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Aesthetic Plastic Surgery Oct 2021Facial thread-lifting (FTL) has gained more popularity, but the incidences of complications following FTL remain controversial. We aimed to perform a meta-analysis and... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Facial thread-lifting (FTL) has gained more popularity, but the incidences of complications following FTL remain controversial. We aimed to perform a meta-analysis and systematic review to estimate the incidences of complications and to compare the short- and long-term satisfaction rates following FTL.
METHODS
We searched PubMed, Web of Science, Embase and Cochrane library for eligible studies. The primary outcome was the incidences of complications following FTL. The secondary outcome was the satisfaction rate immediately and 6-month after FTL. The pooled incidences of complications and 95% confidence intervals were estimated using random-effects models.
RESULTS
A total of 26 studies were included in this meta-analysis. Swelling was the most commonly reported complication with a pooled incidence of 35%, followed by skin dimpling (10%), paresthesia (6%), thread visibility/palpability (4%), infection (2%), and thread extrusion (2%). Absorbable threads were associated with a significantly lower risk of paresthesia (3.1% vs. 11.7%) and thread extrusion (1.6% vs. 7.6%) than non-absorbable threads. Patients older than 50 years had a significantly higher risk of dimpling (16% vs. 5.6%) and infection (5.9% vs. 0.7%) than their younger counterparts. In addition, the pooled long-term satisfaction rate was significantly decreased compared to it immediately after FTL (88% vs. 98%).
CONCLUSION
Non-absorbable threads and older age of patients are associated with higher risks of complications. Therefore, we recommend a judicious use of non-absorbable threads and FLT in older patients. Furthermore, it should be discussed with patients preoperatively that the rejuvenation effect of FTL may not maintain in the long-term.
LEVEL OF EVIDENCE III
This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
Topics: Aged; Face; Humans; Incidence; Lifting; Rejuvenation; Treatment Outcome
PubMed: 33821308
DOI: 10.1007/s00266-021-02256-w -
Canadian Family Physician Medecin de... Aug 2014To systematically review the diagnostic accuracy of clinical features associated with colorectal cancer (CRC) presenting in primary care. (Review)
Review
OBJECTIVE
To systematically review the diagnostic accuracy of clinical features associated with colorectal cancer (CRC) presenting in primary care.
DATA SOURCES
MEDLINE and EMBASE were searched for studies in primary care that provided information on clinical features predictive of CRC. Positive predictive values were used to guide the determination of clinical features associated with increased risk of CRC.
STUDY SELECTION
Systematic reviews or primary studies that provided possible clinical features predictive of CRC were included.
SYNTHESIS
Clinical features of patients presenting in primary care that are associated with increased risk of CRC, listed in descending order of association, included palpable rectal or abdominal mass; rectal bleeding combined with weight loss; iron deficiency anemia; rectal bleeding mixed with stool; rectal bleeding in the absence of perianal symptoms; rectal bleeding combined with change in bowel habits; dark rectal bleeding; rectal bleeding and diarrhea; and change in bowel habits. Being male and increasing age were also, in general, associated with increased risk of CRC.
CONCLUSION
Recognition of clinical features associated with increased risk of CRC by FPs might help with earlier identification and referral among patients presenting in primary care. This review might help inform providers and CRC diagnostic assessment programs about indications for assessment and further investigation.
Topics: Colorectal Neoplasms; Humans; Practice Guidelines as Topic; Primary Health Care
PubMed: 25122831
DOI: No ID Found -
Anticancer Research Jul 2020With the increase in detection of non-palpable breast lesions through screening, wire-guided localisation (WGL) has long been the favoured method for preoperative...
BACKGROUND/AIM
With the increase in detection of non-palpable breast lesions through screening, wire-guided localisation (WGL) has long been the favoured method for preoperative localisation. However, this technique comes with several limitations. New methods have been developed, including several non-radioactive, wireless options. We aimed to assess the effectiveness of Savi Scout® localisation (SSL) through this pooled analysis and systematic review.
