scholarly journals Hemorrhage During Induction Chemotherapy in Neuroblastoma: Additional Risk Factors in High-Risk Patients

2021 ◽  
Vol 9 ◽  
Author(s):  
Valerio Voglino ◽  
Giorgio Persano ◽  
Alessandro Crocoli ◽  
Aurora Castellano ◽  
Annalisa Serra ◽  
...  
Keyword(s):  
High Risk ◽  
Induction Chemotherapy ◽  
Management Strategies ◽  
Laboratory Data ◽  
Tube Placement ◽  
Clotting Factors ◽  
Additional Risk ◽  
High Risk Patients ◽  
Hemorrhagic Complications ◽  
Risk Patients

Background: Neuroblastoma is the most common solid extracranial tumor in children. Patients affected by neuroblastoma are stratified into low, intermediate, and high risk in terms of event-free and overall survival. Some high-risk patients have an additional risk of acute hemorrhagic complications during induction chemotherapy.Aim: To find easily and rapidly assessed parameters that help clinicians identify those patients affected by high-risk neuroblastoma who have an additional risk of hemorrhagic complications.Methods: The clinical notes of patients diagnosed with high-risk neuroblastoma from January 2013 until February 2021 were retrospectively reviewed. Clinical, demographic and laboratory data, biological characteristics of the tumor, and information about treatment and hospital stay were identified.Results: In the examined period, 44 patients were diagnosed with high-risk neuroblastoma. Four of these patients had hemorrhagic complications within 2–7 days after the initiation of induction chemotherapy; two patients had hemothorax, one patient had hemoperitoneum and one patient had hemothorax and hemoperitoneum. The patient with isolated hemoperitoneum was treated with blood components transfusions, clotting factors and colloids infusions; the three patients with hemothorax underwent thoracostomy tube placement and respiratory support. At initial presentation, patients who suffered from hemorrhagic complications had a higher degree of hypertension (stage 2, p = 0.0003), higher levels of LDH (median 3,745 U/L, p = 0.009) and lower levels of hemoglobin (mean 7.6 gr/dl, p = 0.0007) compared to other high-risk patients.Conclusions: A subgroup of “additional” high-risk patients can be identified within the high-risk neuroblastoma patients based on mean arterial pressure, LDH levels and hemoglobin levels at presentation. Further studies to define cut-off values and optimal management strategies for these patients are needed.

scholarly journals Uptake and detection rate of a stepwise cardiometabolic disease detection program in primary care—a cohort study

2019 ◽  
Vol 30 (3) ◽  
pp. 402-407
Author(s):  
Daphne M Stol ◽  
Monika Hollander ◽  
Ilse F Badenbroek ◽  
Mark M J Nielen ◽  
François G Schellevis ◽  
...  
Keyword(s):  
Risk Factors ◽  
Primary Care ◽  
Cohort Study ◽  
High Risk ◽  
Newly Diagnosed ◽  
Additional Risk ◽  
High Risk Patients ◽  
Detection Program ◽  
Risk Patients

Abstract Background Early detection and treatment of cardiometabolic diseases (CMD) in high-risk patients is a promising preventive strategy to anticipate the increasing burden of CMD. The Dutch guideline ‘the prevention consultation’ provides a framework for stepwise CMD risk assessment and detection in primary care. The aim of this study was to assess the outcome of this program in terms of newly diagnosed CMD. Methods A cohort study among 30 934 patients, aged 45–70 years without known CMD or CMD risk factors, who were invited for the CMD detection program within 37 general practices. Patients filled out a CMD risk score (step 1), were referred for additional risk profiling in case of high risk (step 2) and received lifestyle advice and (pharmacological) treatment if indicated (step 3). During 1-year follow-up newly diagnosed CMD, prescriptions and abnormal diagnostic tests were assessed. Results Twelve thousand seven hundred and thirty-eight patients filled out the risk score of which 865, 6665 and 5208 had a low, intermediate and high CMD risk, respectively. One thousand seven hundred and fifty-five high-risk patients consulted the general practitioner, in 346 of whom a new CMD was diagnosed. In an additional 422 patients a new prescription and/or abnormal diagnostic test were found. Conclusions Implementation of the CMD detection program resulted in a new CMD diagnosis in one-fifth of high-risk patients who attended the practice for completion of their risk profile. However, the potential yield of the program could be higher given the considerable number of additional risk factors—such as elevated glucose, blood pressure and cholesterol levels—found, requiring active follow-up and presumably treatment in the future.

