Adjuvant Arthroscopy Does Not Improve the Functional Outcome of Volar Locking Plate for Distal Radius Fractures: A Randomized Clinical Trial.

PURPOSE: To evaluate the outcomes of adding arthroscopy to osteosynthesis of distal radius fractures (DRF) with volar locking plate (VLP), by Patient-Rated Wrist Evaluation (PRWE) 1 year after surgery. METHODS: In total, 186 functionally independent adult patients who met the inclusion criteria (DRF and a clinical decision for surgery with a VLP) were randomized to arthroscopic assistance or not. Primary outcome was PRWE questionnaire results 1 year after surgery. For the main variable, PRWE, we obtained the minimal clinically important difference based on a distribution-based method. Secondary outcomes included Disabilities of the Arm, Shoulder and Hand and 12-Item Short Form Health Survey questionnaires, range of motion, strength, radiographic measures, and presence of joint step-offs by computed tomography. Data were collected preoperatively and at +1 and +4 weeks, +3 and +6 months, and +1 year after surgery. Complications were recorded throughout the study. RESULTS: In total, 180 patients (mean age: 59.0 ± 14.9 years; 76% women) were analyzed by modified intention to treat. A total of 82% of the fractures were intra-articular (AO type C). No significant difference between arthroscopic (AG) and control (CG) groups in median PRWE was found at +1 year (median AG: 5.0, median CG: 7.5, difference in medians 2.5; 95% confidence interval [CI] -2.0, 7.0, P = .328). The proportion of patients who exceeded the minimal clinically important difference of 12.81 points in the AG and CG was 86.4% vs 85.1%, P = .819, respectively. Percentage of associated injuries and step-offs reduction maneuvers was greater with arthroscopy (mean differences: 17.1 95% CI -0.1, 26.1, P < .001) and 17.4 (95% CI 5.0, 29.7, P = .007). The difference in percentage of residual joint step-offs at the postsurgical computed tomography in radioulnar, radioscaphoid, and radiolunate joints was not significant (P = .990, P = .538, and P = .063). Complications were similar between groups (16.9% vs 20.9%, P = .842). CONCLUSIONS: Adjuvant arthroscopy did not significantly improve PRWE score +1 year after surgery for DRF with VLP, although the statistical power of the study is below the initially estimated to detect the expected difference. LEVEL OF EVIDENCE: Level I, randomized controlled trial.

Cáncer uterino en pacientes tratadas con tamoxifeno por un cáncer de mama / Uterine cancer in patients treated with Tamoxifen for breast cancer

Objetivo: Evaluar la incidencia de cáncer uterino en mujeres con cáncer de mama tratadas con tamoxifeno. Material y método: Evaluamos a 463 mujeres que se trataron con 20 mg/día de tamoxifeno por una cáncer de mama dependiente de hormonas, con un seguimiento de 6 años. Resultados: Detectamos 7 cánceres uterino s (1,55% de la población en estudio y 2,52/1.000 mujeres/año): 5 adenocarcinomas de endometrio, 1 tumor mulleriano mixto heterólogo y 1 sarcoma de la estroma endometrial. Sólo el crecimiento rápido de 10 que creíamos un mioma uterino detectado por ecografía nos permitió el diagnóstico del sarcoma de la estroma endometrial; los otros 6 tumores se detectaron por la aparición de hemorragia vaginal, a pesar de realizarse controles anuales al grupo de estudio. Conclusiones: Encontramos una mayor incidencia de cáncer uterino en mujeres con cáncer de mama tratadas con tamoxifeno, pero no representa el doble que en la población general. Hubo adenocarcinomas de endometrio principalmente, aunque encontramos también 2 sarcomas (un sarcoma de la estroma endometrial y 1 tumor mulleriano mixto heterólogo) (AU)

