Sclerotherapy for lymphatic malformations of the head and neck in the pediatric population

2016 ◽  
Vol 9 (10) ◽  
pp. 1023-1026 ◽  
Author(s):  
Joanna H Tu ◽  
Huy M Do ◽  
Viraat Patel ◽  
Kristen W Yeom ◽  
Joyce M C Teng
Keyword(s):  
Head And Neck ◽  
Pediatric Population ◽  
Univariate Analysis ◽  
Treatment Session ◽  
Ethanolamine Oleate ◽  
Post Intervention ◽  
Lymphatic Malformations ◽  
Safety And Efficacy ◽  
Disease Characteristics ◽  
Sclerosing Agents

BackgroundSclerotherapy is one of the most commonly used minimally invasive interventions in the treatment of macrocystic lymphatic malformations (LMs). Several different sclerosing agents and injection protocols have been reported in the literature, each with varying degrees of success. The safety and efficacy of the treatments have not been evaluated comparatively in the pediatric population.MethodsChart review of pediatric patients with macrocystic/mixed head and neck LMs who underwent sclerotherapy using OK-432, doxycycline, or ethanolamine oleate at Lucile Packard Children's Hospital at Stanford during 2000–2014. Clinical evaluation and radiographic imaging were reviewed to assess lesion characteristics and response to sclerotherapy following each treatment session. The post-intervention clinical response was categorized as excellent, good, fair, or poor.ResultsAmong the 41 pediatric cases reviewed, 10 patients were treated with OK-432, 19 patients received doxycycline, and 12 patients received ethanolamine. In univariate analysis, different sclerosants had similar effectiveness after the first injection and final clinical outcome (p=0.5317). In multivariate analysis controlling for disease severity stage as well as disease characteristics (macrocystic vs mixed subtypes), different sclerosants also had similar effectiveness after the first injection (p=0.1192). Radiologic analysis indicated an 84.5% average volume reduction, with similar effectiveness between the different sclerosants (p=0.9910).ConclusionsIn this series of LM cases treated at Stanford, we found that doxycycline, OK-432, and ethanolamine oleate sclerotherapy appear to have a similar safety and efficacy profile in the treatment of macrocystic and mixed LMs of the head and neck in the pediatric population.

scholarly journals Cervicofacial lymphatic malformations: diagnosis and management

2021 ◽  
Vol 37 (1) ◽  
Author(s):  
Rachida Bouatay ◽  
Badii Hmida ◽  
Malek Hajjej ◽  
Amira Farhati ◽  
Khaled Harrathi ◽  
...  
Keyword(s):  
Head And Neck ◽  
Lymphatic Vessels ◽  
Neck Region ◽  
Surgical Excision ◽  
Primary Treatment ◽  
Benign Tumors ◽  
Lymphatic Malformations ◽  
Therapeutic Modalities ◽  
Sclerosing Agents ◽  
Primary Treatment Modality

Abstract Background Lymphatic malformations are rare benign tumors that result from congenital and acquired alterations of the lymphatic vessels. They occur most commonly on the head and neck region. The aim of this study is to describe clinical profiles of lymphatic malformations of the head and neck (LMHN) as well as to study therapeutic modalities through our series and review of the literature. Results This is a retrospective record-based descriptive study conducted in the ENT and the Radiology departments over a 17-year period. Our study included twelve patients, aged between 8 months and 52 years. Two swellings were present at birth and had not been prenatally diagnosed in both cases. One patient was affected by TRISOMY 21. All patients consulted for a painless mass of the head or neck. Seven masses were located in the suprahyoid region and five in the infrahyoid region. Ultrasonography, computed tomography (CT), and magnetic resonance imaging (MRI) were realized to establish the diagnosis and assess the extent of the lesions. Surgical excision was performed in 7 patients. It was complete in 6 patients. Five patients were treated with sclerotherapy. The sclerosing agents used were Aetoxisclerol 2%, hypertonic saline, and absolute alcohol. One patient had a reversible paresis of the left mental nerve after surgery. An excellent response to sclerotherapy with complete resolution was obtained in 3 cases with no recurrence of the disease. Conclusions Surgical excision has been the management option of choice for LMHN. The recent advances in sclerotherapy make it safe and effective as a primary treatment modality for these lesions.

scholarly journals Refractory Head and Neck Lymphatic Malformation in Infants Treated With Sirolimus: A Case Series

2021 ◽  
Vol 11 ◽  
Author(s):  
Changhua Wu ◽  
Dan Song ◽  
Lei Guo ◽  
Liang Wang
Keyword(s):  
Head And Neck ◽  
Standard Care ◽  
Case Series ◽  
Efficacy And Safety ◽  
Lymphatic Malformations ◽  
Dosing Schedule ◽  
Safety And Efficacy ◽  
Primary Endpoints ◽  
Continuous Dosing

BackgroundExtensive and complex head and neck lymphatic malformations (LMs) are challenging to manage through traditional therapy. The purpose of this retrospective study was to assess the efficacy and safety of sirolimus in infants with refractory head and neck LMs.MethodsSirolimus was administered orally on a continuous dosing schedule. Patients were seen every month for the first three months and then subsequently every three months. The primary endpoints were safety and efficacy based on clinical and radiological evaluations.ResultsEight patients, refractory to standard care, were enrolled and received sirolimus continuously. After 12 months of follow-up, the response and safety to medication was evaluated: all patients experienced reductions in LMs bulk, ranging from modest to significant. Some minor adverse effects were reported: mouth sores, eczema, gastrointestinal reaction, dyslipidemia, and neutropenia.ConclusionSirolimus was efficient in children with refractory head and neck LMs and was well tolerated.

