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Parth K Modi, Samuel R Kaufman, Tudor Borza, Phyllis Yan, David C Miller, Ted A Skolarus, John M Hollingsworth, Edward C Norton, Vahakn B Shahinian, Brent K Hollenbeck
BACKGROUND: Accountable care organizations (ACOs) have been shown to reduce prostate cancer treatment among men unlikely to benefit because of competing risks (ie, potential overtreatment). This study assessed whether the level of engagement in ACOs by urologists affected rates of treatment, overtreatment, and spending. METHODS: A 20% sample of national Medicare data was used to identify men diagnosed with prostate cancer between 2012 and 2014. The extent of urologist engagement in an ACO, as measured by the proportion of patients in an ACO managed by an ACO-participating urologist, served as the exposure...
June 15, 2018: Cancer
Monique R Pappadis, Robert J Volk, Shilpa Krishnan, Susan C Weller, Elizabeth Jaramillo, Diana Stewart Hoover, Sharon H Giordano, Alai Tan, Kristin M Sheffield, Ashley J Housten, James S Goodwin
OBJECTIVES: Current research on the perceptions of overdiagnosis or overdetection of breast cancer has largely been conducted outside of the USA and with women younger than 70 years.Therefore, we explored older women's perceptions about the concept of overdetection of breast cancer and its influence on future screening intentions. DESIGN: Mixed-methods analysis using purposive sampling based on race/ethnicity, age and educational level. Semistructured interviews, including two hypothetical scenarios illustrating benefits and harms of screening and overdetection, were analysed using inductive and deductive thematic approaches...
June 14, 2018: BMJ Open
Shengmeng Peng, Tao Du, Wanhua Wu, Xianju Chen, Yiming Lai, Dingjun Zhu, Qiong Wang, Xiaoming Ma, Chunhao Lin, Zean Li, Zhenghui Guo, Hai Huang
PURPOSE: The aim of this study was to investigate the associations of serine proteinase inhibitor family G1 (SERPING1) down-regulation with poor prognosis in patients with prostate cancer (PCa). Furthermore, we aim to find more novel and effective PCa molecular markers to provide an early screening of PCa, distinguish patients with aggressive PCa, predict the prognosis, or reduce the economic burden of PCa. METHODS: SERPING1 protein expression in both human PCa and normal prostate tissues was detected by immunohistochemical staining, which intensity was analyzed in association with clinical pathological parameters such Gleason score, pathological grade, clinical stage, tumor stage, lymph node metastasis, and distant metastasis...
June 11, 2018: Urologic Oncology
Dina Valiyakath, Thuraya Al Busaidi, Salma Al Shamsi, Yaqoob Al Sawafi
Spontaneous pneumomediastinum (SPM) is a rare and benign condition predominantly seen in young males. Patients present with non-specific pleuritic chest pain, cough, and dyspnea. Hence, it is difficult to diagnose in the acute setting until other serious differential diagnoses involving the integrity of the aerodigestive tract have been excluded. This results in over investigation and overtreatment until a diagnosis has been confirmed. We report a case of a 21-year-old Omani female who presented with a complaint of cough...
May 2018: Oman Medical Journal
Haige Ye, Aakash Desai, Dongfeng Zeng, Jorge Romaguera, Michael L Wang
The natural history of mantle cell lymphoma (MCL) undergoing chemotherapy is a cyclical pattern of remission followed by recurrence of disease due to acquired chemotherapy resistance. The median age of the occurrence of MCL is 65 years, so half of the newly diagnosed MCL patients are considered "elderly." The tolerance to long-term chemotherapy in elderly patients is decreased; hence, the response to frontline therapy used is of paramount importance. We hope that our review may guide clinicians in treating such populations in a more personalized and evidence-based manner...
June 12, 2018: Oncologist
Vinotha Thomas, Anitha Thomas, Ajit Sebastian, Rachel Chandy, Abraham Peedicayil
Incidental diagnosis of carcinoma endometrium following hysterectomy requires clinical expertise from a gynecologic oncologist, with regard to subsequent management. We report our experience with completion staging in endometrial cancer, to determine the benefits and risks of completion staging in women with posthysterectomy diagnosis of endometrial cancer. DESIGN: A retrospective case series of 20 women with postoperative diagnosis of endometrial cancer, who had undergone completion staging...
June 2018: Indian Journal of Surgical Oncology
F Liu, M Li, L Y Zhang, L Guo, W W Hu, H L Rao
Objective: To study clinicopathologic features, prognosis and differential diagnoses of primary mucosal CD30-positive T-cell lymphoproliferative disorders of the head and neck(mCD30(+) TLPD-head and neck). Methods: Three cases of mCD30(+) TLPD-head and neck were collected from January 2014 to April 2017 at Sun Yat-Sen University Foshan Hospital. A literature review of mCD30(+) TLPD of head and neck was provided. Results: All three cases presented with either bulging/exophytic nodule or mucosal ulcer/erosion...
