Community-based study of unintentional injuries among preschool children in Damascus.

To assess injuries among 1125 preschool children in Damascus, and to investigate the risk factors, a retrospective home survey of childhood injuries for a period of 12 months was carried out in 4 areas of residence: agricultural rural, non-agricultural rural, periurban and urban. More than 75% of mothers believed that injuries were preventable. During the year preceding the study, 261 injuries were reported, an incidence of 23%. The most frequent injuries were from falls, 52.0%, and most injuries (73.9%) occurred inside the home. Area of residence was the only independent predictor for the occurrence of childhood injuries.

Community-based study of unintentional injuries among preschool children in Damascus

To assess injuries among 1125 preschool children in Damascus, and to investigate the risk factors, a retrospective home survey of childhood injuries for a period of 12 months was carried out in 4 areas of residence: agricultural rural, non-agricultural rural, periurban and urban. More than 75% of mothers believed that injuries were preventable. During the year preceding the study, 261 injuries were reported, an incidence of 23%. The most frequent injuries were from falls, 52.0%, and most injuries [73.9%] occurred inside the home. Area of residence was the only independent predictor for the occurrence of childhood injuries

[Voluntary surgical sterilization by laparoscopy in cases of cardiovascular diseases. Prospective study of 19 cases]. / Stérilisation chirurgicale volontaire per-coelioscopique en cas de maladie cardiovasculaire. Etude prospective à propos de 19 cas.

Nineteen women with cardiovascular disease underwent voluntary per-celioscopic sterilisation under local anesthesia at the La Rabta Maternity and Neonatology Centre, Tunis, Tunisia, between 1 July 1988 and 31 March 1989. There were 8 cases of hypertension, 1 of mitral insufficiency and 10 cases of surgically treated valve disease (6 cases of commissurotomy for mitral stenosis and 4 valve replacements). Mean parity of the women was 5 and mean age 35.4. Their educational level was low. Thirteen of them had never used contraception and 4 had had at least 2 therapeutic abortions. Local anesthesia with analgesia was well appreciated since 15 women remained calm and experienced no pain. The procedure involved minimal pneumoperitoneum and Trendelenburg. Recourse to minilaparotomy under general anesthesia was necessary in only one case. The authors stress the importance of counselling patients at the onset and of cooperation with cardiologists and anesthesiologists, and discuss peri-operative treatment protocols (anticoagulants, antibiotics) in particular.

[Induction of labor in fetal death in utero using a Foley catheter and extra-amniotic perfusion of physiologic serum]. / Déclenchement du travail dans les morts foetales in utero par sonde de Foley et perfusion extra-amniotique de sérum physiologique.

Nineteen cases of induction of labour by Foley catheter and extra-amniotic perfusion of normal saline for fetal death in utero occurring more than 24 weeks after the LMP were collected in the La Rabta Maternity and Neonatology Centre, Tunis, during the final 6 months of 1987. The mean age of the women was 27.8 and their mean parity 2.9. Two patients had uterine scars. The mean duration of the pregnancy was 33.3 weeks and initial Bishop score was 4 or less. When the catheter fell out, after 26.4 hours on average, the Bishop score had improved by 4.5 points. Labour occurred spontaneously in 5 cases and required oxytocin stimulation in 5 cases. The interval between induction and fetal expulsion was 44.4 hours. Delivery was followed by routine manual evacuation of the uterus. Two complications were seen: one case of accidental rupture of the membranes and one of rupture of the uterus affecting a scarred uterus. The authors point out certain risk factors concerning rupture of the uterus which should be considered to be contraindications to the method. With the exception of these situations, this method of induction is recommended because of its advantages of efficacy, safety and low cost, in particular in developing countries.

[Voluntary surgical sterilization by laparoscopy in the immediate post partum period. Prospective study in 55 cases]. / Stérilisation chirurgicale volontaire per-coelioscopique dans le post-partum immédiat. Etude prospective à propos de 55 cas.

Fifty five voluntary sterilisations were carried out during the immediate post-partum period via celioscopy and under local anesthesia at the La Rabta maternity and neonatology centre, Tunis, between 1 July 1988 and 31 March 1989. The women had a mean age of 34.6, mean parity of 6 and living children of both sexes. Their socio-economic level was low. They had never used any form of contraception in 50 p. cent of cases and 5 among them had undergone at least one termination of pregnancy. Acceptability of local anesthesia with analgesia was good since 71 p. cent of women remained calm during the procedure and experienced no pain. Among the 16 women who reported pain, this occurred above all when the tubes were grasped (10 cases). There were no notable complications. However, sterilisation was not possible in two cases.

