Rheological and Electrical Study of a Composite Material Based on an Epoxy Polymer Containing Cyclotriphosphazene.

In this work, we have studied, formulated, prepared, and characterized the rheological and electrical behavior of a composite material based on an epoxy resin Diglycidyl Ether of Bisphenol A (DGEBA) reinforced with hexaglycidyl cyclotriphosphazene (HGCP). The epoxy system was cured with 4,4'-methylene dianiline (MDA). DGEBA-HGCP-MDA epoxy composite materials with reinforced HGCP which varied from 5% to 10% by weight were prepared by mixing in the molten state. The morphology was evaluated by SEM. The rheological behavior was studied using small deformation rheology. The electrical characterization was carried out with a frequency variation range from 1 Hz to 100 KHz at room temperature. These measurements revealed that the rheological and electrical behaviors strongly depend on the quantity of HGCP in the DGEBA matrix. The linear viscoelastic properties study reveals that the modulus of elasticity G' is dependent on the amount of HGCP present in the epoxy resin DGEBA. The capacitance-frequency measurements suggest a distribution of localized states in the band gap of the blends.

[Idiopathic granulomatous mastitis: apropos of 8 cases and review of the literature]. / Mastite granulomateuse idiopathique: à propos de huit cas avec revue de la littérature.

AIM OF THE STUDY: The authors report eight cases of idiopathic granulomatous mastitis in which the epidemiological, clinical, diagnostic, therapeutic and prognostic features are discussed. MATERIAL AND METHODS: Retrospective study of eight cases registered among 2,000 breast anatomopathological study during 5-years period. RESULTS: The mead age was 44.3 years. Breast lump measuring 2.5 to 15 cm in size was noted at clinical examination. Mammography noted nodular opacities and ultrasonography showed hypoechoic nodules. Histological findings were consistent on granulomatous inflammation centred on mammary lobules. The inflammatory infiltrate was including leukocytes, lymphocytes, plasma cells as well as epithelioid and giant cells without caseous necrosis in the granuloma. DISCUSSION AND CONCLUSION: Idiopathic granulomatous mastitis is a rare entity. This entity can clinically mimic other breast mastitis disease. Diagnosis is assessed by histological analysis This disease can be treated with drugs and surgical excision of the lump. The prognostic of this chronic disease is favourable.

[Vesico-uterine fistula of obstetrical origin. Report of 3 cases]. / Les fistules vésico-utérines d'origine obstétricale. A propos de 3 cas.

Vesico-uterine fistulae (VUF) lead to an abnormal breech between the bladder and the womb. They are responsible for urinary incontinence and/or cyclic hematuria. They are rare and, in most cases, lead to complications following caesarean deliveries. We report observations of 3 vesico-uterine fistulae treated over a 5 years period at university maternity based at Casablanca, Morocco; they all occurred following caesarean deliveries. These patients were consulted for urinary leakage occurring few weeks up to many years following surgical traumatism. Diagnosis was evoked clinically in all cases and confirmed by intravenous urography and/or hysterography. These VUF were successfully treated by simple breech suture at laparotomy. Treatment is very simple and efficient when the diagnosis is made early and fistula simple. Surgery is recommended after medical treatment failure aiming at fistula drainage.

[Current profile of obstetrical vesicovaginal fistulas at the maternity unit of the University of Casablanca]. / Profil actuel des fistules vésicovaginales obstétricales à la maternité universitaire de Casablanca.

Obstetrical vesicovaginal fistulas are secondary to dystocia. Late and inappropriate treatment are still a health public problem in under development countries. In five years (1993-1997), twelve vesicovaginal fistulas were repertored in the department of obstetrics and gynaecology of Casablanca (Morocco) with a frequency of 0.33@1000 deliveries and 2.4 new cases a year. 80% of the cases occurred after a long labour without efficient obstetrical care. Most of the cases (75%) were simple with an easy surgical treatment. All the fistulas were resolved after one or two surgical procedures realised by vaginal route in eight cases (2/3). During these last decades, with the efforts in obstetrical care in our country, we are assisting in a diminution of the frequency of this pathology and specially the number of complicated fistulas.

