Giant phyllodes tumour of the breast.

Phyllodes tumours are fibroepithelial lesions and count for 0.4% of breast tumours. Telling the difference between phyllodes tumours and fibroadenomas is sometimes difficult but of importance because wide resection is the mainstay of treatment for phyllodes tumours. We present a female patient, 55 years old with a giant phyllodes tumour (38 x 31 x 23 cm) of the breast. The breast reconstruction was done using a pedicled transverse rectus abdominis myocutaneous (TRAM) flap.

[Report of 243 vertical mammoplasties for very large, heavy breasts and/or severe ptosis. Analysis of the result and technical]. / A propos de 243 plasties mammaires verticales pour hypertrophie et/ou ptôse importantes. Etude rétrospective, analyse des résultats et description des modifications techniques.

Vertical mammaplasties for very large breasts and/or severe ptosis were evaluated in 124 patients who underwent operation in our unit between September 1993 and June 2001. In 119 cases it was reduction mammaplasty and in 5 cases unilateral symmetrization after contralateral reconstruction. The mean age was 36 years (13-62 years). Among inclusion criteriae, we choose the resection weight > or = 700 g and/or a ptosis > or = 30 cm. We report a few technical modifications of the initial Lejour vertical technique. About hypertrophic breasts (179 breasts): mean resection weight was 905 g (710-1750 g), mean ptosis was 33.5 cm (30-42 cm). The following complications were noted: 3 haematomas with only one evacuation on the same day, no seroma, 4 infections controlled by local treatment, 44 wound dehiscence or delayed skin healing (> 30 d), 8 partial necrosis, 12 secondary correction under local anaesthesia, 1 cheloïd scar of the areolar complex. About breasts with severe ptosis (64 breasts): the mean value was 31.8 cm (30 cm). Complications were as follow: 2 haematoma, 0 seroma, 16 healing delay, 3 partial necrosis, 6 secondary correction under local anaesthesia. The mean procedure time was 94 mn. The mean stay in hospital was 2.8 days, same as the suction drains. The vertical mammaplasty is a fast technique, giving good results. Scarring amount is reduced. Breasts are well projected, well shaped and remain stable in time. Their base can be modified. We think this technique can safely be applied to large breasts and/or severe ptosis.

24-h ambulatory blood pressure monitoring in healthy young adult Anglo, Hispanic, and African-American subjects.

The purpose of this study was to compare office and 24-h ambulatory blood pressure (ABP) values for adolescent and young adult males and females of Anglo, Hispanic, and African-American descent. One hundred and eighteen healthy subjects (62 females, 56 males) participated, with an ethnic distribution of 50 Anglo, 32 Hispanic, and 36 African-American subjects. All subjects came to the clinic for height, weight, sitting blood pressure (BP), and to begin 24-h ABP monitoring using the SpaceLabs model 90207 automatic noninvasive monitor. The monitor recorded readings every 0.5 h from 06:00 to 22:00 and every hour at night from 22:00 to 06:00. Office systolic and diastolic BP values were higher for all males compared to all females. Mean 24-h, nighttime, and daytime systolic ABP values were also significantly higher for males compared to females. The 24-h mean and daytime systolic ABP values were significantly different by ethnic groups. The African-American subjects always had the highest readings. Mean 24-h diastolic ABP was also significantly different by ethnic groups, with the African-American subjects being higher than the Anglos or the Hispanics. Diastolic ABP (24-h mean, daytime, and nighttime) values (for all subjects combined) increased gradually and varied significantly with age. This study provides preliminary normative data about ABP in an understudied population (ie, teenagers and young adults of different ethnic backgrounds). It also shows that higher blood pressures are present among males and among subjects of African-American descent in the teenage and young adult population.

[Medical imaging and headache: choice of studies and their economic impact]. / Imagerie médicale et céphalées: le choix des examens et son impact économique.

These past few years, new imaging technologies, very efficient but often quite expensive, have been developed. Within the context of budgetary restrictions, these progresses require a carefully planned strategy on the choice of investigations. Within the clinical environment of headaches, we have to discuss: conventional radiology (skill and cervical spine), cerebral CT scan, Magnetic Resonance Imaging and Angiography. These examinations are first discussed about their strong and weak aspects; then their indications are presented by pathology group. The related costs are analysed in terms of: health insurance rate, real production costs, consumption volume and total budgetary cost for Belgium. Based upon these data, concrete recommendations are proposed.

Final adult height and its relationship to blood glucose control and microvascular complications in IDDM.

The effect of longitudinal blood glucose control on final adult height was evaluated in 181 subjects (94 women and 87 men) with IDDM. Diabetes onset was at a median age of 6.9 years with an interquartile range of 4.7 years. Longitudinal glycated haemoglobin values were determined over a mean period of 6.6 +/- 2.6 years during their growth phase. Serial eye and joint examinations and urinary albumin excretion rates were performed with final assessment being carried out at a mean age of 21.1 +/- 3.0 years. The mean adult height standard deviation score of the whole group was -0.22 +/- 1.15 and was reduced compared to the mean height of the general population and to the mean height of the subjects' parents and siblings. There was an inverse correlation with mean longitudinal glycated haemoglobin and final adult height (p < 0.01). There was also an inverse relationship between adult height and the severity of eye, kidney, and joint complications, but when controlled by glycated haemoglobin, this relationship only remained significant for eye complications. Final adult height is reduced in subjects with early onset IDDM who remain in poor blood glucose control during their growth period.

[The diagnostic value of asbestos bodies in mesotheliomas]. / Intérêt diagnostique des corps asbestosiques dans le mésothéliome.

The exposure of asbestos was studied in 31 cases of mesothelioma from case histories and by microscopic mineralogical analysis of the broncho-alveolar lavage fluid (BAL) (31 cases) and of pulmonary tissue (5 cases). When definite exposure had occurred the lavage contained asbestos bodies in every case, except one patient with severe airflow obstruction. The most positive lavages, probably reflecting exposure to industrial amphiboles, were found in patients presenting with radiological evidence of asbestosis. Two patients had positive lavages 50 years after exposure had ceased. The lavage confirmed exposure in 6 out of 11 suspected cases and revealed contamination by asbestos in a further 4 cases, in a group of 6 not known to have been exposed. In 19.3% of cases there was a low concentration of asbestos bodies (less than 1AB/ml of BAL), comparable to what is found in 16.2% of controls from an urban population. An analysis of lung tissue confirmed massive exposure (greater than 20 000 AB/g) in two cases and in particular revealed a significant dust load (greater than 250 AB/g) in patients presenting with a weak positive BAL. Thus it seems that all the positive results should be taken into account. Of the 31 cases, 8 had a BAL without asbestos bodies. These were either mesotheliomas not linked to the inhalation of asbestos, or were the result of false negatives on account of artefacts related either to the BAL technique itself or linked to the technique of mineral analysis. Indeed the microscopic counts of asbestos bodies probably underestimate certain exposures, notably environmental exposure to chrysotile.