Search PubMed⌕ Search

Biomedical subjects

M Porta

Publications and source records attributed to M Porta.

At least 73 records · Page 4Linked to original sources
PubMed1997

Attitudes and views of physicians and nurses towards cancer patients dying at home.

The objective was to study attitudes and views of primary care professionals towards terminally ill cancer patients who die at home, using a cross-sectional study based in the health district of Manresa (province of Barcelona, Catalonia, Spain) of the Catalan Health Service, involving 151 primary health care professionals (87 physicians and 64 nurses). By using a self-responded anonymous questionnaire (response rate 89%) it was found that despite excellent motivation, primary care professionals reported widespread frustration and a poor opinion of the quality of care provided to terminally ill cancer patients. Attitudes and views clearly differ by age, sex and geographic setting. In the study area, most professional are reluctant to disclose the diagnosis of cancer, and this attitude is associated with a more favourable assessment of the support provided to the family. The idea that the most appropriate place of death is at home is strongly linked to the belief that patients ought to be informed of their illness, to feelings of frustration and to youth. These findings further substantiate the need and the potential for ample changes in terminal cancer care in Spain.

Adult↗
PubMed1997

Socioeconomic differences in cancer survival: a review of the evidence.

In the discussion of social inequalities in health there has been much debate on the role of medical care. Large differences in cancer incidence and mortality from cancer have been consistently observed. To understand the potential importance of socioeconomic differences in prompt detection and treatment of cancer it is essential to have data on cancer survival. These have been examined less extensively than differences in cancer incidence. We have reviewed 42 studies on social class differences in cancer survival. Twenty-three studies were conducted in North America, and 15 in western European countries. Twenty-three studies were carried out through population-based cancer registries and 17 through hospitals or hospital-based registries. Seven studies examined survival differences for multiple cancer sites. Social class differences in cancer survival appear remarkably general. Patients in low social classes had consistently poorer survival than those in high social classes. The magnitude of the differences for most cancer sites was fairly narrow, with most relative risks falling between 1 and 1.5. The widest differences were observed for cancers of good prognosis and specifically cancers of the female breast, corpus uteri, bladder and colon. The pattern of the social differences in survival did not vary consistently by sex, country, or source of the study population and did not depend on the socioeconomic indicator used.

Breast Neoplasms↗
PubMed1997

Hypertension and oedema caused by cortexone hyperproduction and cured by monolateral adrenalectomy. Case report.

Excess 11-deoxycorticosterone (DOC) production, mostly due to an enzyme defect 11-beta-hydroxylase, is a rare cause of secondary hypertension. Even rarer are those forms due to an adrenal adenoma or to a bilateral hyperplasia. In this paper we report the case of 23-year-old woman with excess DOC production, presenting with arterial hypertension and oedema, whom we first observed in 1961. Complete clinical remission, persisting more than 30 years later, was obtained by monolateral adrenalectomy. The literature reports of DOC-induced hypertension due to adrenal adenoma or hyperplasia are reviewed and the possible pathogenetic mechanisms are discussed.

Adrenal Glands↗
PubMed1996

Somatotype in panic patients.

The aim of the study was to test whether an association exists between asthenic somatotype, as measured by the Quetelet index, and panic and or agoraphobia. Ninety-nine cases with panic and/or agoraphobia diagnosed at the psychiatric outpatient clinic of a general teaching hospital were compared to 99 controls with psychiatric conditions other than panic and agoraphobia, and to 64 medical controls, matched by age and gender. No differences in weight, height and raw Quetelet and ponderal indexes were found between panic cases and controls. However, 33.3% of cases, but only 19.2% of psychiatric controls and 18.7% of medical controls, were in the asthenic group as defined by the lower quartile of the Quetelet index (age and sex adjusted odds ratio = 2.33, 95% C.I.: 1.21-4.11). In the entire sample, the asthenic somatotype was associated with lower age and with the presence of hypermobility of joints. Since both panic disorder and mitral valve prolapse may be associated with the joint hypermobility syndrome (JHS), an inherited disorder of collagen synthesis, it is suggested that the relationship found between panic and asthenic somatotype might be mediated through JHS.

Adult↗
PubMed1996

Do we believe what patients say about their neoplastic symptoms? An analysis of factors that influence the interviewer's judgement.

