Patient Compliance in the Setting of BI‐RADS Category 3: What Factors Impact Compliance With Short‐Term Follow‐Up Recommendations?

The study aims to define how imaging findings, patient demographics, patient–provider interactions, and health care practices may affect a woman's decision to follow‐up in the setting of a BI‐RADS Category 3. A total of 398 women from the University of Arizona Breast Imaging Center with a BI‐RADS Category 3 assessment for mammography and/or ultrasound findings were evaluated between February 2012 and June 2014. Demographic information was analyzed for all patients, regardless of follow‐up. Women who returned for follow‐up within the recommended time period were given one survey at the time of their follow‐up appointment, and women who returned for follow‐up, but later than recommended, were given a separate survey to complete. Age, palpability of a lesion, and menopause status were related to follow‐up. Self‐rated general health was the only factor found to be associated with the decision to follow‐up on time. The majority of patients who followed up on time reported that mailed reminder cards were the primary practice that prompted follow‐up. Of patients who followed up later than recommended, the major reason was “no time.” The findings suggest that additional counseling regarding the benefits of short‐interval imaging follow‐up might be advantageous for patients.     

Adult Polycystic Kidney Disease: Who Needs Hospital Follow‐Up?

Clinical data from 120 adult patients with genetically undifferentiated polycystic kidney disease who had been followed up for more than 3 months (range 3-172) were reviewed in order to try to identify clinical indicators that might predict deterioration in renal function. They were split into two groups dependent on whether annualized fall in estimated glomerular filtration rate (ΔeGFR mL/min/1.73 m(2) /year) was statistically significant or not. Only 26 patients (22%) had a statistically significantly decreasing ΔeGFR with a median decrease of -2.6 mL/min/1.73 m(2) /year (range -6.2 to -0.7). There was no difference in initial age, gender, or racial distributions between the groups or in initial eGFR. Follow-up was longer (median 86, range 23-172 months vs. 46, range 3-161 months; P = 0.002) and initial blood pressure values tended to be lower (with mean systolic values of 128 vs. 148 mm Hg; P = 0.02) in the group with statistically significant fall in ΔeGFR, but this trend failed to achieve an a priori level of statistical significance. However, the proportion of patients with initial systolic blood pressure ≤ 144 developing a statistically significant fall in ΔeGFR was 0.26 (95% confidence interval = 0.13 to 0.45). No differences were found in initial hemoglobin or cholesterol concentrations. Overall, the annualized rate of decrease in eGFR tended to be greater in those with the higher initial eGFR (P = 0.04), but correlation was poor (rho(2) = 0.04) and failed to achieve an a priori level of statistical significance. No statistically significant correlation was found between ΔeGFR and any other variable. Only those patients with polycystic kidney disease with a statistically significant annualized decrease in eGFR may need to be referred for hospital follow-up in the renal clinic. This simple selection would reduce referrals by 78%.     

Hepatopancreaticobiliary (HPB) Surgery: What Is the Right Fellowship for the Right Training?

BACKGROUND: Reduced resident work hours over the last several years have led to inadequate exposure to hepatopancreaticobiliary (HPB) and complex upper gastrointestinal (UGI) surgical procedures. Therefore, residents are seeking additional training in this field. The purpose of this study is to determine the role of a new fellowship model in the training of general surgery residents in complex HPB/UGI diseases. METHODS: We propose a surgical training model in benign as well as malignant diseases of the UGI tract. The proposed model would focus on an integrated approach that involves allied specialties such as gastroenterology (GI) and radiology. RESULTS: The fellowship was set as 1-year duration with 1-month rotations on interventional GI and transplantation. The fellow spent the remaining 10 months on a UGI laparoscopic and open surgery service caring for complex benign and malignant disease of the esophagus, stomach, bile duct, pancreas, and liver. Didactic conferences were focused specifically at an organ-based approach to diseases of these organs. During a 12-month fellowship, exposure to complex diseases of the UGI tract was accomplished without negatively impacting the general surgery residency program. CONCLUSION: This new mode of advanced training provides a bridge between surgical oncology and transplantation, and it is an excellent model for postgraduate surgical training in UGI diseases.     

Fibroepithelial Lesions (FELs) of the Breast: Is Routine Excision Always Necessary?

World Journal of Surgery - When needle core biopsies (NCBs) of the breast reveal fibroepithelial lesions (FELs), excision is often performed to rule out a phyllodes tumor (PT), despite low...     

Mammography in 40-Year-Old Women: What Difference Does It Make? The Potential Impact of the U.S. Preventative Services Task Force (USPSTF) Mammography Guidelines

Background  

This 10-year retrospective chart review evaluates the potential impact the most recent U.S. Preventative Services Task Force (USPSTF) report recommending against annual mammographic screening of women aged 40–49 years.     

Follow‐up after unilateral nephrectomy in children: is an estimate of glomerular filtration rate necessary?

OBJECTIVE: To determine the need for an estimate of glomerular filtration rate (GFR) in the follow-up of children undergoing unilateral nephrectomy for benign renal disease. PATIENTS AND METHODS: Forty-four children (21 girls and 23 boys) undergoing unilateral nephrectomy for benign renal disease over a 3-year period were reviewed for the underlying diagnosis and indication for nephrectomy, imaging before and after surgery, postoperative GFR and final outcome. The follow-up included ultrasonography (US) of the contralateral kidney at 3 and 12 months and an estimate of GFR before discharge at > or = 1 year. All children were aged > 2 years when the GFR was measured. The criteria for discharge were normal imaging of the contralateral kidney before and after surgery and a normal GFR afterward. Spearman's correlation coefficient was used to determine the relationship between age, GFR and contralateral renal length after surgery. RESULTS: The median (range) age at surgery was 2.5 (0.67-16) years. The indications for nephrectomy included reflux nephropathy in 18, multicystic dysplastic kidney in 12, a congenital obstructive uropathy in eight, congenital renal dysplasia in four and miscellaneous in two. All patients had a normal contralateral kidney before surgery on US and functional imaging, and normal US at the follow-up, with evidence of compensatory hypertrophy in all. The median (range) corrected GFR for the 44 children was 109 (81-140) mL/min/1.73 m2, with no correlation between age and GFR, or between renal length and GFR. CONCLUSION: After unilateral nephrectomy for benign renal disease, provided there is a structurally and functionally normal contralateral kidney before surgery, with no abnormality on US, a routine estimate of GFR is unnecessary before discharge from follow-up. There was no correlation between GFR and age or renal length.     

Is There a Role for Surgery in the Management of Giant B‐Cell Right Atrial Lymphoma?

We describe a case of a giant right atrial large B-cell lymphoma treated with initial surgical excision followed by postoperative chemotherapy. The patient had no clinical evidence of recurrence through 87 months after her hospital discharge. To our knowledge, this is the first reported case of long-term survival following this method of disease management. The discussion reviews the current status of chemotherapy for cardiac lymphomas and the pros and cons of treatment option algorithms.     

The Diagnosis of Diverticulitis in Outpatients: On What Evidence?

Purpose  

Diverticular disease is common in the outpatient setting; yet, rigorous study of diagnosis and management strategies is currently limited to hospitalized patients. Here, we characterize the clinical assessment generating the diagnostic label of diverticulitis in outpatients.