Prediction score for lymph node metastasis from cutaneous squamous cell carcinoma of the external ear.

AIMS: The frequency of lymph node metastasis (LNM) is higher in cutaneous squamous cell carcinoma (cSCC) of the ear than in other head and neck cSCCs. Nodal dissemination is associated with a significantly worse prognosis and disease-specific survival. The aim of this study was to establish a prediction model for LNM in patients with cSCC of the ear. MATERIALS AND METHODS: Tumour characteristics of 353 patients with ear cSCC were analysed to assess differences between those with and without LNM and to calculate a prediction score for LNM occurrence. RESULTS: Regional LNM occurred in 10.5% of patients. Five-year disease-specific survival was significantly lower in the LNM group than in the control group (59% vs. 99%; p < 0.001). Recurrence number, invasion of cartilage, tumour depth, and tumour grading were the most important predictors for LNM, with correct prediction of LNM in 94.0% of cases. Our prediction score stratified patients into high and low risk groups (p < 0.001) with a sensitivity of 89.2%, a specificity of 94.6%, and an overall accuracy of 94.1%. CONCLUSION: Our new prediction model was able to accurately identify patients at high risk of LNM who may benefit from elective lymph node surgery.

Group psychotherapy for opiate addicts in methadone maintenance treatment--a controlled trial.

A controlled trial was conducted evaluating cognitive-behavioural group psychotherapy as a measure to reduce concomitant drug use in methadone maintenance treatment (MMT). 73 opiate addicts were randomly assigned to local routine MMT or to routine MMT plus group psychotherapy (20 sessions over 20 weeks). Psychotherapy was delivered by therapists according to a manual. Drug use (urine screen) was compared at onset of psychotherapy, end of intervention period (6 months after study onset), and 6 months later. Data analysis was done according to intention-to-treat principles. Results indicated that patients in the psychotherapy group (n = 41) showed less drug use than control subjects (n = 32). This group difference was statistically significant at 6-month follow-up (p = 0.02). These findings underscore the usefulness of group psychotherapy in MMT. The delayed effect is comparable to other studies evaluating cognitive-behavioural psychotherapy.

Use of illegally acquired medical opioids by opiate-dependent patients in detoxification treatment.

Take-home dosages in maintenance treatment are of great therapeutic importance, but they include the risk of the substitute being distributed illegally. We reviewed the extent of consumption of illegally acquired medical opiates by 142 opiate- or poly-addicted patients consecutively admitted to a detoxification ward. 76 (53.5%) of them admitted to taking illegally acquired medical opiates, usually methadone, at least once. The cumulative duration was 30 days (median). Motivation was usually due to difficulties in acquiring heroin, however one third reported use in an attempt at self-detoxification or as transition before entering maintenance treatment. Maintenance patients were usually the source of the opiates. The results prove the necessity of stringent conditions for take-home dosages, and illustrate deficits in the health care system.

Cognitive-motor performance of methadone-maintained patients.

Fifty-four methadone-maintained patients and 54 healthy controls, matched for age, gender and educational attainment, completed a battery of six cognitive-psychomotor performance tests. Results of previous studies were replicated in four areas. An attention task was performed less well by patients [mean difference more than 0.7 standard deviations (SD)] as was a tachistoscopic perception task (0. 3 SD). On a simple-choice reaction test, patients showed higher speed in decision making and motor reaction as well as an increased number of decision errors (0.3 SD each). Performing a tracking test, patients showed less deviations (0.4 SD) combined with more time needed (0.8 SD). Our data go beyond previous (seemingly inconsistent) research findings by showing that patients did less well by more than 0.6 SD when on higher speed levels. Absolving a test on visual structuring, more patients than controls achieved a 100% accuracy level (52 vs. 30%), but at the same time patients were slower (0.6 SD) than controls. An inferior test performance of patients in methadone maintenance treatment has been confirmed in some areas, especially in attention. However, the fairly moderate size of these effects and the fact that in the majority of measures the observed variance was better explained by sociodemographic features than by group membership lead on the conclusion that belonging to the group of methadone patients alone is not necessarily sufficient to predict an impairment in cognitive-psychomotor skills. To conclude, assessment of fitness for certain tasks or occupations should be done individually for each patient and should take into account comorbidity, including the extent of alcohol and other drug use.