Esophageal Cancer in Young People: A Case Series of 109 Cases and Review of the Literature

Certain geographically distinct areas of the world have very high rates of esophageal cancer (EC). Previous studies have identified western Kenya as a high risk area for EC with an unusual percentage of cases in subjects 30 years of age or younger. To better understand EC in these young patients, we abstracted available data on all 109 young patients diagnosed with EC at Tenwek Hospital, Bomet District, Kenya from January 1996 through June 2009, including age at diagnosis, sex, ethnicity, tumor histology, residence location, and medical interventions. We also attempted to contact all patients or a family member and obtained information on ethnicity, tobacco and alcohol use, family history of cancer, and survival. Sixty (55%) representatives of the 109 young patients were successfully interviewed. The median survival time of these 60 patients was 6.4 months, the most common tumor histology was esophageal squamous cell carcinoma (ESCC) (98%), the M:F ratio was 1.4∶1, and only a few subjects used tobacco (15%) or alcohol (15%). Seventy-nine percent reported a family history of cancer and 43% reported having a family history of EC. In summary, this case series describes the largest number of young EC patients reported to date, and it highlights the uniqueness of the EC experience in western Kenya

Profile of the foster child likely to experience unstable care: a re-examination

This research reports the results of a survey exploring characteristics associated with the stability of foster care. The survey was developed from a national profile of the child likely to experience unstable foster care. Findings and implications are discussed

Brachial artery repair using the basilic vein as a reliable conduit in a 3-year-old child

A supracondylar fracture of the humerus is the most common upper extremity fracture in children with concurrent neurovascular complications. However, bypass grafting in the management of a pediatric open elbow dislocation with an arterial injury has rarely been reported in the literature. Hence, an adequate conduit for a vessel graft interposition remains questionable when a primary anastomosis is limited in an arterial reconstruction. The purpose of this study is to present a brachial artery reconstruction in a 3-year-old patient with an open supracondylar fracture of the humerus. In the clinical and surgical examination of the patient, an open wound in the left antecubital fossa presented with accompanying brachial artery injury. To repair the artery, a reverse end-to-end anastomosis was conducted using basilic vein graft from the ipsilateral arm under general anesthesia. The patient had palpable radial pulses in the postoperative clinical examination and was discharged without complications. The great saphenous vein (GSV) has proven to be the most common and the best conduit for arterial reconstruction of the upper extremity in the adult patients. However, the GSV graft is known to have the propensity for becoming aneurysmal in pediatric patients. Some studies have demonstrated the basilic vein as a suitable conduit in pediatric patients, in that it has durable patency, fewer branches, size compatibility for anastomosis, and proximity to the brachial artery. Our case confirms the safety of using this autogenous vein from within the zone of injury for arterial reconstruction, after a supracondylar humeral fracture. The management of pediatric elbow fractures accompanying vascular injuries can be technically demanding due to relatively small, delicate structures and concurrent neurovascular network. Nonetheless, a vascular injury should be treated with high level of suspicion and immediate intervention to avoid any limb ischemia or loss. In situations where the brachial artery is compromised and needs repair with a bypass, the basilic vein should be considered as a conduit for its greater accessibility and long-term patency

Distributions of risk factors overall and by sex for esophageal cancer among patients ≤30 years of age seen at Tenwek Hospital from January 1996 through June 2009 who had follow-up information.

<p>Distributions of risk factors overall and by sex for esophageal cancer among patients ≤30 years of age seen at Tenwek Hospital from January 1996 through June 2009 who had follow-up information.</p

Summary of age, sex and histologic data from published reports of esophageal cancer in young persons, overall and separately in developing and developed countries.

<p>Summary of age, sex and histologic data from published reports of esophageal cancer in young persons, overall and separately in developing and developed countries.</p

Distributions of 60 esophageal cancer patients ≤30 years of age seen at Tenwek Hospital from January 1996 through June 2009 who had follow-up information.

<p>Distributions of 60 esophageal cancer patients ≤30 years of age seen at Tenwek Hospital from January 1996 through June 2009 who had follow-up information.</p

Survival with esophageal cancer in young patients by sex.

<p>Survival by sex of the 60 esophageal cancer patients ≤30 years of age seen at Tenwek Hospital from January 1996 through June 2009 who had follow-up information.</p