Peritoneal carcinomatosis from gastric cancer: a multi-institutional study of 159 patients treated by cytoreductive surgery combined with perioperative intraperitoneal chemotherapy

BACKGROUND: Peritoneal carcinomatosis (PC) from gastric cancer has long been regarded a terminal disease with a short median survival. New locoregional therapeutic approaches combining cytoreductive surgery with perioperative intraperitoneal chemotherapy (PIC) have evolved and suggest improved survival. MATERIALS AND METHODS: A retrospective multicentric study was performed in French-speaking centers to evaluate the toxicity and the principal prognostic factors in order to identify the best indications. All patients had cytoreductive surgery and PIC: hyperthermic intraperitoneal chemotherapy (HIPEC) and/or early postoperative intraperitoneal chemotherapy (EPIC). RESULTS: The study included 159 patients from 15 institutions between February 1989 and August 2007. The median follow-up was 20.4 months. HIPEC was the PIC used for 150 procedures. Postoperative mortality and grade 3-4 morbidity rates were 6.5 and 27.8%, respectively. By multivariate analysis, the institution had a significant influence on toxicity. The overall median survival was 9.2 months and 1-, 3-, and 5-year survival rates were 43, 18, and 13%, respectively. The only independent prognostic indicator by multivariate analysis was the completeness of cytoreductive surgery. For patients treated by complete cytoreductive surgery, the median survival was 15 months with a 1-, 3-, and 5-year survival rate of 61, 30, and 23%, respectively. CONCLUSIONS: The therapeutic approach combining cytoreductive surgery with PIC for patients with gastric carcinomatosis may achieve long-term survival in a selected group of patients (limited and resectable PC). The high mortality rate underlines this necessarily strict selection that should be reserved to experienced institutions involved in the management of PC and gastric surgery

“Clip-Stone” Filiation Within the Biliary Tract

A case of cholangitis due to the migration of a metal clip used for surgical cholecystectomy 4 years earlier, is reported. The diagnostic approach and therapeutic options, either endoscopic or surgical are discussed. The use of resorbable clips during the performance of laparoscopic cholecystectomy should avoid this type of complication

Tourism in Conflict Areas: Complex Entanglements in Jordan.

In this article the workings of tourism in areas of socio-political turmoil are critically examined. In so doing the aim is to scrutinize interconnections between tourism, safety and conflict as I contend that tourism, tourists and the danger generated by ongoing socio-political conflicts are intimately connected. The empirical focus is on tourism in Jordan, a country in a region troubled by ongoing conflicts. Fieldwork for this project was carried out in 2009 and 2010 and data was collected from local tourism industry representatives and international tourists in Jordan. Findings indicate that a safety/danger binary is destabilized by industry representatives who operate a ‘sanitization’ process in Jordan meant to erase danger and conflicts from tourism spaces. Tourists in the region also disrupt this binary as they travel to the region in spite of the conflict and downplay violent incidents

Protocolized Versus Nonprotocolized Weaning to Reduce the Duration of Invasive Mechanical Weaning in Neonates A Systematic Review of All Types of Studies

Mechanical ventilation is one of the most commonly used treatments in neonatology. Prolonged mechanical ventilation is associated with deleterious outcomes. To reduce the ventilation duration, weaning protocols have been developed to achieve extubation in adult and pediatric care in a safe and uniform manner. We performed a systematic review to obtain all available evidence on the effect of protocolized versus nonprotocolized weaning on the duration of invasive mechanical ventilation in critically ill neonates. The Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, CINAHL, Web of Science, and the International Clinical Trial Registry Platform were searched until January 2018. Quantitative and qualitative studies involving neonates that investigated or described protocolized versus nonprotocolized weaning were included. Primary outcome was the difference in weaning duration. A total of 2099 potentially relevant articles were retrieved. Three stud

Social and Cultural Sustainability: Criteria, Indicators, Verifier Variables for Measurement and Maps for Visualization to Support Planning

Policies on economic use of natural resources require considerations to social and cultural values. In order to make those concrete in a planning context, this paper aims to interpret social and cultural criteria, identify indicators, match these with verifier variables and visualize them on maps. Indicators were selected from a review of scholarly work and natural resource policies, and then matched with verifier variables available for Sweden’s 290 municipalities. Maps of the spatial distribution of four social and four cultural verifier variables were then produced. Consideration of social and cultural values in the studied natural resource use sectors was limited. The spatial distribution of the verifier variables exhibited a general divide between northwest and south Sweden, and regional rural and urban areas. We conclude that it is possible to identify indicators and match them with verifier variables to support inclusion of social and cultural values in planning

Association of deworming with reduced eosinophilia : implications for HIV/AIDS and co-endemic diseases

Please cite as follows:Fincham, J. E. et al. 2003. Association of deworming with reduced eosinophilia: Implications for HIV/AIDS and co-endemic diseases. South African Journal of Science , 99(3&4):182-184.The original publication is available at http://reference.sabinet.co.za.ez.sun.ac.za/document/EJC97605Eosinophil counts in venous blood were monitored during a randomized controlled deworming trial (n = 155 children) that lasted for a year, and in a whole-school deworming programme (range 174-256 children) of 2 years' duration. Mean eosinophil counts (x109/I) decreased from 0.70 in the randomized trial, and 0.61 in the whole-school study, to well within the normal paediatric range of 0.05-0.45 (P < 0.05). The prevalence of eosinophilia declined from 57% to 37% in the randomized trial (mean for 400, 800 and 1200 mg albendazole doses); and from 47% to 24% in the whole-school study (500 mg stat mebendazole). Benzimidazole anthelminthics were highly effective against Ascaris but less so against Trichuris. Activated eosinophils are effector and immunoregulatory leucocytes of the T-helper cell type 2 (Th2) immune response to parasitic helminths and atopic disorders. Under conditions of poverty where soil-transmitted helminths are hyperendemic, Th2 polarization of the immune profile is characteristic. Regular anthelminthic treatment should reduce contact with worm antigens, and this may contribute to re-balancing of the immune profile. Suppression of eosinophil recruitment and activation, together with related cellular and molecular immunological changes, might have positive implications for prevention and treatment of co-endemic diseases, including HIV/AIDS, cholera, tuberculosis and atopic disorders.Publishers' Versio