Volume 72 - 2009 - Fasc.3 - Case series
Surgical management of hepatic metastases of colorectal origin
Colorectal cancer is the most frequent digestive cancer. Prognosis is greatly depending on the TNM stage at the time of diagnosis. Fifty percent of all patients shall develop, synchronous- ly or metachronously, liver metastases. Different means such as chemotherapy, targeted therapies, radiofrequency ablation, portal vein embolization and two-stage hepatectomy may be used to make these metastases eventually resectable and to increase overall sur- vival. This is a short review of these different methods used to increase resectability but also on the integration of these parame- ters in a larger approach of colorectal liver metastasis surgery especially insisting on multidisciplinary discussion. (Acta gastro- enterol. belg., 2009, 72, 321-326).
Osteonecrosis in Inflammatory Bowel Diseases : a review of the literature
Introduction : Osteonecrosis (ON) of the femoral head can lead to femoral head collapse, necessitating total hip replacement. Reports of patients suffering from both ON and Inflammatory Bowel Diseases (IBD) have prompted us to evaluate the relation- ship between ON and IBD, especially Crohn's disease and ulcera- tive colitis.
Methods : A review of the data from three new cases, along with data from all the published cases of patients presenting ON and IBD found through a systematic search of the Pub Med database.
Results : We encountered some diagnostic problems : The ON diagnosis could not be confirmed in some patients who did not meet the ON diagnostic criteria. Reviewed data was too weak to assess the exact incidence of ON in IBD. Corticosteroid therapy, especially in high dose regimens, is likely the most important etio- logical factor. No evidence supporting other physiopathological hypothesis, such as total parenteral nutrition, osteoporosis, or coagulation disorders, was found. Finally, the multifocal form of ON appears particularly common in IBD, with some patients pre- senting multiple lesions of the hip, shoulder, knee and talus.
Conclusions : ON in IBD, which is frequently multifocal, appears to be a complication of corticosteroid therapy, especially when high doses are used. We recommend regular ON checkups for corticosteroid-treated IBD patients. (Acta gastroenterol. belg., 2009, 72, 327-334).
