scholarly journals Risk factors for unsuccessful removal of central venous access ports implanted in the forearm of adult oncologic patients

2021 ◽  
Author(s):  
Mitsuhiro Kinoshita ◽  
Shoichiro Takao ◽  
Junichiro Hiraoka ◽  
Katsuya Takechi ◽  
Yoko Akagawa ◽  
...  
Keyword(s):  
Risk Factors ◽  
Multivariate Analysis ◽  
Risk Factor ◽  
Independent Risk Factor ◽  
Central Venous Access ◽  
Univariate Analysis ◽  
Venous Access ◽  
Central Venous ◽  
Significant Difference ◽  
Oncologic Patients

Abstract Purpose To evaluate the risk factors for unsuccessful removal of a central venous access port (CV port) implanted in the forearm of adult oncologic patients. Materials and methods This study included 97 adult oncologic patients (51 males, 46 females; age range, 30–88 years; mean age, 63.7 years) in whom removal of a CV port implanted in the forearm was attempted at our hospital between January 2015 and May 2021. Gender, age at removal, body mass index, and diagnosis were examined as patient characteristics; and indwelling period, indwelling side, and indication for removal were examined as factors associated with removal of a CV port. These variables were compared between successful and unsuccessful cases using univariate analysis. Then, multivariate analysis was performed to identify independent risk factors for unsuccessful removal of a CV port using variables with a significant difference in the univariate analysis. A receiver-operating characteristics (ROC) curve was drawn for significant risk factors in the multivariate analysis and the Youden index was used to determine the optimum cut-off value for predicting unsuccessful removal of a CV port. Results Removal of CV ports was successful in 79 cases (81.4%), but unsuccessful in 18 cases (18.6%) due to fixation of the catheter to the vessel wall. Multivariate logistic regression analysis showed that the indwelling period (odds ratio 1.048; 95% confidence interval 1.026–1.070; P < 0.0001) was a significant independent risk factor for unsuccessful removal of a CV port. ROC analysis showed that the cut-off value for successful removal was 41 months, and 54% of cases with an indwelling period > 60 months had unsuccessful removal. Conclusion The indwelling period is an independent risk factor for unsuccessful removal of a CV port implanted in the forearm of adult oncologic patients, with a cut-off of 41 months.

scholarly journals Exploring risk factors for intraoperative aneurysm rupture during clipping

2020 ◽  
Author(s):  
Zhi Zhu ◽  
Ningning Song ◽  
Yoko Kato ◽  
Xi Chen ◽  
Weichao Jiang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Independent Risk Factor ◽  
Clinical Status ◽  
Univariate Analysis ◽  
Multivariate Logistic Regression Analysis ◽  
Aneurysm Rupture ◽  
University Hospital ◽  
Significant Difference ◽  
Intraoperative Rupture

Abstract Objective To investigate risk factors for aneurysm rupture in intracranial aneurysm clipping (IAC). Methods Patients admitted for IAC from April 2010 to December 2017 in the Fujita Health University Hospital or the First Affiliated Hospital of Xiamen University were retrospectively reviewed. Clinical parameters were recorded and analyzed using univariate and multivariate analysis. The Hunt-Hess grade was used to assess the preoperative clinical status of patients. Modified Rankin Scale was applied to evaluate the prognosis of patients 6 months after surgery. Results Univariate analysis showed that the preoperative clinical status ( p = 0.015) and the preoperative aneurysm rupture ( p = 0.005) were significantly associated with intraoperative aneurysm rupture (IAR) during clipping. Multivariate logistic regression analysis showed that the preoperative aneurysm rupture was an independent risk factor of IAR ( p < 0.001, OR = 10.518). There was no significant difference in the prognosis between patients with and without IAR ( p > 0.05). No significant differences existed on aspects of incidences and time points of rupture in the operations conducted by experienced surgeons compared with that conducted by less-experienced surgeons ( p > 0.05). Conclusion Preoperative aneurysm rupture is the independent risk factor for aneurysm rupture during IAC. Intraoperative rupture, if treated properly in time, has no influence on the prognosis of patients receiving IAC. Less-experienced surgeons can also reduce the incidence rate of IAR by strictly controlling surgical indications.

