[Major chest wall resection for the treatment of invasive breast carcinoma: A series of 33 patients]. / Pariétectomie élargie dans le traitement du cancer du sein invasif: à propos d'une série de 33 cas.

INTRODUCTION: Breast cancer can spread to the chest wall. It is an aggressive stage of poor prognosis. We have developed a technique of major chest wall resection extended beyond the breast area in order to reduce the recurrence. PATIENTS AND METHODS: This is a retrospective single-center series of 33 patients with breast cancer spread to the chest wall without metastasis (13 patients present with primary breast cancer and 20 patients present with recurrent breast cancer) treated by major chest wall resection between January 1993 and January 2013, by the same surgeon. Analysis of the results was made by another surgeon. RESULTS: Patients aged between 27-83years with an average of 55years. The removed parts measured 350cm(2) to 1200cm(2), and the average duration of complete healing was 7.9months. The mean follow-up time was 122months (6months-240months). The 1 year survival was 84.4%, at 2years 72.6%, at 3years 69.5% and at 5 years of 66.4%. CONCLUSION: The technique of major chest wall resection is simple and reproducible. Breast cancer with chest wall extension has a poor prognosis. At the end of the study, 20 of 33 patients who benefit from this technique are still alive.

Laryngeal paraganglioma mimicking a laryngeal haemangioma.

Paraganglioma are uncommon neuroendocrine tumours arising from extra-adrenal chromaffin cells of the autonomic nervous system. In the head and neck region, these neoplasms most commonly arise from the carotid body, the vagus nerve, and the jugulotympanic area. We present the case of a 69-year-old woman who suffered from dyspnoea and dysphonia for six months. A biopsy diagnosed a laryngeal haemangioma and a resection of the tumour was performed using supraglottic pharyngolaryngectomy. Definitive histopathological examination revealed a laryngeal paraganglioma. Laryngeal paraganglioma and haemangioma must be evoked when confronted with a submucosal vascular laryngeal tumour. In such cases biopsies should be avoided. Exhaustive imaging is a key factor in the diagnosis and should include an MRI and an arteriography in order to rule out other differential diagnoses. To our knowledge this is the first case focusing on this issue.

[Breast repaired by silicone implant. Case report of necrobiosis lipoidica]. / Nécrobiose lipoïdique sur sein reconstruit par implant en silicone : à propos d'un cas.

The authors report a very rare case of necrobiosis lipoidica, histopathologically confirmed, which happened in the breast a few months following the insertion of a silicone implant (post-mastectomy reconstruction). This case raises two problems: the physiopathology (role of the silicone implant) and the treatment of this accident, resistant to current therapy.

[Preliminary results of percutaneous tracheotomies]. / Résultats préliminaires des trachéotomies percutanées.

OBJECTIVES: Percutaneous tracheotomy (PT) is an alternative to surgical tracheotomy (ST). We describe our procedure and discuss the current status of PT through a retrospective study of our first 30 cases. MATERIAL AND METHODS: Thirty patients had a PT between October 2006 and March 2008 in the intensive care units of Caen University Hospital (France). Twenty-eight were done with the Ciaglia Blue Rhino (CBR) and two with the Percutwist. Each PT was endoscopically guided. We retrospectively collected preoperative data and most of the intraoperative as well as early postoperative complications. RESULTS: No death was reported with the PT application. Twenty-two (73.3%) PTs had neither preoperative nor early postoperative complications. Eight complications were observed, half preoperative and half early postoperative. The most frequent complication was minor bleeding in three cases (10%), the most important one was the intraoperative appearance of a tracheoesophageal fistula with the CBR. DISCUSSION: The principal advantages of PT are safety attributable to simultaneous endoscopic guidance as well as shorter operative time and lower cost in comparison with the ST technique. CONCLUSION: PT is a safe and valid alternative procedure to ST. Initially performed by intensivists, it should be part of the ENT/head and neck surgeon's repertory as the upper airway specialist.

[Lipoma widened to both lobes of the parotide gland: an exceptional entity. Case report]. / Lipome étendu aux deux lobes de la glande parotide: à propos d'un cas exceptionnel.

The authors report a very rare case of lipome extended to the superficial and deep lobes of parotid gland. MRI remains the best complementary examination to direct the diagnosis; however only the surgery will bring a histological proof formal.

Israeli families immigration and intercultural issues: challenges to mental health counselors.

Israeli families who immigrate to the United States present certain sociocultural issues that need to be recognized in order to provide culturally relevant, respectful and empowering mental health counseling. Israeli families are further situated within the complex social, cultural, economic and political context of Jews in the United States, who are themselves rarely recognized as a minority group. The purpose of this article is to present some major themes observed in working with Israeli families. A brief case example and analysis are presented, along with some general guidelines for counselors working with Israeli families.

The posterolateral malleolar flap of the ankle: a distally based sural neurocutaneous flap--report of 14 cases.

The posterolateral malleolar flap is a fasciocutaneous flap designed on the principles of distally based neurocutaneous flaps. It is based distally at the level of the lateral retromalleolar gutter. Elevation of the flap involves the proximal sectioning of the sural nerve, which contributes to its vascularization by reversed flow. This is a very reliable flap, even in patients with distal arterial insufficiency. For this reason, it has emerged, in our experience, as the method of choice in the treatment of heel necrosis. Fourteen cases are reported, of which six were elderly patients.