RESUMEN
INTRODUCTION: The pancreatic heterotopia of fortuitous operational discovery remains rare because of the medical imagery progress. We report a mesenteric localisation of aberrant pancreas identified during the assumption of responsibility of an abdominal emergency. OBSERVATION: A 26-year-old man was allowed with the urgencies for an acute obstruction of the small bowel. Surgical exploration revealed a distal support an ileo-parietal adherence near to an inflammatory hearth of appendicular origin. We noted, in addition to the mesentery of the first jejunal loop, a bilobate mass of glandular-like tissue with a pancreatic aspect. The adjacent jejunal handles were macroscopically healthy. The Pathological examination of the mass confirmed the existence of a mixed glandular exocrine and endocrine origin of pancreatic tissue, type I of the Heinrich's classification. CONCLUSION: This rare topographic entity of fortuitous discovery underlines the need for a meticulous surgical exploration of the abdominal cavity particularly in urgency when a summarized radiological assessment does not permit a complete morphological study.
Asunto(s)
Mesenterio , Páncreas , Adulto , Humanos , Masculino , Páncreas/anatomía & histologíaRESUMEN
PURPOSE: To realize a systematic review to evaluate groin hernia surgery for adults in sub-Saharan Africa. METHODS: We conducted a systematic review and meta-analysis, the primary objective of which was to determine the surgical techniques used for unilateral groin hernia surgery in sub-Saharan Africa. Studies published in the last 20 years were considered. A meta-analysis estimated the pooled prevalence with 95% confidence interval (CI) of mortality, chronic pain and recurrence. A subgroup analysis compared the rate of complications between complicated or uncomplicated hernia. RESULTS: We included 113 articles. The most used technique was Bassini in 40.1%, followed by Lichtenstein in 29.9% and Shouldice in 12.6%. The overall mortality rate was 0.6% (95% CI 0.4-0.9). The pooled recurrence rate was 1.4% (95% CI 1.05-1.9). The pooled rate of chronic pain was 2.7% (95% CI 1.9-3.7). We found that mortality rate for complicated hernias (6.4%) was higher compared to uncomplicated hernias (0.2%). This difference was statistically significant [p ≤ 0.001; OR = 47.7; 95 CI (27.2-83.47)]. CONCLUSION: This review showed that pure tissue repairs are the most used techniques with Bassini and Shouldice as leading procedures. The post-operative rates of recurrence and chronic pain are low. However, there is a high heterogeneity between studies than can underestimate these pooled prevalences. The consultation at complication stage remains frequent and associated with a higher mortality. Futures studies should focus on improving the quality of studies in terms of design and follow-up to increase the degree of evidence.
Asunto(s)
Dolor Crónico , Hernia Inguinal , Humanos , Adulto , Ingle/cirugía , Herniorrafia/efectos adversos , Herniorrafia/métodos , Dolor Crónico/cirugía , Hernia Inguinal/cirugía , Hernia Inguinal/epidemiología , África del Sur del Sahara/epidemiología , Recurrencia , Mallas QuirúrgicasRESUMEN
OBJECTIVE: To determine the frequency of gynaecological and breast cancers among women and to study their risk factors and diagnostic aspects at the Institut Curie of Dakar. PATIENTS AND METHOD: This retrospective study included all cancers seen at the Institute in 2001. Epidemiological and clinical variables were collected from the patients' medical records and analysed. RESULTS: This study showed that of all 786 cancers in women, 507 were gynaecological or breast cancers. Cancer of the uterine cervix accounted for 240 cases (47.3%), followed by 213 cancers of the breast (42%), 35 of the ovaries (6.9%), 10 of the corpus uteri (2%) and 7 of the vulva (1.4%). Mean age was 49.9 years old. There was a statistically significant (p<0.05) between primary tumour sites and all of the following: age at menarche, age at first sexual relations, and number of sexual partners. Mean time until consultation for all patients was 8.24 months and 96% had clinical signs before diagnosis. The histological confirmation rate was 73%. Local or regional tissue involvement was noted in 60% of cases. CONCLUSION: Gynaecological and breast cancers are frequent in Dakar and have the characteristics common to cancers in developing countries. Further efforts are needed to study their risk factors and effective screening for them.