scholarly journals Extramedullary Relapses after Allogeneic Stem Cell Transplant (allo-SCT) in Adult Patients with Acute Lymphoblastic Leukemia (ALL)

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 5690-5690
Author(s):  
Hiroaki Shimizu ◽  
Takuma Ishizaki ◽  
Nahoko Hatsumi ◽  
Satoru Takada ◽  
Akihiko Yokohama ◽  
...  
Keyword(s):  
Risk Factors ◽  
Multivariate Analysis ◽  
Risk Factor ◽  
Stem Cell ◽  
Myeloid Leukemia ◽  
Independent Risk Factor ◽  
Univariate Analysis ◽  
Adult Patients ◽  
Age At Diagnosis ◽  
Cell Transplant

Background: Extramedullary (EM) relapses were sometimes observed in acute leukemia patients both after chemotherapy and allo-SCT. Our recent study described that the rate of EM relapses after allo-SCT was significantly higher when comparing with that after chemotherapy in acute myeloid leukemia (AML) patients. Since more potent graft-versus-leukemia (GVL) effect in EM lesion than bone marrow (BM) is proposed as potential biological basis of this phenomenon, it is expected that EM relapses after allo-SCT more frequently occurred than after chemotherapy also in ALL patients. However, this hypothesis has not been examined, and risk factors of EM relapses after allo-SCT have not been elucidated. So, we conducted this retrospective study to address this unsolved issue. Patients and methods: The study population included in this study was 215 adult patients who were diagnosed as ALL between 1990 and 2017 and received intensive chemotherapy. In the first part of this study, to compare the rates of EM relapses between after chemotherapy and allo-SCT, the initial relapses of the 88 patients were analyzed. In the second part, to investigate risk factors for EM relapses after allo-SCT, 110 patients who underwent allo-SCT against ALL were analyzed. EM relapses included both one only in EM lesions and in concurrent EM and BM lesions. Fisher's exact test was used to compare binary variables. Cumulative incidences (CIs) of EM relapse were compared using the stratified Gray test, considering relapse without EM lesions and death without the event as a competing risk. The logistic regression model and the Fine-Gray proportional hazard model were used for multivariate analysis of risk factors of EM relapses among the initial relapses and after allo-SCT, respectively. Values of p < 0.05 were considered significant. Results: Of the 88 relapsed patients included in the first part of this study, the median age at diagnosis was 47 years (range, 15-79 years), and the median duration of the first complete remission (CR1) was 7.1 months (range, 0.7-105.7 months). Philadelphia chromosome (Ph) and EM lesions at diagnosis were observed in 21 and 21 patients, respectively. Allo-SCT in CR1 was undergone in 12 patients. EM relapses occurred in 21 patients, and the sites of EM relapses were central nervous system (CNS) in 13, mediastinum in two, and bone in two. The median durations of CR1 were not significantly different between relapses with and without EM lesions (16.8 vs. 6.7 months, respectively; p = 0.295). In univariate analysis for risk factors of EM relapses, there was no significant difference in EM relapse rates between relapses after allo-SCT and chemotherapy (8.3% vs. 26.3%, respectively; p = 0.279), and in multivariate analysis, only EM lesion at diagnosis was identified as independent risk factor (odds ratio 4.21; p = 0.008). Of the 110 allo-SCT recipients included in the second part, the median age at diagnosis was 43 years (range, 16-66 years). Ph and EM lesions at diagnosis were observed in 43 and 21 patients, respectively. Disease status at the time of transplant was CR1 in 67, advanced CR in 17, and non-CR in 26. Stem cell sources were related, unrelated, and cord blood in 30, 50, and 25 patients, respectively, and almost all patients were conditioned with total body irradiation-containing myeloablative regimens. EM relapse after allo-SCT occurred in nine patients, and the 2-year CI of EM relapses was 6.5%. The sites of EM relapses after allo-SCT were CNS in three, lymph node in two, and skin in two. In univariate analysis for EM relapses after allo-SCT, the significantly higher CI of EM relapses after allo-SCT was observed in patients with EM lesion at diagnosis when comparing with those without EM lesion (28.6% vs. 1.1%, respectively; p = 0.279). Multivariate analysis extracted only EM lesion at diagnosis as an independent risk factor for EM relapses after allo-SCT (hazard ratio 24.09; p = 0.004). Conclusion: As a higher frequency of EM relapse after allo-SCT in ALL patients was not confirmed in this study, the hypothesis, more potent GVL effect in EM lesion than BM, was not able to apply to these patients. To determine whether this hypothesis is correct or not, further investigation in patients with other hematologic malignancy such as chronic myeloid leukemia is warranted. The vigilance is required regarding EM relapses in adult ALL patients with EM lesion at diagnosis both after chemotherapy and allo-SCT. Disclosures Handa: Ono: Research Funding.

