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Purpose: Antiphospholipid syndrome (APS) is a clinico-biological syndrome, which associates vascular injury and persisting antiphospholipid antibodies (aPL). Patients with clinical symptoms of APS but without aPL are defined as "seronegative APS" (SNAPS). The aim of this study was to evaluate antiphosphatidylethanolamine antibody (aPE) investigation in patients with SNAPS suspicion., Methods: This retrospective study was conducted in patients with SNAPS suspicion. A homemade enzyme-linked immunosorbent assay (ELISA) was used to search for aPE. The results of this homemade method were compared with those from a global screening ELISA., Results: Two hundred twenty-eight patients with SNAPS suspicion were included. Among them, 58.3% had a thrombotic event. The homemade ELISA found positive persisting aPE in 23 patients (10%): 15 with a thrombotic event, 6 with obstetrical morbidity and 2 with a combined event. The global screening ELISA was positive in only 11 of these 23 patients (47.8%)., Conclusion: These results suggest the implication of aPE in SNAPS., (Copyright © 2018 Société Nationale Française de Médecine Interne (SNFMI). Published by Elsevier Masson SAS. All rights reserved.)

Objective: Present the epidemiology and clinical characteristics of typhoid fever in the Lebanon., Methods: Retrospective study of 52 patients admitted to a university hospital center between 1995 and 1999. The criteria for inclusion were a positive Salmonella typhi or paratyphi hemoculture and/or Widal serodiagnosis > 1/160 for O agglutinin, in the presence of evocative symptoms., Results: The patients were aged a mean of 31 +/- 24 years. The mean duration between the onset of fever and diagnosis was of 10 +/- 8 days. Fever was observed in 96% of cases and the other predominant symptoms were diarrhea (37%), abdominal pain (31%) and headache (29%). Feverish gastroenteritis is a frequent manifestation in children (61% of cases). Complications were noted in 33% of cases and were predominantly digestive. Leukopenia is not a good diagnostic marker. S. typhi was the cause in 83% of cases. Resistance to ampicillin was noted in 13% of cases, to cotrimoxazole and to chloramphenicol in 10% and to ofloxacine in 3% of cases. One death was reported (2%) of an immunodepressed patient., Conclusion: Typhoid fever is still an endemic disease in the Lebanon and should be systematically evoked in the case of prolonged fever, feverish gastroenteritis and/or headache. The appearance of bacteria resistant to antibiotics makes ceftriaxone or ciprofloxacine the empirical treatment of choice.

Objective: Evaluation of the efficacy and the safety of the TVT as a surgical treatment for the female stress incontinence., Material and Methods: Prospective non-randomized study undertaken between January 1999 and December 2000 concerning 40 women admitted to the Hotel-Dieu de France Hospital, with specific inclusion criteria. The surgical procedure used is the TVT as described by Ulmsten. Patients' evaluation is made through valid criteria shown in the literature., Results: The mean follow-up is 12 months. The mean operation time is 37 minutes. The mean duration of hospitalization is 2.6 days. Postoperative complications were transient urinary retention in 17.5% of cases, and lower urinary tract infection in 10% of patients. One case of bladder perforation was noted. The mean difference between the numbers of protections used daily before and after TVT is 2.03 +/- 1.89 (p < 10(-4)). 87.5% of patients were totally and objectively continent. The mean post-voiding residue is 85 +/- 91 ml. Bladder instability symptoms were significantly reduced (RR = 0.37). 97.5% of patients are cured or improved by the operation., Conclusion: The TVT is an effective procedure and easy to perform. The results obtained so far are promising. The failure rate is about 2.5%. A standardization of the indications is preferred for future studies.

During an eighteen-year period, forty-nine patients with invasive epidermoid carcinoma of the vulva were treated by a radical vulvectomy at the Hôtel-Dieu de France hospital in Beirut. The age, the clinical presentation, and the lymph nodes involvement were close to what was published in the literature. The overall five-year survival rate was 72%. Those with stage I disease lesions had an excellent survival rate. A review of the literature would indicate that a conservative approach in the treatment of early invasive lesions can give satisfactory results, and that adjuvant radiotherapy is more beneficial than pelvic lymph nodes dissection when there is a high risk of pelvic involvement.

This is an epidemiological study of 1,498 patients who underwent laparoscopic surgery for different reasons. Between 1989 and 1996, 308 cases of endometriosis were identified among 1,498 patients who underwent laparoscopic surgery. One hundred and five patients were admitted for pelvic pain, 794 for infertility, 319 patients had both on admission, and 280 were admitted for non-gynecologic complaints. The incidence of endometriosis is related to the chief complaint on admission. This disease has different clinical manifestations, different locations and different stages. The mean age in our series is greater than that reported by the literature. The symptoms are related to the location of the lesions but not the stage of the disease. Unlike pelvic pain, infertility is correlated to the stages of the disease.

