Comparison of hyperthermia and adrenaline to enhance the intratumoral accumulation of cisplatin in a murin model of peritoneal carcinomatosis

<p>Abstract</p> <p>Background</p> <p>The best method to deliver intraperitoneal chemotherapy (IPC) for peritoneal carcinomatosis from ovarian cancer is not well defined. The aim of this study was to assess the ability of hyperthermia and adrenaline to enhance the intratumoral accumulation of cisplatin in a rat model of peritoneal carcinomatosis.</p> <p>Methods</p> <p>Four groups of 5 BDIX rats with ovarian peritoneal carcinomatosis underwent IPC with 30 mg/l of cisplatin according to the following conditions: normothermia at 37° for 1 or 2 hours, hyperthermia at 42°C for 1 hour or normothermia at 37°C for 2 hours with 2 mg/l adrenaline. Tissue platinum content was measured by atomic absorption spectroscopy. The effect of hyperthermia, adrenaline and the duration of exposure to the drug was measured <it>in vivo </it>(tissue concentration of platinum in tumor, abdominal and extra abdominal tissues) and <it>in vitro </it>(cytotoxicity on human ovarian cancer cells).</p> <p>Results</p> <p><it>In vitro</it>, hyperthermia and longer exposure enhanced the accumulation and the cytotoxic effect of cisplatin on cancer cells. <it>In vivo</it>, only the 2 hours treatment with adrenaline resulted in increased platinum concentrations. The rats treated with adrenaline showed significantly lower concentrations of cisplatin in extra peritoneal tissues than those treated with hyperthermia.</p> <p>Conclusion</p> <p>Adrenaline is more effective than hyperthermia in order to enhance the intratumoral concentration of cisplatin in rats with peritoneal carcinomatosis from ovarian origin. It may also decrease the systemic absorption of the drug.</p

Evaluation de l implantation de bioprothèse pour cure d éventration en milieu septique (Etude rétrospective à partir de 30 cas)

Introduction : La prise en charge des éventrations en milieu septique est un problème fréquent et grave. L implantation de prothèse non résorbable classique, afin de diminuer le taux de récidive, est contre-indiquée dans ces circonstances, rendant nécessaires le développement de nouveaux matériaux et leur évaluation. Objectif : Etudier les circonstances de mise en place et les suites post-opératoires de l implantation de bioprothèse, dont les avantages seraient la possible implantation en milieu septique. Matériels et méthodes : L ensemble des patients ayant bénéficié d une implantation de bioprothèse au CHU Dijon depuis 2010, date de mise à disposition, ont été revus. Résultats : Trente patients ont bénéficié de l implantation d une bioprothèse, dont 21 étaient obèses (70%), 19 dénutris (63%) et 16 ASA III ou IV (53%). Les scores prenant en compte l ASA, la durée opératoire et le degré de contamination ont classé 24 patients à haut risque de complications septiques (80%). Dix ont présenté des suites simples. Parmi les 20 complications, 8 ont pu être traitées avec des soins locaux, 6 ont nécessité une reprise opératoire sans explantation de la bioprothèse et 2 sont décédées. La seule complication imputable au matériel était un délitement d un assemblage de 2 bioprothèses. A distance, 2 patients ont présenté une récidive d éventration. Conclusion : L implantation de bioprothèse en milieu septique ou à risque ne se traduit pas par une absence d infection du site opératoire mais par une capacité de guérison sans explantation obligatoire du matériel. Dans cette population très fragile et à haut risque de complications septiques, le surcoût engendré par ce type de matériel semble être contrebalancé par une diminution de la durée du séjour hospitalier et des soins à domicile. Des études prospectives randomisées et des enquêtes coûts-efficacité doivent être menées afin de déterminer la place de ces bioprothèses.DIJON-BU Médecine Pharmacie (212312103) / SudocSudocFranceF

Gentrifiers and their choice of housing: characteristics of the households living in new developments in Swiss cities

This paper draws on the literature on residential mobility in order to address the housing choice of gentrifiers and its different dimensions (profile, trajectories, and motivations). The gentrification literature is reviewed in regard to these dimensions. Empirical material is based on questionnaires sent to the inhabitants of new high-status developments (new-build gentrification) in two Swiss cities (Zurich and Neuch�tel). By pointing out some of the characteristics found in the Swiss context, the results contribute to an understanding of the attributes of contemporary gentrifiers, such as their diversity in terms of life-course position, the transitory stage that living in a gentrified neighbourhood may represent, and the predominance of the convenience of urban life (proximity and mobility) in their motivations. Keywords:� gentrification, new-build gentrification, housing choice, residential mobility, life course, motivations, Switzerland

Nouvelles approches en chirurgie mini-invasive (chirurgie endoscopique transluminale et chirurgie laparo-endoscopique transombilicale. Avenir à court terme en chirurgie digestive)