Asunto(s)
Neoplasias de la Mama , Neoplasias de los Genitales Femeninos , Adulto , Anciano , Anciano de 80 o más Años , Mama/patología , Neoplasias de la Mama/diagnóstico , Neoplasias de la Mama/epidemiología , Neoplasias de la Mama/patología , Cuello del Útero/patología , Femenino , Neoplasias de los Genitales Femeninos/diagnóstico , Neoplasias de los Genitales Femeninos/epidemiología , Neoplasias de los Genitales Femeninos/patología , Humanos , Menarquia , Persona de Mediana Edad , Estadificación de Neoplasias , Neoplasias Ováricas/diagnóstico , Neoplasias Ováricas/epidemiología , Neoplasias Ováricas/patología , Ovario/patología , Estudios Retrospectivos , Factores de Riesgo , Senegal/epidemiología , Neoplasias del Cuello Uterino/diagnóstico , Neoplasias del Cuello Uterino/epidemiología , Neoplasias del Cuello Uterino/patología , Neoplasias Uterinas/diagnóstico , Neoplasias Uterinas/epidemiología , Neoplasias Uterinas/patología , Útero/patología , Vulva/patología , Neoplasias de la Vulva/diagnóstico , Neoplasias de la Vulva/epidemiología , Neoplasias de la Vulva/patologíaRESUMEN
The authors report three (3) cases of choledoco-duodenal fistula due to perforating duodenal ulcer disease. All of them were male, aged from 35 to 55 years. The ulcer symptomatology summarised the clinical feature. They presented respectively a prestenosis, a stenosis and a chronic ulcer The fistula diagnosis was estasblished at the oesogastro-duodenal radiologic exploration showing an opacification of the common bile duct. The surgical treatment concerned bnly to the ulcer. A gastrectomy of exclusion with digestive continuity re-establishment according to FINSTERER in the pre-stenosis, vagotomy associated to gastrojejunostomy and the pylore closing at both other were performed. After 24, 23 and 5 months follow-up all the patients were disease free; classified VISICK I. Rarely reported among the complications of the duodenal ulcer the choledoco-duodenal fistula is a reality. Currently the majority of the authors recommend the respect of the fistula in the event of surgical operation.
Asunto(s)
Fístula Biliar/etiología , Úlcera Duodenal/complicaciones , Fístula Intestinal/etiología , Úlcera Péptica Perforada/complicaciones , Adulto , Fístula Biliar/cirugía , Colestasis/etiología , Colestasis/cirugía , Úlcera Duodenal/cirugía , Humanos , Fístula Intestinal/cirugía , Masculino , Persona de Mediana Edad , Úlcera Péptica Perforada/cirugíaRESUMEN
STUDY AIM: Sickle cell affection is a public health problem in Africa. The aims of this prospective study were to evaluate the early results of laparoscopic cholecystectomy in sickle cell patients in Senegal. METHOD: From January 1998 to June 2002 all the sickle cell patients undergoing a laparoscopic cholecystectomy were included. Intra- and post-operative protocol (blood transfusion if Hb < 9 g/dl, rehydration, oxygenotherapy) was standardized. RESULTS: Forty-two patients with sickle cell of types SS-33 and AS9 were operated upon by same surgeon. One case of conversion due to an effraction of biliary junction was reported. One homozygote patient died post-operatively because of peritonitis. Two acute thoracic syndromes, three vaso-occlusive crisis, and two cases of wound infection constituted the post-operative morbidity. No case of complication was noted in those who underwent pre-operative transfusion. CONCLUSION: Laparoscopic cholecystectomy can be carried out in sickle cell patients with biliary lithiasis provided that general anaesthetic rules are respected.
