The management of multiple sclerosis by reference centers in south of Italy: a 2011 survey on health demands and needs in Campania region.

This cross-sectional study has investigated the diagnostic and therapeutic management of patients suffering from multiple sclerosis (MS) in the Campania Region (Italy). A survey involving all the reference centers for MS in Campania Region was conducted from March to August 2011. Centers responded to a web-administered questionnaire on management and clinical characteristics of MS patients. In the study period, 3263 patients (mean age 37 years, 66 % females) accessed the centers. Patients received a first diagnosis of MS in 161 cases (4.9 %). About 37 % of the subjects without a previous diagnosis came to the centers on their own initiative. All patients underwent a complete neurological examination and expanded disability status scale. The other most common investigations were magnetic resonance imaging (44.0 %) and evoked potentials (22.1 %). The number of treated patients was 2797 (87.1 %). The most used drugs were interferon ß and glatiramer acetate. The time between diagnosis and initiation of therapy exceeded 6 months in 32 % of cases. Second-line drugs were under-used: 16 % of patients who might benefit from them show high clinical and radiological disease activity despite treatment with immunomodulant drugs. The MS care management of the surveyed centers showed consistent margins for improvement in 2011. Even though these data do not represent the current situation, they can be used to monitor improvements in MS care.

Results of specialization in the surgical treatment of gastric cancer in Peru.

BACKGROUND: The best results in the surgical treatment of gastric cancer are those obtained by the Japanese surgical school that emphasizes D2 lymphadenectomy as a fundamental principle for obtaining better local control of the disease. However, this technique has not gained wide acceptance in the West, owing to the fact that the results of Japanese studies have not been reproduced frequently in Western countries. In recent years, a series of studies have recommended the centralization of gastric cancer treatment in specialized surgical units in order to obtain results similar to those achieved by Japanese centers. The objective of this study was to describe the specialization process and to show the short-term results obtained in the surgical treatment of gastric cancer in the Specialized Unit of the Rebagliati National Hospital, the largest general referral hospital in Lima, Peru. METHODS: In the year 2000 a specialized service was created for the surgical treatment of gastric cancer, initiating a process that included the establishment of surgical treatment guidelines, training in the Japanese surgical technique, and progress along the learning curve for D2 lymphadenectomy. Clinical, surgical, and pathological data were recorded prospectively in a fixed format, considering that strict documentation of cases was also an important step within this process. RESULTS: Between January 1, 2004, and December 31, 2005, 243 consecutive patients with a proven diagnosis of gastric adenocarcinoma were admitted to the operating theater for surgical treatment. During this study period, morbidity was 22.7% and hospital mortality, 2.8%. The numbers (mean +/- SD) of resected lymph nodes for distal gastrectomy and total gastrectomy were 37.3 +/- 12.4 and 45.3 +/- 14.5, respectively. Hospital stay was 13 days for distal gastrectomy as well as for total gastrectomy. CONCLUSION: According to our results, adequate training in the Japanese surgical technique, progress along the learning curve for D2 lymphadenectomy, and the establishment of specialized units are highly recommended for the surgical treatment of gastric cancer in Western referral hospitals.

[Concomitant gastric and pancreatic metastases from renal cell carcinoma: case study]. / Metástasis gástrica y pancreática concomitante por carcinoma de riñón a células claras: reporte de un caso.

This report describes the case of a patient who underwent total gastrectomy, splenectomy and pancreatomy corporo-postero as a consequence of gastric and pancreatic metastasis from carcinoma to clear cells, five years after having undergone radical nephrectomy. Upper digestive bleeding was the first symptom, and pancreatic lesion was detected in previous CT scans. There are many documented cases of pancreatic metastasis, but only eight gastric metastasis in the last 15 years, although we did not find reports about surgical treatment for concomitant gastric and pancreatic injury. Surgical treatment which in some reports include highly complex surgeries such as gastrectomies with combined resections of invaded organs and pancreatoduodenectomy, are good options for select cases, because good survival rates have been reported.

Metástasis gástrica y pancreática concomitante por carcinoma de riñón a células claras: Reporte de un caso / Concomitant gastric and pancreatic metastases from renal cell carcinoma: case study

El presente reporte se describe el caso de una paciente sometida a gastrectomía total, esplenectomía y pancreatectomía corporo-caudal por presentar metástasis gástrica y pancreática de carcinoma renal a células claras, 5 años después de haber sido sometida a nefrectomía radical. El cuadro se presentó como una hemorragia digestiva alta, y la lesión pancreática se evidenció en los estudios tomográficos previos a los que fue sometida la paciente. Existen muchos casos reportados en la literatura de metástasis pancreática, pero solo 8 en relación a metástasis gástrica. Sin embargo no encontramos reportado el tratamiento quirúrgico por lesión gástrica y pancreática concomitante. El tratamiento quirúrgico que en algunos reportes incluye cirugías de alta complejidad como gastrectomías con resecciones combinadas de otros órganos y pancreatoduodenectomía, se ofrecen como una buena alternativa para casos seleccionados ya que se han reportado buenas sobrevidas.

