Localized osteosarcoma of adult patients: Comparison with pediatric population in the same institution over a 16-year period

2001 ◽  
Vol 37 ◽  
pp. S87-S88
Author(s):  
A. Le Cesne ◽  
M.C. Le Deley ◽  
L. Brugières ◽  
C. Kalifa ◽  
G. Missenard ◽  
...  
Keyword(s):  
Pediatric Population ◽  
Adult Patients

scholarly journals A Pediatric Case of Sirolimus-Associated Pneumonitis After Kidney Transplantation

2020 ◽  
Vol 25 (5) ◽  
pp. 459-464 ◽  
Author(s):  
Jelte Kelchtermans ◽  
Jessica Chang ◽  
Wendy Glaberson ◽  
Marissa DeFreitas ◽  
Monica Alba-Sandoval ◽  
...  
Keyword(s):  
Transplant Recipient ◽  
Pulmonary Toxicity ◽  
Pediatric Population ◽  
Kidney Transplant Recipient ◽  
Ventilatory Support ◽  
Solid Organ Transplantation ◽  
Adult Patients ◽  
High Dose ◽  
Solid Organ ◽  
Drug Concentrations

Sirolimus is an immunosuppressive medication often used in solid organ transplantation. It has been associated with severe side effects, including pulmonary toxicity. In adult patients, a single center study found that 14% of those treated with sirolimus developed pulmonary pneumonitis; however, the incidence in the pediatric population is not known. Most reports in adult patients indicate that elevated drug concentrations and a prolonged duration of use are associated with pulmonary toxicity. We report a case of a 17-year-old male kidney transplant recipient who developed rapid-onset respiratory failure, necessitating mechanical ventilation and acute renal replacement therapy for ultrafiltration secondary to sirolimus-induced pneumonitis. He had been treated for acute rejection with corticosteroids 17 days prior to the development of pneumonitis. His symptoms developed within 1 week of initiation of sirolimus and with a serum concentration of 1.1 ng/mL. Sirolimus was discontinued, and, following aggressive diuresis and ventilatory support, his respiratory status returned to baseline. Sirolimus-induced pneumonitis is an important diagnosis to be considered in any transplant recipient receiving sirolimus with new onset fever, cough, or dyspnea without an identifiable source, especially if there is a preceding history of treatment with high-dose corticosteroids.

scholarly journals Veno-Arterial Extracorporeal Membrane Oxygenation for Cardiogenic Shock

Circulation ◽  
2019 ◽  
Vol 140 (24) ◽  
pp. 2019-2037 ◽  
Author(s):  
Peter M. Eckman ◽  
Jason N. Katz ◽  
Aly El Banayosy ◽  
Erin A. Bohula ◽  
Benjamin Sun ◽  
...  
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Cardiogenic Shock ◽  
End Of Life ◽  
Pediatric Population ◽  
Adult Patients ◽  
Ethical Considerations ◽  
Membrane Oxygenation ◽  
Cardiopulmonary Failure ◽  
Practical Management ◽  
Exit Strategies

Extracorporeal membrane oxygenation has evolved, from a therapy that was selectively applied in the pediatric population in tertiary centers, to more widespread use in diverse forms of cardiopulmonary failure in all ages. We provide a practical review for cardiovascular clinicians on the application of veno-arterial extracorporeal membrane oxygenation in adult patients with cardiogenic shock, including epidemiology of cardiogenic shock, indications, contraindications, and the extracorporeal membrane oxygenation circuit. We also summarize cannulation techniques, practical management and troubleshooting, prognosis, and weaning and exit strategies, with attention to end of life and ethical considerations.

scholarly journals P14.77 Reduced dose craniospinal irradiation (CSI) is feasible for standard risk adult medulloblastoma (MBL) patients similarly to pediatric population

