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Balasubramanian I, Malhotra C. Why is end-of-life inpatient cost high among cancer patients? A prospective cohort study. Cancer Med 2024; 13:e7057. [PMID: 38457240 PMCID: PMC10923043 DOI: 10.1002/cam4.7057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 01/23/2024] [Accepted: 02/16/2024] [Indexed: 03/10/2024] Open
Abstract
BACKGROUND Inpatient cost for cancer patients is high during the last year of life, but reasons for this are not understood. We aim to understand the type of hospital admissions and inpatient services associated with an increase in inpatient cost in last year of life. METHODS We used survey and billing records of 439 deceased patients with a solid metastatic cancer, enrolled in a prospective cohort study. Based on cost per day of inpatient admissions, we classified admissions as low- or high-intensity. We decomposed the inpatient cost into cost for different inpatient services. We examined the inpatient cost in the last year of life. We also assessed patient characteristics associated with higher inpatient cost in the next 3 months. RESULTS Towards death, proportion of inpatient cost for "maintenance care" increased while that for intensive care unit (ICU) and surgeries decreased. Low-intensity, compared to high-intensity admissions had a higher proportion of cost for "maintenance care" and a lower proportion for surgeries and ICU. Number of low-intensity admissions increased more steeply towards death than high-intensity admissions. Both admission types contributed equally to the share of inpatient cost. Older patients were less likely to have a high-intensity admission (β:-0.01, CI: -0.02, 0.00). Greater preference for life extension (β: 0.06, CI: 0.01, 0.11) and inaccurate prognostic belief were associated with higher cost of high-intensity admissions (β: 0.32, CI: 0.03, 0.62). CONCLUSIONS Findings suggest that inpatient costs in last year of life may be reduced if maintenance care is availed in low-cost settings such as hospice/palliative care alongside steps to reduce non-beneficial surgeries and ICU admissions.
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Affiliation(s)
| | - Chetna Malhotra
- Lien Centre for Palliative Care, Duke‐NUS Medical SchoolSingaporeSingapore
- Program in Health Services and Systems Research, Duke‐NUS Medical SchoolSingaporeSingapore
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Togashi S, Masukawa K, Aoyama M, Sato K, Miyashita M. Aggressive End-of-Life Treatments Among Inpatients With Cancer and Non-cancer Diseases Using a Japanese National Claims Database. Am J Hosp Palliat Care 2023:10499091231216888. [PMID: 38019734 DOI: 10.1177/10499091231216888] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2023] Open
Abstract
To describe aggressive treatments at end-of-life among inpatients with cancer and non-cancer diseases and to evaluate factors associated with these treatments using the Japanese national database (NDB). We conducted a retrospective cohort study among inpatients aged ≥ 20 years who died between 2012 and 2015 using a sampling dataset of NDB. The outcome was the proportion of aggressive treatments in the last 14 days of life. We considered the underlying causes of death as cancer, dementia/senility, and heart, cerebrovascular, renal, liver, respiratory, and neurodegenerative diseases. We analyzed 54,105 inpatients, with underlying cause of death distributed as follows: cancer, 24.9%; heart disease, 16.5%; respiratory disease, 12.3%; and cerebrovascular disease, 9.7%. The proportion of intensive care unit (ICU) admission was 9.7%, being the highest in heart disease (20.5%), followed by cerebrovascular diseases (12.6%), and least in dementia/senility (.6%). The proportion of cardiopulmonary resuscitation was 19.6%, being the highest in heart disease (38.1%), followed by renal diseases (19.5%), and least in cancer (6.2%). Multivariate logistic regression analysis revealed that having heart diseases, cerebrovascular diseases, younger age, less comorbidities, and shorter length of stay were associated with an increasing risk of aggressive treatments in the last 14 days of life. The proportion of aggressive treatments at the end-of-life varies depending on the disease; additionally, these treatments were associated with having heart diseases, younger age, less comorbidity, and shorter length of stay. Our findings may help develop and set benchmarks for quality indicators at the end-of-life for patients with non-cancer diseases.
