Placental elasticity assessment by point shear wave elastography in pregnancies with intrauterine growth restriction.

Background Placental elasticity varies in different diseases. Our objective was to evaluate placental elasticity using point shear wave elastography (pSWE) in pregnancies with intrauterine growth restriction (IUGR). Methods A total of 66 pregnant women with IUGR and 81 healthy pregnant women were enrolled. Placental elasticity was measured using the transabdominal pSWE method. Ten measurements were made, and the mean was accepted as the mean placental elasticity value in each case. The results for IUGR pregnancies and controls were compared. Results The mean pSWE values were significantly higher in pregnancies with IUGR, which means that women with IUGR have stiffer placentas (P < 0.001). Furthermore, the pSWE values were significantly and positively correlated with Doppler indices and adverse perinatal outcomes. Conclusion The pregnancies with IUGR had stiffer placentas than the healthy controls. The utilization of pSWE for placental elasticity may be useful in the diagnosis and management of IUGR as a supplement to the existing ultrasonography methods.

Retrospective analysis of fetal anterior abdominal wall defects.

OBJECTIVE: To analyze fetal abdominal defects diagnosed during the prenatal period in the perinatology department in a tertiary center in Turkey. METHODS: This retrospective study consisted of 27 cases diagnosed with fetal abdominal wall defects between January 2011 and February 2014 in the perinatology outpatient clinic of Celal Bayar University, Manisa, Turkey. RESULTS: Eighteen (66.7%) cases were diagnosed with omphalocele, 6 (22.2%) had gastroschisis, and 3 (11.1%) had limb body wall defects. Twenty-one (77.7%) patients diagnosed either as omphalocele or limb body wall defect were offered karyotype analysis; 11 (52.4%) of them accepted the intervention, and 2 of the 11 patients (18.2%) had abnormal karyotype. Regarding the omphalocele cases; 12 (66.6%) cases had isolated omphalocele, whereas 6 of the 18 cases (33.3%) had associated anomalies. Expectant management was performed in 8 (66.7%) of 12 isolated omphalocele cases. Two of the isolated omphalocele group (16.7%) had missed abortion, the other 2 (16.7%) had termination of the pregnancy because of the associated chromosomal anomaly (47,XXY and 45,X0). Three of the gastroschisis group (50%) had missed abortion, and the other 3 (50%) had expectant management with cesarean delivery between 38-39 gestational weeks. Cases with limb body wall defect were terminated due to the lethal condition. CONCLUSION: The prenatal diagnosis of fetal abdominal wall defects is important, because they differ greatly in terms of perinatal and neonatal morbidity and mortality due to underlying chromosomal abnormalities and associated structural anomalies.

[Vaginoplasty from peritoneal tube of Douglas' poutch for androgen insensitivity syndrome (two case reports)]. / Vaginoplastie utilisant le péritoine du cul-de-sac de Douglas pour le traitement du syndrome d'instabilité aux androgènes (à propos deux observations).

The androgen insensitivity syndrome (AIS) formerly known as testicular feminization is transmitted on a recessive X-linked. Its diagnosis is usually made at puberty if primary amenorrhea is present because the external genitalia are female. We report the case of two sisters aged 30 and 18 years, with testicular feminization syndrome discovered during the exploration of primary amenorrhea. Clinical examination found fairly well developed mammary glands, an hypertrophied clitoris, two formations in the labia majora corresponding to the testicles and agenesia of vagina. The uterus has not been seen on pelvic ultrasound and computed tomography scan of the pelvis. Cytogenetic analysis has objectified the chromosomal formula: 46 XY. We performed a vaginoplasty using peritoneum from the pouch of Douglas, a clitoroplasty and bilateral orchiectomy. The result was excellent. A neovagina with a depth of 6 cm was created. After 6 months of follow-up, the two sisters keep beautiful vaginal cavities with regular digital dilation. Peritoneum vaginoplasty is a simple and easy method for creating a neovagina with minimal complications. Its anatomical and functional results are satisfactory.

Postpartum depression: is mode of delivery a risk factor?

