[Leiomyoma of the bladder causing the destruction of a kidney]. / Léiomyome vésical entraînant la destruction d'un rein.

Leiomyoma of the bladder is a rare benign tumor deemed to have a good prognosis after surgical treatment. This is unfortunately not always true. We report the case of a 33 year-old patient who consulted for lumbar pain on right side. Exploration of patient revealed bladder floor solid tumor with non-functioning right kidney and left urinary tract dilation. Cystoscopy objectified solid tumor of the right perimeatal bladder. Tumor biopsies were performed together with the insertion of a left double J stent. Anatomo-pathologic study showed leiomyoma of the bladder. The patient underwent laparoscopic myomectomy. The postoperative course was uneventful. Pathological effect and sequelae was complete distruction of kidney.

[Fibroids and pregnancy: complications]. / Fibrome et grossesse: les complications.

AIM: To study the maternal and fetal morbidity in the association fibroid and pregnancy and the management in this case. METHODS: A retrospective study of 80 cases of fibroids associated to pregnancy. These cases were taken from the department "C" of gynecology and obstetrics in the center of maternity and neonatology of Tunis. RESULTS: We studied 80 cases of fibroid associated to pregnancy in our study. The mean age of the patients was 32 years old. 45 % of the patients were primipares. The interstitial fibroids (68 %) are the most frequent. The average number of fibroid is 1, 7 in each pregnancy. The aseptic necrobiosis is the most frequent complication of the fibroid whereas for the mother the main complications are the premature delivery, the premature rupture of membranes and the placenta praevia during the third term of pregnancy. The dystocic presentations are more frequent than in the general population, responsible of a higher rate of caesarian sections. The delivery hemorrhage constitutes the most frequent complication of the post partum. The fetal prognosis is globally good with a morbidity dominated by growth restrictions but with no superior mortality rate. The myomectomy was practiced during the caesarian section in 3 cases, the abstention being the rule for the other patients. CONCLUSION: The association fibroid and pregnancy is not rare, the complications are frequent that is why it is considered as a high risk pregnancy. An early detection of the complications and a prevention of delivery hemorrhage would reduce the maternal and fetal morbidity.

[Management of liver disease during pregnancy]. / Prise en charge des hépatopathies chez les femmes enceintes.

BACKGROUND: Several liver diseases can be observed during pregnancy. Some are proper to pregnancy and others are not. AIM: To study and to analyze the different liver diseases encountered during pregnancy and describe their management. METHODS: Retrospective study of 97 patients having a liver disease during their pregnancy, the cases were managed in the department "C" of obstetrics and newborn of Tunis. RESULTS: The prevalence of hepatopathy associated to pregnancy was 1.61 in our study. The mean term was 35 weeks of amenorrhea. 45% of labors were induced prematurely. 21 patients were transferred to intensive care unit after delivery due to the severity of their pathology. No maternal death was noted. CONCLUSION: The better comprehension of physiopathology of this association can help to improve the patients care.

[Fine-wire localizations in non palpable breast lesions]. / Le reperage par harpon des lesions mammaires infra-cliniques.

BACKGROUND: Breast cancer represents a major health problem in Tunisia. Mammography allows screening and early diagnosis of breast cancer. The Harpoon allows the location of these small lesions in order to have a histological study and to adapt the management. AIM: To demonstrate on one hand, the feasibility and the safeness of the fine-wire localizations of breast lesions due to the collaboration of radiologists and gynecologists, and on the other hand, to show the possibility of outpatient management in these cases. METHODS: Our study is a retrospective study reporting 45 patients who had fine wire breast lesion localization, in the department "C" of the center of maternity and neonatology of Tunis, during a period of 5 years and a half. RESULTS: The rate of malignant lesions was 22.4 % among the patients who had screening mammographies with nine breast cancers among which two bifocal. The rate of in situ cancer was 33.3 % and invasive cancers 66.6 % allowing a less aggressive treatment of a third of the patients. The 38 patients were taken in charge in ambulatory reducing the cost of hospitalization. In our series, we didn't have any complication during the insertion of the harpoon. CONCLUSION: Fine wire breast lesion localization with harpoon is an easy elegant method, under expert hands, allowing a rapid diagnosis compulsory in breast cancers.

