OBJECTIVE: Secondary breast cancer is a frequent late adverse event of mediastinal Hodgkin lymphoma radiotherapy. Secondary breast cancers overwhelmingly correspond to ductal carcinoma and develop from the glandular mammary tissue. In addition, during childhood, radiation overexposure of the glandular tissue may lead to a late breast hypotrophy at adult age. The aim of this study was to evaluate the radiation exposure to the glandular tissue in patients treated for mediastinal Hodgkin lymphoma with intensity-modulated proton therapy, in order to evaluate the potential dosimetric usefulness of its delineation for breast sparing.
METHODS: Sixteen consecutive intermediate-risk mediastinal female patients with Hodgkin lymphoma treated with consolidation radiation with deep inspiration breath hold intensity-modulated proton therapy to the total dose of 30Gy were included. Breasts were delineated according to the European Society for Radiotherapy and Oncology guidelines for treatment optimization (\"clinical organ at risk\"). The glandular tissue (\"glandular organ at risk\") was retrospectively contoured on the initial simulation CT scans based on Hounsfield unit (HU) values, using a range between -80HU and 500HU.
RESULTS: The mean and maximum doses delivered to the glandular organ at risk were significantly lower than the mean and maximum doses delivered to the clinical organ at risk, but were statistically correlated. Glandular organ at risk volumes were significantly smaller.
CONCLUSIONS: Optimizing the treatment plans on the clinical breast contours will systematically lead to overestimation of the dose received to the glandular tissue and, consequently, to an indistinct and involuntary improved glandular tissue sparing. As such, our findings do not support the consideration of the glandular tissue as an additional organ at risk when planning intensity-modulated proton therapy for mediastinal Hodgkin lymphoma in female patients.

In radiotherapy, patient positioning has long been ensured by ionizing imaging (kV or MV). Over the past ten years, surface-guided radiotherapy has appeared in radiotherapy departments. It is a continuous three-dimensional acquisition of the surface of the patient, based on the use of several optical cameras. The acquired surface is compared to an expected surface (usually taken from the planning scanner). Operators can constantly appreciate poor position, anatomical deformity or patient shift. Thus, the system allows an aid to the positioning of the patient, possibly without tattooing, but also a follow-up of the patient during the duration of the session. The most obvious contribution of the system concerns the treatment of the breast. In fact, for this location, the bone registration is not ideal and the target is visible in surface-guided radiotherapy. These systems also make it possible to treat in deep inspiration breath hold. But several other locations can benefit from it (pelvis, thorax, etc.).

