The Prognostic Factor Evaluation of Febrile Neutropenia Before Chemotherapy to Hematologic Malignancies

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 4842-4842
Author(s):  
Byung Soo Kim ◽  
Chul Won Choi ◽  
Seok Jin Kim
Keyword(s):  
Multivariate Analysis ◽  
Febrile Neutropenia ◽  
Treatment Outcomes ◽  
Medical Center ◽  
Univariate Analysis ◽  
Significant Risk ◽  
Onset Time ◽  
Hematologic Malignancies ◽  
Underlying Disease ◽  
Laboratory Findings

Abstract Purpose Febrile neutropenia is one of the major toxicities-associated with chemotherapy especially in hematologic disorders. Thus, the occurrence of febrile neutropenia significantly can affect their treatment outcomes. But, it is difficult to predict their clinical courses and treatment outcomes. In this study, we analyzed the prechemothepeutic clinical characteristics of febrile neutropenia and their relationship with the prognosis of febrile neutropenia in the patients with hematologic malignancies. Methods We retrospectively analyzed 259 cases of febrile neutropenia developed after the chemotherapy for their hematologic malignacies from January 2006 to July 2008 at the Korea University Medical Center to identify the potential prognosis predicting factors. For the early detection of the high risk of febrile neutropenia, we focused on the findings before chemotherapy. Results With univariate analysis, age, underlying disease, recovery of neutropenia, onset time of febrile neutropenia, onset location, the duration of fever, infection sites, and type of cultured organism were significantly associated with mortality (p < 0.05). Also, the risk of mortality was significantly associated with laboratory findings (hemoglobin, platelet count, BUN, AST, albumin, sodium, bicarbonate, PT, ESR, CRP) of prechemotherapy. In multivariate analysis, only three variables of laboratory findings were associated with poor outcomes: albumin, bicarbonate and C-reactive protein of prechemotherapy. The recoveries of neutropenia and respiratory tract infection were also the significant risk factors in multivariate analysis. The complication rate in the patients who had three poor variables (low albumin & bicarbonate level and high CRP level) was 82.8%, while in the patient who had no poor variables was only 5.7%. Conclusion The levels of albumin, bicarbonate and CRP, in prechemotherapic condition were associated with the prognosis of febrile neutropenia in our study. Therefore, the further prospective studies will be warranted to confirm the result of this study.

Treatment Outcomes and Prognostic Factors of Ifosfamide, Etoposide, Cytarabine, Methotrexate, and Dexamethasone (IVAMdex) Regimen As 3rd Line (2nd salvage) Chemotherapy in Patients with Relapsed or Refractory Non-Hodgkin's Lymphoma

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 2685-2685
Author(s):  
Yong Park ◽  
Seh Jong Park ◽  
Seok Young Lee ◽  
Se Ryeon Lee ◽  
Hwa Jung Sung ◽  
...  
Keyword(s):  
Overall Survival ◽  
Multivariate Analysis ◽  
Febrile Neutropenia ◽  
Confidence Interval ◽  
Treatment Outcomes ◽  
Performance Status ◽  
Univariate Analysis ◽  
Early Death ◽  
Salvage Chemotherapy ◽  
Line Setting

