Perception of preventive health needs in a prostate-cancer screening population: a preliminary report.

In follow-up of a screening program for prostate cancer, 192 men from the urban Denver area and 244 men from rural northeastern Colorado completed a mailed questionnaire addressing their health and medical care, insurance coverage, lifestyles, and desire for health education and screening programs. Rural respondents were older and more were self-insured. Twice as many urban men were prompted to participate in the prostate screening program by media announcements (51.0% vs 23.4%), while spouses (21.3% vs 9.4%) and physicians (13.1% vs 6.8%) played greater roles in motivating rural participants. The primary topics for health information and education needs perceived by the rural men were cancer-related, while those for urban men concentrated on cardiac risk factors. Both preferred that this information be provided in the form of written materials or through their personal physicians. This pilot study suggests certain differences in the present health practices, motivational factors, and health information and education needs in urban versus rural men. These differences should be explored further and be considered in the design of cancer prevention and screening programs for these populations.

Survival following surgical treatment of gastric cancer. A challenge for the community endoscopist.

The management of 124 patient diagnosed with adenocarcinoma of the stomach from 1971 to 1990 was reviewed. Early gastric cancer increased from 0% to 9% of the cases between the first and last quarter of the study. Proximal gastric cancer similarly increased from 8% in the first decade to 29% of all cases diagnosed during the second decade of the study. Follow-up information was available for all patients. Nineteen patients (15%) had no operation and two survived more than 2 years. Twelve patients had a surgical biopsy only and four had a palliative bypass; none survived 2 years. Eighty-six patients (69%) had a surgical resection with a 30-day operative mortality of 8% and a 5-year survival of 17%. Prognosis was significantly better for patients with T-1 and T-2 tumors and for those with distal cancers. Patients with early gastric cancer had 67% 5-year survival. These data should encourage efforts to improve the diagnosis of early gastric cancer.

A comparison of outcome and cost of open vs. laparoscopic cholecystectomy.

One hundred elective completed laparoscopic cholecystectomies performed during the period July 1990 to June 1991 were prospectively analyzed for age, sex, and the study variables. A control group of 100 age- and sex-matched patients undergoing elective open cholecystectomy in the year prior to the advent of laparoscopic cholecystectomy was retrospectively analyzed. Both groups were comparable with regard to height, weight, severity of disease, and co-morbidity. The mean operative time for the laparoscopic cholecystectomy group was 107 min vs. 72 min for the open cholecystectomy group. Other significant differences included the use of cholangiography (24% vs. 93%), placement of drains (4% vs. 27%), and morbidity (3% vs. 7%). There was no mortality in either group. The mean length of hospital stay was 1.6 days for the laparoscopic cholecystectomy group vs. 4.8 days in the open cholecystectomy group. The resultant difference in hospital charges to the patient favored laparoscopic cholecystectomy with a mean charge of $6471 vs. $8896 for the open cholecystectomy group. The results of this study support the conclusions that laparoscopic cholecystectomy is a safe and effective alternative to open cholecystectomy and results in a significantly shorter hospital stay with considerable cost savings.