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Objectives: We explored the prognostic utility of the unique combination of C-reactive-protein-to-albumin ratio (CAR) and significant weight loss (WL > 5%) over the preceding 6 months, namely, the CARWL score, in stage IIIC non-small-cell lung cancer (NSCLC) patients who underwent concurrent chemoradiotherapy (CCRT). Methods: For each patient, the CAR was calculated using C-reactive protein and albumin measurements obtained on the first day of CCRT: CAR = C-reactive protein ÷ albumin. The availability of an ideal CAR cutoff that may categorize patients into two distinct progression-free (PFS) and overall survival (OS) outcomes was explored by employing receiver operating characteristic (ROC) curve analysis. Patients were additionally divided into two groups based on their status of significant WL according to the well-recognized Delphi criteria. Then, the CARWL score was created by combining all feasible combinations of the CAR and significant WL groupings. The potential links between pretreatment CARWL groups and the post-CCRT OS and PFS outcomes were determined as the primary and secondary endpoints. Results: This retrospective cohort study comprised a total of 651 stage IIIC NSCLC patients. ROC curve analysis indicated that rounded 3.0 was the ideal CAR cutoff (area under the curve (AUC): 70.1%; sensitivity: 67.8%; specificity: 65.9%), which categorized the patients into CAR < 3.0 (N = 324) and CAR ≥ 3.0 (N = 327) groups. There were 308 (47.3%) and 343 (52.7%) patients without and with significant WL, respectively. The created CARWL groups were CARWL-0: CAR < 3.0 and WL ≤ 5.0%; CARWL-1: CAR < 3.0 and WL > 5.0%, or CAR ≥ 3.0 and WL ≤ 5.0%; and CARWL-2: CAR > 3.0 and WL > 5.0%. The Kaplan-Meier curves showed that the PFS (14.2 vs. 11.4 vs. 7.5 months; P < 0.001) and OS (37.3 vs. 23.6 vs. 12.8 months; P < 0.001) durations were gradually and significantly lowered from the CARWL-0 to CARWL-2 groups. The CARWL score's significant impacts on PFS and OS outcomes were found to be independent of the other variables in the multivariate analysis (P < 0.001, for each). Conclusions: Our findings indicate that the novel CARWL score, which accounts for pretreatment CAR and significant WL during the preceding 6 months, can reliably stratify newly diagnosed stage IIIC NSCLC patients into three groups with significantly different PFS and OS after definitive CCRT.
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Proteína C-Reativa , Carcinoma Pulmonar de Células não Pequenas , Quimiorradioterapia , Neoplasias Pulmonares , Humanos , Carcinoma Pulmonar de Células não Pequenas/terapia , Carcinoma Pulmonar de Células não Pequenas/patologia , Carcinoma Pulmonar de Células não Pequenas/mortalidade , Neoplasias Pulmonares/terapia , Neoplasias Pulmonares/patologia , Neoplasias Pulmonares/mortalidade , Quimiorradioterapia/métodos , Feminino , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Idoso , Prognóstico , Proteína C-Reativa/análise , Estadiamento de Neoplasias , Albumina Sérica/análise , Redução de Peso , Adulto , Curva ROCRESUMO
PURPOSE: Pain, sleep problems, and anxiety due to all these are common problems in patients who have had herniated disk surgery. This study aims to analyze the effect of the guided imagery technique on the patients' pain, anxiety, and sleep levels before and after a lumbar disk herniation (LDH) operation. DESIGN: This study was conducted as a prospective randomized controlled clinical trial. METHODS: The research was conducted with 60 patients who underwent LDH surgery and met the inclusion criteria. Patients were divided into experimental and control groups according to a computer-generated randomization list. The treatment group (n = 31) applied guided imagery techniques twice, once in the preoperative and postoperative periods. The control group (n = 29) was provided with routine care. "Introductory Information Form," "Surgery-Specific Anxiety Scale," "Richard-Campbell Sleep Questionnaire," and "Visual Analogue Scale (VAS)" were used. The data were analyzed using the Shapiro-Wilk test, paired sample t test, independent sample t test, Pearson chi-square exact test, and repeated measures two-way analysis of variance. In all results, P < .05 was considered statistically significant. FINDINGS: The preoperative anxiety level of the treatment group was lower compared to the anxiety level of the control group (P < .05). The sleep score of the treatment group in the preoperative period was higher than the sleep score of the control group (P < .05). The sleep score of the treatment group in the postoperative period was found to be higher than the sleep score of the control group (P < .05). The pain average of the treatment group in the postoperative period was lower than the pain average of the control group (P < .05). CONCLUSIONS: Our study results revealed that guided imagery applied in the preoperative and postoperative periods effectively decreased pain and anxiety levels and increased the sleep quality of patients with LDH.
