[Risk of axillary recurrence after sentinel lymph node biopsy before neoadjuvant chemotherapy in breast cancer]. / Récidive axillaire après prélèvement du ganglion sentinelle avant chimiothérapie néoadjuvante dans le cancer du sein.

OBJECTIVES: In case of large breast cancer, neoadjuvant chemotherapy (NAC) can be performed to reduce the size of the tumor and thus perform a conservative surgery. The place of the sentinel lymph node biopsy (SLNB) in case of NAC is still debated. The main aim of this study is to assess the risk of axillary recurrence after negative SLNB before NAC. METHODS: It is a retrospective, observational and uni-centric study. We included 18 to 80-year-old patients with unilateral breast cancer requiring a NAC and with a negative SLNB before NAC. Our primary endpoint was axillary recurrence. RESULTS: Between August 2006 and October 2016, 64 patients had a negative GS performing before a NAC and did not benefit from axillary dissection after NAC. The average duration of follow-up was 37 months. During our follow-up, we did not find any cases of axillary recurrence. CONCLUSION: This study supports the reliability of lymph node status assessment using the SLNB before CNA.

Use of mesenchymal stem cells for cutaneous repair and skin substitute elaboration.

Human mesenchymal stem cells (MSCs) are a heterogeneous population of fibroblast-like cells, which are present in different locations, including bone marrow, adipose tissue, extra-foetal tissues, gingiva and dermis. MSCs, which present multipotency capacities, important expansive potential and immunotolerance properties, remain an attractive tool for tissue repair and regenerative medicine. Currently, several studies and clinical trials highlight the use of MSCs in cutaneous repair underlining that their effects are essentially due to the numerous factors that they release. MSCs are also used in skin substitute development. In this study, we will first discuss the different sources of MSCs actually available. We will then present results showing that bone marrow-derived MSCs prepared according to Good Manufacturing Practices and included in a dermal equivalent are able to promote appropriate epidermis growth and differentiation. These data demonstrate that bone marrow-derived MSCs represent a satisfactory alternative to dermal fibroblasts in order to develop skin substitute. In addition, MSCs could provide a useful alternative to sustain epidermis development and to promote wound healing.

Lanreotide Autogel 90 mg and lymphorrhea prevention after axillary node dissection in breast cancer: a phase III double blind, randomized, placebo-controlled trial.

AIM: The aim of this study was to assess the efficacy of Lanreotide Autogel 90 mg PR to prevent lymphorrhea after axillary dissection in breast cancer. METHODS: A Phase III double-blind, randomized, placebo-controlled trial was performed between April 1st, 2008, and December 31st, 2010. The primary endpoint was the lymphorrhea volume (ml) in the axillary drain during the first four postoperative days. The secondary end points were the number of days until axillary drain removal, hospital stay duration (days), lymphorrhea volume (ml) up to days 15, 30 and 180, number of cases with seroma aspiration and number of seroma aspirations, evaluation of wound, arm pain and mobility on days 15, 30 and 180. RESULTS: A total of 148 patients were recruited for the study. Altogether 145 patients were randomized and analysed on an intention-to-treat basis. On the day before surgery 73 patients received the placebo and 72 patients received lanreotide. At four postoperative days, there was a tendency towards a reduction of the lymphorrhea volume in the lanreotide group (median 292 ml, range 1-965 ml) as compared to the placebo group (median 337 ml, range 0-1230 ml), although it was not statistically significant (p = 0.18). There was no significant difference for the secondary end points. In the group with axillary dissection performed alone (n = 24), the lymphorrhea volume was shown to be significantly reduced in the lanreotide group, (p = 0.035) as compared to the placebo group. CONCLUSION: Our study did not identify any overall significant reduction of lymphorrhea on lanreotide.

[Low invasion in sentinel lymph node according to the European Working Group In Breast Screening Pathology (EWGBSP) recommendations and non sentinel invasion risk in breast cancer]. / Atteinte minime du ganglion sentinelle selon les recommandations de l'European Working Group in Breast Screening Pathology (EWGBSP) et risque d'atteinte non sentinelle dans le cancer du sein.

OBJECTIVE: Because of variability in histopathological interpretations in studies, it's difficult to elucidate the risk of non-sentinel lymph node involvement in case of sentinel node nanometastases (lesions not larger than 0.2 mm) and micrometastases (lesions not larger than 2 mm but larger than 0.2 mm) in breast cancer. In this study, we have evaluated this risk according to the European Working Group for Breast Screening Pathology (EWGBSP) recommendations. PATIENTS AND METHODS: Among patients who underwent sentinel lymph node dissection between February 2001 and April 2008 in our unit, we reviewed the files of patients who had sentinel lymph node involvement smaller than 2mm. A second interpretation of all sentinel lymph node sections was made according to the EWGBSP recommendations. Each patient had complete axillary dissection. RESULTS: Among 608 patients who had sentinel lymph node dissection for breast cancer, 72 (11.84%) had sentinel lymph node involvement smaller than 2 mm (27 pN0i+ and 45 pN1mi). The percentage of pN1mi patients who had non sentinel involvement is 8.89%. None of pN0i+ patients had non sentinel involvement. DISCUSSION AND CONCLUSION: After making a minimal sentinel lymph node involvement strict interpretation according to EWGBSP restrictive recommendations, nanometastases rate was smaller. Any non sentinel involvement was detected in case of sentinel lymph node nanometastases.

