Current Concepts In Diagnosis Research Articles

Breast Cancer and Pregnancy: Current Concepts in Diagnosis and Treatment

The treatment of breast cancer diagnosed during pregnancy presents a challenging situation for the patient, family, and caregivers. Case series have demonstrated the efficacy and safety of using anthracycline-based chemotherapy during the second and third trimesters. Additionally, patients should be seen, evaluated, and treated in a multidisciplinary setting with facilitated communication among the medical oncologist, surgical oncologist, obstetrician, radiation oncologist, pathologist, and radiologist. This review details the available data regarding the diagnosis and management of the pregnant breast cancer patient.

Childhood craniopharyngioma—current concepts in diagnosis, therapy and follow-up

Craniopharyngiomas have an overall incidence of 0.5-2.0 new cases per million of the population per year, and ∼30-50% of all cases represent childhood craniopharyngioma. These partly cystic embryogenic malformations of the sellar region are presumably derived from Rathke cleft epithelium. Many of the typical manifestations at primary diagnosis are nonspecific and include headache, visual impairment, polyuria and/or polydypsia, growth retardation and weight gain. Total resection is the treatment of choice in patients with favorable tumor localization, with the intention to maintain hypothalamic-pituitary and optical nerve functions. When the tumor localization is unfavorable, a limited resection followed by local irradiation is recommended. The overall survival rates are high (91-98%). High recurrence rates after complete resection and high progression rates after incomplete resection have been observed, although the risk of recurrence or progression is less after complete resection than partial resection. Irradiation of the tumor is protective and the appropriate time point of irradiation after incomplete resection is currently under investigation in a randomized trial. Long-term sequelae substantially reduce the quality of life of ∼50% of long-term survivors, notably extreme obesity owing to hypothalamic involvement.

Current Concepts of Diagnosis and Management of ACL Injuries in Skeletally Immature Athletes

Anterior cruciate ligament (ACL) injuries in skeletally immature athletes are encountered with increasing frequency. The management of such injuries is controversial. Nonsurgical management often results in functional instability and a higher risk of meniscal and chondral injury to the knee. Conventional methods of ACL reconstruction carry the risk of growth disturbance because of iatrogenic damage to the physes around the knee. Multiple cases of growth disturbance have been reported. This article discusses the relevant anatomy, natural history, risk factors, treatment, and prevention of ACL injuries in skeletally immature patients. Surgical treatment is based on physiologic age. For prepubescent patients, we recommend physeal-sparing combined intra-articular/extra-articular reconstruction with autogenous iliotibial band. In adolescent patients with significant growth remaining, we recommend transphyseal ACL reconstruction with hamstrings autograft and fixation away from the physes. In older adolescent patients, we recommend conventional adult ACL reconstruction with autogenous hamstrings or patellar tendon.

Pathogenesis, diagnosis and treatment of neuromyelitis optica: Changing concept of an old disease

The concept of neuromyelitis optica (NMO) has changed considerably during the past few years. The identification of autoantibodies in the sera generated against the water channel aquaporin 4 (AQP4) has increased the specificity of diagnosis and modified guidelines. A pathogenic role of anti-AQP4 antibodies has recently been indicated; they evoke the pathological and clinical hallmarks of the disease on transfer and cause necrosis of astrocytes expressing AQP4. The diagnosis of NMO is based on clinical, neuroimaging and serological criteria. Early therapy preventing relapses is mandatory, because neurological impairment accumulated during relapses is the main cause of permanent disability. In a number of cases defined as NMO spectrum diseases, the clinical manifestation is spatially limited. Such events of separate myelitis or relapsing/bilateral optic neuritis challenge diagnosis and might delay proper therapy. Here, current concepts of diagnosis and treatment of NMO and NMO spectrum diseases are summarized. Diagnostic and treatment decisions in different clinical situations are shown by discussion of cases. (Clin. Exp. Neuroimmunol. doi: 10.1111/j.1759-1961.2010.00011.x, 2010)

