Daily medical education for confined students during coronavirus disease 2019 pandemic: A simple videoconference solution.

The outbreak of coronavirus disease 2019 caused by severe acute respiratory syndrome coronavirus 2 infection has recently spread globally and is now a pandemic. As a result, university hospitals have had to take unprecedented measures of containment, including asking nonessential staff to stay at home. Medical students practicing in the surgical departments find themselves idle, as nonurgent surgical activity has been canceled, until further notice. Likewise, universities are closed and medical training for students is likely to suffer if teachers do not implement urgent measures to provide continuing education. Thus, we sought to set up a daily medical education procedure for surgical students confined to their homes. We report a simple and free teaching method intended to compensate for the disappearance of daily lessons performed in the surgery department using the Google Hangouts application. This video conference method can be applied to clinical as well as anatomy lessons.

Laparoscopic Colorectal Cancer Resection in High-Volume Surgical Centers: Long-Term Outcomes from the LAPCOLON Group Trial.

BACKGROUND: Strong evidence has confirmed the benefit of laparoscopy in colorectal cancer resection but remains a challenging procedure. It is not clear that such promising results in selected patients translate into a favorable risk-benefit balance in real practice. We conducted a multicenter national observational registry to assess operative and oncologic long-term outcomes following laparoscopic colorectal cancer resection. METHODS: All patients with laparoscopic colorectal cancer resection between 2001 and 2004 were included. Data were extracted from the prospective Italian national database of 10 high-volume centers (≥40 colorectal cancer laparoscopic resections per year). Surgical technique and follow-up were standardized. Survivals were analyzed by Kaplan-Meier method. RESULTS: We reported 1832 patients with colon (58.5%) and rectal cancer (41.5%). TNM stage was 0-I-II in 1044 patients (57%) and III-IV in 788 patients (43%). Surgery included a totally laparoscopic procedure in 1820 patients (99.3%). Conversion was 10.5%. Postoperative morbidity and 30-day mortality rates were 17 and 1.2%, respectively. Clinical anastomotic leakage rate was 8.3% (n=152). R0 resection was 95%. With a median follow-up of 54.2 months, cancer recurrence rate was 13.3%. At 5 years, cancer-free survival was 86.7%. Upon multivariate analysis, age (P=0.001) and TNM stage (P<0.001) were associated with cancer-free survival. Predictive factors of cancer recurrence were gender (P=0.029) and TNM stage (P<0.001). CONCLUSIONS: In high-volume centers and non-selective patients, laparoscopic colorectal resection for cancer achieves good operative results with satisfactory long-term oncologic results. Even in the laparoscopy era, age, gender, and TNM stage remain the most powerful predictor of oncologic outcomes.

Type 2 diabetes mellitus as a risk factor for intestinal resection in patients with superior mesenteric vein thrombosis.

BACKGROUND & AIMS: The most serious complication of acute mesenteric vein thrombosis (MVT) is acute intestinal ischaemia requiring intestinal resection or causing death. Risk factors for this complication are unknown. To identify risk factors for severe intestinal ischaemia leading to intestinal resection in patients with acute MVT. METHODS: We retrospectively analysed consecutive patients seen between 2002 and 2012 with acute MVT in 2 specialized units. Patients with cirrhosis were excluded. We compared patients who required intestinal resection to patients who did not. RESULTS: Among 57 patients, a local risk factor was identified in 14 (24%) patients, oral contraceptive use in 16 (29%), and at least one or more other systemic prothrombotic condition in 25 (44%). Five (9%) patients had diabetes mellitus (DM), 33 (58%) had overweight or obesity, 9 (18%) had hypertriglyceridemia and 10 (19%) had arterial hypertension. Eleven patients (19%) underwent intestinal resection. DM was significantly associated with intestinal resection (P = 0.02) while local factors or prothrombotic conditions were not. Computed tomography (CT) scans performed at diagnosis found that occlusion of second order radicles of the superior mesenteric vein was more frequently observed in patients who underwent intestinal resection (P = 0.009). CONCLUSIONS: In acute MVT, patients with underlying DM have an increased risk of requiring intestinal resection. Neither local factors nor systemic prothrombotic conditions are associated with intestinal resection. When CT scan shows the preservation of second order radicles of the superior mesenteric vein, the risk of severe resection is low.

