Medicine and Health Sciences Commons^™

Mixed Germ Cell Sex Cord-Stromal Tumors Of The Testis And Ovary. Morphological, Immunohistochemical, And Molecular Genetic Study Of Seven Cases, Michal Michal, Tomas Vanacek, Radek Sima, Petr Mukensnabl, Ondrej Hes, Dmitry V. Kazakov, Jozef Matoska, Anna Zuntova, Vladimir Dvorak, Alexander Talerman

Department of Pathology, Anatomy, and Cell Biology Faculty Papers

We present the morphological, immunohistochemical, and molecular genetic features of three cases of testicular and four cases of ovarian mixed germ cell sex cord-stromal tumors (MGSCT). The germ cells in the testicular MGSCTs morphologically differed from those in classical seminomas by lacking the typical "square off" quality of the nuclei. In contrast to the nuclei in classical seminomas, their size in testicular MGSCTs was smaller and nucleoli were inconspicuous and the cytoplasm was Periodic Acid-Schiff(PAS) negative. Quite on the contrary, the variability in the size of the nuclei of the germ cells in the testicular MGSCTs was more similar to …

Successful Treatment Of Depot Medroxyprogesterone Acetate-Related Vaginal Bleeding Improves Continuation Rates In Adolescents, Kristin M. Rager, Amy Fowler, Hatim A. Omar

Pediatrics Faculty Publications

High discontinuation rates for depot medroxyprogesterone acetate (DMPA) in adolescents may contribute to the number of unintended pregnancies. Many cite vaginal bleeding as a reason for discontinuing DMPA use. In this study, we attempted to determine if treating DMPA-associated vaginal bleeding with monophasic oral contraceptive pills (OCP) raised continuation rates. A total of 131 patients who reported vaginal bleeding while on DMPA were included in this study and 83 were treated with monophasic OCP. Of those who received OCP, 38.7% reported that vaginal bleeding stopped completely, 51.8% reported that vaginal bleeding stopped temporarily, and 6.0% reported no change. Overall, 94% …

Clinical Holistic Medicine: Holistic Sexology And Acupressure Through The Vagina (Hippocratic Pelvic Massage), Søren Ventegodt, Birgitte Clausen, Hatim A. Omar, Joav Merrick

Pediatrics Faculty Publications

Many gynecological and sexological problems (like urine incontinence, chronic pelvic pains, vulvodynia, and lack of lust, excitement, and orgasm) are resistant to standard medical treatment. In our work at the Research Clinic for Holistic Medicine in Copenhagen, we have found that vaginal acupressure, or Hippocratic pelvic massage, can help some of these problems. Technically, it is a very simple procedure as it corresponds to the explorative phase of the standard pelvic examination, supplemented with the patient's report on the feelings it provokes and the processing and integration of these feelings. Sometimes it can be very difficult to control the emotions …

Abnormal Expression Of Rest/Nrsf And Myc In Neural Stem/Progenitor Cells Causes Cerebellar Tumors By Blocking Neuronal Differentiation, Xiaohua Su, Vidya Gopalakrishnan, Duncan Stearns, Kenneth Aldape, Fredrick F Lang, Evan Snyder, Sadhan Majumder

Faculty, Staff and Student Publications

Medulloblastoma, one of the most malignant brain tumors in children, is thought to arise from undifferentiated neural stem/progenitor cells (NSCs) present in the external granule layer of the cerebellum. However, the mechanism of tumorigenesis remains unknown for the majority of medulloblastomas. In this study, we found that many human medulloblastomas express significantly elevated levels of both myc oncogenes, regulators of neural progenitor proliferation, and REST/NRSF, a transcriptional repressor of neuronal differentiation genes. Previous studies have shown that neither c-Myc nor REST/NRSF alone could cause tumor formation. To determine whether c-Myc and REST/NRSF act together to cause medulloblastomas, we used a …

Analysis Of Epstein-Barr Virus Reservoirs In Paired Blood And Breast Cancer Primary Biopsy Specimens By Real Time Pcr., R Serene Perkins, Katherine Sahm, Cindy Marando, Diana Dickson-Witmer, Gregory R Pahnke, Mark Mitchell, Nicholas J Petrelli, Irving M Berkowitz, Patricia Soteropoulos, Virginie M Aris, Stephen P Dunn, Leslie J Krueger

