Recent findings

Because of earlier detection, the nature of cancer has changed, from a disease usually diagnosed at a late and incurable stage to a heterogeneous condition that varies from clinically insignificant to rapidly aggressive. Screening programs for PLX3397 mouse cancer have resulted in a dramatic increase in the diagnosis of clinically insignificant disease, balanced by improved survival and mortality because of significant cancers being diagnosed at a more curable stage. Overdiagnosis requires the presence of microfocal disease and a screening test to identify this. This exists for breast, prostate, and thyroid

cancers, and to a lesser degree for renal and lung cancer. The problem of cancer overdiagnosis and overtreatment is complex, with numerous causes and many trade-offs. It is particularly important in prostate cancer, but is a major issue in many other cancer sites. Screening for prostate cancer appears, based on the best data from randomized trials, to significantly reduce cancer mortality.

Summary

Reducing overtreatment in patients diagnosed with

indolent disease is critical to the success selleck products of screening.”
“Background: Fixation of intra-articular calcaneal fractures has traditionally been guided by intraoperative fluoroscopy. Recent reports indicate that there is a role for subtalar arthroscopy in surgical fixation of these fractures. The earliest reports described the use of subtalar arthroscopy for joint assessment during late hardware removal. It then served as an adjunct for joint inspection in open reduction and internal fixation. In its final permutation, percutaneous arthroscopy was performed with minimally invasive reduction check details and fixation, minimizing soft tissue complications commonly associated with the open approach. In practiced hands, this technique yields good results with minimal morbidity.

Methods: We performed a prospective analysis of 22 consecutive patients with Sanders II, AO-OTA 83-C2 intra-articular calcaneal fractures who underwent

dual-modality imaging (subtalar arthroscopic- and intraoperative fluoroscopic-) guided percutaneous fracture fixation with a minimum follow-up of 2 years. Maximum accepted postreduction step-off was 1 mm. Fractures were fixed definitively with four to eight percutaneous cancellous screws.

Results: There was significant correction of Bohler’s tuberosity-joint angle from 4.2 degrees +/- 11.1 degrees preoperatively to 21.3 degrees +/- 8.8 degrees on immediate postoperative radiographs, with minimal subsidence to 20.1 degrees +/- 8.2 degrees at 2 years. Bohler’s angle correction and joint surface restoration could not be achieved percutaneously in one patient with an impacted, depressed joint fragment. Compared with preoperative values, there was significant improvement in mean Visual Analog Scale, American Orthopedic Foot and Ankle Society Ankle-Hindfoot Score, and Short Form-36 (Physical Function) scores at 3 months, with further improvement up to 2-years.