RESUMEN
PURPOSE: The extent of lymph node dissection appropriate for gastric cancer is still under debate. We have conducted a randomized trial to compare the results of a limited (D1) and extended (D2) lymph node dissection in terms of morbidity, mortality, long-term survival and cumulative risk of relapse. We have reviewed the results of our trial after follow-up of more than 10 years. PATIENTS AND METHODS: Between August 1989 and June 1993, 1,078 patients with gastric adenocarcinoma were randomly assigned to undergo a D1 or D2 lymph node dissection. Data were collected prospectively, and patients were followed for more than 10 years. RESULTS: A total of 711 patients (380 in the D1 group and 331 in the D2 group) were treated with curative intent. Morbidity (25% v 43%; P <.001) and mortality (4% v 10%; P =.004) were significantly higher in the D2 dissection group. After 11 years there is no overall difference in survival (30% v 35%; P =.53). Of all subgroups analyzed, only patients with N2 disease may benefit of a D2 dissection. The relative risk ratio for morbidity and mortality is significantly higher than one for D2 dissections, splenectomy, pancreatectomy, and age older than 70 years. CONCLUSION: Overall, extended lymph node dissection as defined in this study generated no long-term survival benefit. The associated higher postoperative mortality offsets its long-term effect in survival. For patients with N2 disease an extended lymph node dissection may offer cure, but it remains difficult to identify patients who have N2 disease. Morbidity and mortality are greatly influenced by the extent of lymph node dissection, pancreatectomy, splenectomy and age. Extended lymph node dissections may be of benefit if morbidity and mortality can be avoided.
Asunto(s)
Adenocarcinoma/cirugía , Escisión del Ganglio Linfático , Neoplasias Gástricas/cirugía , Adenocarcinoma/mortalidad , Factores de Edad , Anciano , Análisis de Varianza , Femenino , Gastrectomía , Humanos , Masculino , Países Bajos/epidemiología , Pancreatectomía , Complicaciones Posoperatorias/epidemiología , Modelos de Riesgos Proporcionales , Estudios Prospectivos , Riesgo , Esplenectomía , Neoplasias Gástricas/mortalidad , Tasa de SupervivenciaRESUMEN
Scoring systems seem to be ideal for supporting diagnosis of acute appendicitis because they are non invasive, require no special equipment and can be used in clinical routine. Several scores for appendicitis have been developed with good results in the original publications. Unfortunately these good results could not be reproduced on a German data base. Therefore we developed a new score using multivariate statistics and a quality controlled prospective data base. The score covers 8 variables: tenderness, rebound tenderness, micturition, type of pain, leucocytes, age, relocation of pain, rigidity. Independent evaluation of the score on a Dutch database resulted in a negative appendicectomy rate of 21% and a missing appendicitis rate of 2%. The results are encouraging, so that further testing and clinical application can be recommended.
Asunto(s)
Apendicitis/diagnóstico , Enfermedad Aguda , Adolescente , Adulto , Anciano , Apendicectomía , Apendicitis/patología , Apendicitis/cirugía , Apéndice/patología , Niño , Diagnóstico Diferencial , Femenino , Humanos , Perforación Intestinal/diagnóstico , Perforación Intestinal/patología , Perforación Intestinal/cirugía , Masculino , Persona de Mediana Edad , Garantía de la Calidad de Atención de SaludAsunto(s)
Economía Médica , Ética Médica , Diálisis Renal , Adolescente , Adulto , Gobierno , Humanos , Persona de Mediana Edad , Países Bajos , Salud PúblicaAsunto(s)
Neoplasias Gástricas/diagnóstico , Adenocarcinoma , Antígenos de Grupos Sanguíneos , Carcinoma de Células Escamosas , Europa (Continente) , Femenino , Tecnología de Fibra Óptica , Gastrectomía/mortalidad , Jugo Gástrico/análisis , Humanos , Cooperación Internacional , Laparoscopía , Laparotomía , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Sarcoma , Neoplasias Gástricas/etiología , Neoplasias Gástricas/genética , Neoplasias Gástricas/mortalidad , Neoplasias Gástricas/fisiopatología , Neoplasias Gástricas/cirugía , Factores de TiempoAsunto(s)
Trasplante de Riñón , Animales , Perros , Humanos , Inmunosupresores/uso terapéutico , Trasplante HomólogoRESUMEN
Oesophagocardial plasty combined with intrathoracic fundoplication (Thal-Nissen-Rosetti) appears to be efficacious in the treatment of severe achalasia and of stenosis resulting from reflux in hiatus hernia. Advanced age and moderately severe cardiorespiratory disorders do not preclude good results from this operation. The above procedure was applied to six patients, with results varying from very good to fair.
Asunto(s)
Estenosis Esofágica/cirugía , Adulto , Anciano , Dilatación , Acalasia del Esófago/complicaciones , Estenosis Esofágica/etiología , Esofagitis Péptica/complicaciones , Esofagoplastia , Femenino , Reflujo Gastroesofágico/complicaciones , Hernia Hiatal/complicaciones , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias , PronósticoRESUMEN
A rare case of idiopathic fibrous mediastinitis is reported. Symptoms, etiology, diagnostic and therapeutic aspects are discussed with reference to the literature. In this case in which dysphagia and hoarseness were the presenting symptoms, a successful oesophageal myotomy was performed.
Asunto(s)
Mediastinitis/cirugía , Trastornos de Deglución/etiología , Ronquera/etiología , Humanos , Masculino , Mediastinitis/complicaciones , Mediastinitis/diagnóstico , Persona de Mediana EdadRESUMEN
In certain cases it can be useful to perform percutaneous transluminal angioplasty (PTA) and vascular surgery in the same session. The PTA procedure has to be performed by the radiologist through an artery that has been prepared and visualized by the vascular surgeon. This combined procedure usually lessens the number of hospitalization days and offers the patient the advantage of being cured in one session.