Department of Surgery Faculty Papers

INTRODUCTION: Epstein-Barr virus (EBV) is present in over 90% of the world's population. This infection is considered benign, even though in limited cases EBV is associated with infectious and neoplastic conditions. Over the past decade, the EBV association with breast cancer has been constantly debated. Adding to this clinical and biological uncertainty, different techniques gave contradictory results for the presence of EBV in breast carcinoma specimens. In this study, minor groove binding (MGB)-TaqMan real time PCR was used to detect the presence of EBV DNA in both peripheral blood and tumor samples of selected patients. METHODS: Peripheral blood and breast …

Cutaneous And Presumed Visceral Leishmaniasis In A Soldier Deployed To Afghanistan, James P. Woodrow, Joshua D. Hartzell, Jim Czarnik, David Brett-Major, Glenn Wortmann

Journal Articles: Epidemiology

Leishmaniasis has been frequently diagnosed in US military personnel returning from duty in Southwest Asia. The majority of cases have demonstrated cutaneous disease, although a few cases of visceral disease have been documented. We present the case of an immunocompetent, HIV-negative, US Army soldier who suffered both visceral and cutaneous manifestations of leishmaniasis after returning from deployment in Afghanistan. Overlap of cutaneous and visceral involvement is rare and has not been reported in our cohort. Latent Plasmodium vivax infection may have been an exacerbating cofactor. We discuss this case and present a review of the literature.

Near-Infrared Characterization Of Breast Tumors In Vivo Using Spectrally-Constrained Reconstruction, Subhadra Srinivasan, Brian W. Pogue, Ben Brooksby, Shudong Jiang, Hamid Dehghani, Christine Kogel, Wendy A. Wells, Steven P. Poplack, Keith D. Paulsen

Dartmouth Scholarship

Multi-wavelength Near-Infrared (NIR) Tomography was utilized in this study to non-invasively quantify physiological parameters of breast tumors using direct spectral reconstruction. Frequency domain NIR measurements were incorporated with a new spectrally constrained direct chromophore and scattering image reconstruction algorithm, which was validated in simulations and experimental phantoms. Images of total hemoglobin, oxygen saturation, water, and scatter parameters were obtained with higher accuracy than previously reported. Using this spectral approach, in vivo NIR images are presented and interpreted through a series of case studies (n=6 subjects) having differing abnormalities. The corresponding mammograms and ultrasound images are also evaluated. Three of six …

Cpg Oligodeoxynucleotides Stimulate Cord Blood Mononuclear Cells To Produce Immunoglobulins., Cheri D Landers, Subbarao Bondada

Microbiology, Immunology, and Molecular Genetics Faculty Publications

CpG oligodeoxynucleotides (ODNs) stimulate adult B cells leading to cellular proliferation and immunoglobulin production. It is unknown if CpG-ODNs similarly stimulate neonatal human B cells. Neonates have immature immune responses and are poorly responsive to thymus independent antigens such as polysaccharides. We determined umbilical cord cells' response to CpG-ODNs. Adult and umbilical cord B cells produced similar amounts of IgM (adult 1371 +/- 352 vs. cord 1873 +/- 1084 ng/ml) in response to CpG-ODN stimulation. Although CpG-ODN was able to stimulate adult IgG and IgA production, cord cells produced less IgG (153 +/- 58 vs. 10 +/- 2.5 ng/ml) and …

The Neural Mechanisms Of Speech Comprehension: Fmri Studies Of Semantic Ambiguity, Jennifer M Rodd, Matthew H Davis, Ingrid Johnsrude

Brain and Mind Institute Researchers' Publications

A number of regions of the temporal and frontal lobes are known to be important for spoken language comprehension, yet we do not have a clear understanding of their functional role(s). In particular, there is considerable disagreement about which brain regions are involved in the semantic aspects of comprehension. Two functional magnetic resonance studies use the phenomenon of semantic ambiguity to identify regions within the fronto-temporal language network that subserve the semantic aspects of spoken language comprehension. Volunteers heard sentences containing ambiguous words (e.g. 'the shell was fired towards the tank') and well-matched low-ambiguity sentences (e.g. 'her secrets were written …

A Model Program For Youth Suicide Prevention, Hatim A. Omar

Pediatrics Faculty Publications

Youth suicide continues to be one of the leading causes of death in the United States. Nation wide it is the third leading cause of death in the 10-24 year old age group. The rate of suicide varies somewhat from state to state. In the state of Kentucky, youth suicide is the second leading cause of death. This article describes a grass root, community-based program for youth suicide prevention and its impact on the community. The Stop Youth Suicide Campaign was launched in October 2000 and included more than 30 local agencies. This program worked. through public education, education of …