MATERIALS AND METHODS
A number of databases were searched for records reporting data on localisation and retrieval of SSL reflectors, as well as re-excision rate. We included our own data from 20 patients (22 reflectors) at our institution.
RESULTS
A total of 842 reflectors were inserted across eleven studies and our own data. Pooled analysis revealed an overall successful deployment rate of 99.64% and a successful retrieval rate of 99.64% using SSL. A statistically significant difference in re-excision rate was found in a smaller pooled analysis conducted across four studies comparing SSL and WGL (12.9% and 21.1% respectively, p<0.01).
CONCLUSION
The Savi Scout® localisation system is a safe and effective alternative to WGL. It facilitates flexible scheduling by decoupling radiology and surgery interventions and may reduce the need for re-excision procedures for positive surgical margins.
Topics: Breast; Breast Neoplasms; Female; Humans; Margins of Excision; Radar; Radiography
PubMed: 32620602
DOI: 10.21873/anticanres.14352 -
JAMA Network Open Dec 2022A discrepancy on current guidelines and clinical practice exists regarding routine imaging surveillance after mastectomy, mainly regarding the lack of adequate evidence... (Meta-Analysis)
Meta-Analysis
IMPORTANCE
A discrepancy on current guidelines and clinical practice exists regarding routine imaging surveillance after mastectomy, mainly regarding the lack of adequate evidence for imaging in this setting.
OBJECTIVE
To investigate the usefulness of imaging surveillance in terms of cancer detection and interval cancer rates after mastectomy with or without reconstruction for patients with prior breast cancer.
DATA SOURCES
A comprehensive literature search was conducted in 3 electronic databases-PubMed, ISI Web of Science, and Scopus-without year restriction. References from relevant reviews and eligible studies were also manually searched.
STUDY SELECTION
Eligible studies were defined as those conducting surveillance imaging (mammography, ultrasonography, or magnetic resonance imaging [MRI]) of patients with prior breast cancer after mastectomy with or without reconstruction that presented adequate data to calculate cancer detection rates for each surveillance method.
DATA EXTRACTION AND SYNTHESIS
Independent data extraction by 2 investigators with consensus on discrepant results was performed. A quality assessment of studies was performed using the QUADAS-2 (Quality Assessment of Diagnostic Accuracy Studies-2) template. The generalized linear mixed model framework with both fixed-effects and random-effects models was used to meta-analyze the proportion of cases across studies including 3 variables: surveillance method, reconstruction after mastectomy, and surveillance measure.
MAIN OUTCOMES AND MEASURES
Three outcome measures were calculated for each eligible study and each surveillance imaging method within studies: overall cancer detection (defined as ipsilateral cancer, both palpable and nonpalpable) rate per 1000 examinations, clinically occult (nonpalpable) cancer detection rate per 1000 examinations, and interval cancer rate per 1000 examinations.
RESULTS
In total, 16 studies were eligible for the meta-analysis. The pooled overall cancer detection rates per 1000 examinations were 1.86 (95% CI, 1.05-3.30) for mammography, 2.66 (95% CI, 1.48-4.76) for ultrasonography, and 5.17 (95% CI, 1.49-17.75) for MRI. For mastectomy without reconstruction, the rate of clinically occult (nonpalpable) cancer per 1000 examinations (2.96; 95% CI, 1.38-6.32) and the interval cancer rate per 1000 examinations (3.73; 95% CI, 0.84-3.98) were lower than the overall cancer detection rate (including both palpable and nonpalpable lesions) per 1000 examinations (6.41; 95% CI, 3.09-13.25) across all imaging modalities. The interval cancer rate per 1000 examinations for mastectomy with reconstruction (3.73; 95% CI, 0.41-2.73) was comparable to the pooled cancer detection rate per 1000 examinations (4.73; 95% CI, 2.32-9.63) across all imaging modalities. In all clinical scenarios and imaging modalities, lower rates of clinically occult cancer compared with cancer detection rates were observed.
