Evaluation of Triclosan coated suture in obstetrical surgery: A prospective randomized controlled study (NCT05330650).

OBJECTIVES: To assess the effectiveness of Triclosan coated suture in reducing surgical site infections (SSIs) rate after caesarian delivery (CD). STUDY DESIGN: Three hundred eighty patients were randomly assigned to closure with polyglactin non coated suture VICRYL, or with polyglactin coated suture VICRYL Plus after caesarian section. The primary outcome was the rate of SSIs within 30 days after surgery and secondary outcomes were the rate of wound healing complications. RESULTS: SSI rate was 2.5% in Triclosan group compared to 8.1% with non-coated suture. Use of Triclosan coated suture (TCS) was associated with 69% reduction in SSI rate (p = 0.037; ORa:0.294; 95% CI:0.094-0.921). The use of Triclosan coated suture was associated with statistically lower risk of wound oedema (2.5% vs 10%), (p = 0.019; OR:0.595), dehiscence (3.8% vs 10.6%), (p = 0.023; OR:0.316) and hematoma (p = 0.035; OR:0.423). CONCLUSION: Our results confirm the effectiveness of Triclosan coated suture in reducing SSI rate and wound healing disturbances. TRIAL REGISTRATION: Registered at ClinicalTrials.gov / ID (NCT05330650).

Etude rétrospective sur 70 cas d´hystérectomie d´hémostase dans le département de gynécologie obstétrique de l´Hôpital de Ben Arous, Tunisie.

Introduction: hemostasis hysterectomy is the radical treatment for postpartum hemorrhage. The purpose of this study is to identify risk factors, indications and complications of hemostasis hysterectomy and to determine factors influencing the types of approaches to hysterectomy. Methods: we conducted a monocentric descriptive and analytical retrospective study in the Department of Obstetrics and Gynecology at the Regional Hospital of Ben Arous from 2003 to 2019. Patients were classified according to the type of surgical treatment they received: total or subtotal hysterectomy. Results: seventy patients were included in the study. The rate of hemostasis hysterectomy was 1.3%. The average age of patients was 34.5 years (±5.1). Indications for hemostasis hysterectomy were dominated by placenta accreta (39% of cases; n=27), uterine inertia (34% of cases; n=24) and uterine rupture (16% of cases; n=11). Perioperative morbidity rate was 34 % (n=24). The most frequent complications were hemorrhagic shock (17%; n=12), disseminated intravascular coagulation (6%; n=4) and bladder lesions (6%; n=4). We reported six cases of maternal death, reflecting a rate of 8% (n=6). Subtotal hysterectomy was performed in 79% of patients (n=55) and 21% of women (n=15) underwent total hysterectomy. Placenta accreta was significantly associated with total hysterectomy group (aOR: 6.93, 95% CI: 1.07-44,80, p=0.042) and the average operation time was significantly shorter in subtotal hysterectomy group (aOR: 1.023; 95% CI: 1.009-1.03, p= 0.01). Conclusion: hysterectomy is essential in certain patients with severe postpartum hemorrhage. Placenta accreta is the main indication for hysterectomy. Total hysterectomy is not associated with an increased risk of complications compared to subtotal hysterectomy.

Breast rescue after necrotizing fasciitis.

Necrotizing fasciitis is a dangerous and rapidly spreading infection of soft tissue involving skin, subcutaneous tissue and fascia; muscles can be concerned but often omitted. It's considered as emergency due to its fulminant nature. The necrotizing fasciitis of the breast is exceptional. Management is based on surgical debridement and, in the case of breast, mastectomy in most cases is inevitable. We describe a case-report of breast necrotizing fasciitis with prompt management and with satisfactory cosmetic result owing to dermal autograft.

Molar tubal ectopic pregnancy: Report of two cases.

Ectopic molar pregnancy is a rare occurrence and consequently not often considered as a diagnostic possibility. We report two cases of molar hydatidiform tubal pregnancy. Diagnosis of ectopic pregnancy was confirmed on clinical biological and sonographic investigations. Diagnosis of molar pregnancy was done on histopathology. The clinical course was favorable for both patients. Although rare, molar changes can occur at any site of an ectopic pregnancy. Clinical diagnosis of a molar pregnancy is difficult but histopathology is the gold standard for diagnosis.

[Sertoli-Leydig cell tumor of the ovary]. / Les tumeurs de Sertoli-Leydig de l'ovaire.

Sertoli-Leidig cell tumor of the ovary is a rare tumor. It accounts for 0.5 - 1% of all ovarian tumors. Sertoli-Leidig cell tumors are commonly benign and they occur in young women who desire further childrearing. Although, the treatment must be as conservative as possible. For the malign Sertoli-Leidig cell tumor, radical treatment is required. The aim of this work is the analysis of clinical, para-clinical and therapeutic aspects of these tumors.

[Abdomino-pelvic actinomycosis. Report of 2 cases]. / Actinomycose abdomino-pelvienne. A propos de deux cas.

Actinomycosis is a chronic, granulomatous, suppurative and fistulasing infection related to a gram-positive bacteria (actinomyces israeli). Cervico-facial actinomycosis is the most common localization. The prevalence of abdomino-pelvic actinomycosis is increasing mainly with the increase of the use of intrauterin device. Its clinical presentation is variable and may mimic cancer or tuberculosis. The diagnosis of abdomino-pelvic actinomycosis is hard and most of the cases are detected during surgical exploration. We report two cases of abdomino-pelvic actinomycosis; in the first case, the disease was extended to the caecum and the abdominal wall. The skin biopsies made the diagnosis of actinomycosis, avoiding surgery. In the second case, the diagnosis of actinomycosis is made post operatively because of high suspicion of pelvic cancer. Through these two observations, we review pathogenesis of the disease, its clinical aspects and its diagnostic and therapeutic means.