Percutaneous sclerotherapy with ethanolamine oleate for lymphatic malformations of the head and neck

2013 ◽  
Vol 6 (9) ◽  
pp. 691-694 ◽  
Author(s):  
Matthew David Alexander ◽  
Ryan A McTaggart ◽  
Omar A Choudhri ◽  
Mary L Marcellus ◽  
Huy M Do
Keyword(s):  
Head And Neck ◽  
Ethanolamine Oleate ◽  
Lymphatic Malformations ◽  
Percutaneous Sclerotherapy

scholarly journals Insights on safety and efficacy of renal artery denervation for uncontrolled-resistant hypertension in a high risk population with chronic kidney disease: first Italian real-world experience

2021 ◽  
Author(s):  
Federico Marin ◽  
Simone Fezzi ◽  
Alessia Gambaro ◽  
Francesco Ederle ◽  
Gianluca Castaldi ◽  
...  
Keyword(s):  
High Risk ◽  
Medical Therapy ◽  
Resistant Hypertension ◽  
Univariate Analysis ◽  
Daily Practice ◽  
Renal Sympathetic Denervation ◽  
High Risk Population ◽  
Safety And Efficacy ◽  
Renal Artery Denervation

Abstract Aims To evaluate the safety and efficacy of catheter-based radiofrequency renal sympathetic denervation (RSD) in a daily practice population of patients with uncontrolled resistant hypertension, on top of medical therapy. Methods Consecutive unselected patients with uncontrolled resistant hypertension undergoing RSD were enrolled. Office and ambulatory blood pressure (BP) measurements were collected at baseline and 3, 6 and 12 months after RSD. Efficacy was assessed even in patients with an estimated glomerular filtration rate (eGFR) below 45 mL/min/1.73 m2. Patients were defined as responders if systolic BP decreased by at least 5 mmHg at ambulatory BP or by 10 mmHg at office BP at their last follow-up visit. Results Forty patients with multiple comorbidities underwent RSD from 2012 to 2019. Baseline office and ambulatory BP was 159.0/84.9 ± 26.2/14.9 mmHg and 155.2/86.5 ± 20.9/14.0 mmHg, respectively. At 12-month follow up a significant reduction in office and ambulatory systolic BP, respectively by − 19.7 ± 27.1 mmHg and by − 13.9 ± 23.6 mmHg, was observed. BP reduction at 12-month follow-up among patients with eGFR < 45 mL/min was similar to that obtained in patients with higher eGFR. Twenty-nine patients (74.4%) were responders. Combined hypertension, higher ambulatory systolic BP and lower E/E’ at baseline emerged as predictors of successful RSD at univariate analysis. No major complications were observed and renal function (was stable up to 12 months), even in patients with the lowest eGFR values at baseline. Conclusion RSD is safe and feasible in patients with uncontrolled resistant hypertension on top of medical therapy, even in a high-risk CKD population with multiple comorbidities, with a significant reduction in systolic BP and a trend towards a reduction in diastolic BP lasting up to 12 months. Graphic abstract

scholarly journals 1346. Implementation of a Multidisciplinary 48 Hour Antibiotic Timeout in a Pediatric Population

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S684-S684
Author(s):  
Victoria Konold ◽  
Palak Bhagat ◽  
Jennifer Pisano ◽  
Natasha N Pettit ◽  
Anish Choksi ◽  
...  
Keyword(s):  
Pediatric Patients ◽  
Pediatric Population ◽  
Intervention Group ◽  
Post Intervention ◽  
Days Of Therapy ◽  
New Antibiotics ◽  
Core Elements ◽  
Quasi Experimental ◽  
Empirical Antibiotics ◽  
The Impact

