Trends in incidence and management of cancer of the ampulla of Vater

AIM:To provide trends in incidence,management and survival of cancer of the ampulla of Vater in a welldefined French population.METHODS:Data were obtained from the populationbased digestive cancer registry of Burgundy over a34-year period.Age-standardized incidence rates were computed using the world standard population.Average annual variations in incidence rates were estimated using a poisson regression.A univariate and multivariate relative survival analysis was performed.RESULTS:Age-standardized incidence rates were0.46 and 0.30 per 100000 inhabitants for men and women,respectively.Incidence rate increased from0.26(1976-1984)to 0.58(2003-2009)for men and remained stable for women.Resection for cure was performed in 48.3%of cases.This proportion was stable over the study period.Among cases with curative resection,pancreatico-duodenectomy was performed in94.0%of cases and ampullectomy in 6.0%of cases.A total of 50.8%of cancers of the ampulla of Vater were diagnosed at an advanced stage.Their proportion remained stable throughout the study period.The overall1-and 5-year relative survival rates were 60.2%and27.7%,respectively.Relative survival did not vary over time.Treatment and stage at diagnosis were the most important determinants of survival.The 5-year relative survival rate was 41.5%after resection for cure,9.5%after palliative surgery and 6.7%after symptomatic treatment.In multivariate analysis,only stage at diagnosis significantly influenced the risk of death.CONCLUSION:Cancer of the ampulla of Vater is still uncommon,but its incidence increased for men in Burgundy.Diagnosis is often made at an advanced stage,dramatically worsening the prognosis.

Evaluation and Relevance of Indications for Primary Caesarean Section: A Five-Year Experience Report from Nevers Hospital Center

Context: The caesarean section rate continues to increase in our different health structures specially for women who have not had a scar in the uterus. Objectives: The aim of this study was to analyze the key factors and main indications for primary caesarean sections and to find ways to reduce the increasing rates. Patients and Method: This is a longitudinal and retrospective study carried out from June 1, 2018 to July 31, 2022. The study included all patients who had a cesarean-section for the first time (primary caesarean). An anterior uterine scar was a non-inclusion criterion. Data were collected prospectively using Synfonievre and Agopra software via patients’ files and information collection sheet. Data were analyzed with SPSS 21 software, Mac version. Averages were calculated for quantitative data and percentages for qualitative data. The statistical tests used were the Pearson Chi2 test. The observed differences were considered significant when the p-value was less than 0.05. Results: During the study period, we recorded 8832 deliveries and 3148 caesarean sections (35.6%). Primary CS concerned 70% of overall C-section rate. The main indications were FHR Fetal Heart Rate abnormalities (FHRA) (27%), followed by the other indications (including preterm delivery, umbilical cord dystocia, malpresentation of fetus, foetal abnormalities, elective CS, triple gestation, mother abnormalities);dystocia or prolonged labor (18.7%), breech presentation in a twin pregnancy with 11.3% and 9.6% respectively. We recorded more vaginal deliveries with labor induction: 81.4% against 75.2%. An obstetrical audit led to better labor management and a reduction in the cesarean section rate. Conclusion: We need to focus on diagnosis of fetal distress, management of breech presentation during of a twin birth and a singleton. Induction of labor can be an effective alternative in certain indications. An obstetrical audit is needed to reverse the caesarean section rate.

幽门肌切开术后“无限制原则”进食法的经验:对97例病例进行的回顾

A recent alternative feeding regimen at the progressive feeding (PF) after a pyloromyotomy for hypertrophic pyloric stenosis (HPS) is the so-called ad libitum feeding (AL).The aim of this study was to determine if this new feeding regimen has modified the follow-up of postoperative course in HPS.Population and methods.-From January 1998 to December 2003, 97 consecutive neonates have been operated on for HPS in our hospital.This retrospective study was based on the comparison between two groups of patients with different postoperative feeding regimens: group one of 30 neonates with PF regimen and group two of 60 neonates with AL regimen.Seven remaining neonates had had a mucosal perforation and were not included in this comparative study but in a separate group (MP).The clinical, ultrasonographic, operative and postoperative data were compared.Results.-There was no difference between the PF and AL groups for sex ratio M/F = 4/1, preoperative weight loss ratio, ultrasonographic data and intra-operative difficulties rate.A small difference was found -which was not significative -between the PF and the AL groups for median age at diagnosis (44,6 ν36,7 days, respectively).A statistically significative difference between the PF and the AL groups was observed for time to establish feeding (69 vs 35.6 hours, respectively) (P < 0,001), postoperative stay (4.16 vs 2.98 days, respectively) (P < 0,001) and total hospital charges.We didn’t found any difference in the incidence and severity of postoperative emesis whether slow (PF) or rapid (AL) feeding regimens were used.Furthermore, intra-operative mucosal tear didn’t influence postoperative course and the duration of hospital stay.Conclusion.-We recommend AL regimen for routine feeding in simple cases after pyloromyotomy for HPS.It has a positive impact on length of hospital stay, and decreases hospital charges.Most neonates with MP can be managed with a rapid feeding regimen.

儿童急性阑尾炎:病史和临床表现是否存在相关性

Diagnosis of appendicitis in children represents a continuing diagnostic dilemma for emergency room physicians and paediatric surgeons.If unnecessary surgery should be avoided, delayed diagnosis and treatment of appendicitis is responsible for complications.Use of a diagnostic clinical score may improve the management of the children with abdominal pain.A prospective evaluation of an appendicitis score is presented and discussed.