SURGICAL TREATMENT OF ADVANCED GASTRIC CANCER

Patients with advanced gastric cancer generally have poor overall prognosis as well as survival rate. Unfortunately, in the West, gastric cancer typically occurs at an advanced stage and many of these patients have tumor invasion into adjacent structures (International Union Against Cancer [UICC]/American Joint Committee on Cancer [AJCC] Stage T4). Although T4 gastric cancer patients often have peritoneal dissemination or distant metastasis, many do not have M1 disease and are therefore candidates for surgery with the curative intent. A multivisceral resection (MVR) or gastrectomy with resection of adjacent organs is needed in T4 gastric cancer patients to achieve an R0 resection that is one of the most powerful forecasters of gastric cancer surgery results. Spleen, distal pancreas, liver, and large intestine (mostly transverse colon) were the most commonly resected organs. The therapeutic choice with acceptable postoperative morbidity and mortality rates in locally advanced patients with gastric cancer should be gastrectomy with MVR, where complete resection could be realistically obtained and where metastatic involvement of the lymph node is not evident. MVR is done with a curative R0 resection to provide advanced gastric cancer patients with the best survival chance. It was found that resections involving the pancreas, transverse colon and liver were associated with increased survival rate in comparison to MVR with resection of other structures. It was shown that survival rate significantly decreased in patients who had undergone MVR without complete resection compared to those who had an R0 resection. Nevertheless, the extent of the surgical resection required and further advantages of MVR are disputable

Jejunal Variceal Bleeding Successfully Treated with Percutaneous Coil Embolization

A 52-yr-old male with alcoholic liver cirrhosis was hospitalized for hematochezia. He had undergone small-bowel resection due to trauma 15 yr previously. Esophagogastroduodenoscopy showed grade 1 esophageal varices without bleeding. No bleeding lesion was seen on colonoscopy, but capsule endoscopy showed suspicious bleeding from angiodysplasia in the small bowel. After 2 weeks of conservative treatment, the hematochezia stopped. However, 1 week later, the patient was re-admitted with hematochezia and a hemoglobin level of 5.5 g/dL. Capsule endoscopy was performed again and showed active bleeding in the mid-jejunum. Abdominal computed tomography revealed a varix in the jejunal branch of the superior mesenteric vein. A direct portogram performed via the transhepatic route showed portosystemic collaterals at the distal jejunum. The patient underwent coil embolization of the superior mesenteric vein just above the portosystemic collaterals and was subsequently discharged without re-bleeding. At 8 months after discharge, his condition has remained stable, without further bleeding episodes

Comparative assessment of clinical rating scales in Wilson’s disease

Background: Wilson’s disease (WD) is an autosomal recessive disorder of copper metabolism resulting in multifaceted neurological, hepatic, and psychiatric symptoms. The objective of the study was to comparatively assess two clinical rating scales for WD, the Unified Wilson’s Disease Rating Scale (UWDRS) and the Global Assessment Scale for Wilson’s disease (GAS for WD), and to test the feasibility of the patient reported part of the UWDRS neurological subscale (termed the “minimal UWDRS”). Methods: In this prospective, monocentric, cross-sectional study, 65 patients (median age 35 [range: 15–62] years; 33 female, 32 male) with treated WD were scored according to the two rating scales. Results: The UWDRS neurological subscore correlated with the GAS for WD Tier 2 score (r = 0.80; p < 0.001). Correlations of the UWDRS hepatic subscore and the GAS for WD Tier 1 score with both the Model for End Stage Liver Disease (MELD) score (r = 0.44/r = 0.28; p < 0.001/p = 0.027) and the Child-Pugh score (r = 0.32/r = 0.12; p = 0.015/p = 0.376) were weak. The “minimal UWDRS” score significantly correlated with the UWDRS total score (r = 0.86), the UWDRS neurological subscore (r = 0.89), and the GAS for WD Tier 2 score (r = 0.86). Conclusions: The UWDRS neurological and psychiatric subscales and the GAS for WD Tier 2 score are valuable tools for the clinical assessment of WD patients. The “minimal UWDRS” is a practical prescreening tool outside scientific trials

