R. Lambert

Long-term survival after photodynamic therapy for esophageal cancer

BACKGROUND/AIMS Photodynamic therapy (PDT) has been adapted to the endoscopic treatment of digestive cancer, but its indications and efficacy remain uncertain. The aim of this study was to assess its feasibility in the curative treatment of small esophageal tumors. METHODS From 1983 to 1991, PDT was used to treat 123 patients with esophageal cancer who were recommended for nonsurgical treatment of squamous cell carcinoma (n = 104) and adenocarcinoma (n = 19). Endoscopic ultrasonography (EUS) was performed in 88 patients; 61 were staged uT1 and 27 were staged uT2. A hematoporphyrin derivative was injected 72 hours before laser irradiation with a 630-nm dye laser. PDT was applied alone in 56 patients and as part of a multimodal protocol in the 67 others. RESULTS The complete response rate at 6 months was 87%. The 5-year survival rate was 25% +/- 6%, and the 5-year disease-specific survival rate was 74% +/- 5%. The complete response rate and survival rate were not different (1) between the PDT alone and the PDT multimodal treatment groups, (2) between the adenocarcinoma and squamous cell carcinoma groups, and (3) between the uT1 and uT2 EUS groups. PDT-related complications were esophageal stenosis (n = 43) and cutaneous photosensitization (n = 16). CONCLUSIONS In patients with small esophageal tumors who pose high surgical risk, photodynamic therapy is an effective treatment.

Gallstone disappearance after extracorporeal lithotripsy and oral bile acid dissolution

Extracorporeal shock-wave cholelithotripsy was carried out in 135 symptomatic patients with radiolucent gallstones, followed by oral bile acid dissolution to assess the resultant stone disappearance rates. Fragmentation was satisfactory (all fragments less than 5 mm in diameter) in 34 patients (25%) after a single session of lithotripsy, and in 65 (48%) after multiple sessions. The overall satisfactory fragmentation rate was significantly higher in patients with single stones less than or equal to 20 mm in diameter when compared with those with larger solitary stones (71% vs. 38%, p less than 0.05), as it also was in all subjects with solitary stones when compared with those with multiple stones (60% vs. 34%, p less than 0.05). After 6, 9, and 12 mo of oral bile acid treatment, the stone-free rates were significantly higher in patients with satisfactory than in those with partial fragmentation (55% vs. 0%, 80% vs. 29%, and 90% vs. 33%, respectively; p less than 0.05). Only 1 of the 7 patients who had previously undergone endoscopic sphincterotomy for concomitant choledocholithiasis was free of stones after 1 yr of dissolution. During dissolution therapy, of the 102 patients in whom fragmentation had occurred, 1 (1%) developed mild acute pancreatitis, 23 (23%) suffered attacks of biliary colic, and 6 (6%) required cholecystectomy. We conclude that the result of fragmentation appears to be a major determinant of the success and rapidity of subsequent oral bile acid dissolution, and that when satisfactory, it allows for complete stone disappearance in most patients within the following year. A comparison of the present results with those of previous original studies suggests that to achieve such satisfactory fragmentation, patients should be selected on the basis of their stone characteristics, which optimally should present as solitary gallbladder calculi less than 20 mm in diameter. Furthermore, real-time ultrasonographic monitoring should be used during lithotripsy with a transducer centered along the shock-wave axis. Despite the innocuousness of the shock waves, the incidence of fragment migration and its possible complications, in our experience, emphasizes the need to restrict at present this nonoperative approach to the treatment of symptomatic gallstone disease.

Diffuse varioliform gastritis.

During 8 years experience, 90 cases of diffuse varioliform gastritis were observed (0.3% of examinations). Symptoms suggest either the presence of a gastroduodenal ulcer or of a digestive carcinoma when weight loss is prevalent. The disease proceeds by subacute evolutive bouts with remissions and further relapses. At endoscopy, lesions associate large folds in the fundus and erosive mucosal bulgings disseminated in the fundus and antrum. Histological alterations correspond to a superficial hyperplasic gastritis. Cellular infiltration of the lamina propria includes increased immunocytes population with an abnormal distribution of immunoglobulin classes. An increased percentage of IgE cells characterizes the disease as compared to inflammation in atrophic gastritis. Therapy is based upon agent inhibiting mastocytes degranulation and histamine antagonists. Diffuse varioliform gastritis must be separated from antral varioliform gastritis, a lesion with a higher frequency but no symptomatic individuality.

