Noncompaction of the left ventricle, a genetic cardiomyopathy with a reported incidence of 0.05% to 0.24%, can lead to sudden
cardiac death, particularly among children, if left undetected. Because the diagnosis of isolated noncompaction cardiomyopathy
(NCM) can be overlooked, its association with other congenital heart diseases (CHDs) makes the diagnosis of NCM even more
difficult. This study aimed to assess the impact of NCM on the cardiovascular physiology of children with coexisting CHDs
evaluated by cardiovascular magnetic resonance imaging. A case-control study was performed with 12 children (6 patients with
combined NCM and CHD and 6 control subjects with isolated CHD). The mean left ventricular end-diastolic and end-systolic volume
indices were significantly higher in the CHD patients presenting with NCM than in the CHD patients with no NCM (P = 0.028). However, no differences were observed for right ventricular end-diastolic and end-systolic volume indices, biventricular
ejection fractions, stroke volumes and indices, left ventricular wall thickness, left ventricular fractional shortening, cardiac
output, or cardiac index. This study suggests that NCM in children with CHDs increases left ventricular volumes, and larger
studies are required to demonstrate other changes (e.g., ejection fraction, stroke volume) that were close to being significant. 相似文献
Annals of Surgical Oncology - Uncertainty regarding chemotherapy benefit among breast cancer patients with intermediate Oncotype Dx® recurrence scores (RS; 11–25) led to the TAILORx... 相似文献
Neoadjuvant chemotherapy (NAC) is the standard of care for locally advanced HER2?+?breast cancer (BC). Optimal sequencing of treatment (NAC vs. surgery first) is less clear cut in stage I (T1N0) HER2?+?BC, where information from surgical pathology could impact adjuvant treatment decisions. Utilizing the NCDB, we evaluated the trend of NAC use compared to upfront surgery in patients with small HER2?+?BC.
Methods
We identified NCDB female patients diagnosed with T1 N0 HER2?+?BC from 2010 through 2015. Prevalence ratios (PR) using multivariable robust Poisson regression models were calculated to measure the association between baseline characteristics and the receipt of NAC. Analysis of trends over time was denoted by annual percent change (APC) of NAC versus surgery upfront.
Results
Of the 14,949 that received chemotherapy and anti-HER2 therapy during the study period, overall 1281 (8.6%) received NAC and 13,668 (91.4%) received adjuvant treatment. Patients receiving NAC increased annually from 4.2% in 2010 to 17.3% in 2015, with the most rapid increase occurring between years 2013 (8.5%) and 2014 (14.2%). The greatest increase was seen in patients with cT1c tumors with an APC of 37.8% over the study period (95% CI 29.0, 47.3%, p?<?0.01), although a significant trend was likewise seen in patients with cT1a (APC?=?26.1%,95% CI 1.59, 56.6%), and cT1b (APC?=?27.4%, 95% CI 18.0, 37.7%) tumors. Predictors of neoadjuvant therapy receipt were age younger than 50 (PR?=?1.69, 95% CI 1.52, 1.89), Mountain/Pacific area (PR?=?1.24, 95% CI 1.05, 1.46), and estrogen receptor negativity (ER??PR?+?: PR?=?2.01, 95% CI 1.51, 2.68; ER??PR??: PR?=?1.49, 95% CI 1.32, 1.69).
Conclusions
Neoadjuvant therapy for T1 N0 HER2?+?BC increased over the study period and was mostly due increased use in clinical T1c tumors. This may be consistent with secular change in Pertuzumab treatment following FDA approval in 2013.
The proportion of patients eligible for breast-conservation therapy (BCT) yet opting for mastectomy is increasing. This decision is often driven by the desire to eliminate future screening and/or biopsy of the remaining breast or breasts. This study investigated the incidence of post-mastectomy imaging and biopsy.
Methods
A retrospective review of all unilateral mastectomy (UM) and bilateral mastectomy (BM) cases managed at a single institution was undertaken. Post-mastectomy imaging and biopsy rates were determined.
Results
Between 2009 and 2015, 185 UM and 200 BM cases managed for breast cancer were identified. The mean follow-up period was 30 months (range 3–75 months). For the patients with UM, imaging studies and biopsies done on the contralateral side were excluded given the standard of care for continued surveillance of the contralateral breast. Of the 185 UM patients, 19 (10%) underwent ipsilateral imaging (all ultrasounds) for physical examination findings, 11 (6%) underwent biopsy, and 2 (1%) had malignant findings. Of the 200 BM patients, 31 (15.5%) required imaging (29 ultrasounds and 2 MRIs), with 76% of the ultrasounds performed on the side with previous cancer. Subsequently, 16 (8%) of the BM patients had biopsy, with 11 (69%) of the 16 biopsies performed on the ipsilateral side. Three (1.5%) of the biopsies done on ipsilateral side demonstrated malignancy, whereas all the contralateral biopsies were benign.
Conclusions
For 10–15.5% of patients who undergo mastectomy, either UM or BM, subsequent imaging is required, whereas 6–8% undergo biopsy. The yield of malignancy is low, approximately 1%. Thus, after mastectomy, the need for imaging and biopsy is not eliminated. This information is critical for patient understanding and expectation related to surgical decision making.
