Seventh Decade Research Articles

Drug-resistant Monoarticular Wrist Joint Tuberculosis in Renal Transplant Recipient with Literature Review

Extrapulmonary tuberculosis (TB) is more frequently encountered among renal transplant recipients than in normal population. As per the published literature, this is the first case of a renal transplant recipient with multidrug-resistant (MDR) joint TB from our country. A patient in the seventh decade presented with swelling of the left wrist for 1 month. He underwent positron emission tomography–computed tomography-guided joint aspiration in which GeneXpert came out positive for Mycobacterium tuberculosis and rifampicin resistance was detected. The patient had twice received antituberculous therapy in the past for pulmonary and joint TB. He was started on five-drug MDR-TB drug combination, including bedaquiline, and he responded well with subsidence of joint swelling. Treatment of MDR-TB in a renal transplant recipient is a difficult task as the MDR-TB drugs are potentially toxic and some have drug interactions with immunosuppressive agents that can lead to difficulties in maintaining therapeutic trough levels.

Indija kao motiv u stvaralaštvu Petra Lubarde

During the seventh decade of the 20th century, Petar Lubarda continued to be an important figure in the cultural diplomacy of Yugoslavia. His artistic position and presence on the local and international exhibition scene would root him in a position of a key figure in the First Conference of the Non-Aligned Movement in 1961. His artistic presence would be of major importance for the invitation of the Commission for Cultural Relations of the Republic of India, who then organised exhibitions in New Delhi and Bombay (Mumbai). The aim of the paper is to analyse the artistic production during the first years of the seventh decade of the last century and his personal experiences during his stay in India, in order to point out the changes and his reasons behind those changes on the example of his works on the topic of India.

Cryoablation for the management of Small Renal Masses

Renal cell carcinoma is identified most often in the sixth or seventh decade of life, coinciding with the rise in incidental diagnosis of small renal masses as imaging technology has advanced. However, not all patients in this older age group are surgical candidates owing to their comorbidities. Cryoablation is a well-established minimally invasive technique for the treatment of small renal masses. The advent of less invasive ablative treatment has alleviated the surgical dilemma for certain patients who are contraindicated for extirpative procedures. With the appropriate patient selection, cryoablation is safe and effective, resulting in comparable local tumor control, fewer complications, better preservation of renal function, a faster recovery, and a shorter hospital stay. The percutaneous procedure has increased in popularity due to the advantages of reduced pain, shorter hospitalization, the ability to be performed without general anesthesia, and decreased cost relative to surgery.

Clinical and histopathological findings of a rare sinonasal glomangiopericytoma

Glomangiopericytoma is a rare vascular neoplasm of the nasal cavity and paranasal sinuses that occurs during the sixth or seventh decade of life. It is categorized as a borderline tumor with low malignant potential and classified as a distinct entity of sinonasal tumors with perivascular myoid phenotype by the World Health Organization (WHO). We report the case of a 50-year-old woman with nasal obstruction and severe epistaxis. The nasal sinuses computed tomography (CT), and magnetic resonance imaging (MRI) demonstrated a 3.1 cm soft tissue mass occupying the upper part of the left nasal cavity invading the left paranasal sinuses and nasal septum, and the left eye medial rectus muscle. A total mass resection was performed by nasal endoscopy. The histological and immunohistochemical examination yielded the diagnosis of glomangiopericytoma. This case report aims to contribute to the knowledge of nasal neoplasms. The need for more data on this entity is the main obstacle to developing standardized treatment guidelines.

Amelanotic mucosal melanoma of the nasal cavity

Mucosal melanomas are rare head-and-neck tumors and have a distinct etiology and genetic profile different from cutaneous counterparts. They are most commonly seen in sixth–seventh decade of life and have aggressive behavior. The patients usually present with nodal metastasis, which is the most important poor prognostic indicator for mucosal melanomas. We present a case of mucosal melanomas in a young male (30 years), who presented with nonpigmented, polypoidal mass in the right nasal cavity simulating an inverted papilloma. Histological examination showed small to large pleomorphic cells and no melanin pigment. Based on the immunopositivity of the tumour cells were positive for HMB45 and S100 confirming a diagnosis of amelanotic mucosal melanoma. The partied had a localized disease to the right nasal cavity with no nodal involvement and no recurrences in the available follow-up of 24 months.