Incorporation of Radiosulfate in the Gastric Mucosa of the Rat Subjected to Restraint

Twenty-two rats, carefully paired with 22 controls were subjected to a 24-hr period of restraint. Subsequently, the animals were divided into three groups: 22 control rats without gastric ulcers, 13 rats subjected to restraint with ulcers, and 9 rats subjected to restraint without ulcers. The rats had received an intraperitoneal injection of carrier-free sulfur35 as sodium sulfate. Stomachs were removed 24 hr after the injection and divided into mucosa and muscular layer. After homogenization, each fraction was digested by pepsin for 24 hr. The nondialyzable radiosulfate was divided into two fractions, precipitated and nonprecipitated as cetyl-pyridinium complex. No significant variations of radioactivity were observed in the muscular layer between the three groups of animals. On the other hand, in the gastric mucosa, a significant decrease of radiosulfate incorporation was observed in animals with gastric ulcers following restraint: the value is 60.2% of controls. No decrease was observed in animals without gastric ulcers after restraint.

Epidemiology of Oesophageal Cancer in France

Recent data concerning the mortality from oesophageal cancer by regions and departements in France are reported (around 5,000 deaths yearly). It was decided to investigate whether any time trend had become apparent and whether the correlation with alcoholism could still be observed. Numbers of deaths from oesophageal cancer for the years 1961–1963 and 1967–1968, and from cirrhosis and alcoholism for 1967 and 1968 were collected as well as the corresponding population from the census figures of 1962 and 1968. A cohort analysis using the data for 5 reference years (from 1951 to 1971) is presented. Among European countries, France has the highest mortality rate from oesophageal cancer in males (13.65/100,000) and a very high sex ratio (12.88). The rates are particularly high in western areas, especially Basse-Normandie. Over the 20-year period from 1951 to 1971, a progress of 32.7 % was observed in males. The increase in mortality in males is greatest in the youngest age groups. In 1967–1968, there is a strong correlation between oesophageal cancer mortality and mortality from cirrhosis and alcoholism, the latter being more significant.

Breast cancer and polyps of the colon. A case-control study.

A case‐control study was conducted involving 145 patients with breast cancer and 144 controls. A pansigmoidoscopy was performed in each case and control. There was no statistically significant difference in the length of the colon explored (cases, 50.3 cm; controls, 48.9). The odds ratio for adenomatous polyps was 2.65 (confidence limits, 1.56 and 3.74). As adenomas of the colon can be considered as precursors of colon cancer, this study demonstrates new evidence of the close relationship between breast and colon cancer. These results show the usefulness of performing a pansigmoidoscopy in all breast cancer patients and, if positive, the removal of all of the polyps through the colonoscope.

Sulfated Glycoproteins in Human Salivary and Gastric Secretions

Pure sulphated glycoproteins may be isolated from human gastric and salivary secretions following proteolysis with pepsin and precipitation with cetylpyridinium chloride. The sulphated glycoproteins a

The Interrelationships of Pancreatic Enzymes in Health and Diseases under Cholecystokinin Stimulation

The duodenal aspirates were analyzed for amylase, lipase, trypsin and chymotrypsin contents in healthy patients and in subjects with chronic pancreatitis and pancreatic carcinoma. The duodenal aspirate was obtained in basal conditions and under continuous infusion of 3 U/kg/h of cholecystokinin (GIH). Lipase exhibited the largest increase under cholecystokinin stimulation and the smallest variation coefficient and degree of overlap between control subjects and patients with abnormal pancreas. healthy subjects, cholecystokinin stimulation induced significant deviations from parallelism for the enzyme ratios involving lipase. Such deviations tendedto disappear in patients with pancreatic disease.

Stimulation of Gastric Mucous Secretions in Man by Secretin

Gastric mucous secretions were collected in fasting patients following a careful gastric washout. The stomach, perfused with saline, was continuously reaspirated. Saliva was obtained separately during

Four Cases of Periarteritis Nodosa Associated with Persistant Australia Antigen

Au/SH Antigen was detected in the blood of 4 patients with a clinically typical and histologically proved periarteritis nodosa. The Au/SH antigenemia can be precocious and seem to persist constantly at a high level in all cases. Initial exposure notion to hepatitis virus was present 3 times. Clinical hepatic manifestations initiated the disease in 2 cases and were absent in 1. Association between Australia antigen and periarteritis nodosa (PAN) deserves emphasis and the correlation with similar observations reported by Gocke is a confirmation. A filiation between hepatitis and polyarteritis induced by the same virus is suggested.