scholarly journals The Outcomes of Total Anomalous Pulmonary Venous Connection in Neonates−10-Year Experience at a Single Center

2021 ◽  
Vol 8 ◽  
Author(s):  
Erchao Ji ◽  
Hailong Qiu ◽  
Xiaobing Liu ◽  
Wen Xie ◽  
Rong Liufu ◽  
...  
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Circulatory Arrest ◽  
Venous Pressure ◽  
Surgical Techniques ◽  
Significant Risk ◽  
Postoperative Mortality ◽  
Pulmonary Venous Obstruction ◽  
The Past ◽  
Anomalous Pulmonary Venous Connection

Background: Recent developments in surgical techniques and hospital care have led to improved outcomes following repair of total anomalous pulmonary venous connection (TAPVC). However, surgical repair of neonatal TAPVC remains associated with a high risk of postoperative mortality and pulmonary venous obstruction (PVO). We conducted this retrospective study to identify risk factors associated with surgical outcomes in the neonatal population.Methods: A retrospective review was conducted for all 127 neonates who underwent operations for isolated TAPVC from January 2009 to January 2019.Results: Preoperative PVO occurred in 33 (26.0%) of the 127 patients. Fifty patients (39.4%) required tracheal intubation before the operation. Twenty-three patients (18.1%) underwent emergency surgery. There were 11 (8.7%) early deaths. Significant risk factors were prolonged cardiopulmonary bypass (CPB) time (p = 0.013) and increased postoperative central venous pressure (CVP, p = 0.036). There were 5 (4.3%) late deaths within 1 year of repair. The risk factors for overall death were preoperative acidosis (p = 0.001), prolonged CPB time (p < 0.001) and increased postoperative CVP (p = 0.007). In particular, mortality was significantly higher (p = 0.007) with a postoperative CVP > 8 mmHg. With an increase in use of sutureless techniques (p = 0.001) and decrease in deep hypothermic circulatory arrest (p = 0.009) over the past 5 years, postoperative mortality greatly decreased (21.2%: 6.7%, p = 0.016). Postoperative PVO occurred in 15 patients (11.8%). Risk factors were mixed TAPVC (p = 0.037), preoperative acidosis (p = 0.001) and prolonged CPB time (p = 0.006).Conclusion: Although postoperative mortality of neonatal TAPVC has dropped to 6.7% over the past 5 years, it is still relatively high. Risk factors for postoperative death include preoperative acidosis, prolonged CPB time and increased postoperative CVP. Mortality was significantly higher for neonates with an average CVP > 8 mmHg 24 h after surgery.

Single Ventricle and Total Anomalous Pulmonary Venous Connection: Implications of Prenatal Diagnosis

2018 ◽  
Vol 9 (4) ◽  
pp. 434-439 ◽  
Author(s):  
Hayley S. Hancock ◽  
Jennifer C. Romano ◽  
Aimee Armstrong ◽  
Sunkyung Yu ◽  
Ray Lowery ◽  
...  
Keyword(s):  
Prenatal Diagnosis ◽  
High Risk ◽  
Single Ventricle ◽  
Significant Risk ◽  
Postoperative Mortality ◽  
Significant Risk Factor ◽  
High Risk Group ◽  
Published Data ◽  
Prenatal Diagnostic ◽  
Anomalous Pulmonary Venous Connection

