Biomedical subjects
Publications and source records attributed to H Chelli.
Two cases of third degree tri-segmentary prolapse were associated with bladder calculi. Two cm calculi in the first case and a unique 4 x 5 cm calculus in the second made diagnosis difficult and raised the question of the choice of therapy.
Foetal hydrocolpos is a rare abnormality, which may be detected by antenatal ultrasound, during neonatal clinical examination or during autopsy of the foetus. Foetal prognosis is related to the extent of the initial anatomical abnormality. Foetal hydrocolpos is usually combined with other congenital malformations and is therefore part of a syndrome or combination. A review of the literature was carried out when two cases occurred in the Rabta maternity clinic in Tunis in order to investigate the incidence, diagnostic tools and prognosis of this abnormality.
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We had studied in one year 110 cases of scano-pelvimetry, the clinical examination had not found a shrink pound in 41%, revealed by the sceno-pelvimetry. This method is more precisely than the classic pelvimetry, but more expansive. The simultaneous study of echography and pelvimetry had contributed to a better obstetrical decision.
The opportunity is taken, on the basis of 4 cases of abdominal pregnancy and a review of the literature, to attempt to analyse the various aspects of this increasingly rare pathology. Its incidence is low, being evaluated by our own study at 4/85 757 deliveries, i.e.: 1/21 439 deliveries collected at the Maternity and Neonatology centre of Rabta Tunis during a 10-year period (1981-1990). The essential epidemiological factor is the low socio-economic and cultural status seen in the patients studied. Clinical signs were predominated by metrorrhagia, abdominal pain, disturbed intestinal function and fetal death in utero. The delay in diagnosis explains the onset of frequent fetal complications in the form of fetal death in utero (3 cases out of 4) and of various fetal malformations. Ultrasonography is the essential investigation enabling diagnosis in the presence of clinical suspicion. Surgery is obligatory, excluding any attempt in the majority of cases at extraction of the placenta, which is left in place.
The authors report two cases of umbilical endometriosis. Clinical diagnosis is established on menstrual rhythmicity of pain, swelling and bloody discharge. The treatment of choice for umbilical endometriosis is the surgical removal.
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The association of pelvic hydatid cyst with pregnancy is rare. We collected 4 cases between 1981-1990. Our incidence is of 1/30000 deliveries. The diagnosis was suggested in 3 cases by the patient's country of origin and previous history of extra-pelvic hydatid disease. It is confirmed by ultrasonography, which is still the first choice examination. During the 3 pregnancies managed to term, we did not find any modification in the cyst. One patient had vaginal delivery twice; however complications, sometimes fatal, are reported in the literature. The time for surgery and the mode of delivery are discussed because of the rarity of this association.
The authors report their experience in the treatment of 193 cases of genital prolapse treated surgically in the Rabta Tunis Maternity and Neonatology Unit during a 7 year period between January 1st 1982 and December 31st 1988. The epidemiological characteristics of the study population were dominated by the following factors: advanced age (mean age 54); multiparity (80 per cent of cases); 65.8 per cent of women were post-menopausal. The commonest association of lesions was triple prolapse, present in 78 per cent of cases. Stress incontinence of urine (SIU) was a common feature (59 per cent of cases). Treatment preference was for vaginal hysterectomy combined with anterior colporrhaphy and posterior perineorrhaphy (73.5 per cent). The Kelly Marion operation was often used for SIU (89 per cent of cases) and gave satisfactory results in 73 per cent of cases.
We have found eight granulosa tumours in nine years out of 280 ovarian tumours which were collected in the maternity and neonatology unit in Rabta. The mean age of the patients was 53, the mean parity was 8. Signs of oestrogen excretion were found in all cases and metrorrhagia was the principal reason for consulting doctors in 75% of cases. There was always a palpable mass on clinical examination. Histology was usually only microfollicular. Radical surgical treatment was carried out in all cases and consisted of total abdominal hysterectomy and bilateral salpingo-oophorectomy.
We studied 29 cases of maternal death occurring over a period of 3 years in the "Centre de Maternité et de Néonatologie de La Rabta-Tunis"; managed by the same staff. 42,028 live births occurred during the study years with 43,220 total births from April 24th 1986 to April 23rd 1989. The maternal mortality rate was 69 per 100,000 live births. A maternal age of under 35, nulliparity and grand multiparity were found, as is well known, to be risk factors. Maternal transfer in obstructed labour from rural maternity units raises the maternal death risk 12 times: 14 deaths out of 29 occurred in transferred patients. Haemorrhage represents a quarter of the causes of death (8 cases) while anaesthetic accidents were responsible for one in six maternal deaths. Some factors were not found such as abruptio placentae, while others such as eclampsia were reduced. We concluded that the maternal mortality rate even though it has been reduced over the last 3 decades it is still high compared with developed countries. We can cut it in half by avoiding maternal transfer in labour.
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The authors report five ultrasonic imaging between 13 and 32 weeks of gestation. All of them have an hydrops fetalis and an aspect of like masses located in the nuchal region. A cystic retrocervical hygroma was confirmed at autopsy examination in three cases. The diagnosis of cystic hygroma remains inaccurate in the other two cases in the lack of the radiographic and anatomical verification. A review of the literature was made up to define the diagnostic aspects of the hygroma colli, their histological aspects and the mains etiological factors.
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We present a rare case history of a pregnancy that went to term and was followed by the birth of a live baby in a ruptured rudimentary horn of the uterus. The diagnosis was made when caesarean section was carried out past term in a primiparous woman who had been followed in the antenatal clinic. The child who is now 5 months of age was born live. A review of the literature has produced two similar cases by O'Leary and Bourgeois. After reviewing briefly the embryological, anatomical and physiological factors we have discussed how difficult it is to make a diagnosis before operation.
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Genital tuberculosis is a rare disease in Anglo-Saxon countries but it is still present in our country in spite of a small reduction in the numbers due to the advent of anti-tuberculous drugs and of BCG. Our study derived from 49 cases histories shows that this is an illness that affects young women who become absolutely infertile. Laparoscopy, hysterosalpingography and biopsy of the endometrium are the most efficient ways to make the diagnosis quickly. While anti-tuberculous treatment given routinely is very good at curing the tuberculous infection, it does not improve the prognosis for fertility. Finally, very few cases are diagnosed on screening and it is important to continue the fight to eradicate this disease. The most effective measure among others is vaccination with BCG.
A case of massive ovarian oedema is reported with a review of the literature. We would like to point out the value of thinking about the diagnosis of massive ovarian oedema when confronted with an ovary that seems to contain a tumour and to ask for frozen-section examination. By doing this the diagnosis can be made and the ovary preserved after the torsion has been dealt with in a young girl who is usually nulligravida.