[GrS Montreal: A private hospital specializing in gender-affirming surgery in Canada]. / GrS Montréal : un hôpital privé spécialisé en chirurgie d'affirmation de genre au Canada.

Gender dysphoria refers to the suffering an individual experiences when his or her sex at birth does not correspond to the expression of his or her gender. Gender-affirmation surgery is a procedure that can alleviate this suffering. For 20 years, GrS Montreal has been Canada's only center dedicated exclusively to this type of surgery. Thanks to its expertise, quality of care, state-of-the-art infrastructure and convalescent home, GrS Montreal receives patients from all over the world. This article describes the particularities of this center and puts into perspective the evolution of this type of surgery.

[Immediate breast reconstruction and postoperative radiotherapy: an overview]. / Reconstruction mammaire immédiate et radiothérapie post-opératoire: une mise au point.

Breast reconstruction is nowadays integral part of the treatment of breast cancer. When it is proposed as an immediate reconstruction, the plastic surgeon has to deal with several constraints. The coverage of the patients that must benefit from a mastectomy is complicated by additional treatments of radiotherapy. We propose, in this work, a multidisciplinary splitting of the patients into specific subgroups. An immediate reconstruction will be proposed to certain patients considering the adjuvant radiotherapy. The choices of orientation are complex and a scarce literature on this subject does not allow us to guide in a systematic way all the patients. More studies, with a prospective design, are necessary to guide the patients wishing an immediate reconstruction associated with a radiotherapy after mastectomy.

Early thoracoscopy for the management of empyema in children.

BACKGROUND: Empyema is a significant cause of morbidity in children. Treatment is still a matter of controversy between surgical and non-surgical options. We reviewed our experience with the use of video-assisted thoracoscopy (VATS) in the treatment of empyema and proposed an algorithm. PATIENTS AND METHODS: We retrospectively reviewed all the pediatric patients recorded at our institution from January 2003 to December 2007 who were diagnosed with empyema and treated by surgery. RESULTS: 23 children with empyema were treated with VATS during the review period. Mean age was 58.9 months and the duration of symptoms before admission was 6.1 days. All patients had a parapneumonic empyema treated by preoperative antibiotics (17/23 by parenteral antibiotics and 6/23 by oral antibiotics). Pre-operative imaging included chest X-ray in all cases and ultrasonography in all cases but one and computed tomography in 3 (13%). Our 23 patients underwent VATS within 5.3 days of hospitalisation, the most recent patients within 2 days. Chest tubes were removed after 2.7 days (range 2 to 4) resulting in a postoperative length of stay (LOS) of 10.3 days (range 6 to 28). Total LOS was 13.3 days (range 8 to 30). One patient required a conversion to thoracotomy. One patient required prolonged mechanical ventilation due to a severe myopathy during the post operative course, but there were no complications or deaths. Followup was available for all patients who all remained symptom-free and suffered no recurrence (clinical and radiological). CONCLUSION: Early thoracoscopy for empyema in children is safe and efficient in the short and mid-term outcome. We describe an algorithm based on our initial experience and review the literature for the management of empyema in children.

Catamenial pneumothorax: a case report and review of the literature.

Catamenial pneumothorax is a rare condition that is often misdiagnosed. It is defined as spontaneous pneumothorax occuring within 72 hours before or after onset of menstruation. Etiology is unknown but could be linked to endometriosis. Treatment is medicosurgical: thoracoscopy for pleural abrasion and hormonotherapy to avoid recurrence.