[The status of hormone therapy in breast cancer in 2001?]. / Hormonothérapie dans le cancer du sein etat des lieux en 2001?

Cancer of the breast represents in Tunisia and the most frequent female cancer in the world. Hormonotherapy is one of the main weapons of the medical treatment based on the blockage of hormonal action on the cellular growth. Endocrine therapy remains an essential part of treatment in both adjuvant and metastatic settings and is guided by the presence and degree of expression of estrogen receptor (ER) and progesterone receptor (PgR). Adjuvant 5-years tamoxifen (TAM) is still the standard therapy for postmenopausal ER and/or PgR positive women. In premenopausal women and in adjuvant setting, medical castration by LH-RH analogues plus Tamoxifen in addition to chemotherapy improve the prognosis. All these data arose from the successive meta-analyses done showing a benefit from hormonotherapy for patients with positive HR in term of survival, disease-free survival, loco-regional and distant relapse rate. In metastatic disease, the position of tamoxifen is presently in competition with the third generation antiaromatases that seems to be equally active as tamoxifen opening the way for its use for the future in adjuvant situations.

Role of EUS in the preoperative localization of insulinomas compared with spiral CT.

BACKGROUND: Preoperative radiologic localization of insulinomas often fails because of the small size of these tumors. Endoscopic ultrasound (EUS) can localize insulinomas in up to 80% of the cases. The aim of this study was to compare EUS and computed tomography (CT) diagnostic accuracy for insulinomas. METHODS: We reviewed medical records from 12 patients (10 women) with a biochemical diagnosis of hypoglycemia and hyperinsulinism from 1 university hospital and 1 community hospital. A diagnosis of insulinoma was ultimately made in all cases and before surgery the patients underwent abdominal US, spiral CT and EUS in an attempt to precisely localize the tumor. Surgery was considered the standard for tumor localization. RESULTS: Ten tumors were benign (83.3%) and 2 were malignant (16.7%). The overall sensitivity of EUS in identifying insulinomas was 83.3% compared with 16.7% for CT. Tumors not detected by EUS had a mean size of 0.75 cm. EUS-guided fine-needle aspiration was possible in only 3 patients, with a positive cytologic diagnosis in 2 (66.6%). Tumors located in the head and body of the pancreas were identified by EUS in all patients, but those located in the tail were diagnosed in only 50% of the cases. CONCLUSIONS: EUS is superior to spiral CT and should replace it for the detection of pancreatic insulinomas. EUS identification depends on the site and size of the tumor.

Finsterer-Bancroft operation: an option for the treatment of difficult duodenal ulcers.

BACKGROUND: In the surgical management of duodenal ulcers, the most feared complications are related to the treatment of the duodenal stump after Billroth lI-type gastric resections. Such complications are more evident in so-called 'difficult duodenum' cases, whose identification is directly related to the surgeon's experience. Among available techniques to avoid those complications, one is the treatment of the antralduodenal stump by the method of pre-pyloric exclusion and removal of antral mucosa, as proposed by Finsterer in 1918 and diffused by Bancroft in 1932. This method, however, was criticized, especially because of the possibility of retaining residual antral mucosa, which would be a determinant factor for the ulcer disease recurrence. The objective of the study was to verify whether the Finsterer-Bancroft operation is a valid alternative in the treatment of unresectable duodenal ulcers, as well as to encourage its application by less experienced surgeons, by the standardization of the surgical technique. METHODS: From April, 1984 to December, 1996 two hundred and six elective partial gastrectomies for duodenal ulcers were performed with Billroth II reconstruction. Of these, in thirty-one (15%), the Finsterer-Bancroft method was used. The patients' ages, varied between 23 and 65 years, constituting 25 males and 6 females. In all cases, surgery was indicated due to the presence of stenosis. RESULTS: Three patients (9.7%) had complications. There was one death (3.2%) due to leakage of duodenal stump and peritonitis, one case of duodenal fistula (3.2%), and one case of ulcer recurrence (3.2%). All three complications were caused by inappropriate application of the method. CONCLUSIONS: We conclude that the Finsterer-Bancroft operation is a valid alternative in the surgical treatment of chronic duodenal ulcers, when considered unresectable, and is within the reach of in-training and less experienced surgeons.

Traumatismo de veia cava inferior: análise de 36 casos / Inferior vena cava trauma: analysis of 36 cases

Os autores analisaram 36 casos de traumatismos de veia cava inferior (VCI), a fim de avaliar as formas de tratamento empregadas, bem como os principais aspectos relacionados às altas taxas de morbidade e mortalidade freqüentemente encontradas nesse tipo de lesäo. Os projéteis de arma de fogo foram os agentes lesivos mais comuns, e 55// dos doentes tinham algum grau de instabilidade circulatória à admissäo. A porçäo retro-hepática foi a mais freqüentemente atingida e o fígado, o órgäo mais lesado em associaçäo à lesäo venosa. Dos vinte doentes admitidos com instabilidade hemodinâmica, 17 morreram e, desses, a lesäo era na porçäo retro-hepática em nove e na porçäo supradiafragmática em três, confirmando que a localizaçäo da lesäo e a instabilidade circulatória à admissäo säo os dois fatores mais importantes com relaçäo ao prognóstico pós-operatório

[Inferior vena cava trauma: analysis of 36 cases]. / Traumatismo de veia cava inferior: análise de 36 casos.

