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D Czarnecki

Publications and source records attributed to D Czarnecki.

At least 19 recordsLinked to original sources
PubMed2002

The majority of cutaneous squamous cell carcinomas arise in actinic keratoses.

BACKGROUND: Retrospective studies have given conflicting results with respect to how many cutaneous squamous cell carcinomas (SCCs) arise in actinic keratoses (AK). OBJECTIVE: This study was conducted to determine what percentage of SCCs arise in AKs and to obtain more information about two histological features of SCCs, namely, thickness and ulceration. METHODS: A prospective study was done of all SCCs treated by the authors during one calendar year. RESULTS: Two hundred eight patients with SCC were entered into the study. An AK was contiguous with an SCC in 72% of the cases. This was taken as evidence that the SCC arose in the AK. Men presented with thicker and more ulcerated SCCs than women, but these were not statistically significant: p = 0.06 for thickness and p = 0.07 for ulceration. Ulcerated SCCs were more likely to arise on the head and neck (p = 0.02), on patients who had multiple skin cancers (p = 0.005), and on patients who had a family history of skin cancer (p = 0.03). CONCLUSION: Actinic keratoses need to be removed before they turn into SCCs. The prognostic significance of ulceration of cutaneous SCCs needs to be determined.

Adult↗
PubMed2000

Brain MRI lesions and atrophy are related to depression in multiple sclerosis.

It is unclear whether brain MRI lesions are associated with depression in multiple sclerosis (MS). Neurological dysfunction in depressed (n= 19) and non-depressed (n = 29) MS patients was rated by expanded disability status scale (EDSS). EDSS was weakly predictive of the presence of (p = 0.03) and severity of (p = 0.01) depression. After correcting for EDSS, the presence of depression was predicted by superior frontal and superior parietal hypointense TI lesions (p<0.01); the severity of depression was predicted by superior frontal, superior parietal and temporal TI lesions, lateral and third ventricular enlargement, and frontal atrophy (p<0.01). Depression was not related to bright T2 lesions or enhancement. We conclude that atrophy and cortical-subcortical disconnection due to frontal and parietal white matter destructive lesions may contribute to depression in MS.

Adult↗
PubMed2000

Fatigue in multiple sclerosis and its relationship to depression and neurologic disability.

We studied multiple sclerosis fatigue (MSF) and its relationship to depression and disability. Seventy-one patients [50 relapsing-remitting, 21 secondary progressive] were grouped by Fatigue Severity Scale (FSS) into MS-fatigue (MSF) (FSS>/=5; n=46) or MS-nonfatigue (MSNF) (FSS</=4; n=20). Forty-one patients were grouped into MS-depression (MSD) (n=15) or MS-nondepression (MSND) (n=26) by interview. Higher expanded disability status scale (EDSS) scores were noted in MSF than MSNF patients (P=0.0003); EDSS scores correlated with FSS scores (rho=0.43, P=0.003). However, fatigue was present in 58% (n=29) of relapsing-remitting patients and in 52% (n=26) of patients with mild physical disability (EDSS<3.5). Hamilton/Beck depression severity scores were higher in MSF than MSNF patients and correlated with FSS scores (P<0.05). MSD had higher FSS scores than MSND patients (P=0.008). After controlling for EDSS, depression severity continued to correlate with FSS scores (rho=0.37, P=0.02). After controlling for depression, FSS scores no longer correlated with EDSS scores (rho=0.27, P=0.09). Thus, MSF is independent of physical disability, but is associated with depression, suggesting that common mechanisms play a role in MSF and MSD including psychological factors or brain lesions in specific neuroanatomic pathways. Further study is warranted to determine if antidepressant medications improve fatigue in MS.

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PubMed2000

Is the incidence of malignant melanoma decreasing in young Australians?

Recent reports have detected a decrease in the incidence of malignant melanoma (MM) in young Australian women, but an increase in older Australians. The incidence rates were calculated for the entire population and no adjustments were made to take into account the change in the racial composition of the Australian population. In the past 25 years there has been an influx of immigrants from Asia, the Pacific Islands, and the Middle East who are at low risk for MM. The migrants are relatively young and there are more Asian women than men. The large increase in the percentage of the population that has a low risk for MM may be an important reason why the incidence has fallen in some population groups.

