The occurrence of regional lymph node metastases in thin melanomas is rather low. Our data suggest that sentinel lymph node biopsy may not justified in patients with melanoma <.75 mm thick.
This investigation evaluated the prevalence of depression in female patients who had cancer in any of five predesignated sites. Five hundred five women aged 17 to 80 (190 with breast cancer, 143 with gynecologic malignancies, 111 with melanoma, 37 with bowel cancer, and 24 with lymphoma) were randomly screened. Assessment included the Hamilton rating scale for depression, the Zung self-rating depression scale, the Karnofsky performance scale, and a 10-cm visual pain analogue line. The results revealed a mean Hamilton of 10.2 (range, 0 to 41; SD, 7.5), a mean Zung score of 35.3 (range, 11 to 68; SD, 9.6), a Karnofsky median score of 80, and a median pain score of 0. Scores on the Zung scale were highly correlated with those of the Hamilton scale (r = .75). Based on cutoff scores accepted as indicating depression (Hamilton greater than or equal to 20 and Zung greater than or equal to 50), patients were depressed. The depressed subgroup was in significantly more pain, experienced greater physical disability, and was more likely to have had prior episodes of depression as compared to the non-depressed women. The two best predictors of current depression were performance status (Karnofsky) and history of depression. No relationship was found between depression and other demographic variables or disease parameters (diagnosis, time since diagnosis, stage or phase of illness, and current treatment). Our findings indicate that the prevalence of major depression in cancer patients is lower than many previous studies have indicated and falls within the range seen in the general population.
A case of plexiform neurofibroma of the lower urinary tract is presented as well as a review of all previously reported cases in childhood. We suggest aggressive management in patients with diffuse disease.
Background: Radioisotope mapping is an essential technical component of sentinel lymph node (SLN) biopsy, and most authors define success by an arbitrary threshold SLNbackground ratio.Hypothesis: Few studies have examined the degree to which the relative level of SLN counts correlates with the presence of metastasis. Having removed the SLN with the highest counts, there are no data suggesting how far the surgeon should persist in removing additional SLNs that contain much lower levels of isotope.
Methods:We performed 134 SLN biopsy procedures in 132 patients with melanoma. Successful isotope localization was defined using an SLN/"hottest" SLN ratio; we defined an SLN as any node containing counts at least 10% of that of the hottest SLN.Results: Of 83 patients with more than 1 SLN site identified, 21 (25%) had SLNs that contained metastasis. In 17 (81%) of these cases, the SLN with the highest count (REPRINTED) ARCH SURG/ VOL 138, JAN 2003 WWW.ARCHSURG.COM 63
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