Continuing medical education in oncology in Europe.

A European Conference on Continuing Medical Education (CME) in Oncology was designed and organised in Dublin (Ireland), on 12th and 13th October 1995 by the European School of Oncology in collaboration with University College Dublin and with the financial support of the European Commission (Europe Against Cancer Programme). Two experts were invited from each Member State and all attended the Conference with the sole exception of the representatives of Luxembourg, who did not attend due to unexpected important commitments. Observers were invited to contribute to the discussion as representatives of organisations that were involved either directly or indirectly in CME. The Conference took the format of a plenary session coupled with the identification of five discussion groups formed to debate key areas in CME at a European level in oncology (Table 1). As a result of these discussions and subsequent consultations, an agreement was reached on the following statements: (a) Continuing Medical Education (CME) is an ethical duty and an individual responsibility for each doctor. Although CME should remain voluntary at the present time, it is nevertheless a professional obligation since almost 50% of medical knowledge becomes obsolete after ten years. It should be organised with clear guidelines for medical personnel working in hospitals, in primary health care and in private practice. (b) The CME system within the European Union (EU) should remain self-directed without the necessity for interval examinations: it should be interdisciplinary and must be driven and controlled by the profession itself. (c) A common concept and system within a CME framework may have a considerable impact on EU integration. It should certainly be developed, maintained and monitored at national level but on the basis of a common European model to ensure scientific and cultural interchange among Member States. (d) It was agree that a credit system is needed to help doctors keep track of their CME activities: the system should be based on the accumulation of credit points (one credit equalling one hour of continuing medical education) and monitored at a national level. Credit transfer among Member States is vital to facilitate exchange between Member States. (e) Oncology provides a very useful model of CME within which guidelines can be proposed and tested. Harmonisation of CME systems among the different European cancer organisations and scientific societies within this model system may represent a useful basis that other specialities can follow.

[Pelvic venous compression syndrome: description of a case and literature review]. / Le syndrome de compression veineuse pelvienne: description d'un cas et revue de la littérature.

A case of a genuine common iliac vein compression (Cockett's syndrome) is reported. From review of the literature, it appears that the treatment should be essentially medical. Surgery is indicated in case of severe post-thrombotic sequellae.

Long-term follow-up of patients with hilar malignant stricture treated by endoscopic internal biliary drainage.

Seventy patients with biliary obstruction secondary to hilar tumors underwent attempted endoscopic internal biliary drainage using large transpapillary stents between December 1981 and March 1986. Placement of one or more stents was successful in 68. The type of stricture and mode of treatment were more important in determining subsequent survival than the type of tumor. In type II and III malignant strictures of the bifurcation of the common hepatic duct and the main hepatic duct, use of two or more stents to achieve complete drainage of the biliary system improves survival compared to incomplete drainage (176 vs. 119 days) and reduces procedure-related mortality and the incidence of early and late cholangitis. Patients with hilar tumors causing type II and III strictures treated with placement of multiple stents have at least as good a prognosis as patients with tumor involving only the common hepatic duct treated with use of a single stent. Once ERCP is performed and palliative endoscopic management of bifurcation tumors is begun, it must completed as soon as possible.

Palliative endoscopic management of obstructive esophagogastric cancer: laser or prosthesis?

One hundred forty-four patients with unresectable malignant strictures of the upper digestive tract were managed by palliative endoscopic methods: 116 by intubation and 28 by YAG laser phototherapy. The success rate was 95% for intubation and 100% for laser. The morbidity rate was 13.8% for intubation (perforation 7.8%, bleeding 3.4%, and aspiration pneumonia 2.2%) and 3.6% (one perforation) for laser. The mortality rate was 4.3% for intubation and 0% for laser. Specific indications for intubation were esobronchial fistulas, extensive strictures, and very long stenotic lesions. Very high cervical strictures and nonocclusive asymmetrical tumors were better treated with laser. In select cases, combined therapy can be useful. We conclude that both methods are highly efficient in restoring patency and relieving dysphagia. Further large scale randomized trials are necessary to compare functional results and survival rate.

Endoscopic management of a post-traumatic biliary fistula.

A number of techniques of surgical endoscopy have been used in the management of a post-traumatic biliary fistula. The endoscopic sphincterotomy with placement of a perfused nasobiliary catheter, followed by the insertion of a biliary stent allowed the fistula to dry out. A secondary stricture of the left hepatic duct was treated by endoscopic internal drainage after the insertion of a transhepatic guidewire by an epigastric route. This kind of combined transhepatic and endoscopic procedure is useful in some difficult cases.

Hepatic artery aneurysm: CT and MR features.

The authors report a case of common hepatic artery aneurysm diagnosed by computed tomography (CT) and magnetic resonance (MR). Features of both techniques are described and discussed. The surgical and radiologic literature is reviewed.

[Medico-surgical attitude in the treatment of cancer of the bile ducts]. / Attitude médico-chirurgicale dans le traitement des cancers des voies biliaires.

In order to evaluate the operative possibilities in patients with obstructive carcinoma of the biliary tract a precise diagnosis of local extent of the tumor and metastasis is essential (cholangiography, US, CTscan). The treatment is preferably surgical whether the tumor be resectable or not. However some patients who, for any reason, are not surgical candidates can be helped by new endoscopic intubation techniques. Medical and surgical consultation is essential to set the criteria for the best treatment modality in all patients with this disease, especially those who are not surgical candidates.

Suprahepatic gallbladder: a rare congenital anomaly.

The authors report a case of suprahepatic gallbladder associated with hepatomegaly. The ectopic gallbladder was visualized by sonography, computed tomography, and endoscopic retrograde cholangiography.

Nd-YAG laser, a new palliative alternative in the management of esophageal cancer.

Ten patients with unresectable esophageal malignant tumor have been managed by Nd-YAG laser palliative therapy. Esophageal obstruction, and dysphagia, the most frequent symptoms, were relieved in all cases after periods ranging from 5 to 14 days. The mean total energy required was 26.121 watts sec-1. No serious immediate or late complication was encountered, except for one small transient bleeding without clinical repercussion. Two relapses of dysphagia were successfully managed by the same procedure. This new palliative approach has to be compared with the other available methods, surgical resection and bypass procedures, radiotherapy or endoscopic prosthetic intubation. Its high degree of effectiveness in providing rapid relief of dysphagia, and its low morbidity rate will give to laser therapy an important place in the future palliative management of esophageal cancer, either alone or in combination with other treatments.

[Complementarity and limits of the different technics of pancreatic morphologic investigation for the diagnosis of acute pancreatitis and complications (author's transl)]. / Complémentarité et limites des différentes méthodes d'investigation morphologique dans le diagnostic des pancréatites aiguës et de leurs complications.

The authors have previously proposed the endoscopic retrograde cholangio-pancreatography as a technic to be used systematically in acute pancreatitis; it offers a precise diagnosis of microlithiasis and a possibility of an immediate endoscopic treatment. They have studied the pancreatographic patterns in 355 cases of clinical acute pancreatitis; the pancreatogramm allows the diagnosis of chronic pancreatitis in acute phase in 1/3 of the patients; necrosis is present in 12% of the 240 patients without any radiological signs of chronic pancreatic disease. The computerized axial tomography gives a precise definition of the extra-pancreatic extension of the necrosis; the ultra-sound technic is better for the late complications of acute pancreatitis. The authors consider that these 3 examination technics must be performed at the admission or/and be part of the workup before surgery.