Is it always necessary to perform an axillary lymph node dissection after neoadjuvant chemotherapy for breast cancer?

INTRODUCTION: Recent prospective studies support the feasibility of performing sentinel lymph node biopsy following neoadjuvant chemotherapy in initially fine-needle aspiration cytology or ultrasound-guided biopsy-proven node-positive breast cancer. The main aid is to identify preoperative features that help us predict a complete axillary response to neoadjuvant chemotherapy in these patients and thus select the candidates for sentinel lymph node biopsy post-neoadjuvant chemotherapy to avoid unnecessary axillary lymphadenectomy. MATERIALS AND METHODS: A retrospective observational study with a total of 150 patients, biopsy-proven node-positive breast cancer who underwent neoadjuvant chemotherapy followed by breast surgery and axillary lymphadenectomy were included and retrospectively analysed. A predictive model was generated by a multivariate logistic regression analysis for pathological complete response-dependent variable. RESULTS: The response of the primary lesion to neoadjuvant chemotherapy according to post-treatment magnetic resonance imaging, Her2/neu overexpression and a low estrogen receptor expression are associated with a higher rate of nodal pathologically complete response. The multivariant model generated a receiver operating characteristic curve with an area under the curve of 0.79 and a confidence interval of 0.72-0.87 at a 95% level of significance. CONCLUSIONS: This model could be a helpful tool for the surgeon to help in predicting which cases have a higher likelihood of achieving a pathologically complete response and therefore selecting those who may benefit from a post-neoadjuvant chemotherapy sentinel lymph node biopsy and avoid unnecessary axillary lymphadenectomy.

Supraselective embolization in intractable epistaxis: review of 45 cases.

Epistaxis is a common and in most cases benign event. Severe or recurrent epistaxis, however, can present therapeutic problems. Forty-five cases of supraselective embolization in intractable epistaxis are reported. The authors' success rate of 97%, similar to the success rates reported in the literature, confirms the effectiveness of this technique. Complications occurred in only 8% of the cases. One serious complication was neurologic. Percutaneous embolization is an effective option for managing intractable posterior nasal bleeding but is not recommended as an early form of treatment.

The recurrent laryngeal nerve: related vascular anatomy.

This study was based on 34 recurrent laryngeal nerve dissections after arterial casting with red-colored latex. The aim was to provide specific information about the perineural microvasculature. This study established the following points: 1. a great anatomic variability does exist; 2. the laryngeal nerve is usually in relation to the posterior branch of the inferior thyroid artery; and 3. this vascular branch is sometimes replaced with a vascular network. In all cases, this microvascularization must be preserved during thyroid surgery.

Facial nerve: vascular-related anatomy at the stylomastoid foramen.

We dissected 30 facial nerves in fresh cadavers after arterial casting with red latex to provide specific information about the arterial-related anatomy of the trunk of the facial nerve from the stylomastoid foramen to its bifurcation. We found that a wide anatomic variability does exist. The trunk of the facial nerve was in proximity to the stylomastoid artery, which originated from the posterior auricular artery in 70% of the specimens (21/30), from the occipital artery in 20% (6/30), and directly from the external carotid artery in 10% (3/30). The stylomastoid artery passed medially to the trunk of the facial nerve in 63 of the specimens (19/30) and laterally in 37% (11/30). Among these 11 specimens, 8 were large-caliber stylomastoid arteries. During parotid surgery, the main trunk of the facial nerve may be difficult to identify, because a large-caliber stylomastoid artery can mask it. Therefore, it is important to dissect this artery with caution.

Alagille syndrome with cavernous carotid artery aneurysm.

We present a case of right sided blindness caused by a cavernous carotid artery aneurysm in a 17-year-old patient presenting with an Alagille syndrome. The diagnosis was made by magnetic resonance imaging and confirmed by angiography. This aneurysm was treated successfully with endovascular placement of detachable balloons. Cerebral vascular malformations are rarely reported in association with this syndrome. We discuss the clinical presentation, diagnosis, treatment and detection of this type of abnormality.

[Detection of rubella specific IgM on gel filtration through Sephadex G 200: use of dithiothreitol and limits with MnCl2-heparine pretreatment (author's transl)]. / Détermination des anticorps rubéoliques de classe IgM par gel-filtration sur Sephadex G 200. Utilisation du dithiothréitol et limites du traitement à l'héparine-chlorure de manganèse.