Effects of a multimodal management strategy for acute mesenteric ischemia on survival and intestinal failure.

BACKGROUND & AIMS: Acute mesenteric ischemia (AMI) is an emergency with a high mortality rate; survivors have high rates of intestinal failure. We performed a prospective study to assess a multidisciplinary and multimodal management approach, focused on intestinal viability. METHODS: In an Intestinal Stroke Center, we developed a multimodal management strategy involving gastroenterologists, vascular and abdominal surgeons, radiologists, and intensive care specialists; it was tested in a pilot study on 18 consecutive patients with occlusive AMI, admitted to a tertiary center from July 2009 to November 2011. Patients with left ischemic colitis, nonocclusive AMI, chronic mesenteric ischemia, and other emergencies were excluded. Patients received specific medical management: revascularization of viable small bowel and/or resection of nonviable small bowel; 12 patients received arterial revascularization. We evaluated the percentages of patients who survived for 30 days or 2 years, the number with permanent intestinal failure, and morbidity. Lengths and rates of intestinal resection were compared with or without revascularization, and in patients with early or late-stage disease. RESULTS: Patients were followed up for a mean of 497 days (range, 7-2085 d); 95% survived for 30 days, 89% survived for 2 years, and 28% had morbidities within 30 days. Intestinal resection was necessary for 7 cases (39%), with mean lengths of intestinal resection of 30 cm and 207 cm, with or without revascularization, respectively (P = .03). Among patients with early or late-stage AMI, rates of resection were 18% and 71%, respectively (P = .049). Patients with early stage disease had shorter lengths of intestinal resection than those with late-stage disease (7 vs 94 cm; P = .02), and spent less time in intensive care (2.5 vs 49.8; P = .02). CONCLUSIONS: A multidisciplinary and multimodal management approach might increase survival of patients with AMI and prevent intestinal failure.

Erasable and reversible wrinkling of halogenated rubber surfaces.

Few surfaces can exist at rest in either wrinkled or unwrinkled states and switch reversibly between these states. Here, we report a new approach to creating reversibly wrinkling systems using the halogenation of rubber to induce a local increase in the glass-transition temperature within a thin layer at the surface. Such systems are obtained by the bromination of molded rubber films. By means of thermomechanical experiments and in situ observations, we show that microscopic wrinkles are produced by unstretching a stretched film below the glass-transition temperature of the brominated layer. These surface patterns are erased within seconds when the wrinkled layer is heated to above its glass transition and recovers its initial equilibrium dimensions. New wrinkles can be produced and erased repeatedly on the same surface. A model is proposed that takes into account the existence of a gradient in bromine content along the thickness of the modified layer. It describes the viscoelastic behavior of these brominated films and captures the temperature dependencies of the thickness of the glassy layer and of the wrinkle wavelength.

Segmental reversal of the small bowel can end permanent parenteral nutrition dependency: an experience of 38 adults with short bowel syndrome.

