[Treatment of metastatic carcinoid tumors with interferon-alpha. Five cases]. / Traitement des tumeurs carcinoïdes métastatiques par interféron alpha. Cinq observations.

OBJECTIVE: Interferon has been proposed in treatment of metastatic carcinoid tumours with varied results. METHOD: Five patients with metastatic carcinoid tumours were treated for 1 year with rIFN alpha 2b at a dose of 5 MU. three times a week during the first month and 10 MU. three times a week during the following months. Carcinoid syndrome was present in all cases. RESULTS: Clinical response with improvement of diarrhoea and flushs was obtained in all cases. Urinary excretion of 5 HIAA and blood serotonin were reduced in 2/5 and 4/5 patients respectively. IFN treatment led to a stabilization of the metastatic tumour in all cases. Recurrence of symptoms was observed within three months following the end of the IFN treatment. CONCLUSION: These findings confirm the contribution of IFN in the treatment of metastatic carcinoid tumours.

Incidence of inflammatory bowel disease in northern France (1988-1990).

There were no data concerning the incidence of inflammatory bowel disease (IBD) in France. The aim of this study was to investigate the incidence of Crohn's disease and ulcerative colitis in northern France. This prospective population based study was realised through the gastroenterologists of the region Nord-Pas de Calais and the Somme Department. Each gastroenterologist referred patients consulting for the first time with clinical symptoms compatible with IBD. Data were collected by an interviewer practitioner present at the gastroenterologist's consulting room. Two independent expert gastroenterologists assessed each case in a blind manner and made a final diagnosis of Crohn's disease, ulcerative colitis, ulcerative proctitis, or unclassifiable chronic colitis. From 1988 to 1990, 1291 cases of IBD were recorded: 674 (52%) Crohn's disease, 466 (36%) ulcerative colitis including 162 proctitis (35%), and 151 (12%) unclassifiable chronic colitis. The mean annual incidence was 4.9 per 100,000 for Crohn's disease and 3.2 for ulcerative colitis. The sex ratio F/M was 1.3 for Crohn's disease and 0.8 for ulcerative colitis. The highest age specific incidence rate for Crohn's disease was between 20 and 29 years: 13.1 for women and 9.8 for men. The highest age specific incidence rate for ulcerative colitis was between 20 and 39 years: 5.5 for women and 6.5 for men. This first French prospective study has shown an incidence rate for Crohn's disease comparable with that seen in north European studies but lower than that seen for ulcerative colitis. These results could be related to the different environmental factors or the genetic background of the population studied, or both.

[Endoscopic sclerotherapy of hemorrhagic esophageal varices. 86 cases]. / Sclérose endoscopique des varices oesophagiennes hémorragiques. 86 observations.

OBJECTIVES: Haemorrhage due to rupture of oesophageal varices is a major cause of death in patients with cirrhosis. We evaluated retrospectively our results with endoscopic sclerosis in order to evaluate recurrence, compliance and long-term survival. METHODS: Endoscopic sclerosis was performed with a flexible endoscope in 86 patients from 1986 to 1989. Ninety-nine percent of the patients had cirrhosis; they were equally distributed in the 3 Child-Pugh classes. Sclerosis was performed once a week for three weeks then once every 3 weeks until eradication. Sessions was performed during an episode of haemorrhage in 17 patients and begun after bleeding had stopped in 69 others. Mean clinical follow-up was 24 +/- 14 months and mean endoscopic follow-up, 19 +/- 15 months. RESULTS: The mean number of sessions was 5.3 +/- 3.5 (range 1-17) per patient. Haemostasis was obtained in 4 out of 17 patients treated in emergency situations. Eradication was attained in 50 patients (58%). Recurrent varices were observed in 28 of these 50 and recurrent bleeding in 13, leading to 2 deaths. Global mortality over the period studied was 36%: 24 patients died before eradication, 7 after and 2 due to extra-hepatic causes. More than two-thirds of the deaths occurred during the first 2 months, mainly after recurrent bleeding. Global actuarial survival was 70% at 12 months, 62% at 24 months and 56% at 36 months. There was a significant difference in actuarial survival between Child-Pugh classes A and B patients and Child-Pugh class C patients. CONCLUSION: Our experience and the data in the literature indicate that sclerosis can be beneficial in patients with haemorrhagic oesophageal varices, but must be carried out within the framework of comprehensive care and follow-up.

[Hepatoid adenocarcinoma of the stomach]. / Adénocarcinome hépatoïde de l'estomac.

One year after gastric resection for cancer, a 67 year old patient was hospitalized because of a large hepatic tumor with extremely high serum alpha-foetoprotein levels (13,245 ng/ml). Histological and immunohistochemical studies of the gastric tumor revealed hepatoid foci with alpha-foetoprotein and protease inhibitor-producing cells. Histopathological and immunohistochemical features of this and the 8 previously reported cases of hepatoid adenocarcinoma of the stomach are analyzed.