CONCLUSIONS AND RELEVANCE
Lower detection rates of clinically occult-compared with overall-cancer across all 3 imaging modalities challenge the use of imaging surveillance after mastectomy, with or without reconstruction. Findings suggest that imaging surveillance in this context is unnecessary in clinical practice, at least until further studies demonstrate otherwise. Future studies should consider using the clinically occult cancer detection rate as a more clinically relevant measure in this setting.
Topics: Humans; Female; Mastectomy; Breast Neoplasms; Mammography; Physical Examination; Consensus
PubMed: 36454573
DOI: 10.1001/jamanetworkopen.2022.44212 -
The Journal of Craniofacial SurgeryTitanium plates and screws are essential devices in maxillofacial surgery since late 1980s, but despite their wide use there is no consensus in titanium internal... (Meta-Analysis)
Meta-Analysis
Titanium plates and screws are essential devices in maxillofacial surgery since late 1980s, but despite their wide use there is no consensus in titanium internal fixators removal after bone healing. A systematic literature review and meta-analysis were conducted on seventeen retrospective studies. Effect size and 95% confidence intervals were calculated for plate removal (per plate and per patient) and for removal causes (infection, pain, screws complications, exposition, palpability). Odds ratio, 95% confidence intervals, and χ 2 test were measured for sex, smoking, and implant site. Heterogeneity was evaluated with Cochran and Inconstancy test. Obtained data were used to design Forest and Funnel plots. The aim of the study is to identify and clarify reasons and risk factors for plates and screws removal. Infection is the most frequent reason; the habit of tobacco usage and implant site (mandibula) are the main risk factors. The administration of antibiotic prophylaxis is essential, and patients must quit smoking before and after surgery. In conclusion there is no scientific evidence supporting the removal of internal devices as mandatory step of the postoperative procedure.
Topics: Humans; Titanium; Retrospective Studies; Bone Plates; Mandible; Device Removal; Surgery, Oral; Fracture Fixation, Internal
PubMed: 36217228
DOI: 10.1097/SCS.0000000000009006 -
Langenbeck's Archives of Surgery Mar 2022Giant parathyroid adenoma (GPA) can present with severe biochemical derangement similar to the clinical presentation of parathyroid carcinoma (PC). This study aims to...
PURPOSE
Giant parathyroid adenoma (GPA) can present with severe biochemical derangement similar to the clinical presentation of parathyroid carcinoma (PC). This study aims to present the current evidence on surgical management of GPAs in primary hyperparathyroidism.
METHODS
A systematic review of the literature on GPAs was conducted following the PRISMA guidelines. Data on clinical, biochemical, preoperative diagnostic, and surgical methods were analysed.
RESULTS
Sixty-one eligible studies were included reporting on 65 GPAs in eutopic, ectopic mediastinal, and intrathyroidal locations (61.5%, 30.8%, and 7.7%, respectively). A palpable neck mass was present in 58% of GPAs. A total of 90% of patients had symptoms including fatigue, skeletal pain, pathological fracture, nausea, and abdominal pain. Ninety percent of patients had significant hypercalcaemia (mean 3.51 mmol/L; range: 2.59-5.74 mmol/L) and hyperparathyroidism with PTH levels on average 14 times above the upper limit of the normal reference. There was no correlation between the reported GPA size and PTH nor between GPA weight and PTH (p = 0.892 and p = 0.363, respectively). Twenty-four percent had a concurrent thyroidectomy for suspicious features, intrathyroidal location of GPA, or large goitre. Immunohistochemistry such as Ki-67, parafibromin, and galectin-3 was used in 18.5% of cases with equivocal histology. Ninety-five percent of GPAs were benign with 5% reported as atypical adenomas.
CONCLUSION
The reported data on GPAs are sparse and heterogeneous. In GPAs with suspicious features for malignancy, en bloc resection with concurrent thyroidectomy may be considered. In the presence of equivocal histological features, ancillary immunohistochemistry is advocated to differentiate GPAs from atypical adenomas and PCs.