Background: Single ventricle (SV) patients with total anomalous pulmonary venous connection (TAPVC) are at high risk. Given the limited published data available, we examined outcomes and the implications of a prenatal diagnosis of SV/TAPVC. Methods: A single-center, retrospective review was performed in neonates with SV/TAPVC from 1998 to 2014, identified through institutional databases. Patient demographic, perioperative, and follow-up data were collected. Results: Thirty-four eligible infants with SV/TAPVC were identified (mean birth weight: 3.0 kg). The TAPVC types were supracardiac (59%), infracardiac (21%), mixed (12%), and cardiac (9%). Heterotaxy syndrome was present in 25 (74%) infants. A prenatal diagnosis of SV was made in 26 (76%) infants, with TAPVC identified in 12 (35%). Seventeen (50%) had obstructed TAPVC within the first 48 hours of life; 7 of these patients had obstructed TAPVC identified prenatally. There were two preoperative deaths. Overall survival for the cohort was 65% at 1 year and 50% at 3 years. Survival in the obstructed group was significantly worse compared to the unobstructed group (47% vs 81% at 1 year; 27% vs 73% at 3 years, P = .01). Obstructed TAPVC and a prenatal prediction of obstructed TAPVC were significantly associated with postoperative mortality ( P = .01 and .03, respectively). Conclusions: Patients with SV/TAPVC remain a high-risk group, with obstructed TAPVC a significant risk factor for mortality. Prenatal diagnosis of TAPVC in SV patients is challenging, but given those with obstructed TAPVC are especially at high risk, improved prenatal diagnostic techniques in this group may enhance counseling/delivery planning.

scholarly journals Problem-Orientated Antenatal Notekeeping: A Useful Primary Health Care Tool

Curationis ◽  
1978 ◽  
Vol 1 (3) ◽  
Author(s):  
J.V. Larsen
Keyword(s):  
Risk Factors ◽  
South Africa ◽  
Health Care ◽  
Primary Health Care ◽  
High Risk ◽  
Significant Risk ◽  
Obstetric Care ◽  
Antenatal Screening ◽  
Primary Health ◽  
Risk Patients

It has recently been demonstrated that about 56 percent of patients delivering in a rural obstetric unit had significant risk factors, and that 85 percent of these could have been detected by meticulous antenatal screening before the onset of labour. These figures show that the average rural obstetric unit in South Africa is dealing with a large percentage of high risk patients. In this work, it is hampered by: 1. Communications problems: i.e. bad roads, long distances. and unpredictable telephones. 2. A serious shortage of medical staff resulting in primary obstetric care being delivered by midwives with minimal medical supervision.

EMA-CO chemotherapy for high-risk gestational trophoblastic neoplasia: a clinical analysis of 54 patients

2008 ◽  
Vol 18 (2) ◽  
pp. 357-362 ◽  
Author(s):  
W.-G. Lu ◽  
F. Ye ◽  
Y.-M. Shen ◽  
Y.-F. Fu ◽  
H.-Z. Chen ◽  
...  
Keyword(s):  
Risk Factors ◽  
Survival Rate ◽  
High Risk ◽  
Complete Remission ◽  
Univariate Analysis ◽  
Significant Risk ◽  
Clinical Analysis ◽  
Secondary Malignancy ◽  
Primary Therapy ◽  
Gestational Trophoblastic Neoplasia

This study was designed to analyze the outcomes of chemotherapy for high-risk gestational trophoblastic neoplasia (GTN) with EMA-CO regimen as primary and secondary protocol in China. Fifty-four patients with high-risk GTN received 292 EMA/CO treatment cycles between 1996 and 2005. Forty-five patients were primarily treated with EMA-CO, and nine were secondarily treated after failure to other combination chemotherapy. Adjuvant surgery and radiotherapy were used in the selected patients. Response, survival and related risk factors, as well as chemotherapy complications, were retrospectively analyzed. Thirty-five of forty-five patients (77.8%) receiving EMA-CO as first-line treatment achieved complete remission, and 77.8% (7/9) as secondary treatment. The overall survival rate was 87.0% in all high-risk GTN patients, with 93.3% (42/45) as primary therapy and 55.6% (5/9) as secondary therapy. The survival rates were significantly different between two groups (χ2= 6.434, P = 0.011). Univariate analysis showed that the metastatic site and the number of metastatic organs were significant risk factors, but binomial distribution logistic regression analysis revealed that only the number of metastatic organs was an independent risk factor for the survival rate. No life-threatening toxicity and secondary malignancy were found. EMA-EP regimen was used for ten patients who were resistant to EMA-CO and three who relapsed after EMA-CO. Of those, 11 patients (84.6%) achieved complete remission. We conclude that EMA-CO regimen is an effective and safe primary therapy for high-risk GTN, but not an appropriate second-line protocol. The number of metastatic organs is an independent prognostic factor for the patient with high-risk GTN. EMA-EP regimen is a highly effective salvage therapy for those failing to EMA-CO.

