Attributes of cancer patients admitted to the emergency department in one year / 世界急诊医学杂志（英文）

@#BACKGROUND:Cancer patients frequently visit the emergency department (ED) with various symptoms of cancer. The purpose of this study was to determine the clinical characteristics and 1-year survival rate of cancer patients in the ED of a university hospital. METHODS:We conducted a retrospective review of 408 cancer patients who visited the ED between January 2011 and December 2011. Patient information on demographics, chief complaints, findings, and survival was gathered from the hospital registry and corresponding health administration. RESULTS:The study included 240 (58.8％) males and 168 (41.2％) females with a median age of 57.9 years (range 19–87). Regarding cancer staging, 266 patients (65.3％) had metastatic disease and 142 (34.7％) had local and loco-regional disease. The hospitalization rate was 59.6％. The most common symptoms were shortness of breath (23.2％), pain (17.8％), fever (14.2％), and nausea/vomiting (14.4％). The most common cancer sites were the lung (32.5％), gastrointestinal system (25.4％), and breast (9.3％). The initial evaluation determined progressive disease (42.4％), chemotherapy effects (20.7％), infections (17.2％), radiotherapy effects (4.7％), extravasation (1.8％), anemia (1.4％), and unknown (11.3％). During follow up, 191 (46.8％) patients died after admission to the ED. The 1-year overallsurvival of allpatients was 7.3 months. CONCLUSIONS:Symptom management in cancer patients is a complex multifaceted concern for the emergency physician. Because of the increasing prevalence of cancer patients, emergency physicians should develop consensus algorithms in collaboration with the relevant disciplines to manage the commonly encountered problems.

Prostate small cell carcinoma and skin metastases: a rare entity

To report a rare case of small cell carcinoma of the prostate with unusual skin metastasis. Clinical Presentation and Interventions: A 60-year-old was evaluated for difficulty in urinating. Abdominal computed tomography scans revealed a prostatic mass invading the surrounding tissues and multiple perirectal, periprostatic, para-aortic and pericaval lymph nodes. Needle biopsy specimens showed both small cell carcinoma and adenocarcinoma. He was treated with combination chemotherapy: cisplatin and etoposide and bilateral orchiectomy. After six cycles of the chemotherapy, disease progressed and the patient did not respond to salvage therapy; hence, palliative care was instituted. During the follow-up, papillary lesions were observed in the scrotal skin; biopsy showed metastatic small cell carcinoma. Small cell carcinoma of the prostate is an aggressive disease with a highly metastatic potential; but skin metastases are very uncommon. It has poor prognosis despite therapy. Management resembles that of small cell carcinoma of the lung

Imipenem-cilastatin versus sulbactam-cefoperazone plus amikacin in the initial treatment of febrile neutropenic cancer patients

The treatment of infectious complications in cancer patients has evolved as a consequence of the developments in the chemotherapy of cancer patients. In this prospective, randomized study, we compared imipenem-cilastatin and sulbactam-cefoperazone with amikacin in the empiric therapy of febrile neutropenic ( 0.05). No major adverse effects occurred. This study demonstrated that imipenem-cilastatin monotherapy and combination therapy of sulbactam-cefoperazone plus amikacin were equally effective empiric therapy for febrile granulocytopenic cancer patients.