[Gynecomastia support]

Called gynecomastia, the hyperplasia unilateral or bilateral, non-tumor mammary gland in men, is observed in adolescent or adult with an important psychological impact. Common condition that always requires an etiological prior to surgery. Mastectomy by periareolar incision and liposuction are often associated in this surgery. We must respect the position specific chest male in the position of the areola. 15 patients operated in service in the period from January 2006 to December 2011, there were three cases with unilateral and twelve cases with bilateral, the average age was 32 years [22-47 years]. An unsightly appearance was observed in all patients. Breast pain was observed in three patients with fear of cancer in one patient. On examination the lymph nodes was free and there were no nipple discharge. Gynecomastia stage II bilateral is the most frequent. Echo mammography was performed in all patients and was normal. Hormonal balance was: Testosterone, Estradiol, LH, FSH, liver function tests. Testicular and abdominal ultra-sonography were good. When idiopathic gynecomastia was observed, the etiological was negative in all patients. Gynecomastia is common in 30% of adults. Which causes the most common were the para-pubertal gynaecomastia, the gynecomastia acquired in adulthood, also referred to other causes such as hypogonadias, hepatic and renal failure, hyperthyroidism and the sexual ambiguity. The gynecomastia is a common reason for consultation in plastic surgery. The surgical technique is based on common principles of breast surgery adapted with some details on the thorax male. Liposuction and mastectomy are often associated. Patients were satisfied to find a male figure, leaving an clear ambivalence that can weigh in their socio-professional activity

[Areolar approach to augmentation mammaplasty]

Treatment of breast hypoplasya or hypomastia requires a breast augmentation surgery using implants. The request for surgery remains always a voluntary step of each patient. Beyond the aesthetic improvement that this intervention offers, the psychological repercussion is generally beneficial. However, these implants have side effects and insufficiencies compared to the natural breast. These facts must be perfectly explained to the women who want the breast implants. Let us quote in particular the risk of hematoma or periprosthetic hull which counts among the most serious complications of this type of intervention and which requires an immediate surgical recovery. The aerolar approach to augmentation mammaplasty by implants is an interesting technique in breast augmentation. We report the case of a 36 years old patient who present a breast hypomastia and who profited from this technique

Demons-meigs syndrome

Demons Meigs is a rare, anatomo-clinical syndrome associated, with a benign ovarian tumor, ascitis and hydrothorax. The interest assigned to this triad reside in its similarity to the malignant ovarian tumor in its advanced stage and in its perfect and definitive surgical curability. The authors report here a case of 65 years old female patient, who were consulted for hypogastric pains and signs of vesical compression. Clinical examination showed a well defined hypogastic mass, rounded in shape measured 15cm diameter in a moderately abundant ascitis. The abdomino-pelvic echographic examination, showed a left heterogenic ovarian mass associated with intra peritoneal effusion. Chest X-Ray showed right hydrothorax. As the general condition was conserved, diagnosis of Demons-Meigs syndrome was evoked. This diagnostic was confirmed in the preaperative period by the presence of an ovarian mass without macroscopic malignants signs of malignancy, also histological examination showed benign fibroma. A simple excision was sufficient to have a definite recovery without recurrence six years after the operation. The association of pleural effusion and an ovarian tumour is not synonymous of metastasic invasion. Demon Meigs syndrome must be evoked because the surgical excision of the ovarian tumour permits the definitive recovery without complementary treatment

[Breast carcinoma associated to cancer of the vulva]

The synchronous association of breast infiltrating ductal carcinoma and moderately-differentiated squamous cell carcinoma of the vulva is extremely rare. The interest assigned to this association is not only resides in its rarity, but also in the therapeutic problems that it can raise. A 50 year woman, presented with a lesion of the left labia major of the vulva, its diameter measured 2cm, The tumour was mobile, painful, and bleeds at the least contact. The biopsy concluded to a moderately-differentiated squamous cell-carcinoma. Systematic genital examination revealed the presence of a nodule the right upper quadrant of breast. It was hard, painless and without axillary's nodes. The surgical intervention consisted at a radical mastectomy, with axillary's lymphonodectomy; in followed by a radical vulvectomy and bilateral inguinal lymphatic nodes dissection. The pathological examination concluded to a breast infiltrating ductal carcinoma II rank of SBR, confirmed the histological type of the vulvar tumour, and showed an inguinal involvement node. A postoperative radiotherapy and chemotherapy has been done. The patient was well with a postoperative follow up period of 18 months. The coexistence of a breast infiltrating ductal carcinoma and squamous cell carcinoma of the vulva is an extremely rare occurrence. Two cases have been previously reported in the literature. A congenital origin is possible; adenocarcinoma can be developed from ectopic, mammary gland tissue in the vulva. The acquired origin is also possible; the vulvar localization can be secondary to a metastatic breast cancer. Nevertheless, these two etiological approaches suppose that in the two localizations, the cancers are of the same histological type. The association of distinct types is uncommon. The double localization poses a problem of operative time chronology, and of the necessity of adjustment of doses of radiotherapy or chemotherapy. It must be discussed case by case; indeed the reduced number published case doesn't permit to establish a standard protocol. The logical therapeutic attitude seems to be, the surgical excision in the same time; every localization being considered as isolated. Otherwise all complementary pen-operative treatment [radiotherapy, chemotherapy] should include an adjustment of doses

