[Post-cesarean parietal scar characteristics are predictive of pelvic adhesions. A prospective cohort study]. / Les caractéristiques de la cicatrice pariétale de césarienne sont des facteurs prédictifs des adhérences pelviennes. Étude de cohorte prospective.

OBJECTIVE: To investigate whether abdominal scar characteristics could predict the incidence and severity of intra-abdominal adhesions found at repeat cesarean delivery. PATIENTS AND METHODS: Prospective cohort study including 151pregnant women with at least one previous cesarean delivery and who delivered abdominally in the department of obstetrics and gynaecology of Farhat Hached teaching hospital-Sousse-Tunisia, during 6 months. Abdominal scar characteristics were studied. The main outcome measure(s) were the incidence and severity of intra-abdominal adhesions. Statistical analysis was performed using SPSS 18.0. RESULTS: Of 151 women enrolled into this trial, 111 (73.5%) had adhesions, 57 (37.8%) had dense adhesions. Of all the abdominal scar characteristics studied, a depressed scar was associated with an increased incidence of both dense and filmy intra-abdominal adhesions and frozen pelvis if compared of women who did not have a depressed scar (P<10(-4) ; RR=7.6; IC=2.98-19.45). A number of previous cesarean section equal or more than 2 was also correlated with an increased incidence of severe intra-abdominal adhesions and frozen pelvis if compared with women who had only one previous cesarean section (P=0.002; RR=2.53; IC=1.16-5.56). DISCUSSION AND CONCLUSION: A depressed abdominal scar of a previous cesarean delivery and a number of previous cesarean sections are significantly correlated with the incidence and severity of intra-abdominal adhesions.

[Interest of laparoscopy in infertile couple with normal hysterosalpingography]. / Faut-il cœlioscoper les femmes infertiles ayant une hystérosalpingographie normale.

OBJECTIVES: The diagnostic laparoscopy has long been the key consideration in the export of female infertility. This place is being reconsidered, especially in the case of normal hysterosalpingogrophy (HSG), because of the advent of assisted reproductive technologies which are more efficient, and because of the improvement of medical imaging techniques which are more sensitive and specific. We wanted to clarify the place of the diagnostic laparoscopy in the balance of female infertility in normal HSG. PATIENTS AND METHODS: It is a retrospective study on a series of 100 observations of infertile patients with a normal HSG and having a diagnostic laparoscopy in the department of Gynecology and Obstetrics at Farhat Hached hospital in Sousse (Tunisia) from 1st January 1993 to 1st March 2003. RESULTS: The mean age was 32.3years; the mean duration of infertility was 70.47months. Laparoscopy revealed pelvic abnormalities in 45% of cases, dominated by disease tubo-adhesions (23%), endometriosis was found in 6% of cases. These anomalies are considered major in 23% of cases and minor in 22% of cases. Conducting a surgical procedure in the same operating time (adhesiolysis, tubal plastic surgery, electrocoagulation of endometriosis implants) could improve the prognosis of fertility. Only 20 patients were followed among the 45 with pelvic abnormalities, seven pregnancies have been completed (35% of cases). DISCUSSION AND CONCLUSION: Laparoscopy has improved the prognosis for the fertility of our patients by treating abnormalities involved in infertility. It is estimated that the prognosis can be improved by selecting patients with risk factors for pelvic abnormalities.

[Diabetic mastopathy]. / Mastopathie diabétique.

Diabetic mastopathy is a recently described pathological entity. Little is known about this benign condition. It usually occurs in young patients with type 1 diabetes, or having an autoimmune disorders. Clinically, this mastopathy simulates a breast cancer. Graphic tests are not very informative. The diagnosis is histological. Through a case of diabetic mastopathy occurring in a patient with diabetes on insulin for 16 years and carries multiple degenerative complications, we recall the clinical, radiological and outcome of this disease.

[Place of pelvic ultrasonography using transabdominal technique in the investigation of premature ovarian failure]. / Place de l'échographie pelvienne réalisée par voie sus-pubienne dans l'exploration de l'insuffisance ovarienne prématurée.

