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https://www.readbyqxmd.com/read/28643813/-polymyalgia-rheumatica-diagnostic-and-therapeutic-issues-of-an-apparently-straightforward-disease
#1
Ciro Manzo, Dario Camellino
Polymyalgia rheumatica (PMR) is an inflammatory disease characterized by aching and stiffness in the girdles, which affects typically people over 50 years old and could overlap with giant cell arteritis (GCA) in about 15-20% of cases. Although the diagnosis of PMR is usually considered straightforward, clinicians facing this disease should be aware of its atypical manifestations, which can hamper the correct identification of PMR and, conversely, should be aware of other diseases which may present with polymyalgic features...
May 2017: Recenti Progressi in Medicina
https://www.readbyqxmd.com/read/28635569/stratification-model-based-on-early-postprostatectomy-prostate-specific-antigen-kinetics-may-help-to-reduce-the-risk-of-overtreatment-in-candidates-for-adjuvant-radiotherapy
#2
Stepan Vesely, Ladislav Jarolim, Marek Schmidt, Joana Do Carmo Silva, Katerina Duskova, Marko Babjuk
OBJECTIVE: The aim of this study was to construct a stratification model based on early postoperative kinetics of prostate-specific antigen (PSA) to select the most suitable high-risk patients for early intervention after radical prostatectomy (RP). MATERIALS AND METHODS: The study evaluated 205 men who had undergone RP without any adjuvant treatment. All of the patients had positive surgical margins, extracapsular extension and/or seminal vesicle invasion. The patients underwent multiple ultrasensitive PSA measurements on days 14, 30, 60 and 90 after RP, and subsequently at 3 month intervals...
February 24, 2017: Scandinavian Journal of Urology
https://www.readbyqxmd.com/read/28633327/a-prognosis-based-approach-to-infertility-understanding-the-role-of-time
#3
(no author information available yet)
The current definition of infertility acknowledges the importance of duration of pregnancy seeking but fails to recognize the prevalent negative impact of female age. In fact, the diagnosis of unexplained infertility increases with women's age because of our incapacity to discern between age-related infertility and real unexplained infertility. Physicians' response to the pressures of increased female age has been to take prompt refuge in assisted reproduction despite the lack of robust evidence and the inherent risks and costs of these procedures...
June 13, 2017: Human Reproduction
https://www.readbyqxmd.com/read/28633075/elective-unilateral-nodal-irradiation-in-head-and-neck-squamous-cell-carcinoma-a-paradigm-shift
#4
A Al-Mamgani, M Verheij, M W M van den Brekel
There is a long-standing convention to irradiate the great majority of head and neck squamous cell carcinoma (HNSCC) electively to both sides of the neck, to reduce the theoretically increased risk of contralateral regional failure (cRF). With the currently available diagnostic imaging techniques this treatment paradigm means, in our opinion, an overtreatment in considerable proportion of these patients. From all the published studies (n = 11, with 1116 patients treated in total), the incidence of cRF in patients with oropharyngeal cancer treated to one side of the neck is 2...
June 17, 2017: European Journal of Cancer
https://www.readbyqxmd.com/read/28629687/sensitivity-and-specificity-of-empiric-treatment-for-sexually-transmitted-infections-in-a-pediatric-emergency-department
#5
Kristen Breslin, Lisa Tuchman, Katie L Hayes, Gia Badolato, Monika K Goyal
OBJECTIVE: To determine test characteristics of provider judgment for empiric antibiotic provision to patients undergoing testing for a sexually transmitted infection. STUDY DESIGN: We conducted a retrospective cross-sectional electronic health record review of all patients aged 13-19 years who had Neisseria gonorrhoeae (GC) and Chlamydia trachomatis (CT) testing sent from an urban, academic pediatric emergency department in 2012. We abstracted data, including patient demographics, chief complaint, sexually transmitted infection test results, and treatment...
June 16, 2017: Journal of Pediatrics
https://www.readbyqxmd.com/read/28628487/do-toddler-s-fractures-of-the-tibia-require-evaluation-and-management-by-an-orthopaedic-surgeon-routinely
#6
John S Adamich, Mark W Camp
OBJECTIVE: The majority of uncomplicated toddler fractures of the tibia (toddler's fractures) do not need an orthopaedic surgeon's intervention or follow-up. However, inexperienced emergency room physicians, general practitioners and orthopaedic trainees and surgeons understandably defer to a cautious approach of referral and subsequent frequent clinical and radiographic follow-up. An evidence-based pathway can help prevent this overtreatment, reduce unnecessary radiation exposure and decrease the financial burden on families and the healthcare system...
