Parietal endometriosis is a rare clinical entity whose pathophysiology remains unclear. It occurs most often after gynecological or obstetrical surgery. We report the case of a patient with cyclic pain at the level of the caesarean section scar. With clinical examination, two nodules on both sides of the scar increase in size associated with pain punctuated by the menstrual cycle. Pelvic ultrasonography showed two nodular formations of hypoechoic, avascular Doppler echo, apparently in relation to endometriotic nodules. Hence the decision to excise the lesion widely, whose anatomopathological study confirms the diagnosis of parietal endometriosis. Postoperative follow-up was straight forward with a follow-up of 12 months without recurrence of lesions or pain. Through our case, we will insist on the characteristics of this pathology, which will allow the practitioner to understand the interest of the diagnosis and early management of this condition as well as the possibility of its prevention during each gynecological surgery or obstetric.
Background: The clinical reasoning is expressed daily in the ability to solve clinical problems of patients. Its supervision is essential to establish an individualized educational plan that encourages its development. Objective: To analyze the impact of clinical reasoning learning sessions as remediation strategy of clinical reasoning difficulties. Method: exploratory retrospective study of medical students analyzing the difficulties of clinical reasoning and pedagogic practice of supervision promoting its development through the introduction of clinical reasoning learning sessions guided by a course book and grids evaluation as remediation strategy. Results: After the application of our supervision model of the clinical reasoning, 94.6 % of students were satisfied. They thus suggested the introduction of clinical reasoning evaluation before clinical examinations 7th year. Conclusion: the introduction of clinical reasoning learning sessions both in diagnosis and remediation of difficulties reasoning proves a real need. It would be appropriate to propose models applicable in other disciplines and to integer its evaluation in university program of internship
Juvenile granulosa tumor is a sex cord stromal tumor extremely rare, with usually estrogenic effects, while virilizing form is exceptional, often discovered at a stage confined to the ovary, justifying therefore a conservative treatment. Its prognosis appears favorable, depending on early management. However, its evolvement may be hampered by early and aggressive recurrence. We report a new case compiled in Obstetrics Gynecology Service (HMIMV) of virilizing form of juvenile granulosa cell tumors, discovered during a recent exacerbation of a preexisting androgen syndrome in a girl of 24 years. It's extreme rarity prompted us to report it highlighting, through a literature review, its diagnostic features, therapeutic and evolutionary.
The neurofibromatosis type 1 (NF1) or von Recklinghausen's disease is an autosomal dominant disease. The association of NF1 to breast cancer is unusual and rarely r eported in literature. We report a case of this rare association. The discovery of breast cancer at a 51 years old patient in an advanced stage (T3N1M0), occasioned the appearance of dermatological lesions which are pathognomonic of neurofibromatosis1. Monitoring of patients with neurofibromatosis type1 seems justified to detect Early a possible association to breast cancer.
Bowen vulvar disease is defined as squamous cell carcinoma strictly intraepithelial, it's a viral infection which mostly affects postmenopausal women. It can be associated to other lesions specially gynecological cancers. The diagnosis is essentially histological. The evolution can go to invasion. Its treatment is based on surgery. We report the case of a female patient of 46 years, who consulted for a vulvar ulceration range of 5 cm in diameter, treated with wide excision, the histological examination is in favor of Bowen's disease. Through a review of litterature, we focus on the clinical, evolutionary and therapeutic features of this pathology.
Introduction: Recurrent disease is a genetic autoinflammatory disease autosomal recessive with particular ethnic distribution. Chronic disease evolution paroxysmal often beginning at childhood and characterized by inflammation of the serous with the main risk amyloidosis. Colchicine is the standard treatment. The management of the carrier pregnant women with this disease should be done in collaboration between internist, obstetrician and nephrologist in patients with renal impairment. Observation: We report the case of a woman in labor to 41 years, G5P2 mother of two children with a history of two spontaneous abortions, for MFM Followed by colchicine stopped since the desire to design with pregnancy marked by the occurrence of one crisis first trimester of pregnancy. The evolution was unremarkable and vaginal delivery of a newborn male eutrophic 10/10 Apgar. Discussion and conclusion: FMF Treaty and colchicine have no major impact on the reproductive life of women of childbearing age subject to proper monitoring and good compliance. Obstetrical prognosis is especially marked by the increased risk of abortion in cases of early pregnancy crisis.
