[Evolution of lung cancer in the North of the province of Castellón, Spain, 1993-2002]. / Evolución del carcinoma broncopulmonar en el norte de la provincia de Castellón, 1993-2002.

OBJECTIVE: To investigate the changes in lung cancer incidence, histological type, and survival in patients in the north of the province of Castellón, Spain, during a follow-up period of 10 years, and to compare the findings with other national and international studies. PATIENTS AND METHOD: All patients diagnosed with lung cancer between January 1, 1993 and December 31, 2002 were included in this prospective, observational study. Disease was confirmed by biopsy or suspected from clinical, radiological, and/or bronchoscopic findings. RESULTS: In the study period, 271 patients were diagnosed with lung cancer (239 men and 32 women), with a mean (SD) age of 66.8 (11.8) years. The age-adjusted incidence rate standardized to the world population was 20.42 cases per 100,000 population. Smokers or ex-smokers comprised 88.1% of the study population, and 72.6% of patients were over 60 years old. Biopsy confirmation was obtained in 262 cases (96.7%). Squamous cell carcinoma predominated (46.5%) but the proportion of adenocarcinoma increased (23.6%). Surgery was possible in only 22% of the patients. Mean overall 5-year survival was 15.7 months. CONCLUSIONS: In the north of the province of Castellón, the incidence of lung cancer continues to increase in men but has decreased slightly in women. Squamous cell carcinoma is the most common type, but the incidence of adenocarcinoma has clearly increased. Overall, survival did not improve during the 10 years of follow up despite advances in treatment.

Evolución del carcinoma broncopulmonar en el norte de la provincia de Castellón, 1993-2002 / Evolution of lung cancer in the north of the province of Castellón, Spain, 1993-2002

OBJETIVO: Conocer la evolución de la incidencia, tipos histológicos y supervivencia del carcinoma broncogénico en el norte de la provincia de Castellón, en un período de seguimiento de 10 años, y comparar los resultados con los de otros estudios nacionales e internacionales. PACIENTES Y MÉTODO: Se ha realizado un estudio prospectivo y observacional, en el que se incluyó a todos los pacientes diagnosticados de carcinoma broncogénico desde el 1 de enero de 1993 hasta el 31 de diciembre de 2002. Se exigió la confirmación citohistológica o la sospecha basada en datos clínicos, radiológicos y/o broncoscópicos. RESULTADOS: En el período estudiado se diagnosticó de carcinoma broncogénico a 271 pacientes (239 varones y 32 mujeres), con una edad media (ñ desviación estándar) de 66,8 ñ 11,8 años. La tasa de incidencia ajustada a la población mundial fue de 20,42 casos por 100.000 habitantes. El 88,1 por ciento eran fumadores o ex fumadores, y el 72,6 por ciento de los pacientes tenía más de 60 años. Se obtuvo confirmación citohistológica en 262 (96,7 por ciento) casos. Predominó el tipo epidermoide (46,5 por ciento) pero con un ascenso del adenocarcinoma (23,6 por ciento), y sólo se pudo realizar tratamiento con cirugía en el 22 por ciento de los casos. La supervivencia media global a los 5 años ha sido de 15,7 meses. CONCLUSIONES: En el norte de la provincia de Castellón la incidencia de carcinoma broncogénico sigue aumentando en los varones y ha disminuido ligeramente en las mujeres. Predomina el carcinoma epidermoide pero con un ascenso claro del adenocarcinoma. A pesar de los avances del tratamiento, desde una visión global, la supervivencia no ha mejorado en los 10 años de seguimiento (AU)

[Epidemiological study of lung cancer in the northern part of the province of Castellón]. / Estudio epidemiológico del cáncer de pulmón en el norte de la provincia de Castellón.

OBJECTIVES: To estimate the incidence and survival of bronchopulmonary carcinoma in the northern part of the Spanish province of Castellón while collecting other epidemiologic data. PATIENTS AND METHODS: This prospective, observational study enrolled all patients residing habitually in northern Castellón with diagnoses of bronchopulmonary carcinoma recorded from 1 January 1993 until 31 December 1997. Enrollment criteria were cytohistologic confirmation of diagnosis or suspicion based on clinical, radiologic and/or bronchoscopic data. RESULTS: One hundred eighteen patients (100 men, 18 women) were so diagnosed, giving a world population-adjusted incidence of 17.4 cases per 100,000 inhabitants (men: 31.2; women: 4.5). Smokers or ex-smokers accounted for 84.7% and 74.5% were over 60 years of age. Cytohistologic confirmation was obtained for 117 patients (99%). Epidermoid carcinoma predominated (58%) and surgery was performed in only 23% of the cases. Only one patient was lost to follow-up during the study period. Mean 5-year survival was 7.6%. CONCLUSIONS: The standardized incidence of bronchopulmonary carcinoma in 1993-1997 in the northern part of Castellón was 17.4 cases per 100,000 inhabitants (women: 31.2; women: 4.5), with epidermoid carcinoma predominating and a five-year survival rate of 7.6%.

QT dispersion within the first 6 months after an acute myocardial infarction: relationship with systolic function, left ventricular volumes, infarct related artery status and clinical outcome.

