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Objectives: Despite growing interest in locomotive syndrome (LS), its relationship with subjective well-being remains unclear, highlighting a gap in the existing literature. Therefore, as a pilot study providing preliminary insights, this study aimed to clarify the association of subjective well-being (life satisfaction and happiness) with LS and frailty, a key concept in geriatric medicine, among community-dwelling individuals. Methods: We conducted a cross-sectional study of 111 older adults aged 80 years living in City A, Tochigi Prefecture, Japan. LS (5-question Geriatric Locomotive Function Scale [GLFS-5]), frailty (Kihon Checklist [KCL]), and subjective well-being (life satisfaction and happiness) were assessed. Group comparisons were performed based on life satisfaction (Satisfied vs. Unsatisfied) and happiness (Happy vs. Unhappy). Binary logistic regression analyses were also conducted, with LS and frailty as dependent variables and subjective well-being (Satisfied-Happy [reference], Satisfied-Unhappy, Unsatisfied-Unhappy) as independent variables. Results: LS was observed in 32 participants (28.8%), and frailty was observed in 25 participants (22.5%). In the group comparisons, the prevalence of LS and frailty was significantly higher in the Unsatisfied and Unhappy groups. In multivariable analyses, the Unsatisfied-Unhappy group was significantly associated with LS (p = 0.002) and frailty (p = 0.031). Conclusions: Among community-dwelling individuals aged 80 years, low life satisfaction and happiness were shown to be associated with LS and frailty.
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Mismatch repair-deficient (dMMR) colorectal cancer exhibits poor responsiveness to fluoropyrimidine-based chemotherapy but remarkable sensitivity to immune checkpoint inhibitors (ICIs). Neoadjuvant dual ICI therapy results in high pathologic response rates with minimal toxicity. However, the immunotherapy-induced rapid regression of locally advanced tumors with suspected invasion into adjacent organs may result in fistula formation. We describe here the case of an 80-year-old woman with locally advanced dMMR ascending colon cancer (cT4bN2aM0, stage IIIC), who underwent diverting ileostomy followed by neoadjuvant nivolumab plus ipilimumab therapy. Rapid tumor shrinkage resulted in the formation of a transient fistula between the ascending and transverse colon. Robotic-assisted right hemicolectomy performed 40 days after neoadjuvant therapy initiation revealed a complete pathologic response without residual carcinoma. Histopathology showed complete tumor regression with necrotic and granulomatous tissue at the invasion site, suggesting rapid fistula formation. Postoperatively, the patient developed Grade 2 immune-related pneumonitis, which resolved with corticosteroid therapy using prednisolone; no recurrence was observed six months postoperatively. This study demonstrates that neoadjuvant dual ICI therapy can achieve a complete pathologic response in locally advanced dMMR colon cancer. Preoperative diverting stoma may help reduce the risk of perforation following fistula formation resulting from rapid tumor necrosis. In mismatch repair-deficient cancer, cells cannot repair errors in DNA well, causing many different genetic errors to build up. These cancers often show strong changes in their immune characteristics. Here, we present the case of an 80-year-old woman with advanced mismatch repair-deficient cancer in the ascending colon, The cancer was also suspected of having spread to the transverse colon, located nearby. A treatment called immune checkpoint inhibitor (ICI) therapy can often effectively shrink tumors in patients with mismatch repair-deficient bowel cancer. However, in severe cases with tumors that are suspected of spreading, the fast reduction caused by ICI therapy may create a hole in the bowel, known as a fistula. In this case, doctors first performed surgery on the patient to redirect waste from the colon to an external pouch (stoma), before the ICI therapy was started. The treatment successfully got rid of the invasive cancer cells and the fistula that formed later healed. This diverting surgery, performed prior to ICI therapy, likely helped reduce the risk of bowel leakage and infection at the site of the fistula. Therefore, diverting waste material may be helpful in patients with similar types of colon cancer suspected of invading nearby organs. We recommend that doctors should carefully consider this option in the future.
