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AIMS: We compared histological patterns after lumpectomy for non-palpable breast cancers preoperatively localized by radioguided occult lesion localization plus sentinel node localization (SNOLL) versus wire-guided localization. METHODS: To ensure a homogeneously treated cohort and rigorous comparisons, only patients with invasive cancer and measurable opacity by imaging were included. Exclusion criteria were one or more parameters that could interfere with localization and/or the surgical procedure. Forty-three SNOLL were compared with 86 WGL plus sentinel node (SN) localization. Cancer localization effectiveness was based on careful assessment of histological data from only the first resected glandular specimen, as any additional resection specimens were guided by intraoperative histological examination. RESULTS: Reexcisions to ensure free tissue margins were performed during the same procedure in 13.9% of SNOLL versus 31.3% of WGL; p = 0.02. Significantly more women in SNOLL (53.4%) also had free nearest margins of >9 mm after the first procedure compared with WGL (33.7%); p = 0.03. The median centricity ratio after the first procedure was better in SNOLL (2.8, range 1.3-14) than WGL (5, range 1-50); p = 0.008. The median number of SN detected by lymphoscintigraphy was the same in SNOLL and WGL (1, range 0-9, vs. 1, range 0-8). Intraoperative SN detection by blue dye and/or gamma probe was successful for 97.6% of SNOLL versus 93% of WGL. CONCLUSION: In this study, SNOLL was effective and safe, and this procedure significantly improved the rate of negative margins in the first specimen and the rate of reexcision for positive margins compared with WGL.

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Combined positron emission tomography and computerized tomography (PET/CT) using 18-fluorodeoxyglucose (18-FDG) is the most effective study to identify invasion of pelvic and/or para-aortic lymph node chains in cancers of the uterine cervix. We report the case of a patient who underwent laparoscopic hysterectomy and cytoreductive surgery for endometrial cancer; postoperative PET/CT identified an intense localization of 18-FDG in the region of the right common iliac chain. This finding led to an open re-exploration at which the only finding was a granuloma arising in reaction to a hemostatic sponge.

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PURPOSE: To evaluate the clinical and cosmetic results of our treatment of recurrent periareolar abscess. PATIENTS AND METHODS: Our technique was applied to 27 patients with recurrent periareolar abscess who had been previously surgically treated three or more times between January 2001 and December 2008. Our treatment combined resection of the fistula, the terminal milk ducts, and mammary gland involved in the inflammatory process. This was associated with glandular remodeling and a lift of the periareolar skin. Long-term clinical results and evaluation of cosmetic result are analyzed. RESULTS: The median age of patients was 36 years and the median course of disease was 5 years (2-11 years). The duration of follow-up was 37 months. Before being treated in our service, patients had a median of four prior surgeries for this condition (3-12). The average hospital stay was 3.2±0.6 days after surgery. One recurrence occurred among the 24 patients reviewed. She was treated by excision of the nipple and areola. Six patients (25%) rated their outcome excellent and 13 patients (54%) considered their results good. Five patients assessed their overall result as fair (21%), and no patients judged their results as poor. CONCLUSIONS: Our technique is simple and feasible and the results are encouraging. It can be used regardless of the location of the fistula around the periphery of the nipple-areola complex and it is perfectly suited to the management of chronic fistulous abscess.

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OBJECTIVE: To compare functional results following retropubic and transobturator mid-urethral sling procedures. METHODS: Multicenter randomized controlled trial. Power calculation was based on the rate of bladder injury. The current study concerns an analysis of secondary judgment criteria. RESULTS: One hundred and forty-nine patients were randomly allocated to either TVT (n=75) or TVT-O (n=74). Among them, 132 women completed a 24-month follow-up. There was no significant difference between the two groups, concerning urodynamics data (excluding uroflowmetry) at 12 months follow-up, functional and sexual results at 6, 12 and 24 months follow-up. Concerning sexual results, an improvement in visual analogue scale scores was observed in both groups at 24 months follow-up with no difference between the two groups: median score increased from 70 (IQR: 50-80) pre-operatively to 90 (IQR: 70-100) at 24 months follow-up (P=0,0004) in TVT-O group and from 70 (IQR: 50-80) to 85 (IQR: 70-100) (P=0,0009) in TVT group. CONCLUSION: TVT and TVT-O procedures are both associated with an increase in quality of life with no significant differences in functional results at 2 years follow-up.

