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Parenchyma-sparing pancreatectomy for presumed noninvasive intraductal papillary mucinous neoplasms of the pancreas.

OBJECTIVE: To assess the feasibility and outcomes of parenchyma-sparing pancreatectomy (PSP), including enucleation (EN), resection of uncinate process (RUP), and central pancreatectomy (CP), as an alternative to standard pancreatectomy for presumed noninvasive intraductal papillary and mucinous neoplasms (IPMNs). BACKGROUND: Pancreaticoduodenectomy and distal pancreatectomy are associated with significant perioperative morbidity, a substantial risk of pancreatic insufficiency, and may overtreat noninvasive IPMNs. METHODS: From 1999 to 2011, PSP was attempted in 91 patients with presumed non

Are We Undermedicating Patients With Neuromuscular Scoliosis After Posterior Spinal Fusion?

STUDY DESIGN: Retrospective, matched study of patients with adolescent idiopathic scoliosis (AIS) and patients with cerebral palsy (CP) undergoing (PSF). OBJECTIVES: To compare pain management, through measurement of the amount of narcotic used and pain scores, for patients with neuromuscular (NM) scoliosis undergoing PSF to a cohort of patients with AIS. SUMMARY OF BACKGROUND DATA: Posterior spinal fusion for children with severe NM scoliosis carries a high risk of complications. Appropriate assessment of pain is crucial; undertreatment of pain leads to anxiety whereas overtreatment can lea…

COX-2 expression is predictive for early relapse and aromatase inhibitor resistance in patients with ductal carcinoma in situ of the breast, and is a target for treatment.

BACKGROUND: Stratification of patients for treatment of ductal carcinoma in situ (DCIS) is suboptimal, with high systemic overtreatment rates. METHODS: A training set of 95 tumours from women with pure DCIS were immunostained for proteins involved in cell survival, hypoxia, growth factor and hormone signalling. A generalised linear regression with regularisation and variable selection was applied to a multiple covariate Cox survival analysis with recurrence-free survival 10-fold cross-validation and leave-one-out iterative approach were used to build and test the model that was validated usin…

Single visit approach for management of cervical intraepithelial neoplasia by visual inspection & loop electrosurgical excision procedure.

BACKGROUND & OBJECTIVES: Developing a feasible and sustainable model of cervical cancer screening in developing countries continues to be a … omen, respectively. Sixteen patients with Reid score >3 underwent the "See-and-treat" protocol. The overtreatment rate was 12.5 per cent and the efficacy of LEEP was 81.3 per cent. There were no major complications. INTERPRETATION & CONCLUSIONS: The sensitivity of VIA/VILI was comparable to cytology. A single visit approach using visual screening methods at co …

Predicting the course of IBD: light at the end of the tunnel?

Prognosis in Crohn's disease (CD) and ulcerative colitis (UC) varies substantially between patients. Accordingly, no single treatment strategy will be suitable for everyone. 'Top-down' strategies inevitably overtreat patients destined to experience indolent disease (and risk unnecessary immunosuppression), whilst 'step-up' strategies expose patients with aggressive disease to avoidable disease-related morbidity. Accordingly, for personalised medicine to succeed in IBD, a reliable method of predicting prognosis is critical. In oncology, gene expression profiling enables reliable prediction of s

[The optimult study concept - selective neoadjuvant chemoradiation therapy based on preoperative MRI].

Optimal surgery for rectal cancer, i. e., total mesorectal excision in the middle and lower rectum reduces local recurrence substantially. Multi-modal therapy further improves the rate of local recurrence in advanced rectal cancer. In Germany neoadjuvant chemoradiation therapy is most frequently given for these tumours. However, clinical staging by endosonography, CT scan and / or MRI is unreliable, particulary as regards lymph node category, which entails overtreatment of a relevant number of patients secondary to overstaging. Thus, a subgroup of patients has to tolerate side effects and long…

[Surgery of benign tumors of the parotid gland: the value of fine needle aspiration cytology].