OBJECTIVES: The aim of the present study was to characterize women with premature ovarian failure (POF) by their ovarian ultrasonographic appearances using transabdominal technique to establish the relationship to clinical, hormonal status, and genetic analysis. PATIENTS AND METHODS: We studied a cohort of 80 patients suffering from POF. The surface of the ovary was calculated and we identified the detection or not of follicles. RESULTS: The detection of the two ovaries by ultrasound was positive in 33 patients; only one ovary was identified in seven patients; none was noted in 40 patients. The surface of the ovaries ranged between 0.74 et 5.92 cm(2) (2.2+/-1.13 cm(2)). Ultrasonography identified follicles in 23 patients (28.75%). The presence of follicles suggested at ultrasonography was detected in 14 cases (70%) in normal-sized ovaries (> or =2 cm(2)) and in nine cases (45%) in small-sized ovaries (p=0.1). No significative statistical difference was found between the ultrasonographic appearances and the type of amenorrhea, pubertal development, hormonal status (estradiol, testosterone and delta-4-androstendione) and the chromosomal analysis. CONCLUSION: The clinical and hormonal status and the genetic analysis can't predict the presence or not of follicles in the ovaries of patients with POF.

[Radiation induced breast sarcoma: a case report]. / Sarcome radio-induit du sein: à propos d'un cas.

Radiation-induced breast sarcoma is a late complication of radiation treatment. We report a case of an undifferentiated sarcoma occurring 8 years after breast conserving treatment, which required mastectomy taking pectoralis major.

[Tuberculous axillary lymphadenitis: an unusual presentation]. / Le cas clinique du mois. Tuberculose ganglionnaire axillaire une présentation inhabituelle.

Axillary lymph node tuberculosis is rare and often poses problems of differential, diagnosis, especially with breast carcinoma. We report the case of a tuberculous axillary lymphadenitis discovered at the time of the exploration of a supposedly metastatic liver and, initially, taken for metastases of an occult breast carcinoma. Tuberculous axillary lymphadenitis remains a rare condition which must be considered in patients living in country with endemic tuberculosis.

[Clinical case of the month. Peritoneal tuberculosis mimicking ovarian carcinoma]. / Le cas clinique du mois. Tuberculose péritonéale simulant un cancer ovarien.

Peritoneal tuberculosis can mimic advanced stage ovarian cancer and can lead to the performance of an unnecessary extended surgery. Clinical discrimination between peritoneal tuberculosis and ovarian carcinoma may sometimes be extremely difficult. We report 2 cases of peritoneal tuberculosis mimicking ovarian carcinoma. Diagnosis was made on perioneal biopsy.

[Risk factors for group B streptococcal colonization in pregnant women at term: prospective study of 294 cases]. / Facteurs de risque du portage du streptocoque du groupe B chez la femme enceinte à terme: étude prospective à propos de 294 cas.

OBJECTIVE: To determine the rate and risk factors for group B streptococcus (GBS) colonization in term pregnancies. PATIENTS AND METHODS: Vaginal and anal cultures were prospectively conducted in 294 parturient on admission for term vaginal delivery. RESULTS: Thirty-eight (12.92%) parturient had positive GBS cultures. None of the studied risk factors (age, education status, nulliparity, previous obstetric problem, twin pregnancy and diabetes) was statistically predictive of maternal colonization. All the isolated GBS were sensitive to the penicillin G. DISCUSSION AND CONCLUSION: Systematic screening strategy of GBS close to the delivery on all pregnant women is desirable.

[Cavernous hemangioma of the breast: a case report]. / Hémangiome caverneux du sein: à propos d'un cas.

Cavernous hemangiomas of the breast are uncommon. Clinical diagnosis is rather difficult. Generally there are coincidental microscopic findings. We present a case of a 67-year-old woman which commenced as a 6 cm palpable mass of the right breast. The use of mammography, ultrasound and MRI facilitate diagnosis. Large surgical excision of the lesion was performed and histology allowed to find a cavernous hemangioma without cellular atypia.

[Laparoscopic management of adnexal tumors after the first trimester of pregnancy]. / Le traitement coeliochirurgical des tumeurs des annexes de l'utérus après le premier trimestre de la grossesse: à propos de 25 observations.

