Adrenal Schwannoma in an Elderly Man: A Case Report and Literature Review.

Schwannoma is a common mesenchymal neoplasm; however, adrenal schwannoma is rare, and it is frequently misdiagnosed as adrenal cortical adenoma. We herein report a 91-year-old Japanese man with right adrenal schwannoma that was pathologically diagnosed after adrenalectomy. To our knowledge, this is the first case of adrenal schwannoma in the oldest patient and with the longest follow-up period reported, including radiological images from 10 years earlier.

[Malignant lymphoma with IgG4-related disease arising in a very elderly man].

IgG4-related disease (IgG4-RD) which is characterized by an autoimmune abnormality and elevated serum IgG4 level often presents as swelling, nodules, and the thickening of multiple organs. It typically occurs in middle-aged to elderly patients, but its pathogenesis remains unclear. Lymphadenopathy is frequently seen in IgG4-RD, which clinically requires a differential diagnosis from malignant lymphoma. We herein report a case of malignant lymphoma with IgG4-RD arising in a very elderly man.An 85-year old man with a 6-year history of autoimmune pancreatitis was diagnosed as IgG4-related hypophysitis 13 months prior to admission. Hydrocortisone was prescribed for secondary adrenal insufficiency after this presentation. At 9 months before admission, he began to suffer from central diabetes insipidus, and desmopressin was also prescribed at that time. However, 9 months later, he presented with fever, weight loss, and systemic lymphadenopathy while demonstrating elastic hardness, flexibility, and no tenderness. A pathologic specimen obtained from a right axillary lymph node biopsy revealed diffuse large B cell lymphoma. Considering his age and performance status, palliative therapy was chosen, and thus prednisolone was administered. He was transferred to another hospital to receive palliative care on the 55th day after hospitalization.We should consider the clinical course, pathological findings, serum IgG4 level, and other involved organs in order to differentiate malignant lymphoma from IgG4-related lymphadenopathy. To our knowledge, this case is the oldest known patient to have ever been reported. Both IgG4-RD and malignant lymphoma are frequently seen in elderly people, therefore, we should deepen our knowledge of these diseases.

An elderly man with progressive focal nodular hyperplasia.

Patients with focal nodular hyperplasia (FNH) develop benign hepatocellular nodules. FNH most frequently occurs in young women. There are no reports of the onset of FNH in elderly men. We report a case of FNH in an elderly man, whose nodules increased in number and size. The patient underwent surgery for carcinoma of the left renal pelvis at 69 years of age; no liver masses were noted on yearly follow-up contrast-enhanced computed tomography (CECT). Ten years later, CECT revealed a hepatic mass, and magnetic resonance imaging suggested FNH. The nodules increased in number and size in subsequent follow-up examinations.

Validity and reliability of the Brazilian version of the Caregiver Reaction Assessment / Validez y confiabilidad de la versión brasileña del Caregiver Reaction Assessment / Validade e confiabilidade da versão brasileira do Caregiver Reaction Assessment

ABSTRACT Objective: To analyze the validity based on the internal structure and reliability of the Brazilian version of the Caregiver Reaction Assessment (CRA) applied to informal caregivers of dependent elderly. Method: A methodological study with 120 informal caregivers of the elderly. Validity based on the internal structure evaluated by exploratory factorial analysis, with extraction of main factorial axes, varimax orthogonal rotation and retention of factors by parallel analysis. Reliability assessed by Cronbach's alpha. Results: The instrument revealed a factorial structure different from the original version: three factors were identified, equivalent to subscales, self-esteem, daily activities and family support, with explained variance of 42%. The values of the Cronbach alpha for the items belonging to each subscale were, respectively: 0.71, 0.81 and 0.83. Conclusion: The Brazilian version of CRA presents good evidence of validity based on internal structure and is reliable, and can be used to assess the overload of informal caregivers of dependent elderly.

