Gestational choriocarcinoma at Ibn Rochd Hospital, Casablanca, 2004-2010.

The aim of this retrospective study was to determine the frequency, risk factors, management and prognosis of gestational choriocarcinoma at the gynaecology-obstetrics C department of the Ibn Rochd Hospital in Casablanca, Morocco over a 7-year period (2004-2010). There were 18 760 pregnancies in the study period, among which 8 cases of gestational choriocarcinoma were recorded, a frequency of 43/100 000 or 1 case of gestational choriocarcinoma in 2345 pregnancies. Maternal age ranged from 20 to 48 years. It occurred after a hydatidiform mole in 4 cases, after spontaneous miscarriage in 2 and after normal delivery in 2 cases. All the patients presented with bleeding. Metastases were found in 3 patients, including 2 with pulmonary localization. Positive diagnosis was made mainly by ultrasound and human chorionic gonadotropin level and histological confirmation was done for all cases. Polychemotherapy was used to treat 4 cases, monochemotherapy to treat 3 and one case received only radiotherapy. Of the 8 cases, 2 patients died and 6 had complete remission.

[Partial hydatidiform mole in Morocco: an epidemiological and clinical study]. / Les môles hydatiformes partielles au Maroc: étude épidémiologique et clinique.

This retrospective study reviewed cases of partial hydatidiform mole (PHM) diagnosed at the University Hospital in Casablanca from 2000 to 2010 in order to examine the epidemiological, clinical, therapeutic and progressive pathological factors associated with PHM. All PHM cases confirmed clinically and sonographically at pathological examination were included. We identified 24 cases of PHM among 60 748 births and 1704 abortions, giving a frequency of 0.4 per 1000 pregnancies and 1.4% of abortions. The mean age was 26 years (range: 16-55 years). The circumstances of discovery and clinical ultrasound varied: 79.2% of patients sought consultation for bleeding; clinical thyrotoxicosis syndrome was found in 1 patient (4.2%). Physical examination showed increased uterine size in 83.3% of cases associated with a latero-uterine mass in 25%. The diagnosis was supported by an ultrasound examination combined with measurement of plasma betaHCG. Histological confirmation was made in all cases and treatment was endo-uterine aspiration. Neoplastic drift was observed in 1 case (4.2%) which went into remission with chemotherapy.

Sensor-Based Frailty Assessment in Survivors of Childhood Cancer: A Pilot Study.

BACKGROUND: Survivors of childhood cancer (CCS) are at risk for early aging and frailty. Frailty in CCS has been assessed with established clinical criteria, a time-intensive approach requiring specialized training. There is an unmet need for cost-effective, rapid methods for assessing frailty in at-risk adolescent and young adult (AYA) CCS, which are scalable to large populations. OBJECTIVES: To validate a sensor-based frailty assessment tool in AYA CCS, compare frailty status between CCS and controls, and assess the correlation between frailty and number of CCS comorbidities. DESIGN, SETTING, AND PARTICIPANTS: Mean frailty index (MFI) was assessed by a frailty wrist sensor in 32 AYA CCS who were ≥1 year off therapy and in remission. Results were compared with 32 AYA controls without cancer or chronic disease. MEASUREMENTS: Frailty assessments with and without a simultaneous cognitive task were performed to obtain MFI. Results were compared between cases and controls using a Student t test, and the number of pre-frail/frail subjects by Chi Square test. The contribution of radiation therapy (RT) exposure to MFI was assessed in a sub-analysis, and the correlation between the number of comorbidities and MFI was measured using the Pearson method. RESULTS: MFI was strongly correlated with gait speed in AYA CCS. CCS were more likely to be pre-frail than controls without cancer history (p=0.032), and CCS treated with RT were more likely to be pre-frail than CCS not treated with RT (p<0.001). The number of comorbidities was strongly correlated with MFI (ρ=0.65), with a 0.028 increase in MFI for each added condition (p<0.001). CONCLUSIONS: Results from this study support higher risk for frailty among CCS, especially those with multiple comorbidities or who were treated with RT. A wrist-worn sensor-based method is feasible for application in AYA CCS, and provides an opportunity for cost-effective, rapid screening of at-risk AYA CCS who may benefit from early interventions.

