Dalenda Chelli

Fetal sex assignment by first trimester ultrasound: a Tunisian experience

To assess the feasibility and accuracy of fetal sex identification during the first trimester ultrasound exam.

Pelvic hydatid (echinococcal) disease

To study epidemiologic and clinical features of pelvic hydatid disease and discuss its management.

Imperforation hyménéale : peut-on la traiter en préservant la virginité ?

UNLABELLED Imperforate hymen is a rare congenital anomaly, with an incidence of about 1 in 2000 female births. It is generally diagnosed during puberty. Treatment generally consists of a hymenotomy or a hymenectomy. Because the hymen is a symbol of virginity in some communities, its destruction can be source of social problems for some girls. OBJECTIVES We discuss the diagnostic but especially therapeutic aspects of imperforate hymens and possible surgical techniques, in particular those that preserve the hymen. MATERIAL AND METHODS We describe the cases of 5 girls treated in our department for imperforate hymen between 2001 and 2007. Two of them required the safeguarding of the normal architecture of their hymen to preserve the appearance of virginity. We analysed diagnostic features and surgical techniques. RESULTS The average age of our patients was 14.8 years (range: 11 and 17 years). The most frequent reason for consultation was pelvic pain with primary amenorrhea. Inspection of the vulva revealed in all cases a dome-shaped purplish-red hymeneal membrane. Hymeneal incision allowed drainage of old previously blocked menstrual blood. Three patients were treated by radial incisions of the hymen. The parents of 2 patients demanded that their hymens be preserved. Accordingly, one had a simple excision of a central flange of the hymen and the other was treated by a similar technique that also used a Foley catheter . All five patients did well after surgical treatment. The techniques used to preserve the hymen resulted in an apparently intact annular hymen. CONCLUSION Imperforate hymen is a rare anomaly. Its diagnosis is simple. The traditional technique of radial incisions is a simple procedure that yields good results. The technique using the Foley catheter is an adequate alternative when preservation of the hymen is required.

Desmoid tumors: clinical features and treatment options: a case report and a review of literature

Desmoid tumors are a rare group of locally aggressive, non malignant tumors of fibroblastic origin that can lead to significant morbidity due to local invasion and may even result in a fatal outcome when located around vital organs. Their clinical presentation, biological behavior and natural history can be quite varied and is incompletely understood at the present time. The optimal therapeutic approach depends on various factors, and a multidisciplinary approach is necessary to achieve local control with acceptable morbidity. Despite progress in the understanding of these tumors and the treatment options, local recurrence remains a major problem.

Clinical Assessment of Soluble FMS-Like Tyrosine Kinase-1/Placental Growth Factor Ratio for the Diagnostic and the Prognosis of Preeclampsia in the Second Trimester

BACKGROUND Preeclampsia is one of the most common and serious complications of pregnancy. Various reports have demonstrated that disturbances in angiogenic and antiangiogenic factors are implicated in its pathogenesis and have possible relevance in its diagnosis and prognosis. METHODS In this case-control study, we enrolled 73 patients with 34 preeclamptic cases diagnosed according to clinical criteria and dosing of proteinuria. The cases were matched to controls at the same age and parity. Controls had normal tension and no apparent risk factors for preeclampsia. The dosage of PLGF and sFlt - 1 were performed and correlated to the clinical issue of each group. RESULTS Our results show a significant decrease in PLGF levels in the cases compared to the control group (average PLGF levels in cases 28.3 pg/mL vs. 664.52 pg/mL in controls); p = 0.0006. sFlt-1 level was significantly higher in cases compared to controls. The average sFtl-1 levels in cases was 5780.72 pg/mL vs. 1886.05 pg/mL in controls; p = 0.0008. The (sFlt-1/PLGF) ratio was significantly higher in cases compared to controls (mean ratio of sFlt-1/PLGF cases is 884.12 pg/mL vs. 12.12 pg/mL in controls); p = 0.0002. Patients who developed a complication had a ratio of sFlt-1/PLGF higher than the rest of patients in the severe preeclampsia group (mean ratio of sFlt-1/PLGF 2727 pg/mL vs. 1207.41 pg/mL). The higher the ratio of sFlt1/PLGF, the shorter the period of fetal extraction was (24 hours to a ratio of 2159.16, 48 hours for a ratio of 811.9, more than 48 hours for a ratio of 184). CONCLUSIONS PLGF and sFtl-1 could allow discrimination of women with normal pregnancies from those at high risk for developing pregnancy complications. Their ratio may have a value for the diagnosis and prediction of pregnancy outcome.

Spontaneous subserosal venous rupture overlying a uterine leiomyoma in a young woman

Uterine leiomyomas are very common tumors found in women. Rupture of veins on the surface of uterine leiomyoma is an unusual source of hemoperitoneum. It is an extremely uncommon gynaecological cause of hemoperitoneum. It is a life threatening emergency. We report a case of massive intraperitoneal hemorrhage due to rupture of vessels on the surface of subserous leiomyoma. A differential diagnosis of rupture of leiomyoma’ssurface vessel should be considered, while dealing with a case of hemoperitoneum with pelvic mass.

P34 First-trimester ultrasound screening in Tunisia

viii. No patient had clinical evidence of infection; ix. Eight of the babies were delivered vaginally and two by elective Caesarean Section; x. Eight of the babies are developing normally, with no perinatal deaths and two late neonatal deaths. Conclusion: Emergency cervical cerclage should be considered as a management option where there is painless cervical dilatation and membrane prolapse in the middle trimester.

Richter — type sacro-spinal fixation

Objectives: The aim of the study was to evaluate the long term results of spinal fixation in the genital prolapse treatment. Study Methods: Retrospective study of 63 patients having pelvic organ prolapse with or without stress incontinence were surgically managed from January 1993 to June 1999. The average follow up was 36 months with extremes from 7 to 84 months. It was made by a different operator. Results: Average age was 62.55 ranging from 40 to 85 years and indications were: Prolapsus C3H3R3 with vaginal eversion. 50 cases (79.36 %) Prolapsus C2H2R2 without vaginal eversion 7 cases (11.11 %) Vaginal prolapse following hysterectomy 6 cases (9.52 %) 37 bilateral fixation (58.73 %) and 26 unilateral fixation (41.26 %) were achieved generally according to the choice of the operator. Cervicocystopexy was associated in 55 cases (87,3%).Complications were rare : small rectal laceration (1 case) and venous hemorrhage near the sacro-spinal ligament (1 case). In conclusion we had: 52 satisfying anatomic and functional results (82.53%), 6 satisfying functional results but bad anatomic results (9.5%), 5 satisfying anatomic results but bad functional results (7.9%). No significant differences were observed between unilateral and bilateral spine fixation exept the lengthening of the operating time. Conclusion: The transvaginal sacro-spinal fixation called Richeter operation was initially aimed at curing vaginal vault prollapse after hysterectomy. Indications may be extended to V3U3R3 prolapse and cure of elytrocele with good results in our practice.