[Giant lipoma on the back]. / Lipome géant dorsal.

Solitary lipoma is the most frequent soft tissue tumor, often appearing between 40 and 60 years of age. It is described as "giant" beyond 1 kg of weight and 10 cm of diameter. Its volume is the source of a good many problems in social life (camouflage, difficulties to dress) and causes multiple health problems such as pain, difficulties to sleep, compressions of nerves or vital structures, infections, etc. The diagnosis is primarily clinical. However, it is necessary to systematically exclude a malignant process. Surgical biopsy is recommended if the diagnosis cannot be asserted by the clinic or an imagery. The therapeutic attitude is abstention in case of small volume without functional impairment. Otherwise, total surgical excision is indicated with pathological analysis. We describe the clinical history of a patient suffering from a giant dorsal lipoma.

Current concepts in breast reconstruction.

As the incidence of breast cancer increases, breast reconstruction is more and more often proposed and its indications are viewed in terms of quality of life. In the past, delayed reconstruction was the rule. Progress in reconstructive techniques currently allows performing immediate reconstruction in selected cases, even when the operative field has to be irradiated. These new techniques generally improve the result of breast reconstruction. Moreover, expansion of screening techniques allows detection of small tumors for which a conservative excision is sufficient. Nevertheless, this kind of less aggressive surgery may require a reconstructive procedure in order to maximise the aesthetic result.

[Free flap pedicle loss: clinical study on 8 cases]. / Perte du pédicule nourricier d'un lambeau libre : étude clinique sur 8 cas.

The authors report on 8 cases of free flaps with vascular pedicle disruption that were encountered between postoperative days 8 to 18. In one case, the inflow disappeared 18 months after the transfer without any trouble. This resulted in 2 partial and one complete flap losses. The 4 other flaps survived completely. This complete survival is related to the angiogenesis process coming from the surrounding tissues. The most obvious causal factor responsible for the 2 partial losses was the coverage of large, non viable areas, such as a prosthetic material and bone deprived of periosteum. The only causal factor that could be assessed in the case of total necrosis was the presence of an immunosuppressive treatment. Variables participating in the installation of an adequate angiogenic response are then discussed in accordance to this experience and to the literature. Limited contact with viable tissue, ischemia-reperfusion or drugs limiting the angiogenesis seems to promote failure when the pedicle is quickly disrupted. Hypoxia seems to be the most important cellular mechanism promoting the angiogenesis in this context.

[Discordance between actual and radiologically estimated size of an incidentaloma. Delay in questions regarding operative decision-making criteria]. / Discordance entre la taille réelle d'un incidentalome surrénalien et son estimation radiologique. Remise en question des critères décisionnels opératoires.

AIM OF THE STUDY: The accurate assessment of tumour size is an important consideration during preoperative evaluation of adrenal tumors, particularly incidentaloma; however the "size criteria" is still a controversial topic in some respects: size is a bad indicator of malignancy, there is still a confusion in the "grey zone" for tumors between 3 and 6 cm, and no universal consensus on the exact cut-off value for resection has been agreed. Nowadays it is clearly accepted that the "size criteria" alone is extremely limited in the assessment of adrenal tumor, moreover some studies suggested the relative inaccuracy of conventional CT in evaluating the size: radiological examination underestimated consistently adrenal tumor size. The aim of this study was to confirm those suggested data. PATIENTS AND METHODS: Our study compared the radiological estimated size and the histological size of 26 incidentaloma operated on with a laparoscopic approach. RESULTS: Our data confirm the inaccuracy of CT and MRI in predicting the size of incidentaloma particularly for tumor measuring less than 3 cm. CT and MRI significantly underestimated size of adrenal tumors, 108% for MRI and 101% for CT-scan. CONCLUSION: The decision to operate, even with the advent and safety of laparoscopic adrenalectomy, cannot only rely on the "size criteria". Radiologists have to perform multiple 1 mm cuts until the very superior and inferior tip of this tumor in order to provide a better estimation of the size.

Isotypic and allotypic analysis with monoclonal antibodies and jacalin of 309 serum monoclonal IgA from French and Japanese myeloma patients.

The subclass and allotype distribution of serum monoclonal IgA from myeloma patients was determined by ELISA with monoclonal antibodies in two French and one Japanese laboratory. In addition, the French sera were tested for their reactivity with the lectin jacalin. No significant difference in the isotypic distribution between French and Japanese series could be demonstrated: kappa/lambda ratios were 0.99 and 1.17, and the IgA1 subclass accounted for 93.9% and 91% of cases in the French and Japanese studies, respectively. Five out of 7 myeloma IgA2 from Japan and only one of the 12 IgA2 from France belonged to the A2m(2) allotype (P less than 0.01). All 219 IgA1 tested reacted with jacalin by immunoelectrophoresis (IEP), although with variable intensities. Among IgA2 proteins, only one (of the A2m(1) allotype) yielded a precipitating line with jacalin by IEP. Molecular analysis demonstrated that this protein was an IgA1-IgA2 hybrid bearing most of the A2m(1) epitopes.