[Perigenital hematoma. Diagnosis and management]. / L'hématome périgénital: diagnostic et prise en charge.

OBJECTIVES: Discuss the clinical aspects and the management of perigenital hematoma, a rare complication of delivery that can engage the vital prognosis. CASES: We report 4 cases of peri-genital hematomas recorded in the department C of obstetrics and gynecology, in the maternity center of Tunis. In two cases, the patients had only medical treatment and in the two others arterial embolisation was performed. CONCLUSION: The diagnosis is evoked in front of an unexplained hemorrhagic choc with perineal pain. Upon diagnosis, the patient must be rapidly managed associating resuscitation, surgery and angiographic embolisation.

Analysis of antibody response to HPV 16 and HPV 18 antigens in Tunisian patients.

OBJECTIVE: The aim of this present study was to use Luminex technology to detect antibodies against the late antigen L1 as well as those directed against the early antigens E6 and E7. BACKGROUND DATA: Human papillomavirus (HPV) serology is complex because infection and disease lead to distinct type-specific antibody responses. MATERIALS AND METHODS: Viral antigens were expressed with pGEX vectors in Escherichia coli and then used in Luminex as coating antigens for antibody detection in 205 human sera samples: 71 cervical cancer cases, 64 cases of cervical inflammation, and 70 controls. RESULTS: The data showed that 90.14% of sera among the cervical cancer patients had seropositivity toward at least one of the HPV 16 or HPV 18 antigens. Moreover, the percentages of positivity toward E6 and E7 HPV 16 antigens were 44% and 61%, respectively, versus only 21% for the L1 antigen. Among cervical cancer patients, the data showed different distributions in women of different ages. In addition, the intensity of the antibody response was also different for the six antigens analyzed. CONCLUSIONS: Antibody detection depends on the type of antigen, and is well correlated with international scientific findings. The differences in antibody response between patients with inflammation and patients with cervical cancer were significant.

[Prognosis of delivery from a scared uterus: 123 cases]. / Pronostic de l'accouchement sur uterus cicatriciel: a propos de 123 cas.

BACKGROUND: During these last two decades, the practitioners are more and more confronted to pregnancies on scar womb. AIM: To analyse the behaviour to be held in front of a scar womb and to estimate materno-foetal preview after childbirth (delivery) by vaginal delivery or after a caesarean section at cold. METHODS: It is about a retrospective study held over 123 cases of patients with a scar womb who gave birth in the department "C" of the CMNT over a period of 2 years. RESULTS: Among the 123 cases of scar womb, 70 patients had a preventive caesarean section. The main indication was a pathological pond. Uterine scar was accepted in 53 women, 25 among them gave birth by vaginal tract and 28 had a cesarean section of 2nd intention. There were 4 cases of dehiscence of the scar. 8% of the newborns from vaginal delivery had an apgar < 7 in the 5th mn against 10% in the group of the newborn children stemming from a preventive cesarean-section. CONCLUSION: Pregnancy on scar womb is a pregnancy at high risk requiring an adapted coverage.

[Management of ovarian cyst associated to pregnancy]. / Prise en charge du kyste de l'ovaire et grossesse: a propos de 25 cas.

BACKGROUND: The problem of the association of the ovarian cyst and pregnancy is to determine whether the cyst is functional or organic? AIM: To draw up the epidemiological profile of the patients having a cyst of the ovary, show the peculiarities of this association; and to clarify the therapeutic methods and its effects on the progress of the pregnancy. METHODS: A retrospective study concerning a period of 5 years and interesting 25 patients. RESULTS: The average age of the patients was of 34 years, the average parity was of 2. The discovery of the cyst was in 68% of cases in the first 3 months. On the clinical plan the circumstances of discovery were pelvic pains in 48% of cases and complications in 6% of cases; such us twisting of the cyst. 61% of the patients had a laparoscopy, 44% a laparotomy and a case of guided ultrasound punction, 4% of the patients underwent a pregnancy interruption, 17 pregnancies were led till the end, we noted an intrauterine death of the foetus and a case of late abortion at 22SA. CONCLUSION: problems due to the association of the ovarian cyst and pregnancy are especially of diagnostic and therapeutic order. Obsession was to underestimate a malignant tumour; that's why we should perform a surgical investigation in front of any persevering cyst beyond the first three months of the pregnancy.

