To Say or Not to Say: Medical and Social Project.

Mental health and psychological education activities are being carried out in Moscow (the Russian Federation), along with measures aimed at prevention of social stigma in mental health care. The medical, social and educational project To Say or Not to Say has been developed by a group of experts from the Mental-health clinic No. 1 named after N.A. Alexeev, for Moscow residents. The title chosen for the project urges participants to make a choice: continue living with their problems or take a step towards solving them. A new educational activity format has been created and tested in the course of the project, and this format provides an opportunity to largely overcome the stigmatizing barriers that prevent people from seeking psychological and psychiatric help in Moscow. Sixteen events involving over 7,000 citizens have been held, and the psychiatrists engaged in the project have spent 2,280 man-hours in this volunteering activity. We believe that this educational activity could help to overcome social stigma in psychiatry, further research is needed to measure the effect of our educational project on social stigma associated with mental health.

Gadolinium-containing magnetic resonance imaging contrast and nephrogenic systemic fibrosis: a case-control study.

BACKGROUND: Nephrogenic systemic fibrosis (NSF) is a newly described disorder occurring in persons with renal failure. Gadolinium-based contrast used in magnetic resonance imaging (MRI) has been suggested as a cause. A cluster of patients with NSF was investigated to identify risk factors. Limited preliminary findings from this investigation were presented in the Morbidity and Mortality Weekly Report. STUDY DESIGN: Matched case-control. SETTING & PARTICIPANTS: Dialysis patients with and without a diagnosis of NSF treated at an academic medical center. PREDICTOR: Exposure to gadolinium-based contrast. OUTCOMES & MEASUREMENTS: Laboratory and clinical characteristics of NSF. RESULTS: 19 of 28 cases identified at the hospital from December 2002 to August 2006 met inclusion criteria and were matched to 57 controls. In univariate analysis, receipt of gadolinium-containing MRI contrast in the preceding year (odds ratio [OR], 7.99; 95% confidence interval, 2.22 to 28.8) was associated with NSF; the measure of association increased as cumulative dose increased. Gadodiamide exposure (OR, 9.83; 95% confidence interval, 2.09 to 46.2) was associated more strongly with NSF than gadoversetamide (OR, 1.82; 95% confidence interval, 0.33 to 10.2). Although not statistically significant, cases were more likely than controls to have undergone primarily peritoneal dialysis in the preceding 6 months. There was no significant difference in receipt of high-dose recombinant erythropoietin between cases and controls. In multivariable analysis, gadolinium contrast exposure (OR, 8.97; 95% confidence interval, 1.28 to 63.0) remained significantly associated with NSF. LIMITATIONS: Retrospective design, small sample size, inability to completely evaluate erythropoietin. CONCLUSIONS: Receipt of gadolinium-containing MRI contrast is associated with NSF in a dose-dependent manner. The risk associated with gadolinium may differ by contrast agent and dialysis modality. Use of gadolinium-based contrast agents should be avoided when possible in patients with renal failure.

A pilot quality-of-life instrument for acne rosacea.

BACKGROUND: No rosacea-specific quality-of-life (QOL) instrument exists. OBJECTIVE: We sought to develop a validated, reliable rosacea-specific instrument. METHODS: From 6 in-depth interviews, we composed 21 rosacea-specific items. These items and Skindex-29 were administered in a validation cohort (n = 59). Internal consistency reliability and reproducibility were measured with Cronbach's coefficient alpha and intraclass correlation coefficient, respectively. Responsiveness was assessed comparing baseline with 4- to 6-month responses. Construct validity was assessed with principal axes factor analyses. Discriminant validity was examined with an additional 38 patients comparing differences in responsiveness between the rosacea-specific QOL instrument and Skindex. RESULTS: Reliability was high (Cronbach's alpha: 0.82-0.97, intraclass correlation coefficient: 0.70-0.95). The rosacea-specific QOL instrument showed preliminary responsiveness for patients with improved disease (P

Interferon Alfa-2b or not 2b? Significant differences exist in the decision-making process between melanoma patients who accept or decline high-dose adjuvant interferon Alfa-2b treatment.