The ontology of death is universal, hence archetypal. Nowhere do we witness any organic creature escape its talons. Analytical psychology has had an intimate relationship to death for the simple fact that it contemplates the soul, the numinous, and an afterlife. From Hegel to Heidegger, Freud and Jung, death was an existential force that sustained and transformed life, the positive significance of the negative. Rather than merely a destructive phenomenon, death informs Being, the power of nothingness that dialectically drives life. In this paper, I will introduce the notion of what I call the omega principle, the psychological orientation and trajectory of our being towards death, which we may say is a universal preoccupation and recapitulation of the collective unconscious that subsumes our personal relation to death, an eternal return of the objective psyche constellated as esse in anima.
L’ontologie de la mort est universelle, et ainsi archétypale. Nous ne voyons nulle part une créature organique échapper à son emprise. La psychologie analytique a eu une relation intime avec la mort du simple fait qu’elle contemple l’âme, le numineux et l’au-delà. De Hegel à Heidegger, Freud et Jung, la mort était une force existentielle qui soutenait et transformait la vie, la signification positive du négatif. Plutôt qu’un simple phénomène destructeur, la mort façonne l’Etre ; la puissance du néant qui conduit dialectiquement la vie. Dans cet article, je vais présenter l’idée que j’appelle le principe oméga ; l’orientation et la trajectoire psychologiques de notre être allant vers la mort, dont nous pourrions dire qu’il s’agit d’une préoccupation et d’une récapitulation universelle de l’inconscient collectif, qui englobe notre relation personnelle à la mort, un retour éternel de la psyché objective constellée en tant qu’esse in anima.
Die Ontologie des Todes ist universell, also archetypisch. Nirgendwo sehen wir, wie ein organisches Wesen seinen Krallen entkommt. Die Analytische Psychologie hat eine enge Beziehung zum Tod weil sie die Seele, das Numinose und ein Leben nach dem Tod betrachtet. Von Hegel bis Heidegger, Freud und Jung war der Tod eine existentielle Kraft, die das Leben aufrechterhielt und verwandelte, die positive Bedeutung des Negativen. Der Tod ist nicht nur ein destruktives Phänomen, sondern informiert das Sein, die Macht des Nichts, die das Leben dialektisch antreibt. In diesem Aufsatz werde ich den Begriff des, wie ich es nenne, Omega-Prinzips einführen, der psychologischen Orientierung und Flugbahn unseres Seins zum Tod, von dem wir sagen können, daß es eine universelle Beschäftigung und Rekapitulation des kollektiven Unbewußten ist, das unsere persönliche Beziehung zum Tod umfaßt, eine ewige Wiederkehr der als esse in anima konstellierten objektiven Psyche.
L’ontologia della morte è universale, perciò archetipica. Da nessuna parte vediamo una creatura organica sfuggire ai suoi artigli. La psicologia analitica ha avuto una relazione intima con la morte per il semplice fatto che essa contempla l’anima, il numinoso e l’aldilà. Da Hegel a Heidegger, Freud e Jung, la morte è stata una forza esistenziale che ha sostenuto e trasformato la vita, il significato positivo del negativo. Piuttosto che essere semplicemente un fenomeno distruttivo, la morte informa l’Essere, il potere del nulla che dialetticamente guida la vita. In questo articolo introdurrò la nozione di ciò che chiamo il principio omega, l’orientamento e la traiettoria psicologica del nostro essere verso la morte, che possiamo dire sia una preoccupazione universale e una ricapitolazione dell’inconscio collettivo che sussume la nostra relazione personale con la morte, un eterno ritorno della psiche oggettiva costellata come essere nell\'anima.
Онтология смерти универсальна, следовательно, архетипична. Еще никто не встречался с тем, чтобы какое-либо органическое существо избежало ее когтей. Аналитическая психология имеет тесную связь со смертью по той простой причине, что она размышляет о душе, нуминозном и загробной жизни. Для мыслителей от Гегеля до Хайдеггера, Фрейда и Юнга смерть являлась экзистенциальной силой, поддерживающей и трансформирующей жизнь, позитивным значением негативного. Смерть - это не только разрушительное явление; она питает бытие силой небытия, которое диалектически направляет жизнь. В этой статье я формулирую концепцию, которую я назвала принципом омега, описывающую психологическую ориентацию и траекторию нашего бытия по направлению к смерти, являющуюся, можно сказать, всеобщей задачей и рекапитуляцией коллективного бессознательного, что включает наше личное отношение к смерти, вечное возвращение объективной психики, констеллированной как esse in anima.
La ontología de la muerte es universal, por tanto arquetípica. Ninguna criatura orgánica escapa a sus garras. La psicología analítica ha tenido una relación íntima con la muerte por el simple hecho de que contempla el alma, lo numinoso y una vida después de la muerte. De Hegel a Heidegger, Freud y Jung, la muerte era una fuerza existencial que sostenía y transformaba la vida, el significado positivo de lo negativo. Más que un mero fenómeno destructivo, la muerte informa al Ser, el poder de la nada que impulsa dialécticamente la vida. En este artículo, introduciré la noción de lo que denomino principio omega, la orientación y trayectoria psicológica de nuestro ser hacia la muerte, que podemos decir que es una preocupación y recapitulación universal del inconsciente colectivo que subsume nuestra relación personal con la muerte, un eterno retorno de la psique objetiva constelada como esse in anima.
黑色的敌人:向死而生 死亡的本体是普遍的, 因此是原型的。我们在任何地方都无法看到任何有机生物逃脱它的爪牙。分析心理学与死亡有着密切的关系, 因为它考虑的是灵魂、神性和来世。从黑格尔到海德格尔、弗洛伊德和荣格, 死亡是一种维持和改变生命的存在力量, 是负面的积极意义。死亡不仅仅是一种破坏性的现象, 死亡也为 \"存在 \"提供了信息, 是辩证地驱动生命的虚无的力量。在本文中, 我将介绍我称为欧米茄原则的概念, 即我们对死亡的心理取向, 及向死而生的轨迹, 我们可以说这是集体无意识的普遍关注和重述, 它包含了我们个人与死亡的关系, 是向聚集为实在的阿尼玛的客观心灵的永恒回归。.

