The incidence of melanoma continues to increase in many countries, and primary prevention of melanoma includes avoidance of sunburn as well as adequate sun protection behavior. The aim of this study ...was to examine the prevalence of self-reported sun protection behaviors and sunburn in users of the Internet, and to identify the demographic, clinical, and attitudinal/motivational correlates of sun protection behaviors.
Self-report data were gathered on behalf of the GenoMEL consortium using an online survey available in 10 different languages, and 8,178 individuals successfully completed at least 80% of survey items, with 73% of respondents from Europe, 12% from Australia, 7% from the United States, 2% from Israel, and 6% from other countries.
Half of all respondents and 27% of those with a previous melanoma reported at least one severe sunburn during the previous 12 months. The strongest factors associated with sun protection behavior were perceived barriers to protection (beta = -0.44/beta = -0.37), and respondents who reported a positive attitude toward suntans were less likely to protect (beta = -0.16/beta = -0.14). Reported use of protective clothing and shade, as well as avoidance of midday sun exposure, were more strongly related to reduced risk of sunburn than sunscreen use.
Despite widespread dissemination of public health messages about the importance of sun protection, a substantial proportion of this international sample, including respondents with a previous melanoma, reported inadequate sun protection behaviors resulting in severe sunburn.
Future strategies to decrease sunburn should target the practical, social, and psychological barriers associated with nonuptake of sun protection.
Gensko testiranje za dedno obliko malignega melanoma kože na OI Ljubljana opravljamo od leta 2005. Izbor bolnikov za testiranje poteka v okviru genetskega svetovanja. Testiramo bolnike in njihove ...zdrave sorodnike, če sta v družini najmanj dva obolela člana, in bolnike s primarnimi multiplimi melanomi brez obremenjujoče družinske anamneze. Na oddelku za molekularno diagnostiko z metodo sekvenčne analize iščemo in določamo neznane točkovne mutacije ter manjše delecije in insercije v eksonih genov, povezanih z nastankom malignega melanoma kože: CDKN2A, CDK4 in MC1R. Do sedaj smo testirali 70 oseb: 40 bolnikov in njihovih zdravih sorodnikov iz 28 različnih družin, obremenjenih z družinsko anamnezo, ter 30 bolnikov s primarnimi multiplimi melanomi. Sekvenčna analiza genov, povezanih z dedno obliko malignega melanoma kože, je pokazala, da so mutacije CDKN2A p16INK4a pri bolnikih z družinsko anamnezo zelo pogoste (37,5 %). Mutacij CDKN2A p14ARF in CDK4 pri slovenskih bolnikih nismo našli.
Abstract only
171
Background: Because the population ages, the proportion of breast cancer (BC) patients over age 80 is increasing. To date, there is no consensus as to what the best treatment is for ...older patients with BC. The aim of our retrospective study was to analyze data about surgically treated BC patients with ≥80 years of age and their outcome. Methods: A chart review of 158 early BC patients (mean age 83; range 80-90) that were surgically treated at our institute from 2000 to 2008 was performed. The data on the extent of disease, morphologic characteristics, mode of therapy, recurrence and survival were collected. Correlation between possible prognostic factors, mode of therapy and cause-specific survival was analyzed by univariate and multivariate test. Results: Extension of BC was local, locoregional and unknown in 37%, 46% and 17% of cases; pT1/pT2 and pT3/pT4 tumor stage was present in 75% and 25%, respectively. Conservative breast surgical procedure, mastectomy, axillary lymphadenectomy, sentinel lymph node biopsy and no lymph node surgery was done in 27%, 73%, 57%, 18%, and 25%, respectively. Adjuvant hormone therapy (tamoxifen in 56 and aromatase inhibitors in 47 cases), chemotherapy and external radiotherapy were used in 65%, 1.2% and 15% of patients. Recurrence occurred in 23% of cases during the follow-up period of 0.2-11 years (median 4.3 years); local, regional and/or distant in 10%, 6% and 22% of cases, respectively. Because of BC and other reasons died 20% and 20% of cases, respectively. The 5-year cause-specific survival in patients with local and regional extension of BC was 86% and 74%, respectively. Univariate statistical analysis showed that pT3/pT4 tumor, pN1 stage, mastectomy, sentinel node biopsy and lymphadenectomy correlated with shorter cause-specific survival. Multivariate analysis showed that only pT3/pT4 tumor and pN1 stage correlated with shorter cause-specific survival. Our results indicate that our patients were locoregionally treated adequately to tumor stage Conclusions: Short cause-specific survival indicates that BC in patients with ≥80 years of age and regional metastases may be aggressive. Adjuvant chemotherapy might be considered in selected cases to prolong survival.
