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invasive vs conservative

Hassan Alnaeem, Salah Aldekhayel, Johnathan Kanevsky, Omar Fouda Neel
PURPOSE: The optimal management of undisplaced scaphoid fractures remains controversial. A systematic review was conducted to assess the outcomes of acute, undisplaced scaphoid fractures managed with cast immobilization versus percutaneous or miniopen screw fixation in terms of time to return to work (RTW), time to union, and morbidity. METHODS: PubMed MEDLINE, Ovid MEDLINE, EMBASE, SCOPUS, and Cochrane electronic databases were searched over the period 1974 to 2015...
October 1, 2016: Journal of Hand Surgery
Nathaniel R Smilowitz, Navdeep Gupta, Yu Guo, John T Coppola, Sripal Bangalore
OBJECTIVES: Human immunodeficiency virus (HIV) seropositive individuals are predisposed to acute myocardial infarction (AMI). We sought to evaluate management strategies and outcomes of AMI in patients with HIV in the contemporary era. METHODS: We analyzed data from the National Inpatient Sample from 2002 to 2011 for patients admitted with AMI with or without HIV. Propensity-score matching was used to identify HIV seropositive AMI patients with similar characteristics who were managed invasively (cardiac catheterization, percutaneous coronary intervention [PCI], or coronary artery bypass graft surgery [CABG]) or conservatively...
October 2016: Journal of Invasive Cardiology
Jayant S Vaidya, Frederik Wenz, Max Bulsara, Jeffrey S Tobias, David J Joseph, Christobel Saunders, Chris Brew-Graves, Ingrid Potyka, Stephen Morris, Hrisheekesh J Vaidya, Norman R Williams, Michael Baum
BACKGROUND: Based on our laboratory work and clinical trials we hypothesised that radiotherapy after lumpectomy for breast cancer could be restricted to the tumour bed. In collaboration with the industry we developed a new radiotherapy device and a new surgical operation for delivering single-dose radiation to the tumour bed - the tissues at highest risk of local recurrence. We named it TARGeted Intraoperative radioTherapy (TARGIT). From 1998 we confirmed its feasibility and safety in pilot studies...
September 2016: Health Technology Assessment: HTA
Z Khan, S K Laughlin-Tommaso, A L Weaver, C D Schleck, W A Rocca, E A Stewart
No abstract text is available yet for this article.
November 2015: Journal of Minimally Invasive Gynecology
J Hoogmoed, R van den Berg, B A Coert, G J E Rinkel, W P Vandertop, D Verbaan
BACKGROUND: In patients with poor clinical condition after aneurysmal subarachnoid haemorrhage (aSAH), treatment is often deferred until patients show signs of improvement. Early external ventricular drainage and aneurysm occlusion may improve prognosis also in poor grade patients. The clinical outcome of an expeditious approach was compared with that of a conservative approach. METHODS: In all, 285 consecutive World Federation of Neurological Surgeons (WFNS) grade V aSAH patients admitted to three university hospitals between January 2000 and June 2007 were included...
September 26, 2016: European Journal of Neurology: the Official Journal of the European Federation of Neurological Societies
Jun-Wen Wang, Bradley Chen, Po-Chun Lin, Shih-Hsiang Yen, Chung-Cheng Huang, Feng-Chih Kuo
BACKGROUND: Tranexamic acid (TXA) was reportedly to decrease postoperative blood loss after standard total knee arthroplasty (TKA). However, the blood-conservation effect of TXA in minimally invasive TKA, in particular, receiving a direct oral anticoagulant was unclear. The aim of the study was to investigate the efficacy of combined use of TXA and rivaroxaban on postoperative blood loss in primary minimally invasive TKA. METHODS: In a prospective, randomized, controlled trial, 198 patients were assigned to placebo (98 patients, normal saline injection) and study group (100 patients, 1g TXA intraoperative injection) during primary unilateral minimally invasive TKA...
August 27, 2016: Journal of Arthroplasty
Peter Nolte, Robert Anderson, Elton Strauss, Zhe Wang, Liuyi Hu, Zekun Xu, R Grant Steen
INTRODUCTION: Whether to treat metatarsal fractures conservatively or surgically is controversial. We test a hypothesis that metatarsal fractures treated conservatively with non-invasive low-intensity pulsed ultrasound (LIPUS) obtain heal rates comparable to current surgical techniques. PATIENTS AND METHODS: This is a retrospective observational cohort study, using patient outcomes from a prospectively-collected LIPUS registry required by the U.S. Food & Drug Administration...
