Obstruction of upper airways complicating tracheostomy and use of neodymium Yag laser.

Mucoid impaction of tracheobronchial tree is a common condition which may complicate tracheostomy. Here we describe a case of a 72-year-old man, status after tracheostomy, who presented to the hospital with an acute upper airways obstruction and respiratory arrest due to a tracheal cast. The cast was successfully dislodged by the Nd-Yag laser.

Clinical characteristics in black and white men with prostate cancer in an equal access medical center.

OBJECTIVES: To determine whether black men with newly diagnosed prostate cancer in an equal access health care center are more likely to present with metastatic disease, more poorly differentiated tumors, higher serum prostate-specific antigen (PSA) levels, and/or at younger ages compared with white men. METHODS: A retrospective survey was conducted that identified black and white men with newly diagnosed prostate cancer at the Los Angeles Regional Veterans Affairs Clinics between 1991 and 1997. Patient data were analyzed for racial differences in age at diagnosis, clinical stage, PSA level, and Gleason score of the prostate biopsy specimens. RESULTS: A total of 477 evaluable patients (230 black, 247 white) with newly diagnosed prostate cancer were identified. No significant differences in the average age (66.9 +/- 7.3 versus 67.9 +/- 7.5) or clinical stage at diagnosis were found between black and white men. Among black men, 87% presented with clinically localized disease (T1-2, Nx, M0) compared with 88% of white men. Only 6% of black men presented with distant disease (Tx, Nx, M1) compared with 4% of white men. Black men had higher median PSA levels than white men (14. 2 versus 9.4 ng/mL, P = 0.0001). Black men also had slightly higher average Gleason scores (6.2 versus 5.9, P = 0.025). CONCLUSIONS: This is the first study to show a low and equal percentage of black and white men presenting with metastatic prostate cancer. In this equal access center, no differences were found in patient age or clinical stage of prostate cancer between black and white men at the time of diagnosis. However, black men presented with higher serum PSA values and slightly higher Gleason scores.