Aims: We compared histological patterns after lumpectomy for non-palpable breast cancers preoperatively localized by radioguided occult lesion localization plus sentinel node localization (SNOLL) versus wire-guided localization.Methods: To ensure a homogeneously treated cohort and rigorous comparisons, only patients with invasive cancer and measurable opacity by imaging were included. Exclusion criteria were one or more parameters that could interfere with localization and/or the surgical procedure. Forty-three SNOLL were compared with 86 WGL plus sentinel node (SN) localization. Cancer localization effectiveness was based on careful assessment of histological data from only the first resected glandular specimen, as any additional resection specimens were guided by intraoperative histological examination.Results: Reexcisions to ensure free tissue margins were performed during the same procedure in 13.9% of SNOLL versus 31.3% of WGL; p = 0.02. Significantly more women in SNOLL (53.4%) also had free nearest margins of >9 mm after the first procedure compared with WGL (33.7%); p = 0.03. The median centricity ratio after the first procedure was better in SNOLL (2.8, range 1.3-14) than WGL (5, range 1-50); p = 0.008. The median number of SN detected by lymphoscintigraphy was the same in SNOLL and WGL (1, range 0-9, vs. 1, range 0-8). Intraoperative SN detection by blue dye and/or gamma probe was successful for 97.6% of SNOLL versus 93% of WGL.Conclusion: In this study, SNOLL was effective and safe, and this procedure significantly improved the rate of negative margins in the first specimen and the rate of reexcision for positive margins compared with WGL. (C) 2012 Elsevier Ltd. All rights reserved.

Sir, Uranium, the heaviest naturally occurring element (1), is valued for its radioactive properties. In the past five years, the mining of uranium worldwide reached a peak due to its increasing usage in nuclear weapons and power (2), which undoubtedly aggravated its environmental pollution. This radioactive metal has been proved to be linked to many adverse health effects, such as respiratory diseases, stomach and kidney cancer, kidney failure and leukemia (3,4). Additionally, it has been demonstrated to have reproductive and developmental toxicity in animal experiments (5,6). However, the distribution of uranium in the mother and fetus and its embryonic/fetal toxicity has been scantly investigated in humans. Zhu et al. reported that the uranium content in atmospheric dust of Chinese moderately large cities was relatively high compared with levels in many areas of the world (7). Zhu and Liu also found that uranium in major foodstuffs consumed by Chinese adults was several to several dozen times as much as the world reference values (8). Consequently, the pulmonary uranium in Chinese adult men (1.92g) was higher than that for the ICRP (International Commission on Radiological Protection) Reference Man (1.00g) (7), and the annual committed effective dose of uranium from dietary intake in the whole body for Chinese adult men was determined to be four times as much as that for the world reference man (9). Therefore, we presumed that Chinese pregnant women and their fetuses could be faced with potentially severe health threats induced by this radioactive pollutant and chose Dalian as representative of Chinese moderately large cities to conduct this study. After we obtained ethical approval from the Human Subjects Review Committee of Dalian Medical University and the Ethics Committee of the No. 210 Hospital of the Chinese People’s Liberation Army, we recruited 86 mother–infant pairs from the Department of Obstetrics and Gynecology of this same hospital between October 2006 and March 2007. All mothers had no definite occupational exposure to uranium and delivered at 34–42weeks of gestation. Exclusion criteria were maternal and fetal important diseases and notifiable birth defects. We determined the uranium concentration of maternal and fetal whole blood by inductively coupled plasma mass spectrometry (8). The detection limit of uranium was 0.005μg/L. In our study, the detection rate of uranium in maternal and cord blood was 61.63 and 68.60%, respectively. The median uranium concentration in maternal and cord blood was 0.042 and 0.057μg/L, respectively, and there was no statistical difference between them (p>0.05). A significant positive correlation was shown between maternal and cord blood uranium (p<0.01). The detailed data are presented in Table 1. Our results revealed that the mothers and their fetuses from the general population had been exposed to uranium, and exposure levels of the fetus seemed enhanced with increasing maternal uranium. It is well known that Japan is now faced with radiation leaks, mainly comprising uranium and iodine, from the damaged nuclear power Table 1. Distribution of uranium in maternal and cord blood (μg/L).

