[Well-differentiated papillary mesothelioma of the peritoneum: an attenuated malignant tumor. Review of the literature apropos of a case]. / Le mésothéliome péritonéal papillaire bien différencié: une tumeur à malignité atténuée. Revue de la littérature à propos d'un cas.

The authors present a new case of a well-differentiated papillary mesothelioma of the peritoneum. This is an uncommon tumor which have a slow evolution like a low malignant potential tumor. But, because of its tendency to recurrence, the designation of Well-Differentiated Tumor is better. The diagnosis with others peritoneal tumors is sometimes difficult, especially with the Peritoneal Serous Tumors. Tumor recurrence must be treated by curative surgery. Adjuvant therapy is discussed for the diffuse form.

[Breast reconstruction with inferior transverse abdominal flap after mastectomy for cancer]. / La reconstruction mammaire par lambeau abdominal transverse inférieur après mastectomie pour cancer.

Breast reconstruction with an inferior transversal abdominal flap provides good quality cosmetic results. Indications for this flap technique are presently limited because of the frequency of complications in early series. The aim of this study was to evaluate the different parameters which could reduce the number of complications. From January 1989 to July 1991, 25 patients were treated with this method at the René-Gauducheau Centre. All patients were treated with the same surgical technique. Based on the complications observed in this series and a review of the literature, we were able to determine those factors which could limit the number of complications. Preoperative patient selection defined a population at risk of vascular complications. This population corresponded to a good indication for double pediculated flaps. Global flap removal, the muscle and the anterior sheath of the aponevrose together, and maintaining the patient in a sitting position for five days after the operation helped reduce the frequency of complications. Folding the abdominal wall with a nonabsorbable sheath appeared to be a simple and reliable method of reducing the number of abdominal complications. The double pediculated flap was indicated in all cases at risk of partial necrosis or when a large volume was necessary to avoid asymmetry. Using this type of management, breast reconstruction with inferior transversal abdominal flap is the first intention technique used at the René-Gauducheau Centre in Nantes.

[A new approach to the axilla: functional axillary lymphadenectomy and padding]. / Une nouvelle approche du creux axillaire: lymphadénectomie axillaire fonctionnelle et capitonnage.

Axillary lymph node dissection, which is now mandatory in the conservative breast cancer surgery and classically involves Berg's two lower levels, is burdened with numerous complications. In 1988 and 1989, two technical modifications were introduced and are described here: padding of the axilla as preventive treatment of postoperative lymphocele and, more recently, functional axillary lymphadenectomy (FAL) in which the medial cutaneous nerve of the arm, the two perforating intercostal nerves and above all the lateral thoracic pedicle (external mammary artery and vein) are spared. These two technical innovations, more respectful of anatomy, are aimed at reducing the morbidity of conservative breast cancer at a time when detection enables breast cancers to be treated at an increasingly early stage, which results in a increase of negative axillary dissections. The postoperative period is simplified (no drainage, immediate mobilization), and the hospital stay is reduced to 2 days. Complementary treatments can thus be started early on, without any functional or cosmetic damage while the number of lymph nodes removes remains the same as in the conventional axillary dissection technique. The authors describe the operative procedures and analyse the 100 cases of conservative breast cancer they have treated with padding and FAL. These two technical modifications are now systematically used by them in the management of breast cancers.

[Wadding of the axilla in the conservative treatment of cancer of the breast. Prevention of lymphocele]. / Le capitonnage du creux axillaire dans le traitement conservateur du cancer du sein.

A randomized prospective study was carried out on 53 consecutive female breast cancer cases hospitalized at the Centre René Gauducheau, In Nantes (France), with the intent of investigating whether surgical wadding of the axillary fossa with the use of proximate muscular tissue can prevent lymphocele from occurring, and avoid placement of suction drains usually required in conservative management of breast cancer. Results have been significant regarding the incidence of lymphocele (p less than 0.001), as well as the mean puncture volume and the total number of punctures needed (p less than 0.001), thus reflecting the efficacy of a simple method, which yields satisfactory cosmetic results. Failures with this method were related to the technical procedure per se, and not to its principle. The lapse of time required before additional treatment was initiated as subject to a factor not related to the method, but depended upon the recovery of normal shoulder mobilization.