Jean Claude Pector

Prolonged survival after resection of a malignant melanoma metastatic to the stomach

A man who presented with a secondary gastric melanoma was alive more than 6 years after surgery.

Effect of portal arterialization on hepatic cytochrome P 450 in rats with portacaval shunt

Fractional clearance of colloidal gold particles (k), liver weight and hepatic cytochrome P-450 were measured in rats with portacaval shunt and in rats with portacaval shunt plus arterialization of the hepatic stump of the portal vein. The effects of enzyme induction by phenobarbital was studied in both groups. Total arterialization of the liver provides a probably normal hepatic blood flow and seems to protect the liver from post-shunt atrophy. Nevertheless, in both arterialized and shunted rats, the cytochrome P-450 concentration was significantly lower than in controls. The same results were obtained after treatment by phenobarbital. These findings suggest that normal hepatic blood flow and oxygen supply are not the main determinant of a normal activity of the hepatic microsomal biotransformation system. Substances present in portal blood would probably be necessary in maintaining hepatic cytochrome P-450 level.

Long-term survival of patients downstaged by oxaliplatin and 5-fluorouracil combination followed by rescue surgery for unresectable colorectal liver metastases.

OBJECTIVES To evaluate long-term survival of patients resected for primarily unresectable colorectal liver metastases downstaged by systemic chemotherapy. METHODS Among a group of 82 patients with advanced colorectal cancer, 39 had unresectable liver metastases. After treatment with systemic 3-weekly 5FU/folinic acid/oxaliplatin chemotherapy, the outcome of 11 patients made resectable thanks to chemotherapy was compared to that of 28 patients who were not. Criteria for non-resectability consisted of diffuse bilobar invasion with inability to achieve complete resection, unilobar or bilobar invasion plus vascular extension (invasion of inferior vena cava or 2 supra-hepatic veins plus continuity with the 3rd) or involvment of hepatic pedicle. Before and after surgery, CT scan evaluation was performed every 2 months. Progression free survival was defined as the time between starting chemotherapy and recurrence of the disease. We used Kaplan-Meier survival curves and log-rank test for comparisons, P values were two-sided and considered significant if<0.05. RESULTS Progression free survival times were 14 and 6 months, median overall survival were 60 and 18.5 months, respectively, in favour of secondary resected subjects. CONCLUSION Considering the magnitude of the survival benefit, one may question the need and feasibility for trials to assess more formally the impact of surgery in that setting.

Should Ruptured Liver Haemangioma Be Treated by Surgery or by Conservative Means ? A Case Report

Abstract Spontaneous rupture of a liver haemangioma is a rare but life-threatening acute clinical situation following haemorrhage within the liver, the subcapsular space and the peritoneal cavity in cases of capsular rupture. Rupture of a liver haemangioma has been reported to occur spontaneously in the majority of cases. In the past, prompt surgical treatment was recommended but was associated with high morbidity and mortality. Currently, conservative management and, in cases of recurrent haemorrhage, delayed surgery may be proposed. We report a case of spontaneous rupture of hepatic haemangioma treated by arterial embolisation and conservative means. The literature is also reviewed.

Grading dysplasia in colorectal adenomas by means of the quantitative binding pattern determination of Arachis hypogaea, Dolichos biflorus, Amaranthus caudatus, Maackia amurensis, and Sambucus nigra agglutinins.

The current study deals with the setting up of a new tool that enables the benign versus the malignant nature of colorectal adenomas to be determined accurately. The 2 objectives are to determine (1) whether adenomas should, or should not, be included in a 2- or a 3-tier grading system, and (2) whether severe dysplasias and carcinomas in situ share common or different biological characteristics. The levels of expression of different types of glycoconjugates were characterized in a series of 166 colorectal specimens, including 14 normal, 90 dysplastic, and 62 cancerous cases. The glycoconjugate expressions were demonstrated for 5 lectins, namely, Arachis hypogaea (PNA), Dolichos biflorus (DBA), Amaranthus caudatus (ACA), Maackia amurensis (MAA) and Sambucus nigra (SNA). The glycoconjugates demonstrated by these 5 lectins belong to the family of the Thomsen-Friedenreich antigens. The binding patterns of the 5 lectins were quantitatively determined by means of computer-assisted microscopy. The quantitative data were submitted to discriminant analyses. Our results show that the specific glycochemical staining patterns could be identified unambiguously and without misclassification between benign (normal and low dysplasia) and malignant (ie, either as moderate/severe dysplasia, carcinoma in situ, or cancer) cases. The data also strongly suggested that (1) dysplasias seem to be distinguishable in 2 instead of 3 groups, that is, low versus moderate/severe (high); and (2) moderate/severe dysplasias are biologically distinct from carcinomas in situ. The methodology developed can be applied directly in routine diagnosis to identify moderate/severe dysplasia specimens already exhibiting features common to carcinomas, and which therefore should be treated consistently in view of the fact that our data strongly suggest that most moderate/severe dysplasias are still benign, whereas carcinomas in situ are real carcinomatous lesions.

