[Evaluation of different techniques for vaginoplasty in the treatment of Mayer-Rokitansky-Kuster-Hauser syndrome]. / Evaluation des différentes techniques de vaginoplastie dans le cadre du traitment du syndrome de Mayer-Rokitansky-Küster-Hauser.

BACKGROUND: Rokitansky syndrome is an utero-vaginal aplasia with a frequency of 1 / 5000 female births. To correct this anomaly whose prognosis is mainly functional and psychological numerous surgical techniques have been described. AIMS: To report our experience about 13 patients with Rokitansky syndrome and having benefited from a vaginoplasty between 1993 and 2008 and to evaluate the results of the various anatomical techniques. METHODS: This is a retrospective study of 13 patients who underwent a vaginoplasty in the center of maternity and neonatal units, over a period from December 1993 to April 2008. During this period, two operative techniques were used: the technique of Mac-Indoe and the technique of Davydov. RESULTS: The mean age at the time of surgery was 22 years (15 years-32 years). In 6 patients operated using the technique of Davydov the average depth of neovagina was 6.83 cm, one treatment failure was noted. Among the 7 patients operated using the technique of Mac Indoe the average length of neovagina was 7 cm, 3 treatment failures were noted. It was noted that there was no failure of the anatomical results in patients who have had regular sex after surgery. It was noted that there was failure of the anatomical result in 4 of 9 patients who did not have sexual intercourse after the procedure regardless of the technique used, a failure rate of 44%. CONCLUSION: The choice of technique will be based on the experience of the teams as each technique has similar anatomical and functional results in the literature. Both anatomical and functional, the main factor that determines the success of treatment seems to be the motivation of the patient to have a married life and sexual relationship.

[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.

[Physiologic skin changes in pregnancy]. / Modifications physiologiques de la peau au cours de la grossesse.

INTRODUCTION: Pregnancy is a period of hormonal, immunological, metabolic and vascular changes. Some of them are considered to be physiologic, but others are real diseases specific or not of pregnancy. The aim of our study is to present the epidemiological and clinical physiologic dermatological changes of pregnancy. METHODS: We present a transversal monocentric study. One hundred pregnant women attending the department of dermatology of the La Rabta hospital were enrolled. Systematic detailed cutaneous examination was performed by a dermatologist to look for a physiologic skin changes. RESULTS: The mean age was 29 years [20-46 years]. Pigmentary changes were the most preponderant (93%), dominated by the areolar region pigmentation (77%). The glandular changes were noted in 75% of cases. The vascular modifications were observed in 77% of pregnant women. Of these, gingival hyperemia was the most common (46%). Others cutaneous changes were less frequent (stria distensae 45%, nevi changes 35%, molluscum gravidarum 10%). DISCUSSION: The physiologic cutaneous changes during pregnancy are numerous. Our study confirms the frequency and the variability of these modifications. The pigmentary changes were the most common finding.

[Borderline tumors : diagnosis and management : report of 10 cases]. / Les tumeurs borderlines : diagnostic et prise en charge. Apropos de 10 cas.

BACKGROUND: Since their discovery in 1929 by Taylor border tumors of the ovary, also known as borderline tumor (TOLM) inspired confusion, apprehension and disagreement. AIM: Identify epidemiological, clinical and therapeutic particularities of borderline tumors of the ovary. -Study the different surgical approaches for borderline tumors of the ovary. -Assess the value of frozen section in this pathology. METHODS: This is a retrospective study of 10 patients operated for borderline tumor of the ovary and collected at the department C of the center of maternity and newborn in Tunis. RESULTS: The average age of our patients was 35.6 years Pelvic pain was the main circumstance of discovery, it accounted for 50% of the cases. The discovery was fortuitous in 40% of the cases Ultrasound has shown purely cystic tumors in 70% of cases and solido-cystic ones in 30% of cases. There was a tumor in the controlateral ovary in only one case. The surgery was conservative whenever possible. Histological examination concluded to 6 cases of serous tumor and 4 cases of mucinous ones. Among the 10 patients, 8 were classified as stage Ia, one stage Ib and one stage Ic. The frozen section was performed in 8 cases CONCLUSION: The diagnosis of borderlines tumors of the ovary remains difficult. The laparoscopy is of great use in the management of this pathology. Histological examination is an interesting addition and the conservative treatment is the more appropriate treatment.

[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.

Thyroid disorders in pregnancy: frequency and association with selected diseases and obstetrical complications in Tunisian women.

