Search

Background and Aim: Recurrence in oesophageal cancer continues to remain high after curative surgery. The aim of this study was to determine the presence of recurrence after curative surgery during follow-up, and the associated variables., Methods: A retrospective and prospective follow-up study in patients with an anatomical-pathological diagnosis of oesophageal cancer who underwent curative surgery (n = 57) in the health district of A Coruña (Spain) during the period 2003-2008. The calculation of recurrence-free survival was made using a competing risks survival analysis., Results: Out of the 57 patients included in the study, 87.7% were men with a mean age of 61.4 ± 10.3 years. The median follow-up period was 18.5 months, during which 28 recurrences were detected (50.9%). Patients with dysphagia on diagnosis of the disease, as well as patients in stages III-IV, have a higher probability of recurrence during the follow-up period. The median disease-free interval was 8.5 months. After one year of follow up, 57.1% of the recurrences were diagnosed and 82.1% after 2 years of followup. The median post-recurrence survival rate was 4.7 months. After adjusting for a multivariate regression model, the variable with an independent effect for predicting recurrence is the TNM classification (HR = 8.49)., Conclusions: The majority of the recurrences will be developed during the 2 years after surgery, with a very poor prognosis. The predictor variable for recurrence is the TMN classification.

Objective: To analyse the presentation forms and prognosis of patients with advanced gastric cancer at the time of diagnosis., Design: Retrospective cohort study., Patients and Methods: We studied all patients with gastric cancer (n=2,334) and synchronic metastases diagnosed in Lugo and A Coruña hospitals between 1975 and 1993. We estimated survival probability using the Kaplan-Meier method, and prognostic factors with Cox's regression models., Results: Metastases were detected at the time of diagnosis in 585 (25.1%) patients, with the liver (346; 14.8%) and peritoneum (61; 6.9%) being the most frequently involved sites. The liver was exclusively affected in 213 (9.1%) cases, the peritoneum in 70 (3.3%), and another intraabdominal site in 121 (5.2%). Patients with peritoneal metastases were older (p=0.05), more commonly had a diffuse type of cancer according to Lauren's tumor classification (p<0.001), and underwent surgery more frequently (p=0.01). Curative resection was possible for only 11 (5.2%), 7 (10%), and 25 (20.7%) patients with metastases in only the liver, peritoneum, or another site, respectively, but in all cases survival probability was significantly enhanced. No surgery (HR=2.92), and simultaneous involvement of the liver and peritoneum (HR=1.62) were factors associated with a higher mortality rate., Conclusions: Patients with gastric cancer and metastases in only one intraabdominal organ show characteristic forms of presentation. Furthermore, in all cases candidacy for surgery should be carefully evaluated, as prognosis may improve in selected patients.

Objective: To determine the usefulness of different intensities of follow up when atorvastatin is used in the secondary prevention of ischemic heart disease., Material and Methods: Design. Prospective study with balanced randomized allocation including a concurrent control group., Setting: Ambulatory care., Patients: 75 patients hospitalized because of acute coronary syndromes were administered atorvastatin as secondary prevention of ischemic heart disease and randomized either to intensive follow up or to a control visit 6 months apart., Interventions: The intensive follow up group (40 patients) was controlled every 2 months as outpatients and a physical examine and lipid profile was done, enhancing diet and exercise and adjusting the statin dose. The control group was evaluated just once after a 6 six month period., Results: 88% were males and the average age was 63.7 +/- 10 year. Basal characteristics, myocardial infarction, revascularized procedures and initial chemistry and lipid profile were similar in both groups, although there was a higher proportion of patients in the control group taking ACE. After 6 months total cholesterol, LDL cholesterol and triglycerides reduction was higher in the intensive follow up group (33 vs. 24, 34 vs. 26 y 51 vs. 24 mg/dl, respectively) without realising statistical significance. Hospital readmissions were lesser in the intensive group (7.3% vs. 19.4%, P = 0.114). There was one death in each group., Conclusions: Results show a tendency indicating that follow up planification is relevant to obtain the target lipid level recommended in the secondary prevention.

Objective: To study the etiology, precipitating factors, clinic features, patterns of ventricular disfunction, treatment, hospital length of stay and mortality of patients admitted to hospital because of heart failure., Patients and Methods: It's a prospective study of 305 patients with heart failure admitted consecutively in a short stay unit., Results: The mean age was 73.6 +/- 10.8 years. 50.5% were women and 49.5% men. Women (76.5 +/- 9.7 years) were older than men (70.5 +/- 11.0 years). The etiology was valvular heart disease 30.8%, hypertensive heart disease 26.2%, ischemic heart disease 21.6%, idiopathic dilated cardiomyopathy 8.2% and alcoholic cardiomyopathy 5.6%. The more frequent precipitating factors were respiratory infection (37.3%) and arrhythmias (28.7%). No precipitating factor was detected in 13.9%. 46.1% had systolic disfunction (erection fraction < 50%). 96.7% were treated with diuretics, 79.3% with ACE inhibitors and 51.9% with digoxin. 5.3% needed cardiac surgery. Mean length of stay was 5.64 days. In hospital mortality was 5.6%.

Objective: To determine the influence of location in the stomach on the finding of detectable metastasis in patients with gastric cancer., Design: Retrospective analysis of patients with gastric adenocarcinoma diagnosed in a our hospital from 1981 to 1990., Patients: Four hundred fifty four patients with gastric adenocarcinoma have been analyzed. In order to assess the presence of metastasis, we reviewed the imaging studies, the surgical description and the pathological records., Results: Significant differences were not found regarding age, sex or diagnosis delay in patients with or without metastasis. The patients with tumours diffusely affecting the stomach had the greatest incidence of metastasis (hepatic, peritoneal or other) (p < 0.05). On the contrary, patients with tumours in the distal third of the stomach showed the least incidence of metastasis of any location (p < 0.05). Besides, patients with tumours in the distal third showed a progressive decrease in the presence of hepatic metastasis as delay in diagnosis increased., Conclusions: The results of our study suggest that tumours in the distal third of the stomach have a less aggressive metastatical dissemination than those in other locations of the stomach.