Citations

AbstractProperly performed clinical trials provide a foundation for evidence‐based medical practice. The surgeon plays a central role in the management of patients with malignant solid tumors, including thyroid cancer, because operative extirpation of the malignancy is the essential first step in effective therapy. This article discusses the role of the surgeon in the clinical research of thyroid cancer and also reviews the important clinical trials that have influenced the treatment of patients with thyroid cancer. Recent discoveries defining the genetic mutations underlying the various types of thyroid cancers have led to the development of targeted therapies. These chemical compounds, which are now being evaluated in clinical trials, hold great promise for the treatment of patients with locally advanced and distant metastatic disease. The surgical investigator also plays an important role in procuring tumor tissue from patients in clinical trials. The molecular analysis of these tissues is of critical importance in selecting specific therapies and predicting patient response and prognosis.

Abstract Background: Family-based linkage studies, association studies, and studies of tumors have highlighted human chromosome 8q as a genomic region of interest for prostate cancer susceptibility loci. Recently, a locus at 8q24, characterized by both a single nucleotide polymorphism (SNP) and a microsatellite marker, was shown to be associated with prostate cancer risk in Icelandic, Swedish, and U.S. samples. Although the data were provocative, the U.S. samples were not population based, which precludes assessment of the potential contribution of this locus to prostate cancer incidence in the United States. Methods: We analyzed both markers in a population-based, case-control study of middle-aged men from King County, Washington. Results: Overall, there was a significant positive association between the A allele of the SNP rs1447295 and prostate cancer risk [odds ratio, 1.4; 95% confidence interval (95% CI), 1.1-2.0] but no significant association with the microsatellite DG8S737. However, significant associations were observed for both markers in men with high Gleason scores. Adjusting for age, first-degree family history of prostate cancer, and prostate cancer screening history, the adjusted odds ratios were 1.4 (95% CI, 1.1-1.8) for the A allele of the SNP and 1.9 (95% CI, 1.2-2.8) for the −10 allele of the microsatellite. Conclusions: These data suggest that the locus on chromosome 8q24 harbors a genetic variant associated with prostate cancer and that the microsatellite marker is a stronger risk factor for aggressive prostate cancers defined by poorly differentiated tumor morphology. (Cancer Epidemiol Biomarkers Prev 2007;16(4):809–14)

Hip simulators are regularly used by researchers to assess total hip arthroplasty (THA) implants, range of motion, stability, and alignment of acetabular cup and stem. Previous papers have described three types of simulators: three-dimensional protractors, biaxial rocking motion (BRM) protractors, and single-axis prosthetic range-of-motion (PROM) devices. We have developed a new hip simulator in which the ROM device is completely automated in three independent axes (elevation, internal/external rotation, and plane of elevation). Coupled with the simulator, we used a FaroArm Gold Series coordinate measuring machine (CMM) to accurately align the implant components. The results show that the methodology and alignment setup are accurate and repeatable. With this simulator and digitizer, we are able to study the characteristics of numerous THA implants at various orientations of the pelvis, acetabular cup, stem, and femur.

Purpose There has been a significant increase in surgeon as well as patient interest in arthroscopic treatment of shoulder pathology. We hypothesize that patients have a strong preference for arthroscopic shoulder surgery. Currently, there are no data in the literature reporting on how people perceive open versus arthroscopic shoulder surgery. Methods Prospectively, a total of 202 patients were administered a questionnaire at the offices of 2 fellowship‐trained shoulder surgeons, 1 located at a tertiary referral center (center A) and 1 in private practice (center B). The questionnaire asked a series of questions about specific factors when choosing an orthopaedic surgeon and the preference for arthroscopic or open surgery. In addition, 7 short‐term and long‐term outcomes were listed, and the patient was asked to choose whether open or arthroscopic surgery would provide the best outcome or whether he or she felt that there was no difference. Results Among patients at center A, 88% would prefer arthroscopy if they were to have shoulder surgery, as would 96% of patients at center B. Among patients at center A, 14% would avoid shoulder surgery if the only option was open surgery, as would 25% at center B. The reputation of the surgeon and institution were the primary factors in choosing a surgeon. Recommendation of a former patient and years of surgeon experience were less important factors for patient selection of a shoulder surgeon. Conclusions The study shows that the vast majority of patients perceive multiple advantages of arthroscopic shoulder surgery despite a lack of published data to support many of these assumptions, particularly with regard to expected functional outcome of arthroscopic versus open shoulder surgery. Clinical Relevance Shoulder surgeons should be aware of these perceptions when discussing treatment options with patients. A continued effort should be made to emphasize known scientific data when considering the relative risks and benefits of arthroscopic and open shoulder surgery.

Purpose We tested the hypothesis that the preimplantation mechanical properties of BioCleanse‐treated bone–patellar tendon–bone (BPTB) allografts are not significantly different from those of untreated specimens. Methods For this controlled laboratory study, specimens were harvested as central third or hemi‐BPTB units from both knees of 17 cadaveric tissue donors (11 men and 6 women) aged 19 to 88 years. Donor‐matched specimens (20 per group) were randomly assigned to either BioCleanse‐treated or untreated control groups. Specimens were subjected to 25 minutes of pretensioning at 89 N and then cyclically loaded under longitudinal tension between 50 N and 250 N for 1,000 cycles at 1 Hz, followed by ramp to failure at 50 mm/min. Results No statistically significant difference was found between untreated and BioCleanse‐treated specimens in stiffness (235.3 ± 37.6 N/mm v 222.3 ± 53.4 N/mm, P = .37), cyclic creep (0.38 ± 0.42 mm v 0.40 ± 0.26 mm, P = .81), maximum force (1,685.7 ± 471.6 N v 1,807.0 ± 657.8 N, P = .47), or ultimate stress (29.0 ± 9.8 MPa v 29.0 ± 12.8 MPa, P = .98). Conclusions The preimplantation mechanical properties of BPTB allografts treated with BioCleanse are not significantly different from those of untreated controls. Clinical Relevance This laboratory study compares the biomechanical properties of chemically treated allografts, which are currently being used in anterior cruciate ligament reconstruction, with those of nontreated fresh‐frozen allografts.