June 16, 2017: European Journal of Emergency Medicine: Official Journal of the European Society for Emergency Medicine
https://www.readbyqxmd.com/read/28627021/superficial-papular-neuroma-case-series-of-a-new-entity-r2
#7
Stephanie J T Chen, Rajiv M Patel, Christine P Hans, May P Chan, Douglas R Fullen
BACKGROUND: Dermal neural lesions arise in various circumstances and may be difficult to classify. METHODS: We describe the clinical, histopathologic and immunophenotypic features of a series of terminally-differentiated neural lesions not described previously, to our knowledge. RESULTS: Four cases from men aged 58-66 years were included. Some lesions reportedly bled, but no inciting trauma or prior biopsies were reported. None recurred after biopsy, with follow-up ranging from 19 to 113 months...
June 19, 2017: Journal of Cutaneous Pathology
https://www.readbyqxmd.com/read/28625275/advance-directives-and-powers-of-attorney-in-intensive-care-patients
#8
Geraldine de Heer, Bernd Saugel, Barbara Sensen, Charlotte Rübsteck, Hans O Pinnschmidt, Stefan Kluge
BACKGROUND: Advance directives and powers of attorney are increasingly common, yet data on their use in clinical situations remain sparse. METHODS: In this single center cross-sectional study, we collected data by questionnaire from 1004 intensive care patients in a university hospital. The frequencies of advance directives and powers of attorney were determined, and the factors affecting them were studied with multivariate logistic regression analysis. RESULTS: Usable data were obtained from 998 patients...
June 5, 2017: Deutsches Ärzteblatt International
https://www.readbyqxmd.com/read/28620555/a-discussion-of-high-risk-hpv-in-a-6-year-old-female-survivor-of-child-sexual-abuse
#9
Connie D Cao, Lena Merjanian, Joelle Pierre, Adrian Balica
BACKGROUND: Human papilloma viruses (HPVs) cause a variety of clinical manifestations in children including skin warts, laryngeal papillomas, and condyloma acuminatum. Whereas the mode of transmission is well understood and management of HPV infection is clearly defined by guidelines in adults, less is known about the mode of transmission, natural history of disease, and appropriate management of high-risk anogenital HPV infections in children. CASE: The patient is a previously healthy 6-year-old female who presented with multiple vaginal lesions causing pain and discomfort and was diagnosed with HPV 18 positive CIN I...
2017: Case Reports in Obstetrics and Gynecology
https://www.readbyqxmd.com/read/28614405/overdiagnosis-and-overtreatment-of-thyroid-cancer-a-population-based-temporal-trend-study
#10
Sabrina Jegerlehner, Jean-Luc Bulliard, Drahomir Aujesky, Nicolas Rodondi, Simon Germann, Isabelle Konzelmann, Arnaud Chiolero
BACKGROUND: The increase in incidence of thyroid cancer during the last decades without concomitant rise in mortality may reflect the growing detection of indolent forms of thyroid cancer, and may have fueled unnecessary thyroidectomies. Our aim was therefore, to compare recent secular trends in surgical intervention rate for thyroid cancer with the incidence and mortality of thyroid cancer to assess overdiagnosis and resulting overtreatment. METHODS: We conducted a population-based temporal trend study in Switzerland from 1998 to 2012...
2017: PloS One
https://www.readbyqxmd.com/read/28614085/a-multiparametric-approach-to-improve-upon-existing-prostate-cancer-screening-and-biopsy-recommendations
#11
Brian T Helfand, Carly A Conran, Jianfeng Xu, William J Catalona
PURPOSE OF REVIEW: To provide an overview of how genetic, serum, and urine biomarkers can help identify men at high risk for prostate cancer (PCa) and aggressive disease and men who would benefit from prostate biopsy. RECENT FINDINGS: Screening for PCa is controversial because of concerns about overdiagnosis and overtreatment of nonlife-threatening tumors. Therefore, an approach to screening that includes a detailed family history with genetic testing of risk single nucleotide polymorphisms and high-penetrance genetic variants should be considered...