Asunto(s)
Anemia de Células Falciformes/complicaciones , Colecistectomía Laparoscópica , Colelitiasis/complicaciones , Colelitiasis/cirugía , Adolescente , Adulto , Niño , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Factores de Riesgo , SenegalRESUMEN
Stabbed penetrating abdominal wounds are becoming more and more frequent in our emergency surgical unit due to increase of aggressions. The goal of our study is to evaluate the conservative treatment of these wounds. This concerns a study carried out between January 1997 and October 1998. Exploratory laparotomy was proposed at each time when one or more of the following criteria was noticed: choc, evisceration of intestines, digestive hemorrhagy or hematuria, outlet of digestive fluids, sign of peritoneal irritation, wounds by gunshots or wounds at the frontal regions. In the other cases, the conservative treatment with wound dressing following an antibiotic and serovaccination therapy of tetanus was the therapeutic option. Our study was carried out on 40 patients of whom were 37 males and 3 females of average age 24.9 years with extremities of 7 to 52 years. It arrived to the following results: 32 of the patients (80%) were victim of aggression and 29 cases were stabbed wounds. The wounds were in the central region (umbilicus 29.5%) and superior to the abdomen and were associated with outlet of the omentum (50%) outlet of the intestines (12.5%), peritoneal irritation (27.5%), digestive hemorrhagy (10%), hematuria (2.5%) outlet of faeces (2.5%). 17 patients (42.5%) underwent exploratory laparotomy on the basis of criteria afor mentioned and the 23 others (57.5%) underwent medical surveillance and 3 of them developed peritonitis and underwent surgery. The rate of negative laparotomy was 5% and retarded interventions was 13%. The morbidity was also 13% and mortality 2.5%. The average period of internship in hospital was 11,4 days with extremities of 1 to 101 days. The conservative treatment of penetrating stabbed abdominal wounds out of the criteria mentioned were quite satisfactory.
Asunto(s)
Traumatismos Abdominales/terapia , Heridas Penetrantes/terapia , Adolescente , Adulto , Niño , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios ProspectivosRESUMEN
There are many variants in vaginal hysterectomy procedures owing to precises indications. We have performed a total vaginal hysterectomy procedure which technique is described herein. Our procedure was using the preexisting anatomic structures. It allows a solid cure adapted to each compound of the genital prolapse. Among a series of 10 cases, we report few complications. An important peroperative bleeding occurred in one case. The postoperative morbidity included 1 case of genital infection and 1 case of urinary fistula. One patient died from a cause not reliable to the procedure. The mean duration of the hospital stay was 10 days. After 2 years follow up, 9 of our patients have good anatomical and functional results. The shortness of this series does not allow us to concluded definitively. However, our results are comparable with those reported in the literature.
Asunto(s)
Histerectomía Vaginal , Prolapso Uterino/cirugía , Estudios de Evaluación como Asunto , Femenino , Estudios de Seguimiento , Humanos , Persona de Mediana Edad , Paridad , Diafragma Pélvico/cirugía , Complicaciones Posoperatorias , Enfermedades de la Vejiga Urinaria/cirugíaRESUMEN
The wertheim complications are dominated by the urinary dysfonction and the lymphocele which are linked at this procedure. This study reported 412 Wertheim associated to the radiotherapy. The purpose was to evaluate the complications among patients who underwent the Wertheim and to analyse the differents factors promotions the complications. The diagnosis was always late and the disease stage was advanced. The stages II, III and IV represented more than 80%. We found 86 complications (20.87%) distributed as follow: 17 urinary (19.76%), 30 secondary infections (34.88%), 8 colonic fistula (9.30%), 7 hemorrage (8.13%), 6 lymphedema (6.97%), 3 occlusions (3.48%), 1 phlebitis (1.16%), 1 lymphocele (1.16%). among all patients, 17 died, the mortality rate was 4.12%. A very good dissection preceded by radiotherapy may reduce the complications rate.
Asunto(s)
Histerectomía/efectos adversos , Escisión del Ganglio Linfático/efectos adversos , Neoplasias del Cuello Uterino/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Histerectomía/métodos , Persona de Mediana Edad , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , SenegalRESUMEN
Through a retrospective study of 50 cervix carcinoma during pregnancy, the authors determine the epidemiology, discuss the therapeutic and the pronostic. The mean age of patients were 36 years and the clinical staging of FIGO found : 3 stages Ia, 3 Ib, 7 IIa, 14 IIb, 7 IIIa, 7 IIIb, 4 IVa, 5 IVb The diagnosis of carcinoma was in 6 cases(12%) at first trimester, in 6 cases(12%) at midtrimester, in 13 cases(27%) at third trimester, in 19 cases(28%) after delivery. The termination of pregnancy was an abortion in 6 cases(12%). The treatment was: 29 delivery whose 12 followed bycolpohysterectomy,1 byconisation and 16 had not a colpohysterectomy. 5 cesarean section whose 2 followed by colpohysterectomy in the same time and 3 in the second time. The radiotherapy was neoadjuvant in 3 cases and adjuvant in 3 cases. The mortality was 4 % and the global survival at 5 years was 30%. The prognostic of the cervix carcinoma during pregnancy would get better by Pap test which must be systematic at the pregnant woman.
