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1. Rare non‐trophoblastic vascular placental tumor: A diagnostic challenge

Author

Faten Limaiem, Anissa Ben Amor, Khalil Saffar, and Ahmed Halouani

Subjects
chorioangioma, pathology, placenta, placental tumor, pregnancy, ultrasonography, Medicine, Medicine (General), R5-920
Abstract

Key Clinical Message Pathologists should consider the differential diagnoses of placental chorioangioma, which encompass chorangiosis, chorangiomatosis, chorangiocarcinoma, intervillous thrombus, and placental infarct. Abstract Chorioangiomas are rare non‐trophoblastic vascular neoplasms of the placenta, occurring in approximately 1% of pregnancies. Large chorioangiomas (>4 cm) are infrequent and associated with an increased risk of pregnancy complications. There are limited reports in the literature regarding uncomplicated cases of large placental chorioangiomas.

Published
2023
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2. Early versus late amniotomy during induction of labor using oxytocin: A randomized controlled trial.

Author

Ahmed Halouani, Yassine Masmoudi, Rym Hamdaoui, Aymen Hammami, Amel Triki, and Anissa Ben Amor

Subjects
Medicine, Science
Abstract

ObjectiveTo assess the effect of early amniotomy on labor duration, maternal and neonatal outcomes during induction of labor (IOL).MethodsThis was a randomized controlled trial, conducted over a period of eight months at a monocentric site. Singleton pregnancies in nulliparous and parous patients with cephalic presentation and Bishop score ≥ 6 were enrolled in the study. One hundred participants were randomized into two groups: early amniotomy (initiating IOL with amniotomy followed by oxytocin) versus late amniotomy (initiating IOL with oxytocin followed by amniotomy 4 hours later). The primary endpoint was the time to active phase (cervical dilation ≥ 5 cm) during IOL. Secondary outcomes were time to vaginal delivery, mode of delivery, and maternal and fetal outcomes.ResultsEarly amniotomy reduced time to active phase by 2 hours and 46 minutes compared to the late amniotomy group (3 h 42 min vs. 6 h 28 min; pConclusionsEarly amniotomy in IOL significantly shortens the time to active phase as well as the overall duration of labor without compromising maternal and neonatal safety.

Published
2023
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3. Evaluation of Triclosan coated suture in obstetrical surgery: A prospective randomized controlled study (NCT05330650)

Author

Wael Mbarki, Hajer Bettaieb, Nesrine Souayeh, Idriss Laabidi, Hadhemi Rouis, Soumaya Halouani, Rami Boufarghine, Maha Bouyahia, Rahma Bouhmida, Mariem Ouederni, Anissa Ben Amor, Amal Chermiti, Hadir Laamiri, Amira Lika, Imen Chaibi, Hedhili Oueslati, Najeh Hsayaoui, and Chaouki Mbarki

Subjects
Medicine, Science
Abstract

Objectives To assess the effectiveness of Triclosan coated suture in reducing surgical site infections (SSIs) rate after caesarian delivery (CD). Study design Three hundred eighty patients were randomly assigned to closure with polyglactin non coated suture VICRYL, or with polyglactin coated suture VICRYL Plus after caesarian section. The primary outcome was the rate of SSIs within 30 days after surgery and secondary outcomes were the rate of wound healing complications. Results SSI rate was 2.5% in Triclosan group compared to 8.1% with non-coated suture. Use of Triclosan coated suture (TCS) was associated with 69% reduction in SSI rate (p = 0.037; ORa:0.294; 95% CI:0.094–0.921). The use of Triclosan coated suture was associated with statistically lower risk of wound oedema (2.5% vs 10%), (p = 0.019; OR:0.595), dehiscence (3.8% vs 10.6%), (p = 0.023; OR:0.316) and hematoma (p = 0.035; OR:0.423). Conclusion Our results confirm the effectiveness of Triclosan coated suture in reducing SSI rate and wound healing disturbances. Trial registration Registered at ClinicalTrials.gov / ID (NCT05330650).