There are various factors related to postpartum depression. In this study we have aimed to determine the effect of mode of delivery on the risk of postpartum depression. A total of 318 women who applied for delivery were included in the study. Previously diagnosed fetal anomalies, preterm deliveries, stillbirths, and patients with need of intensive care unit were excluded from the study. Data about the patients were obtained during hospital stay. During the postpartum sixth week visit Edinburgh postnatal depression scale (EPDS) was applied. There was no significant difference between EPDS scores when compared according to age, education, gravidity, wanting the pregnancy, fear about birth, gender, family type, and income level (P > 0.05). Those who had experienced emesis during their pregnancy, had a history of depression, and were housewives had significantly higher EPDS scores (P < 0.05). Delivering by spontaneous vaginal birth, elective Cesarean section, or emergency Cesarean section had no effect on EPDS scores. In conclusion healthcare providers should be aware of postpartum depression risk in nonworking women with a history of emesis and depression and apply the EPDS to them for early detection of postpartum depression.

Seminome spermatocytaire: a propos d'un cas et revue de la litterature spermatocytic seminom

Le seminome spermatocytaire est une tumeur rare; representant moins de 2des cancers du testicule; survenant essentiellement chez le sujet age. Nous rapportons une nouvelle observation d'un patient age de 48 ans. La tumeur se presentait comme une proliferation de cellules en nappes compactes; avec 3 types cellulaires; des cellules de petite taille; des cellules intermediaires et des grandes cellules. Il n'a ete retrouve ni contingent sarcomateux; ni seminome classique. L'analyse en immun histochimie n'a retrouve aucune expression des cellules tumorales pour les anticorps classiques testes; notamment l'Ac anti PLAP et les marqueurs lymphoides. Le seminome spermatocytaire doit etre reconnu; car son evolution est tres favorable et ne necessite qu'une simple orchidectomie; en l'absence d'un exceptionnel contingent sarcomateux ou de metastase ou une chimiotherapie s'impose

[Persistent Müllerian ducts syndrome]. / Syndrome de persistance des canaux de Müller.

Persistent Müllerian ducts syndrome is a rare form of internal male pseudohermaphroditism, characterized by the presence of the uterus, fallopian tubes and upper vagina in an otherwise normally virilised male with a 46 XY karyotype. It is the result of a deficiency in anti-Müllerian hormone or abnormality of this hormone receptor. Often, the diagnosis is made incidentally during surgical exploration for cryptorchidism or herniorrhaphy, and exceptionally during cancer of ectopic testis. We discuss a rare case of this syndrome revealed by a bilateral intra-abdominal gonadal tumor.

The epineural sleeve technique for nerve graft reconstruction enhances nerve recovery.

The purpose of the study was evaluation of nerve recovery following epineural sleeve technique for graft reconstruction in rat sciatic nerve. This technique provides the epineural sleeve to cover and separate the site of coaptation. Animals were divided into three groups: CNG-conventional nerve grafting, ESN-epineural sleeve from recipient nerve stumps, ESG-epineural sleeve from graft. Nerve regeneration was evaluated by pin-prick, toe-spread test, walking track analysis and somatosensory-evoked potentials (SEP), gastrocnemius index (GI), and histomorphometric evaluation. Most parameters (SFI, SEPs, and GI) showed significantly better nerve recovery for ESN group when compared to conventional CNG group. Also ESG group revealed better result for SFI. Better functional results for ESN and ESG groups were further confirmed by histomorphometric analysis: higher axon density and diameters as well as thicker myelin sheath. Epineural sleeve graft technique may be promising method with potential application for nerve reconstructive procedures. Better functional nerve recovery can be anticipated.

[Encrusted cystitis due to Corynebacterium urealyticum]. / Cystite incrustante àCorynebacterium urealyticum.

We reported the case of a 61 year-old man who presented an encrusted cystitis by Corynebacterium urealyticum associated with bilateral hydronephrosis four months after adenomectomy complicated by vesicocutaneous fistula. Medical treatment by quinolones and oral acidification of the urine allowed regression of the encrusted calcifications and resolution of the hydronephrosis.

[Bladder paraganglioma (pheochromocytoma): report of a new case]. / Paragangliome vésical (phéochromocytome): à propos d'une nouvelle observation.

