Masquerade in the Cecum

Objective To explore the characteristics of blood lipids in younger patients with hypertensive intracerebral hemorrhage (HICH). Methods We collected the blood samples from HICH patients in eight hospitals, and then divided them into either a younger patient group (30-40 years old) or an older patient group (50-60 years old). At the same time, younger and older healthy people were randomly selected as control groups. The levels of total cholesterol (TCH), triglyceride (TG), high-density lipoprotein (HDL-C), and low-density lipoprotein (LDL-C) in blood were examined, and their differences were compared between different groups by t-tests. Results The levels of TG and HDL-C presented a significant difference between the younger patient and healthy groups [(1.95±1.34) mmol/L vs (1.25±0.63) mmol/L, t=5.40, P<0.001; (1.18±0.45) mmol/L vs (1.34±0.36) mmol/L, t=3.23, P=0.001], and TG level in the younger patient group was significantly higher than that of the older patient group [(1.95±1.34) mmol/L vs (1.43±1.09) mmol/L, t=3.39; P=0.001]. However, the level of HDL-C in the younger patients was significantly lower than that in the older HICH patients [(1.18±0.45) mmol/L vs (1.35±0.38) mmol/L, t=3.30; P=0.001]. Besides, 46.5% of younger HICH patients had abnormal TG levels. Conclusion Abnormal level of TG or HDL-C is an important risk factor for HICH in younger patients, and monitoring and management of blood lipids such as TG is a promising preventive method against HICH in younger people. Key words: Younger age; Hypertensive intracerebral hemorrhage; Blood lipids; Triglyceride

AGA Clinical Practice Update on Management of Inflammatory Bowel Disease in Elderly Patients: Expert Review

To the Editor. Cystic fibrosis (CF) patients frequently suffer from recurrent abdominal pain1 because of various mechanisms such as gut motility disorders and uncontrolled pancreatic insufficiency, but also surgical events. This makes diagnosis difficult.2–5 We report on 8 children (5 boys, 3 girls) with chronic abdominal pain due to appendicular mucocele (AM) detected by colonic transabdominal ultrasonography (CUS). Abdominal pain symptoms appeared between ages 3 and 11. All patients have pancreatic insufficiency controlled with an effective pancreatic enzyme preparation (6000 ± 2000 U lipase/kg/d); 4 had a neonatal meconium ileus. Genotype is homozygous δ F 508 for 4 children. Shwachman scores are 70 to 95.All but one suffered from constipation or distal intestinal obstruction syndrome (DIOS); 6 had mild abdominal pain and 2 had severe pain with colicky abdominal cramps. Pain was initially intermittent and then became continuous in 2 children. Otherwise, the children appeared well and had no weight loss, no bloody stools, or vomiting. One child had a fever for a few days just before diagnosis.Physical examination revealed tenderness of the right lower quadrant in 5 children, with a mobile mass in this area in 3. X-rays of the abdomen showed only a large amount of fecal material in the right colon. Their failure to respond to the usual medical management of symptoms of DIOS led to further radiological investigation.CUS (Hitachi EU B 415 CFM, Tokyo, Japan; 0.6 mm lateral resolution, 7.5 MHz linear transducer) was used to scan the entire abdomen in both longitudinal and transverse directions focusing on the right iliac fossa. Patients were not required to fast and the bowel was not prepared. One patient had a typical ileocecal intussusception (ICI) with a target pattern.2 Another had a large, multilayered mass in the right lower quadrant (4 × 3 cm). The remaining cases had appendices which were enlarged (7–20 mm, normal <6 mm), with a lumen obstructed with echogenic material, and a clearly stratified wall. A barium enema confirmed both intussusceptions, with a partial reduction for 1 child; patients had an impression of the internal side of the cecum. The appendix was not visible in any patients, and the ileum was not opacified in 6 of them. A barium enema was not required for the most recent case because ultrasonography provided sufficient information.Surgery was performed: large ileocecal junction resections were necessary for the two ileocecal intussusceptions. One periappendicular abcess was identified. The 6 other children underwent appendectomy with resection of the cecal tip to prevent any recurrence. Pathological studies disclosed appendicular mucocele in all patients.All the patients are doing well, with follow-ups of 20 to 42 months.Transabdominal ultrasonography focusing on the right iliac fossa is a rational approach to abdominal pain in patients with CF inasmuch as appendicular mucocele is readily diagnosed. Early surgery may prevent complications such as intussusception3–5 and/or appendicular abscess.

