AIM： To analyze retrospectively, our results about patients who underwent surgical treatment for adenocarcinoma of the cardia in relation to age, in order to evaluate surgical problems and prognostic factors. METHODS...AIM： To analyze retrospectively, our results about patients who underwent surgical treatment for adenocarcinoma of the cardia in relation to age, in order to evaluate surgical problems and prognostic factors. METHODS： From January 1987 to March 2003, 140 patients with adenocarcinoma of the cardia underwent resection in the authors＇ institution. They were divided into three groups with regard to age. Patients 〈70 and 〉 60 year old （31） were excluded; we also excluded 18 out of 109 patients with poor general status or systemic metastases. So, we compared 51 elderly （≥ 70 year old） and 58 younger patients （≤ 60 year old）. The treatment was esophagectomy for type I tumors, and extended gastrectomy and distal esophagectomy for type Ⅱ and Ⅲ lesions. RESULTS： Laparotomy was carried out in 91 patients （83.4%）, 38 in the elderly （74.5%） and 53 in younger patients （91.3%, P〈0.05）. Primary resection was performed in 81 cases （89%） without significant differences between the two groups. Postoperative death was higher in the elderly （12.1%） than the other group （4.1%, P〈0.05）, while morbidity was similar in both groups. A curative resection （R0） was performed in 59 patients （72.8%）, 69.6% in the elderly and 75% in the younger group （P〉0.05）. The overall 3- and 5-year survival rates were 26.7% and 17.8% respectively for the elderly and 40.7% and 35.1% respectively for younger patients （P = 0.1544）. Survival rates were significantly associated with R0 resection, pathological node-poskive category and tumor differentiation in both groups.CONCLUSION： As the age of the general population increases, more elderly patients with gastric cardia cancer will be candidates for surgical resection. Age alone should not preclude surgical treatment in elderly patients with gastric cardia cancer and a tumor resection can be carried out safely. Certainly, we should take care in defining the surgical treatment in elderly patients, particularly as regarding the surgical approach; although the surgical approach does not influence the survival rate, the transhiatal way still remains the best one due, to the lower incidence of respiratory morbidity and thoracic pain.展开更多
The metabolic syndrome is common after liver transplant being present in approximately half of recipients. It has been associated with adverse outcomes such as progression of hepatitis C and major vascular events. As ...The metabolic syndrome is common after liver transplant being present in approximately half of recipients. It has been associated with adverse outcomes such as progression of hepatitis C and major vascular events. As the United States population ages and the rate of obesity increases, prevention of the metabolic syndrome in the post-transplant population deserves special consideration. Currently, the metabolic syndrome after transplant appears at least two times more common than observed rates in the general population. Specific guidelines for patients after transplant does not exist, therefore prevention rests upon knowledge of risk factors and the presence of modifiable elements. The current article will focus on risk factors for the development of the metabolic syndrome after transplant, will highlight potentially modifiable factors and propose potential areas for intervention. As in the non-transplant population, behavioral choices might have a major role. Opportunities exist in this regard for health prevention studies incorporating lifestyle changes. Other factors such as the need for immunosuppression, and the changing characteristics of wait listed patients are not modifiable, but are important to know in order to identify persons at higher risk. Although immunosuppression after transplant is unavoidable, the contribution of different agents to the development of components of the metabolic syndrome is also discussed. Ultimately, an increased risk of the metabolic syndrome after transplant is likely unavoidable, however, there are many opportunities to reduce the prevalence.展开更多
Colorectal cancers （CRC） account for frequent and serious cancers which result from the interaction between individual genetic factors and environmental factors, and in particular widely studied nutritional ones. Th...Colorectal cancers （CRC） account for frequent and serious cancers which result from the interaction between individual genetic factors and environmental factors, and in particular widely studied nutritional ones. The role of other occupational factors remains a controversial subject. The objective of this study is to evaluate the possible impact of occupational factors on the risk of developing CRC. Materials and Methods： This is a retrospective case-control study. The cases and the control group were enlisted in the general surgical ward of Farhat Hached Teaching Hospital of Sousse （Tunisia） during the period extending from 2004 to 2008, and they were age and gender-matched. The data were analyzed using SPSS 11.0 software with a signification threshold fixed at 5%. A univariate analysis was carried out as well as a multiple binary logistical regression. Results： During the period of the study, 40 cases of colorectal cancers have been colligated including 28 men and 12 women with a sex ratio of 0.43. The average age of the cases was 61.55 ± 13.3 years and 60.40 ± 12.84 years for the control group, with a non significant difference （P = 0.69）. The univariate analysis has objectivized significant associations between colorectal cancer and the housing conditions, the neoplastic and digestive family history, the occupational activity sector, exposure to pesticides, and lack of periodic medical supervision. After logistical regression, the occurrence risk of CRC was significantly associated with： alcohol and smoking （ORa = 3.43; Pa = 0.05）, meat consumption （ORa = 3.34; Pa = 0.03）, exposure to pesticides （ORa = 20.44; Pa = 0.012） and lack of periodic medical supervision （OR = 7.45; P = 0.004）. Conclusion： The occupational risk factors might play a role in the etiopathogenesis of colorectal cancers. With regard to our study, pesticides seem to be most implicated and necessitate suitable preventive measures. Nevertheless, it seems useful to multiply the studies to a much larger scale in order to further explore such relationship and to further reinforce the prevention of such serious disease.展开更多
