Análise epidemiológica dos adenocarcinomas gástricos ressecados em um serviço de cirurgia oncológica / Epidemiological analysis of resected gastric adenocarcinomas in a oncologic surgery service

Introdução: O adenocarcinoma de estômago é a quarta neoplasia mais incidente no mundo e a segunda causa de morte relacionada ao câncer. O objetivo deste estudo é determinar o perfil epidemiológico e patológico dos pacientes intervidos cirurgicamente por adenocarcinoma gástrico e sua sobrevida relacionada à classificação TNM. Métodos:Estudo de coorte histórica de 216 pacientes submetidos à gastrectomia por adenocarcinoma gástrico. Foram analisados dados epidemiológicos, patológicos e a sobrevida. Resultados: A média de idade foi de 61,84 anos. Foram 76 (35,2%) pacientes do gênero feminino e 140 (64,8%), masculino. Quanto à localização, 79 (36,6%) no antro, 45 (20,8%) na cárdia, 70 (32,4%) no corpo. Em relação à diferenciação celular, 5 (2,3%) bem diferenciados, 71 (32,9%) moderadamente diferenciados, 133 (61,6%) pouco diferenciados e 7 (3,2%) eram indeterminados. O estadiamento clínico demonstrou 11 (5,1%) pacientes com estádio 0, com sobrevida de 100%; 23 (10,6%) no estádio I, com sobrevida de 82%; 55 pacientes (25,5%), com sobrevida de 60% no estádio II; 101 pacientes (46,7%), com sobrevida de 25% no estádio III e 26 pacientes (12%), com sobrevida de 15% no estádio IV. Em relação às complicações pós-operatórias, 52,3% dos pacientes não tiveram complicações e 7,9% (17 pacientes) com óbito no período pós-operatório. Conclusões: Aproximadamente 70% das neoplasias eram distais, enquanto cerca de 30% eram proximais. A grande parte dos pacientes era de estádios mais avançados, o que conferiu um pior prognóstico, refletindo a necessidade de uma revisão das políticas públicas para câncer gástrico do Brasil, visando aprimorar o diagnóstico e tratamento, melhorando o prognóstico desses pacientes.

Introduction:The gastric adenocarcinoma is the fourth most frequent cancer worldwide and the second leading cause of cancer-related death. The aim of this study is to determine the epidemiological and pathological profile of gastric adenocarcinoma patients and their survival regarding the TNM classification. Methods: A historical cohort study of 216 patients undergoing gastrectomy for gastric adenocarcinoma. Epidemiological, pathological and survival data were analyzed. Results: The mean age was 61.84 years. There were 76 (35.2%) females and 140 (64.8%) males. Regarding location, 79 (36.6%) cases were in the antrum, 45 (20.8%) in the cardia, and 70 (32.4%) in the body. Regarding cell differentiation, 5 cases (2.3%) were well differentiated, 71 (32.9%) moderately differentiated, 133 (61.6%) poorly differentiated, and 7 (3.2%) were indeterminate. Clinical staging showed 11 (5.1%) patients with stage 0 with a survival rate of 100%, 23 (10.6%) in stage I with a survival rate of 82%, 55 patients (25.5%) in stage II with a survival rate of 60%,101 patients (46,7%) in stage III with a survival rate of 25% and 26 patients (12%) in stage IV with a survival rate of 15%. Regarding postoperative complications, 52.3% of the patients had no complications and 7.9% (17 patients) died in the postoperative period. Conclusions: Approximately 70% of tumors were distal, while approximately 30% were proximal. The majority of patients had more advanced stages, which conferred a worse prognosis, reflecting the need for a revision of public policies for gastric cancer in Brazil, aiming to improve the diagnosis and treatment and determining a better prognosis for these patients.

Estudo longitudinal dos fatores relacionados à infecção e reinfecção pelo schistosoma mansoni em área endêmica, Minas Gerais' / Schistosoma mansoni infection and reifection an endemic area, Minas Gerais

