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S Delgado

Publications and source records attributed to S Delgado.

At least 55 records · Page 3Linked to original sources
PubMed1995

Short-term outcome analysis of a randomized study comparing laparoscopic vs open colectomy for colon cancer.

The authors examined the impact of the laparoscopic approach on the early outcome of resected colon carcinomas. The role of laparoscopic techniques in the treatment of colon carcinomas is questionable. Previous studies have suggested technical feasibility of surgical resections of these cancers by laparoscopic means and have implied a benefit to laparoscopic technique for patients undergoing colorectal resections. A prospective, randomized study was conducted comparing laparoscopic assisted colectomy (LAC) open colectomy (OC) for colon cancer. We present the preliminary results in relation to the short-term outcome and judge the feasibility of the laparoscopic procedure to as a way of performing accurate oncologic resection and staging. Benefit has been demonstrated with LAC in this setting. Passing flatus, oral intake, and discharge from hospital occurred earlier in LAC- than OC-treated patients. The mean operative time was significantly longer in the LAC group than in the OC group. The overall morbidity was significantly lower in the LAC group. No significant differences were observed between both groups in the number of lymph nodes removed or the pathological stage following the Astler-Coller modification of the Dukes classification. The laparoscopic approach improves the short-term outcome of segmental colectomies for colon cancer. However, the further follow-up of these patients will allow us to answer in the near future whether or not the LAC may influence the long-term outcome.

Adenocarcinoma↗
PubMed1995

Canine seroprevalence of Rickettsia conorii infection (Mediterranean spotted fever) in Castilla y León (northwest Spain).

A seroepidemiological study was conducted in 308 dogs to determine the presence of antibodies to Rickettsia conorii, using an indirect immunofluorescence assay (IFA). Seven of the provinces of the Castilla y León region (Burgos, León, Palencia, Salamanca, Soria, Valladolid, and Zamora) were covered by the study. Of the 308 dogs analysed, 72 (23.4%) showed significant titers by IFA (1/40 or higher). Seroprevalences were significantly different between provinces of origin of the animals. These were below 30% in almost all the provinces studied, except for Salamanca province, where the percentage of seropositive dogs was much greater (93.3%). Potential risk factors (presence of ticks on the animals, age, sex, use, habitat, and season) relating to the presence of Mediterranean spotted fever, or Boutonneuse fever, were evaluated. Animals used for guard or pastor activities and those living in rural areas (these factors are closely linked), together with those suffering from tick infestation, had significantly higher seroprevalence than the remainder. The frequency of seropositive dogs increased during the summer months, and these coincide with the period of greatest activity by the vector. Sex and age variables were not identified as risk factors.

Age Factors↗
PubMed1995

Seroepidemiological survey for Borrelia burgdorferi (Lyme disease) in dogs from northwestern of Spain.

A random epidemiological study was undertaken to estimate the prevalence of canine borreliosis (Lyme disease) in Castilla y León, the largest region in Spain. The presence of antibodies was determined by indirect immunofluorescence assay (IFA), using the Borrelia burgdorferi B31 strain as antigen. Sera from 308 dogs from 7 provinces in the region were tested. Of all the animals sampled, 37 (21%) were seropositive (titres of 1/64 or above). Almost all the provinces had seroprevalence of 20% or below, except for an important focus of borreliosis in the Zamora province (42.8%). Potential risk factors (age, sex, use, habitat, season, and presence of ticks on the animals) relating to the presence of antibodies were evaluated. Those dogs which had at some time had ticks were more often seropositive, at 24.2%, than those which had never had them, at only 6.2% (p < 10-n). No significant differences were discovered for the remaining factors studied. This work indicates that dogs in Castilla y León, even if in most cases they do not develop the disease, are exposed to the Lyme disease agent.

Animals↗
PubMed1995

Alternating combination chemotherapy and interferon improves survival in poor prognosis multiple myeloma.

