[Laparoscopic resection of gastric stromal tumors]

Gastro-intestinal stromal tumors [GIST] are the most common mesenchymal gastrointestinal tumors. The Gastric location represents 60% of cases [1,2]. Complete surgical excision remains the treatment of reference for the localized forms. This surgery can be made by laparoscopy when the lesion's size doesn't exceed 5 cm. Some principles must e respected: a mono-block complete surgical resection, with healthy margins and without effraction. This technique will be reserved for trained teams and for selected cases according to the size and location. We herein try to explain the surgical laparoscopic excision of gastric stromal tumors explaining

Prevalence and risk factors of cesarean section in a population of Tunisian diabetic pregnant women

To determine the rate of and indication of cesarean section among women with preexisting and gestational diabetes mellitus compared with glucose-tolerant women. From case-control study of 400 Tunisian pregnant women [200 in group diabetes and 200 in group control] seen over a 5-year period for medical management, women who had a cesarean section were identified and the reason for the section determined from a review of the medical record. A control group of women who had a section were obtained from an existing data-base of glucose-tolerant women Women in group diabetes were significantly more aged, with higher BMI and birth weight than in control group [p<0, 05]. Global cesarean rate was significantly higher in diabetes group [50, 2%] than in control group [28, 2%] [OR=2, 72 IC[1, 76-4, 20]]. Rate of elective cesarean delivery was significantly higher in diabetes group [40, 5%] than in control group [8, 5%] [OR=4, 87 [2, 69-8, 90]]. However, vaginal delivery success rate when trial of labour was tried was similar in study groups [76%and 78%]. Most frequent indications for cesarean delivery in diabetes group were foetal macrosomia and scared uterus. Multivariate analysis showed that maternal obesity, unbalanced diabetes, unplanned pregnancy, and foetal macrosomia were significantly correlated to risk of cesarean delivery in diabetic women. Cesarean rate in our population of diabetic. pregnant women is higher than in group control. Maternal-obesity, unbalanced diabetes, unplanned pregnanc1, and foetal macrosomia were significantly correlated to risk of cesarean delivery in diabetic women

Fetal macrosomia at 4500 gm: prevalence and determinants

Foetal macrosomia with a weight higher than 4500g, is observed in approximately 1.5% of pregnancies at term. It is a high-risk condition for mother and infant with an important morbidity and mortality risk. The objective of our retrospective and comparative study [1999-2002] was to evaluate the prevalence of foetal macrosomia [birth weight >/= 4500 g] and to describe the maternal characteristics in pregnancies with foetal macrosomia. All births with a weight >/= 4500g [n°:321] were compared with two control groups, the first with a birth weight between 4000 and 4500g [n°: 240] and the second with a birth weight between 3500 to 4000g [n°: 241]. On our total of 12835 newborns, we had 2.9% with a birth weight >/= 4500g. The comparative study showed that the determining factors macrosomia were a maternal age of >/= 36 year, a parity of >/= 4, a maternal weight of >/= 90kg, a history of gestational family or macrosomia and history of diabetes mellitus in the family

Prevalence and risk factors of fetal macrosomia in diabetic women in Tunisian center

The objective of our study was to evaluate the frequency and the risk factors for fatal macrosomia in a population of Tunisian diabetic pregnant women. During five years, 400 pregnant women entered our case-control study, including 200 with diabetes and 200 as a control group. These pregnant women had a single foetus and were at term. The diabetes group was composed of 143 women with gestational diabetes and 57 women with pregravid diabetes. The women with diabetes were significantly older, multiparous and with a more elevated BMI than the women in the control group [p <0.01]. The risk of foetal macrosomia was significantly more associated with a BMI of > 30 [OR = 1.29], a poor diabetic control during pregnancy [OR = 9.41] and previous antecedent foetal macrosomia [OR = 7.93]. However, multivariate analysis after the control for confounding factors [BMI, term, and parity], limited the significantly increased risk for foetal macrosomia to the number of consultations and the insulin doses used in the third trimester of the pregnancy

Decollement sereux de la retine dans la pre-eclampsie severe. A propos de 2 cas

The serous detachment of the retina is a rare but serious complication of the severe preeclampsia. It's diagnosis rests on the systematic exam of the eye fundus at the time of the stern shapes of preeclampsia and especially at every change of the visual acuteness. Therefore the observed anomalies must be confirmed by the practice of a retina angiography in the following week. The observation of such complication at the pregnant wamen must induce the childbirth who is the only efficient treatment to preserve her visual prognosis. Usually the serous detachment of the retina disappears spontaneously in some days but some visual aftermaths can occurs in cases where papillary edema is prolonged or in cases of macular pigmentary migrations. As for foetal prognosis, it's often reserved