Neuroblastoma is considered a pediatric malignancy as over 95% of cases are diagnosed in patients ≤10 years old. This cancer is extremely rare in elderly patients. We conducted a Surveillance, Epidemiology, and End Results (SEER) database analysis in the USA between 1973–2007 that revealed only 35 elderly patients (>60 years of age) with neuroblastoma of whom only 2 patients had primary mediastinal neuroblastoma. There is a paucity of treatment and survival outcomes data for the elderly owing to the rarity of neuroblastoma in this population. Currently there are no standard guidelines or protocols for treatment of adult neuroblastoma. We report a rare and challenging case of an 86-year old patient presenting with mediastinal neuroblastoma and syndrome of inappropriate antidiuretic hormone secretion (SIADH) successfully treated with resection. Herein, we also provide a review of the literature and updated survival data on neuroblastoma based on results of our SEER database review.
Coccidioides has diverse cytological appearance and varied host response depending on the site and type of preparation examined. In endemic areas, the disease should be considered in all patients, independent of immune status, and throughout the year.
Key Clinical MessageMixed phenotype acute leukemia with t(9;22) is a rare disease with poor prognosis, and information on optimal treatment is limited. We describe a case where our patient experienced positive outcome after nonacute myeloid leukemia‐type intensive induction therapy followed by postremission therapy with stem cell transplant.
Managed care systems allegedly discharge psychiatric inpatients "quicker and sicker" than fee-for-service programs. Study subjects were admitted to a general hospital that served adjacent counties. During 1994, both counties operated fee-for-service Medicaid mental health systems. In 1995, one county remained fee-for-service and the other assumed inpatient financial risk. Lengths of stay declined in both counties between 1994 and 1996. Managed care patients had longer lengths of stay than their fee-for-service counterparts (even after adjustment for confounders). Secular trends and practice patterns may influence length of stay more than managed care.
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