RESUMO
BACKGROUND: There is a lack of national guidance specifying how skin surgery, including Mohs micrographic surgery (MMS), should be conducted, leading to a degree of heterogeneity in the set-up of skin surgery services and how skin surgeries are performed. OBJECTIVES: To provide the first UK-wide cross-sectional study reporting real-world data on the set-up and waste management practices of skin surgery, including MMS. METHODS: A UK-wide service evaluation study was conducted between 1 March 2022 and 30 June 2022 using a standardized data collection pro forma. Twelve participating sites from England, Northern Ireland, Scotland and Wales provided data from 115 skin surgery lists involving 495 patients and 547 skin surgery procedures between 1 March 2022 and 30 June 2022. RESULTS: Mean total weight of nonsharps skin surgery waste was 0.52â kg per procedure (0.39â kg clinical waste, 0.05â kg general waste and 0.08â kg recycling waste). Data from a single site using disposable surgical instruments reported a mean of only 0.25â kg of sharps waste per procedure. The recycling rate ranged between 0% and 44% across the cohort with a mean recycling rate of 16%. CONCLUSIONS: We advocate that staff transition to the British Society of Dermatological Surgery 2022 sustainability guidance, which made wide-ranging recommendations to facilitate staff to transition to sustainable practices in skin surgery.
Assuntos
Neoplasias Cutâneas , Gerenciamento de Resíduos , Humanos , Cirurgia de Mohs/métodos , Neoplasias Cutâneas/cirurgia , Estudos Transversais , Procedimentos Cirúrgicos Dermatológicos , EscóciaRESUMO
Hydroxychloroquine is considered a relatively benign drug and is regularly used by rheumatologists and dermatologists. We highlight the severe adverse drug reaction potential of this commonly prescribed medication. We report the case of a 63-year-old male, who presented with widespread skin eruption following initiation of hydroxychloroquine two weeks earlier for an inflammatory arthritis. He had typical clinical, biochemical and histological features of the now recognised formal 'diagnosis' of severe cutaneous adverse drug reaction. The culprit drug was stopped and he responded to oral and topical steroids as well as supportive measures. Severe reactions to hydroxychloroquine are uncommon; however, as in this case, drug hypersensitivity reactions often manifest in skin. In a drug normally considered to be safe, these potential cutaneous side effects should be highlighted in information given to patients prior to commencement.
Assuntos
Antirreumáticos/efeitos adversos , Toxidermias/patologia , Hidroxicloroquina/efeitos adversos , Sistemas de Notificação de Reações Adversas a Medicamentos , Anti-Inflamatórios/uso terapêutico , Antirreumáticos/administração & dosagem , Toxidermias/tratamento farmacológico , Humanos , Hidroxicloroquina/administração & dosagem , Masculino , Pessoa de Meia-Idade , Furoato de Mometasona/uso terapêutico , Prednisolona/uso terapêutico , Resultado do TratamentoRESUMO
Hereditary leiomyomatosis and renal cell carcinoma (HLRCC) syndrome is an autosomal-dominant disorder that results from a germline pathogenic variant in the fumarate hydratase (FH) gene on chromosome 1, characterised by renal cell carcinoma (RCC), cutaneous leiomyoma and uterine leiomyoma. Leiomyosarcomas are reported in less than 1% of those with HLRCC. We report a case of a man in his 30s who had a long-standing plaque excised from the left upper arm after undergoing a radical nephrectomy for a fumarate-deficient RCC, with histological exam revealing a grade 1 leiomyosarcoma. Genetic testing confirmed a heterozygous pathogenic variant in the FH gene. This is a rare case of leiomyosarcoma associated with HLRCC, and our patient remains under surveillance with interval abdominal imaging and skin examination. Leiomyosarcomas are difficult to distinguish clinically from their benign counterpart; therefore, histopathological examination is paramount with a low threshold for excision.
Assuntos
Fumarato Hidratase , Leiomiomatose , Leiomiossarcoma , Síndromes Neoplásicas Hereditárias , Neoplasias Cutâneas , Neoplasias Uterinas , Humanos , Leiomiomatose/genética , Leiomiomatose/patologia , Leiomiomatose/cirurgia , Leiomiomatose/diagnóstico , Masculino , Neoplasias Cutâneas/genética , Neoplasias Cutâneas/diagnóstico , Neoplasias Cutâneas/patologia , Leiomiossarcoma/genética , Leiomiossarcoma/diagnóstico , Leiomiossarcoma/cirurgia , Leiomiossarcoma/patologia , Síndromes Neoplásicas Hereditárias/genética , Síndromes Neoplásicas Hereditárias/diagnóstico , Síndromes Neoplásicas Hereditárias/cirurgia , Síndromes Neoplásicas Hereditárias/patologia , Neoplasias Uterinas/genética , Neoplasias Uterinas/patologia , Neoplasias Uterinas/diagnóstico , Neoplasias Uterinas/cirurgia , Adulto , Fumarato Hidratase/genética , Nefrectomia , Neoplasias Renais/genética , Neoplasias Renais/patologia , Neoplasias Renais/diagnóstico , Neoplasias Renais/cirurgiaRESUMO
Lung cancer is the second most common cancer diagnosed in men and women worldwide with the highest mortality. A rare site of metastases for lung cancer is the skin. Typically, the diagnosis is secure prior to developing cutaneous metastases. We present a case of a man in his mid-70s who presented to dermatology with cutaneous metastases. We outline the presentation, diagnostic workup and management of this case. We also review the literature of cutaneous metastases in lung cancer; highlighting the clinical need for a timely accurate diagnosis and the implication in terms of prognosis.
