A double blind randomized trial of wound infiltration with ropivacaine after breast cancer surgery with axillary nodes dissection

<p>Abstract</p> <p>Background</p> <p>The effect of local infiltration after breast surgery is controversial. This prospective double blind randomized study sought to document the analgesic effect of local anaesthetic infiltration after breast cancer surgery.</p> <p>Methods</p> <p>Patients scheduled for mastectomy or tumorectomy and axillary nodes dissection had immediate postoperative infiltration of the surgical wound with 20 ml of ropivacaine 7.5 mg.ml^-1or isotonic saline. Pain was assessed on a visual analogue scale at H2, H4, H6, H12, H24, H72, and at 2 month, at rest and on mobilization of the arm. Patient'comfort was evaluated with numerical 0-3 scales for fatigue, quality of sleep, state of mood, social function and activity.</p> <p>Results</p> <p>Twenty-two and 24 patients were included in the ropivacaine and saline groups respectively. Postoperative pain was lower at rest and on mobilization at 2, 4 and 6 hour after surgery in the ropivacaine group. No other difference in pain intensity and patient 'comfort scoring was documented during the first 3 postoperative days. Patients did not differ at 2 month for pain and comfort scores.</p> <p>Conclusion</p> <p>Single shot infiltration with ropivacaine transiently improves postoperative pain control after breast cancer surgery.</p> <p>Trial registration number</p> <p><a href="http://www.clinicaltrials.gov/ct2/show/NCT01404377">NCT01404377</a></p

Risques de récidives axillaires après prélèvements du ganglion sentinelle dans le cancer du sein (à propos de 140 cas)

PARIS6-Bibl.Pitié-Salpêtrie (751132101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Cancers du sein bilatéraux synchrones (à propos de 62 cas)

L'objectif de cette thèse est d'évaluer les caractéristiques et le traitement des cancers du sein bilatéraux synchrones (CSBS). Entre Juillet 1992 et Mai 2006, 62 patientes ont été prises en charge pour un CSBS. Les tumeurs ont été séparées en tumeurs droite et gauche et la population divisée en deux périodes d'étude. Les données épidémiologiques, les circonstances diagnostiques, les traitements et les caractéristiques histologiques tumorales ont été analysés et comparés entre les différents groupes d'étude. L'incidence globale des CSBS était de 2,6 %. Les patientes présentant un CSBS avaient un antécédent familial de cancer du sein dans 23,7 % des cas. Le tableau le plus fréquent associait une tumeur palpable à une lésion controlatérale infraclinique (43,5 %). L'IRM a permis de diagnostiquer 7 tumeurs. 38,7 % des patientes ont eu une mastectomie bilatérale et 33,9 % ont bénéficié de la technique du ganglion sentinelle. La proportion de carcinomes lobulaires invasifs était de 17,7 % et 17,7 % des tumeurs étaient multifocales. Les tumeurs avaient le même type histologique dans 78,3 % des cas et l'expression des récepteurs aux oestrogènes était identique dans 91,4 % des cas. Les principaux facteurs de risque de CSBS sont la notion d'une histoire familiale de cancer du sein, le type histologique lobulaire invasif et le caractère multifocal de la première tumeur. Une prise en charge chirurgicale conservatrice est possible ainsi que l'utilisation de la technique du ganglion sentinelle. Les CSBS ont des similitudes histologiques, probablement dues à des facteurs environnementauxPARIS6-Bibl.Pitié-Salpêtrie (751132101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Peut-on proposer un prélèvement du ganglion sentinelle en cas de chimiothérapie néoadjuvante dans les cancers du sein et à quel moment ?

International audienceThe main goal of preoperative chemotherapy is to reduce the size of the tumor and allow conservative treatment. Neoadjuvant treatment can affect axillary status with a downstaging in one third of the cases. For these patients, the benefit of axillary node dissection is questioned and the sentinel node biopsy (SLNB) seems to be a relevant option. However, the timing of performing SLNB is still debated especially for clinical negative patients with negative axillary ultrasound before preoperative chemotherapy. For axillary positive nodes proved by biopsy/cytology before preoperative chemotherapy, SLNB can be an option if there is a good clinical and radiological response.La chimiothérapie néoadjuvante (CNA) peut permettre une réduction de la taille de la tumeur en vue d’un traitement conservateur impossible initialement. Elle permet également une réponse ganglionnaire axillaire histologique complète dans un tiers des cas. La pertinence du curage axillaire (CA) systématique après CNA est remise en question, en faveur de la procédure du ganglion sentinelle (GS). Cependant, le moment optimal par rapport à la CNA est encore débattu dans la littérature pour les patientes n’ayant pas d’envahissement ganglionnaire évalué par échographie avant la chimiothérapie. Pour les patientes avec envahissement ganglionnaire prouvé avant CNA, la réalisation d’un GS après CNA paraît envisageable en cas de réponse radio-clinique

Results of transurethral injection of silicone micro-implants for females with intrinsic sphincter deficiency.: Transurethral injection of silicone microimplants

International audiencePURPOSE: We evaluated the medium term efficiency of silicone micro-implants injected in women with intrinsic sphincter deficiency. MATERIALS AND METHODS: A total of 21 women with intrinsic sphincter deficiency underwent transurethral injection of silicone micro-implants between August 1996 and February 1997. Each patient was assessed preoperatively by questionnaire, physical examination and urodynamic study. The results were evaluated by questionnaire at 1 month, and 1 and 2 years after silicone injection. The outcome was classified as dry in all circumstances, improved or failure. RESULTS: All patients (median age 68 years, range 46 to 83) had undergone previous anti-incontinence or prolapse surgeries. At 1 month 2 patients (10%) were dry and 9 (42%) were improved, and treatment failed in 10 (48%). At 1 year (median 16 months, range 14 to 22) 2 cases (10%) were classified as dry, 8 (38%) improved and 11 (52%) failures. At last followup (median 31 months, range 24 to 34) 4 cases (19%) were classified as dry, 6 (29%) improved and 11 (52%) failures. None of the 6 patients with bladder neck hypermobility was dry. CONCLUSIONS: Our results of silicone transurethral injection are disappointing but comparable to other bulking agents without a time dependent decrease in efficiency. The use of silicone micro-implants is an alternative for the treatment of intrinsic sphincter deficiency in patients without bladder neck hypermobility and in whom the sling procedure has failed

Delayed hysteroscopic resection of retained tissues and uterine conservation after conservative treatment for placenta accreta

International audienceBackgroundConservative management of both the uterus and the abnormal placenta, which is left inside the uterus at the time of delivery, is one option of placenta accreta management. Complete elimination of the residual placenta is the main challenge of this procedure.AimTo report the role, efficacy and safety of hysteroscopic resection in women presenting with severe pelvic pain and chronic intra-uterine retention after conservative treatment of placenta accreta.Material and methodsFour consecutive women who were treated with hysteroscopic resection of retained tissues after conservative treatment of placenta accreta or percreta at the time of delivery. Clinical files and surgical procedures were reviewed. All procedures were performed because of chronic pelvic pain and the absence of a complete spontaneous placental elimination.ResultsAll procedures were successful and uneventful. The uterus was conserved with a complete disappearance of the symptoms in the four women, and two of them became pregnant.ConclusionHysteroscopic resection seems effective and safe for shortening the duration of placental elimination after conservative treatment in women with severe pelvic pain due to uterine retention. This approach allows conserving the uterus and future fertility