The health and well-being of the older adults in Africa, particularly in Nigeria, are often neglected. Nutritional program interventions predominantly focus on newborns, children, teenagers, and expectant and nursing mothers. This study evaluated the sociodemographic characteristics and family support as predictors of nutritional status in the older population, as these factors are critical for identifying and implementing preventive interventions. This is a hospital-based cross-sectional analytical study involving 160 older adult participants (both male and female) aged 65-98 years, selected through systematic random sampling. Data analysis employed Chi-square tests, t -tests, and logistic regression, with statistical significance set at P < 0.05. There was a 100% response rate in this study. The respondents had a mean age of 76.31 ± 8.34 years for males and 76.87 ± 7.47 years for females. The over-80-year-old, poorly educated, low-income-earning farmer who had no spouse and source of care, and who had to travel a longer distance for a source of food with limited availability of transport services was statistically and significantly more likely to be malnourished. Age (odds ratio [OR] = 3.794; 95% CI = 1.381-10.427), marital status (OR = 3.354; 95% CI = 1.197-9.399), and education (OR = 3.965; 95% CI = 1.146-13.719) independently predicted nutritional status. Sociodemographic characteristics and family support substantially influenced the nutritional status of the older adults. The significant level of undernutrition observed emphasizes the need for advocacy to improve family support and the biopsychosocial, biomedical, and economic well-being of hospital-attending older adults to prevent nutritional decline.
Background: Malignant lymphoma is the most common hematological malignancy; however, primary central nervous system lymphoma accounts for only a small percentage of non-Hodgkin lymphoma (NHL). Among these, primary cauda equina lymphoma (CEL) is extremely uncommon. Its rarity and atypical clinical presentation often make diagnosis challenging. Case Presentation: An 80-year-old man presented with progressive gait disturbance, lower-extremity weakness, and numbness. MRI revealed diffuse swelling and homogeneous gadolinium enhancement of the cauda equina at T12-L1; additionally, CSF cytology identified malignant lymphocytes. Open biopsy confirmed a diagnosis of diffuse large B-cell lymphoma. At diagnosis, the patient was classified as Ann Arbor stage IV, and the clinical parameters corresponded to a high-risk International Prognostic Index (IPI) category. The patient received five courses of immunochemotherapy with rituximab, methotrexate, vincristine, and procarbazine (R-MPV), resulting in marked radiological improvement and functional recovery, achieving a complete response. However, consolidation therapy was discontinued as the patient did not wish to continue. Unfortunately, intracranial relapse occurred four months later, and the patient ultimately succumbed to infectious complications. Only 29 cases of primary CEL have been reported. For all cases, a biopsy with histopathological examination is required for a definitive diagnosis. Currently, combined chemotherapy and radiotherapy are considered the standard treatment. This case was diagnosed through nerve biopsy with cauda equina at T12 to L1 levels, and immunochemotherapy successfully reduced the lesion while improving lower extremity function. Conclusions: Despite the considerable burden on patients, nerve biopsy is necessary for primary CEL to obtain a diagnosis and an early therapeutic approach for both neurological and vital prognoses.
The gonadal arteries are highly variable vascular structures responsible for supplying blood to the testes and ovaries. Although a standard description of these vessels is typically given in medical texts, variations in number, origin, and course are well documented. Here, we review the literature, report an unusual origin and course of a right gonadal artery (RGA), and discuss these findings in the context of embryological hypotheses of RGA course in relation to inferior vena cava (IVC) development. During routine dissection of an 80-year-old female donor, the RGA was found to originate from the cranial aspect of the right renal artery posterior to the left renal vein. From this position it emerged inferior to the left renal vein and coursed anterior to the IVC where it began to course with the left gonadal vein. The left gonadal artery presented with the typical origin and course. To our knowledge, this case provides the third reported instance in the literature of an RGA originating at the level of or above the left renal vein and passing anterior to the IVC.
Thiamine is a vital vitamin and one-sided diet carries a high risk of deficiency. Supplementation is simple with appropriate pharmaceutical products. Unfortunately, the availability of medicines is still not guaranteed everywhere in the world, while at the same time, perfectly good medicines are being disposed of after their expiry date. For this reason, the shelf-time has often been critically questioned in recent years. Analysing finished pharmaceutical products, stored for decades under uncontrolled conditions, offers a rare insight in real-world stability of pharmaceuticals. Hence, this study examined 80-year-old thiamine hydrochloride ampoules. For comparison, test solutions were stored at 60 °C for 40 days in order to induce degradation reactions. A novel HPLC-UV method was developed and validated in accordance with ICH Guideline Q2(R2). Gradient elution, using a hydrophilic end-capped C18 column (150 × 4.6 mm, particle size 5 µm) with eluent A water/formic acid (100/0.1 v/v) and eluent B acetonitrile/formic acid (100/0.1 v/v) from 0% B to 90% B under UV detection (254 nm), enables the separation of thiamine, 6 degradation products, the preservatives methyl- and propylparaben and their degradation product p-hydroxybenzoic acid. The method enables the structural elucidation of degradation products using high-resolution tandem mass spectrometry experiments. A significant degradation of thiamine hydrochloride, with a residual content of 30.1, 37.2, and 44.8%, was observed. In addition to the expected degradation products, resulting from hydrolysis, further degradation products were formed, that were not expected in the given acidic range. Stress samples showed the same degradation profile as the expired ampoules.