BackgroundOccurrence at a young age is known to be associated with unique clinical features in colorectal cancer (CRC). However, the genomic differences between young and old patients with CRC are not well elucidated and, to the best of our knowledge, have never been investigated in a Chinese population.MethodsTumor tissue samples from 29 young (age ≤50 years) and 46 old (age >50 years) patients with CRC were collected. Targeted sequencing of 808 cancer‐related genes was conducted to characterize the genomic landscape for Chinese CRC.ResultsOverall, mutational profiles exhibited notable differences between the two groups. In particular, APC and PIK3CA mutations were more frequently observed in old patients (p = 0.009 and p = 0.012, respectively), while SMAD4 mutations tended to occur in young patients (p = 0.054). Mutation loci distributions of KRAS in the young cohort differed from those in the old cohort, and a higher frequency of KRAS codon 12 mutations was potentially associated with a young age (p = 0.076). The frequencies of clinically actionable alterations were analyzed by defined age categories, which unveiled a distinctive targeted genomic profile in the young group. Furthermore, among patients with mismatch repair‐proficient (pMMR) CRC, tumor mutation burden (TMB) was positively correlated with age (Pearson's r = 0.306, p = 0.011), and genomic alterations associated with high TMB in young patients differentiated from those in old patients.ConclusionsThese findings revealed different molecular characterization between young and old Chinese patients with CRC, which may provide novel insights for the personalized treatment of CRC.

In adolescents and young adults, primary hyperparathyroidism (PHPT) is an uncommon diagnosis. We compared the clinical characteristics of these patients to those of older adult patients with PHPT. We hypothesized that PHPT in adolescents and young adults is more often caused by single-gland disease and is amenable to minimally invasive parathyroidectomy (MIP). We retrospectively reviewed the medical records of 452 consecutive patients who had surgery for PHPT. Patients ranged in age from 13 to 94 years and were dichotomized into younger (age <30 years, n = 17, 3.8%) and older (age ≥ 30 years, n = 435, 96.2%) patients. Continuous baseline and intraoperative and postoperative measures were not normally distributed and were summarized with medians and interquartile ranges (IQRs). Groups were compared using Wilcoxon rank sum test or Fisher exact test, and significance was set at P < .05. Median [IQR] age was 24 [23-27] years for the younger group and 58 [51-66] years for the older group. Though not statistically significant, a smaller proportion of the younger patients compared with the older patients had a positive (99m)Tc-sestamibi scan (71%; 95% confidence interval [95% CI] = 44-90% vs. 83%; 95% CI = 79-86%) and showed a suspected parathyroid adenoma on ultrasound (65%; 95% CI = 38-86% vs. 80%; 95% CI = 76-83%). The younger and older age groups did not significantly differ on preoperative serum PTH levels (median [IQR]: 111 [76-145] pg/ml vs 110 [84-152] pg/ml; P = .73 respectively). The younger group had higher serum calcium levels (11.6 [11.1-12.2] mg/dl) compared with the older group (11.1 [10.7-11.5] mg/dl; P = .01). MIP was performed less frequently on the younger patients (70.6%) compared with older patients (88.7%; P = 0.04). Though the incidence of a single adenoma was somewhat more frequent in older patients (90%; 95% CI = 87-93%) than in younger patients (82%; 95% CI = 57-96%) it was the most frequent cause of PHPT in the younger patients. The younger and older groups did not significantly differ on percent drop from baseline for intraoperative PTH monitoring (81.7 vs 79.3%; P = .46), respectively. Younger patients with PHPT present with significantly higher serum calcium levels than older patients. However, younger patients are less likely to localize abnormal parathyroid glands on sestamibi or ultrasound. Though younger patients appear to have a higher incidence of hyperplasia compared with older patients, single gland disease is still the overall most frequent cause. Our data suggest that MIP should be more frequently considered in younger patients because of the high incidence of single gland disease.

