Le nodule de Soeur Marie Joseph, une rare métastase contributive

Les métastases cutanées ombilicales sont rares et habituellement associées à un adénocarcinome intra-abdominal en particulier les carcinomes gastriques. Nous rapportons l'observation d'une patiente de 80 ans admise pour une masse abdominopelvienne compliquée d'une ascite de grande abondance d'origine carcinomateuse à la cytologie évoluant dans un contexte d'altération de l'état général. La TDM abdominale a conclue à une ascite d'origine carcinomateuse avec des stigmates de carcinome péritonéale généralisée dont l'étiologie ne pouvait être déterminée. L'examen clinique entrepris lors de l'hospitalisation trouve une masse de l'ombilic polylobé d'aspect bleuâtre, poreuse au niveau de la fossette ombilicale et déformant complètement l'ombilic, saignante au toucher. Un prélèvement biopsique sur cette masse a été effectué et l'étude histologique était en faveur d'un adénocarcinome peu différencié de l'ovaire.il s'agissait en effet d'un nodule de S'ur Marie Joseph. Une découverte clinique qui est d'une aide inestimable orientant le diagnostic étiologique et la prise en charge thérapeutique et épargnant à la patiente une intervention chirurgicale d'exploration sur un terrain fragilisé par sa pathologie maligne. Nous attirons l'attention des cliniciens: oncologue et chirurgiens à cette entité clinique, qui est rare certes, mais très contributive au diagnostic étiologique et par conséquent à une prise en charge optimale pour ce genre de patient.Pan African Medical Journal 2015; 2

Burnout among surgeons before and during the SARS-CoV-2 pandemic: an international survey

Background: SARS-CoV-2 pandemic has had many significant impacts within the surgical realm, and surgeons have been obligated to reconsider almost every aspect of daily clinical practice. Methods: This is a cross-sectional study reported in compliance with the CHERRIES guidelines and conducted through an online platform from June 14th to July 15th, 2020. The primary outcome was the burden of burnout during the pandemic indicated by the validated Shirom-Melamed Burnout Measure. Results: Nine hundred fifty-four surgeons completed the survey. The median length of practice was 10 years; 78.2% included were male with a median age of 37 years old, 39.5% were consultants, 68.9% were general surgeons, and 55.7% were affiliated with an academic institution. Overall, there was a significant increase in the mean burnout score during the pandemic; longer years of practice and older age were significantly associated with less burnout. There were significant reductions in the median number of outpatient visits, operated cases, on-call hours, emergency visits, and research work, so, 48.2% of respondents felt that the training resources were insufficient. The majority (81.3%) of respondents reported that their hospitals were included in the management of COVID-19, 66.5% felt their roles had been minimized; 41% were asked to assist in non-surgical medical practices, and 37.6% of respondents were included in COVID-19 management. Conclusions: There was a significant burnout among trainees. Almost all aspects of clinical and research activities were affected with a significant reduction in the volume of research, outpatient clinic visits, surgical procedures, on-call hours, and emergency cases hindering the training. Trial registration: The study was registered on clicaltrials.gov "NCT04433286" on 16/06/2020