To assess the efficiency and toxicity of alternating combination chemotherapy plus interferon-alpha-2b (IFN) in the treatment of poor prognosis multiple myeloma, we began a prospective clinical trial. The study involved 103 previously untreated patients with poor prognosis: Stage III, haemoglobin below 8.5 g/dl, beta 2-microglobulin > 5.0 micrograms/ml and multiple lytic lesions. All patients were treated with an alternating combined regimen given monthly for 2 years. After randomization, 52 patients also received IFN at a dosage of 5.0 MU three times weekly during the first year of the therapy. The remaining 51 patients received chemotherapy alone. Compared with patients treated with chemotherapy alone, those treated with chemotherapy plus IFN had a higher overall rate of response: (80% versus 47%), a longer duration of remission (36 months versus 18.5 months) and a higher rate of survival at 5 years (74% versus 39%; P < 0.001). Toxicity was similar in both arms. All patients received the planned dose of IFN. There were no deaths related to treatment. The addition of IFN to a regimen of alternating chemotherapy increased the rate of response, duration of remission and survival in patients with poor prognosis multiple myeloma, without serious side effects.

Adult↗
PubMed1995

Sphincter-saving surgery with and without pre-operative radiation therapy as treatment for adenocarcinoma of the mid-rectum.

AIMS: To determine if pre-operative radiation therapy induces a local response in patients with complete tumour penetration into the rectal wall and allows for anal sphincter preservation, we compared the results from pathological specimens and local recurrences as measurable end-points in patients treated with pre-operative radiation therapy plus low anterior resection vs. those only treated with low anterior resection. METHODS: From January 1986 to December 1992, we treated 62 patients with mid-rectal adenocarcinoma (5-10 cm from the anal verge as determined by rigid proctosigmoidoscopy with the patient in the jackknife position). Pre-operative evaluation included: complete blood cell count, chemistry profile and the determination of carcinoembryonic antigen, chest X-ray, barium enema or colonoscopy and CT scan of the abdomen and pelvis. Only tumours potentially curative by resection in patients with performance status 0-2 (ECOG) were included. Twenty-one patients received pre-operative radiation therapy at a dose of 45 Gy delivered to the pelvis; 4-8 weeks later a low anterior resection was performed. Forty-one patients were treated with low anterior resection alone. Surgical specimens were classified according to the Astler-Coller modification of Dukes' classification. RESULTS: There were 36 males and 26 females, with a mean age of 56 years. The surgical specimens of those treated only with surgery were classified as: A, 5; B1, 4; B2, 15; C1, 2; and C2, 15. Postirradiated specimens: no residual tumour, 3; A, 4; B1, 4; B2, 7; C2, 3. One surgical death occurred in the group who underwent surgery alone. The median follow-up was 50 months in patients treated with surgery alone vs. 62 months in the combined approach group. Local recurrences occurred in 15/40 patients treated with surgery alone and in 2/21 of those treated with the combined approach (P = 0.043). Anal sphincter continence was classified as excellent by 24/40 patients treated with surgery only and by 18/21 patients treated with the combined approach. The 5-year survival period was 58% in the surgery only group and 82% in the group with combined treatment (P = 0.08). CONCLUSIONS: The use of pre-operative radiation therapy plus low anterior resection was associated with a lower rate of local recurrence and with a higher number of surgical specimens with no lymph node metastases. Thus, this combined treatment modality should be further evaluated as a possible treatment of mid-rectal cancers in good surgical candidates selected for sphincter-saving procedures.

Adenocarcinoma↗
PubMed1995

Morbidity and mortality following preoperative radiation therapy and total pelvic exenteration for primary rectal adenocarcinoma.