scholarly journals Thromboembolic Events in Patients with Testicular Germ Cell Tumours Are Predominantly Triggered by Advanced Disease and by Central Venous Access Systems

2020 ◽  
pp. 1-7
Author(s):  
Klaus-Peter Dieckmann ◽  
David Marghawal ◽  
Uwe Pichlmeier ◽  
Christian Wülfing
Keyword(s):  
Risk Factors ◽  
Central Venous Access ◽  
Multivariable Analysis ◽  
Venous Access ◽  
Germ Cell Tumours ◽  
Thromboembolic Events ◽  
Central Venous ◽  
Testicular Germ Cell ◽  
Testicular Germ Cell Tumours ◽  
Independent Risk Factors

<b><i>Background:</i></b> Thromboembolic events (TEEs) may significantly complicate the clinical management of patients with testicular germ cell tumours (GCTs). We analysed a cohort of GCT patients for the occurrence of TEEs and looked to possible pathogenetic factors. <b><i>Patients, Methods:</i></b> TEEs occurring within 6 months after diagnosis were retrospectively analysed in 317 consecutive patients with testicular GCT (median age 37 years, 198 seminoma, 119 nonseminoma). The following factors were analysed for association with TEE: histology, age, clinical stage (CS), chemotherapy, use of a central venous access device (CVA). Data analysis involved descriptive statistical methods with multivariable analysis to identify independent risk factors. <b><i>Results:</i></b> Twenty-three TEEs (7.3%) were observed, 18 deep vein thromboses, 4 pulmonary embolisms, and 1 myocardial infarction. Univariable risk calculation yielded the following odds ratios (ORs) : &#x3e;CS1 OR = 43.7 (95% confidence intervals [CIs] 9.9–191.6); chemotherapy OR = 7.8 (95% CI 2.3–26.6); CVA OR = 30.5 (95% CI 11.0–84.3). Multivariable analysis identified only CS &#x3e; 1 (OR = 16.9; 95% CI 3.5–82.4) and CVA (OR = 9.0; 95% CI 2.9–27.5) as independent risk factors. <b><i>Conclusions:</i></b> Patients with CSs &#x3e;CS1 are at significantly increased risk of TEEs even without chemotherapy. Particular high risk is associated with the use of CVA devices for chemotherapy. Caregivers of GCT patients must be aware of the particular risk of TEEs.

Risk factors determining central venous access device-associated deep vein thrombosis resolution in children: a retrospective study

2021 ◽  
Author(s):  
Miguel García-Boyano ◽  
José Manuel Caballero-Caballero ◽  
Marta García Fernández de Villalta ◽  
Mar Gutiérrez Alvariño ◽  
María Jesús Blanco Bañares ◽  
...  
Keyword(s):  
Risk Factors ◽  
Deep Vein Thrombosis ◽  
Central Venous Access ◽  
Venous Access ◽  
Central Venous ◽  
Central Venous Access Device ◽  
Access Device ◽  
Vein Thrombosis ◽  
Venous Access Device ◽  
Deep Vein