Published
2022

4. Expression stromale de CD10 dans les cancers du sein: marqueur de mauvais pronostic

Author

Dhouha Bacha, Anissa Ben Amor, Farah Ben Farhat, Sana Ben Slama, Ahlem Lahmar, Saadia Bouraoui, and Amel Triki

Subjects
tumeurs du sein, cd10, cellules stromales, pronostic, Medicine
Abstract

INTRODUCTION: Les marqueurs du stroma carcinomateux comme la classe de différenciation 10 (CD10) seraient corrélés à un potentiel invasif et métastatique de plusieurs types de cancers en favorisant la croissance tumorale et l´apparition de métastases. Pour les carcinomes mammaires, sa valeur pronostique reste encore controversée avec des résultats discordants. Les objectifs de notre étude étaient d´étudier l´expression stromale de CD10 dans les carcinomes mammaires et d´évaluer la valeur pronostique de cette expression. METHODES: notre étude était rétrospective, descriptive et pronostique. Elle avait intéressé 57 patientes porteuses de carcinomes invasifs de type non spécifique, colligés au service d´anatomie pathologique de l´hôpital Mongi Slim, sur une période de 38 mois. L´étude de CD10 a été réalisée par immunohistochimie et son interprétation était basée sur un score semi-quantitatif en trois catégories avec des seuils de 10 et 30%. RESULTATS: l´âge moyen de nos patientes était de 56,4 ans. Vingt-huit patientes (49%) avaient un marquage stromal de CD10, la moitié était de score 1 (faible) et l´autre moitié de score 2 (fort). Ce marquage diminuait significativement la survie sans récidives (p=0,001). Il n´y´a en revanche pas d´influence sur la survie globale (p=0,84). L´étude de corrélation avait montré que l´expression stromale de CD10 était significativement corrélée à 12 facteurs de mauvais pronostic dans les cancers du sein. CONCLUSION: l´expression de CD10 dans le stroma des carcinomes mammaires invasifs constitue un facteur de mauvais pronostic, prédictif d´une faible survie sans récidives et est associée à un potentiel invasif et métastatique élevé.

Published
2020
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5. Severe gestational hypertriglyceridemia: a rare but serious situation

Author

Anissa Ben Amor, Kaouther Dimassi, Moez Attia, Chiraz Amrouche, and Amel Triki

Subjects
hypertriglyceridemia, pregnancy, acute pancreatitis, management, Medicine
Abstract

The severe hypertriglyceridemia during pregnancy is a rare condition. It is a problem for diagnostic, prognostic and therapeutic. This dyslipidemia benefit from specific and effective treatments, but it is still poorly codified. Dietary is still the essential therapeutic, but fetal extraction should also be considered if the gestational age permits. Post-partum monitoring is required but etiologic thorough is not recommended if the triglycerides rate normalizes. The major complication of hypertriglyceridemia should be actively sought because of important maternal mortality rate.

Published
2019
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9. Improving the communicational skills in medicine using role play: a study about 28 students in the second cycle of medical studies

Author

Mona, Mlika, Anissa, Ben Amor, and Faouzi, Mezni

Subjects
Students, Medical, Education, Medical, Humans, Clinical Competence, Curriculum, Students, Article, Checklist
Abstract

