[Markers of the hepatitis B virus and chronic alcoholism. Prevalence and risk factors]. / Marqueurs du virus B et alcoolisme chronique. Prévalence et facteurs favorisants.

In this retrospective study, the prevalence of hepatitis B virus markers was studied in groups of heavy drinkers and primary hepatocellular carcinoma patients (202 patients), hospitalized for the first time in a medical department of gastroenterology in France. HBs Ag, anti-HBs and anti-HBc were respectively detected in 1.1, 25.8 and 20.9 p. cent of alcoholic patients without hepatocellular carcinoma. The overall prevalence of hepatitis B virus infection was 26.9 p. cent. The presence of hepatitis B virus markers did not depend on excess alcohol consumption, sex, age, alcoholic liver disease intensity, or previous gastrointestinal bleeding or hospitalization, but was related to racial group and residence in countries with a high prevalence of HBs Ag. HBs Ag, anti-HBs and anti-HBc were observed in 0, 36.4 and 36.4 p. cent of the alcoholic cirrhotic patients with hepatocellular carcinoma and the prevalence of hepatitis B virus markers was 45.5 p. cent. The findings reported in this study suggest that hepatitis B virus infection has no major role in determining the rate of progression of alcoholic liver disease and plays a far lesser causal role in hepatocellular carcinoma in France than in high incidence regions.

Randomized double-blind clinical trial of aluminum phosphate versus ranitidine in the acute treatment of duodenal ulcer.

A randomized double-blind clinical trial of aluminum phosphate versus ranitidine in the treatment of noncomplicated acute duodenal ulcer has been conducted in 91 patients. After randomization the 42 patients of the aluminum phosphate group were comparable to the 49 patients of the ranitidine group. At 4 weeks, 6 patients were not endoscoped and according to the intention-to-treat method they were considered as treatment failure. The endoscopy showed a 60% healing rate in the aluminum phosphate group (25/42) versus 55% in the ranitidine group (27/49); this difference was not significant. Among the factors assessed, only one, the round shape of the ulcer, was significantly and independently associated with ulcer healing in a multidimensional analysis. In conclusion, this double-blind trial showed that aluminum phosphate is an effective, save and cheap treatment of acute duodenal ulcer.

[Descriptive epidemiology of cancer of the pancreas]. / Epidémiologie descriptive du cancer du pancréas.

Cancer of the pancreas is a relatively common malignancy in France, where it represents 10% of all digestive tract cancers. Over the world, there is little variation in incidence rates; Europe, North America, South America, Oceania and parts of Asia represent high risk areas. The regions with the lowest incidence rates are India, mid-western countries and Africa. In most countries, pancreatic cancer incidence rates increased between 1950 and 1965; however little change in incidence has been observed over the past 20 years. Pancreatic cancer occurs more frequently in males than in females in all age groups. No consistent differences have been identified in urban/rural distribution or in socioeconomic status. Studies of migrant populations and some religious groups indicate that environmental factors are of overwhelming importance in determining the incidence of pancreatic cancer in a given population. In the same areas, difference in incidence has been reported among various ethnic groups: in the United States the rate is higher in Blacks than in Whites, in New Zealand in Maoris and Polynesians than in Whites, in Israel in Jews than in non-Jews. This data leads us to the conclusion that diet is of importance in pancreatic cancer etiology. No premalignant lesion has been clearly identified. Particular attention has been paid to diabetes mellitus and chronic pancreatitis, but a firm conclusion cannot be drawn. Some potentially valuable clues for clarifying the etiology of pancreatic cancer have been found by way of descriptive epidemiology. In view of the severe prognosis of the disease, there is an urgent need for further aetiological studies in order to develop effective methods of prevention.

[Is the Tru-Cut needle more efficient than the fine needle in the diagnosis of hepatic lesions? Comparative study of 45 echography-guided punctures]. / L'aiguille Tru-Cut est-elle plus efficace que l'aiguille fine dans le diagnostic des lésions hépatiques? Etude comparative de 45 ponctions guidées par l'échographie.

