[Peripartum dilated cardiomyopathy]. / Cardiomyopathies dilatées du péripartum.

AIM: To analyze the clinical characteristics and to evaluate the different factors that influences the prognosis of the peripartum cardiomyopathy (PPCM). METHODS: A retrospective review was undertaken on records of women who were diagnosed with peripartum cardiomyopathy at Farhat Hached Hospital (Sousse) between January 1992 and December 2004. RESULTS: Clinically, PPCM shows pulmonary symptoms such as dyspnea and tachypnea. The diagnosis is established by echocardiography that showed decreased systolic function of the left ventricular. Both gynecologist and cardiologist must check the patients regularly. No patient died. Three preterm pregnancies occured with 9 health newborns (2 sets of twins). One miscarriage took place. PPCM is often undetected or misdiagnosed because of the low incidence and the unspecific symptoms. The treatment is also unspecific and similar to dilated cardiomyopathy or acute cardiac failure. CONCLUSION: Early diagnosis of the peripartum cardiomyopathy is extremely important. Pregnancy in patients with dilated cardiomyopathy is associated with maternal and fetal morbidity. Left ventricular function is a prognostic factor and must be the most parameter when conseling patients with peripartum cardiomyopathy about a new pregnancy.

[Recurrent hydatidiform mole. Case report of 9 successive molar pregnancies]. / La mole hydatiforme recidivante. A propos d'un cas avec 9 grossesses molaires successives.

The recurrent hydatiform mole is rare, its frequency is lower to 1%. We report the observation of a 28 years old women. without antecedents of molar pregnancy in the family and without considerable pathological antecedents. She had 9 successive molar pregnancies, without inset normal pregnancies and without living children. The delay of at least 1 year between the gestations has been respected in 6 pregnancies. The etiologic balance in particular the caryotypes of parents is normal. The authors debate the étiopathogénic and prognostic factors of this pathology.

[Hydatid cyst of the spermatic cord]. / Kyste hydatique du cordon spermatique.

The authors report the third published case of hydatid disease of the spermatic cord and describe its unusual presentation in the form of hydrocele. Hydatid disease is endemic to some countries, where it constitutes a real public health problem. It can affect all organs of the body. However, primary involvement of the spermatic cord is exceptional. Implantation of the hydatid larva is essentially haematogenous. The positive diagnosis is based on ultrasound. Eosinophilia is neither constant nor specific and only contributes to the diagnosis when it is positive. However positive hydatid serology has a diagnostic and prognostic value. Resection of the roof of the cyst is the treatment of choice.

[Ovary teratoma. Report of 91 cases]. / Teratomes de l'ovaire. A propos de 91 cas.

OBJECTIVE: To analyse the clinical and anatomic aspects of cystic teratomas of the ovary, caracteristics of patients having cystic teratomas and the management trends at our institution. STUDY DESIGN: Retrospective study of 91 cases of cystic teratomas of the ovary diagnosed and treated at Farhat -Hached Hospital (Sousse) between 1 january 1995 and 30 june 2003. RESULTS: Cystic teratomas constituted 12.13% of all ovarian tumors diagnosed and treated at our institution during the study period. The median of age was 33.35 ans. Abdominal or pelvic pain was the most frequent symptom for presentation in 67% of the cases. In addition; incidental finding was noted in 25.3% of the cases and swelling in 23% of the cases. The mean tumor diameter was 10 cm. The rate of bilateral cystic teratomas of the ovary was 14.3%. 19.8% of cystic teratomas has occurred in pregnancy. The operative video-laparoscopy was employed in 9 cases, laparotomy was employed in82 cases. Histopathological evaluation has detected 96.7% cases of mature teratomas, and 3.3% cases of immature teratomas. CONCLUSION: Cystic tertomas are the most common ovarian neoplasms, that occurs most commonly during the reproductive years. The operative laparoscopy is the most common modality of treatment of mature cystic teratomas. Immature teratomas must be treated by laparotomy associated if necessary to chimiothrapiy.

[Prognosis of local recurrence of breast cancer in Tunisia]. / Les recidives loco-regionales du cancer du sein dans le Centre Tunisien (etude anatomo-clinique et facteurs pronostiques).

OBJECTIVE: To evaluate locoregional recurrence rate of breast cancer, determine its anatomoclinical characteristies and discuss the available therapeutic alternatives. PATIENTS AND METHODS: A retrospective study including 41 patients with LRR following modified radical mastectomy or conservative surgery of invasive breast carcinoma without metastasis, between January 1993 and December 2002. RESULTS: 38 cases of LRR occurred after mastectomy and 3 cases after conservative surgery. LRR rate was 4.84%, mean follow-up 44.7 months. Mean age of patients was 45 years and LRR mean occurrence time-interval 22.4 months. Recurrence was parietal in 25 cases, mammary in 2 cases, and nodal in 14 cases. 18 patients had to be operated on. CONCLUSION: Prognosis of breast cancer depends on distant metastasis. LRR constitutes the second major risk liable to influence the overall prognosis.

[Adrenal myelolipoma]. / Le myélolipome surrénalien.

Adrenal myelolipoma is a benign, non-secreting tumour, which can be complicated by pain or retroperitoneal haemorrhage. The diagnosis is based on CT or preferably MRI. Surgery may be necessary in the case of complications. The contribution of interventional radiology has not been reported in the literature and selective embolization has also not been previously reported.

[Skin metastasis from invasive bladder tumour]. / Métastase cutanée d'une tumeur vésicale infiltrante.

Metastatic spread of advanced transitional cell bladder carcinoma rarely involves the skin. However, the presence of a skin metastasis indicates at least microscopic dissemination of cancer cells to the liver or lung, corresponding to a poor prognosis. The authors report a new case of single skin metastasis during the course of a poorly differentiated stage pT3a N0 M0 transitional cell bladder carcinoma. The patient died 5 months after the appearance of the skin metastasis.

[Adult Wilms tumour]. / Néphroblastome de l'adulte.

Wilms tumour is an exceptional tumour in adults. This diagnosis, often histological, is generally established at a more advanced clinical stage than in children and the prognosis, for the same clinical stage, is comparatively poorer in adults. Treatment consists of radical nephrectomy and adjuvant chemotherapy and radiotherapy. The authors report a case of Wilms tumour in an adult treated by a combination of radical nephrectomy and adjuvant chemotherapy. The patient is currently in clinical remission with a follow-up of 2 years.

[Ureterocalicostomy: indications and results based on a series of 16 patients]. / L'anastomose urétéro-calicielle: indications et résultats d'une série de 16 patients.

Formerly considered to be a salvage or last resort technique before nephrectomy, ureterocalicostomy can be indicated in certain well defined situations, when strictly dependent drainage of urine is essential. Due to its particular indications, this procedure is rarely performed and operators have limited experience. The authors report 17 cases of ureterocalicostomy performed in 16 patients: 8 cases obtained an excellent long-term result with absence of clinical signs, urinary tract infection and proximal dilatation of the neo-junction. 4 cases obtained a good result with resolution of clinical symptoms and bacteriological signs and improvement of the dilatation on intravenous urography. 3 cases obtained a poor result with persistence of clinical symptoms and dilatation on intravenous urography. 2 nephrectomies were subsequently performed 4 years and 10 years after ureterocalicostomy for non-functioning kidney and for chronic pyelonephritis.