Carotid paragangliomas are usually slowly enlarging and painless lateral neck masses. These mostly benign lesions are recognized due to their typical location, vessel displacement and specific blood ...supply, features that are usually seen on different imaging modalities. Surgery for carotid paraganglioma can be associated with immediate cerebrovascular complications or delayed neurological impairment.We are reporting the case of a 36-year-old man who presented with a painless mass on the right side of his neck 11 months after being treated for testicular cancer. After a fine-needle aspiration biopsy, he was diagnosed with a testicular cancer lymph node metastasis. Neck US and fluorine F-18-fluorodeoxy-D-glucose (FDG) PET-CT showed no signs of hypervascularity or vessel displacement. The patient underwent a level II to V functional neck dissection. During the procedure, suspicion of a carotid paraganglioma was raised and the tumour was carefully dissected from the walls of the carotid arteries with minimal blood loss and no cranial nerve dysfunction.The histology report revealed carotid paraganglioma with no metastasis in the rest of the lymph nodes. The patient's history of testicular germ cell tumour led to a functional neck dissection during which a previously unrecognized carotid paraganglioma was removed.Surgery for carotid PG can be associated with complications that have major impact on quality of life. A thorough assessment of the patient and neck mass must therefore be performed preoperatively in order to perform the surgical procedure under optimal conditions.
Aim of this study was toinvestigate changes in health behavior of melanoma survivors with emphasis on safe sun behavior (SSB) and skin self-examination (SSE). We also identified factors with ...significant impact on SSE improvement. We performed a cross-sectional (epidemiological) survey based on a structured questionnaire. 150 patients from three medical institutions were invited and 144 patients responded. Statistical analysis was performed with SPSS version 23.0, with the level of significance set to 0.05. After being diagnosed with cutaneous melanoma, patients significantly improved preventive health behavior: 68.1% showed improvement in SSE, and 91.5% of patients improved SSB. There was statistically significant ( P <0.001) improvement in the frequency of skin examination, examination of poorly visible areas (between the toes, genitals), and obtaining help in examination. Use of melanoma images remained scarce. Results for SSB were even better, and statistically significant improvement was recorded in all areas: using higher UV protection filters, wearing sunglasses, headgear, long sleeves, and trousers, and especially in staying in deep shade during hours of heavy UV radiation. The only factor with a positive influence on expected improvement in SSE was female gender. On the other hand, there were two factors that had a negative impact on SSE: patients with melanoma stage 1 and patients who had already self-examined themselves before their melanoma diagnosis. Preventive health behavior improved significantly after diagnosis of cutaneous melanoma. Patients markedly improved SSB and substantially enhanced SSE. We believe that it is reasonable to improve SSE further, encouraging patients by increasing their feeling of self-efficacy.
The aim of this retrospective study was to find predictive factors of carcinoma in patients with follicular neoplasm. The specific aim was to discover whether preoperative serum thyroglobulin (Tg) ...concentration in patients with thyroid neoplasm can differentiate between those with thyroid carcinoma and those with benign disease.
A total of 327 patients (263 females, 64 males, median age: 51.5 years) with follicular neoplasm in whom carcinoma was only suspected and who were surgically treated at the authors' institute in 1988-2004 were included in the study. Patients who had distant and/or regional metastases were excluded. Risk factors for malignancy were identified by the chi-squared test and logistic regression.
The histopathological diagnoses were carcinoma, benign goiter, and adenoma in 119 (36%), 104 (32%), and 104 (32%) patients, respectively. The independent predictors of malignancy as shown by multivariate logistic regression were tumor diameter and preoperative Tg concentration. Thyroid carcinoma was more common in the patients with follicular neoplasm and serum Tg concentration over 300 ng/ml than in those with lower Tg concentrations.
Predictors of malignancy were tumor diameter and preoperative Tg concentration.
Strategije učenja danas predstavljaju aktualno područje ispitivanja u
području usvajanja stranoga jezika. Oxford (1990) ih definira kao specifične aktivnosti koje učenik poduzima kako bi proces ...učenja učinio lakšim, bržim i ugodnijim te kako bi ih mogao primijeniti u novim situacijama učenja i uporabe jezika. Primjena prikladnih strategija učenja osigurava veći uspjeh u učenju i veću sigurnost. U prvome dijelu rada navode se ključne definicije pojma ‘strategija učenja’, dok su u drugome dijelu predstavljeni rezultati kvantitativnoga istraživanja koje je provedeno na Američkoj visokoj školi za management i tehnologiju u Dubrovniku (ACMT) i na Sveučilištu u Dubrovniku. Uzorak je obuhvatio 181 ispitanika koji uče njemački, španjolski, francuski i talijanski kao strani jezik na dvije razine učenja: početnoj i srednjoj. Za ispitivanje strategija učenja izrađen je upitnik koji se temelji na upitniku o strategijama učenjima (Strategy Inventory for Language Learning) koji je oblikovala Oxford (1990). Ciljevi istraživanja bili su utvrditi razlike u uporabi strategija učenja u odnosu na razinu učenja stranoga jezika te prethodnu ocjenu iz stranoga jezika. Rezultati ovoga istraživanja pokazali su da se u odnosu na razinu učenja stranoga jezika ispitanici statistički značajno razlikuju prema uporabi strategija učenja. Razlike su prisutne za dvije skupine strategija učenja: društveno-afektivne i kognitivne, i to u smjeru veće zastupljenosti kod ispitanika na početnom stupnju učenja. S druge strane, utvrđena je statistički značajna razlika u uporabi strategija učenja u odnosu na prethodnu ocjenu iz stranoga jezika. Učenici s izvrsnom ocjenom više se koriste skupinom društveno-afektivnih strategija i strategija pamćenja. U završnome dijelu navode se implikacije za nastavnu praksu te se daju smjernice za buduća istraživanja.