Objective: To evaluate the incidence of uterine cancer in women with breast cancer who had been treated with Tamoxifen. Material and methods: We evaluate 463 women who were treated with 20mg of Tamoxifen daily for a hormone dependent breast cancer, and followed up for 6 years. Results: We detected 7 uterine cancers (1.55% of the study population and 2.52 /1.000 women ayear). Of these, 5 were endometrial carcinomas, a malignant heterologous mixed mesodermal tumour and one endometrial stromal sarcoma. Only the rapid growth of what we believed to be a uterine myoma, detected by ultrasound, allowed us to diagnose the endometrial stromal sarcoma. The other 6 tumours were detected by the appearance of vaginal bleeding, in spite of the annual controls carried out on the study group. Conclusions: We find a higher incidence of uterine cancer in women with Tamoxifen treated breast cancer, but it is not the double of the general population. We found mainly endometrial carcinomas, although there were also 2 sarcomas (an endometrial stromal sarcoma and a malignant heterologous mixed mesodermal tumour) (AU)

Sarcomas de útero después de tratamiento con tamoxifeno por cáncer de mama / Uterine sarcomas after breast cancer treatment with tamoxifen

• Propósito: Descripción de dos casos de sarcomas en mujeres que recibieron tamoxifeno después del tratamientoquirúrgico de cáncer de mama.• Material y métodos: Se describen dos casos de dos mujeres de 74 y 53 años que recibieron tratamientocon 20 mg diarios de tamoxifeno después del tratamiento quirúrgico de un cáncer de mama. Cuatro y dosaños después de iniciar el tratamiento, desarrollaron un tumor Mülleriano mixto maligno heterólogo (EstadioIII) y un sarcoma del estroma endometrial (Estadio I).• Discusión: Los carcinosarcomas y otros sarcomas uterinos son raros, y ocurren en menos del 4% de lostumores uterinos. En la mayoría de los estudios se refieren tasas altas de estos tumores en mujeres postmenopáusicas,con cáncer de mama, tratadas con tamoxifeno, en comparación a las no tratadas, especialmente aquellasexpuestas a largos periodos de tratamiento

• Purpose: Description of two cases of sarcoma in women who received tamoxifen after the surgical treatment of breast cancer. • Material and methods: We report two cases of 74 and 53 years old women that received tamoxifen 20 mg daily after the surgical treatment of breast cancer. Four and two years after initiation of tamoxifen treatment, they developed an heterologous malignant mixed Müllerian tumor (stage III) and an endometrial stromal sarcoma (stage I), respectively. • Discussion: : Carcinosarcomas and other uterine sarcomas are rare, accounting for fewer than 4% of uterine tumors. Most studies reported on a higher rate of these sarcomas among postmenopausal women with breast cancer treated with tamoxifen when compared with non-treated patients, especially those exposed to a long term treatment

Malignant degeneration of presacral teratoma in the Currarino anomaly.

The autosomal dominant Currarino anomaly (CA) comprises a presacral mass, partial sacral agenesis, and anorectal defects. Chronic constipation in childhood related to anorectal defects is the most common presenting symptom and hemisacrum the most frequent malformation. The presacral mass may be an anterior meningomyelocele, teratoma, hamartoma, dermoid cyst, neuroenteric cyst, or a combination of these. Sepsis and meningitis are frequent serious problems related to the anterior meningomyelocele, whilst malignant transformation of presacral teratoma is a rare, severe complication in CA. Here, we report on a three-generation family segregating the CA, presenting with anorectal defects, severe constipation, and sacral involvement in affected relatives. Teratoma was the most frequent component of the presacral mass. In this kindred a 22-year-old man died of a neuroendocrine tumor, probably related to malignant change in a presacral teratoma. A novel mutation in HLXB9 consisting of a 24-bp deletion and insertion of 2-bp into exon 1, was identified in all patients and in also three asymptomatic members of this family. Anterior meningomyelocele is the most frequently reported component of the presacral masses in CA; however, presacral teratomas carry an inherent risk for malignancy that must be considered in the counseling, surgical treatment options, and follow-up of CA patients.

Struma ovarii: tres presentaciones clínicas diferentes en un infrecuente tumor de ovario / Struma ovarii: three presentations of an uncommon ovarian tumor

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Heterotopic gastric mucosa in the rectum.

A case of an ulcer of the rectum in a 20-year-old patient with rectal pain and rectal bleeding is reported. Histological examination of the endoscopic biopsy showed the presence of gastric or fundic mucosa. The patient was treated with Cimetidine and alkaline drugs, with positive results. Ulcer cicatrization was verified at subsequent endoscopic examinations, and biopsies obtained at different levels of the colon revealed a normal histological picture.