Localized Prostate Cancer: Treatment Options.

In the United States, prostate cancer will be diagnosed in one out of seven men in his lifetime. Most cases are localized, and only one in 39 men will die from the disease. Prostate cancer is most often detected using serum prostate-specific antigen testing. The National Comprehensive Cancer Network guidelines use four main factors to stratify risk of disease progression or recurrence and to determine the recommended treatment: clinical stage, pathologic grade, prostate-specific antigen level, and comorbidity-adjusted life expectancy. Radical prostatectomy or external beam radiation therapy should be considered for patients with high-risk prostate cancer regardless of comorbidity-adjusted life expectancy. These treatments are almost equivalent in effectiveness but have different adverse effect profiles. Patients who undergo radical prostatectomy are more likely to experience urinary incontinence and trouble obtaining or sustaining an erection compared with patients who opt for radiation therapy. Brachytherapy is an option for patients with low-risk disease and some patients with intermediate-risk disease. Active surveillance is an option for patients with low-risk and very low-risk disease. With active surveillance, patients are closely followed and undergo invasive treatments only if the cancer progresses. Prostate cancer progression may be indicated by an increase in the pathologic grade, a significant rise in serum prostate-specific antigen level, or an abnormality on digital rectal examination.

Sports medicine training room clinic model for the military.

A transition from traditional problem-based clinics to the Sports Medicine and Reconditioning Team (SMART) clinic model was completed by January 2009 at Marine Corps Base Camp Lejeune. The SMART clinic model allows for more patients to be seen and enhances coordinated care between providers. The objective of this research is to show the advantages of implementing a training room team approach for the care of musculoskeletal injuries in active duty members by comparing the number of patients seen, the number of limited duty (LIMDU) periods, the number of physical evaluation boards (PEBs), and the percentage of orthopedic referrals. Electronic medical records for patients seen at sports medicine clinics between January 1, 2007 and December 31, 2010 were reviewed. Naval Hospital Camp Lejeune provided a database of patients placed on LIMDU and PEB from 2007 through 2010. Fifty-eight and twenty-four percent more encounters occurred in 2009 and 2010, respectively, than that in 2007. The percentage of LIMDU referred for PEB in 2010 was reduced to 9% compared to that in 2007. In conclusion, the SMART clinic model allows for more patients to be seen and a reduction in the percentage of patients recommended for PEB from LIMDU.

Results of an alternative autogenous iliac crest bone graft harvest method.

This article reports the results using a previously described technique of obtaining iliac crest bone graft using an acetabular reamer in a consecutive series of patients with complex acute traumatic injuries and nonunions. A retrospective chart review was conducted on a cohort of 34 consecutive patients who underwent complex orthopedic procedures for the definitive management of acute or reconstructive problem fractures and nonunions using autogenous iliac crest bone graft. All of the patients had autogenous bone graft prepared using a low speed, high torque power source and small acetabular reamers. The inner or outer wall of the ileum or the posterior superior iliac spine was reamed providing a large volume of corticocancellous graft. This material was used to pack defects in established nonunions, to augment plate osteosynthesis in segmental fractures, or to facilitate arthrodesis. Follow-up averaged 10 months (range: 6-18 months). Thirty-three out of 34 patients went on to uneventful union. No patients experienced morbidity from the graft harvest site. Specifically, no patients developed a superficial or deep wound hematoma or infection, nor did they experience persistent donor-site pain or paresthesias. Autogenous iliac crest bone graft harvest using the reaming technique provides a large volume of corticocancellous graft that has proven effective in treating complex acute nd reconstructive trauma cases.