Effect of Portal Arterialization on Hepatic Blood Flow and Ammonia Clearance after End-to-Side Portacaval Shunt

Total hepatic blood flow (THBF), blood ammonia concentration and ammonia tolerance test have been measured in two groups of dogs: group I with end-to-side portacaval shunt, group II with end-to-side p

Hepatic arterial ligation and portal vein infusion: a clinical trial by the Gastrointestinal Tract Cancer Group of the European Organization for Research and Treatment of Cancer.

Liver metastases are frequently observed in the natural history of colorectal cancers. In 15% of patients they are diagnosed before or during laparotomy for surgical resection of the primary tumor [6]. If the metastatic invasion is well limited and located to one segment or to one lobe of the liver, controlled segmentectomy or hepatectomy are currently performed, with the advantage of curing approximately 10%–20% of patients [3, 6, 13, 14].

Interim Analysis of a Double-Blind Phase-III Clinical Trial of Adjuvant Levamisole Versus Control in Resectable Dukes-C Colon Cancer: A Study of the EORTC Gastrointestinal Tract Cancer Cooperative Group

The 5-year survival of patients with Dukes-C colon cancer is about 35%. Adjuvant therapy after surgical resection is therefore warranted, but since no therapy has proven effective so far, a control group receiving no further treatment is ethically justified and scientifically required. Results that had been obtained with immunotherapies (BCG, MER-BCG, Corynebacterium Parvum and Levamisole) in colorectal cancer were either ambiguous or based on uncontrolled trials when this trial was initiated by the EORTC in 1978.

Septicemias in cancer patients during parenteral nutrition: Contributing factors and detection by weekly blood cultures

Infections constitute the main complication of parenteral nutrition, particularly in cancer patients, but prediction of catheter-related septicemias (CRS) has been little investigated. We have evaluated, in 200 consecutive episodes of parenteral nutrition (PN) in cancer patients, the factors contributing to infectious complications, and the predictive value of weekly blood cultures performed through the nutrition catheter. The median duration of PN was 22 days with a total of 5816 patient-days of PN, neutropenia (neutrophils < 1,000/microl) being present in 872 (15%). Catheters were placed either in a jugular vein (71% single-lumen silicone catheters, 18.5% double-lumen Hickman-Broviac catheters) or in a femoral vein (10.5%). We observed 62 episodes of septicemia of which 22 were CRS (11% incidence for the 200 cycles) and 40 were non-CRS (20% incidence); CRS were mostly due to Staphylococcus epidermidis (14/22). Neutropenic patients as a group did not suffer more CRS than non-neutropenic patients, but the risk of CRS was slightly increased when expressed per day of neutropenia (8 CRS/872 days vs 14 CRS/4942 days without neutropenia, P < 0.05). On the other hand, a femoral insertion site was associated with a much higher incidence of CRS (9 CRS/21 femoral catheters vs 13 CRS/179 jugular catheters, P < 0.0001). It was possible to evaluate 20 episodes of CRS for their predictability by weekly blood cultures: the sensitivity for detecting CRS due to Staphylococcus epidermidis was 67%, the specificity 92%, the negative predictive value 98% and the positive predictive value 36%. The simple and widely available procedure of routine surveillance blood cultures performed through the PN catheter should be further investigated, because it could help the clinician to determine the origin of recent fever, particularly to exclude CRS and avoid unnecessary removal of PN catheters.

Venous thrombosis associated with catheter-related mediastinal perforation due to catheter mispositioning.

A 57-year old woman with an epidermoid carcinoma of the rhinopharynx was referred at our institution for treatment. A Totally Implantable Venous Access Device (BRAUN, Model CELSITE ST301) was placed percutaneously in the left subclavian vein under radioscopy. The postoperative chest x-ray showed no complications but the tip of the catheter was situated too high. Its functionality was satisfactory and we decided to keep it in place and to use it for chemotherapy administration. Twenty months after her last treatment, she was admitted for asthenia and pyrexia. She complained about pain in her left superior arm during TIVAD testing. A cavography was performed and showed an extravasation of the contrast solution in the anterior mediastinum (Fig. 1). A thoracic CT was then performed to confirm the diagnosis and to exclude mediastinitis. It showed a complete thrombosis of the left brachio-cephalic trunk but no sign of mediastinitis (Fig. 2). TIVAD was removed and the patient was treated with low molecular weight heparin. The patient was monitored in the intensive unit care for 24 hours. The clinical evolution was uneventful and the patient was discharged on the second day. She presents without any complications at 21 months follow-up.