Abstract:
INTRODUCTION:Over the past 2 decades, there has been a significant increase in the number of incidentally found small renal cortical neoplasms (RCNs). As more RCNs are being discovered in the elderly and infirmed patient populations, there has been a growing interest in the role of active surveillance (AS). Active surveillance is recommended for high surgical-risk patients and those with a reduced life expectancy. It is also an option for patients wishing to avoid surgery. We review the current literature on AS and highlight the natural history of disease, the important factors to evaluate during AS, and the contemporary role of biopsy. METHODS AND MATERIALS:The MEDLINE database was searched using PubMed. Search terms included active surveillance, renal mass, natural history, and renal mass histology. From 1966 to present, 17 AS series were identified, all of which have been included in this summary. A summary was performed by compiling all available data and performing a weighted mean where applicable. RESULTS:Initial tumor size does not correlate with growth rate or malignancy. The mean growth rate in large published series is low (0.28-0.34 cm/year). Tumors with high growth rates usually represent malignant lesions and typically undergo delayed intervention. Progression to metatatic disease is a low-probability event for tumors on AS (1.4%); however, this is still a risk that patients must be willing to accept. Larger tumors (cT1b and cT2) also demonstrate relatively low growth (0.57 cm/year); however, these tumors should be monitored carefully. Tumors followed for > 5 years demonstrate a low growth rate (0.15 cm/year), will not likely require intervention, and have a low chance of progression to metastatic disease. CONCLUSION:For highly selected patients with RCN, AS is a reasonable treatment option. Age, surgical risk, comorbidities, and patient opinion must all factor into the final decision when considering a patient for AS.
journal_name
Postgrad Medjournal_title
Postgraduate medicineauthors
Graversen JA,Mues AC,Pérez-Lanzac de Lorca A,Landman Jdoi
10.3810/pgm.2011.01.2251subject
Has Abstractpub_date
2011-01-01 00:00:00pages
105-13issue
1eissn
0032-5481issn
1941-9260journal_volume
123pub_type
杂志文章,评审abstract:OBJECTIVE:There is a need to identify safe and effective opioid-sparing multimodal alternative treatment strategies and approaches, including topical analgesics, for opioid-experienced chronic pain patients to mitigate the risk of addiction, misuse, and abuse of opioids. METHODS:This subset analysis from a prospective...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.2018.1414551
更新日期:2018-01-01 00:00:00
abstract::GRATEFUL MED is a computer program for searching the medical literature, designed with the novice in mind. It contains an extensive list of medical subject headings, so the user does not have to page through an index of key words before starting the search. Because of its efficiency and ease of operation, the program ...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1988.11700124
更新日期:1988-01-01 00:00:00
abstract::Gastroesophageal reflux is not synonymous with sliding hiatus hernia. It should be approached as a condition dependent on the intrinsic strength of the lower esophageal sphincter rather than on the presence of a hiatus hernia. The patient's account of symptoms is probably the most important means of diagnosis, but in ...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1975.11713946
更新日期:1975-01-01 00:00:00
abstract::A high index of suspicion and careful application of diagnostic methods are essential for accurate diagnosis of parasitic bowel diseases. The varied clinical spectrum of giardiasis, amebiasis, and strongyloidiasis emphasizes the need to consider these pathogens when patients present with gastrointestinal complaints. G...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.1080/00325481.1982.11716069
更新日期:1982-05-01 00:00:00
abstract:BACKGROUND:Symptoms of irritable bowel syndrome (IBS) can have a profound impact on emotional health and quality of life, and current treatments are sometimes unsatisfactory for patients facing this lifelong disease. Probiotics, which can normalize gastrointestinal microflora, may alleviate symptoms of IBS. OBJECTIVE:...
