Surgery of esophageal cancer]

From 1975 through 1988, 257 patients with carcinoma of the thoracic oesophagus have been treated in our department. Operability was 90% (232/257), overall resectability 77% (198/257) and for the operated group 85% (198/232). Hospital mortality was 9.6% but decreased to 3% over the period 1986-1988. There were 65% squamous cell epitheliomas and 35% adenocarcinomas. pTNM staging was as follows: Stage I: 11.6%, Stage II: 23.2%; Stage III: 37.9%; Stage IV: 27.3%. Overall survival was 62.5% after one year, 42.4% after 2 years and 30% after 5 years. According to the pTNM staging 5-year survival was 90% for stage I, 56% for stage II, 15.3% for stage III. There was no 5-year survival for patients with stage IV carcinoma. There were statistically significant differences according to tumour localisation, pathologic type, sex and age. Introducing extensive resection and extended lymphadenectomy seems to improve significantly survival in patients in whom an operation with curative intention was performed. The 1-year survival was 90.8 versus 72%, 2-year survival was 81 versus 46% and 5-year survival was 48.5 versus 41% for respectively radical and non-radical resections. Radical surgery in stage IV carcinoma substantially prolonged median survival from 6 months to 1 year. From this study it can be concluded that in experienced hands, surgery today offers the best chances for optimal staging, potential cure and prolonged high-quality palliation.     

Decomposing Area of Residence Differences in Multiple Regression Studies: The Relative Contributions of Independent Variables and Model Coefficients

When rural/urban differences are found in health status or health care use, it is often desirable to identify those factors (such as age, social structure, income, etc.) that influence such differences. To this end, researchers often test rural/urban differences in age, social structure, income, etc., for statistical significance. Also, researchers commonly perform multivariate analyses (such as multiple regressions) to examine rural-urban differences in the influence of various independent variables on the dependent variable of interest. Frequently, researchers discover: (1) statistically significant rural/urban differences in the independent variables (such as age, social structure, income, etc.) and (2) statistically significant rural/urban differences in the effects of these independent variables (i.e., statistically significant rural/urban differences in regression coefficients). The analysis typically stops here, without addressing the relative contributions of (1) and (2) to the rural/urban differences in the dependent variable. This paper argues that the relative contributions of (1) and (2) have important implications for the way policy-makers address rural health problems. This paper presents a method for assessing the relative contributions of differences in the independent variables and differences in regression coefficients to observed differences in the dependent variable, and illustrates the application of the method by analyzing rural/urban differences in the risk of institutionalization.     

Nursing leaders' and nurses' view of health

This study is part of a scientific project, 'Multidimensional Health', the main goal of which is to introduce a broad view on health into health care and nursing The purpose of this study is to examine the view of health among nursing leaders and members of caring staff and to compare it to that of patients (a previous study in the project) The study is based on K Eriksson's theory of caring and its view of the human being with a body, soul and spirit, and health as a dynamic process concerning all aspects of human life An inquiry form with open questions that brought to the fore various aspects and dimensions of health was filled in by 20 nursing leaders and was used in interviewing 49 nurses According to the results many aspects of life are contained in the concept 'health' Health is above all an experience of well-being Ways of promoting one's health are described in terms of various 'healthy' living habits and preventive measures A supporting and humane attitude is hoped for in others There is unanimity that feelings affect health Belief may have a positive influence on health The meaning of life is connected with health Even suffering is part of health In interpreting the answers we assume three dimensions of health 'Health as behaviour' connects health with living in a healthy way 'Health as being' would mean a state of health and is characterized by a search for some kind of balance in one's inner state 'Health as becoming', growing towards health, means that a person becomes whole on a higher level of integration     

Ambulatory 24-hour esophageal pH monitoring

If 24-hour esophageal pH monitoring is to be a useful diagnostic tool, it must reliably discriminate gastroesophageal reflux patients despite daily variations in distal esophageal acid exposure. To address this issue, we studied 53 subjects (14 healthy normals, 14 esophagitis patients, and 25 patients with atypical symptoms) with two ambulatory pH tests performed within 10 days of each other. Intrasubject reproducibility of 12 pH parameters to discriminate the presence of abnormal acid reflux was determined. As a group, the parameters of percent time with pH<4 (total, upright, recumbent) were most reproducible (80%). Therefore, a subject was defined as having gastroesophageal reflux disease if at least one of these three values were abnormal. Intrasubject reproducibility for the diagnosis of reflux disease was 89% for the entire sample. Among subsets, the reproducibility was 93% for the normals and esophagitis patients and 84% for the atypical symptom patients. Total percent time with pH<4 was the single most discriminate pH parameter (85%) and nearly equaled that of the three combined parameters (89%). The intrasubject variability of this parameter was determined by the mean ±2sd of the relative differences between the two test results for all 53 subjects. Total percent time with pH<4 may vary between tests by a factor of 3.2-fold or less (218% higher to 69% lower). We conclude: (1) ambulatory 24-hr esophageal monitoring is a reproducible test for the diagnosis of gastroesophageal reflux disease; and (2) the large intrastudy variability in 24-hr total acid exposure may limit this test's usefulness as a measurement of therapeutic improvement.Supported, in part, by Public Health Services Grant AM 34200-01A1 from NIADDIK.