[Transuterine migration of intrauterine contraceptive devices]

The intrauterine contraceptive device (IUCD) is frequently used. The use of IUCD can be responsible of serious complications as transuterine migration. In this study, we evaluate the physiopathology, the strategy of diagnosis and treatment of the IUCD translocation.

MATERIAL AND METHODS

We conducted a retrospective study of nine cases of IUCD migration having occurred between 2004 and 2009. We discussed the age, the type of IUCD, the risk factors, the mechanisms of migration, the circumstances and methods of diagnosis, the treatment and the evolution of IUCD migration. Mean age of the patients was 35 years. The risk factors were: multiparity, anteversus uterus, scarred uterus, IUCD postpartal insertion, inexperience of the operator. Most patients were asymptomatic. Two patients had urinary symptoms. The diagnosis of an extrauterine device was confirmed by abdominal X-ray and ultrasound results in all patients. The endoscopic treatment was successful in 66% of cases. All patients had an uneventful recovery. Transuterine migration remains one of the least common but most serious complications associated with the use of an IUCD. This complication could be controlled if thorough gynaecological exam was performed, if risk factors were delineated, if the IUCD was technically well inserted and a rigorous surveillance was performed.

[Malignant degeneration of benign cystic teratoma of the ovary]

Malignant transformation of mature cystic teratoma of the ovary is a rare complication occurring preferentially during peri- and post-menopausal period. No clinical nor radiological, nor biological signs are specific to malignant transformation. The treatment is surgical and similar to that of epithelial tumors of the ovary. We report an observation of a squamous cell carcinoma developed on a mature cystic teratoma of the ovary, in a patient aged 46 years.

Ile481 from the guinea pig alpha-subunit plays a major role in the activation of ENaC by cpt-cAMP

The epithelial sodium channel (ENaC) is the major rate-limiting step for vasopressin and aldosterone sensitive Na(+) reabsorption across kidney epithelia. Recently, ENaC activity was shown to be modulated by extracellular factors such as proteases, Na(+) ion and several other elements. However, the molecular mechanisms of these actions remain unclear. We and others have shown that ENaC composed of the guinea-pig alpha-subunit (alphagp), and the beta gamma rat subunits (betargammar) could be activated by cpt-cAMP, a cAMP analogue, through a mechanism not involving the cAMP-PKA pathway. In the present study, we confirmed by patch-clamp experiments on Xenopus oocytes that the number of open channels increased by 2.4-fold after cpt-cAMP exposure. In order to characterize the extracellular domain involved in this activation, we generated alpha-subunit chimera's harboring different portions of the extracellular loop of the alphagp and alphar. Using two-electrode voltage-clamp, we established that Tyr456-Ser532 from the alphagp confers sensibility to cpt-AMP. Then, by site-directed mutagenesis, we have isolated Ile481 as a major residue for cpt-cAMP-dependant activation. Taken together, these experiments provide evidence of an extracellular-ligand stimulating ENaC. They also contribute to the further understanding of the structure-function relationship of this channel.

[Pulmonary arterial hypertension and porto-caval fistula in a 17 year old patient]

The authors report the case of a 17 year old patient with severe pulmonary arterial hypertension accompanied with a congenital porto-caval shunt. This patient had been admitted with dyspnoea on exertion with signs of pulmonary arterial hypertension on clinical examination. Echocardiography revealed a systolic pulmonary arterial pressure of 80 mmHg with no left heart anomaly or intracardiac shunt. Pulmonary investigations, as well as immunology, clotting, liver function and retroviral serology were all negative. A routine abdominal ultrasound showed a 10 mm proximal porto-caval fistula with no sign of portal hypertension. This case shows that anomalies of the portal system can cause pulmonary arterial hypertension even in the absence of any symptoms suggestive of hepatic disorder.

[Pregnancy and delivery in adolescents: characteristics and profile of 311 cases]

OBJECTIVE

Adolescent pregnancy is considered to be a high-risk situation in a large part of the world. The aim of this study is to assess the validity of this notion for Moroccan teenagers.

MATERIAL AND METHODS

From January 1999 to December 2000, there were 311 teenagers who gave birth in the "Les orangers" maternity hospital in Rabat, Morocco. We compared these adolescents with 155 women aged more than 18 years who delivered during the same period.

RESULTS

We were unable to demonstrate a high risk for complications among our adolescent population. The only statistically significant differences found between the two groups concerned use of contraception (22.4% for teenagers vs. 57.6%), traditional practices (6.1% vs. 1.93%), frequency of episiotomy (90% vs. 67.14%), instrumental extraction (37.32% vs. 27.14%), lower birth weight in teenagers (3074 g vs. 3199 g) and a higher rate of low birth weight in unmarried adolescents in comparison with married ones (23.3% vs. 9.6%).

CONCLUSION

Adolescent pregnancy in Morocco remains well accepted, particularly within the context of marriage.

[Uterine leiomyoma in a patient with Rokitansky-Kuster-Hauser syndrome. Report of a case]

We report the discovery of a leiomyoma which developed from a fibrous myometrial band in a woman with Rokitansky-Kuster-Hauser syndrome. This localization is exceptional. The diagnosis was suspected at physical examination and pelvic ultrasonography and laparoscopy. Histology confirmed leiomyoma.

[Norplant. Experiences at the maternity services of Orangers in Rabat during two years]

Norplant is a pure progestative method which couples efficaciousness, reversibility and a period of prolonged action. We have counted 189 insertions since March 1993, the date of the introduction of this contraceptive method in the center of family planning at the university maternity of Orangers. The analytical study of different parameters collected in admission files and preestablished control allowed to draw the epidemiologic profile of the patients as well as acceptability, the tolerance and the efficiency of this method.