Cerebral meningioma during pregnancy mimicking eclampsia: About a rare case

INTRODUCTION

Pregnancy is a physiological state whose association with any pathology gives it specific characteristics in the management of patients. Meningioma is the most frequent brain tumor but rarely develops during pregnancy. Treatment of the tumor generally follows the same principle as that proposed outside pregnancy, with priority given to the mother's life.

PRESENTATION OF CASE

We report a rare case of gestational meningioma that was wrongly attributed to prepartum eclampsia, in a poorly monitored pregnancy estimated at 34 weeks' amenorrhea, which resulted in the termination of the pregnancy by cesarean section for maternal rescue. The patient underwent complete surgical removal of the tumor postpartum.

DISCUSSION

Cerebral meningioma in pregnancy is a rare but often fatal disease characterized by unusual behavior compared to meningiomas in non-pregnant women. It is suspected that endocrine and vascular changes play a crucial role in the pathophysiology of rapid tumor growth during pregnancy. The tumor's harmful effect on the fetus is not direct but is mediated by its consequences, such as intracranial hypertension and epileptic seizures, which can be life-threatening for both mother and fetus and in some cases necessitate termination of pregnancy.

CONCLUSION

The management of cerebral meningioma during pregnancy must take into account the gestational-fetal pairing, both in diagnosis and treatment. This requires close coordination and collaboration between various experts, including anesthetists, obstetricians, neurosurgeons, and pediatricians.

Surgical management of a transverse vaginal septum: About a rare case

INTRODUCTION

The transverse vaginal septum is a rare anomaly of the müllerian ducts whose pathophysiology is linked to a defect in the resorption of the embryological tissue located between the vaginal dome and the caudal terminal part of the fused müllerian ducts.

CASE PRESENTATION

We report a rare case of a permeable transverse vaginal septum in a 41-year-old patient, who consulted for cyclic pelvic pain.

DISCUSSION

The vaginal septum is a rare anomaly of the Müllerian ducts whose approximate frequency is around 1/70,000 women. The vaginal septum can be permeable or impermeable and can affect all levels of the vagina. The combination of conventional ultrasound and MRI confirms the diagnosis of these abnormalities. The treatment is surgical and must be implemented quickly. Several surgical techniques have been described, the simplest of which is the "crevice" technique.

CONCLUSION

The combination of conventional ultrasound and MRI is useful in confirming the diagnosis of these abnormalities. Surgical treatment should always be well planned. The risks of postoperative stenosis and the impact on the upper genital tract must be taken into account.

Healthy adnexal torsion in pregnancy: A case report

•

Adnexal torsion during pregnancy is a rare surgical emergency.

•

The diagnosis of certainty of adnexal torsion can only be made intraoperatively.

•

In the absence of any contraindication, laparoscopy should be the preferred approach.

•

Ovariopexy is proposed by certain authors in order to prevent recurrence.

70 Comparative study between PIMS and Kawasaki disease

Background

Kawasaki disease (kDa) is a multisystemic vasculitis affecting medium and small vessels with a predilection for the coronary arteries. It appears to be very similar to the pediatric multisystemic inflammatory syndrome (PIMS), which is a post-infectious inflammatory condition occurring after SARS-COV2 infection. Although these two entities have clinical and biological similarities, marked differences are identified. The aim of this study is to compare the two conditions in order to highlight the specific criteria of each of these related entities and to describe their demographic, clinical, biological and therapeutic characteristics in our context.

Method

Single center prospective observational study from January 2021 to March 2022 was conducted, comparing children admitted for PIMS on the basis of persistent fever, inflammatory syndrome, and positive COVID-19 IgG serology to patients hospitalized for kDa according to American Heart Association criteria.

Results

42 cases were recruited, among them 24 PIMS and 18 kDa, with a male predominance. The average age was 5 years for PIMS and 2 years and 7 months for kDa. All had a persistant fever with an average duration of 8 days as reason for consultation. Conjunctivitis was found in 88% of kDa vs 75% of PIMS and cheilitis in 94% of kDa vs 75% of PIMS. Skin rash, extremity involvement, cervical adenopathy were reported in both pathologies with respective percentages of 62.5%, 17.4% and 25% for PIMS vs 61.1%, 33.3% and 33.3% for kDa. Abdominal pain was reported in 54.2% of PIMS patients vs 5.6% of kDa. All patients had an inflammatory syndrome. The mean sedimentation rate was 67 mm at the first h in PIMS and 99 mm at the first h in kDa. The mean CRP was 147 mg/l in PIMS vs 132 mg/l in kDa. Lymphopenia was predominant in PIMS with 33% vs 11% in kDa. Cardiac enzymes were higher in PIMS with 29% of myocarditis and 15% of coronary dilatation vs 16.7% of coronary involvement in kDa. All PIMS patients received immunoglobulin infusion IV-IG, corticosteroid therapy, and an antiplatelet agent, whereas patients with kDa received IV-IG and acetyl salicylic acid in anti-inflammatory doses. Apyrexia was obtained at day 1 of treatment in the majority of patients, whereas 5.6% of kDa had persistent aneurysm.

