Small bowel involvement is a prognostic factor in colorectal carcinomatosis treated with complete cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy

<p>Abstract</p> <p>Background</p> <p>Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) is a promising treatment for patients with peritoneal carcinomatosis (PC). Our objective was to identify new prognostic factors in patients with PC from colorectal cancer treated with this procedure.</p> <p>Methods</p> <p>All patients with PC from colorectal cancer treated by HIPEC from January 2000 to December 2007 were prospectively included. The tumor extension was assessed by the Peritoneal Cancer Index (PCI) and the residual disease was recorded using the completeness cytoreductive score (CCs). All clinical and treatment data were computed in univariate and multivariable analyses using survival as primary end point.</p> <p>Results</p> <p>We carried out 51 complete procedures in 49 consecutive patients. The mean PCI was 10. The allocation of CCs was: CC-0 = 37, CC-1 = 14. The five-year overall and progression-free survival rate were 40% and 20%, respectively. Several prognostic factors for survival were identified by univariate analysis: PCI < 9 (<it>P </it>< 0.001), CC-0 vs. CC-1 (<it>P </it>< 0.01) and involvement of area 4 (<it>P </it>= 0.06), area 5 (<it>P </it>= 0.031), area 7 (<it>P </it>= 0.014), area 8 (<it>P </it>= 0.022), area 10 (<it>P </it>< 0.0001), and area 11 (<it>P </it>= 0.02). Only the involvement of the distal jejunum (area 10) was significant in the multivariable analysis (<it>P </it>= 0.027).</p> <p>Conclusions</p> <p>We demonstrated that the involvement of area 10 (distal jejunum of the PCI score) was an independent factor associated with poor prognosis.</p

HIF-1alpha (le poumon du cancer)

NICE-BU Sciences (060882101) / SudocSudocFranceF

HIF prolyl-hydroxylase 2 is the key oxygen sensor setting low steady-state levels of HIF-1α in normoxia

Hypoxia-inducible factor (HIF), a transcriptional complex conserved from Caenorhabditis elegans to vertebrates, plays a pivotal role in cellular adaptation to low oxygen availability. In normoxia, the HIF-α subunits are targeted for destruction by prolyl hydroxylation, a specific modification that provides recognition for the E3 ubiquitin ligase complex containing the von Hippel–Lindau tumour suppressor protein (pVHL). Three HIF prolyl-hydroxylases (PHD1, 2 and 3) were identified recently in mammals and shown to hydroxylate HIF-α subunits. Here we show that specific ‘silencing’ of PHD2 with short interfering RNAs is sufficient to stabilize and activate HIF-1α in normoxia in all the human cells investigated. ‘Silencing’ of PHD1 and PHD3 has no effect on the stability of HIF-1α either in normoxia or upon re-oxygenation of cells briefly exposed to hypoxia. We therefore conclude that, in vivo, PHDs have distinct assigned functions, PHD2 being the critical oxygen sensor setting the low steady-state levels of HIF-1α in normoxia. Interestingly, PHD2 is upregulated by hypoxia, providing an HIF-1-dependent auto-regulatory mechanism driven by the oxygen tension

Swallowing a safety pin: Report of a case

Ingestion of a foreign body is a frequent and well-known medical problem with several diagnostic and therapeutic approaches. Usually, ingested foreign bodies pass through the alimentary tract without incident. In some cases, they can be lodged in the appendix and may cause appendicitis. We report a case of a 29-year old woman, suffering from mental illness, with a safety pin lodged in the appendix. Initially, the patient consulted for abdominal pain. After a period of waiting, during which time the foreign body did not move, a colonoscopy was performed but failed to see the safety pin. Then, the patient underwent a laparoscopic appendectomy. Pathological examination showed an ulcerative appendicitis

Risk factors of acute renal failure in patients with protective ileostomy after rectal cancer surgery

Abstract Background Despite the potential benefits of protective ileostomy in rectal surgery, diverting loop ileostomy construction is not free of specific medical consequences implying unplanned hospital readmissions. The most common reason for readmission in these patients is a dehydration with a prevalence of acute renal failure (ARF) of 20%. The objective of this study was to establish the predictive factors of ARF in patients with protective ileostomy after surgery for rectal cancer from a bicentric study. Methods we conducted a bicentric retrospective cohort study to identify the risk factor of ARF. This study was carried out on 277 patients operated for rectal cancer with necessity of a protective ileostomy during the study period. ARF was measured at any endpoint between ileostomy creation and reversal. Multiple logistic regressions were performed to identify independent risk factors. Results A total of 277 patients were included, and 18% (n = 50) were readmitted for ARF. In multivariate logistic regression, increased age (OR 1.02, p = 0.01), Psychiatric diseases (OR 4.33, p = 0.014), Angiotensin II receptor blockers (OR 5.15, p < 0.001) and the ASA score ≥ 3 (OR 9.5, p < 0.001) were significantly associated with ARF. Conclusion Acute renal failure is a prevalent and significant event in the postoperative course of ileostomy patients. Patients at risk should be risk stratified before discharge and targeted for intensive preventive measures