RESUMEN
There is a reported association between hypertension (HTN) and sleep disorders. The American Academy of Pediatrics recommends screening children with HTN for sleep disorders because sleep disorders increase the risk for cardiovascular disease. We quantified the frequency and severity of sleep disorders within our institution's hypertensive pediatric population and evaluated the effectiveness of performing nocturnal polysomnography (NPSG). In the hypertensive pediatric population referred for NPSG at our institution, 64% were diagnosed with obstructive sleep apnea (OSA) and/or periodic limb movement disorder. Thirty-three percent of those children with HTN had moderate to severe OSA, whereas only 20% of all children evaluated by NPSG had moderate to severe OSA. Those children with HTN were also two times more likely to be diagnosed with periodic limb movement disorder. Screening for sleep disorders and obtaining NPSG in children with HTN increase the identification of comorbid sleep disorders and reduce the risk for cardiovascular disease.
Asunto(s)
Enfermedades Cardiovasculares/prevención & control , Hipertensión/epidemiología , Síndrome de Mioclonía Nocturna/epidemiología , Polisomnografía/métodos , Apnea Obstructiva del Sueño/epidemiología , Adolescente , Alabama/epidemiología , Presión Sanguínea , Monitoreo Ambulatorio de la Presión Arterial , Niño , Preescolar , Comorbilidad , Femenino , Humanos , Masculino , Tamizaje Masivo , Guías de Práctica Clínica como Asunto , PrevalenciaRESUMEN
PURPOSE: To evaluate chemoreduction (CRD) for group E retinoblastoma. DESIGN: Retrospective, comparative case series. PARTICIPANTS: Seventy-six eyes of 56 patients with group E retinoblastoma were treated with CRD alone or CRD plus low-dose prophylactic external beam radiotherapy (CRD+P-EBR). The CRD included vincristine, etoposide, and carboplatin (6 cycles). The P-EBR was given routinely 2 months after completion of CRD at a suggested dose of 2600 cGy. Therapeutic EBR (T-EBR) was only given at the time of extensive tumor recurrence at a suggested dose of 3800 cGy. METHODS: Retrospective chart review. MAIN OUTCOME MEASURES: Globe salvage. RESULTS: Of the 76 eyes, 64 received CRD alone and 12 received CRD+P-EBR. At the 2-year follow-up, globe salvage was achieved in 29 (53%) of 55 eyes in the CRD group and in 10 (91%) of 11 eyes in the CRD+P-EBR group. At 5 years, globe salvage was achieved in 20 (48%) of 42 eyes in the CRD group and in 4 (80%) of 5 eyes in the CRD+P-EBR group (P=0.347). Of the 64 eyes in the CRD group, 16 (25%) were salvaged with CRD alone and 13 (20%) with CRD+T-EBR, whereas 22 (34%) were enucleated after CRD alone and 13 (20%) were enucleated after CRD+T-EBR. Of the 12 eyes in the CRD+P-EBR group, 10 (83%) were salvaged with CRD+P-EBR, whereas 2 (17%) were enucleated and none required T-EBR. The median dose for T-EBR was 3800 cGy, and that for P-EBR was 2600 cGy. Eyes treated with CRD+P-EBR showed significantly less recurrence, leading to less chance of enucleation or therapeutic radiotherapy than that for CRD alone (P<0.001). Visual acuity was 20/100 or better or fix and follow in 9 (32%) of 28 salvaged eyes in the CRD group and in 4 (40%) of 10 in the CRD+P-EBR group. At 5 years, there were no patients in either group with metastasis of pinealoblastoma or who had died. In one patient in the CRD group, a second cancer developed. CONCLUSIONS: Group E retinoblastoma managed with CRD+P-EBR showed significantly less need for enucleation or therapeutic radiotherapy than eyes treated with CRD alone. These findings merit further study and consideration.
Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Radioterapia de Alta Energía , Neoplasias de la Retina/terapia , Retinoblastoma/terapia , Carboplatino/uso terapéutico , Niño , Preescolar , Terapia Combinada , Etopósido/uso terapéutico , Enucleación del Ojo , Femenino , Humanos , Lactante , Masculino , Recurrencia Local de Neoplasia , Neoplasias de la Retina/clasificación , Neoplasias de la Retina/tratamiento farmacológico , Neoplasias de la Retina/radioterapia , Retinoblastoma/clasificación , Retinoblastoma/tratamiento farmacológico , Retinoblastoma/radioterapia , Estudios Retrospectivos , Resultado del Tratamiento , Vincristina/uso terapéutico , Agudeza VisualRESUMEN
PURPOSE: To evaluate visual outcome of eyes with combined hamartoma of the retina and retinal pigment epithelium (RPE). DESIGN: Noncomparative case series. PARTICIPANTS: Seventy-nine eyes of 77 patients. METHODS: Retrospective chart review. MAIN OUTCOME MEASURES: Visual outcome. RESULTS: The presenting symptoms were decreased vision (n = 32; 40%), strabismus (n = 22; 28%), both (n = 3; 4%), irritation (n = 4; 5%), and none (n = 18; 23%). The tumors had the following characteristics: a mean diameter of 7.6 mm, a mean thickness of 1.9 mm, round (n = 52; 66%) or curvilinear (n = 27; 34%) configuration, and other features including intralesional corkscrew vessels (n = 51; 65%), feeding straight vessels (n = 50; 63%), retinal traction (n = 64; 81%), fibrosis/gliosis (n = 36; 46%), and exudation (n = 10; 13%). Referring diagnosis was unknown (n = 40; 51%) or incorrect (n = 19; 24%) as retinoblastoma (n = 4), astrocytoma (n = 1), toxocariasis (n = 2), choroidal nevus (n = 5), melanoma (n = 6), and hemangioma (n = 1). The mean initial visual acuity by logarithm of the minimum angle of resolution (Snellen) for macular (n = 29) versus extramacular (n = 28) tumors was 1.2 (20/320) versus 0.61 (20/80) and at 4 years was 1.72 (20/800) versus 0.79 (20/125). Visual acuity loss of >or=3 Snellen lines was 60% versus 13%. By univariate analysis, the most important factors predictive of poor visual acuity included macular location and clock hour meridian of the tumor. CONCLUSIONS: Combined hamartoma of the retina and RPE can cause profound visual acuity loss, particularly with macular tumors. FINANCIAL DISCLOSURES: The authors have no proprietary or commercial interest in any materials discussed in this article.