Analyse des facteurs de risque des marges positives et de la récidive à long terme dans le traitement conservateur du cancer du sein

Introduction: breast conserving therapy remains the first choice in breast cancer care for the early stages. Adequate surgical margins are essentia to reduce the risk of locoregional recurrence. This study aims to identify risk factors of positive margins and locoregional recurrence. Materials and Methods: 437 patients who underwent a lumpectomy for invasive breast carcinoma or ductal carcinoma in situ have been included. Age, surgical margins, size, type, grade and number of tumor foci, the presence of ducta carcinoma in situ, lymph node status, expression of hormone receptors and HER-2 gene were assessed as risk factors for positive margins and locoregional recurrence. Results: The disease-free survival is 94 % a 10 years. Patients with positive margins have lower survival (92 %) than those with negative margins (96 %) (p ≤ 0.05). Lobular and multifoca tumors are at risk of positive margins. Tumors with positive margins, T2, grade III, triple negative and HER-2 positive neoplasms are at risk o locoregional recurrence while the expression o hormone receptors is a protective factor for loca recurrence. Conclusion: It appears in our study that invasive lobular and multifocal tumors may present positive surgical margins. Studies on preoperative work-up are needed. Biological factors of the tumor seem to play a fundamental role in the locoregional recurrence or persistence of the tumor.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Fasciite nécrosante de la paroi abdominale post-césarienne

Necrotizing fasciitis (NF) is a rare infection (0,2 to 0,4/100,000 adults) of the dermis and hypodermis extending along muscular fascia1. The absence of pathognomonic symptoms makes its diagnosis difficult. Rapidly progressive, it is a life-threatening emergency whose prognosis is letal in 30 % of cases. Treatment of necrotizing fasciitis is mixed and involves aggressive surgical debridement and medical treatment with antibiotics and supportive agents. This article is presenting the case of a young woman who developed abdominal necrotizing fasciitis following a caesarean section. In forty-eight hours, the patient developed septic shock with an extensive and rapid destruction of her abdominal wall. After hysterectomy and multiple surgical debridements, evolution was favorable. After one month, a reconstruction of the abdominal wall could be performed.SCOPUS: ar.jinfo:eu-repo/semantics/publishe