BACKGROUND: Pelvic exenteration, the standard treatment for patients with locally advanced rectal adenocarcinoma infiltrating neighbouring pelvic visceras, carried a significant morbidity and mortality rate. AIMS: The aim of this study was to determine the morbidity and mortality rates in a group of patients who were treated with preoperative radiation therapy and total pelvic exenteration. METHODS: Between January 1980 and January 1995, we treated 18 patients. Pretreatment staging was determined by clinical examination and computed tomography (CT) scan of the abdomen and pelvis. Each patient received preoperative radiation therapy of 45 Gy in 20 fractions delivered to the whole pelvis; approximately 6 weeks later total pelvic exenteration was performed. RESULTS: There were 17 males and 1 female, with a median age of 59 years. All patients underwent and completed the scheduled radiation therapy treatment. The main complaints related to radiotherapy were transient skin erythema in five patients and diarrhoea in four. Blood loss (estimated by the surgeon) ranged from 1000 ml to 4200 ml, with a mean loss of 2020 ml. Eight patients (44%) developed major complications: anastomatic leak from the uretero-intestinal suture line (n = 1); perineal wound infection (n = 2); abnormal wall infection (n = 1); haemorrhage from the right internal iliac vein (n = 1) and pneumonia (n = 1). Three patients required surgical reintervention for immediate postoperative haemorrhage from the sacral venous plexus (n = 1), small bowel obstruction (n = 1), and intra-abdominal and pelvic abscess (n = 1). There were two postoperative deaths (11%). The mean and median follow-up was 41 and 32 months, respectively. Two patients (12%) developed local recurrence at 5 and 8 months, and six developed distant recurrences (37%). The overall 5-year survival rate was 61%. CONCLUSION: Our treatment approach was associated with high morbidity and mortality rates, but was similar to previously published series based on total pelvic exenteration without prior radiation therapy. In addition, our therapeutic approach was associated with a low rate of overall local recurrences. Surgical Oncology 1995; 4: 295-301.

Adenocarcinoma↗
PubMed1995

Evaluation of an enzyme-linked immunosorbent assay for the detection of sheep infected and vaccinated with Brucella melitensis.

An indirect enzyme-linked immunosorbent assay (ELISA), using the lipopolysaccharide of the cell wall as an antigen, was used to detect Brucella melitensis antibodies in ovine serum. The test was carried out on 703 samples of field serums, which were also analyzed by the complement fixation (CF) test and the rose Bengal (RB) test. The ELISA results were more similar to those of the CF test (kappa = 0.89) than to the results of the RB test (kappa = 0.73). The ELISA also had high sensitivity (94.7%) and a somewhat lower specificity (90.4%). One group of 139 young brucellosis-free animals 3-6 months of age were vaccinated with B. melitensis rev. 1 at a dose of 1.2 x 10(9) live organisms. The ELISA detected a significantly lower number of reactors than the CF and RB tests (P < 0.001). The ELISA values remained below the cutoff level during the 9 months following vaccination.

Animals↗
PubMed1994

Adjuvant radiotherapy to sites of previous bulky disease in patients stage IV diffuse large cell lymphoma.

PURPOSE: To evaluate the usefulness of adjuvant radiotherapy to sites of previous bulky disease in patients with advanced diffuse large cell lymphoma (DLCL) who were in complete remission after chemotherapy. METHODS AND MATERIAL: Two-hundred and eighteen patients were initially treated with combined chemotherapy CEOP-bleo (cyclophosphamide, epirubicin, vincristine, prednisone, bleomycin) alternating with DAC (dexamethasone, cytosine arabinoside, and cisplatinum). One hundred and fifty-five patients achieved complete remission. Eighty-eight patients with initial bulky disease were randomly assigned to either received (43 patients) or not received radiotherapy (45 patients). Dose ranged from 40-50 Gy. RESULTS: The median time to treatment failure has not been reached in patients who received radiotherapy. At 5 years 72% of the patients treated with the combined therapy remain alive disease in free compared to only 35% in the control group. Projected survival at 5 years was better in the patients with adjuvant radiotherapy: 81% compared to 55% in the patients who received no radiotherapy. Toxicity was mild and manageable. No lethal toxicities were observed. CONCLUSION: This treatment sequence produced durable control disease in patients with disseminated DLCL and bulky disease with acceptable toxicity. The role of radiation therapy in patients with disseminated DLCL will be confirmed in large clinical trials, but we felt that this sequence of treatment could be useful in patients with this clinical condition.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1994

Combined therapy for angioimmunoproliferative lesions.

43 patients with a diagnosis of angioimmunoproliferative lesions (AIL) entered onto a prospective clinical trial to evaluate the use of combined therapy as a primary therapeutic approach. Patients were treated initially with involved field radiotherapy 40-55 Gy (40 patients received 45 Gy) followed by six cycles of chemotherapy which consisted of CEOP-Bleo (cyclophosphamide, epirubin, vincristine, prednisone and bleomycin). Complete response was achieved in 41 cases (95%). At a median follow-up of 40 months, 40 patients (91%) remain in first complete remission. 2 patients died during radiotherapy secondary to sepsis and tumour progression. Treatment was well tolerated. The treatment of AIL remains controversial. Our results show that combined therapy appears to be the best therapeutic approach in patients with this type of malignant lymphoma. More studies are necessary to define the role of combined therapy in patients with AIL.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1992

Local recurrence of rectal adenocarcinoma following preoperative radiation therapy and surgery.