The detection of rubella haemagglutination inhibiting antibody, in the IgM fraction of the serum, on gel filtration through Sephadex G 200, needs precautions to exclude false results. Treatment with dithiothreitol is a satisfactory method for confirming the content of rubella IgM antibody. The failure of MnCl2-heparin pretreatment to remove non specific inhibitors of rubella hemagglutinin is unfrequent (7/108) and so do be repeated. Rarely (1/108) aggregated IgG fractionates with IgM and yield false positive results.

[Cervical chemodectoma disclosed by coma. Pathogenic hypotheses]. / Chémodectome cervical se révélant par un coma. Hypothèses pathogéniques.

The authors reported a case of cervical paraganglioma. Patient had a coma suggesting secretary activity of the lesion or cerebral venous thrombosis. Angiography showed an hypervascular lesion characterized by venous reflux into the contro-lateral sinus. After neurological stabilization by tumor embolization, the tumor was surgically removed.

[Primary meningioma of the maxillary sinus. Apropos of a case]. / Méningiome primitif du sinus maxillaire. A propos d'une observation.

A case report concerning a left primary maxillary meningioma is presented. Clinical, conventional radiographic and CT signs are presented. The diagnosis was made after histologic examination of the specimen. The pathogenesis is discussed.

[Severe laryngeal injury due to a nasogastric tube]. / Lésion sévère du larynx provoquée par une sonde nasogastrique.

We report the case of a 71-year-old woman where nasogastric tube provoked a severe laryngeal injury, revealed by acute respiratory distress. Direct laryngoscopic findings included arytenoid edema, postcricoid ulceration and bilateral vocal cord paralysis in adduction. A tracheotomy was performed. Several months later, no improvement was noted because of a cricoid necrosis. Physiopathology, prophylaxis and management are discussed.

[Eosinophilic granuloma of the ear. General review apropos of 2 case reports]. / Granulome ésoinophile de l'oreille. Revue générale à propos de deux observations.

The eosinophilic granuloma is part of the histiocytosis X classification, having a common histological substratum, the granuloma, which is characterized by a proliferation of histiocytes (reticulo-endothelial cells) and a cytoplasmic inclusion body (the X body) whose étiopathogenic significance is not yet established. These histiocytes are accompanied by other cells and in particular granulocytes, the majority of which are eosinophils. Histiocyte proliferation leads to a destruction of bone which is the organ preferentially affected. At first there is osteolysis (this explains the lacunar aspects seen radiologically) followed by sclerosis. The clinical classification established by Lichtenstein in 1953 outlines the tissue form (eosinophil granuloma), the acute disseminated form (Letterersive) and the chronic disseminated form (Hand-Schüller-Christian). This classification is still accepted today but it needs to be refined to include the transitionary forms, and solitary bone granulomas whose long terme evolutive nature it is impossible to measure clinically, biologically, or histologically. From our observation we note that therapy (surgery, radiotherapy, chemotherapy) is effective in controlling the acute growth spurts in a majority of the cases but does not seem to effect the potential long terme evolution.

[Radiological examination of the temporo-mandibular joint. Basic principles (author's transl)]. / L'examen radiologique de l'articulation temporo-mandibulaire. Principes fondamentaux.

Radiological examination of the temporo-mandibular joint remains technically difficult. Standard views using usual X-ray techniques are inadequate. Preference must be given to selective tomography (sagittal, frontal or even axial) after determination of the axis of the condyles on a Hirtz position film. In certain cases, arthrography may also make it possible to define the contours of joint surfaces not seen on plain films. Radiocinematography is little used.

[Arterial vascularization of the nasal fossae]. / La vascularisation artérielle des fosses nasales.

An anatomical and neuroradiologic study was conducted to define arterial irrigation of the nasal fossae, the topography of the different vascular territories, particularly that supplied by territories, particularly that supplied by the internal maxillary artery which is by far the most important, and the anastomoses of the different endo- and extra-nasal internal and external carotid systems.

[Embolization of the internal maxillary artery in severe essential epistaxis]. / L'embolisation de l'artère maxillaire interne dans les épistaxis essentielles graves.

Selective embolization of the distal branches of the internal maxillary artery was performed to treat severe essential epistaxis in 11 patients. Elective indications for this technique are elderly patients with profuse epistaxis.

[Unilateral endonasal approach to hypophyseal adenomas]. / Abord endonasal unilatéral des adénomes hypophysaires.

The endonasal approach for transsphenoidal hypophysectomy is a simple technique for exposing the floor of the sella turcica. In our institution we have operated 162 patients (64 microadenomas and 98 macroadenomas), over a ten-year period, by using that approach. The floor of the sella turcica is exposed through an incision performed posteriorly to the nostril at the junction of cartilaginous and bony septum. Postoperative rhinological complications are less frequently observed after unilateral endonasal approach than after sublabial one, and it is more comfortable for the patient. The morbidity of unilateral endonasal transsphenoidal approach is comparable to that of other series.