Abstract Abstract 2685 Although high dose chemotherapy with hematopoietic stem cell support is the current standard for patients with relapsed or refractory non-Hodgkin's lymphoma (NHL), all patients are not eligible for this strategy. A portion of this patients experiences refractory or relapsing disease after first salvage. However there are few data for treatment outcomes in this group of patients. In this retrospective analysis we evaluated the efficacy of ifosfamide, etoposide, cytarabine, methotrexate plus dexamethasone (IVAMdex) regimen in 2nd salvage (3rd line) setting and analyzed the pretreatment factors for patients who would be beneficial for this 2nd salvage regimen. A total of 41 patients with relapsed or refractory NHL after 1st salvage chemotherapy were analyzed. All patients were treated with IVAMdex regimen which consisted of ifosfamide (1500 mg/m2 daily from day 1 to day 5), mesna (1500 mg/m2 daily from day 1 to day 5), etoposide (150 mg/m2 daily from day 1 to day 3), cytarabine (100 mg/m2 daily from day 1 to day 3), methotrexate (3 g/m2 on day 5), leucovorin rescue (100 mg/m2 daily from day 5 to day 7), and dexamethasone (40mg on day 1 to day 3). The response rate was assessed after a minimum of two courses of chemotherapy. Toxicity and survival were analyzed in all patients. The median age was 51 years. Performance 0–1 and 2 was 56% and 44%, respectively. 28 evaluable patients completed more than 2 cycles. 13 patients were not evaluated due to early death (n=10), death without response evaluation (n=2), and follow-up loss (n=1), respectively. The overall response was as follows: 9 complete remission (32%), 4 partial remission (14%), 2 stable disease (8%), and 13 progressive disease (46%). The median overall and progression-free survival was 185 days (95% confidence interval, 84 days to 285 days) and 119 days (95% confidence interval, 30 days to 207 days), respectively (Figure 1). Univariate analysis of pretreatment factors for overall survival showed increased LDH (p=0.001), presence of B symptom (p=0.001), chemosensitive disease to prior regimen (p=0.044), performance status 0–1 (p=0.003), and low/low-intermediate IPI group (p=0.017) were significant. Multivariate analysis by Cox regression method showed that increased LDH (p=0.028, harad ratio 3.47, 95% confidence interval 1.147 to 10.526) and performance status 0–1 (p=0.041, hazard ratio 0.35, 95% confidence interval 0.13 to 0.96) were independently significant factor for overall survival. Treatment-related mortality (TRM) was reported in 16 patients (39%) and the cause of all TRMs was infection associated with febrile neutropenia. Of these, 10 deaths (63%) occurred within 30 days after initiation of chemotherapy (early death). Univariate analysis of pretreatment factors for early death showed increased LDH (p=0.011) and presence of B symptom (p=0.017) were significant. However multivariate analysis by log-rank test did not show any independently significant factors for early death. In this study salvage chemotherapy with IVAMdex regimen in 3rd line setting showed moderate response with high toxicities. However, we discovered that there might be subgroup of patients who can benefit from this regimen and serum LDH level and presence of B-symptoms may be useful indicators in differentiating these patients. However, considering high toxicities, the strategy to prevent early death associated with febrile neutropenia should be required. It might include prophylactic G-CSF and antimicrobial agent administration. To draw the conclusion, validation should be warranted in prospective trial with large scale. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Impact of Lymphovascular Invasion on Prognosis in the Patients with Bladder Cancer—Comparison of Transurethral Resection and Radical Cystectomy

Diagnostics ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. 244
Author(s):  
Kei Yoneda ◽  
Naoto Kamiya ◽  
Takanobu Utsumi ◽  
Ken Wakai ◽  
Ryo Oka ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Radical Cystectomy ◽  
Transurethral Resection ◽  
Lymphovascular Invasion ◽  
Medical Center ◽  
Univariate Analysis ◽  
The Other ◽  
Significant Prognostic Factor ◽  
Cancer Specific Survival ◽  
Positive Results

(1) Background: This study aimed to evaluate the associations of lymphovascular invasion (LVI) at first transurethral resection of bladder (TURBT) and radical cystectomy (RC) with survival outcomes, and to evaluate the concordance between LVI at first TURBT and RC. (2) Methods: We analyzed 216 patients who underwent first TURBT and 64 patients who underwent RC at Toho University Sakura Medical Center. (3) Results: LVI was identified in 22.7% of patients who underwent first TURBT, and in 32.8% of patients who underwent RC. Univariate analysis identified ≥cT3, metastasis and LVI at first TURBT as factors significantly associated with overall survival (OS) and cancer-specific survival (CSS). Multivariate analysis identified metastasis (hazard ratio (HR) 6.560, p = 0.009) and LVI at first TURBT (HR 9.205, p = 0.003) as significant predictors of CSS. On the other hand, in patients who underwent RC, ≥pT3, presence of G3 and LVI was significantly associated with OS and CSS in univariate analysis. Multivariate analysis identified inclusion of G3 as a significant predictor of OS and CSS. The concordance rate between LVI at first TURBT and RC was 48.0%. Patients with positive results for LVI at first TURBT and RC displayed poorer prognosis than other patients (p < 0.05). (4) Conclusions: We found that the combination of LVI at first TURBT and RC was likely to provide a more significant prognostic factor.