Urinary Bladder Primary Squamous Cell Carcinoma: A Rare Case Description and Literature Review

Cancer of the urinary bladder is a commonly encountered malignancy of the urinary tract. The most common histologic type is Transitional cell carcinoma (TCC). It accounts for 90-95% of all bladder cancers. It is usually seen in the sixth and seventh decades of life. Men are affected three to four times more than women. The remaining 5-10% of the bladder tumors are other types of epithelial and mesenchymal tumors. Squamous cell carcinoma (SCC) of the urinary bladder is a very uncommon malignancy.

Atypical hemolytic uremic syndrome in a patient with HIV treated with eculizumab: A case report

Thrombotic microangiopathy defines a group of pathologies characterized by microvascular dysfunction with the concurrence of microangiopathic hemolytic anemia, thrombocytopenia, and organ damage. It represents the most frequent microvascular manifestation of human immunodeficiency virus (HIV) infection. We report the case of a man in the seventh decade of life with a recent diagnosis of infection by HIV, who develops hemolytic uremic syndrome, requiring continuous renal replacement therapy and plasma replacement therapy, without response, ADAMTS13 with preserved activity, ruling out other etiologies (infectious, metabolic, and genetic) with successful response to eculizumab.

Collaboration of Primarius Dr. Svetozar Zivojnovic and academician architect Nikola Dobrovic in the development of medical infrastructure in Igalo

Urban positioning, architectural concept and construction of health facilities are parts of a complex process with a number of actors from fields of engineering, but also political and management structures on whose decisions the success of project implementation depends. In general, throughout history, the involvement of representatives of the medical profession in such endeavors has proven to be fruitful because in such a way they directly participate in the functional and formal design of their own work environment. In that sense, it can be stated that the collaboration of engineers, specifically architects, with medical doctors is all the more valuable for scientific research in the field of both the history of medicine and the history of architecture. This text deals with the implications of the collaboration between Primarius Dr. Svetozar Zivojnovic (1899-1981) and academician architect Nikola Dobrovic (1897-1967) on the design and construction of several health facilities as well as the planning of urban zones in Igalo during the sixth and seventh decades of the 20th century. The paper emphasizes their respective contributions, which are considered crucial for the socio-economic development that has turned Igalo into a modern international health center, and one of the main centers of health tourism in the Mediterranean region.

Malignant Male Genital Tract and Urinary System Tumours: Tumour Registry Data Analysis at Armed Forces Institute of Pathology, Pakistan (2009-2018)

Objective: To study the frequency and distribution of malignancies of the male genital tract and urinary system.
 Study Design: Retrospective longitudinal study.
 Place and Duration of Study: Histopathology Department, Armed Forces Institute of Pathology, Rawalpindi Pakistan, fromJan 2009 to Dec 2018.
 Methodology: Two thousand four hundred thirteen cases of malignant tumours of the male genital tract and 4278 cases of tumours of the urinary system were extracted from the tumour registry of the Armed Forces Institute of Pathology (AFIP).
 Results: Thirty-seven thousand seven hundred ninety-three malignant cases were reported at AFIP from 2009-2018, in which 2413(6.38%) were of the male genital tract and 4278(11.32%) were of the Urinary system. The most frequent tumour out of these was carcinoma prostate 2024(83.8%), followed by tumours of testis 359(14.8%), penis 7(0.3%) and MGT tumours (NOS).In the urinary system, bladder cancers were most frequently seen 3289(78%), followed by kidney tumours 989(22%). Bladder cancer was the top most and prostate cancer was the second most common tumour in males in the seventh decade (60-69 years). Kidney tumours were the third most common in female children in the first decade, following eye and lymph node malignancies.
 Conclusion: Carcinoma prostate was the most frequent male genital tract cancer, followed by the testicular tumour. In the urinary system, bladder cancers were most frequently reported with male predominance followed by kidney tumours.