June 8, 2018: Zhonghua Bing Li Xue za Zhi Chinese Journal of Pathology
M G M Derks, E Bastiaannet, W van de Water, N A de Glas, C Seynaeve, H Putter, J W R Nortier, D Rea, A Hasenburg, C Markopoulos, L Y Dirix, J E A Portielje, C J H van de Velde, G J Liefers
AIM: Due to increasing life expectancy, patients with breast cancer remain at risk of dying due to breast cancer over a long time. This study aims to assess the impact of age on breast cancer mortality and other cause mortality 10 years after diagnosis. METHODS: Postmenopausal patients with hormone-receptor positive breast cancer were included in the Tamoxifen and Exemestane Adjuvant Multinational (TEAM) trial between 2001 and 2006. Age at diagnosis was categorised as <65 years (n = 3369), 65-74 years (n = 1896) and ≥75 years (n = 854)...
June 6, 2018: European Journal of Cancer
Gian Francesco Mureddu
The concept that 'the lower the blood pressure (BP) achieved the better the outcome' rests on the demonstration of a direct relationship between BP and incident outcomes, down to levels of 115 mmHg of systolic BP (sBP) and 75 mmHg of diastolic BP (dBP) carried out in 1 million individuals from 61 cohorts recruited between 1950 and 1990 and followed for about 14 years. The alternative to the 'lower the better' concept is the hypothesis of a J-shaped relationship, according to which the benefits of reducing sBP or dBP to low values may be dangerous leading even to an increase in total mortality and/or in CV outcomes...
June 7, 2018: Monaldi Archives for Chest Disease, Archivio Monaldi Per le Malattie del Torace
Marloes G M Derks, Esther Bastiaannet, Mandy Kiderlen, Denise E Hilling, Petra G Boelens, Paul M Walsh, Elizabeth van Eycken, Sabine Siesling, John Broggio, Lynda Wyld, Maciej Trojanowski, Agnieszka Kolacinska, Justyna Chalubinska-Fendler, Ana Filipa Gonçalves, Tomasz Nowikiewicz, Wojciech Zegarski, Riccardo A Audisio, Gerrit-Jan Liefers, Johanneke E A Portielje, Cornelis J H van de Velde
BACKGROUND: Older patients are poorly represented in breast cancer research and guidelines do not provide evidence based recommendations for this specific group. We compared treatment strategies and survival outcomes between European countries and assessed whether variance in treatment patterns may be associated with variation in survival. METHODS: Population-based study including patients aged ≥ 70 with non-metastatic BC from cancer registries from the Netherlands, Belgium, Ireland, England and Greater Poland...
June 7, 2018: British Journal of Cancer
Carl Schümichen, Matthias Schmidt, Thomas Krause
The S1 guideline for lung scintigraphy has been updated and extended in order to emphasize the advantages oft the method in detecting acute pulmonary embolism (PE) in the periphery oft the lung (subsegmental PE), in underlying subacute and chronic pulmonary disorders, as well as in detecting chronic LE (CTEPH). Method of choice is ventilation / perfusion (V/P) SPECT or V/P SPECT/CT with even higher specificity. Because of its high sensitivity, a threshold (V/P mismatch in at least one segment or two subsegments) is introduced to avoid overtreatment...
June 2018: Nuklearmedizin. Nuclear Medicine
Hiroyuki Miyahara, Tomoyuki Akiyama, Kenji Waki, Yoshio Arakaki
BACKGROUND: Nonepileptic twilight state with convulsive manifestations (NETC) is a nonepileptic state following a febrile seizure (FS), which may be misdiagnosed as a prolonged seizure and result in overtreatment. We aimed to describe clinical manifestations of NETC and to determine characteristics that are helpful to distinguish NETC from other pathological conditions. METHODS: We conducted a retrospective chart review from January 2010 to December 2016 and selected the patients who presented with symptoms resembling status epilepticus with fever and a confirmed diagnosis using an electroencephalogram (EEG)...
June 1, 2018: Brain & Development
Ying Xiao, Dong Xu, Haixing Ju, Chen Yang, Liping Wang, Jinming Wang, John D Hazle, Dongguo Wang
PURPOSE: To determine the accuracy of biplane transrectal ultrasonography (TRUS) plus ultrasonic elastosonography (UE) and contrast-enhanced ultrasonography (CEUS) in preoperative T staging after neoadjuvant chemoradiotherapy for rectal cancer. MATERIALS AND METHODS: Fifty-three patients with advanced lower rectal cancer were examined before and after neoadjuvant chemoradiotherapy with use of TRUS plus UE and CEUS and were diagnosed as having T stage disease. We compared ultrasonic T stages before and after neoadjuvant chemoradiotherapy and analyzed any changes...
