[The oncology patient in emergencies. Epidemiological data]. / Enfoque global del enfermo oncológico en urgencias. Datos epidemiológicos.

Oncology patients do not form a large proportion within the overall figures of an emergency service, but their clinical characteristics mean that attending to them is often complex. The elaboration of a complete clinical history, specifying the characteristics and stage of the tumoural disease, is a basic weapon for taking decisions when an emergency arises. According to the data from our centre, oncology patients account for 5% of the total of emergency cases. The most frequent type of tumour that we deal with is pulmonary, followed by breast and colon. It is often the case that these patients come to the emergency department several times in the same month and pain is the most frequent reason for consultation, although it is normal for them to mention several causes on each occasion. In a high percentage of cases the reason for the consultation is related to the disease itself, but on as many as 35% of occasions it is an intercurrent pathology. The index of admissions is high (around 50%), especially if the patient has come for a reason related to the disease. In global terms, they account for 14% of total admissions from emergencies.

Enfoque global del enfermo oncológico en urgencias. Datos epidemiológicos / The oncology patient in emergencies. Epidemiological data

Los pacientes oncológicos no representan un gran volumen dentro del global de un servicio de urgencias, pero sus características clínicas hacen que su atención sea a menudo compleja. La realización de una historia clínica completa, en la que se especifiquen las características y estadio de la enfermedad tumoral, es un arma fundamental para la toma de decisiones en el momento urgente. Según datos de nuestro centro, los enfermos oncológicos representan un 5% del total de las urgencias. El tipo de tumor que más frecuentemente atendemos es el pulmonar, seguido del de mama y colon. Es frecuente que estos enfermos acudan a urgencias varias veces en un mismo mes y el motivo de consulta más frecuente es el dolor, aunque es habitual que comenten varias causas en cada ocasión. En un alto porcentaje de casos la causa de su consulta está relacionada con la propia enfermedad pero hasta en un 35% de las ocasiones es una patología intercurrente. El índice de ingresos es elevado (alrededor del 50%) y especialmente si el paciente ha acudido por un motivo relacionado con la enfermedad. En global suponen un 14% del total de ingresos desde urgencias (AU)

Oncology patients do not form a large proportion within the overall figures of an emergency service, but their clinical characteristics mean that attending to them is often complex. The elaboration of a complete clinical history, specifying the characteristics and stage of the tumoural disease, is a basic weapon for taking decisions when an emergency arises. According to the data from our centre, oncology patients account for 5% of the total of emergency cases. The most frequent type of tumour that we deal with is pulmonary, followed by breast and colon. It is often the case that these patients come to the emergency department several times in the same month and pain is the most frequent reason for consultation, although it is normal for them to mention several causes on each occasion. In a high percentage of cases the reason for the consultation is related to the disease itself, but on as many as 35% of occasions it is an intercurrent pathology. The index of admissions is high (around 50%), especially if the patient has come for a reason related to the disease. In global terms, they account for 14% of total admissions from emergencies (AU)

[Effectiveness of maintenance treatment with cimetidine in duodenal ulcer. Variations depending on the risk group]. / Eficacia del tratamiento de mantenimiento con cimetidina en el ulcus duodenal. Variaciones según el grupo de riesgo.

One hundred and twenty-two patients with confirmed duodenal ulcer were treated with cimetidine during 6 or 12 weeks. After gastroscopic confirmation of healing, treatment was suppressed during 3 months. Patients were randomized into two therapeutic regimens: intermittent according to recurrence of symptoms and maintenance with 400 mg cimetidine. In patients considered as having mild disease (healing at 6 weeks without recurrence) fared better with maintenance therapy than with intermittent dosage. All patients with moderate to severe disease on intermittent therapy had a recurrence (criterion: more than 6 weeks for healing the ulcer or recurrence before three months). Those on maintenance therapy had the following results: no recurrences 28%, one recurrence 56% and more than one 16%. Ninety three patients were followed during one entire year. There was also a statistical difference in the number of severe complications among patients on continuous maintenance (nil) and those on intermittent therapy (8%, p less than 0.05).

[Esophageal motility disorders in cirrhotics treated by sclerosing the varices]. / Trastornos motores esofágicos en cirróticos tratados con esclerosis de varices.

We performed esophageal manometry on 17 cirrhotic patients (group I) treated with repeated varicose sclerosis (VS) after the varices had been completely eradicated. We used 5% ethanolamine oleate with the free hand technique, administering intra-varix injections at the cardia level, never exceeding 25 cc per session. The first two sessions were spaced a week apart, and the consecutive ones were on a monthly basis. The mean number of VS sessions was 5.52. The esophageal motility study was carried out on the average 12.3 months after the last VS session, with a minimum of six and maximum of 17 months. As controls we used 16 cirrhotic patients with unsclerosed varices (group II) and 26 healthy subjects (group III). The mean age and patient distribution were similar, according to Pugh grading. The length of the lower esophageal sphincter (LES) and the amplitude of the propulsive waves in the middle esophagus were similar in all three groups. We found the LES pressure to be significantly reduced in group I (17.52 +/- 2.8 mmHg) in relation to group II (20.26 +/- 2.49 mmHg) (p less than 0.001) and group III (22.86 +/- 3.73 mmHg) (p less than 0.01). The group II patients showed significantly lower pressure levels than the group III ones (p less than 0.05). The amplitude of peristaltic waves in the distal esophagus was significantly less in group I (22.94 +/- 7.31 mmHg) than in group II (37.46 +/- 10.95 mmHg) (p less than 0.01) and group III (44.8 +/- 11 mmHg) (p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

[Combined therapy using ranitidine and sucralfate in duodenal ulcer resistant to cimetidine]. / Tratamiento combinado con ranitidina y sucralfato en úlceras duodenales resistentes a la cimetidina.

122 patients with duodenal ulcus have been treated with a cimetidine's single night dose of 800 mg over 6 or 12 weeks. After this period of time, 18 patients still had their wounds without complete healing. This group of patients had been afterwards treated with a combination of ranitidine and sulfacrate over a six weeks period. Only 3 of them achieved a complete ulcus reepitelization, although all of them were clinically asymptomatic. These 3 patients moved to a nightly maintenance treatment guideline of 150 mg of ranitidine, but they quickly presented relapses. A significantly higher consumption of tobacco and alcohol was observed among the patients who did not heal after 12 weeks of treatment with cimetidine. On the other hand the rest of the general facts and ulcus endoscopic characteristics have been similar both in patients resistant to cimetidine and in those who had a favorable evolution.