Adult↗
PubMed1996

Lymphocyte counts of patients who have had skin cancer.

BACKGROUND: Investigations of lymphocyte counts in patients with skin cancer have given conflicting results, possibly because homogeneous groups of patients were not studied. OBJECTIVE: Our purpose was to measure lymphocyte counts in patients with skin cancer to determine whether any abnormalities were associated with the number of cancers removed and to determine whether a lymphocyte count could identify patients at risk of the development of large numbers of cancers. METHODS: Apparently otherwise normal patients who had histologically confirmed skin cancers removed were studied. One group consisted of patients who had one skin cancer removed but had not had another within a minimum of 5 years. The other group consisted of patients who had had three or more skin cancers. Standard flow cytometry was used to determine the total lymphocyte count, CD4 (helper cell) count, and CD8 (cytotoxic cell) count. RESULTS: Ninety-six patients with multiple skin cancers, and 24 with one skin cancer were studied. Only basal cell carcinomas (BCCs) were removed from 84 patients and the results from this homogeneous group were as follows: women had a higher CD4 cell count than men (p < 0.05); patients with 20 or more BCCs had a lower lymphocyte count (p < 0.01); and patients with one BCC had a higher CD4/CD8 ratio than those who had multiple BCCs (p < 0.05). CONCLUSION: Differences were found between men and women, as well as between subgroups of patients with skin cancer. However, the range of lymphocyte counts was large and it was not possible to determine a threshold below which patients had a worse prognosis. A lymphocyte count is not a reliable way of predicting which patients will have a large number of skin cancers.

Adult↗
PubMed1996

Recurrent nonmelanoma skin cancer in southern Australia.

BACKGROUND AND OBJECTIVE: In retrospective studies of non-melanoma skin cancers, the recurrence rates were relatively high. This study had as its aim to determine the recurrence rate of nonmelanoma skin cancer (NMSC) and prospectively, risk factors for recurrence in southern Australia. STUDY DESIGN: This is a prospective study of outpatients with histologically confirmed NMSC. All patients seen by a dermatologist between November 1988 and November 1989 were entered into the study and followed for at least 3 years. Any recurrent NMSCS were removed and recorded. RESULTS: Four hundred and eighty-one patients were entered and 420 followed for at least 3 years. A recurrent NMSC developed in 8% (adjusted for losses). A multivariate analysis determined that the main risk factor for recurrence within the first 3 years of follow-up was the number of NMSC a patient had when entering into the study. Those with 3 to nine NMSC were five times more likely to develop a recurrence than those with less than three NMSC. Those with 10 or more NMSC were 25 times more likely to develop a recurrence. Age, sex, and types of skin cancers removed were not risk factors within the first 3 years of follow-up. CONCLUSION: Patients who have had multiple skin cancers require careful follow-up because of the risk of developing recurrences.

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PubMed1996

Cell-mediated immunity of patients who have had basal cell carcinomas.

The cell-mediated immunity of patients who had basal cell carcinomas (BCCs) removed was studied by measuring cuntaneous delayed hypersensitivity reactions to recall antigens (Multitest CMI, Pasteur-Merieux), and by measuring lymphocyte counts and subsets. One group of patients had multiple BCCs (3 or more) removed and were considered to have a high risk of new BCC formation. The other group consisted of patients who had one BCC and had not developed another within 5 years; these were considered to have a low risk of new BCC formation. The low-risk patients had significantly larger cutaneous reactions to recall antigens (p < 0.05) and significantly fewer were anergic (p < 0.01). There was a correlation between smaller cutaneous reactions and increasing numbers of BCCs (p < 0.05). There was no significant difference between the groups in lymphocyte counts or subsets, but the low-risk patients had a significantly higher CD4:CD8 ratio (p < 0.05) than the high-risk group. The Multitest CMI test can be used to determine which patients are at risk of developing many BCCs.

Adult↗
PubMed1995

Impaired cell-mediated immunity of apparently normal patients who had multiple skin cancers.