Introduction: La formation médicale, souvent axée sur une approche par objectifs et influencée par une démarche flexnerienne, consacre souvent plus d’importance à l’acquisition d’aptitudes relevant des domaines du savoir et du savoir-faire. Le savoir être est souvent mal ou peu enseigné, en plus d’être difficilement évalué. Objectif : Evaluer l’amélioration des compétences relationnelles des étudiants en médecine qui sont relatives à l’annonce d’une mauvaise nouvelle grâce à des jeux de rôle. Notre objectif secondaire était d’évaluer la satisfaction des étudiants par rapport au scénario pédagogique adopté. Méthodes : Nous avons inclus les externes en DCEM1, réalisant leur stage dans un service de Pathologie d’un Hôpital universitaire de la capitale durant l’année universitaire 2018-2019. Sept groupes comportant respectivement 4 externes ont effectué une période de stage de 3 semaines. Nous avons commencé par un pré-test sous forme d’une station ECOSM type patient simulé, avec un observateur qui disposait d’une grille critériée d’évaluation. Par la suite, tous les étudiants ont reçu un enseignement théorique et étaient tous appelés à jouer un jeu de rôle qui était filmé par un smartphone. La scène était par la suite projetée et évaluée par tous les étudiants. A la fin de la séance de débriefing, les étudiants étaient amenés à remplir un questionnaire de satisfaction. Puis, un post test identique au pré-test était réalisé. Résultats: Au total, 28 étudiants ont participé à cet apprentissage. Les résultats du pré-test et du post test ont montré respectivement une moyenne de 6,76 +/- 2,78 sur 20 et 13,17 +/- 1,99 sur 20. Nous avons objectivé une amélioration statistiquement significative des notes des étudiants entre le pré-test et le post test (p

Published
2021

15. Severe gestational hypertriglyceridemia: a rare but serious situation

Author

Moez Attia, Kaouther Dimassi, Chiraz Amrouche, Amel Triki, and Anissa Ben Amor

Subjects
Pediatrics, medicine.medical_specialty, acute pancreatitis, 030231 tropical medicine, Case Report, Hypertriglyceridemia, pregnancy, management, 03 medical and health sciences, 0302 clinical medicine, medicine, 030212 general & internal medicine, Pregnancy, Fetus, Maternal mortality rate, business.industry, digestive, oral, and skin physiology, nutritional and metabolic diseases, Gestational age, General Medicine, medicine.disease, Acute pancreatitis, Gestation, business, Dyslipidemia
Abstract

The severe hypertriglyceridemia during pregnancy is a rare condition. It is a problem for diagnostic, prognostic and therapeutic. This dyslipidemia benefit from specific and effective treatments, but it is still poorly codified. Dietary is still the essential therapeutic, but fetal extraction should also be considered if the gestational age permits. Post-partum monitoring is required but etiologic thorough is not recommended if the triglycerides rate normalizes. The major complication of hypertriglyceridemia should be actively sought because of important maternal mortality rate.

Published
2019

17. Diagnosis of fetal occiput position using transperineal ultrasound

Author

Kaouther, Dimassi, Helmi, Temessek, Anissa, Ben Amor, and Amel, Triki

Subjects
Adult, Palpation, Delivery, Obstetric, Perineum, Sensitivity and Specificity, Ultrasonography, Prenatal, Labor Presentation, Young Adult, Labor Stage, Second, Predictive Value of Tests, Pregnancy, Humans, Female, Prospective Studies, Head, Physical Examination
Abstract

To compare Transperineal (TP) and Transabdominal (TA) ultrasound in the assessment of fetal head position during the second stage of labor.A prospective comparative Study including low risk parturients. The assessment of fetal head position was performed for each patient at full dilation. The ultrasound examination was performed by one examiner using TP technique first then TA. A routine digital vaginal examination was performed by a different examiner blinded to ultrasound findings. Considering TA as reference, the three methods were compared.Fifty two patients were enrolled in the study group. Agreement between the clinical examination and TA ultrasound was average with Kappa index = 0.579. Agreement between TA and TP Ultrasound was good with Kappa index = 0.766. TP technique was accurate in the diagnosis of fetal head position (sensitivity =91.3%, specificity=98.38%, PPV=87.5%, NPV=98.91%). TA ultrasound was the most reliable method in case of high presentations. For lower fetal presentations, the TP approach was more relevant.Assuming that an accurate diagnosis of fetal head position is required before any instrumental delivery where, by definition, fetal presentation is engaged, the TP ultrasound is advised. In a single time this technique provides the necessary information about the station, and the position of the fetal head.