Outcomes for and Risk Factors Associated With Vancomycin-ResistantEnterococcus faecalisand Vancomycin-ResistantEnterococcus faeciumBacteremia in Cancer Patients

2007 ◽  
Vol 28 (9) ◽  
pp. 1054-1059 ◽  
Author(s):  
G. Ghanem ◽  
R. Hachem ◽  
Y. Jiang ◽  
R. F. Chemaly ◽  
I. Raad
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Mortality Rate ◽  
Cancer Patients ◽  
Independent Risk Factor ◽  
Response To Therapy ◽  
Aminoglycoside Therapy ◽  
Significant Difference ◽  
Vancomycin Resistant ◽  
And Control

Objective.Vancomycin-resistant enterococci (VRE) are a major cause of nosocomial infection. We sought to compare vancomycin-resistant (VR)Enterococcus faecalisbacteremia and VREnterococcus faeciumbacteremia in cancer patients with respect to risk factors, clinical presentation, microbiological characteristics, antimicrobial therapy, and outcomes.Methods.We identified 210 cancer patients with VRE bacteremia who had been treated between January 1996 and December 2004; 16 of these 210 had VRE. faecalisbacteremia and were matched with 32 patients with VRE. faeciumbacteremia and 32 control patients. A retrospective review of medical records was conducted.Results.Logistic regression analysis showed that, compared with VRE. faecalisbacteremia, VRE. faeciumbacteremia was associated with a worse clinical response to therapy (odds ratio [OR], 0.3 [95% confidence interval (CI), 0.07-0.98];P= .046) and a higher overall mortality rate (OR, 8.3 [95% CI, 1.9-35.3];P= .004), but the VRE-related mortality rate did not show a statistically significant difference (OR, 6.8 [95% CI, 0.7-61.8];P= .09). Compared with control patients, patients with VRE. faecalisbacteremia were more likely to have received an aminoglycoside in the 30 days before the onset of bacteremia (OR, 5.8 [95% CI, 1.2-27.6];P= .03), whereas patients with VRE. faeciumbacteremia were more likely to have received a carbapenem in the 30 days before the onset of bacteremia (OR, 11.7 [95% CI, 3.6-38.6];P<.001). In a multivariate model that compared patients with VRE. faeciumbacteremia and control patients, predictors of mortality included acute renal failure on presentation (OR, 15.1 [95% CI, 2.3-99.2];P= .004) and VRE. faeciumbacteremia (OR, 11 [95% CI, 2.7-45.1];P<.001). No difference in outcomes was found between patients with VRE. faecalisbacteremia and control patients.Conclusions.VRE. faeciumbacteremia in cancer patients was associated with a poorer outcome than was VRE. faecalisbacteremia. Recent receipt of carbapenem therapy was an independent risk factor for VRE. faeciumbacteremia, and recent receipt of aminoglycoside therapy was independent risk factor forE. faecalisbacteremia.

Risk Factors for Totally Implantable Central Venous Access Port-related Infection in Patients With Malignancy

2021 ◽  
Vol 41 (3) ◽  
pp. 1547-1553
Author(s):  
SATORU FURUHASHI ◽  
YOSHIFUMI MORITA ◽  
SHINYA IDA ◽  
RYUTA MURAKI ◽  
RYO KITAJIMA ◽  
...  
Keyword(s):  
Risk Factors ◽  
Central Venous Access ◽  
Venous Access ◽  
Central Venous ◽  
Access Port ◽  
Venous Access Port

Infections in Patients with Acute Non-Lymphocytic Leukemia Nursed with Central or Peripheral Venous Access

1993 ◽  
Vol 79 (2) ◽  
pp. 112-115 ◽  
Author(s):  
Gianpiero Fasola ◽  
Chiara Savignano ◽  
Maria Gloria Revignas ◽  
Luigi Virgolini ◽  
Michele Baccarani
Keyword(s):  
Risk Factor ◽  
Central Venous Access ◽  
Venous Access ◽  
Lymphocytic Leukemia ◽  
Nursing Facilities ◽  
Central Venous ◽  
Gram Negative ◽  
Peripheral Venous Access ◽  
Almost All ◽  
Infecting Organisms

