Cancer prone persons. A randomized screening trial based on colonoscopy: background, design and recruitment.

OBJECTIVE: Evidence-based counseling and prevention are not available so far for hereditary cancer prone persons, since we lack data based on clinical trials. There are very few high-risk persons in the population as a whole. Based on a familial history analysis, only 1.2% of all healthy volunteers attending screening centers reached the arbitrary high-risk level defined as a Relative Risk of more than 4. We describe a randomized trial based on colonoscopic screening for colorectal cancer on a sub-group of high-risk group persons. MATERIALS AND METHODS: Among the 77 members of the French Institutional Preventive Center Network, 37 took part in this protocol. During the first 3 years, 850,000 persons were interviewed at these 37 Health centers. The enrollment process was particularly time-consuming, since a large amount of information had to be delivered to the participants. RESULTS: The mean rate of recruitment of eligible candidates was far lower than predicted, averaging only 1.4 per 1,000 persons interviewed instead of the 9/1,000 expected. This mean figure was based, however, on inclusion rates ranging from 0.06/1,000 to 7/1,000 among the different centers. The low rates of recruitment were mainly due to the inter-center heterogeneity (differences in commitment and in the resources), and to the fact that the acceptability of undergoing a colonoscopy turned out to be lower than predicted. CONCLUSION: Population trials on cancer prone persons are feasible, but vast numbers have to be pre- screened to identify the few people with a high hereditary risk and willing to accept screening within a controlled trial.

[Efficacy of a daily application of mesalazine (Pentasa) suppository with progressive release, in the treatment of ulcerative proctitis. A double-blind versus placebo randomized trial]. / Efficacité d'une application quotidienne d'un suppositoire de mésalazine (Pentasa) à libération progressive, dans le traitement des poussées de rectite ulcéro-hémorragique. Essai randomisé en double aveugle contre placebo.

Therapeutic efficacy of mesalazine controlled-release suppository 1 g once daily was compared with that of a placebo during 2 weeks in 50 patients (26 in the mesalazine group, 24 in the placebo group) with ulcerative proctitis, in a double-blind randomized trial. Endoscopic and clinical remission was seen in 69 and 65% of mesalazine-treated patients and in 33 and 25% of placebo-treated patients respectively (P < or = 0.01). No side effects were seen. It is concluded that a once-a-day administration of 1 g mesalazine controlled-release suppository is effective for topical treatment of patients with ulcerative proctitis.

[Functional interpretation of villous atrophy of the small intestine]. / Pour une interprétation fonctionnelle des atrophies villositaires de l'intestine grêle.

The villosities of the small intestine form a special structure (absorbing enterocytes, functional vascularisation of mucosa), manifestly adapted to the working of the absorption function. As a reciprocal, we propose the hypothesis that the maintenance of villous structures depends on the use of the absorption function and we have classified villous atrophies in three groups, according to their mechanism: by insufficiency of the absorbing enterocytary coating, alteration of the connective tissue and especially of functional vascularisation of mucosa, insufficient absorption (functional regression). Though based on a largely conjectural theoretical conception, this classification corresponds, in fact, to particular aspects of the mucosa as to organization of the connective tissue and especially to maturation of the enterocytary series: it should therefore help pathologists to add to the static appreciation of the hight of villosities and the abondancy of plasmocytes, an appreciation of anatomoclinical syndromes or, at least, of unquestionable lesional mechanism.