Self-perceptions of age among 292 chemotherapy-treated cancer patients: Exploring associations with symptoms and survival

ObjectiveA growing literature suggests that older individuals who report feeling younger than their actual chronological age enjoy better health and survival. The purpose of this study was to explore similar associations in patients with cancer.MethodsChemotherapy-treated cancer patients completed a previously-validated questionnaire item on their self-perception of age. Concurrent patient-reported number of symptoms and pain severity were recorded. In addition, baseline and longitudinal data captured demographics and vital status, respectively.ResultsAmong 292 patients, 185 (63%) reported that they perceived themselves as younger than their actual age, 45 as older (15%), and 56 (19%) as the same age (unable to be determined in 6). The mean actual chronological age (standard deviation) among those who perceived themselves as younger, older, or the same age was 63 years (11), 54 (12), and 60 (10); (p < 0.0001). An inverse relationship was observed between self-perceived age and actual age (odds ratio 1.05 with 95% confidence interval of 1.02, 1.07; p = 0.0001) but, otherwise, no statistically significant relationships were observed with gender, cancer curability potential, number of symptoms, or pain severity. Improved survival was associated with fewer symptoms and the potential for curing the cancer, but not with patients' age perceptions. Qualitative themes such as positive thinking, staying engaged with life, the importance of family, and maintaining a sense of humor emerged among those who felt younger.ConclusionA substantial percentage of patients with cancer – particularly older ones – report feeling younger than their actual age; this perception appears to have no relevance to symptoms or survival.     

Acute myopericarditis after multiple vaccinations in an adolescent: case report and review of the literature

We report a case of postvaccination acute myopericarditis in an adolescent. The patient presented with acute chest pain, diffuse ST-segment elevation, and elevated cardiac enzyme levels. Cardiac MRI was consistent with acute myocarditis. He recovered within a few days with nonsteroidal antiinflammatory treatment and remains clinically stable, with improvement of MRI findings at the 10-week follow-up. Postvaccination cases of myopericarditis reported in the pediatric literature are also reviewed.     

Dietary orotic acid enhances the incidence of {gamma}-glutamyltransferase positive foci in rat liver induced by chemical carcinogens

Feeding male Fischer F-344 rats for 5 weeks a diet containing1% orotic acid, a precursor for pyrimidine nucleotide biosynthesis,resulted in an increased incidence of -glutamyltrans-ferase(EC 2.3.2.2 [EC] ) positive foci induced by chemical carcinogens including1,2-dimethylhydrazine, diethylnitrosamine, benzo[a]pyrene, andaflatoxin B₁. This unique effect of orotic acid can be accentuatedby supplying a liver cell proliferative stimulus. The enzymealtered hepatocytes have a higher labelling index (4.4%) comparedwith that of the hepatocytes in the surrounding liver (0.26%).The effect of orotic acid on the increased incidence of focicannot be attributed to either the induction of liver cell proliferationor the imposition of a preferential inhibitory effect on theproliferation of normal hepatocytes while permitting the carcinogen-modifiedhepatocytes to respond to an endogenous or exogenous liver cellproliferative stimulus and grow to form foci. Orotic acid alsodid not behave like some of the promoters of liver carcinogenesissuch as phenobarbital and polychlorinated biphenyls in thatit did not induce either the phase I or phase II componentsof hepatic drug metabolizing enzyme systems. Some of the possiblemechanisms by which orotic acid enhances the incidence of -glutamyltransferasepositive foci by carcinogens are discussed.     

Bilateral internuclear ophthalmoplegia—an unusual initial presenting sign of giant cell arteritis

A 63-year-old man presented six days after the sudden onset of horizontal double vision. His left eye became divergent two days later. On initial examination he had bilateral internuclear ophthalmoplegia with weakness of adduction and abducting nystagmus. Convergence was weak but there were no other neuro-ophthalmic signs. Constitutional signs included confusion and unsteadiness on his feet. A provisional diagnosis of arteritis was made. His ESR was 92 mm/h and a superficial temporal artery biopsy confirmed the diagnosis of giant cell arteritis. After two weeks or oral prednisolone his eye movements returned to normal. There have been no further relapses.
This would appear to be a unique presentation of giant cell arteritis. The causes of internuclear ophthalmoplegia are discussed along with a review of the ocular and neuro-ophthalmic signs of giant cell arteritis.     

Orotic acid, a promoter of liver carcinogenesis induces DNA damage in rat liver

Orotic acid, a precursor of pyrimidine nucleotide biosynthesisand a promoter for liver carcinogenesis, when fed at 1% levelin a diet for 5 weeks resulted in liver DNA damage. The damagecan be monitored as alkali-labile lesions using alkaline sucrosegradients as well as alkaline elution technique. Furthermore,the induced DNA damage persists for up to three weeks afterwithdrawal of the orotic acid diet. The fad that several skin-tumourpromoters also induce DNA damage raises the question whetherDNA damage is a component in tumour promotion.     

A review of choledochal cyst in pediatric and adult patients

A review of 80 pediatric and 13 adult patients with choledochal cyst disease occurring in a multiracial population is presented to define the incidence, clinical pattern, surgical techniques, and complications seen over periods of 30 years (pediatric) and 15 years (adult patients). In pediatric patients, most cases are now being diagnosed at a much earlier age, usually in infancy or early childhood, presumably due to the ready availability of ultrasound. Adult patients, by contrast, present a complex picture of heptobiliary disease, and delay in diagnosis is not uncommon. Jaundice appears to be the predominant symptom and the classical triad (pain, jaundice, and mass) is seldom seen. The surgical technique emphasises complete excision of the cyst, including the distal end, as the critical factor in the prevention of late complications. Avoidance of anastomotic stricture depends on the apposition of gut to healthy duct wall and not on the size of the anastomosis alone. Postoperative results have been excellent with no immediate mortality and no evidence of cholangitis in patients with extrahepatic cysts. The morbidity is related to patients with persistent intrahepatic biliary dilatation, Caroli's disease, and carcinoma. While endoscopic intervention, hepatic resection, and liver transplantation have been utilized in the management of cystic disease in the liver, the outlook for patients with cholangiocarcinoma associated with choledochal cyst remains extremely poor, with no survivors in this series.