Le traitement chirurgical des gynecomasties [a'propos de deux series de 95 cas]

The management of gynecomastias is mainly surgical and aims to lead to a normal male thoracic morphology with minimal cicatrical damages. The classical technique based on Dufourmentel and Webster principles is still the most used; however, it does not allow to manage all clinical forms of gynecomastia. Through a study of two large series; those of J. Baudet [Bordeaux] including 65 cases [first series] and Grabb [New-York] including 30 cases [second series], we try here to point out the tendencies as for the different surgical approaches, the glandular resection, the eventual cutaneous interventions as well the recent contribution of liposuction to this treatment

Tumeur benigne langerhansienne non fonctionnelle [a propos d'un cas] Revue de la litterature

A case of non functional langerhansian tumor is reported here. A literature review was done and 14 cases were recorded. These pancreatic tumors whose course is quiet are uncommonly diagnosed in case of acompressive picture. The paraclinical examinations are not always able to give of the pancreatic origin, the therapeuticaL management is mainly surgical and consists of tumor excision. The histological examination allows to diagnose non secretory langerhansian tumor and suspects a benignity that only the course of disease can confirm

leiomyosarcome gastrique [LMSG]: a propos de 2 cas dont un revele par un hemoperitoine

The authors describe two cases of gastric leiomyosarcoma, reported in the department of surgery [Unite B] in the period between Jan. 1974-1 990. One of these cases presented by heamoperitoneom which is an uncommon complication. [Only 6 case presented in medical literatur]. The authors discuss, etiology, diagnostic of this rare tumor which shows difficulty in diagnostic preoperativly, Managment which is mainly surgical, prognosis which is better than that relating to adenocarcinoma

Lesreinterventions tardives apres thyroidectomie pour lesion benigne

From january 1974 to decembre 1988, 1252 thyroidectomies were caried out including 33 cases who are twice surgically managed for recurrence, 2,6% Of the 33 patients, 18 [544% did not undergo primitive surgery in the service. Recurrence results from two main diseases multiheteronodular goiter [4,85%] and Basedow's disease [4,30%] Among the methods that were used, enucleation is the most implicated [33%]; subtotal lobectomy ranks second with 7,62%. Recurrence is often Contralateral reproducing the primary disease in most cases; however it is neoplasic in one case [3%]. This latter eventuality justifies the surgical remanagement whose main preoccupations must be, as far as possible, preservation of thyroidal function and respect of reccurrents and parathyroids The treatment must be essentially preventive since that the rate of complications and sequelae is higher than in the usual surgery. Prevention is more particularly based on surgery during the first management. As for opotherapy, its braking is still a controversial question

Resultats de l'examen clinique du cancer du sein: [a propos de 310 cas]

Breast cancer is an affection which occurs frequently in woman and in our country, it ranks second after cervix neoplasm. In spite of accessibility of mammary glands at the clinical examination, the diagosis is done lately in most caes. From the analysis of data of the clinical examination it results that: the consultation delay is over 6 months in more than 50% of cases, the tumor is the main reason of consultation in 76% of cases, its diameter is over 2 cm in 90% of cases. The regional adenopathies are found to be present in 82% of patients; metastases were noted in 10% of cases, cancer in developing eruption represents 10,88% and affection was diagnosed at very advanced stages [III or IV] in most cases. Prognosis in bad and the improvement can result from the early detection in which affected by the socio-economic level, the management conditions and apprenticeship of breast self-examination which remains an important element that one should take into consideration