Published
2018

18. Successful management of acquired uterine arteriovenous malformation

Author

Kaouther, Dimassi, Anissa, Ben Amor, Ahmed, Halouani, Nadida, Dali, Leila, Ben Farhat, and Amel, Triki

Subjects
Adult, Arteriovenous Malformations, Uterine Artery, Treatment Outcome, Pregnancy, Uterus, Humans, Abortion, Induced, Female, Uterine Hemorrhage, Uterine Artery Embolization
Abstract

Uterine arteriovenous malformation (UAVM) is uncommon. They are usually acquired, due to previous intra uterine trauma. We report a case of acquired UAVM in a 28-years-old patient after a medical abortion, diagnosed with ultrasonography and successfully managed with uterine artery embolization.

Published
2018

19. Abstracts of the 40th National Congress of Medicine Tunis, 19-20 October 2017

Author

Meya, Abdallah, A, Abdelaziz, O, Abdelaziz, Nour, Abdelhedi, Amina, Abdelkbir, Med, Abdelkefi, Leila, Abdelmoula, S, Abdennacir, Mahdi, Abdennadher, H, Abidi, Abir, Abir Hakiri, Sana, Abou El Makarim, M, Abouda, Wafa, Achour, C, Aichaouia, Amina, Aissa, Yosra, Aissa, W, Aissi, Meriem, Ajroudi, Emna, Allouche, Haithem, Aloui, D, Aloui, Feten, Amdouni, Y, Ammar, Y, Ammara, S, Ammari, A, Ammous, A, Amous, Adel, Amri, Mohamed, Amri, R, Amri, H, Annabi, Saoussen, Antit, Samira, Aouadi, A, Arfaoui, Assia, Assadi, Lilia, Attia, Moez, Attia, Leila, Attia, I, Ayadi, Imene, Ayadi Dahmane, Ayari, Ayari, S, Azzabi, Heifa, Azzouz, N, B Mefteh, C, B Salah, Hedi, Baccar, Asma, Bachali, M, Bahlouli, Gada, Bahri, Hassène, Baïli, Mejda, Bani, W, Bani, Mohamed Amine, Bani, E, Bassalah, R, Bawandi, M, Bayar, Najla, Bchir, R, Bechraoui, Maher, Béji, Rami, Beji, D, Bel Haj Yahia, Syrine, Belakhel, Houda, Belfkih, Olfa, Belgacem, Nesrine, Belgacem, Ahlem, Belhadj, Najeh, Beltaief, N, Beltaief, M, Ben Abbes, Ahmed, Ben Abdelaziz, Imen, Ben Ahmed, Nizar, Ben Aissia, M, Ben Ali, Hanen, Ben Ammar, Boutheina, Ben Ammou, Anissa, Ben Amor, Mohamed, Ben Amor, M, Benatta, Nahla, Ben Ayed, Wided, Ben Ayoub, Nejla, Ben Charrada, Mamoun, Ben Cheikh, Fatma, Ben Dahmen, M, Ben Dhia, Sinda, Ben Fadhel, Leila, Ben Farhat, F, Ben Fredj Ismail, Emira, Ben Hamida, E, Ben Hamida Nouaili, M, Ben Hammamia, Abir, Ben Hamouda, L, Ben Hassine, Ahmed, Ben Hassouna, Asma, Ben Hasssen, Manel, Ben Hlima, Badreddine, Ben Kaab, Nabyl, Ben Mami, Fatma, Ben Mbarka, N, Ben Mefteh, N, Ben Kahla, M, Ben Mrad, N, Ben Mustapha, Mahdi, Ben Nacer, Kaouther, Ben Neticha, E, Ben Othmen, S, Ben Rhouma, Meriam, Ben Rhouma, Sana, Ben Saadi, Amine, Ben Safta, Zoubeir, Ben