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ABSTRACT: Dural venous sinus cysts are very infrequent lesions, generally asymptomatic and incidental. These cystic lesions may include venous structures continuing with superficial cortical veins. A 23-year-old male patient presented with a severe headache. Cranial computed tomography and contrast-enhanced magnetic resonance imaging demonstrated a well-defined, central curvilinear enhanced lesion, located in the superior sagittal sinus which was compatible with the intraluminal dural venous cyst. The patient was included imaging follow-up for possible growth of this cystic lesion. Dural venous sinus cysts are asymptomatic lesions by far. However, these incidental lesions should be followed up just in case the progression-occlusion of the dural sinus. Possible venous components that may have connections with cortical veins should be considered in terms of surgery.
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Cistos , Seio Sagital Superior , Humanos , Masculino , Adulto Jovem , Crânio , Tomografia Computadorizada por Raios XRESUMO
INTRODUCTION: This retrospective study aimed to investigate if pretreatment platelet (PLT) levels can predict the risk of osteoradionecrosis of the jaw (ORNJ) in patients with locally advanced nasopharyngeal carcinoma (LA-NPC) who received concurrent chemoradiotherapy (CCRT). MATERIAL &METHODS: ORNJ instances were identified from LA-NPC patients' pre- and post-CCRT oral exam records. All pretreatment PLT values were acquired on the first day of CCRT. Receiver operating characteristic curve analysis was used to determine the optimal PLT cutoff that divides patients into two subgroups with distinctive ORNJ rates. The primary outcome measure was the association between pretreatment PLT values and ORNJ incidence rates. RESULTS: The incidence of ORNJ was 8.8 % among the 240 LA-NPC patients analyzed. The ideal pre-CCRT PLT cutoff which divided the patients into two significantly different ORNJ rate groups was 285,000 cells/µL (PLT ≤ 285,000 cells/µL (N = 175) vs. PLT > 285,000 cells/µL (N = 65)). A comparison of the two PLT groups revealed that the incidence of ORNJ was substantially higher in patients with PLT > 285,000 cells/L than in those with PLT≤285,000 cells/L (26.2% vs. 2.3 %; P < 0.001). The presence of pre-CCRT ≥3 tooth extractions, any post-CCRT tooth extractions, mean mandibular dose ≥ 34.1 Gy, mandibular V57.5 Gy ≥ 34.7 %, and post-CCRT tooth extractions > 9 months after CCRT completion were also associated with significantly increased ORNJ rates. A multivariate Cox regression analysis demonstrated that each characteristic had an independent significance on ORNJ rates after CCRT. CONCLUSION: An affordable and easily accessible novel biomarker, PLT> 285,000 cells/L, may predict substantially higher ORNJ rates after definitive CCRT in individuals with LA-NPC.