Late-Onset Hemorrhagic Cystitis in Children after Hematopoietic Stem Cell Transplantation for Thalassemia and Sickle Cell Anemia: A Prospective Evaluation of Polyoma (BK) Virus Infection and Treatment with Cidofovir

It has been known that young breast cancer patients have worse outcomes compared with older premenopausal or postmenopausal patients. Survival difference between young and older breast cancer patients is evident only in hormone receptor positive breast cancer regardless of tamoxifen treatment according to our previous report. However, the biology of aggressiveness and endocrine resistance of breast cancer in very young women is largely unknown. The purpose of this study is to find molecular characteristics of hormone receptor positive breast cancers of very young age women (&amp;lt;35) compared with those of older premenopausal women. We extracted mRNA from fresh frozen hormone receptor positive primary breast cancer tissues of 24 young age breast cancer patients (&amp;lt;35 years) and 31 older premenopausal women (40 to 49 years) by standard method. All tumor specimens analyzed contained more than 50% tumor cells. Hormone receptor status was determined by immunohistochemistry (IHC). Gene expression microarray experiment was done in the 55 samples using Illumina HumanRef-8 v3 Expression BeadChip (Illumina, Inc., San Diego, CA). Functional and pathway analysis of differentially expressed genes were done using DAVID (http://david.abcc.ncifcrf.gov/home.jsp) and Ingenuity pathway analysis (IPA, http://www.ingenuity.com). Ki-67 assay was done using IHC in 4,957 ER+ breast cancer patients of Seoul National University cohort and 1,863 ER+ patients from National Cancer Center, Korea. 355 genes were upregulated (&amp;gt;1.5 fold) and 209 genes were down-regulated in breast cancer tissues of young age patients (&amp;lt;35) compared with those of older patients. In pathway analysis of the highly expressed genes in young patients, cell cycle function and pathway was significantly activated. The genes of central role in this pathway were MYC and CCND1. In IHC assay for 4,957 ER+ Seoul National University dataset, the proportion of high Ki-67 expression (&amp;gt;=10%) was positively correlated with decreasing age: 26.4%, 24.0%, 21.3%, 14.8%, 12.0% of women aged &amp;lt;30, 30–34, 35–39, 40–49, 50–59, respectively (p&amp;lt;0.001). The same correlation pattern between younger age and high Ki-67 expression was also seen in another 1,863 patient cohort. In conclusion, we showed that genes involved in cell cycle pathway were upregulated in very young age (&amp;lt;35) ER+ breast cancer using microarray study. It was validated in large data set using Ki-67 IHC assay. High proliferation and fast cell cycle could be a mechanism of worse outcome and tamoxifen resistance of ER+ very young age breast cancer patients. Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P4-01-13.

Colorectal cancer (CRC) is mostly considered a disease of the elderly. But the rate is increasing among young adults and is associated with different clinical patterns. The objective was to study the frequency of CRC in young patients and compare the clinicopathological profile and survival with the older cohort. Five-year (2012-2016) data of the 912 consecutive CRC cases treated at the center were analyzed. Clinical and histopathological characteristics were compared in young (≤40) and older (>40) patients. Descriptive statistics were used for data presentation. Categorical data were compared by the Chi-square test; survival analyses were performed by Kaplan-Meier method. In total, 231 (25.3%) and 681 (74.7%) cases were in the young and older age groups, respectively. Male predominance was noted. Young patients presented predominantly in stage III (46%). Majority of the young patients harbored left-sided tumors (75.8% vs 63.7% in old patients, P = 0.001) and rectum was the favored site in young patients (53.7% vs 37%; P < 0.001). Poorly differentiated adenocarcinoma was more common in the young age group (46.88% vs 24.16% in old patients, P < 0.001), also signet-ring cell morphology occurred more often in young patients (11.7% vs 4%, P < 0.001). Survival was inferior in the patients presenting at an advanced stage or with adverse histology or poor tumor grade. However, stage-specific survival showed no significant difference between both groups. This study shows that though young CRC patients present with higher stage, aggressive morphology, and predominantly rectal localization, the overall survival and stage-specific survival did not differ significantly from the older patients.

Purpose: Several studies have reported controversial results about prognosis of gastric cancer in young age patients. The difference may partially result from variable definitions of young age. The aim of this study was to find out the relation between age and prognosis of gastric cancer patients, and to analyze the clinicopathological features and prognostic factors in young gastric cancer patients.Methods: Data queried for this analysis included GC patients from the Surveillance, Epidemiology, and End Results Program database from 1973 to 2014. Gastric cancer patients (N=79,505) diagnosed with an age≥18 were included. By combining patients with similar prognosis, we figured out 3 cutoff values of age, 35 years old, 65 years old and 75 years old. We divided patients into 4 groups: young age patients: 18-34 years; middle-age patients: 35-64 years; elderly patients: 65-74 years; extremely elderly patients: >74 years. GC patients from Sun Yat-sen University Cancer Center (SYSUCC) were used as external validation data.Results: The clinicopathological features of young age gastric cancer patients included: poor-differentiated, diffuse type of cancer, and advanced stage at diagnosis. The median survival of patients <35 years old was significantly lower than middle-age patients (35-64 years) and elderly patients (65-74 years) (12 months vs. 15 and 16 months, respectively, both p <0.001). Location of tumor, ethnicity, tumor size, surgery and TNM stage were independent prognostic factors by multivariate analysis in young patients. The poor prognosis for young patients remained valid in the SYSUCC database.Conclusions: Our results demonstrated that gastric cancer patients <35 years old had an extremely poor prognosis. Early detection of gastric cancer is of paramount importance in young age people.