Recurrent miscarriage: current concepts in diagnosis and treatment

Although recurrent miscarriage (RM) affects only 1-3% of couples, it has a major influence on the wellbeing and psychosocial status of patients. Therefore, research into improved diagnosis and development of new treatment strategies is essential. In this review, we summarize current concepts on diagnosis and treatment in RM, drawing upon research reports and international guidelines to provide insights into the pathophysiology of pregnancy disrupted by repeated miscarriage. Anatomical malformations, infectious diseases, endocrine disorders, autoimmune defects as well as acquired and inherited thrombophilia are established risk factors in RM. In addition, our recent findings indicate an impact on miscarriage incidence of glycoproteins such as glycodelin, and nuclear hormone receptors such as the peroxisome proliferator-activated receptors (PPARs). Significantly reduced glycodelin expression is associated with miscarriage, whereas up-regulation of PPARs appears to compensate for either the activated immune response or the disturbed cytotrophoblast differentiation in RM patients. There is also evidence that circulating placental microparticles are increased in a subgroup of RM patients, indicating an acquired procoagulant state even outside pregnancy. Treatment strategies like aspirin and low molecular weight heparin (LMWH) are standard medications in RM, although only a few placebo-controlled trials have proven their benefit in respect to live birth rate. There is emerging evidence that new treatment options, including drugs like TNFalpha inhibitors and granulocyte colony-stimulating factor (G-CSF) might be beneficial in some cases of RM. However, larger clinical trials must be completed to further prove or disprove benefits of these drugs in the treatment of RM patients.

Vascular injuries after blunt chest trauma: diagnosis and management

BackgroundAlthough relatively rare, blunt injury to thoracic great vessels is the second most common cause of trauma related death after head injury. Over the last twenty years, the paradigm for management of these devastating injuries has changed drastically. The goal of this review is to update the reader on current concepts of diagnosis and management of blunt thoracic vascular trauma.MethodsA review of the medical literature was performed to obtain articles pertaining to both blunt injuries of the thoracic aorta and of the non-aortic great vessels in the chest. Articles were chosen based on authors' preference and clinical expertise.DiscussionBlunt thoracic vascular injury remains highly lethal, with most victims dying prior to reaching a hospital. Those arriving in extremis require immediate intervention, which may include treatment of other associated life threatening injuries. More stable injuries can often be medically temporized in order to optimize definitive management. Endovascular techniques are being employed with increasing frequency and can often significantly simplify management in otherwise very complex patient scenarios.

Velopharyngeal insufficiency: current concepts in diagnosis and management

To discuss principles of evaluation and treatment of children with velopharyngeal insufficiency, and to review recent reports of surgical outcomes. Velopharyngeal insufficiency significantly impacts both quality-of-life and speech intelligibility in children. Diagnosis is made through history and physical, perceptual speech assessment, and instrumental measures including nasendoscopy and radiographic multiplanar videofluoroscopy. Treatment options for velopharyngeal insufficiency consist of prosthetic management or surgery, supplemented with speech therapy when appropriate. Surgical interventions are palatal, palatopharyngeal or pharyngeal in nature. Despite some controversy, most recent reports identify no significant difference in outcomes following pharyngeal flap or sphincter pharyngoplasty. Complications of surgical therapy relate to postoperative obstructive breathing or persistent velopharyngeal insufficiency. Although there is no universally accepted measure to assess velopharyngeal insufficiency severity, nasendoscopy and multiplanar videofluoroscopy are most commonly used for clinical diagnosis. A speech pathologist is an integral member of the velopharyngeal insufficiency team, and momentum toward a standardized reporting system of perceptual speech measurements is increasing. Treatment of velopharyngeal insufficiency should be tailored to the specific needs of the child and family. Surgical therapy may improve velopharyngeal function but may negatively impact upper airway patency and respiration during sleep. The otolaryngologist should be familiar with strengths and limitations of different surgical options for velopharyngeal insufficiency.

Tratamiento de la anemia con eritropoietina y hierro en Enfermedad Renal Crónica

Anemia is one of the most common manifestations of Chronic Renal Failure (CRF), specially during the dialysis period. Growth failure and a high cardiovascular morbimortality are 2 of the most important consequences. Objective: To present a review of the current concepts in diagnosis and management of anemia in pediatric CRF patients. Erythropoietin (EPO) deficit is the main cause of anemia, requiring exogenous replacement through intravenous or subcutaneous route, in hemodialyzed or peritoneodialyzed patients respectively. A longer half-life allows to use EPO one or twice weekly when given by intraperitoneal route, in order to reach a target hemoglobin between 11-12 gr/dl, a level that avoids the cardiovascular risk associated to higher levels as described in adult CRF population. In pediatrics, 100-300 U/kg/weekly can be used to reach the desired hemoglobin levels, always monitoring about the potential complications of EPO, specially arterial hypertension. If anemia seems to be resistent to EPO therapy, iron deficit should be considered and properly treated, as described in this article. Ferritin and saturation of hemoglobin need to be routinely monitored to diagnose iron status in these patients, values less than 100 ng/ml and 20% respectively require exogenous suplementation. Iron doses in pediatrics still need to be defined. Anemia needs to be evaluated and treated in all CRF children, properly management must always be instaured in order to prevent its undesired effects.

