Limiting factors for development of ambulatory breast surgery in the French hospital network.

INTRODUCTION: Ambulatory breast surgery is not well developed in France. This is especially true for oncologic procedures, MATERIALS AND METHODS: Between January 2005 and June 2006, we performed a retrospective evaluation of the factors thought to limit the development of this type of hospitalization. RESULTS: The principal limiting factors were distance restrictions (respect of the 100 km perimeter), the complexity of patient management for small breast tumors (several practitioners involved) and last, the non-motivating reimbursement policy. CONCLUSION: By changing to the Anglo-American ("one day surgery", i.e. hospital stay less than 24 hours) or hybrid system (less than 12 hours+1 day surgery), ambulatory surgery could easily be offered to patients excluded by the current system (ambulatory department open less than 12 hours).

Randomized clinical trial comparing axillary padding with closed suction drainage for the axillary wound after lymphadenectomy for breast cancer.

BACKGROUND: After axillary lymphadenectomy for breast cancer, a suction drain is routinely inserted into the axilla to prevent seroma formation. This drain is an obstacle to reducing hospital stay after breast-conserving surgery. This was a prospective randomized clinical trial to assess the safety and results of axillary padding without the use of a drain. METHODS: Between May 2001 and August 2003, 100 women were randomly allocated axillary padding without a drain or with the use of an axillary suction drain. Prospective assessments were made of morbidity, pain, shoulder mobility, quality of life and medical costs including length of hospital stay. RESULTS: Using axillary padding significantly reduced the mean (s.d.) length of hospital stay (1.8(1) versus 4.5(2) days, P < 0.001). Postoperative complications, pain, shoulder mobility and quality of life were similar in the two groups. There was no difference in the duration of the two procedures. CONCLUSION: Axillary padding after axillary lymphadenectomy was feasible and safe, without a drain, and shortened hospital stay.

Post-operative care and patient satisfaction after ambulatory surgery for breast cancer patients.

AIM: This study aimed to evaluate patient information provided, the management of post-operative symptoms and post-operative care, and patient satisfaction with ambulatory breast surgery over a 1-year period. METHODS: From January to December 2000, all breast cancer patients undergoing conservative breast surgery were offered surgery as an outpatient procedure at the Ambulatory Surgery Unit. RESULTS: Two hundred and thirty six patients underwent outpatient surgery. None were readmitted during the first night or the first week. Two hundred and nineteen patients completed a questionnaire. One hundred and sixty nine patients (group 1) underwent wide local excision (WLE) and 50 (group 2), WLE and axillary lymphadenectomy. Patients in group 2 experienced more pain at discharge from the hospital (p < or = 0.01) and during the first week after discharge (p < or = 0.00001) than patients in group 1. The mean overall satisfaction score was 8.97 on a scale of 1-10. Post-operative information provided by the surgeon before discharge from the hospital was rated 8.90 on a scale of 1-10 while information provided by the nurse was rated 9.33 (p < 0.0001). CONCLUSION: Ambulatory surgery for breast cancer patients is safe and popular with patients, however, post-operative pain presents problem.

[Role of outpatient surgery in breast surgery. Prospective feasibility study]. / Place de la chirurgie ambulatoire en chirurgie sénologique. Etude prospective de faisabilité.

STUDY AIM: The objective of this prospective study was to assess the feasibility of outpatient breast surgery, the reasons for inpatient procedures (IPP), the reasons for conversion and the conversion rate, and the postoperative morbidity after outpatient procedures (OPP). PATIENTS AND METHODS: In 1999, among 625 patients eligible for OPP (diagnostic surgery or conservative curative surgery), OPP was performed in 418 patients (67%) and IPP was performed in 207 patients (33%). The reasons for IPP rather than OPP were environmental (64%) rather than medical (16%). RESULTS: The conversion rate to conventional surgery was 12.4% and the definitive OPP rate was 58.6%. The reasons for conversion were more often medical (50%) and environmental (21%) than surgical (23%). The morbidity, except for axillary seroma, was similar for OPP and IPP. The axillary seroma rate after axillary lymph node dissection was higher with OPP (27.4 vs 16.1%). CONCLUSION: OPP is a good alternative to IPP in breast surgery, especially for diagnostic purposes. OPP is also feasible for partial mastectomy with axillary lymph node dissection, but patients must be clearly informed about the risks of axillary morbidity. The patients' quality of life and satisfaction index should also be evaluated.

An armoured endotracheal tube obstruction in a child.

The case of a child whose tracheal tube became obstructed intraoperatively 30 minutes after intubation is reported. It appears that this obstruction was related to the development of bubbles within the walls which expanded upon exposure to nitrous oxide and diffusion of that gas into the bubbles. The authors want to point out the risk of gas diffusion into the walls of the tube and the possibility that repeated sterilization may enhance the development of bubbles.

[Gougerot-Sjögren's syndrome. Clinical and biological correlations with the serology of Yersinia infections]. / Syndrome de Gougerot-Sjögren. Corrélations cliniques et biologiques avec la sérologie des infections à Yersinia.

An unusual case of Sjögren's syndrome (SS) induced or revealed by a Yersinia pseudotuberculosis serotype IV infection has prompted the authors to undertake a retrospective study of 32 patients with that syndrome. High titers of antibodies to Y. pseudotuberculosis serotype IV (greater than 1/200 th) were found in 4 patients with primary Sjögren's syndrome and Sharp's syndrome. Seven other patients (5 with primary Sjögren's syndrome, 1 with systemic lupus erythematosus and 1 with Sharp's syndrome) had positive serology with low titres, of doubtful significance. Serology was negative in the 20 remaining patients. Nine out of 25 patients had anti-thyroid antibodies, and their relationship with positive Y. pseudotuberculosis IV serology is discussed. The responsibility of the infection in the induction or disclosure of Sjögren's syndrome may be considered. However, since the syndrome frequently develops before serology becomes positive (8/12 cases with a 1 to 6 years' follow-up), an alternative hypothesis would be that diminished digestive defences in Sjögren's syndrome result in an increased frequency of Yersinia infections.