2019 ◽  
Vol 21 (Supplement_3) ◽  
pp. iii85-iii86
Author(s):  
M Massimino ◽  
M Sunyach ◽  
L Gandola ◽  
E Pecori ◽  
F Spreafico ◽  
...  
Keyword(s):  
Posterior Fossa ◽  
Pediatric Population ◽  
Pediatric Brain Tumor ◽  
Molecular Classification ◽  
Adult Brain ◽  
Adult Patients ◽  
Current Therapy ◽  
Published Data ◽  
Adult Medulloblastoma ◽  
Standard Risk

Abstract BACKGROUND MBL is the most common malignant pediatric brain tumor but represents 1% of adult brain tumors. Recent molecular classification suggests that MBL is not the same disease in children and adults. For standard risk pediatric medulloblastomas current therapy includes CSI at reduced doses (23.4Gy) associated with chemotherapy. Most adult patients with similar risk factors still receive CSI at 36 Gy±chemotherapy (CT): in the adult series treated according to the HIT protocol (CSI 35.2 Gy + boost to 55.2 Gy to posterior fossa followed in most patients by maintenance CT with lomustine, vincristine and cisplatin) a 73% 5-year PFS was reported {Friedrich, Eur J Cancer 2013}, so far the best published data. Hence retrospective experience of 23.4 Gy together with CT for adult patients in some institutions is worthwhile reporting. MATERIAL AND METHODS We gathered M0 patients, aged over 18 years with medulloblastomas and no/minimal post-surgical residues/no biological negative factor, between 1996–2018 in Centre Léon Bérard of-Lyon and Fondazione IRCCS Istituto Nazionale dei Tumori-Milan. RESULTS Forty-four patients were included, median age 26 (18–48) years,20 females. Median follow-up 90 months(10–227). Thirty-six and 8 received 23.4Gy and 30Gy CSI, respectively, + posterior fossa/tumor bed boost and CT in all: pre-RT (carbo/VPx2 courses or 8 drugs-in-one day x 2 courses (13 patients)) and/or post-RT (carbo/VPx2 courses in 11 and 8 drugs-in-one day x 2 courses in 10; CDDP/VCR/CCNU x 8courses in other 22). The 5/10 year PFS and OS were respectively 80.9±6.5%/76.8±7.4% and 88.4±5.5%/73.1±8.5%. Median progression time was 44 months. Relapses (8) were local (4), local+CSF or spine or bone in one instance each and bone only in one. Among variable considered, higher CSI dose than 23.4 Gy, pre-RT CT did not influence PFS, while females had a trend to better PFES and OS (P=0.07). CONCLUSION These combined series present results comparable to - or even better than- those obtained after high CSI doses highlighting the need for treatment redefinition in adults.

Art-Contemplation: A Tool for Spiritual Care in the Pediatric Department?

2021 ◽  
pp. 154230502110301
Author(s):  
Elizabeth D. Topper
Keyword(s):  
Children And Adolescents ◽  
Spiritual Care ◽  
Preliminary Report ◽  
Pediatric Population ◽  
Adult Patients ◽  
Hospitalized Children ◽  
Pediatric Department ◽  
Future Direction

Facilitated contemplation of artwork has been found to be a valuable tool in the spiritual care encounter with adult patients. No reports were found on art-contemplation as a tool in the spiritual care of the pediatric population. This article is a preliminary report of facilitated art-contemplation as a portal to spiritual care encounters with hospitalized children and adolescents, their families and the staff. A series of such encounters is presented, and future direction discussed.

scholarly journals MON-LB016 Tyrosine Kinase Inhibitor Induced Hypothyroidism in Pediatric and Young Adult Population: An Institutional Review

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Shruthi Arora ◽  
Janet Chuang
Keyword(s):  
Young Adult ◽  
Tyrosine Kinase ◽  
Tyrosine Kinase Inhibitor ◽  
Thyroid Dysfunction ◽  
Kinase Inhibitor ◽  
Pediatric Population ◽  
Adult Population ◽  
Primary Hypothyroidism ◽  
Adult Patients ◽  
Young Adult Population

