2616例肠癌死亡率分析及预防对策探讨

通过对成都市七区两县监测点中２６１６例肠癌死亡率的统计学分析,总死亡率为７．００／１０万,标化死亡率为６．６７／１０万（其中,大肠癌死亡１６７４例,占肠癌死亡例数构成比６４％,其总死亡率４．８８／１０万,标化死亡率４．２７／１０万）,均呈逐年上升趋势。男性死亡率７．６７／１０万,标化死亡率７．２９／１０万,女性死亡率６．２９／１０万,标化死亡率６．００／１０万,男性明显高于女性（Ｐ＜０．０１）;城区死亡率９．３０／１０万,郊（区）县死亡率４．９４／１０万,二者有显著性差异,城区高于郊（区）县（Ｐ＜０．０１）;在２６１６例肠癌死亡例数中,工人、农民、干部、离退休人员占８２．６５％,且以４５岁以上的男性居多。     

香港脑血管病死亡率时间趋势研究

OBJECTIVE: To describe the time trend of mortality rates of cerebrovascular diseases (CVD) in Hong Kong for the period of 1976 to 1995, and to compare them with those in the more developed countries around the world. METHODS: Mortality rates of CVD were standardized directly using world standard population in 1961. Annual percent changes of mortality rates of CVD were estimated with a non-linear regression. Birth-cohort analysis was carried out at an interval of five-year of age to compare their age-specific mortality rates of CVD in different birth cohorts. Time trend of cause-specific mortality rates of CVD both in males and females was fitted with a simple linear regression model. RESULTS: Considerable downward trend of CVD mortality was observed during the past twenty years. Mortality rates among men and women decreased by 50.96% and 37.85% in 1995, as compared to those in 1976, respectively. Although in general, a greater trend in CVD mortality was observed during the last 10 years, as compared with that in the previous 10 years, an annual increase in CVD mortality of 1.34% was found among males aged 35 to 44 years during the latter 10 years. CVD mortality for both males and females decreased steadily by 1% per year. CVD mortality for females will catch up with that for males by the year of 2013, if such a trend continues. Birth-cohort analysis showed that those born more recently at the same age-group had lower mortality of CVD (except for those born after 1955). Data from hospital admission showed that improvement in the treatment for CVD could have contributed partly to the decrease in its mortality. CONCLUSION: Time trend of mortality of CVD in Hong Kong was similar to that in many other economically developed areas around the world.     

Health inequality and population variation in fertility-timing

We estimate the impact of fertility-timing on the chances that children in poor urban African American communities will have surviving and able-bodied parents until maturity. To do so, we use census and vital statistics data to compute age- and sex-specific rates of mortality and functional limitation among prime-aged adult residents of impoverished African American areas in Harlem, Detroit, Chicago, and the Watts area of Los Angeles and for blacks and whites nationwide. Findings are consistent with the hypothesis that the early fertility-timing characteristic of poor urban African American populations mitigates some of the costs to families associated with excess mortality and early health deterioration in young through middle adulthood.     

Predictors of cancer mortality in elderly subjects

Cancer mortality was analysed in 3282 elderly subjects aged 65 years from 2 cohorts of general population having different life-style patterns. They took part in the CASTEL (CArdiovascular STudy in the ELderly), a 12-year lasting prospective Italian study. The aim of the present analysis was to identify the items able to influence cancer mortality. A biochemical profile and a questionnaire on lifestyle were collected. Continuous items were averaged and compared with analysis of variance, frequencies with the Pearson's ² test. Mortality was recorded yearly for 12 years from the Registrar's Office and causes of death double-checked by consulting medical case sheets and family doctors' files. The influence of items on mortality was evaluated with the Cox multivariate analysis. Relative risk (RR) of each item was adjusted for confounders. Age, gender, tobacco smoking, the presence of respiratory symptoms, low body mass index in males, serum alanine transaminase (ALT) and alkaline phosphatase (ALP), as well as the town of residence, were powerful predictors of cancer mortality. In the entire population, 12-year overall mortality was 49.4%, cardiovascular 22.8%, and neoplastic 11%; the latter was higher in males than in females (15.7% vs. 7.9%, p < 0.00001). In subjects with respiratory symptoms neoplastic mortality was 11.6% (RR: 1.47) vs. 9.7% in those without symptoms (p < 0.01). Subjects with very low cholesterol ( 178 mg/dl), those with high uric acid ( 8.7 mg/dl) and males with low body mass index ( 22.7 kg/m²) has an increased risk of cancer mortality. RR of cancer mortality increased with increasing ALT or ALP. It was 1 in those having ALT and ALP between 9 and 41.2U/I, 1.41 in those exceeding this latter level and < 1 in those below 9U/I. RR of ALP had a similar trend, the best protective cut-off value being <106 and the worst one > 177U/I. When both serum enzymes were simultaneously raised, RR of cancer mortality increased to 2.84.     

