CT-Guided Percutaneous Gastrostomy without Preliminary Placement of a Nasogastric Tube.

Percutaneous radiologic gastrostomy (PRG) requires preliminary gastric inflation through a nasogastric tube (NGT) to safely perform gastric puncture. However, in case of pharyngeal or esophageal obstruction, NGT placement may be impossible even with a hydrophilic angiography catheter and wire. This brief report describes percutaneous computed tomography (CT)-guided gastrostomy with a 2-stick approach without nasogastric insufflation in 13 patients.

Computer tomography-based body surface area evaluation for drug dosage: Quantitative radiology versus anthropomorphic evaluation.

Objective: The measure of body surface area (BSA) is a standard for planning optimal dosing in oncology. This index is derived from a model having questionable performances. In this study, we proposed measurement of BSA from whole body CT images (iBSA).

Nutritional status and feeding-tube placement in patients with locally advanced hypopharyngeal cancer included in an induction chemotherapy-based larynx preservation program.

The objective of the study is to evaluate the nutritional status and determine its impact on clinical outcomes in patients with locally advanced hypopharyngeal cancer included in an induction chemotherapy (ICT)-based larynx preservation program without prophylactic feeding-tube placement. All patients with locally advanced (T3/4, N0-3, M0) hypopharyngeal squamous cell carcinoma, technically suitable for total pharyngolaryngectomy, treated by docetaxel, cisplatin and 5-fluorouracil (TPF)-ICT for larynx preservation at our institution between 2004 and 2013, were included in this retrospective study. Patients' nutritional status was closely monitored.

General anaesthetic agents do not influence persistent pain after breast cancer surgery: A prospective nationwide cohort study.

Background: It has recently been suggested that propofol exerts a protective effect on the occurrence of persistent pain after breast cancer surgery. We analysed data from a subcohort taken from a multicentre study to validate this information.

Objective: The objective of this article is to study the role of the agent used for maintenance of general anaesthesia on the occurrence of persistent pain, with adjustment for multiple pre and peri-operative variables using the generalised linear model.

Reduced infections with perioperative immunonutrition in head and neck cancer: exploratory results of a multicenter, prospective, randomized, double-blind study.

Background & Aims: Head and neck cancer surgery is affected by complications in 20-60% of cases, with risk factors being malnutrition, alcoholism and immunosuppression due to cancer. The aim of the study was to investigate whether preoperative or perioperative immunonutrition could reduce postoperative infectious complications (IC) and surgical-site infections (SSI) in this population.

Methods: This was a multicenter, prospective, randomized, double-blind study.

Impact of patient comorbidities on head and neck microvascular reconstruction. A report on 423 cases.

The aim of this study was to assess the impact of the different subtypes of patient comorbidities on the outcomes of head and neck microvascular reconstruction. A total of 423 patients who underwent head and neck free flap reconstruction in our institution between 2000 and 2010 were included in this retrospective study. The impact of the different subtypes of patient comorbidities (as defined by the Kaplan-Feinstein Index) and other global health status-related factors on free flap success, local and general complications, postoperative mortality and length of stay was assessed in univariate and multivariate analysis.

Prevalence, risk factors and clinical implications of malnutrition in French Comprehensive Cancer Centres.

Background: This epidemiological observational study aimed at determining the prevalence of malnutrition in non-selected adults with cancer, to identify risk factors of malnutrition and correlate the results with length of stay and 2-month mortality.

Methods: This prospective multicentre 1-day study conducted in 17 French Comprehensive Cancer Centres included 1545 patients. Body mass index (BMI), weight loss (WL) in the past 6 months and age were routinely recorded according to the French national recommendations for hospitalised patients; malnutrition was rated as absent, moderate or severe according to the level of WL and BMI.

[Concomitant bifractionated radiotherapy and chemotherapy with cisplatin and 5-fluorouracil in locally progressive, non-resectable epidermoid carcinomas of the pharynx: ten years experience at the Antoine Lacassagne center].

Purpose: Patients suffering from locally advanced unresectable squamous cell carcinoma of the oropharynx and hypopharynx treated with radiotherapy alone have a poor prognosis. More than 70% of patients die within 5 years mainly due to local recurrences. The aim of this study was to evaluate retrospectively the Antoine Lacassagne Cancer Center's experience in a treatment by concomitant bid radiotherapy and chemotherapy.

Comparison between nasogastric tube feeding and percutaneous fluoroscopic gastrostomy in advanced head and neck cancer patients.

Wasting is a major complication of advanced head and neck cancer and the aim of this study was to compare nasogastric tube feeding (NG) and percutaneous fluoroscopic gastrostomy (PFG) in these patients. The goal of these two methods of nutritional support was to improve or maintain the initial nutritional status during treatment. A total of 90 patients, all stage IV oropharynx or hypopharynx tumor, were reviewed from a prospective databank.