In order to analyze factors that influence an interviewer's judgement of the validity of responses given by patients on the duration of their neoplastic signs and symptoms, 183 consecutive symptomatic patients hospitalized for a digestive tract neoplasm were personally interviewed. The validity of the answers was judged by the interviewers to be high in 156 cases (85%), and low in 27 (15%). The subjective validity of the interview (SVI) was inversely related to the time elapsed from first medical symptom to interview (TFMSI), even after adjusting for the duration of the interview (p < 0.05). SVI was not influenced by whether patient and interviewer agreed on the first symptom. SVI was inversely related to educational level (p < 0.01) and to occupational class (p = 0.04). Patients whose Karnofsky's Index (KI) was > or = 80 were over twice as likely to yield valid responses (TFMSI-adjusted odds ratio [OR] = 2.82, p = 0.037). Multivariate analyses selected education, TFMSI and KI as independent predictors of the interviewer assessment. The SVI of patients admitted to the hospital through the Emergency Department was lower than that of subjects whose admission was planned (OR = 6.49, p = 0.005). In this study SVI related in a logical manner to the characteristics of the interview, of the subjects and of their clinical course. It hence appeared to reasonably estimate the validity of data collected. Identifying factors that affect the reliability of patients' responses would help increase the validity of studies on the duration of cancer symptoms.

Aged↗
PubMed1996

Thiamine corrects delayed replication and decreases production of lactate and advanced glycation end-products in bovine retinal and human umbilical vein endothelial cells cultured under high glucose conditions.

This study aimed at verifying whether thiamine, a co-enzyme which decreases intracellular glycolysis metabolites by allowing pyruvate and glyceraldheyde 3-phosphate to enter the Krebs cycle and the pentose-phosphate shunt, respectively, corrects delayed replication caused by high glucose concentrations in cultured human umbilical vein (HUVEC) and bovine retinal endothelial cells (BREC). After incubation in physiological (5.6 mmol/l) or high (28.0 mmol/l) glucose with or without 150 mumol/l thiamine, cells were counted and proliferation assessed by mitochondrial dehydrogenase activity. Lactate was measured in both cell types as an index of glycolytic activity and fluorescent advanced glycosylation end-products (AGE) concentration was determined in the HUVEC lysate. Both cell counts and proliferation assays in either of the cell types confirmed the impairment to cell replication induced by high glucose. When thiamine was added to cells kept under high glucose conditions, the number of surviving cells was significantly increased and the reduced cell proliferation appeared to be corrected. Lactate assays confirmed the increased production of this metabolite by BREC and HUVEC in high glucose, which was reduced by thiamine. Fluorescent AGE determination showed that thiamine may prevent non-enzymatic glycation in HUVEC. Thiamine restores cell replication, decreases the glycolytic flux and prevents fluorescent AGE formation in endothelial cells cultured in high glucose, suggesting that abnormal levels of glycolytic metabolite(s) may damage cells.

Animals↗
PubMed1996

Causal thinking, biomarkers, and mechanisms of carcinogenesis.

The use of biomarkers is increasing both in acute and chronic disease epidemiology, but the rationale for their introduction is not always firmly established (e.g., when and how their use is scientifically justifiable and cost effective). The use of biomarkers should be considered within the context of causal models in epidemiology, and of the intertwining of causation and pathogenesis. Unlike infectious diseases, for cancer and cardiovascular disease external "necessary" causes have not been identified. Thus, the classification of cancer and other chronic diseases cannot be based on unequivocal criteria such as the "etiologic" classification of infectious diseases. As far as morphology is concerned, "neoplasia" and "anaplasia" are attributes of cancer that cannot be defined in a straightforward way. Tissue pathologies are minimal and difficult to differentiate from normal tissue in some cancers but are obvious in others. From a mechanistic point of view, unless molecular biology discovers specific mechanistic steps in carcinogenesis, which indicate the existence of "necessary" events in carcinogenesis, we cannot adopt an unequivocal definition of cancer. The potential contribution of biomarkers to the elucidation of the pathogenetic process should be considered in the light of such uncertainties. There is a range of indications for biomarkers, from the use of very specific measurements aimed at single molecules, to measurements indicating cumulative exposure to agents with the same mechanism of action. The potential uses of markers in chronic disease epidemiology include (1) exposure assessment in cases in which traditional epidemiologic tools are insufficient (particularly for low doses and low risks); (2) multiple exposures or mixtures, in which the aim is to disentangle the etiologic role of single agents; (3) estimation of the total burden of exposure to chemicals having the same mechanistic target; (4) investigation of pathogenetic mechanisms, and (5) study of individual susceptibility (e.g., metabolic polymorphism, DNA repair).

Animals↗
PubMed1996

Sex as a prognostic factor in gastric cancer.

