Multicentre randomised phase III trial comparing Tamoxifen alone or with Transarterial Lipiodol Chemoembolisation for unresectable hepatocellular carcinoma in cirrhotic patients (Fédération Francophone de Cancérologie Digestive 9402).

The FFCD 9402 multicentre phase III trial was designed to compare the effects of the combination of Transarterial Lipiodol Chemoembolisation (TACE) and tamoxifen with tamoxifen alone on overall survival and quality of life in the palliative treatment of hepatocellular carcinoma with cirrhosis. From 1995 to 2002, 138 patients were randomised between the two groups. One hundred and twenty three patients were eligible including 61 in the Tamoxifen group and 62 in the TACE group. Baseline characteristics were similar: Child-Pugh class A: 70%, alcoholic cirrhosis: 76%, Okuda stage I: 71%, multinodular tumour: 70% and segmental portal vein thrombosis: 10%. At 2years, the overall survival was 22% and 25% in the Tamoxifen and TACE groups (P=.68), respectively. Multivariate analysis identified four independent prognostic factors for survival: alpha-fetoprotein (AFP)>400ng/mL (P=.008), abdominal pain (P=.011), hepatomegaly (P=.023) and Child-Pugh score (P=.032). The Spitzer Index level assessing the quality of life during follow-up did not differ between the two groups (P=.70). Amongst patients with stage Okuda I, the 2-year overall survival was 28% in the Tamoxifen group and 32% in the TACE group (P=.58). In this subgroup, two prognostic factors were statistically significant for survival: AFP>400ng/mL (P=.004) and Spitzer Index (P=.013) as shown by multivariable analysis. In conclusion, this study suggests that TACE improves neither the survival nor the quality of life in patients with HCC and cirrhosis.

[Singular diaphragm-like colonic stricture and short-term administration of a non-steroidal anti-inflammatory drug]. / Diaphragme colique unique et prise brève d'anti-inflammatoire non stéroïdien.

A case of diaphragm-like stricture of the colon induced by non steroidal anti-inflammatory drug (diclofénac LP) is reported in a 65-year-old man who presented abdominal pain. Colonoscopy revealed ulcer in the transverse right colon. The patient gradually developed diaphragm-like stricture in the transverse right colon. A right hemicolectomy was performed.

[Treatment of duodenal ulcer outbreak with omeprazole. Results of a multicenter non-controlled study]. / Traitement de l'ulcère duodénal en poussée par l'oméprazole. Résultats d'une étude non contrôlée multicentrique.

Sixty-one patients with symptomatic endoscopically confirmed duodenal ulcer, 5 mm or more in diameter, were treated with omeprazole 30 mg once daily in the morning for 4 weeks. Complete ulcer healing was assessed by endoscopy performed after 15 and, if necessary, 29 days of treatment. The healing rate as 83 p. 100 (49/59 patients) after 2 weeks, and 98 p. 100 (58/59 patients) after 4 weeks. Only 5 patients remained symptomatic on day 15. Fifty-six patients did not take any antacid during the course of treatment. There were few adverse effects. No clinically significant changes in laboratory parameters were observed. These results confirm: the remarkable efficiency of omeprazole in short-term treatment of duodenal ulcer, the good tolerance to this drug, at least in short duration treatment.

[Functional, morphological and biochemical study of the jejunal mucosa in cryptogenetic colitis]. / Etude fonctionnelle, morphologique et biochimique de la muqueuse jéjunale dans les colites cryptogénétiques.

The function of the jejunum has been assessed in patients with ulcerative colitis (n = 23) and Crohn's disease of the colon (n = 20) by measurement of serum folate levels, oral folic acid and D-xylose absorption. Forty-six normal subjects served as controls. The mean serum folate level was 4.5 +/- 2.0 ng/ml in patients with the disease and 7.8 +/- 1.7 ng/ml in controls (p less than 0.001) and was similarly decreased in both ulcerative colitis and Crohn's disease patients. It was lower in patients under sulphasalazine therapy (n = 15) than in those untreated: 3.5 +/- 1.5 vs. 4.8 +/- 2.1 ng/ml (p less than 0.05). Serum folate correlated with disease activity in the latter only. The peak serum folate obtained during the oral absorption test was decreased in patients: 38.9 +/- 12.9 vs. 60.8 +/- 19.3 ng/ml in controls (p less than 0.001); this decrease was similar in ulcerative colitis and Crohn's disease, in treated and untreated patients and was independent of disease activity. Basal serum folate did not correlate with peak serum folate in any patient group. D-xylose absorption was normal in every case. Jejunal biopsies were performed in 23 patients, 13 of whom had folic acid malabsorption (13 with ulcerative colitis, 10 with Crohn's disease of the colon). The crypt height/villus height ratio was abnormal (greater than 0.6) in only 2 patients and borderline in 9 others. The fragility of enterocyte brush-borders and lysosomes, as assessed by biochemical methods, was normal in all cases.(ABSTRACT TRUNCATED AT 250 WORDS)

[Gastroesophageal reflux after percutaneous endoscopic gastrostomy. Scintigraphic study in 51 patients]. / Reflux gastro-oesophagien après gastrostomie percutanée endoscopique. Etude scintigraphique chez 51 malades.

