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https://www.readbyqxmd.com/read/28819868/one-level-step-section-histological-analysis-is-insufficient-to-confirm-complete-pathological-response-after-neoadjuvant-chemoradiation-for-rectal-cancer
#1
M A Pereira, A R Dias, S F Faraj, C S R Nahas, A R Imperiale, C F S Marques, G C Cotti, B C Camargo, S C Nahas, E S de Mello, U Ribeiro
BACKGROUND: Neoadjuvant chemoradiation therapy (nCRT) for rectal cancer may lead to cure. As we currently lack reliable methods to clinically confirm the absence of disease, some patients undergo radical resection and have pathological complete response (pCR) still undergo surgery. Furthermore, it is uncertain if conventional one-level histopathological analysis is accurate enough to determine complete response. Confirming pCR is essential to determine the prognosis and to consider the patient's inclusion in trials of adjuvant therapy...
August 17, 2017: Techniques in Coloproctology
https://www.readbyqxmd.com/read/28815065/neoadjuvant-treatment-of-locally-advanced-esophageal-and-junctional-cancer-the-evidence-base-current-key-questions-and-clinical-trials
#2
REVIEW
Claire L Donohoe, John V Reynolds
Recent trials, including CROSS, MAGIC, ACCORD, and OEO2, have established neoadjuvant therapy as standard of care for locally advanced (cT2-3NanyM0) esophageal and junctional cancer compared with surgery alone. The CROSS trial in particular defines a new benchmark for outcomes from multimodal therapy, with a 5 year survival rate of 47%, a median survival of 47 months, a pathologic complete response rate (pCR) of 29% and an R0 resection rate of 92%. Several key questions remain, in particular whether CROSS-regimen chemoradiotherapy is superior to neoadjuvant chemotherapy alone for esophageal cancer, in particular adenocarcinoma...
July 2017: Journal of Thoracic Disease
https://www.readbyqxmd.com/read/28813557/facial-erosive-pustular-dermatosis-after-cosmetic-resurfacing
#3
Julie E Mervak, Stephanie D Gan, Emily H Smith, Frank Wang
Importance: Erosive pustular dermatosis (EPD) is a rare condition that typically affects actinically damaged skin of the scalp. Characterized by sterile pustules, erosions, and crusts, EPD is difficult to treat and heals slowly. The exact cause of EPD is unknown, although trauma is an inciting factor. Objective: To describe 3 women who presented with prolonged facial erosions after cosmetic resurfacing procedures, specifically fully ablative carbon dioxide laser or medium-depth chemical peel...
August 16, 2017: JAMA Dermatology
https://www.readbyqxmd.com/read/28812133/-watchful-waiting-as-a-therapeutic-principle-for-diseases-of-the-vitreoretinal-interface
#4
REVIEW
H Hoerauf, B Kirchhof
Elective surgery of the vitreoretinal interface is currently the most common reason for vitrectomy in Germany. The evaluation and correct interpretation of spectral domain optical coherence tomography (SD-OCT) images is of great importance but the indications for vitrectomy in macular surgery should be based more on patient symptoms and not only the OCT findings. Watchful waiting is highlighted as an alternative therapeutic option in individual patients. This article addresses a number of aspects and discrepancies between findings and patients' level of suffering based on binocular symptoms...
August 15, 2017: Der Ophthalmologe: Zeitschrift der Deutschen Ophthalmologischen Gesellschaft
https://www.readbyqxmd.com/read/28808787/malignant-transformation-of-a-conservatively-managed-incidental-childhood-cerebral-mass-lesion-controversy-regarding-management-paradigm
#5
Jehuda Soleman, Jonathan Roth, Zvi Ram, Michal Yalon, Shlomi Constantini
BACKGROUND: Incidental findings on neuroimaging in the pediatric population are an emerging treatment challenge. Treatment options for these incidental childhood brain mass lesions, which radiologically may be assumed to be low-grade gliomas (LGG), vary, ranging from careful conservative "wait and scan" treatment to surgical biopsy, gross total resection, and upfront radiation and/or chemotherapy. As malignant transformation of LGG in children is extremely rare, some series advocate careful conservative management of these lesions; however, universal treatment protocols are not totally agreed upon...
