Early and late vulval cancer recurrences: Are they different?

Vulval cancers are rare, but after primary treatment, known to recur with a high frequency (30%). Clinico-pathological predictors of recurrence have been established to a great extent. However, there is paucity of literature on predictors of early versus late recurrence. We sought to identify such predictors through a retrospective study of vulval cancer recurrences in a single cancer centre over 11 years. Age of women, depth of invasion/site of primary tumour and presence of background VIN/lichen sclerosus do not appear to affect timing of recurrence. However, vulval cancers that recur after 2 years of primary tumour recognition are more likely to be well-differentiated tumours, have undergone radical surgery and have had a closest disease-free margin >1 cm. Late recurrences are entirely local rather than distant metastases and this translates into a better survival as shown in our study (40 months median survival in the early group versus 112 in the late recurrence group).

Survival following the placement of gastrostomy tube in patients with multiple sclerosis.

BACKGROUND: Around a third of people with multiple sclerosis (MS) experience dysphagia. There is a need for disease-specific information on survival following placement of gastrostomy tube in people with MS. OBJECTIVE: We aimed to study survival following gastrostomy in patients with MS. METHODS: We reviewed medical records, home enteral feeding database and death certificates of people with MS who had gastrostomy from 2005 to 2017. Cox regression analysis was performed to identify independent predictors associated with mortality after gastrostomy. RESULTS: Median survival of 53 patients with MS after gastrostomy was 21.73 months. Median duration of hospital stay after gastrostomy was 14 days (IQR 5.25, 51.5). Survival at 30 days, 3 months, 1, 2, 5 and 10 years were 100% (53/53), 98.1% (52/53), 81.1% (43/53), 54.7% (29/53), 22.4% (11/49) and 6.8% (3/44), respectively. Of 53 patients, 24 died due to respiratory tract infection. Patients who had gastrostomy tube before 50 years of age survived longer (median 28.48 months) compared with those who had the gastrostomy after age 50 years (median 17.51 months) (p = 0.040). CONCLUSION: Around 54% of patients with MS survived two or more years following gastrostomy. Younger patients had better survival. The most frequent cause of death was respiratory infection.

A hunt for the source of sepsis.

A 42-year-old woman presented with a 2-day history of drowsiness, confusion, worsening headache, high fevers, urticarial rash, bilateral leg pains and urinary retention. Preceding this was a 1-month history of headache unresponsive to various analgesics for which her general practitioner started carbamazepine. Suspected central nervous system infection was investigated and treated with cefotaxime. A full septic screen, lumbar puncture and MRI of the spine were all inconclusive. After 3 days, the patient deteriorated and repeated blood tests-initially unremarkable-revealed neutropaenia and acutely deranged liver function. Connective tissue disorder was considered due to a negative septic screen and lack of response to antibiotics, but autoimmune screens failed to reveal a culprit. At this point, carbamazepine was suspected and stopped, after which the patient and her blood results recovered dramatically. This adds to previous reports of known reactions to carbamazepine and reinforces recommendations that patients should be made aware of potential complications of this drug.