Study of factors related to quality of life in patients with locally advanced rectal cancer.

OBJECTIVES: Given the increasing concern about the physical, psychological, and social welfare of patients surgically treated for rectal cancer, we designed a study of the factors influencing quality of life in these patients. EXPERIMENTAL DESIGN: We prospectively analyzed factors related to quality of life in a cohort of patients using the Nottingham Health Profile and the EORTC questionnaire (QLQ-CR 38). PATIENTS: A total of 116 patients with locally advanced rectal cancer surgically treated in our hospital from 1994 to 1999. RESULTS: Quality of life scores for the various factors studied showed that quality of life was worse in women, in patients with tumors in the middle third of the rectum, and in patients undergoing low anterior resection. CONCLUSIONS: Factors influencing quality of life in patients surgically treated for locally advanced rectal cancer included sex, tumor site, and surgical technique. Since only this latter factor is modifiable, we suggest that the surgical technique be individualized in persons with mid-lower and lower-third tumors of the rectum, bearing in mind that quality of life in amputated patients is, in many respects, better than that of patients with preserved sphincters.

[Pancreatic cystic metastasis from pulmonary carcinoma. Report of a case]. / Metastasi cistica pancreatica da carcinoma polmonare. Presentazione di un caso.

We report the case of a patients with a metachronous cystic pancreatic metastasis from an undifferentiated large cell lung carcinoma two years after the primary tumor had been surgically removed. Clinically, he presented with epigastric pain, fever, weakness and anorexia. The patient was operated and a palliative cystogastrostomy was performed after an intraoperative biopsy had been informed as positive for carcinoma. Six months later the patient died. Pancreatic metastases from lung carcinoma are found in approximately 7-9% of patients deceased of this neoplasm. Clinical and radiological findings simulate primary pancreatic tumors, being epigastric pain, jaundice and upper digestive bleeding the most frequent symptoms. They represent stages of advanced systemic disseminated tumoral disease, and because of this reason total or partial surgical curative resections will only be performed in a few cases of patients with isolated metastasis, criteria of resectability and without evidence of extended disease to other organs or systems. In the most of the cases, the treatment will only be palliative, even medical or surgical.

[Carcinoid tumor of the Vater's ampulla]. / Tumor carcinoide de la ampolla de Vater.

We report a patient with biliary obstruction of two years evolution. Blood chemistry evaluation was compatible with obstructive jaundice. Endoscopy and CT were suggestive of ampullary tumor. At laparotomy, the biopsy specimen was diagnosed as carcinoid tumor, and was treated by a Whipple's procedure.

[Correlation between dysplasia and malignization risk of Crohn disease]. / Correlación entre displasia y riesgo de malignización de la enfermedad de Crohn.

The malignancy risk in Crohn's disease is less than that of ulcerative colitis, although it has not been so well studied. The possibility of an early detection of malignant changes during the long term follow-up of the patients induces to look for parameters which might be helpful in this respect. In the second surgical clinic of the Hospital Clinico in Madrid, the pathological findings of 11 patients with the diagnosis of Crohn's disease have been analyzed and correlated with the clinical findings. The evaluation of the degree of dysplasia was done on 15 samples obtained by endoscopy and compared with the findings of the surgical specimens in 6 operated patients. The degree of dysplasia increases with age of the patients and years of evolution of the disease with a significant correlation (p less than 0.001) between negative dysplasia and positive dysplasia grade I.

[Diagnostic and therapeutic assessment of liver trauma]. / Valoración diagnóstica y terapéutica de los traumatismos hepáticos.

We have observed an increase in the frequency of hepatic trauma. They are very severe (44% of our group in IV-V stage), right hepatic lobe is the most frequently injured (22 patients), are associated with several lesions and in 20% of patients radical proceedings (parenchymal resection) were needed. A high incidence of associated lesions (24 patients), mainly thoracic and cranio-encephalic, have been observed. Therefore we have to improve the vital support measures, both in the accident place and in their transport, as quick and safe as possible, to hospital. We have at present better diagnostic and management methods to evaluate these patients: abdominal puncture, echography and abdominal CT. The echography in emergencies is the examination of choice in severe abdominal trauma and laparatomy is an urgent procedure in uncertain cases. Most of the hepatic traumatisms were treated by conservative surgical procedures (suture, hemostasis and abdominal drainage in 25 patients), but at times hepatic resection was needed (6 patients). The main aim is this surgery is the hemorrhage control, which determines mortality and prompt reoperation. That happened in two cases. Respiratory problems, infection with sepsis, renal failure, biliary fistulas, upper digestive tract hemorrhages and hemobilia, are complications most frequently observed in our patients. The vital support measures (respiratory, cardiovascular, nutritional, neurologic, etc.) improve the clinical evolution. In our patients the mortality rate was 12%. This rate is very similar to the one reported by other authors.

[Immunologic control in patients with cancer of the gastrointestinal tract]. / Control inmunológico en pacientes con carcinomas del tracto gastrointestinal.

Blastic transformation in vitro was used to estimate immunological competence in patients having gastrointestinal cancer. The authors found a correlation between lymphocyte transformation by phytohemagglutinin and prognosis. Autologous plasma inhibited lymphocyte transformation, particularly in those patients that proved to have an unfavorable clinical evolution one year after surgery.