Role of adjuvant therapy in resected stage IA subcentimeter (T1a/T1b) pancreatic cancer.

BACKGROUND: The standard of care for patients with resected stage I to stage III pancreatic ductal adenocarcinoma (PDAC) is adjuvant gemcitabine-based chemotherapy. The role of adjuvant treatment in patients with subcentimeter, stage IA PDAC is unknown. The current study evaluated the effect of adjuvant treatment on survival outcomes among patients with American Joint Committee on Cancer/International Union Against Cancer stage IA (T1N0) resected PDAC using the National Cancer Data Base (NCDB). METHODS: A retrospective review of the NCDB was conducted for patients diagnosed with T1 (tumor limited to the pancreas and measuring ≤2 cm in greatest dimension), lymph node-negative (N0), resected PDAC between 2004 and 2013. Patient demographics, histology, adjuvant treatment, and survival trends were examined. Kaplan-Meier analysis and log-rank tests were performed to determine the unadjusted association between overall survival (OS), tumor size, and treatment. RESULTS: A total of 876 patients met the inclusion criteria. The patients had a mean age of 66.2 years (range, 32-90 years); approximately 83.3% were white (730 patients) and 53.1% were female (465 patients). Approximately 45.9% of the patients had moderately differentiated tumor histology (402 patients); 70.0% (613 patients) had tumors measuring 1 to 2 cm (T1c) and 30.0% (263 patients) had tumors measuring <1 cm (T1a/T1b). Approximately 94.2% of patients had negative surgical margins (815 patients) and 46.9% (410 patients) received adjuvant therapy. The median OS was significantly different for patients who received adjuvant therapy compared with patients who did not (70.7 months vs 46.9 months; P = .0001). For patients with tumors measuring <1 cm, survival was not found to be significantly different between patients who received adjuvant treatment compared with those who did not (not reached vs 85.3 months; P = .54). In the multivariable analysis, none of the covariates (treatment group, Charlson-Deyo Score, age, insurance, and facility status) demonstrated significant differences for patients with tumors measuring <1 cm. CONCLUSIONS: The current study is the first to demonstrate no survival benefit for adjuvant therapy in patients with resected subcentimeter PDAC.

Adaptation of Single-Cone Gutta-Percha in Curved Canals Prepared and Obturated with Protaper and Heroshaper Systems by Using Cone Beam Computed Tomography.

OBJECTIVE: The aim of this study is to prepare and obturate the curved canals of the mesiobuccal root of maxillary first molar with four different file systems that is protaper hand files, rotary pro taper (RP) files, heroshaper hand files, and rotary hero shapers files and to evaluate the adaptation of their single-cone Gutta-percha by cone beam computed tomography (CBCT). MATERIALS AND METHODS: Eighty teeth were selected and were divided into two groups (G1A1, G1A2 and G2A1, G2A2 as hand and RP file system, G1A3, G1A4 and G2A3, G2A4 as hand and rotary hero shaper files system) of fourth teeth each. After access opening working length of the mesiobuccal canal was established. The distobuccal and palatal roots of the samples were removed using the diamond disc at the furcation level. "Endoanalyser" software was used to measure Schneider's angle on the preoperative radiograph. This angle was measured by drawing two lines-one parallel to the long axis of the canal, in the coronal third, and the second line from the apical foramen to intersect the point where the first line left the long axis of the canal. The canals of each group were then prepared according to the manufacturer's instructions for protaper hand files, RP files, heroshaper hand files, and rotary hero shapers files systems. Direct digital radiography image of all the samples was obtained. And then, the samples were exposed to CBCT to evaluate their single-cone adaptations. The data were analyzed using SPSS 20, IBM, Armonk, NY, United States of America. RESULTS: The null hypothesis that there will not be any gap area in the adaptation of their single-cone of different file system was rejected. Minimal gap area was seen in rotary hero shapers file system (0.001 mm2) and was maximum in hand protaper (HP) file system (0.015 mm2). CONCLUSION: CBCT is a useful tool in detecting the gap area after obturation in curved canals. The HP single-cone adaptation showed the maximum gap area and rotary heroshaper single-cone adaptation showed the minimum gap area.

Isolated Traumatic Brachialis Muscle Tear: A Case Report and Review of Literature.

Isolated traumatic brachialis muscle tears are uncommonly reported - leading to occasional misdiagnosis and misdirected treatment. The rarity of brachialis muscle tear may promote misdiagnosis or mistreatment of this injury. We report an isolated brachialis muscle tear in a young female, possibly caused by strenuous exercise in the gymnasium. The diagnosis was made clinically and confirmed by magnetic resonance imaging. The patient was subsequently managed adequately with conservative treatment. We herein present a 35-year-old woman who was diagnosed with an acute brachialis muscle tear being diagnosed with a combination of clinical signs and imaging and successfully managed non-operatively. A chronologically arranged review of literature is also presented.