Intensity of Follow-Up After Melanoma Surgery

This contemporary review of melanoma surveillance strategies seeks to help practitioners examine and improve their surveillance protocols based on the currently available data. In general, there is no definitive benefit from increased screening or more aggressive use of interval imaging. Low-intensity surveillance strategies do not appear to adversely affect patient outcomes and should be the preferred approach compared with high-intensity strategies for most melanoma patients. All surveillance programs should emphasize education in order to maximize the effectiveness of patient-based detection of recurrent disease.     

Evaluation of Malignant Breast Lesions in the Diagnostic Setting with Cone Beam Breast Computed Tomography (Breast CT): Feasibility Study

To investigate the feasibility of noncontrast and contrast‐enhanced cone beam breast Computed Tomography (CT) in demonstrating malignant breast lesions in the diagnostic setting. This Institutional Review Board approved, Health Information Portability and Accountability Act compliant, prospective study enrolled BI‐RADS four and five patients from 2008 to 2010. Eighty‐seven subjects had noncontrast breast CT, 42 had contrast‐enhanced breast CT (CE‐breast CT) with 70 pathologically confirmed cancer diagnoses. All 70 comprise the study cohort for noncontrast breast CT, and 23 who had CE‐breast CT comprise the cohort for CE‐breast CT. All had diagnostic work‐up. Patient age, breast density, lesion size and characteristics, biopsy method, and core pathology were recorded. A Fisher's exact test was used to detect a difference in detectability. For agreement in size measurement between the imaging modalities, a paired t‐test was employed. Reported p‐values were based on 2‐sided tests. Two one‐sided tests were calculated to determine equivalence within ±0.3 cm at a 90% significance level. Noncontrast breast CT identified 67 of 70 malignant lesions, detected by diagnostic work‐up. CE‐breast CT identified 23 of 23 index malignant lesions and in addition, found three malignant lesions in three cases not previously detected. Noncontrast breast CT demonstrated the index lesion in 67 of 70 cases and CE‐breast CT demonstrated the index lesion in all 23 cases. An additional three new malignant lesions not seen with conventional diagnostic work‐up were detected. In this preliminary study, breast CT with or without contrast was shown to be accurate at identifying malignant breast lesions in the diagnostic setting.     

Vitamin D Status Is Associated With Grip Strength in Centenarians

Low serum concentrations of 25-hydroxyvitamin D (25(OH)D) have been associated with poor physical function in older adults, but few, if any, studies have examined this relationship in the very old. Therefore, the purpose of this study is to examine this relationship in the very old. Serum 25(OH)D concentrations were obtained from 194 centenarians and near centenarians (98 years and older). The associations between 25(OH)D concentrations and measures of physical function were evaluated with unadjusted and adjusted regression models. We found that 35% of centenarians had 25(OH)D concentrations less than 50 nmol/L. Adjusted mean grip strength was lower for centenarians with 25(OH)D concentrations less than 75 nmol/L than for centenarians with higher concentrations (P<0.05). However, there were no differences in the Georgia Centenarian Study (GCS) Composite Scale, a global measure of physical function, between those with higher and lower 25(OH)D concentrations. We conclude that low 25(OH)D concentrations are associated with poor grip strength, but not GCS Composite Scale, in the very old. Considering the high burden of poor physical function in older adults, understanding the relationship between vitamin D and different measures of physical function, including strength, becomes increasingly important.