Axillary recurrence after negative sentinel lymph node biopsy under local anesthesia in breast cancer.

UNLABELLED: The procedure known as sentinel lymph node biopsy (SLNB) under local anesthesia (LA) allows surgical teams to avoid the uncertainties of frozen tissue examination and to perform axillary dissection on patients who have been informed of the risks of lymph node invasion prior to the procedure. OBJECTIVE: In the absence of studies that assess the risk of obtaining false negatives during SLNB under LA, we believed it would be relevant to do a study of the safety of SLNB under LA to ensure that the risk of axillary recurrence is as low as with SLNB carried out in the traditional manner under general anesthesia. Through the experience of the Department of Gynecological Surgery at the Limoges CHU, we were able to assess the risk of axillary recurrence after SLNB under LA. MATERIALS AND METHODS: Between July 2001 and November 2008, 319 SLNB under LA was performed in cases of invasive breast cancer. Axillary dissection was done in 125 cases. In total, 194 patients underwent SLNB with no lymph node invasion and without additional axillary dissection. Follow-up was monitored until May 30, 2008. RESULTS: With a median follow-up period of 39.5 months, there were no patients with axillary recurrence. We recorded 6 local recurrences and 3 distant metastases. CONCLUSION: With an experienced team, SLNB under LA is a procedure that does not expose patients to a greater risk of axillary recurrence than SLNB carried out in the traditional manner under general anesthesia.

[Adrenal metastasis: survival following surgical resection]. / Métastase surranélienne: survie après chirurgie d'exérèse.

GOAL: This study aims to determine the post-surgical survival after resection of adrenal metastasis from extra-adrenal primary cancers. PATIENTS AND METHODS: A retrospective study of sixteen patients undergoing surgery for adrenal metastasis between 1995 and 2005 analyzed age, type of primary cancer, interval to detection of adrenal metastasis, type of surgery performed, and survival (Kaplan-Meier curve). RESULTS: The study included 10 men and 6 women with a mean age of 55.5 years (25-74). Adrenal metastasis causes no clinical signs or symptoms. Diagnosis was made on the basis of CT scan in 12 cases and PET scan in 4 cases. The primary cancer site was lung (6), kidney (3), melanoma (2), colorectum (2), esophagus (1), pancreas (1), and B-cell lymphoma (1). Metastasis was confined to the adrenal in 7 cases and associated with other-site metastasis in 9. The interval from diagnosis of the primary cancer to detection of the adrenal metastasis ranged from 9 months to 11 years. Surgery consisted of radical resection in 5 cases, metastasectomy in 10 cases, and biopsy in one case. The overall survival was 12 months (range 2-120 months); when the diagnosis of the metastasis was synchronous with that of the primary, survival was just 8 months. CONCLUSION: The survival after surgery for adrenal metastasis is poor; it is even more dismal when the metastasis is diagnosed synchronously with the primary tumor. Surgical management depends on the primary neoplasm and the extent of metastases.

[Gynandroblastoma: a rare ovarian tumour. Case report]. / Gynandroblastome: une tumeur rare de l'ovaire. A propos d'un cas.

Gynandroblastoma is an extremely rare sex cord-stromal ovarian tumor. Only thirty cases have been published in the literature up to now. Clinical investigations include virilism associated with menstrual irregularity, or amenorrhea. The surgical treatment is salpingo-oophorectomy and lymphadenectomy if malignant spread is suspected.

[Practicability of the vaginal prolapse surgery in the elderly woman]. / Faisabilité de la chirurgie vaginale du prolapsus chez la patiente très âgée.

OBJECTIVE: To evaluate the vaginal prolapse cure in the elderly woman. PATIENTS AND METHODS: A retrospective study is carried out on 38 patients of more than 80 years, operated for a vaginal genital prolapse cure between November 1997 and October 2004. The patients' general state of health, the type of analgesia, the operative type and time, the per- and postoperative complications and the evolution of the patients one month after the intervention, had been assessed. RESULTS: The average age of the patients was 84.2 (80-95). The patients' general state of health, according to the ASA classification was about 55.3% ASA II, and about 44.7% ASA III. The anaesthesia was general in 92.1% and spinal in 7.9%. The operating type was vaginal hysterectomy associated to a Marion-Kelly and a posterior perineorrhaphy in 68.4%; and a simple vaginal hysterectomy, associated more or less to the installation of a TVT in 13.1%; an intervention of Lefort, a case of Richter and a case of simple colpectomy in 10.5%. The average operative time is about 43 minutes. The peroperative complications can be summed up in a conversion in laparotomy due to haemorrhage, and a case of ligation of the right urethra. The transfer in an intensive care unit during 24 hours is necessary only for one case in 38. The postoperative complications are in one case death at eleventh day as a result of a pulmonary embolism, and a case of temporospatial disorientation and a prolapse relapse at 6 months. The duration of stay in hospital is about 7 days (2-18). The surgery did not affect the autonomy of the patients at one month. DISCUSSION AND CONCLUSION: Vaginal prolapse concerning the elderly woman is workable in quite common practice; it involves a good cooperation between anaesthetist and surgeon. The vital risk is really present but relative. This functional surgery must not be delayed by the installation of a pessary which must be used only for the inoperable patients.

Lobular capillary haemangioma of the nasal cavity: observation of three specific cases.

Lobular Capillary Haemangioma of the nasal cavity: Observation of three specific cases. Lobular Capillary Haemangioma, unproperly called "Pyogenic granuloma", is a benign vascular tumour pedunculated on the skin and on mucous membranes of the oral and nasal cavities. Microtrauma and pregnancy are the most often evocated aetiologic factors. Epistaxis and nasal obstruction are the most marked symptoms of this irregular and friable mass. We report three cases (two adult and one paediatric) of this pathology. Two have as trigger factor a nasal microtrauma, the third an oestro-progestative impregnation. A clinical, radiological and histological description allows us to expose the characteristics of this lesion that remains obscure to many rhinologists. Lobular Capillary Haemangioma has to be evocated in the differential diagnosis of each haemorrhagic endonasal mass.

Treatment and clinical management of recurrent knee empyema due to methicillin-resistant Staphylococcus aureus (MRSA) after total knee replacement.

We describe a patient with recurrent knee empyema and associated complications caused by methicillin-resistant Staphylococcus aureus (MRSA) after total knee replacement and the difficulties and limited options in its clinical management.