[Pelvic tuberculosis mimicking bilateral ovarian tumor. A case report]. / Tuberculose pelvienne simulant une tumeur ovarienne bilatérale: à propos d'un cas.

Tuberculosis is a curable infectious disease which can mimic ovarian cancer. This case report illustrates that the association of a pelvic mass with elevated CA125 is not necessarily suggestive of ovarian malignancy. A 22-Year-old woman presenting with bilateral ovarian masses and an elevated CA 125 underwent an exploratory laparotomy to search for ovarian tumor. The final pathology diagnosis was ovarian tuberculosis without pulmonary involvement. Tuberculosis is a differential diagnosis to consider in patients with a pelvic mass because of the lack of pathognomonic clinical and biological signs.

[Hydatic cyst of the fallopian tube: a case report]. / Kyste hydatique tubaire: à propos d'un cas.

A 37-year-old woman was seen for pelvic pain. Ultrasonography and laparoscopy led to the diagnosis of bilateral hydrosalpinx. Analgesics and antibiotics were given several times but the clinical picture worsened. Laparotomy was performed and disclosed bilateral hydatidosis of the fallopian tubes requiring bilateral salpingectomy. Postoperatively, hydatic serology was strongly positive and a calcified hydatic splenic cyst was identified. Medical treatment with albendazole was prescribed for these multiple localizations of hydatid cysts.

[Heterotopic pregnancies: 8 cases]. / Grossesses hétérotopiques: à propos de huit cas.

Heterotopic pregnancy is the combination of intra-uterine pregnancy and ectopic pregnancy in the same patient whatever is the localization of the ectopic pregnancy. The aim of this work was to summarize the epidemics and clinical factors, the diagnostic means and the therapeutic methods for the spontaneous heterotopic pregnancy in Moroccan context. In a period of 6 years (1993-1998), 8 patients were treated for heterotopic pregnancy in Lalla Meryem Maternity of Casablanca, with a rate of 0.2/1000. Patients' ages ranged from 19 to 37. The backgrounds were: abortions (4 cases), secondary sterility (2 cases) and genital infection (2 cases). Five patients consulted for metrorrhagia associated with pelvic pain. Two for pelvic pain and one for metrorrhagia. The diagnosis was confirmed before echography in 5 cases. All patients were operated on, 3 in a condition of haemorrhagic shock. Ectopic pregnancy lay at the level of the fallopian tube in 7 cases and at the level of the ovary in one. The treatment consisted of a salpingectomy in the 7 patients with tubal localisations, the ovary pregnancy benefited from ovariectomy. Evolution has been marked by expulsion of intra-uterine pregnancy in 6 cases. Two women were able to carry out their pregnancy. Heterotopic pregnancy is more and more frequent because of genital infection increase and especially the wide diffusion of the assisted medical procreation.

[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.

[Pelvic hydatid yst: apropos of 8 cases]. / Kystes hydatiques pelviens: à propos de huit cas.

The hydatidosis fisues in the endemic state in Morocco, its pelvigenital localization is rare and doubtful. The objective of this study is to examine the epidemio-clinic appearance, the diagnosis means and the therapeutic flow of the pelvigenital hydatid cyst in Morocco. This retrospective study is about eight patients hospitalized and cured for pelvigenital hydatid cyst in lalla Meryem maternity of Casablanca during a period of six years (1992-1997). The hydatid cyst diagnosis was confirmed by anatomopathology. This affection represented 0.80% of the pelvic mass operated during the same periode. The majority of our patients was from rural origin, their age varies between 22 and 70 years old. The discovery circumstances were dominated by abdomino-pelvic mass. The diagnosis was nearly certain prior to the surgery for half of the cases. The genital organs were the most reached by the pelvic hydatidosis (75%). The treatment was purely surgical, adapted to each case in according to the localization, the volume and the contribution of the cyst. The medical treatment has been prescribed in one case in post surgery. The evolution was good in all the cases. The hydatidos cyst must always be present in mind when dealing with cyst pelvic formation in an endemic country like Morocco. The prophylaxia preserves its important value and must constitute a hinder against this disease in endemic countries.

[Pregnancy and AIDS. Report of 9 cases]. / Grossesse et SIDA. A propos de 9 cas.

