Angel Herrera-Gómez

Gastric cancer in young people under 30 years of age: worse prognosis, or delay in diagnosis?

Background Gastric cancer is an aggressive disease with nonspecific early symptoms. Its incidence and prognosis in young patients has shown considerable variability. Purpose of the study Our objective was to retrospectively study patients from our institution aged <30 years with gastric carcinoma. The study was undertaken to describe the experience of gastric cancer in this population, and to demonstrate its specific clinical and pathological characteristics. Materials and methods We reviewed the cases of histologically confirmed gastric cancer between 1985 and 2006 at the Instituto Nacional de Cancerología of Mexico (INCan); emphasis in our review was placed on clinical presentation, diagnostic and therapeutic intervention, pathology, and the results. Results Thirty cases of gastric carcinoma were reviewed. The patients’ median age was 27 years (range, 18–30 years) and the male:female ratio was 1:1. Conclusion Gastric cancer exhibits different behavior in patients aged, 30 years, but delay in diagnosis and the tumor’s behavior appear to be the most important factors in prognosis of the disease.

Pelvic exenteration for colorectal cancer: oncologic outcome in 59 patients at a single institution

Background Pelvic exenteration (PE) continues to be the only curative option in selected patients with advanced or recurrent pelvic neoplasms. A current debate exists concerning the appropriate selection of patients for PE, with the most important factor being the absence of extrapelvic disease. Aim To evaluate the outcome of patients submitted to exenterative surgery. Patients and methods A review of the clinical charts of patients with colorectal cancer who underwent PE between January 1994 and June 2010 at the Institute National of Cancerología in Mexico City was performed. Results We selected 59 patients, 53 of whom were females (90%), and six of whom were males (10%). Mean age at the time of diagnosis was 50 years (range, 21–77 years). A total of 51 patients underwent posterior PE (86%), and eight patients underwent total PE (14%). Operative mortality occurred in two cases (3%), and 29 patients developed complications (49%). Overall, 11 patients (19%) experienced local failure with mean disease-free survival time of 10.2 months. After a mean follow-up of 28.3 months, nine patients are still alive without evidence of the disease (15%). Conclusions PE should be considered in advanced colorectal cancer without extrapelvic metastatic disease. PE is accompanied by considerable morbidity (49%) and mortality (3%), but local control is desirable. Overall survival justifies the use of this procedure in patients with primary or recurrent locally advanced rectal cancer.

Outcomes of critically ill gynecological cancer patients admitted to intensive care unit.

Purpose: To assess the characteristics of critically ill patients with gynecological cancer, and to evaluate their prognosis. Methods: Fifty-two critically ill patients with gynecological cancer admitted to intensive care unit (ICU) were included. Univariate and multivariate logistic regressions were used to identify factors associated with hospital mortality. Results: Thirty-five patients (67.3%) had carcinoma of the cervix uteri and 11 (21.2%) had ovarian cancer. The mortality rate in the ICU was 17.3% (9 of 52) and hospital mortality rate were 23%(12 of 52). In the multivariate analysis, independent prognostic factors for hospital mortality were vasopressor use (odds ratio [OR] = 8.60, 95% confidence interval [CI] 2.05-36; P = .03) and the Acute Physiology and Chronic Health Evaluation (APACHE) II score (OR = 1.43, 95% CI 1.01-2.09; P = .048). Conclusions: The independent prognostic factors for hospital mortality were the need for vasopressors and the APACHE II score.

Mortality of patients with cancer admitted to intensive care unit.

Outcomes of critically ill cancer patients admitted to the intensive care unit (ICU) had improved; it could be associated with medical advances in critical care, introduction of new anticancer treatments, and better supportive care. Recent reports have described ICU mortality for critically ill cancer patients ranged from 15.9% to 32%. During the period 2007 to 2011, a total of 1418 critically ill cancer patients were admitted to our ICU with a mortality rate lower (17.5%) than that reported by other centers. The ICUs around the world should consider the improvement in the prognosis of critically ill cancer patients who require critical care and they should not be denied ICU admission only on the basis of a patient having cancer.

Hypomagnesaemia in critically ill patients with haematological malignancies

INTRODUCTION There is currently little information regarding the incidence of hypomagnesaemia and its impact on the prognosis of critically ill patients with haematological malignancies. OBJECTIVE This study sought to describe the incidence of hypomagnesaemia in critically ill patients with haematological malignancies admitted to an oncological intensive care unit (ICU). METHODS A total of 102 critically ill patients with haematological malignancies, who were 18 years of age and admitted to the ICU between January 2008 and April 2011, were included in this study. Hypomagnesaemia was defined as a serum magnesium concentration below 1.7 mg/dl. RESULTS The incidence of hypomagnesaemia at admission or during the first 24 hours of stay in the ICU was 22.5% (23/102). The hospital mortality rates of patients with and without hypomagnesaemia were 47.8% and 60.7%, respectively. CONCLUSION The incidence of hypomagnesaemia in critically ill patients with haematological malignancies was 22.5%. Mortality in the ICU and in the hospital was similar in patients with and without hypomagnesaemia.