There is concern about the long-term carcinogenic effects of psoralen and ultraviolet A radiation (PUVA) for treatment of skin disorders. Many authors have found an increased risk for cutaneous squamous cell carcinoma (SCC). Except in anecdotal reports, malignant melanoma had not been observed in patients treated with PUVA until recently. In the U.S.A., a 16-centre prospective study of 1380 patients showed for the first time that there might also be an increased risk for malignant melanoma in patients treated with high cumulative dosages of PUVA. We have therefore followed up the Swedish PUVA cohort until 1994. This cohort had previously been followed up until 1985. Information from 4799 Swedish patients (2343 men, 2456 women) who had received PUVA between 1974 and 1985 was linked to the compulsory Swedish Cancer Registry in order to identify individuals with cancer. The average follow-up period was 15.9 years for men and 16.2 for women. We did not find any increased risk for malignant melanoma in our total cohort of 4799 patients treated with PUVA or in a subcohort comprising 1867 patients followed for 15-21 years. For cutaneous SCC there was an increase in the risk: the relative risk was 5.6 (95% confidence interval, CI 4. 4-7.1) for men and 3.6 (95% CI 2.1-5.8) for women. Significant (P < 0.05) increases were also found in the incidence of respiratory cancer in men and women and of kidney cancer in women. In conclusion, we did not find any increased risk for malignant melanoma in our patients treated with high doses of PUVA and followed up for a long time. We confirm previous reports of an increase in the incidence of cutaneous SCC in patients treated with PUVA, and recommend that patients should be carefully selected for PUVA and rigorously followed up.
There is not a clear clinical recommendation for the determination of prosthetic candidacy. Guidelines do not delineate which member(s) of the multidisciplinary team are responsible for prosthetic candidacy decisions and which factors will best predict a positive outcome. Also not clearly addressed is a patient-centered decision-making role. In a previous systematic review (SR), Sansam et al. reported on the prediction of walking ability following lower limb amputation using literature up to 2007. The search strategy was designed from the previous Sansam SR as an update of previously valuable predictive factors of prosthetic candidacy. An electronic literature search was executed from August 8, 2007, to December 31, 2015, using MEDLINE (Pubmed), Embase, The Cumulative Index to Nursing and Allied Health Literature (CINAHL) (Ovid), and Cochrane. A total of 319 studies were identified through the electronic search. Of these, 298 were eliminated, leaving a total of 21 for full evaluation. Conclusions from this updated study are drawn from a total recruited sample (n) of 15,207 subjects. A total of 12,410 subjects completed the respective studies (18% attrition). This updated study increases the size of the original Sansam et al. report by including 137% more subjects for a total of 21,490 between the two articles Etiology, physical fitness, pre-amputation living status, amputation level, age, physical fitness, and comorbidities are included as moderate to strongly supported predictive factors of prosthetic candidacy. These factors are supported in an earlier literature review and should be strongly considered in a complete history and physical examination by a multidisciplinary team. Predictive factors should be part of the patient’s healthcare record.
OBJECTIVE -The purpose of this study was to compare the incidence of vascular lowerlimb amputation (LLA) in the diabetic and nondiabetic general population. RESEARCH DESIGN AND METHODS-A population-based cohort study was conducted in a representative Swedish region. All vascular LLAs (at or proximal to the transmetatarsal level) performed from 1997 through 2006 were consecutively registered and classified into initial unilateral amputation, contralateral amputation, or reamputation. The incidence rates were estimated in the diabetic and nondiabetic general population aged Ն45 years.RESULTS -During the 10-year period, LLA was performed on 62 women and 71 men with diabetes and on 79 women and 78 men without diabetes. The incidence of initial unilateral amputation per 100,000 person-years was 192 (95% CI 145-241) for diabetic women, 197 (152-244) for diabetic men, 22 (17-26) for nondiabetic women, and 24 (19 -29) for nondiabetic men. The incidence increased from the age of 75 years. Of all amputations, 74% were transtibial. The incidences of contralateral amputation and of reamputation per 100 amputeeyears in diabetic women amputees were 15 (7-27) and 16 (8 -28), respectively; in diabetic men amputees 18 (10 -29) and 21 (12-32); in nondiabetic women amputees 14 (7-24) and 18 (10 -28); and in nondiabetic men amputees 13 (6 -22) and 24 (15-35).CONCLUSIONS -In the general population aged Ն45 years, the incidence of vascular LLA at or proximal to the transmetatarsal level is eight times higher in diabetic than in nondiabetic individuals. One in four amputees may require contralateral amputation and/or reamputation. Diabetes Care 32:275-280, 2009
Background: The Locomotor Capabilities Index (LCI) is a validated measure of lower-limb amputees' ability to perform activities with prosthesis. We have developed the LCI Swedish version and evaluated its validity and reliability.
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