[Interest of systematic shavings to reduce reoperation in breast-conserving surgery of breast cancer]. / Intérêt des recoupes systématiques pour éviter les réinterventions dans la chirurgie conservatrice du cancer du sein.

OBJECTIVE: The INCa and HAS have developed quality and safety indicators for care specific to breast cancer. Among these, in the conservative surgery of this cancer includes the reoperation rate: target˂10%, alert>20%. The main objective of our study was to evaluate whether the practice of systematic recuts still called "shaving" would meet the objectives of the indicators. METHODS: Observational, retrospective, single-center study over two years in a regional referral center. Two groups of patients were compared: one with "shaving" and one without (no shaving or oriented shaving). RESULTS: In total, 381 patients were operated on, including 48 (12.6%) with shaving and 333 (87.4%) without. Revision rates for damaged margins were 18.75% (9/48) in the shaving group which met the quality criterias vs. 23.7% (79/333) which did not satisfy them; P=0.4. Furthermore, the rate of discovery of occult sites on recuts was higher in the shaving group: 22.9% (11/48) vs. 9.9% (33/333); P=0.02. In the shaving group, 10.4% (5/48) of the patients were resected again for damaged margins for the initial cancer vs. 18.6% (62/333) in the group without shaving; P=0.23. CONCLUSION: Our study confirms the interest of performing "shaving" to meet the requirements of the INCa and HAS quality criteria. The absence of systematic cross-sectioning leads to the risk of not recognizing the existence of occult sites. However, the discovery of occult cancers does not significantly reduce the rate of repeat surgery.

[Correlation between prenatal and postnatal observations in case of gastroschisis: Experience in a prenatal referral diagnosis center]. / Corrélation des données anténatales et postnatales en cas de laparoschisis : expérience d'un CPDPN.

OBJECTIVES: Ultrasonography plays a key role in surveillance of gastroschisis. Indeed, ultrasound should allow an early diagnosis of its specific complications all the while avoiding their over-diagnosis which could induce an unnecessary prematurity in these fragile children. The aim of this study was to evaluate the relevance of ultrasonography in the surveillance of this malformation. METHODS: We conducted a retrospective single center study from 2008 until 2018 including all cases of apparently isolated gastroschisis followed during the prenatal period and surgically treated in our institution. Prenatal data gathered during the ultrasound follow-up were compared to those observed during surgery. RESULTS: Thirty-one cases of gastroschisis were included. Regarding the abdominal wall defect, the latter was described prenatally as tight in seven cases with a weak correlation, and as situated to the right of the umbilical cord insertion in 11 cases with a high correlation to the per-operative observations. Sonographic observations were responsible for inducing birth in 14 cases (45%), of which 12 due to the presence of a specific gastroschisis complication, confirmed in five cases (42%, weak correlation). Pre- and post-natal correlation for compression/atresia/stenosis and eviscerated bowel inflammation were very weak in both cases, with a respective tendency of over- and under-diagnosis. CONCLUSIONS: Diagnosing the specific complications of gastroschisis by ultrasound is difficult, even though ultrasonography is responsible for many anticipated births. Thus, this monitoring should be performed by experienced sonographers on devices with appropriate settings. In addition, reproducible parameters such as oligohydramnios or increased bowel dilations should alone be indications of anticipated birth.

[Giant mesocolic cystic lymphangioma: A treacherous prenatal presentation. Case report]. / Lymphangiome kystique géant du mésocôlon : un diagnostic anténatal difficile. À propos d'un cas.

Cystic lymphangiomas are usually located in the neck region. Less frequently, they can be found in the abdomen. In those cases, pre- and neonatal diagnosis is extremely difficult. We report on the case of a giant mesocolic cystic lymphangioma, diagnosed at birth, in a child who had been monitored during the prenatal period for what was believed to be a digestive dilatation. The progression was marked by excellent tolerance despite a complete lack of regression in the first 10 months of life. The authors discuss the prenatal signs that should suggest this diagnosis and an MRI, as well as management during the 1st year of life.

[Prevention of seroma post-mastectomy by surgical padding technique]. / Prévention du sérome post-mastectomie par capitonnage.

INTRODUCTION: Every year, 20,000 mastectomy are realized. The most common complication of these surgical procedure is seroma, occurring in a range of 10 to 85% of the cases, which may be responsible for an increased morbidity by complications: disunity of surgical flap, infection, and delay in administrating adjuvant therapies. OBJECTIVE: We focused on a post-mastectomy padding technique, aiming at decreasing incidence of postoperative seromas. PATIENTS AND METHODS: We conducted a retrospective study of patients treated with mastectomy from January 2012 to March 2014 in Amiens University Hospital. Forty-two patients were included: 20 to the "padding's" group and 22 to the "control's" group. RESULTS: Drainage flow was significantly decreased at Day 1, Day 2, Day 3 and throughout hospitalization after padding (358.5mL versus 685mL; P=0.02). Hospital stays were significantly shortened by 2 days (5.3 versus 7.3 days; P<0.05) for patients receiving padding surgery. DISCUSSION AND CONCLUSION: Our results show a benefit in the mastectomy padding flap. However, the retrospective character of our study and its strength character imply bias and data not available such as complications in type of wound dehiscence, pain, necrosis, the period from the establishment of the adjuvant therapies and aesthetic evaluation of technique. As such, we initiated a prospective randomized multicenter study late 2013, named PRELYMCA, which should be able to answer the pending questions.

