Factors predicting iliac metastasis and overall survival in malignant melanoma of the lower extremities.

BACKGROUND: To analyse the patient-related, disease-related and treatment-related factors in a group of melanoma patients to assess their impact on iliac metastasis and on overall survival. METHODS: Medical records of thirty-nine patients with lower extremity malignant melanoma were retrospectively reviewed to confirm all of the clinical data. Age and gender were recorded as patient-related factors. Tumor location, size, histology, ulceration status, and TNM stage, Breslow thickness, Clark level, presence of inguinal LN metastases, and locoregional metastases (local recurrences, in transit metastases and regional LN metastases) were evaluated as disease-related factors. Type of surgery (en block excision of primary tumor, en block excision of primary tumor and inguinal lymph node dissection, en block excision of primary tumor and ilioinguinal lymph node dissection) and postoperative chemotherapy were taken into account as treatment-related factors. RESULTS: The presence of inguinal lymph node metastases was significantly associated with iliac metastasis (p = 0.015). Tumor size (p = 0.046), tumor TNM stage (p = 0.009), Breslow thickness (p = 0.033), Clark level (p = 0.029), presence of in transit metastases (p = 0.010) and postoperative chemotherapy (p = 0.002) has been related to impaired overall survival rate. CONCLUSIONS: Therapeutic lymph node dissection appears to carry a small but definite therapeutic benefit. Selection of appropriate patients for the more extensive procedure would be ideal, but at present there are no well proven selection criteria. The authors advocate therapeutic dissection when the inguinal lymph nodes are involved.

Recovery of mental health parameters after ablation in patients with premature ventricular complex induced cardiomyopathy.

OBJECTIVE: The diagnosis of premature ventricular complex-induced cardiomyopathy (PVC-CMP) is based on the presence of common PVCs associated with cardiomyopathy without a reasonable etiology for the cardiomyopathy. The treatment strategies for PVCs include radiofrequency catheter ablation (RFCA) and drug therapy. In addition to physiological symptoms, PVCs also cause psychological symptoms. Impaired quality of life and sleep quality parameters have been observed in these patients. The aim of the study was to investigate the effects of RFCA treatment on cardiac function and psychiatric health parameters. PATIENTS AND METHODS: A total of 60 consecutive patients undergoing catheter ablation for cardiomyopathy-associated idiopathic PVCs were included in this study. Each patient underwent a three-lead ECG recording over a 24-hour period during normal daily ambulatory activities at a screening visit before and 3 months after RFCA. The Beck Depression Inventory Index (BDI-I), Beck Anxiety Inventory Index (BAI-I), and Global Pittsburgh Sleep Quality Index (GPSQI) were assessed before and after RFCA. RESULTS: PVC frequency decreased from 21.99±6.10 to 1.2% after RFCA. Left ventricular ejection fraction (LVEF) increased from 0.41±0.05 to 0.50±0.06 after RFCA (p<0.001). GPSQI (4.90±1.99 to 3.80±1.75, p <0.001), BDI-I (14.12±7.05 to 8.67±5.13, p<0.001), BAI-I (15.12±6.89 to 9.40±5.11, p<0.001) values decreased after RFCA. We found a moderate negative correlation between GPSQI, BDI-I, BAI-I and LVEF (rs=-0.56; p <0.001, rs=-0.55; p<0.001 and rs=-0.62; p<0.001). CONCLUSIONS: In addition to the recovery of systolic and diastolic cardiac functions, mental and psychiatric health parameters also showed great improvement.

The assessment of urinary function following extended lymph node dissection for colorectal cancer.

AIMS: The aim of the current study is to demonstrate whether the effects of extended systematic lymph-node dissection (ESLND) on urinary dysfunctions differ from those of curative radical surgery (CRS) only for rectal cancer. METHODS: We present data about our patients who underwent rectal resection for rectal cancer over 5 years. One hundred and seventy patients with rectal cancer were reviewed with respect to surgical procedures and post-operative urinary problems. RESULTS: We performed CRS on 146 patients and CRS+ESLND on 24 patients, and analysed the incidence of post-operative urinary dysfunction in both groups. Urinary incontinence rates were 39 and 58%, urinary retention rates were 4 and 16%, for the patients from CRS group and CRS+ESLND group, respectively. CONCLUSIONS: We conclude that the addition of ESLND to CRS does not increase the frequency of post-operative urinary dysfunction, apart from an increased risk of urinary retention.