[Ultrasound diagnosis of ectopic pregnancy : prospective study of 200 cases]. / Diagnostic échographique de la grossesse extra-utérine: étude prospective à propos de 200 cas.

BACKGROUND: the ectopic pregnancy is responsible for 10% of maternal mortality in the first quarter. Progress in transvaginal ultrasound; have revolutionized the diagnosis of ectopic pregnancy, allowing her diagnosis earlier. AIM: To evaluate the contribution of ultrasonography in the diagnosis of ectopic pregnancy. METHODS: A prospective study about 200 patients hospitalized for ectopic pregnancy between July 2009 and July 2011. All patients underwent a transvaginal ultrasound. RESULTS: The average age was 25.4 years. The study of the endometrium showed an endometrial thickness of 10.1mm in 152 cases. An haematosalpinx was observed in 71% of cases. The average size was 30.5mm. Hemoperitoneum was observed in 64.5% of cases. An ectopic gestational sac with embryo was found in 9 cases (4.5%). In 51 cases no pathological sonographic signs were noted. CONCLUSION: The transvaginal ultrasound is the method of choice in the diagnosis of ectopic pregnancy. However the use of BHCG is still necessary.

[Swyer syndrome: report of 5 cases]. / Syndrome de Swyer: à propos de cinq cas.

INTRODUCTION: Swyer's syndrome is a distinct type of pure gonadal dysgenesis characterized by a 46 XY karyotype in female phenotypic patients. It shows an abnormality in testicular differentiation. The disease is a sex-reversal disorder resulting from embryonic testicular regression sequences. MATERIAL AND METHODS: We present the clinical, sonographic and endocrine findings in five cases of phenotypic young girls with XY karyotype and gonadal dysgenesis. The treatment and the follow-up are discussed. RESULTS: The mean age was of 17.6 years. All patients presented with primary amenorrhea. All patients had female-type external genitalia. Secondary sexual characters were merely developed in all cases. FSH levels were high with a mean of 80.5. The surgical findings were steak fibrous gonads, two cases of gonadoblastoma and one case of dysgerminoma in a 13-year-old teenager. CONCLUSION: The risk of gonadal neoplasia is high, dictating early prophylactic removal of these dysgenesic gonads.

[Ovarian fibrothecal tumors. Apropos of 12 cases]. / Les tumeurs fibrothécales de l'ovaire. A propos de 12 observations.

OBJECTIVE: To identify diagnosis, therapeutic and histological particularities of ovarian fibro-thecomas. STUDY DESIGN: A retrospective study of 12 patients who underwent surgical treatment for ovarian fibro-thecoma between January 1994 and December 1999 was reported. Clinical, ultRasonographic, tumour marker, therapeutic and histologic data were analysed. RESULTS: Mean age of patients was 46.83 years. Three patients were in perimenopausal period and six were menopausal. Ultrasonographic findings were: ovarian echogenic tumor in six cases, hypoechogenic tumor in three cases, mixed tumor in three cases and anechogenic tumour in one case. CA 125 level measured in 11 cases was normal. Nine patients underwent laparotomy. Three patients underwent laparoscopy, however, one was converted to laparotomy due to a suspected tumour. A conservative treatment was performed for three patients and radical treatment for nine patients. Histological findings were eight fibromas and five fibro-thecomas. CONCLUSION: Ovarian fibro-thecoma is uncommon. These lesions occur often in perimenopausal and menopausal patients. Clinical, ultrasonographic and tumour marker data remains the best preoperative approach currently available for ovarian tumours. However, the diagnosis remains histological. Tumorectomy is well indicated for young patients, however radical treatment is indicated for perimenopausal and menopausal patients.

[Obstetrical prognosis of gestational pemphigoid. Study of a series of 13 cases and review of the literature]. / Pronostic obstétrical de la pemphigoïde gestationnelle. Etude d'une série de 13 cas et revue de la littérature.

