[Stomach cancer: have changes in surgical strategy influenced the results? 20-year retrospective study]. / Cancer de l'estomac: les changements dans la stratégie chirurgicale ont-ils une influence sur les résultats? Etude rétrospective sur 20 ans.

STUDY AIM: The aim of this retrospective study was to compare a group of patients who underwent resection for gastric adenocarcinoma (cancer of cardia excluded) and to assess the influence of radical lymphadenectomy on postoperative mortality and morbidity and 5-year survival rate. PATIENTS AND METHOD: One hundred and six patients were operated on from 1975 to 1985 and 99 from 1986 to 1995 for gastric adenocarcinoma located in the distal portion of the stomach in 56% and 61% respectively and, undifferenciated in 56%. Gastric resection was a subtotal gastrectomy for cancers of the lower third and total gastrectomy for cancers of the middle and superior thirds. In the first group (1975-1985), a D1 lymphadenectomy was performed in all patients. In the second group (1986-1995) a D1.5 lymphadenectomy without systematic splenectomy and pancreatectomy was applied to 49 patients. RESULTS: In the second group, the proportion of curative resection was higher (85% versus 75%) along with a higher rate of total gastrectomy (42% versus 17%). The postoperative mortality rate was 2% in the first group and 1% in the second group. The morbidity rate was 33% in the first group and 15% in the second group with a rate of anastomotic leak of 11% and 2% respectively. Among the second group, the morbidity rate was 20% after D1,5 lymphadenectomy versus 10% after D1 lymphadenectomy. The overall 5-year survival rate was 29% in the first group versus 38% in the second group. In this latter group, the overall 5-year survival was 32% after D1 lymphadenectomy and 46% after D1,5 (p = 0.038). CONCLUSION: Radical lymphadenectomy without associated splenic or pancreatic resection in good general status patients may provide a better staging of resected gastric cancer without increase of the postoperative mortality. However, the influence of radical lymphadenectomy on long-term survival remains to be proven.

[Late morbidity after esophagectomy for cancer: is partial esophagectomy preferred?]. / Morbidité tardive après oesophagectomie pour cancer: faut-il préférer les oesophagectomies partielles?

PURPOSE: The aim of this study is to report late postoperative complications occurring after oesophagectomy for cancer over a 12-month period and to compare the incidence of these complications according to the level of the anastomosis. PATIENTS AND METHOD: This study included 106 consecutive patients 51% with subtotal oesophagectomy (thoracic anastomosis), and 49% with total oesophagectomy (cervical anastomosis). The two groups were comparable for age, mean weight loss before surgery, life expectancy, number of positive margins, TNM grading, size and tumour differentiation. RESULTS: Late morbidity concerned 67.9% of the 106 patients. Predominant complications were dysphagia (32.1% of the 106), gastro-esophageal reflux (25.5% of the 106), and diarrhoea (18.8% of the 106). Among all the factors causing dysphagia, evaluated by logistic regression, the level of anastomosis was only found significant with a 20.4% occurrence for thoracic anastomosis and 44.2% for cervical anastomosis (P = 0.012). All the other complications were similar in the two groups. CONCLUSION: Functional results of oesophagectomy for cancer are poor. As partial oesophagectomy morbidity is lower, total oesophagectomy should not be proposed in all cases of oesophageal cancer.

The sea urchin larva, a suitable model for biomineralisation studies in space (IML-2 ESA Biorack experiment '24-F urchin').

By the ESA Biorack 'F-24 urchin' experiment of the IML-2 mission, for the first time the biomineralisation process in developing sea urchin larvae could be studied under real microgravity conditions. The main objectives were to determine whether in microgravity the process of skeleton formation does occur correctly compared to normal gravity conditions and whether larvae with differentiated skeletons do 'de-mineralise'. These objectives have been essentially achieved. Postflight studies on the recovered 'sub-normal' skeletons focused on qualitative, statistical and quantitative aspects. Clear evidence is obtained that the basic biomineralisation process does actually occur normally in microgravity. No significant differences are observed between flight and ground samples. The sub-normal skeleton architectures indicate, however, that the process of positioning of the skeletogenic cells (determining primarily shape and size of the skeleton) is particularly sensitive to modifications of environmental factors, potentially including gravity. The anatomical heterogeneity of the recovered skeletons, interpreted as long term effect of an accidental thermal shock during artificial egg fertilisation (break of climatisation at LSSF), masks possible effects of microgravity. No pronounced demineralisation appears to occur in microgravity; the magnesium component of the skeleton seems yet less stable than the calcium. On the basis of these results, a continuation of biomineralisation studies in space, with the sea urchin larva as model system, appears well justified and desirable.

Behavior of bacteria and antibiotics under space conditions.