[The ovarian immature teratoma with gliomatosis peritonei]. / Tératome immature de l'ovaire avec gliomatose péritonéale. A propos d'un cas et revue de la littérature.

OBJECTIVE: We return a case of ovarian immature teratoma with peritoneal gliomatose at a woman aged of 20 years. MATERIAL AND METHODS: The diagnosis discovered following pelvic mass increasing volume and treaty by a one-sided annexectomy, with chemotherapy. RESULTS: Eighty-seven cases have been published in the literature. Although potential for recurrence is high, the risk of malignancy is very low. CONCLUSION: Ovarian immature teratoma is a malignant germ cell tumor and represents less than 1% of ovarian malignant tumors. Tissues are derived from the three germ layers (endo-, meso- and ectoderm). Tumor grading is based on the amount of immature neuroepithelium present. The prognosis is directly correlated to histological grade. Rapid (fast) growth leads to large tumors with an early diagnosis. Gliomatosis peritonei is a rare situation, characterized by the recurrence of peritoneal implants after the surgical treatment of ovarian teratoma. This entity does not modify the good prognosis of mature teratomas, but we recommend regular follow-up.

[Atrial flutter ablation: initial experience in a general hospital]. / Ablation de flutter atrial: experience initiale d'un centre hospitalier general.

BACKGROUND: Right atrial flutter has a relatively high incidence. It is often symptomatic and can have a poor outcome particularly in case of thrombo-embolic events. AIM OF STUDY: We evaluate the results of radiofrequency catheter ablation for right atrial flutter since the introduction of this technique inour hospital. METHODS: The 28 first patients referred in our institution for atrial flutter and relevant for cavo-tricuspid isthmus ablation were enrolled. Ablation used a 8 mm tip electrode catheter and one or two conventional diagnostic catheters. The goal of ablation was complete bidirectional isthmus block. RESULTS: The first-line success rate was 96 percent with 4 percent early flutter recurrence. The mean duration of radiofrequency current applications was 652 +/- 409 seconds. No complication was observed. CONCLUSION: This results are comparable with the published data and encourage the development of basic ablation procedures and maintenance of rhythmic competence in general hospital inside medical network.

High mass and spatial resolution mass spectrometry imaging of Nicolas Poussin painting cross section by cluster TOF-SIMS.

The painting Rebecca and Eliezer at the Well, which hangs in the Fitzwilliam Museum, Cambridge, UK, is possibly one of the last figure painting executed by Nicolas Poussin at the very end of his life and is usually dated to the early 1660s. In this perspective special feature, Philippe Walter, Alain Brunelle and colleagues give new insights on the artist's working methods by a careful stateof-the-art imaging ToF-SIMS study of one sample taken on the edge of the painting. This approach allowed for the identification of the pigments used in the painting, their nature and components and those of the ground and preparatory layers, with the identification of the binder(s) and possible other additions of organic materials such as glue. This study paves the way to a wider use of ToF-SIMS for the analysis of ancient cultural heritage artefacts. Dr. Walter is the Director of the Molecular and Structural Archeology Laboratory (Université Pierre et Marie Curie, Paris, France). Dr. Brunelle is Head of the Mass Spectrometry Laboratory at the Institut de Chimie des Substances Naturelles (CNRS, Gif-sur-Yvette, France). Their long standing collaboration has led to several seminal publications on the analysis of ancient artefacts by mass spectrometry.

[Amniotic adhesions. A case report]. / Maladie des brides amniotiques. A propos d'un cas.

Amniotic adhesions occur in a wide variety of foetal malformations and can involve the limbs, the cranio-caudal region and the trunk. They usually occur after premature rupture of the aminos membranes. We report a case of amniotic adhesions diagnosed late at 37 weeks gestation.

[Phyllodes tumors of the breast. Forty one cases]. / Tumeurs phyllodes du sein. A propos de 41 cas.

