Risk Factors of Mortality from All Asbestos-Related Diseases: A Competing Risk Analysis.

BACKGROUND: The mortality from all malignant and nonmalignant asbestos-related diseases remains unknown. The authors assessed the incidence and risk factors for all asbestos-related deaths. METHODS: The sample included 544 patients from an asbestos-exposed community in the area of Barcelona (Spain), between Jan 1, 1970, and Dec 31, 2006. Competing risk regression through a subdistribution hazard analysis was used to estimate risk factors for the outcomes. RESULTS: Asbestos-related deaths were observed in 167 (30.7%) patients and 57.5% of these deaths were caused by some type of mesothelioma. The incidence rate after diagnosis was 3,600 per 100,000 person-years. In 7.5% of patients death was non-asbestos-related, while pleural and peritoneal mesothelioma were identified in 87 (16.0%) and 18 (3.3%) patients, respectively. CONCLUSIONS: Age, sex, household exposure, cumulative nonmalignant asbestos-related disease, and single malignant pathology were identified as risk factors for asbestos-related death. These findings suggest the need to develop a preventive approach to the community and to improve the clinical follow-up process of these patients.

Estudio descriptivo sobre el uso de catéteres peritoneales en el manejo de la ascitis maligna / Descriptive study on the use peritoneal catheters for the management of malignant ascites

Objetivo: Se pretende valorar la frecuencia de complicaciones con los catéteres peritoneales para el manejo de la ascitis maligna, así como la duración de los mismos. Material y métodos: Estudio descriptivo de una serie de casos. Incluidos mayores de 18 años afectos de cáncer y con colocación de catéter peritoneal entre 2003 y 2010.Recogidas variables socio-demográficas, de neoplasia, situación funcional, localización del paciente al realizar el procedimiento (ingresado/ambulatorio), duración del catéter, complicaciones y supervivencia. Resultados: Incluidos 41 pacientes, mediana de edad de 63 años [39-90]; 73,2% mujeres. El tumor más frecuente fue ovario (26,8%); 61% de los pacientes con tumores metastásicos, con una mediana en el índice de Karnofsky de 60 [40-100].Los síntomas previos fueron disnea (82,9%), disminución de movilidad (65,9%) y dolor (53,7%)En el 51% de los pacientes la técnica se realizó estando ingresado. Un 53,7% presentaron mejoría sintomática posterior. El 48,8% de los pacientes presentó una complicación, 12,2% dos complicaciones; principalmente infecciosas (14,6% de los pacientes con infección en la zona de inserción, 4,9% peritonitis,7,3% sepsis). Tras la primera complicación se retiró el catéter en 4 ocasiones; en aquellos con2 complicaciones en dos casos se tuvo que retirar. En la muestra recogida, en el análisis realizado no se han identificado factores asociados al desarrollo de complicaciones. La mediana de la duración del catéter fue de 24 días [2-246] y de la supervivencia global de los pacientes de 31,5 días [2-323].Conclusiones: El uso de los catéteres peritoneales para la ascitis maligna presenta complicaciones frecuentes, la mayoría leves, requiriendo retirada del mismo en pocas ocasiones (AU)

Aim: The aim of this study is to determine the frequency of complications with peritoneal catheters and their duration, for the management of malignant ascites. Methods: Observational case series study. Patients included were those over 18 years with cancer in whom a peritoneal catheter had been placed between 2003 and 2010.Demographic and neoplasm data were collected, as well as functional status, location (outpatient/inpatient) where the procedure was performed, complications and survival. Results: A total of 41patients were included, with a mean age of 63 years [39-90], of whom73.2% were women. The main tumour was ovarian (26.8%).The majority (61%) of patients had metastatic cancer and a Karnofsky Index of 60 (40-100).Symptoms before the placement were dyspnoea (82.9%), lack of mobility (65.9%) and pain(53.7%)The catheter was placed in 51% of cases as inpatients. There was relief of pain symptoms in53.7% of patients. A single complication occurred in 48.8% of patients, with 12.2% having two. Those complications were mainly infectious (14.6% of patients had a local infection surrounding the area were the catheter was placed, 4.9% peritonitis, and 7.3% sepsis). After the first complication the catheter was removed in 4 patients, and the catheter was withdrawn twice in 2 of those who had two complications. No factors associated to the developing of infections were found in the patient sample studied. The median duration of the catheter was 24 days [2-246] and patient survival was31.5 days [2-323].Conclusions: Complications frequently appear with the use of peritoneal catheters for malignant ascites, but those complications are mainly mild, and do not involve catheter replacement in most of cases (AU)