Abstract Tyrosine Kinase Inhibitor Induced Hypothyroidism in Pediatric and Young Adult Population: An institutional reviewBackground:Tyrosine kinase inhibitors (TKIs) are a class of molecular targeted therapies approved for the treatment of several hematological and solid tumors in pediatric population. Thyroid dysfunction, most commonly primary hypothyroidism, is a well described adverse effect in adults. There is no available data in the pediatric population regarding the risk of thyroid dysfunction with the use of TKIs.Objective:To document the incidence of hypothyroidism in the pediatric and young adult patients on TKI therapy.Methods:A retrospective chart review including patients’ ≤ 21 years of age who had been treated with at least 1 of 10 predetermined TKIs for malignancy was performed. Demographics, TKI use and duration, thyroid hormone labs, and history of head/neck radiation were collected. We excluded patients with pre-existing thyroid disease prior to start of TKI therapy. Thyroid dysfunction was defined as TSH >5mcIU/mL during TKI therapy. Results:A total of 152 patients who were treated with TKIs for malignancy were identified. The mean age was 12.4 years (SD 6.5). About 20% of patients had therapy with multiple TKI drugs. A total of 24 patients were noted to have TSH elevation >5mcIU/ml of which 19 had a TSH >10 mcIU/mL or low free T4. Fourteen patients were started on levothyroxine. Average duration of TKI therapy prior to development of thyroid dysfunction was 6.7 months but over half developed hypothyroidism within 3 months of initiation of TKI therapy. Cabozantinib and pazopanib were responsible for 70% of TKI associated cases of thyroid dysfunction.Conclusion:This is the first report of incidence of primary hypothyroidism in pediatric and young adult patients treated with TKIs. Thyroid dysfunction can develop in the first few months of therapy and often is clinically significant. Early recognition and treatment of this complication will be important for patient care especially as use of these class of drugs increase.

Abstract 25: The Use of Voltage Mapping for Slow Pathway Visualization and Ablation of Atrioventricular Nodal Reentry Tachycardia in Pediatric and Young Adult Patients

2012 ◽  
Vol 111 (suppl_1) ◽  
Author(s):  
Lindsey Malloy ◽  
Ian Law ◽  
Nicholas Von Bergen
Keyword(s):  
Low Voltage ◽  
Pediatric Population ◽  
Adult Patients ◽  
Voltage Gradient ◽  
Slow Pathway ◽  
Anatomical Location ◽  
Voltage Mapping ◽  
Atrioventricular Nodal Reentry Tachycardia ◽  
Reentry Tachycardia ◽  
Lower Voltage

Atrioventricular nodal reentry tachycardia (AVNRT) is a common arrhythmia in both pediatric and adult patients. Ablation of the arrhythmia substrate has typically been guided by anatomical location and electrogram morphology within the triangle of Koch. Using an anatomic approach can be challenging because of unusual pathway locations and anatomic variance. The use of voltage gradient mapping has been proposed in adults to aid in identification of the “slow pathway”, guiding placement of the ablation applications. The purpose of this study was to evaluate this novel technique of voltage guided ablation of AVNRT in a pediatric patient population, with a smaller triangle of Koch. Patients with atrioventricular nodal reentry tachycardia at the University of Iowa Children’s Hospital who underwent voltage mapping within the slow pathway area were included. Using intracardiac electrical recordings, three-dimensional voltage maps of the right atrium were created. A voltage map identified a bridge of lower voltage signals surrounded by even lower voltage tissue. This bridge was used to guide cryoablation of the slow pathway. Patient demographics, appearance of the intracardiac voltage mapping, timing of procedure, lesions to success, and total number of lesions was obtained. In this study there were 29 patients with an average age of 14 years (range 7 to 20 years) who underwent AVNRT ablation with voltage mapping. Ten were male. In these patients there was procedural success (no inducible AVNRT, single AV node echo beat or less) in all patients. In 25 of 29 patients, there was an adequate lower voltage saddle to allow guided ablation. The successful ablation site was within the first three lesions in 15/25 patients. Total lesions ranged from 5-34. There has been recurrence in 1 patient over an average follow-up period of one year (range five months - twenty months). The use of voltage guided ablation of a low voltage saddle in atrioventricular nodal reentry tachycardia is a technique that appears to be effective and safe in the pediatric population and has the advantage of allowing an electrically guided ablation therapy. Voltage guided ablation of atrioventricular nodal reentry tachycardia is a safe and effective technique for ablating AVNRT.