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Affiliation(s)
- Shintaro Togashi
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Japan
- Center for Outcomes Research and Economic Evaluation for Health, National Institute of Public Health, Wako-shi, Japan
| | - Kento Masukawa
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Maho Aoyama
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kazuki Sato
- Division of Integrated Health Sciences, Department of Nursing for Advanced Practice, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Mitsunori Miyashita
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Japan
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Agrawal KU, Limaye Joshi K, Gad M. A Rare Case of Fulminant Acute Postoperative Morganella morganii Endophthalmitis. Ocul Immunol Inflamm 2023; 31:123-126. [PMID: 34802374 DOI: 10.1080/09273948.2021.1993269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
PURPOSE The authors present a case of a 60-year-old Indian female presented with sudden loss of vision in the right eye three days after an uneventful cataract surgery which revealed a rare organism and which was treated successfully. METHODS She was diagnosed with acute postoperative endophthalmitis with fulminant disease and on further work up, culture showed Morganella morganii (gram negative bacilli). RESULTS She was successfully treated with intravitreal imipenem, dexamethasone and vitrectomy. A review of literature was conducted to identify and discuss additional reports on similar cases. As per PubMed search with keywords "Morganella morganii endophthalmitis" this is the best achieved visual outcome to date in a case of acute post-operative Morganella morganii endophthalmitis. CONCLUSION Intravitreal imipenem can be considered to treat Morganella morganii endophthalmitis. Aggressive treatment in these patients can help in improving visual outcome.
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Affiliation(s)
| | | | - Maikel Gad
- Biochemistry, Middle Tennessee State University, Murfreesboro, Tennessee, USA
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Abstract
There is no consensus on a treatment strategy for spinal giant cell tumor of bone (GCTB) because of the difficulty in their treatment. Treatment options often include the use of the controversial denosumab, an antibody therapy aimed at tumor shrinkage, different curettage techniques, resection, or a combination of these therapies. The current study aimed to identify treatment methods associated with favorable outcomes in patients with spinal GCTB. We retrospectively reviewed 5 patients with spinal GCTB, including patients with tumors of the sacrum, treated at our hospital between September 2011 and November 2020. Two men and 3 women were included in the study. The median follow-up period was 74 months (range: 14-108 months). We surveyed the tumor site, treatment method, denosumab use, and outcomes. The median age was 17 years (range: 17-42 years). There were 2 cases of sacral GCTB and 1 case each of lumbar, cervical, and thoracic vertebral GCTB. The comorbidities observed included hepatitis, malignant lymphoma, atopic dermatitis, and asthma. The treatment method included zoledronic acid after embolization and denosumab, denosumab only, curettage and posterior fusion, and curettage resection after embolization and anterior and posterior fusion. Denosumab was used in all cases. Three patients were continuously disease-free, 1 patient with no evidence of disease, and 1 patient alive with disease. Aggressive treatment, especially surgical treatment, may lead to good results in spinal GCTB.
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Affiliation(s)
- Kazuhiko Hashimoto
- Department of Orthopedic Surgery, Kindai University Hospital, Osaka, Japan
- *Correspondence: Kazuhiko Hashimoto, Department of Orthopedic Surgery, Kindai University Hospital, Osaka-Sayama City, Osaka 589-8511, Japan (e-mail: )
| | - Shunji Nishimura
- Department of Orthopedic Surgery, Kindai University Hospital, Osaka, Japan
| | - Hiroshi Miyamoto
- Department of Orthopedic Surgery, Kindai University Hospital, Osaka, Japan
| | - Kensuke Toriumi
- Department of Orthopedic Surgery, Kindai University Hospital, Osaka, Japan
| | - Terumasa Ikeda
- Department of Orthopedic Surgery, Kindai University Hospital, Osaka, Japan
| | - Masao Akagi
- Department of Orthopedic Surgery, Kindai University Hospital, Osaka, Japan
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Qiao X, Shi J, Liu J, Liu J, Guo Y, Zhong M. Recurrence Rates of Intraosseous Ameloblastoma Cases With Conservative or Aggressive Treatment: A Systematic Review and Meta-Analysis. Front Oncol 2021; 11:647200. [PMID: 34094934 PMCID: PMC8170394 DOI: 10.3389/fonc.2021.647200] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 04/26/2021] [Indexed: 11/24/2022] Open
Abstract
Objective This study aimed to systematically investigate and compare the post-treatment recurrence of intraosseous ameloblastoma in patients treated with conservative or aggressive approaches. Methods Systemic searches of PubMed, Medline, Cochrane Library, and Embase databases from inception to October 28, 2020, were conducted. Studies that aimed to evaluate the recurrence of intraosseous ameloblastoma by conservative and aggressive treatment approaches were included. Results A total of 20 studies with 942 ameloblastoma cases were included. Fourteen studies included patients with ameloblastoma who received conservative treatment, and 16 studies reported the overall recurrence rate for patients undergoing aggressive treatment. The pooled results indicated that the recurrence rate for aggressive treatment [0.12, 95% confidence interval (CI) = 0.09–0.16] was significantly lower than that for conservative treatment, with a recurrence rate of 0.30 (95% CI = 0.23–0.39). Similar results were obtained when stratifying the participants by the histological classification. When trying stratification analysis following the original included studies, multicystic ameloblastoma presented a much higher recurrence rate than solid and unicystic ameloblastomas. Conclusion These findings supported the hypothesis that aggressive treatment might lead to a lower recurrence rate than conservative treatment. More studies and meta-analyses following the new histological classification of ameloblastomas are needed to validate and support the findings.
