A Case Report of Rare Synchronous Esophageal Malignancies With Dissimilar Histology: Squamous Cell Carcinoma and Small Cell Carcinoma

The presence of synchronous primary malignancies is a rare phenomenon reported in the literature. Most synchronous malignancies reported include carcinomas and adenocarcinomas of the gastrointestinal tract, head and neck cancers, thyroid and breast cancers. Among the neuroendocrine tumors, carcinoid tumors in the duodenum or the esophagus are most commonly reported with other primary malignancies. We report the case of a 56-year-old male with tobacco use disorder, presenting with dysphagia and weight loss for six months, who was thought to have multicentric squamous cell carcinoma of the esophagus. In actuality, he was diagnosed with synchronous metastatic neuroendocrine tumor (NET) favoring small cell carcinoma and squamous cell carcinoma of the esophagus. The patient responded well to minimally invasive thoracoscopic esophagectomy with regional lymphadenectomy followed by chemotherapy and radiation therapy. We have not been able to find a literature referencing the presence of synchronous small cell carcinoma and squamous cell carcinoma of the esophagus, making our case unique

International Nosocomial Infection Control Consortiu (INICC) report, data summary of 43 countries for 2007-2012. Device-associated module

We report the results of an International Nosocomial Infection Control Consortium (INICC) surveillance study from January 2007-December 2012 in 503 intensive care units (ICUs) in Latin America, Asia, Africa, and Europe. During the 6-year study using the Centers for Disease Control and Prevention's (CDC) U.S. National Healthcare Safety Network (NHSN) definitions for device-associated health care–associated infection (DA-HAI), we collected prospective data from 605,310 patients hospitalized in the INICC's ICUs for an aggregate of 3,338,396 days. Although device utilization in the INICC's ICUs was similar to that reported from ICUs in the U.S. in the CDC's NHSN, rates of device-associated nosocomial infection were higher in the ICUs of the INICC hospitals: the pooled rate of central line–associated bloodstream infection in the INICC's ICUs, 4.9 per 1,000 central line days, is nearly 5-fold higher than the 0.9 per 1,000 central line days reported from comparable U.S. ICUs. The overall rate of ventilator-associated pneumonia was also higher (16.8 vs 1.1 per 1,000 ventilator days) as was the rate of catheter-associated urinary tract infection (5.5 vs 1.3 per 1,000 catheter days). Frequencies of resistance of Pseudomonas isolates to amikacin (42.8% vs 10%) and imipenem (42.4% vs 26.1%) and Klebsiella pneumoniae isolates to ceftazidime (71.2% vs 28.8%) and imipenem (19.6% vs 12.8%) were also higher in the INICC's ICUs compared with the ICUs of the CDC's NHSN