Unveiling the intriguing grape-like mass: Uterine cervical adenosarcoma.

Key Clinical Message: Adenosarcoma of the uterine cervix should be considered in the evaluation of post-menopausal bleeding, as it can be a potential underlying cause. Timely diagnosis and appropriate management are essential to optimize patient outcomes. Abstract: Adenosarcoma is a biphasic neoplasm comprising both a benign epithelial component and a typically low-grade sarcomatous stromal component. Adenosarcoma mainly affects the endometrium (71%), with a lesser incidence in the cervix (2%). Herein, the authors report a case of adenosarcoma of the uterine cervix with distinct gross features.

Laparoscopic resection of a uterine lipoleiomyoma.

Uterine lipoleiomyomas are rare variants of leiomyomas that usually occur in postmenopausal women. Their incidence ranges from 0.03% to 0.2%. Few cases of laparoscopically resected lipoleiomyomas have been reported in the literature. Further accumulation of lipoleiomyomas could help establish an accurate preoperative diagnosis of this uncommon and benign mesenchymal tumor.

[Role of the hysteroscopy and laparoscopy in management of the female infertility: about 200 cases]. / Intérêt de l'hystéroscopie et de la coelioscopie dans la prise en charge du couple infertile: a propos de 200 cas.

AIM: Infertility is a common disease which affects nearly 10% of women at reproductive age. The hysteroscopy and laparoscopy are becoming very important in the management of this pathology. We tried to assess the current results of both hysteroscopy and laparoscopy, to study the prognosis factors as well as operating techniques and to clarify their contribution in comparison with other therapeutic techniques. METHODS: This is a retrospective study about 200 cases of hysterolaparoscopy performed for female infertility in women admitted at the department of Gynaecology and Obstetrics in Mongi Slim's Hospital La Marsa. RESULTS: The hysteroscopy was abnormal in 75% of cases: the uterine synechias (23%), endometria hypertrophy (19%), endometrial polyps (10%), uterine fibroids (9%), atrophy (7.5%) and malformations (3.5%). The operating hysteroscopy procedure was performed in 27.3% of cases with a rate of subsequent pregnancy in 34.9%. There is different data between the hysterosalpingography and hysteroscopy in 34.8%. The operating laparoscopy was performed in 70% of cases divided between adhesiolysis (27.2%), tubal surgery (37.8%), electrocoagulation or excision of endometriosis nodule (17.2%) and ovarian drilling for PCOS (17.8%). The rate of pregnancy is 39.9% after laproscopic surgery (divided between intrauterine pregnancy 37.1% and ectopic pregnancy 2.8%). The data of the hysterosalpingography and laparoscopy are different in 21.1%. CONCLUSION: Hysteroscopy and laparoscopy are diagnosing and treating both uterine and tubal infertility as well as some ovarian abnormalities. They have, thus, the main role in diagnosis and treatment of female infertility. They permit to correct data from the HSG in more than a quarter of cases and to improve the rate of pregnancy in more than one third of cases.

[Giant placental chorioangioma]. / Le chorioangiome placentaire geant.

The large placental chorioangioma is a non-trophoblastic vascular tumor of placenta which size is more than 4 cm. It's a rare tumor, the incidence is between 1/3500 and 1/9000 birth. We analyze, on base of our case and from a literature review, the ultrasonography aspects of this tumor: we bring out also the physiological mechanisms of maternal and fetal complications and finally we detail the therapeutic possibilities. Chorioangioma appears in ultrasound scan like a thoroughly limited hypo-echogenic zone The vascular origin of the tumor can be confirmed by color Doppler. A left-right shunt effect results from arterio-venous communications and causes backwardness growth and fetal death in-utero The fetus is exposed to anemia and microangiopathic thrombopenia The maternal complications are: hydramnios, abruption placenta, premature ruptured membrane. Therapeutic possibilities are reduced: In several fetal anemia, blood transfusion can be done. Some techniques for tumor devascularization are be tried by someone.

[Postmenopausal uterine bleeding. Analytic study about 65 cases]. / Les métrorragies post-ménopausiques. Etude analytique à propos de 65 cas.

UNLABELLED: Postmenopausal uterine bleeding is frequent in gynecology. This symptom can reveal benign causes as well as cancers. So it's essential to rule out organic pathology. MATERIALS AND METHODS: We propose a retrospective study of 65 postmenopausal women who had uterine bleeding for two years. OBJECTIVES: - To study the relative frequency of different causes of postmenopausal uterine bleeding. - To evaluate the different investigation procedures. RESULTS: In 65 cases of postmenopausal bleeding, we found: - 6 cases of cancer (9.2 %): 4 cases of cancer of uterine corpus and 2 cases of cancer of uterine cervix. - Benign pathology was more frequent (59 cases : 90.8%), essentially represented by endometrial atrophy (37 cases) and hyperplasia (11 cases). - Hysteroscopic aspect in the 4 cases of endometrial cancer: - Polypoid hypertrophy: 2 cases. - Simple hyperplasia: 2 cases. CONCLUSION: Despite the fact that benign pathology is more frequent than malignancy as a cause postmenopausal uterine bleeding, we must always rule out a cancer by oriented biopsy.

