[Embryo vitrification: First Tunisian live birth following embryo vitrification and literature review]. / Vitrication embroyonnaire: Présentation de la première naissance Tunisienne d'embryon vitriflé et de la literature.

Embryo cryopreservation is an essential tool in assisted reproduction. The option to freeze gametes and embryos provides unique possibilities for patients with various indications. After a review on some of the technical details of embryo freezing the idea of vitrification compared to slow freezing is discussed. It is recognized that the slow freezing technique is still overwhelmingly applied in most human in vitro fertilization (IVF) centers, but there is mounting evidence demonstrating the benefit of vitrification. Theoretical and practical examples are now sufficient to convince the embryologist that the time has arrived to switch to the vitrification technique. We report our experience that is the first Tunisian live birth following embryo vitrification at the blastocyst stage, collected at the military hospital of Tunis-Tunisia. A 29-year-old woman presented a primary infertility of 3 years of male origin. IVF with intra-cytoplasmic spermatozoid injection ICSI has been indicated. 7 blastocysts were obtained at fifth day. Two of them were replaced and ended in terminated pregnancy at 6AW. Vitrification method is a procedure which is to immerse the embryos directly into liquid nitrogen at -196 ° C. thereby achieving descents temperature of about -2000 ° C per minute within a secure glitter. The kit used in our laboratory is "irvine scientific" with glitter cryobiocystem. Six months later 2 blastocysts were devitrified in February 2012 and after replacement provided a normal progress pregnancy, delivery by caesarean section of a newborn male in good health.

Testis development in the absence of SRY: chromosomal rearrangements at SOX9 and SOX3.

Duplications in the ~2 Mb desert region upstream of SOX9 at 17q24.3 may result in familial 46,XX disorders of sex development (DSD) without any effects on the XY background. A balanced translocation with its breakpoint falling within the same region has also been described in one XX DSD subject. We analyzed, by conventional and molecular cytogenetics, 19 novel SRY-negative unrelated 46,XX subjects both familial and sporadic, with isolated DSD. One of them had a de novo reciprocal t(11;17) translocation. Two cases carried partially overlapping 17q24.3 duplications ~500 kb upstream of SOX9, both inherited from their normal fathers. Breakpoints cloning showed that both duplications were in tandem, whereas the 17q in the reciprocal translocation was broken at ~800 kb upstream of SOX9, which is not only close to a previously described 46,XX DSD translocation, but also to translocations without any effects on the gonadal development. A further XX male, ascertained because of intellectual disability, carried a de novo cryptic duplication at Xq27.1, involving SOX3. CNVs involving SOX3 or its flanking regions have been reported in four XX DSD subjects. Collectively in our cohort of 19 novel cases of SRY-negative 46,XX DSD, the duplications upstream of SOX9 account for ~10.5% of the cases, and are responsible for the disease phenotype, even when inherited from a normal father. Translocations interrupting this region may also affect the gonadal development, possibly depending on the chromatin context of the recipient chromosome. SOX3 duplications may substitute SRY in some XX subjects.

Pregnancy in kidney transplanted women: what are the optimal conditions for a better pregnancy outcome?

BACKGROUND: Motherhood has long been not recommended for kidney transplanted women for fear of adverse effects on the graft and the risks to the fetus. AIMS: This article aimed to provide evidence based answer to the following questions regarding pregnancy in kidney transplanted women: 1. what are the nephrologic and obstetrical parameters that can influence the pregnancy outcome? 2. What is the impact of pregnancy on graft? 3. What are the optimal conditions for pregnancy planning in kidney transplanted women? METHODS: A literature search was conducted using as key words "pregnancy", "renal transplant", "renal graft survival" in the PubMed database over the period from January 1994 to December 2011. RESULTS: Recovery of renal function in kidney transplanted patients is followed by restoration of endocrine function. Knowledge of the initial nephropathy assesses the risk of recurrence after transplantation, which may affect the graft. Chronic glomerular nephropathies are the most frequent from 32 to 76.1%. Duration of hemodialysis (over 2 years) is associated with a risk of preterm delivery and growth retardation. A period of 1 year between renal transplantation and conception seems reasonable to stabilize renal function and reduce the doses of immunosuppressants. The number of unintended pregnancies remains high (50%). The incidence of pregnancy after renal transplantation varies between 3 and 21.2%. Graft survival in patients who carried a pregnancy is equivalent to that of patients who were not pregnant. CONCLUSIONS: Pregnancy in kidney transplanted patients is a highrisk pregnancy, but it does not seem to affect graft function through certain conditions.

