparoscopy performed for female infertility in women admitted at the department of Gynaecology and Obstetrics in Mongi Slim's Hospital La Marsa. The hysteroscopy was abnormal in 75% of cases: the uterine synechias [23%], endometria hypertrophy [19%], endometrial polyps [10%], uterine fibroids [9%], atrophy [7.5%] and malformations [3.5%]. The operating hysteroscopy procedure was performed in 27.3% of cases with a rate of subsequent pregnancy in 34.9%. There is different data between the hysterosalpingography and hysteroscopy in 34.8%. The operating laparoscopy was performed in 70% of cases divided between adhesiolysis [27.2%], tubal surgery [37.8%], electrocoagulation or excision of endometriosis nodule [17.2%] and ovarian drilling for PCOS [17.8%]. The rate of pregnancy is 39.9% after laproscopic surgery [divided between intrauterine pregnancy 37.1% and ectopic pregnancy 2.8%]. The data of the hysterosalpingography and laparoscopy are different in 21.1%. Hysteroscopy and laparoscopy are diagnosing and treating both uterine and tubal infertility as well as some ovarian abnormalitis.They have, thus, the main role in diagnosis and treatment of female infertility.They permit to correct data from the HSG in more than a quarter of cases and to improve the rate of pregnancy in more than one third of cases

[Ovarian cyst: comparison between sonography, coelioscopy and patholy about 100 cases]

The ovarian cysts are a common pathology in gynecology. The aim of our study is to confront ultrasound and coelioscopic data in final anatomo pathological diagnosis of ovarian cysts and to assess the efficiency and the morbidity of coelioscopic treatment. We report a retrospective study of 100 ovarian cysts collected in CHU of Mongi Slim La Marsa from October 1st, 2003 to November 30th, 2007. The coelioscopic exploration coupled with the extemporany review has a sensitivity of 100%. The benefits of coelioscopy are: less esthetic desagrement, a decrease in morbidity per and post operatory and economic benefit. The risk of ignoring a malignant lesion is not zero with a risk of spread tumor .That's why it must respect strict rules and convert if malignancy is suspected. Coelioscopy has let a reliable diagnosis of malignancy with a low morbidity, it is an efficient and comfortable technic for patients

[Fetal cystic hygroma antenatal diagnosis, prognosis and management]

Fetal cystic hygroma is a rare congenital malformation. The incidence of this pathology is 1/700 pregnancies. This malformation can be seen at antenatal ultrasonography from the end of the first trimester of pregnancy. The prognosis depends on chromosome analysis, other ultrasound abnormality and the size of the fetal cystic hygroma. Starting from a case diagnosed in the prenatal follow up and from literature review, the authors discuses the ultrasound diagnosis, prognosis and management of this malformation

[Malignant degeneration of mature benign teratoma of the ovary: a case report]

Malignant transformation of ovarian mature benign teratomas is an uncommon complication which often occurs in the postmenopausal period. Clinical presentation is similar to that of benign ovarian cysts. The diagnosis of malignant transformation is often made per-operatively by the break of the capsule and the adhesions of the tumor or during histological examination. The diagnosis is based on the association between a mature teratoma and a non metastatic unitissular, carcinoma or sarcoma. All histological forms can be met, but squamous cell carcinoma accounts for 75% of all cases. We report the case of a 70-year-old woman who had a squamous cell carcinoma which developed on a teratoma of the ovary, for whom the disease was fatal. The survival rate for this kind of ovarian tumour is reduced, with 15 to 30% survival after 5 years, irrespective of stages and histological types. Although it is not easy to define the best requested therapy, surgery associated with polychemotherapy or radiotherapy is apparently the only way of improving the poor prognosis for these tumours

[Adolescent's pregnancy and foetal maternal prognosis]

The adolescent's pregnancies is not rare. In the clinical view the maternal prognosis is better than the foetal which is reserved. In fact the rate of prematurity, intra-uterine under development, genetous malformation and perinatality death is increased. In the psychosocial view, these pregnancies occurs problems specially the relationship between mother and child and real social break of these adolescents