Thirteen-month registration of patients with gastroenteropancreatic endocrine tumours in France.

The prevalence, clinical profiles and management of gastroenteropancreatic endocrine tumours (GEP) in France are not known. From August 1, 2001 to September 1, 2002, standardized records on patients with GEP were prospectively completed in 87 participating centres. The total group amounted to 668 patients (median age: 56 years, range: 12-89). WHO performance status was 0/1 for 80.2% of patients. The primary sites were the small bowel and colon (288), pancreas (211), unknown (77), stomach (33), non-digestive primary sites (24), appendix (20), rectum-anus (12), and oesophagus or cardia (3). GEP were functional in 260 patients (39%). Most pancreatic tumours were non-functional (72%). Metastatic disease was observed in 73.4% of cases. Most tumours (85.8%) were well or moderately differentiated. Somatostatin receptor scintigraphy was performed in only 55% of patients. The following treatment modalities were employed: resection of primary tumour: 66%; systemic chemotherapy: 41%; somatostatin analogues: 44 and 26% for GEP of small intestine and pancreas, respectively; interferon: 12%, and intra-arterial hepatic (chemo)embolization in 23 and 15% of GEP arising from the midgut and pancreas, respectively. Despite their low prevalence, well-differentiated GEP represent a significant and heterogeneous clinical group, which warrants improved medical education, referral to expert centres at an early stage, and the design of prospective therapeutic trials.

Discordance between biochemical markers of liver activity and fibrosis (Actitest-Fibrotest) and liver biopsy in patients with chronic hepatitis C.

INTRODUCTION: The purpose of this clinical trial was to determine in routine practice and in comparison with liver biopsy the limitations of two blood tests, Actitest and Fibrotest, for the evaluation of hepatic activity and fibrosis in patients with chronic hepatitis C. METHODS: Routine blood tests, Actitest and Fibrotest, and liver biopsy were performed in 96 patients with chronic hepatitis C attending routine outpatient clinics. Receiver operating characteristics (ROC) curves were used to assess the diagnostic value of the biochemical tests in comparison with the METAVIR classification. RESULTS: The study population was predominantly male (63.5%) with a mean age of 48 years; 83.3% of the patients had genotype 1 hepatitis C virus infection. Treatment status was naive (62.5%), nonresponders (17.7%), relapsers (7.3%), or unknown (12.5%). The comparison of F0-F2 versus F3-F4 estimated the negative predictive value at 92% and the positive predictive value at 52% for a cut-off of 0.455. Discrepancies in activity score were more frequently due to a higher score of the biochemical test compared to biopsy (18 cases out of 19). Discrepancies for fibrosis were observed in 18 patients with a higher score for biochemical test in eight and a higher score for liver biopsy in 10 cases. A significant increase of gamma-glutamyl-transferase (GGT) (p=0.0001) and alanine aminotransferase (ALT) (p<0.0001) was observed in case of biochemical test overestimation of activity, and a significant increase of alpha2-macroglobulin (p=0.006) and GGT (p=0.018) in case of biochemical test overestimation of fibrosis. CONCLUSION: This prospective study confirms the good diagnostic value of biochemical tests for necrotico-inflammatory activity and fibrosis as compared with the histological analysis of liver biopsy. Clinicians must interpret Actitest and Fibrotest results with caution in patients with a significant elevation of ALT, and/or GGT and/or alpha2-macroglobulin which could overestimate hepatic injury.

Short-term effect of oestradiol on neurokinin B mRNA expression in the infundibular nucleus of ewes.

