Colorectal adenocarcinoma in patients under 40 years of age

OBJECTIVES: The aim of this study was to assess prognosis and treatment of colorectal cancer in young adults. METHODS: In a retrospective review of 1,917 patients with colorectal cancer, 80 patients were under the age of 40 years (4.2%). RESULTS: The mean follow-up was 5.2 years (range: 0-16 years). There was a family history of colorectal cancer in 20% of the patients, either familial adenomatous polyposis (FAP) or hereditary nonpolyposis colorectal cancer (HNPCC syndrome). Five prognostic factors for the 10 year survival rate were found: stage of tumor in the Astler-Coller classification (A, B1-2, C1-2 and D, 100, 75, 38 and 11% respectively), tumor vascular invasion (16%), poorly differentiated tumors (30%), emergency surgery (21%) and non curative resections (5%). The colon recurrence rate at 8 years was 14% in the case of HNPCC syndrome. The recurrence rate for patients with neither FAP nor HNPCC syndrome was 11.5% at 8 years and for patients alive at 1 year was 16.5%. CONCLUSIONS: In patients under the age of 40 years, a subtotal colectomy, even as a second operation should be considered, if the prognostic factors are favorable. A genetic analysis seems to be essential in the management of these patients.     

Primary lung cancer in patients under 40 years of age

There seems to be a resistance of patients and physicians towards aggressive diagnostic evaluation of the symptoms of lung cancer in young people. We here review nine series of young patients with primary lung cancer. Patients below 40 years of age represent between 1.2 and 5% of the total lung cancer population. The distribution of sex and histopathologic findings is different, there being more women, fewer cases of squamous cell and more cases of small anaplastic and adenocarcinoma in the young group. Between 87 and 96% are smokers. There is a delay from the debut of symptoms to the first contact with a general physician of 2.4 to 10.8 months. There is a wide variation concerning tendency to operate with a frequency of curative resection of between 15 and 57%. Based on the survival of young patients who are treated by curative surgical resection, the outcome of surgical treatment for young patients does not differ from the general experience concerning resection in patients of all ages. Young patients who are found inoperable have worse survival than the older patients. Seventy to 90%, more than in the group of patients of all ages, have stadium II or III at the time of diagnosis. In conclusion, physicians should be aggressive with respect to the diagnostic evaluation even of young patients with symptoms suggestive of lung cancer.     

Medical versus surgical management of diverticulitis in patients under age 40

BACKGROUND: Diverticulitis in patients under age 40 is a distinct entity. We compared the medical versus surgical management of diverticulitis for complications and outcomes in these patients. METHODS: A retrospective review was performed for treatment, hospitalizations, complications, and outpatient visits. Complications included readmission, recurrent symptoms after antibiotic therapy, and postoperative problems. RESULTS: Twenty-nine patients had a radiographic or surgical diagnosis of diverticulitis (18 surgical, 11 medical). Medically managed patients had significantly more emergency department visits (4.7 +/- 6.6 versus 0.3 +/- 0.6, P < or =0.01), and readmissions (7 versus 4, P < or =0.02). Three surgical patients (17%) had a total of 6 complications as compared with 6 medical patients (55%) with 25 complications (chi square, P < or =0.05). All medically treated patients had recurrent symptoms, and 6 required surgery. CONCLUSION: Medically managed patients had significantly more emergency department visits and complications than those managed surgically. Surgery is the indicated treatment for the first episode of diverticulitis in patients under age 40.     

Stage I carcinoma of the uterine cervix in patients under 40 years of age

A retrospective analysis was made 94 patients, 39 years of age or younger, who were treated for Stage I carcinoma of the uterine cervix from 1942 through 1972 at the Los Angeles Tumor Institute and the Southern California Cancer Center. Comparisons were made between the frequency of Stage I and other stages of carcinoma of the uterine cervix, as well as the frequency of Stage I carcinoma in young and older individuals. Survival rates for the younger group were compared to those for the same stage of disease for all ages of patients. There is discussion of the treatment modalities used in light of recommendations for future plans of therapy for these young patients. Tumor recurrences are discussed, with special reference to 43 patients who survived over 10 years. Eight of these patients were found to show new or recurrent tumors after this period of time. The importance of careful, long-term follow-up and early secondary treatment for recurrent lesions is emphasized, since subsequent radical surgery may salvage a number of these individuals.     

