Hedi Khairi

Growth factor concentrations and their placental mRNA expression are modulated in gestational diabetes mellitus: possible interactions with macrosomia

BackgroundGestational diabetes mellitus (GDM) is a form of diabetes that occurs during pregnancy. GDM is a well known risk factor for foetal overgrowth, termed macrosomia which is influenced by maternal hypergycemia and endocrine status through placental circulation. The study was undertaken to investigate the implication of growth factors and their receptors in GDM and macrosomia, and to discuss the role of the materno-foeto-placental axis in the in-utero regulation of foetal growth.Methods30 women with GDM and their 30 macrosomic babies (4.75 ± 0.15 kg), and 30 healthy age-matched pregnant women and their 30 newborns (3.50 ± 0.10 kg) were recruited in the present study. Serum concentrations of GH and growth factors, i.e., IGF-I, IGF-BP3, FGF-2, EGF and PDGF-B were determined by ELISA. The expression of mRNA encoding for GH, IGF-I, IGF-BP3, FGF-2, PDGF-B and EGF, and their receptors, i.e., GHR, IGF-IR, FGF-2R, EGFR and PDGFR-β were quantified by using RT-qPCR.ResultsThe serum concentrations of IGF-I, IGF-BP3, EGF, FGF-2 and PDGF-B were higher in GDM women and their macrosomic babies as compared to their respective controls. The placental mRNA expression of the growth factors was either upregulated (FGF-2 or PDGF-B) or remained unaltered (IGF-I and EGF) in the placenta of GDM women. The mRNA expression of three growth factor receptors, i.e., IGF-IR, EGFR and PDGFR-β, was upregulated in the placenta of GDM women. Interestingly, serum concentrations of GH were downregulated in the GDM women and their macrosomic offspring. Besides, the expression of mRNAs encoding for GHR was higher, but that encoding for GH was lower, in the placenta of GDM women than control women.ConclusionsOur results demonstrate that growth factors might be implicated in GDM and, in part, in the pathology of macrosomia via materno-foeto-placental axis.

Prise en charge obstétricale des grossesses prolongées au-delà de 41 semaines d’aménorrhée avec un score de Bishop défavorable

Journal de Gynecologie Obstetrique et Biologie de la Reproduction - Vol. 34 - N° 5 - p. 454-462

Quality of life of infertile Tunisian couples and differences according to gender

To compare quality‐of‐life gender differences within infertile couples from Tunisia and between infertile couples and controls.

Mifépristone à la dose de 100 mg dans les avortements médicamenteux

Journal de Gynecologie Obstetrique et Biologie de la Reproduction - Vol. 34 - N° 3-C1 - p. 257-261

Le traitement cœliochirurgical des tumeurs des annexes de l’utérus après le premier trimestre de la grossesse: À propos de 25 observations

Resume But Etudier la faisabilite, les avantages et les risques du traitement cœliochirurgical des tumeurs annexielles au cours des deux derniers trimestres de la grossesse. Materiel et methodes Etude retrospective d’une serie de 25 cas de tumeurs annexielles operees par voie cœlioscopique au cours du deuxieme et du troisieme trimestres de grossesse, durant une periode de 49 mois allant du 1 er janvier 1999 au 30 janvier 2003. Resultats L’âge gestationnel moyen au jour de l’intervention etait de 16 SA et 3 jours (extremes : 12 et 29 SA). La tumeur annexielle correspondait a un kyste ovarien dans 24 cas et a un kyste para-tubaire dans un seul cas. On a eu recours a la laparo-conversion dans un seul cas en raison d’une difficulte de l’hemostase. Une seule reprise a ete realisee par voie cœlioscopique au cours de la meme grossesse pour cystadenome sereux a la limite de la malignite. Aucune complication peroperatoire n’a ete enregistree. Le sejour postoperatoire moyen etait de 36 heures (extremes : 24 et 72 heures). On a note une seule menace d’avortement en postoperatoire immediat mais aucune complication thrombo-embolique. Le deroulement ulterieur des grossesses etait normal. Conclusion Le traitement cœliochirurgical des tumeurs annexielles est faisable au cours des deux derniers trimestres de la grossesse moyennant une technique rigoureuse et un operateur entraine. Les avantages de la cœlioscopie deja connus sont majores pendant la grossesse.PURPOSE OF THE STUDY To study the feasibility, advantages and risks of laparoscopic management of adnexal tumors in the course of the last two trimesters of the pregnancy. MATERIAL AND METHODS Retrospective study of a series of 25 cases of adnexal tumors operated by laparoscopy in the course of the second and the third trimester of pregnancy, during a period of 49 Months from 1st January 1999 to 30 January 2003. RESULTS Mean gestational age at surgery was 16 weeks 3 days (range 12-29 weeks). The adnexal tumor was an ovarian cyst in 24 cases and in a paratubal cyst in a single case. Conversion was necessary in only one case due to difficult hemostasis. One revision required for borderline malignancy cystadenoma was performed laparoscopically during the same pregnancy. No operative complication was noted. Average post-operative stay was 36 hours (range 24-72 hours). There was one situation of eminent abortion in early the postoperative period but no thromboembolic complications. The pregnancy progress was normal after laparoscopy. CONCLUSION Laparoscopic treatment of adnexal tumors is feasible in the course of the last two trimesters of the pregnancy in the hands of an experienced surgeon using advanced techniques. The well-known advantages of laparoscopy are particularly important during the pregnancy.