Constitutional breast asymmetries are responsible not only for esthetic unsightliness, but also, at times, for psychological disorders, and medical management is necessitated. While surgical treatment is the only viable therapeutic option, given the wide variety of morphological presentations of mammary asymmetries, the surgeon is called upon to be well versed in breast surgery techniques. The authors have put forward a classification of mammary asymmetries and principles of treatment.

Gynecomastia is the most frequently breast lesion in males. 148 patients (mean age 24,7 years) operated in our department were reviewed with a mean follow-up of five years. Gynecomastia occurred most frequently during puberty (77,7 %), was bilateral (86,5%) and idiopathic (89,9%). The size of the enlargement was evaluated according to Simon\'s-classification based on breast-volume and skin-redundancy. 17 (11,5%) stage 1, 77 (52%) stage 2A, 32 (21,6%) stage 2B, 22 (14,9%) stage 3. Clinical examination and mammography determined the consistency of gynecomastia: adipose or firm. 4 different surgical managements were used: 17 (11,5%) subcutaneous mastectomies, 4 (2,7%) liposuctions, 110 (74,3%) liposuctions associated with subcutaneous mastectomy, 17 (11,5%) total mastectomy. All techniques gave good morphologic results. Nonetheless, the authors recommend the combination «liposuction and subcutaneous mastectomy», as this technique presents many advantages: small intraoperative blood loss, good skin redraping, short hospital stay, complete histologic examination of the material removed.

Embryology and anatomy of the chest wall and breast will be developed in this chapter. The walls of the thorax will be described; the anatomical notions of thoracic deformities will be detailed. The anatomy of the mammary gland will be developed around the understanding of the means of fixity and vascularization. The anatomical descriptions come from the writings of ancient anatomists, notably Testut and Latarjet, as well as the iconographies taken from their various works.

Adolescence is defined as the period extending from puberty to adulthood, the limit of which is difficult to determine. It is a delicate period, in which the distancing from one\'s own body image can have deleterious consequences on psychological development and social-emotional life. Breast hypertrophy and the correction of hypertrophic tuberous breasts in adolescents raise some questions that we will attempt to answer in this article. There are specificities to manage, in relation to surgical indications, resection volume, postoperative follow-up and cutaneous healing.