[Abdominal pregnancy, a rare anatomoclinical entity. 4 case reports (1981-1990)]. / La grossesse abdominale, entité anatomoclinique rare. A propos de 4 cas (1981-1990).

The opportunity is taken, on the basis of 4 cases of abdominal pregnancy and a review of the literature, to attempt to analyse the various aspects of this increasingly rare pathology. Its incidence is low, being evaluated by our own study at 4/85 757 deliveries, i.e.: 1/21 439 deliveries collected at the Maternity and Neonatology centre of Rabta Tunis during a 10-year period (1981-1990). The essential epidemiological factor is the low socio-economic and cultural status seen in the patients studied. Clinical signs were predominated by metrorrhagia, abdominal pain, disturbed intestinal function and fetal death in utero. The delay in diagnosis explains the onset of frequent fetal complications in the form of fetal death in utero (3 cases out of 4) and of various fetal malformations. Ultrasonography is the essential investigation enabling diagnosis in the presence of clinical suspicion. Surgery is obligatory, excluding any attempt in the majority of cases at extraction of the placenta, which is left in place.

[Pregnancy following female surgical sterilization. A study apropos of 38 cases]. / Grossesses survenues après stérilisation chirurgicale féminine. Etude à propos de 38 cas.

A study of 38 cases of pregnancy that occurred after sterilisation between 1st January 1981 and the 30th September 1987 at the Maternity and Neonatology Department of La Rabta, Tunis. This complication is rare because the overall global figure for failure is 7.1/1000. This is what is found in the literature. When we came to analyse the failures we found there were two groups: 15% of these failures were in women who had been sterilised correctly. This also happens when women have been sterilised with the Yonn ring as with Pomery's ligation technique. In this case when patients become pregnant there is a big chance of their being ectopic (2 tubal pregnancies as against 5 intrauterine pregnancies). 85% of failures were due to technical faults. They particularly happen with laparoscopic sterilisation (85%). They are usually due to lack of experience on the part of the operator. In any case patients do not like it; in fact 73.7% of the patients asked for a termination of the pregnancy and sterilisation was repeated in 87% of the cases.

[Intramural pregnancy: a case report]. / Grossesse intramurale: un cas.

Implantation into the muscle wall is one of the rarer forms of ectopic pregnancy. We report an uncomplicated case which was discovered during therapeutic termination of pregnancy at 10 weeks. We point out how valuable the use of ultrasound during the operation is for making the diagnosis when suction does not provide adequate quantities of products.

[The anatomo-clinical characteristics of granulosa tumors observed at the maternity unit of Rabta-Tunisia. Review of the literature]. / Caractéristiques anatomo-cliniques des tumeurs de la granulosa observées à la Maternité de la Rabta-Tunis. Revue de la littérature.

We have found eight granulosa tumours in nine years out of 280 ovarian tumours which were collected in the maternity and neonatology unit in Rabta. The mean age of the patients was 53, the mean parity was 8. Signs of oestrogen excretion were found in all cases and metrorrhagia was the principal reason for consulting doctors in 75% of cases. There was always a palpable mass on clinical examination. Histology was usually only microfollicular. Radical surgical treatment was carried out in all cases and consisted of total abdominal hysterectomy and bilateral salpingo-oophorectomy.

[Results at the Rabta Tunis Maternity and Neonatology Center of the surgical treatment of genital prolapse. 193 cases in 7 years (1982-1988)]. / L'expérience du Centre de Maternité et de Néonatologie de la Rabta Tunis dans le traitement chirurgical des prolapsus génitaux. A propos de 193 cas en 7 ans (1982-1988).

The authors report their experience in the treatment of 193 cases of genital prolapse treated surgically in the Rabta Tunis Maternity and Neonatology Unit during a 7 year period between January 1st 1982 and December 31st 1988. The epidemiological characteristics of the study population were dominated by the following factors: advanced age (mean age 54); multiparity (80 per cent of cases); 65.8 per cent of women were post-menopausal. The commonest association of lesions was triple prolapse, present in 78 per cent of cases. Stress incontinence of urine (SIU) was a common feature (59 per cent of cases). Treatment preference was for vaginal hysterectomy combined with anterior colporrhaphy and posterior perineorrhaphy (73.5 per cent). The Kelly Marion operation was often used for SIU (89 per cent of cases) and gave satisfactory results in 73 per cent of cases.

[Maternal mortality at the Maternity and Neonatology Center in Rabta of Tunis from 1986 to 1989]. / La mortalité maternelle au Centre de Maternité et de Néonatologie de la Rabta de Tunis de 1986 à 1989.

