Citations

AbstractDespite the fact that the choice of bearing design has been thought to influence the functional outcomes and longevity of unicompartimental knee arthroplasty (UKA), there is a lack of clinical evidence supporting the decision‐making process in patients who have undergone high tibial osteotomy (HTO). A systematic review of studies was carried out that reported the outcomes of fixed‐bearing (FB) or mobile‐bearing (MB) medial UKA in patients with a previous HTO. A random effect meta‐analysis using a generalized linear mixed‐effects model to calculate revision rates was done. Seven retrospective cohort studies were included for this study. Regarding the fixation method, 40 were the FB‐UKA and 47 were MB‐UKA. For both groups, the mean post‐operative follow‐up was 5.8 years. The survival rates were 92% for the FB‐UKA with a mean follow‐up of 10 years. For the MB‐UKA, it ranged from 35.7 to 93%, with a mean follow‐up of 4.2 years. For the FB, the time to revision was reported as 9.3 years, while 1.2, 2.5 and 2.91 years was reported for the MB. The results of the meta‐analysis showed that the revision rate for the patients receiving a FB‐UKA after failed HTO was 8%, compared to 17% in those who received an MB‐UKA. The results of the review suggest that the use of the FB‐UKA is associated with lower revision rates and a longer survival time than the MB‐UKA and have similar functional ability scores.Level of evidence: III (systematic review of level‐III studies).

Background and Aims . EUS-FNA is an accurate and safe technique to biopsy mediastinal lymph nodes. However, there are few data pertaining to the role of EUS-FNA to biopsy central lung masses. The aim of the study was to assess the diagnostic yield and safety of EUS-FNA of indeterminate central mediastinal lung masses. Methods . Design: Retrospective review of a prospectively maintained database; noncomparative. Setting: Tertiary referral center. From 10/2004 to 12/2010, all patients with a lung mass located within proximity to the esophagus were referred for EUS-FNA. Main Outcome Measurement: EUS-FNA diagnostic accuracy and safety. Results . 73 consecutive patients were included. EUS allowed detection in 62 (85%) patients with lack of visualization prohibiting FNA in 11 patients. Among sampled lesions, one patient (1/62 = 1.6%) had a benign lung mass (hamartoma), while the remaining 61 patients (61/62 = 98.4%) had a malignant mass (primary lung cancer: 55/61 = 90%; lung metastasis: 6/61 = 10%). The sensitivity, specificity, and accuracy of EUS-FNA were 96.7%, 100%, and 96.7%, respectively. The sensitivity was 80.8% when considering nonvisualized masses. One patient developed a pneumothorax (1/62 = 1.6%). Conclusions . EUS-FNA appears to be an accurate and safe technique for tissue diagnosis of central mediastinal lung masses.

Learning Objectives Analyze the clinical trial data for the treatment of breast cancer. Evaluate the risk of cardiotoxicity associated with the use of trastuzumab. Design and conduct a practical approach to managing patients with trastuzumab-associated cardiotoxicity. This article is available for continuing medical education credit at CME.TheOncologist.com.