A comparison of diagnostic efficiency of fine needle biopsy (22 G) versus coarse needle biopsy (Tru-Cut 14 G) was performed on ultrasound-guided liver biopsies in 45 patients. Diagnosis was established through clinical, paraclinical and pathologic features. For each patient pathologic examination of both fine needle biopsy (cytology and histology) and coarse needle biopsy (histology) were performed by a pathologist unaware of any clinical data. Of 36 malignant tumors, diagnosis of malignancy was made in 83 percent of the cases by fine needle biopsy and in 81 percent of the cases by Tru-Cut biopsy, and distinction between primary and secondary cancer, in 83 and 86 percent of cases respectively. Specificity was 100 percent with both techniques. Of 9 benign lesions, the 6 focalized fatty infiltrations were diagnosed by both fine and coarse needle biopsies. As fine needle biopsy is less invasive than coarse needle biopsy and gave equally satisfying results, we suggest that it should be used preferentially in the diagnosis of focalized liver lesions.

[Preliminary results of a mass screening program for colorectal cancer]. / Résultats préliminaires d'une campagne de dépistage de masse du cancer colorectal.

The Digestive Tumours Registry of Burgundy set up a study to assess acceptability and results of colorectal cancers screening using the Hemoccult test. A total of 95,000 people, aged 45 to 74, were included, 55,000 in 1988 and 40,000 in 1989. The aim of this paper is to report the results of the first screening process in the population tested from January to July 1988, i.e. 27,421 subjects. Information on colorectal cancer was mailed to all homes in the screening areas and a news campaign was organized. During the first 4 months, the general practitioners (GPs) either prescribed the test which was then reimbursed (Autun area), or gave it free to their patients (other areas). After that phase, the test was mailed to all subjects who had not consulted their GP, and a second letter was sent 1 month later when the test had not been sent back. A total of 14,603 subjects performed the Hemoccult test (53.3 percent). Acceptability was higher in those areas there the test was initially given free by the GPs (57.3 percent) than in those where it was prescribed (40.0 percent). Acceptability was higher in women (55.8 percent) than in men (50.6 percent). A total of 57.8 percent of the performed tests were done during the medical offer phase, 29.1 percent after mailing and 13.1 percent after the recall letter. There was a positive test in 340 subjects (2.3 percent) and 288 (84.7 percent) had colonic investigations, a colonoscopy in 99 percent of the cases.(ABSTRACT TRUNCATED AT 250 WORDS)

[Treatment and prognosis of stomach cancers in the population of the Cote d'Or's District (1976-1985)]. / Traitement et pronostic des cancers de l'estomac dans la population du département de la Côte-d'Or (1976-1985).

The present study on treatment and prognosis of gastric cancers is based on the data of the digestive tract cancer registry set up for the French department of Côte-d'Or. During the 1976-1985 period, 784 cases of gastric cancer were diagnosed. Resection for cure was performed in 41.3% of gastric cancers and that proportion remained the same during the course of the study period. Operative mortality was 18.5% after resection for cure and 26.7% after palliative surgery. The overall survival rate was 31.7% at 1 year, 17.0% at 3 years, and 13.0% at 5 years. Ten different criteria (personal data, histologic and therapeutic parameters) were studied in relation to survival. With the univariate analysis, the survival rates were related to age, duration of the symptoms, history of previous gastric ulcer, tumour location, stage of diagnosis and treatment. Only 4 aspects were of good prognosis according to the multivariate analysis (Cox model): extension limited to the gastric wall, resection for cure, duration of the symptoms and location to the antrum or the angulus. These results underline the fact that the prognosis of gastric cancer in a well-defined population remains poor. Because of its severity, gastric cancer still represents a major cancer problem.

[Rectocolonic cancers in young patients. A population study (Côte-d'Or: 1976-1983]. / Les cancers rectocoliques du sujet jeune. Etude de population (Côte-d'Or: 1976-1983).

Between 1976 and 1983, 1,783 colorectal cancers were diagnosed among the Cote-d'Or residents; of these 44 (2.5 p. 100) were under age 45. Cancer developed more often on familial polyposis (11.4 p. 100), ulcerative colitis (2.3 p. 100) or in the Lynch cancer family syndrome (4.6 p. 100) before 45 than in older patients: 0.2 p. 100 (p less than 0.01), 0.2 p. 100 (NS) and 0 p. 100 (p less than 0.01) respectively. There was no significant difference between young and older patients concerning the site, the histologic type or the stage of diagnosis. Curative resection rates were similar before age 45 (68.2 p. 100) as after that age (61.8 p. 100). Operative mortality was lower in younger (3.3 p. 100) than in older patients (12.6 p. 100; NS). After surgery for cure (operative mortality excluded) the 5-year corrected survival rates were similar in the two age groups: 69.4 +/- 8.8 p. 100 and 64.0 +/- 1.8 p. 100 respectively (NS). These data suggest that with the exception of predisposing diseases there is no important difference between young and older patients with regard to the anatomoclinical and evolutive aspects of colorectal cancers.