scholarly journals Risk Factor Analysis for Infection after Medial Open Wedge High Tibial Osteotomy

2021 ◽  
Vol 10 (8) ◽  
pp. 1727
Author(s):  
Ta-Wei Liu ◽  
Chih-Hao Chiu ◽  
Alvin Chao-Yu Chen ◽  
Shih-Sheng Chang ◽  
Yi-Sheng Chan
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Multivariate Analysis ◽  
High Tibial Osteotomy ◽  
Univariate Analysis ◽  
Arthroscopic Surgery ◽  
Underlying Disease ◽  
Tibial Osteotomy ◽  
Open Wedge ◽  
Wedge High Tibial Osteotomy

Background: Medial open wedge high tibial osteotomy (MOWHTO) is a well-established treatment for osteoarthritis of the medial tibiofemoral compartment. Surgical site infection (SSI) after MOWHTO is a devastating complication that may require further surgery. In this study, we aimed to identify the risk factors for infection after MOWHTO over 1 to 4 years of follow-up. Methods: Fifty-nine patients who underwent MOWHTO combined with knee arthroscopic surgery were included in this prospective study. Artificial bone grafts were used in all cases. Possible risk factors, including sex, age, body mass index (BMI), underlying disease, hospitalization length, correction angle, and surgery time, were recorded. Both univariate and multivariate analysis were used. Results: A total of 59 patients who underwent 61 operations were included. Eleven patients (18.0%) were reported to have SSI. Univariate analysis showed that smoking and diabetes mellitus were positively associated with SSI. Multivariate analysis showed that smoking and age were positively associated with SSI. Three patients (4.9%) were reported to suffer from deep SSI, requiring surgical debridement, all of whom were male smokers. Conclusion: Smoking, diabetes mellitus, and old age were identified to be possible risk factors of SSI after MOWHTO. These findings are common risk factors of SSI after orthopedic surgery according to the literature. Patient selection should be performed cautiously, and postoperative prognosis for MOWHTO should be carefully explained to patients who smoke.

Abstract 17: Prehospital Deterioration During Transport by Emergency Medical Services for Stroke Patients: A Population-Based Study

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Sabreena J Gillow ◽  
Heidi Sucharew ◽  
Kathleen Alwell ◽  
Charles J Moonmaw ◽  
Daniel Woo ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Multivariate Analysis ◽  
Univariate Analysis ◽  
Onset Time ◽  
Population Based ◽  
Neurological Deterioration ◽  
Stroke Patients ◽  
Stroke Subtype ◽  
Hospital Arrival ◽  
Neurologic Deterioration

Introduction: Stroke patients can experience neurological change in the prehospital setting. We sought to identify factors associated with prehospital neurologic deterioration. Methods: Among the Greater Cincinnati/Northern Kentucky region (pop. ~1.3 million), we screened all 15 local hospitals’ admissions from 2010 for acute stroke, and included patients with age ≥20 and complete EMS records. Glasgow Coma Scale (GCS) at hospital arrival was compared with GCS evaluated by EMS, with decrease ≥2 points considered neurologic deterioration. Data obtained included age, sex, race, medical history, antiplatelet or anticoagulant use, stroke subtype [ischemic (IS), ICH, or SAH] and IS subtype (e.g., small vessel, large vessel, cardioembolic), seizure at onset, time from symptom onset to EMS arrival, time from EMS to hospital arrival, blood pressure and serum glucose on EMS arrival, and EMS level of training. Univariate analysis was completed using Wilcoxon rank sum test for continuous measures and chi-square or Fisher’s exact test for categorical measures. Multivariate analysis was completed on variables with p ≤ 0.20 in the univariate analysis. Results: Of 2708 total stroke patients, 1097 (870 IS, 176 ICH, 51 SAH) had EMS records (median [IQR] age 74 [61, 83] years; 56% female; 21% black). Onset to EMS arrival was ≤4.5 hours for 508 cases (46%), and median time from EMS to hospital arrival was 26 minutes. Neurological deterioration occurred in 129 cases (12%), including 9.1% of IS and 22% of ICH/SAH. In multivariate analysis, black race, atrial fibrillation, ICH or SAH subtype, and ALS transport were associated with neurological deterioration. Conclusion: Atrial fibrillation may predict prehospital deterioration in stroke, and preferential transport of patients with acute worsening to centers capable of managing hemorrhagic stroke may be justifiable. Further studies are needed to identify why race is associated with deterioration and potential areas of intervention.