The evolution of breast cancer mortality and morbidity in Spain (1977–1988)

A study of breast cancer mortality and cancer morbidity has been carried out in Spain recently for the period 1977–1988, covering the population of the 17 Autonomous Communities and 50 provinces of the country. Data was obtained from INE, Instituto Nacional de Estadistica (National Institute of Statistics), with age standardization using the indirect method. The different Autonomous Communities and provinces were compared in order to establish possible significant differences. The crude mean mortality rate was 21 cases per 100,000 inhabitants/year; Las Palmas, Gerona, Barcelona, the Balearic Islands, Navarra and Zaragoza have the highest mortality rates, with a proportional increment of 54% in that period. The crude national mean morbidity rate for the considered period was 64.0 cases per 100,000 inhabitants, and the proportional increment 180%. According to provincial figures, Alava had the highest fitted mean morbidity rate, 135 cases per 100,000 inhabitants, whilst the highest fitted mean rate was Las Palmas (28 cases/100,000 inhabitants), and the highest proportional increment was the rate for the province of Huesca (169%). When using the ANOVA test on the mean rate of the period, for mortality as well as morbidity, we observed significant differences among provinces and among Autonomous Communities (p 0.05).     

Epidemiology and risk factors of pneumonia in critically ill patients

Risk factors for pneumonia were analysed in a large population of critically ill patients, collected in two prospective multicentre pneumonia studies in Italy. Twenty-three intensive care units were involved and the study time was 150 unit months. Only patients without previous pulmonary infection, with intensive care unit stay 48 hours and no rapidly irreversible illness at admission were included. The incidence of pneumonia in the 1475 selected patients was 15% (220 cases). 239 patients died in ICU; the mortality rate was significantly higher in patients developing pneumonia (p<0.0001); pneumonia was found to be an independent highly significant risk factor for death in critically ill patients (OR = 3.88; p<0.0001).Multivariate analysis of seven risk factors for pneumonia showed a significantly higher risk in patients with neuromuscular disease (OR = 3.8, p<0.002), impairment of airway reflexes at admission (OR = 2.93, p<0.0001), and 24h respiratory assistance (OR=3.05, p<0.0001). Impairment of airway reflexes at admission to the emergency room or intensive care unit identifies the population who will experience 3/4 of the overall lower respiratory tract infections.Rapid recognition of at-risk patients seems clinically important and may improve awareness programs and preventive approaches.Intensive Care Unit Group for Infection Control (I.C.U.G.I.C.), a list of participating physician co-authors of the paper is reported at the endCorresponding author.     

Correlation between mortality trends of ischaemic cardiopathy and some nutritional factors in Spain 1968–1986

After describing the evolution of mortality from ischaemic cardiopathy (IC) in Spain from 1951 to 1986, which is tending to stabilize in some age groups, and from cerebrovascular accidents (CVA), which is clearly declining, an attempt is made to relate these developments to the prevalence of the main risk factors (hypertension, cholesterol, tobacco) associated with IC and CVA. Certain advances, though of a limited number, have been made in recent years in the control of arterial hypertension in Spain, although campaigns on a national scale as in other countries have not been carried out. Regarding alimentary factors, there is an obvious increase in the consumption of food rich in proteins and animal fats, abandoning to a great extent the traditional Mediterranean diet, with health care action being limited to the improvement of nutrition education of the public. Furthermore, the consumption of tobacco has been increasing in Spain during the study period in spite of health legislation in force in recent years.It is therefore deduced that there is no obvious relationship between mortality due to IC and CVA and the prevalence of the main risk factors associated with these diseases, especially when taking into account that preventive actions on a public health level have been very limited.Corresponding author.     

