Omitting radiation therapy after lumpectomy for pure DCIS does not reduce the risk of salvage mastectomy.

Purpose: Radiation therapy (RT) after breast-conserving surgery (BCS) for Ductal Carcinoma in Situ (DCIS) halves the risk of local recurrence (LR). The omission of RT is often supported by the paradigm that patients who develop LR can be salvaged with further breast-conserving therapy leading to higher rates of breast preservation and improved quality of life. However, population-based, long-term rates of breast preservation in women treated by upfront BCS ± RT are unknown.

Multigene Expression Assay and Benefit of Radiotherapy After Breast Conservation in Ductal Carcinoma in Situ.

Background: Most women with ductal carcinoma in situ (DCIS) will receive breast-conserving surgery (BCS) and radiation (RT). RT can be omitted for women at low risk of local recurrence (LR). The Oncotype DX DCIS score (DS) predicts LR risk after BCS alone.

Close or positive resection margins are not associated with an increased risk of chest wall recurrence in women with DCIS treated by mastectomy: a population-based analysis.

Mastectomy is effective treatment for ductal carcinoma in situ (DCIS) but some women will develop chest wall recurrence. Most chest wall recurrences that develop after mastectomy are invasive cancer and are associated with poorer prognosis. Past studies have been unable to identify factors predictive of chest wall recurrence.

Age at diagnosis predicts local recurrence in women treated with breast-conserving surgery and postoperative radiation therapy for ductal carcinoma in situ: a population-based outcomes analysis.

Purpose: The main goal of treating ductal carcinoma in situ (dcis) is to prevent the development of invasive breast cancer. Most women are treated with breast-conserving surgery (bcs) and radiotherapy. Age at diagnosis may be a risk factor for recurrence, leading to concerns that additional treatment may be necessary for younger women.

Squamous lesions of the ovary.

The ovary shows an innate potential for markedly variable histogenesis, including squamous differentiation. Although not uncommon, squamous differentiation in ovarian lesions can be present in several diagnostic contexts, both benign and malignant. We present a review of the literature pertaining to squamous lesions of the ovary.

The vexing problem of guidelines and conflict of interest: a potential solution.

Issues of financial and intellectual conflict of interest in clinical practice guidelines have raised increasing concern. Professional organizations have responded by more rigorous regulation of conflict of interest. Nevertheless, tension remains between the competing goals of optimizing guideline quality by using the experience and insight of experts and ensuring that financial and intellectual conflicts of interest do not influence recommendations.

Prevalence of osteoporosis in osteoarthritic patients undergoing total hip or total knee arthroplasty.

Objective: To determine the prevalence of osteoporosis in osteoarthritic patients undergoing total hip or total knee arthroplasty.

Design: Cross-sectional study.

Setting: The Specialized Outpatient Rehabilitation Service's (SORS) Pre-surgical Arthroplasty Service located at the Chedoke Hospital, Hamilton Health Sciences, Hamilton, ON, Canada.

Antithrombotic therapy for venous thromboembolic disease: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition).

This chapter about treatment for venous thromboembolic disease is part of the American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Grade 1 recommendations are strong and indicate that the benefits do or do not outweigh risks, burden, and costs. Grade 2 suggests that individual patient values may lead to different choices (for a full understanding of the grading, see "Grades of Recommendation" chapter).

Hemorrhagic complications of anticoagulant and thrombolytic treatment: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition).

This article about hemorrhagic complications of anticoagulant and thrombolytic treatment is part of the Antithrombotic and Thrombolytic Therapy: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Bleeding is the major complication of anticoagulant and fibrinolytic therapy. The criteria for defining the severity of bleeding vary considerably between studies, accounting in part for the variation in the rates of bleeding reported.

Solitary fibrous tumor (SFT) of the pelvis.

Solitary fibrous tumors (SFTs) are well recognized in the pleura, but their occurrence at other sites has only become appreciated in recent years, as a consequence of which extrapleural examples often go unrecognized and misdiagnosed. Because of their rarity, overall experience concerning this tumor has not been significant and reports detailing radiological findings are few. We herein report an unusual case of a large retroperitoneal pelvic SFT with features of high vascularity negating successful surgical resection.

Pseudotumoral appearance of a ruptured epidermal cyst in the foot.

We present a case of keratin granuloma due to a ruptured epidermal cyst, occurring in the foot, in a 52-year-old woman. The patient presented with a history of a slow-growing lump in the web space of the foot that had been present for over a year. Imaging appearances suggested a soft tissue neoplasm.