[Do there still exist risk factors for breast cancer?]. / Existe-t-il encore des facteurs de risque de survenue d'un cancer du sein ?

OBJECTIVES: To evaluate the risk factors associated with a breast cancer, and to compare the proportion of women at high and low risk for developing breast cancer. PATIENTS AND METHODS: Retrospective study among 194 women with breast cancer between January 2007 and December 2008 in the Obstetrics, Gynaecology and Reproductive Medicine department of the Amiens' University hospital. RESULTS: Concerning all the series, only age, overweight and family antecedents seem risk factors of breast cancer. The proportion of women in the low-risk group (12.3%) is not significantly different from that of the high-risk group (18.5%). In the low-risk group, the factors which seem to influence a breast cancer are those in connection with high levels of estrogens (early age of the first menstruation, late age of the menopause and oral contraceptive use) and the smoke habitus; whereas in the high-risk group, the factors are the nulliparity and the absence of breast feeding. DISCUSSION AND CONCLUSIONS: One finds in this series a part only of the known risk factors of breast cancer; and the proportion of women at low risk (12.3%) is comparable with that at high risk (18.5%). This study shows the relative weight of the various risk factors of breast cancer, at a time when its prevalence reached 10%.

[Diagnosis and current concepts of management of advanced abdominal pregnancy]. / Diagnostic et concepts actuels de prise en charge de la grossesse abdominale avancée.

Authors report a case of abdominal pregnancy diagnosed by MRI at 17 SA with prospective follow-up and planned delivery at 37 SA. The diagnosis is clinically suspected when extra-uterine pregnancy risk factors or history of uterine trauma are present. This is confirmed by MRI, which may be considered as the gold standard. A conservative management may be proposed when the diagnosis is made after 20 weeks and under the following conditions: absence of fetal growth malformation, placental implantation remote from the upper abdomen, good maternal condition, close management in a hospital setting of the patient previously informed of the risks and outcomes. Placental location on the uterus seems to be a major positive factor of outcome for these pregnancies. Materno-fetal follow-up is based on physical examination, repeated ultrasonic investigations with Doppler imaging and daily fetal heart rate monitoring. In the absence of complications, a laparotomy should be planned at 34 weeks. The placenta may not be removed when a serious risk of hemorrhage is feared.

Cerebro-costo-mandibular syndrome in a father and a female fetus: early prenatal ultrasonographic diagnosis and autosomal dominant transmission.

Ultrasonography in a female fetus revealed cystic cervical hygroma, severe micrognathia, and vertebral and upper limb anomalies suggestive of cerebro-costo-mandibular syndrome (CCMS) which was diagnosed ultrasonographically at 16 weeks' gestation. The father is affected and presents with a Pierre Robin sequence, short stature and typical costovertebral anomalies. CCMS is a rare and severe disorder. The high frequency of sporadic cases, vertical transmission, and the excess of sibs affected via horizontal transmission suggest dominant autosomal mutation with possible germinal mosaicism. The vertical familial case detailed in the present report is a reminder of the high risk when one parent or one sibling is affected and the extreme variability of phenotype and costal ossification. Early prenatal ultrasound diagnosis is possible in a severely affected fetus.

[Screening and diagnosis of cervical cancer]. / Dépistage et diagnostic des cancers du col.

The screening of cervical cancer is ideal. Performing its screening allows discovering early stage of invasive cancer but above all to diagnose numerous precursor lesions: their treatment carry out the prevention of invasive cancer. Without an organised screening in France, there is a spontaneous screening. Nevertheless the incidence of invasive cancer decreased twofold since twenty years. It remains unfortunately frequent. With a well organised mass screening its rate will probably decrease significantly.

[Treatment of stress urinary incontinence. Experience at the Gynecology-Obstetrics Center of Amiens]. / Traitement de l'incontinence urinaire d'effort. Expérience du Centre de Gynécologie-Obstétrique d'Amiens.

The authors report their experience of the surgical treatment of stress urinary incontinence. They underline the value of urodynamic tests in the examinations for urinary continence and prolapses. In the presence of a transmission defect, three different techniques are used: indirect colpopexy by strips (Loffredo) in the absence of prolapse, mixed route using vaginal strips (Bologna) in case of cystocele, sub-urethral plication reserved for elderly patients presenting a prolapse with stress urinary incontinence revealed by the urodynamic tests. The follow-up of the patients treated by the Loffredo technique is studied: 92% of good middle-term results (after 5 years).

[Electro-conization of the cervix uteri]. / L'électroconisation du col utérin.

After having reported various opposite techniques for the treatment of dysplasia and in situ carcinomas of the uterine cervix, the authors present their experience with 125 cases of conisation, performed between 1984 and 1988. The electroconisation technique, performed in 88 cases, is compared with other conisation techniques: conisation with a cold scalpel, laser conisation. The use of a cold scalpel is simple and effective, but presents the disadvantage of peroperative (22.2% in our series) and secondary (7.4%) haemorrhages requiring preventive overlapping stitches which impede subsequent monitoring. Laser conisation seems long and tedious. On the contrary, electroconisation presents the advantage of being simple and quick, with very few peroperative (6.8%) or secondary (3.4%) haemorrhages, but two minor drawbacks: impeding pathological interpretations (1%), causing secondary stenoses which seem to be related to the height of the cone and not to the type of conisation.