Showing papers by "Marc Giovannini published in 2002"

A phase II single institutional experience with preoperative radiochemotherapy in pancreatic adenocarcinoma.

Abstract: Background : Resection of pancreatic adenocarcinoma has a limited impact on survival. We hypothesized that delivering preoperative radiochemotherapy (RTCT) might enhance local control of the cancer and improve survival. Methods : Nineteen patients with localized pancreatic cancer (14 head and 5 body) were treated during the past 4 years with an intramural protocol consisting of continuous infusion of fluorouracile (5-FU: 650 mg/m 2 /D1–D5 and D21–D25 and Cisplatin 80 mg/m 2 /bolus D2 and D22 with preoperative external beam radiotherapy (RT) (30 Gy split course RT or 45 Gy standard fractionation RT). Results : Four patients did not have surgical resection: Three patients were noted to have liver metastases and 1 patient developed peritoneal carcinomatosis. The remaining 15 patients had potentially curative resection (12 Whipple procedure and 3 distal subtotal pancreatectomy). There was no postoperative death. Pathologic findings showed five major responses including 2 patients with complete pathologic response. The overall median survival for the 19 study patients was 20 months. The median disease free and 2-year overall survival for the group with resection were 30 months and 52.3%. Conclusions : Preoperative RTCT followed by resection is well-tolerated and safe for patients with localized pancreatic cancer. Major histological response occurred for 25% of patients. This approach could offer improvement in patient survival.

Low‐grade rectal malt lymphoma occurring in a patient with chronic lymphocytic leukaemia

Abstract: The guidelines on oral anticoagulation from the Haemostasis and Thrombosis Task Force for the British Committee for Standards in Haematology (1998) recommended that, after dental extractions, prevention of bleeding can be achieved with oral tranexamic acid mouth rinse (4Æ8%) without dose modification of oral anticoagulants. However, tranexamic acid does not have a product licence in the UK (Evans et al, 2001) and a letter from the North-west Medicines Information Centre to the Deans of UK dental schools clearly states that tranexamic acid mouth rinse should not be used in primary dental care (Randall, 2001). To investigate whether warfarin can be continued during dental extractions, we performed a randomized controlled trial at Morriston Hospital in Swansea (Evans et al, 2002). The intervention group who continued on warfarin had a higher incidence of bleeding complications compared with the control group who stopped warfarin 2 days before extractions. However, this difference was not statistically significant. Furthermore, all but two patients controlled their minor postoperative bleeding by biting on gauze squares at home. In those two patients who attended hospital, the bleeding was stopped by local treatment of the extraction socket. Our study supports the recommendations of the Northwest Medicines Information Centre that warfarin does not need to be stopped before dental surgical procedures, providing the International Normalized Ratio of the patient is below 4. However, our study was performed in a hospital setting and it remains to be seen whether these findings can be translated to general dental practices.