Accuracy of preoperative real-time dynamic transvaginal ultrasound sliding sign in prediction of pelvic adhesions in women with previous abdominopelvic surgery: prospective, multicenter, double-blind study.

OBJECTIVE: To investigate the role of the transvaginal sonographic (TVS) sliding sign in predicting pelvic adhesions in women with previous abdominopelvic surgery. METHODS: This was a multicenter, prospective, interventional, double-blind study of patients with a history of abdominopelvic surgery who were undergoing laparoscopy or laparotomy during the 6-month period from March to August 2016 in one of three academic obstetrics and gynecology departments. Prior to surgery, patients were examined by TVS to assess the vesicouterine pouch, uterus, ovaries and pouch of Douglas, using the TVS pelvic sliding sign. Ultrasound findings and medical and surgical data were recorded. We assessed the accuracy of the preoperative TVS sliding sign in the prediction of pelvic adhesions overall and in each compartment separately. RESULTS: During the study period, complete TVS sliding sign and laparoscopic or laparotomic data were available for 107 women. Their mean age was 44.0 (95% CI, 41.6-46.4; range, 20-79) years. Their mean parity was 2.0 (95% CI, 1.7-2.3; range, 0-9) and the mean number of previous abdominal surgical procedures per patient was 1.3 (95% CI, 1.2-1.5; range, 1-4). Adhesions were noted in 27/107 (25.2%) patients. The TVS sliding sign had a sensitivity of 96.3% and specificity of 92.6% in predicting pelvic adhesions. There was a significant relationship between adhesions in each compartment and the TVS sliding sign (P < 0.05). CONCLUSIONS: The TVS sliding sign is an effective means to detect preoperatively pelvic adhesions in patients with previous abdominopelvic surgery. Use of such a non-invasive and well-tolerated technique could help in the planning of laparoscopy or laparotomy and counseling of these patients. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.

Sonographic landmarks to differentiate "false labor" and "early true labor" as a possible new application of ultrasound in labor ward.

OBJECTIVE: To evaluate discrimination of clinical parameters and ultrasound examination to differentiate "false labor" and "true labor". METHODS: In a prospective study during a period of 6 months, a total of 178 patients in term (37-41 weeks) consulting our obstetric unit for uterine contraction, were enrolled. Patients were examined separately by a midwife and a resident and separated into "true labor group" and "false labor group". The clinical characteristics of true versus false labor patients were compared. ROC curves were developed to determine an optimal cervical length and uterocervical angle for prediction of true labor. RESULTS: The prevalence of real labor was 57.3%. Patients who were in true labor had more painful and more frequent contractions. The "true labor" group had shorter cervical length and larger uterocervical angle. The optimal CL cut-off was 1.4mm with a specificity of 73% (RR 4.3, sensibility 63%, PPV 14%, NPV 95%). The optimal UCA cut off was 123° (RR 6.7, sensitivity 50%, specificity of 83%, PPV 10%, NPV 96%). The best performance was demonstrated by combined testing, yielding LHR+ that rich 13. CONCLUSION: In this study, we reported a new application of ultrasound to identify false labor and avoid unnecessary hospitalization with obstetric and adverse economic impacts.

[What's the optimal time of cesarean section antibiotic prophylaxis, before skin incision or after umbilical cord clamping? A prospective randomized study]. / Quel est le moment optimal de l'antibioprophylaxie pour césarienne élective, avant l'incision cutanée ou après clampage du cordon ombilical ? Étude prospective randomisée.

OBJECTIVES: To compare the effect of antibiotics prophylaxis within 30 mins before skin incision (A) and after umbilical cord clamping (C) on the incidence of postoperative infections in patients undergoing elective caesarean section at Farhat Hached university teaching hospital. MATERIALS AND METHODS: We conducted a randomised clinical trial evaluating 279 patients undergoing elective caesarean section. Patients were randomly assigned a group number that allocated them to either arm of the study. They received the same prophylactic antibiotic (cefazol® 2g) according to their allotment. They were followed up to detect infection up to 30 days postoperatively. The primary outcome was postoperative infection. The data collected were analysed with SPSS version 18.0 using univariate and bivariate analysis. RESULTS: The risk of overall postoperative infection was not significantly lower when prophylaxis was given before skin incision (4.37 % (A) vs 9.85 % (C); P=0.07; OR=0.42 [0.15-1.12]). We also found wound infections to be significantly reduced in the pre-incision group (2.2 % [A] vs 8.45 % [C]; P=0.03; OR=0.24 [0.06-0.88]). However, there was no difference in the endometritis infectious. On the other hand, there was no negative impact on the neonatal features. CONCLUSIONS: Giving prophylactic antibiotics before skin incision reduces risk of postoperative infection, in particular of wound infections.

