Prognosis of Nasopharyngeal Carcinoma in the Elderly is Worse than in Younger Individuals–Experience of a Medical Institute

SummaryPurposeWe aimed to evaluate outcomes of the elderly (>65 years) by comparing with younger (<40 years) patients after treatments for nasopharyngeal carcinoma (NPC).Materials and methodsWe retrospectively obtained clinical data from charts for 23 older and 21 younger patients in whom NPC was diagnosed and who underwent curative managements during 2007 and 2011. Occurrence of local recurrence, distant metastasis, and death from any cause were recorded as endpoints. Cox proportional hazards regression was applied to determine age effects on survival risks after adjusting for the potential confounders.ResultsOlder patients more commonly received a diagnosis of chronic diseases than the younger patients (56.5% versus 23.8%, p = 0.036), whereas they were less likely to have received intensive treatments for NPC. After adjusting for medical history and neoadjuvant chemotherapy, older age was the only significant predictor in the study cohort for overall survival and progression-free survival. The adjusted hazard ratio (HR) for death from all causes in older patients was 6.3 (95% confidence interval [CI] = 1.3–30.2), and the adjusted HR for disease progression in older patients was 10.9 (95% CI = 2.3–50.6).ConclusionAging was the only independent prognostic risk factor in this study cohort. Medical history and treatment variations could not fully explain the difference in prognosis. Our results strengthen the need to ameliorate toxicities and improve supportive care for older patients with a diagnosis of NPC

Genome-Wide Association Study of Young-Onset Hypertension in the Han Chinese Population of Taiwan

Young-onset hypertension has a stronger genetic component than late-onset counterpart; thus, the identification of genes related to its susceptibility is a critical issue for the prevention and management of this disease. We carried out a two-stage association scan to map young-onset hypertension susceptibility genes. The first-stage analysis, a genome-wide association study, analyzed 175 matched case-control pairs; the second-stage analysis, a confirmatory association study, verified the results at the first stage based on a total of 1,008 patients and 1,008 controls. Single-locus association tests, multilocus association tests and pair-wise gene-gene interaction tests were performed to identify young-onset hypertension susceptibility genes. After considering stringent adjustments of multiple testing, gene annotation and single-nucleotide polymorphism (SNP) quality, four SNPs from two SNP triplets with strong association signals (−log10(p)>7) and 13 SNPs from 8 interactive SNP pairs with strong interactive signals (−log10(p)>8) were carefully re-examined. The confirmatory study verified the association for a SNP quartet 219 kb and 495 kb downstream of LOC344371 (a hypothetical gene) and RASGRP3 on chromosome 2p22.3, respectively. The latter has been implicated in the abnormal vascular responsiveness to endothelin-1 and angiotensin II in diabetic-hypertensive rats. Intrinsic synergy involving IMPG1 on chromosome 6q14.2-q15 was also verified. IMPG1 encodes interphotoreceptor matrix proteoglycan 1 which has cation binding capacity. The genes are novel hypertension targets identified in this first genome-wide hypertension association study of the Han Chinese population

Dermatofibrosarcoma protuberans of the cheek

Dermatofibrosarcoma protuberans (DFSP) is a rare soft-tissue neoplasm that was first identified by Taylor, RW in 1890. It is a clinically challenging tumor because it is highly invasive and aggressive locally. This article describes an 83-year-old male with a history of prostate adenocarcinoma pT1bN0M0 (stage Ib) who presented to our facility with a painless lump on the right cheek. Detailed clinical and laboratory examinations were performed. The lesion was completely excised under local anesthesia, and histopathology revealed a DFSP. A brief review of the literature including clinical features, histopathological characteristics, and treatment modalities is also herein reported

Adenosquamous carcinoma of the hypopharynx

Adenosquamous carcinoma (ASC) is an uncommon tumor of the head and neck and is histologically characterized by the presence of both glandular and squamous components. In this article, we describe a 42-year-old male patient who presented with a left neck mass for about 2 months. Direct microlaryngoscopy with biopsy demonstrated adenosquamous carcinoma. We also discuss the results of a brief review of the literature for the clinical features, histopathological characteristics, and treatment strategies for ASC. Keywords: Adenosquamous carcinoma, Head and neck, Hypopharynx, Mucicarmine stain, CK5/6, Therap

