A comprehensive approach for evaluating telemedicine-delivered multidisciplinary breast cancer meetings in southern Scotland.

Multidisciplinary team (MDT) meetings for decisions on cancer management are a cornerstone of UK cancer policy. We have proposed a comprehensive methodology to assess the clinical and economic effectiveness of telemedicine in this setting, which is being tested in a randomized breast cancer trial. Pre- and post-telemedicine assessment includes attitudes to and expectations of telemedicine, based on semistructured interviews. The communication content of videotapes of the MDT meeting is being scored using Borgatta's revised Interaction Process Analysis System. The technical performance of the telemedicine equipment is reported on a standardized pro forma. A short questionnaire captures key elements of professional satisfaction for each patient discussion (consensus on future management, confidence in and sharing of decision), added value of linkage, group atmosphere, overall conduct of the meeting and compliance with SIGN guidelines. A cost-minimization analysis will be used for economic assessment.

A case of sacro-coccygeal chordoma masquerading as pilonidal sinus.

Chordoma is a rare, slow-growing, but locally aggressive malignant tumour derived from the primitive notochord. Pilonidal sinus disease, characterised by communicating granulating natal cleft tracts and abscesses, is a common condition. We report a case of a sacro-coccygeal chordoma diagnosed incidentally on surgical exploration of a case of presumed pilonidal disease.

Phaeochromocytoma of the spermatic cord.

Phaeochromocytoma of the spermatic cord is very rare. It can arise anywhere in the distribution of cells of neural crest origin, but 80-90% arise in the adrenal medulla and only 3% are extra-abdominal. A small tumour may be asymptomatic because insufficient catecholamines are secreted to cause haemodynamic disturbance.

Pyoderma gangrenosum severely affecting both hands.

We report a case of pyoderma gangrenosum affecting both hands simultaneously. Pyoderma gangrenosum affecting the hands is an extremely rare condition which may result in considerable tissue destruction. Management includes immunosuppressant therapy, treatment of associated medical conditions and minimal surgical intervention. Despite a high maintenance dose of corticosteroid and adequate control of coexisting ulcerative colitis and rheumatoid arthritis, tissue destruction in the hands spread rapidly in our patient. The key to the patient's dramatic improvement was the tissue biopsy suggesting pyoderma gangrenosum and the subsequent treatment with the cytotoxic immunosuppressant, azathioprine.

Helicobacter pylori and Meckel's diverticulum.

Helicobacter pylori is invariably associated with peptic ulceration of the upper gastrointestinal tract. This has led to speculation about its pathogenic role in peptic ulceration. The literature and this present study show that H. pylori is not often associated with peptic ulceration in Meckel's diverticulum and hence it is unlikely that it has any significant role in peptic ulceration at this site.

Coeliac disease and collagenous colitis.

We describe a case of collagenous colitis in a young man with coeliac disease who had responded clinically and histologically to a gluten-free diet three years previously. The collagenous colitis responded initially to oral corticosteroid therapy and he is now asymptomatic (and with normal rectal mucosa) on oral mesalazine. Collagenous colitis should be considered in the coeliac patient with diarrhoea despite adherence to a gluten-free diet.

Sinus histiocytosis with massive lymphadenopathy (Rosai-Dorfman disease).

A child of 11 years with a solitary involvement of the right radius by sinus histiocytosis with massive lymphadenopathy (Rosai-Dorfman disease) is presented. The literature of bone involvement in this condition is reviewed.