Este estudo teve como objetivo avaliar a relação entre a infecção e a reinfecção pelo Schistosoma mansoni e os fatores demográficos, socioeconômicos, imunológicos e de contato com água, em 127 indivíduos residentes em Virgem das Graças, área rural endêmica domunicípio de Ponto dos Volantes, Minas Gerais. Foram coletados dados socioeconômicos, demográficos e de contato com água além de fezes e sangue para análises parasitológicas e sorológicas de todos os indivíduos participantes do estudo no período entre 2001 e 2009. Osoro foi utilizado para avaliação da reatividade dos anticorpos IgE e IgG4 específicos contra antígenos do ovo (SEA) e do verme adulto (SWAP). A prevalência da endemia no inicio do estudo (2001) foi 59% (IC 95%= 50,38- 67,72) e a média geométrica de ovos por grama de fezes (OPG) de 61,05 (IC95%= 58,70 – 63,40). Um ano após o tratamento de todos os indivíduos (2002), a prevalência e a carga parasitária reduziram significativamente para 16,5% (IC 95%= 9,98 – 23,08) e 40,6 opg (IC 95%= 37,80 – 43,42), respectivamente. Em 2005, a prevalência aumentou para 27,6% (IC 95%= 19,68 – 35,43), mas a carga parasitáriamanteve-se semelhante à de 2002 sendo de 39,81 opg (IC95%= 37,27 – 42,35). No último ano avaliado (2009) a prevalência permaneceu em 26,8% (IC 95%= 18,96 – 34,57), mas a carga parasitária reduziu significativamente para 8,78 opg (IC 95%= 6,45 – 11,11) quandocomparada aos anos anteriores. A análise multivariada mostrou que a idade, o contato com água e as características imunológicas foram associadas à infecção pelo S. mansoni. Um maior risco de infecção foi observado nos indivíduos mais jovens (6-14 e 15-29 anos) e naqueles que realizavam atividades de pescar e atravessar o córrego. Foi evidenciado também que o aumento na reatividade de IgG4 anti-SEA e SWAP e da razão entre IgG4/IgE contra esses antígenos relacionaram-se ao risco de infecção pelo parasito, deixando os indivíduos mais susceptíveis. A análise da...

This study aimed to evaluate the relationship between S. mansoni infection and reinfection using demographic, socioeconomic, immunological and water contact factors, in 127 individuals in Virgem das Graças, an endemic area in municipality of Ponto dos Volantes,Minas Gerais. Demographic, socioeconomic and water contact behavioral data were collected, as well as feces and blood for parasitological and serological analysis, of all individuals participating in the study between 2001 and 2009. Serum was used to evaluate specific IgE and IgG4 antibody reactivity against soluble egg (SEA) and adult worm (SWAP) antigens. The prevalence for S. mansoni infection before treatment (2001) was 59% (CI 95%= 50.38-67.72) with the geometric mean egg count (epg) of 61.05 (CI95%= 58.70 – 63.40). One yearafter treatment (2002), prevalence and intensity of infection reduced significantly to 16.5% (CI 95%= 9.98 – 23.08) and 40.6 epg (CI 95%= 37.80 – 43.42), respectively. In 2005, the prevalence increased to 27.6% (CI 95% = 19.68 to 35.43), but the intensity of infection remained similar to that of 2002 with 39.81 epg (CI 95% = 37.27 - 42.35). In the last year ofevaluation (2009), the prevalence remained at 26.8% (CI 95% = 18.96 to 34.57) but the intensity of infection reduced significantly to 8.78 epg (CI 95% = 6.45 to 11.11) when compared to previous years. Multivariate analysis showed that age, water contact and immunological characteristics were associated with S. mansoni infection. A higher risk of infection was observed in younger individuals (6-14 and 15-29 years) as well as in those who performed activities of fishing and crossing stream. It was shown that the increase in IgG4 anti-SEA and SWAP reactivity and the IgG4/IgE ratio against these antigens were related torisk of infection, with individuals being more susceptible to infection. Analysis of IgE anti-SEA and SWAP reactivity showed an increase over time for both infected and uninfected individuals...