scholarly journals ПОРІВНЯЛЬНА ХАРАКТЕРИСТИКА ФАКТОРІВ РИЗИКУ

2012 ◽  
Author(s):  
І. К. Чурпій
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Pulmonary Embolism ◽  
High Risk ◽  
Significant Risk ◽  
Female Gender ◽  
Electrolyte Composition ◽  
Terminal Phase ◽  
Phase Flow ◽  
History Of

<p>To optimize the therapeutic tactics and improve the treatment of peritonitis on the basis of retrospective analysis there are determined the significant risk factors: female gender, age 60 – 90 years, time to hospitalization for more than 48 hours, a history of myocardial infarction, stroke, cardiac arrhythmia, biliary, fecal and fibrinous purulent exudate, the terminal phase flow, operations with resection of the intestine and postoperative complications such as pulmonary embolism, myocardial infarction, pleurisy, early intestinal obstruction. Changes in the electrolyte composition of blood and lower albumin &lt;35 % of high risk prognostic course of peritonitis that requires immediate correction in the pre-and postoperative periods. The combination of three or more risk factors for various systems, creating a negative outlook for further treatment and the patient's life.</p>

scholarly journals 186. Risk Factors for Extended Spectrum β-Lactamase Bacteremia and External Application of a Clinical Prediction Tool

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S113-S114
Author(s):  
Jacqueline Burnell ◽  
Rebecca Fallis ◽  
Peter Axelrod ◽  
Daniel Mueller
Keyword(s):  
Risk Factors ◽  
Antibiotic Therapy ◽  
Klebsiella Oxytoca ◽  
Significant Risk ◽  
University Hospital ◽  
Prediction Tool ◽  
External Application ◽  
The Past ◽  
Extended Spectrum ◽  
History Of

Abstract Background Extended spectrum β-lactamase (ESBL) bacteria are resistant to many antibiotics, which increases the risk of inadequate early antibiotic therapy. A previous single-center study had created a prediction tool to assist clinicians in identifying patients at risk for ESBL bloodstream infections. The purpose of our research project was to assess validity of this tool while also identifying risk factors for ESBL bacteremia within our own institution, which would allow for assessment of alternative prediction tools. Methods We performed a retrospective chart review of adult patients admitted to an urban university hospital who were found to have bacteremia with Escherichia coli, Klebsiella pneumoniae, and/or Klebsiella oxytoca between October 2016 and April 2018. Demographics and comorbidities were assessed, along with other potential risk factors including exposure to antibiotics and hospitalizations within the past 6 months. Results A total of 214 instances of bacteremia were identified and 14% were due to ESBL organisms. Risk factors for ESBL bacteremia in our cohort included history of positive culture for ESBL (RR = 5.9) or MRSA (RR = 3.5) and antibiotic usage in the past 6 months (RR = 2.3). Patients with ESBL bacteremia were hospitalized longer (mean 16 days vs. 6 days for non-ESBL), received longer durations of antibiotic therapy (11.7 days vs. 5.3 days), and were exposed to greater numbers of different antibiotics (1.9 vs. 0.7) in the previous 6 months. Multivariate logistic regression showed that history of prior ESBL infection (OR 14.7, CI 1.8–120) and increasing number of different antibiotic classes administered in the prior 6 months (OR 4.3, CI 1.7–11.2) were significant risk factors for ESBL bacteremia. The previously created prediction tool did not sufficiently differentiate higher and lower risk for ESBL bacteremia in our cohort. Conclusion Although risk factors were similar, the previously derived stepwise prediction tool did not predict ESBL bacteremia in our external cohort. Point-based prediction modeling might better assess risk across institutions. Additionally, the number of different antibiotics received was associated with risk for ESBL bacteremia and should be investigated further. Disclosures All authors: No reported disclosures.