Comparison in young and elderly patients of pharmacodynamics and disposition of labetalol in systemic hypertension

Despite diagnostic and therapeutic advancements in cardiovascular medicine, myocardial infarction (MI) remains a major cause of adverse outcomes in younger MI patients, i.e., those who are aged 55 years or younger. Traditional cardiovascular risk factors have not often been emphasized in the management of younger MI patients. However, plaque rupture or erosion, which is deeply related to cardiovascular risk factors, remains the most common etiology of MI even in younger patients. The global increase in the prevalence of obesity underscores the clinical importance of metabolic syndrome (MetS), i.e., obesity-associated cardiovascular risk factors, dyslipidemia, diabetes mellitus and particularly hypertension, in younger people. The concept of "lifetime risk" of cardiovascular disease reinforces the need for prevention or treatment of MetS. This review focuses on the risk factors related to MetS and an overall understanding of recent profiles of younger MI patients. We hope that this review will aid in the primary prevention of MetS-related risk factors and the prevention of cardiovascular disease, particularly MI, in younger patients.

Cerebral Venous Sinus Thrombosis in a Patient with Appendicular Abscess

The aim – to optimize diagnostic and treatment measures for salmonella infection byanalyzing the clinical features of the course of the disease in hospitalized children ofdifferent ages.Material and methods. A comprehensive clinical and paraclinical examination of 63children who were inpatients in the infectious disease department No. 2 of the ChernivtsiRegional Children's Clinical Hospital during 2024 with a bacteriologically confirmeddiagnosis of salmonellosis was conducted. The first (I) group included 30 sick childrenunder 3 years of age, the comparison group (II group) was formed from 32 children over3 years of age. The average age of the examined patients was 4.6±0.5 years. The groupswere comparable in terms of the main clinical characteristics. The study was conductedin accordance with the principles of biomedical ethics and in compliance with the mainprovisions of the “Rules of Ethical Principles for Conducting Scientific MedicalResearch Involving Humans”, approved by the Declaration of Helsinki (1964-2013),ICH GCP (1997), EEC Directive No. 609 (dated 11/24/1986), orders of the Ministry ofHealth of Ukraine No. 690 dated 09/23/2009, No. 944 dated 12/14/2009, No. 616 dated08/03/2012. Inclusion criteria for the study: age of patients - from birth to 18 years;written informed consent of the parents or legal representatives of the child toparticipate in the study; laboratory-confirmed salmonellosis, established on the basis ofthe isolation of Salmonella spp. during bacteriological examination of feces;Hospitalization for acute intestinal infection with typical clinical manifestations(diarrheal syndrome, fever, intoxication, vomiting, abdominal pain); acute course of thedisease at the time of hospitalization; availability of clinical and laboratory informationsufficient to assess the features of the disease course. Exclusion criteria from the study:lack of laboratory confirmation of salmonellosis; mixed intestinal infections (bacterial,viral or parasitic), which could significantly affect the clinical course of the disease;chronic diseases of the gastrointestinal tract in the acute phase or severe concomitantsomatic or neurological diseases that can change the clinical picture of the disease;incomplete medical data that make it impossible to conduct a correct comparativeanalysis between age groups. Statistical processing of the results was carried out usingthe Statistica v.10.0 software package (StatSoft Inc., USA) and Microsoft Excel XP forWindows. To compare the mean values, the Student t-test (Pt) was used, and to analyzethe differences in frequencies (%) - the Fisher's exact transformation test (Pφ). Resultswere considered statistically significant at the level of p &lt; 0.05.Results. When analyzing the etiological structure of the disease, it was found that S.typhimurium is probably more often the cause of salmonellosis in patients of the youngerage group compared to older children (52.2% vs. 11.1%, pφ&lt;0.05). The most commonsymptoms of salmonellosis in children were fever, diarrhea, nausea, vomiting and signsof intoxication syndrome, in particular, general weakness, decreased appetite,adynamia, as well as abdominal pain, combined with rehydration of varying degrees. Atthe same time, pronounced vomiting and pronounced abdominal pain were significantlymore often observed in patients with manifestations of intestinal infection, older than 3years of age (87.0% vs. 34.8% (рφ&lt;0.05) and 29.6% vs. 17.0% (рφ&lt;0.05). Repeatedvomiting lasting more than one day was recorded significantly more often in youngerpatients (8.1% of patients, vs. 3.7%, рφ&lt;0.05), while the average duration of abdominalpain, diarrhea and fever in stationary conditions was the same in both groups. Laboratory features in children of the older group were characterized by rejuvenationof neutrophilic granulocytes with a tendency to leukocytosis and thrombocytosis inyoung children.Conclusions: 1. In modern conditions, 70% of cases of salmonellosis in hospitalizedchildren are caused by S. enteritidis. In patients In the younger age group, the causativeagent of salmonellosis was S. typhimurium more often than in older children. 2.Repeated vomiting and severe abdominal pain in the first days of illness with intestinalinfection in a patient older than 3 years increases the likelihood of salmonellosis in himcompared to the younger age group. 3. Children older than 3 years with salmonellosiswere significantly more often hospitalized in the first 3 days of illness in a severecondition compared to younger patients. 4. Vomiting in the hospital for more than 1 daywas recorded significantly more often in younger patients, who required the use ofantiemetic drugs to ensure the possibility of oral rehydration therapy. 5. Hematologicalparameters of patients with salmonellosis in patients older than 3 years werecharacterized by a significantly higher relative content of rod-shaped granulocytes inthe blood serum compared to younger age children. in whom a predisposition toleukocytosis and thrombocytosis has been established.