ENDOSCOPIC DIAGNOSIS AND TREATMENT OF UPPER GASTROINTESTINAL BLEEDING

Upper gastrointestinal bleeding (UGB) is a common medical emergency problem with significant morbidity and mortality. The aim of this paper is to establish the incidence of upper gastrointestinal bleeding in relation to sex and age, determine the prevalence of bleeding lesions and perform analysis of bleeding peptic ulcer in relation to the location, age, gender, Forrest classification and the need for endoscopic hemostasis. Thе prospective study included 70 patients with UGB, 42 men and 28 women, mean age 68.64±13.66 years. The diagnosis of bleeding lesions was made exclusively by means of esophagogastroduodenoscopy. Forrest classification was used in the evaluation of the activity of bleeding ulcers of the stomach and duodenum. The largest number of bleeding patients was of male sex (60%). Bleeding most commonly occurred in patients older than 60 years (84.29%). Statistically, female patients were significantly older than patients of male gender (p=0.001). The most common cause of bleeding was peptic ulcer (65.71%). The average age of patients with gastric ulcer was 70.57±15.68 years, with a duodenal ulcer 63.78±16.70 years. In the duodenum, Forrest Ib, IIa and IIb ulcers were usually confirmed, whereas Forrest IIc ulcers were identified in the stomach. Endoscopic hemostasis was required in 55.56% of patients with duodenal and in 23.81% of patients with gastric ulcer. The incidence of UGB is higher in men and it increases with age. The most common cause of bleeding is ulcer disease. Patients with gastric ulcer are older than patients with duodenal ulcer, while both gastric and duodenal ulcers are found in the oldest patients. Duodenal ulcers cause serious bleeding and more often require endoscopic hemostasis

COMPARISON OF ELLIPTIC EQUATION – ABC/2 WITH COMPUTERASSISTED SEMIAUTHOMATIC METHODS FOR MEASURING THE VOLUME OF INTRACEREBRAL HEMORRHAGE

Hemorrhage volume, level of consciousness and ventricular extension and expansion of the hematoma are prognostic factors for clinical outcome of intracerebral hemorrhage (ICH). Volumetric measurement of ICH has an important clinical and prognostic meaning. The aim of this study was to compare the methods which are being used to measure ICH volume: the ABC/2 method and semiautomated method with computer volumetric program. Our study represents a retrospective analisys of 54 patients (61.11% male and 38.89% female patients with mean age 67.20±10.30 years) who underwent computed tomography (CT) scan of endocranium. Volumetric measurements were performed by ABC/2 method and computer semiautomated method with volumetric program on Аdvantage Windows 3D Workstation 4.1. Mean value and standard deviation obtained by ABC/2 method were 41.98±35.47, while mean value and standard deviation obtained by computer semiautomated method with volumetric program were 52.12±45.61. There is a statistically significant difference between the values obtained by these two methods (p=0.03). The absolute difference was 10.14 cm3. The values acquired by computer method were by 19.46% higher than those acquired by formula. There is a statstically strong positive correlation between these two methods (r=0.852, p<0.05). Both methods are very useful in determining ICH volume. Our results show that values obtained by computer semiauthomatic method were by 19.46% higher than those obtained by the elliptic equation. Elliptic equation-ABC/2 method is better for measuring regular ICH shapes and fast orientation, while semiautomated computer method is more accurate and more selective

MAGNETIC RESONANCE PRESENTATION OF INTRACRANIAL MENINGIOMAS

International audienceCiv. 1re, 1er févr. 2012, n° 10-24.843, D. 2012. 447 ; ibid. 1228, obs. H. Gaudemet-Tallon et F. Jault-Sesek

Comparison of biohumoral and morphological parameters in acute pancreatitis

Introduction. Acute pancreatitis occurs as a result of autodigestive activation of pancreatic proenzymes, within the parenchyma of the glands. Objective. The goal of the work was to establish possible connection of etiology and severity of the acute pancreatitis and biohumoral parameters, ultrasound and CT. Methods. The study included 273 patients with pancreatitis, classified by Ranson’s score, according to degree of severity and etiology, whose biohumoral parameters were correlated with each other, and with the ultrasound and CT findings. Results. The values of amylase and ALT were significantly higher in the severe form of pancreatitis and biliary etiology compared to etilic (p<0.05). The ratio of AST/ALT was significantly higher in the group of etilic compared to biliary etiology (p<0.05). LDH was significantly higher in the severe form group compared to moderate form of pancreatitis (p<0.01). Cholesterol was significantly higher in the group of biliary compared to the group of etilic pancreatitis (p<0.05). There was a negative low correlation between the value of calcium ions in the plasma and CT analysis (p=0.05). Low degree negative correlation between the value of calcium ions and ultrasound analysis was established (p=0.0001). Conclusion. There was a negative correlation between the level of ionized calcium in the blood and the degree of the acute pancreatitis by the Balthazar score. Mean value of alpha amylase, total value of cholesterol and ALT were significantly higher in the group of biliary compared to the group of etilic acute pancreatitis. The average values of the alpha amylase, LDH and ALT were significantly higher in the group of severe form of the acute pancreatitis compared to the group of moderate form. The ratio AST/ALT was significantly higher in the group of etilic than in the group of biliary pancreatitis