An aortopulmonary fistula is a rare but catastrophic complication of thoracic aortic aneurysm rupture. An 80-year-old woman presented with shock, respiratory failure, and severe lactic acidosis. Contrast-enhanced computed tomography demonstrated a ruptured saccular aortic arch aneurysm with an aortopulmonary fistula to the left pulmonary artery. Emergent hybrid thoracic endovascular aortic repair with supra-aortic debranching and a chimney graft achieved prompt fistula exclusion. Although a small gutter-related type Ia endoleak persisted, hemodynamics improved. Postoperative computed tomography confirmed aneurysm sac thrombosis and complete fistula closure.
Exophiala endophthalmitis of exogenous origin is an exceptionally rare but severe ocular infection, characterized by diagnostic delays, limited therapeutic guidance, and frequently poor outcomes. Herein, we report one new case of an 80-year-old woman who presented with severe fungal keratitis progressing to endophthalmitis two years after an uncomplicated cataract surgery. The condition was initially misdiagnosed and treated with topical antibiotics and corticosteroids. By cultivation, microscopy, histopathological, and PCR analysis of the samples, Exophiala dermatitidis was identified as the causative agent. Despite targeted antifungal therapy with voriconazole, the disease rapidly progressed, resulting in corneal perforation and evisceration of the affected eye. The number of confirmed cases of this infection remains very limited. To address this gap, we conducted a structured review of all reported instances of exogenous Exophiala endophthalmitis, in which Exophiala dermatitidis emerged as the predominant causative species. Common predisposing factors included corneal barrier disruption, ocular surgery, diabetes mellitus, and corticosteroid use. Diagnostic confirmation was frequently delayed, and treatment outcomes varied. Amphotericin B-based regimens were associated with poor results, whereas voriconazole, particularly when combined with surgical intervention, demonstrated more favorable outcomes. Exogenous Exophiala endophthalmitis remains underrecognized, with limited evidence to guide management. This entity should be considered in postoperative or trauma-associated intraocular inflammation, and current evidence supports azole-based therapy combined with surgical intervention when indicated.
Acquired hemophilia A (AHA) is a rare autoimmune coagulopathy caused by factor VIII inhibitors. Intracranial hemorrhage is an uncommon but potentially devastating presentation. The authors systematically reviewed reported cases of AHA-associated intracranial hemorrhage and present an illustrative case highlighting diagnostic and management considerations. A PRISMA-guided review of PubMed, ScienceDirect, and Scopus included original case reports describing clinical features, management, or outcomes. Sixteen patients were identified, with a median age of 66.5 (IQR 15.5) years and slight male predominance (56%). Hemorrhage types included intracerebral hemorrhage (50%), acute subdural hematoma (38%), subarachnoid hemorrhage (12%), and intraventricular hemorrhage (19%); 3 patients had multiple hemorrhage types. Prolonged activated partial thromboplastin time was reported in 14 patients (mean 76.0 ± 28.6 seconds) with markedly reduced factor VIII activity. Hemostatic therapy was administered in 81% of patients and immunosuppression in 69%. Among those receiving hemostatic therapy, bypassing agents were used in 56% (recombinant activated factor VIIa 50%; activated prothrombin complex concentrate 19%). Surgical intervention occurred in 31%. The overall survival was 62%, and 30% of survivors achieved full neurological recovery. An additional case describes an 80-year-old woman with acute subdural hematoma who underwent decompressive craniectomy before AHA diagnosis and recovered after factor-directed and immunosuppressive therapies. Intracranial hemorrhage in AHA is rare but highly morbid. Early recognition of isolated prolonged activated partial thromboplastin time and prompt initiation of bypassing agents may improve outcomes. https://thejns.org/doi/10.3171/CASE26195.