Cervical Epidural and Retropharyngeal Abscess Induced by a Chicken Bone

Retropharyngeal abscess is occasionally seen in children, but is less common in adults where it usually occurs secondary to iatrogenic oropharynx trauma or a perforated foreign body in the oropharynx. Spinal epidural abscess in combination with a retropharyngeal abscess, which may cause rapid and irreversible neurological deterioration, is not often found, as indicated by the very few reports in the literature. Here we report a 52-year-old male with a clinical history of seizure and mental retardation since childhood who presented at our emergency room with severe sore throat of 1 day’s duration. A chicken bone was removed successfully. However, he complained of progressive dysphagia, sore throat and posterior neck pain during the following 5 days. Flexible fiber-laryngoscopy showed bulging of the retropharyngeal wall and a small ulcer at the right posterior pharyngeal wall. A neck computed tomography (CT) scan showed a retropharyngeal abscess at the oropharynx and hypopharynx level. His symptoms showed partial improvement after the administration of intravenous antibiotics. However, 2 weeks later he developed high fever, posterior neck pain and flaccid tetra-paresia. Emergent neck CT scan revealed a mild retropharyngeal abscess and epidural abscess formation between the second and third cervical vertebrae. The patient’s family refused drainage of the pre-vertebral and epidural pus. After receiving 2 months of antibiotics, the patient regained the mobility of his limb

The Optimal Post-therapeutic Surveillance Schedule for Head and Neck Cancers

AbstractHead and neck cancers encompass malignancies in the nasal cavity, paranasal sinuses, oral cavity, oropharynx, larynx, hypopharynx, and salivary gland. The mainstay treatments are surgery, radiotherapy and chemotherapy in single modality or sequential settings. The surveillance of head and neck cancer patients varies among individuals, medical centers, and even countries. By reviewing the clinical guidelines and pertinent medical literature, we attempted to determine the optimal surveillance schedule for all stages of disease.At our hospital, the surveillance schedule for head and neck cancer patients after complete treatment comprises of monthly follow-up in the first year by a multidisciplinary team, bi-monthly in the second and third years, tri-monthly in the fourth and fifth years, and semiannually thereafter. A complete cancer workup is performed annually in the first 3 years. Increasing frequencies or changes in diagnostic tools are suggested if there is any evidence of recurrence or metastasis. The follow-up principle in the first 3 years is on-schedule, and gradually shifts to symptom-oriented 5 years after treatment if there is no evidence of recurrence. The optimal post-therapeutic surveillance schedule for head and neck cancers should be set by a multidisciplinary team based on disease severity and staging

Implications of Age-Related Changes in Anatomy for Geriatric-Focused Difficult Airways

The structure and function surrounding the airway change by the age, which may ultimately result in having anatomic features of difficult airways in the elderly. Hence, we reviewed the literature focusing on the age-related anatomic changes and accordingly to compare the characteristics of difficult airways. With age, teeth wear and loss, protein and collagen synthesis reduction, and bone loss and muscle atrophy results in aged face (chin protrusion, cheek retraction and drooping), jaw restriction (temporo-madibular joint disc displacement and osteoarthritis), neck and back stiffness, and kyphotic deformities (degeneration of spinal articular cartilage, intervertebral discs, and spinal osteoporosis). These age-related changes in anatomy are compatible with the predictors of a difficult airway. We hope that these age-related anatomic approaches will prospectively allow a detailed understanding of the hallmarks resulting in geriatric-focused difficult airways in the future studies

Prevalence of different carbapenemase genes among carbapenem-resistant Acinetobacter baumannii blood isolates in Taiwan

Abstract Background Although the prevalence of the carbapenem-resistant A. baumannii (CRAB) has increased in Taiwan, few studies have elucidated the prevalence of different carbapenemase genes in Taiwan. The first objective of this study was to identify the types and prevalence of different carbapenemase genes, and the second objective was to determine the carbapenem antimicrobial susceptibility of carbapenemase producing isolates. Methods In total, 269 CRAB blood isolates from four medical centres in Taiwan from 1/1/2009 to 31/12/2013 were analysed. Antimicrobial susceptibilities were determined using the Vitek 2 system. Carbapenemase genes were identified by polymerase chain reaction (PCR) and sequencing. Pulsed-field gel electrophoresis (PFGE) was used to identify the different pulsotypes. Results All 269 CRAB isolates had the bla OXA-51-like gene, while 237 (88.1%) had the bla OXA-23-like gene, and 11 (4.09%) had the bla OXA-24-like gene. Twenty-one CRAB isolates (7.81%) contained only the bla OXA-51-like gene. None of the isolates had the bla OXA-58-like gene or the metallo-β-lactamases (MBL)-encoding genes. In 28.69% of isolates with the bla OXA-23-like gene and 90.91% of isolates with the bla OXA-24-like gene, the minimum inhibitory concentrations (MICs) for imipenem were 64 mg/L or more. In 37.55% of isolates with the bla OXA-23-like gene and 100% of isolates with the bla OXA-24-like gene, meropenem MICs were 64 mg/L or more. PFGE analyses indicated that six highly similar genomes which harbored the bla OXA-24-like gene came from three different medical centres. Conclusion Our study determined the prevalence of CRAB, the types and prevalence of carbapenemase genes, carbapenem susceptibility among CRAB isolates, and documented that the bla OXA-24-like gene had greater resistance to carbapenem than the bla OXA-23-like gene. We also demonstrated inter-hospital transmission of the highly resistant bla OXA-24-like gene