The aim of this study was to assess whether survival of gastric cancer patients differed between males and females. Although it is well known that the incidence of gastric cancer is higher for men than for women, the existence of a sex-specific prognosis has seldom been addressed. Studies based on population registries have not assessed the role of stage and histology. Cases of histologically confirmed gastric carcinoma were obtained from three Spanish hospitals in Soria (n = 405), Barcelona (n = 249) and Mataró (n = 197). Differences in possible confounders were tested between men and women and survival analyses were performed separately by hospital. Cox's proportional hazards models were used to account for age, tumour stage, histology and tumour sub-location. Only in Mataró was a significant difference in the stage distribution observed between women and men, with a lower proportion of local stage tumours among women (P = 0.047). No statistically significant differences of histological type between men and women were observed in any of the centres. After adjusting for tumour stage and age, women were observed to have significantly better survival in Barcelona (female to male hazard ratio (HR) = 0.578, P < 0.001); this effect was marginal in Soria (HR = 0.788, P = 0.092) and non-significant in Matar-o (HR = 0.895, P = 0.54). Age-adjusted hazard ratios were calculated within each tumour stage. For Barcelona, the effect of better prognosis among women was most marked at local stage (HR = 0.320, P = 0.013), and in Soria at the regional stage (HR = 0.426, P = 0.002). Although in Mataró all HRs were below unity, none were statistically significant. Little effect was observed at the disseminated stage. The other covariables exerted no influence. Women appear to have a better prognosis than men, and the difference could be tumour stage dependent. Confirmation of these findings would give a valuable insight into gastric cancer growth and ultimately be of use in planning treatment.

Aged↗
PubMed1995

Improvement in survival after myocardial infarction between 1978-85 and 1986-88 in the REGICOR study. (Registre GIroní del COR) registry.

Aspirin, intravenous nitrates and fibrinolysis were being used by 1986 in Girona, Spain. These combined factors should be reflected in myocardial infarction patients' outcome. We assessed changes in 28-day and 3-year survival after a first myocardial infarction between 1978-85 and 1986-88 in the REGICOR (Registre GIroní del COR) registry. This included 1216 consecutive patients with a first transmural myocardial infarction (834 in 1978-85 and 372 in 1986-88). Their 28-day and 3-year mortality rates were 14.6% and 8.8% respectively. Although patients admitted in the second period were more frequently hypertensive and diabetic, a history of angina was less common in patients admitted between 1978 and 1985. After adjusting for diabetes, hypertension, age, and sex, the relative risk of 28-day mortality of those admitted in the second period was 0.65 (95% confidence interval 0.42-0.99). The lower severity, as measured by Killip class of patients in the second period, was the main (confounding) variable responsible for this protective effect. Three-year mortality of those surviving 28 days in 1978-85 (8.3%) did not differ from 1986-88 (8.3%). In the second study period hospitalized patients with myocardial infarction in Girona, Spain showed a better 28-day survival. It is possible that therapeutic and diagnostic refinements, together with other factors not controlled in the present study, have resulted in such an improvement. However, 3-year mortality remained unmodified among those surviving 28 days.

Adult↗
PubMed1995

Pancreatitis and the risk of pancreatic cancer.

To offer quantitative evidence on the association between pancreatitis and pancreatic cancer, we analyzed data from a hospital-based case-control study conducted in northern Italy between 1983 and 1992, including a total of 362 incident cases of histologically confirmed pancreatic cancer and 1,408 controls admitted to hospital for acute, nonneoplastic, nondigestive tract disorders. Information was obtained using a structured questionnaire on sociodemographic characteristics and lifestyle habits (including tobacco and alcohol consumption) and a problem-oriented medical history, which included history of pancreatitis and age at its first diagnosis. Pancreatitis was reported by 24 (6.6%) cases and 18 (1.3%) controls, yielding an age- and sex-adjusted relative risk (RR) of 5.7 (95% confidence interval, 2.9-11.4). The risk of pancreatic cancer was appreciably higher 5 or more years after diagnosis of pancreatitis (RR = 6.9) than in the first 4 years (RR = 2.1), and in subjects below age 60 (RR = 8.3) than in elderly ones (RR = 2.6), but similar in males and females. The time-risk relationship is strongly indicative of a real relationship between pancreatitis and pancreatic cancer. After allowing for tobacco and alcohol, besides area of residence and education, the association between pancreatitis and pancreatic cancer appeared to be partly explained by such covariates (RR = 3.9); however, this may represent some degree of overadjustment if, for instance, alcohol is causally linked to pancreatitis, which, in turn, is causally related to pancreatic cancer. In terms of population attributable risk, pancreatitis would explain approximately 5% of pancreatic cancer cases.

Adult↗