Ultrasound cervical length measurement in prediction of labor induction outcome.

Induction of labor is one of the most common procedures in modern obstetrics, with an incidence of approximately 20% of all deliveries. Not all of these inductions result in vaginal delivery; some lead to cesarean sections, either for emergency reasons or for failed induction. That's why, It seems necessary to outline strategies for the improvement of the success rate of induced deliveries. Traditionally, the identification of women in whom labor induction is more likely to be successful is based on the Bishop score. However, several studies have shown it to be subjective, with high variation and a poor predictor of the outcome of labor induction. Transvaginal sonography for cervical measurement can be a more objective criterion in assessing the success of labor induction. Many studies have been done recently to compare cervical measurement and Bishop Score in labor induction.This paper reviewed the literature that evaluated sonographic cervical length measurement to predict induction of labor outcome.

Bishop Score vs. ultrasound cervical length in the prediction of cervical ripening success and vaginal delivery in nulliparous women.

AIM: The aim of this paper was to compare the predictive value of Bishop Score and sonographic measurement of cervical length for predicting cervical ripening success and vaginal delivery in nulliparous women with low Bishop Score. METHODS: A prospective observational study including 77 nulliparous pregnant women at exactly 41 weeks of gestation with a Bishop Score ≤ 5. Cervical measurement was performed by transvaginal ultrasonography and Bishop Score was determined by digital examination. All patients had cervical ripening with Prostaglandins prior to labor induction with oxytocin. RESULTS: Cervical ripening was successful in 63 patients (81%) and vaginal delivery occurred in 51 women (66.2%). Multiple logistic regression analysis demonstrated cervical length assessed by transvaginal sonography as the only independent predictor of successful cervical ripening and vaginal delivery. The best cut-off point was 34.6 for predicting successful cervical ripening and 32.5 mm for predicting vaginal delivery. The chance of vaginal delivery was 90% when initial cervical length was < 32.5 mm and 50% when cervical length was >32.5 mm. CONCLUSION: Compared with the Bishop score, ultrasound cervical length measurement is a better predictor of cervical ripening success and vaginal delivery in nulliparous women at 41 weeks of gestation with an unfavorable cervix.

[Yolk sac tumor revealed by an ascite of great abundance]. / Tumeur vitelline de l'ovaire révélée par une ascite de grande abondance.

We report the case of a 16-year-old girl explored for an ascite of great abundance responsible for a respiratory embarrassment. Its symptomatology proved to be secondary to a vitelline tumour of the ovary. It required several drainings of ascite before surgical operation. She had a conservative treatment followed up by a chemotherapy which allowed a clinical and biological remission. We report this observation considering the originality of the mode of revelation of the tumour. We insist in addition on the possibility of a conservative treatment.

[Imperforate hymen: Can it be treated without damaging the hymenal structure?]. / Imperforation hyménéale : peut-on la traiter en préservant la virginité ?

UNLABELLED: Imperforate hymen is a rare congenital anomaly, with an incidence of about 1 in 2000 female births. It is generally diagnosed during puberty. Treatment generally consists of a hymenotomy or a hymenectomy. Because the hymen is a symbol of virginity in some communities, its destruction can be source of social problems for some girls. OBJECTIVES: We discuss the diagnostic but especially therapeutic aspects of imperforate hymens and possible surgical techniques, in particular those that preserve the hymen. MATERIAL AND METHODS: We describe the cases of 5 girls treated in our department for imperforate hymen between 2001 and 2007. Two of them required the safeguarding of the normal architecture of their hymen to preserve the appearance of virginity. We analysed diagnostic features and surgical techniques. RESULTS: The average age of our patients was 14.8 years (range: 11 and 17 years). The most frequent reason for consultation was pelvic pain with primary amenorrhea. Inspection of the vulva revealed in all cases a dome-shaped purplish-red hymeneal membrane. Hymeneal incision allowed drainage of old previously blocked menstrual blood. Three patients were treated by radial incisions of the hymen. The parents of 2 patients demanded that their hymens be preserved. Accordingly, one had a simple excision of a central flange of the hymen and the other was treated by a similar technique that also used a Foley catheter . All five patients did well after surgical treatment. The techniques used to preserve the hymen resulted in an apparently intact annular hymen. CONCLUSION: Imperforate hymen is a rare anomaly. Its diagnosis is simple. The traditional technique of radial incisions is a simple procedure that yields good results. The technique using the Foley catheter is an adequate alternative when preservation of the hymen is required.

[Intestinal invagination after vagotomy in adults]. / Invagination intestinale après vagotomie chez l'adulte.

Intestinal intussusception is a rare condition in adults. In most cases, it is caused by a benign or malignant intestinal tumor. Primitive forms are infrequent, and their occurrence following troncular vagotomoy has never been described in the literature, according to our knowledge. Two cases of post-vagotomy jejuno-jejunal intussusception are reported.