IgG4-related disease (IgG4-RD) is a systemic immune-mediated fibroinflammatory condition that can involve virtually any organ. Renal involvement, referred to as IgG4-related kidney disease (IgG4-RKD), represents an uncommon manifestation and may pose significant diagnostic challenges, particularly when renal dysfunction is the only presenting feature. We report the case of an 80-year-old man who presented with severe renal insufficiency, manifested by markedly elevated serum creatinine levels, in the absence of prior renal disease or significant comorbidities. Imaging evaluation revealed no abnormalities in abdominal organs other than the kidneys. A comprehensive non-contrast multimodality imaging assessment-including ultrasound, computed tomography, and magnetic resonance imaging-was performed due to impaired renal function. Imaging demonstrated multiple bilateral renal parenchymal lesions with features suggestive of an inflammatory process. Histopathological examination of the renal biopsy specimens revealed dense lymphoplasmacytic infiltrates with storiform fibrosis, and immunohistochemical analysis confirmed the presence of abundant IgG4-positive plasma cells, establishing the diagnosis of IgG4-related kidney disease (IgG4-RKD). Corticosteroid therapy resulted in progressive improvement and stabilization of renal function. This case highlights the importance of considering IgG4-related kidney disease (IgG4-RKD) in the differential diagnosis of unexplained renal failure, particularly in elderly patients with bilateral renal lesions. Integration of imaging findings with histopathological confirmation is essential for early diagnosis and timely treatment, which may prevent irreversible renal damage.
An 80-year-old man with osteoporosis sustained a complex, comminuted medial clavicle (MC) fracture that failed nonoperatively. A novel reconstruction involved MC resection, midclavicle distraction osteoplasty (DO) with iliac crest bone graft, and sternoclavicular (SC) joint reconstruction using a semitendinosus tendon allograft. By 1 year, the patient achieved successful healing and functional recovery. Patients with excessive MC bone loss may require a clavicular lengthening to approximate the MC to the manubrium. Restoring clavicular length through a DO in conjunction with a SC joint reconstruction using a tendon allograft is a salvage maneuver which can yield a successful outcome.
Treatment-emergent neuroendocrine prostate cancer (t-NEPC) is an aggressive variant arising from lineage plasticity after androgen receptor pathway inhibitor therapy. We report an 80-year-old man with metastatic prostate adenocarcinoma treated with enzalutamide who developed lung lesions despite stable prostate-specific androgen levels. A transbronchial lung biopsy revealed poorly differentiated carcinoma without confirmation of the primary site. Suspecting t-NEPC based on his treatment history, a prostate rebiopsy confirmed the diagnosis. He was treated with carboplatin, etoposide, and durvalumab, but he later succumbed to carcinomatous meningitis. This case highlights the limitations of small metastatic biopsies and the importance of considering phenotypic transformation during prostate cancer treatment.
Wnt/β-catenin-activated rosette-forming carcinoma (WARFC) is a recently proposed cutaneous tumor entity characterized by rosette formation, CDX2 expression, RB1 loss, and Wnt/β-catenin pathway activation. Extracutaneous counterparts of WARFC have not been documented to date. We report a distinctive case of lung carcinoma closely resembling WARFC. An 80-year-old man with a smoking history presented with a rapidly enlarging lung nodule. The resected tumor consisted of a rosette-forming large cell carcinoma with a trabecular pattern and lacking neuroendocrine marker expression, combined with squamous cell carcinoma. The rosette-forming component showed aberrant nuclear β-catenin expression, diffuse CDX2 expression, and RB1 loss. Targeted sequencing identified a pathogenic APC splice-site mutation. This case likely represents the pulmonary counterpart of cutaneous WARFC. Pulmonary WARFC should be considered in the differential diagnosis of large cell lung carcinoma with neuroendocrine morphology.
Hepatic duct perforation (HDP) is a rare and life-threatening condition in adults, typically caused by direct injury or increases in intraductal pressure. The risk of HDP following cardiac surgery is poorly documented, although predisposing factors, such as bilirubin overload and ischemia from cardiopulmonary bypass, share common pathophysiological mechanisms with postoperative cholecystitis. We report the case of an 80-year-old woman who underwent mitral valve replacement for infectious endocarditis. Preoperatively, she was asymptomatic with mild common hepatic duct dilatation but no stones or ascites. However, her condition was also complicated by anemia and sepsis-induced disseminated intravascular coagulation. The cardiac surgery involved 153 minutes of extracorporeal circulation and required massive transfusion. On postoperative day (POD) four, she developed respiratory failure requiring re-intubation. A subsequent computed tomography and abdominal paracentesis confirmed HDP. Given her hemodynamic instability and prohibitive surgical risk, percutaneous drainage was performed. Although the acute biliary peritonitis initially improved, she developed persistent low-grade inflammation. On POD 61, she suffered from pancytopenia and reactivation of both varicella-zoster virus and cytomegalovirus, ultimately leading to multiple organ failure and death on POD 84. HDP can be a critical postoperative complication of cardiac surgery, potentially triggered by bypass-induced hypoperfusion and systemic stress. Despite successful percutaneous drainage, the persistent inflammatory state may induce secondary immunodeficiency and fatal opportunistic viral reactivation. This case highlights the inherent limitations of conservative management and the difficulty of deciding on definitive surgical intervention in critically ill postoperative patients.
