[Contributions and limitations of transcutaneous ultrasonography in the preoperative evaluation for hepatic resections].

From October 1990 to January 1992, 36 patients were operated in order to perform an hepatectomy for hepatic metastases (n = 33) or primary malignant tumors (= 3). The authors evaluated the reliability of preoperative ultrasonography (US) by comparing US data to intraoperative findings without consideration of others preoperative examinations. Preoperative US detected 65 out the 78 nodules founded intra-operatively; 13 nodules (4 to 30 mm) and a micronodular dissemination were not detected (sensitivity 82% for the whole lesions).

[Cutaneous metastasis disclosing adrenal cortical carcinoma].

Metastases to the skin from internal malignant neoplasms are uncommon and often preterminal event. Cutaneous metastases from an adrenal cortical carcinoma have rarely been reported even in the advanced stages of the disease. A patient was initially seen with a small cutaneous lesion on the cheek and was found to have a large adrenal cortical tumor.

[Surgical interventions for erroneous diagnoses of liver metastases].

Among 635 laparotomies carried out for liver metastases (LM) between June 1983 and December 1992, twenty three operations (with 6 hepatectomies) were performed for a false positive diagnosis of LM. They represented 3.6% of the whole population, but only 2.

Neoadjuvant chemotherapy in locally advanced gastric carcinoma--a phase II trial with combined continuous intravenous 5-fluorouracil and bolus cisplatinum.

Locally advanced gastric adenocarcinomas (LAGC) have a poor prognosis, particularly when tumours are bulky, located in the cardia or in the event of locoregional lymph node involvement. Patients bearing these tumours were entered in a phase II trial of neoadjuvant chemotherapy, combining continuous intravenous 5-fluorouracil (5FU) (1000 mg/m2 for 5 days) and cisplatinum (CDDP) (100 mg/m2 on day 2) repeated every 4 weeks, for one to six cycles according to response and tolerance. 30 patients have been entered, 26 after clinical evaluation (CAT scan and upper gastrointestinal endoscopy) and 4 with unresectable tumours at prior laparotomy.

Efficacy of combined 5-fluorouracil and cisplatinum in advanced gastric carcinomas. A phase II trial with prognostic factor analysis.

Combined chemotherapy has demonstrated a degree of efficacy in gastric carcinoma. As 5-fluorouracil (5FU) and cisplatinum are two of the most active drugs, we have tested the efficacy of combined 5FU and cisplatinum in a prospective phase II trial. Cycles were administered every 4 weeks and consisted of 5FU 1000 mg/m2/day 5 days continuous intravenous (i.

[Intra-arterial hepatic chemotherapy. Experience of 200 cases].

Objectives: This retrospective study had three aims: a) to investigate whether one catheter, whatever the number of hepatic arteries, associated with miscellaneous arterial ligations, produced the same results as the implantation of multiple catheters, b) to study the survival rate after intra-arterial chemotherapy, and c) based on a multifactorial study of prognostic factors, to define the best indications of this treatment in the future.

Methods: Two hundred catheters were surgically implanted to perform intrahepatic arterial chemotherapy in patients with multiple unresectable isolated liver tumors. The origins of these tumours were colorectal cancer in 152 cases, neuroendocrine tumour in 13 cases, hepatocellular carcinoma in 9 cases, and miscellaneous tumours in 22 cases.

Repeat hepatectomy for cancer.

In a series of 279 hepatectomies performed for cancer between June 1984 and March 1992, 46 were repeat operations, for metastases in 41 patients. The primary tumour was in the colon and rectum (28 patients), APUDoma (five) and miscellaneous (eight). Repeat hepatectomies were performed in 26 per cent of patients who had recurrence after the first liver resection and in 40 per cent of those who had liver recurrence.

Transcatheter chemoembolization of progressive carcinoid liver metastasis.

Purpose: The authors report their experience treating progressive liver metastases from carcinoid tumor with doxorubicin, iodized oil, and gelatin sponge embolization.

Materials And Methods: Of 23 patients, 18 had carcinoid syndrome and 19 had elevated urinary 5-hydroxyindoleacetic acid (5-HIAA) levels. Relief of symptoms, changes in 5-HIAA levels, and changes in tumor size could be evaluated in 10, 11, and 17 patients, respectively.

[Surgical approaches to segment I for malignant tumors (20 cases)].

Seven complete and 13 partial resections of segment I (caudate lobe) were performed for malignant tumors. In all except one instance, removal of segment I was combined with other types of hepatic resection for technical or carcinologic reasons. Six were iterative hepatic resections for recurrent hepatic metastases.