[Partial splenectomy in thalassemia major. Apropos of 19 cases]. / La splénectomie partielle au cours des thalassémies majeures. A propos de 19 cas.

Nineteen cases of B Thalassemia have benefited from partial splenectomy at the General Surgery Service of Farhat Hached Hospital in Sousse (Tunisia). The partial splenectomy indication was to reduce hypersplenism, thus transfusion needs, to suppress splenic pain and to conserve a splenic remnant, which preserves patients' immunity. The operation was in reality a subtotal splenectomy keeping the lower pole in all cases. We had no per-operatory complication. The preoperatory bleeding was not more serious than in total splenectomy. In all the patients, we noticed reduction of about half the transfusion need, except one who had also a chronic deficit in glyco-six phospho-dehydrogenase. The average hemoglobin rate increased from 60 g/L in the pre-operatory to 80 g/L after the operation. Consequently, this reduction of transfusion needs results in the decrease of the hemochromatosis, which is one of the main complications of hypertransfused thalassemia.

[Partial splenectomy requiring ligation of splenic vessels. Apropos of 40 cases]. / Les splénectomies partielles avec nécessité de ligature des vaisseaux spléniques. A propos de quarante cas.

Conservative treatment of the spleen is generally based on segmental terminal vascularization of the spleen. The practise of partial splenectomies in the case of major trauma and hilar hydatid cyst led us to perform subtotal splenectomies after splenic vessel ligation. The upper pole splenic remnant after reduction of its volume, remains vascularized by other short vessels through the gastro-splenic ligament. The lower pole splenic remnant remains vascularized by the left gastro-epiploic artery. The follow-up of 40 subtotal splenectomies performed in these conditions revealed better results than those obtained after spleen autotransplantation in the omentum. Conservation of all the vessels of the gastro-epiploic ligament allows gastric transposition of the spleen.

[Cysto-hepatic ducts; surgical consequences. Apropos of 29 cases]. / Les canaux cysto-hépatiques; conséquences chirurgicales. A propos de vingt-neuf cas.

Cysto-hepatic ducts are a rare entity constituting less than 2% of biliary tract operations. Twenty-nine cases have been encountered in our General Surgical Service between 1980 and 1989. The frequency is about 2.3% in a series of 1,265 operative and/or postoperative cholangiographies analysed during the same period. Cystohepatic ducts were discovered in 3 cases at dissection, in 10 cases on operative cholangiography, in one case after biliary tract lesion, and in 15 cases on postoperative cholangiography. The cystohepatic duct was voluntarily or involuntarily respected in 23 cases, voluntarily ligated in one case, involuntarily in 2 others, cut and drained outside in one case, injured and repaired in one case, and cut in another. From our experience, we conclude that the roles of dissection of the cystic duct and the recognition of well known biliary bifurcation do not permit in all cases to avoid common bile duct lesions, particularly in the presence of an unforeseeable and dangerous variant such as a cystohepatic duct draining a large hepatic territory. As a result, the first stage of cholecystectomy should not be dissection of the biliary bifurcation, ligation of the cystic duct and its intubation but especially dissection of all elements of Budd's triangle before intubation of the supposed cystic duct. This avoids leaving upstream from the sectioned cystic duct, an hepatic territory not drained by the common bile duct. A good quality systematic operative cholangiography reveals in the other cases this anatomical variant and constitutes an essential medico-legal document for the patient's and surgeon's safety.

[Conservative treatment of the spleen. Report of 50 cases]. / Le traitement conservateur de la rate. A propos de cinquante cas.

From 1983 to 1989, 50 patients have been treated by spleen conservation. Traumatism was iatrogenic in 9 cases, caused by public highway accidents in 31 cases, domestic accident in 9 cases and penetrating trauma in one case. Spleen conservation includes: 26 partial splenectomies, 11 cauterisations, 10 sutures, 5 auto-transplantations, and 3 abstensions after laparotomy and little spleen trauma. Three deaths were observed secondary to cerebral trauma, and two complications have been seen: one during the operative solved by total splenectomy, and one rebleeding after splenorraphy, reoperated and splenectomy was performed with good evolution. The follow-up of partial splenectomy showed that splenic remnant keeps an epuration activity.

[Exogastric cystic schwannoma. Observation of a case]. / Schwannomes kystiques exogastriques. Réflexions à propos d'un cas.

The authors report a case of giant gastric schwannoma with dominating extra-gastric development and a cystic component simulating a pancreatic pseudo-cyst on ultrasound and computed tomography examination, the diagnosis was made only at surgery that consisted in total gastrectomy. The rarity of these tumors, their diagnostic difficulties and the particularities of their surgical treatment are outlined.