[Association fibromyoma and pregnancy. About 23 cases]. / Association fibrome uterin et grossesse. A propos de 23 cas.

UNLABELLED: The coexistence of leiomyoma and pregnancy may lead to complications with unequal gravity. MATERIAL AND METHODS: The authors propose a retrospective study about 23 cases of association of fibromyoma and pregnancy collected over a period of seven years. OBJECTIVES: Study of the effect of fibromyoma on pregnancy and vice-versa. Analysis mode of delivery. RESULTS: Aseptic necrobiosis: 21.7%. Urinary tract compression: 4.3%. Miscarriage: 13%. Threatened premature birth: 26%. Caesarean section: 47.8%. Premature birth: 8.6 %. Neonatal death: nil. CONCLUSION: Maternal morbidity due to this association is important. It is essential that pregnant women be aware of the importance of prenatal consultation during the first trimester of pregnancy.

[Malign Brenner's tumor particularities and coverage]. / La tumeur de Brenner maligne: particularites et prise en charge.

Brenner's tumour of the ovary is rare, mostly benign. It was described for the first time by Mac-Naughton-Jones in 1898. Von Numers listed the first malign form in 1945 that represents 2 % of tumours. On the basis of a personal report and of 160 cases listed in the literature, we propose to study anatomoclinical and epidemiological elements of this hurt and to study histological particularities and various therapeutic processes. Malignant Brenner's tumour arises mostly in peri and postmenopausal period. Clinical signs are not specific. Histological exam puts the problem of the choice of the histological malignant criteria. Metastasis occurs in half of cases. They are mostly loco-regional. The treatment is essentially surgical. The efficiency of an additive treatment seems to be debatable.

[Breech presentation: vaginal delivery or planned caesarean section?]. / Presentation de siege: accouchement par voie basse ou cesarienne systematique?

UNLABELLED: Breech delivery is a high risk situation because of its numerous dystocies. The most serious is the last head retention. The authors realized a retrospective study concerning 347 patients who had given birth to a newborn child in breech presentation during a period of 4 years. RESULTS: The vaginal delivery was associated in a significant way to an excess of obstetric traumatisms (5.5%) versus caesarean section (0.5%) and this even after strict selection of vaginal delivery's conditions (P = 0.00453). The rate of the newborn child having Apgar's score < 7 in 5 min was higher in case of vaginal delivery (17.39%) than caesarean section's birth (3.48%). Corrected neonatal mortality is higher in the group of vaginal delivery than caesarean section's group (34% versus 0.49%, P = 0.02553). There is no significant difference of maternal morbidity between caesarean section and vaginal delivery group (P = 4.65). Vaginal delivery is associated to an excess of morbidity and neonatal mortality even after strict selection of the candidates of the vaginal delivery.

[The obstetrical advantages of epidural analgesia in a trial of labor]. / Les avantages obstetricaux de l'analgesie peridurale au cours de l'épreuve de travail.

Two series of labour trial were compared in a forward-looking study. The first series of 24 parturient women (series I) to whom the labour trial took place under peridural analgesy. The second series of 80 parturient women (series II) to whom the labour trial took place without peridural analgesy. The rate of caesarean section is significantly less important in the series I (33.3% versus 58%) P = 0.37. The average duration of the labour trial is significantly prolonged under peridural analgesy but without bared effects for the newborn children. The authors consider that the peridural analgesy is the method that brings ideal conditions for a real test allowing to eliminate dynamic dystocia and maternal restlessness in order to have an accurate cephalo-pelvic confrontation.

[The association of Recklinghausen's disease and pregnancy. Report of 6 cases]. / Reflexion sur l'association de la maladie de Recklinghausen et grossesse. A propos de six cas.

Recklinghausen's neurofibromatosis is a phacomatosis with dominant autosomal transmission and variable expression. The authors propose an analysis of six cases of Recklinghausen's disease associated to the pregnancy. From these observations and review of the literature, they release the particularities of this association. The appearance of high blood pressure seems more frequent at the patients affected by Recklinghausen's disease than in the unhurt population. A disease prevention of hypertensive complications by the use of low dose of Aspirin can be proposed in the presence of gravitiy's criteria.

[Advantages and risk of a trial of vaginal delivery in the scarred uterus]. / Avantages et risques de la tentative de la voie basse sur utérus cicatriciel.

We present a retrospective study of 1235 deliveries in scarred uterus. The aim of this study is to analyse the materno-fetal mortality and morbidity after caesarean section and a trial vaginal delivery. Uterine challenge has been tried is 578 cases with success in 12.14%. The global rate of real uterine rupture is 1.3% and of scare opening is 3.16%. The trial vaginal birth was complicated by uterine rupture in 5.9% versus 2.89% in planned caesarean section. (P = 0.00967). The length of hospitalization, the number of blood transfusion and the rate of puerperal infections are lower in the vaginal delivery trial group. The rate of new-born with Apgar < 7 in the 5th minute is in a significative way, lower in the iterative caesarean section group. (2.58% versus 4.67%), (P = 0.048). In the other hand, uterine rupture rate as well as fetal distress rate are higher in case of failure of the vaginal delivery. Maternal and fetal complications are rare and seem to be more frequent in case of failure of the uterine challenge. Accurate analysis of different obstetrical situations is necessary in order to predict the success or the failure of the vaginal delivery trial. It may lessen the maternal and fetal morbidity.