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Quimiorradioterapia , Carcinoma Nasofaríngeo , Neoplasias Nasofaríngeas , Osteorradionecrose , Humanos , Estudos Retrospectivos , Osteorradionecrose/etiologia , Osteorradionecrose/diagnóstico , Osteorradionecrose/epidemiologia , Osteorradionecrose/terapia , Masculino , Feminino , Carcinoma Nasofaríngeo/terapia , Carcinoma Nasofaríngeo/diagnóstico , Carcinoma Nasofaríngeo/patologia , Pessoa de Meia-Idade , Quimiorradioterapia/efeitos adversos , Contagem de Plaquetas , Neoplasias Nasofaríngeas/terapia , Neoplasias Nasofaríngeas/diagnóstico , Neoplasias Nasofaríngeas/sangue , Adulto , Idoso , Doenças Maxilomandibulares/diagnóstico , Doenças Maxilomandibulares/epidemiologia , Doenças Maxilomandibulares/terapia , Doenças Maxilomandibulares/etiologia , Incidência , Valor Preditivo dos TestesRESUMO
OBJECTIVE: We aimed to investigate sleep disorders in patients with epilepsy (PWE) and to investigate the effects of sleep disorders on quality of life. METHODS: In our multicenter study conducted in Turkey, 1358 PWE were evaluated. The demographic and clinical data of the patients were recorded. The Insomnia Severity Index (ISI), Epworth Sleepiness Scale (ESS), Pittsburgh Sleep Quality Index (PSQI), Beck Depression Inventory (BDI), and Quality of Life in Epilepsy Inventory-10 (QOLIE-10) were administered. RESULTS: The mean age of 1358 patients was 35.92⯱â¯14.11 (range, 18-89) years. Seven hundred fifty-one (55.30â¯%) were women. Some 12.7â¯% of the patients had insomnia (ISIâ¯>â¯14), 9.6â¯% had excessive daytime sleepiness (ESSâ¯>â¯10), 46.5â¯% had poor sleep quality (PSQIâ¯>â¯5), and 354 patients (26.1â¯%) had depressive symptoms (BDIâ¯>â¯16). The mean QOLIE-10 score was 22.82⯱â¯8.14 (10-48). Resistant epilepsy was evaluated as the parameter with the highest risk affecting quality of life Adjusted odds ratio (AORâ¯=â¯3.714; 95â¯% confidence interval (CI): [2.440-5.652]â¯<â¯0.001)). ISI (AORâ¯=â¯1.184; 95â¯% CI: [1.128-1.243]; pâ¯<â¯0.001), ESS (AORâ¯=â¯1.081; 95â¯% CI: [1.034-1.130]; pâ¯<â¯0.001), PSQI (AORâ¯=â¯0.928; 95â¯% CI: [0.867 - 0.994]; pâ¯=â¯0.034), BDI (AORâ¯=â¯1.106; 95â¯% CI: [1.084-1.129]; pâ¯<â¯0.001), epilepsy duration (AORâ¯=â¯1.023; 95â¯% CI: [1.004-1.041]; pâ¯=â¯0.014), were determined as factors affecting quality of life. SIGNIFICANCE: Sleep disorders are common in PWE and impair their quality of life. Quality of life can be improved by controlling the factors that may cause sleep disorders such as good seizure control, avoiding polypharmacy, and correcting the underlying mood disorders in patients with epilepsy.
