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Telemedicine offers new possibilities for multidisciplinary care of cancer patients, allowing direct communications between different, complementary and geographically distant specialists. Thus, it is possible to form oncology committees in small hospitals where all specialties are not represented. The purpose of this study was to evaluate the medical and economic impact of visioconferences in the therapeutic management of cancer patients without access to oncology centers.A telemedicine network was created in Paris between the General Surgery and Gastroenterology services of Rothschild Hospital and the services of Oncology at Saint-Antoine Hospital and Radiotherapy at Tenon Hospital. The three hospitals were connected simultaneously (multipoint) by visioconference and thus constituted a pluridisciplinary oncology committee of radiotherapy, chemotherapy and surgery. Eighty seven cases were evaluated in 27 staff conferences. In 48 cases, this consisted of re-evaluating therapeutic decisions made in surgery or gastroenterology, and in 39 cases opinions were requested by surgery (18), gastroenterology (14) or oncology departments (7).In only 34/87 cases therapeutic agreement was reached directly. The 53 other cases (60.9%) were debated. In fact, all 39 requests for opinion in difficult therapeutic decisions resulted in consensus. Among the 48 re-evaluations, disagreement persisted in one case between the surgeon in charge of the patient and the chemotherapist. Importantly, in 13 of 48 cases (27%), the discussion modified the therapeutic protocol initially proposed. The average cost was 118 French Francs per case and per center. Total initial investment was 334,762 French Francs, but the price of some equipment has already dropped from 30 to 60%.In our study, the visioconference improved management of cancer patients for a weak working cost.

This study was designed to establish a possible relationship between the pharmacokinetics of 5-FU and response to treatment. Thirteen patients with advanced, histologically proven malignancies of the gastrointestinal tract were studied. 5-FU, at a single weekly dose of 15 mg/kg, was given in bolus or as an 8-h infusion to every patient. Plasma clearance of 5-FU after an i.v. bolus injection of 15 mg/kg was individually determined and found to vary widely among patients (from 0.39 to 2.55 l/min). A clearance greater than or equal to 0.86 l/min was seen in all the patients who did not respond to treatment. All patients (except one) with a partial response or a stable disease had a clearance less than or equal to 0.72 l/min. The mean clearance of non-responders (1.40 +/- 0.21 l/min) was significantly greater (P less than 0.02) than that of partial responders or patients with stable disease (0.73 +/- 0.15 l/min). These preliminary results deserve further investigation on a larger number of patients, before plasma levels of 5-FU may be accepted as an indication of response to chemotherapy.

We report a case of gastrointestinal lymphomatous polyposis revealed by a rectal tumor. Numerous polypoid lesions, 5 to 20 mm in diameter, were found at various levels of the gastrointestinal tract. Microscopic examination of gastric, duodenal, colic and rectal specimens led to the diagnosis of small cleaved-cell type lymphoma. The immunohistochemical study showed a monotypic surface staining of the lymphomatous cells with anti-IgM, IgD, kappa, C3b, and CD5 antibodies. This type of lymphoma is rare and presents as multifocal polyposis of the gastrointestinal tract. Only histologic and immunohistologic studies can establish diagnosis. Gastrointestinal lymphomatous polyposis is classified as a low-grade malignant lymphoma, with frequent nodal, hepatosplenic, bone marrow, and blood involvement. Chemotherapy is the appropriate treatment.

