Gastric cancer in the province of Zaragoza (Spain): a survival study.

A study of the main prognostic factors and of the overall survival rate of gastric cancer (GC) is presented. It covered 895 cases diagnosed histopathologically in the province of Zaragoza (Spain) over a ten-year period (1980-1989). The analysis of the survival rate was carried out according to the Kaplan-Meier method and the Mantel-Haenszel test. The average overall survival rate of the sample was 6.5 months and the five-year survival rate was 16.5%. Lauren's intestinal histological type is associated with a better prognosis (a five-year survival rate of 25%) than the diffuse type (15%). The survival rate with regard to gastric wall invasion ranges from 78% for T1 tumors to 8% for T4 tumors (p < 0.0001). There are significant differences in survival rate between the TNM classification stages, ranging from a five-year survival rate of 77% for Stage I to 0% for Stage IV.

[Primary/psychiatry interconsultation care: use of the single consultation]. / Interconsulta atención primaria/psiquiatría: utilización de la consulta única.

OBJECTIVE: To study the use of single consultation in Primary Care/Psychiatry liaison. DESIGN: A retrospective study. SITE. Outpatients psychiatry department. Hospital Clínico Universitario. Zaragoza. PATIENTS OR OTHERS PARTICIPANTS: 200 consecutive referrals. PERIOD: June-December 1992. MEASUREMENTS AND MAIN RESULTS: GP does not report psychiatric symptoms in 24% of cases. If he reports it, describes significatively between GP and psychiatrist. There are important differences in relation to diagnosis: psychiatrist tend to diagnose less than GP Depression but uses more Dysthymia and Adjustment Disorder. 20% of patients referred to the psychiatrist are not considered psychiatric cases. GP ask for single consultation in 35% of patients, but psychiatrist discharges back to GP only 15% of cases. CONCLUSIONS: Primary Care/Psychiatry liaison should be improved. GP should clearly explain the amount of clinical responsibility they want to be involved in. Psychiatrists should asses more frequently the possibility of single consultation.

[Validation of a method for calculating the cardiovascular risk in primary care]. / Validación de un método de cálculo del riesgo cardiovascular en atención primaria.

OBJECTIVE: To design a simple method to calculate overall cardiovascular risk (CVR), which could be used in Primary Care (PC). DESIGN: A descriptive study to correlate and validate our method (called CVR-PC) using the Framingham, the British Regional Heart study and the Spanish Society to fight against Arterial Hypertension methods. SETTING: Urban health centre. PATIENTS: 670 patients of both sexes chosen at random in clinics, to apply a programme of preventive measures. MEASUREMENTS AND MAIN RESULTS: The age, gender, blood pressure, tobacco consumption, Cholesterolaemia and Glycaemia were determined for each patient. A multiplicative memory method was designed to obtain the index of cardiovascular risk without recourse to electronic support. Figures obtained were correlated with those from the equation of the Framingham study. The Pearson r values were: 0.85 for the series total (0.85 for men and 0.83 for women). The cut-off point for high/low-moderate risk was identified. From this 76.3% sensitivity and 95.7% specificity were obtained. CONCLUSIONS: The method studied shows adequate correlation as well as high sensitivity and specificity when compared with the Framingham method. It can be useful in Primary Care clinic for identifying individuals at high cardiovascular risk.

[What has the reform of primary care meant in the community approach to arterial hypertension?]. / Qué ha supuesto la reforma de la atención primaria en el abordaje comunitario de la hipertensión arterial?