The authors report one case of vesical paraganglioma, not suspected in a 50-years-old female patient who presented gross hematuria as only symptom. The patient was not hypertensive. Radiologic and endoscopic investigations revealed a trigonal submucosal tumour. Complete transurethral resection of the tumor was performed with no intraoperative complications. The histopathological diagnosis indicated pheochromocytoma. Blood pressure was stable. There has been no recurrence for 18 months after transurethral resection.

[Bladder infiltrating tumor: retrospective study of 225 cases]. / Tumeurs infiltrantes de vessie: étude rétrospective à propos de 225 cas.

The authors report a retrospective serial of 225 patients presenting an infiltrating bladder tumor. The infiltrating tumors represent 29.2% of bladder tumors. The middle age of our patients is 59 years with a sex-ratio of 7.3. In the histology, 80% of the tumors are a cell transitional carcinoma and 65% of the patients are classified stage T3T4. The surgical treatment has could be achieved at 73.3% of the cases and 66.7% of the patients had a radical cystectomy. The urinary diversion was essentially an continent urostomy using Benchekroun's hydraulic valve. At 28 months mean follow-up, a locoregional recurrence has been noted from 18% of the Tur achieved alone and 4% of the radical cystectomy. A metastasis has been noted from 18% of the patients and this in a mean delay of 12 months.

[Neurogenic bladder: report of 73 cases]. / Les vessies neurogènes: à propos de 73 cas.

The authors report their experience of neurogenic bladder about 73 cases during 16 years. The analysis of the data permits to affirm that the neurogenic bladder remained a rare pathology, that their aetiologies is acquired in 87.6% of the cases with a predominance of spinal cord traumatisms, which explains the predominance of the pathology among the young subject of masculine sex (middle age of 32 years, sex-ratio is 2.5). The clinical signs are represented by urinary incontinence that constitutes the main motive of consultation, followed by obstructive signs and frequent miction associated to urge miction. The explorations put in evidence an important rate of complications because of the diagnostic delay. The therapeutic management aims to assure a most complete draining of the bladder to low pressure, to assure the continence or at least to manage the incontinence while assuring the comfort and the patient's autonomy.

[Vaginoplasty with sigmoid graft: report of 3 cases]. / Vaginoplastie par un greffon sigmoïdien: à propos de trois cas.

We report our experience with treating the vaginal aplasia by vaginoplasty used sigmoid graft in about three cases. Two patients presented with the Rokitansky-Kuster-Hauser syndrome and one a gender reassignment for intersex. Anatomic and functional results were satisfactory with no vagina stenosis. All three are sexually active. The sigmoid colon is the best choice for interposition vaginoplasty.

[Primary and bilateral non-Hodgkin's lymphoma of the adrenal gland (a case report and literature review)]. / Le lymphome malin non hodgkinien bilatéral et primitif de la surrénale (à propos d'une observation avec revue de la littérature).

Primary non-Hodgkin's lymphoma of the adrenal gland is rare. We report the case of a 31-years-old patient hospitalized with asthenia and adrenal insufficiency. The CT scan showed a bilateral adrenal mass. A scano-guided biopsy suspected an endocrinoid tumor. The surgical exploration demonstrated a huge mass invading the retroperitoneal space, and the biopsy concluded to a central follicular phenotype B rmalignant lymphoma with a high rank of malignity. The thoracic CT scan did not show any lymph node. The medullar biopsy eliminated a secondary lymphoma. The patient was treated by chemotherapy and radiotherapy with a good result during 16 months.

[Perinephretic phlegmon: about 36 cases]. / Le phlegmon périnéphrétique: à propos de 36 cas.

The authors report a series of 36 cases of perinephric phlegmon during 15 years. The patients are 27 men and 9 women. Mean age was 37 years (ranging between 25 and 70). The promoting factors of PPN are diabetes (27.8%), and kidney calculi (22.3%). Delay diagnosis is more than 3 weeks in 80% of the patients. The clinical symptomatology was dominated by pain, fever and flank mass. Diagnosis is carried out by ultrasonography in 84% and by CT scan whenever it is done. The common germs are negative Gram bacilli and staphylococcus. The treatment consists in antibiotherapy associated to a percutaneous drainage of the collection in 6 patients (16.7%) and a surgical drainage in 30 patients (83.7%). The follow-up are favorable in all cases.

