Biomedical subjects
Publications and source records attributed to A Himmi.
Youssef's syndrome is an uncommon form of vesico-uterine fistula, caracterized clinically by the association: amenorrhea cyclic, hematuria without urinary leakage. This entity is the result of pressure gradient between uterin cavity and bladder reservoir. We report on one case.
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Fibromatosis (desmoid tumors) is a rare entity expressing a mesenchymatous proliferation. The breast is an exceptional localisation. The origin is either the gland itself or the breast is an extension of a desmoid tumor originating from the chest wall or shoulder. Etiology is still unknown. Clinical and radiological features mimic the breast carcinoma. Diagnosis is made by histological studies which show a benign structure contrasting with its aggressive potential. Surgery is the treatment of choice and consists of wide excision which can lead to mutilation. Hormonotherapy is used if surgery is too invasive. We report a case of a female patient aged 21 years who presented for a mammary fibromatosis, treated by a large surgical excision. Evolution was marked by the appearance of an other localisation in the contralateral breast.
The aim of this study is to have an idea about the epidemiologic and clinic profile of the PRM, the management of the PRM. We conclude from this retrospective study about 374 cases, that the PRM frequency is about 2.67%. It reaches particularly the young women, primipar (57.48%) and not happen of this accident. The diagnosis was clinical in general. In the doubtful cases, amniotic infection was present in 25.13%. The delivery was characterized by the complications were dominated by prematurity and neonatal infection which both caused a high perinatal mortality 49.3%). A better sanitary education of any pregnant woman, a regular follow-up of the pregnancies, a treatment of each etiologic factor of this accident, a good per and postnatal supervision could remarkably limit the incidence of this obstetrical accident and also improve the maternal and fetal prognosis.
OBJECTIVE: To determine whether a trial of labor in twin pregnancy is a valuable alternative to routine repeat cesarean section. MATERIAL AND METHODS: Based on retrospective analysis of 31 cases of twin gestation with previous cesarean section, we tried to assess the outcomes of 25 cases of trial of labor. The outcomes of trial of labor in twin pregnancy were compared to those of trial of labor in singleton pregnancy. RESULTS: The trial of labor was successful in 21 cases (84%). There was one case of scar dehiscence among the women who underwent a trial of labor, that occurred in the parturient with two previous cesarean sections after complete breech extraction. There were no significant differences in perinatal outcomes in any comparison of trial of labor versus no trial of labor. The outcomes of trial of labor in the twin pregnancy were similar to singleton pregnancy. CONCLUSIONS: Routine repeat cesarean section in the twin pregnancy is not necessarily warranted; a controlled trial of labor in selected cases would be a valuable alternative.
Phyllode tumors of the breast are fibroepithelial tumors similar to fibroadenomas but with a predominant conjunctive tissue component. The aim of this work was to determine the specific diagnostic, therapeutic and prognostic features of this tumor. A retrospective series of 41 cases was collected in the gynecology-obstetrics ward from 1980 to 1991. The analysis of this series showed the following characteristics: incidence of phyllode tumors was 0.46% of all breast tumors. Mean age at diagnosis was 30 years, in 75.6% of the women were in a period of reproductive activity. Mean delay between the first clinical signs and diagnosis was 20 months. Mean size was 12 cm Diagnosis was confirmed at pathology examination in all cases. The tumor was classed grade 1 and 2 in 65.9% of the cases, grade 3 in 9.8%, grade 4 in 17.1%. Surgical treatment alone was used in all cases with large tumorectomy (48%), simple mastectomy (30%), and total mastectomy with node dissection (22%). After a follow-up of 1 to 7 years, there were 3 deaths and 11 local recurrences requiring reoperation. In the remaining cases, the outcome was favorable without recurrence or metastasis. These results together with those reported in the literature show that histological confirmation is required for the diagnosis of phyllode tumors. Surgical treatment alone is required with wide exeresis because of the voluminous tumor formation the age of the patient and the histological grade. Finally, prognosis depends on the histological characteristics of the conjunctive tissue component of the tumors.
Diagnostic procedures used in 9 cases of pseudo-uterus unicornis were presented. There are no manifestations of this malformation excepting during pregnancy and rare episodes of uncontrollable dysmenorrhoea. If pregnancy develops in the rudimentary cornis, major complications require hemihysterectomy.
