Albert Einstein College of Medicine, Yeshiva University: Open Journal Systems
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The Risk of Fracture in Patients Undergoing Androgen Deprivation May Be Overstated: Analysis of an Unselected Cohort of Patients
Get PDFObjective: In this study we examined the prevalence of fracture among men undergoing ADT for prostate cancer to determine if the fracture risk was increased among this population.Background: Androgen deprivation therapy (ADT) is a therapeutic approach for men with various prostate cancer disease states. Treatment-related side effects of ADT include rapid bone loss. Previous studies have found that the bone loss related to ADT leads to the development of fractures. Methods: This is a retrospective cohort study of patients treated with ADT in a radiation oncology and medical oncology practice at an urban academic medical center from 2005 to 2010. Patients with evidence of bone metastases responsive to ADT were included. Those with androgen-independent prostate cancer were excluded. Results: One hundred thirty patients met the inclusion criteria and among them only three fractures occurred during 373 person-years of follow-up. The fracture-free survival (FFS) rate at three years for all was 97.7%. Excluding fractures occurring within six months of ADT initiation, the FFS rate was 100% at three years. No significant difference was demonstrated in those screened with a pretreatment dual-emission X-ray absorptiometry (DEXA) scan; there was no relationship between the number of ADT cycles, recovery of testosterone to normal, or total time on ADT. Older patients, surprisingly, had a lower risk (p = 0.054). Patients with normal bone mineral density (BMD) had an FFS rate of 93.8% at three years, osteopenic patients had 94.7%, and patients with osteoporosis and hormone-responsive metastases had 100%. Conclusion: The prevalence of fracture among this group is significantly less than what has previously been reported for men receiving ADT, potentially suggesting an overstatement of risk in the literature to date. Further prospective study with a larger sample size is needed
From Sacrilege to Privilege: The Tale of Body Procurement for Anatomical Dissection in the United States
Get PDFAnatomical dissection remains an integral part of most medical schools’ curricula, and in order to meet their educationalneeds, schools turn to a mixture of donated and unclaimed bodies. However, the procurement of bodies foranatomical dissection has not always been a simple task. The history of the cadaver supply in the United States, asin many other countries, is a story of crime, punishment, and legal dilemmas. The method by which medical schoolsobtain cadavers has affected not only anatomists and medical students, but all members of society. Methods of procurementthrough the centuries have been able to change only along with concurrent changes in societal perceptionsof death and dissection. An appreciation of this history and these societal changes may benefit students in theirstruggles to come to terms with how their cadavers were obtained and how society has granted them the privilegeto dissect a fellow human’s body
The Role of the Medical Profession in Swaying Public Policy: Exploring Physician Responsibility and Advocacy
Get PDFA Single-Hit Model of Embryonal Tumorigenesis
Get PDFA singl hit model for dominantly heritable tumor syn dromes Is presented. This model suggests that: 1) During emb ogenesis replication tential may nor mally restrict by Interaction of ll lin s ific maturation factors with a finite num r of su a r ptors of each ll of the appropriately match line. 2) In dominantly heritable multlfocal tumor prone con ditions, emb onic "rest" lls may result from chance Insu iciencies of functional cell su ace r ptors at the time of ak con ntration of the appropriate em b onic maturation factor. 3) Congenital unlf al non heritable emb onic "rests" could arise as a con quen of rare chance failure of a normal, yet fallible, system. 4) Emb onal dominantly h eritable tumors are of monoclonal derivation.
Left-Sided Gallbladder: Uncommon Presentation and Laparoscopic Approach
Get PDFSinistroposition, or left-sided placement of the gallbladder, is a rare congenital anomaly with a prevalence of about 0.3%. These gallbladders, through multiple proposed developmental aberrations, are situated beneath segment III or IV (or both, as in this case) of the liver, and can lead to diagnostic difficulty. We present a case of atypical presentation of acute cholecystitis from a left-sided gallbladder and the modified laparoscopic technique used for its safe removal.