Apport pronostique du Doppler de l’isthme aortique fœtal dans la prise en charge du retard de croissance intra-utérin: Étude prospective longitudinale

Resume Objectif Evaluer l’apport de l’etude du spectre velocimetrique Doppler au niveau de l’isthme aortique fœtal en cas de retard de croissance intra-uterin entre 28 et 38 semaines d’amenorrhee dans la prediction de la mortalite et morbidite perinatales. Patientes et methodes Etude prospective longitudinale incluant les fœtus des grossesses uniques de terme precis, suivies dans notre institution et chez qui le diagnostic de retard de croissance intra-uterin a ete pose (circonference abdominale e percentile) ; etaient exclues les fœtus malformes et/ou chez qui une aberration chromosomique avait ete diagnostiquee. Le dernier examen Doppler etait pratique au maximum 10 jours avant l’accouchement et le choix de la voie et du terme de l’extraction etaient collegiales. La mortalite et morbidite perinatales etaient comparees dans 1) le groupe avec flux anterograde net au niveau de l’isthme aortique et 2) le groupe avec flux retrograde net a ce meme niveau. Le risque relatif etait calcule et une valeur de p Resultats Trente-deux dossiers etaient retenus pour analyse : les fœtus presentant un flux anterograde net au niveau de l’isthme aortique (n = 26) versus ceux qui presentaient un flux retrograde net (n = 6). Les caracteristiques demographiques maternelles etaient comparables dans les deux groupes. A l’exception de la longueur femorale, les valeurs moyennes des biometries n’etaient pas significativement differentes entre les deux groupes. Les valeurs des index de resistances au niveau des arteres uterines, ombilicales et cerebrales etaient similaires dans les deux groupes. Le terme d’accouchement ainsi que le poids de naissance n’etaient pas significativement differents entre les deux groupes : respectivement de 239,65 ± 20,1 versus 247,3 ± 16,4 jours (p = 0,349) et 1748,8 g ± 468,7 versus 1933,3 g ± 468,7 (p = 0,408). Le risque relatif de deces perinatal en cas de flux retrograde net au niveau de l’isthme aortique etait significativement plus eleve : 8,66 (IC 95 % 2,03 - 36,84). A noter que les nouveau-nes du groupe flux retrograde net etaient plus souvent extrait par voie haute pour etat fœtal non rassurant avec un risque relatif de 3,22 (IC 95 %, 1,29 - 8). Conclusion Dans notre etude, la constatation d’un flux retrograde au niveau de l’isthme aortique en cas de retard de croissance intra-uterin est associee a un risque de mortalite perinatale plus eleve.OBJECTIVE Our purpose was to determine whether the use of aortic isthmus Doppler waveform analysis in growth restricted fetuses delivered at 28 to 38 weeks predicts perinatal outcomes. MATERIAL AND METHODS Prospective longitudinal study including singleton non-malformed euploid fetuses with accurate dating and diagnosed as growth restricted (abdominal circumference<10th percentile) and who were followed up at our institution and delivered<10 days after the last Doppler. Timing of delivery was collegial. Perinatal mortality and morbidity outcomes were compared in cases with anterograde blood flow versus retrograde net blood flow in aortic isthmus. Relative risk (RR) were calculated with 95% CI and P<0,05 was considered significant. RESULTS Thirty-two cases were considered for analysis: growth-restricted foetuses with anterograde blood flow (n=26) versus retrograde net blood (n=6). Maternal demographic characteristics in the two groups were similar and exceptions made of femur length average values for fetal biometrics were not significantly different. Doppler velocimetry results at the uterine, umbilical and cerebral arteries were similar in the two groups. Gestational age at delivery and birth weight were similar in both groups (respectively (239.65 20.1 vs. 247.3 16.4 (days) (p=0.349) and 1748.8 gr 468.7 vs. 1933.3 gr 468.7 (p=0.408)). There was a statistically significant increase in perinatal mortality in retrograde net blood flow group: 8.66 [IC 95% 2.03 - 36.84]. An interesting finding was that neonates with aortic isthmus retrograde net blood flow were more frequently born by cesarean delivery because of a suspected fetal compromise RR=3.22 CI 95% [1.29-8]. CONCLUSION In our study Doppler identification of aortic isthmus retrograde net blood flow in growth-restricted fetuses was associated with an increase of perinatal death.

