New Developments in Assessing Risk of Local Recurrence in Patients with Ductal Carcinoma In Situ after Lumpectomy and Breast Radiation

Ductal carcinoma in situ of the breast comprises nearly 25 % of all diagnoses of breast cancer. The current paradigm for management of DCIS consists of breast-conserving surgery followed by post-operative radiotherapy. The goal of the treatment of DCIS is to reduce the risk of local recurrence (and invasive local recurrence) to prevent the detrimental psychological impact of recurrence and minimize the need for additional treatment. A number of clinical, pathological, and molecular variables have been identified as predictive markers of recurrence and can be used to help risk stratify women with this diagnosis. We present here a review of current markers of recurrence, risk prediction tools, and future directions.     

Oncoplastic Breast Surgery: What,When and for Whom?

Oncoplastic surgery is integral to all breast cancer surgeries. The use of an aesthetic approach to breast conservation or mastectomy greatly enhances the range of options that can be offered to women with breast cancer and facilitates better outomes from it. It should be the standard of care. However, a structured approach to selecting appropriate techniques is essential, and although many operative procedures are reported, this article sets out to describe a set of principles and an algorithm by which the what, when and for whom for oncoplastic surgery can be defined.     

Aromatase Inhibitor-Associated Arthralgia: How Big Is the Problem and What Can Be Done?

Aromatase inhibitor-induced arthralgia (AIA) remains a significant clinical dilemma for breast cancer survivors and their oncologists. Approximately half of women who take aromatase inhibitors (AIs) experience joint pain which often affects daily functioning and quality of life. Effects can be so severe that many women stop taking the AI; nonetheless, we know very little about what causes AIA, or how to effectively treat it. This article briefly describes the syndrome of AIA and then discusses several potential management strategies for this frequent clinical quandary.     

UK guidelines for the management of bone sarcomas

This document is an update of the British Sarcoma Group guidelines published in 2010. The aim is to provide a reference standard for the clinical care of patients in the UK with bone sarcomas. Recent recommendations by the European Society of Medical Oncology, The National Comprehensive Cancer Network and The National Institute for Health and Care Excellence have been incorporated, and the literature since 2010 reviewed. The standards represent a consensus amongst British Sarcoma Group members in 2015. It is acknowledged that these guidelines will need further updates as care evolves. The key recommendations are that bone pain or a palpable mass should always lead to further investigation and that patients with clinico-radiological findings suggestive of a primary bone tumour at any site in the skeleton should be referred to a specialist centre and managed by a fully accredited bone sarcoma multidisciplinary team. Treatment recommendations are provided for the major tumour types and for localised, metastatic and recurrent disease. Follow up schedules are suggested.     

Emerging Targets for the Management of Osteoarthritis Pain

Worldwide, osteoarthritis (OA) is one of the leading causes of chronic pain, for which adequate relief is not available. Ongoing peripheral input from the affected joint is a major factor in OA-associated pain. Therefore, this review focuses predominantly on peripheral targets emerging in the preclinical and clinical arena. Nerve growth factor is the most advanced of these targets, and its blockade has shown tremendous promise in clinical trials in knee OA. A number of different types of ion channels, including voltage-gated sodium channels and calcium channels, transient receptor potential channels, and acid-sensing ion channels, are important for neuronal excitability and play a role in pain genesis. Few channel blockers have been tested in preclinical models of OA, with varying results. Finally, we discuss some examples of G-protein coupled receptors, which may offer attractive therapeutic strategies for OA pain, including receptors for bradykinin, calcitonin gene-related peptide, and chemokines. Since many of the pathways described above can be selectively and potently targeted, they offer an exciting opportunity for pain management in OA, either systemically or locally.     

