[Treatment of fibroadenomas by high-intensity focused ultrasound: What results? Review]. / Prise en charge des fibroadénomes par échothérapie : quels résultats ? Revue de la littérature.

OBJECTIVES: To assess benefits and adverse effects of high-intensity focused ultrasound (HIFU) as a treatment for fibroadenomas (FA). METHODS: To ensure the quality of the methodology, the PRISMA criteria have been met at all stages of the development of this review. We searched MEDLINE from inception to May 2017, without any restriction. KEYWORDS: fibroadenoma, focused ultrasound, HIFU and fibroadenomata were used. Data were extracted and the results were compared. Two reviewers independently extracted study characteristics and outcome data. RESULTS: Of 20 identified abstracts, 5 primary studies met inclusion criteria. All studies reported a reduction in the size of FA treated with an increasing effect over time. Pain tolerance was most often assessed as moderate. Adverse effects of HIFU were not severe in all studies. CONCLUSIONS: HIFU appears to be a promising technique in the treatment of fibroadenomas with a volume decrease of approximately 50 % at 6 months of therapy.

[Postpartum contraception: medical guidelines, women's point of view]. / La contraception du post-partum: les recommandations médicales, le point de vue des femmes.

PURPOSE: Postpartum contraception is subjected to specific medical guidelines related to the suckling mode. The practitioner must conciliate prescription rules with women's expectations. The purpose of this work was to estimate the medical practice in the maternity centre at a local hospital and the actual practice of women at home, in immediate postpartum and during the year that followed the childbirth. METHOD: One hundred and four new mothers from the maternity centre, in September 2004, took the survey. During their stay after birth, they filled a questionnaire on contraception. Various data have been collected from their obstetrical file. The analysis allowed the synthesis of medical guidelines on postpartum contraception. One year later, patients answered a telephone survey about their contraceptive practice. RESULTS: In our survey, two-third of the new mothers (61.5%) chose breast-feeding. Seventy percent of them received progestins as contraceptives. Three out of four women (78%) followed this prescription after they left the hospital. Two-third (62.5%) of the women who had chosen artificial suckling received a prescription of estroprogestin. The majority of them (96%) used it after their return home. A high number of women (87.5%) estimated that these contraceptions were efficient, but more than a third of them thought they were uneasy to use (38.9%). Half of the women (52.8%) forgot their contraception during postpartum and the majority of them (86%) changed it within a year. A quarter (23.1%) of the contraception follow-up during this time was made by a general practitioner. CONCLUSION: The practice in the maternity centre generally follows medical guidelines. However, it seems important to adapt postpartum contraception to the real practice of women. The general practitioner plays a major role in this management, especially during well-baby visits.

[Feedback of ultrasound and RMI in the staging of endometrial carcinoma in early stage]. / Évaluation de l'échographie et de l'IRM dans la stadification des tumeurs de l'endomètre de stage I.

OBJECTIVES: Endometrial cancer is the most common gynecological cancer in France. The therapeutic management is based on preoperative staging. The recommended imaging examination remains the MRI. This is to evaluate ultrasound and MRI in the staging for localized cancers. METHODS: This is a retrospective observational study, conducted from July 2012 to July 2014, at the University Hospital of Nancy, on all patients care for endometrial cancer stage I, who underwent a pelvic ultrasound and MRI for the assessment of myometrial infiltration. RESULTS: Twenty-nine patients were included with a mean age of 69 years and a BMI of 30 kg/m(2). Using ultrasound, we have a sensitivity of 58%, a specificity of 100%, a positive predictive value (PPV) of 100%, a negative predictive value (NPV) of 70% and an accuracy of 75%. Using MRI, we have a sensitivity of 83%, a specificity of 100%, a PPV of 83%, a VPN of 88%, and an accuracy of 86%. CONCLUSION: Transvaginal sonography should be performed before post-menopausal bleeding. It remains possible in the staging of localized cancers.

