[Cerebral venous thrombosis during pregnancy: about 7 cases]

BACKGROUND

cerebral venous thrombophlebitis (CVT) is a rare but serious pathology. The pregnancy and especially the postpartum constitute supporting circumstances occured of the CVT.

AIM

the aim of our study is to remember the symptomatology of CVT, the importance of the IRM and the angio IRM in the diagnosis of CVT, and its treatment.

OBSERVATIONS

We present a retrospective study relating to 7 cases of CVT during gravidopuerperality over 7 years (1996 to 2002). The average age of our patients is 32.1 years. The CVT occured during the first trimester of the pregnancy in one case and in the postpartum in 6 cases. The symptomatology was dominated by cephalgia and the signs of intracranian hypertension. Convulsions occured in 3 cases. The diagnosis of CVT was confirmed by IRM coupled with the Angio-IRM in all cases. The treatment by heparinotherapy was instaured immediately and relayed by the Anti-Vit K as the evolution was favorable in all cases.

CONCLUSION

cerebral venous thrombophebitis (CVT) is a serious pathology (especially in pregnancy and post partum). The diagnosis is performed by the magnetic resonance imaging (IRM) and the early introduction of the heparinotherapy.

[Intra-uterine growth retardation: etiologic factors and management]

OBJECTIVE

The aim of this study is to define the etiologic factors, the diagnostic proceduresand obstetrical rules to be observed during a pregnancy in relation with low birth weight.

PATIENTS AND METHODS

This is a retrospective study of 124 cases, carried out at the military hospital of Tunis, between January 1st 1999 and December 31 st 2001.

RESULTS

The frequency of intra-uterine growth retardation (IVGR) was 2.1%. 46.8% of the patients were primiparous. The mean age of the patients was 30 years. 25.8% of the patients developed toxemia. The etiology was predominantly renovascular-syndromes, urinary infections, and idiopathic hypotrophy. The positive diagnosis was suggesred by the measure of the uterine height in 96% and was confirmed by sonogaphy in all cases. The ombilical Doppler was pathological in 17.76% of the cases. A corticosteroid administration for pulmonary maturation was prescribed in 28% of the cases. Obstetrical common rule was fetal extraction: 42.7% of the patients were delivered by cesarean.

CONCLUSION

There is a real need to insist on the importance of early detection of fetal hypotrophy and of better management of the women at risk.

[Endometrectomy. Analytical study of 20 cases]

Endometrial removal represents a therapeutic alternative to hysterectomy.

AIMS

Through a retrospective study of 20 cases of endometrial removal colleted over a period of 4 years, the authors try to determine the indications of this therapeutic method, its efficiency, its advantages as well as its contra indications.

RESULTS

Average age of the patients was 44 years. Average parity was 4. Functional menstrual disorders were found in 90% of cases. Gynaecological examination revealed a uterus of normal size in 85% of cases, and increased in size in 15% of cases. All the women had a preoperative diagnostic hysteroscopy. A simple endometrectomy was performed in 70% of the cases, an endometrectomy with a polypectomy in 25% of the cases and an endométrectomy with a myomectomy in 5% of the cases. The rate of success was 90%. We had a case of uterine perforation, because of uncontrollable bleeding a hysterectomyhad to be carried out in 2 cases.

CONCLUSION

Endometrectomy is an alternative to hysterectomy in cases of menorrhagia due to mild functional disorders resistant to medical treatment.

[Urinary incontinence with effort: surgical management in the maternity ward of a Tunisian military hospital (91 case reports)]

We bring back a retrospective study on the surgical treatment of the incontinence in the effort about 91 cases. Our objective is to estimate the results of our surgical techniques. Three procedures were used: plicatures under urethrales; intervention of bologna; intervention of Burch. The incontinence in the effort was associated to a genital prolapse in every cases; prolapse was of third degree in 70% of cases. We obtained a good functional result in 94% of cases and a good anatomical result in 96% of cases on an average recession of 60 months. The complications per and postoperating are marked especially by the urinary infections. Our study shows that classical technics are still available.

[Umbilical endometriosis: apropos of 3 cases]

Umbilical endometriosis is a rare localisation of the disease. The authors report three cases of umbilical endometriosis. The symptomatology is not usually typic. The only effective treatment remains the surgical exercise thus allowing the confirmation histological.

