[Congenital high airway obstruction syndrome (CHAOS): a case report]. / Syndrome congénital d´obstruction des voies aériennes supérieures (syndrome du CHAOS): à propos d'un cas.

Congenital upper airway obstruction syndrome is a rare malformation that can be fatal to a newborn baby. It is defined as a complete or almost complete obstruction of the upper airways. CHAOS rate is unknown. We here report the case of a 24-year-old primiparous patient with no medical or surgical history. First-trimester ultrasound didn't show any abnormality. During the second trimester, ultrasonography showed extensive subcutaneous edema, hypertrophied lung with hyperechoic appearance, hypoplastic heart and large-volume ascites associated with severe oligoamnios. After having excluded the most common causes, including isoimmunization (indirect negative Coombs), infections (negative serologies) kariotiping was not performed because the patient refused it. The results of ultrasonography suggested fetal hydrops secondary to CHAOS syndrome, because of pathognomonic signs of pulmonary hypertrophy with inverted or convex diaphragm. MRI was requested; it suggested CHAOS syndrome associated with other malformations: laryngeal atresia, microphthalmia with hypertelorism and deviation of the nasal septum with lack of visualization of the thymic tissue, no clear identification of the bladder, absence of right kidney and hypoplastic left kidney. The outcome of pregnancy was marked by premature labour at the 24th week of amenorrhea. The baby had a birth weight of 1475g, polimalformations such as sexual ambiguity, distended abdomen and polydactyly . The newborn died 3 min after birth. Karyotyping was performed which showed 46XX.

Hydatid cyst of the breast: case report.

INTRODUCTION: The hydatid cyst of the breast is a rare pathology even in countries endemic to tuberculosis, however there remains a differential diagnosis evoked in front of any breast tumor. The clinic, mammography and ultrasound sometimes allow us to suspect the hydatid nature of the lesion. The definitive diagnosis remains histological and the treatment is always surgical. From one case, we recall the important role that cytology can play in preoparatory diagnosis. CASE PRESENTATION: We report an observation of 59-year-old patient who lives in a tuberculosis endemic area of morocoo. the patient presented to our institute with palpable nodule in the right breast associated with pain of long duration. Clinical examination shows 2 masses occuping the entire upper outer quadrant of the right breast. Radiological explorations (mammography + ultrasound) objectified: A voluminous opacity of the QSE of the right breast corresponding on ultrasound to two cystic with anechoic content. the first classified ACR2 BIRADS. the second has ultimately echogenic content with a sloping portion producing the appearance of pseudo vegetation,classified ACR3 BIRADS. A fine needle aspiration of the cyst only showed the presence of altered polynuclear, without evidence of tumor cells. Treatment consisted of surgical excision such as perikystectomy and pathology examination demonstrated breast hydatidosis.postoperative evolution was favourable. Patient was put on medical treatment based on albendazole immediately.The patient was monitored for one year without local or distant recurrences. CONCLUSION: Although hydatid disease of the breast remains a rare localization of tuberculosis disease, it should nevertheless be considered as a differential diagnosis of breast tumors. Ultrasound, cytology and MRI play an important preoperative diagnostic role. Treatment is essentially based on surgical pericystectomy associated with medical treatment based on albendazole.

[Uterine necrosis following uterine compressions in combination with vascular ligation during postpartum hemorrhage: a case report]. / Nécrose utérine suite à une combinaison de compressions utérines et de ligature vasculaire lors d'une hémorragie post-partum: à propos d'un cas.

Delivery hemorrhage is the leading cause of maternal mortality in Morocco. It is an obstetric emergency requiring early, effective and multidisciplinary management in patients with severe postpartum bleeding resistant to medical treatment. Advances in interventional radiology and especially, in surgical techniques have provided safe and effective alternatives to hemostasis hysterectomy . We here report a case of uterine necrosis following conservative surgical treatment of delivery hemorrhage based on B-Lynch uterine compression suture combined with Tsirulnikov triple vascular ligation. The patient had sepsis on day 4 after delivery associated with fever and pelvic pain and biological inflammatory syndrome which worsened 48 hours after the onset of abdominal contracture. Abdomopelvic scanner, showed gas bubbles in the uterine myometer suggestive of necrosis. Exploratory laparotomy was performed, which objectified complete necrosis of the uterus. Uterine compression sutures are surgical techniques which play a major role in the therapeutic armamentarium of postpartum hemorrhage during cesarean section. It allows, in addition to or as an alternative to vascular ligation, the preservation of patient's fertility, but it also requires maximum caution and monitoring of complications, the most serious of which is uterine necrosis.

Placenta accreta in the department of gynaecology and obstetrics in Rabat, Morocco: case series and review of the literature.

Placenta accreta spectrum disorders is a rare pathology but the incidence has not stopped to increase in recent years. The purpose of our work was the analysis of the epidemiological profile of our patients, the circumstances of diagnosis, the interest of paraclinical explorations in antenatal diagnosis and the evaluation of the evolutionary profile. We hereby report a case series spread over a period of one year from 01/01/2015 to 01/01/2016 at the Gynaecology-Obstetrics department of the University Hospital Center IBN SINA of Rabat where we identified six cases of placenta accreta. We selected patients whose diagnosis was confirmed clinically and histologically. The major risk factors identified were a history of placenta previa, previous caesarean section, advanced maternal age, multiparity. 2D ultrasound and magnetic resonance imaging (MRI) allowed us to strongly suspect the presence of a placenta accreta in a pregnant woman with risk factor(s) but the diagnosis of certainty was always histological. Placenta accreta spectrum disorders were associated with a high risk of severe postpartum hemorrhage, serious comorbidities, and maternal death. Leaving the placenta in situ was an option for women who desire to preserve their fertility and agree to continuous long-term monitoring in centers with adequate expertise but a primary elective caesarean hysterectomy was the safest and most practical option. Placenta accreta spectrum disorders is an uncommon pathology that must be systematically sought in a parturient with risk factors, to avoid serious complications. In light of the latest International Federation of Gynecology and Obstetrics (FIGO) recommendations of 2018, a review of the literature and finally the experience of our center, we propose a course of action according to whether the diagnosis of the placenta is antenatal or perpartum.