WETENSCHAPPELIJK jaarverslag 2012 CHIRURGIE CHIRURGIE Pubmed artikel Treatment outcome in breast cancer patients with ipsilateral supraclaviculair lymph node metastasis at time of diagnosis: A review of the literature. Grotenhuis BA, Klem TMAL, Vrijland WW. Eur J Surg Oncol. 2012 Dec 8. doi:pii: S0748-7983(12)01304-2. 10.1016. PMID: 23232205. In the revised 6th edition of the AJCC-TNM staging system for breast cancer, metastasis in ipsilateral supraclavicular lymph node(s) is considered as a locoregional disease and classified as N3c rather than M1 distant disease. The aim of this review was to search the recent literature in order to investigate whether the reported treatment outcome of patients with ipsilateral supraclavicular metastases in breast cancer patients justifies this revision. A review of the recent English-language literature (January 2001-June 2012) concerning breast cancer with supraclavicular involvement was performed. A total number of six studies were included in the current review. All reported comparable data with regard to treatment outcome after multimodality treatment, despite considerable heterogeneity in study populations. Patients with ipsilateral supraclavicular lymph node involvement showed outcomes more similar to locally advanced breast cancer patients rather than patients with distant tumor spread. It seems that the 2002 revision of the AJCC-TNM staging system for breast cancer has appropriately reclassified patients with supraclavicular disease to a new category (N3c). Re-diplacement of stable both-bone forearm fractures in children: A randomised controlled multicentre trial. Colaris JW, Allema JH, Biter LU, de Vries MR, van der Ven CP, Bloem RM, Kerver AJH, Reijman M, Verhaar JAN. Injury.2012 Dec 3.doi:pii:S0020-1383(12)00488-3.10.1016/j.injury.2012.11.001 PMID: 23217981. INTRODUCTION: Displaced metaphyseal both-bone fractures of the distal forearm are generally reduced and stabilised by an above-elbow cast (AEC) with or without additional pinning. The purpose of this study was to find out if re-displacement of a reduced stable metaphyseal both-bone fracture of the distal forearm in a child could be prevented by stabilisation with Kirschner wires. METHODS: Consecutive children aged <16 years with a displaced metaphyseal both-bone fracture of the distal forearm (n=128) that was stable after reduction were randomised to AEC with or without percutaneous fixation with Kirschner wires. The primary outcome was re-displacement of the fracture. RESULTS: A total of 67 children were allocated to fracture reduction and AEC and 61 to reduction of the fracture, fixation with Kirschner wires and AEC. The follow-up rate was 96% with a mean follow-up of 7.1 months. Fractures treated with additional pinning showed less re-displacement (8% vs. 45%), less limitation of pronation and supination (mean limitation 6.9 (±9.4)° vs. 14.3 (±13.6)°) but more complications (14 vs. 1). CONCLUSIONS: Pinning of apparent stable both-bone fractures of the distal forearm in children might reduce fracture re-displacement. The frequently seen complications of pinning might be reduced by a proper surgical technique. 13 Pagina 12
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