The purpose of this prospective study was to evaluate the usefulness of carcinoembryonic antigen (CEA) assays in effusion fluids for the diagnosis of cancer. From 1978 to 1981, 63 patients totaling 67 effusions were investigated for malignant cells and CEA concentrations. There were 62 cases of ascites and 5 cases of pleural effusion resulting from 35 cirrhoses and 28 cancers, including 17 adenocarcinomas. Macroscopic examination of serous membranes was possible in 24 patients. CEA concentrations at least 4 times higher than the upper limit of normal laboratory values were required to diagnose malignancy in effusions. The specificity of both cytology and CEA assays was 100 p. 100 in cirrhotic ascites. Malignant cells were present in 14 cases and positive CEA levels in 19 cases. CEA concentrations were highly significant (p less than 0.001) of cancerous effusions due to adenocarcinomas. In cancers other than adenocarcinoma and in hepatocarcinoma, CEA assays did not prove useful, and cytological examination remained the best diagnostic method. Both cytology and CEA levels were positive for malignancy in 11 effusions, and a diagnosis of cancer could be made on these grounds in 22 out 28 cases. Lack of correlation between CEA concentrations in sera and in effusion fluids suggests local production consecutive to invasion of the serous membranes. All 8 adenocarcinoma patients with grossly detectable extension to the peritoneum had high CEA concentrations, but malignant cells were absent in 4 cases. This discrepancy might tentatively be explained by local dissemination via the lymphatic system without disruption of the membrane but resulting in reflux of CEA into the effusion fluid.(ABSTRACT TRUNCATED AT 250 WORDS)

An epidemiological survey, carried out from 1978 to 1982 in 460 public and private institutions randomly selected from all parts of France, provided an assessment of the activity performed in digestive surgery. The sample included 37,967 patients, yielding an annual estimation of 700,000 patients operated on in the entire country. Digestive surgery was the first surgical domain (20 p. 100 of the entire surgical activity); 51.5 p. 100 of the patients were males and 53 p. 100 were under 35 yr of age. The annual incidence of these operations was 1.3 per 100 population. The first reason for operation was appendicitis (43 p. 100), followed by hernia (17.2 p. 100), gallbladder and biliary tract (10 p. 100), and anal diseases (7.7 p. 100). Digestive cancers led to 32,000 operations each year, with a majority of colonic cancers (40 p. 100). Except for appendectomy and operations on the gallbladder and biliary tract, most procedures were more frequent in males, especially operations on the stomach and esophagus. Incidences of appendectomy, cholecystectomy, inguinal hernia repair and operations for digestive cancers were assessed by sex and age. Incidence of appendectomy was 3 to 4 times greater than in other countries. Intraoperative and immediate postoperative (less than 24 h) mortality was higher for digestive operations (4.7 p. 1000) than for surgery as a whole (2 p. 1000). It increased with age and was higher in males.

Endobiliairy tissue specimens were obtained for cytologic and histologic examinations at the site of stenosis after percutaneous biliary drainage or endoscopic retrograde sphincterotomy in 49 patients with benign (10 cases) or malignant (39 cases) biliary stricture. Final etiologic diagnosis was obtained by surgery (18 cases), autopsy (one case), aspiration cytology of metastasis (2 cases), serology (2 cases), and in 26 cases, was determined by the course and outcome of the disease. As the sensitivity of each method, cytology and histology, was weak, it was necessary to associate them to improve results. Accurate etiologic diagnosis was achieved in 77 p. 100 of cases. The specificity of the method was satisfactory and specimen examination allowed to correct and confirm the initial etiologic diagnosis in 12 and 65 p. 100 of cases, respectively. The specificity of the method and its low morbidity prompt us to recommend it during transhepatic or retrograde therapeutic drainage as it can serve as a guide for later treatment. On the other hand, achievement of a transhepatic drainage or an endoscopic sphincterotomy only to obtain endobiliairy tissue specimens means taking into account the poor sensitivity of the method and the complications inherent to transhepatic drainage and endoscopic sphincterotomy. The practice of obtaining specimens by the retrograde technique without sphincterotomy or under cholangioscopy should be developed.

A 35-year-old HIV positive patient with skin and gastrointestinal localization of a Kaposi's sarcoma was admitted for severe diffuse edema. Increased alpha-I-antitrypsin clearance (150 ml/24 h) allowed us to confirm the diagnosis of protein loosing enteropathy resulting from sarcoma infiltration in the stomach, the duodenum and the entire small bowel. At autopsy, ileal ulcerations were found. Gastrointestinal involvement occurring during Kaposi's sarcoma is common and usually symptomless. The discovery of a protein loosing enteropathy in our patient suggests that this gastrointestinal involvement could play a role in the hypoalbuminemia often found in these patients.