Abstract A focused surgical approach based on pre-operative localization replaced the classical four-gland exploration in patients with primary hyperparathyroidism (PHP). Sestamibi scanning and ...ultrasound are most often used localization modalities with reported sensitivity of 54–100% for identification of single gland disease. The aim of this study was to analyze the results of pre-operative localization with1 ⁸F-Fluorocholine PET/CT (FCh-PET) in patients with PHP.A retrospective review of 151 patients with PHP who underwent surgery after pre-operative localization with FCh-PET was performed. Only a focused parathyroidectomy without ioPTH testing had been done in patients with single adenoma on FCh-PET. Primary outcome was operative failure, defined as persistent PHP. According to pre-operative FCh-PET 126 (83,4%) patients had single adenoma, 22 (14,5%) multiglandular disease and the test was negative in only two patients. Intraoperative failure experienced 4/126 patients (3,3%) with single adenoma. Removed parathyroid glands were normal in three and hyperplastic in one patient with intraoperative failure. A limited bilateral neck exploration with ioPTH testing was used in 14/22 patients with double adenoma according to pre-operative FCh-PET. In 6/14 patients surgery confirmed double adenoma while 8 patients had only a single adenoma and all 14 patients were cured. A classical four-gland exploration without ioPTH testing was used in 8/22 patients with more than two pathological glands according to pre-operative FCh-PET. All 8 patients had hyperplasia and two experienced intraoperative failure. In two patients with negative FCh-PET a classical four-gland exploration without ioPTH testing was used. One patient had a single adenoma and was cured and only normal parathyroid glands were found in the other patient with intraoperative failure.A preoperative localization with FCh-PET is a reliable test in patients with PHP. Patients with a single adenoma on FCh-PET can safely undergo a focused parathyroidectomy without ioPTH testing.
Cutaneous melanoma continues to increase in incidence in many countries, and intentional tanning is a risk factor for melanoma. The aim of this study was to understand how melanoma risk factors, ...perceived threat and preferences for a suntan relate to intentional tanning. Self-report data were collected on behalf of GenoMEL (www.genomel.org) from the general population using an online survey. A total of 8178 individuals completed the survey, with 72.8% of respondents being from Europe, 12.1% from Australia, 7.1% from the US, 2.5% from Israel and 5.5% from other countries. Seven percent of respondents had previously been diagnosed with melanoma and 8% had at least one first-degree relative with a previous melanoma. Overall, 70% reported some degree of intentional tanning during the past year, and 38% of respondents previously diagnosed with melanoma had intentionally tanned. The total number of risk factors was positively correlated with perceived risk of melanoma correlation coefficient (ρ) = 0.27, and negatively correlated with intentional tanning (ρ = – 0.16). Preference for a dark suntan was the strongest predictor of intentional tanning regression coefficient (β) = 0.35, P<0.001, even in those with a previous melanoma (β = 0.33, P<0.01). A substantial proportion of participants reported having phenotypic and behavioural risk factors for melanoma. The preference regarding suntans seemed more important in the participants’ decision to intentionally tan than their perceived risk of developing melanoma, and this finding was consistent among respondents from different countries. The drive to sunbathe to tan is a key factor to be moderated if melanoma incidence is to be reduced.
Survival of patients with cutaneous melanoma (CM) has improved significantly worldwide despite moderate treatment changes. The aim of our study was to determine whether the time period of diagnosis ...was an independent prognostic factor. The data of 1752 patients diagnosed with CM in Slovenia between 1983 and 1997 were analyzed. Cox proportional hazards model was used to assess the effect of multiple variables on survival. No significant decrease was observed in mean tumor thickness, whereas mean age at the time of diagnosis increased from 36.58 to 53.32 years. Multivariate analysis confirmed tumor thickness, age at the time of diagnosis, regional metastases and period of diagnosis as independent predictors of survival (P<0.0001). The most important independent predictor of survival of patients diagnosed with CM in the time period from 1983 to 1997 was the time of diagnosis.
PDF