RESUMEN Objetivo: Analizar la validez basada en la estructura interna y la confiabilidad de la versión brasileña del Caregiver Reaction Assessment (CRA) aplicado a cuidadores informales de ancianos dependientes. Método: Estudio metodológico, realizado con 120 cuidadores informales de ancianos. Validez basada en la estructura interna evaluada por análisis factorial exploratorio, con extracción de principales ejes factoriales, rotación ortogonal varimax y retención de factores por análisis paralelos. Confiabilidad examinada por el alpha de Cronbach. Resultados: El instrumento reveló una estructura factorial diferente de la versión original: tres factores fueron identificados, equivalentes a las subescalas autoestima, programación de las actividades diarias y soporte familiar, con varianza explicada de 42%. Los valores del alpha de Cronbach para los elementos integrantes de cada subescala fueron, respectivamente: 0,71, 0,81 y 0,83. Conclusión: La versión brasileña del CRA presenta buenas evidencias de validez basadas en la estructura interna y es confiable, pudiendo ser empleada en la evaluación de la sobrecarga de cuidadores informales de ancianos dependientes.

RESUMO Objetivo: Analisar a validade baseada na estrutura interna e a confiabilidade da versão brasileira do Caregiver Reaction Assessment (CRA) aplicado a cuidadores informais de idosos dependentes. Método: Estudo metodológico, realizado com 120 cuidadores informais de idosos. Validade baseada na estrutura interna avaliada por análise fatorial exploratória, com extração de principais eixos fatoriais, rotação ortogonal varimax e retenção de fatores por análises paralelas. Confiabilidade aferida pelo alpha de Cronbach. Resultados: O instrumento revelou estrutura fatorial diferente da versão original: três fatores foram identificados, equivalentes às subescalas, autoestima, programação das atividades diárias e suporte familiar, com variância explicada de 42%. Os valores do alpha de Cronbach para os itens integrantes de cada subescala foram, respectivamente: 0,71, 0,81 e 0,83. Conclusão: A versão brasileira do CRA apresenta boas evidências de validade baseada na estrutura interna e é confiável, podendo ser empregada na avaliação da sobrecarga de cuidadores informais de idosos dependentes.

Height is an indicator of vascular maintenance capacity in older men.

AIM: Bone-derived circulating CD34-positive cells are reported to play an important role in vascular maintenance. Additionally, height might influence age-related hematopoietic bone marrow decline, as it positively correlates with total bone marrow volume. As hypertension should mask the beneficial effects of circulating CD34-positive cells, hypertension status should account for this correlation. The present study aimed to clarify the clinical importance of height on vascular maintenance in older Japanese men. METHODS: We carried out a cross-sectional study of 343 older men aged 65-69 years who underwent a general health checkup from 2013 to 2015. RESULTS: Independent of known cardiovascular risk factors, height was found to be slightly, but significantly, positively correlated with the log number of circulating CD34-positive cells in systolic, but not non-systolic, hypertensive men. Multilinear regression analysis showed a parameter estimate (B) and standardized parameter estimate (ß) of 3.23 × 10-2 , 0.28 (P = 0.003) for systolic hypertensive men and -0.49 × 10-2 , -0.04 (P = 0.495) for non-systolic hypertensive men. CONCLUSIONS: Height positively correlates with circulating CD34-positive cells in systolic, but not non-systolic, hypertensive men. As the beneficial effects of circulating CD34-positive cells on endothelial repair might be masked by hypertension where the production of CD34-positive cells is stimulated by hypertension-induced vascular damage, among individuals with systolic hypertension, circulating CD34-positive cells should indicate the limits of endothelial repair. Therefore, height might indicate the capacity for adequate vascular maintenance in older men. Geriatr Gerontol Int 2017; 17: 1729-1736.

Cytopathological findings of primary pulmonary Ewing family of tumors with EWSR1 translocation: A case report.

Primary pulmonary neoplasms of the Ewing family of tumors (EFT) are extremely rare and usually occur in adolescents or young adults. Only about 40 cases of pulmonary EFT have been reported in English literature, and no cytological studies have been documented. In this report, we describe the cytopathological findings of a primary pulmonary EFT in an elderly patient. A 70-year-old man sought care because of a progressing cough and dyspnea. Chest computed tomography revealed a circumscribed mass of 6 cm in the left upper lobe. Fine needle aspiration cytology and core needle biopsy revealed uniform round cell proliferation. The predominant population consisted of cells with thickened nuclear membranes, finely dispersed chromatin, single distinct nucleoli, and indistinct cytoplasm. The other population consisted of smaller cells with darker chromatin. The cytoplasm stained positive for periodic acid-Schiff stain and was digested by diastase. Immunohistochemistry showed positivity for MIC2 (CD99), and focal positivity for neuron specific enolase, synaptophysin, and chromogranin A. Fluorescence in situ hybridization (FISH) revealed EWSR1 translocation. Although rare, pulmonary EFT cannot be disregarded, regardless of age. When two populations of uniform, round cells are observed, immunohistochemistry with MIC2 (CD99) and cytogenetic analysis by reverse transcription polymerase chain reaction or FISH should be considered. Cytological diagnosis may play an important role in the early diagnosis and treatment of pulmonary EFT.