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.

[MRI evaluation of primary chemotherapy response in breast cancer]. / Evaluation par IRM de la réponse à la chimiothérapie d'induction dans les cancers du sein.

The aim of this work was to evaluate the value of contrast enhanced MRI for determination of response to neoadjuvant chemotherapy (type FEC) in breast cancer according to two parameters: size of the enhancing tumor and the maximum relative enhancement curve (MRC) in the same tumor area. Twenty women with breast cancer (15 invasive ductal carcinomas and 5 invasive lobular carcinomas) T2 (n = 8) or T3 (n = 12) were evaluated by physical examination and MRI after a minimal of three courses of FEC and prior to surgery. Data from physical examination and imaging studies were compared to histopathological findings. Physical examination estimated correctly the residual tumor size in 45% of cases and MRI in 60% with 3 false negative cases. Among evaluated patients with MRI measurable residual tumor, tumor size was underestimated in 69% of the cases and overestimated in 31% of the cases. A MRC flattening was observed in 5 cases among the patients with a partial response or clinical stable disease correlated with a poor cellular density in the microscopic findings. MRI monitoring of chemotherapy response can be useful for guiding surgery. Therefore, underestimation of the residual tumor size and false negative rate are remaining problems.

[How to avoid the uncertainties of intraoperative examination of the sentinel lymph node in breast cancer?]. / Comment éviter les aléas de l'examen extemporané du ganglion sentinelle dans le cancer du sein?

The sentinel lymph node procedure is now admitted by many teams for axillary evaluation in the early stage of breast cancer. The classical technique consists in an intraoperative examination of the sentinel lymph node under general anaesthesia during tumorectomy, deciding whether or not complete axillary lymphadenectomy must be done. Intraoperative examination seems to us to have a poor predictive value. In the case of a false positive, the surgeon would perform lymphadenectomy unnecessarily, while a false negative would mean that the patient would have to be re-operated for lymphadenectomy once the definitive results have become available. For all these reasons, we propose the detection of the sentinel lymph node under local anaesthesia and to await its definitive analysis before carrying out tumorectomy on the patient and axillary lymphadenectomy if necessary under general anesthesia. Hence, we consider that the best way to avoid the uncertainties of an intraoperative examination of the sentinel lymph node is not to carry out intraoperative examinations.

Detection of the sentinel lymph node under local anaesthesia in early-stage breast cancer: feasibility study in a series of 78 unselected patients.

AIMS: To evaluate the feasibility of excision of the sentinel lymph node under local anaesthesia in early-stage breast cancer. METHODS: Sentinel lymph node detection under local anaesthesia was carried out on all patients presenting with breast cancer at Stage T0, T1 or T2 < 3 cm and N0, M0. The lymph node was mapped using a radioisotope and patent blue dye and lymphoscintigraphy was routinely performed. No premedication was given, and local anaesthesia was carried out with xylocaine. The patients underwent tumorectomy one week later under general anaesthesia, with or without complete axillary dissection, depending on the results of the definitive histopathological examination of the sentinel lymph node. RESULTS: 78 patients underwent this procedure over a period of 20 months. The procedure was successful in 76 out of the 78 patients, with one failure in mapping and one failure in detection (detection rate = 97.4%). The mean time to detection was 21 min (range: 6-45). It was unnecessary to interrupt the procedure due to patient discomfort in any of the cases. One allergic reaction to patent blue dye was noted and required corticosteroid therapy without interruption of the procedure. The time to detection was correlated with the experience of the surgeon carrying of the procedure, the patient's body mass index and the number of labelled lymph nodes found at lymphoscintigraphy. CONCLUSION: We have shown that it is feasible to detect the sentinel lymph node under local anaesthesia in an unselected population. Using this procedure, patients can undergo surgery with the knowledge of their axillary lymph node status while at the same time avoiding the uncertainties of an intraoperative examination of the sentinel lymph node--a source of many false negatives, particularly in the event of micrometastases.

How to avoid the uncertainties of intraoperative examination of the sentinel lymph node in breast cancer?

