Presentation, diagnosis, and management of the Li-Fraumeni syndrome.

Li-Fraumeni syndrome is a hereditary cancer syndrome that results in a dramatically increased risk of developing cancer over a patient's lifetime. Proper understanding of this syndrome is important for physicians across all specialties, as it can result in earlier cancer diagnosis and treatment. Here, we present the case of a patient presenting with Li-Fraumeni syndrome and discuss the appropriate screening recommendations and management of patients with this disorder.

Role of Surgery and Perioperative Therapy in Older Patients with Resectable Pancreatic Ductal Adenocarcinoma.

Background: It is unclear whether results from recent trials of resectable pancreatic ductal adenocarcinoma (PDAC) are generalizable to older patients, who are underrepresented. We aimed to evaluate outcomes of surgery and of neoadjuvant and adjuvant therapy in older patients with resectable PDAC.

Patients And Methods: We included patients aged ≥65 years with upfront resectable PDAC from a prospectively maintained pancreatic cancer registry from 2007 to 2016.

Survival Benefit of Combination Chemotherapy in Elderly Patients With Metastatic Pancreatic Ductal Adenocarcinoma.

Objectives: Survival benefit of combination over single-agent chemotherapy for metastatic pancreatic ductal adenocarcinoma (PDAC) was demonstrated in younger patients in clinical trials. The authors aimed to evaluate whether this survival benefit of combination chemotherapy is present in elderly patients with metastatic PDAC.

Materials And Methods: The authors identified elderly patients (age 65 y or older) with stage IV PDAC and extracted available clinical information from a prospectively maintained institutional pancreatic cancer registry from 2007 to 2016.

The Management of Older Adults with Pancreatic Adenocarcinoma.

Pancreatic cancer is the eleventh most common cancer, yet it is the third leading cause of mortality. It is also largely a disease of older adults, with the median age of 71 at diagnosis in the US, with <1% of diagnoses occurring prior to age 50. Current NCCN guidelines recommend surgery for localized disease, followed by adjuvant therapy and/or consideration of enrollment in a clinical trial.

Adolescent Hip Dislocation Combined With Proximal Femoral Physeal Fractures and Epiphysiolysis.

Background: The risks and long-term effects of acute hip dislocation combined with proximal femoral physeal fractures and epiphysiolysis have been minimally addressed in the literature. This infrequent combination must be understood to avoid the major complications of complete separation of proximal femoral components during attempted reduction and to predict the probable outcome of surgical treatment.

Methods: Medical records and imaging were retrospectively reviewed to identify patients with a diagnosis of severe to complete slipped capital femoral epiphysis (CFE) or proximal femoral epiphysiolysis in association with hip dislocation.

Continued growth after limited physeal bridging.

Background: After any physeal injury, the primary concern is the possibility of some pattern of growth alteration, particularly transphyseal bridging that may cause lasting deformities and impact subsequent patient care. Small areas of physeal bridging, however, may be associated with continued growth, rather than impairment.

Methods: Seven patients with small central physeal bridges of the distal femur were identified.

Marine spatial planning (MSP): a first step to ecosystem-based management (EBM) in the Wider Caribbean.

The rapid decline of coastal ecosystems of the Wider Caribbean is entering its fifth decade. Some of the best science documenting this decline and its causes has been done by the laboratories of the Association of Marine Laboratories of the Caribbean (AMLC). Alarmed at the trends, Caribbean conservation pioneers established marine protected areas (MPAs) which spread throughout the region.

Scapulothoracic dissociation secondary to major shoulder trauma.

Three skeletally immature patients with scapulothoracic dissociation were reviewed. A 5-year-old child's arm, caught in a conveyor belt, led to complete upper extremity amputation. Multiple fractures, muscular damage, and cutaneous and subcutaneous tissue disruption (degloving) were present throughout the avulsed extremity.

The effectiveness of skills training for improving outcomes in supported employment.

Objective: This study evaluated whether a supplementary skills training program improved work outcomes for clients enrolled in supported employment programs.

Methods: Thirty-five recently employed clients with severe mental illness who were receiving supported employment services at a free-standing agency were randomly assigned to participate in either the workplace fundamentals program, a skills training program designed to make work more "successful and satisfying," or treatment as usual. Knowledge of workplace fundamentals (for example, identifying workplace stressors, problem solving, and improving job performance) was assessed at baseline and at nine months; employment outcomes and use of additional vocational services were tracked for 18 months.