September 13, 2016: Injury
Lauren M Bergeron, Katherine C Bishop, Holly R Hoefgen, Margaret S Abraham, Nhial T Tutlam, Diane F Merritt, Jeffrey F Peipert
STUDY OBJECTIVE: The purpose of this study was to compare ovarian conservation rates and surgical approach in benign adnexal surgeries performed by surgeons versus gynecologists at a tertiary care institution. DESIGN: A retrospective cohort review. SETTING: Children's and Adult tertiary care university-based hospital. PARTICIPANTS: Patients ≤21 years of age undergoing surgery for an adnexal mass from January 2003 through December 2013...
September 14, 2016: Journal of Pediatric and Adolescent Gynecology
Conny Vrieling, Erik van Werkhoven, Philippe Maingon, Philip Poortmans, Caroline Weltens, Alain Fourquet, Dominic Schinagl, Bing Oei, Carla C Rodenhuis, Jean-Claude Horiot, Henk Struikmans, Erik Van Limbergen, Youlia Kirova, Paula Elkhuizen, Rudolf Bongartz, Raymond Miralbell, David A L Morgan, Jean-Bernard Dubois, Vincent Remouchamps, René-Olivier Mirimanoff, Guus Hart, Sandra Collette, Laurence Collette, Harry Bartelink
Importance: Prognostic factors of ipsilateral breast tumor recurrence (IBTR) may change over time following breast-conserving therapy. Objective: The EORTC "boost no boost" trial showed that young age and high-grade invasive carcinoma were the most important risk factors for IBTR. This study reanalyses pathological prognostic factors related to IBTR using long-term follow-up. Design, Setting, and Participants: Participants included 5569 early-stage breast cancer patients, treated with breast-conserving surgery (BCS) and whole-breast irradiation (WBI), who were randomized between no boost and a 16-Gy boost in the EORTC phase III "boost no boost" trial (1989-1996)...
September 8, 2016: JAMA Oncology
Nurhan Torun, Yosef Laviv, Kianush Karimian Jazi, Anand Mahadevan, Rafeeque A Bhadelia, Anderson Matthew, Mitchell Strominger, Ekkehard M Kasper
Schwannomas of cranial nerves in the absence of systemic neurofibromatosis are relatively rare. Among these, schwannomas of the trochlear nerve are even less common. They can be found incidentally or when they cause diplopia or other significant neurological deficits. Treatment options include observation only, neuro-ophthalmological intervention, and/or neurosurgical management via resection or sterotactic radiosurgery (SRS). In recent years, the latter has become an attractive therapeutic tool for a number of benign skull base neoplasm including a small number of reports on its successful use for trochlear Schwannomas...
September 1, 2016: Neurosurgical Review
Richard Bostelmann, Tamara Bostelmann, Adrian Nasaca, Hans Jakob Steiger, Frank Zaucke, Christoph Schleich
BACKGROUND CONTEXT: On a molecular level, maturation or degeneration of human intervertebral disc is among others expressed by the content of glycosaminoglycans (GAGs). According to the degenerative status, the disc content can differ in nucleus pulposus (NP) and annulus fibrosus (AF), respectively. Research in this area was conducted mostly on postmortem samples. Although several radiological classification systems exist, none includes biochemical features. Therefore, we focused our in vivo study on a widely spread and less expensive imaging technique for the cervical spine and the correlation of radiological patterns to biochemical equivalents in the intervertebral discs...
August 25, 2016: Spine Journal: Official Journal of the North American Spine Society
Eyal Lotan, Omer Weissman, Larisa Guranda, Nir Kleinmann, Rachel Schor, Harry Winkler, Orith Portnoy
OBJECTIVE: The purpose of this study was to determine the value of clinical parameters and radiologic findings on unenhanced CT to the choice between interventional and conservative management for patients with acute renal colic. MATERIALS AND METHODS: Unenhanced CT records of 183 consecutive patients with acute renal colic were retrospectively reviewed. Urolithiasis was confirmed at both unenhanced CT and clinical follow-up findings of 80 patients (study group)...
November 2016: AJR. American Journal of Roentgenology
Traci LeMasters, S Suresh Madhavan, Usha Sambamoorthi
BACKGROUND: Breast conserving surgery (BCS) followed by radiation therapy (RT) (BCS+RT) is as effective for long-term survival of invasive early-stage breast cancer (ESBC) as mastectomy, and is the local treatment option selected by the majority of women with ESBC. Women of older age and vulnerable socio-demographic characteristics are at greater risk for receiving substandard (BCS only) and non-preferred treatments (mastectomy), such as populations of women from the Appalachian region of United States...