基金Supported by the Second University of Study of Naples
文摘AIM： To analyze retrospectively, our results about patients who underwent surgical treatment for adenocarcinoma of the cardia in relation to age, in order to evaluate surgical problems and prognostic factors. METHODS： From January 1987 to March 2003, 140 patients with adenocarcinoma of the cardia underwent resection in the authors＇ institution. They were divided into three groups with regard to age. Patients 〈70 and 〉 60 year old （31） were excluded; we also excluded 18 out of 109 patients with poor general status or systemic metastases. So, we compared 51 elderly （≥ 70 year old） and 58 younger patients （≤ 60 year old）. The treatment was esophagectomy for type I tumors, and extended gastrectomy and distal esophagectomy for type Ⅱ and Ⅲ lesions. RESULTS： Laparotomy was carried out in 91 patients （83.4%）, 38 in the elderly （74.5%） and 53 in younger patients （91.3%, P〈0.05）. Primary resection was performed in 81 cases （89%） without significant differences between the two groups. Postoperative death was higher in the elderly （12.1%） than the other group （4.1%, P〈0.05）, while morbidity was similar in both groups. A curative resection （R0） was performed in 59 patients （72.8%）, 69.6% in the elderly and 75% in the younger group （P〉0.05）. The overall 3- and 5-year survival rates were 26.7% and 17.8% respectively for the elderly and 40.7% and 35.1% respectively for younger patients （P = 0.1544）. Survival rates were significantly associated with R0 resection, pathological node-poskive category and tumor differentiation in both groups.CONCLUSION： As the age of the general population increases, more elderly patients with gastric cardia cancer will be candidates for surgical resection. Age alone should not preclude surgical treatment in elderly patients with gastric cardia cancer and a tumor resection can be carried out safely. Certainly, we should take care in defining the surgical treatment in elderly patients, particularly as regarding the surgical approach; although the surgical approach does not influence the survival rate, the transhiatal way still remains the best one due, to the lower incidence of respiratory morbidity and thoracic pain.
文摘The metabolic syndrome is common after liver transplant being present in approximately half of recipients. It has been associated with adverse outcomes such as progression of hepatitis C and major vascular events. As the United States population ages and the rate of obesity increases, prevention of the metabolic syndrome in the post-transplant population deserves special consideration. Currently, the metabolic syndrome after transplant appears at least two times more common than observed rates in the general population. Specific guidelines for patients after transplant does not exist, therefore prevention rests upon knowledge of risk factors and the presence of modifiable elements. The current article will focus on risk factors for the development of the metabolic syndrome after transplant, will highlight potentially modifiable factors and propose potential areas for intervention. As in the non-transplant population, behavioral choices might have a major role. Opportunities exist in this regard for health prevention studies incorporating lifestyle changes. Other factors such as the need for immunosuppression, and the changing characteristics of wait listed patients are not modifiable, but are important to know in order to identify persons at higher risk. Although immunosuppression after transplant is unavoidable, the contribution of different agents to the development of components of the metabolic syndrome is also discussed. Ultimately, an increased risk of the metabolic syndrome after transplant is likely unavoidable, however, there are many opportunities to reduce the prevalence.
文摘Colorectal cancers （CRC） account for frequent and serious cancers which result from the interaction between individual genetic factors and environmental factors, and in particular widely studied nutritional ones. The role of other occupational factors remains a controversial subject. The objective of this study is to evaluate the possible impact of occupational factors on the risk of developing CRC. Materials and Methods： This is a retrospective case-control study. The cases and the control group were enlisted in the general surgical ward of Farhat Hached Teaching Hospital of Sousse （Tunisia） during the period extending from 2004 to 2008, and they were age and gender-matched. The data were analyzed using SPSS 11.0 software with a signification threshold fixed at 5%. A univariate analysis was carried out as well as a multiple binary logistical regression. Results： During the period of the study, 40 cases of colorectal cancers have been colligated including 28 men and 12 women with a sex ratio of 0.43. The average age of the cases was 61.55 ± 13.3 years and 60.40 ± 12.84 years for the control group, with a non significant difference （P = 0.69）. The univariate analysis has objectivized significant associations between colorectal cancer and the housing conditions, the neoplastic and digestive family history, the occupational activity sector, exposure to pesticides, and lack of periodic medical supervision. After logistical regression, the occurrence risk of CRC was significantly associated with： alcohol and smoking （ORa = 3.43; Pa = 0.05）, meat consumption （ORa = 3.34; Pa = 0.03）, exposure to pesticides （ORa = 20.44; Pa = 0.012） and lack of periodic medical supervision （OR = 7.45; P = 0.004）. Conclusion： The occupational risk factors might play a role in the etiopathogenesis of colorectal cancers. With regard to our study, pesticides seem to be most implicated and necessitate suitable preventive measures. Nevertheless, it seems useful to multiply the studies to a much larger scale in order to further explore such relationship and to further reinforce the prevention of such serious disease.