[Prevalence of urinary incontinence in Moroccan women. Report of 1,000 cases]. / Prévalence de l'incontinence urinaire chez la femme marocaine. A propos de 1,000 cas.

An inquiry concerning the prevalence of urinary incontinence for the moroccan women has been archived about 1000 women aged more than 18 years to study prevalence, epidemiology and risk factors of urinary incontinence. 271 women among the 1000 women said that they had suffered from the mictional disorder at least one time during the last month, let 27.1%; 48.7% of the incontinent women are from 30 to 60 years; 22.5% are less than 30 years old, and 8.85% are more than 75 years old. Among these 271 women, 49.44% suffered from leakage after making an effort; 42.80% an imperiosity, and 7.76% spontaneous leakage. Seventy per cent among these women had level of study at least medium; 85.97% among these women suffered the discomfort; but 8.48% of them had been consulted for this disorder, 78.96% are able to consult a medical and to have a clinical or paraclinical exams. The elements who are responsible of this disorder are: menopause, parity, the use of forceps, the weight of first child birth over 3.5 kg, the perineal tearing. Among the medical antecedents we find: chronic bronchitis, urinary infections, chronic constipation, diabetes, and in the other way among surgical antecedents are: hysterectomy and prolapsus cure.

[Mammary tuberculosis: a series of 14 cases]. / Tuberculose mammaire.

OBJECTIVES: We examined cases of mammary tuberculosis in order to determine the different modes of presentation and analyze diagnostic difficulties. METHODS: Retrospective analysis of 14 cases of mammary tuberculosis treated at the Ibn Rochd University Hospital in Casablanca over a 16 year period. RESULTS: Patient age ranged from 16 to 65 years. Contact with a contaminated person was recognized in 2 cases. The predominant clinical presentation was a tumor formation (12 cases) which sometimes simulated cancer. Axillary nodes were observed in 10 cases with 1 case of fistulization. Mammography suggested cancer in 3 cases. The diagnosis of mammary tuberculosis was based on pathology findings in 14 cases (2 biopsies, 12 peroperative specimens) and isolation of bacilli from pus in one case. Medical treatment was given. Surgery was associated as needed (abscess drainage, residual lesions). Except for one death due to tuberculous meningoencephalitis, clinical course was favorable with ad integrun breast recovery. DISCUSSION: Mammary tuberculosis is uncommon and often produces a pseudoneoplastic presentation. Pathology confirmation is required for diagnosis.

[Premature rupture of fetal membranes. Its management is still disputed!]. / La rupture prématurée des membranes. Une prise en charge encore controversée!

The aim of this study is to have an idea about the epidemiologic and clinic profile of the PRM, the management of the PRM. We conclude from this retrospective study about 374 cases, that the PRM frequency is about 2.67%. It reaches particularly the young women, primipar (57.48%) and not happen of this accident. The diagnosis was clinical in general. In the doubtful cases, amniotic infection was present in 25.13%. The delivery was characterized by the complications were dominated by prematurity and neonatal infection which both caused a high perinatal mortality 49.3%). A better sanitary education of any pregnant woman, a regular follow-up of the pregnancies, a treatment of each etiologic factor of this accident, a good per and postnatal supervision could remarkably limit the incidence of this obstetrical accident and also improve the maternal and fetal prognosis.

[Delivery of large baby after cesarean section: role of trial of labor. Apropos of 355 cases]. / Accouchement du gros bébé sur utérus cicatriciel : la place de l'épreuve utérine.

OBJECTIVE: Our goal is to determine whether a trial of labor in women with suspected fetal macrosomia would be a valuable alternative to elective repeat cesarean. MATERIAL: and methods: Based on retrospective analysis of 355 women with previous cesarean section who delivered macrosomic infants (> or =4,000g), we tried to determine the impact of fetal weight on a trial of labor. The outcomes of trial of labor with fetal macrosomia were compared on the one hand to those of elective repeat cesarean and on the other hand to those of trial of labor with normal birth weight (<4,000g). RESULTS: The trial of labor was conducted in 297 cases (83,7%), and had led to vaginal birth in 189 cases (63,6%). There were 4 uterine ruptures (1,3%) and 8 uterine dehiscences (2,7%) among the women who underwent a trial of labor. In this group, there were 4 perinatal deaths (1,3%) related in one case to uterine rupture, and 2 brachial plexus injuries related to shoulder dystocia after vaginal birth. Perinatal and maternal outcomes of trial of labor were similar to those of elective repeat cesarean. A trial of labor was more associated with scar separations and lower success rate if the infant weighed 4,000g or more. CONCLUSIONS: It appears that the use of trial of labor for delivery of large baby with prior cesarean section was associated with lower success rate and the maternal and fetal risks could be increased. However, carefully others controlled studies are necessary to establish the appropriate management in this setting.

