Dental nurses on perceived gender differences in their dentist's communication and interaction style.

OBJECTIVES: To investigate if dental nurses perceive gender differences in the communication and interaction style used by their dentist in general practice. METHODS: Data were collected from 64 Northern Irish dental nurses (70% response), and from 549 Dutch nurses (41% response). Respondents completed the Communication and Working Styles Questionnaire (CWSQ), a self-report questionnaire with 20 items on staff communication and working styles. Using principal component analysis, six distinguishable factors could be extracted: [1] gender-related (four items, Cronbach's alpha = 0.78), [2] friendly relation (four items, alpha = 0.66), [3] teamwork (four items, alpha = 0.44), [4] playfulness (two items, alpha = 0.69), [5] personal attention (three items, alpha = 0.60), and [6] business-like (two items, alpha = 0.32). Factors [3] and [6] were additionally analysed at item level given their low internal consistencies. RESULTS: MANOVA indicated a main effect for dentist's gender [F(6,541) = 4.649, p < 0.001], and for country [F(6,541) = 37.601, p < 0.001] on the communication style scales. No interaction effect of gender with country was found. Nurses working with a male dentist had higher scores for the 'gender-related' communications styles, whereas those working with a female dentist had higher scores for 'friendly-relation' and 'personal attention' communication styles. Dutch nurses had higher scores on 'playfulness', whereas Northern Irish nurses had higher scores on 'friendly relation' and 'personal attention' communication styles. Some additional differences were found at item level. The age of the dental nurse explained some differences in communication and working styles [F(6,541) = 2.341, p = 0.031); younger dental nurses scored significantly higher for 'gender- related' communication and working style. CONCLUSION: Gender of the dentist does influence dental nurses' perceptions of the communication styles used in the primary dental care setting. Dental nurses working with female dentists report a style predominantly characterized by 'friendly-relation' and 'personal attention', whereas those working with a male dentist report 'gender-related' communication and working styles. Given the steadily growing percentage of females entering the dental profession, it is recommended to raise both dentists' and nurses' awareness on gender influences in professional communication by introducing these topics in their respective education.

The genetic basis of uveal melanoma.

Uveal melanoma (UM) is the most common intraocular malignancy in adults with an incidence of about 1/100,000 new cases per year in the Western world. Risk factors are having a light skin, blond hair and blue eyes. As some UM patients have a young age at diagnosis or an affected family history for UM or other malignancies, there may be an underlying genetic basis. This review discusses known or suspected risk factors for UM, the cancer risk in UM patients and their family members, and the genes that have been reported to predispose to UM (germline mutations) and tumor development (somatic mutations).

Are atypical nevi a risk factor for uveal melanoma? A case-control study.

Atypical nevi and other potential risk factors for uveal melanoma were studied in 109 uveal melanoma patients and 149 controls. Information concerning employment, medical history, drug use, family history of cancer, excess sun exposure, and blistering sunburn before and after the age of 15 was obtained. A total skin examination was performed and skin type, hair color, eye color, freckles, actinic damage, the total number of common acquired nevi, and the number of clinically atypical nevi were noted. More atypical nevi were found in uveal melanoma patients than in controls (age- and sex-adjusted odds ratio of 2.9 [95% confidence interval 1.2-6.3] for one or two atypical nevi versus none; odds ratio of 5.1 [95% CI 1.3-20.0] for three or more atypical nevi versus none). Light skin types and freckling also prevailed in uveal melanoma cases. In our study, atypical nevi are more common in uveal melanoma patients than in controls. Further studies will have to indicate whether risk factors comparable to those for cutaneous melanoma really exist for uveal melanoma.

Autofluorescence of the lens in diabetic and healthy subjects by fluorophotometry.

Autofluorescence (lambda = 530 nm) of the human lens was determined as a function of age by fluorophotometry in insulin-dependent diabetics and in healthy controls. Statistical analysis revealed a significant linear age dependency for both groups (7.98 ng eq X ml-1 y-1 for diabetic patients, P less than 0.001 and 6.36 ng eq X ml-1 y-1 for healthy controls, P less than 0.001) and a significant dependency on diabetes duration (8.78 ng eq X ml-1 per year of diabetes duration, P less than 0.001). The increase with age was found from about zero value at early childhood.