Portal vein embolization: utility for inducing left hepatic lobe hypertrophy before surgery.

Right portal vein embolization (PVE) was performed in patients in need of wide hepatectomy to induce preoperative hypertrophy of the future remnant liver (FRL), which would have been insufficient for safe resection. PVE was achieved with cyanoacrylate or gelatin sponges by using a percutaneous subxiphoid approach in 10 patients with tumors in noncirrhotic liver. Surgery was performed in nine patients 17-48 days (mean, 34 days) after PVE.

[Resectable liver metastases and synchronous extra-hepatic sites of colorectal origin. Surgical indications].

Twenty-two patients with liver metastases and synchronous extra-hepatic localizations or colorectal cancer underwent complete resection of all their cancerous lesion. Their survival was not significantly different from that of 87 patients in whom single or multiple metastases involving only the liver had been resected. Analysis of our 22 patients showed that they fell into two subgroups: those with lung metastases (n = 5) and those with pediculate colonic nodes (n = 6), who benefited from the double resection since their disease-free survival rate at 5 years was 35 percent.

Surgical treatment of hepatic metastases: impact of intraoperative sonography.

Objective: A prospective study was done to determine the influence of intraoperative sonographic findings on surgical decision making in patients with hepatic metastases.

Subjects And Methods: Thirty-seven consecutive patients with hepatic metastases who underwent surgery (for hepatic resection or intraarterial catheter placement) were prospectively evaluated. For each patient, the resectability of the metastases and the surgical approach were determined preoperatively on the basis of the combined results of sonography, bolus dynamic CT, and CT during arterial portography (CTAP).

[Triple hepatectomy for cancer].

The resection of the metastases from digestive malignant lesions are always the most efficient treatment, if it is complete. However it must be performed without major operative risk. According to this point of view, it is logical to examine the feasibility of three successive hepatectomies for metastases.

[Single and multifactorial prognostic study of 400 operated rectal adenocarcinomas].

From 1976 to 1988, 496 patients with rectal adenocarcinoma have been treated at Gustave-Roussy Institute. There were 258 men (52%) and 238 women (48) with a median age of 61 years. Sixty pts (12%) had local treatment (contact-therapy or electro-resection).

Potential contribution of 131I-labelled monoclonal anti-CEA antibodies in the treatment of liver metastases from colorectal carcinomas: pretherapeutic study with dose recovery in resected tissues.

20 patients with liver metastases from colorectal carcinoma undergoing laparotomy received 15-60 mg intravenously, either intact or fragments of, anti-carcinoembryonic antigen (anti-CEA) monoclonal antibodies labelled with 0.55-1.48 GBq (15-40 mCi) of 131I, 3-8 days prior to operation.

[A multivariate prospective study of prognostic factors in 200 operated epidermoid cancers of the esophagus. Definition of patients for whom surgical resection was of benefit].

From 1982 to 1991, 200 patients with squamous-cell esophageal cancers underwent operation. Sixteen prognostic parameters were prospectively collected and analyzed. The main aim of this study was to define the best preoperative criteria for selection for curative surgery and which patients would benefit most from radical resection.

MRI of liver metastases from colorectal cancer vs. CT during arterial portography.

A prospective study was performed to compare, with a lesion-by-lesion analysis, the sensitivities of high field strength MRI and CT during arterial portography (CTAP) in detecting hepatic metastases from colorectal cancer. Twenty-one patients with liver metastases from colorectal cancer were prospectively investigated by high field strength MRI (1.5 or 2 T) and CTAP.

[Desmoid tumors or intra-abdominal fibromatoses].

Intraabdominal desmoid tumour or fibromatosis, recurrent but non-metastatic, invasive, fibroblastic proliferations, are rare tumours. From 1968 to 1989, 16 patients were treated at Gustave Roussy Institute. They were associated with familial adenomatous polyposis in 10% of cases.

[Pseudo-continent perineal colostomies after amputation of the rectum for cancer].

From February 1989 to February 1982, 23 pseudocontinent perineal colostomies (PC), performed after abdominoperineal excision for rectal carcinoma, were evaluated. Perineal colostomy was performed using a free autotransplant of smooth muscle, according to Schmidt, associated with colonic irrigations. This procedure was proposed to the younger and more alert patients without advanced rectal carcinoma.

Holoprosencephaly and midline facial anomalies: redefining classification and management.

Holoprosencephaly encompasses a series of midline defects of the brain and face. Most cases are associated with severe malformations of the brain which are incompatible with life. At the other end of the spectrum, however, are patients with midline facial defects and normal or near-normal brain development.