[Mammary fibromatosis (apropos of 1 case)]. / La fibromatose mammaire (à propos d'une observation).

Fibromatosis (desmoid tumors) is a rare entity expressing a mesenchymatous proliferation. The breast is an exceptional localisation. The origin is either the gland itself or the breast is an extension of a desmoid tumor originating from the chest wall or shoulder. Etiology is still unknown. Clinical and radiological features mimic the breast carcinoma. Diagnosis is made by histological studies which show a benign structure contrasting with its aggressive potential. Surgery is the treatment of choice and consists of wide excision which can lead to mutilation. Hormonotherapy is used if surgery is too invasive. We report a case of a female patient aged 21 years who presented for a mammary fibromatosis, treated by a large surgical excision. Evolution was marked by the appearance of an other localisation in the contralateral breast.

[Twin delivery after cesarean section: is a trial of labor warranted?]. / Accouchement gémellaire sur utérus cicatriciel: peut-on autoriser l'épreuve utérine?

OBJECTIVE: To determine whether a trial of labor in twin pregnancy is a valuable alternative to routine repeat cesarean section. MATERIAL AND METHODS: Based on retrospective analysis of 31 cases of twin gestation with previous cesarean section, we tried to assess the outcomes of 25 cases of trial of labor. The outcomes of trial of labor in twin pregnancy were compared to those of trial of labor in singleton pregnancy. RESULTS: The trial of labor was successful in 21 cases (84%). There was one case of scar dehiscence among the women who underwent a trial of labor, that occurred in the parturient with two previous cesarean sections after complete breech extraction. There were no significant differences in perinatal outcomes in any comparison of trial of labor versus no trial of labor. The outcomes of trial of labor in the twin pregnancy were similar to singleton pregnancy. CONCLUSIONS: Routine repeat cesarean section in the twin pregnancy is not necessarily warranted; a controlled trial of labor in selected cases would be a valuable alternative.

[Phyllodes tumors of the breast. Forty one cases]. / Tumeurs phyllodes du sein. A propos de 41 cas.

Phyllode tumors of the breast are fibroepithelial tumors similar to fibroadenomas but with a predominant conjunctive tissue component. The aim of this work was to determine the specific diagnostic, therapeutic and prognostic features of this tumor. A retrospective series of 41 cases was collected in the gynecology-obstetrics ward from 1980 to 1991. The analysis of this series showed the following characteristics: incidence of phyllode tumors was 0.46% of all breast tumors. Mean age at diagnosis was 30 years, in 75.6% of the women were in a period of reproductive activity. Mean delay between the first clinical signs and diagnosis was 20 months. Mean size was 12 cm Diagnosis was confirmed at pathology examination in all cases. The tumor was classed grade 1 and 2 in 65.9% of the cases, grade 3 in 9.8%, grade 4 in 17.1%. Surgical treatment alone was used in all cases with large tumorectomy (48%), simple mastectomy (30%), and total mastectomy with node dissection (22%). After a follow-up of 1 to 7 years, there were 3 deaths and 11 local recurrences requiring reoperation. In the remaining cases, the outcome was favorable without recurrence or metastasis. These results together with those reported in the literature show that histological confirmation is required for the diagnosis of phyllode tumors. Surgical treatment alone is required with wide exeresis because of the voluminous tumor formation the age of the patient and the histological grade. Finally, prognosis depends on the histological characteristics of the conjunctive tissue component of the tumors.

[Uterine rupture: 50 cases]. / Les ruptures utérines: à propos de 50 cas.

