Factors predicting intolerance to definitive conventional radiotherapy in geriatric patients

Purpose

Although radiotherapy can be administered with a relatively low therapeutic burden, many elderly patients do not complete radiotherapy. In order to predict intolerance during radiotherapy, this study retrospectively analyzed the frequency of and risk factors for radiotherapy interruption among geriatric patients.

Methods

From September 2009 to December 2016, 353 patients aged ≥70 years received definitive radiotherapy with a conventionally fractionated schedule. “Total interruption” included completion of ≤90% of a planned radiotherapy, temporary discontinuation, and treatment-related mortality within 2 months. “Early-phase incompletion” and “mid-phase incompletion” represented completion of ≤50 and ≤80% of a planned radiotherapy, respectively.

Results

The median age of patients was 74 years. Early- and mid-phase incompletions and total interruption occurred in 4.2, 9.3, and 19.3% of patients, respectively. Total interruption occurred frequently in cancers involving the thorax (27.4%), head and neck (23.1%), abdomen (20.0%), pelvis (17.4%), and breast/extremity (8.1%). The Eastern Cooperative Oncology Group (ECOG) performance score (P?=?0.004 and 0.002), serum albumin level (P?=?0.016 and 0.002), and the expected 5?year survival (P?=?0.033 and 0.034) were significant factors for mid-phase incompletion and total interruption. Age?≥?75 years (P?=?0.008), concurrent chemotherapy (P?=?0.017), and the extent of radiation field (P?=?0.027) were factors associated with total interruption.

Conclusion

Overall, 19.3% of the elderly patients showed treatment intolerance during conventional radiotherapy. Serum albumin level and ECOG performance score should be considered as surrogate markers for radiotherapy interruption prior to the decision regarding definite conventional radiotherapy.

     

Anterior chamber aqueous flare,pseudoexfoliation syndrome,and glaucoma

The purpose of this study is to evaluate anterior chamber aqueous flare (ACAF) in Tunisian patients with pseudoexfoliation (PEX) syndrome with or without associated glaucoma. This is a prospective, cross-sectional, comparative study including 53 patients (88 eyes) with PEX syndrome, 48 patients with PEX glaucoma (86 eyes), and 53 healthy sex-and age-matched control subjects (106 eyes). All patients underwent a complete ophthalmic examination and laser flare photometry. Mean ACAF was significantly higher in the PEX syndrome group in comparison with the control group (17.96 ± 10.05 vs 7.06 ± 2.95 ph/ms; p = 10^?4), in patients with PEX glaucoma compared to PEX syndrome without associated glaucoma (27.99 ± 15.45 vs 17.96 ± 10.05 ph/ms; p = 10^?4), in the PEX glaucoma group in comparison with control group (27.99 ± 15.45 vs 7.06 ± 2.95 ph/ms; p = 10^?4), and in patients with unilateral PEX syndrome in comparison with contralateral-unaffected eyes (25.72 ± 14.88 vs 8.58 ± 3.45 ph/ms; p = 0.000). For patients with PEX syndrome, a high ACAF might be a predictor for the development of glaucoma. Further investigations are needed to clarify the role of laser flare photometry in predicting the risk of glaucoma in patients with PEX syndrome.     

The geometry of patella and patellar tendon measured on Knee MRI

This study provides the geometry of patella and patellar tendon measured on sagittal and axial magnetic resonance images of 172 knees (142 males, 30 females) of 163 subjects (135 males, 28 females) whose mean age was 26.7. The gender difference and the relationship with anthropometry were also given. As for patella, the longitudinal lengths of the whole and articulating surface were 44.6, 32.9 mm, and the thickness was 22.3 mm. The mediolateral width was 45.8 mm, and the central ridge was located 19.9 mm or 43% lateral from the medial border. As for patellar tendon, the longitudinal length was 40.2 mm. The widths of proximal and distal part were 30.3, and 24.0 mm. The thicknesses of proximal and distal part were 3.2, and 5.0 mm. The geometry of the patella and patellar tendon was larger in male than in female (P < 0.001). Anthropometry including weight, height, body mass index corresponds well with the thickness of patella but poorly with the length of patellar tendon. These data can provide useful information in the field of knee surgery and sports medicine.     