OBJECTIVE: This study aimed to assess the results of segmental reversal of the small bowel (SRSB) in patients with short bowel syndrome (SBS) who were "permanently" dependent on parenteral nutrition (PN) and to identify possible prognostic factors for weaning. SUMMARY BACKGROUND DATA: SRSB is a nontransplant surgical option for patients with SBS who require long-term PN. Few studies have reported outcomes in humans. METHODS: : All patients who were permanently dependent on PN and underwent a SRSB between 1985 and 2010 for SBS were included. The data were retrospectively retrieved. RESULTS: Thirty-eight patients underwent SRSB. The median age was 55.5 years (range, 18-76). The median length of the small bowel remnant was 49 cm (20-140), including a reversed segment of 10 cm (6-15). The median follow-up was 57.7 months (1-304). At the 5-year follow-up, 17 patients had been weaned from PN (45%). In the remaining patients, PN dependency had decreased from 7 ± 1 to 4 ± 1 days per week. The survival rate was 84%. The prognostic factors for weaning were a short time between subtotal enterectomy and SRSB (P = 0.036), a longer than typical stay in the nutrition unit (P = 0.035), and an SRSB longer than 10 cm (P = 0.024). CONCLUSIONS: SRSB has a role as a conservative alternative to small bowel transplantation in patients with SBS permanently dependent on PN. With a segmental reversal of 10 to 12 cm, almost half of the patients can be expected to be weaned from PN.

Bilobar colorectal liver metastases: a new model for preclinical studies.

SUMMARY: This study aimed to develop a new model of colorectal liver metastases (LM) in the rat. Both single macroscopic and multiple bilobar microscopic LM were investigated, as this closely resembled the human situation, before right hepatectomy was performed for 'single' right LM. The single macroscopic LM was elicited by direct injection of DHD/K12 colorectal cancer cells under the capsule of the median liver lobe in immunocompetent BDIX rats. The bilobar micrometastases were elicited by intraportal injection of DHD/K12 cells. A preliminary protocol was conducted to assess the dose of cells required to inject in to the portal vein, using 10(6) , 2 × 10(6) and 3 × 10(6) DHD/K12 cells (n = 15 rats). The resultant protocol for the experimental model used intraportal injection of 10(6) DHD/K12 cells and direct injections of 0.5 × 10(6) , 10(6) and 1.5 × 10(6) DHD/K12 cells (n = 15 rats). For both protocols, BDIX rats were sacrificed at day 30 after injection. The preliminary protocol showed that intraportal injection of 10(6) DHD/K12 cells was associated with bilobar micrometastases of 0.8 mm mean diameter at day 30. The main protocol assessed that direct injection of 0.5 × 10(6) under the liver median lobe capsule and intraportal injection of 10(6) DHD/K12 cells were associated at day 30 with a single macroscopic metastasis confined to a liver lobe and bilobar micrometastases, without peritoneal carcinomatosis or lung metastasis. Thus we have developed a new experimental model of bilobar colorectal LM including both macro- and microscopic colorectal LMs, which mimics the human situation and which will be useful in preclinical studies.

The expression of the hypoxia markers CA9 and CXCR4 is correlated with survival in patients with neuroendocrine tumours of the ileum.

BACKGROUND/AIM: The hypoxia-inducible factor pathway regulates the expression of a diverse group of molecules such as CA9 and CXCR4. Our aim was to investigate the expression of these markers in a series of patients with an ileal neuroendocrine tumour (IET) at various stages of tumorigenesis. METHODS: The immunohistochemical expression of CA9 and CXCR4 was examined in 51 patients with a resected IET. A 'hypoxic score' was calculated, integrating the expression of both CA9 and CXCR4 (hypoxic score 0: absence of expression of both molecules; hypoxic score 1: expression of CXCR4 and/or CA9). Results were compared to histoprognostic factors (including tumour size, stage and grade, WHO and TNM classifications, presence of vascular or perineural invasion, presence of a fibrotic stroma and microvascular density) and to survival. RESULTS: All tumours were well differentiated. 69% of tumours were less than 25 mm. 46% of tumours largely infiltrated the intestinal wall (≥T3, subserosa and serosa) and 90% were classified as N1 and/or 63% as M1. 57% of tumours were of grade G1, 43% of grade G2. Grade G2 (p=0.004) and larger tumour infiltration (≥T4; p=0.03) correlated with lower survival. Hypoxic score 1 correlated with a greater tumour size (p=0.034), larger tumour infiltration (T3 or T4; p=0.001), grade G2 (p=0.046), presence of lymph node metastasis (p=0.0066) and with lower survival of patients (p=0.03). CONCLUSION: The hypoxia-inducible factors CA9 and CXCR4 were found associated to the malignant progression of neuroendocrine tumours of the ileum. Their expression may reflect higher tumour aggressivity.