A PRELIMINARY STUDY OF RISK FACTORS OF BREAST CANCER AND THE USEFULNESS OF BREAST MRI AS AN ADDITION TO MAMMOGRAPHY IN DETECTING BREAST CANCER IN HIGH RISK WOMEN

2016 ◽  
Vol 78 (11-3) ◽  
Author(s):  
Noor Khairiah A. Karim ◽  
Rohayu Hami ◽  
Nur Hashamimi Hashim ◽  
Nizuwan Azman ◽  
Ibrahim Lutfi Shuaib
Keyword(s):  
Breast Cancer ◽  
Risk Factors ◽  
High Risk ◽  
Cancer Detection ◽  
Significant Risk ◽  
Breast Mri ◽  
Breast Cancer Detection ◽  
P Value ◽  
High Risk Women ◽  
History Of

The risk factors of breast cancer among women, such as genetic, family history and lifestyle factors, can be divided into high-, intermediate- and average-risk. Determining these risk factors may actually help in preventing breast cancer occurrence. Besides that, screening of breast cancer which include mammography, can be done in promoting early breast cancer detection. Breast magnetic resonance imaging (MRI) has been recommended as a supplemental screening tool in high risk women. The aim of this study was to identify the significant risk factor of breast cancer among women and also to determine the usefulness of breast MRI as an addition to mammography in detection of breast cancer in high risk women. This retrospective cohort study design was conducted using patients’ data taken from those who underwent mammography for screening or diagnostic purposes in Advanced Medical and Dental Institute, Universiti Sains Malaysia, from 2007 until 2015. Data from 289 subjects were successfully retrieved and analysed based on their risk factors of breast cancer. Meanwhile, data from 120 subjects who had high risks and underwent both mammography and breast MRI were further analysed. There were two significant risk factors of breast cancer seen among the study population: family history of breast cancer (p-value=0.012) and previous history of breast or ovarian cancer (p-value <0.001). Breast MRI demonstrated high sensitivity (90%) while mammography demonstrated high specificity (80%) in detection of breast cancer in all 120 subjects. The number of cases of breast cancer detection using breast MRI [46 (38.3%)] was higher compared to mammography [24 (20.0%)]. However, breast MRI was found to be non-significant as an adjunct tool to mammography in detecting breast cancer in high risk women (p-value=0.189). A comprehensive screening guideline and surveillance of women at high risk is indeed useful and should be implemented to increase cancer detection rate at early stage

scholarly journals Identification of Intermediate- to High-Risk Papillary Thyroid Carcinoma Patients Who May Be Safely Managed without the Performance of Delayed Stimulated Thyroglobulin Measurements following Total Thyroidectomy and Radioactive Iodine Therapy

2015 ◽  
Vol 2015 ◽  
pp. 1-7
Author(s):  
Kyung-Hee Kim ◽  
Min-Hee Kim ◽  
Ye-Jee Lim ◽  
Ihn Suk Lee ◽  
Ja-Seong Bae ◽  
...  
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Total Thyroidectomy ◽  
Radioactive Iodine ◽  
Significant Risk ◽  
Disease Status ◽  
Radioactive Iodine Therapy ◽  
Papillary Thyroid ◽  
Independent Risk Factors

Background. The measurement of stimulated thyroglobulin (sTg) after total thyroidectomy and remnant radioactive iodine (RAI) ablation is the gold standard for monitoring disease status in patients with papillary thyroid carcinomas (PTCs). The aim of this study was to determine whether sTg measurement during follow-up can be avoided in intermediate- and high-risk PTC patients.Methods. A total of 346 patients with PTCs with an intermediate or high risk of recurrence were analysed. All of the patients underwent total thyroidectomy as well as remnant RAI ablation and sTg measurements. Preoperative and postoperative parameters were included in the analysis.Results. Among the preoperative parameters, age below 45 years and preoperative Tg above 19.4 ng/mL were significant risk factors for predicting detectable sTg during follow-up. Among the postoperative parameters, thyroid capsular invasion, lymph node metastasis, and ablative Tg above 2.9 ng/mL were independently correlated with a detectable sTg range. The combination of ablative Tg less than 2.9 ng/mL with pre- and postoperative independent risk factors for detectable sTg increased the negative predictive value for detectable sTg up to 98.5%.Conclusions. Based on pre- and postoperative parameters, a substantial proportion of patients with PTCs in the intermediate- and high-risk classes could avoid aggressive follow-up measures.

