Citations

Abstract Background Treatment guidelines for stage II and III rectal cancer include neoadjuvant chemoradiotherapy, surgery and postoperative adjuvant chemotherapy. Although data support this recommendation in younger patients, it is unclear whether this benefit can be extrapolated to elderly patients (aged 75 years or older). Methods This was a retrospective review of patients aged at least 75 years with stage II or III rectal cancer who underwent surgery with curative intent from 1996 to 2013 at the Mayo Clinic. Kaplan–Meier analysis and log rank test were used to compare overall survival between therapy groups. Cox proportional hazards model was used to estimate the independent effect of treatment group on survival. Results A total of 160 elderly patients (median age 80 years) with stage II (66) and stage III (94) rectal cancer underwent surgical resection. Only 30·0 and 33·8 per cent received neoadjuvant or adjuvant therapy respectively. Among patients with stage II disease, there was no significant difference in 60-month survival between patients who received any additional therapy and those who had surgery alone (55 versus 38 per cent respectively; P = 0·184), whereas additional therapy improved survival in patients with stage III tumours (58 versus 30 per cent respectively; P = 0·007). Multivariable analysis found a survival benefit for additional therapy in elderly patients with stage III disease (hazard ratio 0·58, 95 per cent c.i. 0·34 to 0·98). Conclusion A multimodal approach in elderly patients with stage III rectal cancer improved oncological outcomes.

The mechanisms by which bacteria colonize and damage ciliated epithelium are important in understanding the pathophysiology of rhinitis, sinusitis, and otitis. Bacteria that have the ability to impair mucociliary clearance would be at an advantage in establishing infection of ciliated surfaces. This study investigates the effect of Hemophilus Influenzae, Streptococcus pneumoniae, Brahmanella catarralis, and Staphylococcus epidermidis on the ciliary activity of normal ciliated nasal epithelium in human beings. Ciliary activity of the nasal epithelium in the presence of each pathogen was assessed for more than 240 minutes with a photometric method of ciliary beat frequency (CBF) measurement. H. influenzae exerted significant effects on ciliary activity, with a 46% decrease in the CBF by 4 hours (with bacteria‐containing broth) and a 32% decrease with bacteria‐free filtrate. S. epidermidis decreased CBF by 44% with the bacterial broth. A sterile cell‐free filtrate had no significant effect. S. pneumoniae and B. catarralis had no significant effect on CBF within a 240‐minute period. H. influenzae and S. epidermidis disrupted normal synchronous ciliary motion, causing adjacent cilia to beat at different rates.

Fifty patients who underwent nasal septal reconstruction for anterior septal deformities were examined preoperatively and postoperatively with anterior mask rhinomanography. A high degree of correlation was found between the reduction in nasal resistance after operation and the patients' subjective assessment of improvement. Those patients who improved subjectively had a mean decrease in nasal resistance of 1.2 cm H2O/L/sec, whereas those patients who indicated no improvement had a mean increase in nasal resistance of 0.2 cm H2O/L/sec.

Posterior mask rhinomanometry was used to measure nasal resistance during exercise and hypercapnia in 10 healthy adult volunteers. Exercise was produced by peddling a stationary bicycle at three loads. Hypercapnia was produced by breathing O2 mixtures containing 5%, 6%, and 8% CO2. The results showed that (1) nasal resistance decreases linearly as expired CO2 levels and exercise levels increase, (2) minute ventilation increases linearly as expired CO2 levels and exercise levels increase, and (3) nasal resistance varies inversely with minute ventilation during both hypercapnia and exercise. The constant relationship between nasal resistance and minute ventilation during hypercapnia and exercise suggests that nasal resistance is regulated by the respiratory center to match the level of respiratory demand.

Nasal secretory activity was measured in seven dogs in response to topical stimulation by histamine and methacholine. The methacholine response was blocked by atropine but not by chlorpheniramine. The histamine response was blocked by chlorpheniramine but not by atropine. These results suggest that there are two independent mechanisms of nasal secretion in the dog.

One hundred seventy‐one patients had closure of symptomatic nasal septal perforations by insertion of a Silastic nasal septal prosthesis between June 1972 and August 1981. Follow‐up revealed that successful closure of the defect was accomplished in 73% of cases, with reduction in crusting and epistaxis and improvement in nasal respiration in many cases. Prefabricated prostheses have been effective in treating smaller perforations. The treatment of four patients with unusually large septal perforations by custom‐carved prostheses sized using computerized axial tomographic scanning is described.

AbstractIntroductionCurrent National Comprehensive Cancer Network guidelines for Stages II and III rectal cancer recommend neoadjuvant chemoradiation followed by curative intent surgery and adjuvant chemotherapy. It is unclear whether therapies in addition to surgery are truly beneficial in elderly patients. Our aim was to compare the survival of patients over 80 with Stages II and III rectal cancer undergoing curative intent surgery with or without additional therapy.Materials and methodsThe National Cancer Data Base (NCDB 2006–2011) was queried for patients over 80 with Stages II and III rectal cancer. The primary outcome was overall survival. Patients were stratified based upon therapy group. Univariate group comparisons were made. Unadjusted Kaplan–Meier and multivariable Cox proportional hazards modeling survival analyses were performed.ResultsThe query yielded 3098 patients over 80 with Stage II (N = 1566) or Stage III (N = 1532) disease. Approximately, half of the patients received surgery only. Kaplan–Meier analysis showed improved survival for patients receiving neoadjuvant and/or adjuvant therapy in addition to surgery, but there was no significant difference between those that received guideline concordant care (GCC), neoadjuvant chemoradiation only, or post‐operative chemotherapy only. Cox proportional hazard modeling identified age >90 and margin positivity as independent risk factors for decreased overall survival.ConclusionAnalysis of NCDB data for Stages II and III rectal cancer in patients over 80 shows a survival benefit of adjuvant and/or neoadjuvant therapy over surgery alone. There does not appear to be a difference in survival between patients who received neoadjuvant chemoradiation, post‐resection adjuvant chemotherapy, or GCC.