Post-Sling Urinary Retention in Women

As many as 80 % of all women who complain of urine leakage will be diagnosed with stress urinary incontinence (SUI). As the population ages and SUI becomes more widespread, it is imperative to understand how to manage potential complications of the therapies used to treat this condition. As the mid-urethral sling has become the “gold standard” of SUI treatment, it is important to be aware of post-operative complications associated with this procedure. One significant complication of the MUS is subsequent urinary retention. In this review, we discuss the potential etiologies of post-sling urinary retention and outline the various modalities for achieving a timely and accurate diagnosis. We also emphasize the applications of various diagnostic tools, such as urodynamics, when evaluating patients with post-sling urinary retention. Lastly, various treatments for this complication are discussed. This chapter serves as a comprehensive overview of how to approach post-sling urinary retention, underlining the recent academic research contributions that have enhanced our understanding of how to manage this condition.     

Minimally Invasive Techniques for the Management of Adult UPJ Obstruction

Ureteropelvic junction obstruction (UPJO) is a common congenital abnormality that often presents in adulthood. Open dismembered pyeloplasty was considered the gold standard for the management of this condition; however, recent advancements in laparoscopic and robotic surgery have dramatically shifted the landscape to more minimally invasive techniques. A literature search of ureteropelvic junction obstruction, pyeloplasty, endopyelotomy, laparoscopic pyeloplasty, robotic pyeloplasty, and microlaparoscopic pyeloplasty was performed. A focus was placed on literature published since 2013. Minimally invasive laparoscopic and robotic techniques have become the gold standard for the management of UPJO. With the rise of robotic pyeloplasty, open repairs are becoming less frequent, while endoscopic treatments have remained stable. Minimally invasive (robotic) techniques have become the gold standard for the management of UPJO. Newer, even less-invasive techniques are also showing promise, but technical challenges still exist.     

Technik der Austauschmarknagelung bei aseptischen hypertrophen Femurschaftpseudarthrosen

Femoral shaft pseudarthrosis is mostly hypertrophic and aseptic. Exchange intramedullary nailing is the gold standard following failed dynamization and leads to successful healing in 95?% of cases. A prerequisite is that the technical characteristics are taken into consideration in addition to a thorough scrutiny of the indications. These include limited and protective overdrilling of the medullary cavity, the use of an implant which fills the medullary cavity, sufficient number and thickness of the locking bolts and the use of modern compression option intramedullary nails. Furthermore, axis correction must be carried out in the varus-valgus plane and torsion deviations must be corrected. Early mobilization and full load-bearing of the affected extremity supplement the concept of exchange intramedullary nailing and are also of decisive importance. Exchange intramedullary nailing alone is not very promising as a therapy concept for atrophic aseptic pseudarthrosis. In this instance additional procedures, such as shock waves, growth factors and in the future potentially also stem cell therapy should be taken into consideration.     

Aktionsplan zur UN-Behindertenrechtskonvention der gesetzlichen Unfallversicherung

The German statutory workers compensation board with more than 20,000 employees started an action plan 1.0 for implementing the Convention of the United Nations on the Rights of Persons with Disabilities (CRPD) in 2012 which was followed by another 3-year action plan 2.0 (2015–2017) in order to provide preventive and rehabilitative measures related to working accidents and occupational diseases for all insured persons in all enterprises and schools in Germany. The technical inspectors and disability managers of the statutory accident insurance carriers and the governing body (DGUV) as well as the partners who provide medical and professional services for insured persons must follow the goals for inclusion, barrier-free accessibility, diversity and participation. This article summarizes the current state of implementation of the action plans.     

Abwägung oder doch harte Kriterien in der Begutachtung von Läsionen der Rotatorenmanschette

The majority of rotator cuff tears are related to a natural aging process and caused by multifactorial influencing factors. A pure or essentially extrinsic origin due to a traumatic event is rare and is particularly difficult to differentiate because of the frequency of age-related degenerative alterations to the tendons. As the basic understanding of the development of traumatic cuff tears is based mainly on biomechanical studies and empirical observations, assessing the potential link between structural tendon damage and a traumatic event involves a weighing up process of all available medical evidence. This includes the initial clinical examination, assessment of pain and clinical function over time, radiographic imaging, analysis of the injury mechanism and patient history of pre-existing shoulder dysfunction or inherent risk factors as well as operative findings and histological results.