Case-control study of long-term survivors of glioblastoma

e13021

Background: Survival of patients with glioblastoma (GBM) remains poor. However, a small percentage of GBM patients live ≥ 3 years. Relatively little is known about the patterns of care and outcomes of these long term survivors relative to GBM patients with standard or short-term survival. Methods: Nested case-control study of long term survivors (≥ 36 months), short term survivors (≤ 6 months) and standard survivors (> 6 months but < 36 months). Pathology was confirmed in all study subjects by a single neuropathologist. Each long term survivor (LTS) was matched to a short term survivor (STS) and 3 standard survivors (SS) by the well-established prognostic factors, age and postoperative Karnofsky Performance Status. Clinical characteristics, treatment regimens and outcomes were reviewed. Conditional logistic regression models were used to assess potential associations between baseline factors and the probability of long or short term survival. Results: Matching yielded 23 LTS with 23 STS and 69 SS. Patient characteristics are summarized in the table below. Conclusions: Controlling for the well-established prognostic factors of age and performance status, long-term GBM survivors differed significantly from short-term GBM survivors based on tumor location and extent of resection. However, there were no significant differences in baseline factors between long-term survivors versus standard survivors in this analysis. Short-term GBM survivors differed from standard survivors by tumor location and extent of resection. Molecular factors are being assessed in these groups as potential contributors to these survival differences.

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Novel symptomatology and changing epidemiology of domoic acid toxicosis in California sea lions (Zalophus californianus): an increasing risk to marine mammal health

Harmful algal blooms are increasing worldwide, including those of Pseudo-nitzschia spp. producing domoic acid off the California coast. This neurotoxin was first shown to cause mortality of marine mammals in 1998. A decade of monitoring California sea lion (Zalophus californianus) health since then has indicated that changes in the symptomatology and epidemiology of domoic acid toxicosis in this species are associated with the increase in toxigenic blooms. Two separate clinical syndromes now exist: acute domoic acid toxicosis as has been previously documented, and a second novel neurological syndrome characterized by epilepsy described here associated with chronic consequences of previous sub-lethal exposure to the toxin. This study indicates that domoic acid causes chronic damage to California sea lions and that these health effects are increasing.

Comparison of laboratory values obtained by phlebotomy versus saline lock devices

OBJECTIVES

To assess the utility of a peripheral saline lock device (SLD) as an alternative to a second venipuncture for obtaining selected blood samples.

METHODS

This prospective study used a comparative design and was conducted in an urban emergency department (ED). Adult patients with an existing SLD in place who required serial phlebotomy were eligible for inclusion in the study. Each subject had blood samples obtained by venipuncture (control) with a Vacutainer adapter according to standard protocols. Within 5 minutes of obtaining the control samples, a sample was obtained from the patients' SLDs; a tourniquet was applied proximal to the intravenous line, a 5-mL waste portion was obtained, and a Vacutainer adapter was placed to draw specimens for testing. Each of the paired samples was analyzed for hematocrit, electrolytes, and cardiac enzymes. The Bland-Altman method was used to analyze the concordance between each pair of measurements. Paired t-tests for each of the eight laboratory tests were used to assess whether the values were statistically different from each other. The 95% limits of agreement around the mean differences were calculated. Differences between SLD aspirates and venipuncture aspirates also were compared with the federal regulatory standards that ensure reliable and accurate laboratory testing.

RESULTS

Eighty-one patients were eligible for the study; in 73 (90.1%; 95% confidence interval [CI] = 81.5% to 95.6%) of the patients, the SLD could be aspirated for testing. The paired t-tests indicated that there were no statistically significant differences between the mean values of the two methods of testing. Of the 584 paired values analyzed, 35 (6.0%; 95% CI = 4.3% to 8.2%) exceeded the Bland-Altman limits of agreement, and 43 (7.4%; 95% CI = 5.4% to 9.8%) fell outside the acceptable range determined by the federal regulation of clinical laboratories. Of those values that exceeded the acceptable Bland-Altman limits of agreement, none would have resulted in clinical intervention.

CONCLUSIONS

Aspirating blood via an SLD is an acceptable method of obtaining serial laboratory values in a group of stable, consenting adult ED patients.

Fetal cardiac calcifications: report of four prenatally diagnosed cases and review of the literature

Fetal cardiac calcifications are defined as diffuse hyperechogenicities in the different layers of the heart. This is an uncommon fetal ultrasound finding associated with significant myocardial dysfunction. We report four cases with massive fetal myocardial calcifications detected on prenatal ultrasound at 18-22 weeks' gestation and associated, in all cases, with significant cardiac dysfunction. Detailed fetal echocardiographic evaluation, chromosome analysis, and an extensive search for intrauterine infection as a cause of these abnormalities, were carried out on all cases. A thorough autopsy was performed on all deceased fetuses and postnatal investigation of the sole survivor was performed. Two of our patients chose to interrupt their pregnancies, one fetus suffered intrauterine demise, and one child was born alive. In all of our cases the karyotypes were normal, and no specific infectious etiology or maternal autoantibody was noted. Histopathology findings in the non-survivors included myo- and epicardial calcification maximal at the base of the heart. The living child has findings suggestive of an intrauterine infection, although no infectious entity was identified. Long-term follow-up showed sensorineural hearing loss and severe developmental delay.