ABSTRACT
Background: Pediatric solid malignant neoplasms (PSMNs) are a significant cause of death among children. Our aim was to evaluate the pattern and frequency of PSMNs at our hospital in the United States and compare the results to data from other regions of the world. Materials and Methods: This is a retrospective review of 127 PSMNs in the Pathology database at Stony Brook University Medical Center (SBUMC) from 2000 to 2008. We compared our cases to a cohort of 101 cases from an academic hospital in India (1975-1982) (Christian Medical College and Hospital) and to reports from other parts of the world. Results: We report a male to female ratio of 1.16 : 1 and a mean age of 4.8 years for cases at SBUMC. Lymphomas and central nervous system (CNS) neoplasms were more common in the 5-12-year-old group while other major diagnostic groups were more common in the 0-4-year-old group. The top five most frequent tumor categories included CNS, sympathetic nervous system (SNS), soft tissue, lymphoid and renal tumors. Lymphomas were more common than soft tissue and SNS tumors in the United States' registries but all three occurred with equal frequency in our study. Tumors of the soft tissue and SNS were more frequent at SBUMC compared to registries around the world. At the academic hospital in India, the male to female ratio was 4 : 1 and the five most frequent tumor categories included lymphoid, SNS, CNS, renal and bone tumors. Lymphoid tumors made up a greater percentage and CNS tumors made up a lesser percentage of tumors at the hospital in India compared with SBUMC. The differences between CNS tumors, lymphomas and retinoblastomas between the two hospitals were statistically significant (P value <0.05 by Fisher's Exact test). Conclusions: Geographic differences in the incidence and histologic types of PSMNs exist. Despite advancements in diagnosis and treatment, PSMNs continue to be tragically lethal.
ABSTRACT
Objectives: To summarize incidence and risk factors for each main cause of visual loss in an African-Caribbean population and discuss the implications of these data from a public health perspective. Methods: A nationally representative cohort (n = 4 709; ages 40-84 years at baseline) had ophthalmic and other examinations over 9 years. Incidence rates were estimated by the product-limit approach. Risk factors were evaluated from Cox regression models. Results: Average incidence was ~ 0.1 percent per year for blindness (< 6/120) and 0.7 percent per year for low vision (< 6/18 to 6/120), increasing steeply with age (P < 0.05) and affecting related quality of life (P < 0.05). Age-related cataract and open-angle glaucoma (OAG) accounted for 73.2 percent of blindness and diabetic retinopathy (DR) for 8.9 percent; cataract caused two-thirds of low vision. Average incidence was 5.1 percent per year for all lens changes (gradable/ungradable opacities or aphakia) and 0.4 percent per year for cataract surgery. Incidence of definite OAG was 0.5 percent per year (0.9 percent for suspect or probable); 53 percent of the affected were unaware. Persons with diabetes mellitus (DM) had a DR incidence of 4.4 percent per year. Age-related macular degeneration was rare (0.08 percent per year). Main cataract risk factors were age and DM. OAG incidence increased with age, intraocular pressure, family history, low ocular perfusion pressures, and thinner corneas. DR risk increased with early DM onset, DM duration, oral/insulin treatment, increased systolic and diastolic blood pressures, and hyperglycemia. Antihypertensive treatment halved DR risk. Conclusions: Incidence of visual impairment was high and significantly affected quality of life. Age-related cataract and OAG caused ~ 75 percent of blindness, indicating the need for public health action to increase appropriate cataract surgery and early OAG detection and treatment. Controlling DM and hypertension would help prevent...
Objetivo: Presentar un resumen de la incidencia y los factores de riesgo de cada causa principal de pérdida de la visión en una población afrocaribeña y examinar las implicaciones de estos datos desde una perspectiva de salud pública. Métodos: En una cohorte representativa al nivel nacional (n = 4 709; edades de 40 a 84 años al inicio) se hicieron exploraciones oftálmicas y de otros tipos durante nueve años. Se calcularon las tasas de incidencia mediante el método del producto-límite. Los factores de riesgo se evaluaron mediante modelos de regresión de Cox. Resultados: La incidencia promedio fue ~ 0,1 por ciento al año para la ceguera (< 6/120) y de 0,7 por ciento al año para la visión deficiente (< 6/18 a 6/120), que aumentó de manera pronunciada con la edad (P < 0,05) y afectó a la calidad de vida relacionada (P < 0,05). Las cataratas y el glaucoma de ángulo abierto relacionados con la edad representaron 73,2 por ciento de los casos de ceguera, y 8,9 por ciento de los casos de retinopatía diabética; las cataratas causaron dos tercios de los casos de visión deficiente. La incidencia media fue de 5,1 por ciento al año en todos los cambios del cristalino (opacidades graduables o no graduables o afaquia), y de 0,4 por ciento al año en la cirugía de cataratas. La incidencia del glaucoma de ángulo abierto definitivo fue de 0,5 por ciento al año (0,9 por ciento en el caso de la sospecha o la probabilidad); 53 por ciento de los pacientes afectados no era conciente. Las personas que padecían diabetes tenían una incidencia de retinopatía diabética de 4,4 por ciento al año. La degeneración macular relacionada con la edad fue muy infrecuente (0,08 por ciento al año). Los principales factores de riesgo de las cataratas fueron la edad y la diabetes. La incidencia de glaucoma de ángulo abierto aumentó con la edad, la presión intraocular, los antecedentes familiares, las presiones bajas de perfusión ocular y el grosor más fino de la córnea. El riesgo de retinopatía...