BACKGROUND: Investigations of the immune status of patients with skin cancer have had conflicting results, possibly because uniform groups of patients were not studied. Patients who had multiple skin cancers (three or more) were studied to determine whether they had impaired cell-mediated immunity (CMI). METHODS: Thirty-four patients and 34 matched control subjects were studied who were younger than 60 years, were not immunosuppressed, and were free from internal cancer. Cell-mediated immunity was tested by the cutaneous reaction to recall antigens (Multitest CMI, Pasteur Merieux, Lyon, France) and the estimation of lymphocyte levels. RESULTS: Patients had significantly lower Multitest CMI scores (P < 0.0005), lower lymphocyte counts (P < 0.02), and were more likely to have a first-degree relative with skin cancer (P < 0.002). Multitest CMI scores decreased with the number of skin cancers removed (P < 0.0006) and were a significant predictor for CD4 (P < 0.04) and CD8 cell counts (P < 0.02). CONCLUSIONS: Patients who had multiple skin cancers had impaired CMI, and the degree of impairment correlated with the number of skin cancers removed.

Adult↗
PubMed1994

Nonmelanoma skin cancer: number of cancers and their distribution in outpatients.

BACKGROUND: Nonmelanoma skin cancer (NMSC) is increasing in incidence and more are developing on the trunk and limbs. The objectives were to determine how many outpatients have more than one NMSC at the time they present for treatment and to determine the anatomical distribution of the cancers. METHODS: All outpatients with histologically confirmed NMSC visited by the authors during 1992 received a total body examination and the number and sites of NMSC were recorded. RESULTS: A total of 952 outpatients were seen. A single NMSC was present in 69.4%, two in 16%, three in 6.4%, four in 3.5%, five to nine in 4.2%, and 0.5% had ten or more. Of the 291 patients with more than one NMSC, one anatomical region was involved in 53.4%, two were involved in 38.4%, and 8.2% had three or more regions involved. CONCLUSION: Patients with NMSC required a total body examination to detect unsuspected skin cancers.

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PubMed1994

Metastases from squamous cell carcinoma of the skin in southern Australia.

BACKGROUND: The frequency with which squamous cell carcinoma (SCC) of the skin metastasizes is a matter of dispute. Studies from private practices have reported much lower rates than hospital-based surveys, and one school of thought is that SCCs which arise in sun-damaged skin have a low risk of metastasis. METHODS: A prospective study of out-patients with histologically confirmed SCC was undertaken in southern Australia, a region with a very high incidence of skin cancer. RESULTS: Between November 1988 and November 1989, 481 patients were entered into the study and 420 followed for at least 3 years. An SCC was the initial diagnosis for 73 patients, 3 were immunosuppressed and 2 had an SCC of the lip, leaving 68 immunocompetent patients with SCC of the skin. Metastatic SCC developed in 2 patients (5.8% adjusted for losses) within 3 years. The SCCs were small and arose in sun-damaged skin. CONCLUSION: Patients with SCC of the skin need a careful follow-up because of the risk of metastasis.

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PubMed1994

The development of non-melanocytic skin cancers in people with a history of skin cancer.

OBJECTIVE: To determine the incidence of new skin cancer formation in people who have had skin cancer removed. STUDY DESIGN: A prospective study of Melbourne out-patients with histologically confirmed non-melanoma skin cancer (NMSC). All patients with NMSC seen by one author (D.C.) between November 1988 and November 1989 were entered into the study and reviewed regularly. New skin cancers were removed and recorded. RESULTS: Four hundred and eighty-one patients were entered and 420 followed for at least 3 years. New NMSC developed in 60% (adjusted for losses) by the end of 3 years. A multivariate analysis determined that the main risk factor for new NMSC formation was the number of previous skin cancers that a patient had. Those who had had multiple skin cancers (3 or more) were at significantly greater risk than those with less than 3. Age, sex and type of NMSC were not risk factors for new skin cancer formation. CONCLUSION: Patients with NMSC require long-term follow-up because of the risk of new skin cancer formation. Those with multiple NMSC need more careful follow-up, and possibly more frequent examinations, because they are at greater risk.

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PubMed1994

Multiple non-melanoma skin cancer: evidence that different MHC genes are associated with different cancers.

HLA DR frequencies of patients with multiple non-melanoma skin cancers were analysed. There were significant differences in the frequencies of HLA DR1, DR4 and DR7 between patients who only had basal cell carcinomas and patients who had both basal and squamous cell carcinomas. There were significant differences in the frequency of HLA DR53 between the two groups. This antigen is in linkage disequilibrium with HLA DR4 and DR7, and it is not possible to distinguish the primary susceptibility locus.

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