简介：Apocrinecarcinomaisararemalignantadnexalneoplasm.Thedifferentialdiagnosisbetweenapocrinecarcinomaandcutaneousmetastasisisoftendifficult.Here,wereportacaseoflocallyrecurrentpenileapocrinecarcinomainitiallydiagnosedasmetastaticadenocarcinomaofthecolon.A75-year-oldmanwithahistoryofsurgicalresectionduetosigmoidcoloncancerandpenilemetastasistwoyearspriortothisstudypresentedwithanoduleattheleftpenilebase.Heunderwentawidelocalresectionofthepenilemassunderasuggestedpreoperativediagnosisofextra-mammaryPaget’sdisease(EMPD)associatedwithprevioussigmoidcoloncancer.However,thepreviouslyandcurrentlyresectedpenilemasseswereidentifiedasprimaryapocrinecarcinomauponhematoxylinandeosin(H&E)stainingandimmunohistochemicalstaining.Althoughtheincidenceisextremelyrare,bothcliniciansandpathologistsshouldbealerttothepossibilityofsynchronousdoubleprimaryapocrinecarcinomaincancerpatientswithmalignantcutaneouslesions.

简介：AIM:Todeterminethelong-termeffectsofselectivelasertrabeculoplasty(SLT)onintraocularpressure(IOP)andthenumberofmedicationsusedupto5yfollowingtreatmentinglaucomapatientsreceivingmaximallytoleratedmedicaltherapy(MTMT).·METHODS:TheWillsEyeHospitalGlaucomaResearchCenterretrospectivelyreviewedthechartsofglaucomapatientswhounderwentSLTafterreceivingMTMT.Eyesthatdidnotachievetheirtargetpressurewithin3mofollowingSLTwereexcludedfromthestudy.ChangesinmeanIOPandnumberofglaucomamedicationsusedwereanalyzedat1,3,and5yfollowingSLT.·RESULTS:Seventy-fiveeyesof67patientswereincludedinthestudy.FifteeneyesthatreceivedSLTfailedtoachievetheirtargetpressurewithin3moandwereexcludedfromthestudy.Theaveragefollow-uptimewas37.4mo(±14.4).MeanIOPwassignificantlyreduced1yaftertreatment(P=0.005).Itwasalsoreduced3,5yaftertreatmentwithoutreachingstatisticalsignificance(P=0.20andP=0.072,respectively).Therewasasignificantdecreaseinmeannumberofmedicationsused1,3,5yaftertreatment(P<0.001,P<0.001,andP=0.039,respectively).Inthespanof5y,2eyes(2.7%)underwentrepeatSLT,7eyes(9.3%)underwentglaucomasurgeryandanadditional3eyes(4.0%)underwentboth.·CONCLUSION:SLTsignificantlyreducedthenumberofglaucomamedicationsused5yfollowingtreatmentinglaucomapatientsreceivingMTMT.SLTmaydelayoperating-roomsurgery.

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简介：BackgroundTheCHA2DS2-VAScschemahasrecentlybeenintroducedtocomplementtheCHADS2scoreandimprovetheidentificationofatrialfibrillation(AF)patientsat'trulylowrisk'forthromboembolism.WetestedthepredictiveabilityoftheCHA2DS2-VASc,CHADS2andvanWalravenriskstratificationschemesinacohortof'lone'AFpatientswitha12-yearfollow-up.MethodsandResultsWeconductedaregistry-based,observationalcohortstudyof345patientsinitiallydiagnosedwith'lone'AFbetween1992and2007.Atbaseline,allpatientshadtheCHADS2andvanWalravenscoresof0,and262(75.9%)hadaCHA2DS2VAScscore=0.Duringfollow-up(orwithinayearpriortostroke),228(66.1%),234(67.8%)and150patients(43.5%)retainedtheCHADS2,vanWalravenandCHA2DS2VAScscoresof0,respectively.Theoverallrateofischemicstrokewas0.19(95%CI:0.18-0.20)per100patient-years.Inthemultivariableanalysis,onlytheCHA2DS2-VAScscoreof0wassignificantlyrelatedtotheabsenceofstroke(OR5.1,95%CI:1.5-16.8,P=0.008).OnlytheCHA2DS2-VAScscorehadasignificantpredictionability(c-statistic0.72[0.61-0.84],P=0.031).ConclusionsTheCHA2DS2-VAScscorereliablyidentifiedthe'lone'AFpatientswhowereat'trulylowrisk'forthromboembolism,andwastheonlytestedriskstratificationschemewithasignificantpredictiveabilityforthromboembolismamongstloneAFpatients.