Predictive Parameters for Infections During Azacitidine Therapy in High Risk MDS Patients,

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 3811-3811
Author(s):  
Drorit Merkel ◽  
Kalman Filanovsky ◽  
Ariel Aviv ◽  
Moshe E. Gatt ◽  
Yair Herishanu ◽  
...  
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Creatinine Level ◽  
Prospective Studies ◽  
Univariate Analysis ◽  
Significant Risk ◽  
Surrogate Marker ◽  
Prophylactic Antibiotics ◽  
Infection Prophylaxis ◽  
Transfusion Dependency

Abstract Abstract 3811 Background: Azacitidine is an effective therapy for high risk myelodysplastic syndrome (MDS). Neutropenic fever is a common life threatening complication during azacitidine therapy, however predicting it, is challenging. Despite a number of large scale prospective studies, there are no established indications for primary or secondary prophylactic antibiotics or for the use of granulocyte colony-stimulating factor (G-CSF) (Pierre Fenauxa et al. Leukemia Research 2010). We used a retrospective survey of 98 high risk MDS and AML patients treated with Azacitidine, to develop a predicting model for infection during each cycle of Azacitidine therapy. Methods: We retrospectively studied 82 high risk MDS and 16 AML patients treated with 456 azacitidine cycles between 9.2008 and 7.2011at 11 institutions from Israel. Information, of complete blood count, creatinine and liver enzymes was documented prior to initiation of each cycle. Results: Patients' median age was 71 (range 27–92) and 57 (58%) of them males. Poor cytogenetic abnormalities were detected in 30.8% (25 of 82 patients with available cytogenetic) and 65 (67%) were transfusions dependent. The median interval between the initial diagnosis and the initiation of azacitidine therapy was 187 days (range 4 days – 18 years). Azacitidine was administrated as first line therapy in 24 (24%) of patients, 37 (38%) had failed growth factors, 5 (5%) were relapsing after allogeneic transplantation and 32 (33%) were given different chemotherapies prior to azacitidine therapy. Doses and schedule of azacitidine data were available for 98% (446/456) of cycles. The prevalence of 7 days cycles of 75mg/m2, 5 days cycles of 75mg/m2 or attenuated doses were 50.4%, 30%, 16.9% respectively. Adverse events were obtained from patient's charts. 13 major bleeding and 78 infections episodes (2.85% and 16.9% of all cycles) were recorded. Due to the low number of bleeding events we focused on factors predicting infection episodes. Infection rates of 22.7%, 14.2% and 6.9% correlated with azacitidine dose (75mg/m2x7d Vs 5d) and lower respectively). Excluding 87 cycles of doses lower than 75mg/m2 for 5 days, predictors of infections were evaluated in 369 cycles. Nine parameters were included in final analysis: age, sex, cytogenetics, being transfusion dependent prior to first cycle, time from diagnosis to the first cycle, azacitidine dose and neutrophil, thrombocyte and creatinine values prior to each cycle. The odd ratio off infections related to neutrophils count was higher than ANC, so we used neutrophils counts as a predictor. For each cycle we considered full 7 days Vs 5 days schedule, neutrophil above or below 500 cells/mcl, platelet above or below 20,000 cells/mcl and creatinine level prior to the first day of cycle. In univariate analysis neutrophil below 500, platelet below 20,000, creatinine level, azacitidine dose and being transfusion dependent were correlated with infection. In a multivariate analysis (table 1) transfusion dependency and platelets lower than 20,000 were the only significant parameters. Risk of infection was higher when a full seven days cycle was administrated but haven't reach statistical significance (p=0.07). Conclusions: Transfusion dependency prior to first cycle and platelets lower than 20,000 prior to each cycle, are the main significant risk factors for infections during azacitidine therapy. Neutropenia and age are known risk factors for infections in general, but were not significant in our study. We assume that in high risk MDS patients when most off the patients are old and neutropenic, thrombocytopenia is a surrogate marker of disease status which makes the patient more prone to infections. Therefore physicians should considerer these two parameters prior to every azacitidine cycle as guidance in the debate of concurrent prophylactic antibiotics, G-CSF or a tolerable dose of azacitidine. Our findings should be confirmed in a larger sample set but may pave the road for prospective studies of infection prophylaxis during azacitidine therapy. Disclosures: No relevant conflicts of interest to declare.

