Introduction: Catheter ablation procedures are utilized for rhythm control of atrial fibrillation (AF) but the utilization of this procedure based on gender remains uncertain. Purpose: We investiga...
9554 Background: Aggressive management of elderly patients with metastatic cancer has helped prolong their survival. Respiratory failure in elderly patients with metastatic disease may significantly contribute to a decline in their functional status. However, the outcomes of the use of invasive mechanical ventilation (IMV) in patients with rapidly declining functional status have not been studied in detail. Methods: Using the Healthcare Cost and Utilization Project – Nationwide Inpatient Sample database 2000-2009, patients aged 65 and above undergoing IMV were identified using appropriate ICD-9-CM codes. The rates of prolonged IMV (≥96 hours) and use of tracheostomy were examined. Chi square test and Wilcoxon rank test were used to compare discrete and continuous variables respectively. Significance was defined as p value set at <0.05. Bonferroni’s correction as applied for multiple comparisons. Results: 4,256,372 patients aged 65 and above underwent IMV during the years 2000 to 2009. Of these, 192,852 (4.5%) had metastatic cancer. After adjusting for age, the odds of mortality were 1.86 times higher (95% CI 1.8-1.9) when compared to those without any cancer. The outcomes of patients undergoing IMV are shown below (see Table). Conclusions: The hospital LOS and hospital charges in patients undergoing IMV were higher in patients with cancer and in those with metastatic disease. The mortality was however significantly higher in patients with metastasis. Of the survivors, almost twice the number of patients are discharged to hospice facilities when compared to cancer patients with no metastatic disease. The use of prolonged IMV portends a higher mortality and worser outcomes in elderly patients with metastatic disease. No cancer Solid organ cancer Metastatic solid organ cancer Mortality (%) 39.4 42.4* 53* Prolonged IMV (> 96 hrs) 39.8 37.8 37.6 Tracheostomy (%) 8.8 10.3* 8.4 Disposition of survivors Home 21.6 25.2* 20.4 Home healthcare 14.1 19.7* 22.6* Skilled Nursing Facility 50.6 41.2* 37.3* Hospice 4.5 6.6 13.5* Others 9.2 7.3 8.2 Median LOS in survivors, days(IQR) 12 (7-20) 13(8-21)* 14(8-22)* Median time to death 6(2-14) 8(3-16)* 8(3-16)* Median hospital charges, USD 61,035 68,378* 67,181* * p<0.025 when compared with no cancer.
Renal medullary cancer is a rare malignancy almost exclusively seen in young patients of African ethnicity. These patients often present with the cardinal symptoms of hematuria, flank pain, and an abdominal mass, and this malignancy has been associated with patients carrying sickle cell trait. It is estimated that 300 million people worldwide carry sickle cell trait, and the presence of hematuria in these patients should be treated as a harbinger of a possible malignancy. Notably, this tumor mostly develops on the right side of the body. Patients often present with it at an advanced stage and the prognosis is poor. Therefore, a high index of suspicion in a patient of African descent presenting with a right sided abdominal mass and hematuria may assist in an early diagnosis. Current chemotherapy options are very limited, and early detection may provide a chance for surgical resection. It may also provide a bigger time frame for the initiation of novel chemotherapy regimens in patients who fail current chemotherapy regimens.
Adrenal myelolipomas are rare benign tumors of the adrenal cortex composed of adipose and hematopoietic cells. They have been postulated to arise from repeated stimulation by stress, inflammation and ACTH oversecretion. Myelolipomas are usually detected incidentally on imaging and do not require any active intervention besides regular follow-up by imaging. However, myelolipomas may insidiously grow to large sizes and cause mass effects and hemorrhage. Timely diagnosis and surgical resection are curative and lifesaving.
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