Pigmentary anomaly caused by mosaic 3q22.2q29 duplication.

A 39-year-old woman sought advice regarding potential risks to her offspring due to previous possible diagnosis of incontinentia pigmenti. She had linear hyperpigmentation along the lines of Blaschko affecting the upper and lower limbs, and skin-coloured papules on the left palm. Ophthalmoscopy revealed hypopigmented spots in the macular region of the retina in each eye due to focal areas of depigmentation of the retinal pigment epithelium. An array comparative genomic hybridization on DNA extracted from a skin biopsy revealed a 63.63-Mb duplication, arr[GRCh37] 3q22.2q29(134212001_197837069)x3, on the long arm of chromosome 3. This case is an example of genetic mosaicism resulting from a de novo genetic defect arising at some point in embryonic development. Click here for the corresponding questions to this CME article.

Successful treatment of high-grade vulval intra-epithelial neoplasia with imiquimod 5% in a renal transplant recipient.

Organ transplant recipients are at a higher risk of pre-malignant human papillomavirus-associated lesions due to immunosuppression. The efficacy of immunomodulants such as imiquimod 5% is not yet fully evaluated in this population. We describe a case of vulval intra-epithelial neoplasia in a renal transplant recipient which was successfully treated with topical imiquimod.

Time in motion--testing efficiency in the dermatology procedure setting.

BACKGROUND: Time-in-motion studies are validated means of determining efficiency and identifying sources of delay in a complex working environment. This analysis technique was applied to the dermatological surgical services provided by a university hospital department of dermatology. OBJECTIVE: To identify any sources of low efficiency in dermatological surgical service provision and to make recommendations for increasing efficiency. METHOD: Three types of dermatology surgical sessions were observed (consultant-led procedure list, nurse-led procedure list, and dermatology day-surgery list). Activities of staff were noted every 2 minutes throughout the sessions, and the data were compiled for processing in Microsoft Excel. RESULTS: The results show that treatment of dermatology patients with day surgery was less efficient and cost effective than the other settings. Consultant-led procedure lists were the most efficient. Nurse-led sessions were less expensive but also less efficient than the consultant-led lists. Paperwork and generic communication were identified as major constituents of non-operating time. CONCLUSIONS: The most efficient setting for dermatological procedures is the consultant-led procedure list. Paperwork and generic communication are identified as sources of service delay. Suggestions are made regarding possible solutions to these problems. We demonstrate the advantages of broad, objective appraisal of practice as opposed to numerical target-driven approaches that fail to address specific aspects of efficiency.