[Importance of dermatologic screening within the frame work of a general cancer prevention program]. / Importanza di uno screening dermatologico nell'ambito di un programma di prevenzione oncolologica generale.

BACKGROUND: Skin tumours represent about 11% of all the malignant neoplasms and their frequency is increasing annually. Skin tumours (melanoma, basal and squamous cell carcinoma, etc.) can be used for a good screening activity, but in relation to breast or cervix uteri cancer needs to be better defined. A test on a population of selected patients against skin malignant neoplasms has been carried out in our Centre. All of them had skin lesions and further checks were necessary. METHODS: The diagnostic protocol used in our Centre for Oncological Prevention uses the collection of anamnestic data and an objective examination. Between 1996 and 2000, 222 patients between the ages of 18 and 80 have been selected. All of them had suspected skin lesions. The patients were selected by the oncologist, particularly for pigmentation, asymmetry, irregular borders and heterogeneous colour of their skin lesions. Subsequently, the patients were sent for a further examination to the dermatologist oncologist, who on the basis of the objective dermatological examination with possible dermatoscopy, made a clinical diagnosis of the skin injuries or suggested surgical removal for the histological control of the same. RESULTS: Requested consultations: 222. Exami-nations made: 195. Patients considered: 190. Skin injuries examined: 190. The following skin lesions were identified: melanoma: 4 (2.1%) [2: I Clark level; 2: II Clark level]; basal cell carcinoma: 14 (7.37%); dermatofibrosarcoma: 1 (0.53%); keratoacanthoma: 1 (0.53%); dysplastic nevus: 4 (2.1%); actinic keratosis: 7 (3.68%); benign lesions: 159 (83.68%). CONCLUSIONS: These data were obtained by a screening program and it is therefore not a random study. This study shows interesting results because tumoral skin lesions and in particular melanoma were recognised at early stages. This is more than enough for us to create a specific screening program for skin lesions to cut down the rate of morbidity and mortality.

Normalization of maximal cardiovascular variables for body size in premenarcheal girls.

Previous studies have indicated the importance of allometric scaling of VO2max for body size. However, no information is available on adjusting maximal cardiac output (Qmax) and stroke volume (SVmax) for body dimensions. The allometric exponent b was determined for the equation Y = aXb (where Y is the physiological outcome and X is the anthropometric variable) for VO2max, Qmax, and SVmax relative to mass, height, and body surface area (BSA) in 24 premenarcheal girls (mean age 12.2 years) during cycle testing. Values for b were 1.08 and 1.05 for BSA relative to Qmax and SVmax, approximating that of 1.0 using the traditional ratio standard (cardiac index and stroke index). Exponents of body mass relative to VO2max, Qmax, and SVmax (0.55, 0.55, and 0.59, respectively) eliminated the effects of body size, but the ratio standard (M1.0) did not. In this group of subjects, use of the ratio standard BSA was an appropriate means of adjusting maximal values of Q and SV for body size.

Influence of cardiac functional capacity on gender differences in maximal oxygen uptake in children.

OBJECTIVE: To examine the role of gender differences in cardiac functional capacity in explaining higher mean values for maximal oxygen uptake (VO(2)max) in boys than in girls. DESIGN: Comparative group exercise testing. SETTING: Pediatric exercise testing laboratory. SUBJECTS: Twenty-five prepubertal boys (mean [+/- SD] age, 12 +/- 0.4 years) and 24 premenarcheal girls (mean age, 11.7 +/- 0.5 years). INTERVENTIONS: Maximal incremental upright cycle exercise. MEASUREMENTS AND RESULTS: Mean values for VO(2)max were the following: boys, 47.2 +/- 6.1 mL/kg/min; and girls, 40.4 +/- 5.8 mL/kg/min (16.8% difference; p < 0.05). The average maximal stroke index with Doppler echocardiography was 62 +/- 9 mL/m(2) for boys and 55 +/- 9 mL/m(2) for girls (12.7% difference; p < 0.05). No significant gender differences were seen in maximal heart rate or arterial venous oxygen difference. When VO(2)max and maximal stroke volume (SV) were expressed relative to lean body mass, gender differences declined but persisted, falling to 6.2% and 5.2%, respectively. CONCLUSIONS: These findings indicate that differences in SV as well as in body composition contribute to gender-related variations in VO(2)max during childhood. Whether this reflects small gender differences in relative heart size or dynamic factors influencing ventricular preload and contractility during exercise is unknown.

Cardiovascular fitness in premenarcheal girls and young women.

Maximal oxygen uptake (VO2max) in females, expressed as ml x kg(-1) x min(-1), declines steadily during the first three decades of life. The contribution of diminished cardiovascular function to this apparent fall in aerobic fitness is unknown. Cardiac responses to maximal cycle exercise were compared in 24 premenarcheal females (mean age 11.7 years) and 17 young adult women (mean age 27.4 years) using Doppler echocardiography. Mean VO2max was 40 ml x kg(-1) x min(-1) and 34.7 ml x kg(-1) x min(-1) in the girls and women, respectively (p < 0.05). When VO2max was expressed relative to allometrically-derived mass(0.52), however, no significant difference was observed in aerobic fitness between the two groups. Similar allometric analyses revealed no significant differences in average maximal cardiac output (10.50 vs 10.07 L x min(-1) BSA(-1.11) for girls and women, respectively) nor maximal stroke volume (53 vs 56 ml BSA(-1.13) respectively). These findings suggest that 1) allometric scaling is important in eliminating the effects of body size on VO2max, 2) body dimension differences can account for variations in VO2 in young females, and 3) cardiac functional reserve is similar in premenarcheal girls and young adult women.

