Severe peripheral oedema as the only presenting symptom of intravascular large B-cell lymphoma: a diagnosis too frequently made on autopsy.

Intravascular large B-cell lymphoma is seen in less than one per million people and can be an extremely difficult antemortem diagnosis to make due to a vast diversity of presenting symptoms. We present a case of an otherwise healthy 74-year-old woman whose predominant symptom was pitting oedema, and who likely died from multiorgan failure after >14 months of extensive workup that was unable to secure a definitive diagnosis.

Evaluation of patient-perceived satisfaction with photodynamic therapy for Bowen disease.

OBJECTIVE: to formally evaluate patient concerns and patient-perceived satisfaction with photodynamic therapy (PDT) using topical application of 5-aminolevulinic acid for Bowen disease (BD). DESIGN: Initial focus groups and mailout questionnaire. SETTING: tertiary care hospital. METHODS: a novel 32-item self-reported patient satisfaction questionnaire was mailed out to all patients treated with PDT for BD from January 1, 2000, to March 31, 2008. MAIN OUTCOME MEASURES: a written questionnaire addressing side effects experienced, self-perceived effectiveness, and the personal and social consequences of PDT. RESULTS: one hundred thirty-two adults were treated with PDT for BD over this time period. Ninety-five patients (47% male, 53% female) completed the questionnaire. A majority (> 90%) indicated a very favourable impression of the effectiveness of PDT for BD and that side effects were mild. The most significant side effects were a burning sensation (21%) and crusting or scabbing (14%). Side effects were judged to be predictable. The process of treatment and overall time demands were judged by only 7% of respondents to be problematic. The most substantial limitations with PDT were social limitations secondary to treatment (26%), self-consciousness (28%), and skin appearance in the immediate posttreatment period (30%). Respondent reliability in response to questions was excellent. CONCLUSIONS: PDT is favourably received by those diagnosed with BD. PDT resulted in a high degree of perceived satisfaction for those patients with BD. Based on these data, PDT is supported as a viable method of treatment for BD.

Development of a new visual analogue scale for the assessment of area scars.

OBJECTIVE: Clinical scar assessment lacks standardized methodology and consensus on the most appropriate evaluation instrument. This study empirically evaluated whether area scars could be validly assessed by naive observers with the objective to develop and validate a novel multidimensional visual analogue scale (VAS) for the assessment of area scars. METHODS: Standardized digital photographs of radial forearm free flap (RFFF) donor sites were obtained. Naive observers evaluated the images in three sequential psychophysical experiments, which led to the development of the new scar scale. These experiments involved initial evaluation of four dimensions (pigmentation, vascularity, observer comfort, acceptability) using a paired comparison (PC) paradigm and correlation with ratings of overall severity using a VAS, and initial VAS test phase followed by formal debriefing, and, subsequently, evaluation of a VAS for the four dimensions in addition to contour. Validation involved determination of intra- and interrater reliability and correlational analysis. RESULTS: Across all three experiments, 56 observers evaluated 101 images, generating 12 720 observations for analysis. PC data demonstrated that observers could assess scars with high reliability and internal consistency for all dimensions (> 95%). Overall (VAS) severity correlated highly with all dimensions, including contour. The new VAS yielded high levels of correlation (r = .72-.98, p < .01). CONCLUSION: Comprehensive VAS analysis demonstrates high reliability in mirroring PC results for multiple dimensions of area scars. These data support our novel multidimensional VAS method as a valid, reliable, simple, and time-efficient instrument for clinical and research use. We introduce the Western Scar Index as a new measurement tool with many potential applications.