[Haemorrhage delivery. About 65 cases]. / Hémorragie de la délivrance: etude rétrospective a propos de 65 cas.

The delivery haemorrhage is actually a problem of public health. It is responsible of 31.5 % of the maternal death in Tunisia. The goal of this work is to study the frequency of this complication, its gravity, its risk factors, its etiologists and its methods of treatment. It is a retrospective study. of 65 cases of delivery haemorrhage recorded to the obstetric gynaecology service "C" of the centre of motherhood and neonatology of Tunis during 4 years. The frequency of the delivery haemorrhage in our study is 1.19%. The middle age of the patient is of 31 years. Their middle parity is 2.4. Factors of risk taking out again our set are: gestational toxemia (35.4%), primiparity (33.8%), advanced maternal age (30.7%), pre-existent anaemia (24.6%). the uterine surdistension (21.3%), an abnormal middle length of labour (69.6%). use of oxytocin during labour (34%), induction (21.5%). Etiologists in our set are: atone in 63% of cases, retained placenta in 31.2% des cases, coagulopathie (9.2%), placenta previa (1.5%), uterine inversion (1.5%). The hold must be in charge multidisciplinary, systematized, precocious and dynamic.

[Management of ectopic pregnancy. about 77 cases]. / Prise en charge de la grossesse extra-utérine. A propos de 77 cas.

We report a retrospective study of 77 ectopic pregnancies, collected over a period of 5 years and 4 months. The aim of this study was to analyse the epidemiology, the clinical and special investigation findings of this pathology, and to report our result as regards management of ectopic pregnancy, eectopic pregnancy affects young women (mean age : 31.8 years), whether multiparous or pauciparous (81.1%). The most important risk factors were endouterine maneuvres (42.8 %) and IUD (36.3%). Suspicion of the diagnosis was based on clinics findings, US examination and beta HCG dosage. Diagnostic coelioscopy was performed in 90 % of cases to confirm the diagnosis. 7 patient underwent immediate laparotomie. Ectopic pregnancy was ampullar in 80% of cases. Treatment was given through a coelioscopy in 44 cases (57%). A laparo-conversion was required in 26 patient (33.7%). Treatment was radical in 52% of cases. We didn't note any serious per-operative or post-operative complication. About eighteen percent (18.1%) of out patient who subsequently wanted to get pregnatn, got an intra-uterine pregnancy. Only one case of recurrence was noted in our series.

[Coelioscopy in gynecologic emergencies. About 239 cases]. / Place de la coelioscopie en cas d'urgence gynecologique. A propos de 239 cas.

OBJECTIVE: The goal of this study was to determine the efficiency of lapaorscopy as method of diagnosis and treatment of gynecologic emergencie. METHODS: A laparoscopy was performed in two hundred and thirty-nine patients who presented in emergency with signs like acute pelvic pain, uterine bleeding or fever. Diagnoses and treatments are presented in a retrospective study. RESULTS: The median patient age was 30.4 years and median parity was 14 sonography was performed in all patients and bHCG rate was positive in 101 patients. The most suspected diagnosis was ectopic pregnancy (42%) followed by complicated cysts (30%) and ligh genital infections (27%) At laparoscopy 92 cases of ectopic pregnancy, 66 cysts complicated or not and 47 high genital infections were found. Laparoscopy didn't show any evident pathology in 6.6% of patients. We didn't note any anesthesial or surgical complication. CONCLUSION: Laparoscopy for gynecologic emergencies can be satisfactorily performed in the majority of patients, regardingly to low fiability of usual diagnostic methods. II is useful for diagnosis and treatment. The rate of it's overall complications is relatively low.