Topics: Adenoma; Humans; Hypercalcemia; Hyperparathyroidism, Primary; Parathyroid Hormone; Parathyroid Neoplasms
PubMed: 35039921
DOI: 10.1007/s00423-021-02406-3 -
Acta Cytologica 2019Differentiation between gynecomastia, a common cause of male breast enlargement, and breast cancer is crucial for appropriate management. Fine-needle aspiration biopsy...
OBJECTIVE
Differentiation between gynecomastia, a common cause of male breast enlargement, and breast cancer is crucial for appropriate management. Fine-needle aspiration biopsy has been shown to be sensitive and specific in assessing female breast lesions, comparable to core needle biopsy. Few such studies have been conducted in men. We assessed its diagnostic value in a male patient cohort.
STUDY DESIGN
Men who underwent fine-needle aspiration (FNA) for palpable breast lesions at Massachusetts General Hospital from January 2007 to December 2016 were evaluated. Clinical data, radiographic findings, and cytologic diagnoses of 74 breast FNA from 71 men were reviewed. Breast aspirates were classified as nondiagnostic, benign, atypical, suspicious for malignancy, or malignant. Histology was obtained in 37 cases, and clinical and radiological data were used as follow-up in 37 patients.
RESULTS
Most FNA biopsies (73%) were performed by cytopathologists, and 93.2% of the breast FNA in men were adequate; 58% showed benign processes, mostly gynecomastia (n = 22), and 28.4% (n = 21) were malignant, most often ductal carcinoma. No false-positive cytologies were obtained, and there was 1 false-negative cytology. In our study, FNA of palpable male breast lesions was 95.8% sensitive and 100% specific.
CONCLUSIONS
FNA allows sensitive, specific, and safe evaluation and diagnosis of palpable male breast lesions.
Topics: Biopsy, Fine-Needle; Breast Neoplasms, Male; Cytodiagnosis; Humans; Male; Pathology, Clinical; Practice Guidelines as Topic; Predictive Value of Tests
PubMed: 30904908
DOI: 10.1159/000494486 -
Asian Pacific Journal of Cancer... Aug 2022Currently, the standard method for staging and treatment of axillary lymph nodes for early-stage breast cancer is sentinel lymph node biopsy (SLNB), while axillary lymph... (Meta-Analysis)
Meta-Analysis
Comparing Early-Stage Breast Cancer Patients with Sentinel Lymph Node Metastasis with and without Completion Axillary Lymph Node Dissection: A Systematic Review and Meta-Analysis.
BACKGROUND
Currently, the standard method for staging and treatment of axillary lymph nodes for early-stage breast cancer is sentinel lymph node biopsy (SLNB), while axillary lymph node dissection (ALND) is used in cases with palpable axillary lymph nodes or positive SLNB cases. The aim of this review was to compare overall survival (OS), disease-free survival (DFS), and axillary recurrence in early-stage breast cancer patients underwent SLNB or SLNB and completion ALND.
METHODS
The databases of PubMed, Scopus, and Cochrane Library were searched using the key words of "breast cancer", "axillary lymph node dissection", and "sentinel lymph node dissection". In addition, other sources were searched for ongoing studies (i.e., clinicaltrials.gov). The clinical trials were evaluated based on the Jadad quality criteria, and cohort studies were evaluated according to the STROBE criteria. At the end of the search, the articles were screened independently by two reviewers to check their eligibility to be included in the study. Afterwards, the data were extracted independently by two researchers.
RESULTS
After searching the databases, 169 papers were retrieved. However, after removing the duplicates and studying the titles and abstracts of these papers, only ten ones underwent further investigation. After reading full-text of each article, four studies were finalized. Following a manual search, 27 papers were entered into the study for the final evaluation, 11 of which were included in the meta-analysis based on the inclusion and exclusion criteria. The findings showed no significant differences in OS, DFS, and axillary recurrence in early-stage breast cancer patients underwent SLNB or SLNB and completion ALND.
