Jean-Louis Bernard

Small bowel involvement is a prognostic factor in colorectal carcinomatosis treated with complete cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy

BackgroundCytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) is a promising treatment for patients with peritoneal carcinomatosis (PC). Our objective was to identify new prognostic factors in patients with PC from colorectal cancer treated with this procedure.MethodsAll patients with PC from colorectal cancer treated by HIPEC from January 2000 to December 2007 were prospectively included. The tumor extension was assessed by the Peritoneal Cancer Index (PCI) and the residual disease was recorded using the completeness cytoreductive score (CCs). All clinical and treatment data were computed in univariate and multivariable analyses using survival as primary end point.ResultsWe carried out 51 complete procedures in 49 consecutive patients. The mean PCI was 10. The allocation of CCs was: CC-0 = 37, CC-1 = 14. The five-year overall and progression-free survival rate were 40% and 20%, respectively. Several prognostic factors for survival were identified by univariate analysis: PCI < 9 (P < 0.001), CC-0 vs. CC-1 (P < 0.01) and involvement of area 4 (P = 0.06), area 5 (P = 0.031), area 7 (P = 0.014), area 8 (P = 0.022), area 10 (P < 0.0001), and area 11 (P = 0.02). Only the involvement of the distal jejunum (area 10) was significant in the multivariable analysis (P = 0.027).ConclusionsWe demonstrated that the involvement of area 10 (distal jejunum of the PCI score) was an independent factor associated with poor prognosis.

Ascites and malnutrition are predictive factors for incomplete cytoreductive surgery for peritoneal carcinomatosis from gastric cancer

BACKGROUND Prognosis in peritoneal carcinomatosis from gastric cancer has improved with cytoreductive surgery (CS) and hyperthermic intraperitoneal chemotherapy. The aim of this study was to identify predictive factors for incomplete CS. METHODS Forty-five patients undergoing laparotomy for gastric cancer with peritoneal carcinomatosis were prospectively included from January 2000 to December 2010. In case of optimal CS, patients (n = 14) received hyperthermic intraperitoneal chemotherapy. Otherwise, the laparotomy was closed or a palliative procedure was performed if necessary. All preoperative data were compared between the 2 groups. RESULTS Ascites (hazard ratio, .09; 95% confidence interval, .010-.48; P = .0103) and nutritional status evaluated by the prognostic nutrition index (hazard ratio, .11; 95% confidence interval, .0019-.54; P = .027) were independent predictive factors for incomplete CS. CONCLUSIONS The selection of patients for CS plus hyperthermic intraperitoneal chemotherapy should include the assessment of nutritional status and the detection of an ascites.

Torsion of a huge pedunculated uterine leiomyoma.

Uterine leiomyoma in torsion is an uncommon emergency and mimics generalized peritonitis. We report the case of a 62-year-old woman with a huge subserous fibroid in torsion. The lesion was removed surgically with the uterus and ovaries. Imaging is an essential tool in the diagnosis of myomata and should serve to exclude other diseases, especially malignancy.

Gas gangrene of the breast: management of a potential life-threatening infection

IntroductionGas gangrene of the breast is a rare infection and potentially mortal.Case reportWe report a case of a fast extension of a painful right breast erythema whose starting point was a right parasternal cutaneous abscess. A diagnosis of gas gangrene of the right breast was made. A right mammectomy was carried out in Emergency and an antibiotherapy adapted to the germs was given.ConclusionMixed anaerobic and aerobic florae are often responsible for the infection. Its medico-surgical management is an emergency.

Primary cyst of the spleen presenting as a splenocolic fistula.

i t n a t t i A 57-year-old Caucasian man was admitted to our hospital for fever and chills access lasting for 6 months. This patient had no medical past except for a calcified splenic cyst fortuitously discovered 23 years ago on a screening abdominal radiograph (Fig. 1). Physical examination was normal. White blood cell count and blood cultures were normal. C-Reactive Protein was 57 mg/l. Serodiagnosis of hydatidosis was negative. A computed tomography of the abdomen showed an 8.5 cm splenic abscess with an air-fluid level (Fig. 2). Double-contrast barium enema and coloscopy did not highlight any communication between the colon and the spleen. Subsequent laparotomy confirmed the splenic mass with a retraction of the splenic flexure. Splenopancreatectomy, left hemicolectomy, and temporary colostomy were performed. The pathologic examination confirmed a 7 cm splenic cyst with hemorrhagic content, calcified wall and fistulization to the colon by a punctiform opening. Microscopic examination found a primary, nonparasitic splenic cyst (epidermoid cyst). The recovery period was uncomplicated, and the patient was discharged on the ninth postoperative