High-Risk Cutaneous Squamous Cell Carcinoma without Palpable Lymphadenopathy: Is There a Therapeutic Role for Elective Neck Dissection?

PURPOSE: The beneficial role of elective neck dissection (END) in the management of high-risk cutaneous squamous cell carcinoma (CSCC) of the head and neck remains unproven. Some surgical specialists suggest that END may be beneficial for patients with clinically node-negative (N0) high-risk CSCC, but there are few data to support this claim. We reviewed the available literature regarding the use of END in the management of both CSCC and head and neck SCC (HNSCC). METHODOLOGY: The available medical literature pertaining to END in both CSCC and HNSCC was reviewed using PubMed and Ovid Medline searches. RESULTS: Many surgical specialists recommend that END be routinely performed in patients with N0 HNSCC when the risk of occult metastases is estimated to exceed 20%; however, patients who undergo END have no proven survival benefit over those who are initially staged as N0 and undergo therapeutic neck dissection (TND) after the development of apparent regional disease. There is a lack of data regarding the proper management of regional nodal basins in patients with N0 CSCC. In the absence of evidence-based data, the cutaneous surgeon must rely on clinical judgment to guide the management of patients with N0 high-risk CSCC of the head and neck. CONCLUSIONS: Appropriate work-up for occult nodal disease may occasionally be warranted in patients with high-risk CSCC. END may play a role in only a very limited number of patients with high-risk CSCC.     

Lymphocyte predominance Hodgkin's disease (nodular paragranuloma)–a bcl-2 negative germinal centre lymphoma

Hodin's disease, lymphocyte predominance type (nodular paragranuloma), is of germinal centre origin and the tumours cells have a B-cell phenotype. As the t(14;18) translocation, and the subsequent expression of bcl-2 protein by germinal centre cells, is the most characteristic finding of centroblastic-centrocytic lymphoma, we have tested a series of 11 cases of lymphocyte predominance Hodgkin's disease, using Southern blot analysis for the major breakpoint region and the minor breakpoint cluster region, polymerase chain reaction with primers for the major and minor breakpoint cluster region, and immunohistological studies with a monoclonal antibody specific for the bcl-2 protein. All three techniques gave negative results in the cases of Hodgkin's disease, establishing a clear differentiation from centroblastic-centrocytic lymphoma. These findings are useful in the differential diagnosis between the two entities and raise the question of the non-clonal nature of lymphocyte predominance Hodgkin's disease.     

THE GRIEF EVALUATION MEASURE (GEM): AN INITIAL VALIDATION STUDY

ABSTRACT

This article describes the development of the Grief Evaluation Measure (GEM), a new instrument designed to screen for the development of a complicated mourning response in a bereaved adult. The GEM provides a quantitative and qualitative assessment of risk factors, including the mourner's loss and medical history, coping resources before and after the death, and circumstances surrounding the death. It is designed to provide an in-depth evaluation of the bereaved adult's subjective grief experience and associated symptoms. Reliability and validity studies were conducted with two samples of bereaved adults (n = 23 and n = 92, respectively) from various clinical and support settings. Data on the two central sections of the GEM that assess the mourner's grief response and the level of symptomatology are described. Results indicate that the GEM's internal consistency and test–retest reliability are high. The GEM demonstrates good concurrent validity for established measures of bereavement, trauma, and physical and psychiatric symptoms, and good predictive validity for mourner adjustment one year after initial assessment. Plans for future development and an invitation for other researchers to collaborate with research on the GEM are also discussed.     

Modulators of length of gestation: A study in Greece

In order to ascertain correlates of gestational age and predictorsof prematurity, all the mothers delivered in 1993 at the maternityclinic of the First University Department of Obstetrics andGynaecology and at one division of a private maternity hospitalin Athens, Greece, were interviewed. From a total of 3,770 deliveries,those involving multiple pregnancies or Caesarean deliverieswere excluded, as were pregnancies with an apparent durationof less than 150 or more than 300 days. The analysis was eventuallybased on 2,538 singleton deliveries. The duration of gestationwas modelled as an outcome variable through multiple regression.The following factors were found to be significantly (p<0.05)related to the duration of gestation: maternal education, +0.8day per 3 schooling years; family integrity, single comparedto currently married mother, –3.7 days; parity, muttiparous(4+ births) compared to primiparae, +2.8 days; age at menarche,+1.8 days per 2 years; maternal age, +3.9 days for younger than20 years and –1.7 days for older than 30 years in comparisonto women 20–29 years old; maternal weight before pregnancy,+0.4 day per 5 kg; coffee drinking, +0.7 day per cup per day;tobacco smoking, –1.8 days per 0.5 pack per day. Bleedingduring any trimester of pregnancy and maternal diabetes weresignificantly associated with shorter duration of gestationby 6.7 and 8.2 days respectively. The constellation of riskfactors for a pre-term delivery in Greece appears similar tothat in other populations. However, a positive association betweencoffee drinking and duration of pregnancy has not always beendemonstrated in other studies and the longer duration of pregnancyamong very young women represents an unusual finding. At therange of variation under investigation the individual factorsare not powerful predictors but their combination could identifywomen at high risk for prematurity.