Preoperative radiotherapy of rectal cancer. The Lyons experience, 1985-1996. Prognostic study apropos of 312 patients

AIM OF STUDY: Preoperative radiotherapy is used increasingly in rectal cancer in Europe. This study is a retrospective analysis of a series of 312 patients with rectal adenocarcinoma treated by preoperative radiotherapy. MATERIAL AND METHOD: From 1985 to 1996, 312 patients were included in this study. Preoperative staging was: T2: 83, T3: 192 et T4: 21. On digital rectal examination, 25 patients were classified as N1. Endorectal sonographic staging was: uT1: 3, uT2: 77, uT3: 163, uN0: 122, uN1-2: 127. After surgery, pathological staging was: pT0: 43 (14%), pT1 24, pT2: 81, pT3: 151, pN0: 229, pN1-2: 81. Radiotherapy was delivered to the posterior pelvis with an accelerated schedule 39 Gy/13 fractions/17 days with x 18 MV. RESULTS: Median follow-up is 54 months. For pM0 patients (297 patients), the overall 5-year survival rate is 67%. Local failure rate is 9%. Since 1986, the rate of sphincter saving surgery is close to 65%. Various parameters related to the tumor were found to be significant prognostic factors on multivariate analysis in relation to 5-year overall survival rate: the T stage as judged by digital rectal examination and endorectal sonography, the N stage as evaluated on digital rectal examination but not with endorectal sonography. Pathological examination of the operative specimen retains a very strong prognostic value for pT and pN. CONCLUSION: Pathological examination of the specimen of rectal carcinoma retains a very strong prognostic value after preoperative radiation therapy. Endorectal sonography is of interest to evaluate T staging of the tumor but is not reliable for N stage.     

Primitive seminoma of the mediastinum: a case report

In this study, the case has been reported of a 36-year old male who was treated at the Ibn Rochd Oncology Center in Casablanca for a primary mediastinal seminoma revealed by a symptomatology including cough, dyspnea, laterocervical swelling, rachidial pain and gait disorder. The preliminary investigation showed significant mediastinal enlargement with a right pleuritis and vertebral metastases; tumor markers were normal. The diagnosis of seminoma was confirmed by pathological and immunohistochemical analysis of the cervical adenopathy. Disease management consisted of BEP/cisplatin type chemotherapy and lumbar, mediastinal, and supraclavicular radiotherapy. The response after four courses of combined chemo-/radiotherapy was estimated at 25%, but the patient died from respiratory failure five months after the initiation of treatment.     

Association of fallopian tube cancer and polymyositis. Apropos of 1 case

A 51-year-old woman consulted for pelvic pain, metrorrhagia and leukorrhea. Physical examination revealed a renitent and mobile mass in the pelvis. A right lateral uterine mass with hydroxalpinx was found at ultrasonography. Pathology examination of the right annexectomy specimen provided the definitive diagnosis: fallopian tube cancer with polymyositis. No residual tumor was found at total hysterectomy with total bilateral annexectomy. The patient was lost to follow-up for three years without complementary treatment then consulted later for functional disability of the upper then lower limbs with myalgia, swallowing disorders and left supraclavian node enlargement resulting from pelvic relapse of the right fallopian tube adenocarcinoma and left supraclavian metastasis with paraneoplastic polymositis. The patient was given 6 courses of chemotherapy with radiotherapy (45 Gy) centered on the left clavian region. The patient exhibited a spectacular response, and remains in complete remission 50 months after diagnosis. The association of a fallopian tube tumor with polymyositis is exceptional, requiring rapid anticancer treatment effective against the cancer and the paraneoplastic polymyositis.     

Papillary carcinoma from the thyroglossal duct cyst: review of the literature and report of a case

Cancer of a thyroglossal duct cyst is very rare. Clinical presentation is identical that of a benign cyst, and the diagnosis is histopathological. We report the case of 36 year-old woman treated for papillary carcinoma of a thyroglossal duct cyst. The treatment was surgical excision according Sistrunk method. There was no distant spread. After 22 months follow up, the patient is alive, with no signs of recurrence.     

Guérison complète de l’hépatite virale C: une réalité

Acta Endoscopica - La réponse virologique complète soutenue est actuellement synonyme de guérison de l’infection virale C [1, 2). Néanmoins, nous pensons que le degré...     

Safety and outcome using endoscopic dilatation for benign esophageal stricture without fluoroscopy

AIM:To investigate the use of Savary-Gilliard marked dilators in tight esophageal strictures without fluoros-copy. METHODS:Seventy-two patients with signif icant dysphagia from benign strictures due to a variety of causes were dilated endoscopically. Patients with achalasia, malignant lesions or external compression were excluded. The procedure consisted of two parts. First, a guide wire was placed through video endoscopy and then dilatation was performed without fluoroscopy. In general, "the rule of three" was followed. Effective treatment was defi ned as the ability of patients, with or without repeated dilatations, to maintain a solid or semisolid diet for more than12mo. RESULTS: Six hundred and sixty two dilatations in a total of72patients were carried out. The success rate for placement of a guide wire was100%and for dilatation97%,without use of fluoroscopy, after6mo to4years of follow-up.The number of sessions per patient was between1and7,with an average of2sessions.The ability of patients, after 1 or more sessions of dilatation, to maintain a solid or semisolid diet for more than 12mo was obtained in70patients(95.8%).For very tight esophageal strictures, all patients improved clinically without complications after the endoscopic procedure without fluoroscopy, but we noted3failures. CONCLUSION:Dilatation using Savary-Gilliard dilators without fluoroscopy is safe and effective in the treatment of very tight esophageal strictures if performed with care.     

Une hématémèse révélant un faux anévrisme de l’artère hépatique

The false aneurysm of the hepatic artery (HA) is a rare and severe. A potentially fatal. It follows a non-specific clinical symptoms. The significance of this observation is to bring a unique mode of revelation of a false aneurysm by upper gastrointestinal bleeding due to a fistula communicating the false aneurysm and the duodenum.     

Ictère fébrile révélant un DRESS syndrome avec réactivation virale à herpès simplex 1 et 2

Introduction  

Le syndrome d’hypersensibilité médicamenteuse ou DRESS (Drug Rash with Eosinophilia and Systemic symptoms) est une entité nouvellement décrite en 1996, pouvant mimer un tableau de sepsis sévère avec au premier plan un ictère fébrile. Devant de telles manifestations, il faut penser à ce syndrome. Plusieurs réactivations virales ont été décrites en association avec ce syndrome pour le groupe Herpès virus (HHV6, HHV7, HHV8 et Epstein-Barr virus) [1,2,3]. En revanche, nous ne disposons pas de cas documentés en ce qui concerne l’herpès simplex 1 et 2. Nous rapportons le cas d’un patient ayant présenté suite à une prise médicamenteuse de phénylbutazone, un DRESS syndrome associé à une réactivation virale à herpès simplex 1 et 2.