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We report the only case of recurrent bilateral adnexal torsion during pregnancy with normal ovaries. This rare situation raises diagnostic as well as therapeutic management difficulties.

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Münchausen's syndrome is a psychiatric disease with behaviour disorders including self-injuries. Self mutilations interest all the body, and among others the abdominal wall, who can mimic complications of surgery. We report the history of a woman consulting for an abdominal wall panniculitis two years after a caesarean. Medical history, histological patterns and the psychological history of the patient excluded the diagnosis of a surgical complication and Münchausen's syndrome was strongly evocated. The treatment was surgical, with excision of the cutaneous necrosis. The healing was obtained by treatment with Vacuum Assisted Closure System (VAC).

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AIMS: Doughnut mastopexy lumpectomy (DML) is a unique breast resection in which a tissue segment is removed and the breast reshaped through a periareolar incision. The present prospective investigation compares DML and standard lumpectomy (SL) in relation to surgical variables, histological parameters, postoperative morbidity and cosmetic outcome. METHODS: 127 patients with breast cancer were offered the choice between two conservative surgical approaches: doughnut mastopexy lumpectomy (DML group, n=39) or standard lumpectomy (SL group, n=88). The groups were comparable for radiological tumour size, tumour location within the breast, histological size, and pT category. Comparison was performed in term of surgical variables, histological parameters, postoperative morbidity and cosmetic outcome. RESULTS: The patients undergoing DML were younger than the patients who chose SL. In the DML group, the skin incision was 3-fold longer than in the SL group but was obtained with a final scar located around the nipple areola complex without further postoperative complications. The average volume of the breast specimen was higher in the DML group compared with SL group. The clinician assessment of cosmetic outcome reported a higher rate of acceptable result in the DML group than in the SL group. However, patient's assessment did not show difference of cosmetic satisfaction between groups. CONCLUSION: Our comparative study indicates that DML may be a useful alternative to SL not only in terms of accurate breast tissue resection but also in term of cosmetic results.

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UNLABELLED: The integration of oncoplastic techniques with a concomitant contralateral symmetrization procedure is a novel surgical approach that allows wide excisions and prevents breast deformities. AIM OF THE STUDY: This prospective study was undertaken to compare the accuracy of breast resection, between standard narrow lumpectomy and oncoplastic surgery. PATIENTS AND METHODS: Ninety-nine consecutive women undergoing breast cancer resection were enrolled in a prospective study comparing oncoplastic surgery (42 women) and standard lumpectomy (57 women). The size of the glandular resection, the width of the nearest margins, the ratio of clear margins and the need for further surgery were recorded. RESULTS: The oncoplastic approach resulted in significantly greater glandular resection and wider free histological margins than did standard lumpectomy. The need for re-exicsional surgery was significantly lower in the oncoplastic group than in the lumpectomy group. Furthermore, a trend towards fewer secondary mastectomies was seen for the oncoplastic approach versus standard lumpectomy. CONCLUSIONS: The use of oncoplastic techniques and concomitant symmetrization of the contralateral breast allows extensive resections for conservative treatment of breast carcinoma achieves accurate tumour resection and reduces the need for further surgery.

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We report a young patient suffering from a uterine rhabdomyosarcoma. Particular features of the present case are: accuracy of the tumour spread evaluation performed by MRI of the pelvis; and the use of pre-operative arterial embolisation. The present multimodal management highlights the usefulness of cooperation between surgeons and radiologists in lowering operative bleeding and finally permitting uterine conservation.

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In cases of cervical cancer, there are 2 major advantages to preserving the ovaries, with or without transposition: hormone function is maintained during subsequent cancer treatment and patient quality of life is improved. We report the first case of pregnancy in a surrogate mother following stimulation of a transposed ovary before irradiation and chemotherapy for a squamous cell carcinoma of the uterine cervix. Because of the wide dissemination of information on the technical progress in this area, patients are now in a position to make therapeutic choices that are no longer guided by strictly medical considerations.