journal_title:Postgraduate medicine
pub_type: 杂志文章,随机对照试验
doi:10.3810/pgm.2009.03.1984
更新日期:2009-03-01 00:00:00
abstract::Motor fluctuations and dyskinesia often develop in patients with Parkinson's disease after 3 to 5 years of levodopa therapy. Dosage adjustments, addition of a second medication to the drug regimen, and dietary modifications may help maximize response to symptomatic therapy. Given the dramatic variability of symptoms a...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:
更新日期:1996-01-01 00:00:00
abstract::The use of topical tretinoin (Retin-A) for comedonal lesions, benzoyl peroxide for inflamed papules and pustules, and topical or oral antibiotics for more severe or widespread disease gives excellent results for the majority of patients with acne. At present, oral isotretinoin (13-cis-retinoic acid) (Accutane) should ...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1985.11698996
更新日期:1985-05-01 00:00:00
abstract::Acute compartment syndrome is a surgical emergency. A high index of suspicion is needed in cases of severe contusion, especially if patient complaints seem to outweigh physical findings. Acute surgical fasciotomy is an effective treatment and should be carried out expeditiously if compartment pressures are elevated ov...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.3810/pgm.1999.03.599
更新日期:1999-03-01 00:00:00
abstract::More than one half of middle-aged Americans have undesirably high serum lipid levels. Diets high in fiber and carbohydrate and low in fat reduce serum lipid levels two to four times more than the widely recognized American Heart Association diet. High intake of soluble fiber is especially effective for lowering serum ...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1987.11699970
更新日期:1987-09-15 00:00:00
abstract::A study was undertaken to determine whether the platelet estimate included in the routine CBC is being utilized as a guide to ordering quantitative platelet counts. Requisition slips and results were reviewed for a one-month period. The data showed that platelet estimates were not being used properly. In fact, much of...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1980.11715507
更新日期:1980-08-01 00:00:00
abstract::Male factors play a role in up to half of subfertile couples, contrary to the myth that male factors rarely play a role. In this article, Dr Sandlow counters this and other myths about male infertility and suggests that primary care physicians can increase a couple's chance of conceiving by evaluating for male as well...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.3810/pgm.2000.02.902
更新日期:2000-02-01 00:00:00
abstract::Abdominal paracentesis is a useful and safe technique in the evaluation of ascites. The withdrawn ascitic fluid should be routinely analyzed for appearance, blood cell count, and amylase and total protein concentrations; examined cytologically; and cultured. Results should either substantiate the clinical diagnosis or...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1978.11714844
更新日期:1978-05-01 00:00:00
abstract::In acutely injured patients, recognition of profound shock may be difficult initially. Ensuring adequate oxygenation, restoring intravascular volume, and controlling ongoing blood loss are key principles of treatment in these patients. Additionally, an appreciation for and recognition of the possible adverse consequen...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:
更新日期:1994-03-01 00:00:00
abstract::Effective management of blood-loss anemia depends on an understanding of the physiologic response to volume loss, the pattern of marrow response to acute depletion of red cell mass, and the controlling influence of iron supply. Each of these elements must be evaluated and incorporated into the plan of management. ...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1978.11714948
更新日期:1978-10-01 00:00:00
abstract::Ingested ethylene glycol is readily absorbed and metabolized into toxic metabolites that can cause CNS depression, cardiopulmonary failure, and renal failure. Thorough history taking, physical examination, and laboratory testing are essential for diagnosis. Careful differential diagnosis is important because symptoms ...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.3810/pgm.1999.10.1.734
更新日期:1999-10-01 00:00:00
abstract:OBJECTIVES:We aimed to determine the prevalence of chronic diseases and unhealthy lifestyle behaviors of Turkish doctors as compared with the general population and the frequency of compliance with preventive clinical practices among doctors. METHODS:This was an observational, prospective cohort study that enrolled gr...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.2017.1272399
更新日期:2017-04-01 00:00:00
abstract::The solitary pulmonary nodule observed on chest films should be pursued aggressively, usually by means of tissue study, since the clinical and roentgenographic characteristics of the nodule are often misleading and do not permit a reliable diagnosis. A decision to follow a patient without definitive tissue study shoul...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1983.11697794
更新日期:1983-03-01 00:00:00
abstract:OBJECTIVES:The diagnosis of malignant pleural effusion (MPE) remains a clinical challenge. As a negative regulator of T-cell activation, cytotoxic T lymphocyte-associated antigen-4 (CTLA-4) has been associated with many malignant diseases. However, there is limited data about the relationship between CTLA-4 and MPE. Th...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.2017.1331112
