Survival of patients with surgery for lung cancer.

INTRODUCTION: Lung cancer is the leading cause of death in oncological diseases all over the world. It is a major health problems in Bulgaria. Early diagnosis is of great significance for improving survival in this group of patients. OBJECTIVE: The aim of this study was to analyze survival of patients with surgery for lung cancer. MATERIALS AND METHODS: Retrospective information for all 86 patients with surgery for lung cancer during the period 1995-1998 was obtained from the surgery protocols in the Clinic of Thoracic and Abdominal Surgery at the Higher Medical Institute (Plovdiv, Bulgaria). However, relevant follow-up data were found only for 50 patients. Medical histories were provided by the Plovdiv Oncological Center. Kaplan-Meier analysis was applied to study survival of patients. The log rank test was used to compare cumulative survival functions between groups of patients with different stage at diagnosis. Univariate Cox regression analysis allowed the development of a model to assess the influence of the stage at diagnosis on cumulative survival. RESULTS: Survival was assessed till June 1998. Mean survival period was 15 months (95% CI 13, 18). Patients were divided into two sub-groups: group A (stage I and II) and group B (stage III and IV). The analysis showed a marginally significant difference in cumulative survival between two groups (p = 0.0599). The mean survival period of patients from group A was 18 months (95% CI 14, 22) while for group B it was 12 months (95% CI 9, 16). Univariate Cox regression model showed that the relative risk of patients in group B to patients in group A is 3.2 (95% CI 1.11, 9.06). Early diagnosis of lung cancer is of crucial importance for surgery management and prognosis in such patients.

Treatment of bleeding oesophageal varices with endoscopic sclerotherapy--first results.

Patients with bleeding oesophageal varices represent 5% of cases of upper GIT bleeding. Varices develop and bleed as a result of portal hypertension which is a complication occurring in 30% of patients who suffer from chronic liver diseases. The mortality rate for the first bleeding episode is 50% and 30% for subsequent episodes. Almost 100% of those who survive the first episode, bleed again within the following two years. The risk of rebleeding is higher with varices increasing their number, length and extension, varices of III and IV degrees, portal pressure over 16 mm Hg. Despite of some recent advances the endoscopic sclerotherapy still remains the initial treatment of choice in patients with bleeding oesophageal varices. Authors report of having achieved control over bleeding in 80 to 90% of patients. Over the next few days of the same hospitalisation 10 to 20% of those patients rebleed and require a second sclero-therapy session. When the latter fails in controlling the hemorrhage, the mortality rate is estimated as high as 100% which prompts more invasive surgical and radiological interventions.