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Affiliation(s)
- Xue Qiao
- Department of Central laboratory, School and Hospital of Stomatology, China Medical University, Liaoning Province Key Laboratory of Oral Disease, Shenyang, China.,Department of Oral Biology, School and Hospital of Stomatology, China Medical University, Liaoning Province Key Laboratory of Oral Disease, Shenyang, China
| | - Junxiu Shi
- Department of Developmental Cell Biology, Cell Biology Division, Key Laboratory of Cell Biology, Ministry of Public Health, Key Laboratory of Medical Cell Biology, Ministry of Education, China Medical University, Shenyang, China
| | - Jiayi Liu
- Department of Oral Histopathology, School and Hospital of Stomatology, China Medical University, Liaoning Province Key Laboratory of Oral Disease, Shenyang, China
| | - Jinwen Liu
- Department of Periodontics, School and Hospital of Stomatology, China Medical University, Liaoning Province Key Laboratory of Oral Disease, Shenyang, China
| | - Yan Guo
- Department of Central laboratory, School and Hospital of Stomatology, China Medical University, Liaoning Province Key Laboratory of Oral Disease, Shenyang, China.,Department of Oral Biology, School and Hospital of Stomatology, China Medical University, Liaoning Province Key Laboratory of Oral Disease, Shenyang, China
| | - Ming Zhong
- Department of Central laboratory, School and Hospital of Stomatology, China Medical University, Liaoning Province Key Laboratory of Oral Disease, Shenyang, China.,Department of Oral Histopathology, School and Hospital of Stomatology, China Medical University, Liaoning Province Key Laboratory of Oral Disease, Shenyang, China.,Department of Stomatology, Xiang'an Hospital of Xiamen University, Xiamen, China
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Robausch M, Grössmann N, Wild C. Cancer care near the end-of-life in Austria: A retrospective data analysis. Eur J Cancer Care (Engl) 2021; 30:e13423. [PMID: 33554389 PMCID: PMC8365662 DOI: 10.1111/ecc.13423] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 08/04/2020] [Accepted: 01/11/2021] [Indexed: 11/28/2022]
Abstract
Objective Since end‐of‐life care (EOL) is an internationally accepted indicator for the quality of oncological care we aimed to investigate the current EOL care situation for Austrian cancer patients especially concerning the place of death cancer treatment hospitalisation near death and palliative care. Methods A retrospective data analysis was carried out based on Austrian routine inpatient data of the years 2012 to 2016. Data including the date of death of adult patients with a main hospital discharge diagnosis of a neoplasm were included. All analyses were source‐related and based on the place of residence. Results In total 80818 cancer patients have died between 2012 and 2016 of whom 53.4% died in the inpatient setting. Palliative care at the EOL (last hospitalisation) was present in 12.9% of patients whereby more than 50% were admitted two to 14 days before death. Considering cancer treatment at the EOL (30 days before death) 6.9% of cancer patients have received chemotherapy 1.7% radiation therapy and 0.75% were treated with a monoclonal antibody. Conclusion In international comparison Austria appears to do well on quality indicators concerning ICU‐admission and chemotherapy treatment average on hospital death and poorly on hospital admissions and timely referral for palliative care.