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Epilepsia , Distúrbios do Início e da Manutenção do Sono , Transtornos do Sono-Vigília , Feminino , Humanos , Masculino , Epilepsia/complicações , Qualidade de Vida , Sono , Distúrbios do Início e da Manutenção do Sono/complicações , Transtornos do Sono-Vigília/etiologia , Inquéritos e Questionários , Turquia/epidemiologia , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou maisRESUMO
BACKGROUND AND OBJECTIVES: We explored the prognostic usefulness of the pan-immune-inflammation value (PIV) in patients with stage IIIB/C non-small-cell lung cancer (NSCLC) who underwent concurrent chemoradiotherapy (CCRT). METHODS AND PATIENTS: For all patients, the PIV was calculated using platelet (P), monocyte (M), neutrophil (N), and lymphocyte (L) measures obtained on the first day of CCRT: PIV = P × M × N ÷ L. Using receiver operating characteristic (ROC) curve analysis, we searched for the existence of an ideal cutoff that may partition patients into two groups with unique progression-free- (PFS) and overall survival (OS) results. The primary endpoint of this retrospective cohort research was to determine whether there were any significant relationships between pretreatment PIV measures and post-CCRT OS outcomes. RESULTS: The present research included a total of 807 stage IIIB/C NSCLC patients. According to ROC curve analysis, the ideal PIV cutoff was 516 [area under the curve (AUC): 67.7%; sensitivity: 66.4%; specificity: 66.1%], which divided the whole cohort into two: low PIV (L-PIV: PIV < 516; N = 436) and high PIV (H-PIV: PIV ≥ 516; N = 371). The comparisons between the PIV groups indicated that either the median PFS (9.2 vs. 13.4 months; P < 0.001) or OS (16.7 vs. 32.7 months; P < 0.001) durations in the H-PIV group were substantially inferior to their L-PIV counterpart. Apart from the H-PIV (P < 0.001), the N3 nodal stage (P = 0.006), IIIC disease stage (P < 0.001), and receiving only one cycle of concurrent chemotherapy (P = 0.005) were also determined to be significant predictors of poor PFS (P < 0.05, for each) and OS (P < 0.05, for each) outcomes in univariate analysis. The multivariate analysis findings revealed that all four variables had independent negative impacts on PFS (P < 0.05, for each) and OS (P < 0.05, for each). CONCLUSIONS: The findings of this hypothesis-generating retrospective analysis claimed that the novel PIV was an independent and steadfast predictor of PFS and OS in stage IIIB/C NSCLC patients.
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BACKGROUND: Skeletal muscle loss is associated with adverse outcomes in critically ill patients and risk factors of acute skeletal muscle loss are not well described. This study aims to determine the factors associated with acute skeletal muscle loss in critically ill patients. METHODS: This prospective observational cohort study was conducted with patients who were expected to stay in the intensive care unit (ICU) for at least a week. Rectus femoris cross-sectional area (RFCSA) measurements were performed within 48 h of ICU admission and on study day 7. The percentage change in RFCSA and variables associated with this change were evaluated by univariate and multivariate regression analysis. RESULTS: Over a 12-month period, 518 patients were assessed for eligibility and 44 critically ill patients with a mean age of 59.3 ± 10.9 years were enrolled; 52.3% of them were female. There were significant reductions in RFCSA (16.8 ± 16.5%; P < 0.001). The mean amounts of protein and energy consumed compared with those prescribed were 67.0 ± 28.8% and 71.5 ± 38.3%, respectively. Multivariate regression analysis revealed that frailty was independently associated with acute skeletal muscle loss after adjusting for confounding factors in our cohort of patients. CONCLUSION: Frailty status before ICU admission is associated with acute skeletal muscle loss and may be important for identifying critically ill patients at high risk of muscle wasting.
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BACKGROUND: We sought to determine the prognostic value of the newly developed Global Immune-Nutrition-Inflammation Index (GINI) in patients with stage IIIC non-small cell lung cancer (NSCLC) who underwent definitive concurrent chemoradiotherapy (CCRT). METHODS: This study was conducted on a cohort of 802 newly diagnosed stage IIIC NSCLC patients who underwent CCRT. The novel GINI created first here was defined as follows: GINI = [C-reactive protein × Platelets × Monocytes × Neutrophils] ÷ [Albumin × Lymphocytes]. The receiver operating characteristic (ROC) curve analysis was used to determine the optimal pre-CCRT GINI cut-off value that substantially interacts with the locoregional progression-free (LRPFS), progression-free (PFS), and overall survival (OS). RESULTS: The optimal pre-CCRT GINI cutoff was 1562 (AUC: 76.1%; sensitivity: 72.4%; specificity: 68.2%; Youden index: 0.406). Patients presenting with a GINI ≥ 1562 had substantially shorter median LRPFS (13.3 vs. 18.4 months; p < 0.001), PFS (10.2 vs. 14.3 months; p < 0.001), and OS (19.1 vs. 37.8 months; p < 0.001) durations than those with a GINI < 1562. Results of the multivariate analysis revealed that the pre-CCRT GINI ≥ 1562 (vs. <1562), T4 tumor (vs. T3), and receiving only 1 cycle of concurrent chemotherapy (vs. 2-3 cycles) were the factors independently associated with poorer LRPS (p < 0.05 for each), PFS (p < 0.05 for each), and OS (p < 0.05 for each). CONCLUSION: The newly developed GINI index efficiently divided the stage IIIC NSCLSC patients into two subgroups with substantially different median and long-term survival outcomes.
