Disseminated Bisifusarium infection following toxic epidermal necrolysis in a child with B-cell acute lymphoblastic leukemia.

Fusarium is a polyphyletic genus of plant pathogens, members of which can cause opportunistic human infections with varying superficial and systemic presentations, including disseminated infections which typically occur in immunocompromised patients and have a poor prognosis. Treatment is challenging due to intrinsic resistance to many antifungal agents, and antifungal susceptibility testing is therefore essential. Early suspicion, isolation of the organism, and prompt initiation of management are crucial to improving survival. We present a case of disseminated Bisifusarium infection following toxic epidermal necrolysis in a child with B-cell acute lymphoblastic leukemia, successfully treated with liposomal amphotericin B, voriconazole, flucytosine, and terbinafine.

Two challenging cases of anti-MDA-5 dermatomyositis with rapidly progressive interstitial lung disease.

Anti-MDA-5 dermatomyositis (DM) is a subtype of idiopathic inflammatory myopathy, commonly presenting as clinically amyopathic dermatomyositis. It is associated with rapidly progressive interstitial lung disease and a poor prognosis. Here, we present two cases of anti-MDA-5 DM and discuss the challenges associated with timely diagnosis, and the importance of early and aggressive treatment.

The development and validation of a decision aid to enhance shared decision-making for the management of actinic keratosis.

Actinic keratoses (AKs) are common pre-malignant lesions. There are numerous management options including active surveillance, multiple topical therapies, cryotherapy, curettage and cautery, and photodynamic therapy, each with their own risks, benefits and efficacy. Best practice currently involves shared decision-making between patient and clinician, particularly in the setting of multiple management options. Patient decision aids have been shown to be beneficial in the shared decision-making process. In view of this, we have developed and validated a decision aid for the management of AKs, in concordance with the International Patient Decision Aids Standards.

Pathological review of primary cutaneous malignant melanoma by a specialist skin cancer multidisciplinary team improves patient care in the UK.

AIMS: The National Institute for Health and Care Excellence advocated the development of specialist skin cancer multidisciplinary teams (SSMDTs) for the management of higher risk invasive skin cancers in the UK. The interobserver variability in the histopathological assessment of primary cutaneous malignant melanoma (PCMM) is well recognised. METHODS: We evaluated the discordance rates in the assessment of the histopathological criteria of PCMM based on the eighth American Joint Committee on Cancer (AJCC) melanoma staging system and subsequent change in prognosis and management following pathology review by an SSMDT. RESULTS: 353 cases of PCMM were referred to our SSMDT between April 2015 and May 2016. Cases in which there was a discrepancy in one or more histological parameters following expert review were collected retrospectively. Of 341 eligible cases, there were 94 (27.6%) in which there was an alteration in any parameter. There was interobserver agreement in final diagnosis in 96.8%, Breslow thickness in 86.8%, ulceration in 98.2%, microsatellites in 98.5%, tumour mitotic rate in 88.9%, histological subtype in 92.4%, growth phase in 98.5%, angiolymphatic invasion in 97.7%, perineural invasion in 98.8%, regression in 95.3% and tumour-infiltrating lymphocytes in 95.0%. A corresponding change in AJCC stage occurred in 23 cases (6.7%), with a resulting change in clinical management in 10 cases (2.9%). CONCLUSIONS: Disagreements in the pathological assessment of PCMM can have significant clinical implications for a small number of patients. Our findings highlight the value of the SSMDT for high-quality care of patients with melanoma in the UK.

Measurements of solutions and contact lenses with a vapor pressure osmometer.

PURPOSE: To investigate the influence of sample volume and contact lens material on osmolality measurements made with a Wescor vapor pressure osmometer. METHODS: Accuracy: Sample volumes of 0.8, 2.0, and 10.0 microL were tested with 290, 320, and 1000 mmol/kg after the osmometer was calibrated with the intended sample volume. Influence of sample volume: Sample volumes ranging from 0.5 to 1.1 microL (0.1 steps) were applied with solutions of 290, 320, 500, and 1000 mmol/kg after the osmometer was calibrated with 0.8 microl, independent of the intended sample volume. Influence of contact lens material: Lens discs of 3.4 millimeters were trephined from the center of Lotrafilcon B, Nelfilcon A, Balafilcon A and Etafilcon A lenses, and equilibrated in phosphate buffered saline with 290 mmol/kg after dehydration for 16 h. The osmometer was calibrated with 0.8 microl and lens discs were inserted into the small sample holder of the osmometer. RESULTS: There were no significant differences between the nominal and measured osmolalities for each sample volume and solution combination (all p > 0.05). Influence of sample volume: Differences of more than 0.1 microl between the calibration and sample volume significantly affected osmolality readings, with sample volumes larger than calibration volume resulting in lower readings, and smaller volumes resulting in higher readings. Influence of contact lens material: Measured osmolalities of Lotrafilcon B (358.8 +/- 45.4 mmol/kg) and Balafilcon A (356.7 +/- 38.7 mmol/kg) were not significantly different to each other (p = 0.999) but were significantly higher than Etafilcon A (298.2 +/- 15.9 mmol/kg) and Nelfilcon A (281.2 +/- 12.2 mmol/kg, p < 0.05). There was no significant difference between Etafilcon A and Nelfilcon A lenses (p = 0.056). The main factors associated with measured osmolality were water content, sample volume and their interaction (r(2) = 0.716). CONCLUSION: Osmolality readings varied with calibration and sample volume, and with different contact lens materials.