BACKGROUND: Patients with thick (Breslow>4 mm) primary melanoma and/or regional nodal metastasis have a high risk of tumor recurrence. High-dose adjuvant interferon (IFN) alfa-2b offers/=50% risk of recurrence/disease-related mortality and offered IFN. Telephone surveys delineated reasons behind patients' decisions to accept IFN. RESULTS: Acceptors, 60 of 135 (45%), decided to take IFN alfa-2b whereas 75 of 135 (55%) declined. Being female (OR, 2.4; 95% CI, 1.17-5.03; p=.017) and positive SLN status (OR, 2.2; 95% CI, 1.01-4.97; p=.048) were strongly associated with patients who chose IFN. Acceptors of IFN were younger, more influenced by physicians, and less affected by depression and side effect profile (p<.05 for all). Decliners were more concerned by strained relationships with family and social life (p<.05). CONCLUSIONS: Gender and positive SLN were predictive of high-risk melanoma patients' acceptance of IFN treatment. Physician insight into melanoma patients' therapeutic decision-making process can guide patients through this difficult disease.

Sentinel node biopsy in vulvar and vaginal melanoma: presentation of six cases and a literature review.

BACKGROUND: Urogenital melanoma is a rare neoplasm with poor prognosis. Its management in the past involved radical vulvectomy and complete bilateral inguinofemoral lymphadenectomy. Sentinel lymph node biopsy is an accurate low-morbidity procedure when used in the context of cutaneous melanoma. However, prophylactic lymphadenectomy has not been shown to improve survival of melanoma patients. We wanted to determine the feasibility of sentinel lymph node biopsy in patients with female urogenital melanoma as a staging procedure. METHODS: Six patients with vulvar or vaginal melanomas underwent preoperative lymphatic mapping with (99m)Tc-labeled sulfur colloid followed by sentinel lymphadenectomy. In addition, we reviewed the literature on the application of sentinel lymph node biopsy in urogenital tract melanomas. RESULTS: One or more sentinel nodes were identified in all six patients by lymphoscintigraphy. All patients underwent sentinel lymphadenectomy, except for one patient with a deep vaginal melanoma that drained to pelvic nodes. The five successful cases had unilateral drainage patterns. None of the sentinel lymph nodes excised had tumor invasion. Combined with five other patients from the published literature, the success rate of localizing sentinel lymph nodes in the patients with urogenital melanoma approaches 100%. CONCLUSIONS: This experience, plus reports of a small number of patients from three similar studies, supports the impression that sentinel lymph node biopsy is feasible for vulvar and vaginal melanoma.

Problems in the interpretation of apparent "radial growth phase" malignant melanomas that metastasize.

BACKGROUND: The delineation of radial and vertical growth phases in primary cutaneous malignant melanomas has contributed to our understanding of melanoma progression and has enhanced the ability of pathologists to provide clinicians with meaningful prognostic information. Vertical growth phase (VGP) lesions have the potential to metastasize, but radial growth phase (RGP) melanomas are believed to lack competence for metastasis. METHODS: We have identified three cases in which metastasis occurred in association with lesions initially interpreted as RGP melanomas. To determine whether these cases truly represented exceptional metastasizing RGP melanomas or VGP lesions incorrectly identified as RGP lesions, careful microscopic re-review of these cases was performed. RESULTS: In one case, additional microscopic sectioning revealed a focus of vertical growth that was not evident on the original sections. In the other two cases, only radial growth was found. In one of these cases there was melanoma in situ with regressive changes, but no evidence for invasive melanoma. In the other, a RGP lesion was associated with an adjacent compound nevus with periadnexal involvement. CONCLUSIONS: These cases suggest that, while true RGP melanomas have an excellent prognosis, caution must be exercised in defining a lesion as having no metastatic potential when multiple sections of the primary lesion are unavailable, when the lesion is accompanied by regressive changes, or when there is an associated melanocytic nevus. It is possible that strictly defined RGP melanomas may metastasize in very rare cases. Our observations also suggest that metastatic potential is a function of numerous factors, and may not be evaluable on morphological grounds alone.