[Percutaneous nephrostomy in treatment of urinary tract obstructions and malformations in the child]. / Place de la néphrostomie percutanée dans le traitement des lésions urinaires obstructives et malformatives chez l'enfant.

Percutaneous nephrostomy (NP) is a routinely applied procedure in adults, but sparsely reported in the pediatric population. We report the treatment of acute obstructive renal diseases in 15 children aged one day to 6 years. The causes of obstruction included pelvi-ureteral junction stenosis (10 cases) by calculus or complicated by pyonephrosis, vesico-ureteral junction stenosis (2 cases), urethral valves and stenosis (2 cases) and one complex urogenital malformation. Catheter placement was performed under ultrasonographic guidance without immediate complication. NP should be considered as a primary preoperative modality for urinary tract obstruction in the pediatric population.

[Sentinel lymph node biopsy in breast cancer: the Lausanne experience]. / La biopsie du ganglion sentinelle en cas de cancer du sein: l'expérience Lausannoise.

A total of 40 patients (mean age 51 yrs; 36-89 yrs) with clinically T1-T2(< 3 cm)N0M0 breast cancer underwent sentinel node (SN) mapping with radioactive tracer (99mTc) injection only in 21 patients, with Patent blue V in 1 patient, or with both techniques in 19 patients. The preoperative injection of 99mTc (20-40 MBq) was followed by lymphoscintigraphy. A handheld gamma probe was used to detect the SN in the operative room. A lumpectomy and an axillary dissection were performed in all the patients. SNs could be identified in 39/40 patients, resulting in a sensitivity of 98%. Successful localization of the SNs was accomplished by isotope only in 19/20 patients, by blue dye only in 1/1 patient, and by both methods in 19/19 patients; in 2 of these 19 patients, SNs were identified by blue dye only. Axillary metastases were found in 12/40 patients (30%), the SN being the only nodal metastasis in 8/12 patients (75%). Six of these 12 patients (50%) had only evidence of micrometastasis. Negative SNs on serial sections stained with hematoxylin-eosin (H&E) were evaluated with cytokeratin immunostain (C11). In all cases of negative SNs the remaining axillary nodes were also free of tumor, resulting in a negative predictive value of 100%. We conclude that SN mapping is a highly accurate method for staging the axillary node status in breast cancer patients. Optimal localization is achieved by the combination of injection of 99mTc-colloid and blue dye as evidence by the cases of positive SN identified by only one of both methods.