更新日期:2017-08-01 00:00:00
abstract::Recurrent herpes simplex labialis (HSL), also known as orofacial herpes or cold sores, is a common clinical presentation of herpes simplex virus (HSV) infection. It may manifest as painful, distressing, and cosmetically displeasing vesicles on the lips, nose, and nasal septum. Although oral or topical treatment with a...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.3810/pgm.2010.09.2216
更新日期:2010-09-01 00:00:00
abstract::Legg-Calvé-Perthes disease affects children, mostly boys, in the age range of 3 to 12 years. Severity and duration are quite variable. Catterall's classification of disease according to degree of femoral head involvement is of real prognostic value. Other factors of prognostic importance are loss of motion, metaphysea...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1976.11714449
更新日期:1976-10-01 00:00:00
abstract::The maximal exercise stress test continues to be an important diagnostic and prognostic tool in the primary care office setting. But are you getting the most accurate information possible? Drs Driggers and Marchant discuss several factors that are crucial to the test's validity--and thus to its usefulness in your clin...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.3810/pgm.1999.05.1.737
更新日期:1999-05-01 00:00:00
abstract::Patients with dyslipidemia receive a cardiovascular benefit from lowering low-density lipoprotein cholesterol (LDL-C). Atorvastatin is currently one of the most effective approved medications for lowering LDL-C, and has been shown to significantly reduce cardiovascular risk in many patient groups. However, even with s...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.3810/pgm.2012.01.2513
更新日期:2012-01-01 00:00:00
abstract::When considering conventional therapy with insulin for patients who have type 2 diabetes mellitus, healthcare providers must weigh the advantages and disadvantages of 3 primary approaches to treatment. Understanding the pros and cons of the various options will help physicians more readily identify the treatment appro...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.3810/pgm.11.2002.suppl21.112
更新日期:2002-11-01 00:00:00
abstract::Elective resection and prosthetic graft replacement of asymptomatic abdominal aortic aneurysms 5 cm or more in diameter are dependable measures to counter the formidable threat of rupture. Operative mortality should be less than 5% among patients without severe associated disease. Those patients who have large aneurys...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1977.11712114
更新日期:1977-02-01 00:00:00
abstract::Bedside pulmonary artery catheterization has proven to be an important addition to the clinical assessment of critically ill patients. Properly used, the procedure may provide hemodynamic information that is not apparent from physical examination or radiography. It may be safely accomplished through various venous rou...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.1080/00325481.1991.11700825
更新日期:1991-02-01 00:00:00
abstract::Hair loss is a common problem likely to be encountered by a clinical practitioner. The most frequent causes of hair loss in pediatric patients include tinea capitis, alopecia areata, traction alopecia, and trichotillomania. In the adult population, causes to be considered are alopecia areata and hair loss associated w...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1986.11699358
更新日期:1986-04-01 00:00:00
abstract:OBJECTIVE:To identify attitudes and practices of endocrinologists (ENDOs), family practitioners (FPs), internists (IMs), primary care nurse practitioners (NPs), physician assistants (PAs), certified diabetes educators (CDEs), retail pharmacists (R-PHs), and hospital pharmacists (H-PHs) with respect to type 2 diabetes m...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.3810/pgm.2014.05.2764
更新日期:2014-05-01 00:00:00
abstract::The term "enteropathic arthritis" describes joint manifestations that occur in conjunction with gastrointestinal disease. Underlying causes include inflammatory bowel disease, reactive arthritis, iatrogenic disease. Whipple's disease, and other gastrointestinal diseases. A possible association between Reiter's syndrom...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.1080/00325481.1989.11704368
更新日期:1989-08-01 00:00:00
abstract::Some patients with severe and chronic pain fail to obtain adequate pain relief with standard pharmacologic treatment agents, including low to moderate dosages of opioids. Understandably, physicians might not believe patients who claim that a standard opioid dosage is an ineffective treatment. These patients may be sev...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.2014.996110
更新日期:2015-01-01 00:00:00
abstract::Pain is among the most common reasons patients seek medical attention, and the care of patients with pain is a significant problem in the United States. Acute pain (mild-to-moderate intensity) represents one of the most frequent complaints encountered by primary care physicians (PCPs) and accounts for nearly half of p...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.3810/pgm.2011.03.2270
更新日期:2011-03-01 00:00:00