Endoscopic palliative treatment of malignant colorectal stenosis with metallic stents: results in 41 patients

But : la colostomie de décharge est la prise en charge thérapeutique admise de l'occlusion rectocolique d'origine tumorale. Le but de cette étude était d'évaluer la faisabilité et l'efficacité du traitement endoscopique des sténoses malignes colo-rectales par prothèses métalliques expansives chez des patients non opérables. Patients et méthodes: entre septembre 1994 et septembre 2002, 41 patients consécutifs (21 femmes, âge moyen de 69,5 ans, extrême 41-92 ans) présentant une occlusion colo-rectale d'origine néoplasique non opérable ont été traités de manière palliative par pose d'endoprothèse métallique auto-expansive. L'occlusion avait pour étiologie une atteinte tumorale colo-rectale primitive dans 32 cas et une atteinte carcinomateuse péritonéale compressive pour les 9 autres patients. Le niveau de l'occlusion était rectal dans 11 cas, sigmoïdien dans 26 cas, transverse colique dans 2 cas, à l'angle colique gauche dans un cas et à l'angle colique droit pour le dernier. Les prothèses utilisées étaient de type Enteral Wallstent®, Colonic Z stent®, Ultraflex precision® ou encore de type Choo stent®. Résultats: l'insertion prothétique était possible chez 37 patients (90,2 %) et permettait de manière constante la levée de l'occlusion. Huit de ces 37 patients présentaient un stent perméable après un suivi moyen de 23,5 semaines. L'évolution fut la suivante pour les 29 autres patients: 22 patients avaient une prothèse perméable au moment de leur décès, 2 prothèses étaient envahies par la tumeur nécessitant un second traitement endoscopique (insertion d'un second stent), 5 prothèses (14,7 %) avaient migré de manière spontanée sans récidive de l'occlusion et un stent avait été retiré pour un ténesme rectal à la suite de sa pose. Conclusion: l'insertion endoscopique de prothèses métalliques auto-expansives est un traitement efficace et bien toléré des sténoses malignes colo-rectales. La complication la plus fréquente est la migration survenant quel que soit le modèle de prothèse utilisé

Skin surface topography grading is a valid measure of skin photoaging

The technique of grading the surface topography of sun-exposed skin using silicone impressions of the skin surface is a simple, non-invasive method for measuring skin damage because of sun exposure, but it has never been validated in a community setting

Randomized phase III trial in elderly patients comparing LV5FU2 with or without irinotecan for first-line treatment of metastatic colorectal cancer (FFCD 2001–02)

International audienceBACKGROUND:Metastatic colorectal cancer (mCRC) frequently occurs in elderly patients. However, data from a geriatric tailored randomized trial about tolerance to and the efficacy of doublet chemotherapy (CT) with irinotecan in the elderly are lacking. The benefit of first-line CT intensification remains an issue in elderly patients.PATIENTS AND METHODS:Elderly patients (75+) with previously untreated mCRC were randomly assigned in a 2 × 2 factorial design (four arms) to receive 5-FU (5-fluorouracil)-based CT, either alone (FU: LV5FU2 or simplified LV5FU2) or in combination with irinotecan [IRI: LV5FU2-irinotecan or simplified LV5FU2-irinotecan (FOLFIRI)]. The CLASSIC arm was defined as LV5FU2 or LV5FU2-irinotecan and the SIMPLIFIED arm as simplified LV5FU2 or FOLFIRI. The primary end point was progression-free survival (PFS). Secondary end points were overall survival (OS), safety and objective response rate (ORR).RESULTS:From June 2003 to May 2010, 71 patients were randomly assigned to LV5FU2, 71 to simplified LV5FU2, 70 to LV5FU2-irinotecan and 70 to FOLFIRI. The median age was 80 years (range 75-92 years). No significant difference was observed for the median PFS: FU 5.2 months versus IRI 7.3 months, hazard ratio (HR) = 0.84 (0.66-1.07), P = 0.15 and CLASSIC 6.5 months versus SIMPLIFIED 6.0 months, HR = 0.85 (0.67-1.09), P = 0.19. The ORR was superior in IRI (P = 0.0003): FU 21.1% versus IRI 41.7% and in CLASSIC (P = 0.04): CLASSIC 37.1% versus SIMPLIFIED 25.6%. Median OS was 14.2 months in FU versus 13.3 months in IRI, HR = 0.96 (0.75-1.24) and 15.2 months in CLASSIC versus 11.4 months in SIMPLIFIED, HR = 0.71 (0.55-0.92). More patients presented grade 3-4 toxicities in IRI (52.2% versus 76.3%).CONCLUSION:In this elderly population, adding irinotecan to an infusional 5-FU-based CT did not significantly increase either PFS or OS. Classic LV5FU2 was associated with an improved OS compared with simplified LV5FU2.CLINICALTRIALSGOV:NCT00303771

Non-Hfe iron overload: Is Phlebotomy the answer?

Iron is an essential factor for life, however a physiologically optimal balance is critical. In this article we explore the role of iron as a co-factor in a range of chronic liver diseases and how it may contribute to the development of liver injury, fibrosis, cirrhosis and ultimately hepatocellular carcinoma. Whilst iron depletion therapy through phlebotomy is the most effective method of reducing iron stores, it is unclear whether this offers utility in the therapy of liver diseases in which iron is not the primary insult resulting in tissue injury. Here we examine the emerging evidence in the field of non-HFE hereditary haemochromatosis conditions associated with iron overload – is phlebotomy the answer