PURPOSE OF THE STUDY: To study the feasibility, advantages and risks of laparoscopic management of adnexal tumors in the course of the last two trimesters of the pregnancy. MATERIAL AND METHODS: Retrospective study of a series of 25 cases of adnexal tumors operated by laparoscopy in the course of the second and the third trimester of pregnancy, during a period of 49 Months from 1st January 1999 to 30 January 2003. RESULTS: Mean gestational age at surgery was 16 weeks 3 days (range 12-29 weeks). The adnexal tumor was an ovarian cyst in 24 cases and in a paratubal cyst in a single case. Conversion was necessary in only one case due to difficult hemostasis. One revision required for borderline malignancy cystadenoma was performed laparoscopically during the same pregnancy. No operative complication was noted. Average post-operative stay was 36 hours (range 24-72 hours). There was one situation of eminent abortion in early the postoperative period but no thromboembolic complications. The pregnancy progress was normal after laparoscopy. CONCLUSION: Laparoscopic treatment of adnexal tumors is feasible in the course of the last two trimesters of the pregnancy in the hands of an experienced surgeon using advanced techniques. The well-known advantages of laparoscopy are particularly important during the pregnancy.

[Adnexal torsion: a report of 135 cases]. / Les torsions des annexes de l'utérus. Aspects cliniques et thérapeutiques: à propos d'une série de 135 cas.

OBJECTIVES: To evaluate the clinical findings and therapeutic options following adnexal torsion. STUDY DESIGN: A retrospective series of 135 patients presenting with adnexal torsion between January 1992 and December 2001 in Sousse- Tunisia- a university teaching hospital. RESULTS: Adnexal torsion accounted for 14.8% of surgically treated adnexal tumors. Pregnancy was associated in 17% of cases and diagnosis was accurate at first clinical examination in only 57.8% of cases. Ultrasound allowed visualisation of Adnexal Diseases in all cases. Operative laparoscopy was successfully achieved in 34% of patients. Conservative management was used in 57% of the premenopausal patients. No major postoperative complication was noted. CONCLUSION: Clinicians must be aware of a possible adnexal torsion in women with acute pelvic pain. Ultrasound is a useful tool in these situations. Laparoscopy allows diagnosis and surgical management even during pregnancy.

[Pseudoaneurysm of the uterine artery: apropos of 1 case]. / Pseudoanévrisme de l'artère utérine. A propos d'un cas.

Pseudoaneurism of the uterine artery is uncommon and is usually associated with pregnancy or surgical trauma. Diagnosis is based on both Doppler sonography and arteriography. We report a case of pseudoaneurysm of the uterine artery associated with a leiomyoma without prior surgery or pregnancy. Treatment, which consisted on laparotomy, allowed avoiding rupture and confirmed diagnosis.

[Periurethral injection of silicone microparticles in the treatment of sphincter deficiency urinary incontinence]. / Injection périurétrale de microparticules de silicone dans le traitement de l'incontinence urinaire par insuffisance sphinctérienne.

OBJECTIVE: To assess the mid-term efficacy of periurethral injection of silicone micro-implants in women with urinary incontinence due to intrinsic sphincter deficiency. MATERIAL AND METHODS: Between July 1992 and March 1999, 25 women (mean age 65.17 +/- 13.5 years) with intrinsic sphincter deficiency underwent periurethral injection of silicone micro-implants. Urodynamic investigations were performed prior to and after surgery. The subjective degree of continence was also assessed for 3 years. RESULTS: Subjective success rate were 80%, 72%, 65%, 60%, and 60% at 6 weeks, 3 months, 6 months, 1 year and 3 years, respectively. Post-operative maximum urethral closure pressure was significantly increased (post-op 32.35 +/- 18.04 cm H2O versus pre-op 23.68 +/- 9.4 cm H2O; P < 0.01) No serious operative or postoperative complication occurred. CONCLUSION: In spite of time-dependent decrease in success rate periurethral silicone micro-implants injection remains an effective and safe procedure for women with urinary incontinence due to intrinsic sphincter deficiency.

[Results of artificial sphincter for the treatment of sphincter incontinence]. / Résultat du sphincter artificiel en cas d'incontinence sphinctérienne.

47 patients were treated since 1987 by implantation of an artificial sphincter. The majority of female patients were operated for bladder neck hypermotility. In the male population, incontinence was mostly a complication of prostatic surgery. The indication, preoperatory assessment, surgical techniques and results are discussed. During a mean follow-up of 38 months, 92.9% of females remained perfectly continent and results were good in 76.7% of males. The results are similar to those reported in the literature.