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We report the observation of a 25-year-old pregnant patient of 39 weeks of amenorrhea proposed for elective cesarean section. This patient suffers from hypertrophic cardiomyopathy since the age of 12. She has an implantable cardioverter defibrillator (ICD). The peculiarities of the ICD in the parturient and the perioperative management of the patient are being reported in this paper.

Introduction: embryo implantation is a crucial step for assisted reproductive technology (ART) achievement. Human chorionic gonadotropin (hCG) is one of the main regulators of the implantation process. Studies focusing on the impact of intrauterine hCG infusion at the time of embryo transfer on clinical ART outcomes have shown controversial results, mainly at blastocyst stage. In this study, we aimed to investigate whether intrauterine hCG infusion one day before human blastocyst transfer in fresh invitro fertilization (IVF) cycles enhances implantation and pregnancy rates. Methods: a total of 174 subfertile women undergoing autologous fresh blastocyst transfer were enrolled in this randomized prospective study. Patients were randomly divided into three groups; group 1 (n = 54) and group 2 (n = 59) received an intrauterine injection of respectively 500 IU and 1000 IU of hCG one day before blastocyst transfer and the control group (n= 61) did not receive any intrauterine injection. The pregnancy and implantation rates were compared between the three study groups. Results: significant difference was found between the study groups. The bio chemical pregnancy rates were 25.9%, 30.5% and 29.5%, the clinical pregnancy rates were 24.1%, 27.1% and 27.9% and the implantation rates were 14.9%, 17.9% and 18.7% respectively in group 1,2 and control group. Conclusion: our results have shown that clinical outcomes in fresh IVF cycles cannot be improved through intrauterine hCG administration one day prior to blastocyst transfer, neither with 500 IU of hCG nor with a higher dose of 1000 IU of hCG. [ABSTRACT FROM AUTHOR]

Objective: Radio isotopes and blue dyes alone or in combination are the most commonly used tracer agents in sentinel node (SN) biopsy for early breast cancer. Recent studies have found fluorescence method using indocyanine green (ICG) as a promising technology with fewer disadvantages. Materials and Methods: Retrospective analysis of our database that included patients with clinically node-negative breast cancer scheduled for breast surgery and SN biopsy between 2016 and January 2021. Patients who underwent detection using fluorescence-ICG were included in this study. Results: A total of 47 patients were included. Median age was 50 (range: 24-78) years. Mean tumor size was 3.4 ± 1.5 cm. All patients received ICG injection and 11 received a combination of ICG and blue dye. Forty-five successful SN identifications with ICG were performed and 99 nodes retrieved. Eleven procedures were undertaken after initial systemic therapy. Twenty-four patients had at least one positive SN for malignancy. Mean follow up was 29.2 months and no axillary recurrence was noted during the study period. Conclusion: ICG appears to be a feasible and accurate method for SN biopsy with high identification rate. This is the first study of ICG in sentinel node biopsy in a North African population. [ABSTRACT FROM AUTHOR]

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The occurrence of acute appendicitis during pregnancy may pose diagnostic and therapeutic difficulties. In fact pregnancy can make the clinical diagnosis delicate and the use of morphological examinations is still subject to controversy. The debates concerning the ideal surgical approach during pregnancy continue. On the other hand, in some cases the occurrence of acute appendicitis, especially in its complicated form, which is frequent in pregnant women, exposes to obstetrical complications and an increased risk of premature delivery We aims to describe the clinical and management features of acute appendicitis in pregnant women and the maternal and neonatal outcomes and carry out a review of the literature on this topic. It is a retrospective analysis of a series of 33 cases of appendicitis in pregnant women who were diagnosed and managed, in collaboration between the departments of General and digestive surgery, Gynecology and Obstetrics and Anaesthesia at Farhat Hached Universitary Hospital Sousse Tunisia between January 2005 and December 2015. The average age of the patients was 29 (20-40). Fourteen patients were in the first trimester, twelve in the 2nd and seven in the third trimester. The main symptom was pain in the right iliac fossa. The mean delay between consultation and surgery was 2.7 days. Twenty five patients had a preoperative ultrasound. Eight of the 33 pregnant patients presented complicated appendicitis with localized or generalized peritonitis. Thirty patients underwent laparotomic appendectomy: 28 with a Mc Burney incision and 2 with a midline incision and only three patients underwent laparoscopy. Preventive tocolysis was given to 14 patients, maternal mortality was null. Twenty four pregnancies were followed until delivery: one case of premature birth and one case of preterm labor were observed. Pregnancy makes it difficult to diagnose appendicitis, which explains the high rate of complicated acute appendicitis in our series. An early treatment improves maternal and fetal outcome. [ABSTRACT FROM AUTHOR]