Learning To Like: A Role For Human Orbitofrontal Cortex In Conditioned Reward, Sylvia M L Cox, Alexandre Andrade, Ingrid Johnsrude

Brain and Mind Institute Researchers' Publications

A great deal of human behavior and motivation is based on the intrinsic emotional significance of rewarding or aversive events, as well as on the associations formed between such emotional events and concurrent environmental stimuli. Recent functional neuroimaging studies have implicated the ventral striatum, orbitofrontal cortex (OFC), and amygdala in the representation of reward values and/or in the anticipation of rewarding events. Here, we use functional magnetic resonance imaging to compare brain activation during the presentation of reward with that during presentation of (conditioned) stimuli that have been paired previously with reward. Specifically, we aimed to investigate conditioned reward in …

Clinical Characteristics Of Individuals Using An Online Alcohol Evaluation Program., Daniel Z Lieberman

Psychiatry and Behavioral Sciences Faculty Publications

Access to treatment for substance abuse disorders is limited, and practical strategies are needed to expand opportunities for individuals to receive effective interventions. Automated or semi-automated treatments have shown promise in other disorders. Identifying the characteristics of patients who will be able to benefit from this unconventional approach will increase the likelihood of success. The current study examined 1,297 individuals using an online alcohol evaluation program. Subjects had high scores on the Alcohol Use Disorders Identification Test (AUDIT) and a substantial amount of ambivalence about the possible harm that their drinking caused, but they also had very low levels of …

The Meaning Of Computers To A Group Of Men Who Are Homeless., Kathleen Swenson Miller, Stacey Bunch-Harrison, Brett Brumbaugh, Rekha Sankaran Kutty, Kathleen Fitzgerald

Department of Occupational Therapy Faculty Papers

The purpose of this pilot study was to explore the experience with computers and the meaning of computers to a group of homeless men living in a long-term shelter. This descriptive exploratory study used semistructured interviews with seven men who had been given access to computers and had participated in individually tailored occupation based interventions through a Work Readiness Program. Three themes emerged from analyzing the interviews: access to computers, computers as a bridge to life-skill development, and changed self-perceptions as a result of connecting to technology. Because they lacked computer knowledge and feared failure, the majority of study participants …

A Pilot Randomized, Controlled Trial Of An In-Home Drinking Water Intervention Among Hiv + Persons, John M. Colford, Sona R. Saha, Timothy J. Wade, Catherine C. Wright, Mai Vu, Sandra Charles, Peter Jensen, Alan Hubbard, Deborah A. Levy, Joseph N. S. Eisenberg

Journal Articles: Epidemiology

Although immunocompromised persons may be at increased risk for gastrointestinal illnesses, no trials investigating drinking water treatment and gastrointestinal illness in such patients have been published. Earlier results from San Francisco suggested an association (OR 6.76) between tap water and cryptosporidiosis among HIV + persons. The authors conducted a randomized, triple-blinded intervention trial of home water treatment in San Francisco, California, from April 2000 to May 2001. Fifty HIV-positive patients were randomized to externally identical active (N = 24) or sham (N = 26) treatment devices. The active device contained a filter and UV light; the sham provided no treatment. …

A Randomized, Controlled Trial Of In-Home Drinking Water Intervention To Reduce Gastrointestinal Illness, John M. Colford, Timothy J. Wade, Sukhminder K. Sandhu, Catherine C. Wright, Sherline Lee, Susan Shaw, Kim Fox, Susan Burns, Anne Benker, M. Alan Brookhart, Mark Van Der Laan, Deborah A. Levy

Journal Articles: Epidemiology

Trials have provided conflicting estimates of the risk of gastrointestinal illness attributable to tap water. To estimate this risk in an Iowa community with a well-run water utility with microbiologically challenged source water, the authors of this 2000-2002 study randomly assigned blinded volunteers to use externally identical devices (active device: 227 households with 646 persons; sham device: 229 households with 650 persons) for 6 months (cycle A). Each group then switched to the opposite device for 6 months (cycle B). The active device contained a 1-microm absolute ceramic filter and used ultraviolet light. Episodes of "highly credible gastrointestinal illness," a …

