Daylight photodynamic therapy with methyl aminolevulinate cream as a convenient, similarly effective, nearly painless alternative to conventional photodynamic therapy in actinic keratosis treatment: a randomized controlled trial.

BACKGROUND: Daylight photodynamic therapy (DL-PDT) of actinic keratosis (AK) has shown preliminary efficacy and safety results comparable to conventional photodynamic therapy (c-PDT), using methyl aminolevulinate (MAL) cream. OBJECTIVES: To demonstrate the efficacy and safety of DL-PDT vs. c-PDT in treating mild facial/scalp AK. MATERIALS AND METHODS: This 24-week randomized, controlled, investigator-blinded, multicentre, intra-individual efficacy (non-inferiority) and safety (superiority regarding pain) study enrolled 100 subjects. AKs on the face/scalp were treated once, with DL-PDT on one side and c-PDT on the contralateral side. Primary end points for DL-PDT at week 12 were efficacy [non-inferiority regarding complete lesion response (mild AK)] and safety (superiority regarding subject's assessment of pain). Lesions with complete response 12 weeks after one treatment session were followed until week 24. The safety evaluation included incidence of adverse events. Subject satisfaction was classified using a questionnaire. RESULTS: At week 12, the complete lesion response rate with DL-PDT was non-inferior to c-PDT (89·2% vs. 92·8%, respectively; 95% confidence interval -6·8 to -0·3), confirmed by intention-to-treat analysis. Additionally, regardless of the treatment used, 96% of mild lesions were maintained in complete response 24 weeks after the PDT session. For DL-PDT, subject-reported pain was significantly lower (0·8 vs. 5·7, respectively; P < 0·001), with better tolerability and significantly higher subject satisfaction regarding convenience and outcome. CONCLUSIONS: Daylight-mediated PDT was not inferior in efficacy to Metvix c-PDT (mild AK response rate), better tolerated, nearly painless and more convenient for patients.

The effects of a weakly acidic meal on gastric buffering and postprandial gastro-oesophageal reflux.

BACKGROUND: Exclusion of the meal during ambulatory pH monitoring presumes that a meal completely buffers gastric acid and reflux of acidic food content cannot be distinguished from gastric acid. However, the ability of a meal to completely buffer gastric acid remains unclear. AIM: To determine the effect of a weakly acid meal on gastric buffering and oesophageal acid exposure. METHODS: Patients undergoing multichannel intraluminal impedance pH studies were given a standard weakly acidic meal (pH = 5.9). Gastric and oesophageal pH was measured during the meal and in 15 min intervals for 2 h postprandially. RESULTS: The study included 30 patients, with pathological acid reflux detected in 18 patients. Complete gastric buffering occurred in seven patients (23%) and was lost in all patients within 75 min of the meal. Oesophageal acid was detected in 33% of patients within 30 min of the meal and 81% of patients during the 2 h postprandial period. Postprandial oesophageal acid exposure was greater in patients with pathological acid reflux (9 ± 2.7% vs. 1.7 ± 0.8% P = 0.05) with a trend towards more incomplete gastric acid buffering and significant differences when measuring weak acid reflux (pH 4-5). Acid reflux rarely occurred in the absence of gastric acid, with gastric acid present in 74 of 79 (94%) fifteen minute postprandial intervals with acid reflux. CONCLUSIONS: The ability of a meal to buffer gastric acid is poor. Early postprandial oesophageal acid reflux occurs in a substantial proportion of patients. Addition of a weakly acidic or pH neutral meal to ambulatory pH monitoring may unmask early postprandial acid reflux and provide data on gastric acid buffering.

A unique approach to multidisciplinary cancer education.

BACKGROUND: Almost every health care worker, regardless of specialty, interacts with individuals who have histories of cancer. Some health care workers are relatively unfamiliar with the cancer experience and those who are familiar with it are interested in additional information. METHOD: The Mayo Clinic Cancer Center Education Subcommittee designed a monthly educational program titled Cancer Connections: A Multidisciplinary Update. The goals of this program were to provide: 1) up-to-date information about cancer issues, 2) a better understanding of various team members' roles in caring for people with cancer, 3) insight into patients' responses to the diagnosis and treatment of their cancers, and 4) greater awareness of the resources available to cancer patients and their families. Each session consists of a "panel" of presenters: three healthcare professionals and a patient. RESULTS AND DISCUSSION: The success of this program is reflected in the regular high attendance and consistently positive evaluations of the participants.

