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1.
J Surg Res ; 184(1): 330-6, 2013 Sep.
Article in English | MEDLINE | ID: mdl-23773720

ABSTRACT

BACKGROUND: Sacrococcygeal teratoma is the most common neonatal tumor. Fetuses with large tumors may develop hydrops from a high cardiac output state (HCOS) and progress rapidly to fetal demise. We postulate that the prenatal solid tumor volume index (STVI), or the ratio of solid tumor volume to the estimated fetal weight (EFW), has greater impact than the total tumor volume in outcome prediction. METHODS: A retrospective chart review of all sacrococcygeal teratoma patients (n = 38) between 2005 and 2012 was conducted. Total tumor volume and percent of solid component were calculated by magnetic resonance imaging and then normalized by dividing them by either head circumference or EFW. Outcomes measured were survival, hydrops or high cardiac output state, defined as a combined ventricular output of >625 mL/min/kg with abnormal Doppler or echocardiogram findings. RESULTS: Thirty-one patients were included in the study. All deaths (n = 7) had either high cardiac output state or hydrops. At a total tumor volume/EFW >0.16, the patient was 17 times more likely to develop HCOS/hydrops (P = 0.001) with 81.25% sensitivity and 86.67% specificity. At a STVI >0.09, the patient was 120 times more likely to develop HCOS/hydrops (P < 0.0001) with 81.25% sensitivity and 100% specificity. CONCLUSIONS: While total tumor volume aids in stratifying patients into high risk categories, STVI (solid tumor volume/EFW) is a better predictor of adverse outcomes. This data will allow us to identify patients who are high risk for cardiac compromise and guide appropriate therapy.


Subject(s)
Fetal Diseases/pathology , Magnetic Resonance Imaging , Sacrococcygeal Region/pathology , Teratoma/pathology , Tumor Burden , Adult , Cardiac Output, High/diagnostic imaging , Cardiac Output, High/mortality , Cardiac Output, High/pathology , Edema/diagnostic imaging , Edema/mortality , Edema/pathology , Female , Fetal Death/epidemiology , Fetal Diseases/diagnostic imaging , Fetal Diseases/mortality , Humans , Male , Predictive Value of Tests , Pregnancy , Retrospective Studies , Risk Factors , Sacrococcygeal Region/diagnostic imaging , Teratoma/diagnostic imaging , Teratoma/mortality , Ultrasonography, Prenatal , Young Adult
2.
J Trauma Acute Care Surg ; 73(2): 479-85, 2012 Aug.
Article in English | MEDLINE | ID: mdl-23019674

ABSTRACT

BACKGROUND: Anoninvasive cardiac output (CO) monitor (NICOM), using Bioreactance technology, has been validated in several nontrauma patient studies. We hypothesized that NICOM CO would have more significant associations with clinical conditions than would systolic blood pressure (sBP). METHODS: This is a prospective observational study of consecutive trauma activation patients during the first 10 to 60 minutes after emergency department arrival. RESULTS: Analysis includes 270 consecutive trauma activation patients with 1,568 observations. CO was decreased (p ≤ 0.002) with major blood loss, hypotension, red blood cell transfusion, Injury Severity Score (ISS) higher than 20, low PetCO2, abnormal pupils, elderly, preexisting conditions, low body surface area level, females, hypothermia, and death. CO was increased (p < 0.0001) with base deficit, ethanol positivity, and illicit drug positivity. The sBP was decreased (p ≤ 0.0005) with major blood loss, red blood cell transfusion, low PetCO2, low body surface area level, and illicit drug positivity. The sBP was increased (p e 0.01) with ISS higher than 20, elderly, and preexisting conditions. Total significant condition associations were CO 83% (15 of 18 patients) and sBP 47% (8 of 17 patients; p = 0.03). In hypotensive patients, CO was lower with major blood loss (3.3 ± 2.1 L/ min) than without (6.0 ± 2.2 L/min; p < 0.0001). Of survivors with ISS 15 or higher, NICOM patients experienced a shorter hospital length of stay (10.5 days) when compared with 2009 and 2010 patients (14.0 days; p = 0.03). CONCLUSION: The multiple associations of CO with patient conditions imply that NICOM provides an objective and clinically valid, relevant, and discriminate measure of cardiac function in acutely injured trauma activation patients. NICOM use may be associated with a shorter length of stay in surviving patients with complex injuries.


Subject(s)
Cardiac Output/physiology , Emergency Service, Hospital , Hospital Mortality/trends , Monitoring, Physiologic/instrumentation , Wounds and Injuries/diagnosis , Wounds and Injuries/mortality , Adult , Age Factors , Aged , Blood Pressure , Cardiac Output, High/diagnosis , Cardiac Output, High/mortality , Cardiac Output, Low/diagnosis , Cardiac Output, Low/mortality , Cause of Death , Cohort Studies , Comorbidity , Female , Follow-Up Studies , Humans , Male , Middle Aged , Prospective Studies , Reproducibility of Results , Risk Assessment , Survival Analysis , Time Factors , Trauma Centers , Trauma Severity Indices , Triage , Wounds and Injuries/therapy
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