No abstract

Obesity, deregulation of adipocytokines, and insulin resistance are interrelated and have been implicated in carcinogenesis. In search of novel risk factors for melanoma, we explored the association of this disease with insulin resistance in a small size, case-control study. Homeostasis Model Assessment for Insulin Resistance (HOMA-IR), serum leptin, and adiponectin levels were determined in 55 patients with incident melanoma and 165 age-matched and sex-matched controls. Odds ratios were derived after adjusting for skin type, medical history, sociodemographic, lifestyle, and anthropometric parameters. Among the controls, HOMA-IR correlated positively with BMI (r=0.34; P=0.0001), waist-to-hip ratio (r=0.20; P=0.01) and negatively with serum adiponectin (r=-0.21; P=0.006), whereas the correlation with leptin was essentially null (r=0.09; P=0.27). The mean HOMA-IR was approximately 1.5 times higher in cases than in controls (P=0.05). The established positive association of melanoma with skin type was evident in multiple logistic regression models and so was the association with increasing HOMA-IR quintile (odds ratio for the fifth quintile=3.68; 95% confidence intervals 1.15-11.79, P=0.02). The latter persisted after adjustment for anthropometric variables and adiponectin but was attenuated when leptin was introduced in the model. These findings point to insulin resistance as a potentially independent risk factor for melanoma and need to be confirmed by future larger studies, ideally allowing the control of the directionality of the association.

We explored the potential association of depression history and personality, evaluated through a robust questionnaire tool, namely the Eysenck Personality Scale, with disease risk and progression among Greek patients. A total of 106 melanoma patients and their 1 : 1 sex-matched controls were interviewed on the basis of a questionnaire comprising phenotypic, sociodemographic, lifestyle and medical history variables, as well as information on history of lifetime major depression. The Eysenck Personality Questionnaire, measuring the four personality dimensions (extraversion, neuroticism, psychoticism, lie), was thereafter completed. Adjusted odds ratios (ORs) for melanoma risk were derived through multiple logistic regression analyses, whereas potential predictors of survival were explored using Cox proportional hazards models. Sun sensitivity score [OR: 1.55, 95% confidence interval (CI): 1.16-2.06] and major depression history (OR: 5.72, 95% CI: 1.38-23.73) were significantly associated with melanoma, whereas inverse associations of extraversion (OR: 0.90, 95% CI: 0.83-0.97) and psychoticism score (OR: 0.88, 95% CI: 0.78-1.00) were noted. These associations were more pronounced and remained solely among female patients; notably, decreased extraversion (OR: 0.86, 95% CI: 0.76-0.98) and psychoticism score (OR: 0.63, 95% CI: 0.43-0.91), as well as increased depression history (OR: 10.69, 95% CI: 1.43-80.03) were evident. Cox-derived hazard ratios showed nonsignificant associations of depression history and personality with disease outcome. Our data support the hypotheses that depression history and personality are associated with melanoma risk. No effect on survival after cancer diagnosis was observed. If confirmed in future studies, these associations may contribute toward better understanding the etiology of melanoma, enhancing health-related quality of life.

No abstract

Burst fractures of the lower cervical spine (C3-7) are often associated with severe neurological injury. During the last 5 years (1987-1992) we operated on 11 patients who had sustained burst fractures together with neurological deficit. The operations were performed through an anterior approach. The burst vertebra was excised, and the defect was filled with bone graft. Implants (plates and screws) were used in 10 cases. The preoperative examination was conducted by computed tomography and revealed that in 4 patients with complete tetraplegia (Frankel grade A) there was more than 50% spinal canal narrowing, whilst in the remaining 7 patients, with various levels of incomplete tetraplegia, there was less than 50% spinal canal narrowing, resulting in considerable improvement. The above results support the hypothesis that a correlation exists between the magnitude of the spinal canal encroachment, the initial neurological deficit and the final outcome.