June 12, 2017: Current Opinion in Urology
https://www.readbyqxmd.com/read/28608502/systematic-differences-between-ultrasound-and-pathological-evaluation-of-thyroid-nodules-a-method-comparison-study
#12
Carolyn R Chew, Tracey Lam, Steven T F Chan, Laura Chin-Lenn
BACKGROUND: The size of thyroid nodules as measured by ultrasound (ultrasound size, USS) is routinely used in clinical decision-making. Reports of discrepancy between USS and pathological size (PS) evaluation have not analysed their systematic differences. The objective of this study was to uncover the lack of agreement (bias) between USS and PS measurements. METHODS: A retrospective study was performed on 121 patients who had a total or hemi-thyroidectomy for a solitary nodule...
June 13, 2017: ANZ Journal of Surgery
https://www.readbyqxmd.com/read/28594447/potential-overtreatment-among-men-aged-80-years-and-older-with-localized-prostate-cancer-in-japan
#13
Hiroyuki Masaoka, Hidemi Ito, Akira Yokomizo, Masatoshi Eto, Keitaro Matsuo
Despite treatment guidelines recommending observation for men with low-risk prostate cancer with life expectancy <10 years, a majority of elderly patients choose active treatment, which may result in overtreatment. Given the growing burden of prostate cancer among men aged ≥80 years (super-elderly men), accumulation of survival data for evaluation of overtreatment among super-elderly patients is imperative. Here, we conducted a population-based cohort study to clarify potential overtreatment of super-elderly men with localized prostate cancer...
June 8, 2017: Cancer Science
https://www.readbyqxmd.com/read/28591173/overinterpretation-is-common-in-pathological-diagnosis-of-appendix-cancer-during-patient-referral-for-oncologic-care
#14
Mark A Valasek, Irene Thung, Esha Gollapalle, Alexey A Hodkoff, Kaitlyn J Kelly, Joel M Baumgartner, Vera Vavinskaya, Grace Y Lin, Ann P Tipps, Mojgan V Hosseini, Andrew M Lowy
CONTEXT: Low-grade appendiceal mucinous neoplasm (LAMN) and appendiceal adenocarcinoma are known to cause the majority of pseudomyxoma peritonei (PMP, i.e. mucinous ascites); however, recognition and proper classification of these neoplasms can be difficult despite established diagnostic criteria. OBJECTIVE: To determine the pathological diagnostic concordance for appendix neoplasia and related lesions during patient referral to an academic medical center specialized in treating patients with PMP...
2017: PloS One
https://www.readbyqxmd.com/read/28590316/recurrence-of-choroidal-neovascularization-lesion-activity-after-aflibercept-treatment-for-age-related-macular-degeneration
#15
Tomotaka Wakazono, Kenji Yamashiro, Akio Oishi, Sotaro Ooto, Hiroshi Tamura, Yumiko Akagi-Kurashige, Masayuki Hata, Ayako Takahashi, Akitaka Tsujikawa, Nagahisa Yoshimura
PURPOSE: To examine the recurrence rate of choroidal neovascularization (CNV) lesion activity in age-related macular degeneration (AMD) and associated factors after 1-year aflibercept treatment. METHODS: Age-related macular degeneration eyes with 1-year aflibercept fixed-regimen treatment and a follow-up period of at least 18 months from the initial aflibercept injection for treatment-naive exudative AMD were retrospectively evaluated. The recurrence rate was examined...
January 11, 2017: Retina
https://www.readbyqxmd.com/read/28586788/trends-in-reoperation-after-initial-lumpectomy-for-breast-cancer-addressing-overtreatment-in-surgical-management
#16
Monica Morrow, Paul Abrahamse, Timothy P Hofer, Kevin C Ward, Ann S Hamilton, Allison W Kurian, Steven J Katz, Reshma Jagsi
Importance: Surgery after initial lumpectomy to obtain more widely clear margins is common and may lead to mastectomy. Objective: To describe surgeons' approach to surgical margins for invasive breast cancer, and changes in postlumpectomy surgery rates, and final surgical treatment following a 2014 consensus statement endorsing a margin of "no ink on tumor." Design, Setting, and Participants: This was a population-based cohort survey study of 7303 eligible women ages 20 to 79 years with stage I and II breast cancer diagnosed in 2013 to 2015 and identified from the Georgia and Los Angeles County, California, Surveillance, Epidemiology, and End Results registries...
