Background: The standard of care in operable oral cavity cancer is curative surgery followed by adjuvant therapy. However, adjuvant management of elderly patients with early-stage oral cavity squamous cell carcinoma (OCSCC) remains controversial. This study aims to identify predictors that will guide the adjuvant management in these patients.Methods: We retrospectively analyzed 85 patients who were older than 70 years and had received surgical intervention for early-stage OCSCC in our institution between 2007 and 2015. The Kaplan-Meier analysis and log-rank test were used to estimate the disease-free survival (DFS), overall survival (OS). The predictor for DFS and OS was evaluated through COX regression and receiver operating characteristic (ROC) curve analysis.Results: With a median follow-up time of 4.13 years, patients aged <77.82 years had better OS (P=0.032).Depth of invasion ≥3.25 mm was associated with poorer DFS (P=0.024).Conclusions: Elderly patients with early-stage OCSCC might experience disease progression after surgery. Prospective trials are warranted to investigate the benefit of adjuvant treatment.
Eosinophilic myocarditis is recognized by severe heart failure and marked eosinophilia infiltration resulting from different etiologies. Acute necrotizing eosinophilic myocarditis, the initial presentation of the disease, is rare and often fatal, with unique echocardiographic pictures, and followed by endocardial thrombosis and chronic endomyocardial fibrosis. We report a young female with acute lymphoblastic leukemia who presented fever and acute heart failure syndrome. The echocardiography showed severe left ventricle diastolic dysfunction with preserved ejection fraction. Systemic eosinophilia and the unique echocardiographic images made the diagnosis of acute necrotizing eosinophilic myocarditis. The patient survived after intensive cytotoxic chemotherapy including high-dose steroid.
in diameter and of GII. UTUC developed in 59 (3.7%) of the patients; most of the patients were symptomatic and hematuria was the most common symptom in this cohort 64%, while UTUC was discovered on routine follow-up imaging in 30% of the patients. The median time for the development of UTUC was 20 (6-106 months). Most of the recurrences were on the ureter; either alone (39/59[66%) or ureteral with pelvicalyceal collecting system (10/59[17%), and (10/59[17%) were pelvicalyceal only. Among the isolated ureteral tumors (#39), distal ureteral tumors were more common (30/39[75%) than multicentric or proximal ureter (15% and 10% respectively). Bivariate analysis of the risk factors showed that gender, tumor size, site, tumor stage and grade were not predictors for the development of UTUC recurrence, but only bladder tumor number (single or multiple) and the number of previous recurrences were the predictors for UTUC recurrence (p[ 0.02 and 0.01 respectively). Three or more previous recurrences were the only predictors that sustained their significance in multivariate analysis (p[ 0.03 and 0.001 respectively). UTUC recurrence does not affect the overall survival.CONCLUSIONS: UTUC develops in 3.7% of patients with NMIBC. One-third (30%) of the patients were diagnosed with routine follow up imaging, so regular surveillance of the upper tract is still recommended to all patients. More strict surveillance is advised in the cases of those having had three or more bladder recurrences, yet the optimum protocol and frequency for upper tract imaging is to be determined by future prospective studies.
of adrenal gland was not associated with an increased risk of hypertension or major cardiovascular events at follow-up (p>0.05).CONCLUSIONS: In patients undergoing RN, the risk of hypertension or major cardiovascular events is predicted by presence of nephropathy, heart failure or history of myocardial infarction, but not by the removal of adrenal gland at surgery. The first observation underlines the role of renal parenchyma loss and cardiovascular abnormalities in exposing patients to higher risk of hypertension or major cardiovascular events. The latter may be explained by compensation mechanism of the contralateral adrenal gland.
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