INTRODUCTION: We analysed QT dispersion within the first 6 months postinfarction, its relationship with the main established risk stratifiers and its clinical value. METHODS AND RESULTS: In 55 patients with a first Q-wave myocardial infarction the 12-lead electrocardiogram was scanned and digitised for analysis of QT dispersion (QT maximum-QT minimum) at first day (72 [61-96] ms), first week (69 [47-90] ms), first month (67 [46-88] ms) and sixth month (47 [40-74] ms; P<0.0001 vs. first day). Cardiac catheterization was performed at first week and at sixth month; QT dispersion was not related to ejection fraction, left ventricular volumes, infarct related artery status or contractile reserve (improvement of the infarcted area with low-dose dobutamine); no relation was found between QT dispersion decrease from first week to sixth month with regional systolic function improvement. Finally, during a mean follow-up period of 35+/-22 months QT dispersion was not independently related to clinical events. CONCLUSION: QT dispersion decreases progressively during the first months after myocardial infarction. These changes should be taken into account to define cut-off values of clinical interest in this phase. This variable does not seem related to the classic prognosis predictors. In a nonselected postinfarction population it has a low clinical value.

Estudio epidemiológico del cáncer de pulmón en el norte de la provincia de Castellón / Epidemiological study of lung cancer in the northern part of the province of Castellón (Spain)

OBJETIVOS: Conocer la incidencia y la supervivencia del carcinoma broncopulmonar en el norte de la provincia de Castellón, así como otros aspectos clinicoepidemiológicos. PACIENTES Y MÉTODOS: Se ha realizado un estudio prospectivo y observacional, en el que se incluyó a todos los pacientes diagnosticados de carcinoma broncopulmonar desde el 1 de enero de 1993 hasta el 31 de diciembre de 1997 que residían de forma habitual en esta zona. Se exigió la confirmación citohistológica o la sospecha basada en datos clínicos, radiológicos y/o broncoscópicos. RESULTADOS: Se diagnosticó a 118 pacientes, 100 varones y 18 mujeres. Esto supone una tasa de incidencia ajustada a la población mundial de 17,4 casos por 100.000 habitantes (varones: 31,2; mujeres: 4,5). En un 84,7 por ciento eran fumadores o ex fumadores, y el 74,5 por ciento de los pacientes tenía más de 60 años. Se obtuvo confirmación citohistológica en 117 casos (99 por ciento). Predominó el tipo epidermoide (58 por ciento), y sólo se pudo realizar tratamiento con cirugía en el 23 por ciento de los casos. Durante el período del estudio sólo se perdió el seguimiento de un paciente. La supervivencia media global a los 5 años ha sido del 7,6 por ciento. CONCLUSIONES: En el norte de la provincia de Castellón, la tasa de incidencia estandarizada del carcinoma broncopulmonar en el período 1993-1997 ha sido de 17,4 casos por 100.000 habitantes (varones 31,2; mujeres: 4,5), predomina el tipo epidermoide y la supervivencia a los 5 años es del 7,6 por ciento (AU)

ST-segment elevation on Q-leads during exercise in patients with ST-segment elevation at rest after myocardial infarction.

INTRODUCTION: ST-segment elevation on Q-leads after an acute myocardial infarction is related to a greater infarct size. The meaning of a further exercise-induced ST-segment elevation in these patients has not been analyzed. METHOD: Thirty-six patients with ST-segment elevation on Q-leads were studied after a first acute myocardial infarction. Exercise testing and cardiac catheterization were performed at the first week. Left ventricular volumes (ml/m(2)); the extent of abnormal wall motion (AWM: chords); contractile reserve (AWM improvement with low dose dobutamine) and coronary patency in the culprit artery were analyzed. Cardiac catheterization was repeated at the sixth month in 20 patients; systolic recovery (AWM improvement), left ventricular volumes and coronary patency were again evaluated. RESULTS: Patients with exercise-induced ST-segment elevation in two or more Q-leads (n=21) showed lesser contractile reserve (6+/-6 vs. 12+/-7 chords, P=0.01) than patients without exercise-induced ST-segment elevation (n=13). AWM (F=8.1) and absence of exercise-induced ST-segment elevation (F=9.5; positive predictive value: 80%; negative predictive value: 68%) were the only independent predictors of contractile reserve. Nevertheless, this electrocardiographic sign was not related to left ventricular volumes, coronary patency or systolic function and it did not predicted late systolic recovery. CONCLUSIONS: In patients with baseline ST-segment elevation on Q-leads an exercise-induced ST-segment elevation is independently related to a lesser contractile reserve but not to the evolution of volumes or regional dysfunction during the first 6 months post-infarction. Therefore, the clinical value of this sign seems to be limited to the non-invasive detection of myocardial viability during the early post-infarction phase.

Ischemic colitis attributable to a cleansing enema.

A 42-year-ole woman developed ischemic colitis shortly after the administration of a cleansing enema. As possible predisposing factor in out patient we assess treatment with contraceptives by parenteral route, started one year before her episode of bowel ischemia. To out knowledge, this is the first patient without underlying pathology with proven ischemic colitis secondary to a cleansing enema.

PIP: A 42-year-old woman was administered a cleansing enema to treat chronic constipation. Immediately after the procedure she developed intense pain in the abdominal region, nausea, vomiting, and rectal bleeding. The patient, who was in good general health, had been on contraceptive administration of Depo-Provera (150 mg each month) for 1 year. Radiological investigation, endoscopy and histopathological examinations revealed acute ischemic colitis. A left hemicolectomy was performed with colorectal anastomosis through laparotomy; the postoperative period was good and the patient was discharged in good health. The majority of cases of ischemic colitis occur in persons of advanced age, because of arteriosclerosis. In young female patients it is necessary to systematically investigate contraceptive use as a possible iatrogenic cause; surgery may be indicated in some cases.