Assuntos
Neoplasias Pulmonares , Segunda Neoplasia Primária , Neoplasias Cutâneas , Masculino , Humanos , Feminino , Neoplasias Pulmonares/patologia , Neoplasias Cutâneas/patologia , Prognóstico , Pele/patologiaRESUMO
BACKGROUND: The COVID-19 pandemic necessitated a change in the provision of outpatient care in dermatology. OBJECTIVE: A novel, asynchronous, digital consultation platform was codeveloped with 2 National Health Service dermatology teams to improve access and enhance choice in outpatient care. METHODS: The rollout of the platform was accelerated during the initial COVID-19 lockdown, and its wider use across 2 Scottish health boards was retrospectively evaluated. Integrated with the hospital booking system and electronic patient record, the platform provides an alternative to face-to-face consultations, using information and images submitted by the patients. RESULTS: In total, 297 new patient consultations and 108 return patient consultations were assessed, and 80% (324/405) of the images submitted were of satisfactory quality. The consultations were, on average, 3 minutes shorter than equivalent face-to-face interactions, and a total of 5758 km of patient travel was avoided. Outcomes included web-based reviews (66/405, 16.3%), face-to-face reviews (190/405, 46.9%), biopsies (46/405, 11.4%), discharge (89/405, 22%), and other treatments or investigations (14/405, 3.5%). High levels of patient satisfaction (92/112, 82.1%) were reported. CONCLUSIONS: Digital dermatology assessments are now included in the choices for consultation types that are available to patients, helping to augment service capacity during pandemic recovery.
RESUMO
Surgery of the middle ear is a delicate process that requires the surgeon to manipulate the ossicles, the smallest bones in the body. Excessive force applied to the ossicles can easily be transmitted through to the inner ear which may cause a permanent sensorineural hearing loss. An instrument was required to measure the forces applied to cadaveric temporal bone ossicles with the vision of measuring forces in vivo at a later stage. A feasibility study was conducted to investigate a method of measuring force and torque applied to the ossicles of the middle ear. Information from research papers was gathered to determine the expected amplitudes. The study looked at commercially available transducers as well as constructing an instrument using individual axis transducers coupled together. A prototype surgical instrument was constructed using the ATI industrial automation Nano17 six axis transducer. The Nano17 allows for the measurement of force and torque in the X, Y and Z axis to a resolution of 1/320 N. The use of the Nano17 enabled rapid development of the surgical instrument. It meets the requirements for its use on cadaveric models and has the potential to be a useful data collection tool in vivo.
Assuntos
Orelha Média/fisiopatologia , Orelha Média/cirurgia , Monitorização Intraoperatória/instrumentação , Procedimentos Cirúrgicos Otológicos/instrumentação , Transdutores de Pressão , Desenho de Equipamento , Análise de Falha de Equipamento , Humanos , Projetos Piloto , Estresse MecânicoAssuntos
Procedimentos Cirúrgicos Dermatológicos/instrumentação , Equipamentos Descartáveis/estatística & dados numéricos , Instrumentos Cirúrgicos , Biópsia/instrumentação , Contaminação de Equipamentos/prevenção & controle , Reutilização de Equipamento , Humanos , Esterilização , Inquéritos e Questionários , Reino UnidoAssuntos
Carcinoma de Células Escamosas/induzido quimicamente , Diuréticos/efeitos adversos , Hidroclorotiazida/efeitos adversos , Transtornos de Fotossensibilidade/induzido quimicamente , Neoplasias Cutâneas/induzido quimicamente , Idoso de 80 Anos ou mais , Carcinoma de Células Escamosas/terapia , Feminino , Humanos , Pessoa de Meia-Idade , Transtornos de Fotossensibilidade/terapia , Neoplasias Cutâneas/terapiaRESUMO
HYPOTHESIS: The forces applied to the middle ear structures during surgery are measurable. BACKGROUND: Surgical forces applied to the middle ear are often cited as a cause of postoperative sensorineural hearing loss; however, no literature exists on how much total force is applied during common middle ear procedures. METHODS: Using our novel middle ear surgical force sensor, we took measurements from 6 temporal bones of common middle ear manipulations. RESULTS: Temporal bones of 3 males and 3 females yielded 72 measurements for an average peak applied force and 68 measurements for total applied force across 3 levels of operator experience. Statistically significant differences were seen between different levels of operator and how much force was applied, with senior operators using less force. CONCLUSION: We show it is possible to measure the applied forces in middle ear surgery and that some of these forces are very large. Larger forces are seen in destructive procedures and in procedures performed by inexperienced operators. This project is an important first step in investigating the association between surgically applied middle ear forces and postoperative sensorineural hearing loss.