Sperm DNA status in infertile patients with clinical varicocele.

OBJECTIVE: To evaluate if a potential relationship exists between sperm nuclear DNA damage and clinical varicocele and to determine the impact of clinical varicocele on standard semen parameters. MATERIALS AND METHODS: A prospective study involving 30 infertile patients with clinical varicocele and 15 controls patients referred to our laboratory for routine spermiological exploration. Spermograms were performed and analyzed according to World Health Organisation (WHO) guidelines 2010. The DNA fragmentation was detected by the terminal desoxynucleotidyl transferase-mediated deoxyuridine triphosphate biotin nick-end labeling (TUNEL) assay. RESULTS: The DNA fragmentation index (DFI) was significantly higher in patients with clinical varicocele compared to controls (13.3±3.4% versus 6.1±2.5%, P=0.0001). In addition, the DFI was positively and significantly correlated with the degree of severity of varicocele thus the DFI was 15.24±1.9% in patients with grade 3 versus 12.92±3.5% in those with grade 2(P<0.0001). However, an abnormality of at least one of the spermatic parameters was found in 90% of varicocele patients, and all semen characteristics such as sperm count, vitality, mobility and typical forms were decreased compared to the controls. Furthermore, statistically significant negative correlations were noted between sperm DNA fragmentation index and sperm concentration (P=0.0001), motility (P=0.03), and normal sperm morphology (P=0.03). CONCLUSION: Clinical varicocele generates a significant increase of sperm abnormalities and DNA damage, and these changes are positively correlated with varicocele grade. Sperm DNA damage independent of its cause, may affect the quality of the ejaculated sperm and may have implications on patient's fertility potential. LEVEL OF EVIDENCE: 3.

Vascular endothelial growth factor antagonist reduces the early onset and the severity of ovarian hyperstimulation syndrome.

BACKGROUND: Ovarian hyperstimulation syndrome (OHSS) is the most serious complication of controlled ovarian stimulation (COH) during assisted reproductive technology (ART) protocols. This syndrome is a result of ovarian expression of vascular endothelial growth factor (VEGF), which increases vascular permeability. OBJECTIVES: To evaluate the efficiency of prophylactic and therapeutic use of cabergoline in women with higher risk of developing OHSS. MATERIALS AND METHODS: In this prospective randomized study, 146 women undergoing in vitro fertilization (IVF) cycles with GnRH agonist protocols with a higher risk of OHSS diagnosed during the HCG day administration (more than 18 follicles observed larger than 12mm in diameter during COH and/or estradiol levels of 3000-3500pg/ml, previous episodes of OHSS). Women were randomly divided in two groups. The first group included 78 women who received 0.5mg per day of cabergoline (Dostinex®) orally for 7 days starting from hCG administration day. The second group included 68 women who received no medication treatment. Overall, in each group 25 patients have developed OHSS. This defines subgroup 1 that includes 25 cases of OHSS obtained in group 1 and subgroup 2 where 25 cases of OHSS obtained in group 2. Early OHSS was defined as being when the onset of the syndrome was initiated during the first 9 days after hCG administration and late OHSS was defined as being when the onset of the syndrome was initiated from 10 days after hCG administration. Outcome measures of this study were the incidence of moderate and severe OHSS, early or late OHSS and pregnancy rates. RESULTS: There was no evidence of a statistically significant reduction in the incidence of OHSS in cabergoline group (32.05% vs. 36.76%; P>0.05). Late OHSS was observed in 60.6% of cases in cabergoline group while 39.4% of cases in the other group (P=0.036). Early OHSS decreased significantly (P<0.05) in the cabergoline group. Severe OHSS cases were more common within subgroup 2 than subgroup 1 (32% vs. 8%, P=0.000). There was no difference in clinical pregnancy rates (PR) and miscarriages rates between the two subgroups. CONCLUSIONS: The cabergoline administration (Dostinex®) for patients with high-risk of OHSS can reduce the rate of early OHSS and its severity in GnRH agonist IVF cycles, but cannot prevent the incidence of OHSS.

[Temporomandibular joint primitive tumors and pseudo tumors]. / Pseudotumeurs et tumeurs primitives de l'articulation temporomandibulaire.

The temporomandibular joint (TMJ) can be the site of bone, cartilaginous, or synovial tumors. There is no well-defined histological classification. We listed all benign tumors, malignant primitive tumors, and rare pseudo tumors of the TMJ. We provide a list to help for the diagnosis and the differential diagnosis of non-tumoral lesions by far the most frequent.

