Outcomes of chordomas of the sacrum and mobile spine: Clinical series with average 6-year follow-up.

STUDY DESIGN: Retrospective clinical series. PURPOSE: To search for spinal chordoma's survival rates, recurrences, and complications and compare sacral and mobile spine chordomas. OVERVIEW OF LITERATURE: The primary spinal chordoma treatment is mainly considered radical surgery, although recurrence rates are pretty high. Radical surgery with extra marginal resection is possible with significant neurologic deficits and very high complication rates. MATERIALS AND METHODS: This study reviews 48 spinal chordoma patients (sacrum 28, mobile spine 20) surgically treated between 1995 and 2019. Follow-up times ranged between 12 months and 238 months (average 6.16 years). Six patients were lost to follow-up after at least 1 year of control; three died 30 days after surgery. RESULTS: Surgery for sacrum tumors was an extra marginal resection (sacrectomy) in 19 patients, while nine patients had intralesional surgery. There were 13 cervical chordomas and seven thoracolumbar chordomas. Although we tried marginal resections for cervical chordomas, all had positive margins, and we accepted them as intralesional. Surgery for thoracolumbar chordomas was total spondylectomy in four cases and intralesional excision in three patients. Because of recurrences, the average surgery per patient was 3.45. It was more common in mobile spine chordomas (average 4.2) than sacral chordomas (average 2.92). Surgical complications of mobile spine chordomas (15/20; 75%) were also more than sacral chordomas (16/28; 57%). Chordomas of the mobile spine had no metastasis, while sacral chordomas had a 21% (6/28) metastasis rate. The recurrence rates of sacral chordomas (16/21; 76%) were not significantly different from the mobile spine (15/18; 83%). Among sacral chordomas, in all five cases who had no recurrence, the level of sacrectomy was S2 and below. CONCLUSIONS: Recurrence and survival rates of mobile spine and sacral chordomas are not different. Sacral chordomas tend to metastasize. Sacrectomy is successful for sacral chordomas at S2 and below.

Assessment of skills using a spacer device for a metered-dose inhaler and related independent predictive factors in caregivers of asthmatic preschool children.

BACKGROUND: The correct use of inhalation devices is essential for successful therapy. We aimed to evaluate the skills in the use of a spacer device with an metered-dose inhaler (MDI) and factors that influence this skill in asthmatic preschool children's caregivers. METHODS: The caregivers of 12-month-old to 72-month-old children were interviewed face-to-face and filled out questionnaires. To assess use of the spacer device, we asked the caregivers to verbally describe and demonstrate how they used the device. RESULTS: A total of 244 patients were included in the study, and 142 (58.2%) of the caregivers demonstrated every step for using the spacer device. The most frequently mistaken step was waiting for 30 seconds for the second puff after the first puff. When statistically significant and clinically important parameters were analyzed in a logistic regression model, the parameters satisfaction with the spacer device (odds ratio [OR] 29.9; 95% confidence interval [CI], 7.64 to 117.39; p < 0.001), a university graduate (OR 13.5; 95% CI, 3.36 to 54.8; p < 0.001), family monthly income of more than US$1500 (OR 5.3; 95% CI, 2.16 to 13.39; p < 0.001), device training provided by a clinical trainer (OR 12.3; 95% CI, 4.82 to 31.73; p < 0.001), regular follow-ups (OR 3.6; 95% CI, 1.57 to 8.47; p = 0.003), and the absence of a severe attack during the last year (OR 6.5; 95% CI, 2.64 to 16.43; p < 0.001) were found to be independent factors that affected the correct demonstration of the device. CONCLUSION: The factors most effective in the correct use of the MDI spacer device were satisfaction with the device, training having been given by a clinical trainer on this subject, and the caregiver being a university graduate.

The Platelet Parameters as Inflammatory Markers in Preschool Children with Atopic Eczema.

BACKGROUND: Mean platelet volume has been frequently used as an inflammatory marker in various diseases associated with inflammation. In this study, we compared platelet parameter levels between preschool children with and without atopic eczema (AE). METHODS: Preschool children with AE and age-matched healthy children were included in the study. Complete blood count was assessed in children with AE while platelet parameters were compared between children with and without AE. RESULTS: One hundred twenty eight pediatric patients (78 boys, mean age: 14 months) diagnosed with AE and 128 healthy patients (71 boys, mean age: 12 months ) were included in the study. There were no statistically significant differences between the genders (p = 0.375) and ages (p = 0.273) of both groups. WBC (p = 0.952), Hb (p = 0.370), MCV (p = 0.314) and RDW values (p = 0.124), and platelet counts (p = 0.198) of both groups were similar. In the AE group, while the MPV value was found to be higher (p = 0.003), mean PDW value (p = 0.025) and PLT/MPV ratio were found to be lower (p = 0.021). In addition, there was no correlation between the severity of AE and MPV (rho; 0.1, p = 0.257), PDW (rho; -0.1, p = 0.269) and PLT/MPV (rho; 0.07, p = 0.432) ratio. CONCLUSIONS: In patients with AE, as a sign of inflammation, PDW value and PLT/MPV ratio decrease while MPV value increases. This study has also shown that there is no association between the severity of AE and platelet parameters.