We present a study of 37 women who underwent uterine compression suture for postpartum hemorrhage, with 13 postoperative assessments by hysteroscopy. Synechia occurred in seven patients, of whom three had Asherman syndrome (23% of women who desired pregnancy and had hysteroscopic evaluation) that could not be corrected.

La tomographie par émission de positons couplée au scanner (TEP-TDM) au 18-fluorodésoxyglucose (18-FDG) est l’examen le plus performant pour chercher un envahissement des chaînes ganglionnaires pelviennes et/ou lombo-aortiques dans les cancers du col utérin. Nous rapportons le cas d’une patiente, traitée chirurgicalement par laparoscopie pour un cancer de l’endomètre, dont la TEP-TDM réalisée en postopératoire a identifié une fixation élevée du 18-FDG en regard de la chaîne iliaque primitive droite. Cela a conduit à une ré-intervention par laparotomie concluant à la présence d’un granulome sur une compresse hémostatique.

We are writing in reply to the comments raised by Dr. Sentilhes on our recently published article (1). We much appreciate the remarks made by a team who have been working on surgical treatment to control severe postpartum hemorrhage and especially on uterine-sparing procedures (2, 3). Our purpose was mostly to highlight the potential mid- and long-term effects of uterine compression sutures on fertility.

Combined positron emission tomography and computerized tomography (PET/CT) using 18-fluorodeoxyglucose (18-FDG) is the most effective study to identify invasion of pelvic and/or para-aortic lymph node chains in cancers of the uterine cervix. We report the case of a patient who underwent laparoscopic hysterectomy and cytoreductive surgery for endometrial cancer; postoperative PET/CT identified an intense localization of 18-FDG in the region of the right common iliac chain. This finding led to an open re-exploration at which the only finding was a granuloma arising in reaction to a hemostatic sponge.

We report the only case of recurrent bilateral adnexal torsion during pregnancy with normal ovaries. This rare situation raises diagnostic as well as therapeutic management difficulties. (C) 2010 Elsevier Masson SAS. All rights reserved.

Feasibility and oncological safety of post-adjuvant skin-sparing mastectomy (SSM) plus immediate breast reconstruction (IBR) cannot be evaluated by randomized trials. However, comparative study could modify guidelines for the oncosurgical treatment of invasive breast cancer. Our study compared the feasibility, oncological safety and esthetic outcome of SSM plus latissimus dorsi (LD) flap IBR after chemotherapy (CT) and radiotherapy (RT) with the standard management for invasive breast cancer: mastectomy as primary treatment, adjuvant CT and RT, and LD flap delayed breast reconstruction (DBR). Twenty-six selected patients with stages IIA–IIIA breast cancer were offered post-neoadjuvant SSM plus IBR with LD flap plus implant (IBR group). Seventy-eight other patients had primary mastectomy, adjuvant CT and RT, and LD-assisted DBR (DBR group). After 4.1 years (range 1–8) of follow-up, feasibility, oncological safety, and esthetic outcome were compared. Sixteen (61%) early complications were reported for the IBR group versus 44 (56%) for the DBR group ( P = 0.645). Early implant loss was 0% in IBR versus 12% in DBR. IBR had 8 (30%) late complications versus 17 (21%) for DBR ( P = 0.362). Capsular contracture and reconstruction failure rates were similar. Local recurrence was 7.7% (2/26) in IBR and 6.4% (5/78) in DBR ( P = 0.823). Cosmetic evaluation by independent physicians and by the patients themselves was identical in the two groups. Our concept provides a basis for offering more women the opportunity to elect for immediate reconstruction, even in the setting of radiation therapy.