[Thyroid metastases of digestive carcinomas (author's transl)]. / Métastases thyroïdiennes des cancers digestifs.

The authors report a case of thyroid metastasis of a rectal carcinoma 9 years after excision of the primary tumour. They study the prevalence of thyroid secondary localisations of the chief primary tumours responsible, the time before appearance of the metastasis, and clinical and histological features on the basis of cases reported in the literature. They then describe the pathogenic factors and criteria in prognosis which is always grave, as a result of the dissemination of metastases.

[Head and neck desmoid tumor in children: a case report and review of the literature]. / Tumeur desmoïde cervico-faciale de l'enfant. A propos d'un cas et revue de la littérature.

We report a case of desmoid tumor in the submandibular region in an 18-month-old girl. Head and neck desmoid tumors are uncommon in children and diagnosis is a difficult task because the tumors are often classified as different types of fibromatosis. This histologically benign affection is characterized by local expansion or destruction and tends to recur. Pathology gives the positive diagnosis, showing fibroblastic monoclonal proliferation between the cellular center and the collagen periphery. Electron microscopy evidences an abundant collagen network enclosing a polymorphous cellular proliferation. Immunohistochemistry defines vimentin and actin positive desmoid tumors. Surgery is usually the therapeutic choice. Chemotherapy and radiotherapy may be used in conjunction with surgery in situations of recurrence or unsatisfactory surgical margin. There is a risk of recurrence which can be detected with regular follow-up examinations.

[Temporal fibrous dysplasia with labyrinthine involvement. Apropos of a case and review of the literature]. / Dysplasie fibreuse temporale avec atteinte labyrinthique. A propos d'un cas et revue de la littérature.

Craniofacial fibrous dysplasia manifests clinically with dysmorphic syndrome, ophtalmologic or otologic signs. We report a case of temporal polyostotic fibrous dysplasia with vertigo and sensorineural hearing loss. Sensorineural hearing loss, with no cholesteatoma associated, as described in our case is rarely described. We review the literature concerning main clinical, diagnostic and therapeutic aspects of this disease.

[Chondromas and low-grade chondrosarcomas of the larynx: a case report]. / Chondromes et chondrosarcomes de bas grade du larynx. A propos d'un cas.

OBJECTIVE: We report a case of cricoid chondroma, underlining the difficulty in establishing a precise differential diagnosis between chondroma and low-grade chondrosarcoma of the larynx. MATERIAL AND METHODS: A 48-year-old woman developed inspiratory dyspnea. The final diagnosis was cricoid chondroma. We reviewed our case and data in the literature on these cartilaginous tumors. RESULTS: The patient was treated with conservative surgery. At 18 months follow-up, no recurrence has been detected. DISCUSSION: These tumors are rarely found in an ENT location and have similar histological features. According to many authors, the clinical course alone enables a distinction between chondroma and low-grade chondrosarcoma. Surgical treatment is indicated and provides good phonatory function in the vast majority of the cases.

[Parathyroid cysts]. / Les kystes parathyroïdiens.

Two cases of parathyroid cysts are described. One cyst was symptomatic, the other was discovered while performing thyroidectomy. In both cases, the cysts were non-functional. There have been reports of functional cysts occurring in a lesser proportion and causing primary hyperthyroidism. These benign cysts are rare (300 cases reported in the literature). Surgery is the treatment of choice in most cases.

[Bronchial foreign bodies in children]. / Corps étrangers intra-bronchiques de l'enfant.

BACKGROUND: Tracheobronchial aspiration of foreign bodies in children is a rare event that can be serious. We report a 10-year retrospective study of tracheobronchial foreign body aspiration in children. METHOD: This retrospective analysis involved 87 patients who underwent endoscopy at the ENT unit of the Caen University Hospital. RESULTS: Foreign bodies were found in 34 of the 87 patients. Average age was 3 years, with a male predominance. Peanuts were the most common foreign bodies observed (16/34). Most of the foreign bodies were removed via the right main bronchus (17/34). Clinical and radiological signs depended on delay to admission and were found to be normal in 15% and 37.5% of the cases respectively. Twenty-four children out of 34 had a positive history of foreign body inhalation. All foreign bodies were removed during the endoscopy procedure. CONCLUSION: This work underlines the much-debated function of chest x-ray, the need for a rigorous technically correct endoscopy procedure and the importance of close cooperation between the anesthesiologist and the endoscopist.