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Background: Children who do not produce single words by the expected age have been described as 'late talkers' or as demonstrating 'late language emergence' (LLE). Although their short-term growth in vocabulary is often strong, longer-term consequences of LLE remain in dispute. It has been argued that the majority of school-age children who had LLE move into the average range for narrative production, though studies have not examined narrative comprehension. It has also been argued that school-age children with LLE score in the average range on standardized tests of syntax, though studies have not examined performance in conversational contexts., Aims: This article compared school-age children with and without histories of LLE for performance on standardized narrative comprehension and production tasks, as well as the use of complex sentences and relative clauses in narration and conversation. Both complex syntax and relative clause use are reduced in children with specific language impairment (SLI), so these structures may be useful as indicators of linguistic weakness., Methods & Procedures: The participants were twenty-two 8-year-old children, divided into two groups. Eleven children who had been diagnosed with LLE at 30 months were compared with a control group of 11 children with typical development (TD). All participants completed a standardized test of narrative comprehension and production and a 10-min conversational sample. Both narrative and conversational samples were analysed for the number of complex sentences and relative clauses., Outcomes & Results: Overall results indicated that children with a history of LLE did not have comprehension or production scores that were significantly different from the TD group on the standardized narrative test; nor did groups differ for production of complex sentences or relative clauses in narrative samples. However, a significant difference was found for the production of complex sentences in conversational samples, with the children diagnosed with LLE producing fewer complex sentences than the TD group. There was no difference between groups for relative clause use in conversation or in narratives., Conclusions & Implications: These data suggest that children with a history of LLE may exhibit age-appropriate performance on a standardized narrative test, but still lack the syntactic complexity of their TD peers in conversation. Assessments for school-age children with a history of language delay should include analysis of syntactic complexity in conversation to identify continuing weakness. Future research should examine use of other specific types of complex structures (e.g. infinitival and clausal complements) in this population, as well the feasibility of increasing complex sentence production through intervention. In addition, future studies should examine whether this decreased production of complex syntax in conversation is noted by naive listeners., (© 2011 Royal College of Speech & Language Therapists.)

Background: Medical records of 50 patients with malignant mesothelioma were reviewed to determine the clinical features and factors influencing survival., Methods: Charts of all patients whose conditions were diagnosed as malignant mesothelioma were abstracted and analyzed by statistical software., Results: The male-to-female ratio was 4:1. The age distribution was younger than 45 years of age, 10%; 45-54 years of age, 12%; 55-64 years of age, 37%; 65-74 years of age, 33%; and 75 years of age or older, 8%. Both mean and median ages were 58 years. Among the 32 patients in whom asbestos exposure was recorded, 24 had documented exposure. The sites were pleura, 73%; peritoneum, 20%; and both, 6%. The histologic types were epithelial, 51%; sarcomatous, 10%; mixed, 15%; and not specified, 24%. The stage at presentation was Stage I, 37%; II, 39%; III, 12%; IV, 6%; and unknown, 6%. The common symptoms in pleural disease were dyspnea and pain; in peritoneal disease, abdominal distension and pain were common. The median time from first symptom to diagnosis was 3 months (range, 0-23 months). The median survival after the appearance of symptoms, the diagnosis, and the treatment were 13, 10, and 8 months, respectively., Conclusions: The survival was independent of age, sex, and smoking behavior. It was longer in patients with earlier-stage disease, a good performance status, a longer duration of symptoms, an absence of pain, and who were treated with combined surgery and chemotherapy. Chemotherapy using anthracyclines yielded more remissions (9 of 21) than that using nonanthracyclines (0 of 13). The remission rate after primary chemotherapy with anthracyclines (7 of 16) may be higher than in recurrent tumor (2 of 14). In future trials, stratification into primary chemotherapy and chemotherapy of recurrent cancer is suggested. There is a need for multitechnique trials incorporating primary chemotherapy.

Bronchoesophageal fistulae, a form of respiratory tract fistula, occurred in four patients with squamous cell carcinoma arising in the esophagus or left bronchus after cytoreductive chemotherapy. All four had locoregional cancer, recurrent after high-dose external radiation therapy. Esophageal cancer was treated with sequential intravenous cisplatin 100 mg/m2 (day 1) and 5-fluorouracil (5-FU) 40 mg/m2/hour X 120 (days 2-7). Lung cancer was treated with sequential intravenous cisplatin 100 mg/m2 (day 1), 5-FU 40 mg/m2/hour X 72 (days 2-5), and etoposide 80 mg/m2/day X 3 (days 2, 3, and 4). All patients had symptomatic relief and tumor regression after oncolytic chemotherapy, which was well tolerated with no hematologic toxicity. After the second or third cycle of chemotherapy, bronchoesophageal fistula occurred in all four patients with manifestations of pneumonia, which proved fatal in two patients. The other two patients were effectively palliated for 14 and 36+ weeks after celestin tube placement. Bronchoesophageal fistula should be managed by antibiotics and respiratory support followed by elective placement of celestin tube in most patients and by esophageal exclusion or esophageal bypass in a few select patients. In aerodigestive cancers, respiratory tract fistula may be a rare and potentially fatal complication of chemotherapy induced tumor lysis.

A 67-year-old white man developed a locally recurrent pilomatrix carcinoma of the back. Within a 4-year period bilateral pulmonary metastases developed. This to the knowledge of the authors is the first reported case of a metastasizing pilomatrix carcinoma in the medical literature.