Diagnosis and management of adenocarcinoma of the ampulla of Vater during pregnancy.

BACKGROUND: Cancer of the biliary tract has a poor prognosis and its association with pregnancy is uncommon. Early diagnosis allowing curative surgical resection offers the only hope of long-term survival. CASE: This report describes the case of a young 26-week-pregnant woman admitted for cholestatis documented by clinical and laboratory examination. Ultrasonography (US) and magnetic resonance cholangiopancreatography (MRCP) were indicative of common bile tract obstruction. Caesarian section was performed at 32 weeks of pregnancy and the tumor was promptly biopsied. Histology demonstrated carcinoma of the ampulla of Vater. The patient underwent a Whipple procedure. Both mother and baby survived. CONCLUSION: Pregnant patients with digestive cancer require careful management. Acute non-invasive assessment and radical surgery improve outcome for both the mother and fetus.

Mechanically stapled esophagojejunostomy. Results of a prospective series of 176 cases.

BACKGROUND/AIMS: To evaluate the reliability of stapled esophagojejunostomy. MATERIAL AND METHODS: We studied a non-selected prospective series of 176 consecutive total gastrectomies (169 cancers, 7 benign pathologies). RESULTS: Hand-sewn esophagojejunostomy was performed 5 times after failure of the stapled esophagojejunostomy. There were fourteen hospital deaths (8%), and 63 patients (36%) presented complications. There were 5 anastomotic leaks (2.8%) but non were responsible for deaths. In these 5 cases, there had been an incident during construction of the esophagojejunostomy. Such an incident was the only significant risk factor for an anastomotic leak: 17% after an incident and 0% in the absence of an incident (p < 0.001). We observed no cases of anastomotic stricture. CONCLUSION: Stapled esophagojejunostomy is a reliable technique when technical precautions are taken. It is easier to reproduce than hand-sewn esophagojejunostomy and has demonstrated low specific morbidity and no direct mortality.

Comparative study of CYP1A1 induction by 3-methylcholanthrene in various human hepatic and epidermal cell types.

Hepatocytes and keratinocytes are among the most widely used cells in pharmaco-toxicology, but a limitation of these models is the provision of human tissues on a regular basis. The suitability of HepG2, HaCaT and HESV cell lines as an acceptable substitute for primary cultures was examined. In these cell types, the effects of 3-methylcholanthrene (3-MC) were analysed on CYP1A1 gene expression, a crucial CYP subfamily in the activation of chemical carcinogens. Ethoxyresorufin O-deethylase (EROD) activity was never detected in HESV cells, but in other cell types it was stimulated in a concentration-dependent manner (maximal induction, 1-2.5 mum). Above this peak induction the effect fell rapidly. Northern blot analysis of CYP1A1 mRNA agreed with the trends obtained for EROD values. However, the decrease of the EROD activity observed at the highest 3-MC concentrations was not correlated with CYP1A1 mRNA reduction. This study also demonstrated that 3-MC is capable of significantly inducing CYP1A1 in HaCaT cells (17-fold over control), as in human hepatocytes (six- to 18-fold) and HepG2 (fourfold). Therefore, in contrast to SV40-immortalized keratinocytes (HESV), spontaneously immortalized keratinocytes (HaCaT) may constitute a valuable tool for studying epidermal CYP1A1 gene regulation by xenobiotics.

Insecticide cytotoxicity and CYP1A1/2 induction in primary human and rat hepatocyte cultures.

With the increasing demand for insecticide products, the question of their safety has become one of the serious world public health concerns. The capability of compounds belonging to the major insecticide families [such as chlorinated hydrocarbons (DDT), carbamates (carbaryl: CBR), organophosphorus compounds (malathion, tetrachlorvinfos: MAL, TCV), pyrethroids (cypermethrin: CPR) and benzoylurea (diflubenzuron: DFU)] in inducing CYP1 Al in rat and human hepatocyte cultures has been tested. Cells were treated during 3 days with six non-toxic increasing doses of insecticides and CYP1A1 expression was assessed by ethoxyresorufin O-deethylase (EROD) activity and by Northern blots. A strong and dose-dependent induction was observed with TCV and DFU, both in human (approx. five- and sevenfold over control, respectively) and in rat hepatocytes (approx. sevenfold). However, EROD induction and CYP/A1 mRNA levels were correlated for DFU but not for TCV, suggesting different regulation mechanisms for PCYP1A1 gene expression by the two compounds. CBR and CPR exerted less induction in both cell types (approx. 2.5-fold induction compared with approximately 16-fold for 3-methylcholanthrene), whereas DDT and MAL showed no action on human hepatocytes but decreased EROD activity in rat cells. Finally, cytotoxicity studies performed using the MTT and the neutral red tests demonstrated significant differences between insecticides.

The value of splenectomy in chronic lymphocytic leukemia.

Between January 1, 1980, and July 31, 1985, 168 patients were treated at our institution for chronic lymphocytic leukemia (CLL). Splenectomy was performed on 32 (23 men and 9 women). The mean age of these surgical patients was 59.4 years (range, 43-75). Twenty-four patients had received chemotherapy and/or corticotherapy prior to surgery and 1 of these 24 also underwent splenic radiotherapy. The interval between diagnosis and splenectomy ranged from 1 to 108 months (mean, 33.6 months +/- 28.6). Before splenectomy, 9 patients had platelet counts greater than 100,000/mm3 (3 with normal counts), 18 had counts between 50,000 and 100,000/mm3, and 5 had less than 50,000/mm3. Seven patients had anemia with hemoglobin levels less than 10 g/dl (3 associated with thrombocytopenia); in the other 25 patients, hemoglobin levels were between 10 and 11 g/dl in 12 (9 associated with thrombocytopenia) and greater than 11 g/dl in 13. All patients but one had splenomegaly (mean spleen weight 1780 g +/- 938.7 range, 160-4300 g). One postoperative death was recorded. Postoperative morbidity occurred in 7 of 31 cases; severe infection was never observed. The average duration of hospitalization was 15 +/- 4.7 days (range, 9-28). Twenty-two of the 23 patients with thrombocytopenia less than 100,000/mm3 had complete remission after splenectomy. One had a partial remission that was later completed by means of drug therapy. Two patients relapsed within 6 months and one after 32 months. All but two cases of anemia responded to splenectomy; one patient relapsed. In 15 of 31 surviving patients, further treatment was required within a few weeks or months after surgery. Five patients died at 8, 17, 22, 26, and 35 months, respectively. The other 26 patients are alive and well with a mean follow-up of 34 months (range, 11-71 months). Splenectomy may be an effective treatment for CLL patients with splenomegaly, thrombocytopenia, and/or anemia.