Multi-institutional analysis of cervical esophageal carcinoma patients treated with definitive chemoradiotherapy: TROD 01-005 study

The aim of this study was to examine the prognostic factors and treatment outcomes of cervical esophageal carcinoma (CEC) patients who underwent definitive chemoradiotherapy (CRT). The clinical data of 175 biopsy-confirmed CEC patients treated with definitive CRT between April 2005 and September 2021 were retrospectively analyzed. The prognostic factors predicting overall survival (OS), progression-free survival (PFS), and local recurrence-free survival (LRFS) were assessed in uni- and multivariable analyses. The median age of the entire cohort was 56 years (range: 26–87 years). All patients received definitive radiotherapy with a median total dose of 60 Gy, and 52% of the patients received cisplatin-based concurrent chemotherapy. The 2-year OS, PFS, and LRFS rates were 58.8%, 46.9%, and 52.4%, respectively, with a median follow-up duration of 41.6 months. Patients’ performance status, clinical nodal stage, tumor size, and treatment response were significant prognostic factors for OS, PFS, and LRFS in univariate analysis. Non-complete treatment response was an independent predictor for poor OS (HR = 4.41, 95% CI, 2.78–7.00, p < 0.001) and PFS (HR = 4.28, 95% CI, 2.79–6.58, p < 0.001), whereas poor performance score was a predictor for worse LRFS (HR = 1.83, 95% CI, 1.12–2.98, p = 0.02) in multivariable analysis. Fifty-two patients (29.7%) experienced grade II or higher toxicity. In this multicenter study, we demonstrated that definitive CRT is a safe and effective treatment for patients with CEC. Higher radiation doses were found to have no effect on treatment outcomes, but a better response to treatment and a better patient performance status did.     

Behcet's Syndrome with Obstruction of the Venae Cavae: A REPORT OF SEVEN CASES

Seven patients with Behçet's syndrome are presented.All fulfilled at least two of the three major criteria of thesyndrome—oral ulceration, genital ulceration, and ocularmanifestations. In addition, in all the patients either thesuperior vena cava (five cases) or the inferior vena cava (fivecases) or both (three cases) were partially or totally occludedas demonstrated by angiography. Analysis of these cases, togetherwith 10 cases reported in the literature, indicates that inBehçet's syndrome the caval thrombosis begins in theseor adjacent large veins themselves and the initiating eventis probably vasculitis. It is concluded that the eaval thrombosisis not a mere association, but an integral manifestation ofBehçet's syndrome. ¹Present address: Dept. of Medicine, Jersey City Medical Center,Jersey City, N.J., U.S.A. ²Present address: The Moore Clinic, Johns Hopkins Hospital,Baltimore, Md., 21205, U.S.A. (Reprints from F. L. Özer). ³Present address: Dept. of Medicine, University of KentuckySchool of Medicine, Louisville, Ky., U.S.A.     

OCULODENTODIGITAL DYSPLASIA SYNDROME

A 23-month-old boy with typical findings of oculodentodigital dysplasia syndrome was presented and the inheritance pattern of this syndrome was discussed.     

Tardive dyskinesia with ziprasidone and citalopram use in an elderly female patient

Tardive dyskinesia (TD) is occasionally an irreversible condition caused by antipsychotic treatment. Second-generation antipsychotics are considered to have less extrapyramidal effects, including causing TD. Herein, we present a case of TD following ziprasidone use. A 67 year-old woman started to hear voices and 'see' people speaking to her, especially while praying. She presented to our clinic with anxiety, anhedonia, dysphoria, and auditory hallucinations. She was admitted with a diagnosis of depressive disorder with psychotic features. Citalopram 20 mg/day and ziprasidone 40 mg b.i.d. were started. After her symptoms had been relieved, the patient was was discharged and with monthly follow up. At her first visit 1 month after discharge, orofacial dyskinesia was found on physical examination. Ziprasidone may be associated with TD, even in someone who has never been exposed to a traditional neuroleptic. However, concomittant treatment with a serotonin reuptake inhibitor in the present case may have favored the appearance of TD.     

Unanswered Questions in Complex Fractionated Atrial Electrogram Ablation

Pulmonary vein isolation has been accepted as potential target for ablation of paroxysmal atrial fibrillation (AF) given that the pulmonary veins are the main source of AF triggers. However, ablation strategies for persistent AF are less well defined. Mapping and ablation of complex fractionated atrial electrograms (CFAEs) is one strategy that has been proposed as a strategy for substrate modification although there is no consensus on their definition and procedural end points. Results of clinical studies have been conflicting. In this review, we aimed to discuss yesterday, today, and tomorrow of CFAEs ablation in persistent AF ablation.