Primary liver cancer in Côte d'Or (France).

The registry of digestive tract tumours established for the department of Cote d'Or (France) was used to study the incidence and some of the characteristics of primary liver cancer (PLC) in this area. The annual age-standardized incidence rate was 7.6/100,000 for males, and 1.8/100,000 for females. As compared to other areas the Cote d'Or is in the intermediate incidence areas. The risk of PLC was higher in urban than in rural areas in men (p less than 0.01). There was no significant variation in PLC incidence over the eight years of the study. Alfafoetoprotein levels over 200 ng/ml were observed in only 48.9% of the cases. Alfafoetoprotein measurement has to be complemented by other investigations in screening of high-risk patients. Liver cirrhosis was present in 70.9% of the cases in which the information was available. The male:female ratio in the non-cirrhotic group was 1.5:1, very different to the 8.8:1 in the cirrhotic group. Cirrhosis was associated with excessive alcohol consumption in 92% of cases. The prevalence of serological markers of hepatitis B virus infection was investigated in 91 patients. Hepatitis Bs-antigen was found in 8.8% and evidence of past or present infection in 28.2%. In view of the prevalence of chronic alcoholism in patients with cirrhosis it is suggested that alcohol leads to an increased risk of cirrhosis followed by an increased incidence of PLC. Further studies are needed to elucidate the eventual role of HBV infection and other suspected environmental factors in the aetiology of PLC.

[Colorectal cancers disclosed by an obstruction. Frequency and prognosis in a population]. / Les cancers colorectaux révélés par une occlusion: fréquence et pronostic dans une population.

The registry of digestive tumors of the department of Cote-d'Or recorded between 1976 and 1982, among 1543 colorectal cancers, 142 cases (9.2%) diagnosed with acute obstruction. Distribution of the tumors along the large bowel was as follows: rectal cancers were rarely obstructive (3.8%) whereas it was a more common feature in the sigmoid (14.2%), the caecum (12.2%) and the transverse colon (15.8%). Symptoms preceded the acute obstruction in 39.7% of the cases. Limited tumors were rare in obstructive cancers, 2.8% were Dukes A, 30.3% Dukes B; the corresponding data for non obstructive cancers were 15.6 and 27.7% respectively (P less than 0.01). Treatment was surgical in 97.9% of obstructive cancers. Surgery was more often palliative in obstructive tumors (45.8%) than in the other types of tumors (21.3%; P less than 0.01). The postoperative mortality rate was 30.9%, ie 21.6% after curative surgery, 30% after palliative surgery, 43.6% after derivative surgery. The overall survival rates for obstructive cancers were 42.7% after one year and 17.6% after 5 years; they were respectively 59.1 and 31.1% for non obstructive cancers (P less than 0.001). After curative surgery and excluding postoperative mortality prognosis was the same for obstructive and obstructive cancers within the same Dukes' stage. This study permitted to highlight the rather high frequency of obstructive colorectal cancers, and their bad prognosis linked to the extension of the tumors and to high postoperative mortality rates.

[Epidemiology of cancers of the small intestine. Evaluation of 10 years' registration at the Cote-d'Or department]. / Epidémiologie des cancers de l'intestin grêle. Bilan de dix années d'enregistrement dans le département de la Cote-d'Or.

The registry of digestive tract tumours established for the department of Côte-d'Or was used to study the epidemiologic characteristics of cancer of the small intestine. Over a period of 10 years (1976-1985), 42 new cases were recorded. Age standardized incidence rates, based on world standard population, were 0.7/100,000 for males and 0.4/100,000 for females. As compared with the data from other cancer registries, the risk in Côte-d'Or is in the intermediate range. The mean age was 60.9 years for males and 73.3 years for females (P less than 0.05). Adenocarcinomas represented 40% of the cases, lymphomas 20%, carcinoid tumours 20%, sarcomas 17% and undifferentiated carcinomas 2%. The mean time between symptoms and diagnosis was 4.6 months. Lymph node involvement or metastatic disease were found in 3/4 of the cases at time of diagnosis (31/42). Patients were treated by surgery in 95% of the cases. Curative surgery was used in 23 cases (55%). The post-operative death rate was 13% after curative surgery and 37.5% after palliative surgery. The overall survival rates were 39.9% at 1 year, 19.5% at 3 years and 11.7% at 5 years. Prognosis depended on the stage of diagnosis and the finality of surgical treatment. These results indicate that cancers of the small intestine are rare and difficult to diagnose, explaining the delay in diagnosis and the poor prognosis.