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Endometrial cancer is the most common gynaecologic cancer and its incidence increases with age. Prognosis is good because in over 80% of cases the cancer is discovered early. Preoperative work-up should include definition of the operability of such patients, who are often elderly with frequent co-morbidity. Preoperative evaluation and operative findings allow guiding the treatment and evaluating the prognosis. Main determinants are local extension, penetration into the myometrium, histologic stage of the tumour and involvement of lymph modes or peritoneum. Surgery is the first approach since it establishes the evaluation and comprises the first step of treatment. When necessary, subsequent treatment uses irradiation. Treatment with hormones or antimitotic drugs is less effective and is used for forms that are locally advanced, metastatic or recurrent after initial treatment.

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OBJECTIVE: To compare the incidences of tachysystole, hypertonia and fetal heart rate (FHR) abnormalities in women treated by mifepristone plus prostaglandins (PGs), mifepristone alone or PGs alone for an unfavourable cervix. STUDY DESIGN: In this retrospective study, all women between 37 and 42 weeks were eligible for the study if they had undergone cervical ripening prior to labour induction. In group 1, the women were treated with mifepristone plus PGs (n=103). Group 2 women were treated with mifepristone alone (n=96) and group 3 women with PGs alone (n=100). Incidences of tachysystole, hypertonia and FHR abnormalities were compared. RESULTS: During induction of labour, tachysystole and hypertonia occurred more frequently in women treated with mifepristone. Severe bradycardia and recurrent late decelerations were more frequent after the initiation of oxytocin in groups 1 and 2 than in group 3. CONCLUSIONS: In this study, mifepristone increased the incidences of tachysystole, hypertonia and FHR abnormality.

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OBJECTIVE: To present a case of IVF-surrogate pregnancy in a patient with ovarian transposition who had undergone chemotherapy and total pelvic irradiation. DESIGN: Case report. SETTING: Teaching hospital. PATIENT(S): A 29-year-old woman who had undergone Wertheim's hysterectomy for a bulky carcinoma of the uterine cervix. INTERVENTION(S): Ovarian transposition before chemotherapy and total pelvic irradiation. Standard IVF treatment, transabdominal oocyte retrieval, and transfer to the surrogate mother. MAIN OUTCOME MEASURE(S): Results of the IVF cycle. RESULT(S): A twin pregnancy at the first cycle and two live newborns. CONCLUSION(S): This is the first reported case of ovulation induction and oocyte retrieval performed on a transposed ovary.

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OBJECTIVE: To determine whether early placental drainage plus cord traction reduces the incidences of manual removal and blood loss, and to determine the risk factors associated with blood loss after delivery. DESIGN: Prospective randomised study. SETTING: University teaching hospital, Montpellier, France. METHODS: A randomised study compared 239 women who had placental cord drainage plus cord traction with 238 women with expectant delivery. The need for manual removal of the placenta and the drop in haemoglobin after delivery were assessed. The duration of the third stage of labour and the time between birth and the beginning of perineal suturing were measured. Statistical analysis used the paired t test for continuous variables, the Kruskal-Wallis test for nonparametric data and chi2 test for categoric variables. Stepwise logistic regression analyses were performed with a drop in haemoglobin as the outcome variable. RESULTS: No significant difference was found in the two groups with regard to the incidence of manual removal of retained complete or incomplete placenta or postpartum haemorrhage. The median values of the duration of the third stage of labour, birth-to-perineal suture time and drop in haemoglobin were significantly lower in the cord drainage group than in the control group. After controlling for confounding variables, parity proved to be the only significant predictor of drop in haemoglobin. CONCLUSION: Cord drainage decreases the duration of the third stage of labour and reduces blood loss but not the incidence of manual removal of the placenta.