Randomized trial of dietician counseling to try to prevent weight gain associated with breast cancer adjuvant chemotherapy.

This study was developed to test whether prospective dietician counseling could abrogate the unwanted weight gain seen among women receiving adjuvant chemotherapy for resected breast cancer. It was also designed to examine predictive factors for weight gain in an exploratory manner. Premenopausal women starting adjuvant chemotherapy for primary breast cancer were recruited for this trial. After appropriate stratification, they were randomized to a group which received monthly dietician counseling primarily aimed at weight maintenance versus a control group (whose attending physicians and nurses told them about possible weight gain but provided no formalized dietician counseling). One hundred and seven evaluable women were equally divided between the two protocol arms. The median weight changes 6 months after start of chemotherapy were gains of 2.0 kg in the dietician counseling group versus 3.5 kg in the control group. The median changes in average calorie consumption were reductions of 120 versus 46 cal/day on weekdays and 196 versus 20 cal/day on weekends for the counseling and control groups, respectively. Study data suggest that more weight was gained by patients with higher Quetelet's indices (p = 0.01) and patients who had been on a diet in the preceding 6 months (p = 0.02). Routine prospective dietician counseling aimed at weight maintenance appeared to produce small but statistically insignificant reductions in both calorie consumption and weight gain in this group of patients.

Randomized controlled study of injury in the canine right colon from simultaneous biopsy and coagulation with different hot biopsy forceps.

BACKGROUND: Monopolar hot biopsy forceps (HBF), bipolar HBF, and cold biopsy forceps (CBF) followed by bipolar electrocoagulation are used clinically to simultaneously perform a biopsy and coagulate diminutive colon polyps and angiomata. Our purpose was to conduct a randomized, controlled study to evaluate the safety of these different techniques in the canine right colon. METHODS: After right colotomy in 8 mongrel dogs, colonic mucosa was grasped en face, tented, and biopsy performed in randomized order. The dogs were sacrificed after nine days and the biopsy sites were identified and histologically examined. RESULTS: Monopolar HBF caused an overall mean rate of acute serosal whitening of 29% compared with 0% for bipolar HBF and CBF and 6% for CBF/bipolar probe. Histologically confirmed transmural injury 9 days after biopsy occurred in 44% of monopolar HBF compared with 5% of bipolar HBF, 0% of CBF, and 50% of CBF/bipolar probe. CONCLUSIONS: Monopolar HBF had significantly higher rates of acute serosal whitening and histologic transmural damage than bipolar HBF or cold biopsy alone. On the basis of these results, monopolar HBF should be avoided for coagulation of small or flat right colon lesions such as diminutive polyps or angiomata.

Ocular complications of PUVA therapy.

PUVA, the combination of psoralen and long wave ultraviolet radiation is widely used in the management of psoriasis, vitiligo and several other dermatological disorders. The potential for long term treatment to cause ocular damage remains to be determined and despite the large numbers of patients who have received PUVA treatment, development of cataract is exceedingly rare. This paper discusses cataract formation, reviews the literature concerning the ocular complications of PUVA therapy and proposes guidelines for ocular protection during photochemotherapy.

HIV infected patients: correlation of cutaneous disease with degree of immunosuppression.

The AIDS epidemic has become a world-wide health problem since the disease was identified ten years ago. An HIV-dermatology outpatient clinic was established at the Albion Street Centre in Sydney to manage patients with cutaneous manifestations of AIDS. This study reviews the spectrum of skin disorders seen, and attempts to correlate skin disease with the degree of immunosuppression as reflected by CD4 or T helper lymphocyte counts, whereas previous reports have attempted to correlate skin disease with clinical signs and symptoms. Brief summaries of HIV disease and the cutaneous manifestations of AIDS are given.