BACKGROUND: Fine needle aspiration cytology (FNAC) is a widely used diagnostic tool to evaluate neoplastic or inflammatory tumorous lesions of the salivary glands. This method influences the selection of the modality of surgical treatment. In cases of benign tumors of the parotid gland, a (partial) superficial parotidectomy is usually recommended. However, for tumors other than pleomorphic adenomas (such as cystadenolymphomas, other adenomas, or benign tumor-like lesions) this operation is considered an overtreatment because extracapsular satellites are rare and recurrences in case of a capsul…

[Is prevention better than healing?].

Preventive and screening interventions have been met with great enthusiasm. This is due to a widespread misunderstanding of what prevention … ing programmes will benefit only a few but harm many more, though. Harm is due to overdiagnosis and overtreatment as well as to side effects related to the investigation itself. This includes psychological and other distress related to work-up of false test results. All prevention programmes have to undergo sound scientific evaluation before they can be recomme …

ACVIM Заявление мелких животных о болезни лайма у собак: диагностика, лечение и профилактика.

Цель настоящего доклада состоит в том, чтобы предложить дипломатам АЦВИМ согласованное мнение по вопросам диагностики, лечения и профилактики инфекций Борелия бурдорфери у собак (болезнь канина Лайм). Клинические синдромы, которые, как известно, обычно ассоциируются с болезнью собаки Лайма, включают полиартрит и гломерулопатию. Результаты серологических испытаний могут использоваться для документирования воздействия B. burborferi, но не доказывают наличие болезни. Хотя сыворотка с ферментом иммуносорбента/непрямой флуоресцентный анализ антител может оставаться положительными в течение месяцев-

Совпадение в аннотации оригинала
The purpose of this report is to offer a consensus opinion of ACVIM diplomates on the diagnosis, treatment, and prevention of Borrelia burgd … udy. Serological screening of healthy dogs is controversial because it can lead to overdiagnosis or overtreatment of normal dogs, most of which never develop Lyme disease. However, serological screening can provide seroprevalence and sentinel data and stimulate owner education about tick infections and control. Although it is unknown whether treatment of seropo …

Preoperative evaluation of prognosis in breast cancer patients by [(18)F]2-Deoxy-2-fluoro-D-glucose-positron emission tomography.

PURPOSE: [18F]2-Deoxy-2-fluoro-D-glucose (FDG)-positron emission tomography (PET) was applied to breast cancer patients for the purpose of p … y by the preoperative evaluation of patient prognosis with FDG-PET due to a possible elimination of overtreatment for those who have good prognosis and, thus, need not to be treated with chemotherapy.

Considerations in the treatment of the node-negative (N0) neck in glottic carcinomas.

Treatment of lymph node negative (N0) glottic carcinoma has raised numerous controversy for decades. Prevention is one of the oldest axioms in medicine. On the other hand, overtreatment can cause unnecessary harm to patients. This retrospective study was performed in 206 patients having glottic cancers with clinically node-negative (N0) necks. The aim of this assessment is to deal with the diagnosis, predictive factors and surgical therapy of occult metastases of squamous cell cancers originating from the glottic region. The examinations were performed in three phases. Preoperative clinical, h…

What do you do when they grow up? Approaches to seizures in developmentally delayed adults.

Epilepsy and developmental disabilities (DD) often occur together but affect individuals differently and have a complex causal relationship. … difficulties may lead to undertreatment, and the motivation to lessen certain behaviors may lead to overtreatment. Because those with DD may be unusually sensitive to adverse effects of both seizures and AEDs, cognitive and behavioral side effects must be carefully monitored. Few relevant studies exist. For some patients, comorbid psychiatric disorders may be t …

[Early selective surfactant treatment--also to very premature infants treated with CPAP?].

