Annales De Chirurgie Plastique Esthetique最新文献

Background: Primary cutaneous amebiasis is a rare manifestation of Entamoeba histolytica infection, often underdiagnosed due to its uncommon occurrence.

Objective: To report a new case and analyze epidemiological, clinical, and diagnostic data through a review of the literature.

Case report: A 23-year-old female patient presented with a cutaneous lesion on the left thigh. The diagnosis of primary cutaneous amebiasis was confirmed by histological examination.

Conclusion: Any atypical cutaneous lesion, particularly in individuals living in endemic areas, should raise the suspicion of amebiasis. Histology remains the key examination for establishing the diagnosis of this rare form, thereby allowing appropriate management.

Background: Transgender individuals continue to report inadequate, and at times discriminatory, medical care. Concurrently, healthcare professionals frequently acknowledge a lack of preparedness in providing appropriate care to this population. The objective of this study was to evaluate the impact of an elective course on transgender health in enhancing the knowledge of fourth-year medical students.

Materials and methods: A 20-hour elective course was offered to fourth-year medical students, covering both medical and legal aspects of transgender identity. Sessions were delivered by a range of professionals with relevant expertise. Students (n=90) completed a knowledge assessment questionnaire prior to and following the course.

Results: There was a significant improvement in students' knowledge regarding the care of transgender patients between the pre- and post-course assessments. Moreover, participants expressed high levels of satisfaction with the elective.

Discussion: This elective course, delivered over four half-day sessions, provided medical students with essential foundational knowledge for the care of transgender patients. The persistent disparities faced by transgender individuals in mental and physical health, as well as in access to healthcare, highlight the urgent need to reassess the training provided to future healthcare professionals. Incorporating transgender health education into medical training is essential to promote equitable care and to mitigate the systemic barriers that contribute to health disparities in this population.

Introduction: Pregnancy and the immediate postpartum are periods of immune reconstitution inflammatory syndrome (IRIS), exposing patients to an increased risk of severe infections. Among these, necrotizing soft tissue infection (NSTI) is a rare but serious, life- and function-threatening condition.

Case report: We report the case of a 31-year-old patient three weeks postpartum, admitted for acute right hand pain with septic signs. The initial clinical picture, typical of a pyogenic flexor tenosynovitis of the ring finger, rapidly evolved into NSTI of the palm. Despite urgent medical and surgical management including two successive surgical interventions, broad spectrum antibiotic therapy and intensive care follow-up, the evolution was marked by necrosis of multiple fingers, necessitating digital amputations.

Discussion: This case illustrates the potential severity of bacterial infection of the hand in a postpartum context, favored by IRIS. It also highlights the importance of early surgical management, even in cases of minimal cutaneous entry point, to limit major functional complications.

Conclusion: In the context of pregnancy or postpartum, any soft-tissue infection should alert to the risk of fulminant evolution. Early, multidisciplinary medical and surgical management is essential to limit morbidity, mortality and preserve function.

Introduction: Asian women, including Vietnamese, generally have smaller breast volumes than Europeans. Breast-conserving surgery or unilateral reconstruction often results in contour deformities and poor symmetry in patients with small breasts. Therefore, they may require not only breast reconstruction but also contralateral augmentation to achieve optimal symmetry. Previously, surgery was typically performed in two stages, increasing both cost and treatment time for patients. In this study, we report the outcomes of direct-to-implant (DTI) breast reconstruction with simultaneous contralateral augmentation.

Methodology: This is a prospective observational study on 60 breast cancer patients undergoing skin-sparing or nipple-sparing mastectomy (SSM/NSM) with DTI reconstruction and simultaneous contralateral augmentation from January 2019 to January 2024. Data on patient characteristics, disease stage, surgical techniques, complications, aesthetic and oncologic outcomes were collected.

Results: The mean age was 40.4±7.5 years. Most patients had a BMI <25 (86.7%) and small breast volume. Over a median follow-up of 25.7 months (range, 14-59 months), complications occurred in 11 patients (18.3%), including 10 related with the reconstructive implant and 1 with the contralateral augmentation. 1 patient (1.7%) developed local recurrence, and another (1.7%) presented with liver metastasis. No deaths were reported. Aesthetic outcomes were rated as "good" to "excellent" in 75% of cases at 12 months.

Conclusion: Direct-to-implant reconstruction with simultaneous contralateral augmentation can be safely performed in breast cancer patients with small breast volume, showing low complication rates and favorable aesthetic outcomes.

Introduction and importance: Pyoderma gangrenosum (PG) is a rare condition caused by dermal inflammation with neutrophilic infiltration, often associated with an underlying systemic disease. The breast is an uncommon site for this condition. It is an exclusion diagnosis, challenging to establish, which may initially lead to an alternative one and the initiation of inappropriate treatment.

Presentation of case: A 41-year-old woman with a medical history of morbid obesity, breast reduction 14 years ago, common variable immunodeficiency (CVID), and autoimmune thrombocytopenia presented with a spontaneous inflammatory ulcer of the left breast. The clinical course rapidly deteriorated, progressing to septic shock despite antibiotics. This presentation led to the consideration of necrotizing soft tissue infection (NSTI) as the primary diagnosis. The patient underwent multiple surgical debridements combined with broad- spectrum antibiotic therapy, which resulted in only a slow improvement in her condition. Histopathological examination of the surgical specimens revealed a cutaneous ulcer with dermal inflammation predominantly composed of neutrophils. Her condition eventually stabilized, allowing for reconstruction of the left breast with a split-thickness skin graft. In the immediate postoperative period, the patient developed a fever of unknown origin and inflammatory lesions with a violaceous border at the graft donor site. PG was suspected. One month later, the patient presented with a spontaneously occurring violaceous inflammatory lesion on the controlateral breast.

Clinical discussion: This case of spontaneous PG, is a condition only very rarely described in the literature. A combination of concordant findings support this diagnosis.

Conclusion: PG is a rare condition with a challenging diagnosis, as it is one of exclusion. The breast is an uncommon site of involvement, typically described in postoperative cases and very rarely presenting spontaneously. When a patient presents with breast dermo-hypodermitis that shows limited improvement despite appropriate treatment, PG should be considered as a differential diagnosis.