Benign and Malignant Diseases of The Prostate - A Clinicohistopathological Study

Background: Neoplastic and non-neoplastic prostate gland lesions are the main reasons for morbidity and mortality throughout the world. The risk of diseases increases with age. Basically, Prostate biopsy is a test which detects malignant and other benign conditions of the prostate in patients who have urinary symptoms. Other modalities of diagnosis also have been developed, comprising of radiological modalities and prostatic biomarkers. However, biopsy with microscopic examination is the gold standard for the ultimate diagnosis.
 Objectives: The present study was done to recognize and determine the different histopathological patterns of prostatic diseases and their clinical presentation correlations.
 Patients and methods: Reviewing of 194 patient specimens of prostatic tissues in the department of pathology, faculty of medicine, university of Benghazi from January to December 2009 was conducted. The received specimens were fixed in 10% neutral buffered formalin and routine paraffin processing followed by hematoxyline and eosin staining was done. All the specimens were analysed with following parameters: type of specimen, age of patient, histopathological pattern and final diagnosis. With application of modified Gleason scoring for grading.
 Results: 131 TURP, 42 needle biopsies, and 21 prostatectomy specimens were assessed, they were grouped into benign, premalignant, and malignant disorders. Modified Gleason`s Scoring was used to score the prostatic adenocarcinoma. The Mean of all patient's age was 70.7 years. 153 (78.87%) were benign, 7 (3.6%) were premalignant and 34 (17.53%) cases were malignant. Malignant to benign ratio (1: 4.7). Age ranged was 24-100 years. The most frequent disease encountered was BPH, mainly in the sixth decade. Glandular-stromal pattern was more frequently seen (86.8%), followed by glandular predominance (13.2%). Concomitant conditions such as prostatitis, Basal cell hyperplasia, squamous metaplasia, and atypical adenomatous hyperplasia (AAH) (premalignant) were observed. Among the malignant conditions, acinar adenocarcinoma was the commonest disease seen in sixth and seventh decades by (91%), and Gleason`s score 7 was the commonest. One of the cases was metastatic TCC from urinary bladder.
 Conclusion: Benign lesions of prostate are more common than malignant lesions, most commonly encountered in age group of 61 to 70 years. There is a major difference in symptoms between malignant and benign conditions. More studies are needed in future to identify environmental and social factors contributing prostate disease.

Prostatic Artery Embolization: Technical Pearls.

Benign prostatic hyperplasia (BPH) is a condition that primarily affects men between the fourth and seventh decades of life, occurring due to enlargement of the prostate which subsequently causes compression of the prostatic urethra causing chronic obstruction of the urinary outflow tract. BPH can cause significant quality-of-life issues such as urinary hesitancy, intermittency, decreased urinary stream, a sensation of incomplete emptying, dysuria, urinary retention, hematuria, and nocturia. Several medical and surgical treatment modalities are available for the treatment of lower urinary tract symptoms and other BPH-related sequela; however, increasingly prostate artery embolization is being utilized in this patient population. Technical demands for this procedure in this population can be significant. This article describes the optimal techniques, tricks, and advanced imaging techniques that can be used to achieve desired technical outcomes.

Sternotomy in thyroid surgery

Introduction: A bulky retrosternal goiter means for the surgeon to consider an extracervical approach, usually from a partial sternotomy. Methods: Retrospective evaluation of a group of thyroid operations requiring sternotomy in a ten-year period (year 2012–2021), in an attempt to predict the need for sternotomy. Results: We performed a total of 1254 thyroid operations, with partial sternotomy required in 11 cases (0.88%): in 6 women and 5 men aged 43–84 years (mean 73.1 years). For these, 3 total thyroidectomies and 6 hemithyroidectomies (lobectomies) were performed. In 2 cases, we operated on the mediastinal residue, or regenerate, after a previous thyroidectomy from the cervical approach. The duration of hospitalization was 5–14 days, once there was bleeding with the need for operative revision, otherwise the procedures were without complications, including phonation. The border of the lower part of the thyroid gland in relation to the upper border of the aortic arch was in the range of +20 to -22 mm. The mean was -8.5 mm. Conclusion: All sternotomy thyroidectomies performed by us had a close relationship to, or overlapped with the upper line of the aortic arch. Significantly retrosternal propagating goiters are mostly eufunctional (81.9 % in our group) and develop in patients in the seventh or eighth decade of life. Therefore, if only one lobe propagates intrathoracically, a hemithyroidectomy is sufficient. A carcinoma is rarely present; in one case in our group. We believe that the necessity of sternotomy cannot be accurately predicted, but it is necessary to be prepared for it, especially in the case of a goiter exceeding the level of the aortic arch. In case of greater retrosternal propagation, it is certainly appropriate to perform a CT, for surgical reasons (possibility of sternotomy, risk of leaving part of the gland) and anesthetic reasons (compression and deviation of the trachea).