CONCLUSION
The findings did not confirm that ALND improved OS, DFS, and axillary recurrence in patients who were clinically node-negative and positive SLNB.
Topics: Axilla; Breast Neoplasms; Female; Humans; Lymph Node Excision; Lymph Nodes; Lymphatic Metastasis; Neoplasm Staging; Sentinel Lymph Node; Sentinel Lymph Node Biopsy
PubMed: 36037108
DOI: 10.31557/APJCP.2022.23.8.2561 -
Otolaryngology--head and Neck Surgery :... Apr 2022To conduct a systematic review on the demographics, characteristics, management, treatment, complications, and outcomes of Ewing sarcomas in the craniofacial bones.
OBJECTIVES
To conduct a systematic review on the demographics, characteristics, management, treatment, complications, and outcomes of Ewing sarcomas in the craniofacial bones.
DATA SOURCES
Using Cochrane Library, EmBase, and PubMed, the authors identified 71 studies to be included.
REVIEW METHODS
The Cochrane Library, EmBase, and PubMed databases were used to identify literature relating to Ewing sarcomas in the craniofacial bone to conduct a systematic review. Patient demographics, clinical characteristics, and treatment strategies were extracted.
RESULTS
Seventy-one studies encompassing 102 patients were identified. The most common craniofacial locations involved were the frontal bone (16.7%, n = 17), nasal cavity (16.7%, n = 17), and temporal bone (14.7%, n = 15). Stratified by location, the most common presenting symptoms were frontal bone (palpable mass, n = 8, 47.1%), nasal cavities (epistaxis, n = 9, 52.9%), and temporal bones (headache, n = 5, 33.3%). The 3 most commonly used treatment strategies were a combination of surgical intervention/radiotherapy/chemotherapy (n = 43, 43%), a combination of radiotherapy/chemotherapy (n = 18, 18%), and a combination of surgical intervention/chemotherapy (n = 15, 15%). Patients who received a combination of surgical intervention/radiotherapy/chemotherapy experienced local recurrence rate of 16.6%. However, other combinations of therapies such as surgical intervention/chemotherapy and radiotherapy/chemotherapy had a lower local recurrence rate but were limited by small sample size. Most patients (79.0%) were disease free without evidence of recurrence.
CONCLUSION
Ewing Sarcoma of the craniofacial bones has a good prognosis when treated appropriately. Given that our study was limited by retrospective data, we advise clinicians to use the findings of this article with their own clinical judgment to determine which treatment strategy they should pursue.
Topics: Bone Neoplasms; Disease-Free Survival; Humans; Retrospective Studies; Sarcoma, Ewing; Temporal Bone
PubMed: 34255595
DOI: 10.1177/01945998211022228 -
Anticancer Research Apr 2020Wire-guided localisation (WGL) remains the most widely used technique for the localisation of non-palpable breast lesions; however, recent technological advances have... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND/AIM
Wire-guided localisation (WGL) remains the most widely used technique for the localisation of non-palpable breast lesions; however, recent technological advances have resulted in non-wire, non-radioactive alternatives, such as magnetic seeds (Magseeds). The aim of this pooled analysis was to determine whether Magseeds are an effective tool for localising non-palpable breast lesions.
MATERIALS AND METHODS
Various databases were searched for publications which reported data on the localisation and placement rates of Magseed. Data on re-excision rates under use of Magseed and WGL were also collected.
RESULTS
Sixteen studies, spanning the insertion of 1,559 Magseeds, were analysed. The pooled analysis showed a successful placement rate of 94.42% and a successful localisation rate of 99.86%. Four studies were analysed in a separate pooled analysis and showed no statistically significant difference between re-excision rates using Magseeds and WGL.
CONCLUSION
The use of Magseeds is an effective, non-inferior alternative to WGL that overcomes many of the limitations of the latter.
Topics: Breast; Breast Neoplasms; Female; Humans; Magnetic Field Therapy; Magnetic Fields; Magnetics; Mastectomy, Segmental
PubMed: 32234869
DOI: 10.21873/anticanres.14135