Management of metastatic colorectal cancer current treatments and new therapies

Colorectal cancer represents 8% of metastatic cancers. For decades, the gold standard therapy has been infusional chemotherapy with 5-Fluorouracil [5-FU] associated to folinic acid. The discovery of irinotecan, oxaliplatin and oral forms of 5-FU in the nineties is considered a milestone in the treatment of this disease. Since 2004, targeted therapy with monoclonal antibodies including anti-EGFR and angiogenesis inhibitors showed superiority in terms of mortality compared to conventional therapy. Metastatic colorectal cancer, however, remains an incurable disease. We present the current treatments of metastatic colorectal cancer, the clinical development of these emerging treatments, and their position in the Lebanese health care system

Pancreatic panniculitis: a rare complication of pancreatitis secondary to ERCP

Panniculitis is an uncommon and rare complication of systemic fat necrosis in patients with pancreatic diseases. The skin manifestations are independent of the severity of the pancreatic pathology and can occur at any time. The lesions can preceed, be concomitant with or rarely follows the pancreatic illness. We report a case of acute pancreatitis post Endoscopic Retrograde Cholangio Pancreatography [ERCP] for common bile duct stone, with subcutaneous panniculitis. We noted a complete resolution within two weeks after the treatment of the pancreatic pathology

[Insertion des chambres a catheter implantables sous guidage echographique et scopique. Etude prospective portant sur 120 cas]

We compare our results of a prospective study, on 120 totally implantable venous access ports [TIVAP] inserted at angiographic unit, under ultrasound and fluoroscopic guidance, with those of the literature. The 120 AP data, placed under ultrasound and fluoroscopic control for chemotherapy treatment, were prospectively analyzed. The detailed technique of insertion is noted. Data related to the technical success rate and to complications were classified into major, minor, early or late, according to the recommendations of the interventional radiology society. The technical success rate is 100% with no major complication noted. Eight [6.6%] TIVAP were withdrawn because of infection in 4 cases [3.3%], and end of treatment in the other four. The withdrawals took place in chemotherapy clinics. Three [2.5%] are classified as early infections, within two months of the procedure, two of which were associated to wound non-healing. Four patients [3.3%] presented early minor complications [hematoma surrounding TIVAP insertion site]. Our results correspond to previously published data. The insertion of AP at the angiographic unit under ultrasound and fluoroscopic control has lower risk of complications and a success rate higher than that being inserted following anatomical location. Collaboration with a specialized care nurses team is of paramount importance

Encephalopathy induced by antihelminthic use of levamisole. A report of two patients

The antihelminthic Levamisole [LVM] is actually used as an immunomodulator in colon cancer. Its neurological toxicity is well known when used concomitantly with 5-Fluorouracil [5 FU] and, rarely when used solely at high doses. Antihelminthic imidazoles induced encephalopathy [AIIE], has been reported only in China. methods: We report two Lebanese patients with AIIE, with literature review concerning the pathophysiology, clinical presentation, laboratory, imaging and prognosis of this entity. AIIE supervenes after sensitization and re-exposure to the drug. It resembles the acute disseminated encephalomyelitis [ADEM] and the differentiation from multiple sclerosis is primarily based on the monophasic clinical and radiological [MRI] pattern of the disease. The treatment consists of steroids, and it has a good prognosis. The immunomodulatory role of Levamisole is evident but the pharmacokinetics remain unknown. This disease entity has to be considered anytime a patient, in an endemic area for helminthiasis, develops an encephalopathy, especially after a documented exposure to imidazoles, even at low doses and particularly after re-exposure to the drug that has to be prudent