2016: Global J Breast Cancer Res
Edina Cenko, Beatrice Ricci, Sasko Kedev, Zorana Vasiljevic, Maria Dorobantu, Olivija Gustiene, Božidarka Knežević, Davor Miličić, Mirza Dilic, Olivia Manfrini, Akos Koller, Lina Badimon, Raffaele Bugiardini
BACKGROUND: We explored benefits and risks of an early invasive compared with a conservative strategy in women versus men after non-ST elevation acute coronary syndromes (NSTE-ACS) using the ISACS-TC database. METHODS: From October 2010 to May 2014, 4145 patients were diagnosed as having a NSTE-ACS. We excluded 258 patients managed with coronary bypass surgery. Of the remaining 3887 patients, 1737 underwent PCI (26% women). The primary endpoint was the composite of 30-day mortality and severe left ventricular dysfunction defined as an ejection fraction <40% at discharge...
November 1, 2016: International Journal of Cardiology
W A Slijkhuis, E M Noorda, H van der Zaag-Loonen, M J Bolster-van Eenennaam, K E Droogh-de Greve, W B Lastdrager, J W C Gratama
Ultrasound guidance (USG) during breast-conserving surgery improves tumor-free surgical resection margins. The objective of this study was to evaluate whether USG reduces resection volumes without compromising margin status. 134 patients with palpable or nonpalpable T1-2N0-1 invasive breast cancer were treated with USG and compared with a historical reference control group (CON) consisting of palpation-guided (PAG) or wire-guided localization (WIG) breast-conserving surgery. Primary outcomes were excess resection volume and clear margin status, and secondary outcome was re-excision rate...
August 2016: Breast Cancer Research and Treatment
Emily C Daugherty, Michael R Daugherty, Jeffrey A Bogart, Anna Shapiro
PURPOSE: Published prospective trials have questioned the role of post-lumpectomy radiotherapy in older women with early-stage, estrogen receptor-positive (ER(+)) breast cancer. As the population with ER(-) tumors may be at greater risk for relapse, particularly given that endocrine therapy is not effective, we hypothesize the addition of radiation would be of benefit in patients age ≥ 70. METHODS AND MATERIALS: The Surveillance, Epidemiology, and End Results database was queried from 1998 to 2011 for patients age ≥ 70 years receiving breast-conserving surgery for T1, ER(-) invasive ductal carcinoma...
June 23, 2016: Clinical Breast Cancer
Alina M Mateo, Todd A Pezzi, Mark Sundermeyer, Cynthia A Kelley, Vicki S Klimberg, Christopher M Pezzi
BACKGROUNDS AND OBJECTIVES: Medullary breast carcinoma (MBC) is a subtype with a more favorable prognosis. Tumors with some, but not all, characteristics of MBC are classified as atypical medullary carcinoma of the breast (AMCB). METHODS: Patients with invasive MBC and AMCB reported to the National Cancer Data Base (NCDB) from 2004 to 2013 were compared for tumor characteristics and overall survival, using infiltrating ductal carcinoma (IDC) as a reference. RESULTS: Patients with MBC (n = 3,688), AMCB (n = 288), and IDC (n = 918,870) met inclusion criteria...
October 2016: Journal of Surgical Oncology
Sanjay Patel, Tuan Dinh, Joyce Noah-Vanhoucke, Badri Rengarajan, Kevin Mayo, Peter E Clark, Ashish M Kamat, Cheryl T Lee, Wade J Sexton, Gary D Steinberg
Introduction: There have been no randomized controlled trials (RCTs) evaluating the clinical or economic benefit of mitomycin C intravesical therapy vs. radical cystectomy in patients with high-risk non-muscle invasive bladder cancer (NMIBC). We used the Archimedes computational model to simulate RCT comparing radical cystectomy versus intravesical mitomycin C (MMC) therapy to evaluate the clinical and economic outcomes for BCG-refractory NMIBC as well demonstrate the utility of computer based models to simulate a clinical trial...
2015: Bladder Cancer
Julie M Jorns, Kelley M Kidwell
OBJECTIVES: To evaluate use of sentinel lymph node (SLN) frozen section (FS) before and after publication of the Z0011 trial. METHODS: We identified 116 pre-Z0011 and 134 post-Z0011 patients from 18 months before and after Z0011-initiated changes. Clinicopathologic features were assessed by chart review. RESULTS: Post-Z0011 SLN FS use markedly declined when performed with breast-conserving therapy (BCT) (P < .0001), with SLN FS in 53 (73...
July 2016: American Journal of Clinical Pathology
Jennifer S Winn, Mary G Baker, Ibrahim S Fanous, Jill K Slack-Davis, Kristen A Atkins, Patrick M Dillon
BACKGROUND: The predominant breast cancer subtypes, invasive lobular carcinoma (ILC) and invasive ductal carcinoma (IDC), have similar recurrence and survival rates but differing patterns of metastatic recurrence. METHODS: A retrospective review of breast cancers treated at an academic medical center from 1999 to 2012 was performed. Demographic, pathologic, treatment, and follow-up data were collected for 179 ILC and 358 IDC patients (1:2 stage-matched). The median follow-up was 4...
2016: Oncology
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