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Affiliation(s)
- Martin Robausch
- Austrian Institute for Health Technology Assessment (AIHTA), Vienna, Austria.,Austrian Health Insurance Fund (ÖGK), St. Pölten, Austria
| | - Nicole Grössmann
- Austrian Institute for Health Technology Assessment (AIHTA), Vienna, Austria
| | - Claudia Wild
- Austrian Institute for Health Technology Assessment (AIHTA), Vienna, Austria
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Gauvin C, Krishnan V, Kaci I, Tran-Thanh D, Bédard K, Albadine R, Leduc C, Gaboury L, Blais N, Tehfe M, Routy B, Florescu M. Survival Impact of Aggressive Treatment and PD-L1 Expression in Oligometastatic NSCLC. ACTA ACUST UNITED AC 2021; 28:593-605. [PMID: 33498159 DOI: 10.3390/curroncol28010059] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 11/03/2020] [Indexed: 12/25/2022]
Abstract
Background: Studies have shown that aggressive treatment of non-small cell lung cancer (NSCLC) with oligometastatic disease improves the overall survival (OS) compared to a palliative approach and some immunotherapy checkpoint inhibitors, such as anti-programmed cell death ligand 1 (PD-L1), anti-programmed cell death protein 1 (PD-1), and T-Lymphocyte-associated antigen 4 (CTLA-4) inhibitors are now part of the standard of care for advanced NSCLC. However, the prognostic impact of PD-L1 expression in the oligometastatic setting remains unknown. Methods: Patients with oligometastatic NSCLC were identified from the patient database of the Centre hospitalier de l’Université de Montréal (CHUM). “Oligometastatic disease” definition chosen is one synchronous metastasis based on the M1b staging of the eight IASLC (The International Association for the Study of Lung Cancer) Classification (within sixth months of diagnosis) or up to three cerebral metastasis based on the methodology of the previous major phase II randomized study of Gomez et al. We compared the OS between patients receiving aggressive treatment at both metastatic and primary sites (Group A) and patients receiving non-aggressive treatment (Group B). Subgroup analysis was performed using tumor PD-L1 expression. Results: Among 643 metastatic NSCLC patients, we identified 67 patients with oligometastasis (10%). Median follow-up was 13.3 months. Twenty-nine patients (43%) received radical treatment at metastatic and primary sites (Group A), and 38 patients (57%) received non-aggressive treatment (Group B). The median OS (mOS) of Group A was significantly longer than for Group B (26 months vs. 5 months, p = 0.0001). Median progression-free survival (mPFS) of Group A was superior than Group B (17.5 months vs. 3.4 months, p = 0.0001). This difference was still significant when controlled for primary tumor staging: stage I (p = 0.316), stage II (p = 0.024), and stage III (p = 0.001). In the cohort of patients who were not treated with PD-L1 inhibitors, PD-L1 expression negatively correlated with mOS. Conclusions: Aggressive treatments of oligometastatic NSCLC significantly improve mOS and mPFS compared to a more palliative approach. PD-L1 expression is a negative prognostic factor which suggests a possible role for immunotherapy in this setting.
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Duan H, He ZQ, Guo CC, Li JH, Wang J, Zhu Z, Sai K, Chen ZP, Jiang XB, Mou YG. Bone metastasis predicts poor prognosis of patients with brain metastases from colorectal carcinoma post aggressive treatment. Cancer Manag Res 2018; 10:2467-2474. [PMID: 30122996 PMCID: PMC6084076 DOI: 10.2147/cmar.s169563] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Purpose The presence of brain metastasis (BM) in patients with colorectal cancer (CRC) is usually associated with terminal-stage illness; however, a subgroup of patients receiving aggressive treatment can have a satisfactory prognosis. This study was designed to investigate the profile of prognostic factors in CRC patients with BM treated aggressively. Patients and methods CRC patients with BM were retrospectively reviewed. Survival analysis was performed to identify potential prognostic factors in the entire cohort of patients and a subgroup of patients treated aggressively. Aggressive treatments included surgical resection, radiotherapy, and/or chemotherapy. Overall survival was defined as the time between the diagnosis of BM and death or until the date of the last follow-up visit. Results A total of 78 CRC patients were confirmed as having BM. Sixty-eight of them had extracranial metastases at the time of their BM diagnosis. The most common sites of extracranial metastases were lung (n=51, 65.4%), followed by liver (n=25, 32.1%) and bone (n=12, 15.4%). Fifty-one patients who were treated aggressively had significantly longer overall survival than those who accepted palliative care (14.1 months vs 2.0 months, P<0.0001). Multivariate analysis was applied, and the results showed that aggressive treatment (n=51), recursive partitioning analysis class I/II (hazard ratio [HR]=0.27, 95% CI: 0.12–0.6, P=0.001), and fewer BM (HR=0.4, 95% CI: 0.21–0.78, P=0.07) predicted longer survival. In contrast, the presence of bone metastasis, rather than lung or liver metastasis, at the time of diagnosis of BM (HR=2.38, 95% CI: 1.08–5.28, P=0.032) predicted a poor prognosis. Conclusions Although the prognosis of CRC patients having BM is frequently very poor, those with good performance status and few brain lesions responded to aggressive treatment, while those with bone metastasis at the time of diagnosis of BM had relatively dismal survival rates, even when treated aggressively.