Breast carcinoma located in ectopic breast tissue: a case report and review of the literature.

Ectopic breast tissue usually develops along the mammary ridge. The incidence of this anomaly has been reported as high as 6%. Malignant development is rare. A case of carcinoma of aberrant breast tissue, located in the axilla is described. Mammographies of the ectopic breast performed few years before the diagnosis of carcinoma are presented and also those done for the diagnosis of the tumor. A literature study was performed on carcinoma and ectopic breast tissue. Considering high frequence of node involvements for these cases, the optimal therapeutic strategies are discussed.

Sentinel node biopsy in vulvar malignancies: a preliminary feasibility study.

Sentinel lymph node biopsies (SLNB) were investigated in 8 cases (6 squamous cell carcinomas, 2 melanomas) of vulvar malignancy. The sentinel node was detected by patent blue dye injection (1 case), pre operative lymphoscintigraphy with intra-operative gamma hand-held probe (2 cases), and combined techniques (5 cases). The procedure was successful in all cases but one (1 invasive squamous cell carcinoma) in which there was medial groin recurrence at 6 months. Nodal invasion was observed in only one case and was confined to the sentinel node. No specific morbidity related to the SLNB procedure occurred. SLNB appears to be a feasible and promising technique, however, requiring further evaluation before being considered as a reliable method to spare inguinofemoral lymphadenectomy in early-stage patients free of sentinel node metastasis, or to be substituted in screening elderly clinically node-negative females.

[Ovarian puncture in fertilization in vitro: what analgesia?]. / Ponction ovarienne en fécondation in vitro: quelle analgésie?

UNLABELLED: We compared two techniques of local anesthesia used in transvaginal ultrasound guided oocyte recovery in in vitro fertilization: paracervical lidocaïne block versus vaginal application of Emla, a topical anesthesic cream. STUDY DESIGN: The study included 103 patients divided in two groups. Pain was evaluated by visual analog scale and questionnaire. RESULTS: Univariate analysis showed that the patients were satisfied with neither of the two protocols. Multivariate analysis revealed paracervical lidocaïne block to be superior. The premedication appeared inadequate. CONCLUSION: We decide to use paracervical lidocaïne block and to improve the premedication. Indications for general and locoregional anesthesia were also enlarged. A new study showed a significantly greater patient satisfaction. One variable analysis indicated that no one of these protocols satisfied our patients.

[Value of limited resections in the surgical treatment of lung cancers]. / Valeur des exérèses limitées dans le traitement chirurgical des cancers bronchiques.

From 1969 to 1990, 88 limited lung resections were performed for the treatment of malignant lung tumours. These operations consisted of 73 typical resections (29 segmentectomies, 15 bisegmentectomies, 23 middle lobectomies, 6 lingulectomies) and 15 atypical resections. In 15 cases, they were completed by lymph node dissection. These operations were performed in patients with a mean age of 55.8 years (range: 24 to 76). The ventilatory functional status contraindicated wider resection in only 7 cases. The immediate postoperative mortality (7 cases, i.e. 8%) and the postoperative complications observed in 29.6% of cases were higher than those observed after wide resections, but do not constitute a specific argument in the indication for partial resection. Histological examination of the operative specimens revealed 80 primary lung cancers (42 squamous carcinomas, 28 adenocarcinomas, 8 anaplastic and unclassifiable tumours, 1 bronchiolo-alveolar tumour and 1 malignant carcinoid tumour). The primary nature of the tumour could not be definitely confirmed in the other 8 patients (history of head and neck neoplasm in 7 cases and bladder carcinoma in 1 case). The survival according to TNM stage, histological nature of the tumour, positivity of the resection margins and intraoperative tumour effraction was identical to that associated with lobectomies.

[Parkinson's disease and pregnancy: case report and literature review]. / Maladie de Parkinson et grossesse: cas clinique et revue de la littérature.