Antiplatelet therapy for the prevention of peri-coiling thromboembolism in high-risk patients with ruptured intracranial aneurysms

2017 ◽  
Vol 127 (6) ◽  
pp. 1326-1332 ◽  
Author(s):  
Nancy J. Edwards ◽  
Wesley H. Jones ◽  
Aditya Sanzgiri ◽  
Juan Corona ◽  
Mark Dannenbaum ◽  
...  
Keyword(s):  
High Risk ◽  
Antiplatelet Therapy ◽  
Intracranial Aneurysms ◽  
Treated Group ◽  
Parent Artery ◽  
Aneurysm Neck ◽  
High Risk Patients ◽  
Ruptured Aneurysms ◽  
Hemorrhagic Complications ◽  
Risk Patients

OBJECTIVEThe most frequent procedural complication of the endovascular treatment of intracranial aneurysms is a thromboembolic event (TEE); in a subset of patients, such events will cause permanent neurological disability. In patients with unruptured aneurysms, increasing evidence supports the use of periprocedural antiplatelet therapy to prevent TEEs. The object of this study was to evaluate whether patients with ruptured aneurysms and subarachnoid hemorrhage would also benefit from periprocedural antiplatelet therapy.METHODSThe authors reviewed a prospective registry of 169 patients with endovascularly treated intracranial aneurysms to delineate angiographic features associated with periprocedural TEEs. They then performed a controlled before-and-after study in 79 patients with ruptured aneurysms who were deemed to be at high risk for TEEs (for example, patients with at least 1 angiographic feature associated with TEEs) to evaluate whether selective aspirin administration would reduce the rate of periprocedural thromboembolism without increasing major hemorrhagic complications.RESULTSSix angiographic features were associated with periprocedural TEEs in the study cohort: wide aneurysm neck, coil or loop protrusion, small parent artery diameter, an incorporated branch, intraprocedural thrombus formation, and intracranial parent vessel atherosclerosis. Aspirin administration to high-risk patients significantly decreased the rate of periprocedural TEEs, from 53.8% in the control group to 10.6% in the aspirin-treated group (p = 0.001). The reduction in TEEs in the aspirin-treated group continued to be statistically significant even when adjusted for age, sex, cardiovascular risk factors (smoking, diabetes, hypertension, dyslipidemia, coronary artery disease), and factors associated with TEEs in other large studies (wide aneurysm neck, aneurysm size ≥ 10 mm), with an adjusted OR of 0.16 (95% CI 0.03–0.8). There were no major systemic hemorrhagic complications, and aspirin did not increase the risk of aneurysm rebleeding, symptomatic intracranial hemorrhage, or major external ventricular drain (EVD)–associated hemorrhage (p = 0.3), though there was an increase in asymptomatic, minor (< 1 cm) EVD-associated hemorrhage in the aspirin-treated group (p = 0.02).CONCLUSIONSThe study findings suggest that for ruptured aneurysm patients with high-risk features, antiplatelet therapy can significantly reduce the rate of periprocedural TEE without increasing major systemic or intracranial hemorrhages.

DPEJ Tube Placement Prevents Aspiration in High-Risk Patients

2005 ◽  
Vol 100 ◽  
pp. S285-S286
Author(s):  
Panagiotis H. Panagiotakis ◽  
Kristen Hilden ◽  
Maydeen Ogara ◽  
James A. DiSario ◽  
John C. Fang
Keyword(s):  
High Risk ◽  
Tube Placement ◽  
High Risk Patients ◽  
Risk Patients