The cornual pregnancy is a rare entity that represents almost 2% of ectopic pregnancies. Its diagnosis is almost always based on laparoscopy. The risk of rupture with severe bleeding remains high. The surgical treatment is often conventionally cornual radical resection, although cases medical methotrexate have been described. The objective of this work is to describe a rare form of ectopic pregnancy and expose its diagnostic features, management and prognosis. Patient and method: We report the case of a cornual pregnancy discovery intraoperatively in a patient of 27 years, admitted for acute pelvic pain with bleeding in the first quarter with pelvic ultrasound: empty uterus, endometrium 10mm, with an average abundance of peritoneal effusion. Rate of beta-hcg 2017. Given the strong suspiscion of ectopic pregnancy the patient was admitted immediately block with discovery of a right cornual pregnancy ruptured. Discussion and Conclusion: Interstitial pregnancy ectopic pregnancy is a rare, difficult to diagnose which may involve life and maternal fertility prognosis. Taking conventional charge is surgical. In subsequent pregnancies the clinician wary risk of recurrence of interstitial pregnancy and uterine rupture.
Introduction: The combined degeneration of the cord is a rare cause of myelopathy, it is linked to a deficiency in vitamin BI2 which is the most common cause pernicious anemia. Rapid diagnosis is necessary because the recovery is more complete than replacement therapy with vitamin B12 is administered early. Pregnancy by increasing needs of the mother's body can be a vitamin deficiency. However, we have little data in the literature that describe the impact of this disease on the course of pregnancy. Observation: We report the case of a 24-year-old primigravida in the third trimester of pregnancy presented a radiculo-cordonal syndrome later in connection with a hypovitaminosis B12. The course of pregnancy was unremarkable, with a marked improvement in his neurological symptomatology in vitamin supplementation. Discussion and conclusion: combined degeneration of the cord is the main secondary to neurological hypovitaminosis B12. MRI can guide the diagnosis, favorable after adequate vitamin supplementation is a therapeutic test to retain the diagnosis. There is no particular impact of the disease on pregnancy or pregnancy on the disease. However, some cases of IUGR, preeclampsia and pseudo Hellp syndrome were described. In terms of obstetrical prognosis is marked by an expansion of instrumental delivery instructions and those depending on the severity of neurological involvement. Epidural and spinal anesthesia should be avoided. General anesthesia should not use nitrous oxide.
Conn adenoma is the first cause of secondary hypertension of endocrine origin. His discovery during pregnancy is a rare situation. The objective of this work is to review the diagnostic features and management of this disease during pregnancy. Observation: We report the case of a primigravida 24 years hospitalized in the second trimester to tetraparesis related to a secondary hypokalemia Conn adenoma. Adrenalectomy were expected in the second quarter, but the occurrence of thrombophlebitis of the left leg had repporter gesture until postpartum. The patient was hospitalized several times for blood pressure control but showed during his last hospitalization 35SA SFA having imposed a fetal extraction by high way. Discussion and Conclusion: The Conn adenoma discovered during pregnancy has certain diagnostic and therapeutic features that need to know for proper care.
Introduction: If the uterine leiomyoma is a common and well known disease entity, ectopic location, is rare. The treatment is surgical enucleation and the diagnosis is histological. The objective of this work is to describe a rare location of myoma. Observation: We report the case of a patient of 50 years postmenopausal, who consulted for a vaginal nodule. MRI has to say vaginal tumor origin. The patient therefore underwent surgical resection of a nodule 1cm white and firm. Histological study has allowed us to retain the vaginal leiomyoma diagnosis. Discussion and conclusion: The leiomyoma is a benign mesenchymal tumor whose extra-uterine seat is rare. In her vaginal location, it is usually asymptomatic, discovered incidentally during a clinical examination. Vaginal myoma is usually a nodule on average 3cm, firm and painless, affecting middle-aged women. Radiological explorations show the origin of the vaginal origin of the lesion. Surgical resection is required because of sarcomatous degeneration have been described. The diagnosis is based on histological examination of the tumor.
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