DIJON-BU Médecine Pharmacie (212312103) / SudocSudocFranceF

CA 19–9 predicts resectability of pancreatic cancer even in jaundiced patients

IF 2.763 (2017)International audienceBackgroundSurgical resection remains the only curative option for pancreatic adenocarcinoma. Despite recent improvements in medical imaging, unresectability is still often discovered at the time of surgery. It is essential to identify unresectable patients preoperatively to avoid unnecessary surgery. High serum CA 19-9 levels have been suggested as a marker of unresectability but considered inaccurate in patients with hyperbilirubinemia.Aim of the studyTo evaluate CA 19-9 serum levels as a predictor of unresectability of pancreatic adenocarcinomas with a special focus on jaundiced patients.MethodsAll patients presenting with histologically-confirmed pancreatic adenocarcinoma and having serum CA 19-9 levels available prior to any treatment were included in this retrospective study. The relationship between serum concentrations of CA 19–9 and resectability was studied by regression analysis and theROC curves obtained. A cut-off value of CA 19–9 was calculated. In jaundiced patients, a CA 19–9 adjusted for bilirubinemia was also evaluated.ResultsOf the 171 patients included, 49 (29%) were deemed resectable and 122 (71%) unresectable. Altogether, 93 patients (54%) had jaundice. The area under the ROC curve for CA 19–9 as a predictor of resectability was 0.886 (95%CI:[0.832–0.932]); in jaundiced patients it was 0.880 (95% CI [0.798–0.934]. A cut-off in CA 19–9 at 178 UI/mlyielded 85% sensitivity, 81% specificity and 91% positive predictive value for resectability. There was no correlation between the levels of bilirubin and CA 19–9 (r = 0.149).ConclusionSerum CA 19–9 is a good predictive marker of unresectability of pancreatic adenocarcinoma, even in jaundiced patients. CA 19-9 levels over 178 UI/ml strongly suggest unresectable disease

A "happy marriage" between open and closed techniques of heated intraperitoneal chemotherapy.

International audienc

Dépistage précoce de l'obésité de l'enfant (la formation nous rend-elle plus performants ?)

Contexte : La progression de l'obésité de l'enfant est un problème de santé publique en France depuis une dizaine d années. Il est pourtant reconnu que la prévention passe par le dépistage précoce. Celui-ci consiste à calculer systématiquement l'indice de masse corporelle des enfants vus en consultation, et à reporter les valeurs sur la courbe de corpulence. Des actions sont donc menées par différents organismes et associations dans le cadre de la formation permanente, afin d'inciter les praticiens à mener ce dépistage. Objectifs : Déterminer si 3 de ces actions ont entrainé une amélioration des performances en termes de dépistage. Méthode : J'ai interviewé 15 des généralistes ayant participé à l'une ou plusieurs de ces actions, selon la technique de l'entretien semi-directif, et réalisé une analyse de contenu des discours recueillis. Résultats : 14 des 15 médecins interrogés déclarent dépister l'obésité de l'enfant à l issue de cette(ces) formation(s) ; pour 12 d'entre eux, il s'agit d un dépistage systématique. Cela représente une modification des pratiques professionnelles pour 11 médecins. Conclusion : En Loire Atlantique, les actions de formation de 2006 et 2007 que j'ai étudiées ont permis une amélioration des performances de dépistage chez 92 % des médecins interviewés.NANTES-BU Médecine pharmacie (441092101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Inflammatory markers as early predictors of infection after colorectal surgery: the same cut-off values in laparoscopy and laparotomy?

IF 2.426International audiencePURPOSE:C-reactive protein and procalcitonin are reliable early predictors of infection after colorectal surgery. However, the inflammatory response is lower after laparoscopy as compared to open surgery. This study analyzed whether a different cutoff value of inflammatory markers should be chosen according to the surgical approach.METHODS:A prospective, observational study included consecutive patients undergoing elective colorectal surgery in three academic centers. All infections until postoperative day (POD) 30 were recorded. The inflammatory markers were analyzed daily until POD 4. Areas under the ROC curve and diagnostic values were calculated in order to assess their accuracy as a predictor of intra-abdominal infection.RESULTS:Five-hundred-one patients were included. The incidence of intra-abdominal infection was 11.8%. The median levels of C-reactive protein (CRP) and procalcitonin (PCT) were lower in the laparoscopy group at each postoperative day (p < 0.0001). In patients without intra-abdominal infection, they were also lower in the laparoscopy group (p = 0.0036) but were not different in patients presenting with intra-abdominal infections (p = 0.3243). In the laparoscopy group, CRP at POD 4 was the most accurate predictor of overall and intra-abdominal infection (AUC = 0.775). With a cutoff of 100 mg/L, it yielded 95.7% negative predictive value, 75% sensitivity, and 70.3% specificity for the detection of intra-abdominal infection.CONCLUSION:The impact of infection on inflammatory markers is more important than that of the surgical approach. Defining a specific cutoff value for early discharge according to the surgical approach is not justified. A patient with CRP values lower than 100 mg/L on POD 4 can be safely discharged