An important therapeutic endpoint of the surgical treatment of rectal adenocarcinoma is to obtain local control. In an attempt to enhance this goal, we started a regimen of treatment consisting of preoperative radiation therapy (PRT), 45 Gy in 5 weeks, followed by surgery 4-6 weeks after termination of the PRT. Depending on the local characteristics of the tumor, either an abdominoperineal resection (APR), a posterior pelvic exenteration (PPE), and a total pelvic exenteration (TPE) were performed. All patients found with distant metastasis were excluded from this study. There were 66 patients: 40 males and 26 females. Fifty six underwent an APR, six a PPE, and four a TPE. Their median age was 56 years. Major complications were intraoperative bleeding (15%); perineal wound infection (21%); abdominal wound infection (9%). Five patients (7.5%) died within 30 days of surgery; two after APR, two after PPE and one after TPE. Median follow-up is 60 months. The overall local recurrence rate is 9.8%. Recurrences related to the Astler-Coller modification of Dukes' stage were 0/21 in A or B1, but 6/40 (15%) when the stages were B2, B3, C1, C2 and C3. In conclusion, we found this treatment approach effective in obtaining local control of the rectal adenocarcinoma and comparable to the results of other series. However, it was associated with significant morbidity and mortality.

Actuarial Analysis↗
PubMed1991

Suicide in the Canary Islands, 1977-1983.

We studied suicide in the Canary Islands between 1977 and 1983 and found 775 cases, twice the official number of 381. This indicates the lack of validity and reliability of official figures for suicide in Spain today. The figures reveal an upward trend in the Canary Islands, with the annual rate of 6.81 per 100,000 in 1977 having increased to 10.64 per 100,000 in 1983. There were no significant differences in the frequency of suicide according to season, month or day of the week.

Atlantic Islands↗
PubMed1990

Usefulness of frozen-section examination in resected mid-rectal cancer after preoperative radiation.

The surgical treatment of rectal cancer of the middle third remains controversial. We treated 30 consecutive patients with preoperative radiotherapy (45 Gy) and low anterior resection. Anastomoses were performed with a stapler. Intraoperative frozen-section examination of the rectal margin established that it was free of tumor. Two patients died of surgery-related causes. Median follow-up of the remaining patients is now 52 months (range: 26 to 76 months). Eight patients had recurrences documented at surgical re-exploration: two local (pelvic) only, three local and distant, and two distant only. Local recurrences happened despite a frozen-section examination of the rectal margin negative for tumor. Six of the eight patients who experienced a recurrence have died of disease progression. Distant metastases were found in six other patients during follow-up; they subsequently died. Thus, our therapeutic approach was not associated with decreases in local or overall recurrences.

Adenocarcinoma↗
PubMed1979

Electroencephalographic affects of an anti-inflammatory analgesic: mefenamic acid.

A study of the electroencephalographic patterns observed following iv administration of increasing doses of mefenamic acid in acute experiments on curarized cats and rats and the possible modification of these effects by naloxone was carried out. Mefenamic acid produced in both species a progressive and dose-related increase of the voltage of the baseline patterns. With high doses, besides slow waves and fusiform complexes, an irritative activity with spikes and complexes of polyspikes was observed. The recovery of the basal activity was obtained within 15 min, except for the highest dose, under which the effect lasted 30 min after administration. Cats displayed a higher sensitivity than did rats. Naloxone did not modify the EEG effects of mefenamic acid, neigher in rats nor in rats. This fact suggests that the locus of action of these drugs is different. Mefenamic acid appears to act centrally with relatively short-lasting depressant effects at low doses and facilitating or stimulant effects at high doses.

Animals↗
PubMedDate not supplied

The influence of pre-operative radiation therapy on the patterns of recurrence in rectal adenocarcinoma.