Asunto(s)
Complicaciones Neoplásicas del Embarazo , Neoplasias del Cuello Uterino , Adulto , Femenino , Humanos , Persona de Mediana Edad , Embarazo , Complicaciones Neoplásicas del Embarazo/epidemiología , Complicaciones Neoplásicas del Embarazo/cirugía , Estudios Retrospectivos , Neoplasias del Cuello Uterino/epidemiología , Neoplasias del Cuello Uterino/cirugíaRESUMEN
Burns are very frequent. Skin cancer on burns scars are one of the known complications. The mechanisms and the risk factors of this disease are not very well known. To review the risk factors and the mechanisms of transformation of burn scars into cancer, we analyzed 67 retrospective cases of Marjolin's ulcer to describe the epidemiological features of the disease in our practice and identify the factors of relapse. Our patients are young (means age 41), mainly male (54%), with disease localized on arms and legs (88%). The initial burn was from flames (54%), charcoal or hot cooking oil (19.5%) and never from ionizing radiation. It was never a superficial burn and covered from 4 to 37% of the body surface (mean 14%). The initial treatment was medical in only 9% of cases and ended with 85% of complete healing. After 4 to 67 years of evolution, 95% of re-ulceration occurred. Abnormal lymph node and distant metastasis were diagnosed in respectively 68 and 7% of the cases. Amputation and groin dissection were respectively done in 63 and 50%. One third of patients were lost during the follow up. 25% of the cases are still alive and free of disease. We found 30% of local recurrence and 17.5% of regional recurrence. By univariate analysis we found that the factors significantly associated to loco-regional relapse are: male status (p = 0.0327), burns by cooking oil (p = 0.0118), lack of treatment during initial burn (p = 0.0001), sclerous scar (p = 0.0281), supra regional lymph nodes (p = 0.028) lack of treatment during re ulceration (p = 0.0308). Squamous cell carcinomas on burn scars are rare diseases and of bad prognosis. Mainly associated to domestic accidents they frequently occur on limbs and arms on an articulation. Metastasis is not frequent. Conservative treatment is associated with 30% of recurrence. In our practice, the relapse risk factors are male status, burns by cooking oil, lack of treatment during the initial burn, sclerous scar, supra regional lymph nodes, lack of treatment during re ulceration.
Asunto(s)
Quemaduras/complicaciones , Carcinoma de Células Escamosas/etiología , Cicatriz/patología , Neoplasias Cutáneas/etiología , Piel/lesiones , Accidentes Domésticos , Adolescente , Adulto , Anciano , Brazo , Quemaduras/terapia , Carcinoma de Células Escamosas/patología , Carcinoma de Células Escamosas/cirugía , Transformación Celular Neoplásica , Cicatriz/etiología , Culinaria , Femenino , Humanos , Pierna , Masculino , Persona de Mediana Edad , Metástasis de la Neoplasia , Recurrencia Local de Neoplasia , Factores de Riesgo , Senegal/epidemiología , Neoplasias Cutáneas/patología , Neoplasias Cutáneas/cirugíaRESUMEN
The purpose of this retrospective study of 60 breast carcinoma during pregnancy collected at the Cancer Institut of Dakar from 1962 to 1998 was to determine the epidemiology, the clinical appearance and to discuss the pathogeny, the diagnosis, the prognosis and the treatment. The mean of age of patients was 34.5 years. The number of parity was 5 and the first pregnancy at 20 years. The authors arrived at diagnosis in the post partum in 28 cases (47.45%), in the first trimester in 8 cases (13.55%), in the midtrimester in 13 cases (22.03%) and in the third trimester in 11 cases (18.64%). The polychemotherapy preceded the surgery in 30 cases and succeded in 16 cases. The hormonotherapy with Tamoxifen prescribed in 17 cases after the delivery. The mastectomy and axillary lymphadenectomy was realised in 26 cases in the post partum. The adjuvant radiotherapy was done in 12 cases. The mortality was 31% and the global survival at 2 years, 34.6%.
