Danish guidelines for management of non-APC-associated hereditary polyposis syndromes

Hereditary Polyposis Syndromes are a group of rare, inherited syndromes characterized by the presence of histopathologically specific or numerous intestinal polyps and an increased risk of cancer. Some polyposis syndromes have been known for decades, but the development in genetic technologies has allowed the identification of new syndromes.. The diagnosis entails surveillance from an early age, but universal guideline on how to manage and surveille these new syndromes are lacking. This paper represents a condensed version of the recent guideline (2020) from a working group appointed by the Danish Society of Medical Genetics and the Danish Society of Surgery on recommendations for the surveillance of patients with hereditary polyposis syndromes, including rare polyposis syndromes.

Medical cannabis and cannabinoids for chronic pain: Summary of a Rapid Recommendation

LAY SUMMARY Medical cannabis is increasingly used by Canadian Veterans to manage chronic pain; however, the benefits and harms are uncertain. This commentary summarizes a recent guideline that found small to very small benefits of medical cannabis for pain relief, physical functioning and sleep quality, and evidence for a small to very small increase in several transient harms. The close balance between benefits and harms supports shared decision-making with Veterans living with chronic pain to ensure the decision whether to pursue a trial of medical cannabis is consistent with their values and preferences.

Subclinical hypothyroidism: to treat or not to treat?

There is controversy on the treatment of subclinical hypothyroidism (SCH). While a number of guidelines from professional societies recommend treatment of SCH based on TSH levels, age, and presence of comorbidities, a recent guideline issued a recommendation against thyroid hormone treatment in adults with SCH. In this debate article, we explore this controversy by presenting two points of view about SCH and its treatment. Treatment of patients who are pregnant or trying to become pregnant will not be discussed.

Early Inguinal Lymphadenectomy is Necessary in the Treatment of Penile Cancer T1G2.

Backgroud：At present, there is still no consensus on the early inguinal lymph node dissection (eILND) of T1G2 or T1aG2. In this study, we investigated the peculiarities of penile cancer T1G2 and T1aG2 to assess the necessity of eILND for this subgroup.Methods: A total of 144 patients had been treated for penile squamous cell carcinoma with primary tumor excision and early bilateral inguinal lymphadenectomy in my institution from January 2002 to March 2017, thus, 53 patients definitely diagnosed as T1G1 or T1G2 were included in this study. According to the recent guideline, T1aG1 and T1aG2 were even researched. The chi-square test and the Fisher exact test were used to compare categorical variables. Survival were retrospectively analyzed by the Kaplan-Meier method and assessed by log-rank tests. RESULTS: Among 53 patients, the proportion of positive lymph node of T1G2 was 68.8%, which was significantly higher than T1G1 (18.9%, P=0.001). Then we analyzed the patients of clinically node-negative patients (cN0), micro metastatic disease occurred in T1G2 was 50% but in T1G1 was 14.8%, which also reached statistical significance (p=0.043). According to the recent guideline, T1aG1 and T1aG2 had been further analyzed. As the risk for lymphatic spread, T1aG2 was 44.4% while only 4.5% of T1aG1 was found Inguinal lymph node metastasis, significant differences of which were also reached (P=0.017). In an addition, Survival Curve had been demonstrated but no statistical differences found between T1G1 and T1G2, as the same result also existed in the cohort of T1aG1 and T1aG2, all of which revealed a strong proof of therapeutic benefits of eILND.CONCLUSIONS: The option of a surveillance strategy is not applicable to patients of T1G2 or T1aG2, eILND should be highly recommended for this subgroup to achieve the most therapeutic benefits.