Multiple myeloma

AbstractMultiple myeloma is a clonal plasma cell malignancy that accounts for slightly more than 10% of all hematologic cancers. In this paper, we present a historically focused review of the disease, from the description of the first case in 1844 to the present. The evolution of drug therapy and stem-cell transplantation for the treatment of myeloma, as well as the development of new agents, is discussed. We also provide an update on current concepts of diagnosis and therapy, with an emphasis on how treatments have emerged from a historical perspective after certain important discoveries and the results of experimental studies.

Systemic and endocrine manifestations of Langerhans’ cell histiocytosis: current concepts in diagnosis and management

Langerhans’ cell histiocytosis (LCH) is a rare disease of unknown etiology and variable biologic behavior and course. Almost every organ can be affected; however, it frequently involves the bones, lungs, skin and lymph nodes. LCH exhibits a particular predilection for involvement of the hypothalamo–pituitary axis resulting in diabetes insipidus and/or other anterior pituitary deficiencies. Although LCH can sometimes resolve spontaneously, it usually follows a chronic course and systemic treatment is mandatory for the management of multisystem disease. However, a significant number of patients will develop at least one permanent sequela as a consequence of the disease, with diabetes insipidus being the most common. A multidisciplinary approach is always needed in diagnosis, treatment and follow-up of all patients with LCH.

Minimal uterine serous carcinoma: current concepts in diagnosis and prognosis

Uterine serous carcinoma (USC) is an aggressive type of endometrial cancer with a propensity to have extra-uterine spread at diagnosis, in some cases despite limited involvement of the uterus. Serous endometrial intra-epithelial carcinoma (EIC) is a recently recognised entity with the same cytological features and p53 mutations as USC, but it does not demonstrate stromal or myometrial invasion. In addition to representing the putative precursor to USC, the pure form of serous EIC may also be associated with extra-uterine tumour at the time of diagnosis and with risk for recurrence, spread, and eventual death from tumour. Current evidence indicates that serous EIC is a form of minimal USC with behaviour that is stage dependent, thereby necessitating complete surgical staging despite limited disease in the uterus. We review the diagnostic criteria for minimal USC, pitfalls in the differential diagnosis, and discuss a practical approach to evaluating biopsies, polypectomies, or hysterectomies containing minimal USC.

Effort thrombosis (Paget-Schroetter syndrome) in active young adults: Current concepts in diagnosis and treatment

Effort thrombosis or Paget-Schroetter syndrome most often affects young, active adults who are engaged in sports activities or whose professions require repetitive arm movements causing trauma to the axillary-subclavian vein and precipitating deep vein thrombosis. The presence of unilateral edema in the upper extremity is often thought to be attributable to trauma from an exercise regimen rather than acute deep vein thrombosis or compression of the subclavian vein by extrinsic anatomic structures. Because this syndrome occurs in young, active adults it has the potential for considerable long-term morbidity if it remains undetected or inadequately treated. Inadequate or inappropriate treatment may cause a loss of productivity over a lifetime and significantly affect the quality of life. Although more prevalent in male athletes, it is now increasingly affecting young women as they become more seriously involved in athletic endeavors. The purpose of this article is to increase the awareness of the prevalence, clinical significance, and importance of early detection of effort thrombosis of the axillary-subclavian vein, also known as Paget Schroetter syndrome, to educate health care providers regarding the limitations of some diagnostic tools, and to introduce new methods of treatment that offer better long-term results. The prevalence, differential diagnosis, diagnostic modalities, and medical and surgical interventions that have been successfully used to treat Paget-Schroetter syndrome are discussed, and evidence is provided to support the selections. The results of patients who were identified and treated within the last 2 years at the University of Southern California Center for Vascular Care are reviewed.

Cardiac Arrhythmias in the Intensive Care Unit

Cardiac arrhythmias are a common problem encountered in the intensive care unit (ICU) and represent a major source of morbidity. Arrhythmias are most likely to occur in patients with structural heart disease. The inciting factor for an arrhythmia in a given patient may be an insult such as hypoxia, infection, cardiac ischemia, catecholamine excess (endogenous or exogenous), or an electrolyte abnormality. Management includes correction of these imbalances as well as medical therapy directed at the arrhythmia itself. The physiological impact of arrhythmias depends on ventricular response rate and duration, and the impact of a given arrhythmia in a given situation depends on the patient's cardiac physiology and function. Similarly, urgency and type of treatment are determined by the physiological impact of the arrhythmia as well as by underlying cardiac status. The purpose of this review is to provide an update regarding current concepts of diagnosis and acute management of arrhythmias in the ICU. A systematic approach to diagnosis and evaluation will be presented, followed by consideration of specific arrhythmias.