Squamous cell carcinoma in individuals under 40 years of age

We reviewed all the cases of Squamous Cell Carcinoma in people under 40 years of age, diagnosed histologically at the Dermatopathology Laboratory of the Santa Maria Hospital, from January 1985 to December 1993. The 19 cases detected were analysed for age, sex, occupation, anatomical site of the tumor, evolution, smoke and alcoholic habits, skin phototypes, immunosuppression, previous viral infections, previous radiotherapy or PUVA therapy and associated diseases. A prevalence of an occupation involving more exposure to the sun was found. Males were more affected than females (2.2/1). In 37% of the patients we detected heavy alcoholic habits. The most frequent anatomical site was the lower lip (42%). Patients with skin phototype I were more affected (53%).     

Surgical treatment of primary lung cancer in patients less than 40 years of age

PURPOSE AND METHODS: The major purpose of this study was to determine whether the survival rate in young lung cancer patients after surgical treatment differs from that in older patients. An analysis was performed for all patients with bronchogenic carcinoma who underwent surgery at Mie University Hospital from 1965 to 1990. RESULTS: Of 803 patients, 24 (2.99%) were 33 to 39 years old. At the time of surgery, the disease was diagnosed as stage I in seven patients (29%), stage II in four (17%), stage IIIa in seven (29%), stage IIIb in two (8%), and stage IV in four (17%), while 46.3% of the patients older than 40 years of age had either stage IIIa, IIIb, or IV disease. All of the 24 patients less than 40 years of age underwent thoracotomy: curative resection in 14 cases, palliative resection in sex, and probe-thoracotomy in four. The 5-year survival rate for all stages of disease was 31.4% in these 24 patients, and 41.9% in 603 patients greater than 40 years of age. The 5-year survival rate for stage I disease was 35.7% in the seven younger patients and 78.0% in the 207 older patients; for stage II, it was 25.5% in the four younger patients and 40.6% in the 98 older patients; for stage III, it was 33.3% in the nine younger patients and 15.6% in the 250 older patients; and for stage IV, it was 25% in the four younger patients and 6.6% in the 48 older patients. There were no significant differences in survival rate between the two age groups for all patients or for those with each stage of disease. CONCLUSION: Although younger patients tended to have more advanced disease, long-term survival in these patients did not differ from that of older patients.     

Chromosome sensitivity to bleomycin-induced mutagenesis in lymphocytes from colorectal cancer patients under 40 years of age

PURPOSE: The incidence of colorectal cancer in young adults (under 40 years of age) is rare. The reason for the occurrence in these patients may lie in their genetic background. METHODS: We studied chromosomal fragility in peripheral blood lymphocytes of patients under the age of 40 with large bowel cancer. Lymphocytes from 24 subjects were examined: 10 untreated large bowel cancer patients under the age of 40 and 14 age-matched and sex-matched controls. RESULTS: The mean number of spontaneous chromosomal breaks per cells (b/c) was significantly higher in the right-sided large bowel cancer patients (0.23 +/- 0.12 b/c) compared with the control group (0.09 +/- 0.04 b/c; P < 0.01), but with no significant difference between the left-sided colorectal cancer patients and the control group. Lymphocytes exposed to the radiomimetic agent, bleomycin, were arrested in methaphase and analyzed for chromosome fragility. Mean chromosome breaks per cell in the left-sided colorectal cancer patients (1.60 +/- 0.49 b/c) were significantly higher than in either the controls (0.72 +/- 0.31 b/c; P < 0.001) or the right-sided, large bowel cancer patients (0.91 +/- 0.24 b/c; P < 0.05). CONCLUSIONS: The increased spontaneous chromosomal breaks in the right colon, as opposed to the increased mutagen-induced chromosomal breaks in the left colon, might indicate that in young colon cancer patients the occurrence of right-sided colon cancer is more likely to be genetically determined, whereas in left-sided colon cancer, environmental carcinogens might play a greater role.     

