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Raman spectroscopy has been recognised as a valuable analytical tool in biological and medical research. This technique allows probing molecular vibrations of samples without external labels or extensive preparation. This non-destructive optical technique can provide rapid and objective and reproducible measurements of sample biochemistry and identify variations that occur between healthy and diseased tissues. In fact, biochemical changes within tissue may either initiate disease or occur as a result of the disease process. The qualitative analysis of such changes provides important clues in the search for a specific diagnosis and the quantitative analysis of biochemical abnormalities is important in measuring the extent of the disease process, designing therapy and evaluating the efficacy of treatment. In this paper, we discuss one medical application of near-infrared Raman microspectroscopic imaging as a diagnostic tool to investigate, ex vivo, the changes between normal and adenocarcinomatous human colonic tissues. Multivariate statistical analysis was applied on these measured data to identify the molecular composition and distribution of lipids, proteins, mucus and collagens in normal and malignant tissue. Unsupervised hierarchical cluster analysis shows two unsupervised distinct clusters that were assigned to normal and adenocarcinomatous in accordance with conventional histopathological examination. The spectral images allowed good correlation between pseudo-color Raman and histopathological features.

We report two observations of malignant gastric and pancreatic tumors with choroid metastasis. Clinical course was rapidly and spontaneously unfavorable.

The authors report about 3 cases of bovis endocarditis revealing a colic carcinoma. This morbidity confirms the need for routine digestive investigations in endocarditis due to group D streptococci and eventually a liver disease.

Surgery remains the ideal emergency treatment for biliary lithiasis in elderly subjects despite perioperative morbidity and mortality. Minimally invasive techniques appear promising but require assessment. The aim of this work was to determine the usefulness of these techniques and evaluate outcome in a series of 157 patients over 75 years of age who were hospitalized in an emergency setting of complicated biliary lithiasis from January 1990 to December 1996. There were 103 women and 54 men, mean age 82 years. The patients' general status was evaluated according to the ASA classification; 66% of the patients were ASA III, IV or V. Diagnoses at admission were acute cholecystitis (n = 71, 45%), angiocholitis (n = 50, 31%) subintrant hepatic colic (n = 17, 10.8%), pancreatitis (n = 10, 6%), isolated jaundice (n = 2), peritonitis (n = 2) and occlusion (n = 5). Within 24 hours of admission, 7 patients underwent emergency surgery, and the 150 others were given medical treatment. Among these 150 patients, cure was considered to have been achieved with medical treatment alone in 41 (subsequent surgery being required in only one 6 months later), semi-emergency was performed in 17, and a minimally invasive procedure was performed in the 92 others (echo-guided percutaneous cholecystostomy in 42, endoscopic sphincterotomy in 50) followed by a subsequent operation in 29. In the 103 patients (65.5%) in this series who did not undergo surgery, mortality was 3.8% and in the 54 patients (34.5%) who did, mortality was 15%, but this rate was only 6.9% when the open procedure followed a minimally invasive technique. Surgical treatment of complicated biliary disease remains the ideal therapy but indications should be carefully weighed in these elderly fragilized subjects. Under surgical observation, abstention from surgery or use of minimally invasive techniques can play an important role in the therapeutic strategy aimed at lowering perioperative mortality.

The authors report the results and indications of 160 Hartmann's procedures performed over a period of 15 years. Between 1978 and 1992, 160 patients (90 males, 70 females), with a mean age of 72, underwent Hartmann's procedure for rectosigmoid carcinoma in 55% of cases, for complications of sigmoid diverticulitis in 36% and for other lesions in 14%. Hartmann's procedure was performed either electively (42%) or as an emergency (58%) with a mortality of 6% and 32% respectively. The majority of complications included wound infections or intraperitoneal abscess, and the overall morbidity was 30%. Re-establishment of bowel continuity was performed in 30.7% of patients, most of whom had been initially operated as an emergency for a benign lesion. These 160 cases of Hartmann's procedure represent 27% of the 590 operations performed during the same period as an emergency or electively for rectosigmoid lesion. Hartmann's procedure remains a most effective technique for emergency surgery for benign or malignant lesions with colonic septic complications, and is also indicated electively for palliative treatment of rectosigmoid carcinoma.

Between January 1, 1984 and December 31, 1993, we treated 191 patients with diverticular sigmoiditis. Three groups of patients were distinguished in this retrospective study. In group 1, there were 108 patients (56.5%) who were referred by gastroenterologists after one or two episodes of sigmoiditis and who underwent planned exeresis. In group 2, there were 42 patients (21.9%) in whom the sigmoiditis was revealed by a complication and who underwent and emergency procedure. In group 3, there were 41 patients (21.6%) over 70 years of age with major risk for anesthesia and/or surgery who were treated medically. Mortality, morbidity and duration of hospital stay were analyzed by group. Operative mortality was 0.92, 19 and 7.3% respectively. Operative morbidity among the survivors was 21 and 35% in groups 1 and 2 respectively. Mean hospital stay varied from 15 days for planned procedures up to 20 days for emergency surgery. It was 9 days in group III. These findings recall the need for radical preventive exeresis for diverticular sigmoiditis.