Therapeutic Surgical Management of Palpable Melanoma Groin Metastases: Superficial or Combined Superficial and Deep Groin Lymph Node Dissection

Item does not contain fulltextBACKGROUND: Management of patients with clinically detectable lymph node metastasis to the groin is by ilioinguinal or combined superficial and deep groin dissection (CGD) according to most literature, but in practice superficial groin dissection (SGD) only is still performed in some centers. The aim of this study is to evaluate the experience in CGD versus SGD patients in our center. METHODS: Between 1991 and 2009, 121 therapeutic CGD and 48 SGD were performed in 169 melanoma patients with palpable groin metastases at our institute. Median follow-up was 20 and, for survivors, 45 months. RESULTS: In this heterogeneous group of patients, overall (OS) and disease-free survival, local control rates, and morbidity rates were not significantly different between CGD and SGD patients. However, CGD patients had a trend towards more chronic lymphedema. Superficial lymph node ratio, the number of positive superficial lymph nodes, and the presence of deep nodes were prognostic factors for survival. CGD patients with involved deep lymph nodes (24.8%) had estimated 5-year OS of 12% compared with 40% with no involved deep lymph nodes (p = 0.001). Preoperative computed tomography (CT) scan had high negative predictive value of 91% for detection of pelvic nodal involvement. CONCLUSIONS: This study demonstrated that survival and local control do not differ for patients with palpable groin metastases treated by CGD or SGD. Patients without pathological iliac nodes on CT might safely undergo SGD, while CGD might be reserved for patients with multiple positive nodes on SGD and/or positive deep nodes on CT scan

Late Holocene linkages between decade–century scale climate variability and productivity at Lake Tanganyika, Africa

Microlaminated sediment cores from the Kalya slope region of Lake Tanganyika provide a near-annually resolved paleoclimate record between ~~2,840 and 1,420 cal. yr B.P. demonstrating strong linkages between climate variability and lacustrine productivity. Laminae couplets comprise dark, terrigenous-dominated half couplets, interpreted as low density underflows deposited from riverine sources during the rainy season, alternating with light, planktonic diatomaceous ooze, with little terrigenous component, interpreted as windy/dry season deposits. Laminated portions of the studied cores consist of conspicuous dark and light colored bundles of laminae couplets. Light and dark bundles alternate at decadal time scales. Within dark bundles, both light and dark half couplets are significantly thinner than within light bundles, implying slower sediment accumulation rates during both seasons over those intervals. Time series analyses of laminae thickness patterns demonstrate significant periodicities at interannual¿centennial time scales. Longer time scale periodicities (multidecadal to centennial scale) of light and dark half couplet thicknesses are coherent and in some cases are similar to solar cycle periods on these time scales. Although laminae thickness cycles do not strongly covary with the actual ¿14C record for this same time period, two large ¿14C anomalies are associated with substantial decreases in both light and dark laminae thickness. In contrast to the multidecadal¿ centennial time scale, significant annual to decadal periodicities, which are broadly consistent with ENSO/PDO forcing and their impact on East African climate, are not coherent between light and dark half couplets. The coherency of light¿dark couplets at decadal¿centennial time scales, but not at shorter time scales, is consistent with a model of a long-term relationship between precipitation (recorded in wet season dark laminae thickness) and productivity (light laminae thickness), which is not manifest at shorter time scales. We hypothesize that this coupling results from long-term recharging of internal nutrient loading during wet periods (higher erosion of soil P) and reduced loading during drought intervals. The relationship is not expressed on short time scales during which the dominant control on productivity is wind-driven, dry season upwelling, which is uncorrelated with wet-season precipitation. Our record greatly extends the temporal record of this quasi-periodic behavior throughout the late Holocene and provides the first evidence linking decade- to century-scale episodes of enhanced productivity to enhanced precipitation levels and nutrient recharge in a productive tropical lake