Choriocarcinoma is a gestational trophoblastic tumor that mainly affects women of childbearing age. Cases of choriocarcinoma in postmenopausal women are exceptional. Through an observation and literature review, we propose to study the specific diagnosis and treatment features of this tumor in menopausal women. We report the observation of a pure uterine choriocarcinoma, which occurred in post-menopause. The diagnosis was made on the analysis of surgical specimens confirmed by measurement of hCG. Chemotherapy was started after a total hysterectomy and bilateral salpingo-oophorectomy first. The improvement was dramatic after 3 courses of chemotherapy and the patient is in complete remission after five years of monitoring. The primitive forms of pure choriocarcinoma in postmenopausal women are exceptional. Their etiology is poorly understood and their treatment based on chemotherapy. [ABSTRACT FROM AUTHOR]

Introduction Ovarian sex cord-stromal tumors are uncommon neoplasms that represent approximately 7% of all ovarian tumors. These tumors, which develop from cells arising from the primitive sex cords or stromal cells, comprise a diverse group. As a result, these tumors are currently subdivided as pure stromal tumors, pure sex cord tumors, or mixed sex cord-stromal tumors. Ovarian sex cord-stromal tumors differ from the more frequent epithelial neoplasms via strong associations with hormone-mediated syndromes, presentation in a broad age range, and the near-ubiquitous diagnosis of low-stage disease with a good outcome. Material and methods This is a descriptive study of all cases of malignant tumors of the Sertoli Leydig cell ovary diagnosed at the pathology laboratory of the Farhat Hached Hospital of Sousse, Tunisia, since the creation of the center's cancer register over a 12-year period from 2004 to 2016. Results 13 cases of ovarian cancer with Sertoli Leydig cell tumors between 2004 and 2016 were collected. The onset of the first signs of the disease ranged from 14 years to 79 years with a median age of 30 years. At diagnosis, seven patients were in genital activity; the others were menopausal. Two women had a personal carcinological history: one was operated on a borderline tumor of the ovary and the other on a basal cell carcinoma of the face. Clinical presentation can be divided into two major signs: endocrine signs present in 76.92% of cases and non-endocrine signs present in 53.84% of cases. Pelvic ultrasound was performed in all patients. The use of computed tomography (CT) was performed in 8 patients. The scan confirmed in most cases the existence of the tumor and allowed a local, regional and remote study of possible lesions. All patients underwent surgical exploration. It was performed in 6 patients by laparoscopic and 7 patients by laparotomy from the outset. Peritoneal carcinomatosis was present in 5 patients. At the end of the clinical, radiological and surgical explorations, the tumor can be classified into anatomo-clinical stages according to the FIGO classification: 10 patients were in stage I and 3 patients were in stage III. Four of our patients had metastasis during the course of development, and accounted for 30.76% of the cases. For overall survival, five of the thirteen patients are still alive; representing an overall survival rate of 38.46%. Conclusion The rarity of sex cord-stromal tumors contributes to a low index of suspicion; therefore, a thorough knowledge of clinical, pathological and radiologic findings of these tumors is important and allows radiologists to narrow the differential diagnoses for ovarian tumors, thus facilitating surgical planning and the avoidance of inappropriate treatments. [ABSTRACT FROM AUTHOR]

Objective: To examine the association between surgeon gender and early postoperative complications, including 30-day death and readmission, in elective surgery., Background: Variations between male and female surgeon practice patterns may be a source of bias and gender inequality in the surgical field, perhaps impacting quality of care. However, there are limited and conflicting studies regarding the association between surgeon gender and postoperative outcomes., Methods: MEDLINE and Embase were searched in October 2023 for observational studies including patients who underwent elective surgery requiring general or regional anesthesia across multiple surgical specialties. Multiple independent blinded reviewers oversaw the data selection, extraction, and quality assessment according to the PRISMA, MOOSE, and Newcastle Ottawa Scale guidelines. Data were pooled as odds ratios, using a generic inverse-variance random-effects model., Results: Of 944 abstracts screened, 11 studies were included in this systematic review and meta-analysis. A total of 4,440,740 postoperative patients were assessed for a composite primary outcome of mortality, readmission, and other complications within 30 days of elective surgery, with a total of 325,712 (7.3%) surgeries performed by 7,072 (10.9%) female surgeons. There was no association between surgeon gender and the composite of mortality, readmission, and/or complications (odds ratio=0.97, 95% CI 0.95 to 1.00; I2=64.9%; P=0.001)., Conclusions: These results support that surgeon gender is not associated with early postoperative outcomes, including mortality, readmission, or other complications in elective surgery. These findings encourage patients, healthcare providers, and stakeholders not to consider surgeon gender as a risk factor for postoperative complications., Competing Interests: Disclosures: The authors have no financial disclosures or conflicts of interest to declare., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Introduction: embryo implantation is a crucial step for assisted reproductive technology (ART) achievement. Human chorionic gonadotropin (hCG) is one of the main regulators of the implantation process. Studies focusing on the impact of intrauterine hCG infusion at the time of embryo transfer on clinical ART outcomes have shown controversial results, mainly at blastocyst stage. In this study, we aimed to investigate whether intrauterine hCG infusion one day before human blastocyst transfer in fresh invitro fertilization (IVF) cycles enhances implantation and pregnancy rates., Methods: a total of 174 subfertile women undergoing autologous fresh blastocyst transfer were enrolled in this randomized prospective study. Patients were randomly divided into three groups; group 1 (n = 54) and group 2 (n = 59) received an intrauterine injection of respectively 500 IU and 1000 IU of hCG one day before blastocyst transfer and the control group (n= 61) did not receive any intrauterine injection. The pregnancy and implantation rates were compared between the three study groups., Results: significant difference was found between the study groups. The bio chemical pregnancy rates were 25.9%, 30.5% and 29.5%, the clinical pregnancy rates were 24.1%, 27.1% and 27.9% and the implantation rates were 14.9%, 17.9% and 18.7% respectively in group 1,2 and control group., Conclusion: our results have shown that clinical outcomes in fresh IVF cycles cannot be improved through intrauterine hCG administration one day prior to blastocyst transfer, neither with 500 IU of hCG nor with a higher dose of 1000 IU of hCG., Competing Interests: The authors declare no conflicts of interest., (Copyright: Henda Mustapha et al.)

