A two-stage hepatectomy procedure combined with portal vein embolization to achieve curative resection for initially unresectable multiple and bilobar colorectal liver metastases

OBJECTIVE: To assess outcome after a 2-stage hepatectomy procedure (TSHP) combined with portal vein embolization (PVE) in the treatment of patients with unresectable multiple and bilobar colorectal liver metastases (MBCLM). BACKGROUND: Patients with MBCLM are often considered for palliative chemotherapy only, due to too small future remnant liver (FRL). Recently, right hepatectomy with simultaneous left liver wedge resections after previous right PVE has been reported in a curative intent. However, the growth of metastatic nodules in FRL after PVE can be more rapid than that of the nontumoral remnant hepatic parenchyma. Therefore, metastases located in the FRL should be ideally resected before PVE. Then, a right (or extended right) hepatectomy can be safely performed during a second-stage hepatectomy. Therefore, we analyzed our experience with the use of TSHP combined with PVE in treatment of MBCLM. PATIENTS AND METHODS: Between December 1996 and April 2003, 33 patients with unresectable MBCLM were selected for a TSHP. A right or an extended right hepatectomy was planned after treatment of left FRL metastases to achieve a curative resection. The first-stage hepatectomy consisted in a clearance of the left hemiliver by resection or radiofrequency destruction of metastases of the left FRL. Subsequently, a right PVE was performed to induce atrophy of the right hemiliver and hypertrophy of the left hemiliver. Finally, a second-stage hepatectomy was planned to resect the right liver metastases. RESULTS: There was no operative mortality. Post-PVE morbidity was 18.1%; postoperative morbidity was 15.1% and 56.0% after first- and second-stage hepatectomy, respectively. TSHP could be achieved in 25 of 33 patients (75.7%). The 1- and 3-year survival rates were 70.0% and 54.4%, respectively, in the 25 patients in whom the TSHP was completed. CONCLUSIONS: In selected patients with initially unresectable MBCLM, a TSHP combined with PVE can be achieved safely with long-term survival similar to that observed in patients with initially resectable liver metastases.     

Radiation-Induced Sharpening in Cr-Coated Zirconium Alloy

To improve the safety of nuclear power plants, a Cr protective layer is deposited on zirconium alloys to enhance oxidation resistance of the nuclear fuel cladding during both in-service and hypothetical accidental transients at High Temperature (HT) in Light Water Reactors. The formation of the Cr₂O₃ film on the coating surface considerably helps in reducing the oxidation kinetics of the zirconium alloy, especially during hypothetic Loss of Coolant Accident (LOCA). However, if the Cr coating is successful to increase the oxidation resistance at HT of the zirconium substrate, for in-service conditions, under neutron irradiation, Cr desquamation has to be avoided to guarantee a safe use of the Cr-coated zirconium alloys. Therefore, the adhesion properties have to be maintained despite the structural defects created by sustained neutron irradiation in the reactor environment. This paper proposes to study the behavior of the Zircaloy-Cr interface of a first generation Cr-coated material during a specific in situ ion irradiation. As deposited, the Cr-coated sample presents a f.c.c. C15 Laves-type intermetallic phase at the interface with off-stoichiometric composition. After irradiation and for the specific conditions applied, this interfacial phase has significantly dissolved. Energy Dispersion Spectroscopy revealed that the dissolution was accompanied by a counterintuitive “sharpening” effect.     

Menstrual Pattern,Sexual Behaviors,and Contraceptive Use among Postpartum Women in Nairobi Urban Slums

Postpartum months provide a challenging period for poor women. This study examined patterns of menstrual resumption, sexual behaviors and contraceptive use among urban poor postpartum women. Women were eligible for this study if they had a birth after the period September 2006 and were residents of two Nairobi slums of Korogocho and Viwandani. The two communities are under continuous demographic surveillance. A monthly calendar type questionnaire was administered retrospectively to cover the period since birth to the interview date and data on sexual behavior, menstrual resumption, breastfeeding patterns, and contraception were collected. The results show that sexual resumption occurs earlier than menses and postpartum contraceptive use. Out of all postpartum months where women were exposed to the risk of another pregnancy, about 28% were months where no contraceptive method was used. Menstrual resumption acts as a trigger for initiating contraceptive use with a peak of contraceptive initiation occurring shortly after the first month when menses are reported. There was no variation in contraceptive method choice between women who initiate use before and after menstrual resumption. Overall, poor postpartum women in marginalized areas such as slums experience an appreciable risk of unintended pregnancy. Postnatal visits and other subsequent health system contacts provide opportunities for reaching postpartum women with a need for family planning services.     

Experimental Assessment of Calvarial Bone Defect Re-Ossification Stimulation Using Low-Intensity Pulsed Ultrasound

Ultrasound treatment has been proposed by several authors to enhance the repair of long bone injury. The present study investigated in a murine model the treatment by low-intensity pulsed ultrasound (LIPUS) of calvarial flat bone defect. The animals were operated to create bone defect and exposed to ultrasound for 5 min per day, 5 d per week, during two weeks. Two intensities of ultrasound (1 MHz, 100 Hz pulse repetition frequency and 20% duty cycle) were investigated: 100 and 300 mW/cm² spatial-averaged, time-averaged. Re-ossification surface and volume were determined after 30 and 60 days using computerized X-ray tomography in all animals of the control and treated groups. The results showed a significant increase of bone re-ossification in the group treated with the higher-intensity ultrasound (mean value of 18% volume reconstruction), whereas lower bone reconstruction was observed in the lower-intensity and control groups (respective mean values of 10 and 12% volume reconstruction). (E-mail: bernard.lavandier@inserm.fr)