Exchange Transfusion and Leukapheresis in Pediatric AML Patients with High Risk of Early Death for Bleeding and Leukostasis

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 3741-3741
Author(s):  
Ursula Creutzig ◽  
Claudia Rossig ◽  
Michael Dworzak ◽  
Arendt von Stackelberg ◽  
Wilhelm Woessmann ◽  
...  
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Exchange Transfusion ◽  
Clinical Symptoms ◽  
Conflicts Of Interest ◽  
Significant Risk ◽  
Early Death ◽  
Myelogenous Leukemia ◽  
Acute Monocytic Leukemia ◽  
Metabolic Disturbances

Abstract Background. The risk of early death (ED) due to bleeding and/or leukostasis is high in AML patients with initial hyperleukocytosis (white blood cell count [WBC] > 100 000/µl) and highest in those with hyperleukocytosis and mono- or myelomonocytic leukemia (FAB M4/M5). (Creutzig, et al 1987) Within the AML-BFM studies, emergency strategies for children with AML and high risk for bleeding and leukostasis included exchange transfusion (ET) or leukapheresis (LPh). In order to determine whether these interventions reduced the rate of ED, 1251 AML-BFM patients from the trials AML-BFM 98 and 04 were analyzed. Risk factors for ED and interventions performed were verified focusing on patients with hyperleukocytosis. Patients . 238 of 1251 (19%) AML-patients <18 years of age (FAB M3 excluded) presented with hyperleukocytosis. Twenty-three out of 1251 (1.8%) patients died by bleeding and leukostasis within 15 days from diagnosis, 18 (78%) of these 23 ED patients had hyperleukocytosis. Seventy-two patients received ET and 17 LPh (including 14 patients with WBC counts < 100 000/µl). 149 patients with hyperleukocytosis did not receive ET/LPh. The median age of patients receiving ET was significantly lower compared to those with LPh (3.5 years vs 12.6 years, p = 0.015). WBC counts were similar in both treatment groups (ET median 224 000/µl vs LPh 218 000/µl, p = 0.20). Results. The percentage of ED by bleeding/leukostasis increased with higher WBC counts and was highest in 105 patients with WBC > 200 000/µl (14.3%). The ED rates were even higher in patients with FAB M4/M5 and hyperleukocytosis >200 000/µl compared to others with WBC >200 000/µl (M4/M5 13/65 [20%] vs. others 2/40 [5%], p=0.04). Patients with WBC counts >200 000/µl did slightly better with ET or LPh compared to those without ET/LPh (ED rate 7.5 % vs 21.2 %, p=0.055). Patients with WBC between 100 000/µl and 200 000/µl received ET/LPh less frequently compared to those with WBC >200 000/µl (22/133 [17%] vs. 53/105 [50%]). ET/LPh was mainly given in case of clinical symptoms of bleeding or leukostasis or coagulopathies or insufficient reduction (or increase) of WBC counts despite low dose chemotherapy. 15/80 (19%) patients with FAB M4/5 and WBC 100 000-200 000/µl received ET/LPh and none of these patients died early. ET/LPh was even given in 14 patients with WBC <100 000/µl because of clinical symptoms of bleeding or leukostasis or coagulopathies or rising WBC counts. In multivariate analysis WBC >200 000/µl was the strongest independent risk factor for ED (hazard ratio =15.0, 95% confidence interval 4.9-46.3, p(chi)<0.0001). FAB M4/M5 subtypes, general condition grade 4 and initial bleeding were also significant risk factors. Application of ET/LPh seems to have a non-significant benefit for a reduced ED rate by bleeding/leukostasis (p=0.13). The assessment of the general clinical condition of the patients plays a major role for the decision for ET/LPh. However, this possibly selective cofactor could not be included completely in our calculation because of lack of standardized assessments and documentation of clinical reasons for decision making in particular in patients without ET/LPh. There was no difference in ED rates between ET and LPh. (2/17 vs 5/72, p =0.61). Compared to LPh, ET can be given without time delay. ET is easier to perform especially in young children who need smaller exchange volumes, as well as in adolescents where it can be applied also as partial ET. ET also corrects metabolic disturbances and avoids deterioration of coagulation. Conclusion. Our data confirm the high risk of bleeding/leukostasis in patients with hyperleukocytosis. Although we could only disclose a trend for a clinical benefit of ET/LPh in this retrospective analysis - probably due to some negative selection bias in patients with the intervention - we strongly advocate ET/LPh in AML patients with WBC >200 000/µl, and in particular in those with FAB M4/M5 subtypes or with clinical symptoms of bleeding or leukostasis or coagulopathies even with lower WBC (100 000/µl - 200 000/µl). Creutzig, U. et al. (1987) Early deaths due to hemorrhage and leukostasis in childhood acute myelogenous leukemia: Associations with hyperleukocytosis and acute monocytic leukemia. Cancer,60, 3071-3079. Disclosures No relevant conflicts of interest to declare.