Breast cancer is the second cancer of women in Mali. Immunohistochemistry is poorly performed in our African countries.
OBJECTIVE: To describe the immunohistochemical aspect and determine the prognosis of breast cancer.
METHODS: This is a retrospective descriptive study (March 2006-July 2016) in the General Surgery Department of Gabriel Toure University Hospital in Bamako, Mali. Immunohistochemistry was performed in all patients through a collaboration of our German partners.
RESULTS: We collected 98 patients (95 women and 3 men) with an average age of 40.04 ± 13.07 years. Twenty-two patients (22.44%) had a personal history of benign breast disease. In 16 patients (16.33%), we found a family breast cancer. The most common histological types were intra ductal carcinoma with 84 (85.72%) and invasive lobular carcinoma in 9 cases (9.18%). Immunohistochemistry found a predominance of triple negative with forty nine patients (50%) followed by Luminal A subtype with 26 cases (26.23%). According to the TNM classification, 44 patients (44.90%) were received at stage III. The median survival was 60 months in the group of patients who received hormone therapy versus 28 months for the group without hormone therapy (p = 0.007).
CONCLUSIONS: Immunohistochemistry is essential for the adequate management of breast cancer. Its realization has allowed us to improve the prognosis of hormone-dependent cancers.
Le sein est le deuxième siège du cancer chez la femme au Mali. Les examens immunohistochimiques sont peu réalisés dans nos pays africains.
OBJECTIVE: Décrire l\'aspect immunohistochimique et déterminer le pronostic du cancer du sein.
UNASSIGNED: C\'est une étude descriptive à collecte rétrospective (mars 2006-juillet 2016) dans le service de chirurgie générale du CHU Gabriel TOURE de Bamako au Mali. L\'examen immunoihistochimique a été réalisé chez tous les malades grâce à la collaboration de nos partenaires allemands.
UNASSIGNED: Nous avons colligé 98 malades (95 femmes et 3 hommes) avec un âge moyen de 40,04 ± 13,07 ans. Vingt-deux malades (22,44 %) avaient un antécédent personnel de pathologie bénigne du sein. Chez 16 malades (16,33 %), il y avait une notion familiale de cancer du sein. La prise d\'œtroprogestatifs a été évoquée chez 28 femmes (28,57%). Les types histologiques les plus fréquents étaient le carcinome canalaire infiltrant avec 84 (85,72%) et le carcinome lobulaire infiltrant dans 9 cas (9,18%). L\'immunohistochimie a permis de trouver une prédominance du triple négatif avec quarante neuf malades (50%) suivi du sous type Luminal A avec 26 cas (26,23%).Selon la classification TNM, 44 patients (44,90 %) ont été reçus au stade III. La médiane de survie a été de 60 mois dans le groupe des patients ayant bénéficié d\'une hormonothérapie versus 28 mois pour le groupe sans hormonothérapie (p=0.007).
CONCLUSIONS: l\'immunohistochimie est essentielle pour la prise en charge adéquate des cancers du sein. Sa réalisation nous a permis d\'améliorer le pronostic des cancers hormono dépendant.

Breast surgery is usually recommended for women who have completed puberty. Indeed, during adolescence the breast is constantly changing, the patient\'s weight is often unstable, the risk of inflammatory scars (hypertrophic or keloid) is higher and disturbances of areolar sensitivity can affect the patient\'s quality of sexual life. In addition, the risk of infection is not negligible, especially during an acne outbreak. In case of early implant placement, iterative changes should be planned. Finally, the result obtained is not always stable but above all the lack of psychological maturity and the legal need to obtain the agreement of both parents are obstacles to early surgery. However, the authors argue for the possibility of surgical correction of the breast around puberty, in particular because of the very clear positive psychological impact. Other arguments are also detailed: to ensure a breast reconstruction in successive stages started early, to limit the repercussions of hypertrophy, to correct thoracic or skin anomalies. These indications are illustrated by numerous clinical cases demonstrating the need for customized surgery on a case-by-case basis.

Tuberous breasts are defined by a shape anomaly, in certain relatively rare situations, patients are satisfied with the volume and only ask for a shape correction without increase or decrease. They may also be very young girls in whom the indication for implantation of a prosthesis could be premature or who do not have sufficient fat reserves for fat transfer. We discuss the different possible techniques and we propose a simple technique, relatively fast, easily reproducible whatever the experience of the surgeon, without vascular complications in our experience due to the absence of skin detachment, with a satisfactory and stable result in the time. The authors are based on a series of 12 patients operated between 2000 and 2021.