Prognosis Of Young Patients Research Articles

Squamous carcinoma of the lower lip in patients under 40 years of age.

In a series of 1,308 squamous carcinomas of the lower lip, 97 (7%) occurred in patients under 40. Among the 56 followed up for at least five years, there were 12 deaths due to disease for a determinate mortality of 21%. In five of these patients (41%) the tumor persisted more than three years from the time of initial treatment and in four others (33%), for more than five years. Of all 97 patients, 15 (15%) developed additional primary tumors. Most second lesions were squamous or basal cell carcinomas of the skin; however, four patients developed second primary lesions with considerable malignant potential (one melanoma and three visceral cancers). Three of these patients died of their second tumors, raising the overall mortality to 26%. Squamous carcinoma of the lower lip appears to have a worse prognosis in younger patients. A significant fraction of these patients succumb to their disease more than five years after initial treatment. This, coupled with a tendency to develop significant second primaries, suggests that a protracted period of close clinical follow-up is essential.

HYPERTENSION AND UNILATERAL PARENCHYMAL RENAL DISEASE (UPRD)

The management of hypertension associated with UPRD in children constitutes a major therapeutic dilemma, the decision to nephrectomize a patient must be made on the basis of clinical judgment since available diagnostic procedures have not proven useful.11 patients less than 20 years of age have been studied at the Univ. of Minn, hospital with UPRD. 8 were 15 years or less. Hypertension was found in 8 subjects at routine physical examination; 2 had recurrent urinary tract infections; and 1 had seizures 2 months following a motor accident. All had diastolic pressures greater than 100 mmHg as well as normal renal function. Radiographic studies revealed non-visualization of 1 kidney in 3 patients, unilaterally small kidneys in 7 (5 of which had evidence of scar formation) and a small cortical defect in the upper pole of 1 kidney in 1 patient. Selective renal vein renin determinations were obtained in 6 patients but lateralization to the affected side was noted in only 2 patients.Surgery appears to have been effective in the majority of patients. 9 are considered cured, 1 is improved on antihypertensive therapy (Aldomet) and 1 has shown no improvement. These results suggest that nephrectomy in cases of hypertension with UPRD offers a better prognosis in young patients than that reported in adults.

Benignity of neonatal tumors.

To the Editor .—Bolande 1 has drawn attention to the benign nature of neonatal tumors and discussed the concept of cancer repression in early life. There are two other tumors that could be added to his list. The yolk sac tumor of the testes has a much better prognosis in younger patients. More important, in over 700 cases of Burkitt's lymphoma reported from Africa, there were no patients under one year old. I have already suggested an alternative reason for these findings. 2 The improved prognosis could be related to passive immunity inherited from the mother. Passive immunological defenses are maximal at birth and decay slowly thereafter until active immunologic defense mechanisms take over. There is some experimental evidence to support this theory. Mothers and close relatives of children with neuroblastoma are immune to neuroblastoma antigens. Moreover, it has been shown that at least the mothers have cytotoxic antibodies

Clinical pathologies of breast cancer in the elderly and youths and their prognosis.

Objective: To explore the correlation between the clinical pathologies of breast cancer in the elderly and youths as well as their prognosis. Methods: Two hundred and eighty breast cancer patients were divided into a youth group (<60, n=120) and an elderly group (≥60, n=160) according to the age. Their routine clinical pathological indices and immune indices were observed and determined, and the prognosis was observed after effective treatment. Results: The positive expression rates of p63, CK5/6, CK14 and CK17 in the elderly group were significantly higher than those of the youth group (P<0.05). The tumor-free survival rate of the youth group (95.8%) was significantly higher than that of the elderly group (84.4%) (P<0.05). Multivariate Logistic regression analysis showed that the positive expressions of p63 and estrogen receptor, age, and postoperative chemotherapy were the independent risk factors of tumor-free survival rate (P<0.05). Conclusion: The immunohistochemical typing characteristics of the elderly and youths were different, and the prognosis of young patients was better, being correlated with the typing.

Selected Aspects of Hodgkin's Disease in a Whole Community

Abstract All available hospital records of patients with Hodgkin’s Disease, diagnosed in Israel during a 5-year period were reviewed. A bimodal incidence curve was obtained both for all patients, and for such subcategories as sex and ethnic origin. There was no significant difference in incidence between males and females, nor between various ethnic groups. The frequency of patients presenting with a generalized disease at diagnosis was relatively higher in males and in older patients of both sexes. The median survival was 27 months with a considerably better prognosis in younger patients of both sexes and in females younger than 45, as compared to males of the same age group. Lymphocytopenic males had a shorter survival course, but no such pattern was evident among females.