Medical Symptoms Associated With Tobacco Smoking With And Without Marijuana Abuse Among Crack Cocaine-Dependent Patients., Ashwin A. Patkar, Vikas Batra, Paolo Mannelli, Sarah Evers-Casey, Michael J. Vergare, Frank T. Leone

Department of Psychiatry and Human Behavior Faculty Papers

Despite the widespread use of tobacco and marijuana by cocaine abusers, it remains unclear whether combined tobacco and marijuana smoking is more harmful than tobacco smoking alone in cocaine abusers. We investigated the differences in medical symptoms reported among 34 crack cocaine abusers who did not smoke tobacco or marijuana (C), 86 crack cocaine abusers who also smoked tobacco (C + T), and 48 crack abusers who smoked both tobacco and marijuana (C + T + M). Medical symptoms were recorded using a 134-item self-report instrument (MILCOM), and drug use was assessed using the Addiction Severity Index (ASI). After controlling …

The Relationship Between Future Orientation And Street Substance Use Among Texas Alternative School Students, Christine M Markham, George S Yacoubian

Faculty, Staff and Student Publications

Self-reported substance use data were collected from 963 alternative school students in grades 7-12 who were surveyed through the Safer Choices 2 study in Houston, Texas. Data were collected between October 2000 and March 2001. Logistic regression analyses indicated that lower levels of future orientation was significantly associated (OR = 0.88, 95% CI = 0.81-0.97) with thirty-day substance use after controlling for age and gender. In addition, lower levels of future orientation was found to have a significant association with students' lifetime substance use (OR = 0.93, 95% CI = 0.87-.99) after controlling for age, race, and gender. While the …

Identifying Inaccuracies On Emergency Medicine Residency Applications., Eric D Katz, Lee Shockley, Lawrence Kass, David Howes, Janis P Tupesis, Christopher Weaver, Osman R Sayan, Victoria Hogan, Jason Begue, Diamond Vrocher, Jackie Frazer, Timothy Evans, Gene Hern, Ralph Riviello, Antonio Rivera, Keith Kinoshita, Edward Ferguson

Department of Emergency Medicine Faculty Papers

BACKGROUND: Previous trials have showed a 10-30% rate of inaccuracies on applications to individual residency programs. No studies have attempted to corroborate this on a national level. Attempts by residency programs to diminish the frequency of inaccuracies on applications have not been reported. We seek to clarify the national incidence of inaccuracies on applications to emergency medicine residency programs. METHODS: This is a multi-center, single-blinded, randomized, cohort study of all applicants from LCME accredited schools to involved EM residency programs. Applications were randomly selected to investigate claims of AOA election, advanced degrees and publications. Errors were reported to applicants' deans …

Persuasive Email Messages For Patient Communication, Jiajie Zhang

Faculty, Staff and Student Publications

To improve health and reduce costs, we need to encourage patients to make better health care decisions. Since email is widely available, it may be useful for patient-directed interventions. However, we know little about how the contents of an email message can influence a health-related decision. We propose a model to understand how patients may process persuasive email messages.

Relationship Of Serum Prolactin With Severity Of Drug Use And Treatment Outcome In Cocaine Dependence., Ashwin A. Patkar, Paolo Mannelli, Kenneth M. Certa, Kathleen Peindl, Heather Murray, Michael J. Vergare, Wade H. Berrettini

Department of Psychiatry and Human Behavior Faculty Papers

RATIONALE: Alteration in serum prolactin (PRL) levels may reflect changes in central dopamine activity, which modulates the behavioral effects of cocaine. Therefore, serum PRL may have a potential role as a biological marker of drug severity and treatment outcome in cocaine dependence.

OBJECTIVE: We investigated whether serum PRL levels differed between cocaine-dependent (CD) subjects and controls, and whether PRL levels were associated with severity of drug use and treatment outcome in CD subjects.