Mortality after colorectal cancer surgery: a French survey of more than 84,000 patients.

OBJECTIVES: This study aimed to identify risk factors of postoperative 30-day mortality (POM) after colorectal cancer resection. SUMMARY: Meta-analyses have failed to demonstrate any significant benefit of laparoscopy in terms of postoperative mortality. This could be explained by the lack of a large sample size. METHODS: All patients who underwent colorectal resection for cancer between 2006 and 2008 in France were included. Data were extracted from the French National Health Service Database. A multivariate analysis evaluating risk factors for POM was performed including the following factors: age, gender, tumor location, associated comorbidities, emergency surgery, synchronous liver metastasis, malnutrition, and surgical approach. RESULTS: During the 3-year period, a total of 84,524 colorectal resections for colorectal cancer were performed: 22,359 through laparoscopy (26%) and 62,165 through laparotomy (74%). From 2006 to 2008, laparoscopic approach rate increased from 23% to 29% (P < 0.001). POM was 5.0%: 2% after laparoscopy and 6% after laparotomy (P < 0.001). In multivariate analysis, 7 independent factors were significantly associated with a higher POM: age 70 years or more [P < 0.001, odds ratio (OR): 3.28; (3.00-3.59)], respiratory comorbidity [P < 0.001, OR: 3.16; (2.91-3.37)], vascular comorbidity [P < 0.001, OR: 2.66; (2.48-2.85)], neurologic comorbidity [P < 0.001, OR: 1.78; (1.51-2.09)], emergency surgery [P < 0.001, OR: 2.68; (2.48-2.90)], synchronous liver metastasis [P < 0.001, OR: 2.63; (2.41-2.86)], and preoperative malnutrition [OR: 1.33; (1.19-1.50)]. Laparoscopic surgery [P < 0.001, OR: 0.59; (0.54-0.65)] was independently associated with a significant decreased POM. CONCLUSIONS: This all-inclusive national study showed that POM after colorectal cancer surgery is significantly reduced in case of age less than 70 years, elective surgery, and absence of synchronous liver metastasis, malnutrition, respiratory, neurologic, or vascular comorbidity. Furthermore, it is suggested that a laparoscopic surgery is independently associated with a decreased POM. This result, observed at a national level, must be considered when choosing the best surgical approach for colorectal cancer treatment.

Selective portal vein embolization and colorectal liver metastases in rat: a new experimental model for tumor growth study.

BACKGROUND: Portal vein embolization (PVE) has been proposed to induce hypertrophy of liver before major resection. Because there are some concerns about the effect on tumor growth, experimental research is needed, requiring reliable small animal model. The aim was to assess technical feasibility of PVE model in rat and to report colorectal liver metastases (LM) tumor growth. METHODS: LM were induced in 40 rats by injecting DHDK12 cells into the left liver lobe. At d 7, a portography was performed through a laparotomy in 20 rats allowing the left PVE. Twenty rats without PVE served as control. All rats were sacrificed at d 30. Liver and tumor volume were calculated. RESULTS: Mortality rate was 20% (n=8). PVE was successful in 15/19 rats (79%). Compared with control rats, the left PVE induced both significant atrophy of the left lobe (3.5±0.8 versus 7.4±0.9 mm3, P<0.0001) and contralateral hypertrophy (5.8±1.1 versus 3.6±0.7 mm3, P<0.0001). LM tumor volume in the left liver was significantly decreased in PVE group compared to control, 124.4±95.7 mm3versus 231.1±90.1 mm3, P=0.008. CONCLUSION: PVE is feasible in rats with a 79% success rate. Significant hypertrophy of the remnant liver and atrophy of the embolized liver were noted suggesting the efficacy of PVE. LM tumor growth decreased significantly in the embolized lobe. Our model can be used for experimental studies evaluating tumor growth and effects of new drugs against LM in a situation that mimics the human situation before partial hepatectomy.