The pregnancy at women infected by the HIV characterizes by the risk of transmission of the HIV to the child. The goal of this retrospective study concerning 9 deliveries of women infected by the HIV cured in the Infectious Diseases Service and the Lalla Meryem's Maternity of Casablanca CHU Ibn-rochd during 10 years (1990-1999) is to specify the experience of two services of concerning plug in cost of the patients infected by HIV by trying to pull some a protocol of plug in cost. The antiretroviral therapy has been used in 8 cases out 9. The AZT long protocol has been used in 6 cases and the bitherapy in 2 cases. The delivery has taken place by the natural way under cover of AZT in all cases. All babies have received the AZT in syrup and none has been breastfed to the breast. Two newborns on 9 out 9 have been contaminated by the HIV.

[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.

[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.

[Granulomatous recurrent mastitis during pregnancy]. / Mastite granulomateuse récurrente et grossesse.

We report a case of granulomatous mastitis during pregnancy which raised important diagnostic and therapeutic problems. Several diagnoses were suspected and subsequently different therapeutic regimen were tried (antibiotic therapy associated with nonsteroidal antiinflammatory drugs, progestogens, vein tonicity drugs and bromocriptine). All were ineffective and the patients status worsened. Histology confirmed the diagnosis of granulomatous recurrent mastitis. Corticosteroid therapy and interruption of pregnancy successfully controlled the disease process.

[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.

[Subcapsular hematoma of the liver. Six cases and review of the literature]. / Hématome sous-capsulaire du foie. A propos de 6 cas et revue de la littérature.

Defined as a blood collection under the Glisson capsule, the subcapsular haematoma of liver is a rare complication of pre-eclampsia. We observed 6 cases of subcapsular haematoma of the liver in the Gynaecology-Obstetrics ward of the Ibnou Rochd University Hospital in Casablanca, Morocco. Age range was 18 to 39 years. Five of the patients were multiparous. All except one had at least one sign of pre-eclampsia. The diagnosis was made post-partum in 5 cases and was only confirmed intra-operatively in 6 cases. The treatment was tamponing-drainage of the peritoneal cavity in 3 cases, ligature of the hepatic artery in 2, and in one case with rupture of the liver, no therapy could be performed. There were 3 maternal deaths and 2 foetal deaths. These results were compared with those in the literature to determine the epidemiologic, diagnostic, therapeutic and prognostic characteristics of the subcapsular haematoma of the liver. The prognosis is poor and requires early diagnosis and treatment. Effective prevention of this severe complication should be based on correct screening and care for pregnant patients with hypertension.

[Uterine sarcoma. Apropos of 25 cases]. / Les sarcomes de l'utérus. A propos de 25 cas.

This study involved an analysis of 25 cases of sarcoma of the uterine body collected at the Gynecology and Obstetrics Clinic of the Ibn Rochd CHU teaching hospital, Casablanca (Morocco) during a 15-year period (1977-1992). These are unusual malignant tumours (accounting for only 0.9% of uterine cancers) which occur after the menopause and have an appalling prognosis. Metrorrhagia was the most common alerting symptom. Presurgical diagnosis was difficult and uterine sarcoma was usually identified during surgery. The most common histological type encountered was leiomyosarcoma. Treatment was primarily surgical: total hysterectomy combined with bilateral appendectomy (20 cases), with radiotherapy (5 cases) or with adjuvant chemotherapy (1 case). Radiotherapy was the only treatment in 2 patients. The survival rate was low: 10% after 2 years, 5% after 5 years. Age, histological type, extent of the tumor and method of treatment were all recognised as prognostic factors. One interest of this work is to recall the existence and the severity of this pathology in those periods of endoscopic games and excessive conservative treatments.

[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.

[Jaundice and pregnancy. The role of viral hepatitis]. / Ictère et grossesse. La place de l'hépatite virale.

Through a series of 76 cases of jaundice observed in pregnant women, the authors emphasize on the biggest frequency of viral hepatitis among the all of etiology. In fact that one represents the 2/3 of cases. They insist on the graves forms of the diseases which are responsible of a high maternal mortality and big foetal complications.

[Uterine rupture due to placenta accreta at 28 weeks of pregnancy]. / Rupture utérine par placenta accreta à 28 semaines de grossesse.

The authors report the case of uterine rupture occurring after 28 weeks of amenorrhea and related to placenta accreta and treated by means of hysterectomy. They stress the diagnostic problems and discuss possible conservative treatment.