Subacute oculomotor dysfunction encompasses a broad differential diagnosis, including autoimmune, infectious, vascular, and neoplastic etiologies. Primary skull base diffuse large B-cell lymphoma (DLBCL) is a rare but treatable cause of cranial nerve dysfunction and may present subtly on conventional neuroimaging. We report an 80-year-old man with subacute diplopia, dysfunction of multiple cranial nerves, left-sided ptosis, and headache. Diagnostic workup included cranial imaging, cerebrospinal fluid (CSF) analysis with cytology and flow cytometry, neurophysiological studies, serum diagnostics, and dedicated MRI of the skull base. Transsphenoidal biopsy was performed following identification of an infiltrative lesion. Initial investigations including cranial CT, CSF analysis, and serum diagnostics were unremarkable. Dedicated skull base MRI revealed a diffuse infiltrating mass involving the clivus, petrous bone, occipital condyles, and perisellar/posterior pituitary region, with anatomical correlation to multiple cranial nerves. Mildly elevated prolactin levels suggested a stalk effect. Histological analysis confirmed DLBCL (NOS, GCB type). Treatment with corticosteroids followed by dose-adjusted R-CHOP resulted in complete clinical remission and radiologically confirmed tumor regression. This case illustrates a rare presentation of primary bony skull base DLBCL with perisellar infiltration, highlighting the diagnostic challenges of complex oculomotor dysfunction. Dedicated skull base MRI is essential in the workup of unexplained cranial neuropathy. CSF-based molecular markers may complement the diagnostic approach in similar presentations.
An 80-year-old man underwent endovascular aneurysm repair at our institution. Preoperative imaging demonstrated celiac artery occlusion caused by median arcuate ligament syndrome and markedly developed pancreaticoduodenal arcades; however, a pancreaticoduodenal artery (PDA) aneurysm (PDAA) was not identified. On postoperative day 2, contrast-enhanced computed tomography (CT) showed no aneurysm, hematoma, or vascular injury involving the arcade vessels. On postoperative day 3, sudden abdominal pain developed. Contrast-enhanced CT revealed a retroperitoneal hematoma with active extravasation, and emergency angiography demonstrated a newly formed ruptured 4-mm aneurysm of the anterior inferior PDA. Coil embolization was successfully performed. This case demonstrates that PDAAs may form and rupture rapidly. Clinicians should explore this rare but potentially fatal condition even when recent imaging studies show no evidence of aneurysm formation.
Clear cell renal cell carcinoma (ccRCC) is the most frequent kidney cancer, and its clinical course has been improved by the development of new anticancer immunotherapies. A rare variant of ccRCC is characterized by the presence of syncytial giant cells (SGCs), whose biological significance remains unclear. This study aimed to report a case of ccRCC with SGCs and to characterize its immune microenvironment. We report the case of an 80-year-old man with ccRCC with SGCs who developed a subcutaneous mass in the upper arm after five years. Imaging revealed multiple pulmonary nodules and an enlarging left renal mass. The resected skin lesion was analyzed using histopathology and immunohistochemistry. Resection of the skin lesion confirmed metastatic ccRCC with SGCs. Immunohistochemically, SGCs were strongly positive for PAX8 and weakly positive for keratin, but negative for Iba-1 and CD163, indicating a tumor cell origin. Immune profiling demonstrated marked spatial heterogeneity: SGCs were localized exclusively within a CD8+ T cell-poor "cold" area, whereas no SGCs were observed in the T-cell-inflamed "hot" area. TGF-β expression was focally strong in SGCs within the cold area. SGCs may represent a terminally differentiated tumor cell variant of ccRCC associated with localized TGF-β-related immunosuppressive niche formation, potentially contributing to tumor immune evasion and progression.