Mortality by treatment in patients ≥80 years of age with gastroesophageal cancer seen in a 20-year period at a single medical center.

The treatment approach to patients 80 years of age and older with gastroesophageal cancer at Baylor Scott and White in Temple, Texas, has historically favored conservative measures in the form of palliation and observation. To evaluate this trend in practice, the administered treatments and subsequent patient outcomes of this group were retrospectively reviewed. The study group included all patients 80 years of age and older with a diagnosis of gastroesophageal cancer seen at our facility between 1991 and 2010. Of the 117 cases, 49% received none of the available treatment modalities. The median overall survival (OS) of patients who received treatment, however, was significantly longer than the OS of those who did not, regardless of modality. Specifically, surgical intervention offered an almost double median OS compared with no therapy (6.8 vs. 3.9 months, respectively; P = 0.02); chemotherapy, an almost 4-fold OS benefit (14.8 vs. 3.9 months; P = 0.03); and radiation therapy, a >3-fold OS benefit (11.1 vs. 3.5 months; P = 0.04). These results further substantiate chronological age as an inaccurate predictor of treatment benefit, and age alone should not dictate the administration or withholding of available treatment options.

Occult splenic rupture presenting as acute scrotal swelling.

BACKGROUND: Scrotal pain and swelling is a common complaint encountered in emergency medicine. The differential diagnosis includes testicular, scrotal, and intra-abdominal pathology. CASE REPORT: We present a case of an 80-year-old man on warfarin therapy presenting with acute atraumatic scrotal pain and swelling initially diagnosed as a hydrocele. The diagnosis was subsequently determined to be a communicating hematocele secondary to occult splenic rupture. CONCLUSION: Intra-abdominal pathology can result in scrotal pain and swelling due to passage of intra-abdominal contents into the scrotum via a patent processus vaginalis. Therefore, any cause of hemoperitoneum may also cause hematocele and hematocele should be considered in the differential diagnosis of acute scrotal swelling in any patient with risk factors for bleeding. In these patients, both scrotal and abdominal imaging should be considered.