Rectal cancer surgery with or without bowel preparation: The French GRECCAR III multicenter single-blinded randomized trial.

OBJECTIVE: To assess with a single-blinded, multicenter, randomized trial, the postoperative results in patients undergoing sphincter-saving rectal resection for cancer without preoperative mechanical bowel preparation (MBP). BACKGROUND: The collective evidence from literature strongly suggests that MBP, before elective colonic surgery, is of no benefit in terms of postoperative morbidity. Very few data and no randomized study are available for rectal surgery and preliminary results conclude toward the safety of rectal resection without MBP. METHODS: From October 2007 to January 2009, patients scheduled for elective rectal cancer sphincter-saving resection were randomized to receive preoperative MBP (ie, retrograde enema and oral laxatives) or not. Primary endpoint was the overall 30-day morbidity rate. Secondary endpoints included mortality rate, anastomotic leakage rate, major morbidity rate (Dindo III or more), degree of discomfort for the patient, and hospital stay. RESULTS: A total of 178 patients (103 men), including 89 in both groups (no-MBP and MBP groups), were included in the study. The overall and infectious morbidity rates were significantly higher in no-MBP versus MBP group, 44% versus 27%, P = 0.018, and 34% versus 16%, P = 0.005, respectively. Regarding both anastomotic leakage and major morbidity rates, there was no significant difference between no-MBP and MBP group: 19% versus 10% (P = 0.09) and 18% versus 11% (P = 0.69), respectively. Moderate or severe discomfort was reported by 40% of prepared patients. Mortality rate (1.1% vs 3.4%) and mean hospital stay (16 vs 14 days) did not differ significantly between both groups. CONCLUSIONS: This first randomized trial demonstrated that rectal cancer surgery without MBP was associated with higher risk of overall and infectious morbidity rates without any significant increase of anastomotic leakage rate. Thus, it suggests continuing to perform MBP before elective rectal resection for cancer.

A laparoscopic approach to iterative ileocolonic resection for the recurrence of Crohn's disease.

BACKGROUND: Laparoscopy is a valuable approach to primary ileocecal resection for ileocolonic Crohn's disease (CD). This study aimed to evaluate the feasibility of using laparoscopy for reoperation in the case of ileocolonic CD recurrence and to determine the risk factors and consequences of conversion for these patients. METHODS: From 1998 to 2008, 57 patients underwent 62 reoperations for CD recurrence. Of these 62 reoperations, 29 were laparoscopic procedures (laparoscopy group [LG]). Preoperative and intraoperative characteristics and postoperative outcome were compared with those for 33 open procedures (open group [OG]). RESULTS: The preoperative characteristics were similar in the two groups. The number of intraoperative intestinal injuries was higher in the LG group (n = 5) than in the OG group (n = 0) (p = 0.01). The use of a temporary stoma (7/29 vs. 6/33; nonsignificant difference [NS]) and the mean operating time (215 + or - 70 vs. 226 + or - 107 min, NS) were similar in the two groups. The postoperative mortality was nil in both groups. The overall morbidity rate was 38% (11/29) in LG and 30% (10/33) in OG (NS). Severe complications (DINDO > or = 3) occurred for three of the 29 patients in LG (10%) compared with five of 33 patients in OG (15%) (NS). The median hospital stay was 9 days in both groups. The conversion rate was 31% (9/29). Univariate analysis showed that the risk factors for conversion were fistulizing disease (p = 0.02) and intraoperative intestinal injury (p < 0.001). The morbidity rate was not increased by the need for a conversion (7/20 for the nonconverted vs. 4/9 for the converted patients, NS). CONCLUSION: Laparoscopy for ileocolonic CD recurrence is challenging and complex. The morbidity rate was similar to that for the open approach, and the risk of small bowel injury associated with laparoscopy could possibly induce postoperative septic complications. However, the authors believe that laparoscopy can be recommended for selected patients with CD recurrence, especially patients with nonfistulizing disease.

