[Role of pelvic exenterations in the treatment of cervix cancers. Apropos of 41 surgically treated cases]. / La place des exentérations pelviennes dans le traitement des récidives des cancers du col utérin. A propos de 41 cas opérés.

The Department of surgical oncology of the Paul-Strauss Cancer Center of Strasbourg (France) reports its experience about pelvic exenterations in recurrent cervix carcinomas. Based on a series of 41 cases (median age: 48.5 years), all patients, but one, have been primarily treated by sole external beam irradiation or surgery combined with radiotherapy. Salvage ultraradical surgical procedures were total (25 cases), anterior (7 cases) and posterior exenterations (9 cases). Overall 5 and 10 years crude survival were 39 and 27.5%, respectively. Advances in surgical procedures, new developments in techniques of pelvic floor reconstruction and improvement in devices of urinary diversions have mainly contributed to a decrease of postoperative morbidity associated with the obtaining of long survivals in selected patients previously treated, in a curative intent, by other therapeutic modalities. The current place of palliative pelvic exenterations and the support of intraoperative radiotherapy are discussed according to recent literature data.

[Prevention of radiation injuries of the small intestine with pelvic exclusion by polyglactin 910 mesh. Contribution to gynecologic and digestive cancer surgery]. / Prévention des radiolésions du grêle avec exclusion pelvienne par un treillis de polyglactine 910. Application en chirurgie cancérologique gynécologique et digestive.

Used in 13 cases of advanced gynecological and gastrointestinal carcinoma, pelvic exclusion using a suspension of the small intestine above the pelvis using absorbable material. The low-level of morbidity, value in dosimetric estimation, perfect feasibility and low cost of this technique should lead to its more widespread use whilst strictly respecting its indications. Nuclear magnetic resonance has been found to be a particularity novel and valuable method of post-operative investigation in visualisation and assessment of resorption of the polyglactine 910 trellis. Results in this series are analyzed at the end of a 5 to 14 month follow-up period and compared with data from experimental and clinical studies in the recent world literature.

Low dose heparin versus low molecular weight heparin (Kabi 2165, Fragmin) in the prophylaxis of thromboembolic complications of abdominal oncological surgery.

Eighty patients undergoing pelvic or abdominal surgery for cancer were randomized in two groups for prevention of postoperative thromboembolism: 40 patients received a 15,000 IU day-1 Calciparine prophylaxis and 40 patients a 5000 anti-Xa U/d Fragmin prophylaxis for 10 days. In the Calciparine group, two patients (5%) developed postoperative pulmonary embolism but none developed it in the Fragmin group. Two patients in the Fragmin group (5%) developed isotopic DVT, which was not confirmed by phlebography. There was no deep vein thrombosis of the lower limbs in the two groups. Important postoperative bleeding (one patient in the Calciparine group and two patients in the Fragmin group) was similar in both groups. Moderate and minor bleeding were significantly lower in the Fragmin group. Haemoglobin and haematocrit changes, total blood loss and transfusion requirements were not different in both groups. It is concluded that, over a 10-day period, one daily 5000 U Fragmin prophylaxis was as effective and safe as three daily 5000 IU Calciparine injections.

[Spontaneous regression of pulmonary metastasis of cancer of the kidney. Apropos of a case occurring after the irradiation of a pelvic metastasis. Review of the literature]. / Régression spontanée de métastases pulmonaires de cancer du rein. A propos d'un cas survenu après irradiation d'une métastase pelvienne. Revue de la littérature.

Spontaneous regression of metastases from cancer of kidney is an exceptional event, original but non-specific to this neoplasm. Observed principally in secondary pulmonary localizations this phenomenon occurs most frequently after nephrectomy. A personal case is presented of regression of pulmonary images considered as being metastatic after irradiation of a pelvic metastasis from renal adenocarcinoma, and a literature review carried out. The various pathogenic hypotheses are discussed and the place of nephrectomy for metastatic renal cancer (Robson's stage IV) debated.

[Preliminary results of a randomized trial comparing the efficacy of standard heparin with that of fragmine, a low molecular weight heparin, in the prevention of postoperative thrombosis in cancer surgery]. / Résultats préliminaires d'un essai randomisé comparant l'efficacité d'une héparine standard à celle de la fragmine, une héparine de bas poids moléculaire, dans la prophylaxie des thromboses post-opératoires en chirurgie oncologique.

Low molecular weight heparins have stimulated much interest because of their supposedly more selective action on Xa factor. A randomized study in 50 patients compared efficacy of low doses of a standard heparin, calciparin (5,000 IU/8 h) with that of a low molecular weight heparin, fragmine (Kabi 2165) (5,000 anti-Xa U/24 h), in the prophylaxis of postoperative thrombosis after oncologic surgery. Three of 25 patients receiving calciparin developed pulmonary embolism, as against one of 25 treated with fragmine who developed a periphlebitis. Hemorrhagic complications were comparable in the two groups. Anti-Xa activity was significantly higher in the fragmine group, whereas platelet counts, cephalin times with activator and anti-IIa activity were similar. These findings indicate equal efficacy of fragmine and calciparin in the prophylaxis of post-oncology surgery venous thrombosis.

[Comparative study about the analgesic effect of buprenorphine (author's transl)]. / Etude sur l'efficacité analgésique de la buprénorphine.

In that study we compared the analgesic effects of equianalgesic doses of buprenorphine and morphine taken as the narcotic of reference. The experiment has been undertaken in ten adults having severe cancer pain. The results have been analysed by statistical non parametric tests. We found that buprenorphine and morphine have the same pattern of action despite the fact that intramuscular buprenorphine has a clinical duration of approximately 9 hours.