[Subcapsular hematoma of the liver, a complication of pregnancy toxemia]. / L'hématome sous-capsulaire du foie, complication de la toxémie gravidique.

The authors report three cases of subcapsular liver hematomas occurring after delivery and diagnosed by ultrasonography (1 case), and exploratory laparotomy (2 cases). These three cases compared with the data from the literature, illustrate the conditions of occurrence and the clinical signs of subcapsular liver hematomas during pregnancy or in the post-partum period. The frequency of this complication is most likely underestimated, since benign forms remain latent and the severe forms, responsible for sudden death, eludes the diagnosis in the absence of anatomical confirmation.

[Comparative study of 2 series of cases of uterine rupture collected at the Averroès Hospital in Casablanca from 1979 to 1981 and from 1984 to 1986]. / Etude comparative de 2 séries de ruptures utérines colligées au C.H.U. Averroès de Casablanca de 1979 à 1981 et de 1984 à 1986.

There were 156 uterine ruptures collected out of 34,807 deliveries in the gynaecological and obstetrical department of the University Hospital of Averroes in Casablanca. This is a rate of 1 per 223 deliveries. The factors that predispose to this complication are low socio-economic status of the patients, multiparity and, above all, a scarred uterus. Surgical abnormalities of the pelvis and dystocia due to malpresentations and above all inappropriate manoeuvres which continue to be practised are all responsible for the condition. The rupture usually occurs in the lower segment. When the lesions are extensive the cervix and the bladder are most often damaged. Treatment should be as conservative as possible to maintain the woman's fertility but at the same time doing whatever is necessary for her.

[Maternal mortality and perinatal mortality]. / Mortalité maternelle et mortalité périnatale.

PIP: 94 maternal deaths and 1546 fetal and neonatal deaths were registered among 28,706 births at the CHU Averroes in Casablanca between 1978-80. 45% of women who deliver at the clinic are very poor and only 10% are relatively well off. Obstetrical antecedents were noted in 27% of the fetal deaths. 70% of the maternal deaths occurred in women aged 20-34. 32 maternal deaths occurred among 16,232 women with 1-2 children, 30 among 6514 women with 3-5 children, and 32 among 5960 women with 6-14 children. 11,027 of the 28,706 were primaparas. Perinatal mortality was 4.46% among primaparas, 8.24% among grand multiparas, and 4.1% among secondiparas. In 58 of the 94 cases of maternal mortality the woman was hospitalized after attempting delivery at home or in a village clinic. Among women with 1 or 2 children, hemorrhage was the cause of death in 8 cases, infection in 7 cases, eclampsia in 3 cases, thromboembolism in 2 cases, uterine inversion in 2 cases, pulmonary tuberculosis in 1 case, embolism in 5 cases, and other causes 1 case each. Among women with 3-5 children hemorrhage was the cause of death in 10 cases, septicemia in 3 cases, uterine rupture in 3 cases, eclampsia in 3 cases, uterine inversion in 2 cases, viral hepatitis in 2 cases, emboli in 2 cases, and other reasons 1 case each. Among grand multiparas hemorrhage was the cause of death in 11 cases, uterine rupture in 12 cases, peritonitis in 2 cases, eclampsia in 2 cases, emboli in 2 cases, and other causes 1 case each. 19 of the maternal deaths were judged to have been avoidable with better management. Prematurity and birth weight of 1000-2500 g associated or not with other pathology were found in 714 of 1546 perinatal deaths. Of 390 cases of death in utero with retention and maceration, 68 were caused by reno-vascular syndromes, 76 by maternal infections, 33 by maternal syphilis, 26 by fetal malformation, 18 by maternal diabetes, 10 by Rh incompatability, and 159 by indeterminate causes. In 795 cases of intrapartum mortality without maceration, 114 were caused by retroplacental hematomas, 61 by placenta previa, 74 by uterine rupture, 119 by prolapse of the cord, 51 by fetal malformation, 45 by dystochia, 53 by twin pregnancies, 104 by fetal distress, 44 by obstetrical trauma, 55 by prematurity, and 75 by undetermined causes. In 361 cases of early neonatal mortality, 88 were caused by renovascular syndromes, 24 by diabetes, 13 by Rh incompatibility, 34 by placenta previa, 94 by prematurity, 28 by fetal malformation, 35 by fetal infections, 31 by fetal distress, and 14 by obstetrical trauma. The rates of maternal and perinatal mortality are very high compared to those of European countries.^ieng