We studied 29 cases of maternal death occurring over a period of 3 years in the "Centre de Maternité et de Néonatologie de La Rabta-Tunis"; managed by the same staff. 42,028 live births occurred during the study years with 43,220 total births from April 24th 1986 to April 23rd 1989. The maternal mortality rate was 69 per 100,000 live births. A maternal age of under 35, nulliparity and grand multiparity were found, as is well known, to be risk factors. Maternal transfer in obstructed labour from rural maternity units raises the maternal death risk 12 times: 14 deaths out of 29 occurred in transferred patients. Haemorrhage represents a quarter of the causes of death (8 cases) while anaesthetic accidents were responsible for one in six maternal deaths. Some factors were not found such as abruptio placentae, while others such as eclampsia were reduced. We concluded that the maternal mortality rate even though it has been reduced over the last 3 decades it is still high compared with developed countries. We can cut it in half by avoiding maternal transfer in labour.

[Large placental chorioangiomas: 2 case reports]. / Les chorio-angiomes placentaires volumineux. A propos de deux observations.

Two cases of large placental chorioangiomas are reported. These tumors gave rise to obstetric and neonatal complications with perinatal death in both cases. These rare tumors were discovered by pathological examination of the products of delivery, with their precise nature being identified histologically. Review of the literature shows that fetal, neonatal and obstetric consequences are multiple and can often be explained by placental and cardiac insufficiency in utero secondary to the presence of these vascular tumors.

[The role of culdocentesis in the diagnosis of ectopic pregnancy. Prospective study of 478 cases]. / Place de la culdocentèse dans le diagnostic de la grossesse extra-utérine. Etude prospective à propos de 478 cas.

Four hundred and seventy height Culdocenteses were carried out in cases of possible ectopic pregnancy between the 20th September 1986 and 31st December 1987. Culdocentesis was considered to be positive if 2 cm3 or more of dark non-coagulated blood was removed, and negative if only a yellow liquid or blood stained serum was removed. It was not conclusive if nothing could be aspirated or if the blood was coagulated. Of the 94 cases where culdocentesis was positive, 74 were found to have an ectopic pregnancy. There were 20 false positive cases (due to 5 haemorrhagic ruptures of follicles, 3 refluxes of menstrual blood, 2 with other aetiology, and 10 without known cause). There were 21 cases of ectopic pregnancy in the 293 cases where culdocentesis was non-conclusive. Of the 91 cases where culdocentesis was negative, a second culdocentesis showed an ectopic pregnancy. It was positive 11 days after the first. In our series this diagnostic test was reliable in 77.1% of cases. Laparotomy was carried out in 22.3% of cases and only 18.6% had to have laparoscopy thanks to the use of culdocentesis.

[Female genital tuberculosis in Tunisia. Apropos of 118 cases at the Rabta Neonatology and Maternity Center in Tunis (January 1984-December 1988)]. / La tuberculose génitale féminine en Tunisie. A propos de 118 cas au Centre de Maternité et de Néonatalogie de la Rabta de Tunis (Janvier 1984-Décembre 1988).

The authors have reviewed 118 cases of female genital tuberculosis collected over a 5 year period, from 1st January 1984 up until 31 December 1988, and have compared their results (study group, SG) with those of a similar study (reference group, RG) carried out in the same centre 2 years previously. The following points stand out: the incidence of the disease is stable (6.6 p. cent in the SG versus 5.6 p. cent in the RG); the profile of the woman with genital tuberculosis is that of a young woman of rural origin, generally unvaccinated; sterility is increasingly the predominant motive for consultation (81 p. cent in the SG versus 73 p. cent in the RG); the latent form of genital tuberculosis constitutes 96.4 p. cent of cases in their series versus 93.8 p. cent in the RG; the diagnosis of genital tuberculosis was confirmed histologically in 46 p. cent of cases versus 30 p. cent in the RG, and bacteriologically in 7 p. cent of cases versus 4 p. cent in the RG; medical treatment was initiated for the acute and evolutive forms (35 p. cent of cases). Surgical treatment was indicated for macro-lesional forms which were resistant to medical treatment.

[Retrocervical cystic hygroma. Ultrasonic diagnosis. Apropos of 5 cases]. / L'hygroma kystique rétrocervical. Un diagnostic échographique. A propos de cinq observations.

The authors report five ultrasonic imaging between 13 and 32 weeks of gestation. All of them have an hydrops fetalis and an aspect of like masses located in the nuchal region. A cystic retrocervical hygroma was confirmed at autopsy examination in three cases. The diagnosis of cystic hygroma remains inaccurate in the other two cases in the lack of the radiographic and anatomical verification. A review of the literature was made up to define the diagnostic aspects of the hygroma colli, their histological aspects and the mains etiological factors.