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Affiliation(s)
- Hao Duan
- Department of Neurosurgery/Neuro-Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China, ;
| | - Zhen-Qiang He
- Department of Neurosurgery/Neuro-Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China, ;
| | - Cheng-Cheng Guo
- Department of Neurosurgery/Neuro-Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China, ;
| | - Jue-Hui Li
- Department of Neurosurgery/Neuro-Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China, ;
| | - Jian Wang
- Department of Neurosurgery/Neuro-Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China, ;
| | - Zhe Zhu
- Department of Medicine, Division of Regenerative Medicine, University of California, San Diego, School of Medicine, La Jolla, CA, USA
| | - Ke Sai
- Department of Neurosurgery/Neuro-Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China, ;
| | - Zhong-Ping Chen
- Department of Neurosurgery/Neuro-Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China, ;
| | - Xiao-Bing Jiang
- Department of Neurosurgery/Neuro-Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China, ;
| | - Yong-Gao Mou
- Department of Neurosurgery/Neuro-Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China, ;
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Takahashi K, Sasaki A, Wada S, Wada Y, Tsukamoto K, Kosaki R, Ito Y, Sago H. The outcomes of 31 cases of trisomy 13 diagnosed in utero with various management options. Am J Med Genet A 2017; 173:966-971. [PMID: 28266126 DOI: 10.1002/ajmg.a.38132] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Revised: 10/16/2016] [Accepted: 12/15/2016] [Indexed: 11/11/2022]
Abstract
There are few reports on the prognosis of prenatally diagnosed trisomy 13 in relation to postnatal management. The aim of this study was to report on the prenatal and postnatal outcomes and postnatal management of trisomy 13 fetuses that were prenatally diagnosed at our center between 2003 and 2015. The data were retrospectively reviewed from medical records. Of the 31 cases of trisomy 13, 12 patients were diagnosed before 22 weeks of gestation, and 19 were diagnosed at or after 22 weeks of gestation. Nine families opted for termination of the pregnancy, 14 fetuses died, and 8 were born alive. Aggressive treatment was requested in two of the live births, with one patient achieving long-term survival (7 years). The other died during infancy (Day 61). One out of four who received palliative treatment is alive at two years of age with only nutrition supplementation. These three patients who achieved neonatal survival had few structural anomalies. Fetal death and early neonatal death are common in trisomy 13; however, fetuses that receive medical treatment for cases without major ultrasound abnormalities may achieve neonatal survival. Therefore, it is useful to provide comprehensive information, including precise ultrasound findings and treatment options, to parents with trisomy 13 fetuses during genetic counseling.