INTRODUCTION: Early selective surfactant treatment of premature infants on mechanical ventilation, defined as treatment of selected children within the first two hours of life, reduces the incidence of complications to neonatal respiratory distress syndrome (RDS) as compared with delayed selective surfactant treatment. Treatment of children judged to be solely at risk of RDS, however, eventually leads to overtreatment in some. MATERIALS AND METHODS: A population of premature neonates born at a gestational age of 24 + 0 to 29 + 6 weeks at Rigshospitalet, were studied retrospectively. RESULTS:…

The systemic inflammatory response and its impact on iron nutriture in end-stage renal disease.

In most chronic disease conditions, the systemic inflammatory response and its mediators play an essential pathogenic role. Protein calorie … s iron supplementation (10 to 20 mg per dialysis treatment or 100 mg every second week) avoids iron overtreatment and should reduce adverse events. In ESRD patients receiving dialysis, the importance of the systemic inflammatory response in the development of protein calorie malnutrition, the impact of the acute-phase response on iron nutriture, and the respons …

Reproductive-tract infections in women in low-income, low-prevalence situations: assessment of syndromic management in Matlab, Bangladesh.

BACKGROUND: In the control of reproductive-tract infections, including sexually transmitted infections (STIs), in low-income and middle-inco … n 36% and 87% of costs would have been spent on uninfected women. INTERPRETATION: The high rate of overtreatment in the population studied carries both financial and social costs--the latter in potentially exposing women misdiagnosed as having an STI to threats of domestic disruption or even violence. We make recommendations for management programmes in areas …

Diagnosis and therapy surveillance in Addison's disease: rapid adrenocorticotropin (ACTH) test and measurement of plasma ACTH, renin activity, and aldosterone.

The rapid ACTH injection test is an indirect screening test for adrenocortical insufficiency. As a supplement to this test, we evaluated the … e for FC replacement therapy. It should be titrated into the upper normal range to avoid under- and overtreatment.

Respiratory arrest in near-fatal asthma.

BACKGROUND AND METHODS: The majority of asthma-related deaths occur outside the hospital, and therefore the exact factors leading to the ter … ere asphyxia rather than cardiac arrhythmias. These results suggest that undertreatment rather than overtreatment may contribute to an increase in mortality from asthma.

Age is the wrong axis: rethinking surgical selection for octogenarians with early-stage non-small cell lung cancer.

Lung cancer is increasingly a disease of older age, and as low-dose computed tomography screening extends into the ninth decade, a growing n … mong screen-detected tumors, tempers the survival gain expected from aggressive treatment and makes overtreatment as real a hazard as age-based exclusion. A graded menu of options now exists, extending from minimally invasive lobectomy through sublobar resection and stereotactic ablative radiotherapy to active surveillance, and intensity should descend with res …

Digital analysis of spatial expression of stromal fibroblast activation protein alpha (FAP) in DCIS.

INTRODUCTION: The presence of non-progressing ductal carcinoma in situ (DCIS) cases has raised concerns of overtreatment, necessitating comprehensive risk prediction. The tumour microenvironment, especially cancer-associated fibroblasts (CAFs), plays a key role in DCIS progression. Fibroblast activation protein alpha (FAP), a CAF biomarker, has shown prognostic potential, but its clinical significance and spatial organization in DCIS remain rarely discussed. METHODS: In this study, we employed a digital pathology pipeline to quantify stromal FAP expression and map its spatial organization. A …

A Holistic Framework for Cervical Cancer Screening and Risk Stratification: Integrating Etiology, Morphology, Epigenetics, and Microecology.

Cervical cancer (CC) remains a major global health burden despite being highly preventable through early detection. Current screening strategies, predominantly high-risk human papillomavirus (HR-HPV) testing and liquid-based cytology (LBC), have limited specificity, leading to unnecessary colposcopic referrals and overtreatment. This narrative review proposes a conceptual holistic screening framework-termed HADm-that integrates four complementary pillars into a unified risk stratification system: (1) Etiology (HR-HPV genotyping), (2) Morphology (artificial intelligence-assisted LBC, Ai-LBC), (…