The author reports 50 cases of rupture of the uterus among 11,060 labors i.e. one rupture per 220 labors. This study shows that rupture of the uterus occurs in women in poor socio-economic circumstances. Uterine scarring seems to be a more important factor than age and multiparity. Traumatic rupture is also common, resulting from obstetric procedures but above all from abdominal expression, most often performed outside hospital. Rupture of the uterus may present in many different ways. It was diagnosed in 32 cases before delivery while in 18 cases it was discovered during cesarean section or extraction of retained placenta. The lower segment was the elective site of rupture. With regard to treatment, suture was possible in 42 cases while hysterectomy proved necessary in the other 8 cases in view of the poor local tissue state. The prognosis remains gloomy, with a high risk of maternal death and, above all, a 58% fetal death rate.

[Hypertrophic tuberculosis of the cervix]. / La tuberculose hypertrophique du col utérin.

The authors report two cases of tuberculosis of the uterine cervix. They point out the exceptional nature of this form of genital tuberculosis, and its epidemiological aspects. They stress that its macroscopic appearance is highly suggestive of a carcinomatous lesion. Doubt can be eliminated only by cervical biopsy and appropriate treatment for tuberculosis can then be started. Surgery is only very rarely required.

[Degenerative vulvar Buschke-Loewenstein tumor]. / Tumeur de Buschke-Loewenstein vulvaire dégénérée.

The authors report the case of a degenerative Buschke-Löwenstein tumor located on the vulva. The authors stress the unusual nature of this disorder, recall its etiopathogenic factors and insist on the necessity for surgery to avoid a transition to malignancy.

[Delivery in the presence of cicatricial uterus. Apropos of 150 cases]. / Accouchements sur utérus cicatriciel. A propos de 150 cas.

Analysis of 150 cases of women with uterine scarring seen in our unit showed that vaginal delivery was possible in 49.7% of them provided that a number of rules, which the authors particularly stress, are applied. An attempt has been made to define factors likely to weaken the uterus and predispose to uterine rupture. Our maternal mortality rate of 0.6%, often due to infection and bleeding, agrees with that of the literature. The 0.4% uterine rupture rate was related to lack of health education of pregnant women. Fetal status at birth was usually good after vaginal delivery. The authors feel that knowledge of the circumstances of the first cesarean section and the subsequent course is essential, while hysterosalpingography has a major role to play in the choice of the most appropriate type of delivery.

[Cancer of the ovary and pregnancy]. / Cancer de l'ovaire et grossesse.

Three cases of an association of carcinoma of the ovary and pregnancy are reported. The authors stress the following points: the diagnosis should be made earlier by clinical and sonographic monitoring of pregnancy; high incidence of low-malignancy forms; fetal prognosis is particularly threatened during the first three months of pregnancy; treatment can be conservative in forms limited to one ovary.

[Krukenberg's tumor: still a somber prognosis. 4 cases]. / Tumeur de Krükenberg: un pronostic encore sombre. A propos de 4 observations.

The authors report four cases of Krukenberg's tumour. They point out its rarity and that the diagnosis can come as a surprise on histological examination. The tumour always has Signet ring cells. How the ovary comes to be involved is not known as yet. Treatment is mainly surgical with added chemotherapy but the prognosis is still very poor indeed.

[Ovarian struma: 2 cases]. / Les goitres ovariens: 2 cas.

The authors report two cases of ovarian goiters; they insist upon their rarity and the difficulty of their pré-operatory diagnosis. Only histologic examination can affirm their goitrous origin. The treatment of ovarian goiters is surgical. The evolution is favorable except their exceptional malignant transformation.

[Pelvic echinococcosis in women. Two case reports]. / L'échinococcose pelvienne chez la femme. A propos de 2 cas.

The purpose of this report of two cases of pelvic hydatid disease is to recall the aetiology and pathogenesis of this endemic condition in Morocco. We point out that because it gives rise to many different clinical signs it is difficult to diagnose accurately but if the appropriate blood tests are carried out in every case with a pelvic mass the diagnosis could not be missed. It is important to treat effectively this condition which can compromise both the gynaecological and obstetrical future of the patient and that can have serious repercussions extending to the upper urinary tract. The authors, too, show how important it is to follow up these cases after operation in order to spot recurrences.