A Retrospective Epidemiologic Analysis of Burn Patients at Hanil Hospital

PURPOSE: Burn injuries still produce a significant morbidity and mortality. The collection and analysis of burn epidemiology data would provide insights into new prevention management strategies in terms of nationwide profile. We reviewed and compared the data from other countries. METHODS: This study was carried out to analyze the epidemiology, current etiological factors (circumstances), treatment methods and mortality of 4,321 acute burn patients, excluding electrical burn, who were admitted to Hanil Hospital Burn Center during 12 years (1996~2007). RESULTS: 1) The male to female ratio was 1.3:1. The mean age of admission was 30.0 years. The children below 18 years made up 38.9%, and adult over 60 years 10.2%. 2) The scald was the most common cause making up 53.8% followed by flame (30.8%), contact (9.3%), steam (3.6%) and chemical (2.1%) burn. The mean extent was 9.8%, 19.1%, 3.8%, 7.2%, 8.7% respectively. 3) The etiologies of scald burn were boiled water (32.9%), hot food soup (28.1%), boiling water (13.8%), instant food (10.3%) at home (87.4%). The 13.7% of victims underwent surgery of STSG (12.9%), FTSG (0.6%), local flap (1.2%) and advanced flap (0.1%). 4) The majority of flame burn occurred at home (43.7%) and work place factory (23.5%). Leading causes were inflammables (29.3%), fire (14.0%), explosion of butane can (12.8%), gas range (10.1%) and LPG (8.7%). The 31.4% of victims underwent STSG (26.2%), FTSG (0.8%), local flap (0.2%) and major amputation (0.1%). 5) The major victims (50.6%) of steam were children below 2years by exposing to steam of rice cooker (70.0%) at home. The 28.9% of victims underwent STSG (14.7%), FTSG (16.0%) and local flap (5.1%). 6) The contact burns occurred at various places (home; 56.5%, work place; 16.9%, vehicles; 9.0%, sauna; 4.5%) by various causes (Ondol; 11.9%, hot pack; 11.2%, oriental herb medicine; 6.7%). The 45.8% of victims underwent STSG (36.3%), FTSG (6.7%), local flap (5.2%), advanced flap (2.0%) and minor amputation (1.2%). 7) The chemical burn occurred at various place (home; 39.3%, work place; 49.4%) by acids (43.8%), alkalies (11.2%), vinegar (15.7%) and herb moxa (16.9%). The 28.1% of victims underwent STSG (22.5%), FTSG (9.0%), local flap (7.9%) and minor amputation (6.7%). 8) Children<18 years old were burnt mainly by scald (79.0%) while for adults below 50 years old was flame, over 50 years was scald. Children below 2 years old had higher frequency of steam (9.2%) and contact (7.9%) burn. The contact burn had relatively higher frequency among 7th (17.6%) and over 8th (20.4%), while chemical among 6th (3.9%) decade. 9) Inhalation injury was accompanied in 13.8% of flame burn (4.3% of total). The inhalation injury only was 4.9% of flame (1.5% of total). 10) The overall mortality rate was 1.8%. The mean age of death was 47.3 years old and burn extent was 74.5%TBSA. There was a strong correlation between flame burn (96.2% of total death), TBSA (50~60%; 9.3% vs 70~80%; 65.2%, 80~90%; 71.4%, over 90%; 87.9%) and mortality. The prognosis was poor for those over 70 year old (7.7% vs 30~50 yo; 2.8%, 7 th decade; 3.7%), flame burn (5.6% vs scald; 0.04%) and combined inhalation injury (22.3%). The patients died at mean 17.3 PBD by ARDS (51.3%), sepsis (44.9%), burn shock (20.5%) and ARF (5.1%) 11) The severity and sequelae of scald by prepackaged instant food, steams of rice cooker, flame by used butane can, contact by Ondol, sauna and chemical by vinegar should be added to preventive programs. CONCLUSION: Further study for implications of changes in management protocols and policies on treatment outcomes would improve the provision of appropriate care for the patients.

Definition, Epidemiology and Pathogenesis of Chronic Obstructive Pulmonary Disease

Aworking definition of chronic obstructive pulmonary disease (COPD) is given within the GOLD Global strategy as a disease state characterized by airflow limitation that is not fully reversible. The airflow limitation is usually progressive and associated with an abnormal inflammatory response of the lungs to noxious particles or gases. There is consensus that there has been a world-wide increase in COPD, reflecting increases in cigarette smoking, especially in developing countries. According to the Global Burden of Disease Study, in terms of lost disability-adjusted life years, COPD was ranked the 12th in 1990 and predicted to rise to the 5th ranking by 2020 and COPD was the sixth most common cause of death in the world in 1990 and will rise to the third most common by 2020. COPD is characterized by exaggeration of the normal inflammation response to irritant such as cigarette smoke. The mechanisms for this amplification of inflammation in COPD are not yet certain, but may be determined by genetic factors, latent viruses and impaired histone deacetylase activity. In addition to inflammation, extracellular matrix proteolysis. Cell death and ineffective repair are thought to be important in the pathogenesis of COPD.

The Review on Characteristics, Pathophysiology and Risk Factors of Irritable Bowel Syndrome / 재활간호학회지

PURPOSE: Irritable bowel syndrome (IBS) is frequently yet little understood disease. Review was performed to promote understanding on the characteristics, pathophysiology, and risk factors of IBS. CONTENT: IBS is characterized by abdom in women and people with higher educational and social background, but there are some controversies. IBS is diagnosed by the Rome II or Manning criteria after excluding organic gastrointestinal diseases. The pathophysioloy is explained by abnormal control mechanism of central and enteric nervous system. Mucosal immunity, secretions, and neurotransmitter are also associated with the hypersensitivity and motility change of bowel function. Stress is known as a major triggering factor and contributed to symptoms. Other risk factors are genetic elements, childhood experiences, inflammation, anxiety, depression, diet, and sleep disorders.