We have previously reported an increase of the "resistance" to antibiotics of bacteria during space missions. In the present experiment, we studied the growth of Escherichia coli cultured in vitro in space in the presence of dihydrostreptomycin: tritiated and nontritiated. This experiment was carried out during the STS 42 mission aboard the U.S. Space Shuttle Discovery (IML-1 program). Cells were cultured in plastic bags and growth was stopped at six different time points by lowering the temperature to 5 degrees C. Several methods were used: viable cell counting by Colony Forming Units; total cell number by optical densitometry; electron microscopy; radioactivity measurements. The investigations show no difference between flight and ground experiments for the cultures without antibiotic. The growth rate with antibiotic was accelerated in flight, the growth yield was not changed, and there were no differences in the ultrastructures. The results suggest some changes in antibiotic binding in space. We did not observe any differences between the cultures developed in flight in the 1-g centrifuge and the cultures placed in the static rack in microgravity.

Radical retropubic prostatectomy: complications and quality of life (429 cases, 1983-1989).

From March 1983 to December 1989 we have performed radical prostatectomy on 429 patients with prostate cancer. With 117 of the cases we performed the sparing nerve procedure. Follow-up was 6-72 months. Early postoperative complications concerned 36 patients (8.4%). We have not had any total incontinence. After a 6-month postoperative period we had a rate of 13.8 +/- 3% of stress incontinence with a confidence level of 95%. This percentage changed to 6.2 +/- 3% after a 12-month period. 33% of the patients after 6 months and 68.5% after 1 year reported full potency with similar pre- and postoperative quality of sexual intercourse. To manage localized prostate cancer it is important to know that with radical prostatectomy we can obtain an excellent quality of life with low morbidity even if the best management of localized prostate cancer is not resolved.

[Effects of pneumogastric nerve stimulation and injection of a beta 2 stimulant (terbutaline) on the lipid composition of the alveolar lining fluid and on pulmonary compliance in the rat]. / Effets de la stimulation du nerf pneumogastrique et de l'injection d'un beta 2 stimulant (terbutaline) sur la composition lipidique du liquide de revêtement alvéolaire et sur la compliance pulmonaire chez le rat.

The effects of vagal stimulation and of terbutaline injection on lipidic composition of alveolar fluid and pulmonary compliance were studied. Three groups of rats were used: control, after right vagus nerve stimulation, after 0.2 mg terbutaline injection. The lungs of the rats were isolated. We studied pulmonary pressure-volume curves with air and we measured pulmonary compliance. We realised an alveolar lavage to obtain alveolar lipids. We observed: Vagus nerve stimulation and beta 2 agonist significantly increased fatty acids of total lipids respectively by 52.5% and 25.5% and phospholipids, respectively by 43.6% and 25.7%. beta 2 agonist did not change fatty acid composition of total lipids and phospholipids. Right vagus nerve stimulation increased the percentage of palmitic acid in phospholipids and decreased the percentage of saturated fatty acids and of palmitic acid in total lipids. Terbutaline injection induced more significant changes in pressure-volume curves and in pulmonary compliance than right vagus nerve stimulation. Our results suggest that both vagal stimulation and beta 2 agonists increase lipid release in alveolar lining, but only vagal stimulation modifies the composition of these lipids. These modifications could be, at least in part, correlated with the changes observed in the pressure-volume curves.

Effects of very low doses of ionizing radiation on the clonal life-span in Paramecium tetraurelia.

Effects of very low doses of ionizing radiation were investigated on life-span in Paramecium tetraurelia. After autogamy single cell cultures were place (1) in a control chamber with radiopermeable walls; (2) in a shielded device with 10 cm thick lead walls; (3) in a similar shielding device including a 60Co source giving a dose of 760 mrad per year at the culture level. Life-spans, expressed in days and in mean total number of fissions measured from autogamy to the death of all sublines, were about 200 fissions and 55 days in controls. Life-spans of shielded sublines were increased and lower life-spans were observed in both shielded and irradiated sublines. These findings provide new evidence for a biological effect of very low doses of ionizing radiations and show that fission potential of Paramecium tetraurelia can be affected by variations in the background radiation level.

[A test for acute hypocalcemia using swine and salmon calcitonin]. / Test d'hypocalcémie aiguë à la calcitonine de porc et de saumon

The production of acute hypocalcemia was investigated using either 80 U. MRC of salmon calcitonin or 160 1. mrc of pork calcitonin in 117 subjects (58 patients with Paget's disease, 22 with osteoporosis, 22 with Sudeck-Leriche algodystrophy and 15 control subjects). The results obtained with the two types of calcitonin did not differ. Induced acute hypocalcemia was more pronounced in patients with Paget's disease than in the other subjects studied. In patients with Paget's disease there were statistically significant correlations between the hypocalcemia produced and the initial levels of alkaline phosphatase and total 24 hours urinary hydroxyproline.