June 5, 2017: JAMA Oncology
https://www.readbyqxmd.com/read/28583942/management-of-endocrine-disease-risk-of-overtreatment-of-patients-with-adrenal-insufficiency-current-and-emerging-aspects
#17
Gherardo Mazziotti, Anna Maria Formenti, Stefano Frara, Elisa Roca, Pietro Mortini, Alfredo Berruti, Andrea Giustina
The effects of long-term replacement therapy of adrenal insufficiency (AI) are still a matter of controversy. In fact, the established glucocorticoid replacement regimens do not completely mirror the endogenous hormonal production and the monitoring of AI treatment may be a challenge for the lack of reliable biochemical markers. Consequently, several AI patients may be exposed to relative glucocorticoid excess that, even if mild, may potentially lead to development of chronic complications, such as diabetes mellitus, dyslipidemia, hypertension and fragility fractures with consequent impaired QoL and increased mortality risk...
June 5, 2017: European Journal of Endocrinology
https://www.readbyqxmd.com/read/28583470/insights-into-the-current-management-of-older-adults-with-type-2-diabetes-in-the-ontario-primary-care-setting
#18
Graydon S Meneilly, Lori D Berard, Alice Y Y Cheng, Peter J Lin, Lori MacCallum, Ross T Tsuyuki, Jean-François Yale, Nahal Nasseri, Jean-François Richard, Lianne Goldin, Anatoly Langer, Mary K Tan, Lawrence A Leiter
OBJECTIVE: The Goal Oriented controL of Diabetes in the Elderly populatioN (GOLDEN) Program assessed the management of older persons with type 2 diabetes in Canadian primary care. METHODS: Data were extracted from the records of 833 consecutively identified persons 65 years of age or older who had type 2 diabetes and were taking 1 antihyperglycemic agent or more; they were managed by 64 physicians from 36 Ontario clinics. RESULTS: More than half (53%) had glycated hemoglobin (A1C) levels of 7...
June 2, 2017: Canadian Journal of Diabetes
https://www.readbyqxmd.com/read/28582521/the-prognostic-value-of-tumor-multifocality-in-clinical-outcomes-of-papillary-thyroid-cancer
#19
Fei Wang, Xiaolong Yu, Xiaopei Shen, Guangwu Zhu, Yueye Huang, Rengyun Liu, David Viola, Rossella Elisei, Efisio Puxeddu, Laura Fugazzola, Carla Colombo, Barbara Jarzab, Agnieszka Czarniecka, Alfred K Lam, Caterina Mian, Federica Vianello, Linwah Yip, Garcilaso Riesco-Eizaguirre, Pilar Santisteban, Christine J O'Neill, Mark S Sywak, Roderick Clifton-Bligh, Bela Bendlova, Vlasta Sýkorová, Yangang Wang, Shiguo Liu, Jiajun Zhao, Shihua Zhao, Mingzhao Xing
Context: Multifocality is often treated as a risk factor for papillary thyroid cancer (PTC), prompting aggressive treatments, but its prognostic value remains unestablished. Objective: To investigate the role of tumor multifocality in clinical outcomes of PTC. Methods: Multicenter study of the relationship between multifocality and clinical outcomes of PTC in 2638 patients (623 men and 2015 women) with median (interquartile range [IQR]) age of 46 (35-58) years and median (IQR) follow-up time of 58 (26-107) months at 11 medical centers in 6 countries...
June 5, 2017: Journal of Clinical Endocrinology and Metabolism
https://www.readbyqxmd.com/read/28580596/cervical-cancer-screening-in-a-low-resource-setting-a-pilot-study-on-an-hpv-based-screen-and-treat-approach
#20
Margot Kunckler, Fanny Schumacher, Bruno Kenfack, Rosa Catarino, Manuela Viviano, Eveline Tincho, Pierre-Marie Tebeu, Liliane Temogne, Pierre Vassilakos, Patrick Petignat
Cervical cancer (CC) is the leading cause of cancer-related death among women in sub-Saharan Africa, primarily because of limited access to effective screening and preventive treatment. Our aim was to assess the feasibility of a human papillomavirus (HPV)-based CC screen-and-treat approach in a low-resource context. We recruited 1012 women aged 30-49 years through a CC screening campaign conducted in the District Hospital of Dschang, Cameroon. Participants performed HPV self-sampling, which was tested for high-risk HPV (HR-HPV) DNA using the point-of-care Xpert HPV assay...
June 4, 2017: Cancer Medicine
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