August 14, 2017: Child's Nervous System: ChNS: Official Journal of the International Society for Pediatric Neurosurgery
https://www.readbyqxmd.com/read/28808514/nodular-pulmonary-amyloidosis-with-primary-pulmonary-malt-lymphoma-masquerading-as-metastatic-lung-disease
#6
Sunil Upadhaya, Mohd Baig, Basim Towfiq, Samer Al Hadidi
Nodular pulmonary amyloidosis is a very rare form of localized amyloidosis involving the lung, with very little known about its nature. It is usually associated with indolent B cell lymphoproliferative disorder and also connective tissue disorders. No definite treatment guideline exists. Many patients respond to chemotherapy with low risk of progression and a 'wait and watch' strategy is also considered a valid treatment option. In this report the authors present a case of nodular pulmonary amyloidosis with pulmonary mucosa associated lymphoid tissue (MALT) lymphoma that presented with features of metastatic malignant disease and after definitive diagnosis decided not to undergo treatment...
July 2017: Journal of Community Hospital Internal Medicine Perspectives
https://www.readbyqxmd.com/read/28807086/oral-steroids-alone-or-followed-by-intranasal-steroids-versus-watchful-waiting-in-the-management-of-otitis-media-with-effusion
#7
A Hussein, H Fathy, S M Amin, N Elsisy
OBJECTIVE: To evaluate the effects of oral steroids alone or followed by intranasal steroids versus watchful waiting on the resolution of otitis media with effusion in children aged 2-11 years. METHODS: A total of 290 children with bilateral otitis media with effusion were assigned to 3 groups: group A was treated with oral steroids followed by intranasal steroids, group B was treated with oral steroids alone and group C was managed with watchful waiting. Patients were evaluated with audiometry and tympanometry...
August 15, 2017: Journal of Laryngology and Otology
https://www.readbyqxmd.com/read/28789623/the-cost-effectiveness-of-active-surveillance-compared-to-watchful-waiting-and-radical-prostatectomy-for-low-risk-localised-prostate-cancer
#8
Chunhuan Lao, Richard Edlin, Paul Rouse, Charis Brown, Michael Holmes, Peter Gilling, Ross Lawrenson
BACKGROUND: Radical prostatectomy is the most common treatment for localised prostate cancer in New Zealand. Active surveillance was introduced to prevent overtreatment and reduce costs while preserving the option of radical prostatectomy. This study aims to evaluate the cost-effectiveness of active surveillance compared to watchful waiting and radical prostatectomy. METHODS: Markov models were constructed to estimate the life-time cost-effectiveness of active surveillance compared to watchful waiting and radical prostatectomy for low risk localised prostate cancer patients aged 45-70 years, using national datasets in New Zealand and published studies including the SPCG-4 study...
August 8, 2017: BMC Cancer
https://www.readbyqxmd.com/read/28781240/outcomes-in-patients-with-contained-ruptures-of-the-aortic-annulus-after-transcatheter-aortic-valve-implantation-with-balloon-expandable-devices
#9
Philipp Breitbart, Jan Minners, Gregor Pache, Jochen Reinöhl, Nicolaj Christopher Hansson, Bjarne L Nørgaard, Franz-Josef Neumann, Philipp Ruile
AIMS: To evaluate incidence and long-term outcomes of patients with contained ruptures of the aortic annulus (CR) after transcatheter aortic valve implantation (TAVI). METHODS AND RESULTS: From May 2012 to June 2017 a total of 1030 patients underwent post- TAVI computed tomography angiography (CTA) at three centers in Germany and Denmark. CR were identified in 12 patients (1.2%, 80.7+5.0 years, STS-Score 4.1+1.4%). All 12 patients had received a balloon-expandable valve...
August 8, 2017: EuroIntervention
https://www.readbyqxmd.com/read/28776215/-cavernomas-of-the-central-nervous-system-observational-study-of-111-patients
#10
C Mayer, U M Mauer, G Bluhm, R Mathieu, C Hackenbroch, S Mayer
PURPOSE: The prevalence of cavernomas (cavernous hemangioma) is 0.1-0.7%. Cavernomas are often found as an incidental finding within the framework of magnetic resonance imaging (MRI) examinations in mainly young and healthy patients. In the literature, the reported risk of hemorrhage varies greatly and is sometimes higher than that of aneurysms, which is surprising given that cavernomas are part of the low blood pressure system. After the diagnosis the medical practitioner and the patient have to decide on the further therapy, either surgical removal or the strategy of watchful waiting (conservative treatment)...
August 3, 2017: Der Nervenarzt
https://www.readbyqxmd.com/read/28764679/economic-evaluation-of-stepped-care-versus-usual-care-for-depression-and-anxiety-in-older-adults-with-vision-impairment-randomized-controlled-trial
#11
Hilde P A van der Aa, Ger H M B van Rens, Judith E Bosmans, Hannie C Comijs, Ruth M A van Nispen
BACKGROUND: A stepped-care program was found effective in preventing depressive and anxiety disorders in older adults with vision impairment. However, before a decision can be made about implementation, the cost-effectiveness of this program should be investigated. Therefore, we aimed to compare the cost-effectiveness of stepped-care versus usual care within low vision rehabilitation. METHODS: An economic evaluation from a societal perspective was performed alongside a multicenter randomized controlled trial...