Cardiac responses to progressive exercise in normal children: a synthesis.

UNLABELLED: The cardiac responses to exercise are influenced by a complex interplay of changes in diastolic filling, intrinsic myocardial contractility, heart rate, and ventricular afterload. PURPOSE: To characterize these responses in children, findings are reported from two studies utilizing Doppler echocardiographic assessment of stroke volume and cardiac output during maximal upright and semisupine cycle exercise. METHODS: In study 1, stroke volume, heart rate, and peak aortic velocity were assessed during upright cycle exercise to exhaustion in 39 sixth-grade boys. In study 2, similar methods were used to examine cardiac responses to semisupine exercise with measurement of left ventricular dimensions by two-dimensional echocardiography. RESULTS: The findings support patterns similar to that previously described in adults, with an initial rise in stroke volume reaching a plateau at mild-moderate exercise intensities. CONCLUSIONS: The observations in these two studies also suggest 1) peripheral vasodilatation plays an important role in the early rise in stroke volume, 2) increasing heart rate acts to maintain a stable stroke volume and left ventricular diastolic dimension at high workloads, and 3) improvements in contractility serve to maintain stroke volume as the systolic ejection period shortens.

One-mile run performance and cardiovascular fitness in children.

BACKGROUND: Endurance run tests are administered in schools to assess cardiovascular fitness, defined in the laboratory as maximum oxygen consumption. OBJECTIVE: To examine the validity of this concept, assessing the influences of body fat and maximum values of oxygen consumption per unit time, stroke volume, heart rate, and arteriovenous oxygen difference on 1-mile (1.6-km) run time in healthy sixth-grade boys. STUDY DESIGN: Subjects were 36 boys with a mean (SD) age of 12.2 (0.5) years. The relationship was examined between body fat content (estimated by skinfold measurements) and maximum oxygen consumption per kilogram and cardiac variables (during maximum cycle testing) with 1-mile run velocity. RESULTS: Body fat content and maximum oxygen consumption per kilogram (independent of body fat) accounted for 31% and 28% of the variance in run velocity, respectively. Stroke volume was the only component of maximum oxygen consumption that related to run performance. CONCLUSIONS: These findings suggest that cardiovascular fitness and body fat content contribute equally to 1-mile run time in healthy boys and together account for only 60% of the variance in performance on this endurance fitness test. Consequently, 1-mile run performance in children may not serve as a strong indicator of cardiovascular fitness.

Cardiac responses to exercise in child distance runners.

Cardiovascular responses to exercise in trained endurance child athletes have been largely unexplored. Doppler echocardiography was utilized to compare cardiac variables during progressive upright cycle exercise to exhaustion in trained male prepubertal distance runners (n = 8) and untrained control boys (n = 14). Athletes demonstrated a greater maximal stroke index and cardiac index. Stroke volume rose progressively with increasing workloads in the runners but remained stable beyond low intensities in the non-athletes. No significant differences in stroke volume were observed between the two groups at rest. This contrasts with the greater resting stroke volumes typically seen in adult endurance athletes compared to non-athletes. Likewise, values for maximal stroke index were less in the child runners than those typically seen in trained adults. This study demonstrated that the stroke volume response to exercise differs in boy runners compared to non-athletes. The findings also suggest quantitative differences in such responses between prepubertal and young adult athletes.

Test-retest reproducibility of maximum cardiac output by Doppler echocardiography.

Test-retest reproducibility of stroke volume and cardiac output using Doppler echocardiography was examined during maximum cycle exercise in 13 young men. A coefficient of variation of 8.5% and 8.1% and intraclass correlation coefficient of 0.90 and 0.91 for maximum stroke volume and cardiac output, respectively, indicate a high degree of reproducibility using this technique.

Cardiac responses to maximal upright cycle exercise in healthy boys and men.

Previous investigations have indicated that children demonstrate a lower cardiac output at a given oxygen uptake during exercise compared with adults. This study compared cardiac responses with maximal upright cycle exercise in 15 boys (mean age 10.9 yr) and 16 men (mean age 30.7 yr) to determine whether this observation reflects differences in size or age-related influences on myocardial function. Stroke volume, aortic peak velocity, and systolic ejection time were measured to peak exercise in all subjects using Doppler ultrasound techniques. No significant differences were observed in resting, submaximal, or peak mean values for these variables relative to body size between the boys and men. Average values for peak stroke index, cardiac index, and peak aortic velocity were 59 (+/-11) mL.m-2, 11.33 (+/-2.32) L.min-1.m-2, and 152 (+/-30) cm.s-1, respectively, for the boys. Respective values for the men were 61 (+/-14) mL.m-2, 11.08 (+/-2.52) L.min-1.m-2, and 144 (+/-24) cm.s-1 (P > 0.05). This study failed to demonstrate evidence of impaired cardiac responses to maximal exercise in prepubertal boys compared with that in adult males.

Complete resolution of breast cancer bone metastasis through the use of beta-interferon and tamoxifen.

A case report is described referring to a patient affected by single bone metastasis to the cranium from breast cancer. A traditional pharmacological approach was tried but proved clinically disappointing, though radiological and scintigraphic investigation confirmed a complete regression of the metastasis following a combined therapy with beta-interferon and tamoxifen for six months. Results suggest that beta-interferon and tamoxifen may offer an alternative effective approach in treating metastatic breast cancer.