[Cerebral venous thrombosis during pregnancy: about 7 cases]. / Thrombophlebite cerebrale survenant lors de la grossesse: a propos de 7 cas.

BACKGROUND: cerebral venous thrombophlebitis (CVT) is a rare but serious pathology. The pregnancy and especially the postpartum constitute supporting circumstances occured of the CVT. AIM: the aim of our study is to remember the symptomatology of CVT, the importance of the IRM and the angio IRM in the diagnosis of CVT, and its treatment. OBSERVATIONS: We present a retrospective study relating to 7 cases of CVT during gravidopuerperality over 7 years (1996 to 2002). The average age of our patients is 32.1 years. The CVT occured during the first trimester of the pregnancy in one case and in the postpartum in 6 cases. The symptomatology was dominated by cephalgia and the signs of intracranian hypertension. Convulsions occured in 3 cases. The diagnosis of CVT was confirmed by IRM coupled with the Angio-IRM in all cases. The treatment by heparinotherapy was instaured immediately and relayed by the Anti-Vit K as the evolution was favorable in all cases. CONCLUSION: cerebral venous thrombophebitis (CVT) is a serious pathology (especially in pregnancy and post partum). The diagnosis is performed by the magnetic resonance imaging (IRM) and the early introduction of the heparinotherapy.

[Endometrectomy. Analytical study of 20 cases]. / Endométrectomie. Etude analytique de 20 cas.

UNLABELLED: Endometrial removal represents a therapeutic alternative to hysterectomy. AIMS: Through a retrospective study of 20 cases of endometrial removal colleted over a period of 4 years, the authors try to determine the indications of this therapeutic method, its efficiency, its advantages as well as its contra indications. RESULTS: Average age of the patients was 44 years. Average parity was 4. Functional menstrual disorders were found in 90% of cases. Gynaecological examination revealed a uterus of normal size in 85% of cases, and increased in size in 15% of cases. All the women had a preoperative diagnostic hysteroscopy. A simple endometrectomy was performed in 70% of the cases, an endometrectomy with a polypectomy in 25% of the cases and an endométrectomy with a myomectomy in 5% of the cases. The rate of success was 90%. We had a case of uterine perforation, because of uncontrollable bleeding a hysterectomyhad to be carried out in 2 cases. CONCLUSION: Endometrectomy is an alternative to hysterectomy in cases of menorrhagia due to mild functional disorders resistant to medical treatment.

[Intra-uterine growth retardation: etiologic factors and management]. / Retard de croissance intra-utérin: etiologie et prise en charge obstetricale.

OBJECTIVE: The aim of this study is to define the etiologic factors, the diagnostic proceduresand obstetrical rules to be observed during a pregnancy in relation with low birth weight. PATIENTS AND METHODS: This is a retrospective study of 124 cases, carried out at the military hospital of Tunis, between January 1st 1999 and December 31 st 2001. RESULTS: The frequency of intra-uterine growth retardation (IVGR) was 2.1%. 46.8% of the patients were primiparous. The mean age of the patients was 30 years. 25.8% of the patients developed toxemia. The etiology was predominantly renovascular-syndromes, urinary infections, and idiopathic hypotrophy. The positive diagnosis was suggesred by the measure of the uterine height in 96% and was confirmed by sonogaphy in all cases. The ombilical Doppler was pathological in 17.76% of the cases. A corticosteroid administration for pulmonary maturation was prescribed in 28% of the cases. Obstetrical common rule was fetal extraction: 42.7% of the patients were delivered by cesarean. CONCLUSION: There is a real need to insist on the importance of early detection of fetal hypotrophy and of better management of the women at risk.

[Maternal mortality: epidemiology, risk factors and evitability. About ten cases]. / La mortalité maternelle : épidémiologie, facteurs de risque et évitabilité. A propos de dix cas.

OBJECTIVES: To determine maternal mortality rate during the last decade as revealing the quality of obstetrical follow-up and the necessary measures to be taken. PATIENTS AND METHODS: A retrospective study conducted in the department of gynaecology in the military hospital in Tunis between 1990 and 2001, permitted to count 10 cases of maternal death. RESULTS: Maternal mortality rate was about 33.72/100,000 live births. Mean age of patients was 31.2 years. Primiparity, multiparity, poor socio-economic conditions, high-risk pregnancies and bad follow-up were responsible in 5, 1, 6 and 3 cases and represent the risk factors of mortality. All deaths occurred after delivery, with 60% before 24 h. Causes of death were haemorrhage in 40%, gravidic hypertension in 20%, anesthetic accidents in 10%, acute hepatic failure in 10%, and infection in 10%. Indirect causes are responsible for 20% of cases. DISCUSSION AND CONCLUSION: Deaths were judged evitable in 66.6% of cases, which confirms, although maternal mortality has diminished in the recent past, the necessity of pursuing study of risk factors together with study of remedies to them.

