Management of functional neurological disorder.

Functional neurological disorder (FND) is a common cause of persistent and disabling neurological symptoms. These symptoms are varied and include abnormal control of movement, episodes of altered awareness resembling epileptic seizures and abnormal sensation and are often comorbid with chronic pain, fatigue and cognitive symptoms. There is increasing evidence for the role of neurologists in both the assessment and management of FND. The aim of this review is to discuss strategies for the management of FND by focusing on the diagnostic discussion and general principles, as well as specific treatment strategies for various FND symptoms, highlighting the role of the neurologist and proposing a structure for an interdisciplinary FND service

Completeness of data on malignant melanoma skin sites and morphology in Croatian National Cancer Registry 2000-2014: an overview of recent progress

Mortality rates and five-year relative survival for malignant melanomaMM of the skin in Croatia are poor compared with most Europeancountries. Epidemiological data recorded at the National Cancer Registry(CNCR) are used for informing various decision-makers and researchers, aswell as comparisons with other countries. We analyzed CNCR data on MMskin sites and morphology for 2000-2007 and 2008-2014 and comparedthem with European 2000-2007 data. We further stratified skin site analysesin Croatia by sex, different age groups, and sources of reports. We found 52%of case with “non-specified sites” in Croatia in 2000-2007; however, that ratiodecreased to 36% in 2008-2014, with 29% of registered MM cases occurringon the trunk, 22% on the limbs, and 13% on the head and neck. The ratio of“non-specified sites” cases in reports originating from university hospitalsdecreased by 25% and by 9.2% in those from general hospitals. The ratioof “not otherwise specified” among histologically verified cases decreasedfrom 96% in 2000-2007 to 84% in 2008-2014. Our results reveal a substantialratio of inadequately reported cases, in particular when compared to data atthe European level, where in 2000-2007 only 7.7% of cases were from “nonspecifiedsites” and 19% were of non-specified morphology. Irrespective ofrecent progress, the proportion of unspecified cases still hampers insight into sitedistribution by subgroups. A further increase in the overall completeness ofMM data within CNCR is needed to enable research-informed improvementof melanoma control in the country. Our findings call for engagement ofall stakeholders in optimization of the national melanoma registration processesand using models such as RegisTree to facilitate these initiatives.</p

Trends in incidence and prognosis of the histological subtypes of lung cancer in North America, Australia, New Zealand and Europe

Background: Since the incidence of the histological subtypes of lung cancer in industrialised countries has changed dramatically over the last two decades, we reviewed trends in the incidence and prognosis in North America, Australia, New Zealand and Europe, according to period of diagnosis and birth cohort and summarized explanations for changes in mortality. Methods: Review of the literature based on a computerised search (Medline database 1966-2000). Results: Although the incidence of lung cancer has been decreasing since the 1970s/1980s among men in North America, Australia, New Zealand and north-western Europe, the age-adjusted rate continues to increase among women in these countries, and among both men and women in southern and eastern Europe. These trends followed changes in smoking behaviour. The proportion of adenocarcinoma has been increasing over time; the most likely explanation is the shift to low-tar filter cigarettes during the 1960s and 1970s. Despite improvement in both the diagnosis and treatment, the overall prognosis for patients with non-small-cell lung cancer hardly improved over time. In contrast, the introduction and improvement of chemotherapy since the 1970s gave rise to an improvement in - only short-term (<2 years) - survival for patients with small-cell lung cancer. Conclusions: The epidemic of lung cancer is not over yet, especially in southern and eastern Europe. Except for short-term survival of small cell tumours, the prognosis for patients with lung cancer has not improved significantly. Copyrigh

Completeness of data on malignant melanoma skin sites and morphology in Croatian National Cancer Registry 2000-2014: an overview of recent progress

Mortality rates and five-year relative survival for malignant melanomaMM of the skin in Croatia are poor compared with most Europeancountries. Epidemiological data recorded at the National Cancer Registry(CNCR) are used for informing various decision-makers and researchers, aswell as comparisons with other countries. We analyzed CNCR data on MMskin sites and morphology for 2000-2007 and 2008-2014 and comparedthem with European 2000-2007 data. We further stratified skin site analysesin Croatia by sex, different age groups, and sources of reports. We found 52%of case with “non-specified sites” in Croatia in 2000-2007; however, that ratiodecreased to 36% in 2008-2014, with 29% of registered MM cases occurringon the trunk, 22% on the limbs, and 13% on the head and neck. The ratio of“non-specified sites” cases in reports originating from university hospitalsdecreased by 25% and by 9.2% in those from general hospitals. The ratioof “not otherwise specified” among histologically verified cases decreasedfrom 96% in 2000-2007 to 84% in 2008-2014. Our results reveal a substantialratio of inadequately reported cases, in particular when compared to data atthe European level, where in 2000-2007 only 7.7% of cases were from “nonspecifiedsites” and 19% were of non-specified morphology. Irrespective ofrecent progress, the proportion of unspecified cases still hampers insight into sitedistribution by subgroups. A further increase in the overall completeness ofMM data within CNCR is needed to enable research-informed improvementof melanoma control in the country. Our findings call for engagement ofall stakeholders in optimization of the national melanoma registration processesand using models such as RegisTree to facilitate these initiatives.</p

Excess mortality from breast cancer 20 years after diagnosis when life expectancy is normal

In a population-based study, causes of death were traced of 418 deceased breast cancer patients diagnosed in 1960–1979 who survived at least 10 years after diagnosis. The pattern of causes of death in these patients was compared with the general female population using standardized mortality ratios (SMRs). Of 418 patients surviving at least 10 years, 196 (47%) died from breast cancer and 50 (12%) died from another cancer. The SMR for breast cancer was 15.8 (95% CI: 13.1–18.8) 10–14 years after diagnosis; it was still 4.7 (95% CI: 2.6–7.8) after 20 years. Overall mortality was higher than expected 10–14 years after diagnosis (SMR: 1.3; 95% CI: 1.1–1.5), but lower after more than 20 years (SMR: 0.6; 95% CI: 0.4–0.7). Despite a normal (or even improved) life expectancy for breast cancer patients 20 years after diagnosis the risk of dying from this disease remained elevated. © 2001 Cancer Research Campaign http://www.bjcancer.co