Ultrasonography is the evidence-based diagnostic method for thyroid nodules. The account has to specify the technical used, and has to exactly describe the echogenicity of the thyroid, the feature of the nodules (number, size, echostructure, echogenicity, edges), and the presence or absence of lymph nodes. The malignancy criteria of thyroid nodules are: (1) hypoechoic solid nodule, (2) presence of internal microcalicifications, (3) ill-defined–irregular edges or absence or breaking of the peripheral halo. The nodes' criteria of malignancy are: (1) diameter of 1 cm or more, (2) clear hypoechoic pattern or non-homogeneous pattern, with alternating hypoechoic and hyperechoic areas, (3) cystic appearance (4) presence of internal calcifications (5) rounded shape with increased anteroposterior diameter, (6) long/short diameter ratio higher than 0.7, (7) absence of hilum. When these criteria are present, a histological diagnosis has to be performed. They could change the operative procedure in the patients.
Incidence of chronic pain is lower following laparoscopic hernioplasty than open surgery, probably due to the location of the patch in the preperitoneal space. But since laparoscopy is more demanding, the rates of complications and recurrences are higher. The aim of this study was to evaluate the results of a procedure consisting of placement of a patch, endowed with some memory of shape, provided by a thin peripheral memory ring, in the preperitoneal space, by inguinal incision, through the hernia orifice, under spinal or local anesthesia.
The study was carried out in two stages. The first study consisted of evaluating the results of a prosthesis made of a polypropylene mesh endowed with a memory-ring made of a PDS cord (Ethicon SAS, 92787 Issy-les-Moulineaux). The second study evaluated the results of the Polysoft® patch manufactured by Bard C° (Bard France, 78960 Voisins-le-Bretonneux), according to this concept.
The first study involved 129 hernias operated on 126 patients of mean age 60 years (27–84). There were 3 (2.3%) benign complications. With a median follow-up of 24.5 months (12–42), 124 hernias (96%) were evaluated. There were 2 recurrences (1.6%) and 7 cases (5.6%) of chronic pain. The second series involved 150 hernias operated on 139 patients of mean age 60 years (21–94). Four (2.7%) benign complications occurred. The median length of surgery was 36 min (20–60), the median postoperative hospital stay was 1 day (0–5), the median time to return to normal activity was 3 days (0–8) and the median time off work was 18 days (1(30). The patients took paracetamol for 3 days (0–10) and the total units number was 8 (0–28).
These results suggest that the method, easily reproducible, provides a low rate of complications and recurrences, as well as a low level of postoperative and chronic pain. They are worth being confirmed by a randomised comparison to the laparoscopic and Lichtenstein techniques.
Infections due to Listeria monocytogenes usually occur in pregnant women, in elderly or immunocompromised patients. We report the case of an immunosuppressed woman who had been hospitalized for a meningoencephalitis due to L. monocytogenes. She was operated on for an abdominal hemorrhagic shock due to a ruptured mycotic aneurysm of the inferior mesenteric artery. Arterial aneurysms due to this germ are rare and occur on large arteries. Only 17 cases have been previously described in the literature and just one concerning a mesenteric artery.
To make a development on the recent data of the literature concerning the functional anatomy of the lymphatic drainage of the breast, observed during interventions of sentinel lymph node biopsy; to compare the descriptive anatomy taking into consideration these new results.
The population of our descriptive anatomical study is made-up of five patients. All the patients underwent a radical mastectomy during which, an injection of 2 ml of patented blue, realized at the periareolar area allowed to observe the glandular lymphatic vessels. Bibliographic researches were undertaken on Internet site of the National Library of Medicine and on Internet site of the library of anatomy (Faculté de médecine des Saints-Pères Paris).
Lymphatic anatomy of the breast was described since more than one century starting from works undertaken on anatomical subjects. Recent works, completed during sentinel lymph node biopsy, enriched these descriptive data of new functional anatomical data on the lymphatic drainage of the breast. Thus, the superficial ways of lymphatic drainage already described by Sappey, drain the surface glandular parenchyma until in the axillary lymph node. A deep plexux described more recently by Hidden drain the deep glandular parenchyma until in the internal mammary lymph nodes and the axillary lymph nodes. The results of our in vivo study corroborated the descriptive and functional data ever known.
Thanks to the sentinel lymph node biopsy technique, the descriptive anatomy described since 1885, grows rich by new functional data which make it possible on the one hand, to understand at best the descriptive anatomy, and on the other hand, to apprehend the lymphonodal metastatic risk in breast cancer. These recent data are of an interest real, as well anatomical as therapeutic, and constitute a interesting research orientation.
To report a single-institution retrospective study of radical en bloc resection for lung cancer invading the spine.
Between 1993 and 2004, 32 patients underwent partial or total vertebrectomy for non-small cells lung cancer with spinal extension. Twenty-one received induction treatment (chemotherapy, N = 16; radiation, N = 1 and chemoradiotherapy, N = 4). Pneumonectomy was performed in 3 patients, lobectomy in 26 patients and wedge resection in 3 patients. Partial vertebrectomy was performed in 26 patients and total vertebrectomy was performed in 6 patients. Tumor stage was IIb in 9 patients, IIIa in 2 patients and IIIb in 21 patients.
There was no immediate postoperative mortality. Major morbidity was observed in 10 patients (31%), including 4 complications related to spinal surgery. For 28 patients, a completed resection was achieved (87%). 2-years survival was 65% and 5-years survival was 24%. Completed resection and induction chemotherapy appear to be determinant prognostics factors (respectively p = 0,01 and p = 0,04 in univariate analysis).
Radical en bloc resection with vertebrectomy for lung cancer is technically demanding. Encouraging long-term survival suggest that this surgical approach could be a valid option for selected patients with vertebral involvement of lung cancer.
The sternalis muscle is a normal anatomic variant, which exists in about 5 to 8% of people. It runs longitudinally superficial to pectoralis major, alongside the sternum. Although the sternalis seems common in cadaveric studies, physicians are not familiar with it, which may lead to confusion in diagnosis. Occasionally, the sternalis may be misinterpreted as a breast mass on mammogramm. In that case, computed tomography and magnetic resonance imaging are useful. We report herein two cases of sternalis muscles encountered during mastectomy.
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