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Excessive, incorrect exposure to the sun at a young age can be a risk factor for skin cancer at a later age. In this study we have investigated the exposure and protection habits of a group of children to see whether there are behavioral errors that should and possibly could be corrected. We handed out a multiple-choice questionnaire to 310 subjects, 212 boys and 98 girls between the ages of 6 and 14, all residents in the province of Udine in the northeastern part of Italy. Of these children, 24% had sunburn on several occasions; boys were four times more at risk than girls (OR = 0.4) and the frequency reduced by 30% for each skin phototype class higher. In children between 11 and 14 years of age, exposure was prolonged (43% for 2-4 hours, 38% for 4-8 hours) and 30% preferred peak hours. Eighty percent of the children, mostly girls, younger children (6-10), and the lower skin phototypes used sunscreens, but only 38% used them on a regular basis, whereas 20% applied them after sunbathing and 42% used a single daily application. Two percent of the children used sunglasses and 5% wore a T-shirt regularly. The dermatologist and pediatrician play an important role in advising parents that the sun is good for children, but appropriate measures must be taken to reduce any risks, both immediately and in the long term.

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Background: Median sternotomy is the most frequently used incision for cardiac procedures but carries a substantial risk for deep sternal wound infections and/or sternal dehiscence. In contrast to previous studies that examined risk factors for sternal infections this study evaluates factors that lead to poor outcome after surgical revision of the non healing sternum. Methods: Between 1985 and 1999, 193 adults (mean age 64 ± 9 years, m/f = 3/1) necessitated sternal revisions (incidence 1.93%). Pre-, intra- and post-operative risk factors were evaluated for their influence on the outcome after sternal revision. Results: 65 of the 193 patients had a complicated course: ten (5.2%) died due to sepsis/multi organ failure ( n = 6) or cardiac causes ( n = 4). 32 patients (16.6%) needed several revisions, 17 (9%) were discharged with sternal instability, 5 (3%) with chronic fistula and one with persistent osteomyelitis. Univariate and multivariate analysis identified cardiopulmonary resuscitation (odds ratio ( OR) = 11.188, p = 0.010), corticoid treatment ( OR = 7.043, p = 0.0055), diabetes ( OR = 4.130, p = 0.0128), smoking history ( OR = 2.996, p = 0.0041), renal insufficiency (hazard ratio ( HR) = 1.884), old age ( OR = 1.108, p = 0.0266), high body mass ( HR = 1.06), ECC time ( p = 0.023), cross clamp time ( p = 0.028), systemic hypothermia ( p = 0.016), non-use of IMA ( p = 0.042) or prolonged ventilation as risk factors for mortality or poor outcome. No correlation between sternal closure technique, mediastinal irrigation or antibiotic therapy and outcome after mediastinal revision could be found. Conclusions: To avoid disappointing results after sternal revision one should aim to preoperatively identify high-risk patients and aggressively address risk factors. This rather than modifications of the surgical and medical approach might improve the outcome of patients with mediastinal complications.