Breast cancer is the most common neoplastic disease in women. Several treatment strategies are used: chemotherapy, radiotherapy, surgery and hormone therapy. Each of these treatments may affect sexual health of patients in the short or long term. The purpose of our study is to assess the quality of sexual life in women after breast cancer treatment. We made a quantitative descriptive estimate of 100 sexual active patients followed up for non-metastatic breast cancer, met during their consultations with a gynaecologist at the Farhat Hached hospital in Sousse. Data collection was carried out using an information sheet and two validated scales: RSS (relation Ship and sexual) and BESAA (Body EsteemScale for adolescents and Adults) to assess the quality of sexual life and body image. The average age of patients was 53.8 years. About half of patients (48%) had impaired sexuality due to the disease. The frequency of intercourse, sexual desire and the ability to reach orgasm were decreased in 65. 45, and 54 patients, respectively. The overall score for the three body image dimensions was 49.4. Women aged between 35 and 39 years were significantly more afraid of sexual intercourse (p=0.002) and less of sexual frequency (p=0.004). Adequate and enhanced training focused on the management of women with cancer and their sexual problems and multidisciplinary approach can improve women's psychological status., Competing Interests: Les auteurs ne déclarent aucun conflit d´intérêts., (Copyright: Safa Smida et al.)

The occurrence of acute appendicitis during pregnancy may pose diagnostic and therapeutic difficulties. In fact pregnancy can make the clinical diagnosis delicate and the use of morphological examinations is still subject to controversy. The debates concerning the ideal surgical approach during pregnancy continue. On the other hand, in some cases the occurrence of acute appendicitis, especially in its complicated form, which is frequent in pregnant women, exposes to obstetrical complications and an increased risk of premature delivery We aims to describe the clinical and management features of acute appendicitis in pregnant women and the maternal and neonatal outcomes and carry out a review of the literature on this topic. It is a retrospective analysis of a series of 33 cases of appendicitis in pregnant women who were diagnosed and managed, in collaboration between the departments of General and digestive surgery, Gynecology and Obstetrics and Anaesthesia at Farhat Hached Universitary Hospital Sousse Tunisia between January 2005 and December 2015. The average age of the patients was 29 (20-40). Fourteen patients were in the first trimester, twelve in the 2 nd and seven in the third trimester. The main symptom was pain in the right iliac fossa. The mean delay between consultation and surgery was 2.7 days. Twenty five patients had a preoperative ultrasound. Eight of the 33 pregnant patients presented complicated appendicitis with localized or generalized peritonitis. Thirty patients underwent laparotomic appendectomy: 28 with a Mc Burney incision and 2 with a midline incision and only three patients underwent laparoscopy. Preventive tocolysis was given to 14 patients, maternal mortality was null. Twenty four pregnancies were followed until delivery: one case of premature birth and one case of preterm labor were observed. Pregnancy makes it difficult to diagnose appendicitis, which explains the high rate of complicated acute appendicitis in our series. An early treatment improves maternal and fetal outcome.

Guillain Barre syndrome is an autoimmune disorder characterized by an acute demyelinisation in the peripheral nervous system. It is an extremely rare situation during pregnancy. There are at present no recommendations concerning the mode of delivery and the anesthetic management. We report a case of Guillain Barre Syndrome at the 38 th week gestation proposed for cesarean section.