Gastro-oesophageal reflux and pneumonia are complications of enteral feeding. We report our experience of a scintigraphic technique in 51 patients fed by percutaneous endoscopic gastrostomy. The technique was very well tolerated; only one patient (2 percent) had vagal discomfort. A quantitative isotopic study using Tc 99 m labelled enteral infusion demonstrated episodes of reflux in 26 patients (51 percent). The reflux was greater than 6 percent of recording time in 15 patients. All patients with pneumonia had positive scintigraphy. Our study suggests that reflux is frequent after percutaneous endoscopic gastrostomy and constant in patients with pneumonia.

[Severe gastroduodenal ulcer hemorrhage. Treatment with endoscopic injections of an epinephrine solution]. / Hémorragies ulcéreuses gastroduodénales graves. Traitement par injections endoscopiques d'une solution d'épinéphrine.

Eighty-three patients (more than one half of whom were at high surgical risk) presenting with haemorrhages from a gastric or duodenal ulcer were treated with endoscopic injections of an epinephrine-hypertonic saline mixture. The overall rate of definitive haemostasis was 83 p. 100. Depending on the degree of haemorrhagic activity, this rate was 64 p. 100 in pulsatile lesions, 90.5 p. 100 in oozing lesions, 85.7 p. 100 in cases with visible vessels and 81.2 p. 100 when signs of recent bleeding were present. There was no dangerous complication related to the technique. The overall survival rate was 67.5 p. 100 and 20 out of the 26 deaths were due to other causes than haemorrhages. On follow-up, 94.7 p. 100 of the ulcers healed under antisecretory treatment within the usual length of time. This simple, effective and inexpensive technique is suggested as initial treatment of gastric or duodenal haemorrhages in subjects at high surgical risk, especially since the haemorrhage has no influence on the course of the ulcer.

[Association of celiac disease and esophageal small cell carcinoma]. / Association d'une maladie coeliaque et d'un carcinome de l'oesophage à petites cellules.

BACKGROUND: Coeliac disease is known to favor the development of neoplasia. Coeliac disease associated with small-cell carcinoma of the esophagus has not been reported to date. CASE REPORT: A 51-year-old man with coeliac disease known for several years was hospitalized for epigastric pain. Work-up led to the diagnosis of small-cell carcinoma of the lower esophagus. The patient was treated with 6 cycles of chemotherapy using an etoposide-ciplatinum protocol associated with 60 Gy radiotherapy starting at the third cycle. The patient has remained in complete remission 2 years after diagnosis. DISCUSSION: Small-cell carcinoma of the esophagus is an exceptional finding in a patient with coeliac disease. Chemotherapy associated with radiotherapy has been successful in our patient.

[Necrolytic migrating erythema without glucagonoma]. / Erytheme necrolytique migrateur sans glucagonome.

INTRODUCTION: The glucagonoma syndrome is an uncommon but well-known entity associating erythema necroticans migrans (ENM) with glucagonoma. CASE REPORT: A 43-year-old man with a past history of alcoholic cirrhosis and ascitis was hospitalized for skin disorders which had developed over the past 4 months. Centrifugal erythematous skin lesions were observed, some with non-turgid bullae and marginal desquamation, others with an erosive center. Lesions first appeared on the hands then diffused widely without involving the periorifical areas, folds and lower limbs. Laboratory results revealed an anemia, hypovitaminosis K, cholestatic liver failure, a beta-gamma block and low zinc levels. Histology study of the skin biopsy demonstrated a << Neapolitan trench >> image suggestive of ENM. A paraneoplasic syndrome and pancreas tumor were not found. Despite supplementation with zinc, amino acids and vitamins, the patient died from his liver disease. DISCUSSION: There have been 4 cases of ENM reported in the literature, all in cirrhosis patients, two of which had low zinc levels. Our case is thus the third with cirrhosis and low zinc. Bazex's syndrome, acrodermatitis enteropathica, annular chronic lupus erythematosis and annular superficial pemphigus were eliminated as possible diagnoses. The failure of zinc and amino acid supplementation would favor the secondary nature of the zinc deficiency and the predominant role of cirrhosis in this skin disease. The possible role of essential fatty acids in ENM is raised.

[Annular pancreas. Considerations on 2 cases]. / Páncreas anular. Consideraciones sobre dos observaciones.

Two patients with annular pancreas are presented. Sintoms, complications, association with another congenital diseases, diagnosis, treatment and postoperative course are commented. Theories of embriologic development of pancreas and annular pancreas etiology are mentioned.