Safta, C, Ben Salah, Nawel, Ben Salah, Samia, Ben Sassi, Jihène, Ben Sassi, Souha, Ben Tekaya, R, Ben Temime, Achref, Ben Tkhayat, Riadh, Ben Tmim, Yosra, Ben Yahmed, Soraya, Ben Youssef, Mouadh, Ben Ali, Mahmoud, Ben Atta, M, Ben Salah, Imen, Berrahal, Gazi, Besbes, Leila, Bezdah, Ahlem, Bezzine, A, Bezzine, Z, Bokal, Rim, Borsali, Ibtissem, Bouasker, J, Boubaker, Meriam, Bouchekoua, Faten, Bouden, Slim, Boudiche, I, Boukhris, Salem, Bouomrani, Saadia, Bouraoui, Soumaya, Bourgou, Elhem, Boussabeh, Khaled, Bouzaidi, K, Chaker, Lilia, Chaker, Amine, Chaker, Fatma, Chaker, Nessrine, Chaouech, M, Charfi, M R, Charfi, Fatma, Charfi, Lamia, Chatti, F, Chebbi, Wael, Chebbi, Rzaieg, Cheikh, Sarra, Cheikhrouhou, Jihène, Chekir, E, Chelbi, Ines, Chelly, Beya, Chelly, Manel, Chemakh, Sarra, Chenik, M, Cheour, Mejda, Cheour, E, Cherif, Yosra, Cherif, W, Cherif, Rahma, Cherni, Ahmed, Chetoui, Mélika, Chihaoui, Chiraz, Chiraz Aichaouia, Salsabil, Dabousii, Amin, Daghfous, A, Daib, N, Daib, Rahma, Damak, Nawel, Daoud, Z, Daoud, Nawel, Daoued, Habiba, Debbabi, Wiem, Demni, R, Denguir, Safa, Derbel, B, Derbel, Selma, Dghaies, Sonia, Dhaouadi, Issaoui, Dhilel, Kaouther, Dimassi, A, Dougaz, Wejih, Dougaz, H, Douik, Leila, Douik El Gharbi, Chadli, Dziri, Sahar, El Aoud, Zouhaeir, El Hechmi, Azza, El Heni, S, ELaoud, Emna, Elfeleh, S, Ellini, Faten, Ellouz, Othmane, Elmoez Ben, Rim, Ennaifer, S, Ennaifer, Mejda, Essid, Nadia, Fadhloun, Mariem, Farhat, M, Fekih, M, Fourati, Fadhel, Fteriche, Ons, G Hali, Said, Galai, S, Gara, Gada, Garali, W, Garbouge, Wafa, Garbouj, Ons, Ghali, Feriel, Ghali, Emna, Gharbi, Radhouane, Gharbi, Wafa, Ghariani, Houda, Gharsalli, Ghaya, Ghaya Jmii, F, Ghédira, A, Ghédira, Habib, Ghédira, Asma, Ghériani, Esma Leila, Gouta, F, Guemira, Emna, Guermazi, Ahmed, Guesmi, Jihène, Hachem, Anis, Haddad, Kaouther, Hakim, A, Hakiri, S, Hamdi, Wassim, Hamed, S, Hamrouni, Meriem, Hamza, Slim, Haouet, A, Hariz, Lotfi, Hendaoui, M, Hfaidh, H, Hriz, Mohamed, Hsairi, Hamza, Ichaoui, D, Issaoui, H, Jaafoura, Rached, Jazi, R, Jazia, H, Jelassi, Hichem, Jerraya, Housseina, Jlassi, Ghaya, Jmii, Mohamed, Jouini, M, Kâaniche, Montasser, Kacem, Mohsen, Kadhraoui, M, Kalai, Kalthoum, Kallel, Omar, Kammoun, Mehdi, Karoui, Souhaiel, Karouia, M, Karrou, Ahlem, Kchaou, R, Kchaw, Niadhameddine, Kchir, Héla, Kchir, I, Kechaou, Mna, Kerrou, Samira, Khaled, N, Khalfallah, Mehdi, Khalfallah, Rim, Khalfallah, K, Khamassi, M, Kharrat, Emira, Khelifa, Mohamed, Khelil, A, Khelil, Nadia, Khessairi, M