This study involved an analysis of 25 cases of sarcoma of the uterine body collected at the Gynecology and Obstetrics Clinic of the Ibn Rochd CHU teaching hospital, Casablanca (Morocco) during a 15-year period (1977-1992). These are unusual malignant tumours (accounting for only 0.9% of uterine cancers) which occur after the menopause and have an appalling prognosis. Metrorrhagia was the most common alerting symptom. Presurgical diagnosis was difficult and uterine sarcoma was usually identified during surgery. The most common histological type encountered was leiomyosarcoma. Treatment was primarily surgical: total hysterectomy combined with bilateral appendectomy (20 cases), with radiotherapy (5 cases) or with adjuvant chemotherapy (1 case). Radiotherapy was the only treatment in 2 patients. The survival rate was low: 10% after 2 years, 5% after 5 years. Age, histological type, extent of the tumor and method of treatment were all recognised as prognostic factors. One interest of this work is to recall the existence and the severity of this pathology in those periods of endoscopic games and excessive conservative treatments.
Sciatic nerve endometriosis is rare but must be included in the sciatic pain aetiology diagnosis. Typically the patient's sciatic pain is cyclic. Electromyography and computed tomographic scanning or nuclear resonance imagery contribute to the diagnosis. Different mechanisms of this localization have been proposed. The patient often requires conservative surgery with excision of endometriosis from the nerve. Medical treatment (LH-RH analogues) may be associated in young patients who need to preserve reproductive function. Total hysterectomy with bilateral salpingo-oophorectomy may be mandatory in stage III or IV endometriosis and older patients.
The authors report the case of uterine rupture occurring after 28 weeks of amenorrhea and related to placenta accreta and treated by means of hysterectomy. They stress the diagnostic problems and discuss possible conservative treatment.
The authors report a new case of a Mullerian mixed tumor with malignant double composition with homologous tissue. They are uncommon, probably sometimes unrecognised. These tumors have the same clinical expression but their prognosis is linked to their benign or malignant composition. The treatment proposed by different authors is radical even for benign tumors in the fear of malignant evolution. The number of cases is not sufficient to propose a more economic treatment tested on patients.
We carried out a prospective study of 200 pregnant women who required induction of labor at full term, at the Lalla Meryem maternity unit of the Ibn Rochd University Hospital, Casablanca, between January 1st 1996 and June 30th 1997. The aim of this study was to evaluate the efficacy, tolerance and acceptance of misoprostol (Cytotec) as a drug for inducing labor in unfavorable conditions (Bishop < 5). Misoprostol (a PGE1 analog) was administered to the women via the vagina, with a dose of 1/4 tb (50 mg) given every 6 hours, and a maximum of 3 doses (150 mg). If labor had not begun 18 h after the start of the protocol, misoprostol induction was considered to have failed. We found that misoprostol failed to induce labor in 5% of cases, Syntocinon was required in 40% of cases and the interval between misoprostol insertion and vaginal delivery was 13.3 + 11.1 h. The rate of delivery by cesarean section was 22% and the mean amount of misoprostol required was 1.3 doses (66 mg). The mean cost of labor induction was 0.6 FF, the frequency of uterine hyperstimulation was 3.5% and maternal, fetal and neonatal tolerance was good. Our results confirm that intravaginal misoprostol is very effective and well tolerated for the induction of labor in pregnant women at full term, in unfavorable obstetric conditions.
We carried out a retrospective analysis of 3,231 cases of cesarean section between 1994 and 1997, to assess the maternal mortality and morbidity associated with this intervention. The frequency of cesarean delivery was 12.4%. The indications for cesarean section were of three types: elective indications (627 cases, 19.4%), emergency indications (454 cases, 14.1%), failure of normal labor (2,150 cases, 66.5%). Nine maternal deaths were noted (2.8 per thousand), one of which was directly linked to surgery. The peroperative complications were primarily major hemorrhagia (39 cases, 1.2%), visceral lesions such as bladder rupture (3 cases, 0.1%) and intestinal lesions (3 cases, 0.1%). Postoperative morbidity was predominated by infectious complications, particularly endometritis (5.1%). Thromboembolism was reported in 7 cases (0.2%). Cesarean section is used to preserve the life of both the mother and the child. However, maternal morbidity and mortality rates are higher with cesarean section than with vaginal delivery and therefore its indications must be justified.