Desmoid tumor: prognostic factors and outcome after surgery, radiation therapy, or combined surgery and radiation therapy.

PURPOSE: To evaluate the therapeutic value of resection and the potential benefits of and indications for adjuvant and definitive radiation therapy for desmoid tumors. MATERIALS AND METHODS: We performed a retrospective review of 189 consecutive cases of desmoid tumor treated with surgical resection, resection and radiation therapy, or radiation therapy alone. Treatment was surgery alone in 122 cases, surgery and radiation therapy in 46, and radiation therapy alone in 21. Median follow-up was 9.4 years. RESULTS: Overall, 5- and 10-year actuarial relapse rates were 30% and 33%, respectively. Uncorrected survival rates were 96%, 92%, and 87% at 5, 10, and 15 years, respectively. For the patients treated with surgery, the actuarial relapse rates were 34% and 38% at 5 and 10 years, respectively. Among 78 patients with negative margins, the 10-year recurrence rate was 27%, whereas 40 margin-positive patients had a 10-year relapse rate of 54% (P = .003). Tumors located in an extremity also had a poorer prognosis than did those in the trunk. For patients treated with radiation therapy for gross disease, the 10-year actuarial relapse rate was 24%. For patients treated with combined resection and radiation therapy, the 10-year actuarial relapse rate was 25%. The addition of radiation therapy offset the adverse impact of positive margins seen in the surgical group. CONCLUSION: Wide local excision with negative pathologic margins is the treatment of choice for most desmoid tumors. Function-sparing resection is appropriate because adjuvant radiation therapy can offset the adverse impact of positive margins. Unresectable disease should be treated with definitive radiation therapy.

Universal newborn hearing screening: feasibility in a community hospital.

BACKGROUND: The National Institutes of Health and the Joint Committee on Infant Hearing have recommended universal newborn hearing screening. The feasibility of universal newborn hearing screening in a community hospital, however, has not been demonstrated. We initiated a universal newborn hearing screening program using transient evoked otoacoustic emissions (TEOAE) at a community hospital to assess the feasibility of universal hearing screening in this setting. METHODS: A screening team composed of a family practice physician, family medicine resident, audiologist, and four technicians was developed. The study compared testing time between the technicians and the audiologist and assessed whether the technicians were able to perform hearing testing accurately and reliably. RESULTS: A total of 627 infants were screened. Of those, 11 (1.8%) failed TEOAE screening and were referred to a tertiary care center for further evaluation. Six of the 11 referrals were found to have a hearing impairment. Trained technicians were found to be capable of performing the screening accurately and reliably. CONCLUSIONS: Universal newborn hearing screening using transient evoked otoacoustic emissions is feasible in a community hospital.

Critical evaluation of the short "Z" bunionectomy.

The authors reviewed 120 "short Z" bunionectomy operations and, on the basis of available clinical and radiographic data, selected 50 osteotomies in 36 patients for review. Follow-up averaged 21 months and ranged from 13 to 26 months. Excellent and good results were found in 92%, while fair and poor results were obtained in 8% of patients. Although seven fractures occurred in the 50 osteotomy sites, most of these resolved without sequellae after appropriate treatment.