| Popis: |
1. 1. In the four years that we have been attending 127 patients with gastric cancer, 84 per cent of the total were seen in the last two years, due to the recognition of the specialization of this matter on this service. Table XVI Gastrectomy in patients with heart disease No. of Observation Age Diagnosis Operation Anesthetic Prognosis 37—1950 65-A Gastric cancer—aortic insufficiency; arteriosclerosis Subtotal gastrectomy Local novocain Died, 8th day, peritonitis 39—8721 58-A Gastric cancer; hypertension; low pulse pressure; rheumatic mitral insufficiency Subtotal gastrectomy Local novocain Died, two months. No metastases; cardiac insufficiency 39—5521 41-A Gastric cancer—aortitis—aortic insufficiency (Hodson) Subtotal gastrectomy Local novocain Died, 4 months; cardiac insufficiency; no metastases 40—8471 55-A Gastric cancer; aortic insufficiency; luetic aortitis Total gastrectomy Local splanchnic Died, 7 months; right pleural metastases; carcinomatous peritonitis 2. 2. We have observed the greater frequency of gastric cancer in the masculine sex (74 per cent) and in the fifth decade of life. 3. 3. The presence of dyspeptic symptoms (57 per cent) or the ulcer syndrome (25 per cent) in individuals over forty years and without previous digestive disturbance should lead us to suspect gastric cancer. 4. 4. The gastric resectability is greater (52 per cent) in individuals whose symptoms are of one year's duration than in those patients with shorter histories, since they are tumors of slow evolution. 5. 5. The lesser curvature and prepylorus are the regions in which gastric cancer localizes more frequently. They interfere with the flow of gastric juice, producing anachlorhydria or else the cancer spreads itself into previously degenerated mucosa (chronic gastritis). 6. 6. Gastric resectability is one of the highest of those published (55.76 per cent) with a mortality of 20 per cent corresponding to a 16 per cent in subtotal gastrectomies and 44 per cent in total gastrectomies. 7. 7. The operative mortality increases in direct relation with the age and the difficulty of the operation. 8. 8. The most frequent postoperative complications are: respiratory and wound infections, whose percentage has diminished notably since the routine use of the sulfanilamides. 9. 9. The evolution of gastric cancer is in possible relation with its histological type; the slowest evolution has been the mixed cell cancers followed by adenocarcinoma. The solid cancers are the most rapid in growth. 10. 10. The prognosis is better for exploratory laparotomy than for the palliative operations, i.e., gastroenterostomy, jejunostomy, gastrostomy, etc. 11. 11. The gastrectomies were executed without difficulty in four patients with severe cardiac difficulties, one of which was a total gastrectomy with equal good evolution postoperatively, as easily as in an individual with normal cardiac function. 12. 12. The only treatment in gastric cancer is radical gastrectomy performed at an opportune time. |