August 1, 2017: BMC Psychiatry
https://www.readbyqxmd.com/read/28763451/effectiveness-of-a-stepped-care-intervention-to-prevent-major-depression-in-patients-with-type-2-diabetes-mellitus-and-or-coronary-heart-disease-and-subthreshold-depression-a-pragmatic-cluster-randomized-controlled-trial
#12
Alide D Pols, Susan E van Dijk, Judith E Bosmans, Trynke Hoekstra, Harm W J van Marwijk, Maurits W van Tulder, Marcel C Adriaanse
PURPOSE: Given the public health significance of poorly treatable co-morbid major depressive disorders (MDD) among patients with type 2 diabetes mellitus (DM2) and coronary heart disease (CHD), we need to investigate whether strategies to prevent the development of major depression could reduce its burden of disease. We therefore evaluated the effectiveness of a stepped-care program for subthreshold depression in comparison with usual care in patients with DM2 and/or CHD. METHODS: A cluster randomized controlled trial, with 27 primary care centers serving as clusters...
2017: PloS One
https://www.readbyqxmd.com/read/28758827/lymphoproliferative-disorders-in-patients-with-rheumatoid-arthritis-in-the-era-of-widespread-use-of-methotrexate-a-review-of-the-literature-and-current-perspective
#13
Masayoshi Harigai
Lymphoproliferative disorders (LPD) in patients receiving methotrexate (MTX) have gained strong attention. In this article, I reviewed the basic and clinical findings of this issue. Patients with RA possess a high risk of lymphoma, but epidemiological evidence showing an association between the use of MTX and lymphoma is still limited. Rapid regression of LPD after stopping MTX in patients with RA strongly suggests that there is a causative relationship. Genetic predisposition, accumulated inflammation, impaired generation of Epstein-Barr virus (EBV)-specific cytotoxic T lymphocytes, effects of MTX on the regulation of EBV genes, and low hypermethylation of apoptosis-related genes are relevant to the development of LPD and rapid regression after cessation of MTX...
July 31, 2017: Modern Rheumatology
https://www.readbyqxmd.com/read/28755256/rectal-sparing-approach-after-preoperative-radio-and-or-chemotherapy-resarch-in-patients-with-rectal-cancer-a-multicentre-observational-study
#14
A Barina, A De Paoli, P Delrio, M Guerrieri, A Muratore, F Bianco, D Vespa, C Asteria, E Morpurgo, A Restivo, C Coco, U Pace, C Belluco, C Aschele, S Lonardi, V Valentini, G Mantello, I Maretto, P Del Bianco, A Perin, S Pucciarelli
BACKGROUND: Rectum-sparing approaches appear to be appropriate in rectal cancer patients with a major (mCR) or complete clinical response (cCR) after neoadjuvant therapy. The aim of the present study is to evaluate the effectiveness of rectum-sparing approaches at 2 years after the completion of neoadjuvant treatment. STUDY DESIGN: Patients with rectal adenocarcinoma eligible to receive neoadjuvant therapy will be prospectively enrolled. Patients will be restaged 7-8 weeks after the completion of neoadjuvant therapy and those with mCR (defined as absence of mass, small mucosal irregularity no more than 2 cm in diameter at endoscopy and no metastatic nodes at MRI) or cCR will be enrolled in the trial...
July 28, 2017: Techniques in Coloproctology
https://www.readbyqxmd.com/read/28742703/organ-preservation-in-ct2n0-rectal-cancer-after-neoadjuvant-chemoradiation-therapy-the-impact-of-radiation-therapy-dose-escalation-and-consolidation-chemotherapy
#15
Angelita Habr-Gama, Guilherme Pagin São Julião, Bruna Borba Vailati, Jorge Sabbaga, Patricia Bailão Aguilar, Laura Melina Fernandez, Sergio Eduardo Alonso Araújo, Rodrigo Oliva Perez
OBJECTIVE: To demonstrate the difference in organ-preservation rates and avoidance of definitive surgery among cT2N0 rectal cancer patients undergoing 2 different chemoradiation (CRT) regimens. BACKGROUND: Patients with cT2N0 rectal cancer are more likely to develop complete response to neoadjuvant CRT. Organ preservation has been considered an alternative treatment strategy for selected patients. Radiation dose-escalation and consolidation chemotherapy have been associated with increased rates of response and may improve chances of organ preservation among these patients...