Results of ruthenium irradiation of uveal melanoma.

The follow-up results are presented for the radiotherapeutic treatment of 49 patients with uveal eye melanoma using ruthenium-106 (106Ru/106Rh) applicators. Graded doses were applied and the degree of regression was found to be correlated with the dose at the top of the tumour. Complete regression is found in 66% of the patients treated with a top dose above 150 Gy, in which case the initial tumour prominence diminishes in about three years to a stable disease or to a flat scar. At this dose a marginal increase in complications was observed as compared with lower dose groups. Useful vision could be preserved in 75% of the eyes.

Results of ruthenium irradiation of uveal melanomas: the Dutch experience.

BACKGROUND AND PURPOSE: To update our results of the treatment of uveal melanomas using ruthenium applicators in 49 patients treated with graded doses and subsequently in 52 patients with maximal scleral doses of 800 Gy and an effective top dose of at least 160 Gy. MATERIAL AND METHODS: One hundred and one patients were treated with brachytherapy only, in 25 patients it was combined with transpupillary thermotherapy (TTT). RESULTS: A complete remission was found in 62.6% of the patients and in 31.3% a stable disease with an average follow-up of 74.6 months. Above a top dose of 120 Gy only in one of 95 patients continuous tumour growth after treatment was observed. Useful vision could be preserved in 51.5% of the patients. The initial tumour prominence and top dose strongly correlated with treatment outcome. CONCLUSIONS: Ruthenium application for uveal melanomas with the doses we have used is successful, with a substantial number of patients having their eyes preserved, their tumour controlled and their vision retained. Further improvements can be obtained with ruthenium irradiation with lower maximal scleral doses combined with TTT.

Transpupillary thermotherapy in choroidal melanomas.

OBJECTIVE: To determine safety and efficacy of transpupillary thermotherapy (TTT) as a new treatment for choroidal melanoma. METHODS AND PATIENTS: To perform TTT, diode laser energy at 810 nm was used with a beam diameter of 1.5 to 4.5 mm for a 1-minute exposure. All 12 patients had choroidal melanoma. Six had had insufficient response to ruthenium 106 (106Ru) brachytherapy. Three patients with tumors more than 5 mm in height were treated simultaneously with 106Ru and TTT. Three patients with juxtapapillary or macular tumors were treated by TTT only. RESULTS: All but one tumor exhibited a reduction of tumor height in a follow-up period of 3 to 14 months. Side effects were minimal. Severe visual loss occurred in two patients due to radiation retinopathy, in two patients whose foveas were included in the TTT area, and in one patient resulting from a serous retinal detachment that extended over the posterior pole. CONCLUSIONS: Treatment with TTT may be useful as a complementary modality to brachytherapy. A longer follow-up period is required for final evaluation.

Corneal autofluorescence in choroidal melanoma or in choroidal naevus.

AIMS: To investigate whether corneal autofluorescence is different in patients with choroidal melanoma or choroidal naevus. METHODS: Corneal autofluorescence was determined by fluorophotometry in both eyes of 32 patients with a unilateral choroidal melanoma, 32 patients with a unilateral choroidal naevus, and 32 age matched healthy controls. The corneal autofluorescence ratio between affected and contralateral eyes of patients or between randomly selected eyes of healthy controls was calculated. RESULTS: Mean corneal autofluorescence ratio of patients with a choroidal melanoma was significantly higher than that of healthy controls (mean ratio: 1.09 (SD 0.15) and 1.00 (0.09), respectively, ANOVA p=0.014), and than that of patients with choroidal naevus (mean ratio 0.96 (0.09), p<0.001). Mean ratios of patients with choroidal naevus and healthy controls were not significantly different (p=0.27). CONCLUSIONS: Corneal autofluorescence ratio of patients with a unilateral choroidal melanoma is increased. This is probably due to an increased flow of glucose through the impaired blood-aqueous barrier in the affected eye, resulting in additional glycation of corneal proteins and hence in increased autofluorescence. The corneal autofluorescence is not increased in patients with a choroidal naevus, because the blood-aqueous barrier is not impaired in the affected eye in these patients. Measurement of corneal autofluorescence is simple, fast, and non-invasive, and might be helpful to distinguish between patients with choroidal melanoma and those with choroidal naevus.