OBJECTIVE: To determine the prevalence of thyroid disorders (TDs) and identify groups at risk for TDs in Tunisian pregnant women. METHODS: Thyroid-stimulating hormone (TSH) and anti-thyroid peroxidase antibodies (TPO-Ab) were determined in 1519 pregnant women. Thyroid disorder was defined as hyperthyroidism (TSH< or =0.10 mIU/L) or hypothyroidism (TSH>4.5 mIU/L), and/or positive TPO-Ab (>12 IU/L). RESULTS: TDs were observed in 147 women (9.7%). The prevalence was 6.5%, 3.2% and 1.3% for positive anti-TPO, hypothyroidism and hyperthyroidism, respectively. According to a trimester of gestation (first, second, and third, respectively), the prevalence decreases for positive TPO-Ab (7.7%, 7.5% and 4.7%) and for hyperthyroidism (2.7%, 0.7% and 0.5%), but increases for hypothyroidism (2.2%, 3.3% and 3.7%). TDs were more frequent in women with non-thyroid autoimmune disease [25% vs 9.6%; odds ratio (OR), 95% confidence interval (95% CI), 3.16 (1.01-11.8); p=0.05]. Women with positive TPO-Ab showed higher prevalence of non-thyroid autoimmune disease [25% vs 6.4%; OR (95% CI), 4.90 (1.31-18.4); p=0.04] and a trend toward increase of past gestational hypertension (p=0.09), late abortion (p=0.09), and fetal death (p=0.09). Hypothyroidism was more frequent in women with non-thyroid autoimmune disease and those with past pregnancy loss. CONCLUSIONS: TDs are common in Tunisian pregnant women and are associated with autoimmune diseases and poor gestational outcomes. These data support the benefit of thyroid testing in pregnant women, especially those with these conditions.

[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 malignant vulvar tumors]. / Prise en charge des tumeurs malignes de la vulve.

BACKGROUND: Vulva anatomy--FIGO classification--Vulva tumors anatomopathology--Tretments of vulva cancers. METHODS: Our stady is a retrospective, longitudinal and continuous one. It concerns 11 malignant vulva tumors whith were treated in the département "C" of the centre of maternity of Tunis. The period of stady is fifty four months (2002-2006). AIM: The aim of our study is to analyse the charactéristics of the vulva cancer and to compare our results to littérature. RESULTS: Mean age of our patients is 67 years old. They are all menaused. The principal signs are vulva tuméfaction in 72.7% of the cases, vulva prurit in 27.3% of the cases and genital bleeding in 27.3% of the cases. The mean period of consultation is of 14 months. We have ten cases of vulvar epidermoid carcinoma and one melanoma. The treatment was surgical in the eleven cases (10 total vulvectomy and one hemivulvectomy) They all benefited of an inguinal bilateral curage. The adjuvant radiotérapie was indicated in 3 cases. A patient was classed stage Ib of FIGO, 7 stage II, one stage III and one stage IVa. Nine patients are in remission, 3 are dead: 2 because of their cancer and one due to a pulmonar embolism. The survival of 6 month is 72.2%. CONCLUSION: The prevention of this cancer passes by the close follow of dystrophic states and viral pathologies of the vulva.

[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.

[Endometrial stromal nodule: a case report]. / Nodule stromal endometrial: a propos d'une observation.

The endometrial stromal nodule is the rarest of the endometrial stromal tumours. It is a benign tumour composed of well-differentiated endometrial stromal cells arranged as a well-circumscribed nodule with smooth, non invasive margins. We describe a case of uterine stromal nodule occurring in a 45-year-old woman with history of menometrorrhagia in which case ultrasonography conclude to a leiomyoma. Epidemiology, pathologic aspects, differential diagnosis, treatment and prognosis are reviewed.

[Sclerosing stromal tumor of the ovary. Report of 3 cases]. / Tumeur stromale sclérosante de l'ovaire. A propos de 3 observations.

Sclerosing Stromal Tumor (SST) is an uncommon benign tumor of the ovary, distinct from thecoma and fibroma because of predominant occurrence below 30 years of age, lack of hormonal manifestations and histologic heterogenity. Three cases of SST occuring in a 15, 26 and 56-year-old females are reported. Review of the literature and clinicopathological features are described in the present article. Histogenesis and differential diagnosis are also discussed.

[Retrocervical cystic hygroma: about 35 cases]. / Hygroma kystique du cou: à propos de 35 cas.

Retrocervical cystic hygroma is a congenital defect associated to chromosomic anomalies. We report a retrospective study about 35 cystic hygroma autopsies colliged in C.M.N.T in 10 years. Antenatal sonography has a sensibility 94.5%. Genetic abnormalities dominated by trisomie 13 Turner syndrome dad found in 11.5%. Medical abortion has done in 48.5%. A multidisciplinary management autorized to understand etiopathogeny of this defect.