Surgical adjuvant therapy of rectal carcinoma: a controlled evaluation of leucovorin, 5-fluorouracil and radiation therapy with or without interferon-alpha2b.

BACKGROUND: The aim of this study was to determine whether the efficacy of the combination of 5-fluorouracil (5-FU), leucovorin (LV) and radiation therapy (RT) could be improved by the addition of interferon-alpha2b (IFN-alpha) in patients who have had a 'curative' resection, for rectal adenocarcinoma (Dukes' B2/C; T3 N0, T4 N0, N1-3). PATIENTS AND METHODS: A total of 207 eligible patients with a performance status of 0 or 1 were randomized postoperatively between days 21 and 70 to one of the two treatment groups: group A, LV 20 mg/m2 i.v. bolus and 5-FU 425 mg/m2 i.v. days 1-5 and 29-33, LV 20 mg/m2 and 5-FU 400 mg/m2 days 57-60 and 85-88, LV 20 mg/m2 and 5-FU 380 mg/m2 days 1-5 and 29-33 with the second day 1 occurring 28 days after the completion of RT (45 Gy); group B, LV, 5-FU and RT as in group A, and IFN-alpha 5 x 10(6) IU s.c. three times during each week chemotherapy is given. RESULTS: 104 patients were randomized into group A and 103 into group B. There was no statistically significant difference in either disease-free survival or overall survival between the two groups. Toxicity was also the same, except for the flu-like syndrome associated with the IFN-alpha administration. CONCLUSIONS: There was no difference in efficacy between the two combinations. Toxicity was greater with the LV + 5-FU + IFN-alpha regimen because of the flu-like syndrome.

Carcinoma within an epiphrenic esophageal diverticulum. Case report.

A case of squamous cell carcinoma arising in an epiphrenic diverticulum in a 59-year-old woman is presented. This unusual condition was suggested by barium esophagograms and confirmed at endoscopy.

Serum and bile digoxin levels in patients subjected to cholecystectomy with or without choledochostomy.

Digoxin levels were measured perspectively in the serum of 12 patients subjected to cholecystectomy and in serum and bile (Kehr) of 15 patients who underwent cholecystectomy plus choledochostomy in order to assess adequate digitalization. All patients were volunteers with no cardiac problems. In the cholecystectomy group serum digoxin levels increased in all patients from the second to the fourth postoperative day (P = 0.0001), while in patients with choledochostomy both serum and bile digoxin levels displayed wide variations. This last finding was associated with signs reflecting inadequate digitalization, probably due to significant digoxin losses through the choledochostomy.

Prophylactic cholecystectomy during splenectomy for beta thalassemia homozygous in Greece.

The impact of prophylactic cholecystectomy upon early mortality and morbidity of splenectomy for patients with beta TH H was investigated. The results of our study suggested that it is a safe procedure that is not associated with any increase in operative mortality and postoperative complications. This was true even when beta TH H was complicated by pigment cirrhosis and ascites. In view of increasing longevity of those patients with beta TH H, as well as the increased risk for gallstones even after splenectomy, we recommend the use of prophylactic cholecystectomy as a standard approach for all patients undergoing splenectomy for beta thalassemia homozygous.

[Eosinophil granuloma of the stomach. Report of three cases (author's transl)]. / Le granulome éosinophile de l'estomac. A propos de trois observations.

The authors report three cases of eosinophil granuloma of the stomach are presented with different symptoms. The authors discuss the problems concerning the etiology, pathology and the symptoms of this rare disease. Special importance is attributed to problems of diagnosis and surgical treatment. The authors conclude that local excision of this lesion is sufficient in most cases except the rare cases with intestinal obstruction.

[Bilio-bronchial fistulae caused by rupture of an hydatid cyst of the liver. Experiences with a modified method of operation (author's transl)]. / Biliobronchiale Fistel nach Ruptur einer Echinokokkuszyste der Leber. Erfahrungen mit einer modifizierten Operationsmethode.

In this study, bilio-bronchial fistulae caused by the rupture of an hydatid cyst of the superior surface of the liver to the bronchi of the middle or lower lobe of the right lung, are discussed. Bilio-bronchial fistulae are treated surgically at one stage, through thorako-abdominal or separate abdominal and thoracic incision in combination. The radical treatment of the hydatid cyst of the liver consists in partial cystectomy and capitonnage, followed by common bile duct drainage. The radical treatment of the thoracic lesions consists in excision of the empyematic sac and lung lobectomy or segmental resection if necessary. The results are compared with those of former surgical management.

[Treatment of flail chest from the general surgical view. Experience with 20 cases]. / Grundsätze der Behandlung des "Instabilen Thorax" aus allgemeinchirurgischer Sicht. Erfahrungen mit 20 Fällen

Flail chest is a serious complication of multiple fractures of the ribs that needs immediate management in order to avoid its disastrous respiratory and circulatory consequences. The authors present their experience with 20 cases of flail chest injury and discuss especially some practical aspects of its treatment. Skeletal traction was used frequently to stabilize the chest wall, while intermittent positive pressure respiration was reserved only for patients with uncompensated respiratory disturbances. The authors urge that a well-organized surgical unit should be able to provide appropriate management in such cases, since most of these patients have multiple injuries that need general surgical together with more specialized treatment.

Use of the gallbladder neck in the reconstruction of the bifurcation of the main hepatic ducts.

A case of successful resection of an adenocarcinoma of the junction of the right, left and common hepatic ducts is reported. The right hepatic duct was anastomosed to the gallbladder neck and the left hepatic to the common hepatic duct in order to restore the continuity of the biliary tract. This unusual technique offered effective decompression. It may prove, in selected patients with a normal gallbladder and a wide cystic duct, to be a useful alternative to other commonly performed internal drainage procedures.