Rare femoral metastasis in late recurrent squamous cell carcinoma of the oral cavity

Background/Aim: Squamous cell carcinoma (SCC) is the most frequent carcinoma when dealing with malignant tumors of the oral cavity. SCC of the head and neck show cervical lymphatic metastasis, which is the most important prognostic factor for the long-term outcome of these patients. Hematogenous spread of this entity is rare, especially distant osseous metastasis. Therefore, the therapy for SCC typically consists of surgical tumor resection, neck dissection and plastic reconstruction. Most recurrences occur within the first two years postoperatively. This results in the need for close tumor follow-up. Case report: The present case report describes a 79-year-old female suffering from a recurrent SCC of the oral cavity 19 years postoperatively firstly noticed through symptomatic osseous metastasis of the right femur. Trial excision of the right femur revealed the finding of a metastatic squamous cell carcinoma. The patient received palliative radiation therapy. Conclusion: Osseous metastasis of SCC to the femur is rare. What is remarkable about this case report is the time span of 19 years between primary curative treatment, unremarkable follow up and the presence of metastatic late recurrence. Therefore long-term close follow-up in the treatment of oral cavity SCC in an interdisciplinary context is crucial

Psychophysical stress and strain of maritime pilots in Germany. A cross-sectional study.

IntroductionMaritime pilots work in an irregular deployment system (rotation system) with unpredictable work assignments under high levels of physical and mental stress. Fatigue or chronic diseases, e.g. coronary heart disease, peptic ulcers or gastritis can occur as a consequence. This can lead to long-term limitations of pilots' work ability. The aim of this study is to analyse current stress and strain in maritime pilots.MethodsInitially, all German pilots were interviewed with an online questionnaire about their living and working situation (response rate 43%). Subsequently, a medical and psychological examination of a random sample was carried out with pilots working in a 4-month rotation system compared with those working in a 1-week system. Most of the measurements took place at the beginning and the end of continuous work assignments each lasting several weeks (pre vs post-rotation). The questionnaires RESTQ-work 27, Resilience Scale RS-13 and Berlin Questionnaire were used as well as a sleeping diary. Furthermore, cardiovascular parameters (during rest and under ergometric stress), activity and blood parameters, urine stress hormones, and the pupillary unrest index were surveyed.Results60 pilots were recorded with an average age of 48.7 years (SD 8.3 years). Among the parameters collected, there were no significant differences between pre and post-rotation examinations. Pilots with a 4-month rotation system experienced a much higher subjective strain level in RESTQ work-27 (OR 10.12 (95% CI 1.21-84.59)). According to the sleep diaries of the pilots working in a 4-month rotation system, reduced levels were found concerning the pre and post-rotation subjective performance level (p = 0.042 and 0.029), subjective sleep duration (p = 0.032) and current subjective feeling post-rotation (p = 0.036). Objectively measured arterial hypertension was significantly more frequent among pilots working 4 months at a time (OR 21.41 (95% CI 1.26-364.05)). In addition, elevated levels of total cholesterol, triglycerides and uric acid were more common among this group of pilots (p = 0.038, p = 0.033 and p = 0.038). In particular, the risk of hypertriglyceridemia was increased (OR 4.41 (95% CI 1.15-16.91)).DiscussionMaritime pilotage represents a very straining profession that has been studied very little up to this point. The present results indicate that 4-month rotation systems lead to higher levels of subjective and objective strain than 1-week rotation systems. Interventions are therefore recommended; especially a change in the rotation system should be considered

Work profile of maritime pilots in Germany

Long and irregular shifts, unforeseeable operations and high responsibility are still prominent in the job of a pilot and pose high psycho-physical demands. Furthermore, there is a disturbed work-family balance. Working hours of pilots are highly variable and not bound by regulations due to irregularities of vessel traffic. The pilots have to work in a shifting rotation system. This paper demonstrates the stressors during their work routine and shows the usual working profile of a pilot during their service