Merckel cell carcinoma: the impact of multidisciplinary management.

Merkel cell carcinoma (MMC) is a rare primary neuroendocrine skin tumor associated with a poor prognosis. MMC is histologically similar to small cell lung carcinoma. The incidence of MCC is increasing with a median age of discovery of approximately 70 years old. Treatment of MCC, which usually occurs in sun-exposed skin, includes surgery with reconstruction associated with radiotherapy and/or chemotherapy for advanced stages including widespread metastases. We report two cases of Merkel cell carcinoma in 76 and 84 year old patients and describe the natural history of this cancer and management in geriatric patients. Merkel cell carcinoma (MCC) is a rare cancer with high malignant potential that mainly affects people over the age of 65. It must be diagnosed early to improve the prognosis. The survival rate at 5 years for local or regional invasion is 65%. The median survival for metastasized stages is 10 months. The therapeutic regimen recommended for the treatment of MCC is influenced by the geriatric status of patients, and a multidisciplinary oncogeriatric approach could be of interest.

Internal jugular vein thrombosis: outcome and risk factors.

INTRODUCTION: The aims of this study were to analyse the characteristics of patients with internal jugular venous thrombosis. We compared the characteristics of patients with internal jugular venous thrombosis with those of patients exhibiting upper extremity deep venous thrombosis (UEDVT) without internal jugular vein involvement. PATIENTS: From 1998 to 2007, 1948 consecutive patients were referred to our Department of Internal Medicine for deep venous thrombosis. RESULTS: Sixty-four patients exhibited UEDVT. Internal jugular venous thrombosis was diagnosed in 29 patients. Twenty-three patients had secondary thrombosis mainly due to cancer, central venous catheter and ovarian hyperstimulation syndrome; three of the four patients with bilateral DVT exhibited cancer. Six patients had primary internal jugular vein thrombosis. Complications of internal jugular vein thrombosis were pulmonary embolism (10.3%) and post-thrombotic syndrome (41.4%). Under multivariate analysis, significant factors for internal jugular vein thrombosis were older patients (P = 0.0008), female gender (P = 0.0035) and ovarian hyperstimulation syndrome (P = 0.0093). CONCLUSION: Our study underscores that the most common causes of internal jugular vein thrombosis are cancer, central venous catheter and ovarian hyperstimulation syndrome; it also underlines that bilateral internal jugular vein thrombosis is a significant risk indicator of malignancy Thrombosis led to high morbidity related to pulmonary embolism and post-thrombotic syndrome, principally in patients with secondary DVT. The knowledge of predictive factors of internal jugular vein thrombosis seems to be of utmost importance to improve patients' management.

[Upper limb deep venous thrombosis]. / Les thromboses veineuses profondes des membres supérieurs.

Deep venous thrombosis of the upper limb has become recently more common because of the increasing use of central venous catheters. Diagnosis is sometimes difficult. Main causes are pacemaker and central venous catheter related thrombosis. The thoracic outlet syndrome is a rare cause and requires a multidisciplinary diagnostic and therapeutic approach. A systematic research of a thrombophilic disorder is not recommended because of the weak therapeutic impact. Duration of anticoagulation is similar to lower limb deep venous thrombosis despite a lower rate of recurrence. Therapeutic alternatives recently developed include thrombolysis, angioplasty and vein stenting. To date, no randomized controlled studies have evaluated the efficacy and safety of the various treatments that have been proposed for upper limb deep venous thrombosis.