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Affiliation(s)
- Ken Takahashi
- Center of Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development (NCCHD), Tokyo, Japan
| | - Aiko Sasaki
- Center of Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development (NCCHD), Tokyo, Japan
| | - Seiji Wada
- Center of Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development (NCCHD), Tokyo, Japan
| | - Yuka Wada
- Center of Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development (NCCHD), Tokyo, Japan
| | - Keiko Tsukamoto
- Center of Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development (NCCHD), Tokyo, Japan
| | - Rika Kosaki
- Division of Medical Genetics, Department of Medical Subspecialties, National Center for Child Health and Development (NCCHD), Tokyo, Japan
| | - Yushi Ito
- Center of Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development (NCCHD), Tokyo, Japan
| | - Haruhiko Sago
- Center of Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development (NCCHD), Tokyo, Japan
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Abstract
GlySH-surfactant herbicide (GlySH), one of the most commonly used herbicides worldwide, has been considered as minimally toxic to humans. However, clinical toxicologists occasionally encounter cases of severe systemic toxicity. The US Environmental Protection Agency (EPA) states that 'GlySH' is of relatively low oral and acute dermal toxicity. It does not have anticholinesterase effect and no organophosphate-like central nervous system (CNS) effects. The clinical features range from skin and throat irritation to hypotension and death. Severe GlySH-surfactant poisoning is manifested by gastroenteritis, respiratory disturbances, altered mental status, hypotension refractory to the treatment, renal failure, and shock.[1] GlySH intoxication has a case fatality rate 3.2-29.3%. Pulmonary toxicity and renal toxicity seem to be responsible for mortality. Metabolic acidosis, abnormal chest X-ray, arrhythmias, and elevated serum creatinine levels are useful prognostic factors for predicting GlySH mortality.[2] There is no antidote and the mainstay of treatment for systemic toxicity is decontamination and aggressive supportive therapy. We report a case of acute pulmonary edema, which is a rare but severe manifestation of oral GlySH poisoning, where patient survived with aggressive supportive therapy.
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Affiliation(s)
- Darshana Sudip Thakur
- Department of Medicine, Indira Gandhi Government Medical College, Nagpur, Maharashtra, India
| | - Rajashree Khot
- Department of Medicine, Indira Gandhi Government Medical College, Nagpur, Maharashtra, India
| | - P P Joshi
- Department of Medicine, Indira Gandhi Government Medical College, Nagpur, Maharashtra, India
| | - Madhuri Pandharipande
- Department of Medicine, Indira Gandhi Government Medical College, Nagpur, Maharashtra, India
| | - Keshav Nagpure
- Department of Medicine, Indira Gandhi Government Medical College, Nagpur, Maharashtra, India
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Lee LW, Hsiao SH, Chen LK. Clinical treatment outcomes for 40 patients with bisphosphonates-related osteonecrosis of the jaws. J Formos Med Assoc 2012; 113:166-72. [PMID: 24630034 DOI: 10.1016/j.jfma.2012.04.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2012] [Accepted: 04/25/2012] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND/PURPOSE Bisphosphonates (BPs) are used to treat osteoporosis and bone metastases from malignancy. They may result in BPs-related osteonecrosis of the jaws (BRONJ) in a subset of patients receiving BPs. This study examined whether conservative or aggressive surgical approach could result in successful treatment of BRONJ lesions and assessed whether concomitant steroid administration or tobacco smoking habit might hinder the remission of BRONJ lesions. METHODS The 40 BRONJ patients were evenly divided into four different groups. Group 1 contained 10 patients with concomitant corticosteroid medication but without smoking habit. Group 2 contained 10 patients with smoking habit but without concomitant corticosteroid medication. Groups 3 and 4 each consisted of 10 patients without concomitant corticosteroid medication and smoking habit. To avoid bias, each group contained equal number of patients with different stages of BRONJ. Patients in Groups 1, 2, and 3 received conservative treatment, including antibiotic coverage, antibacterial solution irrigation, and minor surgical debridement. Patients in Group 4 were treated with aggressive surgical excision of necrotic bone segment. RESULTS The mean duration to achieve complete remission of BRONJ lesion was 19.7±0.6, 18.2±0.5, 13.0±1.0, and 7.6±1.1 months for patients in Groups 1, 2, 3 and 4, respectively. Student's t-test showed significant differences in the mean duration to achieve complete remission of BRONJ lesion between Groups 1 and 3, between Groups 2 and 3, between Groups 3 and 4, between Groups 1 and 4, and between Groups 2 and 4 (all p values < 0.001). CONCLUSION Although both conservative and aggressive surgical approaches can result in successful treatment of BRONJ lesions, aggressive surgical treatment needs a shorter mean duration to achieve complete remission of BRONJ lesion than conservative treatment. Concomitant corticosteroid administration or tobacco smoking may prolong the duration for complete remission of BRONJ lesion.
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Affiliation(s)
- Li-Wan Lee
- Department of Dentistry, Taipei City Hospital, Renai Branch, Taipei, Taiwan.
| | - Sheng-Huang Hsiao
- Department of Neurosurgery, Taipei City Hospital, Renai Branch, Taipei, Taiwan
| | - Li-Kai Chen
- Department of Dentistry, Taipei City Hospital, Zhongxiao Branch, Taipei, Taiwan
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