Cistadenoma mucinoso del apéndice cecal en paciente con cuadro clínico de apendicitis aguda operado de apendicetomía por laparoscopia

Mucoceles of the appendix are rare, predominate in women and usually present as a palpable mass in the right lower quadrant. Most patients are asymptomatic. The mucocele is defined as a cystic dilatation of the appendicular lumen caused by mucin accumulation. We present the case of a male patient in his seventh decade with clinical symptoms of acute abdomen with suspicion of acute appendicitis, laparoscopic hemicolectomy surgery was performed after finding findings of tumor dependent on ascending colon (blind region), indurated 80 × 100 mm approximately, performing right hemicolectomy plus ileocolonic lateroterminal anastomosis with adequate postoperative evolution. Keywords: Mucocele; appendix; appendicitis.

Clinical Characteristics and Outcomes of Young Adult Patients with Small Intestinal Neuroendocrine Tumors Differ from Those of Older Adults

INTRODUCTION: Small intestinal neuroendocrine tumors (siNETs) are most commonly diagnosed in the sixth and seventh decades of life. Little is known about the characteristics and outcomes of patients diagnosed at younger ages. METHODS: The National Cancer Database was queried for patients diagnosed with siNETs from 2004 to 2018. Young adults (18 to 39 years) and older adults (40+ years) were compared using Wilcoxon and Chi-square tests and Kaplan-Meier estimates. RESULTS: A total of 26,902 adults with siNETs were identified. Median age was 62 years (interquartile range [IQR] 53 to 71). Young adults (1,130; 4.2%) were more likely to be of non-white race (21.2% vs 15.0%, p < 0.001) and Hispanic ethnicity (8.4% vs 4.5%, p < 0.001). Of young adults, 51.9% had stage 3 disease and 24.7% had stage 4 disease, compared with 54.4% and 29.2%, respectively, of older adults (p < 0.001); 91.5% of young adults and 91.6% of older adults underwent resection (p = 0.89). Young adults were more likely to have negative margins (90.6% vs 84.7%, p < 0.001) and more regional nodes examined (median 11.0 (IQR 1.0 to 20.0) vs 9.0 (IQR 1.0 to 16.0), p < 0.001). Ninety-day mortality was 0.9% for young adults and 3.5% for older adults (p < 0.001). Across all stages, young adults had more favorable 5-year survival (Table). Table. - Clinical Characteristics and Survival Rates of Young vs Older Adults with siNETs Variable Young adults (n = 1,130) Older adults (n = 25,772) p Value Grade 1 76.9% 79.9% 0.046 Grade 2 20.7% 18.1% Grade 3 2.4% 2.0% Stage 1-2 23.4% 16.4% <0.001 Stage 3 51.9% 54.4% Stage 4 24.7% 29.2% 5-year survival: stage 1–2 93.2% (95% CI 88.0–98.5) 80.3% (95% CI 78.6–82.0) <0.001 5-year survival: stage 3 97.0% (95% CI 94.7–99.1) 86.6% (95% CI 85.8–87.5) 5-year survival: stage 4 84.1% (95% CI 78.3–90.3) 71.3% (95% CI 69.8–72.9) CONCLUSION: Young adults with siNETs are demographically different from older patients, with a higher percentage of non-white and Hispanic patients. Young adults present with less advanced disease and are more likely to undergo resection with negative margins and have more regional nodes examined. Young adults have more favorable short- and long-term survival regardless of stage, which warrants separate evaluation for prognostication.