A, Khezami, Hassen, Khouni, C, Kooli, B, Korbsi, M A, Koubaa, Rachid, Ksantini, A, Ksentini, I, Ksibi, J, Ksibi, Hamida, Kwas, Asma, Laabidi, A, Labidi, Nizar, Ladhari, R, Lafrem, R, Lahiani, M, Lajmi, J, Lakhal, Mariem, Laribi, Najla, Lassoued, Khaoula, Lassoued, F, Letaif, Faten, Limaïem, Sonia, Maalej, Nadia, Maamouri, R, Maaoui, Houda, Maâtallah, Sarra, Maazaoui, Houcine, Maghrebi, S, Mahfoudhi, Yacine, Mahjoubi, Sana, Mahjoubi, Ines, Mahmoud, T, Makhlouf, Amin, Makni, S, Mamou, S, Mannoubi, Amira, Maoui, Adel, Marghli, Zahra, Marrakchi, Jihène, Marrakchi, S, Marzougui, Ines, Marzouk, Nabil, Mathlouthi, K, Mbarek, Mondher, Mbarek, S, Meddeb, Azza, Mediouni, Nejla, Mechergui, Islam, Mejri, Mohamed Béchir, Menjour, Yosra, Messaoudi, Tahar, Mestiri, Alya, Methnani, Imed, Mezghani, Olfa, Meziou, A, Mezlini, Samira, Mhamdi, M, Mighri, S, Miled, I, Miri, Dorsaf, Mlayeh, Zied, Moatemri, Weil, Mokaddem, Mourad, Mokni, N, Mouhli, Mohamed Sami, Mourali, Ali, Mrabet, Fadhel, Mrad, Maroua, Mrouki, Hela, Msaad, A, Msakni, Sabrine, Msolli, Sana, Mtimet, Sabeh, Mzabi, Z, Mzoughi, E, Naffeti, Souhir, Najjar, Abdelwahab, Nakhli, S, Nechi, E, Neffati, Henda, Neji, Yosra, Nouira, Ramzi, Nouira, Souheil, Omar, Sana, Ouali, Y, Ouannes, Fatma, Ouarda, Wejdène, Ouechtati, Jamila, Ouertani, Jihene, Ouertani, Haroun, Ouertani, Annouar, Oueslati, J, Oueslati, Ibtissem, Oueslati, Bassem, Rabai, H, Rahali, E, Rbia, Wael, Rebai, Nesrine, Regaïeg, Ons, Rejeb, Wafa, Rhaiem, Houcem, Rhimi, I, Riahi, Rym, Ridha, Leila, Robbena, Leila, Rouached, Sana, Rouis, Mouna, Safer, Khalil, Saffar, Hana, Sahli, Ghada, Sahraoui, Olfa, Saidane, D, Sakka, Houda, Salah, Satâa, Sallami, Issam, Salouage, A, Samet, Kais, Sammoud, Asma, Sassi Mahfoudh, Cyrine, Sayadi, A, Sayhi, T, Sebri, Yassine, Sedki, A, Sellami, M, Serghini, Ines, Sghaier, W, Skouri, Wa, Skouri, Iskander, Slama, Hédia, Slimane, Olfa, Slimani, Omar, Souhail, Souhir, Souhir, Asmahen, Souissi, Roua, Souissi, A, Taboubi, Ghofran, Talbi, Makram, Tbini, A, Tborbi, Rawdha, Tekaya, Helmi, Temessek, Moez, Thameur, Asma, Touati, Haifa, Touinsi, Abir, Tounsi, H, Tounsia, Sonia, Trabelsi, Safa, Trabelsi, Amel, Triki, M, Triki, Jihen, Turki, Khadija, Turki, Hassan, Twinsi, Yasmine, Walha, J, Wali, Haythem, Yacoub, F, Yangui, Meriem, Yazidi, Imen, Youssef, Aymen, Zaier, Rim, Zainine, Lilia, Zakhama, Haifa, Zalila, Hayet, Zargouni, Alia, Zehani, Zeineb, Zeineb, Imen, Zemni, Molka, Zghal, J, Ziadi, Z, Zid, Imen, Znagui, Chokri, Zoghlami, Chadia, Zouaoui, B, Zouari, L, Zouiten, and Hazem, Zribi