Pemphigoid gestationis (PG) Herpes Gestationis (HG) is an auto-immune bullous dermatosis which usually occurs in pregnancy. We have studied the maternal and fetal prognosis of this pathological condition. Thirteen cases were reported at the same time by the departments of dermatology and obstetrics of the Charles-Nicolle Hospital between 1980 and 1990. Two women were not followed up. In the remaining eleven there was one intrauterine fetal death and one intrauterine fetal growth retardation (IUGR). One case was delivered prematurely because of obstetric indications. Four infants were delivered by Caesarean section on purely obstetrical indications. The other cases were delivered normally. There were no dermatological lesions or other malformations in the infants. Immediately after delivery ten women showed exacerbation of the skin lesions and most of these were treated by general corticotherapy. Our results were compared with those found in the literature. The prognosis differs according to different authors but in order to avoid any risks the condition must be followed carefully by obstetricians and dermatologists and laboratories working together.

[Ultrasonographic diagnosis of ectopic pregnancies. A report of 109 cases]. / Diagnostic échographique des grossesses extra-utérines. A propos de 109 cas.

OBJECTIVE: To assess the accuracy of ultrasonographic diagnosis of ectopic pregnancies. METHODS: A retrospective study of ultrasonographic findings of 109 patients operated for ectopic pregnancy between january 1997 and december 1998. Ultrasonography was performed with an Aloka SSD 620 sonographic imager and a 5 MHz endovaginal transducer. RESULTS: All patients had a transvaginal sonography. Of these, 15 had a transabdominal sonography. Ultrasonographic findings of the 109 ectopic pregnancies were an extrauterine gestational sac in 10 cases (9.17%), an adnexel mass clearly separated from uterus and ovary in 87 cases (79.81%), a pelvic fluid in 90 cases (82.56%) and pseudogestational sac in 6 cases. Ultrasonography established the diagnosis of ectopic pregnancy in 89% of cases. Serum B HCG level was needed for diagnosis in 12 cases (11%). CONCLUSION: Transvaginal sonography is the method of choice for the evaluation of women with a suspected ectopic pregnancy. However, serum B HCG levels are useful for diagnosis in 11% of cases.

[Retrospective study of 167 ovarian tumors]. / Etude rétrospective de 167 cas de tumeurs ovariennes.

OBJECTIVE: Our purpose was to assess clinical particularities, diagnosis and therapeutic problems of ovarian tumors. STUDY DESIGN: A retrospective study of 156 patients having undergone an operation for ovarian tumor not suspected to be malignant between january 1991 and june 1998. The clinical, ultrasonographic and tumor marker data were analysed. RESULTS: Mean age of our patients was 34 years. 19 patients were menopausal. All ovarian masses were considered as benign at ultrasonographic scan. Serum CA125 level was measured in 42 cases. It was abnormal in 2 cases. 102 patients underwent laparotomy. 54 patients underwent laparoscopy, of these, 19 were converted to laparotomy due to a suspect macroscopic diagnosis (2 cases) or to technical difficulties (13 cases). Histological findings were 150 benign ovarian tumors, 12 fonctional cysts and 5 malignant ovarian tumors. Therefore, preoperative assessment had failed diagnosis of cancer in 5 cases. CONCLUSION: The clinical, ultrasonographic and tumor markers triad remains the best preoperative approach currently available for ovarian tumors. However, the final diagnosis remains histological.

[Comparison of ultrasonographic and hysteroscopic results in perimenopausal metrorrhagias]. / Confrontation des résultats échographiques et hystéroscopiques dans les métrorragies périménopausiques.

