Total gastrectomy for gastric cancer in elderly patients.

BACKGROUND/AIMS: The increased average life expectancy and the changing patterns in gastric carcinoma have resulted in a considerable rise in the number of older patients requiring total gastrectomy. Results of total gastrectomy for gastric cancer in elderly patients are presented. METHODOLOGY: Between January 1987 and December 1996, 115 patients underwent total gastrectomy for gastric adenocarcinoma. At the time of surgery, 25 (21.8%) patients were older than 70 years. The results achieved in these patients were compared with those observed in 90 younger ones. RESULTS: The hospital mortality and morbidity rates for the elderly patients were 16% and 56%, respectively; for the younger ones they were 3.3% and 30%, respectively. No difference was seen between the two age groups concerning the average post-operative hospital stay. CONCLUSIONS: In our series, age was a major determinant with respect to post-operative morbidity and mortality. However, age alone could not be clearly defined as a determining risk factor considering that the accompanying illness and preexisting factors predispose for poor prognosis.

[Presence of inhibitors of activated partial thromboplastin time (TTPA). Clinical repercussion in obstetric patients]. / Presencia de inhibidores del tiempo tromboplastina parcial activada (TTPA). Repercusión clínica en pacientes obstétricas.

Partial thromboplastin time, activated with kaolin (TTPA) is a qualitative test used to find defects of some factor of intrinsic via of coagulation or to rule out the presence of some circulating inhibitor. The lupus anticoagulant (LA) is part of a group of several auto-antibody with pathogenic potential in several branches of medicine, mainly rheumatology, hematology and gyneco-obstetrics. In this last area the LA has been associated with different obstetrical repercussions. The purpose of this study was to determine the main obstetrical events associated with patients with circulating anticoagulants identified by TTPA with kaolin. Ninety six patients were included in cases-control study. Group I (n = 48) cases and Group II (n = 48) controls, were selected from the same population and information source. The cases were included when presenting prolongation of more than 4 seconds of TTPA activated with kaolin regarding a control with lack of correction with normal plasma. A registration sheet for data captation, was designed specially for this study. The comparability of both groups was established, as there were no differences (significant) among the variable considered as basal. The group of cases presented with a greater frequency of habitual abortion, neonatal death and thrombotic phenomena. This relationship of autoimmunological pictures with recurrent fetal loss and thromboembolic incidents has been consistently described in literature. To this respect, several immunological abnormalities. Including positive anticardiolipin antibodies and VDRL falsely positive. The incidence, in this country of these entities, is unknown. These observations show the need of a methodologic superation.(ABSTRACT TRUNCATED AT 250 WORDS)

PIP: In a retrospective case control study of 96 obstetrical patients 48 cases had partial thromboplastin time (TTPA) with kaolin over 4 seconds compared with the test group. The control group of 48 women with normal TTPA were also studied. Age, socioeconomic status, weight, family and personal illness history were included. Habitual abortion,neonatal death, and hypertension were recorded. The average TTPA value was 53.6 +or- 7.87 seconds for the case group vs 38.8 =or- 4.9 for the controls which was not statistically significant. No statistical significance was found regarding age, start of menarche, nutritional and socioeconomic status, and blood group. The body weight of the case group was higher with 58.5 kg =or- 14.4 kg (a range of 43.4-81.4 kg). There were 7 cases of thrombophlebitis (14.5%) in the lower extremities in the case group and none in the controls. There were 7 cases of habitual abortion in the case group defined as 3 or more miscarriages before 20 weeks of gestation vs 2 cases in controls. There were 4 cases of neonatal deaths associated with premature delivery in the case groups and none in controls. Acute hypertensive disease associated with pregnancy totaled to 8 cases in the 1st group (16.6%) and 4 cases in controls (8.3%). In both groups there were 2 cases of fetal death. In the case group there was 1 case of chromosomopathy and in the control group 1 case of premature expulsion of placenta. The TTPAs test is used mostly for the initial phase of studying patients suspected of having lupus anticoagulant (LA). LA belongs to abnormalities characterized by the presence of antiphospholipid antibodies. It is often used for diagnosing initial stages of autoimmunity which can frequently occur in thrombotic process, fetal loss, intrauterine growth retardation, and increased hypertensive illness in pregnancy.

[Importance of free intracellular calcium in the physiopathology of pre-eclampsia]. / Importancia del calcio libre intracelular en la fisiopatología de la preeclampsia.

Due to the participation of intracellular free calcium in the mechanisms of vascular smooth muscle contraction, and its importance in the physiopathology of essential arterial hypertension, its possible role in pre-eclampsia physiopathology, was investigated as a cellular model, platelets, were use, as they are similar to vascular smooth muscle cells. The study purpose was to investigate if intracellular concentration of ionized calcium is greater in the patients with pre-eclampsia than in normotensive pregnant women, and also, if there exists a correlation between intracellular calcium concentrations and arterial tension, Seven pre-eclamptic patients, diagnosed by the following criteria: arterial tension greater than or equal to 130/90 mmHg, edema and proteinuria, between 20 to 35 years of age, during the third trimester of gestation, without personal nor family antecedents of hypertension; none of them received treatment at the time, were studied. As control group seven normotensive pregnant women, equal by chronologic and gestational age, were included. Intracellular calcium in platelets was measured by Fluo-3-Am, and arterial blood pressure with conventional sphygmomanometer. Intracellular calcium and arterial blood pressure values, were compared, in both groups by Student's t, and analysis of lineal regression between intracellular calcium and mean arterial blood pressure, was done. Intracellular calcium was significantly greater in patients with pre-eclampsia, than the ones in the control group (142 +/- 5.6 vs 110 +/- 14 p less than 0.0001). Mean arterial blood pressure was also significantly greater in patients with pre-eclampsia (114 +/- 5 vs 83 +/- 3 p less than 0.0001).(ABSTRACT TRUNCATED AT 250 WORDS)