OBJECTIVE: To evaluate an arterial Hypertension programme (AHP), with analysis of its feasibility and the problems inherent in the methodology used. DESIGN: A retrospective evaluation of the results of an AHP programme. A population projection of the results by means of an extrapolated calculation. SETTING: An urban Health Centre. PATIENTS: A random sample of 282 patients selected from the total of 564 individuals diagnosed with AHT over the 6 years of the programme's operation. MEASUREMENTS AND MAIN RESULTS: The 564 patients in the records made up 16.5% of the Health Area's adult population. The iceberg phenomenon (the percentage of undiagnosed hypertension sufferers) has evolved from 59% in 1988 to the present 17%. 7.4% of the sample received no treatment. Average AHT figures for the patients in treatment were 143 +/- 15 mm Hg systolic pressure and 85 +/- 9 mm Hg diastolic. 75% had adequate control of their tension figures (< 160/95). The population projection of these findings indicated that 57% of Hypertension sufferers calculated to be living in the Health area were diagnosed and monitored. CONCLUSIONS: The results show that the AHT situation among the population has substantially improved. The methodology used is easy to manage and can be of service in the evaluation of the impact of AHT programmes on the population.

[A serum cholesterol study in a consulting population and its implications in clinical practice]. / Estudio del colesterol sérico en población consultante y sus implicaciones en la práctica asistencial.

OBJECTIVE: To investigate serious cholesterol levels in the population seeking medical attention, utilising HOTH (How Often That High) graphs, and to look at implications these results have for recording of cholesterol incidence. DESIGN: This was a non-longitudinal, retrospective, observational study. SETTING: Carried out at the general practice level, in the Valdefierro Basic Health Area (Zaragoza Province). PATIENTS: 742 subjects aged between 18 and 65 years with no previous history of dyslipemia. MEASUREMENTS AND MAIN RESULTS: After obtaining the figures on cholesterolemia, the HOTH graph was drawn from which, for a given cholesterol value, the percentage of the population with a given value can be seen. The mean cholesterol value was 201 mg/dl. A total of 54% of male subjects and 40% of female subjects were situated above the threshold figure of 200 mg/dl. Furthermore, 15% of male subjects and 10% of female subjects were situated above 250 mg/dl. CONCLUSIONS: The application of recording procedures for cholesterol, based on a globally discriminatory score, reveals a startling number of patients who need tests and treatment. We suggest a strategy based on the different levels according to age, sex, bloodstream cholesterol level, and the existence or otherwise of other cardiovascular risk factors. Lastly, we would mention the usefulness of the HOTH graphs in improving our knowledge of the cholesterol levels in a population.

[Where does the terminal patient die?]. / Dónde fallece el paciente terminal?

OBJECTIVE: To determine whether patients terminally ill with gastric cancer die in hospital or at home and what the conditioning factors are. DESIGN: Descriptive, crossover and retrospective study. SITE. A province-wide study in Zaragoza province. PATIENTS: The sample consisted of 606 patients in Zaragoza province who had been diagnosed, between 1980 and 1989, as suffering gastric cancer and who later died of this condition. MEASUREMENTS AND MAIN RESULTS: The follow-up rate of the patients' evolution was 96%. Of these, 50.2% died in hospital and 46.2% at home. Average age was 67 +/- 10 years. 62% were men; 38% women. Average time of survival was 6 months. None of these factors nor the existence or otherwise of surgery affected the place of death. What was notable was that 42% of patients in urban areas died at home; whereas 66% did so in rural areas (p < 0.0001). CONCLUSIONS: Patients terminally ill with gastric cancer in Zaragoza province are just as likely to die at home as in hospital. In rural areas people are significantly more likely to die in their own homes. We believe these findings demonstrate the need to develop Primary Care programmes to alleviate terminal suffering.

[Rare manifestations of diabetic neuropathy]. / Manifestaciones poco frecuentes de la neuropatía diabética.

Up to 50% of diabetic patients develop neuropathies during their lives. Distal symmetric polyneuropathy is the most frequent variety, but there are other forms that are not exceptional and must be considered for the differential diagnosis of these patients. In this paper, the authors present three clinical cases of rare types of diabetic neuropathy: oculomotor cranial neuropathy (Case 1), diabetic amyotrophia (Case 2) and mixoide type with proximal asymmetrical locomotor neuropathy and distal polyneuropathy (Case 3). Their most relevant clinical characteristics are described, along with their differential diagnosis, evolution and therapeutical alternatives, in order to contribute to a better management of these patients.