The occurrence of multiple malignancy was studied in 674 patients with hematologic malignancies who were admitted to this department during the past 10 years. Of the 674 patients, 205 were aged 65 years or older, and 56 (8.3%) had another cancer. The frequency of multiple malignancy was significantly higher in older patients than in younger patients: 44 (21.5%) vs. 12 (2.6%). The major hematologic conditions in patients with multiple malignancy were multiple myeloma, myelodysplastic syndromes, non-Hodgkin's lymphoma, and chronic myelogenous leukemia. The major sites of cancers other than hematological malignancies were the stomach, colon, breast, and esophagus. Many of the older patients had gastric cancer or colon cancer, and gastric cancer was common in the younger patients. The multiple malignant neoplasms were synchronous in as many as 20 of the 44 older patients. There was only one such case among the younger patients. Of the 56 patients, nine had received alkylating agents, and one has received etoposide. In brief, elderly patients with hematologic malignancies are likely to have multiple malignant neoplasms. If they are synchronous, the patient's prognosis may be adversely affected, because simultaneous management of multiple malignant neoplasms is not easy.
We compared the rate of ischemic strokes in elderly patients (those aged 65 years or more) who had paroxysmal atrial fibrillation (E-PAf) with those of younger patients (less than 65) with paroxysmal atrial fibrillation (Y-PAf) and of elderly patients with chronic atrial fibrillation (E-CAf) in a retrospective study. A total of 95 E-PAf patients (mean age 73.6), 79 Y-PAf patients (mean age 52.4), and 95 E-CAf patients (mean age 73.6) were studied. The incidence of all ischemic strokes in E-PAf patients (4.8%/yr) was significantly lower than in E-CAf patients (8.3%/yr) and higher than in Y-PAf patients (2.5%/yr) (p<.01). We found the same tendency in the occurrence of brain embolism. Brain embolism occurred in 2.7% of E-PAf patients per year which was significantly lowre than in E-CAf patients (5.1%/yr) and higher than in Y-PAf patients (1.3%/yr) (p<.01). E-PAf patients suffered more brain thrombosis than Y-PAf patients, but they had nearly the same incidence as did E-CAf patients. Fifty-seven E-PAf patients had only one attack of atrial fibrillation and the remaining 38 had more than two attacks. Patiens with many attacks of atrial fibrillation had significantly higher rate of brain embolism than did those who had only one attack (4.6 vs. 0.8%/yr) (p<.005). Those two groups did not differ with regard to the rate of brain thrombosis.
A 73-year-old man was admitted to our hospital due to weight loss and melena. Roentgenograms and endoscopy showed a Borrmann type 2 tumor occupying the entire duodenal bulb. Histologtical findings of the lesion (H-E stain) showed poorly differentiated adenocarcinoma. Almost the entire specimen showed positive staining granules for Grimelius stain. Ultrastructurally, remarkable endocrine granules covered a layer of the limited membrane (membrane-bound granule) in the tumor cell. We diagnosed endocrine cell carcinoma. Since it was difficult to operate due to age and invasion to the fundus of the gall-bladder and the pancreatic head, we treated this case by chemotherapy.
Familial nonobstructive hypertrophic cardiomyopathy in 78-year-old woman was diagnosed in 1988. Since then she has been treated with a beta-blocking drug and a calcium antagonist. Her clinical condition was NYHA I or II for several years. Echocardiography revealed asymmetric septal hypertrophy in 1988 (interventricular septal thickness=21mm, posterior wall thickness=10mm). Systolic anterior motion of the mitral valve was first observed at the end of 1992. The left ventricular pressure gradient also gradually increased; it was about 138mmHg in 1993 (age 82 yrs). The left ventricular ejection time index increased from 376msec in May, 1992 to 459msec in May, 1994. In September, 1994, the patient's condition gradually deteriorated (NYHA IV), and she was admitted to our hospital. To attenuate the left ventricular pressure gradient, 150mg of disopyramide was administered. Her condition markedly improved: the left ventricular pressure gradient decreased from 180mmHg to 76mmHg, and the left ventricular ejection time index decreased from 485msec to 419msec. These results indicate that a left ventricular pressure gradient can be generated rapidly even in a very old patient, and that disopyramide may be useful to attenuate the left ventricuolar pressure gradient.