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PURPOSE: The aim of this retrospective study was to explore whether pretreatment Pan-Immune-Inflammation-Value (PIV) measurements might predict the risk of mandibular osteoradionecrosis (ORN) in patients receiving concurrent chemoradiotherapy (CCRT) for locally advanced nasopharyngeal cancer (LA-NPC). METHODS: The platelet, monocyte, neutrophil, and lymphocyte counts acquired on the first day of CCRT were used to compute pretreatment PIV levels: PIVâ¯= (Plateletsâ¯× Monocytesâ¯× Neutrophils)â¯÷ Lymphocytes. Receiver operating characteristic curve analysis was used to determine the association between ORN rates and PIV levels. Spearman correlation analysis was used to examine the probable intergroup correlations. The potential link between the pretreatment PIV levels and the post-treatment ORN rates was determined as the primary objective. RESULTS: 21 (10.0%) of 210 eligible patients were diagnosed with ORN. The optimal pre-CCRT PIV cutoff was 833, which separated patients into two PIV groups with divergent ORN prevalence estimates: Group 1: PIV <â¯833 (Nâ¯= 153), and Group 2: PIV ≥â¯833 (Nâ¯= 57). The comparison analysis found that the PIV ≥â¯833 cohort had significantly higher ORN rates than the PIV <â¯833 cohort (29.8% vs. 2.6%; Pâ¯< 0.001). Other characteristics linked to significantly higher ORN rates were the patient's continuing smoking, the use of the Three-dimensional conformal radiation therapy technique, the mean mandibular dose of ≥â¯58.1â¯Gy, the number of tooth extractions before CCRT ≥â¯4, and the presence of tooth extractions after CCRT. The independent importance of all factors on higher ORN occurrence rates were retained in multivariate analysis (Pâ¯< 0.05). CONCLUSIONS: Our findings revealed a strong link between aggravated inflammatory response and ORN genesis, with high pretreatment PIV levels related to significantly higher ORN rates.
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Objectives: The objective of our study was to assess the prognostic significance of the Pan-Immune-Inflammation Value (PIV) before concurrent chemoradiation (C-CRT) and prophylactic cranial irradiation (PCI) in patients with limited-stage small-cell lung cancer (SCLC). Methods: The medical records of LS-SCLC patients who underwent C-CRT and PCI between January 2010 and December 2021 were retrospectively analyzed. PIV values were calculated using the peripheral blood samples obtained within the past 7 days before the initiation of treatment: PIV = [neutrophils × platelets × monocytes] ÷ lymphocytes. Using receiver operating characteristic (ROC) curve analysis, the optimal pretreatment PIV cutoff values that can partition the study population into two groups with substantially distinct progression-free survival (PFS) and overall survival (OS) outcomes were determined. The relationship between PIV values and OS outcomes was the primary outcome measure. Results: Eighty-nine eligible patients were divided into two PIV groups at an optimal cutoff of 417 [Area under curve (AUC): 73.2%; sensitivity: 70.4%; specificity: 66.7%]: Group 1: PIV < 417 (N = 36) and Group 2: PIV ≥ 417 (N = 53). Comparative analyses revealed that patients with PIV < 417 had significantly longer OS (25.0 vs 14.0 months, p < .001) and PFS (18.0 vs 8.9 months, p = .004) compared to patients with PIV ≥ 417. The outcomes of the multivariate analysis have verified the independent significance of pretreatment PIV concerning PFS (p < .001) and OS (p < .001) outcomes. Conclusion: The findings of this retrospective study indicate that the pretreatment PIV is a reliable and independent prognostic biomarker for patients with LS-SCLC who were treated with C-CRT and PCI.