Relative incidence and mortality of congenital heart defects diagnosed by angiohemodynamic methods: A 17-year study

Summary Over a 17-year period (January 1971 to January 1988), 2322 children, aged 0–14 years, were diagnosed as having congenital heart disease (CHD) by cardiac catheterization and angiography. Excluding those with highly complex or undiagnosed defects, there were 2156 children with CHD, 72.4% of whom were treated surgically with a total surgical mortality rate of 24.1%. After a mean follow-up of 9 years the overall mortality of the cohort was 29.9%, 29.1% occurring in the first month of life, 39.6% between 1 month 1 year, and 31.2% between 1 and 14 years. The incidence, mortality, and age at death of each cardiac defect are presented and compared with the results of other studies. The overall mortality for congenital heart defects in eastern Spain remains elevated, whereas there has been a significant decrease in neonatal mortality and a trend towards a lower mortality in the last years of the study.     

Treatment of vertebro-basilar aneurysms

Summary In continuation of investigations on classification and treatment of ICA-system aneurysms and on the classification of the vertebro-basilar-system aneurysms their treatment has been discussed. Based on this, classification has been improved and the preoperative topographic diagnosis and the choice of approach have been influenced. The operative management has been pioneered by C. G. Drake, who described the technique in detail on hand of his enormous experience with 469 aneurysms of the vertebro-basilar-system (13). The necessity of a normal aneurysm neurosurgeon treating such aneurysms requires certain modifications of indication, approach and dissection. In a personal statement based on 35 VB-aneurysms (6 per cent) the strategy of handling these aneurysms has been developed (45). Microsurgical technique is regarded absolutely necessary. Thetransoral transclival access to aneurysms of the lower clivus should be included in the approaches, similarly to the transsphenoidal operations. It facilitates the direct isolation in a very difficult region.Electrothermic dissection of the aneurysm diminishes the risk of rupture during the isolation of the sack and facilitates the isolation of the neck. The statistics of Drake provide full data for the prognosis of these aneurysms. It is to note that in the recent time the results reported from different centres became more and more similar. The embolization of large bulbous or spheric and giant aneurysms by inflatable balloon-technique possibly may replace some risky direct or indirect operations.

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Zusammenfassung In Fortsetzung unserer Untersuchungen über die mikrochirurgische Klassifikation und Behandlung der Aneurysmen des A. carotis interna-Systems, sowie die Klassifikation der Aneurysmen des Vertebro-Basilaris-Gebietes befaßt sich der Beitrag mit der Therapie letzterer. Die moderne Klassifikation und parallel dazu die präoperative angiographische Diagnostik haben die Wahl der Craniotomie und des direkten Zugangs zum Aneurysma unmittelbar beeinflußt. Die operative Behandlung ist im wesentlichen das Werk eines Mannes — Charles Drake — der die Technik anhamd seines großen Krankengutes von derzeit 469 Fällen im Detail beschrieben hat. Die Notwendigkeit für den normalen Aneurysma-Neurochirurgen, derartige Aneurysmen zu behandeln, erfordert nach meiner Überzeugung gewisse Modifikationen der Indikation, des Zuganges und der Präparation. In einer persönlichen Stellungnahme, die sich auf eine Erfahrung von 35 Aneurysmen des Vertebro-Basilaris-Gebietes stützt (6%), werden die Prinzipien des Vorgehens erläutert. Die mikrochirurgische Technik ist unerläßlich.Dertransorale transclivale Zugang sollte für bestimmte Aneurysmen der A. basilaris ebenso durchgeführt werden, wie der transsphenoidale Zugang für Hypophysenadenome selbstverständlich geworden ist. Er erleichtert die direkte Freilegung in dem sehr risikoreichen Gebiet von Brücke und Hirnnerven.Dieelektrothermische Dissektion verringert das Risiko der Ruptur während der Präparation und erleichtert die Isolierung des Aneurysmahalses.Drake's Statistik enthält alle Einzelheiten über die Prognose der verschiedenen Vertebro-Basilaris-Aneurysmen als Maßstab für das eigene Resultat. Erfahrungen der letzten Jahre aus verschiedenen Kliniken zeigen, daß die Ergebnisse sich mehr und mehr angleichen.DieEmbolisation großer bulböser und sphärischer Aneurysmen und der Riesenaneurysmen durch die Ballon-Technik erscheint geeignet, risikoreiche direkte oder indirekte Operationen zumindest teilweise zu ersetzen.