METHODS: Basal PRL concentrations were assayed in 141 African-American (AA) CD patients attending an outpatient treatment program and 60 AA controls. Severity of drug use was assessed …

Differential Expression Of Toll-Like Receptors 2 And 4 In Tissues Of The Human Female Reproductive Tract, Patricia A. Pioli, Eyal Amiel, Todd M. Schaefer, John E. Connolly, Charles R. Wira, Paul M. Guyre

Dartmouth Scholarship

Toll-like receptor (TLR) signal transduction is a central component of the innate immune response to pathogenic challenge. Although recent studies have begun to elucidate differences in acquired immunity in tissues of the human female reproductive tract, there is a relative paucity of work regarding innate defense mechanisms. We investigated TLR mRNA and protein expression in tissues of the human female reproductive tract. Constitutive mRNA expression of TLRs 1 to 6 was observed in fallopian tubes, uterine endometrium, cervix, and ectocervix. Furthermore, transcripts of the signaling adapter MyD88 and the accessory molecule CD14 were also detected in all tissues assayed. Quantitative …

Collecting Duct Carcinoma Of The Kidney: An Immunohistochemical Study Of 11 Cases., Andrea Vecchione, Tommaso Prayer Galetti, Marina Gardiman, Hideshi Ishii, Enrico Giarnieri, Francesco Pagano, Leonard G Gomella, Carlo M Croce, Raffaele Baffa

Department of Urology Faculty Papers

BACKGROUND: Collecting duct carcinoma (CDC) is a rare but very aggressive variant of kidney carcinoma that arises from the epithelium of Bellini's ducts, in the distal portion of the nephron. In order to gain an insight into the biology of this tumor we evaluated the expression of five genes involved in the development of renal cancer (FEZ1/LZTS1, FHIT, TP53, P27kip1, and BCL2). METHODS: We studied eleven patients who underwent radical nephrectomy for primary CDC. All patients had an adequate clinical follow-up and none of them received any systemic therapy before surgery. The expression of the five markers for tumor initiation …

Clinical Profiles, Occurrence, And Management Of Adolescent Patients With Hair-An Syndrome, Hatim A. Omar, Stephanie Logsdon, Jessica Richards

Pediatrics Faculty Publications

The syndrome of hyperandrogenism, insulin resistance, and acanthosis nigricans (HAIR-AN) is a subphenotype of the polycystic ovary syndrome. It is one of the most common causes of menstrual problems, hyperandrogenic symptoms, and insulin resistance among young women. Review of clinical data in an outpatient adolescent clinic showed that of the 1,002 young women (ages 10-21 years) attending the clinic over a 2-year period, 50 (5%) were diagnosed with HAIR-AN syndrome. Mean age of the patients was 15.5, initial mean weight at diagnosis was 94.5 kg, and the mean BMI was 33.33 kg/m2. Patients were treated with a weight-stabilization and -reduction …

Predictors Of Paralysis In The Rheumatoid Cervical Spine In Patients Undergoing Total Joint Arthroplasty., Jonathan N Grauer, Edwin M Tingstad, Nahshon Rand, Michael J Christie, Alan Hilibrand

Rothman Institute Papers

BACKGROUND: Rheumatoid arthritis is sometimes associated with radiographic evidence of instability of the cervical spine, most commonly an abnormal subluxation between vertebrae. When this instability compromises the space that is available for the spinal cord, it may be predictive of paralysis. However, the prevalence of radiographic signs of instability that are predictive of paralysis among patients with nonspinal orthopaedic manifestations of rheumatoid arthritis is unknown.

METHODS: Radiographs of the cervical spine of patients with rheumatoid arthritis who had undergone total joint arthroplasty over a five-year period were retrospectively reviewed. The radiographs were evaluated for predictors of paralysis (a posterior atlantodental …

Test-Retest Reliability Of Temporal And Spatial Gait Characteristics Measured With An Instrumented Walkway System (Gaitrite®), Cornelius J.T. Van Uden, Marcus P. Besser

Department of Physical Therapy Faculty Papers

Background
The purpose of this study was to determine the test-retest reliability of temporal and spatial gait measurements over a one-week period as measured using an instrumented walkway system (GAITRite®).

Methods
Subjects were tested on two occasions one week apart. Measurements were made at preferred and fast walking speeds using the GAITRite® system. Measurements tested included walking speed, step length, stride length, base of support, step time, stride time, swing time, stance time, single and double support times, and toe in-toe out angle.