A perspective on early mobilization for adult patients with respiratory failure: Lessons for the pediatric population

2010 ◽  
Vol 3 (3) ◽  
pp. 215-227 ◽  
Author(s):  
Michele Munkwitz ◽  
Ramona O. Hopkins ◽  
Russell R. Miller III ◽  
Peter M Luckett ◽  
Eliotte L. Hirshberg
Keyword(s):  
Respiratory Failure ◽  
Pediatric Population ◽  
Early Mobilization ◽  
Adult Patients

Cervical spinal stenosis and sports-related cervical cord neurapraxia

2011 ◽  
Vol 31 (5) ◽  
pp. E7 ◽  
Author(s):  
Aaron J. Clark ◽  
Kurtis I. Auguste ◽  
Peter P. Sun
Keyword(s):  
Spinal Cord ◽  
Cervical Spine ◽  
Axial Load ◽  
Cervical Spinal Cord ◽  
Pediatric Population ◽  
Adult Patients ◽  
Cervical Cord ◽  
Cervical Lesions ◽  
Cervical Spinal Stenosis ◽  
Population Treatment

Cervical cord neurapraxia is a common sports-related injury. It is defined as a transient neurological deficit following trauma localizing to the cervical spinal cord and can be caused by hyperextension, hyperflexion, or axial load mechanisms. Symptoms usually last less than 15 minutes, but can persist up to 48 hours in adults and as long as 5 days in children. While a strong causal relationship exists between cervical spine stenosis and cervical cord neurapraxia in adult patients, this association has not been observed in children. Likewise, while repeated episodes of neurapraxia can be commonplace in adult patients, recurrences have not been reported in the pediatric population. Treatment is usually supportive, but in adults with focal cervical lesions or instability, surgery is an option. Surgery for neurapraxia in children is rarely indicated.

scholarly journals Epidemiological Characterization of Brain Tumors in Colombia, a 10-Year Period

2021 ◽  
Vol 8 (6) ◽  
pp. 01-08
Author(s):  
Juan Gómez-Vega
Keyword(s):  
Brain Tumors ◽  
Pediatric Population ◽  
Adult Population ◽  
Descriptive Analysis ◽  
Cancer Registries ◽  
Population Based ◽  
Adult Patients ◽  
Age Group ◽  
Neuroepithelial Tumors ◽  
Incidence And Mortality

Introduction: Central nervous system tumors are rare; in 2015 they represented approximately 1.4% of new cancer diagnoses, causing 2.6% of deaths by cancer that year. In Colombia, there are few reports on the epidemiology of brain tumors, and those that exist are local databases that do not have a rigorous and massive registry. Due to limited epidemiological information in our country, this document aims to characterize the epidemiology of brain tumors in Colombia over a 10-year period. Methods: A retrospective descriptive observational study was conducted, using databases of population-based cancer registries in Colombia. We extracted information from a 10-year period recorded in patients with tumors without age group restriction. A descriptive analysis was carried out for all the variables considered, the incidence and mortality rates per 100,000 person years were calculated. Statistical software Stata 14.0 was used. Results: Our analysis was performed with a population of 775 adult patients and 123 pediatric patients, with an incidence of 1.55 per 100.000 individuals in the pediatric population and 3.19 per 100.000 individuals in the adult population. The mortality rate for pediatric and adult patients was 0.063 per 100.000 individuals and 1.86 per 100.000 individuals respectively. The most frequent tumors in the pediatric age group were neuroepithelial tumors, embryonal tumors and ependymal tumors, whereas for adults, the most frequent were neuroepithelial tumors, meningiomas and hematolymphoid tumors. Conclusions: This study constitutes the most recent work on the epidemiology of brain tumors in Colombia. There was a clear general underreporting and statistics lower than those compared with the literature. It is intended to expand coverage and data collection in population-based cancer registries.

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