Average 7-Year Survivorship and Clinical Results of a Newer Primary Posterior Stabilized Total Knee Arthroplasty

We evaluated the average 7-year survivorship and clinical results of a newer primary posterior stabilized total knee arthroplasty (TKA). The modifications in this design included a deeper patellar sulcus aimed at reducing contact stresses, improving patellar tracking, and achieving greater maximum flexion. A consecutive group of 137 patients (171 knees) who underwent TKAs using the Optetrak PS knee prosthesis between October 1997 and March 2004 were followed for an average of 6.8?years (range 4.0-11.5?years). Preoperative range of motion (ROM) and Knee Society scores were obtained and compared to that of the patients' most recent follow-up. Manipulation under anesthesia (MUA) and revision of the implant for any reason were considered endpoints for Kaplan-Meier survival analysis of all knees. Twenty-one knees (12.3%) underwent MUA. Three knees (1.8%) underwent revision, resulting in a 97.2% survival at a mean 10?years follow-up. Pain scores and ROM significantly improved after surgery (from preoperative average of 5.3 and 105° respectively to 44.6 and 120° postoperatively). These findings suggest that this posterior stabilized knee design is both a safe and effective option for patients undergoing primary TKA.     

Features Associated with Successful Recruitment of Diverse Patients onto Cancer Clinical Trials: Report from the American College of Surgeons Oncology Group

Background

The clinical trials mechanism of standardized treatment and follow-up for cancer patients with similar stages and patterns of disease is the most powerful approach available for evaluating the efficacy of novel therapies, and clinical trial participation should protect against delivery of care variations associated with racial/ethnic identity and/or socioeconomic status. Unfortunately, disparities in clinical trial accrual persist, with African Americans (AA) and Hispanic/Latino Americans (HA) underrepresented in most studies.

Study Design

We evaluated the accrual patterns for 10 clinical trials conducted by the American College of Surgeons Oncology Group (ACOSOG) 1999–2009, and analyzed results by race/ethnicity as well as by study design.

Results

Eight of 10 protocols were successful in recruiting AA and/or HA participants; three of four randomized trials were successful. Features that were present among all of the successfully recruiting protocols were: (1) studies designed to recruit patients with regional or advanced-stage disease (2 of 2 protocols); and (2) studies that involved some investigational systemic therapy (3 of 3 protocols).

Discussion

AA and HA cancer patients can be successfully accrued onto randomized clinical trials, but study design affects recruitment patterns. Increased socioeconomic disadvantages observed within minority-ethnicity communities results in barriers to screening and more advanced cancer stage distribution. Improving cancer early detection is critical in the effort to eliminate outcome disparities but existing differences in disease burden results in diminished eligibility for early-stage cancer clinical trials among minority-ethnicity patients.     

Impact of Routine Cavity Shave Margins on Breast Cancer Re-excision Rates

Purpose

Breast-conserving therapy (BCT) is an accepted method of treating early breast cancer. We hypothesized that routine excision of additional cavity shave margins (CSM) at time of initial partial mastectomy reduces the need for additional surgery.

Methods

A single-institution retrospective review was performed of women, 18 years or older, with a new diagnosis of breast cancer who underwent partial mastectomy between 1 January 2004 and 1 October 2009. Five hundred thirty-three charts were reviewed. Of those, 69 patients underwent CSM at time of initial operation. These 69 patients were matched with patients who had undergone partial mastectomy without CSM by tumor size, presence of extensive intraductal component, and primary histology.

Results

The two groups were well matched for age, nuclear grade, associated lymphovascular invasion (LVI), receptor status, and multifocality. We found that 31.9% (44/138) required return to the operating room (OR) for re-excision of margins. Rate of return to the OR was 21.7% (15/69) in the CSM group and 42.0% (29/69) in the matched group (p = 0.011). Multivariate analysis found factors significantly associated with need for additional operation included lack of CSM (odds ratio 9.2, 95% CI 2.8–30.5, p = 0.0003), larger extent of intraductal component (odds ratio 7.0, 95% CI 1.8–27.0, p = 0.005), and lack of directed re-excision (odds ratio 6.4, 95% CI 1.7–25.1, p = 0.007).

Conclusions

CSM at time of initial partial mastectomy decreases rate of re-excision by as much as ninefold. CSM should be considered at time of initial operation to reduce the need for subsequent reoperation.     

Measurement of hearing aid outcome in the elderly: Comparison between young and old elderly

OBJECTIVE: To evaluate speech performance and subjective outcomes for older individuals who have hearing impairment and use digital hearing aids. The outcomes between young and old elderly users were compared. STUDY DESIGN: Prospective. SUBJECTS AND METHODS: Fifty-nine patients with hearing loss fitted with digital hearing aids were included. They were divided into two groups. Group A consisted of 32 subjects aged 65 to 80 years, whereas group B had 27 subjects older than 80 years. Speech performance and subjective outcomes were measured 4 months after fitting of hearing aids. Hearing Handicap Inventory for the Elderly-Screening Version (HHIE-S), Client Oriented Scale of Improvement (COSI), satisfaction, and usage questionnaires were used as subjective assessments. RESULTS: Improvements in speech performance were not significantly different between these two groups. There were no statistical differences in terms of HHIE-S score reduction, satisfaction rate, daily usage time, and COSI scores between both groups. CONCLUSION: Age by itself is not a limiting factor for older patients with hearing impairment to benefit from digital hearing aids.     