Efficacy, Complication Rates, and Cost Effectiveness of Chemotherapy Plus Granulocyte Colony Stimulating Factor Conditioned Mobilisation of Peripheral Blood Haematopoietic Stem Cells in Over 150 Patients with Haematological Malignancies

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 2378-2378 ◽  
Author(s):  
Ian H Gabriel ◽  
Juliet Sharon ◽  
Eduardo Olavarria ◽  
Amin Rahemtulla ◽  
Edward Kanfer ◽  
...  
Keyword(s):  
Stem Cells ◽  
Multivariate Analysis ◽  
Stem Cell ◽  
Peripheral Blood ◽  
Univariate Analysis ◽  
Significant Risk ◽  
Organ Damage ◽  
Complication Rates ◽  
Median Cost ◽  
The Cost

Abstract Autologous stem cell transplantation (ASCT) remains the standard consolidation therapy for patients with multiple myeloma (MM) and chemosensitive relapsed lymphoma (r-Ly). Peripheral blood as a source of stem cells (PBSC) has largely replaced marrow and has the advantage of improved engraftment rates. PBSC are routinely collected following administration of chemotherapy in combination with GCSF. However, the resultant pancytopenia poses a significant risk to patients and additional chemotherapy prior to ASCT may lead to increased end organ damage potentially precluding future therapies (including ASCT). Novel agents can achieve PBSC mobilisation without the use of cytotoxics. In the advent of such drugs, we reviewed the efficacy of, and complications experienced by patients during PBSC mobilisation. We also analysed the cost implications of adverse events. Of 151 consecutive attempts, 13.2% of patients failed to reach our criteria in order to attempt pheresis (1 × 104 CD34 cells/ml). Of those achieving target and undergoing pheresis, 6% did not achieve an adequate cell dose for future ASCT (2 × 106CD34+cells/kg) giving an overall failure rate of 19.2%. Furthermore 17.9% failed to harvest our ideal of 4 × 106/kg (permitting &gt;1 ASCT procedure). Factors contributing to failure in achieving target CD34+ve PB count on univariate analysis were; &gt;2 lines of previous chemotherapy and occurrence of neutropenic sepsis (NS (p=0.002, and 0.005 respectively). These factors remained significant on multivariate analysis (RR: 4.4 and 6.2). These same factors also affected CD34+ cell yield on both univariate and multivariate analysis (RR: 3.3 and 4.6). No differences were seen between MM and r-Ly. Overall, the complication rate was 34.4%, with 24.1% of patients suffering NS requiring admission. The mortality rate was 1.3% (NS and intra-cranial bleed). Of those developing NS, only 52% eventually harvested sufficient cells, but with a median delay of 3 days. The median cost of PBSC collection was $17,381.46 ($1,978.97–$39,355.73). NS significantly increased the cost of mobilisation at a median cost of $25,532.95 vs $16,4921) (p=&lt;0.0001). Conclusion: Our results suggest that patients who are potential candidates for ASCT should be harvested as soon as they achieve remission to prevent failure following additional therapy upon relapse. One fifth of patients will fail. The risks associated with current mobilisation protocols are substantial, and also impact greatly on cost, particularly relevant in the current climate of economic probity. Therefore these data suggests that transplant centres should consider the use of non-myelosuppressive agents either in place of, or as a dose reduction strategy for autologous stem cell procurement.

