Biomedical subjects

L Bosonnet

Publications and source records attributed to L Bosonnet.

3 recordsLinked to original sources

PubMed2003

Double resection for patients with pancreatic cancer and a second primary renal cell cancer.

BACKGROUND: Reports of synchronous or metachronous double kidney-pancreas cancers are very rare. METHODS: We present 2 patients with renal cell carcinoma and synchronous (1 patient) or metachronous (1 patient) primary pancreatic ductal adenocarcinoma. The patients underwent resection for both cancer types with a worthwhile outcome. RESULTS: The appearance of different primaries in an individual may indicate a genetic predisposition to different neoplasms. The study of double primary cancers is important because it might provide understanding of a shared genetic basis of different solid tumors. CONCLUSIONS: The association between these two cancers demands more detailed epidemiological and molecular investigation. From a clinical viewpoint a resectional policy is recommended.

Adenocarcinoma↗

PubMed2003

Pruritus: scratching the surface.

Patients who are jaundiced have an accumulation of bile acids in the plasma, which can cause intense irritation. Pruritus associated with cholestasis is a difficult problem; the pathogenesis remains unknown. In severe cases, it can lead to sleep deprivation and contribute to significant psychological disturbances. Patients who have pancreatic cancer with unrelieved jaundice often say the itching is the worst symptom. Typically patients are prescribed Chlorpheniramine, an antihistamine, and Choleystiramine, which binds bile salts in the bowel and helps to facilitate their excretion. Choleystiramine only works if biliary obstruction is incomplete; it is not very palatable and can cause diarrhoea. A review of the literature revealed that certain drugs not intended for the treatment of pruritus associated with malignant cholestasis eased the symptoms considerably. There was very little relating to skin care in the majority of articles dealing with pruritus. Twycross (1997, Introducing Palliative Care, pp. 112-114) stated that most patients with advanced cancer and pruritus may never need an antihistamine if given appropriate skin care and that drugs are of little use in isolation. A regime of skin care was devised with the main aim of keeping the skin moist and cool. Factors were identified that would alleviate or aggravate the skin surface. With prompt treatment, symptoms were reduced and in some cases eradicated completely. The information gained has led to the planning of a trial to determine efficacy of skin care management and different drug therapies to relieve debilitating pruritus when established treatments fail. Key points include: (1) treatment of pruritus associated with malignant disease is directed towards effective management of the underlying cause; (2) given the subjective nature of pruritus, it is poorly understood and management presents a challenging problem; and (3) effective skin management can help to alleviate debilitating symptoms. Certain drugs not intended for treatment of pruritus associated with malignant cholestasis have proven to be effective.

Biliary Tract Neoplasms↗

PubMed2002

Complications of pancreatic cancer resection.

Pancreatic cancer is a common cause of cancer death in the developed world. Currently, resection is the only chance of long-term survival. The post-operative mortality in nonspecialist centres often exceeds 20% but is around 6% or less in specialist centres. The overall complication rate even in specialist centres is 18-54%. An analysis of eleven large series of pancreatic resections shows an incidence of common complications of 10.4% for fistula, 9.9% for delayed gastric emptying, 4.8% for bleeding, 4.8% for wound infection and 3.8% for intra-abdominal abscess. The median hospital stay is 13-18 days in different series. The re-operation rate varies from 4 to 9% with a mortality rate of 23 to 67%. Major complications are a significant factor in post-operative mortality, especially if they require re-operation. The use of octreotide or somatostatin to prevent complications is supported by several multicentre, double-blind, randomized controlled trials. The best way to improve outcome is to concentrate pancreatic cancer care in regional specialist centres.

Anastomosis, Surgical↗