RESUMO
BACKGROUND: Incidence of gastric cancer (GC) shows different distribution in Italy, with higher incidence in the north and center. We retrospectively analyzed the clinical data of patients resected at the Hospital of Cremona between January 2007 and December 2016. Available clinical variables were linked with survival to identify possible prognostic factors. MATERIALS AND METHODS: Variables analyzed were age, sex, type of surgery, site, histology, invasion, nodal status, resection margins, grade, HER2 status, Helicobacter pylori infection (neo)adjuvant chemotherapy, adjuvant chemoradiotherapy, neutrophil-to-lymphocyte ratio, number of nodes removed and type of lymphadenectomy. Overall survival (OS) was estimated by the Kaplan-Meier method and differences between groups by the log-rank test. Data on OS were analyzed by Cox regression and the final model was obtained using the step-wise method. RESULTS: 379 patients were considered, out of which 195 were operated from 2007 to 2011 and 184 from 2012 to 2016. Median follow-up was 25.5 months, median OS 31.3 months and time to recurrence 23.2 months. D2 resection rate increased from 36% (period 2007-2011) to 74% in 2012-2016 (p = 0.01) with a higher mean number of nodes collected (20.98 for 2007-2011 and 23.53 for 2012-2016, p = 0.040). Only 37% of patients received a postoperative treatment. At multivariate analysis, variables associated with OS were age (p = 0.002), stage (p < 0.001), resection margins status (p < 0.001), adjuvant chemotherapy (p < 0.010) and tumor location (cardia vs non-cardia) (p = 0.029). CONCLUSIONS: Our analysis shows that completeness of resection and lower stage are strong predictors of long-term survival in GC, providing the rationale for adjuvant and neoadjuvant approaches (chemotherapy, radiotherapy or combined). Cardial GC has worse prognosis compared to distal cancers. TRIAL REGISTRATION NUMBER: Service evaluation number 256, protocol 16821/17, date 05 June 2017.
Assuntos
Adenocarcinoma/cirurgia , Quimiorradioterapia Adjuvante , Gastrectomia/métodos , Terapia Neoadjuvante , Neoplasias Gástricas/cirurgia , Adenocarcinoma/genética , Adenocarcinoma/mortalidade , Adenocarcinoma/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Amplificação de Genes , Infecções por Helicobacter , Humanos , Itália , Estimativa de Kaplan-Meier , Excisão de Linfonodo/métodos , Linfonodos/patologia , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Prognóstico , Modelos de Riscos Proporcionais , Receptor ErbB-2/genética , Estudos Retrospectivos , Neoplasias Gástricas/genética , Neoplasias Gástricas/mortalidade , Neoplasias Gástricas/patologia , Taxa de SobrevidaRESUMO
En nuestra realidad clínica los pacientes sometidos a cirugía cardíaca permanecen en ventilación mecánica alrededor de 14 horas, siendo un objetivo primordial la extubación precoz para evitar complicaciones y disminuir costos. Dentro de este contexto, estudiamos el comportamiento de factores predictores de la extubación precoz en 230 pacientes adultos sometidos a cirugía cardíaca entre septiembre de 1994 y abril de 1995 en la Unidad de Recuperación de Cirugía Cardiovascular del Hospital Clínico de la Pontíficia Universidad Católica de Chile. Además de considerar parámetros clásicos de desconexión tales como intercambio gaseoso, estado hemodinámico, nivel de conciencia y patrón respiratorio espontáneo, evaluamos, durante la ventilación mecanica, la distensibilidad estática (Cs) y las distensibilidad dinámica (Cd). Posterior a conexión a tubo Tpor 30 minutos, evaluamos: volumen corriente (Vt),frecuencía respíratoria (FR). Volumen minuto (VE) e índice de respiración superficial. Se consideró extubacíón precoz o (+) a aquella extubación exitosa en las primeras 24 horas del postoperatorio y extubación (-) a quienes permanecieron en VM durante más de 24 horas o requirieron reintubación y conexión a ventilación mecánica. De acuerdo a los resultados, los factores predictores evaluados no permiten predecir significativamente cual es el momento más adecuado para la desconexión precoz de ventilación mecánica en ésta población de pacientes. Sin embargo, los factores que sí presentaron una diferencia estadísticamente significativa entre los pacientes con extubación (+) vls los con extubación (-), fueron algunos factores clínicos como la capacidad funcional, el riesgo operatorio, el tipo y tiempo de cirugía, el tiempo de permanencia en circulación extracorpórea, el uso de drogas vasoactivas y las complicaciones postoperatorias
Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Respiração Artificial/métodos , Cirurgia Torácica , Desmame do Respirador , Tempo de Internação , Período Pós-Operatório , Mecânica RespiratóriaRESUMO
The bioavailability of carba,azepine from 4 comercially available products was evaluated in 12 healthy volonteers. A crossover design was used and each patients received 400 mg of each product. Plasma levels of the drug were determined periodically for 72 h using a gas-liquid chromatographic method. An open model of one compartment for first-order absortion was assumed to derive pharmacokinetic parameters. Dissolution kinetics was also evaluated in each product. Significant differences in biovailability were shown for one product. Results correlated with the in vitro dissolution findings