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Neoplasias Pulmonares , Carcinoma de Pequenas Células do Pulmão , Humanos , Neoplasias Pulmonares/radioterapia , Estudos Retrospectivos , Carcinoma de Pequenas Células do Pulmão/terapia , Prognóstico , QuimiorradioterapiaRESUMO
OBJECTIVES: To explore how well a unique combination of hemoglobin-to-platelet ratio (HPR) and pretreatment maximum mouth opening (MMO) predicts the prevalence of radiation-induced trismus (RIT). PATIENTS AND METHODS: HPR and MMO cutoff values (0.54 and 40.7 mm) divided patients into two groups. To develop the novel HPR-MMO index, four combinations of these factors were tested for predictive power: Group 1: HPR > 0.54 and MMO > 40.7 mm; Group 2: HPR ≤ 0.54 but MMO > 40.7 mm; Group 3: HPR > 0.54 but MMO ≤ 40.7 mm; Group 4: HPR ≤ 0.54 and MMO ≤ 40.7 mm. RESULTS: Data of 198 patients with LA-NPC was analyzed retrospectively. RIT rates for Groups 1 to 4 were 10.2%, 15.2%, 25%, and 59.4%. Groups 2 and 3 were merged to generate HPR-MMO index because of statistically equivalent RIT rates: Low-risk: HPR > 0.54 and MMO > 40.7 mm; Intermediate-risk: HPR ≤ 0.54 but MMO > 40.7 mm or; HPR > 0.54 but MMO ≤ 40.7 mm; High-risk: HPR ≤ 0.54 and MMO ≤ 40.7 mm. It was revealed that the low-, high-, and intermediate-risk group's RIT rates; 10.2%, 59.4%, and 19.2%, respectively. CONCLUSION: The novel HPR-MMO index may to classify LA-NPC patients into low, intermediate, and high-risk RIT groups.
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Neoplasias Nasofaríngeas , Trismo , Humanos , Trismo/epidemiologia , Trismo/etiologia , Neoplasias Nasofaríngeas/radioterapia , Estudos Retrospectivos , Prevalência , Carcinoma Nasofaríngeo , Boca , HemoglobinasRESUMO
Radiotherapy (RT) or concurrent chemoradiotherapy (CCRT) is the cornerstone of organ-sparing or adjuvant therapy for nearly all head and neck cancers. Unfortunately, aggressive RT or CCRT can result in severe late toxicities, such as osteoradionecrosis of the jaws (ORNJ). The incidence of ORNJ is currently less than 5-6% due to advances in dental preventive care programs, RT planning systems, and RT techniques. Although numerous patient-, tumor-, and treatment-related factors may influence the incidence rates of ORNJ, RT modality (equipment), technique, and dose-volume-related factors are three of the most influential factors. This is mainly because different RT equipment and techniques have different levels of success at delivering the prescribed dose to the focal volume of the treatment while keeping the "organ at risk" safe. ORNJ risk is ultimately determined by mandibular dose, despite the RT technique and method being known predictors. Regardless of the photon delivery method, the radiobiological effects will be identical if the total dose, dose per fraction, and dose distribution within the tissue remain constant. Therefore, contemporary RT procedures mitigate this risk by reducing mandibular dosages rather than altering the ionizing radiation behavior in irradiated tissues. In light of the paucity of studies that have examined the impact of RT modality, technique, and dose-volume-related parameters, as well as their radiobiological bases, the present review aims to provide a comprehensive overview of the published literature on these specific issues to establish a common language among related disciplines and provide a more reliable comparison of research results.