Aims and Background Infections are a major problem in patients undergoing induction chemotherapy for acute leukemia. Granulocytopenia is the single most imporant risk factor, but the pattern of infecting organisms can change according to nursing facilities or bacterial and fungal prophylaxis. Methods We reviewed the patterns and types of infections in 30 patients with acute non-lymphocytic leukemia. Eighty-nine periods of neutropenia following chemotherapy were evaluated: in 60 courses patients had central and in 29 had peripheral venous access. Results Almost all patients (97 %) became febrile after the 1st course of therapy, but one-third remained apyretic after the fourth course (P = 0.002). In this series, the incidence of gram-positive, gram-negative and mycotic isolations were respectively 76 %, 18 % and 6 %. The need for antimicrobic treatment varied in relation to the course of chemotherapy. Conclusions We conclude that in acute non-lymphocytic leukemia the first neutropenic period following the onset of disease is the most critical regarding infectious problems. Both quinolonic prophylaxis and central venous access could be responsible for the microbiologic findings.

scholarly journals Risk factor for occlusion of central venous access port system in colon cancer patients

2013 ◽  
Vol 8 (1) ◽  
pp. 135-141
Author(s):  
Hisakazu Nishimori ◽  
Noriko Kouge ◽  
Hitomi Nishimoto ◽  
Yuko Tsuyumu ◽  
Yukie Matsushima ◽  
...  
Keyword(s):  
Colon Cancer ◽  
Risk Factor ◽  
Cancer Patients ◽  
Central Venous Access ◽  
Venous Access ◽  
Central Venous ◽  
Access Port ◽  
Port System ◽  
Venous Access Port

scholarly journals Risk factors for post-bronchoscopy pneumonia: a case–control study

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Yu Sato ◽  
Kengo Murata ◽  
Miake Yamamoto ◽  
Tsukasa Ishiwata ◽  
Miyako Kitazono-Saitoh ◽  
...  
Keyword(s):  
Risk Factors ◽  
Multivariate Analysis ◽  
Risk Factor ◽  
Independent Risk Factor ◽  
Case Control Study ◽  
Case Control ◽  
Control Group ◽  
Tracheobronchial Stenosis ◽  
Control Study ◽  
Age And Sex

AbstractThe bronchoscopy, though usually safe, is occasionally associated with complications, such as pneumonia. However, the use of prophylactic antibiotics is not recommended by the guidelines of the British Thoracic Society. Thus far there are few reports of the risk factors for post-bronchoscopy pneumonia; the purpose of this study was to evaluate these risk factors. We retrospectively collected data on patients in whom post-bronchoscopy pneumonia developed from the medical records of 2,265 patients who received 2666 diagnostic bronchoscopies at our institution between April 2006 and November 2011. Twice as many patients were enrolled in the control group as in the pneumonia group. The patients were matched for age and sex. In total, 37 patients (1.4%) had post-bronchoscopy pneumonia. Univariate analysis showed that a significantly larger proportion of patients in the pneumonia group had tracheobronchial stenosis (75.7% vs 18.9%, p < 0.01) and a final diagnosis of primary lung cancer (75.7% vs 43.2%, p < 0.01) than in the control group. The pneumonia group tended to have more patients with a history of smoking (83.8% vs 67.1%, p = 0.06) or bronchoalveolar lavage (BAL) (4.3% vs 14.9%, p = 0.14) than the control group. In multivariate analysis, we found that tracheobronchial stenosis remained an independent risk factor for post-bronchoscopy pneumonia (odds ratio: 7.8, 95%CI: 2.5–24.2). In conclusion, tracheobronchial stenosis was identified as an independent risk factor for post-bronchoscopy pneumonia by multivariate analysis in this age- and sex- matched case control study.

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