Impact of complex Crohn's disease on the outcome of laparoscopic ileocecal resection: a comparative clinical study in 124 patients.

PURPOSE: This prospective study assessed the feasibility of laparoscopic ileocolonic resection for complex Crohn's disease, i.e., recurrence or complication from abscess and/or fistula, and compared postoperative outcomes in patients with and without complex Crohn's disease. METHODS: Between November 1998 and August 2007, 124 laparoscopic ileocolonic resections were attempted for Crohn's disease: 54 patients with complex Crohn's disease (group I) and 70 patients without complex Crohn's disease (group II). Postoperative mortality and morbidity were compared between group I and group II. RESULTS: Indications for surgery in group I included fistula (43 percent), abscess (30 percent), and recurrent disease after ileocolonic resection (27 percent). Complex Crohn's disease was significantly associated with increased mean (standard deviations) operative time [214 (13) vs. 191(53) minutes, P < 0.05), increased conversion rate to open procedure (37 percent vs. 14 percent, P < 0.01), and increased use of temporary stoma (39 percent vs. 9 percent, P < 0.001). No patients died. Overall postoperative morbidity was similar between both groups [17 percent vs. 17 percent, P = not significant (NS)], including major surgical postoperative complications (7 percent vs. 6 percent, P = NS). Mean (SD) hospital stay was not statistically different between both groups [8 (3) vs. 7 (3) days, P = NS]. CONCLUSIONS: This large comparative study suggested that laparoscopic ileocolonic resection for complex Crohn's disease was feasible and safe with good postoperative outcomes. In our experience, complex Crohn's disease does not appear as a contraindication to a laparoscopic approach.

Total laparoscopic ileal pouch-anal anastomosis: prospective series of 82 patients.

BACKGROUND: Ileal pouch-anal anastomosis (IPAA) is the recommended procedure for ulcerative colitis and profuse familial adenomatous polyposis. The aims of this study were to report a consecutive series of 82 unselected patients who undergone a total laparoscopic IPAA with a special focus on the postoperative morbidity and 1-year functional results. METHODS: Between 2002 and 2008, 82 consecutive patients undergoing IPAA under a total laparoscopic approach were enrolled. Patient data, surgical procedure, and 1-year functional outcome were analyzed. RESULTS: Among the 82 patients, 44 (54%) had a former subtotal colectomy (STC) before IPAA. No patient died postoperatively. Conversion rate was 11%. Overall morbidity was 32%. Symptomatic anastomotic fistulas were observed in nine patients (10%). Reoperation was needed in 5/82 (6%) of the patients. One-year functional results were 4.7 +/- 1.9 during the day and 1 +/- 1.2 during the night. Operating time decreased significantly after the first 40 laparoscopic IPAA (p = 0.0183). No difference was observed in the morbidity and functional results between patients operated for IPAA after a former colectomy or during a restorative proctocolectomy. CONCLUSIONS: This study suggested the feasibility and safety of the total laparoscopic approach IPAA. Total laparoscopic approach could become the best approach for IPAA. Prior colectomy does not modify the result of this demanding surgical procedure.

Atomic force microscopy characterization of the chemical contrast of nanoscale patterns fabricated by electron beam lithography on polyethylene glycol oxide thin films.

The present paper shows that atomic force microscopy (AFM) imaging of friction force and phase lag in ambient air can be used to characterize the chemical contrast induced by electron beam (EB) irradiation on polyethylene glycol oxide (PEO) surface. Time-of-flight secondary emission mass spectroscopy measurements showed that the EB irradiation generates chemical contrast on PEO surface by decreasing the ether bond density. The AFM measurements showed smaller phase lag and lower friction and adhesive forces on the EB irradiated PEO surface, as compared to the non-irradiated PEO surface. While the chemical contrast in friction force had a linear dependence on the EB irradiation dose, the dependence of the chemical contrast in the phase lag was strongly non-linear. As the friction and adhesive forces depended on the AFM probe hydrophilicity and air humidity, the contrast in friction and adhesive forces is ascribed to different capillary condensation of ambient water vapour at the AFM tip contact with the EB irradiated and non-irradiated PEO surfaces, respectively.