[Enterovesical fistula secondary to Crohn's disease manifested by inflammatory pseudotumor of the bladder]. / Fistules entérovésicales secondaires à la maladie de Crohn révélée par une pseudotumeur inflammatoire vésicale.

The authors describe a case of enterovesical fistulas in a patient with Crohn's disease that presented exclusively as urinary symptoms manifesting as bladder tumor. Ultrasound examination showed a normal upper urinary tract and a bladder tumor. Cystoscopy examination revealed a bladder tumor at the retrotrigonal region without showing the fistula orifice. Transurethral resection of the tumor revealed an inflammatory pseudotumor of the urinary bladder at the results of histological studies. Magnetic resonance imaging showed a normal upper urinary tract but a bladder tumor and a sigmoidovesical fistula. The results of barium contrast studies established the presence of numerous enterovesical fistulas. Partial resection of the ileum, ileostomy, colostomy and suture of the bladder fistulas was performed. Histological diagnosis of the affected ileum was Crohn's disease. The clinical features, natural history and treatment of enterovesical fistula secondary of Crohn's disease were discussed.

[Vesico-vaginal fistula: report of 1050 cases]. / Les fistules vésico-vaginales: à propos de 1050 cas.

The authors reports their experience of a large series of 1050 cases of vesico-vaginal fistulas recorded during 30 years and analyse their epidemiological, anatomo-clinical, and therapeutic aspects. Patients could be classified as a function of site of fistula into 3 types, according to the Benchekroun's classification: type I ureto-vaginal fistula (30%); type II cervico-vaginal fistula (22%); type III vesico-vaginal fistula (48%). Etiology was mainly obstetrical (93%). An associated lesion was detected in 10.4% of cases (uterine, ureteral and rectal). Treatment was only performed after a minimal period of three months with the following results in obstetrical vesico-vaginal fistulas. Type I fistula, using a low approach and requiring urethral refection in 100 cases, showed good results in only 60% of cases. Type II fistulae, usually treated through a low approach (80%), were treated with 80% good results. Type III fistula, were nearly always corrected (98%) after two procedures. The overall results are good in 80% of cases. The failures concerned in majority the complex vesico-vaginal fistulas type I, are treated by urinary diversion (51 Coffey, 5 Bricker) and since 1975, 73 continent ileocecal or ileal bladders using Benchekrouns' technique.

[Superficial pT1G3 bladder tumor: 24 case reports]. / Les tumeurs superficielles de vessie pT1G3: à propos de 24 cas.

The authors report 24 patients presenting a transitional tumor of bladder pT1G3 collected between January 1996 and December 2000. They represent 19% of the superficial tumors of bladder. Two patients had of straightaway a cystectomy after resection for an unverifiable tumor by endoscopy and another after a second resection discovering a real pT2. Only 5 patients received a BCG therapy is 24% of the cases. A recurrence without progression has been noted in 38% of the cases and a progression in 19% of the patients. These last patients had a cystectomy and with a follow-up to 28 months, no recurrence has been noted.

[Inflammatory pseudotumor of the bladder: a new case report]. / Pseudotumeur inflammatoire de la vessie: à propos d'une nouvelle observation.

Inflammatory pseudotumor is a reactive benign lesion which can be very difficult to distinguish from some malignant bladder tumors like sarcomas or sarcomatoid carcinoma. Inflammatory pseudotumour (IPT) of the urinary bladder is a benign proliferate lesion which can simulate clinically and histologically a sarcoma. A case of an inflammatory pseudotumor of the urinary bladder in a 18-years-old man is presented. This patient presented with sudden onset of gross painless hematurial related to large polypoid and ulcerated bladder masses found on endoscopy. Initial pathological analysis was interpreted as rhabdomyosarcoma but subsequent reviews were consistent with a benign process resembling nodular fasciitis. This rare, benign and presumed non-neoplastic, reactive lesion must be differentiated from sarcomas of the urinary bladder. Immunohistochemistry seems to be the method of election in differentiating inflammatory pseudo-tumor from other spindle cell proliferations of the bladder. When diagnosis is certain, complete transurethral resection is the treatment of choice. However, if there is no total pathologic confirmation, if it is a very wide lesion or if it is recurring after endoscopic resection, a partial cystectomy is suggested.