Melanoma and the radiograph: sanctity of human life

Parish, LawrenceCharles; Witkowski, Joseph A.

doi:10.1016/s0140-6736(05)61508-5

Cited by 3 publications

(1 citation statement)

References 2 publications

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“…[18][19][20] Many have argued that CXR should be used simply because it is widely available, relatively inexpensive, and noninvasive. 21,22 However, these variables do not satisfy an argument to continue its routine used. The available evidence clearly supports no role for obtaining routine CXRs in patients with clinically node-negative melanoma with no symptoms of metastatic disease.…”

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confidence: 99%

Review of Evidence-Based Support for Pretreatment Imaging in Melanoma

Sabel

Wong

2009

J Natl Compr Canc Netw

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When making a new diagnosis of melanoma, clinicians often obtain imaging studies to rule out clinically occult distant disease. These studies range from inexpensive tests, such as chest radiographs, to more expensive studies, such as PET/CT. The impetus for ordering these studies is usually the desire to identify potentially resectable distant disease, avoid surgery when curative resection is not possible, and assuage patient anxiety by showing that no evidence of distant disease is present. However, some detrimental aspects to these studies are less apparent, including cost and potential for false-positive findings. Although routine use seems reasonable, the true benefit of these studies depends on the probability of clinically occult disease being present, likelihood that disease will be detected with the available technology, and impact of earlier detection on outcome. Contrary to current practice patterns, available evidence suggests that preoperative imaging studies are associated with significant costs and minimal benefit in most patients with melanoma. This article reviews available literature on the role of pretreatment imaging in patients with newly diagnosed cutaneous melanoma.

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confidence: 99%

Review of Evidence-Based Support for Pretreatment Imaging in Melanoma

Sabel

Wong

2009

J Natl Compr Canc Netw

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Diagnosis of systemic metastatic disease

Perry¹

2003

Textbook of Melanoma

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Natural course of treated epilepsy and medico-social outcomes. Turku studies. Part II

Sillanpää¹

2016

Journal of Epileptology

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SummaryIntroduction. Population-based data on the prognosis of childhood-onset epilepsy were almost nonexistent in the 1960s. This prompted me to start an epidemiological prospective study on children with epilepsy.Aim. To study the medical and social outcome of children with epilepsy.Methods. The most important personal data on the natural course and outcome were reviewed and compared with the relevant data of other investigators.Results and discussion. The natural course of treated epilepsy is remitting, uninterrupted by relapse (in 48%); a remitting-relapsing course (interrupted by relapses, in terminal remission) (19%); worsening course (early or late remission followed by drug-resistant epilepsy) (14%); and never in ≥5-year remission (drug resistance) (19%) The medical and social outcomes based on my unique, five decades followed cohort show that most subjects are in 10-year remission without medications, which is the definition of resolved epilepsy. Normal or subnormal IQ, non-symptomatic etiology, and low seizure frequency both in the first year of AED treatment and prior to medication appear to be clinical predictors of cure in childhood-onset epilepsy. Subjects with 1-year remission during the first five years form onset of treatment have more than 10-fold chance for entering 5-year terminal remission vs those who have no 1-year remission during the first five years. Even about one fourth of difficult-to-treat subjects become seizure free on medication and more than half of them enter one or more 5-year remissions. Epilepsy has a substantial impact on quality of life even in those who are seizure free off medication for many years and particularly those not in remission or in remission but still on medication.Conclusions. The prognosis is excellent for medical and social outcome. The successful outcome is confirmed by several longitudinal studies from recent decades. Good response to early drug therapy does not necessarily guarantee a favorable seizure outcome, and even a late good response may still predict a successful prognosis. Our life-cycle study is being continued and targets to answer the question whether or not childhood-onset epilepsy is a risk factor for premature and/or increased incidence of mental impairment and dementia.

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Melanoma and the radiograph: sanctity of human life

Cited by 3 publications

References 2 publications

Review of Evidence-Based Support for Pretreatment Imaging in Melanoma

Review of Evidence-Based Support for Pretreatment Imaging in Melanoma

Diagnosis of systemic metastatic disease

Natural course of treated epilepsy and medico-social outcomes. Turku studies. Part II

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