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BACKGROUND: During pregnancy, the need for maternal chemotherapy for breast carcinoma must be balanced against the fetal risk because modification of cancer therapy to assure the birth of a healthy infant may affect maternal prognosis adversely. To the authors' knowledge few studies have documented the oncologic and obstetric management of this association. METHODS: A retrospective nationwide survey was used to identify women treated with chemotherapy for breast carcinoma during pregnancy. Each member of the Société Française d'Oncologie Gynécologique and the Société Française de Sénologie et de Pathologie Mammaire completed a postal questionnaire regarding cancer staging, oncologic treatment, obstetric details, pregnancy outcome, fetal behavior, and postdelivery follow-up. Twenty women were accrued to the study. RESULTS: The mean gestational age at the first cycle of treatment was 26 weeks. A total of 38 cycles were administered during pregnancy, with a median of 2 cycles. Delivery was performed at a mean of 34.7 weeks. Two pregnancies that were exposed to chemotherapy during the first trimester resulted in spontaneous abortion. One pregnancy exposed in the second trimester resulted in intrauterine death. The remaining 17 pregnancies resulted in live births, although 3 women had complications related to chemotherapy (anemia, leukopenia, and fetal growth retardation) and 1 newborn died 8 days after birth without apparent etiology. Two newborns had complications related to prematurity (transient respiratory distress). At a mean follow-up of 42.3 months, all live infants were reported to have reached normal developmental milestones. CONCLUSIONS: The current study found that even when chemotherapy was initiated after the first trimester, 95% of the pregnancies resulted in live births with low related morbidity in the newborns.

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OBJECTIVE: To compare the histomorphologic and colposcopic results of cold knife conization and loop excision. METHODS: Sixty-six women were randomly allocated to have the cone specimen removed by cold knife excision (n = 38) or loop excision (n = 28). Subjects eligible for inclusion were those who presented histologically verified grade 3 cervical intraepithelial neoplasia (CIN) or grade 2 CIN with squamocolumnar junction not seen. RESULTS: The mean height of the cone specimens was greater in the cold knife group [18.9 mm (SD = 5. 5) and 12.8 mm (SD = 4.3), respectively; P = 0.0001], as was the frequency of clear margins (100 and 80%, respectively; P = 0.001). In the loop excision group, thermal injuries were present in half of the cone sections. The median (range) thickness of thermal injury was 0.98 mm (0-1.5 mm) in the ectocervix and 0.95 mm (0-1.75 mm) in the endocervix. Histologic evaluation of the endocervical margins was not possible in 2 cases (7%). At follow-up colposcopy, evaluation of the entire squamocolumnar junction was possible in 15 (39%) and 20 (71%) women, respectively (P < 0.01). Four patients in the cold knife group and 6 in the loop group had histologically confirmed persistent dysplasia (P > 0.05), yielding success rates of 90 and 79%, respectively (P > 0.05). CONCLUSIONS: Loop excision provides a sample that is adequate for histologic evaluation in most cases, results in the same success rate as cold knife conization, and allows optimal colposcopic surveillance in significantly more cases than cold knife excision.

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OBJECTIVE: To model the growth of triplets. METHOD: Statistical analysis using data of a consecutive series of 76 triplet gestations (223 livebirths). RESULTS: The best model to describe the growth was linear regression (r = 0.76; r2 = 0.577; p < 0.0001; y = -2,858.05 + 139.66x). 34.2% of the sets had an intratriplet discordance rate of at least 25%, and 11.8% of the triplets had a maximum discordance rate over 40%. CONCLUSIONS: (1) Triplet fetal growth is strongly related to the gestational age; (2) the growth of each triplet in a same set may considerably differ, and (3) the use of singleton curves for triplet growth assessment is inadequate.

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BACKGROUND: In performing Vecchietti's operation laparoscopically, it is important to ensure bladder and rectum integrity. We report new techniques of ultrasonography and suture retrieval that simplify and improve the ease and speed of this operation. TECHNIQUE: The pneumoperitoneum is emptied and the bladder filled with 200 mL of sterile water. The ultrasound probe is placed on the suprapubic wall for a sagittal image. The needle progresses medially through the vesicorectal space, with ultrasound guidance, and its emergence into the pelvis is controlled with laparoscopy. The nylon sutures carrying the dilation ball are threaded through the needle and brought back through the abdominal wall. EXPERIENCE: Seven patients with vaginal aplasia had this procedure. There were no complications, and the mean operative time was 43 minutes (range 35-55). Mean vaginal length was 7 cm (range 6-10). Four women defined sexual intercourse as very satisfying and two as moderately satisfying. CONCLUSION: This original technique was used for easy, safe, and rapid creation of neovaginas.

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