Phyllode tumors of the breast are fibroepithelial tumors similar to fibroadenomas but with a predominant conjunctive tissue component. The aim of this work was to determine the specific diagnostic, therapeutic and prognostic features of this tumor. A retrospective series of 41 cases was collected in the gynecology-obstetrics ward from 1980 to 1991. The analysis of this series showed the following characteristics: incidence of phyllode tumors was 0.46% of all breast tumors. Mean age at diagnosis was 30 years, in 75.6% of the women were in a period of reproductive activity. Mean delay between the first clinical signs and diagnosis was 20 months. Mean size was 12 cm Diagnosis was confirmed at pathology examination in all cases. The tumor was classed grade 1 and 2 in 65.9% of the cases, grade 3 in 9.8%, grade 4 in 17.1%. Surgical treatment alone was used in all cases with large tumorectomy (48%), simple mastectomy (30%), and total mastectomy with node dissection (22%). After a follow-up of 1 to 7 years, there were 3 deaths and 11 local recurrences requiring reoperation. In the remaining cases, the outcome was favorable without recurrence or metastasis. These results together with those reported in the literature show that histological confirmation is required for the diagnosis of phyllode tumors. Surgical treatment alone is required with wide exeresis because of the voluminous tumor formation the age of the patient and the histological grade. Finally, prognosis depends on the histological characteristics of the conjunctive tissue component of the tumors.

[Induction of labor by misoprostol, an analog of PGE1. A prospective study of 200 cases]. / Induction du travail par misoprostol, analogue de PGE1. Etude prospective à propos de 200 cas.

We carried out a prospective study of 200 pregnant women who required induction of labor at full term, at the Lalla Meryem maternity unit of the Ibn Rochd University Hospital, Casablanca, between January 1st 1996 and June 30th 1997. The aim of this study was to evaluate the efficacy, tolerance and acceptance of misoprostol (Cytotec) as a drug for inducing labor in unfavorable conditions (Bishop < 5). Misoprostol (a PGE1 analog) was administered to the women via the vagina, with a dose of 1/4 tb (50 mg) given every 6 hours, and a maximum of 3 doses (150 mg). If labor had not begun 18 h after the start of the protocol, misoprostol induction was considered to have failed. We found that misoprostol failed to induce labor in 5% of cases, Syntocinon was required in 40% of cases and the interval between misoprostol insertion and vaginal delivery was 13.3 + 11.1 h. The rate of delivery by cesarean section was 22% and the mean amount of misoprostol required was 1.3 doses (66 mg). The mean cost of labor induction was 0.6 FF, the frequency of uterine hyperstimulation was 3.5% and maternal, fetal and neonatal tolerance was good. Our results confirm that intravaginal misoprostol is very effective and well tolerated for the induction of labor in pregnant women at full term, in unfavorable obstetric conditions.

[Hyperthyroidism in molar pregnancy]. / Hyperthyroïdie au cours d'une grossesse molaire.

INTRODUCTION: Hyperthyroidism is a rare complication of molar pregnancy. CASE REPORT: We report a 39-year-old woman who presented a thyrotoxic syndrome accompanying a molar pregnancy. Serum thyroid hormones were elevated and returned to normal level after uterine evacuation of a molar pregnancy. The authors detail the role of thyroid stimulating property of human gonadotropin chorionic hormone and its structural changes during the gestational trophoblastic diseases. These changes give the latter the thyroid stimulating properties and signs of hyperthyroidism. CONCLUSION: Molar pregnancy may be a cause of hyperthyroidism. The diagnosis of molar pregnancy should be a mention to thyrotoxicosique syndrome in a woman of childbearing age.

[Pregnancy in Gaucher disease]. / Grossesse et maladie de Gaucher.

Gaucher disease is a lysosomal storage disorder due to deficiency of glucocerebrosidase. The association with pregnancy exposes the worsening of the disease and complications of pregnancy and puerperium. We report a case of pregnancy in a woman of 35 years, suffering from Gaucher disease type 1. Pregnancy had a favorable outcome. Complications occurred. They were kept under control. The outcome was favorable. The authors discuss the evolution of the disease during pregnancy and management of complications. They can occur during pregnancy, post-partum and breastfeeding. Support begins with preconception consultation. It involves finding and correcting the biological problems and deficiencies, and management of complications. Genetic counseling is important, it helps prevent inbreeding.