Effect of atorvastatin on serum ferritin levels in elderly male patients with acute coronary syndrome / 中国中西医结合急救杂志

Objective To explore the effect of atorvastatin application on serum ferritin(SF)levels in elderly male patients with acute coronary syndrome(ACS)and its clinical significance. Methods 120 elderly male patients treated in Department of Cardiology in Cangzhou People's Hospital were randomly divided into treatment group and control group(60 cases in each group). All the patients in the two groups took the standard treatment of coronary heart disease,and the patients in treatment group were additionally given atorvastatin 20 mg orally,once-daily for 1 month. After 1 month of treatment,the changes in SF and lipid levels before and after treatment were determined. Results The total cholesterol(TC),low density lipoprotein(LDL)and SF levels of the two groups after treatment were significantly decreased compared with those before treatment. After treatment,triacylglycerol (TG)was decreased,and high-density lipoprotein(HDL)was increased significantly in treatment group,while in the control group,after treatment TG was increased and HDL was decreased. Compared between treatment and control groups after treatment,the differences in SF,TC,TG,HDL and LDL levels were statistically significant〔SF(μg/L):174.33±99.87 vs. 255.66±100.34,TC(mmol/L):4.23±0.60 vs. 5.15±0.56,TG(mmol/L):1.98±0.64 vs. 2.00±1.03,HDL(mmol/L):1.13±0.14 vs. 1.09±0.22,LDL(mmol/L):2.45±0.33 vs. 3.35±0.50,P<0.05 or P<0.01〕. Conclusion In elderly male hospitalized patients with ACS,the level of SF is significantly higher than normal,after atorvastatin specification treatment,the blood fat and SF levels are significantly lower,thus the SF inducing myocardial damage may be reduced and the risk of recurrence of acute coronary events can be decreased.

The correlation between PTH, Vitamin D and bone mineral density in elderly man with type 2-diabetes / 中国综合临床

Objective To explore the impact of calciotropic hormones,such as parathyroid hormone (PTH)and vitamin D,on bone mineral density(BMD)in the old men with type 2-Diabetes.Methods Sixty elderly men with type 2-Diabetes were submitted to dual-energy X-ray absorptiometry to evaluate the BMD at lumbar spine and hip.Fasting blood samples were collected to evaluate the indexes of bone metablism and blood glucose.PTH and 25-(OH)-Vitamin D3 were measured and analyzed for their correlation with BMD at different sites.Results In all patients,the percentage of osteoporosis and osteopenia accounted for 20.0％ and 53.3％ of the patients according to BMD at lumbar or hip.Compared with the patient group with normal BMD,serum PTH was significantly higher in the patient group with osteopenia or osteoporsis([44.87 ± 10.62]μg/L vs[36.96 ±12.36]μg/L,P ＜ 0.05 ;[50.24 ± 20.32]μg/L vs[36.96 ± 12.36]μg/L,P ＜ 0.05).But there was no difference in 25-(OH)-Vitamin D3 levels between all groups.PTH was correlated negatively with BMD at hip (r =-0.224,P ＜ 0.05),but not significantly correlated with BMD at lumbar(r =-0.187,P ＞ 0.05)Conclusions Serum PTH was correlated negatively with BMD at hip in elderly man with type 2-Diabetes.

Accessory mitral valve in an elderly man on maintenance hemodialysis.

This report describes a case of accessory mitral valve in an elderly patient on maintenance hemodialysis. Transesophageal echocardiography revealed a mobile sac-like structure with size of 12 × 10 mm(2), which attached to the left ventricular surface of base of the anterior mitral valve leaflet. Mobile stick-like structure with diameter of 21 mm was extending from this sac-like structure toward the left ventricular outflow tract and had a floating free edge. Peak pressure gradient across the left ventricular outflow tract was 32 mmHg. There were no other congenital cardiac anomalies. No clinical findings suggestive of bacterial or nonbacterial vegetation were seen. Also other possibilities of mobile thrombus or calcification were unlikely. These abnormal structures were diagnosed as accessory mitral valve with rudimentary chordae.