Chemotherapy for colon cancer in a well-defined French population: is it under- or over-prescribed?

BACKGROUND: It has been demonstrated that adjuvant chemotherapy in TNM stage III and palliative chemotherapy are effective treatments for colon cancer. AIM: To determine changes over a 10-year period in the practice of adjuvant and palliative chemotherapy for colon cancer in a well-defined French population. METHODS: Some 4093 patients with colon adenocarcinoma diagnosed between 1989 and 1998 were studied. To estimate the independent effect of the studied variables, a non-conditional logistical regression was performed. RESULTS: The proportion of patients with stage II disease treated with adjuvant chemotherapy increased from 2.3% (1989-90) to 20.5% (1997-98). The corresponding figures for stage III patients were 7.1% and 54.9%. This increase was particularly marked in younger patients, with 47.3% of stage II and 86.1% of stage III patients under the age of 65 years being treated in the 1997-98 period, compared with 4.9% and 24.4% of those over 75 years for the same period (P < 0.0001). The use of palliative chemotherapy increased over time from 13.6% (1989-90) to 38.9% (1997-98). Again, this increase was more dramatic in the younger age group. CONCLUSIONS: The use of adjuvant chemotherapy has increased for stage II disease despite the absence of proven effectiveness. Both adjuvant and palliative chemotherapy are still under-prescribed in patients over the age of 75 years.

[Disposable versus reusable biopsy forceps. A prospective cost analysis in the gastrointestinal endoscopy unit of the Dijon University Hospital]. / Pinces à biopsie jetables versus réutilisables. Evaluation économique prospective dan l'unité d'endoscopic digestive du CHU de Dijon.

AIMS: The goal of this study was to compare the cost of a biopsy session performed with a disposable and a reusable endoscopic biopsy forceps. MATERIAL AND METHODS: Over a 10-month period, 15 new reusable forceps (10 gastric and 5 colonic) were prospectively tracked. A biopsy session performed with a reusable forceps included its current purchase price, the sterilization cost and the number of uses. A biopsy session performed with a disposable forceps was calculated with its current purchase price and its incineration cost. RESULTS: At the end of the study, only one reusable forceps had broken and the number of uses was 65. The cost of a biopsy session performed with a gastric reusable forceps was euro 7.52 (including euro 1.92 of sterilization cost) and euro 8.67 for a reusable colonic forceps (with the same sterilization cost). The cost of a biopsy session performed with a gastric or a colonic disposable forceps was euro 11.98. From 44 uses for a colonic forceps and 37 uses for a gastric one, a biopsy session performed with a reusable forceps was already cheaper. CONCLUSION: In this study, a biopsy session performed with a reusable forceps was less expensive than with a disposable one. However, the extra cost generated by the disposable forceps may be offset by an easier inventory control and the reduction of the cross contamination risk.

Relationships between haemodynamic alterations and the development of ascites or refractory ascites in patients with cirrhosis.

OBJECTIVE: In patients with cirrhosis, the relationships between haemodynamic alterations and the development of ascites or the occurrence of refractory ascites are unknown. The aim of the present study was to compare haemodynamic measurements obtained in patients with non-refractory ascites to haemodynamic measurements obtained in patients without ascites and in patients with refractory ascites. METHODS: A cohort of 121 patients was prospectively studied, of whom 29 patients did not have ascites, 45 had non-refractory ascites and 47 had refractory ascites. Splanchnic, renal and systemic haemodynamics were measured in all patients. RESULTS: The hepatic venous pressure gradient was significantly higher in patients with non-refractory ascites than in patients without ascites (18.5 +/- 0.8 mmHg versus 15.8 +/- 0.7 mmHg). Renal and systemic haemodynamics did not significantly differ between patients with non-refractory ascites and patients without ascites. The glomerular filtration rate and renal blood flow were significantly lower in patients with refractory ascites than in patients with non-refractory ascites (77 +/- 4 versus 107 +/- 5 ml/min and 867 +/- 62 versus 1,008 +/- 68 ml/min, respectively). Splanchnic and systemic haemodynamics did not significantly differ between patients with refractory ascites and patients with non-refractory ascites. CONCLUSIONS: In patients with cirrhosis, an increase in portal hypertension was the sole haemodynamic alteration related to the development of ascites. Renal vasoconstriction (and subsequent renal hypoperfusion and hypofiltration) was the only haemodynamic alteration related to the occurrence of refractory ascites. The development of ascites or refractory ascites was not associated with any alteration in systemic haemodynamics.

Colorectal cancer prevalence in France.

