[Neonatal and maternal prognosis in the delivery of a single large fetus at term. Apropos of 497 cases]. / Le pronostic néonatal et maternel de l'accouchement d'un gros foetus unique à terme. A propos de 497 cas.

We have studied 497 deliveries of large fetuses over a period of two years from 1/1/86 to 31/12/87 in the Maternity Unit of Aziza Othmana. We understand by the term "large fetus" the delivery of a baby weighing 4 kg or more. From this study it appears that: the overall incidence is 6.8% of the deliveries; fetal macrosomia occurs much more frequently in multiparous women who are older; 18.4% of these had large babies previously; diabetes occurred in only 11% of the population studied. We study in this article the complications due to fetal macrosomia during pregnancy, labour and following the delivery. We unfortunately have to report: at fetal level: the mortality is 1.2% and the morbidity is 3.6%; at maternal level: the mortality is nil, the morbidity is 4.6%. Several factors affecting the prognosis were analysed in order to look at the subject from the aetiological and prophylactic points of view (these were the method of delivery, the obstetrical factor, the maternal factors, the factors linked to labour, the factors linked to the pregnancy and other factors).

[Cancer of the cervix uteri in Tunisia. Clinical presentation and development over a 10-year period]. / Le cancer du col utérin en Tunisie. Présentation clinique et évolution au cours d'une période de 10 ans.

Carcinoma of the cervix is still common in Tunisia, where it occupies second place among malignant diseases in women. Accounting for 17% of the female population of the National Cancer Institute of Tunis, it is preceded only by breast cancer (27%). Study of the factors concurrent with the origin of carcinoma of the uterine cervix seems to indicate that its decrease is secondary to the lowered average age at marriage, to the fall in the reproduction rate among the population at large, and to improved socio-economic conditions among the poorer classes. Study of clinical features observed during two separate periods of 10 years shows a modification in the physiognomy of this cancer, with, notably, a larger frequence of lower stages (45% of stage II in 1984 vs 20% in 1974) and a slight tendancy towards the discovery of smaller non - or early - infiltrating tumors (4% in 1984 vs 0% in 1974). Efforts must continue to be made in the domaine of early detection, especially among the "high risk" population.

[Current anatomo-clinical aspects of genital tuberculosis in women. Apropos of 49 cases]. / Aspects anatomo-cliniques actuels de la tuberculose génitale de la femme. A propos de 49 cas.

Genital tuberculosis is a rare disease in Anglo-Saxon countries but it is still present in our country in spite of a small reduction in the numbers due to the advent of anti-tuberculous drugs and of BCG. Our study derived from 49 cases histories shows that this is an illness that affects young women who become absolutely infertile. Laparoscopy, hysterosalpingography and biopsy of the endometrium are the most efficient ways to make the diagnosis quickly. While anti-tuberculous treatment given routinely is very good at curing the tuberculous infection, it does not improve the prognosis for fertility. Finally, very few cases are diagnosed on screening and it is important to continue the fight to eradicate this disease. The most effective measure among others is vaccination with BCG.

Battered child syndrome simulating myositis.

The battered child syndrome is not an unusual problem to be encountered in a clinical orthopedic practice. The manifestations in abused children may be varied and many, necessitating that orthopedists be familiar with the ways in which affected children present to reduce the unfortunate consequences that occur when abuse is not initially recognized. Our purpose in reporting the case of an abused child is to attract the attention of the orthopedic surgeon, who may be the initial physician to see a battered child, to an unusual presentation of this syndrome which simulated myositis. The association of myositis with battered child syndrome has not been previously encountered in the orthopedic literature.