Loss of SMARCB1 expression in colon carcinoma.

SMARCB1 is a tumor suppressor gene, which is part of SWI/SNF complex involved in transcriptional regulation. Recently, loss of SMARCB1 expression has been reported in gastrointestinal carcinomas. Our purpose was to evaluate the incidence and prognostic value of SMARCB1 loss in colon carcinoma (CC). Patients with stage III CC (n= 1695), and a second cohort of 23 patients with poorly differentiated CC were analyzed. Immunohistochemistry for SMARCB1 was performed on tissue microarrays, and cases with loss of expression were controlled on whole sections. Loss of SMARCB1 was compared with the clinico-pathological and molecular characteristics, and the prognostic value was evaluated. Loss of SMARCB1 was identified in 12 of 1695 (0.7%) patients with stage III CC. Whole section controls showed a complete loss in only one of these cases, corresponding to a medullary carcinoma. SMARCB1 loss was not associated with histological grade, tumor size nor survival. In the cohort of poorly differentiated CC, we detected 2/23 (8.7%) cases with loss of SMARCB1; one was rhabdoid while the other had medullary and mucinous histology. These 2 cases were deficient for MisMatched Repair (dMMR) and mutated for BRAF. SMARCB1 loss is rare in stage III CC, but appears more frequent in poorly differentiated CC.

Taking into account successive treatment lines in the analysis of a colorectal cancer randomised trial.

The FFCD 2000-05 randomised trial included 410 patients with advanced colorectal cancer and compared a sequential arm S treated with 5-fluorouracil and leucovorin (LV5FU2) followed by FOLFOX (LV5FU2+oxaliplatin) and then FOLFIRI (LV5FU2+irinotecan) and a combination arm C that begins directly with FOLFOX followed by FOLFIRI. The first aim of this study was to analyse the prognostic effects on overall survival of disease progression, and of toxicities under first-line therapy. We also studied the benefit of introducing irinotecan in each arm. Finally, we compared the effect of treatment on repeated progression and toxicities. For this purpose, we used Cox regression models with time-dependent variables and shared gamma frailty regression models. We found that early on during follow-up, the prognostic effect on survival of progression under first-line therapy was greater in C (hazard ratio [HR]=18.0 [7.9-41.2]) than in S (HR=7.7 [3.9-17.4]). This difference was significant, but it decreased over time. The prognostic effect of severe toxicities was greater in S (HR=2.0 [1.4-2.9]) than in C (HR=1.3 [0.9-1.9]). Introducing irinotecan was significantly more beneficial in S (HR=0.2 [0.1-0.4]) than in C (HR=0.3 [0.2-1.5]). The risk of repeated progression was not significantly different between the two groups (HR=0.9 [0.8-1.1]) whereas the risk of toxicities was greater in C (HR=1.7 [1.4-2.1]). Overall, this study suggests that starting with less toxic first-line treatment is a valid option since it does not exert a deleterious effect on the risk of overall progression or death.

[Endoscopic aspect of ulcerated tumor-like gastritis associated with Helicobacter heilmannii]. / Aspect de gastrite ulcérée pseudo-tumorale due à Helicobacter heilmannii.

We report on 5 cases with an endoscopic aspect exceptionally described of ulcerated tumor-like gastritis associated with Helicobacter heilmannii. This rare but ubiquitary bacteria, belonging to the same family as Helicobacter pylori, is epidemiologically and structuraly different. When these endoscopic lesions are detected, Helicobacter heilmannii has to be looked for carefully. The treatment, which is the same than for Helicobacter pylori, must lead to complete repair of endoscopic and histologic lesions.

[Epidemiology of intestinal functional disorders]. / Epidémiologie des troubles fonctionnels intestinaux.

On the basis of 4 adult population samples subsequently gathered into one sample of 567 healthy subjects, we determined: (1) the annual prevalence of symptoms suggestive of intestinal functional disorders (30.5 per cent); (2) the elements which prompted subjects with symptoms to request medical attention (we found that the request was significantly correlated with the duration of pain, the intensity and chronicity of constipation, the number of symptoms and the triggering of disorders by stress), and (3) an estimate of the "cost" of intestinal functional disorders.

[Anesthesia with perfused methohexital-fentanyl combination]. / Anesthésie par association de méthohexital-fentanyl en perfusion.

A methohexitone-fentanyl association in perfusion has been studied in 53 patients. A description of the anaesthetic technique is given. Induction is quick and haemodynamic changes are moderate. Spontaneous ventilation is possible with the lesser dosage of fentanyl. A quick and rapidly complete awakening authorizes early extubation. Complications were few and minor ones. Two peroperative respiratory depressions followed overdosage.