Systematic percutaneous fluoroscopic gastrostomy for concomitant radiochemotherapy of advanced head and neck cancer: optimization of therapy.

Wasting is a major complication of advanced head and neck cancer. Concomitant chemotherapy and twice-daily continuous radiotherapy with no acceleration represents a promising treatment modality for these tumors, but increases the risk of mucositis. This report describes the results achieved with percutaneous fluoroscopic gastrostomy (PFG) and its impact on the quality of life of patients with head and neck cancer in terms of their nutritional status.

Cost-benefit analysis of percutaneous interventional radiological procedures in cancer patients.

The goal of this work was to evaluate the costs and benefits of percutaneous interventional radiological procedures (PIRP) in terminal cancer patients, from the perspective of the Radiodiagnostics Department. The subjects were 225 patients who underwent different kinds of treatments, such as placement of endovenous or urinary stents, percutaneous gastrostomy, alcoholization of metastatic disease, celiac plexus block, tumor embolization, and inferior vena caval filter. We retrospectively analyzed the consequences in terms of survival, quality of life and cost ratios and found that this study fully justifies the use of interventional radiology in palliative oncology: 60% and 40% of the patients, respectively, were still alive at 1 month and 3 months; the additional cost of PIRP procedures is low (< 12%) compared with the total cost of hospitalization.

[Thoughts on the role of celiosurgery in patients with major obesity].

Is coelioscopic surgery an interesting way in massive obese patients? This is well established concerning the post-operative benefit, with a decreased risk of pulmonary and thrombo-embolic complications. But technical difficulties are not well described, whereas we encountered some: incomplete retraction of intra-abdominal organs, weakness and hemorrhagic tendency of the tissues, and most of all an insufficient pneumoperitoneum in all patients preventing sometime the surgical procedure. We analyse those obstacles to propose solutions when the laparoscopic way seems better regarding to the post-operative risk.

Liver, spleen, and vessels: preliminary clinical results of CT with perfluorooctylbromide.

This phase 1-2 trial investigated the use of a 100% wt/vol emulsion of perfluorooctylbromide (PFOB) in computed tomography (CT) of 30 patients with metastatic cancer. Injection of 3 g/kg (maximum dose administered to these patients) provided an average liver enhancement of +31 HU on CT scans obtained after 48 hours. Maximum splenic opacification occurred immediately after injection; 1 g/kg, which allowed an immediate enhancement of +35 HU, appeared sufficient for the diagnosis of splenic conditions.

[Induction chemotherapy with Cis DDP-5FU in cancers of the upper respiratory and digestive tract after 70 years of age].

Sixty one aged patients with advanced squamous cell carcinoma of the upper aerodigestive tract were given a chemotherapy Cis DDP-5 FU before any local treatment. The objective response rate was 77% which included 46% of complete response. Toxic manifestations were more severe than those observed in the general population with the same protocol (nine deaths during the course of the treatment).

[Intra-arterial chemotherapy of ORL cancer. Value of an implantable infusion system and scintigraphic monitoring].

The technical difficulties and complications related to arterial catheterisation have inhibited the development of regional chemotherapy in ENT oncology despite the numerous theoretical advantages associated with this method. We report our recent experience with a completely implantable infusion system; 12 systems were inserted, 11 unilateral and 1 bilateral. Treatment was carried out in 8 patients and the perfect biocompatibility of the material was confirmed.

Perfluoroctylbromide and hepatosplenic computed tomography. Preliminary clinical study.

The preliminary results of perfluorocytlbromide (PFOB) emulsion when used as an intravenous contrast agent for hepatosplenic CT imaging in humans are reported. Ten patients were examined using dosages ranging from 1 to 2 g/kg. There was good clinical and biochemical tolerance.

[Cardiotoxicity of 5-fluorouracil. Spasm or direct myocardial toxicity?].

The authors report on a case of cardiotoxicity observed during a protocol including a 5-day continuous infusion of 5-fluorouracil; anginal manifestations recurred during a second treatment course. Coronary angiography, thallium scintigraphy and methergine test were all normal. An attempt to prevent the recurrence of such manifestations using a calcium inhibitor and nitroderivatives was unsuccessful.

[Implantation of permanent cardiac pacing electrodes by the retropectoral transvenous approach. Results of a series of 152 cases].

When the cephalic vein is unsuitable for the introduction of pacing electrodes, the retropectoral veins near the external border of pectoralis major near its subclavian attachment, approached through the same incision, may provide a suitable alternative. It was not possible to catheterise the cephalic vein in 23,8% of 756 consecutive implantations of endocavitary pacing electrodes. The retropectoral veins were looked for in 172 cases and found and used in 159 cases (92,4%).