Prognosis has been shown to be worse for patients with multiple primary melanomas than those with a single melanoma. One recent retrospective study showed that older, white men were at higher risk of multiple primary melanomas. In our institution 2057 melanomas were diagnosed between January 1994 and March 2016. We identified 99 (4.8%) patients who had multiple primary melanomas. The average number of melanomas was 2.5 (range: 2-10). The site for first and second melanomas was similar in 30%. We found that subsequent melanomas were more likely to be in situ and thinner in terms of Breslow thickness and Clarks level. The commonest subtypes were superficial spreading and lentigo maligna. The commonest sites involved were the lower limbs. We found no significant difference in age between our total melanoma group and the multiple primary melanoma group (64 and 66 years, respectively). The average time of diagnosis between the first and second melanomas was 33.7 months. Additionally, 70% of second melanomas were diagnosed within 2 years of first diagnosis, highlighting the importance of ongoing skin surveillance in patients with a recent diagnosis of melanoma.
In patients with CF, the correlation between thin-section CT score and exercise limitation is stronger than that between spirometry results or BMI and exercise limitation.
Brachioradial pruritus (BRP) is an unusual clinical entity resulting in pruritus of the upper arms, classically affecting the skin overlying the proximal heads of the brachioradialis muscles. Seven patients with BRP are described. The upper limb was involved in six patients, being bilateral in four and restricted to the right arm in two. Radiological evidence of cervical vertebral osteoarthritis was seen in five. Three patients reported exacerbation with ultraviolet radiation (UVR), i.e., sunlight. All seven were treated with topical capsaicin and four got significant relief. Two of the remaining three patients found relief from amitryptiline. UVR may act as a trigger in some patients although underlying neurological cervical injury also seems to be an important aetiological factor.
We found this method successful in treating lobar atelectasis, which was resistant to conventional therapy with antibiotics and physiotherapy. In all but one of the cases we described, administration of DNase in this manner resulted in a radiographic and clinical improvement of the atelectasis. We recommend that respiratory physicians consider this as a second line treatment in the management of atelectasis.
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