3D index calculated from duration and severity of neutropenia and a degree of fever as prognostic factors predicting mortality of chemotherapy-induced febrile neutropenia in hematologic malignancies.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 9053-9053
Author(s):  
Ryosuke Shirasaki ◽  
Nobu Akiyama ◽  
Haruko Tashiro ◽  
Takuji Matsuo ◽  
Tadashi Yamamoto ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Febrile Neutropenia ◽  
Burden Of Illness ◽  
Therapeutic Option ◽  
Characteristic Curve ◽  
Univariate Analysis ◽  
Total Duration ◽  
Risk Groups ◽  
Objective Evaluation ◽  
Hematologic Malignancies

9053 Background: Risk stratification of patients with febrile neutropenia (FN) is important to select the suitable therapeutic option. Although the MASCC scoring system is used as a reliable risk-discriminator, the objective evaluation of “burden of illness” has been difficult to be pointed-out. The latest IDSA Guidelines on FN proposes a set of risk factors based on the expert’s recommendations. The present study demonstrates usefulness of newly proposed 3D-index on predicting mortality of chemotherapy-induced FN in hematologic malignancies (HM). Methods: Patients with HM admitted to our hospital between Jan 2008 and Dec 2011 were enrolled, and data from 282 FN episodes in 129 FN patients including 20 infection-associated deaths were retrospectively analyzed to determine useful prognostic factors on the mortality of FN. Correlation between mortality and 59 characteristics including 3D-index were examined by univariate analysis and receiver operating characteristic curve analysis. 3D-index is a duration and severity of neutropenia and degree of fever. Total duration of days during neutropenia was not calculate at the time of risk evaluation. 3D-indexes after three and five days from the start of FN were also analyzed. Results: 32 out of 59 characteristics were significantly correlated with mortality by univariate analysis. Among them, 3D-index and 3D-indexes after three and five days were demonstrated as more useful factors (3D-index, p=0.0015; 3D-index after three days, p=0.0030; 3D-index after five days, p=0.0044). And 3D-index after three days over 4000 indicates patients' mortality above 20%, index 2600-4000 15-20% , index 900-2600 10-15%, and index below 900 below 10%, respectively. Conclusions: 3D-indexes after three days were suggested as useful predictors for infection-related mortality during FN. It was suggested that FN patients were categorized into four risk groups according to the value.

scholarly journals Clinical differences between eosinophilic and non-eosinophilic acute exacerbation of chronic obstructive pulmonary disease (AECOPD), a multicenter cross-sectional study

2020 ◽  
Author(s):  
Guangming Dai ◽  
Yajuan Ran ◽  
Jiajia Wang ◽  
Xingru Chen ◽  
Junnan Peng ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Demographic Data ◽  
Univariate Analysis ◽  
Underlying Disease ◽  
Cross Sectional Study ◽  
Chronic Obstructive ◽  
Multiple Logistic Regression ◽  
Sectional Study ◽  
Laboratory Findings ◽  
Cross Sectional

Abstract Background AECOPD is highly heterogeneous with respect to etiology and inflammation. COPD with higher blood eosinophils is associated with increased readmission rates and better corticosteroid response. However, the clinical features of eosinophilic AECOPD aren’t well explored. Then, the aim of this study was to investigate the clinical differences between eosinophilic and non-eosinophilic AECOPD. Methods A total of 643 AECOPD patients were enrolled in this multicenter cross-sectional study. Finally, 455 were included, 214 in normal eosinophils AECOPD (NEOS-AECOPD) group, 63 in mild increased eosinophils AECOPD (MEOS-AECOPD) group, and 138 in severe increased eosinophils AECOPD (SEOS-AECOPD) group. Then, demographic data, underlying diseases, symptoms, and laboratory findings were collected. Multiple logistic regression was performed to identify the independent factors associated with blood EOS. Correlations between blood EOS and its associated independent factors were evaluated. Results The significant differences in 19 factors, including underlying disease, clinical symptom, and laboratory parameters, were identified by univariate analysis. Subsequently, multiple logistic regression revealed that lymphocytes%, neutrophils% (NS%), procalcitonin (PCT), and anion gap (AG) were associated with blood EOS in AECOPD. Both blood EOS counts and EOS% significantly correlated with lymphocytes%, NS%, PCT, and AG. Conclusions The blood EOS was independently associated with lymphocytes%, NS%, PCT, and AG in AECOPD patients. Lymphocytes% was lower, and, NS%, PCT, and AG were higher in eosinophilic AECOPD. Our results indicate that viral dominant infections probably were the major etiology of eosinophilic AECOPD. Non-eosinophilic AECOPD was more likely associated with bacterial dominant infections. The systemic inflammation in non-eosinophilic AECOPD was more severe.