Funding Acknowledgements Type of funding sources: None. Introduction Several studies have suggested a relationship between dyslipidemia and atherogenesis, which displays a main role in the pathophysiology of Acute Coronary Syndrome (ACS). Aim To compare the lipid profile between younger (&amp;lt;55 years) and older (≥55 years) patients admitted due to ACS. Methods A single-centre retrospective study was conducted, with inclusion of all consecutive patients admitted in the Cardiology Department due to ACS. Several analytical parameters were evaluated, including total cholesterol (CT), HDL cholesterol (HDL), LDL cholesterol (LDL) and triglycerides (TG) and CT/HDL, LDL/HDL and TG/HDL ratios were calculated. All parameters are presented in mg/dL. Afterwards, comparison of these data between younger (age &amp;lt; 55 years, Group-A) and older (age≥55 years, Group-B) patients was done. Statistical analysis was performed with SPSS and a p value &amp;lt; 0.05 was considered statistically significant. Results 1168 patients (70.1% male, mean age 69 ±12 years) were included in this study. 15.8% of patients were from Group-A. Mean levels of the analysed parameters were the following: CT 176 ± 55, LDL 111 ± 45, HDL 40 ± 12 and TG 137 ± 102. The following mean ratios were obtained: CT/HDL 4.6 ± 1.9, LDL/HDL 2.9 ± 1.4 and TG/HDL 3.8 ± 3.5. Comparison of the analysed parameters and calculated ratios is exhibited in table 1. Conclusion Overall, a worse lipid profile was observed in younger patients. This data reveals the role of dyslipidemia in coronary heart disease, which displays a main role in atherosclerosis at a younger age. This fact highlights the importance of adopting a healthy lifestyle and the adherence to primary and secondary prevention measures of cardiovascular events. Lipid profile: young vs old patient Group A Group B Total Cholesterol 199 ± 44 170 ± 56 p &amp;lt; 0.001 LDL Cholesterol 128 ± 37 107 ± 46 p &amp;lt; 0.001 HDL Cholesterol 39 ± 10 40 ± 12 p = 0.307 Triglycerides 195 ± 189 125 ± 66 p &amp;lt; 0.001 CT/HDL 5.3 ± 1.5 6.8 ± 2.0 p &amp;lt; 0.001 LDL/HDL 3.4 ± 1.1 2.8 ± 1.4 p &amp;lt; 0.001 TG/HDL 5.6 ± 6.3 3.5 ± 2.5 p &amp;lt; 0.001

Do young breast cancer patients have worse outcomes?