[Physical violence during pregnancy in Morocco]. / Sévices physiques durant la grossesse au Maroc.

INTRODUCTION: Physical abuse are a serious social problem and an issue of perinatal health. MATERIAL AND METHODS: This article presents the results of a survey conducted at the CHU Ibn Rochd of Casablanca (Morocco), over a period of one year, in order to determine their frequency, risk factors, maternal diseases and obstetric complications. RESULTS: The results of our survey found that women who reported physical abuse have a frequency of 12.3% (107 cases). The average age of these women is 22.3 years; 65.6% of parturients are illiterate, 45% are from a disadvantaged socioeconomic status, 47% originated from a rural county; 37% are unmarried; half of the abused are multiparous with an average of 3.2 living children; 23% of the pregnancies are unplanned. Lastly, 37.3% of pregnant partners are unemployed and 67% have toxic habits. Obstetric complications are fairly frequent and mental effects are not negligible with 3 attempted suicides and attempted homicide. CONCLUSION: Early identification of abuse suffered by pregnant women and taking measures to prevent them could reduce the occurrence of these adverse effects.

[Pregnancy and extra-gastrointestinal stromal tumor: an exceptional association]. / Grossesse et tumeur stromale extra-digestive : une association exceptionnelle.

Extra-gastrointestinal stromal tumors (EGIST) are rare entities. The coexistence of a gastrointestinal stromal tumor and pregnancy is exceptional. We describe a case of this association, three years after the first diagnosis of EGIST made during exploratory laparotomy for abdominal-pelvic mass. We report the diagnostic difficulties and management of pregnancy on recurrence of EGIST tumor.

[Complete hydatiforme mole in Morocco: epidemiological and clinical study]. / Les môles hydatiformes complètes au Maroc : étude épidémiologique et clinique.

OBJECTIVE: Complete hydatidiform moles (CHM) are a real public health problem, especially in the "southern countries" and Asia, because of their impact on the female reproduction and the risk to progression to either invasive mole or choriocarcinoma. PATIENTS AND METHODS: We collected the cases of CHM referred to our department over a period of ten years (2000 to 2009). We will present our results, emphasize the modalities of diagnosis, treatment and evolution, with a review of literature. RESULTS: During this study, we identified 254 cases of CHM, and recorded 57,987 births and 1627 abortions. Their incidence was 0.43% of pregnancies. The mean age of our patients is 25 years old (16 to 55). Relative risk observed was much increased among women under 20 years old (×6.8) and those over 40 years old (×15). Both of nulliparous and primiparous patients represented 52.3% of the cohort. Eighty-five percent of patients belonged to an agricultural environment associated with a low socio-economic status. Uterine bleeding was the most common symptom accounting for 93.7%. Toxic syndrome was present in 18.5% of patients. Physical examination showed a highly increased uterine size in 85% of cases associated with lateral uterine mass in 25% of cases. The diagnosis was suspected using ultrasonography in all cases associated with an elevated level of plasmatic ß-human chorionic gonadotrophin (ßhCG). All cases were confirmed histologically. Treatment used was endo-uterine aspiration in all cases. Recurrence of CHM was documented in 25 patients or 9.4%. Neoplasic progression was observed for 6.3% of cases. All of them have evolved into remission with chemotherapy. DISCUSSION AND CONCLUSION: CHM continue to be a public health problem in Morocco, their incidence is among the highest ones. In fact, this studied population corresponds to the lowest socio-economic status and generally described as population at risk. It is subject to drastic weather's conditions causing loss of fresh products. Extreme ages and degree of parity are also risk factors described in the literature. Early diagnosis, appropriate treatment, and supervision of molar pregnancies are obligatory. Despite of the unfavourable initial conditions, our study shows that relevance and continuing care can significantly reduce the morbidity of moles.