Abstract Background To meet the core elements required for antimicrobial stewardship programs, our institution implemented a pharmacy-led antibiotic timeout (ATO) process in 2017 and a multidisciplinary ATO process in 2019. An antibiotic timeout is a discussion and review of the need for ongoing empirical antibiotics 2-4 days after initiation. This study sought to evaluate both the multidisciplinary ATO and the pharmacy-led ATO in a pediatric population, compare the impact of each intervention on antibiotic days of therapy (DOT) to a pre-intervention group without an ATO, and to then compare the impact of the pharmacy-led ATO versus multidisciplinary ATO on antibiotic days of therapy (DOT). Methods This was a retrospective, pre-post, quasi-experimental study of pediatric patients comparing antibiotic DOT prior to ATO implementation (pre-ATO), during the pharmacy-led ATO (pharm-ATO), and during the multidisciplinary ATO (multi-ATO). The pre-ATO group was a patient sample from February-September 2016, prior to the initiation of a formal ATO. The pharmacy-led ATO was implemented from February-September 2018. This was followed by a multidisciplinary ATO led by pediatric residents and nurses from February-September 2019. Both the pharm-ATO and the multi-ATO were implemented as an active non-interruptive alert added to the electronic health record patient list. This alert triggered when new antibiotics had been administered to the patient for 48 hours, at which time, the responsible clinician would discuss the antibiotic and document their decision via the alert workspace. Pediatric patients receiving IV or PO antibiotics administered for at least 48 hours were included. The primary outcome was DOT. Secondary outcomes included length of stay (LOS) and mortality. Results 1284 unique antibiotic orders (n= 572 patients) were reviewed in the pre-ATO group, 868 (n= 323 patients) in the pharm-ATO and 949 (n= 305 patients) in the multi-ATO groups. Average DOT was not significantly different pre vs post intervention for either methodology (Table 1). Mortality was similar between groups, but LOS was longer for both intervention groups (Table 1). Impact of an ATO on DOT, Mortality and LOS Conclusion An ATO had no impact on average antibiotic DOT in a pediatric population, regardless of the ATO methodology. Disclosures All Authors: No reported disclosures

scholarly journals 600. Decreased Hospital Readmission After Programmatic Strengthening of an Outpatient Parenteral Antimicrobial Therapy (OPAT) Program

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S362-S363
Author(s):  
Gaurav Agnihotri ◽  
Alan E Gross ◽  
Minji Seok ◽  
Cheng Yu Yen ◽  
Farah Khan ◽  
...  
Keyword(s):  
Hospital Readmission ◽  
Multinomial Logistic Regression ◽  
Univariate Analysis ◽  
Tertiary Care ◽  
Intervention Group ◽  
Care Hospital ◽  
Full Time ◽  
Post Intervention ◽  
Before And After ◽  
The Impact

Abstract Background Although it is recommended that an OPAT program should be managed by a formal OPAT team that supports the treating physician, many OPAT programs face challenges in obtaining necessary program staff (i.e nurses or pharmacists) due to limited data examining the impact of a dedicated OPAT team on patient outcomes. Our objective was to compare OPAT-related readmission rates among patients receiving OPAT before and after the implementation of a strengthened OPAT program. Methods This retrospective quasi-experiment compared adult patients discharged on intravenous (IV) antibiotics from the University of Illinois Hospital before and after implementation of programmatic changes to strengthen the OPAT program. Data from our previous study were used as the pre-intervention group (1/1/2012 to 8/1/2013), where only individual infectious disease (ID) physicians coordinated OPAT. Post-intervention (10/1/2017 to 1/1/2019), a dedicated OPAT nurse provided full time support to the treating ID physicians through care coordination, utilization of protocols for lab monitoring and management, and enhanced documentation. Factors associated with readmission for OPAT-related problems at a significance level of p&lt; 0.1 in univariate analysis were eligible for testing in a forward stepwise multinomial logistic regression to identify independent predictors of readmission. Results Demographics, antimicrobial indications, and OPAT administration location of the 428 patients pre- and post-intervention are listed in Table 1. After implementation of the strengthened OPAT program, the readmission rate due to OPAT-related complications decreased from 17.8% (13/73) to 6.5% (23/355) (p=0.001). OPAT-related readmission reasons included: infection recurrence/progression (56%), adverse drug reaction (28%), or line-associated issues (17%). Independent predictors of hospital readmission due to OPAT-related problems are listed in Table 2. Table 1. OPAT Patient Demographics and Factors Pre- and Post-intervention Table 2. Factors independently associated with hospital readmission in OPAT patients Conclusion An OPAT program with dedicated staff at a large academic tertiary care hospital was independently associated with decreased risk for readmission, which provides critical evidence to substantiate additional resources being dedicated to OPAT by health systems in the future. Disclosures All Authors: No reported disclosures

Sa1628 Safety and Efficacy of Overtubes for Preventing Cutaneous Metastasis During PEG Tube Placement in Patients With Head and Neck Cancer: a Single-Center Study

2014 ◽  
Vol 79 (5) ◽  
pp. AB280
Author(s):  
Crispin O. Musumba ◽  
Chiao-Yun (Julia) Hsu ◽  
Golo Ahlenstiel ◽  
Nicholas J. Tutticci ◽  
Kavinderjit S. Nanda ◽  
...  
Keyword(s):  
Head And Neck Cancer ◽  
Head And Neck ◽  
Neck Cancer ◽  
Cutaneous Metastasis ◽  
Tube Placement ◽  
Single Center ◽  
Safety And Efficacy ◽  
Single Center Study ◽  
Peg Tube ◽  
Center Study
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