Acute appendicitis in pregnancy: specific features of diagnosis and treatment.

INTRODUCTION: Acute appendicitis is the most frequent surgical emergency arising during pregnancy. Definitive diagnosis is often difficult. The therapeutic options remain the same, i.e. appendectomy. PATIENTS AND METHODS: We present a series of 29 pregnant women who underwent surgery for acute appendicitis over a period of 10 years. The mean age was 28.6 years. Mean gravidity was 1.75 and mean parity was 0.84. The average period of gestation was 18 weeks and 5 days since the last menses. Seven patients underwent surgery during the 1st trimester, 15 during the 2nd trimester, and seven during the 3rd trimester. Eighteen patients underwent appendectomy through a laparoscopic approach and 11 through a McBurney incision. RESULTS: The postoperative course was uncomplicated in 27 patients. Two patients miscarried in the week following surgery. CONCLUSIONS: Acute appendicitis puts both maternal and fetal prognosis at risk. Management should be prompt and undertaken by a multidisciplinary team approach. Morbidity and mortality are not negligible.

[Survival and prognostic factors of colorectal adenocarcinoma: analytic multifactor review of 150 cases]. / Survie et facteurs pronostiques des adénocarcinomes colorectaux: étude analytique uni- et multifactorielle de 150 cas.

INTRODUCTION: Prognostic factors have a pivotal role in clinical oncology. They are helpful in the selection of treatment; provide insights into the disease process and the therapic response. The number of possibility useful prognosis factors in the colorectal cancer is large. This study attempts to observe the survival of colorectal adenocarcinoma and to find prognostic factors and other variables potentially associated with outcome of colorectal adenocarcinoma. MATERIAL AND METHODS: It's a retrospective study based on 150 patients with colorectal adenocarcinoma from 1990 to 2002. There were 150 patients aged of 58 years (median 61 years) with 1.4 sex-ratio. 84 patients had colon adenocarcinoma and 66 patients had rectal adenocarcinoma. In histological exam the adenocarcinoma was well differenced in 69 cases (46%), and undifferentiated in 17 cases (18, 3%). RESULTS: Locoregional extension was found in 18 cases and metastatic extension in 45 cases with hepatic metastasis in 37 cases and pulmonary metastasis in 8 cases. There were 6 cases of peritoneal localized carcinosis and 6 cases of ovary metastasis. There were 6 patients (4%) Dukes stage I TNM, 61 stage II (40, 7%), 51 stage III TNM (34%) and 32 patients stage IV TNM (34%). All patients had surgical curative resection associated with adjuvant chemotherapy in 60 cases of colon adenocarcinoma and preoperative radiotherapy in 33 cases of rectal adenocarcinoma. After a follow up of 46 months, 52 patients was died (10 operative mortality), 35 patients were lost of view and 63 patients were still alive at the point date. Median survival was 20 months with 95% confidence interval: (4, 2-7, 8). Overall one year and 5 years survival were respectively 92,8% and 26,3%. Various prognostic factors had been identified through univariate (Kaplan-Meier) then multivariate (Cox) analyze. In addition to the clinical factors, we found of significant prognostic value undifferentiated adenocarcinoma and an elevated value of serum carcinoembryonic antigen>5 ng/ml.