Biliary tract cancers in Cote-d'Or (France): incidence and natural history.

The registry of digestive tract tumours established for the department of Cote-d'Or (France) was used to study the epidemiological characteristics and the natural history of biliary tract cancers. Age standardised incidence rates for gallbladder cancers were 2.7/100,000 for women and 0.9/100,000 for men. The corresponding rates for extrahepatic bile duct cancers were 0.5/100,000 and 1.7/100,000, and for ampulla of Vater cancer 0.3/100,000 and 0.3/100,000. The three cancers differ in their descriptive epidemiology and should be considered separately in epidemiological analytical investigations. The incidence of each of the three diseases increased with age, and cancers of known histological type were mainly adenocarcinomas. Some gallbladder cancers were undifferentiated or squamous cell carcinomas. There was no significant variation in incidence for gallbladder cancer and extrahepatic bile duct cancer over the eight years of the study. The association with gallstones was frequent in gallbladder cancer: 70.5% compared to 13.0% in other biliary tract cancers (less than 0.001). Although the association of gallbladder cancer with gallstones is frequent, few patients with cholelithiasis experience development of a gallbladder cancer. It is necessary to identify among patients with gallstones a subgroup at high risk of gallbladder cancer in whom prophylactic surgery might be justified. Biliary tract cancers are seldom diagnosed early: lymph nodes or visceral metastases were present in 77% of gallbladder cancers, in 83% of extrahepatic bile duct cancers, and in 55% of ampulla of Vater cancers at the time of diagnosis. The corresponding resectability rates were 46.1%, 11.9%, and 38.9%. The five-year overall survival rates were 2.9% for gallbladder cancer, 0% for extrahepatic bile duct cancer, and 18.3% for ampulla of Vater cancer. The corresponding five-year survival rates after surgery for cure were 10.3%, 0%, and 35.7%. Biliary tract cancer still represent a great therapeutic challenge.

Propranolol for prevention of recurrent gastrointestinal bleeding in patients with cirrhosis: a prospective study of factors associated with rebleeding.

In a previous randomized trial, we demonstrated that propranolol prevented recurrent gastrointestinal bleeding in patients with cirrhosis. We have undertaken the present study in a new group of patients to ascertain the factors associated with rebleeding. Among 232 patients with cirrhosis admitted for gastrointestinal bleeding, 127 were included. They received propranolol orally at a dose reducing the heart rate by 25%. The median follow-up period was 682 days. The following factors were studied: cause of cirrhosis; severity of cirrhosis; hepatocellular carcinoma recognized after inclusion; compliance; persistent decrease in heart rate; dose of propranolol; alcohol abstinence; previous history of hemorrhage; time interval from hemorrhage to onset of propranolol administration, and source of bleeding. The percentage of patients free of rebleeding was 71% at 1 year and 57% at 2 years. Only five factors were significantly and independently associated with rebleeding: occurrence of hepatocellular carcinoma; lack of compliance; lack of persistent decrease in heart rate; lack of abstinence, and previous history of bleeding. In conclusion, this study confirms the results of our previous trial and suggests that certain factors play a role in the mechanism of rebleeding in patients receiving propranolol.

[Cancer of the gallbladder in the Côte d'Or]. / Le cancer de la vésicule biliaire dans le département de la Côte d'Or.

The registry of digestive tract tumours established for the department of Côte d'Or was used to study the epidemiologic characteristics and treatment of gallbladder cancer. During 8 years (1976-1983), 139 new cases were recorded. Age standardized incidence rates based on world standard population were 3.1/100,000 for females, 0.9/100,000 for males. As in all population-based studies, there was a female predominance. As compared with the data of other cancer registries the risk in the Côte d'Or is in the intermediate range. The incidence of gallbladder cancer was similar in urban and rural areas, but high risk lieus were identified by the study. The most frequent histologic type was adenocarcinoma (79.5 p. 100). Only 20.9 p. 100 of the patients underwent curative surgery. The overall 1-year survival rate was 14.4 p. 100 and the 5-year survival rate was 2.9 p. 100. The 5-year survival rate was 11.5 p. 100 after curative surgery. These results underline the fact that the prognosis of gallbladder cancer in a well defined population remains poor. The frequency of gallstones was 73.3 p. 100 in females and 56.5 p. 100 in males. Although this association is frequent few people with cholelithiasis develop gallbladder cancer. Among patients with gallstones, a subgroup at high risk of gallbladder cancer, in whom prophylactic surgery might be justified, remains to be identified.