Correlation between Heterogeneous Expression of Sialyltransferases and MUC16 in Ovarian Tumor Tissues

Background: A number of glycoproteins such as CA125 are abnormally glycosylated in ovarian cancers. Most aberrant glycosylations are a result of altered sialyltransferase (ST) expression. The aim of this study was to evaluate the expression of 6 STs and MUC16, and their correlations in benign and malignant ovarian tissues. Material and Methods: mRNA expression of 6 STs and MUC16 was assessed in 16 human ovarian tumors (7 benign, 9 malignant) by real-time quantitative polymerase chain reaction (RTQ-PCR). Results: mRNA of ST6GAL I and ST3GAL I was not significantly upregulated in ovarian cancer tissues, while ST6GAL II and ST3GAL IV were not significantly increased in benign tumors. There was no change between ST3GAL III and ST3GAL VI expression and tumor subtypes. MUC16 was significantly increased in carcinoma tissue. Significant correlation was found between ST3GAL III and ST3GAL IV. MUC16 correlated with ST3GAL VI and ST6GAL I. ST6GAL I correlated well with ST3GAL VI. ST6GAL II correlated significantly with ST3GAL III and ST3GAL IV. Conclusions: The given STs and MUC16 can be expressed at a heterogeneous level as a consequence of oncogenic transformation of the ovary. A strong correlation between MUC16 and STs may impact specifically on the glycosylation of MUC16.

Mammary-like adenocarcinoma of the vulva associated to Paget's disease: a case report.

Mammary-like adenocarcinoma of the vulva associated to Pagets disease is exceedingly rare. So, it is very important to perform all the pathological and immunohistochemical investigations to achieve differential diagnosis from both a metastatic lesion from an orthotopic breast cancer and a vulvar adnexal tumor. This report describes a case of vulvar Pagets disease associated with underlying mammary-like adenocarcinoma diagnosed in the Department of Obstetrics and Gynecology of Farhat Hached university hospital of Sousse in Tunisia. We also review previously reported cases of primary breast-like carcinoma of the vulva with or without Pagets disease.

Unusual gestational choriocarcinoma arising in an interstitial pregnancy.

Highlights • Choriocarcinoma is a highly malignant trophoblastic neoplasm. Its association with ectopic pregnancy is very rare and aggressive.• Clinical diagnosis of interstitial choriocarcinomas is difficult, since it is rare and manifested by non-specific symptoms.• Imaging findings are also not helpful in ectopic location.• Monitoring of βhCG level was the most useful marker of diagnosis and follow up.• Pathology is the only tool of the diagnosis especially with the trend of treatment of ectopic pregnancy by conservative surgery.

Tumeur vitelline de l’ovaire révélée par une ascite de grande abondance

We report the case of a 16-year-old girl explored for an ascite of great abundance responsible for a respiratory embarrassment. Its symptomatology proved to be secondary to a vitelline tumour of the ovary. It required several drainings of ascite before surgical operation. She had a conservative treatment followed up by a chemotherapy which allowed a clinical and biological remission. We report this observation considering the originality of the mode of revelation of the tumour. We insist in addition on the possibility of a conservative treatment.