Application and validation of a line-source dispersion model to estimate small scale traffic-related particulate matter concentrations across the conterminous US

Numerous studies document increased health risks from exposure to traffic and traffic-related particulate matter (PM). However, many studies use simple exposure metrics to represent traffic-related PM, and/or are limited to small geographic areas over relatively short (e.g., 1 year) time periods. We developed a modeling approach for the conterminous US from 1999 to 2011 that applies a line-source Gaussian plume dispersion model using several spatially and/or temporally varying inputs (including daily meteorology) to produce high spatial resolution estimates of primary near-road traffic-related PM levels. We compared two methods of spatially averaging traffic counts: spatial smoothing generalized additive models and kernel density. Also, we evaluated and validated the output from the line-source dispersion modeling approach in a spatio-temporal model of 24-h average PM <?2.5 μm (PM_2.5) elemental carbon (EC) levels. We found that spatial smoothing of traffic count point data performed better than a kernel density approach. Predictive accuracy of the spatio-temporal model of PM_2.5 EC levels was moderate for 24-h averages (cross-validation (CV) R²?=?0.532) and higher for longer averaging times (CV R²?=?0.707 and 0.795 for monthly and annual averages, respectively). PM_2.5 EC levels increased monotonically with line-source dispersion model output. Predictive accuracy was higher when the spatio-temporal model of PM_2.5 EC included line-source dispersion model output compared to distance to road terms. Our approach provides estimates of primary traffic-related PM levels with high spatial resolution across the conterminous US from 1999 to 2011. Spatio-temporal model predictions describe 24-h average PM_2.5 EC levels at unmeasured locations well, especially over longer averaging times.     

Plummer Vinson syndrome

BACKGROUND: Plummer Vinson syndrome is a rare affection which affects mainly white women. It is characterized by dysphagia, iron deficiency and the presence of superior esophageal web. AIM: The purpose of this study is to precise the epidemiological, clinical, paraclinical and therapeutical features of the affection. METHODS: We report 19 cases of Plummer Vinson syndrome collected over 15 years (1990- 2004). RESULTS: Dysphagia is the main symptom observed in 100% of the cases. 89.4% of the patients had anemia and 15 hyposideremy. All the patients were treated with iron supplementation and endoscopic treatment (dilatation and rupture of esophageal webs). Three patients necessitate multiple sessions of endoscopic dilatation and 15 had favourable evolution. The malignancy was observed in one case.     

Acute renal failure in a prisoner after hunger strike

BACKGROUND: Acute renal failure may occur in varied circumstances. It is potentially reversible spontaneously or after specific treatment. It is rare after hunger strike and fewer cases were reported in the literature. The physiopathological mechanisms are varied and remain incompletely known. AIM: We report the case of a prisoner having presented an acute renal failure after a hunger strike wich was completely reversible. CASE: He's a 29 year old man, without a past medical facts, in July 2004 he was incarcereted in prison. In October 2004 he undertake a hunger strike during one month. In November 2004 he was hospitalized for global dehydration and shock. His physical examination showed blood pressure 60/40 mmHg, weight 59 Kg with a loss of weight about 10 Kg, diuresis 800 cc/day. His biological findings showed urea 100 mmol/l, creatinemia 679 (mo/l, natremia 179 mmol/l, kaliemia 5 mmol/l, glycemia 5.2 mmol/l, albuminemia 35 g/l, calcemia 2.35 mmol/l and biological marques of rhabdomyolysis: CPK at 11 times the normal and LDH two times the normal. His treatment consisted on rehydratation, parenteral then enteral refeeding and psychiatric talks. The evolution was favourable, re-establishment of good hydration state with a gain weight of 7 Kg, normalization of renal function, his creatininemia reached 85 (mol/l in three weeks and normalization of muscles enzymes in one month. CONCLUSION: Hunger strike continue to pose a problem because of it's frequency in penitentiary structures and its organic disorders which can lead to death. A good psychiatric cares may be undertaked in order to prevent a such bad manifestations.     

Intestinal occlusion caused by Rosai-Dorfman disease mimicking colonic diverticulitis

Rosai-Dorfman disease (RDD) involves the gastrointestinal tract only in exceptional cases, and this very unusual site of presentation can confuse the pathologist. We present a case of RDD manifesting as an intestinal occlusion caused by colonic diverticulitis. The patient was a 79-year-old man with myelodysplasia, who presented with fever, abdominal pain, and constipation. Colonoscopy revealed sigmoiditis and diverticulosis. Microscopic study of the sigmoid colon surgical specimen showed the histological and immunological features of RDD. No human DNA of herpesvirus types 6 and 8 (HHV6/HHV8), Epstein-Barr virus (EBV), and cytomegalovirus (CMV) was detected in tissue by polymerase chain reaction. Electron microscopic study revealed no microbes or viral particles. Widespread nodal and extranodal RDD occurred, and the patient died 2y after initial surgery. The etiology of RDD is still under debate. We discuss the association of RDD with hematological disorders.