ABSTRACT
Esophageal cancer (EC) is an aggressive tumor that represents the 6th most common cause of cancer death worldwide. The estimated incidence in Spain is 2090 cases/year. Two main pathological subtypes exist, squamous cell carcinoma and adenocarcinoma. The main differences between them are localization and underlying factors which are the principal cause of the recent incidence changes observed in west countries. Staging techniques and treatment options which combine surgery, chemotherapy and radiotherapy, reflected the high complexity of the EC management. An undeniably multidisciplinary approach is, therefore, required. In this guide, we review the status of current diagnosis and treatment, define evidence and propose recommendations (AU)
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Subject(s)
Humans , Male , Female , Esophageal Neoplasms/diagnosis , Esophageal Neoplasms/therapy , Neoplasm Staging/methods , Neoplasm Metastasis/drug therapy , Esophageal Neoplasms/drug therapy , Esophageal Neoplasms/radiotherapy , Esophageal Neoplasms/surgery , Comorbidity , Carcinoma, Squamous Cell/complications , Carcinoma, Squamous Cell/surgery , Palliative Care/standardsABSTRACT
Se considera asma premenstrual (APM) al deterioro cíclico del asma durante la fase premenstrual y/o los primeros días de la menstruación que experimentan algunas mujeres en edad fértil. Afecta, según diversos estudios, a más del 30 % de asmáticas. No existen criterios unánimes para su definición. Por otra parte, algunas mujeres experimentan cambios físicos y psíquicos en el periodo premenstrual, trastorno denominado síndrome premenstrual (SPM). Respecto al APM, hemos evaluado las distintas definiciones aceptadas y consideramos el criterio semi-objetivo en un ciclo menstrual (deterioro clínico > 20% en el periodo premenstrual, determinado por una metodología específica) como el que mejor refleja la realidad del APM. La prevalencia que hemos obtenido en nuestro medio con esta definición es del 44,7 % (46/103) (IC 95 %: 35,3 - 54,3 %). Las mujeres con APM presentan más síntomas relacionados con SPM, especialmente los de componente edematoso
Premenstrual asthma (PMA) is considered the cyclical deterioration of asthma during the premenstrual phaseand/or the first days of menstruation in some women during the fertile period. According to several studies, PMA affects over 30 % of asthmatic women. There are not unanimous criteria to define it. Moreover some women during premenstrual phase sufferphysical and psychological premenstrual changes known as premenstrual syndrome (PMS). We evaluated different definitions for the PMA and we have considered semi-objective criteria for a complete menstrual cycle -clinical deterioration exceeded 20% in the premenstrual period, determined by a specific methodology- as the criteria that best reflect the reality of this pathology. The prevalence obtained was 44.7 % % (46/103) (IC 95 %: 35.3 - 54.3 %). Women with PMA have more symptoms associated with PMS, especially edematous component
Subject(s)
Female , Humans , Premenstrual Syndrome/epidemiology , Premenstrual Dysphoric Disorder/epidemiology , Asthma/epidemiology , Menstrual Cycle/psychology , Edema/epidemiologyABSTRACT
Introducción: diversos estudios, aunque con resultados dispares, han relacionado el asma premenstrual (AP) con la severidad delasma. Por otra parte, no existe uniformidad respecto al hecho de que las pacientes con AP manifiesten una percepción subjetiva de empeoramiento de su asma en el periodo premenstrual. Objetivo: estudiar en mujeres asmáticas, con o sin criterios de AP, la relación con la clasificación del asma (GINA 2005) y el hecho de manifestar un empeoramiento de su asma en el periodo premenstrual. Material y método: se ha realizado un estudio observacional trasversal sobre una población de mujeres asmáticas en edad fértil en las que se realizó un cuestionario en el que se recogía, entre otros aspectos, la clasificación del asma (GINA 2005) y el hecho de manifestar un empeoramiento de los síntomas asmáticos en el periodo premenstrual. Por otra parte, se recogía diariamente durante un ciclo menstrual completo un cuestionario de síntomas respiratoriosSR (tos, disnea, sibilancias y opresión torácica) y los valores depeak flow (PF) matutino y vespertino durante dicho ciclo. Se considera AP al empeoramiento > 20% en el PF y/o en los síntomas asmáticos (>20%) en el periodo premenstrual. Resultados: hasta el momento, han completado la recogida de los cuestionarios y los valores de PF, en los distintos hospitales participantes,82 pacientes. (6 graves, 29 moderados, 26 persistentes leves y 21 intermitentes leves). De ellas, 35 (42,7%; IC 95%: 31,96-53,41) presentaban criterios clínicos de asma premenstrual. Presentaban criterios funcionales 3 de las mujeres (3,7%), cumpliendo todas ellas también criterios clínicos. El asma premenstrual se distribuyó con frecuencia similar en los distintos grupos de gravedad(p=0,98). Las mujeres con AP reconocían con mayor frecuencia(61,8% frente a 40,4%) el empeoramiento premenstrual de sus síntomas (p=0,06).(..) (AU)
Introduction: A number of studies, although with incongruent results, have related premenstrual asthma (PA) to the severity of the asthma. On the other hand, there is no uniformity regarding the fact that patients with PA express a subjective perception of a worsening of their asthma during the premenstrual period. Objective: To study asthmatic women with/without PA criteria, the relationship between the classification of the asthma (GINA2005) and whether there is a worsening of their asthma during the premenstrual period. Materials and method: A transverse observational study was carried out on a population of fertile, asthmatic women, who completed a questionnaire in which included, amongst other aspects, the asthma classification (GINA 2005) and whether there was a manifest worsening of the asthmatic symptoms during the premenstrual period. On the other hand, a questionnaire of respiratory symptoms (RS), including cough, dyspnea, sibilance and thoracic oppression, was completed daily, during a complete menstrual cycle, plus the Peak Flow values in the morning and evening during this cycle. PA is consider edif there is a worsening >20% during the PF and/or in the asthmatic symptoms (>20%) during the premenstrual period. Results: Up to now, the completed questionnaires have been collected and the values of the Peak Flow (PF), at the different participating hospitals, 82 patients (6 serious, 29 moderate, 26 persistent light and21 intermittent light). Of these, 35 (42.7%; IC95%: 31.96-53.41) presented clinical criteria of Premenstrual Asthma. Three of the women presented functional criteria (3.7%), all them also fulfilling clinical criteria. Premenstrual asthma was distributed with a similar frequently in the different groups of seriousness (p=0.98). The women with PA recognized with more frequency (61.8% as against 40.4%) the premenstrual worsening of their symptoms (p=0.06). (..) (AU)