Conclusion

PIMS cases predominated over kDa cases during this pandemic period. The distinction between the two entities could be difficult given the clinico-biological similarities. Abdominal pain was significantly more frequent in PIMS patients, whereas lymphopenia and myocarditis were not. The prognosis was better in PIMS.

A rare case of limb body wall complex

Limb body wall complex (LBWC) is a complex and rare poly-malformative syndrome. We report a case of this syndrome diagnosed antenatally in a 37-year-old primiparous woman, by a first obstetrical ultrasound performed at 22 weeks of amenorrhea and one day. After termination of pregnancy, macroscopic examination revealed a male newborn with all the diagnostic criteria of LBWC.

Amniotic band syndrome: A case report

Amniotic band syndrome is a rare disorder, which consists of a combination of malformations in which the main feature is the existence of an amniotic band that can envelop the limbs, the body wall, and/or the viscera. We report a case of an antenatal diagnosis of amniotic band syndrome in a 21-year-old female patient at 20 SA + 1 day, who had a medical abortion.

Heterotopic pregnancy: Five case reports diagnosed in 2021

Introduction and importance

Heterotopic pregnancy is the occurrence of pregnancies in at least two different implantation sites in the same time. The diagnosis is one of the most difficult of the gynecological emergencies. In 2021 this pathology still underdiagnosed and remains unknown by physicians. Most patients are admitted in critical stage.

Cases presentations

We reported 5 cases of heterotopic pregnancies in symptomatic women admitted from January 2021 to December 2021, in maternity department, mother and child hospital abderrahim Harouchi, Ibn Rochd University Hospital of Casablanca. The frequency of this pathology in our hospital in 2021 is about 10% of ectopic pregnancies (5/52 cases of ectopic pregnancies). All the cases were received in critical phase of the pathology (vascular collapsus or hemodynamic shock). The mean diagnostic was suspected in gray scale ultrasound that show an intrauterine pregnancy associated with adnexal mass corresponding to hematosalpinx or gestational sac in the uterine tubes with medium to high abundance hemoperitoneum. All of our cases were treated by laparotomy in emergency after resuscitation measures.

Clinical discussion

The existence of intrauterine pregnancy does not exclude an ectopic pregnancy and often confuses the physician who consults the patient in early stage of symptoms. The clinical symptomatology is often related to a threatened or ongoing abortion, the diagnosis of heterotopic pregnancy is usually made in the stage of hemoperitoneum secondary to a rupture of the ectopic pregnancy. The standard treatment is conservative surgery, preferably by laparoscopy. The manipulation of the uterus must be careful to preserve the intra uterine pregnancy. Laparotomy retains its indications especially in forms with hemorrhagic shock. The abortion is not rare after surgery. A progestin treatment is always indicated.

Conclusion

The diagnosis of heterotopic pregnancy should not be delayed by the discovery of an intra-uterine gestational sac in symptomatic women and the adnexa must be systematically examined in the first trimester sonographic exam. The Diagnosis is often difficult and management should be initiated as soon as possible given the risk of maternal mortality.

•

Heterotopic pregnancy is the occurrence of pregnancies in at least two different implantation sites in the same time.

•

The diagnosis of heterotopic pregnancy should not be delayed by the discovery of a intra uterin gestational sac in symtomatic women and the adnexa must be systematically examined in the first trimester by sonographic exam.

•

The main treatment consists of removing the ectopic pregnancy, while preserving the intra uterine pregnancy, that make the second challenge after diagnoses.

Tuberculosis of the breast neoplastic-like about two report cases: A rare often unrecognized diagnosis

Tuberculosis of the breast is a very rare infection; it occurs chiefly in women of childbearing potential, usually as an apparently primary infection and constitutes a diagnosis and therapeutic challenge. Administration of antituberculous agents is the mainstay of therapy. Surgery is required in some cases. We report tow cases of breast tuberculosis. The diagnosis has been established on histology. Outcome was favorable under anti bacillary treatment. Through the literature data we recall the epidemiological, clinical, diagnostic and treatment of this pathology.

Acro-callous syndrome: A case report

A malformative syndrome of unknown prevalence, the diagnosis is based on morphological ultrasound and magnetic resonance imaging of the fetus. The transmission is genetic and autosomal recessive. Courtnes has established 4 diagnostic criteria to affirm the acrocal syndrome and to eliminate the amalgam with other polymalformative syndrome.

Acquired uterine arterio-venous malformation post molar pregnancy suction-curettage: 2 case reports

Introduction

Acquired uterine AVM is an abnormal and non-functional connection between uterine arteries and veins. It is reported as a consequence of uterine trauma as curettage procedures, pelvic surgery.