[Characteristics of pregnancy and delivery in women with rheumatic heart valve disease]. / Les particularités de la grossesse et de l'accouchement chez les femmes porteuses d'une valvulopathie rhumatismale.

UNLABELLED: During a six years period, we followed 55 pregnant women having rhumatismal valvulopathy. The prevalence of the association rhumatismal valvulopathy and pregnancy is about 44%. The RM represents the most frequent rhumatismal valvulopathy that is about 43.5%. Among our patients 5 represented a cardiac decompensation (9%). Our study resulted in:cesarean section rate: 23.6% 1 maternal death neonatal death rate 36%. 14.5% prematurity rate 9% hypotrophy rate. CONCLUSION: The pregnancy of patients bearing the rhumatismal valvulopathy represents a high risk situation. The maternal death during and after pregnancy exist and can reach an average of 1%.

[Delivery by forceps: indications and materno-fetal morbidity]. / L'accouchement par forceps: indications et morbidité materno-foetale.

A retrospective study concerning patients having had a delivery by means pair of forceps over a period going from 1st Jun 1999 to 31st December 2000. The frequency of the use of forceps for delivery is 4.95%. The defect of eviction was an indication of the pair of forceps. Fetal suffering was the main indication. Maternal morbidity was represented essentially by a more or less injury of the genital tract with a rate of 11.1%. The rate of neonatal mortality is 1.28%. The maternal improvement of the maternal and fetal prognosis depends on an accurate indication of the use of forceps. In certain circumstances, mainly in fetal suffering, it is often difficult to choose between the high way and the low way.

[Pregnancy and delivery after kidney transplantation]. / Les particularités de la grossesse et de l'accouchement après greffe rénale.

Authors describe progress of pregnancy of one patient transplanted kidney. In fault this observation and of one review of literature, they analyze conditions optimal for to begin one pregnancy, then they study possible repercussion on kidney transplanted but so repercussion of transplantation on pregnancy. Pregnancy to woman-transplanted kidney is considered as one pregnancy in risk. Absence of refusal recent, one rate of creatine < 180 micromle/liter and absence of high blood pressure arterial seem being factors more important in to respect to assure one exit favorable of pregnancy.

[Cervical maturation in post-term pregnancy: prostaglandin E2 versus Foley probe]. / La maturation cervicale dans le dépassement de terme: prostaglandine E2 versus sonde de Foley.

To compare two methods of cervical maturation in frame of labor induction the case of overtaking of term. Study review compare two groups, first group is to form of 51 patients having had one cervical maturation by gel of predipil, second in compound of 63 patients having benefited of one maturation cervical by one probe of Foley. The entrance spontaneous in labor later administration cervical of gel of prostaglandin is of 45% against 8% only in-group of patients having had one maturation by probe of foley. Duration of labor is more short in first group. Probe Foley countered so effective that gel of prostaglandin it appears as one method of cervical maturation of choice in our environment.

[Acute gravidic steatosis: review and management]. / La steatose aigue gravidique: revue et mise au point.

The acute gravidic steatosis is a specific hepatopaty of pregnancy that has a low frequency witch often very serious. On the light of a gravidic steatosis case histological proved progenitors analyse the clinical criteria of positive diagnosis. The coexistence of an hepatic anomaly that is of an hyperuricemia with a normotensive woman is too suggestive of the diagnosis. The maternal mortality exceeded 92% before 1970, now it has reached 10%. his amelioration is mainly due the obstetric attitude of evacuation and the progress of reanimation.

[The association between Takayasu's arteritis and pregnancy]. / A propos de l'association arterite de TAKAYASU et grossesse.

We present about three observations of patients suffering from TAKAYASU's arteritis two of home have necessitated one carotidien's angioplasties. From these three cases and from a review of literature, we analyse the different materno-foetal risks of the association TAKAYASU'S arteritis and pregnancy. The high arterial pressure and the pre-eclampsia constitute the aim maternal complication. The vascular accident and the cardiac decompensation can be seen in five percent (5%) of cases. The back wordiness of the intrauterine growth the major foetal complication. Eventually, we suggest the behaviour to hold in order to improve the materno-foetal prognostic.

[Complete utero-vaginal duplication with hematocolpos and homolateral renal agenesis]. / Duplicité utéro-vaginale complète avec hematocolpos et agénésie rénale homolatérale.

We relate one observation about a rare case of genital malformation, where is on association of unilateral hematocopos, bicorn uterine and homolateral renal agenesis. The diagnostic was suspected upon the association with a progressive dysmenorrhe and vaginal mass. II was confirmed by ethnographie and IRM. The treatment has been conservative and consisted only in the section of the vaginal partition.