[Management by specialists of patients with digestive cancers in the Department of Côte-d'Or]. / La prise en charge par les médecins spécialistes des malades atteints de cancers digestifs dans le département de la Côte-d'Or.

The relative frequency of consultation of the different specialists involved in the diagnosis and treatment of cancer is not well known in France. This study was completed with data collected by the Digestive Tract Cancer Registry in Côte d'Or. Among 3.192 digestive tract cancers diagnosed between 1976 and 1982, 64 p. 100 were treated by gastroenterologists or surgeons. Only 18% of the patients consulted an oncologist. The frequency of consultation of gastroenterologists in the care of digestive tract cancers was independent on the location of the cancer but varied with the place of residence, fluctuating from 69.7% for patients living in the town of Dijon, to 39.9% for patients living in a town with a regional hospital without gastroenterologist. The inverse phenomenon was observed for oncologists. They treated 63.2% of the patients with esophageal cancer and 31.2 p. 100 of patients with rectal cancer, but less than 10 p. 100 of the patients with gastric, colonic, liver, biliary tract or pancreatic cancer. The number of surgeons consulted depended essentially on the operability of the cancer. Between 1976 and 1982 consultation with gastroenterologists and surgeons by patients with digestive tract cancer increased by 4.4 p. 100 (p less than 0.05) and 2.1 p. 100 per year (p less than 0.01), respectively. The frequency of consultation of oncologists remained stable: +0.3 p. 100 per year. These results confirm the importance of a training policy oriented towards specialists who are not oncologists. They must take note of their importance in the diagnosis and the organization of the fight against digestive tract cancers.

[Cancer of the esophagus in the department of Côte-d'Or]. / Le cancer de l'oesophage dans le département de la Côte-d'Or.

The registry of digestive tract tumors established for the department of Côte-d' Or was used to study the incidence and characteristics of oesophageal cancer in the area. The crude annual incidence rate was 15.5/100,000 for males, ans 1.1/100,000 for females. The corresponding age standardized rate (world standard) were 12.7 and 0.6. The sex ratio was 21.2. As compared to other cancer registries the Côte-d' Or is in intermediate range for males, in the low range for females. The incidence of oesophageal cancer was similar in urban and rural areas. The risk of oesophageal cancer in males was five times higher in workers than in high executives and professionals. There was no significant variation in oesophageal cancer incidence over the 8 years of the study. Rates tended to decrease slightly in both sexes. Most cancers were squamous cell carcinomas (92%). Adenocarcinomas represented 5% of the cases. The risk of an associated tumour of the upper respiratory and digestive tract was important (17.5%). Only 10.4% of the patients underwent curative surgery, while 53.4% were referred for radiotherapy alone. The overall 1-year survival rate was 18.4%, and the 5-year survival rate was 2.8%. The 5-year survival rate was 7.2% after curative surgery, and 3.2% after radiotherapy. These results underline the fact that the prognosis of oesophageal cancer in a well defined population where only one patient out of ten can benefit from curative surgery, remains poor.

[Cancers of the rectum and colon in the Côte-d'Or department: treatment, prognosis]. / Les cancers du rectum et du côlon dans le département de la Côte-d'Or: traitement, pronostic.

The population based registry of digestive cancers in the french county of Côte-d'Or enables a study of the treatment and prognosis of colorectal cancers. During 1976-1981, 587 rectal cancers and 717 colon cancers were diagnosed. Curative resection was performed in 61 p. 100 of rectal and colon cancers. Operative mortality after curative resection was 9.7 p. 100 for rectal cancers and 13.1 p. 100 for colon cancers. The overall 5 year observed survival rate was 26.5 p. 100 for rectal cancers and 29.8 p. 100 for colon cancers. After curative surgery, 5 year corrected survival rates was 57.2 p. 100 for rectal cancers and 66.9 p. 100 for colon cancers. Five year survival rate was related to the topography of the cancer (it was lower for caecal cancers), to the macroscopic type of growth (it was higher for exophytic carcinomas than for infiltrative carcinomas) and to the size (it was higher for tumors less than 3 cm than for larger tumors). The major determinant of the survival was the pathological stage of the tumor. Patients with Dukes' A lesions at the time of curative surgery had almost the same life expectancy as persons without rectum or colon cancer. These data suggest that a substantial improvement in prognosis might result from earlier diagnosis of the disease. This commands modifications in the policy of detection of colorectal cancers.