[Correlation between vital signs and hemoperitoneum in ruptured ectopic pregnancy]. / Corrélation entre signes vitaux et hémopéritoine au cours des grossesses extra-utérines rompues.

BACKGROUND: Ectopic pregnancy (EP) is a medical-surgical emergency. Rupture of an ectopic pregnancy is a serious complication and may develop severe life-threatening to the patient. AIM: To determine correlation between vital signs and hemoperitoneum in ruptured ectopic pregnancy and the association between abnormal vital signs and tubal rupture. METHODS: Via a retrospective study we have considered a sample of 32 patients of ruptured ectopic pregnancy. All patients were diagnosed at the Gynecology and Obstetrics Unit Aat Charles Nicole Hospital, Tunisia. RESULTS: Mean minimum systolic (SBP) 109 mmHg (range 70-150), mean maximum (HR) 81.5 beats/min (range 70-140). Mean volume of hemoperitoneum 693.75 mL (range 100 -2000 mL).Correlation between vital signs and volume of hemoperitoneum was poor (R 2 = 0.279 for HR, R 2= 0.267 for SBP). Hypotension was associated with blood loss of at least 1280 ml. Association of tachycardia with hypotension was observed in only 2 cases.Correlation between HR and SBP was not significant and poor (p=0.23, R 2= 0.05) CONCLUSION: Normal vital signs alone are poor predictors of ruptured ectopic pregnancy and do not correlate well with volumes of hemoperitonieum.

Incidence, clinical analysis, and management of ovarian fibromas and fibrothecomas.

OBJECTIVE: The objective of the study was to identify the incidence, diagnosis, and therapeutic and histological particularities of ovarian fibromas and fibrothecomas. STUDY DESIGN: This was a retrospective study of 24 patients who underwent surgical treatment for ovarian fibromas and fibrothecomas between January 1994 and December 2006. Clinical, ultrasonographic, tumor marker, therapeutic, and histologic data were analyzed. RESULTS: The mean age of patients was 49 years. Thirteen patients were menopausal. Ultrasonographic findings were ovarian echogenic tumor in 6 cases, hypoechogenic tumor in 12 cases, mixed tumor in 6 cases, and anechogenic tumor in 1 case. Cancer antigen-125 level measured in 21 cases was abnormal in 3 cases. Twenty-one patients underwent laparotomy. Three patients underwent laparoscopy; however, 1 was converted to laparotomy because of a suspected tumor. Histological findings were 16 fibromas and 9 fibrothecomas. CONCLUSION: Ovarian fibromas and fibrothecomas are uncommon, accounting for 3.3% of ovarian tumors. These lesions often occur in perimenopausal and menopausal patients. Clinical, ultrasonographic, and tumor marker data remain the best preoperative approach currently available for ovarian tumors. However, the diagnosis remains histological.

Fetal intracranial haemorrhage and periventricular leukomalacia after second-trimester intrauterine fetal death in monochorionic twins.

BACKGROUND: Intrauterine fetal death of one twin in a monochorionic pregnancy may be associated with adverse neurologic sequelae in the surviving co-twin. OBJECTIVE: The aim of this report is to try, through a review of literature, to predict the risk of cerebral impairment in the survivor co-twin and to assess the feasability of neurosonography and magnetic resonance imaging in the prenatal diagnosis of brain damage. CASE REPORT: We report a case of monochorionic twins complicated by a fetal death at approximately 23 weeks' gestation with pathologically confirmed leukomalacia in the surviving twin. A detailed sonographic evaluation of the intracranial anatomy of the surviving twin was performed. Fetal magnetic resonance imaging was offered as well. The patient opted for termination. Evacuation was performed at 24 weeks, and pathologic evaluation revealed severe cerebral infarction with haemorrhage. CONCLUSION: However difficult, a multidisciplinary prenatal counselling should be performed in order to study the prognosis and to try to prevent cerebral palsy in the surviving co-twin.

[Management of dermoid ovarian cysts. Report of 58 cases]. / Prise en charge des kystes dermoides de l'ovaire. A propos de 58 cas.

OBJECTIVE: To assess diagnosis and therapeutic problems of der mo id cysts.' METHODS: A retrospective study of 58 patients having undergone surgery for dermoid cyst between 1991 and 1999. Clinical, ultrasonographic and therapeutic data were analysed. RESULTS: Dermoid cyst accounts for 21.8% of all ovarian tumours. The mean age of patients was 34.75 years (17-73 years). 48 patients (82.7%) presented symptoms. In 10 cases (17.3%), the cysts were discovered during gynaecological and or ultrasonographic examination. The pre-operative diagnosis was precised with the help of ultrasonography in 52 cases, with standard abdominal X-ray in 19 cases and with computed tornography scan in 4 cases. Laparotornic and laparoscopic treatment were performed in respectively 51 and 7 cases. One case of granulornatous peritonitis after laparoscopic surgery was observed. Histological findings were 64 dermoid cysts and 2 serous cysts. Dermoid cysts were bilateral in 6 cases (10.34%) and associated with contro-laterally serous cyst in 2 cases. CONCLUSION: Dermoid cysts are tumors encountered mainly in young patients. After a careful pre-operative assessment, the laparoscopic approach is very interesting. However, a laparotomy should be considered in case of suspected malignancy.

[Struma ovarii. Report of a malignant and a benign case]. / Struma ovarii. A propos d'un cas malin et un cas benin.

Struma ovarii is a rare type of ovarian teratoma, composed entirely or in part of thyroid tissue. Malignant Struma ovarii were exceptional. We report one benign and one malignant cases of Struma ovarii. We insist upon their rarety and the difficulty of preoperatory diagnosis. Prognosis is good after surgery.