Current concepts in diagnosis and treatment of sialolithiasis

Sialolithiasis is one of the most frequent causes of inflammatory changes within the major salivary glands in Europe. Salivary stone formation affects the submandibular gland in 80%, the parotid gland in 20% of cases, and rarely the sublingual gland.

Acute inflammatory demyelinating optic neuritis: current concepts in diagnosis and management

Optic neuritis (ON), defined as an inflammatory demyelinating optic neuropathy, is a frequent cause of visual loss owing to optic nerve dysfunction in young or middle-aged patients. ON can be seen in isolation or in association with multiple sclerosis (MS). Highlighting the importance of this association is the fact that approximately 20% of patients with MS will present with ON. Review was conducted of the literature and pertinent clinical trials. Although the vision prognosis of patients with ON is excellent, with or without the use of corticosteroids, a minority of patients will suffer from significantly poor vision. ON may be the heralding manifestation of MS; the risk stratification for the future development of MS in patients presenting with ON can be determined by the number of white matter lesions on the baseline cerebral magnetic resonance imaging study. To date, 2 randomized, placebo-controlled studies have found that patients with a clinically isolated demyelinating syndrome, such as ON, at risk for MS, may benefit from the early institution of a disease-modifying drug.

Current Concepts in Diagnosis and Treatment of Traumatic Brain Injury: Implications for Healthcare in Nepal

Taumatic brain injury (TBI) is a leading cause of disability and death in the industrialized and in the developing world. With an incidence of 200-400 cases per 100.000, head injuries are a major contributor to socio-economic costs. The 20% suffering from severe head injury (SHI) requiring prolonged intensive care and/or neurosurgical intervention are of particular interest to specialist practitioners from multiple disciplines.This review covers the current concepts of diagnosis and treatment in these patients in the Western world, i.e. mainly the US and Western Europe. Special emphasis is laid upon evidence-based guidelines established during the last decade. Comparison is drawn to the current status of trauma care in Nepal.Management strategies for TBI can not be applied to Nepalese healthcare entirely. Effective management of head injured persons in Nepal is affected by its difficult geographical location, unavailability of trained personnel in the field, and difficulty in transporting the patients due to the lack of motorable roads. While some of the equipment for the treatment of TBI victims is readily available (e.g. ventricular drainage), others are scarce (e.g. operating room capacity, intensive care facilities) or completely unavailable (e.g. emergency medical service providers, specialized monitoring equipment). Realistic proposals for improvement of the current situation are made. Nepal Journal of Neuroscience, Volume 2, Number 1, 2005, page: 29-51

Perineural Invasion of the Facial Nerve by a Cutaneous Squamous Cell Cancer: A Case Report

We report a case of perineural invasion of the facial nerve by a cutaneous squamous cell carcinoma in a 59-year-old man who presented with a slowly progressive facial paralysis. We performed a distal facial nerve dissection and a simple mastoidectomy with facial recess exposure for resection to negative margins. We also performed a simultaneous facial reconstruction and reanimation procedure with excellent results. External-beam radiation completed the treatment regimen. In addition to describing this case, we review current concepts in diagnosis and therapy, as well as the historical background of malignant perineural invasion of the cranial nerves.

Articular cartilage injuries in the athlete's knee: current concepts in diagnosis and treatment.

Articular cartilage injuries in the athlete's knee: current concepts in diagnosis and treatment.

Ewing sarcoma: current concepts in diagnosis and treatment.

Ewing sarcoma: current concepts in diagnosis and treatment.

DCIS: Current Concepts in Diagnosis and Management

: The majority of published outcome studies for breast carcinoma, whether retrospective or prospective, are designed without specific standards for tissue analysis. These studies treat pathology practice as entirely uniform and reproducible; in fact, it is an enormous variable. Such variation has an unrecognized adverse impact on the results. The outcome of in situ carcinoma is highly dependent on pathologic characteristics, probably more so than on the details of treatment. The use of standardized tissue processing and orientation in addition to pathologic taxonomy is urged. Oncologic surgical principles can combine successfully with reconstructive techniques for patients with ductal carcinoma in situ (DCIS), and this combination may increase the number of women who can be treated with breast-conserving surgery rather than mastectomy by allowing surgeons to perform larger breast excisions with acceptable cosmetic results. Excellent outcome has been demonstrated with extremely low local recurrence rates after excision of DCIS with greater than 1 cm surgical margins without subsequent radiation, especially with smaller and lower-grade lesions. However, meticulous surgical approaches, tissue processing, and pathologic examination are all prerequisites in order to achieve these results. Managed care reimbursement guidelines generally do not allow most centers to attain these standards.