Prognostic Factors for Myelodysplastic Syndrome in the Veteran Population: Single Institution Experience.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 4622-4622
Author(s):  
Michael Axelson ◽  
Shirisha Reddy ◽  
Crystal Lumby ◽  
Sue Sivess-Franks ◽  
Jonathan Dowell ◽  
...  
Keyword(s):  
Overall Survival ◽  
Multivariate Analysis ◽  
Prognostic Factors ◽  
Blood Transfusion ◽  
Cox Regression ◽  
Medical Center ◽  
Univariate Analysis ◽  
Single Institution ◽  
Number Of Patients

Abstract Background: Myelodyplastic syndrome (MDS) is the disease of the elderly and increasingly common in the veteran population. Here we report a single institution experience with MDS at the Dallas VA Medical Center. Patients and Method: From a period of 1998–2007, eighty three pts were identified out of which 54 pts had bone marrow (BM) biopsy proven diagnosis of MDS. Overall survival (OS) analysis with dependent variables (Age at diagnosis, IPSS Score, WHO morphologic diagnosis, number of blood and platelet transfusions required, Hb level, ANC, cytogenetics, blast percentage, BM cellularity at diagnosis) were conducted by selection method “foreward” and only these significant variables were used in the Cox regression for multivariate analysis. Methods of Kaplan and Meier were used to generate OS curves. Results: The median age of diagnosis was 74 yrs with a median follow up time of 12.5 months. The WHO morphologic subtype was RA/RARS (n=13), Del5q (n=1), RCMD/RCMDRS (n=34), RAEB1 (n=3), RAEB2 (n=1), missing (n=2). The distribution of IPSS score was 0 (n=25); 0.5 (n=15); 1.0 (n=8), 1.5 (n=4), missing (n=2). Five pts had treatment related MDS and 3 pts transformed to AML. One patient had concurrent MGUS and one patient developed multiple myeloma. At diagnosis, 23 pts had a hemoglobin (Hb) value of less than 10g/dl. Only 4 pts had ANC less than 500; sixteen pts had ANC 500–1800 and 34 pts had normal counts. A majority of pts had normal cytogenetics (n=37), 5 pts had good risk, 5 pts had intermediate risk and 7 pts had poor risk cytogenetics. Six pts had hypocellular (<30%) BM at diagnosis whereas 16 pts had a hypercellular marrow (> 50%). Only 4 pts had more than 5% blast in the BM. Twenty nine pts eventually became blood transfusion dependent and 12 pts needed platelet transfusion at some point. Thirty six pts were treated with erythropoietin (with or without neupogen) and 13 pts received some type of disease modifying therapy (5-azacytidine/lenalidomide/ATG/clinical trial). The mean survival time was 106 months. Median survival was not reached at the time of analysis. In the univariate analysis, IPSS score (p=0.003), No. of blood transfusions (p=0.028), cytogenetics (p=0.0001) and blast percentage (p=0.0015), were statistically significant. BM cellularity (p=0.06) and Hb level (p=0.09) showed a trend towards significance. On multivariate analysis, Hb greater than 10 (HR 0.08; p=0.011), abnormal cytogenetics (HR 4.2; p=0.001), BM Blast > 5% (p=0.026) and BM cellularity < 30% (HR 4.6; p=0.033) emerged as the significant predictors of overall survival. IPSS score or Blood transfusion requirement did not pan out to be significant. Conclusion: MDS in the veteran population may be different from general population and may have unique predictors of survival. A larger number of patients and longer duration of follow up is required to further evaluate these prognostic factors.

scholarly journals Predictors of Nasal Obstruction: Quantification and Assessment Using Multiple Grading Scales

2016 ◽  
Vol 2016 ◽  
pp. 1-9
Author(s):  
Macario Camacho ◽  
Soroush Zaghi ◽  
Victor Certal ◽  
Jose Abdullatif ◽  
Rahul Modi ◽  
...  
Keyword(s):  
Allergic Rhinitis ◽  
Multivariate Analysis ◽  
Nasal Obstruction ◽  
Medical Center ◽  
Univariate Analysis ◽  
Case Series ◽  
Demographic Factors ◽  
Inferior Turbinate ◽  
Nasal Deformity ◽  
External Nasal Deformity