Occurrence of cutaneous and uveal melanoma in patients with uveal melanoma and their first degree relatives.

Uveal and cutaneous melanomas are rare tumours, but have been described to occur together in one patient or in members of the same family. A group of 109 consecutive uveal melanoma patients from one specialized ocular tumour clinic were investigated dermatologically. The patient's own history and medical data and the family history of skin or eye problems were recorded. A total of three cutaneous melanomas were found as a result of this study--two in ocular melanoma patients and one in a first-degree relative. Four patients had first-degree relatives with a skin melanoma (in three of these families dysplastic naevus syndrome was also found), and one patient had a first-degree relative with an uveal melanoma. To find cutaneous and uveal melanoma coexisting in two cases and cutaneous melanoma in first-degree relatives in four cases out of a total of 109 uveal melanoma patients seems more than a coincidence. A linking factor in three cases was the familial atypical multiple mole melanoma syndrome, suggesting a common genetic predisposition to both malignancies in these families. In our only family with familial uveal melanoma, cutaneous melanoma and atypical naevi did not occur. A different genetic mechanism for these cases is probable.

Intracerebral uptake of Tc-99m labeled antimelanoma antibodies.

A patient with an intraocular tumor showed accumulation of Tc-99m labeled antimelanoma antibodies in the head. This was not due to a metastatic lesion but proved to be a benign intracranial osteoma. The reasons for this false-positive result are discussed.

[Eye-preserving treatment of uveal melanoma. Leidse Oogmelanoom Groep]. / Oogsparende behandeling van het uveamelanoom. Leidse Oogmelanoom Groep.

Over 100 new cases of uveal melanoma are diagnosed annually in the Netherlands. In the absence of metastases, eye-preserving treatment is possible in principle. Since 1984, Dutch patients are referred for eye-preserving treatment to Leiden University Hospital which consequently has gained great experience. Brachytherapy (with Ruthenium-106 applicators) is only suitable for uveal melanomas with a diameter < or = 15 mm and a prominence (thickness perpendicular to the sclera) < or = 5 mm; after 10 years, the eye was preserved in 80% of the patients; 75% retained a visual acuity > or = 0.25. Proton irradiation is being applied for large, strongly prominent melanomas in patients for whom enucleation is not acceptable, for instance with a melanoma in the only eye still functioning. The eyes could be preserved in 83.3% over a period of 5 years. Transpupillary thermotherapy combined with episcleral Ruthenium-106 application is called sandwich therapy; in a study involving 50 patients, 49 melanomas (98%) began to regress within 4 weeks and after a follow-up period of 12 months all tumours with a prominence < 5 mm had regressed completely.

Scintimetric detection of choroidal malignant melanoma with [123I]-5-iodo-2-thiouracil.

[123I]-5-iodo-2-thiouracil (123I-ITU) was evaluated as a radiopharmaceutical for tumor detection in 10 patients with proven choroidal melanoma. Uptake of 123I-ITU was measured with a specially designed single eye probe collimator, 24 h after administration of 123I-ITU. Increased uptake in the tumor-bearing eye as compared to the fellow nontumor bearing eye was found in 7 out of 10 cases when the probe was located 3.5 cm in front of the eye (p less than 0.01). By using a double pinhole collimator tests were positive in 3 out of 10 123I-ITU studies only. Tests with 123I-ITU were compared with 67Ga tests in the same patients. The 67Ga tests with the single eye probe collimator were positive in 6 out 10 cases when the probe was located 6 cm in front of the eye. With the double pinhole collimator tests were positive in 7 out of 10 67Ga studies. It is concluded that 123I-labeled thiouracil is at least as useful as a radiopharmaceutical for ocular melanoma diagnosis as 67Ga-citrate, provided measurements are performed with a single eye probe.