Fouling and non-fouling surfaces produced by plasma polymerization of ethylene oxide monomer.

This paper presents the results of plasma polymerization using diethylene glycol dimethyl ether as a precursor in a capacitively coupled radio frequency system. The chemical structure of the coatings was characterized using several analysis techniques (X-ray photoelectron spectroscopy, Fourier transform-infrared spectroscopy, ellipsometry), while the biological response of these coatings has been tested by protein adsorption and cell culture experiments. The modulation of the input plasma power controls the concentration of polyethylene oxide groups in the coatings and allows the production of films with opposite protein and cell repellent properties. The study of the stability of these coatings in different media (water, acetone, phosphate-buffered saline) reveals that these films could be involved in classical lift-off processes for the production of patterned surfaces.

Laparoscopic resection for T4 colon cancer: perioperative and long-term outcomes.

Laparoscopic resection has been considered a contraindication for T4 colorectal cancer. It is argued that it is a challenging and demanding procedure with high conversion rate, inadequate oncologic clearance and surgical outcomes. There are only a few data on short- and long-term operative results. This review aimed at assessing feasibility and operative and oncologic results of laparoscopic resection for T4 colorectal cancer.

Management and prognosis of metastases to the thyroid gland.

BACKGROUND: Intrathyroid metastases (ITM) of extrathyroid cancer are rare and have a poor prognosis. The aim of this work was to identify the sites of primary cancers and the treatment and prognosis of these lesions. STUDY DESIGN: This retrospective study was carried out on patients treated between 1982 and 2002 in the surgical departments of the University hospitals of Poitiers, Limoges, Tours, and Nantes, France. All diagnoses were confirmed by cytology or histologic examination. RESULTS: Twenty-nine patients (41 to 78 years) had ITM. Primary cancers were renal cell in 16 patients, lung in 4, digestive in 4, sarcoma in 1, melanoma in 1, neuroendocrine in 1, and of unknown origin in 1 patient. For 10 patients, diagnoses of primary cancer and ITM were synchronous. For 19 patients, delay between diagnosis of the primary cancer and ITM was 6.8 years (2 months to 16 years). Diagnosis was confirmed with fine-needle aspiration 3 times and with histologic examination of the thyroid 26 times. Twenty-seven patients had thyroidectomy; two were not operated on. After treatment of ITM, 13 patients had new metastatic sites. Mean followup for all patients was 2.3 years. Seven patients (24%) (6 with renal cancer) were disease free (followup 4.5 years). Four patients were alive with disease (followup 1.4 years). Eighteen patients (62%) died of their disease at a mean delay of 1.4 years. CONCLUSIONS: ITM are rare but the diagnosis should be borne in mind when patients have a history of cancer (mainly renal cancer). Preoperative diagnosis and complete evaluation could avoid unnecessary thyroidectomy because numerous patients had diffuse metastases.

[Recurrent glucagonoma 20 years after surgical resection]. / Récidive ganglionnaire d'un glucagonome 20 ans après l'exérèse chirurgicale.

Glucagonoma is a rare islet alpha-cell pancreatic tumor. Patients usually present with necrolytic migratory erythema, diabetes mellitus, thromboembolism, and weight loss. Diagnosis is based on the presence of a pancreatic tumor in association with hyperglucagonemia. Tumor characterization is made by computed tomography and/or pancreatic endoscopic ultrasonic and indium-labeled octreo-scan. Surgery is the main component of the treatment, in some cases in association with chemotherapy. We report the case of a 72-year-old patient who developed a recurrent glucagonoma, 20 years after surgical resection.