Case report: 65-year-old man with metachronous left sided adrenal metastasis of hepatocellular carcinoma.

INTRODUCTION AND IMPORTANCE: Due to therapeutic advances and improvements in follow-up care, the diagnosis and treatment of extrahepatic metastases of hepatocellular carcinoma [HCC] have gained clinical significance. However, adrenal gland metastases of HCC remain a rare clinical encounter. Several systemic and local treatment options are discussed in current literature. Adrenalectomy in cases of isolated adrenal metastases with well-controlled intrahepatic lesions has been shown to benefit patients in case series. PRESENTATION OF THE CASE: This 65-year-old patient presented with suspected metachronous left sided adrenal metastasis seven years after bisegmentectomy for HCC and after undergoing trans-arterial chemoembolization [TACE] for multifocal intrahepatic recurrences while being listed for liver transplantation "beyond Milan criteria". Adrenalectomy was suggested for histopathological confirmation of the suspected metastasis and re-consideration for liver transplant. The resection was performed laparoscopically and metastasis of HCC was confirmed in histopathological analysis. Postoperatively, the patient recovered quickly. However, the patient decided against re-listing for liver transplantation. CLINICAL DISCUSSION: Current literature suggests, that minimally-invasive adrenalectomy should be considered in patients with no more than two extrahepatic lesions, a Child-Pugh-Score of less than A5, low alpha-fetoprotein [AFP] levels <100 ng/ml and size <3 cm. The oncological goal should be to achieve a tumor free extrahepatic situation with a potential oncological benefit. CONCLUSION: Our patient presented as an ideal candidate for resection of the adrenal gland metastasis and could have been re-assessed postoperatively for liver transplantation. Still, more research is needed to improve patient-selection for metastasectomy in HCC.

[Active life expectancy: concepts and a new model approach]. / Aktive Lebenserwartung: Konzeptionen und neuer Modellansatz.

The question about an increasing health burden due to the ongoing aging process of the population has been discussed in the scientific community for a very long time. The concept of active life expectancy seems to be a suitable instrument to test the controversial perceptions about compression or expansion of morbidity in old age. A new model is proposed and described based on the Sullivan method which does not quantify the change in active life expectancy at a certain age, as is common practice. In fact a new model, which measures the difference in active life expectancy at a specific general remaining life expectancy over time (DRALE model), seems to be much more appropriate. Thus cohort effects can be excluded. Finally, possible restrictions in the course of an empirical testing are presented and discussed. Main restrictions are the increasing heterogeneity of aging populations, the availability of appropriate data, and the high variance of raw data in old age.

[Trends in nursing care requirements in German 1990-2050--results of demographic projections]. / Entwicklung der Pflegefälle in Deutschland 1990-2050--Ergebnisse demographischer Projektionen.

Since the political agreement on the financing of elderly primary care, the question of the determinants for both the absolute number of elderly persons requiring care and the care burden is of particular importance. The probable demographic effects of a change in immigration and mortality rates in Germany are shown with the aid of various models. A higher life expectancy under the condition of a stable age-specific care quota leads to a substantial increase in the need for elderly care. Similarly, the future care burden will not remain stable with an increased immigration of young people; rather it will increase as well. It can thus be predicted that the problem of the care burden as well as its financing will remain an important topic in the future for demographic reasons alone.