Gastric metastasis of breast cancer: a single centre retrospective study.

BACKGROUND: Digestive metastasis of breast cancer are rare but when they do occur the stomach is one of the commoner sites. AIM: To describe the clinical, endoscopic, pathological features and treatment. METHODS: 35 cases of gastric metastasis were identified retrospectively between 1980 and 2008. RESULTS: The location of the gastric metastasis was fundus (n=15, 43%), antrum (n=15, 43%) or both (n=5, 14%). The histological subtype of primary breast cancer was invasive lobular carcinoma in 34 patients (97%). Hormonal receptors were positive in 19 out of 24 cases (79%), two out of 22 analysed were HER2 positive (9%). There were 16 (46%) patients with peritoneal carcinosis. The treatment was chemotherapy (n=13, 37%), hormonotherapy (n=2, 6%) or both (n=13, 37%). The 2-year survival rate after gastric metastasis diagnosis was 53% with a median follow up of 31 months [7-84 months]. CONCLUSION: Ninety-seven percent of gastric metastasis from breast cancers are derived from invasive lobular carcinoma. Seventy-nine percent of these are HER+ and comparison with the original histopathological slides of primary breast carcinoma should be performed to differentiate gastric metastasis from primary gastric carcinoma. Peritoneal carcinomatosis accompanied gastric metastasis in almost half the cases in this series and treatment was generally chemotherapy.

Treatment of a ballistic wound of the common carotid artery revealed by a spontaneous carotid-jugular fistula.

The case reported is of a 30-year-old patient with a left internal carotid-jugular fistula secondary to the explosion of an improvised explosive device during the Afghan war. Carotid resection with arterial bypass using a venous allograft and internal jugular ligation were performed by left cervicotomy associated with sternotomy at a specialized center. The management of cervical arteriovenous fistulas that occur as a result of penetrating trauma faced during the war must be considered and it should be noted that, on battlefields, treatment is not always performed in specialized units.

Carotid artery resection and reconstruction with superficial femoral artery transplantation: a case report.

INTRODUCTION: Managing advanced head and neck cancer is often a difficult task, particularly when massive invasion of the carotid artery is present. However, en bloc resection can be a curative procedure, and reconstruction of the carotid artery limits the risk for stroke. The aim of this study was to describe the interest, indication, potential risks, and methods by which we carried out resections as well as reconstructions of the carotid artery using superficial femoral artery transplantation. SUBJECTS AND METHODS: We presented one case of en bloc resection of the carotid artery with reconstruction with superficial femoral artery transplantation. RESULTS: Postoperative care was uneventful. The patient did not suffer from neurological deficiency. After three years of follow-up, the patient survived without any cancer recurrence. CONCLUSION: The occurrence of massive cancer invasion into the carotid artery should not be a contraindication for surgery. En bloc resection of the carotid artery with revascularization using the superficial femoral artery allows for appropriate control of the cancer, and carries an acceptable level of neurological risk.

Cerebral monitoring of somatosensory evoked potentials during carotid surgery: a review of 100 cases.

The purpose of this study was to evaluate immediate and middle-term results of surgical carotid artery revascularization (CAR) with cerebral monitoring of intraoperative somatosensory evoked potentials (SEPs). Between 1998 and 2004, a total of 100 CARs in 86 patients were performed under general anesthesia with SEP monitoring. A shunt was inserted if SEP amplitude decreased by 50% or latency time increased by 10%. Immediate and middle-term results were analyzed retrospectively. The shunt insertion rate was 5%. Two transient ischemic attacks were observed, and one patient died postoperatively due to myocardial infarction. The cumulative stroke and death rate was 1% at 30 days. Intraoperative SEP monitoring with selective shunt placement can be used safely for carotid surgery. Randomized studies will be necessary to determine the respective indications for various cerebral monitoring techniques.

[Accelerated atheroma with prednisone and clopidogrel]. / Athérome accéléré lors d'un traitement par prednisone et clopidogrel.

INTRODUCTION: Several mechanisms may explain the aggravation of atheroma lesions in patients receiving corticosteroid treatments. CASE: This 68-year-old man, a smoker with high cholesterol levels and a history of two transient ischemic attacks, also had severe Horton disease (giant cell arteritis) requiring treatment by corticosteroids and azathioprine. After a new transient ischemic accident, clopidogrel treatment was initiated. Ten months later, severe carotid stenosis was observed. Endarterectomy removed a recent thrombus and the pathology examination showed necrotic lesions complicated by hemorrhage with inflammatory infiltrate. DISCUSSIONS: This patient's atheromatous disease was aggravated by intraplaque hemorrhage, caused by several factors include his corticosteroid therapy and platelet aggregation inhibition treatment.

[Echoendoscopic ultrasound/fine needle aspiration of an hepatic cystadenoma]. / Ponction sous échoendoscopie d'un cystadénome hépatique.

The diagnosis of hepatic cystadenoma is difficult with the conventional radiologic imaging. When these hepatobiliary cystic tumors are located in the left liver, Echoendoscopic ultrasound/Fine needle aspiration can help in the diagnosis by showing high levels of cystic CEA and CA 19-9 in a mucinous fluid. Definitive histological evaluation is assessed by the examination of the operative specimen.

[Urologic presentation of acute appendicitis: a frequent cause of delayed diagnosis, including in HIV infected patients]. / Présentation urinaire d'une appendicite aiguë: une cause fréquente de retard diagnostique, également chez le sujet infecté par le virus de l'immunodéficience humaine.

Acute appendicitis rarely presents in the form or urinary tract symptoms. Atypical forms of acute appendicitis occur more frequently in subjects infected by the human immunodeficiency virus (HIV). The authors report a case of acute appendicitis in an HIV-infected subject mimicking acute pyelonephritis secondary to obstruction. Atypical forms of acute appendicitis must be diagnosed and treated as early as possible. Computed tomography plays an essential role in the diagnostic assessment of abdominal and lumbar symptoms in HIV-infected patients.