A 30-year experience with mixed-type total anomalous pulmonary venous connection: a word of caution

2016 ◽  
Vol 27 (5) ◽  
pp. 870-876 ◽  
Author(s):  
Brian Kogon ◽  
Jan Fernandez ◽  
Subhadra Shashidharan ◽  
Kirk Kanter ◽  
Bahaaldin Alsoufi
Keyword(s):  
Risk Factors ◽  
Cardiopulmonary Bypass ◽  
Pulmonary Vein ◽  
Mixed Type ◽  
Significant Risk ◽  
Pulmonary Vein Stenosis ◽  
Clinical Records ◽  
Vein Stenosis ◽  
Anomalous Pulmonary Venous Connection

AbstractBackgroundPatients with total anomalous pulmonary venous connection can be problematic, particularly those with mixed-type pathology. We aimed to describe a cohort of patients with mixed-type anomalous drainage, highlighting the treatment challenges, and identifying risk factors for poor outcome.MethodsWe reviewed the clinical records of patients who underwent repair for mixed-type total anomalous pulmonary venous connection between 1986 and 2015.ResultsA total of 19 patients were identified. The median age and weight of patients at surgery were 18 days (with a range from 1 to 185) and 3.4 kg (with a range from 1.9 to 6.5), respectively. Venous anatomy included a combination of duplicate supracardiac (four), supracardiac and cardiac (11), and supracardiac and infracardiac (four) drainage. Out of 19 patients, six (32%) died within 30 days or the initial hospital stay; two additional patients died from progressive pulmonary vein stenosis at 72 and 201 days, respectively, resulting in 42% mortality within the 1st year. Follow-up data were available for 8/11 long-term survivors. The median follow-up period was 7.3 years (with a range from 1.8 to 15.7). Only one patient underwent re-intervention for recurrent pulmonary vein stenosis. For surgical mortality, no statistically significant risk factors were identified, although the risk trended to be higher (p⩽0.1) with lower age and weight, an infracardiac component, and prolonged cardiopulmonary bypass. For 1-year mortality, the risk became significant (p⩽0.05) with a lower weight (p=0.01), an infracardiac component (p=0.03), and prolonged cardiopulmonary bypass (p=0.04).ConclusionThe surgical and 1-year mortality in patients with mixed-type total anomalous pulmonary venous connection is high. On the other hand, among patients who survive past the 1st year, most have good outcomes without subsequent sequelae.

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