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BACKGROUND: This retrospective study aimed to investigate whether the pretreatment hemoglobin-to-platelet ratio (HPR) could predict the risk of osteoradionecrosis (ORN) in patients receiving concurrent chemoradiotherapy (C-CRT) for locally advanced nasopharyngeal carcinoma (LA-NPC). METHODS: ORN cases were reported from the records of LA-NPC patients who had oral examinations before and after C-CRT. The pretreatment HPR values were calculated on the first day of C-CRT. The connection between HPR values and ORN occurrences was determined using receiver operating characteristic curve analysis. The primary endpoint was the relationship between the pretreatment HPR values and post-C-CRT ORN incidence rates, while secondary endpoints included the identification of other putative ORN risk factors. RESULTS: We distinguished 10.9% incidences of ORN during the post-C-CRT follow-up period among 193 LA-NPC patients. The optimal cutoff for pre-C-CRT HPR was 0.48 that grouped the patients into two HPR groups with fundamentally different post-C-CRT ORN incidence rates: Group 1: HPR ≤ 0.48 (N = 60), and Group 2: HPR > 0.48 (N = 133). The comparative analysis indicated a significantly higher ORN incidence in HPR ≤ 0.48 group (30%; P < 0.001). The other factors associated with meaningfully increased ORN rates included the presence of pre-C-CRT ≥ 5 teeth extractions, mandibular volume receiving ≥ 64 Gy, post-C-CRT tooth extractions, mean mandibular dose ≥ 50.6 Gy, and C-CRT to tooth extraction interval > 5.5 months. CONCLUSION: Low pretreatment HPR levels were independently and unequivocally linked to significantly increased incidence of ORN post-C-CRT. Pre-C-CRT HPR levels may be used to estimate the incidence of ORN and be useful for taking preventive and therapeutic measures in these patients such as monitoring oral hygiene with strict follow-up, avoidance of unnecessary tooth extractions, particularly after C-CRT, and use of more rigorous mandibular RT dose limits.
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Carcinoma , Neoplasias de Cabeça e Pescoço , Neoplasias Nasofaríngeas , Osteorradionecrose , Humanos , Neoplasias Nasofaríngeas/radioterapia , Osteorradionecrose/epidemiologia , Osteorradionecrose/etiologia , Incidência , Carcinoma Nasofaríngeo , Estudos Retrospectivos , Quimiorradioterapia/efeitos adversos , Neoplasias de Cabeça e Pescoço/radioterapiaRESUMO
AIM: To demonstrate that decreased platelet count in patients with craniosynostosis increases the requirement for blood replacement, thus providing guidance to clinicians by revealing the time at which the platelet count decreases. Additionally, the relationship between the amount of blood transfusion and preoperative and postoperative platelet counts was evaluated. MATERIAL AND METHODS: This study included 38 patients with craniosynostosis who underwent surgery between July 2017 and March 2019. The patients exhibited no cranial pathologies except craniosynostosis. All surgeries were performed by a single surgeon. The demographic data, anesthesia and surgical durations, preoperative complete blood count and bleeding time, intraoperative blood transfusion amount, and postoperative complete blood count and total blood transfusion amount of the patients were recorded. RESULTS: The preoperative and postoperative changes and the timing of changes in hemoglobin and platelet counts, amount and timing of postoperative blood transfusion, and relationship between the amount and timing of blood replacement and preoperative and postoperative platelet counts were evaluated. The postoperative platelet counts tended to decrease after 12, 18, 24, and 36 hours (h), and began increasing after 48 h. Although decreased platelet count did not lead to platelet replacement, it influenced the erythrocyte replacement requirement in the postoperative period. CONCLUSION: Platelet count was associated with the amount of blood replacement. The platelet counts decreased within the first 48 h following surgery and tended to elevate thereafter; thus, clinicians should closely monitor these platelet counts within 48 h after surgery.