July 24, 2017: Annals of Surgery
https://www.readbyqxmd.com/read/28726121/bone-marrow-oedema-predicts-bone-collapse-in-paediatric-and-adolescent-leukaemia-patients-with-corticosteroid-induced-osteonecrosis
#16
Ashok Joseph Theruvath, Preeti Arun Sukerkar, Shanshan Bao, Jarrett Rosenberg, Sandra Luna-Fineman, Sandhya Kharbanda, Heike Elisabeth Daldrup-Link
OBJECTIVES: Corticosteroid treatment of paediatric leukaemia patients can lead to osteonecrosis (ON). We determined whether bone marrow oedema (BME) is an early sign of progressive ON and eventual bone collapse. METHODS: In a retrospective study, two radiologists reviewed MR imaging characteristics of 47 early stage epiphyseal ON in 15 paediatric and adolescent leukaemia patients. Associations between BME on initial imaging studies and subchondral fracture, disease progression and bone collapse were assessed by Cochran-Mantel-Haenszel tests...
July 19, 2017: European Radiology
https://www.readbyqxmd.com/read/28725518/preferences-and-utilities-for-health-states-after-treatment-of-olfactory-groove-meningioma-endoscopic-versus-open
#17
Christopher M Yao, Alyssa Kahane, Eric Monteiro, Fred Gentili, Gelareh Zadeh, John R de Almeida
Objectives  The purpose of this study is to report health utility scores for patients with olfactory groove meningiomas (OGM) treated with either the standard transcranial approach, or the expanded endonasal endoscopic approach. Design  The time trade-off technique was used to derive health utility scores. Setting  Healthy individuals without skull base tumors were surveyed. Main Outcome Measures  Participants reviewed and rated scenarios describing treatment (endoscopic, open, stereotactic radiation, watchful waiting), remission, recurrence, and complications associated with the management of OGMs...
August 2017: Journal of Neurological Surgery. Part B, Skull Base
https://www.readbyqxmd.com/read/28718037/cost-effectiveness-of-surveillance-for-distant-recurrence-in-extremity-soft-tissue-sarcoma
#18
Trevor J Royce, Rinaa S Punglia, Aileen B Chen, Sagar A Patel, Katherine A Thornton, Chandrajit P Raut, Elizabeth H Baldini
BACKGROUND: Optimal distant recurrence (DR) surveillance strategies for extremity soft tissue sarcoma (STS) are unknown. We performed a cost-effectiveness analysis of different imaging modalities performed at guideline-specified intervals. METHODS: We developed a Markov model simulating lifetime outcomes for 54-year-old patients after definitive treatment for American Joint Committee on Cancer stage II-III extremity STS using four surveillance strategies: watchful waiting (WW), chest X-ray (CXR), chest computed tomography (CCT), and positron emission tomography-computed tomography (PET/CT)...
July 17, 2017: Annals of Surgical Oncology
https://www.readbyqxmd.com/read/28710643/-vesicoureteral-reflux-watchful-waiting-surgery-or-antibiotic-prophylaxis
#19
REVIEW
A Schröder
Primary vesicoureteral reflux (VUR) is a dynamic disease with several factors influencing its course. Therapeutic options range from watchful waiting to open surgery. Multiple risk factors for the development of pyelonephritis are identified, which then determine the decision for the appropriate treatment option. They include age, gender, history of pyelonephritis and renal scarring, bladder and bowel dysfunction (BBD), circumcision status and parental preference. The use of continuous antibiotic prophylaxis (CAP) is becoming increasingly controversial with antibiotic resistance being a major concern...
July 14, 2017: Der Urologe. Ausg. A
https://www.readbyqxmd.com/read/28697197/increased-and-normalized-uptake-of-18-f-fdg-in-a-case-of-bone-periprosthetic-infection-treated-by-antibiotics
#20
Valentina Lavelli, Cristina Ferrari, Artor Niccoli Asabella, Corinna Altini, Francesco Saverio Vella, Giuseppe Rubini
We report the case of a 69 years old man with left hip prosthesis, who presented clinical, biochemical and imaging signs of periprosthetic infection treated with linezolid, an antibacterial agent of the oxazolidinone class. Two weeks after this treatment, a fluorine-18-fluoro-2-deoxy-d-glucose positron emission tomography/computed tomography ((18)F-FDG PET/CT) scan showed increased uptake in the skeleton and also increased uptake in several focal areas in the spine and near the prosthesis and the surgical wound on the left gluteus medius...
May 2017: Hellenic Journal of Nuclear Medicine
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