RESUMEN
OBJECTIVE: To study the natural history of non-ulcer dyspepsia. DESIGN: Retrospective study on consecutive cases of non-ulcer dyspepsia diagnosed in 1980 and 1981. The long-term course was ascertained from medical records and from answers to a questionnaire completed by the patients at 10-year follow-up. SETTING: Out-patients at the endoscopy unit of a county hospital. PATIENTS: The diagnosis was based on typical symptoms of dyspepsia, a normal index endoscopy and a lack of evidence of organic disease related to the symptoms during the subsequent 12-month period. Two hundred and seventy-one patients were entered into the study. Of the 195 who received a questionnaire at 10-year follow-up, 165 (85%) responded. RESULTS: The median age at inclusion was 51 years (25-75 percentiles 38-65 years), and 130 men and 141 women were included in the study. The cumulative death rate after 10 years was 18%, a value no greater than that in the general population: 8% had died of cardiovascular disease, 1.5% of gastrointestinal cancer and 3% of other malignancies. One patient had died of a perforated gastric ulcer. At 10-year follow-up, a further three patients had developed peptic ulcers (expected number 4.2), 64% had experienced dyspeptic symptoms during the preceding 12 months and 41% had been taking analgesics during the previous week. Of the symptoms listed by the patients, 30% were typical of irritable bowel syndrome. CONCLUSION: Non-organic dyspepsia seems to be a chronic disease in most patients. The course is benign and unrelated to peptic ulcer disease.
Asunto(s)
Dispepsia , Adulto , Anciano , Causas de Muerte , Enfermedad Crónica , Enfermedades Funcionales del Colon/complicaciones , Dispepsia/diagnóstico , Dispepsia/etiología , Dispepsia/terapia , Endoscopía del Sistema Digestivo , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Úlcera Péptica/complicaciones , Estudios Retrospectivos , Encuestas y CuestionariosRESUMEN
Despite recent advances in chemotherapy, the prognosis of advanced colorectal cancer remains poor. Although the taurine-based nitrosourea tauromustine (TCNU) has demonstrated schedule-dependent synergism with 5-fluorouracil (5-FU) and leucovorin (LV) against a variety of tumors in vitro, its efficacy relative to and in combination with these drugs in vivo remains unknown. To study this, BALB/C mice had C26 tumor implanted subcutaneously five days prior to the following treatment (doses and route of administration being the same in all groups): Group 1--no treatment; Group 2--TCNU (30 mg/kg by gavage); Group 3--LV (100 mg/kg intraperitoneally [IP]) and, one hour later, LV plus 5-FU (100 mg/kg IP); Group 4--LV and, one hour later, LV plus 5-FU and TCNU; and Group 5--TCNU and, on the following day, LV and, one hour later, LV plus 5-FU. All treatments were repeated seven days later. Body weight and tumor weight were measured twice weekly, and survival was noted. Postmortems were performed in all animals, and evidence of primary or secondary tumor was recorded. All surviving animals were sacrificed at 60 days. We found that 1) 87 percent of animals receiving TCNU and 60 percent of animals receiving LV, 5-FU, and TCNU survived to day 60; none of these animals had evidence of tumor when sacrificed; 2) animals in all other groups died by day 34; 3) evidence of metastases was found in five animals in Group 1 and one each in Groups 2 and 5; and 4) administering TCNU 24 hours prior to 5-FU plus LV resulted in death from toxicity in all animals. Thus, while synergism between TCNU and 5-FU plus LV was not seen, the antitumor properties of TCNU are significantly greater than those of conventional chemotherapy.
Asunto(s)
Antineoplásicos/uso terapéutico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Neoplasias del Colon/tratamiento farmacológico , Compuestos de Nitrosourea/uso terapéutico , Taurina/análogos & derivados , Animales , Antibacterianos , Antineoplásicos/toxicidad , Peso Corporal/efectos de los fármacos , Quimioterapia Combinada , Fluorouracilo/uso terapéutico , Leucovorina/uso terapéutico , Masculino , Ratones , Ratones Endogámicos BALB C , Compuestos de Nitrosourea/toxicidad , Taurina/uso terapéutico , Taurina/toxicidadRESUMEN
Esophagojejunostomy after total gastrectomy was attempted in 27 operations with the EEA stapling device (U.S. Surgical Corp., Norwalk, Conn.). After removal of the specimen the anastomosis is performed with an end-to-side technique with insertion of the cartridge and its central rod through the open jejunal end. The 28 mm wide cartridge was used in 24 anastomoses and the 25 mm wide cartridge was used in two. In one case the 25 mm cartridge tore the distal esophagus, and the anastomosis had to be sutured manually. The median operation time was 305 minutes (range, 205 to 560 minutes), and the time to perform the anastomosis was 20 minutes (range, 15 to 60 minutes). Anastomotic leakage occurred in three patients, two of whom were stapled with the 25 mm cartridge. All healed with conservative treatment. One patient developed a stricture at the anastomotic site due to recurrence of the tumor. There was one hospital death. Median hospital stay was 16 days (range, 8 to 71 days) and median survival time was 11 months. It is concluded that the EEA stapler allows the construction of a fast and reliable esophagojejunostomy with good functional results after total gastrectomy for gastric cancer.