[Management of uterine fibromas. Report of 219 cases]

This study is about 219 uterine fibroma treated surgically between 1994 and 1998. The surgical operation represent 19.1% of the gynecological interventions. The average age of our patients was of 41.7 years with 30.6% of nulliparous. The main motives of consultation were: the confusion of the menstrual cycle in 56.6%, the pelvic pains in 32%, the increase of the volume of the belly in 10% and the infertility in 10% of cases. The surgical indications were dominated by the big size of the womb in 68% of cases and hemorrhagic complications in 57.7% of cases. The myomectomy indicated for women young and avid for pregnancy was realized in 94 cases; 80.8% by abdominal way, 13.8% by hysteroscopic way and 5.3% by coelioscopy. Hysterectomy proposed for women near menopauses was realized in 125 cases: 70.4% by abdominal way and 29.6% by vaginal way. The complications per- and post-operating are rare, represented essentially by the bleeding and the urinary infections.

Heart failure induced by pheochromocytoma: laparoscopic treatment and intraoperative changes of several new cardiovascular hormones

Since 1992, adrenalectomy for pheochromocytoma has been recognized as a safe and efficient technique when performed by a laparoscopic approach. Most of the cases of pheochromocytomas treated as such and published in the literature were not associated with malignant hypertension and acute heart failure. We report the case of a 23-year-old woman who presented with this clinical picture and show that laparoscopic adrenalectomy may be as safe and efficient as conventional adrenalectomy when performed in this situation. The intraoperative changes in the secretion of catecholamines, endothelin-1, angiotensin II, N- and C-terminus of atrial natriuretic factor prohormone were also analyzed. Noradrenaline release during tumor dissection was associated with a stimulation of atrial natriuretic factor.

Changes in blood pressure and in vasoactive and volume regulatory hormones during semistarvation in obese subjects

The mechanisms underlying the reduction in blood pressure that occurs with a severe energy-restricted diet were evaluated in 12 obese subjects during 8 days on a very-low-calorie diet (1.67 MJ/d) with a constant intake of 17 mmol sodium per day. The relationship between changes in blood pressure, sodium balance, plasma volume, renin-aldosterone and sympathetic nervous system activities, plasma C-terminus and N-terminus of the atrial natriuretic factor (ANF) prohormone, brain natriuretic peptide (BNP), and endothelin-1 (ET-1) concentrations was investigated. A negative sodium balance was present throughout the diet and was associated with a moderate reduction in plasma volume, a marked activation of the renin-aldosterone system, and a concomitant reduction in C- and N-terminal ANF prohormone levels. Moreover, the postural changes in N-terminal proANF and ANF secretion documented before the diet, disappeared after 8 days of dieting, in contrast to a greater postural stimulation of aldosterone and renin. A negative correlation was found between the changes of C- and N-terminal ANF prohormone levels and those of aldosterone. Urinary catecholamine excretion, BNP, and ET-1 remained unchanged. These results indicate that the decrease in blood pressure occurring during severe caloric restriction was essentially due to the reduction in the effective blood volume, as reflected by the stimulation of the renin-aldosterone system and the decrease in ANF levels. The lack of any changes in catecholamine excretion and endothelin levels suggests that peripheral vascular resistance did not change significantly in these circumstances.

[Fetal prognosis in breech delivery. Statistical study of 543 cases]

The authors report a retrospective study of 543 breech deliveries during a 4-year period (1987-90). The cesarean section rate was 18.4 per cent, and perinatal mortality 3.68 per cent. Poor prognostic factors were: multiparity, large fetus, cord prolapse, second stage of labour lasting more than 30 mins and obstetric manoeuvres. Prenatal care and obstetric evaluation before labour may improve fetal prognosis.

[Characteristics of pregnancy and delivery in women with heart diseases]

The authors report 78 cases of pregnancy in women with heart disease during a 4 year period (1985-1988). Heart disease involved a rheumatic valve lesion in 90 per cent of cases. Heart disease was properly monitored in these patients (74.5 per cent) but the pregnancy in only 50 per cent of cases. These patients gave birth to 78 newborn infants. Labour was premature in 15.38 per cent of cases. Labour was of short duration: less than 6 hours (73 per cent of cases). There was only delivery by cesarean section. Bleeding at the time of delivery was common (12.4 per cent of cases). There were two maternal deaths during the post-partum period (2.56 per cent). Essential risks to the newborn included low birth weight (17.5 per cent) and prematurity (15.38 per cent). Neonatal mortality was 2.5 per cent.