An unusual case of sequential corneal perforation in pellucid marginal degeneration

Spontaneous and sequential corneal perforation is rare in pellucid marginal degeneration (PMD) in the seventh decade of life. Hence, the importance of repeated follow-up, clinical examination along with serial corneal topography even in the seventh and eighth decades of life is of utmost importance in PMD. We report a case of spontaneous corneal perforation in a 64-year-old male patient with PMD having normal corneal thickness in the right eye which was managed with primary suturing and compression sutures. The other eye was absolutely normal with normal topographic findings. Over a period of four years of follow-up, the patient developed progressive diminution of vision in both eyes and was diagnosed with cataract. Temporal phacoemulsification with toric IOL implantation was done in both eyes, following which the left eye developed spontaneous perforation after a period of two months which was also managed with primary suturing and compression sutures.

"BUT I AM TOO YOUNG FOR THIS": EARLY PRESENTATION OF USUAL INTERSTITIAL PNEUMONIA

"BUT I AM TOO YOUNG FOR THIS": EARLY PRESENTATION OF USUAL INTERSTITIAL PNEUMONIA

Necklace Pattern Left Ventricular Noncompaction Cardiomyopathy with Plethora of Paradoxic Septal Premature Ventricular Complexes: A Case Report and Literature Review

We report an extremely rare case of left ventricular noncompaction (LVNC) cardiomyopathy sparing the anterior ventricular wall in an interesting “necklace” pattern in parasternal short axis view in a 76-year-old female with frequent palpitation and shortness of breath for the last 6 months. Interestingly, the patient had a plethora of basal septal premature ventricular complexes (PVCs) both from the anterior and posterior aspects of the paradoxically thinned-out basal septum and they were not from the segment of noncompacted (NC) myocardium. Our case is unique and the first to describe the LVNC in an interesting shape of “necklace” sparing the left ventricular anterior, anteroseptal, and anterolateral wall and paradoxically arising plethora of septal PVCs from the thinned-out basal septum deteriorating the left ventricular function rapidly in an elderly female in her seventh decade of life. Although commonly in LVNC, the PVCs arise from the NC segment, in this unique case plethora of PVCs paradoxically arising from the basal septum were contributing toward rapid deterioration of left ventricular systolic function in an elderly patient in her seventh decade of life without the presence of conventional risk factors.

33 (PB023) - Establishment and characterization of a preclinical platform of subcutaneous renal cell carcinoma (RCC) patient-derived xenograft models to evaluate novel treatment strategies

Background: Renal cell carcinoma (RCC) is a cancer type with an onset mainly during the sixth or seventh decade of the patient’s life. Patients with advanced or metastasized RCC have a poor prognosis. The majority of patients develop drug resistance towards Standard of Care (SoC) drugs within months. Tyrosine kinase inhibitors (TKI) are used in first-line therapy and have been combined with immune checkpoint inhibitors recently. The development of novel therapies targeting acquired TKI resistance mechanisms in advanced and metastatic RCC remains an urgent medical need.

Light-Chain Multiple Myeloma Presenting as a Bone Tumor in the Right Knee Joint – a Case Report

Myeloma is the neoplastic proliferation of plasma cells. The peak age of onset of this disease is the seventh decade, and it is rare in young patients. Myeloma usually presents as lytic lesions in axial bones and rarely present as a joint disease. Usually, the tumor cells secrete monoclonal immunoglobulins. Non-secretory myeloma is a rare clinical entity. The incidence of light-chain myeloma is 16 – 20 % among all multiple myelomas, and the more common subtype is the lambda chain type. We present a case of kappa light chain-type myeloma in a 29-year-old male with the presenting lesion in the right knee joint. The case is presented for its rarity due to the age of patient, presentation, and type of myeloma.

Extramammary Paget’s Disease Arising in the Scrotum of an Elderly Male

Extramammary Paget’s disease (EMPD) is a rare form of primary or secondary intraepithelial adenocarcinoma typically presenting within the fifth through seventh decades of life. Though cases of EMPD localized to the scrotum are typically not associated with underlying malignancy, evaluation of dermal and angiolymphatic invasion in conjunction with pertinent laboratory investigations, e.g., serum CEA, is essential to rule out malignancy and metastatic disease. We present a case of EMPD in an elderly male that presented with a history of a longstanding asymptomatic scrotal lesion that was ultimately managed with excision and skin grafting.