Parkinson's disease begins before the age of 40 in only 5% of patients. We report a case of pregnancy in a 35-year old woman with Parkinson's disease. The patient was treated by levodopa associated with benzerazid. No effect was observed on the pregnancy and the fetus. Only the symptoms were moderately worsened. A literature review is performed.

[Post-rape pregnancy]. / La grossesse après viol.

A rape is a traumatizing circumstance for the victim. This aggression often has, regrettably, immediate repercussions, and then medium and long-term ones. Its complications are psychological, but also sometimes somatic, like pregnancy. Through an international literature review, and the study of the national legislation, we will summarize the main essential elements of the medical and forensic care of a pregnancy arising after a rape.

Sentinel lymph node procedure--a valid selection criterion?

Sentinel node biopsy is currently considered to be an outstanding advance in surgical oncology and represents significant evolution toward minimally invasive breast cancer surgery. Detected by blue dye, radiopharmaceutical or combined techniques, the sentinel lymph node can be selectively used for the detection of micrometastasis through extensive histopathologic analysis. Nevertheless, before considering the sentinel lymph node concept as a new standard of care, the standardization of both detection methods and histopathological protocols is of critical importance. The future of this attractive technique is strictly dependent on the quality of teaching, training and evaluation in prospective controlled multicentric studies.

Radiopharmaceutical-guided surgery in primary malignant melanoma of the vagina.

The sentinel lymph node located in the right iliac basin was successfully pre- and intraoperatively identified by radiopharmaceutical-directed mapping in a case of primary malignant melanoma of the vagina.

[Identification of axillary sentinel node by lymphotropic dye in breast cancer. Feasibility study apropos of 128 cases]. / Individualisation du ganglion axillaire sentinelle par colorant lymphotrope dans les cancers du sein. Etude de faisabilité à propos de 128 cas.

AIM OF THE STUDY: The goal of this study was to evaluate the technical feasibility of sentinel node biopsy in breast cancer and its predictivity of axillary node status. PATIENTS AND METHODS: Between January 1996 and June 1997, 128 patients with invasive breast carcinomas, referred to the Cancer Center of Strasbourg and Lyon (France), underwent lymphatic mapping (Patent Blue dye) and sentinel node biopsy followed by axillary clearance (Berg's level I to II). RESULTS: Sentinel node was identified in 76.5% of cases and was predictive of axillary status in 94.9% of cases. The false negative rate of the procedure was 5.1%. Sentinel lymph node was involved in 43.9% of cases and it was the only one involved in 30.2% of cases. The sensitivity of the procedure was 94% (CI: 95% = [88%-98%]) and its specificity 100%. CONCLUSION: Actually considered as new attractive procedure under ongoing evaluation in prospective controlled trials, this study confirms the feasibility and reproductibility of lymphatic mapping and sentinel node biopsy, first stage before entering a new era of minimally invasive axillary surgery in breast cancer.

Lymphatic mapping and sentinel node biopsy of operable breast cancer.

The aim of this study was to evaluate the reliability and accuracy of sentinel node biopsy for invasive breast cancer and the predictability of axillary node status. Between January 1996 and June 1997 a total of 73 patients underwent patent blue dye lymphatic mapping and sentinel node biopsy followed by standard (level I and II) axillary node dissection (one bilateral procedure). The sentinel node was identified in 82.4% (61/74) of the cases and was predictive of axillary status in 96.7% (59/61). The false-negative rate of the procedure was 8.0% (2/25). The sentinel node was involved in 37.7% (23/61) and was the only one invaded in 30.4% (7/23). The sensitivity of the procedure was 92% (CI95% 74-99%) and its specificity 100%. It is currently considered to be an attractive new procedure undergoing evaluation in prospective controlled trials. This study confirmed the reliability and reproducibility of intraoperative lymphatic mapping and sentinel node biopsy. This is the first step toward a new era of minimally invasive axillary surgery for breast cancer.