A Rare Case of Cutaneous Metastasis of Renal Cell Carcinoma to the Lateral Thigh.

Renal cell carcinoma (RCC) is a common cancer type in the United States, and at the time of diagnosis, many patients already have metastatic disease. RCC typically metastasizes to the lungs, liver, and bones, with few cases manifesting cutaneous metastasis. Most incidences of RCC metastases reported in the literature have been on the face and scalp. We discuss a case of a 64-year-old male patient who presented with a history of RCC and a purpuric nodule on his lateral thigh. Histopathological examination revealed vacuolated cytoplasm with areas of cytoplasmic clearing; the cells stained positively for cytokeratin AE1/AE3, CAM5.2, and PAX8. Cutaneous metastatic RCC was subsequently diagnosed. Cutaneous manifestations of RCC, particularly to the thigh, remain a rare presentation of metastatic RCC.

Leveling the playing field: can psychological coping resources reduce the influence of physical and technical skills on athletic performance?

BACKGROUND AND OBJECTIVES: The present study assessed the extent to which individual differences in psychological coping resources are related to athletic performance; whether they can attenuate the amount of performance variance accounted for by physical/technical skills; and whether coping resources remain significant predictors of performance when physical/technical skill level is statistically controlled. METHODS: Twenty college golf coaches rated the physical/technical skills of 189 men and women varsity golfers on their teams. Athletes completed the Athletic Coping Skills Inventory (ACSI-28), with the total (Personal Coping Resources) score serving as a global measure of sport-relevant psychological coping resources. Subsequent performance (stroke average per round) of 105 golfers was assessed over a mean of 12.04 competitive rounds during the remainder of the season. RESULTS: Physical/technical skills and psychological coping resource measures were minimally correlated and both were significant and similarly influential predictors of performance. With psychological resources controlled, performance variance accounted for by physical/technical skills was reduced from 21.2% to 10.6%. With physical/technical skills statistically controlled, psychological coping resources, though reduced from 18.2% to 7.5% of accountable variance, remained a significant predictor of performance. CONCLUSION: Results support the significant role played by psychological coping resources as predictors of athletic performance, together with their ability to "level the field" by reducing the influence of physical/technical talent.

The interdependence of behavioral and somatic health: implications for conceptualizing health and measuring treatment outcomes.

PURPOSE: The interdependence of behavioral and somatic aspects of various health conditions warrants greater emphasis on an integrated care approach. THEORY: We propose that integrated approaches to health and wellness require comprehensive and empirically-valid outcome measures to assess quality of care. METHOD: We discuss the transition from independent to integrated treatment approaches and provide examples of new systems for integrated assessment of treatment outcome. RESULTS: Evidence suggests that support for an independent treatment approach is waning and momentum is building towards more integrated care. In addition, research evidence suggests integrated care improves health outcomes, and both physicians and patients have favorable impressions of integrated care. CONCLUSIONS: As treatment goals in the integrated perspective expand to take into account the intimate relationships among mental illness, overall health, and quality of life, clinicians need to develop outcome measures that are similarly comprehensive. DISCUSSION: Increased recognition, by researchers, providers, and insurers, of the interdependence between behavioral and physical health holds great promise for innovative treatments that could significantly improve patients' lives.

Implementation of a consumer-directed approach in behavioral health care: problems and prospects.

Consumer-directed care, a payment system designed to make patients aware of the costs of care, requires treatment seekers to be active participants in their health care. Core components of consumer-directed care, such as higher deductibles and increased decision-making responsibilities, might preclude its easy translation from medical to behavioral health care. Aspects of behavioral disorders will force providers, insurers, and patients to compensate for unique barriers to increasing self-care, such as stigma, neuropsychological complications, and poor self-efficacy. This column describes important components of consumer-directed care and the unique barriers that behavioral health care creates for those components. Possible best practices are suggested for surmounting those barriers.