Cancer prevalence is a crucial indicator that allows the magnitude of the problem of colorectal cancer to be monitored. Population-based cancer registries with long-standing activity are the most appropriate tools for providing prevalence data. All colorectal cases registered between 1976 and 1995 in the Côte d'Or Cancer Registry have been considered in this study. Total prevalence (20 years) was the number of patients with a previously diagnosed colorectal cancer, alive on 31 December 1995. Cumulative recurrence rates up to 5 years after diagnosis were calculated and applied to the number of prevalent cases to estimate the number of recurrences by one-year intervals up to 5 years. The overall age-standardized prevalence rate was 170.8/100000, which yielded an estimated 185857 French people alive with a history of colorectal cancer. The 5-year prevalence rates were 149.4/100000, which represented 46.4% of prevalent cases. Five-year prevalence rates regularly increased with periods of diagnosis. These results represent useful indicators for monitoring the colorectal cancer problem and for health care planning.

[Febrile cytolysis disclosing hemorrhagic fever with renal syndrome]. / Cytolyse fébrile révélatrice d'une fièvre hémorragique avec syndrome rénal.

We report the case of a 40-year-old-man who developed febrile cytolysis as the presenting sign of hemorragic fever with renal syndrome (HFRS). On admission, he had fever (40 degrees C) and epigastric pain. The AST level was at 2N, the ALT at 3N. There was a thrombocytopenia (61 000/mm(3)) without anemia or hyperleukocytosis. Three days after admission, the platelet count decreased to 40 000/mm(3), serum urea and creatinine increased from normal rate to 10.8mmol/l, 204.0 micromol/l, respectively. The HIV, HBV, HCV, leptospirosis antibodies were negative. The Hantavirus serology was positive (Ig G: 1/512). This case suggests that HFRS should be entertained as a possible cause of cytolysis with thrombocytopenia in patients with fever and no initial sign of renal involvement in North-Eastern France.

[The characteristics of patients with hepatitis C virus antibodies followed in specialized university hospital units are different from those of patients in the general population. The Research Group of the REBOHC]. / Les caractéristiques des malades ayant des anticorps dirigés contre le virus de l'hépatite C sont différentes en service spécialisé hospitalo-universitaire et dans la population générale. Groupe de Recherche du REBOHC.

OBJECTIVES: To compare the characteristics of patients with anti-hepatitis C virus antibodies followed in a University Hospital Department of Hepatogastroenterology with those in patients who received medical care elsewhere. METHODS: Since 1994, a specialized viral hepatitis register has recorded since 1994 all new cases of anti-hepatitis C virus antibodies diagnosed in inhabitants of the French department of Côte-d'Or (493931). The factors correlated with the type of medical care in patients followed in the University Department were studied by logistical regression. RESULTS: One hundred of the 498 new patients with anti-hepatitis C virus antibodies diagnosed in the Côte-d'Or between 1994 and 1996 were followed in a University Hospital Department. Multivariate analysis showed that age (<60), contamination due to transfusion, elevated ALT levels and no excessive alcohol consumption were factors significantly correlated with follow-up at the University Department. Liver biopsy was more often performed (66%) and a treatment was more often prescribed (34%) in patients followed in a University Department of Hepatogastroenterology patients than in other patients (20.4%; P <0.0001 et 7.5%; P <0.0001 respectively). CONCLUSIONS: This study shows that patients with anti-hepatitis C virus antibodies who are followed by a specialised University Department are a selected group; these patients are more likely to be treated than others. This study emphasizes that the greatest care must be taken when extending the extension of results of hospital series to a non-selected population.

[Incidence of treatment modalities for cancer of the small intestine in Burgundy (France)]. / Incidence et modalités de la prise en charge des cancers de l'intestin grêle en Bourgogne.

AIMS: To determine the epidemiological characteristics and management of cancers of the small bowel, on a population-based survey. METHODS: The registry of digestive tumors of Burgundy recorded all new cases of cancers of the small intestine in the departments of Côte d'Or and Saône et Loire (1,052,000 inhabitants). RESULTS: Two hundred and ten new cases of malignant tumors of the small intestine were recorded between 1976 and 1995 including 4 main histological types: adenocarcinomas (39.5%), carcinoids (26.2%), lymphomas (18.6%) and sarcomas (10.5%). Age-standardized incidence rates for males and females were respectively 8.8 and 5.6 per 1,000,000 inhabitants. There was evidence of lymph node invasion in 29.5% and visceral metastasis in 31.4%. Treatment was primarily surgical (90.5%), with a post-operative death rate of 17.1%. The rate of curative surgery remained constant over time, averaging 58.6%, 20% of the patients underwent chemotherapy, with a high proportion of lymphomas, often in association with surgery. The relative survival rates at 1, 3 and 5 years were 51.2, 38.3 and 32.7%, respectively. The multivariate analysis showed that survival was linked to age, and strongly to histological type and stage of diagnosis. CONCLUSION: Cancers of the small intestine are an heterogeneous group of rare tumors, often diagnosed at advanced stage. No significant improvement has been achieved in their management over the past 20 years.