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No disponible
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Adulto , Femenino , Humanos , Trastornos de Deglución/complicaciones , Trastornos de Deglución , Neoplasias Gástricas/complicaciones , Neoplasias Gástricas/patología , Neoplasias Gástricas , Endoscopía/métodos , Cardias/patología , Cardias , Quistes/complicaciones , Quistes , Diagnóstico DiferencialRESUMEN
BACKGROUND: Non-alcoholic fatty liver disease (NAFLD) is caused by abnormal accumulation of lipids within liver cells. Its prevalence is increasing in developed countries in association with obesity, and it represents a risk factor for non-alcoholic steatohepatitis (NASH), cirrhosis and hepatocellular carcinoma. Since NAFLD is usually asymptomatic at diagnosis, new non-invasive approaches are needed to determine the hepatic lipid content in terms of diagnosis, treatment and control of disease progression. Here, we investigated the potential of magnetic resonance imaging (MRI) to quantitate and monitor the hepatic triglyceride concentration in humans. METHODS: A prospective study of diagnostic accuracy was conducted among 129 consecutive adult patients (97 obesity and 32 non-obese) to compare multi-echo MRI fat fraction, grade of steatosis estimated by histopathology, and biochemical measurement of hepatic triglyceride concentration (that is, Folch value). RESULTS: MRI fat fraction positively correlates with the grade of steatosis estimated on a 0 to 3 scale by histopathology. However, this correlation value was stronger when MRI fat fraction was linked to the Folch value, resulting in a novel equation to predict the hepatic triglyceride concentration (mg of triglycerides/g of liver tissue = 5.082 + (432.104 * multi-echo MRI fat fraction)). Validation of this formula in 31 additional patients (24 obese and 7 controls) resulted in robust correlation between the measured and estimated Folch values. Multivariate analysis showed that none of the variables investigated improves the Folch prediction capacity of the equation. Obese patients show increased steatosis compared to controls using MRI fat fraction and Folch value. Bariatric surgery improved MRI fat fraction values and the Folch value estimated in obese patients one year after surgery. CONCLUSIONS: Multi-echo MRI is an accurate approach to determine the hepatic lipid concentration by using our novel equation, representing an economic non-invasive method to diagnose and monitor steatosis in humans.
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Imagen por Resonancia Magnética/métodos , Enfermedad del Hígado Graso no Alcohólico/patología , Obesidad , Triglicéridos/metabolismo , Cirugía Bariátrica , Estudios Transversales , Método Doble Ciego , Femenino , Humanos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Estudios Prospectivos , Índice de Severidad de la EnfermedadAsunto(s)
Tumor Carcinoide/diagnóstico , Tumor Carcinoide/cirugía , Neoplasias Gástricas/diagnóstico , Neoplasias Gástricas/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Tumor Carcinoide/mortalidad , Estudios de Seguimiento , Humanos , Persona de Mediana Edad , Estadificación de Neoplasias , Estudios Retrospectivos , Neoplasias Gástricas/mortalidad , Análisis de Supervivencia , Resultado del TratamientoRESUMEN
No disponible
Asunto(s)
Humanos , Masculino , Femenino , Persona de Mediana Edad , Neoplasias Gástricas/diagnóstico , Neoplasias Gástricas/terapia , Gastroscopía/métodos , Endoscopía/métodos , Neoplasias Gástricas/fisiopatología , Neoplasias GástricasAsunto(s)
Quiste Esofágico/cirugía , Esófago/anomalías , Esófago/cirugía , Toracoscopía , Adulto , Femenino , HumanosRESUMEN
AIM: To evaluate changes in colorectal cancer (CRC) survival over the last 20 years. METHODS: We compared two groups of consecutive CRC patients that were prospectively recruited: Group I included 1990 patients diagnosed between 1980 and 1994. Group II included 871 patients diagnosed in 2001. RESULTS: The average follow up time was 21 mo (1-229) for Group I and 50 mo (1-73.4) for Group II. Overall median survival was significantly longer in Group II than in Group I (73 mo vs 25 mo, P < 0.001) and the difference was significant for all tumor stages. Post surgical mortality was 8% for Group Iand 2% for Group II (P < 0.001). Only 17% of GroupI patients received chemotherapy compared with 50% of Group II patients (P < 0.001). CONCLUSION: Survival in colorectal cancer patients has doubled over the past 20 years. This increase seems to be partly due to the generalization in the administration of chemotherapy and to the decrease of post surgical mortality.
