Quantitative analysis of detected sentinel lymph nodes and the incidence of micrometastases using two different methods of surgical melanoma treatment--pilot study.

UNLABELLED: The aim of our study was to compare the number of detected sentinel lymph nodes and the incidence of micrometastases between two groups of patients with cutaneous melanoma. METHODS: 100 patients were divided in to two groups: group V and group D. Group V patients (50) with melanoma underwent a single-stage surgery--radical excision of the tumour with sentinel lymph node biopsy (study group "V"). Group D patients (50) with melanoma underwent two-stage surgery; initially primary diagnostic excision of the tumour (0.5 cm from margins of the lesion) followed by a radical re-excision of the post-operative scar and sentinel lymph node biopsy (study group "D"). RESULTS: Study groups "V" and "D" were tested for homogeneity with regard to age, melanoma thickness, location of melanoma, type of melanoma, and ulceration. The groups were found to be homogenous. The average number of removed sentinel lymph nodes in group "D" was 1.0 more than in group "V" (p < 0.05). The averages were 3.7 and 2.7 respectively with a SD of 1.8. The relationship between the SL node staining and type of surgery was (p < 0.05). 49.6% stained radioactive sentinel lymphnodes at the time of surgery was found in group "V", while 33.9% in group "D". CONCLUSIONS: Using two different early-stage cutaneous melanoma management techniques significantly more sentinel lymph nodes (p = 0.006) were detected using the two-stage surgery approach. However, there was no significant difference between the two approaches regarding the number of sentinel lymph nodes with micrometastases that were detected and excised.

The influence of surgical treatment for chronic leg ulcers on the quality dynamics of the patient's life.

THE AIM OF THE STUDY: This study was undertaken to assess the effectiveness of skin grafting and the influence on the quality of the lives of patients who have large chronic venous ulcers. METHODS AND MATERIALS: We have performed the perspective analysis of the course of the disease and of treatment results after 6 months. Two groups of patients were involved in the study. Group O contains patients who have been treated by performing skin graft surgery, while group C contains patients who have been treated only by conservative means. All patients studied have been treated during the period of 2001-2005 at the Department of Plastic Surgery and Burns and at the Clinic of Skin and Venereal Diseases (CSVD) of Kaunas Medical University Hospital (KMUH). During the visit patients had to complete a questionnaire (enclosed with patient's history of treatment), according to which we evaluated the influence of large chronic venous leg ulcers on the quality of patients' lives. This questionnaire has been developed in accordance with the questionnaire for the evaluation of quality of life prepared by prof. dr. M. E. Hyland. RESULTS: At the beginning of the study all patients of O and C groups suffered from pain in the legs. However, at the end of the study, pain decreased only in patients of O group (p < 0.05), while in C group pain practically remained the same. At the beginning of the study, the ulcers deprived many patients from both groups of sleep for most of the night (37-41%). During the repeated questioning it turned out that ulcers only deprived 2.5% of patients in group O of sleep for most of the night, whereas in group C this rose to 19.35%. CONCLUSIONS: Skin grafting positively influences the quality of patients' lives significantly (p < 0.05). Skin grafting has decreased the limitation of function and improved the dysphoric mood. The coverage of ulcers by autografts of skin thickness, had decreased the leg pain within 6 months, significantly more than by conservative treatment alone (p < 0.05). The amount of patients' personal expenditure on the care and treatment of ulcers, increased within the period of 6 months for 11.2% of patients in whom large CVUL were treated conservatively. The amount of personal expenses decreased to 12.8% of patients in whom skin grafting was applied (p > 0.05).