[Abdominal wall necrosis as expression of Munchausen's syndrome: a case report]. / Nécrose cutanée de la paroi abdominale: à propos d'un cas de syndrome de Münchausen.

Münchausen's syndrome is a psychiatric disease with behaviour disorders including self-injuries. Self mutilations interest all the body, and among others the abdominal wall, who can mimic complications of surgery. We report the history of a woman consulting for an abdominal wall panniculitis two years after a caesarean. Medical history, histological patterns and the psychological history of the patient excluded the diagnosis of a surgical complication and Münchausen's syndrome was strongly evocated. The treatment was surgical, with excision of the cutaneous necrosis. The healing was obtained by treatment with Vacuum Assisted Closure System (VAC).

Doughnut mastopexy lumpectomy versus standard lumpectomy in breast cancer surgery: a prospective study.

AIMS: Doughnut mastopexy lumpectomy (DML) is a unique breast resection in which a tissue segment is removed and the breast reshaped through a periareolar incision. The present prospective investigation compares DML and standard lumpectomy (SL) in relation to surgical variables, histological parameters, postoperative morbidity and cosmetic outcome. METHODS: 127 patients with breast cancer were offered the choice between two conservative surgical approaches: doughnut mastopexy lumpectomy (DML group, n=39) or standard lumpectomy (SL group, n=88). The groups were comparable for radiological tumour size, tumour location within the breast, histological size, and pT category. Comparison was performed in term of surgical variables, histological parameters, postoperative morbidity and cosmetic outcome. RESULTS: The patients undergoing DML were younger than the patients who chose SL. In the DML group, the skin incision was 3-fold longer than in the SL group but was obtained with a final scar located around the nipple areola complex without further postoperative complications. The average volume of the breast specimen was higher in the DML group compared with SL group. The clinician assessment of cosmetic outcome reported a higher rate of acceptable result in the DML group than in the SL group. However, patient's assessment did not show difference of cosmetic satisfaction between groups. CONCLUSION: Our comparative study indicates that DML may be a useful alternative to SL not only in terms of accurate breast tissue resection but also in term of cosmetic results.

[Lumpectomy vs oncoplastic surgery for breast-conserving therapy of cancer. A prospective study about 99 patients]. / Traitement conservateur des cancers du sein: zonectomie vs oncoplastie. Etude prospective à propos de 99 patientes.

UNLABELLED: The integration of oncoplastic techniques with a concomitant contralateral symmetrization procedure is a novel surgical approach that allows wide excisions and prevents breast deformities. AIM OF THE STUDY: This prospective study was undertaken to compare the accuracy of breast resection, between standard narrow lumpectomy and oncoplastic surgery. PATIENTS AND METHODS: Ninety-nine consecutive women undergoing breast cancer resection were enrolled in a prospective study comparing oncoplastic surgery (42 women) and standard lumpectomy (57 women). The size of the glandular resection, the width of the nearest margins, the ratio of clear margins and the need for further surgery were recorded. RESULTS: The oncoplastic approach resulted in significantly greater glandular resection and wider free histological margins than did standard lumpectomy. The need for re-exicsional surgery was significantly lower in the oncoplastic group than in the lumpectomy group. Furthermore, a trend towards fewer secondary mastectomies was seen for the oncoplastic approach versus standard lumpectomy. CONCLUSIONS: The use of oncoplastic techniques and concomitant symmetrization of the contralateral breast allows extensive resections for conservative treatment of breast carcinoma achieves accurate tumour resection and reduces the need for further surgery.

[Severe maternal anemia and pregnancy outcome]. / Anémies maternelles sévères et issues de grossesse.

OBJECTIVES: The aim of this study was to determine the effects of severe antenatal maternal anemia on pregnancy outcome. MATERIAL: and methods. A retrospective study comparing 2 groups of pregnant women: 111 (pregnant women) with anemia (Hb < 8 g/dl), 111 non- anemic pregnant women (Hb >10 g/dl). Clinical and biological characteristics for both groups were compared. Data on the newborn babies were collected. RESULTS: In the anemic group: iron deficiency was the most common cause of anemia (92.7%). There was no significant difference between the 2 groups with respect to age or parity. Maternal anemia was found to be significantly associated with more frequent preterm birth (29.2% vs 9.2%) and increased low birth weight (2933 g vs 3159 g). DISCUSSION: The literature is not conclusive on the influence of anemia in pregnant women. More frequent preterm birth and low birth weight have been reported in the majority of studies considering mild to moderate maternal anemia (in contrast to our study where the mothers had severe anemia). Many studies indicated that routine iron supplementation during pregnancy may have beneficial effects on pregnancy outcome. Severe anemia in pregnancy may have adverse effects for the newborn and should be treated or prevented early in pregnancy.

[Evaluation and treatment of endometrial cancer]. / Evaluation et traitement des cancers de l'endomètre.

Endometrial cancer is the most common gynaecologic cancer and its incidence increases with age. Prognosis is good because in over 80% of cases the cancer is discovered early. Preoperative work-up should include definition of the operability of such patients, who are often elderly with frequent co-morbidity. Preoperative evaluation and operative findings allow guiding the treatment and evaluating the prognosis. Main determinants are local extension, penetration into the myometrium, histologic stage of the tumour and involvement of lymph modes or peritoneum. Surgery is the first approach since it establishes the evaluation and comprises the first step of treatment. When necessary, subsequent treatment uses irradiation. Treatment with hormones or antimitotic drugs is less effective and is used for forms that are locally advanced, metastatic or recurrent after initial treatment.