Asunto(s)
Neoplasias de la Mama , Complicaciones Neoplásicas del Embarazo , Adulto , Distribución por Edad , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Neoplasias de la Mama/diagnóstico , Neoplasias de la Mama/epidemiología , Neoplasias de la Mama/terapia , Instituciones Oncológicas , Quimioterapia Adyuvante , Femenino , Hospitalización/estadística & datos numéricos , Humanos , Escisión del Ganglio Linfático , Mastectomía , Persona de Mediana Edad , Estadificación de Neoplasias , Embarazo , Complicaciones Neoplásicas del Embarazo/diagnóstico , Complicaciones Neoplásicas del Embarazo/epidemiología , Complicaciones Neoplásicas del Embarazo/terapia , Pronóstico , Radioterapia Adyuvante , Enfermedades Raras , Estudios Retrospectivos , Senegal/epidemiología , Tasa de Supervivencia , Factores de Tiempo , Resultado del Tratamiento , Salud Urbana/estadística & datos numéricosRESUMEN
The vulvar cancer is an uncommon disease which is beginning mostly on vulvar intraepithelial neoplasma and it keeps a very bad prognostic. The purpose of this study is to report the epidemiological, the anatomo-clinic and and to discuss the treatment. We tell about 23 vulvar cancer from 1956 to 1995 which were followed at the cancer Institut of Dakar. The mean age of patients is 47 years and they are on menopause in 78.6%. The most of the tumors are ulcerate (96%). The clinical investigation find according the staging of FIGO: 15 tumors (T2), 8 tumors (T3), 6 tumors (N1), 9 tumors (N2) and 1 tumor (M1b). The surgery is the principal treatment with 6 radical vulvectomy and 17 palliative vulvectomy. The surgery was associated with radiotherapy and chemotherapy. So the vulvar cancer is uncommon in our country and concern the young wives. The vulvectomy with lymphadenectomy is the principal treatment; the prognostic still very bad because the diagnostic is often later.
Asunto(s)
Neoplasias de la Vulva/epidemiología , Neoplasias de la Vulva/cirugía , Adulto , Distribución por Edad , Anciano , Anciano de 80 o más Años , Braquiterapia , Quimioterapia Adyuvante , Femenino , Número de Embarazos , Humanos , Escisión del Ganglio Linfático , Persona de Mediana Edad , Estadificación de Neoplasias , Cuidados Paliativos/métodos , Paridad , Selección de Paciente , Exenteración Pélvica , Pronóstico , Radioterapia Adyuvante , Estudios Retrospectivos , Senegal/epidemiología , Tasa de Supervivencia , Resultado del Tratamiento , Neoplasias de la Vulva/patologíaRESUMEN
Through a retrospective study of 74 cancer of rectum the autors determine the epidemiology, the anatomic appearance and discuss the treatment, the prognostic. The mean age of patients was 48 years and the Duke's staging found: 16 stages B, 46 stages C and 12 stages D. The pathological anatomy showed: 58 adenocarcinoma, 9 colloïdal adenocarcinoma, 4 epidermoïdal carcinoma, 2 lymphosarcoma, 1 anaplasic adenocarcinoma. The operability rate was 66.2%, the resectability was 40.8% and the sphincteral preserving was 8.1%. The radiotherapy preceded the surgery in 6 cases and associated the chemotherapy. The chemotherapy preceded the surgery thein 14 cases and succeeded in 2 cases. The mortality was 24.4% and the recidivation 35%. The global survival 5 years was 32%. The prognostic could better by an earlier diagnostic and a multidisciplinary treatment.