[Lower urinary trauma complicating gyneacologic and obstetrical surgery]. / Les lésions urologiques provoquées par des interventions chirurgicales gynécologiques et obstétricales.

INTRODUCTION: The trauma of the lower urinary tract in gynecologic and obstetrics surgery is rare. AIM: Discover the circonstances of their happening, their symptoms, and their methods of diagnostic and their treatment. METHODS: Authors report 24 cases observed over a 12 years period. RESULTS: These lesions consisted on 20 bladder lesions and 4 ureteric lesions. The frequency of these urological complications was 0.21% among the 12000 surgical operations performed between 1992 and 2003. The most causal operation was caesarean and abdominal hysterectomy. Urinary trauma was more frequent in patients with history of abdominal surgery. Post operative course was uneventful in most cases. CONCLUSION: Trauma of the lower urinary tract in gynecologic and obstetrics surgery is rare but their ignorance may seriously affect the functional urinary prognostics.

[Cesarean deliveries in the maternity of military hospital of Tunis. Indication and prognosis: about 5008 cases]. / Les césariennes à la maternité de l'hôpital militaire de Tunis indication et pronostic: à propos de 5008 cas.

BACKGROUND: The rates of cesareans increased in many countries, these last years. AIM: we propose to evaluate the indications, and the maternal and foetal prognosis. METHODS: it's a retrospective study of 5008 cesareans during 10 years period, collected in the maternity of the military hospital of Tunis. RESULTS: Cesarean section rate is 21.59%. The cicatricial uterus constitutes the dominant indication (34%). In the event of noncicatricial uterus, the fetal suffering (24.7%), the failure of the trial of labour (14.2%), and the breech presentation (12.7%) are the principal indications. The hemorrhage constitutes the major complication into peroperational (2%). The post-operative complications are noted in 15.5%. Maternal mortality is 0.13%; perinatal mortality is 1.06%; perinatal morbidity is 9.68%. CONCLUSION: The increase of cesarean rate improves fetal and neonatal prognosis however it was associated to an increase of maternal.

[Premature ovarian insufficiency. Analysis of 30 cases]. / Insuffisances ovariennes prematurees. Etude analytique de 30 cas.

Premature menopause is a relatively rare disease but it has delicate consequences dominated by infertility problems. Most often, etiologic investigation is disappointing. Helped in some cases by the association to some auto-immune diseases or a previous treatment with chemotherapy or an irradiation may be useful to understand the origin of the premature ovarian failure. We analyse in this paper 30 cases of premature menopause to try to precise its etiologic factors, its diagnosis tools, the fertility prognostic and the therapeutic possibilities

[Maternal and foetal prognostic during severe toxemia]. / Pronostic maternel et foetal au cours de la toxemie gravidique severe.

Severe gravidic toxemia gives heavy maternal and foetal morbidity and mortality. The purpose of our study is to loosen the factors of bad maternal and foetal prognostic. It's a retrospective study about 100 cases of severe and complicated gravidic toxemia repertorieted in the maternity of Military Hospital of Tunis. Maternal morbidity is dominated by the complications of hypertension and a blood disorders. We raised 4 cases of eclampsia, 9 cases of retro placental hematome and 5 cases of HELLP syndrome. We don't deplore any maternal death. Perinatal mortality is 28.8%. The rate of delay intra-uterine growth was 43.8% and the prematurity 65.9%. More toxemia appears early during pregnancy more maternal and foetal prognostic is compromised.

[The approach diagnoses of ovarian tumors by echography]. / L'approche diagnostique des masses ovariennes par l'echographie.

