Prophylactic nipple-sparing mastectomy with immediate breast reconstruction: results of a French prospective trial.

BACKGROUND: Nipple-sparing mastectomy (NSM) with immediate breast reconstruction (IBR) is used increasingly when performing a prophylactic mastectomy. Few prospective studies have reported on complication rates. This complementary trial to the French prospective multicentre MAPAM trial aimed to evaluate the nipple-areola complex (NAC) necrosis rate in prophylactic NSM with IBR. METHODS: Patient characteristics and surgical data were recorded. Morbidity after prophylactic NSM with a focus on NAC necrosis was analysed. RESULTS: Among 59 women undergoing prophylactic NSM, 19 (32 per cent) of the incisions were partly on the NAC. Reconstructions were performed with 46 definitive implants and 13 expanders. The crude rate of postoperative complications was 25 per cent (15 patients). Complete NAC necrosis was reported in two women (3 per cent) and partial or total necrosis in nine (15 per cent). No NAC resection was necessary. Median BMI was lower in women with total or partial NAC necrosis compared with the others (20.0 versus 21.3 kg/m2 respectively; P = 0.034). CONCLUSION: Results of this prospective study confirm that prophylactic NSM with IBR is associated with a low risk of total NAC necrosis.

[Extrapelvic sentinel lymph nodes in cervical cancer: a review]. / Ganglion sentinelle de localisation extra-pelvienne dans le cancer du col utérin.

OBJECTIVE: To determine the frequency of extrapelvic sentinel lymph node in patients with cervical cancer. MATERIALS AND METHODS: We performed systematic searches (Medline, Pubmed; up to April 2010) to determine the route of lymphatic spread in cervical cancer and to review results on extrapelvic sentinel lymph nodes. RESULTS: According to our search, 2.51% of detected sentinel lymph nodes in patients with cervical cancer were extrapelvic: 2% in the inguinal chain and 98% in the lower paraaortic area. DISCUSSION AND CONCLUSION: The unusual localizations of sentinel lymph nodes impose to the gynaecologic surgeons to be hardened in performing lymph node dissection in all the territories potentially affected.

[Contralateral breast outcome after breast reconstruction for carcinoma]. / Devenir du sein controlatéral après reconstruction mammaire pour carcinome.

UNLABELLED: OBJECTIF: Since the treatment of breast cancer must be followed by a rigorous surveillance of the contralateral breast, especially in breast reconstruction context, we sought to determine contralateral breast cancer frequency after breast reconstruction during the ulterior surveillance. PATIENTS AND METHODS: Retrospective cohort survey of 273 breast reconstructions led at Tours regional and university hospital. Cumulative incidence of sequential contralateral breast cancer has been evaluated. RESULTS: For 6.6 follow-up, the prevalence was 1.8% and cumulated incidence at 4.6 ‰ person/years. DISCUSSION AND CONCLUSION: The probability of localization to contralateral breast after a primitive tumor of the breast is raised. The diagnosis of a sequential cancer must not be delayed by mammaplasty scars overhauls.

[Small cell carcinoma of the ovary of the hypercalcemic type revealed by a severe acute pancreatitis: about one case]. / Carcinome à petites cellules de l'ovaire hypercalcémiant révélé par un épisode de pancréatite aiguë: à propos d'un cas.

Small cell carcinoma of the ovary of the hypercalcemic type is a rare tumour, usually lethal and occurring almost exclusively in young patients. In the majority of described cases, signs of this lesion were revealed by the associated hypercalcemia or by virtue of the physical tumour bulk alone. We report the first case of ovarian small cell carcinoma of the hypercalcemic revealed by a severe acute pancreatitis in a 19-year-old patient.

[Symptomatic bladder or ureteral endometriosis: report of 8 cases and review of the literature]. / Endométriose vésicale ou urétérale, symptomatique: à propos de 8 cas et revue de la littérature.

OBJECTIVES: The aim of this study was to determine the symptoms of bladder and ureteral endometriosis and to review the treatment approaches. MATERIALS AND METHODS: We conducted a retrospective studyover the period November 1989-July 2000. We reviewed the medical data of all women with bladder or utereral endometriosis who underwent a major surgery (ureteral reimplementation on psoas bladder, partial resection of the ureter, partial cystectomy). RESULTS: Eight women met the defined selection criterion, three with bladder injuryand five with ureteral injury. The only adverse postoperative complication was a passive ureteral reflux following ureteral reimplementation on psoas bladder. No recurrence on the urinary tract were reported. CONCLUSION: Surgical treatment is indicated for patient suffering from symptomatic bladder or ureteral endometriosis. Isolated bladder injuries due to endometriosis are mostly treated by laparoscopic surgery. Ureteral endometriosis may deteriorate the renal function. The initial step of the treatment may include an uterolysis by coelioscopy or an ureteral dilatation by ureteroscopy together with a medical treatment. The renal function must be closely monitored. In case of persistent or recurrent endometriosis, an ureteral resection would be justified.