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The " Standards, Options and Recommendations " (SOR) project, started in 1993, is a collaboration between the Federation of French Cancer Centres (FNCLCC), the 20 French cancer centres, and specialists from French public universities, general hospitals and private clinics. The main objective is the development of clinical practice guidelines to improve the quality of health care and the outcome of cancer patients. The methodology is based on a literature review and critical appraisal by a multidisciplinary group of experts, with feedback from specialists in cancer care delivery. Objectives : To update the Standards, Options and Recommendations clinical practice guidelines for the management of ductal carcinoma in situ of the breast (DCIS). Methods : The working group identified the questions requiring up-dating from the previous guideline. Medline(r) and Embase(r) were searched using specific search strategies from year 1996 to year 2003. In addition several Internet sites were searched in October 2002. Results : Clinical guidelines have been defined for the management of diagnosis, treatment, follow-up, and treatment of recurrence of DCIS. The issue of hormone replacement therapy has also been addressed in the context of DCIS.

221 patients have been operated for chronic pancreatitis, secondary to alcoholic intoxication in 92% of cases. Surgery was performed for a complication of the disease (69%), for intractable pain (30%), or for a false diagnostic of cancer; 265 operations were done, among which 41% of resections, 18.5% of internal derivations, and 14.3% of external derivations. Post-operative morbidity was 23.4% and hospital mortality was 6.4%. Late mortality was 35.5%, pancreatitis being responsible for more than half of those deaths during the first three post-operative years. Iterative surgery was necessary in 37 cases. The risk of diabetes was multiplied by 3.2 after resection. Results were good in 50% of cases after 5 years. An important factor was the arrest of alcoholic intoxication. There was no significant difference between resection and derivation. Internal drainage should be preferred when possible. Surgery must be reserved to grave or invalidating complications of chronic pancreatitis.

272 cancers of the thoracic esophagus were resected on 664 cases observed from 1975 to 1985 (resection rate: 41 p.c.): 8.1 p.c. were on the upper third, 71.3 p.c. on the middle third, 20.6 p.c. on the lower third of the esophagus. Tumors were classified as stage I (12: 4.5 p.c.), II (40: 15.2 p.c.), III (100: 37.9 p.c.), IV (112: 42.2 p.c.); 8 cases were not classified. Post-operative radiotherapy was administered to 90 patients. Hospital mortality was 50 (18.4 p.c.). Respiratory complications were the main lethal cause. After a post-operative survival of 81.6 p.c., survival at 1 year was 58.3 p.c., at 3 years 23.3 p.c., at 5 years 9.8 p.c. Actuarial survival at 5 years is 11.1 p.c. +/- 3, 17.2 p.c. for T1 and T2, 8 p.c. for T3. No advantage was noted comparing neck or intrathoracic anastomosis. Post-operative irradiation was beneficial. Factors influencing survival are staging, curative or no curative resection and post-operative irradiation for T3 N+. Nodes invasion is more important than invasion of the site of anastomosis. Palliative resections are the majority. They have no more severity than curative resections and give a 10 p.c. 5 years survival. The main effort must bear on a decrease of post-operative pulmonary complications and mortality.

Seventy-two cases of diffuse pulmonary contusion, 50 of which concerned multiple injury patients, are retrospectively described. The pleuro-parietal and associated lesions, the clinical, radiological and laboratory findings and the extent of the damage are analyzed. Treatment of shock (50 cases), mechanical ventilation (51 cases), thoracotomy (7 cases) and surgery of associated lesions are studied. Morbidity and mortality (34.7%) are detailed. The nosology of pulmonary contusion is discussed in relation to several factors, including shock, perfusions and associated lesions. The principles of treatment are restated. The most important complication is pulmonary superinfection. Diffuse pulmonary contusion is a serious condition. Associated lesions and their treatment contribute to its outcome.

Treatment of duodenal ulcer disease with an anti-acid preparation significantly reduces early postoperative complications after simple suture of a perforation, in relation to the course of the disease. Future prognosis of the latter is unpredictable even when those parameters, normally considered as being important, are allowed for. Percentage recovery is comparable with or without cimetidine. Treatment proposed is a two-stage operative procedure: 1) treat the peritonitis; 2) conduct recovery surgery at a later stage for recurrent lesions or those resistant to medical treatment. This therapy is based on the belief that emergency conditions do not require a complicated procedure and that the latter is useless in 45% of cases, which cannot be predetermined. This attitude is reinforced by the working conditions and the increased postoperative safety after simple suture as a result of the use of cimetidine.