Published
2018

21. Fetal thrombotic vasculopathy: a rare and serious lesion

Author

Sana, Ben Slama, Anissa, Ben Amor, Dhouha, Bacha, Kaouther, Dimassi, and Ahlem, Lahmar

Subjects
Adult, Male, Fetal Diseases, Fetal Growth Retardation, Placenta Diseases, Rare Diseases, Pregnancy, Humans, Female, Thrombosis
Published
2017

22. Ultrasound diagnosis of fetal head engagement

Author

Mohamed Amine Ben Khedija, Cyrine Belghith, Kaouther Dimassi, Amel Triki, Anissa Ben Amor, and Mohamed Faouzi Gara

Subjects
Adult, medicine.medical_specialty, Fetal Engagement, Physical examination, Ultrasonography, Prenatal, Labor Stage, Second, Pregnancy, medicine, Humans, Fetal head, Longitudinal Studies, Prospective Studies, Transperineal ultrasound, medicine.diagnostic_test, business.industry, Ultrasound, Obstetrics and Gynecology, General Medicine, Predictive value, Surgery, Perineum, medicine.anatomical_structure, Female, Radiology, business, Fetal Skull
Abstract

Objective To compare clinical data and transperineal ultrasound results for the diagnosis of fetal head engagement. Methods The present prospective longitudinal study enrolled 100 term women attending the Mongi Slim Hospital, La Marsa, Tunisia, between July and September 2012. The clinical assessment of fetal engagement was compared with ultrasound measurements. Ultrasound examination was performed in the delivery room. The probe was placed on the ano-vulvar area. The measure used was the distance between the perineum and external table of fetal skull. Results The ultrasound measures of the perineum to external table of fetal skull ranged from 13 to 75 mm. The measures of the perineum to succedaneum bump ranged from 22 to 68 mm. A threshold of 55 mm was determined as the perineum to fetal head distance above which a diagnosis of engagement would be reversed. This proposed threshold had a positive predictive value of 98.6%, a sensitivity of 86.7%, and a specificity of 94.1%. Conclusion Transperineal ultrasound is a simple, rapid, and reproducible method for the diagnosis of fetal head engagement. It can be used in the delivery room in addition to clinical examination and when the latter is hampered by a succedaneum bump.

Published
2014
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24. Liver injuries in children: the role of selective non-operative management

Author

Faouzi, Nouira, Yosra, Kerkeni, Anissa, Ben Amor, Yosra, Ben Ahmed, Aouatef, Charieg, Rachid, Khemakhem, Soufiane, Ghorbel, Said, Jlidi, Sonia, Ben Kahlifa, and Beji, Chaouachi

Subjects
Male, Injury Severity Score, Adolescent, Liver, Accidents, Child, Preschool, Humans, Infant, Wounds and Injuries, Blood Transfusion, Female, Child, Retrospective Studies
Abstract

Trauma remains the leading cause of mortality in the pediatric population. Liver injuries occur commonly in blunt abdominal trauma.To assess the selective non-operative management of liver injuries in children.A retrospective review of 51 patients with a discharge diagnosis of traumatic liver injuries at Tunis Children's Hospital, over a 14-year period from 1996 to 2009.We identified 51 patients with liver trauma. The median age was 7 years. Boys accounted for 58% (n= 30), and the most common cause was traffic accident. Head injuries were the most common associated injuries. Forty-nine patients (96%) required non-operative management without complications. The mean in-hospital stay was 10 days in this group. The ultrasound demonstrated complete resolution and healing after 3-6 months. Two patients underwent surgery for hemodynamic instability. The mortality rate was 0.2 %.Safe, non-operative management involves careful serial examination, a CT scanning facility and close monitoring of the patient in a fully equipped high-dependency unit with trained staff to run it. Even though most patients can be treated non-operatively the challenge is to identify the severely injured child early and institute aggressive resuscitation and expedite laparotomy.

Published
2012

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