[Small cell carcinoma of the ovary]. / Carcinome à petites cellules de l'ovaire.

Small cell carcinoma of the ovary of the hypercalcemic type is a rare tumor. We report a case in a 34-year-old patient, revealed by a pelvic pain. The imaging found a large mass of the right ovary. The patient had right oophorectomy and total hysterectomy, a left oophorectomy, pelvic and a para-aortic lymphadenectomy. She subsequently received 6 cycles of adjuvant chemotherapy followed by pelvic radiation therapy. The hypercalcemic small cell carcinoma of the ovary is a rare disease of poor prognosis. Treatment approaches include surgery, chemotherapy with the addition of radiotherapy.

[Does combination of intrathecal magnesium sulfate and morphine improve postcaesarean section analgesia?]. / L'adjonction de sulfate de magnésium à la morphine en intrathécal améliore-t-elle l'analgésie après césarienne ?

BACKGROUND: Intrathecal morphine (IT) is commonly used for postoperative analgesia after caesarean section. The addition of intrathecal (IT) magnesium to spinal bupivacaine-fentanyl anaesthesia increases the duration of spinal analgesia for labour without additional side effects. In this prospective, randomized, double blind, controlled study, we evaluated whether adding intrathecal magnesium could prolong spinal morphine analgesia after caesarean section. PARTURIENT AND METHODS: After ethics committee approval and obtaining written consent, one hundred and five (ASA I or II) adult patients undergoing caesarean section were recruited. They were randomly allocated to one of three groups: (1) group Morphine (M): 10 mg of isobaric bupivacaine 0.5% (2 ml)+100 microg morphine (1 ml)+10 microg fentanyl (0.1 ml)+1 ml of isotonic saline solution, (2) group Magnesium (Mg): 10mg of isobaric bupivacaine 0.5% (2 ml)+100mg of magnesium sulphate 10% (1 ml)+10 microg fentanyl (0.1 ml)+1 ml of isotonic saline solution, (3) group Morphine+Magnesium (MMg): 10mg of isobaric bupivacaine 0.5% (2 ml)+100mg of magnesium sulphate 10% (1 ml)+100 microg morphine (1 ml)+10 microg fentanyl (0.1 ml). We recorded the following: time to the first analgesic request, pain scores with the visual analogic scale at rest and in movement at h0, h1, h2, h4 and then every 4h for the first 36 postoperative hours, the occurrence of adverse events and patients' satisfaction. RESULTS: Time of the first analgesic request was 28+/-8h in group MMg versus 19+/-6h in group M and 7+/-6h in group Mg (p<0.01). Pain scores were statistically lower in group MMg (9+/-7 and 17+/-9 mm respectively) compared to group M (16+/-9 and 28+/-11 mm respectively) and Mg (21+/-9 and 37+/-13 mm respectively) (p<0.01). There was no difference in adverse events among the three groups. Patients satisfaction was better in group MMg (p<0.01). CONCLUSION: In patients undergoing caesarean section under spinal anaesthesia, the addition of IT magnesium sulphate (100mg) to morphine 100 microg improved the quality and the duration of postoperative analgesia without increasing the incidence of adverse effects.

[Management of malignant vulvar tumors]. / Prise en charge des tumeurs malignes de la vulve.

BACKGROUND: Vulva anatomy--FIGO classification--Vulva tumors anatomopathology--Tretments of vulva cancers. METHODS: Our stady is a retrospective, longitudinal and continuous one. It concerns 11 malignant vulva tumors whith were treated in the département "C" of the centre of maternity of Tunis. The period of stady is fifty four months (2002-2006). AIM: The aim of our study is to analyse the charactéristics of the vulva cancer and to compare our results to littérature. RESULTS: Mean age of our patients is 67 years old. They are all menaused. The principal signs are vulva tuméfaction in 72.7% of the cases, vulva prurit in 27.3% of the cases and genital bleeding in 27.3% of the cases. The mean period of consultation is of 14 months. We have ten cases of vulvar epidermoid carcinoma and one melanoma. The treatment was surgical in the eleven cases (10 total vulvectomy and one hemivulvectomy) They all benefited of an inguinal bilateral curage. The adjuvant radiotérapie was indicated in 3 cases. A patient was classed stage Ib of FIGO, 7 stage II, one stage III and one stage IVa. Nine patients are in remission, 3 are dead: 2 because of their cancer and one due to a pulmonar embolism. The survival of 6 month is 72.2%. CONCLUSION: The prevention of this cancer passes by the close follow of dystrophic states and viral pathologies of the vulva.

[Maternal and neonatal effects of remifentanil for general anaesthesia for Caesarean delivery]. / Répercussions maternelles et néonatales de l'anesthésie générale par rémifentanil pour césarienne programmée.

OBJECTIVE: Opioids are routinely omitted at the induction of general anesthesia for Caesarean delivery because of the risks of respiratory neonatal depression. The short-acting opioid remifentanil may afford advantages at the induction and surgical stimulation, without subsequent neonatal depression. PATIENTS AND METHODS: In this double-blinded study, 40 at term women undergoing elective Caesarean section and requiring general anaesthesia were allocated randomly to receive either remifentanil (0,5 microg/kg) at the induction of anaesthesia (G1, n=20) or placebo (G2, n=20). Induction of anaesthesia was performed with propofol 2 mg/kg and succinylcholine 1 mg/kg. Anaesthesia was maintained with nitrous oxide in oxygen (50/50%, v/v), propofol (100 microg/kg/min), remifentanil (0.2 microg/kg/min) and atracurium. Neonates were assessed by using Apgar scores, possible respiratory depression, with or without ventilation in the mask or intubation and umbilical cord blood gas (artery: UA and vein: UV). Values are expressed as mean values +/-SD. Pearson's Chi squared and t-test were used for statistical analysis P<0.05 was considered significant. RESULTS: Maternal systolic pressure, mean pressure and heart rate were significantly higher in G1 at induction. Apgar scores, heart and respiratory rate were similar between groups. Seven episodes of respiratory depressions were noted (3 in G1, 4 in G2). Five neonates required only brief assisted ventilation by face-mask (2 in G1, 3 in G2). CONCLUSION: Remifentanil (0.5 microg/kg) at the induction of anaesthesia in elective Caesarean section under general anaesthesia can be used without subsequent neonatal depression. However, we believe that further research is necessary to extrapolate these results to a pregnancy carrying an acutely distressed foetus.

[Post-traumatic tension pneumothorax and pneumopericardium in spontaneous ventilation]. / Pneumothorax et pneumopéricarde compressifs post-traumatiques en ventilation spontanée.

The occurrence of tension pneumopericardium in patient in spontaneous ventilation after blunt trauma is rare. The diagnosis is difficult and it may remain unrecognized. The authors reported the case of a 50 year-old trauma patient with a tension pneumothorax associated with a pneumopericardium. The patient was not mechanically ventilated at any time. Pericardial relief was obtained by insertion of a chest tube.