RESUMO
Retrospectively collected information on 77 patients who had undergone resection for colorectal cancer at Belén Hospital, Trujillo, Perú, from 1966 to 1993, was analyzed to establish their clinical features and the importance of both clinical and pathological factors affecting outcome. Common presenting features in right colon cancer were abdominal pain, pallor, and palpable mass; in left colon cancer were symptoms of obstruction, and in rectal carcinoma predominated bleeding. The diagnostic accuracy of barium enema (n = 25) and proctosigmoidoscopy (n = 18) was 72 and 100% respectively. In 54.5% (n = 42) curative resection and in 45.5% (n = 35) palliative resection was performed The surgical procedures performed were right hemicolectomy (n = 29), transverse colectomy (n = 6), left hemicolectomy (n = 11), sigmoid resection (n = 14), low anterior resection (n = 5), and abdominoperineal resection of the rectum (n = 12). The total perioperative mortality rate was 18%. The 5 year survival rate in this series was 28% (53% for curative resection and 0% for palliative resection). An univariate analysis of survival time using long-rank test revealed that presence of bowel obstruction or perforation, macroscopic appearance, tumor size, depth of invasion, lymph node status, number of lymph node metastasis, distant metastasis, and clinical stage had and individual prognostic significance. Age, sex, length of disease, serum hemoglobin level, blood transfusions, location of tumor, histologic type, and tumor grade did not affect the prognosis. Improvement in the survival probably depends on development of better adjuvant therapy in association with surgery.
Assuntos
Adenocarcinoma/diagnóstico , Neoplasias Colorretais/diagnóstico , Adenocarcinoma/mortalidade , Adenocarcinoma/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Colectomia , Neoplasias Colorretais/mortalidade , Neoplasias Colorretais/cirurgia , Feminino , Humanos , Laparotomia , Masculino , Pessoa de Meia-Idade , Cuidados Paliativos , Peru/epidemiologia , Prognóstico , Estudos Retrospectivos , Análise de SobrevidaRESUMO
Se estudiaron 53 cepas del Vibrio Cholerae aisladas de pacientes del Hospital Nacional Arzobispo Loayza y 34 procedentes de pacientes pediátricos del Hospital San Bartolomé, con la finalidad de establecer la Concentración Mínima Inhibitoria (CIM) para distintos antibióticos, mediante el método de doble dilución en Agar Muller Hinton. Se encontró que todas las cepas fueron resistentes al Cloramfenicol y a la Lincomicina; además en las cepas aisladas en niños, se halló resistencia a la Gentamicina, Sulfametoxazol y Trimetropin. En el grupo de adultos, la resistencia fue variable, destacando el 11.31% para ampicilina (CIM=0.75 mg/ml), el 13.2% para ácido nalidíxico (CIM=3.5 mg/ml) el 13.20% para penicilina (CIM=3.5 mg/ml) y el 32.1% para amoxicilina (CIM=3.5 mg/ml). En el grupo de cepas aisladas de niños se encontró un 8.82% resistentes a la tetraciclina y a la penicilina (CIM=0.125 y 3.65 UI/ml mg/ml respectivamente), el 5.88% correspondiente a la amoxicilina y ácido nalidíxico (CIM=2.75 mg/ml para ambos) y el 38.23% para ampicilina (CIM=0.75 mg/ml). En relación a los patrones de resistencia a antibiotipos, estos varían de R:3 a R:9; siendo los más frecuentes el R:5 (Cloramfenicol, Clindamicina, Lincomicina, Sulfametoxazol y Trimetropin) en adultos y R:4 (Clindamicina, Lincomicina, Gentamicina y Trimetropin) en niños. Estos resultados sugieren que el Vibrio Cholerae actuaría como posible reservorio de plásmidos de resistencia a antibióticos, lo que complicaría el tratamiento de enfermedades y al mismo tiempo la erradicación del Vibrio Cholerae de nuestro medio.
Fifty three strains of the Vibrio Cholerae were studied, isolated from patients from the National Hospital Arzobispo Loayza and 34 strains coming from pediatric patients from the Bartolome Hospital, with the goal of establishing the Minimun Inhibitory Concentration (MIC) for different antibiotics, by means of the method of double dilution in Agar Muller Hinton. It was found that all the strains were resistant to Cloramfenicol and Lincomicin; besides, at the isolated strains from children, was found a resistance to Gentamicin, Sulfametoxazol and Trimetropin. At the adult group the resistance was variable, being remarkable the 11.32% from ampicilina (MIC=0.75 ug/ml) the 13% for nalidixic acid (MIC=3.5 ug/ml). At the group of isolated strains from children, it was found an 8.82% resistant to tetraciclina and penicillin (MIC=0.152 and 3.65 UL/ml ug/ml respectively) the 5.88% belong to amoxilin and nalidix acid (MIC=2.75 ug/ml for both) and 38.23% for ampicilina (MIC=0.75 ug/ml). In relation to the patterns of resistance to anti-biotic types, these change from r:3 to r:9 being the more frequent ones the R:5 (Cloramfenicol, Clindamicina, Lincomicin, Sulfametoxazol and Trimetropin) in adults and R:4 (Clindamicina, Lincomicin, Gentamicin and Trimetropin) in children. These results suggest that the Vibrio Cholerae will act as a possible reservoir of plasmids of resistance to anti-biotics, and that would complicate the treatment of the illness, and at the same time, the ending of Vibrio Cholerae in our environment.
Assuntos
Humanos , Cólera , Resistência Microbiana a Medicamentos , Vibrio cholerae , Hospitais Estaduais , PeruRESUMO
From January 1, 1966 to December 31, 1991, 137 patients with carcinoma of the stomach underwent standard radical gastrectomy at Belen Hospital, Trujillo, Perú. The patients were classified into two groups--those with age < or = 40 years (n = 19) and those with age > 40 years (n = 118)--and we analyzed herein comparatively clinicopathologic features and five year survival rates using the Mantel Haenszel test. In patients aged 40 years and younger there was a significant increased in the number of patients with carcinomas present in the upper two-thirds of stomach (p < 0.01) and in undifferentiated type adenocarcinoma in histology (p < 0.01) compared with patients more than 40 years old. There were no statistically significant differences between these two groups of age with regard to sex, abdominal mass, size of tumor, type of cancer (early vs advanced carcinoma), Borrmann's criteria, depth of invasion (T), nodal involvement (N), clinical stage (UICC, 1987), type of operation, curability, operative death and five year actuarial survival (8.0 percent vs 6.0 percent, respectively) (p > 0.05). In this study, carcinomas in young people were found to have a higher incidence of undifferentiated forms pathologically and the majority occurred in the body and after gastric resection were similar in both groups of patients.