[Urinary incontinence with effort: surgical management in the maternity ward of a Tunisian military hospital (91 case reports)]. / Incontinence urinaire à l'effort: prise en charge chirurgicale à la maternité de l'hôpital militaire de Tunis (à propos de 91 cas).

We bring back a retrospective study on the surgical treatment of the incontinence in the effort about 91 cases. Our objective is to estimate the results of our surgical techniques. Three procedures were used: plicatures under urethrales; intervention of bologna; intervention of Burch. The incontinence in the effort was associated to a genital prolapse in every cases; prolapse was of third degree in 70% of cases. We obtained a good functional result in 94% of cases and a good anatomical result in 96% of cases on an average recession of 60 months. The complications per and postoperating are marked especially by the urinary infections. Our study shows that classical technics are still available.

[Management of uterine fibromas. Report of 219 cases]. / Prise en charge des fibromes uterins. A propos de 219 cas.

This study is about 219 uterine fibroma treated surgically between 1994 and 1998. The surgical operation represent 19.1% of the gynecological interventions. The average age of our patients was of 41.7 years with 30.6% of nulliparous. The main motives of consultation were: the confusion of the menstrual cycle in 56.6%, the pelvic pains in 32%, the increase of the volume of the belly in 10% and the infertility in 10% of cases. The surgical indications were dominated by the big size of the womb in 68% of cases and hemorrhagic complications in 57.7% of cases. The myomectomy indicated for women young and avid for pregnancy was realized in 94 cases; 80.8% by abdominal way, 13.8% by hysteroscopic way and 5.3% by coelioscopy. Hysterectomy proposed for women near menopauses was realized in 125 cases: 70.4% by abdominal way and 29.6% by vaginal way. The complications per- and post-operating are rare, represented essentially by the bleeding and the urinary infections.

[The association of genito-urinary prolapse and bladder lithiasis]. / L'association prolapsus génito-urinaire et lithiase vésicale.

Two cases of third degree tri-segmentary prolapse were associated with bladder calculi. Two cm calculi in the first case and a unique 4 x 5 cm calculus in the second made diagnosis difficult and raised the question of the choice of therapy.

[Placental aspergillosis: myth or reality? Apropos of a case with fetal death in utero]. / L'aspergillose placentaire: mythe ou réalité? A propos d'une observation avec mort foetale in utero.

The authors report an original case-history of massive aspergillosis of the placenta that occurred in a 24 year old primigravida who had had no previous history or clinical changes in pregnancy. It caused fetal death in utero with retention and maceration of the fetus. Macroscopic examination showed that the left lip was cleft and that the placenta was studded with isolated confluent diffuse whitish granulations. Histologic examination made us think that these appearances were those of aspergillar granulomas occurring even in the placental villi and intravillous spaces. Laboratory findings showed that there was Aspergillus Niger in the blood of the mother. A wide search of the literature failed to find any case in humans. On the other hand aspergillosis occurs frequently in animals causing intrauterine growth retardation and prematurity with abortion. There is great economic loss as a result. Why the animal placenta should be susceptible to infection of aspergillosis and how it acquires it is discussed! Finally the association of aspergillosis of the placenta with a cleft lip found in our case, is unique and one wonders if there is any relationship.

[Sarcoid reaction to a foreign body located in the uterus and the liver]. / Réaction sarcoïdosique à corps étranger localisée à l'utérus et au foie.

A case is reported of a sarcoidosis reaction within the uterine wall which developed following the vaginal injection of an unknown substance for contraceptive purposes. The reaction spread through the body to affect the lymphnodes and liver. Can this serve as an experimental model for the various forms of sarcoidosis observed clinically, notably genital sarcoidosis?

Malformations in 10,000 consecutive births in Tunis.

Malformations were assessed in 10,000 consecutively born infants, dead or alive, at the Wassila Bourgiba Maternity Hospital in Tunis. The medical and social history including the rate of consanguinity was studied in the malformed group as well as in a control group of 229 infants. Three hundred and ninety-six infants were malformed; 248 had major malformations and 148 had minor ones. Thirteen per cent of the stillborn were malformed compared to 3.7% of the liveborn. The rates of most specific malformations were comparable to those in other studies but a relatively high rate of neural tube defects, 2.2/1000, can be noted. There is a significant overrepresentation of consanguinity (65%) in parents of non syndromic multi-malformed infants.