Numerous researchers have confirmed the diagnostic relevance of the sentinel lymph node (SLN) examination in breast carcinoma. Many technical problems are analyzed which are correlated with the intraoperative examination of the SLN and its sensitivity and specificity. In order to avoid the incidence of false positive or false negative intraoperative diagnoses, the authors propose the examination of SLN under local anesthesia, awaiting its definitive analysis before carrying out tumorectomy and/or axillary lymphadenectomy.

[Treatment of uterine fibromas]. / Le traitement des fibromes utérins.

Uterine myomas are frequent tumors, but only some of them need to be treated: only when they are symptomatic. After describing the role of oestrogen and growth factors on the development, and the value of clinical examination and imaging techniques (ultrasonography, outpatient hysteroscopy without anesthesia), the authors study the various treatments. Medical treatments essentially consist of progesterone and preoperative GnRH agonists or in peri-menopause (add-back therapy). When if medical treatment fails, surgery consists of: myomectomy and hysterectomy (by abdominal, laparoscopic or vaginal routes), myolysis and hysteroscopic resection. Three cases are isolated: infertility, pregnancy and menopause associated with uterine myomata.

[Pre-therapeutic management and surveillance of menopausal hormone replacement therapy]. / Bilan pré-thérapeutique et surveillance d'un traitement substitutif de la ménopause.

Pre-therapeutic evaluation of menopausal hormone replacement therapy (HRT) requires certain measures in addition to a standard gynecological assessment. It is important to identify any possible breast or endometrial disorder which might require specific treatment or an adjustment of standard HRT. Skeletal status is assessed by history and, if necessary, by double-photon absorptiometry. Following such evaluation, absolute contra-indications are few in number, by virtue of the use of natural estradiol and non-androgenic progestogens. They essentially concern breast cancer and a thrombo-embolic history. The first follow-up visit, at three months, enables confirmation of the acceptability and efficacy of treatment and its adjustment if required. A monitoring calendar is then suggested.

[Chronic venous insufficiency: prevention and drugless therapy]. / Insuffisance veineuse chronique: prévention et thérapeutiques non médicamenteuses.

The superficial and deep venous network of patients with chronic venous insufficiency is constantly undergoing change requiring careful follow-up and adapted therapy. Prevention, whether physical or medical, is recommended at all stages of the disease. The veins must be protected from factors which worsen venous abnormalities and drugs improving venous return should be prescribed. It is essential to avoid further aggravation of chronic venous insufficiency. The treatment has two objectives. First, and most important, to diminish or alleviate global or local venous hyperpressure which can be attained by surgery or sclerotherapy of venous leaking, via the crosses or perforating veins, into the superficial network. Venous hyperpressure can also be reduced by re-establishing normal venous haemodynamics with conservative techniques included elastic support or surgical techniques including CHI-VA. Finally, the second objective is to diminish or alleviate inaesthetic varicose veins and telangiectases.

[The effect of vascular risk factors in arteriopathy of the legs in women]. / Influence des facteurs de risque vasculaire dans l'artériopathie des membres inférieurs de la femme.

Here the analysis of the results of a multicentered prospective epidemiologic study that has counted only the new cases of chronic atherosclerosis obliterans of the lower extremities. Included have been 989 patients (659 men and 330 women). Critical analysis of data allows a comparative study between the sexes. Thus, specifics of arteriopathy among women can be drawn. It appears that they are only the consequences of the fact that men and women reflect a different level of tobacco use in the two populations.

[The prevention of thromboembolic disease by physical means. Use of an external electric stimulator. Initial results obtained during hip surgery]. / Prévention de la maladie thrombo-embolique par les moyens physiques. Utilisation d'un stimulateur électrique externe. Premiers résultats obtenus dans la chirurgie de la hanche.

The authors report their preliminary results using an external electric stimulator in hip surgery. One group received electric stimulation and the control group did not. There were 75 patients in each group and each patient underwent a total hip replacement. In the non-stimulated group, there were 15 DVT's (20%) and in the stimulated group 3 (4%). These results are discussed.

[Prevention of deep venous thrombosis by physical methods. Use of an external electrical stimulator. Initial results in surgery of the hip]. / Prévention de la thrombose veineuse profonde par les moyens physiques. Utilisation d'un stimulateur électrique externe. Premiers résultats obtenus dans la chirurgie de la hanche.

The aim of this study is to demonstrate the importance of the fight against venous stasis in the prevention of post-operative deep venous thrombosis. The study is based on two perfectly matched groups of 75 patients undergoing surgery for the complete replacement of the hip. As well as the usual preventive methods, one group was given external electric stimulus of the muscles of the lower limbs during the operation, in the immediate post-operative period and for the ten days following, achieving maximum venous drainage which was virtually permanent. The results make it apparent that external electric stimulus meant that 16% of deep venous thromboses were avoided in the group on which it was used.