Two outbreaks of botulism associated with consumption of green olive paste, France, September 2011.

Two family outbreaks of botulism (a total of nine cases) were identified in south-east and northern France in early September 2011. The source of infection was considered to be a ground green olive paste. Botulinum type A toxin was identified in seven cases and in the incriminated olive paste. Incorrect sterilisation techniques were observed at the artisanal producer's workshop. These episodes highlight the potential public health threat of Clostridium botulinum linked to inadequate sterilisation of food products.

[Clinically occult invasive cancers of the breast. Apropos of 136 cases]. / Cancers infracliniques invasifs du sein. A propos de 136 cas.

Between 1978 and 1991, one hundred and thirty-six surgical excision biopsies were performed in our institution for clinically occult breast cancers. A retrospective analysis of histopathologic characteristics was carried out in order to determine the prognostic factors of these cancers detected by mammography. Mammographic findings consisted of microcalcifications alone (49 cases), microcalcifications with opacity (20 cases), stellate opacity (52 cases) and well-circumscribed opacity (12 cases). Preoperative localization was achieved by mammography in 109 cases and ultrasonography in 27 cases. The size of malignant lesions ranged from 3 to 25 mm, 76 lesions were less than 10 mm in diameter. The histopathologic findings were as follows: invasive ductal cancer (IDC) 113 cases (83%), invasive lobular cancer (ILC) 11 cases (8%), ductal or lobular cancer in situ with microinvasion 12 cases (9%). Breast conserving treatment was performed in 106 cases (78%). A high proportion of well differentiated tumors was encountered-59 grade I (52%) were identified out of 113 IDC-and the incidence of axillary node metastases was less than 10%. Clinically occult breast cancers seem to exhibit favorable prognostic factors.

[Laparoscopic hysterectomy. Results in 44 cases]. / Hystérectomie per-coelioscopique. Résultats d'une série de 44 cas.

Laparoscopic hysterectomy is a recent procedure. We present our preliminary results about 44 patients. In 77.3% of cases (34 patients) the operation was carried out completely by laparoscopy and 10 patients (22.7%) required conversion of the laparoscopy to a standard laparotomy. The indications for laparotomy were: hemostasis difficulties (6 cases); bladder injury (1 case); inability to expose the uterine pedicles and or the ureter (3 cases). Three post-operative complications occurred: one small bowel occlusion which was explored by laparoscopy, and two infection treated by antibiotics only. These preliminary results enable us: to affirm that laparoscopic hysterectomy is feasibility without an important risk of per and or post-operative complications. to specify the four situations in which laparoscopic surgery is particularly advantageous for hysterectomy: absence of genital prolapse; when uni or bilateral adnexectomy is required; previous past-history of abdomino-pelvic surgery, salpingitis, endometriosis ...; neoplastic pathologies (lymphadenectomy); to propose a laparoscopic hysterectomy classification.

[Post-menopausal endometriosis developed during tamoxifen treatment]. / Endométriose post-ménopausique développée sous tamoxifène.

The authors report a case of endometriosis (adenomyosis + endometrioma) which occurred in a female patient aged 69 years, who had undergone the menopause 15 years previously and who had been taking Tamoxifen for 7 years as an adjuvant treatment for cancer of the breast. Tamoxifen, a non-steroidal anti-estrogen derived from diethylstilbestrol, has a variable antagonist/agonist so that estrogenic stimulation of the female genital tract may occur, particularly of the endometrial mucosa. The reactivation of the endometriosic foci which had become quiescent under the impact of the natural menopause, which, by iatrogenic analogy is included in the series of paradoxical uterine effects of tamoxifen.