DPEJ Tube Placement Prevents Aspiration Pneumonia in High-Risk Patients

2008 ◽  
Vol 23 (2) ◽  
pp. 172-175 ◽  
Author(s):  
Panagiotis H. Panagiotakis ◽  
James A. DiSario ◽  
Kristen Hilden ◽  
Maydeen Ogara ◽  
John C. Fang
Keyword(s):  
High Risk ◽  
Aspiration Pneumonia ◽  
Tube Placement ◽  
High Risk Patients ◽  
Risk Patients

scholarly journals Effect of Individualized vs Standard Blood Pressure Management Strategies on Postoperative Organ Dysfunction Among High-Risk Patients Undergoing Major Surgery

JAMA ◽  
2017 ◽  
Vol 318 (14) ◽  
pp. 1346 ◽  
Author(s):  
Emmanuel Futier ◽  
Jean-Yves Lefrant ◽  
Pierre-Gregoire Guinot ◽  
Thomas Godet ◽  
Emmanuel Lorne ◽  
...  
Keyword(s):  
Blood Pressure ◽  
High Risk ◽  
Organ Dysfunction ◽  
Management Strategies ◽  
Major Surgery ◽  
Pressure Management ◽  
High Risk Patients ◽  
Blood Pressure Management ◽  
Risk Patients

scholarly journals Utilization of Early Invasive Management Strategies for High-Risk Patients With Non–ST-Segment Elevation Acute Coronary Syndromes

JAMA ◽  
2004 ◽  
Vol 292 (17) ◽  
pp. 2096 ◽  
Author(s):  
Deepak L. Bhatt ◽  
Matthew T. Roe ◽  
Eric D. Peterson ◽  
Yun Li ◽  
Anita Y. Chen ◽  
...  
Keyword(s):  
High Risk ◽  
Acute Coronary Syndromes ◽  
Management Strategies ◽  
St Segment Elevation ◽  
High Risk Patients ◽  
St Segment ◽  
Risk Patients ◽  
Coronary Syndromes ◽  
Invasive Management

scholarly journals Nasal unsedated seated percutaneous endoscopic gastrostomy (nuPEG): a safe and effective technique for percutaneous endoscopic gastrostomy placement in high-risk candidates

2017 ◽  
Vol 9 (2) ◽  
pp. 105-109 ◽  
Author(s):  
Adam McCulloch ◽  
Ovishek Roy ◽  
Dunecan Massey ◽  
Rachel Hedges ◽  
Serena Skerratt ◽  
...  
Keyword(s):  
High Risk ◽  
Percutaneous Endoscopic Gastrostomy ◽  
Case Series ◽  
Nutrition Support ◽  
Tube Placement ◽  
Modified Technique ◽  
Percutaneous Endoscopic Gastrostomy Placement ◽  
High Risk Patients ◽  
Endoscopic Gastrostomy ◽  
Risk Patients

ObjectivePercutaneous endoscopic gastrostomy (PEG) tube placement is associated with a high risk of cardiorespiratory complications in patients with significant respiratory compromise. This study reports a case series of high-risk patients undergoing PEG placement using a modified technique—nasal unsedated seated PEG (nuPEG) placement.DesignRetrospective review of 67 patients at high risk of complications undergoing PEG placement between September 2012 and December 2016.SettingUK specialist tertiary centre for clinical nutrition support.InterventionsPatients underwent ‘push’ PEG placement using nasal endoscopy without sedation in a seated position.Main outcome measuresProcedural success and tolerability, short term (within 24 hours), medium term (24 hours to 30 days) complications and survival were recorded.Results67 patients underwent 68 nuPEG placements. The majority had motor neuron disease (46/67). One patient developed a lower respiratory tract infection the following day. Two patients experienced accidental displacement of their PEG within 2 weeks. One patient died within 30 days of nuPEG insertion due to reasons unrelated to the procedure. Endoscopic comfort scores of 1 or 2 (98.0%) indicated good tolerance. A failure rate of 10.5% was attributed to intrathoracic displacement of the stomach, almost certainly due to the advanced stage of the neurological disease and associated diaphragmatic weakness.ConclusionsOur experience with the nuPEG technique suggests that it is safe and well tolerated in high-risk patients. As a result, it has now entirely supplanted radiologically inserted gastrostomy insertion in our institution and we recommend it as the method of choice for gastrostomy tube insertion in such patients.

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