First report of a necrotising fasciitis of the breast following a core needle biopsy.

Necrotising fasciitis (NF) is the most aggressive form of soft tissue infection. We report the first case of NF of the breast following a core needle biopsy. Aggressive management including surgical debridement and vacuum therapy allowed wound healing and breast conservation.

[Calculous renal failure and pregnancy]. / Insuffisance rénale lithiasique et grossesse.

Obstructive renal failure is a rare but serious complication of pregnancy. Although most cases are due to extrinsic compression, renal tract obstruction can also be due to intraluminal precipitation of sulfadiazine prescribed for maternofoetal toxoplasmosis. The diagnosis is suggested by clinical history, ultrasound (radiolucent stones situated anywhere in the renal tract) and especially analysis of the urine pellet (wheat sheaf formation of yellowish crystals). Urinary drainage by double J stent or percutaneous nephrotomy is indicated in the absence of clinical improvement in response to symptomatic treatment and adequate alkaline rehydration. The risk of sulfadiazine crystallization must be systematically prevented by a sufficient water intake and urinary alkalinization right from the start of treatment.

[Efficacy of suburethral TVT in cases of stress urinary incontinence associated with severe sphincter insufficiency. Report of 22 cases]. / Efficacité de la bandelette sous urétrale TVT en cas d'incontinence urinaire d'effort associée à une insuffisance sphinctérienne sévère. A propos de 22 cas.

INTRODUCTION: The TVT system has revolutionized the management of female stress urinary incontinence (SUI). Less favourable results have been observed in patients with urinary incontinence associated with a low maximum urethral closing pressure (MUCP). The objective of this prospective study was to evaluate the efficacy of TVT in this situation. MATERIAL AND METHODS: From October 1999 to June 2001, 22 patients between the ages of 53 and 84 years (median: 66.7 years) were operated for SUI with an MUCP < 25 cm H2O (mean: 17.6 cm H2O, range: 6 to 22 cm H2O) present for more than 8 months (range: 8 to 48 months). Three patients also had associated urgency. The Ulmstem manoeuvre was positive in every case and the Bonney manoeuvre was positive in 19 patients. Insertion of TVT was associated with sacral colpopexy in two patients. Success of treatment was defined by complete absence of incontinence and voiding disorders after the operation. RESULTS: One patient was lost to follow-up. The median follow-up was 7.5 months (range: 3 to 27 months). The mean duration of bladder catheterization was 1.3 days (range: 1 to 5 days). Fifteen patients were completely cured by TVT (71.4%). In these cases, uroflowmetry and post-voiding volume were not affected by the operation. Treatment was ineffective in 6 patients (4 cases of uncontrolled leaks, one case of de novo urge incontinence, one case of postoperative dysuria with a post-voiding residue of 120 ml). CONCLUSION: The TVT system appears to be an effective method for the treatment of most patients with SUI associated with severe manometric sphincter incompetence. However, these favourable results need to be confirmed by a longer follow-up.

[Prostate cancer and acute disseminated intravascular coagulation. Therapeutic management based on three cases]. / Cancer de la prostate et coagulation intra vasculaire disséminée aiguë. Prise en charge thérapeutique: à propos de trois cas.

Acute DIC is a rare, but life-threatening complication of metastatic prostate cancer. The authors discuss the treatment modalities in the light of three cases and a review of the recent literature. The key to treatment of DIC is treatment anti of the tumour. Androgen blockade is indicated in hormone-dependent tumours. This treatment can sometimes be completed by low-dose oral anticoagulants. Chemotherapy is the treatment of choice of acute DIC during the hormone resistance phase.

Comparative study of the accuracy of breast resection in oncoplastic surgery and quadrantectomy in breast cancer.

BACKGROUND: The aim of this study was to determine whether oncoplastic surgery ensures accurate tumor resection and reduces the need for further surgery in comparison with standard quadrantectomies. METHODS: This was a prospective comparative study of 74 patients with breast tumor diameter >or=15 mm. The principal criterion for case selection was breast size that allowed either quadrantectomy or oncoplastic surgery to be scheduled. The following were recorded and compared between groups: the size of the glandular resection, the width of the nearest margins, the ratio of clear margins, and the need for further surgery. RESULTS: The patients who underwent oncoplastic surgery were younger than those who had quadrantectomy. All other demographic and oncological preoperative data were comparable. The median volume of the excised specimen in the oncoplastic group was higher than in the quadrantectomy group. The nearest lateral margin widths were larger in the oncoplastic group than in the quadrantectomy group. Free surgical margins >or=5 mm and >or=10 mm were obtained more frequently using oncoplastic surgery than standard quadrantectomy. However, the need for fewer secondary surgeries was not demonstrated in our study. CONCLUSIONS: Oncoplastic surgery achieves more accurate tumor resection than standard quadrantectomy. This approach might be useful in extending the indications for conservative therapy.