Plantar fasciopathy and orthotripsy: the effect of prior cortisone injection.

Background: Corticoid steroid injection into the heel is a popular treatment method for painful heel syndromes. However, the positive results usually are short term. Extracorporeal shock wave treatment (ESW) has been shown to have a more permanent effect.

Candida glabrata periprosthetic infection: a case report and literature review.

We present a case of an immunocompromised host who developed a Candida glabrata infection 20 years after her total knee arthroplasty. She was treated with extensive irrigation and debridement, followed by placement of an amphotericin B cement spacer supplemented with 2 months of oral variconazole. She ultimately underwent an above-knee amputation.

Electrohydraulic high-energy shock-wave treatment for chronic plantar fasciitis.

Background: Plantar fasciitis is a common foot disorder that may be resistant to nonoperative treatment. This study evaluated the use of electrohydraulic high-energy shock waves in patients who failed to respond to a minimum of six months of antecedent nonoperative treatment.

Methods: A randomized, placebo-controlled, multiply blinded, crossover study was conducted.

Sever's injury: a stress fracture of the immature calcaneal metaphysis.

Magnetic resonance imaging (MRI) in children with a presumptive diagnosis of Sever's apophysitis and with continuing pain after conservative treatment demonstrated bone bruising within the trabecular bone of the metaphyseal region adjacent to the calcaneal apophysis. Limited portions of the apophyseal secondary ossification center showed similar increased signal changes. MRI studies following treatment with immobilization showed subsidence or disappearance of the metaphyseal but not any apophyseal signal changes commensurate with improvement in symptoms.

Bilateral chronic proximal plantar fasciopathy: treatment with electrohydraulic orthotripsy.

Background: Patients presenting for treatment of chronic plantar fasciopathy often have bilateral involvement. When various nonoperative treatments fail, subsequent intervention may be problematic, especially since bilateral surgery (bilateral fascial release) may not be realistic because of variable, frequently restrictive postoperative weightbearing limitations.

Methods: Twenty-three patients (46 heels) were treated with electrohydraulic high-energy orthotripsy to the plantar entheses of both feet while under the same anesthesia (conscious sedation).

Effect of extracorporeal shock waves on calcaneal bone spurs.

In a prospective study of 435 patients with chronic proximal plantar fasciitis, 283 (65%) had an inferior calcaneal bone spur of variable size evident prior to treatment with electrohydraulic high-energy extracorporeal shock waves (ESW). This included 308 patients who received extracorporeal shock wave treatments and 127 placebo (sham control) patients. At both initial (3 months) and final (12 months) evaluations after receiving ESW, no patient who received shock wave applications had significant disappearance or change in the radiographic appearance of the heel spur.

Symptom duration of plantar fasciitis and the effectiveness of Orthotripsy.

Background: The use of surgically noninvasive application of Orthotripsy (extracorporeal shock waves) for various musculoskeletal disorders is being increasingly utilized. Because most patients have had prolonged symptoms refractory to nonoperative treatments, this study evaluated the effectiveness of electrohydraulic Orthotripsy for chronic proximal plantarfasciitis compared to the duration of symptoms prior to treatment.

Methods: Following evaluation for study inclusion (unresponsive symptoms for more than 6 months), qualified patients received Orthotripsy or placebo.

Nail patella syndrome. A 55-year follow-up of the original description.

The long-term skeletal changes and the lack of significant clinical complaints in a 77-year-old woman with nail patella syndrome are described. Fifty-five years previously she was one of the first reported patients. These early patients came from two families with involvement of multiple individuals with the variable constellation of deformities.

Shockwave therapy for chronic proximal plantar fasciitis: a meta-analysis.

Purpose: Utilizing meta-analysis, the authors have reviewed the available literature to assess the biologic and therapeutic effects of shockwaves on patients with chronic plantar fasciitis and the credibility of these published studies.

Methods: Meta-analysis is a systematic method for statistical analysis that combines data from various independent studies, allowing the assessment of potential benefits of various treatments when conclusions based on individual studies may be difficult to evaluate. We hypothesized that extracorporeal shockwave therapy provided a reasonable nonoperative therapeutic alternative to surgical intervention in the treatment of chronic proximal plantar fasciitis.