July 2018: European Journal of Radiology
S Geller, M Pulitzer, P L Myskowski
Follicular mucinosis (FM) can present as an acneiform eruption, and is usually a benign variant of primary FM unrelated to cutaneous T-cell lymphoma (CTCL). We report two cases of women in their twenties who presented with an acneiform rash on the face, arms and back. In both cases, pathological evaluation of the facial papules revealed predominantly mucinous degeneration of the follicular epithelium, with insufficient lymphocytic infiltration or atypia to diagnose mycosis fungoides. These cases are similar to previous reports of acneiform FM...
May 30, 2018: Clinical and Experimental Dermatology
L Bourke, R Stevenson, R Turner, R Hooper, P Sasieni, R Greasley, D Morrissey, M Loosemore, A Fisher, H Payne, S J C Taylor, D J Rosario
Alternative management strategies for localised prostate cancer are required to reduce morbidity and overtreatment. The aim of this study was to evaluate the feasibility, safety and acceptability of exercise training (ET) with behavioural support as a primary therapy for low/intermediate risk localised prostate cancer. Men with low/intermediate-risk prostate cancer were randomised to 12 months of ET or usual care with physical activity advice (UCwA) in a multi-site open label RCT. Feasibility included acceptability, recruitment, retention, adherence, adverse events and disease progression...
May 30, 2018: Scientific Reports
Nicolai Hübner, Shahrokh Shariat, Mesut Remzi
PURPOSE OF REVIEW: To summarize the highest level evidence that was acquired within the last years, with regard to diagnosis of prostate cancer. With many secondary diagnostic tools becoming available, and not being mentioned in the guidelines, this review is meant to assist clinical decision-making in initial biopsy and rebiopsy settings. RECENT FINDINGS: The PROMIS Trial delivered level 1b evidence about the diagnostic accuracy of prostate multiparametric MRI (mpMRI) as a triage tool for prostate biopsy...
July 2018: Current Opinion in Urology
N H Azawi, S A Tolouee, M Madsen, K D Berg, C Dahl, M Fode
PURPOSE: The purpose of the study was to evaluate the diagnostic accuracy of core biopsy in small renal masses ≤ 4 cm in response to the rising prevalence of renal masses. METHODS: Data from 129 consecutive patients who underwent biopsies of solid renal masses of ≤ 4 cm were prospectively collected between September 2014 and January 2017. In cases with inconclusive biopsies, a repeat biopsy was recommended. Histology from surgical specimens was used as gold standard to evaluate the accuracy of renal biopsies...
May 30, 2018: International Urology and Nephrology
Robert A Huddart, Alison M Reid
Testicular germ cell tumours are the commonest tumours of young men and are broadly managed either as pure seminomas or as 'nonseminomas'. The management of Stage 1 nonseminomatous germ cell tumours (NSGCTs), beyond surgical removal of the primary tumour at orchidectomy, is somewhat controversial. Cancer-specific survival rates in these patients are in the order of 99% regardless of whether surveillance, retroperitoneal lymph node dissection, or adjuvant chemotherapy is employed. However, the toxicities of these treatment modalities differ...
2018: Advances in Urology
Campbell S Roxburgh, Martin R Weiser
INTRODUCTION: The last three decades have seen several major advances in the multidisciplinary management of locally advanced rectal cancer (LARC). Although rectal cancer management varies globally, the standard of care for clinical stage II/III rectal cancer in North America remains chemoradiation followed by total mesorectal excision and adjuvant therapy. EVIDENCE ACQUISITION: In this review we evaluate the evidence for neoadjuvant therapy in LARC and the variety of treatment options available...
May 25, 2018: Minerva Chirurgica
David C Grossman, Susan J Curry, Douglas K Owens, Kirsten Bibbins-Domingo, Aaron B Caughey, Karina W Davidson, Chyke A Doubeni, Mark Ebell, John W Epling, Alex R Kemper, Alex H Krist, Martha Kubik, C Seth Landefeld, Carol M Mangione, Michael Silverstein, Melissa A Simon, Albert L Siu, Chien-Wen Tseng
Importance: In the United States, the lifetime risk of being diagnosed with prostate cancer is approximately 13%, and the lifetime risk of dying of prostate cancer is 2.5%. The median age of death from prostate cancer is 80 years. Many men with prostate cancer never experience symptoms and, without screening, would never know they have the disease. African American men and men with a family history of prostate cancer have an increased risk of prostate cancer compared with other men. Objective: To update the 2012 US Preventive Services Task Force (USPSTF) recommendation on prostate-specific antigen (PSA)-based screening for prostate cancer...
May 8, 2018: JAMA: the Journal of the American Medical Association
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