Axial oblique MR imaging of the intrinsic ligaments of the wrist: initial experience.

Objective: To evaluate two separate MR sequences acquired in the axial oblique plane, parallel to the long axis of the scapholunate (SL) and lunotriquetral (LT) ligaments, to determine whether the addition of these sequences to the standard MR wrist examination improves visualization of the intrinsic ligaments, and the evaluation of their integrity. To our knowledge, this plane has not been described in the literature previously.

Design And Patients: In total we evaluated 26 patients with chronic wrist pain or instability, referred for MR imaging following assessment by an orthopedic surgeon or physiatrist.

Elevated levels of D-dimer and fragment 1+2 upon central venous catheter insertion and factor V Leiden predict subclavian vein thrombosis.

Symptomatic subclavian vein thrombosis is a potential complication in approximately 5-10% patients with indwelling central venous catheters. Having reliable tests that would identify those patients with a high risk of catheter-related thrombosis would be clinically useful by helping to tailor thromboprophylaxis. In this case control study by Jansen et al.

Synchronous transitional cell carcinoma and metastatic hepatocellular carcinoma in the urinary bladder: a case report.

An 83- year-old male presented with intermittent hematuria and obstructive symptoms. A CT scan of the abdomen and pelvis showed diffuse thickening of the urinary bladder and a large 10 cm liver mass. Histopathological examination of bladder biopsy demonstrated two distinct lesions.

Long-term management of patients after venous thromboembolism.

Long-term treatment of venous thromboembolism (VTE) focuses mainly on the duration of anticoagulant therapy, usually with vitamin K (VK) antagonists. The duration of therapy should be individualized based on the risk of recurrent VTE if treatment were stopped and the risk of bleeding if treatment were continued. The risk of recurrence is low if thrombosis was provoked by a major reversible risk factor such as surgery; 3 months of treatment is usually adequate for such patients.

Treatment of deep vein thrombosis.

Most patients who present with deep vein thrombosis (DVT) can be treated with weight-adjusted, fixed-dose, low molecular heparin as an outpatient. The subsequent duration of oral anticoagulant therapy should be individualized according to the risk of recurrent venous thromboembolism and the risk of anticoagulant-induced bleeding. The risk of recurrence is low if thrombosis was provoked by a major reversible risk factor such as surgery; 3 months of treatment is usually adequate for such patients.

Natural history of venous thromboembolism.

Most deep vein thromboses (DVTs) start in the calf; however, thrombi that remain confined to the calf rarely cause leg symptoms or are associated with symptomatic pulmonary embolism (PE). The probability that calf DVT will extend to involve the proximal veins, and subsequently cause PE, increases with the severity of the initiating prothrombotic stimulus and if this stimulus persists. Although acute venous thromboembolism (VTE) usually presents with either leg or pulmonary symptoms, most patients have thrombosis at both sites at the time of diagnosis.

Epidemiology of venous thromboembolism.

The annual incidence of diagnosed venous thromboembolism (VTE) is 1 to 2 events per 1000 of the general population. VTE is very uncommon before age 20 years and, after 40 years of age, the incidence about doubles with each decade. Over half of episodes of VTE are deep vein thrombosis (DVT), and three quarters are first episodes.

Duration of venous thromboembolism prophylaxis after surgery.

Venous thromboembolism (VTE) prophylaxis is indicated while in the hospital after major surgery. There is evidence that the prevalence of asymptomatic deep-vein thrombosis, detected by routine venography after major orthopedic surgery, is lower at hospital discharge in patients who have received 10 days rather than 5 days of prophylaxis. This observation supports the current American College of Chest Physicians (ACCP) recommendation for a minimum of 7 to 10 days of prophylaxis after hip and knee replacement, even if patients are discharged from the hospital within 7 days of surgery.

Ultrasound of intrinsic wrist ligament and triangular fibrocartilage injuries.

Objective: The objective of this study was to evaluate ultrasound as a diagnostic tool for investigating scapholunate and lunatotriquetral ligamentous and triangular fibrocartilage (TFC) tears. Ultrasound findings were compared to conventional arthrogram findings, as the reference gold standard.

Design And Patients: In total 26 patients, 17 males and 9 females ranging in age from 17 to 35 (mean age, 34), were evaluated on referral for investigation of wrist pain.