Clinical results of meniscus repair in patients 40 years and older

The critical role that the meniscus plays in the knee along with the advantages of preserving as much of the meniscus as possible have both been well documented. Whenever possible, meniscus repair has become the procedure of choice for treatment of meniscal tears. However, some researchers have reported less favorable results in older patients. To determine the results of meniscus repair in older patients, patients 40 years and older who underwent arthroscopically assisted meniscus repair were prospectively followed up. Thirty-seven patients were included in the study, all of which had a minimum 2-year follow-up (average, 26.5 months). The average age of the patients at the time of the repair was 44.2 years (range, 40 to 52 years); 26 were males and 11 were females. There were 19 left knees and 18 right knees included in the study. Twenty-two patients had associated anterior cruciate ligament reconstructions. Physical examination at follow-up included swelling, joint line tenderness, locking, and McMurray testing and radiographs. Five of 37 menisci repaired (13.5%) were symptomatic at latest follow-up. All of these patients had joint line tenderness and two had a positive McMurray test. Three of these patients had repeat arthroscopy confirming that the meniscus had not healed. Because of the small number of patients with symptoms at follow-up, the authors feel that meniscus repair in patients 40 years and older is an effective treatment for peripherally located meniscus tears. With 86.5% of the patients having good clinical results, these findings are comparable with other studies with a younger population and signify that repair of peripheral tears is indicated in this age group especially in conjunction with anterior cruciate ligament reconstruction. The findings suggest that the location and meniscal tear, rather than the age of the patient, determine the potential for successful repair.     

Intradural anesthesia with a 27-gauge Sprotte needle for arthroscopic knee surgery in ambulatory patients under 40 years of age

Removal of the initiator methionine and/or acetylation of the alpha-amino group are among the earliest possible chemical modifications that occur during protein synthesis in eukaryotes. These events are catalyzed by methionine aminopeptidase and N alpha-acetyltransferase, respectively. Recent advances in the isolation and characterization of these enzymes indicate that they exist as isoforms that vary in cellular location, function, and evolutionary origins.     

Transitional cell bladder carcinoma in patients younger than 40 years of age

OBJECTIVE: The clinical and pathological characteristics of bladder cancer in young patients were analyzed to determine if patients with bladder cancer under the age of 30 have a better prognosis than older adults and if transitional cell carcinoma of the bladder in patients aged 30 to 40 years has a similar behaviour to that observed in the higher risk population. METHODS: A retrospective review of transitional cell carcinoma of the bladder in patients less than 40 years old that had been treated between January, 1993 to August, 1997 was undertaken. RESULTS: We found 8 patients (5 men and 3 women) with urothelial tumor, accounting for an incidence of 4%. Four cases were diagnosed and staged TaG1, 2 T1G1 and 2 T1G2. Recurrence was observed in one case (12.5%) and progression in none. CONCLUSIONS: Transitional cell carcinoma of the bladder in patients under the age of 40 is usually associated with low grade and low stage tumors. The foregoing finding is certainly observed in those aged less than 30 years old. Bladder cancer is relatively rare in this age group, although we have found a higher incidence than that reported elsewhere. Treatment and follow-up depend on tumor grade and stage, regardless of age.     

Outcome and life prospects after surgical management of medically intractable epilepsy in patients under 18 years of age

A retrospective analysis of seizure outcome and quality of life assessment was done in 64 patients under 18 years of age with medically refractory epilepsy who underwent 64 primary and 16 repeat operative procedures in an attempt to control their epilepsy. At least 2 years' follow-up data were available for each patient. Operative procedures were 44 temporal lobe resections; 16 extratemporal resections; and 4 hemispherectomies. Effective control of previously intractable seizures was obtained in most patients: 55%, 11%, and 17% achieved Engel class I, II, and III status, respectively. Successful seizure control was thus obtained in 83%, while 17% (Engel class IV) failed to improve significantly after operation. Quality-of-life measures parallelled the improvements in seizures control, being highest in Engel I, outcome group and lowest in Engel IV outcome group. In appropriately selected pediatric and adolescent patients with medical refractory epilepsy, surgical management can offer a safe and effective adjunct to medication.     