Results
Twenty-one healthy subjects participated in this study. The group consisted of 12 men and 9 women, …

Test-Retest Reliability Of Temporal And Spatial Gait Characteristics Measured With An Instrumented Walkway System (Gaitrite)., Cornelis J T Van Uden, Marcus P Besser

Department of Physical Therapy Faculty Papers

BACKGROUND: The purpose of this study was to determine the test-retest reliability of temporal and spatial gait measurements over a one-week period as measured using an instrumented walkway system (GAITRite). METHODS: Subjects were tested on two occasions one week apart. Measurements were made at preferred and fast walking speeds using the GAITRite system. Measurements tested included walking speed, step length, stride length, base of support, step time, stride time, swing time, stance time, single and double support times, and toe in-toe out angle. RESULTS: Twenty-one healthy subjects participated in this study. The group consisted of 12 men and 9 women, …

Differences In Peripheral Noradrenergic Function Among Actively Drinking And Abstinent Alcohol-Dependent Individuals., Ashwin A. Patkar, Charles A. Marsden, Prakash C. Naik, David A. Kendall, Raman Gopalakrishnan, Michael J. Vergare, Stephen P. Weinstein

Department of Psychiatry and Human Behavior Faculty Papers

We examined whether excessive alcohol consumption was related to changes in plasma levels of noradrenaline (NA) and whether these changes recover following abstinence. We also explored whether there were differences in NA levels between Type I and Type II alcoholics and controls during active drinking and abstinence. Plasma concentrations of NA were determined in (1) 27 Caucasian men with alcohol dependence who were regularly drinking (active drinkers) within 24 hours of hospitalization, (2) 29 Caucasian alcohol-dependent men who were in remission (abstinent for a minimum of three months), and (3) 28 race- and gender-matched healthy controls. NA concentrations were significantly …

Characterization Of Hemoglobin, Water, And Nir Scattering In Breast Tissue: Analysis Of Intersubject Variability And Menstrual Cycle Changes, Brian W. Pogue, Shudong Jiang, Hamid Dehghani, Christine Kogel, Sandra Soho, Subhadra Srinivasan, Xiaomei Song, Tor D. Tosteson, Steven P. Poplack, Keith D. Paulsen

Dartmouth Scholarship

Near-infrared imaging was used to quantify typical values of hemoglobin concentration, oxygen saturation, water fraction, scattering power, and scattering amplitude within the breast tissue of volunteer subjects. A systematic study of the menstrual variations in these parameters was carried out by measuring a group of seven premenopausal normal women (aged 41 to 47 years) in the follicular (days 7 to 14 of the cycle) and secretory phases (days 21 to 28) of the cycle, for two complete menstrual cycles. An average increase in hemoglobin concentration of 2.6 μM or 13% of the background breast values was observed in the …

Indinavir And Rifabutin Drug Interactions In Healthy Volunteers., Walter K. Kraft, Jacqueline B. Mccrea, Gregory A. Winchell, Alexandra Carides, Richard C. Lowry, Eric J. Woolf, Sandra E. Kusma, Paul J. Deutsch, Howard E Greenberg, Scott A. Waldman

Department of Medicine Faculty Papers

Two studies examined the pharmacokinetics of indinavir and rifabutin when coadministered in healthy subjects. Rifabutin, which induces the expression of cytochrome P450 (CYP) 3A, and indinavir, which inhibits that enzyme system, are frequently coadministered in patients infected with HIV. The second study was undertaken to determine if altering the dose of rifabutin coadministered with indinavir would minimize the drug interaction observed in the first study. Two studies, each with a three-period crossover design, were performed. In study 1, standard doses of rifabutin and indinavir (300 mg of rifabutin qd and 800 mg indinavir q8h) were administered as monotherapy (with placebo …

Mitotic Rate And Younger Age Are Predictors Of Sentinel Lymph Node Positivity: Lessons Learned From The Generation Of A Probabilistic Model., Vernon K Sondak, Jeremy M G Taylor, Michael S Sabel, Yue Wang, Lori Lowe, Amelia C Grover, Alfred E Chang, Alan M. Yahanda Md, Facs, James Moon, Timothy M Johnson

PCI Publications and Projects

BACKGROUND: Sentinel lymph node (SLN) biopsy allows surgeons to identify patients with subclinical nodal involvement who may benefit from lymphadenectomy and, possibly, adjuvant therapy. Several factors have been variably, and sometimes discordantly, reported to have predictive value for SLN metastasis to best select which patients require SLN biopsy.

METHODS: We reviewed 419 patients who underwent SLN biopsy for melanoma from a prospectively collected melanoma database. To derive a probabilistic model for the occurrence of a positive SLN, a multivariate logistic model was fit by using a stepwise variable selection method. The accuracy of each model was evaluated by using receiver …