Objective. To evaluate the association between nasal obstruction and (1) demographic factors, (2) medical history, (3) physical tests, and (4) nasal exam findings. Study Design. Case series. Methods. Chart review at a tertiary medical center. Results. Two hundred-forty consecutive patients (52.1±17.5 years old, with a Nasal Obstruction Symptom Evaluation (NOSE) score of 32.0±24.1) were included. Demographic factors and inferior turbinate sizes were not associated with NOSE score or Nasal Obstruction Visual Analog Scale (NO-VAS). A significant association was found between higher NOSE score on univariate analysis and positive history of nasal trauma (p=0.0136), allergic rhinitis (p<0.0001), use of nasal steroids (p=0.0108), higher grade of external nasal deformity (p=0.0149), higher internal nasal septal deviation grade (p=0.0024), and narrow internal nasal valve angle (p<0.0001). Multivariate analysis identified the following as independent predictors of high NOSE score: NO-VAS: ≥50 (Odds Ratio (OR) = 17.6 (95% CI 5.83–61.6), p<0.0001), external nasal deformity: grades 2–4 (OR = 4.63 (95% CI 1.14–19.9), p=0.0339), and allergic rhinitis: yes (OR = 5.5 (95% CI 1.77–18.7), p=0.0041). Conclusion. Allergic rhinitis, NO-VAS score ≥ 50, and external nasal deformity (grades 2–4) were statistically significant independent predictors of high NOSE scores on multivariate analysis. Inferior turbinate size was not associated with NOSE scores or NO-VAS.

scholarly journals Clinical Presentation and Treatment Outcomes of Children and Adolescents With Pheochromocytoma and Paraganglioma in a Single Center in Korea

2021 ◽  
Vol 11 ◽  
Author(s):  
Hyojung Park ◽  
Min-Sun Kim ◽  
Jiwon Lee ◽  
Jung-Han Kim ◽  
Byong Chang Jeong ◽  
...  
Keyword(s):  
Children And Adolescents ◽  
Treatment Outcomes ◽  
Genetic Screening ◽  
Clinical Presentation ◽  
Medical Center ◽  
Care Center ◽  
Tertiary Care ◽  
Screening Tests ◽  
Laboratory Findings ◽  
Presenting Symptoms

PurposePheochromocytoma (PCC) and paraganglioma (PGL) (PPGL) are rare neuroendocrine tumors, and data on managing these conditions in children and adolescents are lacking. The objective of this study was to demonstrate the clinical presentation and treatment outcomes in children and adolescents with PPGL in a single tertiary care center in Korea.MethodsThis retrospective study included 23 patients diagnosed with PCC (n = 14) and PGL (n = 9) before the age of 21 at Samsung Medical Center (from June 1994 to June 2019). We describe age, gender, family history, clinical characteristics, laboratory findings, pathologic findings, therapeutic approaches, and treatment outcomes.ResultsOf the 23 patients, 14 had PCC and nine had PGL. The median age at diagnosis was 16.8 years (range, 6.8–20.8 years). The common presenting symptoms were hypertension (n = 10), headache (n = 9), palpitation (n = 4), and sweating (n = 4). The plasma or 24-hour urine catecholamine and/or metabolite concentrations were markedly elevated in 22 patients with PPGL, but were normal in one patient with carotid body PGL. All tumors were visualized on computed tomography. Genetic tests were performed in 15 patients, and seven patients showed mutations in RET (n = 3), SDHB (n = 3), and VHL (n = 1). All patients underwent surgery, and complete excision was performed successfully. Three patients with metastasis underwent postoperative adjuvant therapy.ConclusionThis study suggests that pediatric PPGL tends to be extra-adrenal and bilateral and shows a higher potential for genetic mutations. Considering the hereditary predisposition of pediatric PPGL, genetic screening tests are strongly recommended, and lifelong follow-up is needed to detect recurrence and metastasis. Further research with a larger sample size and routine genetic screening is needed to better understand the genetic conditions and long-term prognosis of PPGL.

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