[Interest of laparoscopy in infertile couple with normal hysterosalpingography]. / Faut-il cœlioscoper les femmes infertiles ayant une hystérosalpingographie normale.

OBJECTIVES: The diagnostic laparoscopy has long been the key consideration in the export of female infertility. This place is being reconsidered, especially in the case of normal hysterosalpingogrophy (HSG), because of the advent of assisted reproductive technologies which are more efficient, and because of the improvement of medical imaging techniques which are more sensitive and specific. We wanted to clarify the place of the diagnostic laparoscopy in the balance of female infertility in normal HSG. PATIENTS AND METHODS: It is a retrospective study on a series of 100 observations of infertile patients with a normal HSG and having a diagnostic laparoscopy in the department of Gynecology and Obstetrics at Farhat Hached hospital in Sousse (Tunisia) from 1st January 1993 to 1st March 2003. RESULTS: The mean age was 32.3years; the mean duration of infertility was 70.47months. Laparoscopy revealed pelvic abnormalities in 45% of cases, dominated by disease tubo-adhesions (23%), endometriosis was found in 6% of cases. These anomalies are considered major in 23% of cases and minor in 22% of cases. Conducting a surgical procedure in the same operating time (adhesiolysis, tubal plastic surgery, electrocoagulation of endometriosis implants) could improve the prognosis of fertility. Only 20 patients were followed among the 45 with pelvic abnormalities, seven pregnancies have been completed (35% of cases). DISCUSSION AND CONCLUSION: Laparoscopy has improved the prognosis for the fertility of our patients by treating abnormalities involved in infertility. It is estimated that the prognosis can be improved by selecting patients with risk factors for pelvic abnormalities.

[Holoprosencephaly: pathogenesis, phenotypic characteristics. About four cases]. / L'holoprosencéphalie : étiopathogénies et caractéristiques phénotypiques. À propos de quatre observations.

Holoprosencephaly is a rare brain abnormality resulting from an incomplete cleavage of the primitive prosencephalon of forebrain during early embryogenesis. It includes a series of rare complex and heterogenosis disorders. Alobar form is associated with an extremely poor fetal prognosis. Here we report three cases of alobar holoprosencephaly and one case of semilobar holoprosencephaly diagnosed at the third trimester. Causes, diagnosis and management of holoprosencephaly are discussed referring to literature.

[Diabetic mastopathy]. / Mastopathie diabétique.

Diabetic mastopathy is a recently described pathological entity. Little is known about this benign condition. It usually occurs in young patients with type 1 diabetes, or having an autoimmune disorders. Clinically, this mastopathy simulates a breast cancer. Graphic tests are not very informative. The diagnosis is histological. Through a case of diabetic mastopathy occurring in a patient with diabetes on insulin for 16 years and carries multiple degenerative complications, we recall the clinical, radiological and outcome of this disease.

[Role of deambulation during labour: A prospective randomized study]. / Intérêt de la déambulation au cours du travail obstétrical : étude prospective randomisée de 200 cas.

OBJECTIVE: To assess the effects of ambulation during the first stage of labor on the duration of labor and other maternal and infant outcomes. PATIENTS AND METHODS: A prospective randomized trial conducted from 1st November 2008 to 31st March 2009 at the department of obstetrics and gynecology, CHU Farhat Hached, Sousse, Tunisia. Two hundred mothers with uncomplicated term pregnancies were randomly assigned to one of two groups: first group (100 parturients) authorized to ambulate until 6cm of cervical dilation and a second group (100 parturients) confined to bed in dorsal or lateral recumbence. RESULTS: Upright position reduces significantly (for about 34%) the duration of the first stage of labor (P<0.0001), the pain intensity, the oxytocin consumption (P=0.001), the rate of delivery by cesarean section and of instrumental deliveries. Upright position leads also to a net improvement of the maternal outcome (7% side effects versus 13%) and the fetal outcome (net improvement of the Apgar's score at first and fifth minute, and reduction of a factor 5 of the rate of transfer to the neonatology clinical care unit. CONCLUSION: Our study allowed to confirm the benefits of ambulation on labor progress as well as on the maternal comfort and the maternofetal outcome.

[Cephalopagus conjoined twins: case report and review of literature]. / Les jumeaux conjoints céphalopages: à propos d'une observation avec revue de la littérature.

Cephalopagus are a rare variant of conjoined twins resulting from an incomplete late division of the embryonic disk and associated with an extremely poor fetal prognosis. Here, we report a rare case of a male cepahalopagus conjoined twins diagnosed during the 23rd week of gestation. Delivery was vaginal showing twins fused from the top of the head to the umbilicus. The fused skull showed a cephalocele with agenetic brain. Esophagus, stomach and duodenum are common for the two twins. Causes, diagnosis and management of cephalopagus are discussed referring to literature.

[Primary non-Hodgkin's lymphomas of the breast. Report of two cases]. / Les lymphomes malins non-hodgkiniens primitifs du sein: á propos de deux cas.

Non-hodgkin's lymphoma (NHL) represents 0.04 to 0.53% of all breast cancers. The clinical aspects and therapeutic models of the disease are a subject of debate. We report two cases of primary non-hodgkin's lymphoma of the breast in two patients aged respectively 37 and 57 years. The disease was revealed by breast nodules. Mammography demonstrated a benign cyst. The diagnosis of non-hodgkin's lymphoma was confirmed on histological examination of tumor biopsies. With chemotherapy, the course was favorable with 29 and 52 months follow-up respectively. This is rare tumor. The diagnosis is mainly histological. Chemotherapy is the principal therapeutic method.

[Adenosarcoma of the uterus: a case report]. / L'adénosarcome utérin: à propose d'un cas.

Adenosarcoma of the uterus has two components: a benign epithelial proliferation and a stromal sarcoma. The purpose of this work was to report the clinical aspects and therapeutic modalities of an exceptional case of uterine adenosarcoma in a 15-year-old girl revealed by pelvic pain. Physical examination disclosed a polypoid formation protruding through the hymenal orifice. Histology of the mass confirmed the diagnosis of adenosarcoma of the uterus. The patient underwent hysterectomy and was given chemotherapy. This rare tumor (8% of uterine sarcomas) generally requires hysterectomy. Prognosis is relatively favorable.