In sheep, essentially all the neurokinin B (NKB) neurones of the infundibular nucleus express oestradiol receptor alpha, and analysis of female and male brains has revealed an exceptionally marked female-dominant sex difference in the numbers of NKB neurones in the infundibular nucleus. This neuronal population is located in an oestradiol-sensitive brain area involved in the control of gonadotropin-releasing hormone (GnRH) secretion and oestrous behaviour, but its physiological role is poorly documented. The aim of the present study was to analyse NKB mRNA expression at a crucial time when the steroid has stimulated the pathways leading to the induction of these two events. After cloning a specific ovine NKB antisense riboprobe, we examined the effects of a short oestradiol treatment (4 h subcutaneously) on the expression of NKB mRNA in the caudal part of the infundibular nucleus of progesterone-primed ovariectomized ewes. We demonstrated that oestradiol decreased both the level of NKB mRNA expression (34%) and the number of cells containing NKB mRNA (43%). Oestradiol acts strongly on these NKB cells in the short term. We suggest that this early change in NKB mRNA expression during the preovulatory period might be involved in the control of the induction of GnRH secretion or oestrous behaviour.

[Muscular sarcoidosis: apropos of a case]. / La sarcoïdose musculaire: à propos d'un cas.

We report the case of a 75-year old woman presenting sarcoid myopathy with pseudohypertrophy and skin involvement. Muscular biopsy confirmed the diagnosis of sarcoidosis. Symptomatic muscle involvement in sarcoidosis is rare. Three forms are described: myopathic, myositic and nodular. The relevance of imaging techniques is reviewed. Treatment is based on corticotherapy which is less efficient in myopathic form and in this case we had to use methotrexate with success.

[Epidemiology and prevention of colorectal cancer]. / Epidémiologie et prévention du cancer colo-rectal.

Colorectal carcinoma is very common in western countries. It is in the front line of malignant pathology in France. The estimated number of new cases is almost 26,000 per year. The role played by diet in the onset of colorectal carcinomas is well established. The majority of studies indicate the protective role played by green vegetables. The role of other factors remains controversial: protective role of fibres, calcium and vitamins and favorizing role of fats, proteins, red meat, alcohol and calorie intake. The role of bile salts in increasing the size of adenomas and their malignant change is accepted. A number of therapeutic trials have involved modifications in bile salt concentrations. These should enable the proposal of a primary prevention strategy. The early detection of carcinomas and the secondary prevention of colorectal carcinoma (by detection of the adenomas which precede a high proportion of carcinomas) are areas of great interest. Detection of occult blood in stools as a mass screening test is currently being evaluated. Methods used to obtain a high participation rate among the population vary from one country to another, but are now well-defined. It will be necessary to wait for 2 years before being able to determine the effect on mortality and an even longer period to evaluate the effect on the incidence of colorectal carcinoma.

[Peristomal pyoderma gangrenosum after colectomy for Crohn disease. Successful medical treatment]. / Pyoderma gangrenosum péri-stomial après colectomie pour maladie de Crohn. Succès du traitement médical.

A case of Pyoderma gangrenosum with two different abdominal sites in a female patient suffering from colonic Crohn's disease is presented. Local trauma on the midline scar of an incisional hernia and around the stoma were the possible triggering factors. Despite the major abdominal wall defect and an infected parietal collection, steroid therapy was very effective without the need for surgery.

[Postoperative mortality for colorectal cancer in the Côte-d'Or (France) from 1976 to 1985]. / La mortalité opératoire par cancer colorectal dans le département de la Côte-d'Or entre 1976 et 1985.