84 perimenopausal women with uterine bleeding underwent transvaginal ultrasonography and hysteroscopy. Sonographic and hysteroscopic findings have been evaluated on the basis of specimens obtained from either endometrial biopsy, hysterectomy or operative hysteroscopy. Sensitivity, specificity, positive and negative predictive value of hysteroscopy and transvaginal ultrasonography were calculated. Hysteroscopy had 91.6% sensitivity, 83.3% specificity, 93.2% positive predictive value and 80% negative predictive value in the diagnosis of intrauterine abnormality, whereas transvaginal ultrasonography had only 67.3% sensitivity, 87.5% specificity, 89.7% positive predictive value and 62.2% negative predictive value. In consequence hysteroscopy is better than transvaginal sonography concerning only the sensitivity (p < 0.01). Transvaginal ultrasonography seems to be an excellent initial diagnostic method, but hysteroscopy is a highly accurate means of diagnosing the cause of excessive uterine bleeding.

[Heterotopic pregnancy: 3 case reports]. / Grossesse hétérotopique: à propos de 3 cas.

Heterotopic pregnancy is a rare event combining intra and extra uterine pregnancies. We report 3 cases observed in patients aged 32, 32 and 31 years consulting for pelvic pain and metrorragia with amenorrhea of 6 to 7 weeks. Treatment was conservative in 2 cases and radical for the third patient. The frequency of this association has been increased since the development of medical procreation technique and the increased of ectopic pregnancy. The foetomaternal prognosis will be improved by an early diagnosis.

[Prenatal diagnois of uropathies. Ten case reports]. / Diagnostic anténatal des uropathies. A propos de 10 observations.

UNLABELLED: Obstructive uropathies are a frequent cause of child renal failure. The prenatal diagnosis of such abnomalities should lead to appropriate management. OBJECTIVE: To evaluate the interest of ultrasonographic prenatal diagnosis of urinary tract malformations. PATIENTS AND METHODS: Retrospective study of 10 cases of urinary tract malformations diagnosed in utero. The mean age of the patients was 34.9 years and the mean gestational age at the prenatal diagnosis was 28.2 weeks of amenorrhea. The abnormalities diagnosed were: 2 cases of ureteropelvic junction obstruction, 3 cases of posterior urethral valves and 5 cases of mild hydronephrosis. The fetal karyotype, realised in 8 cases, was normal. In one case the urinary abnormalities was part of a multiple malformation syndrome and led to the termination of the pregnancy. 7 cases had a post-natal follow-up: 5 had a surgical management and two new borns had transient pyelectasies. The prediction of postnatal renal function is made by ultrasonographic appearance of the kidney and the amniotic fluid. Although the analysis of fetal urine for the assessment of renal function leads to conflicting results, it seems that sodium and beta-2 microglobulin urinary rates provide useful informations.

[Molar pregnancy. Retrospective study of 60 cases in Tunisia]. / Les grossesses môlaires. Etude rétrospective de 60 cas en Tunisie.

To identify the epidemiologic, clinical end therapeutic particularities of molar pregnancies in Tunisia. A retrospective study of 60 cases of molar pregnancy Diagnosis of MP was base on elevated urine HCG level and/or histologic examination of uterine revision done for all patients. The incidence of MP is 1/793(60/47624) pregnancies. The mean age of patients was 31.7 years and 16 patients had more than 35 years. The metrorragia is the main symptom (91.6%). Excessive uterine enlargement and lutein ovarian cysts were observed respectively in 57 and 6.6% of cases. Human chorionic gonadotropin level was upper than 50,000 UI/l in 91.4% of cases. Ultrasonography contributed to diagnosis in 82.8% of cases. Histological findings were complete molar in 33 cases and partial molar in 27 cases. 6 of 33 patients having complete molar developed persistent gestational trophoblastic tumor. Actinomycin D induced complete remission in all cases. Molar pregnancy is a relatively common disease in Tunisia. Careful and reliable human chorionic gonadotropin monitoring is essential for the early detection of post molar persistent gestational trophoblastic tumor.

[Proximal tubal unblocking by selective salpingography, apropos of 8 cases]. / Les désobstructions tubaires proximales par salpingographie sélective, à propos de huit observations.

Proximal tubal desobstuction by selective salpingography: through a study of eight cases, the authors give their first results about tubal desobstruction by selective salpingography.