Aim: Pulmonary haemorrhage (PH) is an acute catastrophic event with low incidence yet high mortality among neonates. We aimed to systematically review the management of PH.
Methods:A search was carried out of the PubMed, EMBASE and Cochrane databases according to the PRISMA guidelines. Data were extracted on study design and size, patient demographics, primary and adjunctive treatment methods, and treatment outcomes.Results: Sixteen studies with 385 newborn infants were included and were significantly heterogeneous regarding treatment methods. Primary treatments included surfactant, high-frequency oscillatory ventilation (HFOV), epinephrine, coagulopathy management, intermittent positive pressure ventilation, cocaine and tolazoline.Adjunctive treatment methods included blood products, HFOV, increased positive end-expiratory pressure, vitamin K, surfactant, adrenaline, vasopressors and inotropes. All five studies using surfactant as primary treatment were effective in improving oxygenation index measures and preventing recurrence of PH, and three studies found no association between surfactant and death or long-term disability.Ventilatory support, epinephrine, management of coagulopathy and tolazoline were all found to be effective primary treatments for PH.
Conclusion:There are several effective methods of managing PH in neonates. Further understanding of the aetiology of PH and ongoing research will allow future prevention and improvements in management of PH.
Introduction
Sarcopenia and obesity in cancer may confer negative outcomes, but their prevalence and impact on modern regimens for retroperitoneal sarcoma (RPS) have not been systematically studied. Sarcopaenia and obesity measurements by computed tomography (CT) measurements at L3 may be confounded by the disease process itself. The aim of this study is to determine feasibility in providing the prevalence of sarcopenia and visceral obesity in the management of RPS to assess their potential impact on operative and oncologic outcomes.
Method
Consecutive sample patients undergoing treatment for RPS from our database were retrospectively studied. Total, subcutaneous and visceral fat areas (VFA), myosteatosis, skeletal muscle index (SMI) lean body mass and fat mass were determined at diagnosis by CT. Sarcopenia will be defined by CT at L3 as SMI <52.4 cm2/m2 for males and SMI <38.5 cm2/m2 for females, and visceral obesity as VFA >163.8cm2 for men and >80.1cm2 for women.
Result
40 consecutive patients, 21 [52.5%] female, 56.7±15.1 years, were studied. The most common histologic types were leiomyosarcoma (8 [20.0%]), dedifferentiated liposarcoma (7 [17.5%]), well differentiated liposarcoma (7 [17.5%]), myxoid liposarcoma (4 [10.0%]). Mean±SD body composition measures were: lean body mass, 50.4±12.0 kg; total fat mass, 27.2±8.6 kg; visceral fat area, 148.5±120.2 cm2; subcutaneous fat area, 222.2±20.4 cm2; myosteatosis, 8.9±7.3 cm2.
Conclusion
Assessment of body composition among patients with RPS is feasible. Analysis to identify the prevalence and significance of sarcopenia and visceral obesity and its relationship to operative and oncologic outcomes is ongoing.
Take-home message
Assessment of body composition in RPS is feasible and its effect on outcomes is under investigation
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