Asunto(s)
Esófago/cirugía , Yeyuno/cirugía , Engrapadoras Quirúrgicas , Adulto , Anciano , Femenino , Gastrectomía , Humanos , Masculino , Métodos , Persona de Mediana Edad , Complicaciones Posoperatorias , Reoperación , Neoplasias Gástricas/cirugía , Engrapadoras Quirúrgicas/efectos adversos , Dehiscencia de la Herida Operatoria/etiologíaRESUMEN
The value of parietal cell vagotomy as a safe surgical procedure in the treatment of chronic peptic ulcer disease has been seemingly limited by the high recurrence rate usually reported. In this 10 year experience of 405 consecutive parietal cell vagotomy operations, 57 patients with recurrent ulceration were evaluated to try to answer the questions of where and why recurrent ulceration appears and how to treat it. Patients with pyloric or prepyloric ulcer disease had recurrence of disease earlier than did patients with chronic duodenal ulcer disease. Consequently, pyloric or prepyloric ulcer patients had a higher recurrence rate in the early postoperative period than chronic duodenal ulcer patients, but this difference disappeared after the seventh postoperative year. Patients with recurrent chronic duodenal ulcer disease have high postoperative acid secretion levels, indicating incomplete vagotomy as a causative factor. Patients with recurrent pyloric or prepyloric ulcer disease have postoperative acid secretion similar to that of patients without recurrence, suggesting another etiologic factor. Thirty of 57 patients with recurrent ulcer had successful medical treatment. A conservative attitude towards recurrences is justified, particularly when symptoms are few and the postoperative acid secretion tests indicate complete or partial vagotomy. Surgical therapy consisting of truncal vagotomy and pyloroplasty in cases of incomplete vagotomy and antrectomy in cases of complete vagotomy should be reserved for patients with symptoms and a disease course that cannot be controlled by conservative treatment.
Asunto(s)
Úlcera Duodenal/cirugía , Úlcera Gástrica/cirugía , Vagotomía Gástrica Proximal , Vagotomía , Úlcera Duodenal/epidemiología , Estudios de Seguimiento , Ácido Gástrico/metabolismo , Humanos , Complicaciones Posoperatorias , Píloro/cirugía , Recurrencia , Reoperación , Úlcera Gástrica/epidemiologíaRESUMEN
During the 1970s, parietal cell vagotomy (PCV) gradually became accepted as a suitable method in the surgical treatment of prepyloric, pyloric and duodenal ulcer disease. This study reports the data from a study of 405 consecutive patients with chronic ulcer disease treated with PCV. Mortality was low (0.5%) and there were few postoperative sequelae (periodic loose stools in 2% and mild dumping in 2%). Reduction in basal acid output was 75% and in pentagastrin stimulated acid secretion 50%. The ulcer recurrence rate was initially higher in pyloric-prepyloric (PU/PPU) than in duodenal ulcer disease but after the seventh postoperative year this difference was no longer statistically significant. The accumulated recurrence rate was 17.5%. Few side effects and a comparatively low recurrence rate makes PCV the method of choice in the surgical treatment of peptic ulcer disease.
Asunto(s)
Úlcera Duodenal/cirugía , Úlcera Gástrica/cirugía , Vagotomía Gástrica Proximal , Adulto , Anciano , Enfermedad Crónica , Úlcera Duodenal/mortalidad , Femenino , Estudios de Seguimiento , Humanos , Complicaciones Intraoperatorias , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias , Píloro/cirugía , Recurrencia , Úlcera Gástrica/mortalidadRESUMEN
It is a well established fact that women with recurrent colorectal carcinoma have a high frequency of ovarian metastases. This study was undertaken to see if microscopic metastases could be found in serial sections of ovaries removed at the time of primary operation. Of 58 patients, 4 had microscopic metastases and an additional 2 patients had macroscopic metastases. This finding, plus the risk of the development of a primary ovarian carcinoma, favors prophylactic oophorectomy in women with colorectal carcinoma.