The authors analysed 36 trauma patients with inferior vena cava injuries to evaluate different surgical approaches, as well as, important aspects related to morbidity and mortality. Gunshot wounds were the most frequent cause of inferior vena cava injuries and 55% of the patients had circulatory instability on admission. Retrohepatic inferior vena cava was frequently injured in association with liver injury. From those 20 unstable patients on admission, there were 17 deaths, and injury was in the retrohepatic portion of the inferior vena cava in 9, and in the supradiaphragmatic portion in 3. These data support the concept that site of injury and hemodynamic status on admission are the principal factors related to morbidity and mortality in inferior vena cava injuries.

Sugar in the treatment of infected surgical wounds.

Forty-two patients with infected wounds were treated with common sugar. In all cases, the infections cleared within five to 30 days.

Ulcera duodenal. Estado atual do tratamento cirurgico. / Duodenal ulcer.Present status of the surgical treatment

Os autores discutem as indicacoes cirurgicas da ulcera duodenal, a luz dos metodos atualmente em voga. A conduta adotada no Departamento de Cirurgia da Faculdade de Ciencias Medicas da Santa Casa de Sao Paulo e apresentada, e os resultados de 278 doentes operados sao analisados

Complicaciones de la cirugia tiroidea con referencia a las lesiones de los nervos recurrentes. / Complication of thyroid surgery with reference to injuries of recurrent nerves

Los autores analizan 250 casos de diferentes afecciones tiroideas tratadas durante 1978-1979. La mas frecuente fue el bocio nodular atoxico (156 pacientes, 62,4%); el 90,8% de los enfermos pertenecian al sexo femenino y la edad de mayor incidencia, la 4a. y 5a. decadas de la vida. Analizanse los diferentes metodos diagnosticos empleados. Los procedimientos mas utilizados fueron las tiroidectomias subtotales (48%) y las totales (22,4%).La diseccion y visualizacion de los nervios recurrentes fue practicada en el 28,8% de los casos; se registro un 4% de disfonias definitivas presentes principalmente en los pacientes en quienes no fueron disecados los nervios recurrentes. No ocurrieron muertes imputables a la cirugia tiroidea. Se detalla la tecnica quirurgica indicada en las diversas afecciones

Patologia quirurgica del tiroides. Analisis de 250 casos operados en la F.C.M.S.C.S.P. (Brasil). / The thyroid surgical pathology. Analysis of 250 operated cases in the F.C.M.S.C.S.P. (Brazil)

Los autores presentan 250 casos de patologia de la glandula tiroides operados durante el periodo 1978-1979 en el Departamento de Cirurgia de la Faculdad de Ciencias Medicas da Santa Casa de Sao Paulo. Encontramos una incidencia de carcinoma de 16%, estudiase en estos la distribucion en relacion al sexo, edad y variedades histologicas. Se relatan tambien las complicaciones ocurridas en 11 pacientes (27.5%) siendo la principal la disfonia parcial definitiva en el 15%. Se analizan conjuntamente los casos de bocio multinodular atoxico, hipertiroidismo y tiroidites cronica. No hubo mortalidad en esta serie imputable a la cirurgia tiroidea. Se comenta la opinion de varios autores en relacion al tipo histologico. Resaltase que los mayores resultados pueden ser obtenidos mediante un equipo multi-disciplinario formado por cirujanos, patologistas y endocrinologos trabajando en interaccion

Dupla vesicular biliar. Apresentacao de um caso simulando tumor abdominal. / Double gallbladder. Report of a case simulating abdominal tumor

Os autores apresentam um caso de vesicula dupla, sendo que uma delas simulava um tumor abdominal. Tecem consideracoes acerca da incidencia, anatomia e quadro clinico

Patologia cirurgica da tireoide. Analise de 250 casos com especial referencia aos tumores da tireoide. / Surgical pathology of thyroid. Analysis of 250 cases with special reference to thyroid neoplasms

Os autores apresentam 250 casos de patologias de tireoide, estudados e operados no periodo de 1978-1979 no Departamento de Cirurgia da Faculdade de Ciencias Medicas da Santa Casa de Sao Paulo. Encontrou-se uma incidencia de carcinoma de 16%, dos quais se estudou a distribuicao em relacao ao sexo e a idade, a avaliacao pre-operatoria, o tipo de cirurgia e a variedade histologica de cada caso. Relatam-se tambem as complicacoes ocorridas em 11 pacientes (27,5%), sendo a principal a disfonia parcial definitiva em 15%.Do mesmo modo se analisarmos os casos de bocio multinodular atoxico, hipertireoidismo e tireoidite cronica. Relatam ainda a opiniao de varios autores sobre a conduta cirurgica adequada a cada tipo histologico. Ressaltam que melhores resultados podem ser obtidos quando o estudo e tratamento sao feitos por equipe multidisciplinar, formada por cirurgioes, endocrinologistas e patologistas