BACKGROUND The Vulnerable Elders-13 Survey (VES-13) is a short tool that predicts functional decline and mortality over a 1–2 year follow-up interval. Prognosis over longer intervals is often needed in clinical care. OBJECTIVE To test the predictive properties of the VES-13 over a 5-year interval. DESIGN Longitudinal evaluation with mean follow-up of 4.5 years. SETTING Two managed-care organizations. PARTICIPANTS 649 community-dwelling elders (age ≥75 and older) enrolled in the Assessing Care of Vulnerable Elders (ACOVE) observational study who screened positively for symptoms of fear of falling/falls, bothersome urinary incontinence, or memory problems. MEASUREMENTS VES-13 score (range 1–10, higher indicates worse prognosis); functional decline (defined as decline in count of 5 activities of daily living or nursing home entry); deaths. RESULTS Greater VES-13 scores are associated with greater predicted probability of death and decline among older patients over a mean observation period of 4.5 years. For each additional VES-13 point, the odds of the combined outcome of functional decline or death was 1.37 (95% CI 1.25–1.50), and the area under the receiver operating curve (AUC) was 0.75 (95% CI .71–.80). In the Cox proportional hazards model predicting time to death, the hazard ratio was 1.23 (95% CI 1.19–1.27) per additional VES-13 point. CONCLUSION This study extends the utility of the VES-13 to clinical decisions that require longer-term prognostic estimates of functional status and survival.

Panoramic radiography has a moderate diagnostic accuracy in the detection of carotid artery calcification, but the sensitivity is low.

Schwannomas are generally slow growing asymptomatic neoplasms that rarely occur in the GI tract. However, if found, the most common site is the stomach. Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract, and 60–70% of them occur in the stomach. Owing to their typical presentation as submucosal neoplasms, gastric schwannomas and GISTs appear grossly similar. Accordingly, the differential diagnosis for a gastric submucosal mass should include gastric schwannomas. Furthermore, GI schwannomas are benign neoplasms with excellent prognosis after surgical resection, whereas 10–30% of GISTs have malignant behavior. Hence, it is important to distinguish gastric schwannomas from GISTs to make an accurate diagnosis to optimally guide treatment options. Nevertheless, owing to the paucity of gastric schwannomas, the index of suspicion for this diagnosis is low. We report a rare case of gastric schwannoma in 53-year-old woman who underwent laparoscopic partial gastrectomy under the suspicion of a GIST preoperatively but confirmed to have a gastric schwannoma postoperatively. This case underscores the importance of including gastric schwannomas in the differential diagnosis when preoperative imaging studies reveal a submucosal, exophytic gastric mass. For a gastric schwannoma, complete margin negative surgical resection is the curative treatment of choice.

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Juxtarenal/pararenal aortic aneurysms and type IV thoracoabdominal aneurysms pose particular technical challenges for endovascular repair as they involve the visceral segment in addition to insufficient infrarenal neck for the use of standard endovascular aneurysm repair (EVAR) devices. To overcome these challenges, complex EVAR techniques have been developed to extend the proximal landing zone cephalad with maintaining perfusion to vital aortic branches, thereby broadening the applicability of endografting from the infrarenal to the suprarenal aorta. Complex EVAR can be divided into two broad categories: fenestrated endovascular aneurysm repair (FEVAR) and snorkel EVAR. FEVAR is a valid procedure with the standardized procedure, although it remains as a relatively complex procedure with a learning curve. Given time constraints for the custom fenestrated graft, snorkel EVAR may be an alternative for complex repairs in symptomatic or ruptured patients for whom custom-made endografts may not be immediately available. This article discusses these two most commonly used complex EVAR strategies.