Completion Dissection or Observation for Sentinel-Node Metastasis in Melanoma.

Sentinel-lymph-node biopsy is associated with increased melanoma-specific survival (i.e., survival until death from melanoma) among patients with node-positive intermediate-thickness melanomas (1.2 to 3.5 mm). The value of completion lymph-node dissection for patients with sentinel-node metastases is not clear. In an international trial, we randomly assigned patients with sentinel-node metastases detected by means of standard pathological assessment or a multimarker molecular assay to immediate completion lymph-node dissection (dissection group) or nodal observation with ultrasonography (observation group). The primary end point was melanoma-specific survival. Secondary end points included disease-free survival and the cumulative rate of nonsentinel-node metastasis. Immediate completion lymph-node dissection was not associated with increased melanoma-specific survival among 1934 patients with data that could be evaluated in an intention-to-treat analysis or among 1755 patients in the per-protocol analysis. In the per-protocol analysis, the mean (±SE) 3-year rate of melanoma-specific survival was similar in the dissection group and the observation group (86±1.3% and 86±1.2%, respectively; P=0.42 by the log-rank test) at a median follow-up of 43 months. The rate of disease-free survival was slightly higher in the dissection group than in the observation group (68±1.7% and 63±1.7%, respectively; P=0.05 by the log-rank test) at 3 years, based on an increased rate of disease control in the regional nodes at 3 years (92±1.0% vs. 77±1.5%; P<0.001 by the log-rank test); these results must be interpreted with caution. Nonsentinel-node metastases, identified in 11.5% of the patients in the dissection group, were a strong, independent prognostic factor for recurrence (hazard ratio, 1.78; P=0.005). Lymphedema was observed in 24.1% of the patients in the dissection group and in 6.3% of those in the observation group. Immediate completion lymph-node dissection increased the rate of regional disease control and provided prognostic information but did not increase melanoma-specific survival among patients with melanoma and sentinel-node metastases. (Funded by the National Cancer Institute and others; MSLT-II ClinicalTrials.gov number, NCT00297895 .)

Optimum Currency Areas and Key Currencies: Mundell I versus Mundell II

The East Asian economies are increasingly integrated in trade and direct investment. More than 50 per cent of their foreign trade is with each other. Both the high growth and level of trade integration is similar to what the western European economies achieved in the 1960s. So, in the new millennium, the inevitable question arises: is East Asia also an optimum currency area (OCA)? Despite the apparent success of EMU, many writers familiar with the East Asian scene think not. Taking the seminal papers of Robert Mundell as the starting point, this article first analyses traditional theorizing on the pros and cons of international monetary integration and then suggests new approaches to the problem of international risk-sharing in OCAs. Copyright Blackwell Publishing Ltd 2004.

Public debt in Italy and the European Community Some thoughts on the monetary consequences

Paper presented to conference Debito Pubblico - Teorie ed Esperienze, held at Centro Congressi Universita Roma (IT) from 13-14 November 1990Available from British Library Document Supply Centre- DSC:8368.31(LSE-FMG-SP--30) / BLDSC - British Library Document Supply CentreSIGLEGBUnited Kingdo

Financial control in the transistion to a market economy

Available from British Library Document Supply Centre- DSC:3597.1206(LSE-CEP-DP--40) / BLDSC - British Library Document Supply CentreSIGLEGBUnited Kingdo