[Voluntary surgical sterilization by laparoscopy in cases of cardiovascular diseases. Prospective study of 19 cases]. / Stérilisation chirurgicale volontaire per-coelioscopique en cas de maladie cardiovasculaire. Etude prospective à propos de 19 cas.

Nineteen women with cardiovascular disease underwent voluntary per-celioscopic sterilisation under local anesthesia at the La Rabta Maternity and Neonatology Centre, Tunis, Tunisia, between 1 July 1988 and 31 March 1989. There were 8 cases of hypertension, 1 of mitral insufficiency and 10 cases of surgically treated valve disease (6 cases of commissurotomy for mitral stenosis and 4 valve replacements). Mean parity of the women was 5 and mean age 35.4. Their educational level was low. Thirteen of them had never used contraception and 4 had had at least 2 therapeutic abortions. Local anesthesia with analgesia was well appreciated since 15 women remained calm and experienced no pain. The procedure involved minimal pneumoperitoneum and Trendelenburg. Recourse to minilaparotomy under general anesthesia was necessary in only one case. The authors stress the importance of counselling patients at the onset and of cooperation with cardiologists and anesthesiologists, and discuss peri-operative treatment protocols (anticoagulants, antibiotics) in particular.

[Maffucci syndrome and ovarian tumor]. / Syndrome de Maffucci et tumeur ovarienne.

Maffucci's syndrome was first described in 1881 and results of a mesodermic dysembryoplasia, congenital but not hereditary. Pathogenic hypothesis are multiple. This syndrome is characterized by the occurrence of multiple haemangiomas in the soft tissue, and multiple enchondromas of the bones. The association of ovary tumor is however exceptional. Four cases are reported in the literature; we report the fifth case.

[Voluntary surgical sterilization by laparoscopy in the immediate post partum period. Prospective study in 55 cases]. / Stérilisation chirurgicale volontaire per-coelioscopique dans le post-partum immédiat. Etude prospective à propos de 55 cas.

Fifty five voluntary sterilisations were carried out during the immediate post-partum period via celioscopy and under local anesthesia at the La Rabta maternity and neonatology centre, Tunis, between 1 July 1988 and 31 March 1989. The women had a mean age of 34.6, mean parity of 6 and living children of both sexes. Their socio-economic level was low. They had never used any form of contraception in 50 p. cent of cases and 5 among them had undergone at least one termination of pregnancy. Acceptability of local anesthesia with analgesia was good since 71 p. cent of women remained calm during the procedure and experienced no pain. Among the 16 women who reported pain, this occurred above all when the tubes were grasped (10 cases). There were no notable complications. However, sterilisation was not possible in two cases.

[Hysteroscopy and hysterosalpingography. Which examination to chose?]. / Hystéroscopie et hystérosalpingographie. Quel examen choisir?

The authors report 58 patients undergoing hysterosalpingography (HSG) then hysteroscopy (HC) for investigation of the uterine cavity. Comparison of HSG and HC findings revealed the following: In 26.9 per cent of cases HC disproved or rectified the result of HSG. Results of the two investigations were in agreement in 74.1 per cent of cases. In the light of our results, and after a review of the literature, HSG is indicated as the first line investigation for exploration of the uterine cavity and/or the tuboperitoneal level. HC alone is sufficient for exploration of the cervical canal and of the uterine cavity.

[Peripartum cardiomyopathy. Analysis of 3 cases and review of the literature]. / Cardiopathie du péri-partum. Analyse de 3 cas et revue de la littérature.

Peripartum cardiomyopathy is defined as a syndrome of cardiac failure occurring in the latter part of pregnancy or in the puerperium without obvious cause and without prior evidence of heart disease. Analysis of the particular features of this syndrome and a review of the literature indicate its similarity with other cardiomyopathies in terms of clinical features, natural history and treatment, but maternal and fetal prognosis is poor.

[Bologna operation]. / L'intervention de Bologna.

Thirty cases of urinary incontinence and genital prolapse have been treated using Bologna's method. The authors describe this operation. The post-operative controls were based on the clinical state of the patient and in ten cases on the urodynamic tests. Anatomical result was very satisfactory. In all but one case the abdominal pressure transmission defect to the upper urethral was corrected without deterioration of maximal urethral pressure.

[Evaluation of neonatal prognosis using Doppler velocimeter in cases of a high risk fetus]. / Evaluation du pronostic néonatal par la vélocimétrie Doppler des foetus à haut risque.

The authors describe the main characteristics of the Doppler method in the early diagnosis of chronic fetal distress, and report their personal results in the study of 51 high risk pregnancies. In their study the fetal doppler ultrasound findings were correlated with birth weight related to gestational age, and neonatal morbidity. The parameters established from the doppler ultrasound assessment were the placenta resistance (calculated from the formula of Pourcelot: R = S-D/S applied to the umbilical artery) and the cerebro-placental index, Rp/Rc, Rc being the index of cerebral arterial resistance. The diagnosis performance of the method appeared very good: the Rp index was found to be highly specific for hypotrophy (85,7%) and for neonatal morbidity (90%), the RCP index adding its own good sensitivity (85% for hypotrophy and 83,3% for neonatal morbidity). The authors conclude upon the interest to study simultaneously the fetal umbilical and cerebral arterial circulations. The pathological significance of the two indexes appears different so that they are to be complementary in the evaluation of fetal distress.

[Hysteroscopic metroplasty of uterine septa]. / Les métroplasties hystéroscopiques des cloisons utérines.

A series of 23 patients with septate uteri who underwent hysteroscopic division of the septum between January 1990 and March 1992 were studied. Before operation 19 of the 23 patients had 50 pregnancies with 29 spontaneous abortions, 7 late abortions, 5 premature deliveries and 9 deliveries at term. Sixteen patients who were followed up for more than 6 months conceived 9 times. Six of these went to term with 4 normal deliveries and 2 caesarean sections for obstetrical indications. There are 2 pregnancies continuing at present (at 25 and 27 weeks of amenorrhoea) and one spontaneous abortion in the first trimester. Two patients had to be operated on again because a partial residual septum was found post-operatively.

[Intramural pregnancy: a case report]. / Grossesse intramurale: un cas.

Implantation into the muscle wall is one of the rarer forms of ectopic pregnancy. We report an uncomplicated case which was discovered during therapeutic termination of pregnancy at 10 weeks. We point out how valuable the use of ultrasound during the operation is for making the diagnosis when suction does not provide adequate quantities of products.

[Acute lymphoblastic leukemia and pregnancy. Apropos of a case]. / Leucémie aiguë lymphoblastique et grossesse. A propos d'un cas.

The authors report on a case of a woman with acute lymphoblastic leukemia treated with cortisone therapy during pregnancy. No problems were encountered during the gestational period or at parturition; and no maternal or neonatal complications were observed.