In a review of the literature the authors describe the complications encountered during gynecological laparoscopy, insisting on the preparation phase, the conversion to laparotomy and the death cases. Vascular, digestive and urinary lesions, as well as anesthetic difficulties are discussed, aiming at a better prevention. Early recognition of the problem is an important prognostic factor for these patients.

We report three cases of ovarian carcinoma associated with fertility drugs. Two patients were hyperstimulated by clomiphen citrate (CC). The third had hMG + CC. Two of these patients had a Borderline ovarian carcinoma and the third had an invasive ovarian carcinoma associated with endometrial carcinoma.

Objective: To review our series of radical vulvectomies and to compare it with results of conservatif treatment., Material and Methods: We reviewed the 34 cases of vulvar squamous cell carcinoma treated in Hotel-Dieu de France, between January 1978 and December 1988. The treatment was a radical vulvectomy associated with either ipsilateral inguinofemoral lymphadenectomy (67.64%) or bilateral inguinofemoral and pelvic lymphadenectomy (32.26%)., Results: The age and the clinical presentation were consistent with the world literature as was the incidence of lymph node metastasis correlated with disease stage. The rate of local recurrence was consistent with the world literature (8.82% vs 12%) showing lower risk of urinary incontinence. Seroma and wound dehiscence correlated with stage were 20.6%m 26.5% and 11.8% for stages I, II and III respectively. The 5 year survival correlated with stage for these patients were: 87.5%, 63.1% and 42.8% for stages I, II and III respectively whereas the 5 year survival correlated with lymph nodes metastasis was 78% for node (-) and 42% for node (+)., Conclusion: Between 1978 and 1988,our therapy guideline for vulvar carcinoma was radical total vulvectomy. Modifications to this guideline were made specially in using a more conservative approach and radiotherapy when there was a risk of pelvic node involvement.

We report a case of primary choriocarcinoma of the cervix in which the patient died 9 months later. The treatment consisted to administer 5 cycles of chemotherapy pre-operatively and a colpohysterectomy. The pathogeny is a cervical migration of trophoblastics cells after a normal or molar pregnancy which degenerate to choriocarcinoma.

The association between Hodgkin's disease and pregnancy is rare. Hodgkin's disease does not affect the normal progress of the pregnancy nor of the fetus. Pre-therapy investigations of Hodgkin's disease have to be modified by pregnancy and in particular radiological examinations. Three are certain recommendations to be considered: termination of pregnancy is sometimes indicated in the first trimester but it does not have to be carried out routinely. Chemotherapy can be used in pregnancy as can radiotherapy if the disease is localised to the sub-diaphragmatic area.

The authors present two cases of uterine rupture by placenta percreta at 27 and 36 weeks of gestation. Conservative treatment was used in the first case, and radical in the second. Concerning placenta percreta, an overview is presented. The pathophysiology is unclear, but a perturbation in the equilibrium between the trophoblast and the caduque is accepted. Many factors, maternal uterine and placental, contributes to this situation. Clinical presentations are hemorrhage, uterine inversion or rupture. The disappearance of the retroplacental anechogenic zone is the recent ultrasound's contribution to the early diagnosis. The treatment is either radical which is the treatment of choice or conservative and the methotrexate could be an interested option.

Forty-seven patients were treated for invasive cancer of the cervix from January 1978 till December 1985. Eleven patients were submitted to intracavitary radiation 6 weeks prior to surgery. The 5 years survival rate was 82%. The other 36 patients were treated by surgery alone because radiotherapy was impossible. The 5 years survival of the latter group was 71%: Stage I: 87.5%, Stage IIa: 60%, Stage IIb: 40%. The efficiency of the intracavitary radiation was remarkably evident in the stage II N (-), concerning central recurrences. An alternative to the classical treatment in advanced cancers using a preoperative chemotherapy is currently under investigation.

Androgen secreting ovarian or adrenal neoplasms represent a rare cause of hirsutism in women. Because of their small volume and episodic secretion, a number of these tumors may be difficult to diagnose and treat. The authors report a case of lipoid cell tumor of the ovary, which was only detected, because of its small volume, by catheterization of adrenal and ovarian veins. This latter procedure should be performed when strong clinical and biological suspicion is faced by the negativity of other imaging techniques.

Vaginal deliveries on a scarred uterus are actually admitted and done in many obstetrics-gynecology centers throughout the world. A uterine scar does not represent a formal indication for a repeat cesarean section anymore. In this article, the results of a retrospective study between January 1980 and December 1989 are reported. We reviewed all the files of women having a scarred uterus, delivering at "Hotel-Dieu de France", vaginally or by repeat cesarean section. This study concerns 560 women: 500 delivering by repeat cesarean section & 60 having a trial of labor, 45 of which delivering vaginally. A lot of parameters are compared, such as: days of hospitalization, antibiotic coverage, and materno-foetal complications. No uterine rupture was reported. The hospital stay was reduced following vaginal delivery after the trial of labor. A trial of labor on a scarred uterus, taking some precautions, seems tempting, without enhancing feto-maternal morbidity and mortality.