The European contribution to "Sugarbaker's protocol" for the treatment of colorectal peritoneal carcinomatosis.

INTRODUCTION: In 1981, Dr. PH Sugarbaker, challenging oncological orthodoxy, considered carcinomatosis to be a locoregional stage of the disease that was still susceptible to treatment with curative intent. To this end he developed a new therapeutic alternative based on the combined treatment. The macroscopic disease treated by maximum radical oncological cytoreductive surgery (through the peritonectomies described by him), followed by treatment of the residual microscopic disease with the direct intra-abdominal application of intraoperative chemotherapy with locoregional intensification, modulated by hyperthermia and early normothermic postoperative intra-abdominal chemotherapy. Using this new therapeutic regimen, known as "Sugarbaker s Protocol", his group has reported 45% survival rates in carcinomatosis of colorectal origin at 5 years, and, in selected groups of patients, 50% survival rates at 5 years. The scientific community, however, has criticized these results considering that: it is a personal experience, with a not homogenous treatment protocol with developmental modifications over time, that it is a retrospective non-randomized study, and finally that the cytostatics used in his protocol are obsolete. Various European groups have replied to these main criticisms confirming the good results that this new therapeutic alternative offers for patients with carcinomatosis of colorectal origin. The purpose of this article is to present these contributions. MATERIAL AND METHODS: All the articles published in the English language by European groups in the world s medical literature have been reviewed using the Pubmed-MEDLINE database to identify the relevant articles related to the treatment of carcinomatosis of colorectal origin using cytoreduction and intraperitoneal chemotherapy from January 1980 to January 2008. RESULTS: The European contribution during these 25 years in favour of the "Sugarbaker s Protocol" has consisted fundamentally in: a) one multicenter retrospective study; b) two randomized prospective phase III studies; and c) the use of oxaliplatin and irinotecan as new cytostatic agents in the protocols for intraperitoneal chemotherapy. At the same time, two new transcendental European contributions have been made in which the possibility has been considered of combined simultaneous treatment for patients with hepatic metastases and carcinomatosis, and the introduction, as a selection factor, of patients responsive to intravenous induction chemotherapy within the regimen of sandwich treatment (with systemic neoadjuvant and adjuvant chemotherapy) complementary to intraperitoneal chemotherapy. CONCLUSIONS: The results obtained by European groups using "Sugarbaker s protocol" and "Elias protocol" with oxaliplatin compel us to request that these treatments be considered by all professionals involved in the treatment of patients with colorectal carcinomatosis as the best treatment currently available for this condition. Furthermore a randomized, prospective, multicenter study should be carried out to clarify its value and the degree of scientific evidence. A validation of this treatment will change, in the future, the dogmatic consideration of carcinomatosis as an incurable disease stage.

Acrylamide-N,N'-methylenebisacrylamide silica glass holographic recording material.

In this paper, we describe a photopolymerizable silica glass based on acrylamide (AA) and N,N'-methylenebisacrylamide (BMA) as monomers, triethanolamine (TEA) as coinitiator and yellowish eosin (YE) as photoinitiator. We studied different compositions, analyzing the diffraction efficiency, energetic exposure and effective thickness obtained in the holographic gratings. A diffraction efficiency of 60 % with an energetic exposure of 139 mJ/cm(2) and an effective thickness of 1.1 mm were obtained. Also, by varying the photopolymerizable composition of the material diffraction efficiencies higher than 80 % can be reached with an energetic exposure of 10 mJ/cm(2) and an effective thickness of 113 microm. These values are similar to those obtained in conventional photopolymer systems in polyvinylalcohol and better than the values reached in other sol-gel compositions. Also, 9 holograms were angular multiplexed with diffraction efficiencies between 6 and 12 % and total exposure time shorter than 150 ms, with a dynamic range M/#= 2.4.

Multiplexed holographic gratings for fabricating 3D photonic crystals in BB640 photographic emulsions.

Three multiplexed holographic gratings were used to fabricate 3D photonic crystals without complete band gap using ultra-fine grain holographic emulsion as the storage material. Theoretical and experimental studies were carried out in order to characterize the crystals. Good agreement between theory and experimental results was obtained, showing that it is possible to obtain a band-pass filter for a fixed direction of illumination.

Purple membrane-polyacrilamide films as holographic recording materials.

The holographic parameters of purple membrane-polyacrylamide films obtained from a mutant form of Halobacterium salinarum (originally Halobacterium halobium) were measured. The synthesized films have an absorption of around 2.5 at 532 nm and a pH of 8.65. The results show that diffraction efficiencies of about 1.2 % (measured at 633 nm) can be achieved with writing intensities in the range of 200-400 mW/cm2 (532 nm), and these values remain constant after saturation. Pump-probe experiments were also used to measure the M state lifetime and our PM films were found to have the lowest M state lifetime described at this pH.

Anomalous D-Log E curve with high contrast developer Kodak D8 on ultra fine grain emulsion BB640.

D-Log E curves, also known as H-D curves, are used since the XIX century as a tool for describing the characteristics of silver halide emulsions. This curve has a very standard shape, with a linear region, a toe, a shoulder and a solarization region. In this work we present a distortion of the usual curve due to the action of a high contrast developer, Kodak D8, on an ultra fine grain emulsion, BB640\cite{ov04}. The solarization effect is replaced by a linear zone where developed densities increase with increasing exposures, until all silver halide present in the emulsion is reduced by developer D8 to metallic silver. Densities higher than 11 have been obtained.

Hemodynamic monitoring in a model of shock induced by intestinal reperfusion in the rat.

OBJECTIVE: An experimental model to monitor hemodynamics during intestinal reperfusion syndrome is presented. EXPERIMENTAL DESIGN: A) Three groups of rats were monitored during four hours: 1) CONTROL: sham operated, 2) Ischemic: clamping the superior mesenteric artery for 60' and 3) Saline: adding 2 ml of saline during the last 15' minutes of ischemia. Blood mean pressure, heart rate, breath rate and diuresis are monitored, while mortality is assessed 48 hours later, B) Blood gases, haematimetry and electrolytes were assessed both in control animals and in rats subjected to intestinal ischemia and reperfusion (at the beginning and concluding the ischemic period, and 5', 60' and 180' following reperfusion). RESULTS: Mortality rate was 0% for control animals, while 83% for both ischemic-reperfused groups (p < 0.01). Hemodynamic parameters remained stable during intestinal ischemia. Starting reperfusion, blood pressure and diuresis dropped sharply, while heart and breath rates showed a steady increase. The other parameters assessed also remained constant during ischemia. However, during reperfusion acidosis progressed (pH = 7.15, p < 0.01; HCO3 = 8, p < 0.01), hyperkalaemia appeared (6 mEq/l, p < 0.01), and haematocrit rose (56%, p < 0.01). CONCLUSION: This experimental model is easy to establish, allows an appropriate hemodynamic monitoring of shock during intestinal reperfusion syndrome, and seems appropriate for considering the impact of drug intervention.

Optimization of an acrylamide-based dry film used for holographic recording.

A study of the optimization and the characteristics of a dry film photopolymerizable recording material is presented. The effects of intensity, the thickness, and the variation of the concentration of each component have been studied. Diffraction efficiencies of 80%, with energetic sensitivities of 40 mJ/cm(2), have been obtained in photosensitive films of a 35-mum thickness with a spatial frequency of 1000 lines/mm.