Surgical treatment of bronchogenic carcinoma. Long-term results in 496 surgical patients

BACKGROUND: The operability of lung cancer and the period of survival after resection of the lungs in our country does not yet attain the standard recorded in some advanced countries. The objective of the present work is to analyze factors which influence the survival period after resection therapy of lung cancer. METHODS AND RESULTS: In 1985-90 in our department 496 patients were operated on account of lung cancer. This number comprised 31 patients subjected to explorative thoracototomy and three patients with pulmonary resection on account of a stage IIIb (pTNM) tumour who were excluded from the statistical analysis. The retrospective study proper analyzes the results of 462 patients (403 men and 59 women) operated in stages I, II and IIIa. Their mean age was 57 years (range 30-74 years, SD 7.5 years). The most frequent histological type was epidermoid carcinoma (68.8%), adenocarcinoma 18.2%, small-cell tumours 5.4% (25 patients). In 262 patients operated on account of lung cancer in stage I (pTNM) the probability of five-year survival was 49.2%, in patients in stage II 42.1%, in 158 patients in stage IIIa 20.9% (for all histological types combined). In 437 patients after resection of the lungs on account of non-small-cellular carcinoma the probability of five-year survival was as follows: stage I 50.0%, stage II 45.0%, stage IIIa 21.2%. CONCLUSIONS: The probability of five-year survival for the whole group of 462 patients in stages I, II and IIIa was 38.8%. The most important factor which influenced the probability of five-year survival was the stage of the disease. Neither age nor sex of the patients nor the histological type of the tumour had a statistically significant effect on the probability of five-year survival.     

Thyroid malignant neoplasms. Therapeutic results in 305 patients

Between 1960 and 1972, 305 patients with malignomas of the thyroid gland were surgically treated, irradiated (megavoltage therapy and/or iodine-131), and treated with thyroid hormone according to principles formerly stated. Differentiated adenocarcinomas (34.4% of all the patients) were observed more frequently in women and younger patients, whereas dedifferentiated carcinomas (33.8%) are found relatively more often in men and in an advanced age. Only in 12% of the cases the tumor was discovered in an early stage; thus, an early diagnosis is much too rare so far. In almost two thirds of the patients a spread of metastases occurred. Of these, 11% grew manifest later than five years following the therapy. Distant metastases from differentiated adenocarcinomas accumulated I-131 in sixty per cent, those from undifferentiated carcinomas still in twenty per cent. Treatment results are influenced decisively by histology, tumor spread, age and sex, women less than forty years old with differentiated adenocarcinomas and a circumscribed extension of the tumor having the best prognosis. More prognostic importance is due to the extension of the primary tumor than to the presence of metastases to regionary lymph nodes. Patients with metastases accumulating I-131 have a better chance of survival than those whose metastases do not accumulate. By means of standardized therapeutic rules, utilizing modern therapeutic techniques and based on interdepartmental cooperation, it was possible to improve the results partly by the two- or threefold as compared to a previously treated group of patients.     

Value of routine pre-operative chest X-ray in patients over the age of 40 years

The overall usefulness of routine chest X-ray, its cost benefit ratio and effect on anaesthetic management in patients over the age of 40 years was assessed. Four hundred and seventy-seven consecutive patients undergoing elective non-cardiopulmonary surgery with no cardiopulmonary diseases, having a routine preoperative chest x-ray were selected at the Aga Khan University Hospital, Karachi. Twenty five (5.2%) were excluded from the study as their chest x-ray were not available at the time of surgery. Twenty eight (8.3%) below and 33 (28.7%) above 60 years of age had abnormalities in chest x-ray but the difference in cardiac abnormalities in two age groups was insignificant. The frequency of lung field abnormalities increased with age from 3.2% in less than 60 to 15.6% in patients above 60 years of age. The difference in frequency of occurrence of lung field abnormalities was statistically significant in case of lung abnormalities. Only one case required change in anaesthetic management based on routine preoperative chest x-ray. Our study showed that the incidence of significant lung field abnormalities increased in patients aged 60 years and above with no history of chronic obstructive airway disease. We recommend routine preoperative chest x-ray be carried out only in patients over the age of 60 years.     