Asunto(s)
Neoplasias del Recto/epidemiología , Neoplasias del Recto/terapia , Adenocarcinoma/epidemiología , Adenocarcinoma/terapia , Adolescente , Adulto , Distribución por Edad , Anciano , Anciano de 80 o más Años , Instituciones Oncológicas , Carcinoma de Células Escamosas/epidemiología , Carcinoma de Células Escamosas/terapia , Quimioterapia Adyuvante , Colostomía , Femenino , Humanos , Linfoma no Hodgkin/epidemiología , Linfoma no Hodgkin/terapia , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Exenteración Pélvica , Pronóstico , Radioterapia Adyuvante , Neoplasias del Recto/patología , Estudios Retrospectivos , Senegal/epidemiología , Distribución por Sexo , Análisis de Supervivencia , Resultado del TratamientoRESUMEN
The purpose of this study is to assess the profile of blood pressure and body mass index of children and adolescents in a rural area in Africa. It is a prospective study concerning a sample of 465 children and adolescents in the district of Thiadiaye (Senegal). The ration boys/girls was 1.02. Blood pressure was higher in girls. The prevalence of hypertension was 5.1% for the children and 1.5% for adolescents. There was no significative variation in body mass index for children whereas we were noted an augmentation with age in adolescence. The parameters of corpulence are higher in girls in adolescence. The prevalence of obesity was 3% in children and 2.4% for adolescents. There was no correlation between blood pressure and body mass index. This study show many particularities in rural area as for as blood pressure and body mas index of children and adolescent are concerned.
Asunto(s)
Presión Sanguínea , Índice de Masa Corporal , Adolescente , Niño , Femenino , Humanos , Hipertensión/epidemiología , Masculino , Obesidad/epidemiología , Prevalencia , Estudios Prospectivos , Valores de Referencia , Población Rural , SenegalRESUMEN
The objective of this article is to study the place of tobacco addiction in a rural area in Senegal. We have performed a transversal and domicillary study on a sample of adults and adolescents of the district of Thiadiaye (Senegal). The mean age of the studied population is 39 +/- 8.5 years (extremes: 12 and 100 years). The sex ratio is 0.85%. The prevalence of tobacco addict was 24.07%, 9% of the teenagers and 32% of the adults were smokers. Tobacco use was more frequent among men (89% 5%) than women (10.5%) (p < 10(-7)). The most common form was traditional tobacco: 62.1%. Cigarette was smoked in 14.4% of cases. The mean duration of tobacco use was 13 +/- -12.2 years. The mean consumption per day of traditional tobacco was 5.1 +/- 4, whereas the mean number of cigarettes per day is 12.3 +/- -7. Our study shows that tobacco occupies an important place in rural area in Senegal where coexist with traditional habits, a modern tobacco use represented by cigarette smoking.
Asunto(s)
Fumar/epidemiología , Adolescente , Adulto , Anciano , Niño , Estudios Transversales , Femenino , Hábitos , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Población Rural , Senegal/epidemiologíaRESUMEN
Authors report the results of a prospective study in a sample of the district of Thiadiaye, a rural area in Senegal. They studied blood pressure, body mass index and waist-to-hip ratio of 329 adults. The mean systolic blood pressure is 123 +/- 24.3 mm Hg and the mean diastolic blood pressure is 71.7 +/- 13.2 mm Hg. There is a positive correlation between blood pressure and age (p < 10(-9)). The prevalence of hypertension is 20.18% and one can note a female predominance (21% for women versus 18% for men). The mean body mass index is 21.1 +/- 10.6. There is no correlation between corpulence and age. Conversely, the body mass index is higher in female in all age groups (p < 10(-7)). The prevalence of obesity is 5%. Abdominal fat distribution is 41.6%: 64% for women and 9.7% for men (p = 0.003).