Versagensgründe von Oberflächenersatzimplantaten der Hüfte

Hip resurfacing has been experiencing a revival over the last 5-10 years. Early failure rates are higher than for conventional primary hip arthroplasty. Fractures of the femoral neck or head, cup loosening and persistent pain are the most frequently observed reasons for early revision. In this international retrospective uncontrolled study, 256 revision specimens (219 resurfacing heads, 37 cups) were analysed radiologically, tribologically, morphologically and histologically in order to investigate the failure mechanism. Of the head revisions, 70% were due to neck (median: 67 days after implantation) and head fractures (161 days), 9% were due to cup loosening (350 days) and 21% due to other reasons (602 days). Implants with rim loading (22% of all retrievals, cup inclination 58.0+/-10.9 degrees ) exhibited a head wear rate of 7.1+/-5.2 mm3/year. Non-rim loaded implants exhibited a head wear rate of 0.24+/-0.53 mm3/year (cup inclination 49.0+/-4.0 degrees ). The failure rate was highest during the first 16 weeks after surgery and for the first ten operations performed by a surgeon. Revisions based on problems on the femoral side such as notching and high implantation forces occurred earlier than revisions based on problems on the acetabular side such as cup loosening and high wear due to suboptimal cup position.     

Recent perspectives on the age-related decline of testosterone

A pivotal question is whether the age-related decline of testosterone should be viewed as hypogonadism, i.e. a deficiency of testosterone manifesting itself by the signs and symptoms of insufficient androgen action and, in the best case, reversed by testosterone treatment. There is no clear dividing line between normal and subnormal blood testosterone levels for establishing with certainty whether a man is hypogonadal or not. Rather, symptoms accumulate gradually with decreasing testosterone level, with these levels of testosterone differing between individuals, while within a subject not all symptoms of testosterone deficiency will manifest themselves at the same blood testosterone level.

The diagnosis of late onset hypogonadism (LOH) and, certainly, the decision to provide androgen treatment must be made with caution, taking the specific increment of symptoms in relation to testosterone levels into account. The various symptoms of LOH might start at various concentrations of androgens. With a given plasma testosterone level, some complaints might be present and others not. This has also been confirmed in studies establishing symptom-specific thresholds of androgen levels.

Symptoms of LOH do not manifest themselves at uniform threshold values of testosterone. Therefore, symptoms of testosterone deficiency are not uniformly and predictably related to blood testosterone values, which may lead to different diagnostic criteria for testosterone deficiency. So, the conclusion seems inevitable that the clinical manifestations of hypogonadism are multifactorially determined and that the diagnosis should not only depend on the measurement of testosterone but a proper assessment should comprise somatic and psychological aspects in addition to measurement of testosterone.     

Physician attitudes to the concept of ‘men''s health’ in Asia

BackgroundMen's health is an emerging medical and public health concept, but it is confronted by special challenges in the Asia-Pacific medical and cultural context.MethodsA telephone survey was conducted with physicians in Korea, Taiwan and Singapore. The interview was conducted in Korean (Korea), Mandarin (Taiwan) or English (Singapore) by trained interviewers. The physicians interviewed were drawn from a variety of medical specialties including urology, primary care, endocrinology and cardiology.ResultsIn total, 810 physicians from various medical specialities took part in the survey. There was only broad general agreement (>50%) between the physicians in the various countries on a range of questions relating to men's health, such as the conditions most associated with men's health, the predictability of illness/disability with age etc, and physician willingness to discuss problems in sexual health.ConclusionsThe data from this survey suggest that, although not as clearly defined as women's health, the treatment of men's health cuts across many different medical specialties and takes in a broad spectrum of health conditions. Therefore, there is a clear opportunity for the medical community to define, refine and improve the treatment and understanding of men's health in Asia.     

Treatment Guidelines for Branch Duct Type Intraductal Papillary Mucinous Neoplasms of the Pancreas: When Can We Operate or Observe?

Background The objectives of this study were to investigate the clinicopathological features of branch intraductal papillary mucinous neoplasm (IPMN) and to determine safe criteria for its observation. Most clinicians agree that surgical resection is required to treat main duct-type IPMN because of its high malignancy rate. However, no definite treatment guideline (with respect to surgery or observation) has been issued on the management of branch duct type IPMN. Methods We retrospectively reviewed the clinicopathological data of 138 patients who underwent operations for IPMN between 1993 and 2006 at five institutes in Korea. Results Of 138 patients (mean age, 60.6 years; 87 men, 51 women), 76 underwent pancreatoduodenectomy, 39 distal pancreatectomy, 4 total pancreatectomy, and 20 limited pancreatic resection. There were 112 benign cases: 47 adenoma, 63 borderline cases, and 26 malignant cases, with 9 of these being noninvasive and 17 invasive. By univariate analysis, tumor size and the presence of a mural nodule were identified as meaningful predictors of malignancy. By receiver operating characteristic curve analysis, a tumor size of >2 cm was found to be the most valuable predictor of malignancy. When cases were classified according to tumor size and the presence of a mural nodule, the malignancy rate for a tumor ≤2 cm without a mural nodule was 9.2%, for a tumor of ≤2 cm plus a mural nodule was 25%, and for other conditions such as tumor >2 cm, >25%. Conclusions Many branch duct IPMNs are malignant. Surgical treatment is recommended, except in cases that are strongly suspected to be benign or cases that present a high operative risk. Observation is only recommended in patients with a tumor size of ≤2 cm without a mural nodule.