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Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Colectomía , Neoplasias Colorrectales/terapia , Anciano , Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Quimioterapia Adyuvante , Colectomía/efectos adversos , Colectomía/mortalidad , Neoplasias Colorrectales/mortalidad , Neoplasias Colorrectales/patología , Femenino , Humanos , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Modelos de Riesgos Proporcionales , Estudios Prospectivos , Medición de Riesgo , Factores de Riesgo , España/epidemiología , Factores de Tiempo , Resultado del TratamientoRESUMEN
Fundamento y objetivo: El cáncer de esófago (CE) es una enfermedad poco frecuente pero grave. El objetivo del presente trabajo es describir las características clinicopatológicas y la supervivencia de los pacientes con CE en nuestro hospital. Pacientes y método: Se estudió a 200 pacientes consecutivos diagnosticados o tratados de CE o de la unión gastroesofágica en el Hospital Donostia entre enero del año 2003 y diciembre del año 2007. Se analizó la localización del tumor, el tipo histológico, las pruebas realizadas para establecer el estadio tumoral, los tratamientos utilizados, la supervivencia y la morbimortalidad de la cirugía. Resultados: La ultrasonografía endoscópica (USE) modificó la estrategia terapéutica en un 12% de los pacientes. Un 32% (74) de los pacientes se operaron; de éstos, un 65% (48) recibió radioquimioterapia (RT-QM) neoadyuvante. La supervivencia al año, a los 3 años y a los 5 años fue del 48, el 25 y el 21%, respectivamente. La mortalidad postoperatoria fue del 8% (6 pacientes) y la morbilidad, del 57% (42 pacientes). Los pacientes en estadio III a los que se realizó RT-QM neoadyuvante y cirugía tuvieron un mejor pronóstico que aquéllos a los que sólo se hizo RT-QM (20 meses de supervivencia frente a 9 meses). En el análisis multivariante, los factores de mal pronóstico fueron la localización en el tercio medio (HR [hazard ratio razón de riesgo]=2,3; intervalo de confianza [IC] del 95%: 1,34,1) y la no realización de cirugía tras la RT-QM (HR=1,9; IC del 95%: 1,153) (AU)
Background and objective: The esophageal cancer (EC) is a slightly frequent but serious disease. Our aim is to describe the characteristics of the patients with EC in our Hospital. Patients and method: We included 200 patients consecutively diagnosed and/or treated for CE between between January, 2003 and December, 2007. The location of the tumor was analyzed, the histological type, the proofs realized for to establish the classification, the treatments, the survival and the morbi-mortality of the surgery. Results: The endoscopic ultrasonography (EUS) modified the therapeutic strategy in 12% of the patients. The survival to the year, 3 years and 5 years was 48%, 25% and 21%, respectively. 74 (32%) patients were operated, 48 (65%) of them was treated with neoadyuvant chemoradiotherapy. The postsurgical mortality was 8% (6 patients) and the morbidity was 57% (114 patients). In multivariate analysis, after adjustment for traditional risk factors, were the location in the average third ( [HR, hazard ratio]=2.3; confidence interval [IC] of 95%, 1.34.1) and not accomplishment of surgery after the chemotherapy and radiotherapy (HR=1.9; IC to 95%, 1.153). Conclusions: The diagnosis is realized very later. The EUS has contributed a better therapeutic strategy to our patients. The mortality continues being high (AU)
Asunto(s)
Humanos , Masculino , Femenino , Persona de Mediana Edad , Anciano , Neoplasias Esofágicas/mortalidad , Tasa de Supervivencia , Neoplasias Esofágicas/fisiopatología , Neoplasias Esofágicas/diagnóstico , Indicadores de Morbimortalidad , Análisis Multivariante , PronósticoRESUMEN
BACKGROUND AND OBJECTIVE: The esophageal cancer (EC) is a slightly frequent but serious disease. Our aim is to describe the characteristics of the patients with EC in our Hospital. PATIENTS AND METHOD: We included 200 patients consecutively diagnosed and/or treated for CE between between January, 2003 and December, 2007. The location of the tumor was analyzed, the histological type, the proofs realized for to establish the classification, the treatments, the survival and the morbi-mortality of the surgery. RESULTS: The endoscopic ultrasonography (EUS) modified the therapeutic strategy in 12% of the patients. The survival to the year, 3 years and 5 years was 48%, 25% and 21%, respectively. 74 (32%) patients were operated, 48 (65%) of them was treated with neoadjuvant chemoradiotherapy. The postsurgical mortality was 8% (6 patients) and the morbidity was 57% (114 patients). In multivariate analysis, after adjustment for traditional risk factors, were the location in the average third ( [HR, hazard ratio]=2.3; confidence interval [IC] of 95%, 1.3-4.1) and not accomplishment of surgery after the chemotherapy and radiotherapy (HR=1.9; IC to 95%, 1.15-3). CONCLUSIONS: The diagnosis is realized very later. The EUS has contributed a better therapeutic strategy to our patients. The mortality continues being high.