From January 1976 to December 1994, we evaluated the institutional experience of local recurrence and survival in patients with rectal adenocarcinoma treated with pre-operative radiation therapy (PRT) as compared to those treated with radical surgery alone. There were 412 patients, divided into two groups: 259 patients (142 males and 117 females) in Group I and 153 patients (88 males and 65 females) in Group II. The median age was 56 years. Group I patients with locally advanced tumors, either tethered or fixed, received PRT at doses of 45 Gy delivered to the pelvis in two fields; 4 to 8 weeks later, radical surgery was performed. Patients with mobile tumors underwent radical surgery only (Group II). The operative mortality was 4.6% in Group I as compared to 1.9% in Group II (P = 0.18). At median follow-up of 89 months, there were local recurrences in 12.9% of Group I as compared to 36.2% in Group II (P = 0.0000001). The administration of PRT was associated with a low rate of local recurrence, but this improvement corresponded with a high morbidity rate, especially in patients who underwent abdominoperineal resection or pelvic exenteration.

Adenocarcinoma↗
PubMedDate not supplied

Laparoscopic-assisted vs. open colectomy for colorectal cancer: influence on neoplastic cell mobilization.

Laparoscopic surgery for treatment of colorectal cancer has been suggested to enhance tumor dissemination. Recently, molecular techniques have been developed to detect micrometastatic disease in patients with solid tumors, with a higher accuracy than cytologic or immunohistochemical approaches. This study was undertaken to investigate the potential harmful effects of laparoscopic-assisted colectomy on neoplastic cell mobilization in patients with resectable colorectal cancer. Fifty patients with nonmetastatic colorectal cancer were randomly assigned to laparoscopic-assisted (LAC, n = 26) or open (OC, n = 24) colectomy. Peripheral venous blood samples were obtained preoperatively, immediately after tumor removal, and 24 hours later. In 10 patients from each treatment group, portal blood and peritoneal fluid samples were also obtained before and after resection. Neoplastic cells were detected by means of reverse transcriptase-polymerase chain reaction targeted to carcinoembryonic antigen (CEA) transcription. CEA mRNA was detected in peripheral venous blood samples from 35 of 50 colorectal cancer patients preoperatively. Among those 15 baseline-negative patients, four experienced conversion 24 hours after tumor resection (2 [33%] of 6 in the LAC group vs. 2 [22%] of 9 in the OC group; NS). At that time point, clearance of CEA mRNA expression was observed in 14 of the 35 baseline-positive patients (9 [45%] of 20 in the LAC group vs. 5 [33%] of 15 in the OC group; NS). In addition, only one patient in the LAC group with baseline-negative CEA mRNA expression experienced portal blood conversion after tumor removal, although his peripheral blood level remained negative. Finally, baseline peritoneal fluid CEA mRNA expression was never detected, but one patient in each group became positive postoperatively. These results confirm that preoperative and perioperative mobilization of neoplastic cells is a frequent occurrence in patients with colorectal cancer, but the surgical approach (LAC vs. OC) does not seem to be a determining factor.

Adult↗
PubMedDate not supplied

The rise and fall of New Jersey's uncompensated care fund.

Since 1982, acute care hospitals in New Jersey have been reimbursed on a diagnosis-related group (DRG) basis along with a provision for 100 percent reimbursement of uncompensated care (bad debts and charity care). Initially, that system was based on a hospital-specific surcharge. Eventually, that was replaced with a uniform charge for all hospitals, including reimbursement by Medicare. But the growth in the number of uninsured, an inequitable financing system, increases in bad debts, and the elimination of Medicare payments led to the program's demise. An extended legislative stalemate has resulted in a pair of temporary extensions--aided by an infusion of federal Medicaid dollars--but the state still must find a permanent solution.

Economics, Hospital↗
PubMedDate not supplied

From DRGs to deregulation: New Jersey takes the road less traveled.

Following a 1992 court ruling that declared New Jersey's system of financing uncompensated care unconstitutional, the state radically changed its 12-year-old hospital payment system that pioneered the use of diagnostic-related groups (DRGs). In its place, New Jersey lawmakers approved a package of reforms that lets hospitals set their own charges and collect bad debts, uses the state's unemployment insurance trust fund to pay for charity care, and reforms the individual and small group insurance markets. Immediate results of the law include new subsidies for inner-city hospitals, lower bond ratings, and hospital layoffs.

Diagnosis-Related Groups↗