Asunto(s)
Hipertensión/epidemiología , Tejido Adiposo/anatomía & histología , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Antropometría , Presión Sanguínea , Constitución Corporal , Índice de Masa Corporal , Comorbilidad , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Obesidad/epidemiología , Prevalencia , Estudios Prospectivos , Valores de Referencia , Factores de Riesgo , Población Rural , Senegal/epidemiologíaRESUMEN
Postmastectomy lymphedema of the arm is frequently associated to different factors including axillary node involvement and local and regional treatment of breast cancer. Our aims was to identify risk factors of postmastectomy lymphedema. From a retrospective analysis of 735 breast cancers treated in our institute, we found 61 lymphedema of the arm. We then describe our study population and identify by univariate et multivariate analysis the factors significantly associated to the disease. The majority of the patients were young black African female found to have locally advanced breast cancers (88% of T3 et T4 UICC 1988), inflammatory diseases (46% of PEV 2 and 3 of Gustave ROUSSY Institute classification of inflammatory breast cancers). Ulceration is found in half of the patients, metastasis in 20%. The patients first underwent chemotherapy mainly with cyclophosphamide alone (56%). Only 59 patients (8%) had preoperative radiation. Surgery consisted mainly in modified radical mastectomy and lymph node dissection (95%). Residual disease is left in 50% of the cases. Only 35% had post-operative chemotherapy and 9% postoperative external beam radiation therapy. From that population, during the follow up, 61 patients were found to have postmastectomy lymphedema. The disease was asymptomatic in 60% of the cases and painful in 26%. 30% of all the patients spontaneously partially regressed. From univariate analysis we found 7 factors associated with lymphedema: The big size of the tumor (p = 0.005), clinically involved axillary lymph nodes (p = 0.001), metastatic disease (p = 0.0046), traditional or inadequate surgery out of the Institute (p = 0.001), lack of post-operative chemotherapy (p = 0.002), postoperative external beam radiations (p = 0.005), relapse (p = 0.002). From logistic regression analysis three independent factors were found: clinically involved axillary lymph nodes (p = 0.0267), metastasis (p = 0.0002) and local or regional relapse (p = 0.0405). In our practice we found that advanced disease, treated by traditional healers or surgery nurses who had relapsed after mastectomy and external beam radiations without chemotherapy have higher risks of lymphedema.
Asunto(s)
Neoplasias de la Mama/cirugía , Linfedema/etiología , Mastectomía/efectos adversos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Antineoplásicos Alquilantes , Neoplasias de la Mama/patología , Neoplasias de la Mama/terapia , Terapia Combinada , Ciclofosfamida/uso terapéutico , Femenino , Humanos , Escisión del Ganglio Linfático , Metástasis Linfática , Persona de Mediana Edad , Radioterapia/efectos adversos , Estudios Retrospectivos , Factores de RiesgoRESUMEN
The gastroomental (gastroepiploic) arterial circle of the stomach is the main vascular axis of the gastroplasty use as esophagus substitute after esophagectomy. The aim of this anatomoangiographic study is to study the anastomosis between the right and left gastroomental arteries and emphasize interest of the transillumination: an ordinary anatomic method use in surgical practice. We use forty five fresh cadaveric stomach of adult for determine the anastomotic fashion of the arterial circle of the great gastric curvature. About three models of gastric esophagoplasty we verify similarity of vascular transillumination results and we compare with the radiographic exploration. The thickness of the gastrocolic ligament in which progress the gastroomental arterial circle can lead astray for macroscopic determination of anastomotic mode. Thus the type I, II, III and IV which are of 60%, 22,2%, 13,3% and 4,4% at macroscopic observation become 64,1%, 15,4%, 15,4% and 5,1% after arteriographic analysis. Even if the submucosal arteriolar network and the rich parietal anastomosis confer at the stomach the best qualities for esophageal replacement, the multifactorial particularity of success in esophagogastroplasty require identification and preservation of the gastroomental arterial circle. The transillumination which facilitate evaluation of this arterial axis is a simple and accessible process which we advocate.
Asunto(s)
Esofagoplastia/métodos , Esófago/irrigación sanguínea , Arteria Gastroepiploica/cirugía , Cadáver , Esofagectomía/métodos , HumanosRESUMEN
Il s'agit d'une etude retrospective de 46 cas de cancers du sein survenus chez l'homme et colliges a l'institut du Cancer de Dakar de 1957 a 1999. L'age moyen des malades etait de 60;7 ans et la duree moyenne des symptomes etait de 37;5 mois. La repartition des malades selon la classification TNM de l' UICC revelait : 1T1; 1T2; 4T3; 40T4; 40N1; 1N2; SN3; 10M1 PUL; 8M1 OSS et 2M1 HEP. Le carcinome canalaire invasif representait 78;2 pour cent de l'ensemble des lesions histologiques. Nous avons realise 32 mastectomies dont 23 etaient associees a un curage axillaire. La chirurgie etait associe a une chimiotherapie dans 25 cas et a une radiotherapie dans 14 cas. Le traitement hormonal au Tamoxifene fut institue dans 7 cas. Le suivi moyen des malades etait de 24 mois. Le pronostic de ces cancers pourrait etre ameliore par une meilleure education et un diagnostic plus precoce