Postoperative mortality from colorectal cancers in the resident population of the department of Côte-d'Or was studied for the 1976-1985 period through the data collected by the Registry of Digestive Tumors of the Côte-d'Or (France). The overall postoperative mortality was 14.7 percent for colonic cancers and 11.2 percent for rectal cancers. After surgery with curative intent (n = 1,411), the corresponding figures were 10.3 percent and 6.8 percent, respectively. In patients operated with curative intent, postoperative mortality was slightly less in females than in males (NS), and in patients less than 65 than in older patients (P less than 0.001). It was higher when cancer was discovered through an acute event (20.0 percent) than in the other patients (7.7 percent; P less than 0.001). Stage at diagnosis, gross macroscopical appearance, and tumour size had no influence on postoperative mortality for colonic cancers. For rectal cancers, postoperative mortality was lower in tumors less than 3 cm in diameter (1.3 percent) than in larger tumors (7.5 percent; P less than 0.05). Postoperative mortality decreased by a mean of 9.7 percent per year between 1976 and 1985 (P less than 0.001). This trend was more pronounced after curative surgery: 10.9 percent (P less than 0.001) than after palliative surgery: 5.5 percent (P less than 0.05). After curative surgery, postoperative mortality decreased more in men (annual variation: 13.9 percent; P less than 0.001) than in women (6.3 percent; NS), before age 75 (20.2 percent; P less than 0.001) than in older patients (5.6 percent; NS), and for colonic cancers (13.1 percent; P less than 0.001) than for rectal cancers (9.1 percent; NS).(ABSTRACT TRUNCATED AT 250 WORDS)

[Trends in the incidence of colorectal cancer at the Department of Côte-d'Or between 1976 and 1985]. / Evolution de l'incidence du cancer colo-rectal dans le département de la Côte-d'Or entre 1976 et 1985.

Colorectal cancer is the leading cause of cancer morbidity in France when both sexes are considered together. There are few available data on time trends, although such data would prove both necessary for planning screening programs and usefull to construct hypotheses on etiological factors. Data from the Registre des Tumeurs Digestives de Côte d'Or permitted to establish time trends for the different locations of colorectal cancer during the 1976-1985 period. Changes in incidence rates as based on the world reference population were studied using a log linear model as well as the Armitage test. Overall colon cancer rates have increased in both sexes. The mean annual increase of left colonic cancer was 3.1 p. 100 in men (p less than 0.05) and 4.0 p. 100 in women (NS), whereas rectal cancer decreased by 2.4 p. 100 in men and 3.3 p. 100 in women (NS). In men, left colonic cancer rates increased mainly in rural areas (+ 7.3 p. 100; p less than 0.05) whereas it increased mainly in urban areas in women (+ 6.0 p. 100; NS). In both sexes, the left colonic cancer increase was particularly noticeable in the 45-64 age group, which could indicate that the observed trend is likely to become more important in the next years. As for rectal cancer, the decrease was most important in the 65-74 age groups. That inversed trend for colon and rectum cancer has already been observed in other countries including the USA and Canada. As the trends we observed for right colon, left colon and rectal cancer differ, colorectal cancer etiology should be studied separately.

Altered peripheral nerve conduction in HIV-patients.

An electrophysiological study on peripheral nerves conduction was performed on HIV-seropositive patients without neurological signs on clinical examination. Eight of the 28 patients (28%) had an infraclinical neuropathy, which was myelinic or axonal and rather distal than proximal. The mechanism of these involvements is not known, but their early existence could justify an early treatment even for asymptomatic patients.

The role of glutathione in renal cortical tissue. Effects of diamide on Na+ and GSSG levels, amino acid transport and Na+-K+-ATPase activity.

The effects of diamide were studied in rat kidney cortical tissue. It was found that diamide increased oxidized glutathione levels and inhibited Na+-K+-ATPase activity. Consistent with this finding was the observation that diamide compromised the sodium gradients maintained in renal cortical slices. Amino acid transport studies with ouabain or a sodium-free buffer indicated that diamide interferes with both Na+-dependent and Na+-independent transport systems. These results indicate that diamide has a number of different effects on renal cortical tissue and emphasize the important role of glutathione in maintaining control of a number of key metabolic pathways.

[New molluscocid organophosphorous compounds]. / Nouveaux organophosphorés molluscocides

The authors show that, among the studied phosphoryl compounds, some dissymetric derivatives of the 2,4,5 trichlorophenol have an exceptional activity against the limneas, chosen as representatives of aquatic molluscs, and have, at the same time, a slight toxicity for mice and fish.