The late results of combined surgical treatment in peptic ulcer patients

The authors submit a successful case of penile replantation. They discuss the course of the procedure and document the immediate and long-term result of this procedure.     

Hypertrophic obstructive cardiomyopathy in pediatric patients: results of surgical treatment

Between April 1975 and May 1995, 25 pediatric patients on one hospital service underwent extended left ventricular septal myectomy because of hypertrophic obstructive cardiomyopathy. Ages ranged from 2 months to 20 years (mean, 11.2 years). Seventeen patients had moderate to severe mitral valve insufficiency. Medical therapy had failed in all patients and one patient had undergone dual-chamber pacemaker implantation without improvement. Left ventricular outflow tract gradients ranged from 50 to 154 mm Hg (mean, 99.9 +/- 25.2). Concomitant cardiac procedures included mitral valve repair (n = 2), automatic implantable cardioverter defibrillator implantation (n = 1), and closure of atrial septal defect (n = 1). Intraoperative premyectomy left ventricular outflow tract gradients ranged from 20 to 117 mm Hg (mean, 60.4 + 26.2) and postmyectomy gradients ranged from 0 to 20 mm Hg (mean, 6.6 +/- 5.9). Postmyectomy mitral insufficiency was reduced to a regurgitant fraction of 0% to 12%, and no patient required mitral valve replacement. One patient required a pacemaker because of complete heart block; on subsequent follow-up, normal sinus rhythm had returned. There was no early mortality and no instance of aortic or mitral valve injury or ventricular septal defect. Follow-up ranged from 10 months to 20 years (mean, 6.4 years). There were no late deaths. Left ventricular outflow tract gradients by echocardiography were a mean of 14.2 mm Hg with a median of 5.0 mm Hg. All patients had normal sinus rhythm. Reoperation because of recurrent left ventricular outflow tract obstruction was necessary in two patients at 3.2 years and 12.4 years after initial myectomy, respectively. All patients but one have New York Heart Association class I or II function. We conclude that extended septal myectomy is a safe and effective means of relieving cardiac symptoms and left ventricular outflow tract obstruction in pediatric patients with severe hypertrophic obstructive cardiomyopathy unresponsive to medical management, and late survivorship compares favorably with the natural history of the disease.     

Analysis of the surgical treatment results in patients with acute pancreatitis

The results of treatment of 248 patients with an acute pancreatitis (AP) are analyzed. Conservative therapy was effective in 178 of them. Mortality was 0.3%. Surgical intervention was done in 64 patients, including 25 with AP, of them 2 (8%) have died; 27--with destructive AP, after cholecystectomy, drainage of bursa omentalis and abdominal cavity 15 (55.5%) died. Pancreatic resection, necrotomy, programmed relaparotomy with permanent necrotomy of pancreas and retroperitoneal cellular tissue were conducted in 17 patients, 3 (17.6%) died.     

The results of the surgical treatment of bladder cancer patients

A new method for accommodation training making use of a computer is proposed. A specially generated dynamic grid of concentric rings serves the stimulus. Changes of the accommodation parameters (the nearest and farthest points of clear vision) were examined in 11 display users aged 30 to 50 during a training session and in the course of 15 sessions. The training improved the accommodation volume by an average of 0.9 diopters at the expense of approximating the nearest and withdrawing the farthest clear vision points. In 4 subjects anisoaccommodation disappeared almost completely. The proposed method may be used to normalize the accommodation of display users.