Background: Our aim was to investigate the impact of the extent of surgical resection on local recurrence and survival in high-risk patients treated with the Chicago Pilot II protocol. Methods: Retrospective chart rev...Background: Our aim was to investigate the impact of the extent of surgical resection on local recurrence and survival in high-risk patients treated with the Chicago Pilot II protocol. Methods: Retrospective chart review was performed on 30 patients enrolled in the Chicago Pilot II protocol between 1995 and 2003. Variables studied were location of tumor, extent of resection, timing and location of recurrence, MYCN amplification, surgical complications, event-free survival, and overall survival (OS).Operative reports and postoperative meta-iodobenzylguanidine scans were used to assess extent of resection. Complete resection (CR) was defined as no gross residual tumor including primary and nodal disease. Results: Three-year event-free survival and OS of this cohort of 30 patients was 58%and 82%, respectively. Only 1 patient developed a local recurrence, whereas metastatic recurrent disease was observed in 13 (43%)-of the 30; and this subset had a significantly worse OS (23%vs 94%, P = .001). The most common relapse location was in bone. Patients with incomplete resection (IR) (11/30) and CR (19/30) had recurrence rates of 64%(7/11) and 32%(6/19, P = .12), respectively. Event-free survival was significantly better for patients with CR (68%) vs IR(27%; P = .05; odds ratio, 2.9). Overall survival rates for patients with CR vs IR were 68%vs 55%, respectively (P = .25). Conclusions: Recurrence rate was the significant determinant of survival. Patients with CR had lower recurrence rates; however, they did not have improved local control. Final outcome of patients with unfavorable neuroblastoma will be determined by metastatic recurrence, not by extent of resection.展开更多
The purpose of this study was to provide up-to-date data on the nature of sport related injury (SRI) presenting to a large emergency department in Ireland. Data were collected retrospectively on all children under 17 ...The purpose of this study was to provide up-to-date data on the nature of sport related injury (SRI) presenting to a large emergency department in Ireland. Data were collected retrospectively on all children under 17 years of age with a SRI, presenting to the emergency department of a major teaching hospital, over a 6- month period, and entered into a Microsoft Access database. A total of 1143 SRIs were identified which had occurred over a 6- month period, from 53 different sports. There was a high proportion of humerus and back SRIs in females, and a higher proportion of falls in females. Males were more frequently involved in collisions. Children with SRI were not using protective equipment in 94% of cases. Advice regarding rest, ice, compresssion and elevation (RICE)/general injury advice was given to 25% of patients and regarding injury preventive measures in less than 0.1% of cases. Of children, 28% had previously attended with a SRI. We also observed a lower rate of analgesia prescription to children under age 4, compared to children of an older age, and rarity of topical analgesic prescription. Overall, 10% of SRIs required admission, with 65% of these cases needing orthopaedic intervention. Conclusion:The data provided from this study should raise awareness of the different aspects of sport related injuries affecting children, and may help to provide the impetus for suggesting direction and guidance for reducing such events.展开更多
文摘Background: Our aim was to investigate the impact of the extent of surgical resection on local recurrence and survival in high-risk patients treated with the Chicago Pilot II protocol. Methods: Retrospective chart review was performed on 30 patients enrolled in the Chicago Pilot II protocol between 1995 and 2003. Variables studied were location of tumor, extent of resection, timing and location of recurrence, MYCN amplification, surgical complications, event-free survival, and overall survival (OS).Operative reports and postoperative meta-iodobenzylguanidine scans were used to assess extent of resection. Complete resection (CR) was defined as no gross residual tumor including primary and nodal disease. Results: Three-year event-free survival and OS of this cohort of 30 patients was 58%and 82%, respectively. Only 1 patient developed a local recurrence, whereas metastatic recurrent disease was observed in 13 (43%)-of the 30; and this subset had a significantly worse OS (23%vs 94%, P = .001). The most common relapse location was in bone. Patients with incomplete resection (IR) (11/30) and CR (19/30) had recurrence rates of 64%(7/11) and 32%(6/19, P = .12), respectively. Event-free survival was significantly better for patients with CR (68%) vs IR(27%; P = .05; odds ratio, 2.9). Overall survival rates for patients with CR vs IR were 68%vs 55%, respectively (P = .25). Conclusions: Recurrence rate was the significant determinant of survival. Patients with CR had lower recurrence rates; however, they did not have improved local control. Final outcome of patients with unfavorable neuroblastoma will be determined by metastatic recurrence, not by extent of resection.
文摘The purpose of this study was to provide up-to-date data on the nature of sport related injury (SRI) presenting to a large emergency department in Ireland. Data were collected retrospectively on all children under 17 years of age with a SRI, presenting to the emergency department of a major teaching hospital, over a 6- month period, and entered into a Microsoft Access database. A total of 1143 SRIs were identified which had occurred over a 6- month period, from 53 different sports. There was a high proportion of humerus and back SRIs in females, and a higher proportion of falls in females. Males were more frequently involved in collisions. Children with SRI were not using protective equipment in 94% of cases. Advice regarding rest, ice, compresssion and elevation (RICE)/general injury advice was given to 25% of patients and regarding injury preventive measures in less than 0.1% of cases. Of children, 28% had previously attended with a SRI. We also observed a lower rate of analgesia prescription to children under age 4, compared to children of an older age, and rarity of topical analgesic prescription. Overall, 10% of SRIs required admission, with 65% of these cases needing orthopaedic intervention. Conclusion:The data provided from this study should raise awareness of the different aspects of sport related injuries affecting children, and may help to provide the impetus for suggesting direction and guidance for reducing such events.
