Operative versus non-operative management of pediatric medial epicondyle fractures: a systematic review

There is ongoing debate about the management of medial epicondyle fractures in the pediatric population. This systematic review evaluated non-operative versus operative treatment of medial epicondyle fractures in pediatric and adolescent patients over the last six decades. A systematic review of the available literature was performed. Frequency-weighted mean union times were used to compare union rates for closed versus open treatments. Moreover, functional outcomes and range-of-motion variables were correlated with varying treatment modalities. Any complications, including ulnar nerve symptoms, pain, instability, infection, and residual deformity, were cataloged. Fourteen studies, encompassing 498 patients, met the inclusion/exclusion criteria. There were 261 males and 132 female patients; the frequency-weighted average age was 11.93 years. The follow-up range was 6–216 months. Under the cumulative random effects model, the odds of union with operative fixation was 9.33 times the odds of union with non-operative treatment (P < 0.0001). There was no significant difference between operative and non-operative treatments in terms of pain at final follow-up (P = 0.73) or ulnar nerve symptoms (P = 0.412). Operative treatment affords a significantly higher union rate over the non-operative management of medial epicondyle fractures. There was no difference in pain at final follow-up between operative and non-operative treatments. As surgical indications evolve, and the functional demands of pediatric patients increase, surgical fixation should be strongly considered to achieve stable fixation and bony union

Tumor markers in breast cancer - European Group on Tumor Markers recommendations

Recommendations are presented for the routine clinical use of serum and tissue-based markers in the diagnosis and management of patients with breast cancer. Their low sensitivity and specificity preclude the use of serum markers such as the MUC-1 mucin glycoproteins ( CA 15.3, BR 27.29) and carcinoembryonic antigen in the diagnosis of early breast cancer. However, serial measurement of these markers can result in the early detection of recurrent disease as well as indicate the efficacy of therapy. Of the tissue-based markers, measurement of estrogen and progesterone receptors is mandatory in the selection of patients for treatment with hormone therapy, while HER-2 is essential in selecting patients with advanced breast cancer for treatment with Herceptin ( trastuzumab). Urokinase plasminogen activator and plasminogen activator inhibitor 1 are recently validated prognostic markers for lymph node-negative breast cancer patients and thus may be of value in selecting node-negative patients that do not require adjuvant chemotherapy. Copyright (C) 2005 S. Karger AG, Basel

Group Tenure in Administration of Public Lands

Excerpts from the report Introduction: Ownership, management, and use of public grazing lands are current problems. Essentially they are a matter of landlord-tenant relations with Government as the landlord. The resolving of existing problems in the field deals with individual interest and privileges, public interests, and multiple-use considerations. Through resolving conflicts of interests social progress is made. Group-tenure devices are one means to this end. The term "group tenure" is a convenient designation for various forms of cooperative action by which stockmen obtain control of land for operating purposes. The most notable example of group tenure is the cooperative grazing association or district. In the northern Great Plains, State laws make special provision for these organizations. The district or association acquires control of land through purchase, lease, or other means; thereafter it distributes grazing privileges among its members. The study upon which this report is based is restricted to the northern Great Plains, and particularly to the short-grass range country between the Missouri River and the Rocky Mountains, in the five States of Montana, Wyoming, North Dakota, South Dakota, and Nebraska. It is primarily concerned with the management of public land that is devoted to private use. Public-use lands, such as parks, monuments, national forests, and Indian reservations, are administered for a definite public purpose. Publicly owned land on which group tenure functions, however, derives its chief importance from the private uses to which it is put. All public lands have public values and multiple-use considerations, and no sharp distinction can be maintained between public-use and private-use categories. The public domain, the national forest grazing land, and the submarginal land acquired by Federal purchase present special problems of management. In this report consideration is first given to cooperative grazing associations and districts that function cooperatively with the land-management program of the Soil Conservation Service. Then follows a discussion of advisory boards in Taylor grazing districts and national forests. Finally, examples of other group-tenure devices are presented