This report describes the case of a patient who underwent total gastrectomy,splenectomy and pancreatomy corporo-postero as a consequence of gastric and pancreatic metastasis from carcinoma to clear cells, five years after having undergoneradical nephrectomy. Upper digestive bleeding was the first symptom, and pancreatic lesion was detected in previous CT scans. There are many documented cases of pancreatic metastasis, but only eight gastric metastasis in the last 15 years, althoughwe did not find reports about surgical treatment for concomitant gastric and pancreatic injury. Surgical treatment which in so me reports include highly complex surgeries such as gastrectomies with combined resections of invaded organs andpancreato duodenectomy, are good options for select cases, because good survivalrates have been reported.

[Surgical treatment for gastric cancer in a specialized service: the Rebagliati Hospital experience]. / Tratamiento quirúrgico del cáncer gástrico en un servicio especializado: experiencia del Hospital Rebagliati.

The results of the surgical treatment for gastric cancer within a specialized surgical service in this pathology are described in this work. This system for surgical treatment of gastric cancer is new in our country. The implementation process included prepare a team of surgeons and establish protocols and guides to surgical treatment, based on the recommendations of the Japanese Gastric Cancer Association. Additional training in the Japanese advanced surgical technique was required, as well as a strict documentation of the cases. During 2004, 139 surgical interventions were carried out on 137 patients with tumoral gastric pathology. Surgical mortality was 2.1% and morbidity was 21.8%. The average resected glands was 38.6.t 13.7 (range: 20-87) for distal gastrectomy and 46.6 +/- 16.2 (range: 24-87) for total gastrectomy. The stay in the hospital was 11.7 +/- 6.3 days (range: 5-37) for distal gastrectomy and 14.8 +/- 11.3 days (range: 7-56) for total gastrectomy. The hospital and surgeon volumes are underlined as important factors in determining the short and long term results. Implementation of specialized surgical units in general hospitals, for surgical treatment of gastric cancer, is recommended.

Cancer gastrico: evaluación clínica quirúrgica de cancer gástrico operados en el Servicio de Cirugía N§ 3 HNERMS, IPSS en los años 1983-1985 / Gastric cancer: surgico clinical evaluation of gastric cancer operated in Surgery Service N§ 3 HNERMS, IPSS in 1983-1985

Se realiza un estudio retrospectivo de los pacientes operados por cáncer gástrico en el Servicio de Cirugía N§ 3 del HNERM, durante los años 1983-1985, con la finalidad de complementar el estudio realizado en el mismo Servicio durante el período 1970-1982. El cáncer gástrico predomina en el sexo masculino con una relación de 1.76%1. La edad promedio fué de 60.2 años (D.S. 17.1). El síntoma inicial fué dolor abdominal en 55%, y los síntomas más frecuentes fueron: dolor en epigastrio: 78%, disminución de peso: 74.2%, melena: 42.4%, anemia: 40.28%. La localización mas frecuente fué la región antro-pilórica 44.52%. El tipo histológico más frecuente fué el Adenocarcinoma (papilar-tubular): 31.8%, adenocarcinoma mucinoso 10.6%. De acuerdo a la Clasificación de Lauren, el tipo histológico más frecuente fué el carcinoma diferenciado o intestinal: 69.96%. El tipo de operación realizada fué: Gastrectomía total Ampliada con Esplenectomía y resección de cola de páncreas: 25.56%, Gastrectomía Sub-Total Ampliada: 59.36%, Paliativa (Gastrostomía y Gastroyeynoanastomosis): 8.48% y laparotomía exploratoria: 4.24%. Se presentaron complicaciones post-operatorias inmediatas en 34% de pacientes, siendo las más frecuentes: Peritonitis - Absceso Intra-abdominal: 8.48%, Infección de Herida operatoria: 6.36%. La mortalidad operatoria fué de 4.24%. Los estadíos Clínicos de acuerdo a la Clasificación TNMP fueron: EI: 19.08%, EII: 6.36%, EIII: 19.8%, EIV: 48.76%