Cases presentation

The authors report 2 cases of uterine AVM post suction-curettage procedure on molar pregnancy incidentally discovered in ultrasound screening in the usual follow-up of this disease, diagnosed in the Department of Maternity of Mother and Child University Hospital Abderrahim Harouchi of Casablanca.

Clinical discussion

Uterine AVMs are extremely rare and should be considered in cases of heavy and persistent uterine bleeding. Uterine AVMs are either acquired or, more rarely, congenital, due to abnormal differentiation of the primary vascular structures during embryogenesis. The invasive technique allows confirmation of the diagnosis and identification of the major feeding vessels when embolization may be indicated as a treatment option.

Conclusion

Acquired uterine arteriovenous malformation is the result of uterine trauma; it presents as uterine bleeding through the vagina that can be life threatening, the rarity of the condition makes it difficult to diagnose, however the evolution of investigative techniques helps in the diagnostic process.

•

Arteriovenous malformation (AVM) also called arteriovenous fistula is a short circuit between an organ’s arterial and venous circulation.

•

Acquired arteriovenous malformations are often consequences of uterine trauma

•

They are also associated with infection, retained product of conception, gestational trophoblastic disease

•

Uterine artery embolization remains the treatment of choice for AVMs for patients who wish to preserve their fertility.

Unusual primary location of non-Hodgkin lymphoma in the uterine body with compressive form: About case

INTRODUCTION

Primary non-Hodgkin's malignant lymphoma (NHML) of the uterine body is an extremely rare localization since only eleven cases have been reported in the literature.

CASE PRESENTATION

We report a case of primary NHML of the uterine body discovered during a hysterectomy performed for a uterine mass. The primary character of NHML of the uterine body was retained in view of the absence of extra-genital localization in the clinical, biological and radiological workup (Ann Arbor stage IE) and there were no signs of recurrence during follow-up. The patient received anti-CD20 immunochemotherapy (rituximab-CHOP and rituximab-VCAP combinations) and at 12 months follow-up, she is in complete remission.

DISCUSSION

The diagnosis of primary and isolated NHML of the uterine body is based on a clinical and further examination and regular follow-up for several months. The treatment is not codified; surgery, poly-chemotherapy and radiotherapy are the different therapeutic modalities. Rituximab-CHOP immunochemotherapy is currently the reference treatment for primary malignant lymphomas of the uterine body particularly in young patients who wish to become pregnant. The prognosis depends mainly on two factors: age and Ann Arbor stage.

CONCLUSION

Primary uterine lymphomas are rare tumors of unknown etiopathogeny and of non-specific clinical presentation, the role of the various treatments remains difficult to evaluate due to the small number of published cases.

Anticoccidial effect of apple cider vinegar on broiler chicken: an organic treatment to measure anti-oxidant effect

The objective of this study was to investigate the anticoccidial effect of apple cider vinegar added to drinking water with the anticoccidial effect of amprolium to feed broiler chicken. The study has adopted an observational approach to evaluate the anticoccidial effect of apple cider vinegar on broiler chicken. The antioxidative changes were measured adding natural apple cider vinegar to drinking water. Four hundred and fifty broiler chickens were purchased from the local market and distributed into three groups (T+vc: positive control, T-vc: negative control Tv: apple cider vinegar) with 150 chickens in each group. The three groups were further replicated into 3 blocks each containing 50 chickens. The groups were fed balanced diet, amprolium was added to the feed of positive control group, and apple cider vinegar was added to the water of Tv group. Measurements of the different variables were started from week 3, at the end of each week 3 birds were chosen randomly, blood samples were collected via the wing vein, and fecal oocysts were counted from intestinal contents of each individual bird using the McMaster technique. Broiler in the control groups T+ve and T-ve showed clinical signs of coccidiosis (blood in feces) and the number of coccidial oocytes in feces increased with time. In the vinegar group, no clinical signs of coccidiosis were observed. Concentrations of total antioxidants and catalase enzyme activity significantly increased (p≤0.05); while malondialdehyde concentration significantly decreased (p≤0.05).

Detection of Epstein-Barr virus in oral scrapes in HIV infection, in hairy leukoplakia, and in healthy non-HIV-infected people

Epstein Barr virus (EBV) has been implicated in the pathogenesis of oral hairy leukoplakia (OHL). EBV is normally detected by lesional biopsy. The objectives of this study were to examine oral scrapes containing squamous epithelial cells (squames) from HIV-infected people with and without clinical lesions of OHL, and from healthy non-HIV-infected controls, for EBV-DNA by the polymerase chain reaction (PCR). EBV-DNA was detected in 65% of HIV-infected people and 20% of healthy HIV-negative controls but in HIV-infected individuals it was found as frequently in those without OHL as in those with. Moreover, EBV-DNA was not detected in all HIV-infected individuals, nor in all OHL. The results suggest that the presence or absence of detectable EBV-DNA in oral scrapes, though a guide, cannot be regarded as absolutely reliable in the diagnosis or exclusion of OHL.