Purpose: To evaluate the clinical and cosmetic results of our treatment of recurrent periareolar abscess.Patients and methods: Our technique was applied to 27 patients with recurrent periareolar abscess who had been previously surgically treated three or more times between January 2001 and December 2008. Our treatment combined resection of the fistula, the terminal milk ducts, and mammary gland involved in the inflammatory process. This was associated with glandular remodeling and a lift of the periareolar skin. Long-term clinical results and evaluation of cosmetic result are analyzed.Results: The median age of patients was 36 years and the median course of disease was 5 years (2-11 years). The duration of follow-up was 37 months. Before being treated in our service, patients had a median of four prior surgeries for this condition (3-12). The average hospital stay was 3.2 +/- 0.6 days after surgery. One recurrence occurred among the 24 patients reviewed. She was treated by excision of the nipple and areola. Six patients (25%) rated their outcome excellent and 13 patients (54%) considered their results good. Five patients assessed their overall result as fair (21%), and no patients judged their results as poor.Conclusions: Our technique is simple and feasible and the results are encouraging. It can be used regardless of the location of the fistula around the periphery of the nipple-areola complex and it is perfectly suited to the management of chronic fistulous abscess. (C) 2010 Elsevier Masson SAS. All rights reserved.

Évaluer les résultats cliniques et cosmétiques de notre prise en charge des abcès peri-aréolaire récidivants. Notre technique a été appliquée à 27 patientes présentant un abcès peri-aréolaire récidivant et préalablement traitées chirurgicalement trois fois ou plus entre janvier 2001 et décembre 2008. Le traitement associait une exérèse de la fistule, des galactophores terminaux, et de la glande mammaire intéressée par le processus inflammatoire. Y était associé un remodelage glandulaire et un redrapage cutané autour de l’aréole. Les résultats cliniques à long terme ainsi que l’évaluation cosmétique sont analysés. L’âge médian des patientes opérées était de 36 ans et la durée médiane d’évolution était de cinq ans (deux à 11 ans). La durée de suivi a été de 37 mois. Avant leur prise en charge dans notre service les patientes avaient eu un nombre médian de quatre interventions chirurgicales pour la même raison (trois à 12). La durée moyenne d’hospitalisation a été de 3,2 ± 0,6 jours après l’intervention chirurgicale. Sur 24 patientes revues une seule récidive est survenue. Elle a été traitée par exérèse de la plaque aréolo-mamelonnaire. Six patientes (25 %) ont jugé leur résultat excellent et 13 patientes (54 %) l’on jugé bon. Enfin pour cinq patientes l’appréciation globale a été un résultat moyen (21 %). Aucun résultat n’a été jugé médiocre. Notre technique est simple et ses résultats sont encourageants. Elle est utilisable quelle que soit la localisation de la fistule sur la périphérie de la plaque aréolo-mamelonnaire et adaptée à la prise en charge des abcès chroniques. This work report our experience of treating recurrent disease using oncoplastic techniques based on complete excision of the fistula tract and the diseased duct, wide excision of the pathological breast tissue, and primary skin closure. We included in the study 27 patients who had presented with recurring mammillary fistula and undergone three or more previous surgeries between January 2001 and December 2008. Surgical treatment consisted on wide tissue resection with concomitant breast remodeling to avoid inesthetic breast deformation. Long-term clinical results, recurrence rates, and overall patient satisfaction were obtained through a follow-up survey. The patients ranged in age from 24 to 51 years, with a median age of 36 years. The duration of symptoms ranged from 2 to 11 years (median duration 5 years) and the average postoperative follow-up was 37 months. All patients but three were reviewed. A recurrent abscess developed in one patient, who was treated by areola excision, and the remaining 23 were recurrence free at follow-up evaluation. At cosmetic evaluation, satisfaction was excellent for six patients (25%) and good for 13 patients (54%). Finally the remaining five patients (21%) evaluate the result as fair. Our technique is simple and feasible regardless the location of the cutaneous fistula. This technique is useful to treat recurring subareolar abscess.