In more of positive diagnosis, echography makes it possible to approach the histological nature of ovarian tumors. From a series of 106 cases of ovarian tumours, we propose to evaluate this approach by analysing the various echographic signs according to histological types'. The serous cysts are anechogen in 77,7% of the cases. The mucinous cysts are anechogen in 71,4% and finely echogen in 28,5% of the cases. The dermoid cysts are echogen in 47,3% and heterogeneous in 26,3%. The endometriosic cysts can be finely echogen (45%), heterogeneous (25%) or echogen (20%). The malignant tumors are of mixed aspect in 54,55% of the cases. The sensitivity of echography for the malignant tumors is 81,82% whereas specificity is 75,79%. The negative predictive value is 97,3%, and the positive predictive value is 28,13%. The size of the tumor, the vegetations and the partitions are also studied: a size lower than 5 cm and the absence of partition and vegetation are synonymous with benignity in all the cases.

[Potter's reno-facial syndrome]. / Syndrome de Potter. Etude analytique a propos de 4 cas.

Potter's reno-facial syndrome is a rare innate abnormality. We bring 4 observations repertoried at the maternity of military hospital of Tunis over a period of 6 years (1997 - 2002). The purpose of our work is to determine after a review of the literature the echographic and foetopathologic characteristics, and the forecast of this syndrome. The frequency of the bilateral renale agenesis is of 0.27 per thousand. Positive diagnosis bases essentially on the ultrasound of the 2th, or the 3-th trimester. The signs of appeal are essentially the oligoamnios associated to an hypotrophy. The caryotype is systematic to eliminate an associeted chromosomic abnormality. Foetopathologic exam is usefull for the diagnosis. Main abnormality except the urinary pathology is the lung hypoplasia. Therapeutic interruption of the pregnancy in this situation not compatible with the extra-uterine life., only type IV authorize the development of the pregnancy according to echographic data and of foetal urinaire biochemistry. We insist on the early practice of the morphological ultrasound between 20 - 22 weeks for the diagnosis of foetal abnormalities and the place of the genetic advice in association with the geneticist in the coverage of the couple.

[Surgical laparoscopy in the management of women infertility]. / Apport de la coelioscopie operatoire dans la sterilite feminine.

The authors report their experience about surgical laparoscopy in the management of women infertility. Based on a series of 87 patients (median age: 31 years), 61% have primary infertility. The surgical procedures were distal tuboplasty in 26 cases, endometriosis cure in 19 cases, ovarian driling for polycystic ovarian syndrome in 18 cases and adhesiolysis in 24 cases. The rate of intra uterine pregnancy of the 81 followed patients is 40.7% with 23 newborn (28.39%), 5 abortions (6.17%) and 5 current pregnancies (6.17%). The rate of ectopic pregnancies is 3.7%.

[Umbilical endometriosis: apropos of 3 cases]. / Endométriose ombilicale: à propos de trois cas.

Umbilical endometriosis is a rare localisation of the disease. The authors report three cases of umbilical endometriosis. The symptomatology is not usually typic. The only effective treatment remains the surgical exercise thus allowing the confirmation histological.

[Management of urogenital prolapse in the maternity service of the Tunis military hospital. 82 cases]. / Prise en charge des prolapsus urogenitaux à la maternité de l'hôpital militaire de Tunis. A propos de 82 cas.

This survey has for goal to specify the epidemiological and of the prolapse of our patient, as well as our therapeutic attitude. It is about a retrospective survey that concerned 82 cases of prolapse, structural on a period of 5 years. The average of age of our patient is of 59 years. 73.17% of women are multiparous. 78% of women gave birth less once at home. The main motive of consultation is the vaginal ball sensation, in agreement with the total character of the prolapse that is the third degree in 46.34% of cases. The urinary incontinence is associated to the prolapse in 50% of cases. We achieved a vaginal surgery in 82.93 of cases. The hysterectomy has been achieved at 86.76% of operated then by vaginal surgery whereas for operated them by abdominal surgery, the uterus is preserved in the half of cases.