Electrochemotherapy treatment of a recalcitrant earlobe keloid scar with chronic lymphocytic leukaemia infiltration.

Electrochemotherapy, a tumour ablation modality, which facilitates intracellular delivery of poorly-permeable cytotoxic drugs, such as bleomycin, has shown promising results in the treatment of cutaneous and subcutaneous melanomatous and non-melanomatous metastases. We report the case of a 52-year-old Caucasian gentleman with a keloid scar to his left earlobe that developed following a piercing. Despite multiple intralesional steroidal injections, five intralesional excisions and a course of superficial radiotherapy the keloid scar remained over nine years later. For 15 years the patient had also suffered chronic lymphocytic leukaemia with no nodal disease or systemic involvement. However, histological analysis of the final surgical excision specimen showed chronic lymphocytic leukaemia infiltration of the keloid scar. Further surgical excision seemed unwise considering the recalcitrance of the keloid scar. Additionally, no systemic chemotherapy treatment options were feasible. Electrochemotherapy was performed under local anaesthesia with the aim of eradicating the chronic lymphocytic leukaemia deposit within the keloid lesion. Four sessions of electrochemotherapy using bleomycin were deployed over 11 months. A deep core biopsy of the treated keloid performed three months following the last electrochemotherapy session showed no evidence of chronic lymphocytic leukaemia. Serendipitously, following the initial electrochemotherapy treatment no further growth of the keloid scar was observed. Furthermore, subsequent electrochemotherapy led to a substantial reduction in size of the keloid sustained for 14 months at last follow-up. This report highlights the exciting potential of electrochemotherapy and bleomycin in the treatment of recalcitrant scars. Larger, well-designed clinical and in-vitro studies are required to further elucidate the exact role, mechanism and cost-effectiveness of electrochemotherapy in this area.

Critical evaluation of the clinimetrics of laser Doppler imaging in burn assessment.

Just under a third of clinical assessments of intermediate burn depth overestimate the extent of the injury, potentially resulting in unnecessary surgery. Research evidence suggests that laser Doppler imaging may be a more accurate alternative.

Intra-tendinous gout in a repaired flexor digitorum profundus.

A patient presented with decreased flexion and triggering following a zone IIc flexor digitorum profundus repair 7 years previously. Chalky-white deposits, confirmed histologically as gout, were present at the repair site.

Laparoscopic radical nephrectomy in first-trimester pregnancy.

We present a case of a 30-year-old pregnant woman with renal cell carcinoma who underwent successful laparoscopic radical nephrectomy at 11 weeks of gestational age. The remainder of the pregnancy was uncomplicated, and the patient gave birth to a healthy baby boy at term. Although previous cases of successful nephrectomy performed in pregnancy for renal cell carcinoma have been reported, we believe this is the first case in which it has been performed laparoscopically. We suggest that when the expertise is available, laparoscopic nephrectomy is a safe alternative to open surgery, with the additional benefits of minimal access surgery.

Anaesthesia alert: an integrated, networked, register of paediatric anaesthetic problems.

The Paediatric Register of Anaesthetic Problems (PaedRAP) is a network-based anaesthesia hazard alert system. It is integrated with pre-anaesthesia consultations and patient questionnaires. All files, both electronic and on paper, are available 24 hours a day close to the operating theatres. This ensures that pertinent information is readily available when and where it is most needed. The PaedRAP is also linked to the automated theatre booking system to print warnings on the theatre lists. This minimizes the chance that important information goes unnoticed. Documentation of the progression of the various categories of patient problems and evolving management strategies has been useful both for individuals and groups.

Drug addiction and dental care.

Patients who are addicted to drugs, or are being treated for drug addiction, present a variety of management issues when they attend for dental care. A number of factors are related to the treatment planning and clinical management. Dentists should be aware of these factors in order to manage these patients sensitively and effectively. Important management issues include medical problems associated with drug abuse, dental problems and how drug abuse and its subsequent treatment affect the dentition, behavioural disorders, pain management, and control of cross-infection. People who have recovered from chemical dependency to opiates have special needs, especially in pain management. Establishing a good pre-treatment rapport with the patient will assist the dentist in reducing the need for postoperative analgesics, and will encourage this group of patients to return and obtain needed dental care. The more dental practitioners know about types and patterns of drug abuse and recovery programmes, the more safely this group of patients with special needs can be managed.

Evaluation of the onset time and intubation conditions of rocuronium bromide in children.

We have assessed, in children aged three to eight years, the intubating conditions after administration of rocuronium 0.6 mg/kg at 50 or 60 seconds, in groups of 15 patients. Intubating conditions were excellent in 11, good in 3 and fair in 1 patient at 50 seconds and excellent in 12 and good in 3 patients at 60 seconds. The mean onset time, for all patients, to when the first twitch of the train of four (T1), measured at the adductor pollicis, was depressed to less than 30% and 5% of control was 50 (SD 11.4) seconds and 94 (SD 31.7) seconds respectively. Depression of T1 to less than 30% of control, measured at the adductor pollicis in children, appears to indicate that intubating conditions will be clinically acceptable when using rocuronium.

A macro-driven Excel template for determining the anaerobic capacity using an air-braked ergometer.

This paper describes a microcomputer system for automating the process of data collection, calculation and display of anaerobic capacity tests on an air-braked ergometer. The use of the spreadsheet Excel and associated 'Dalog' program represents an advance on current software which estimates the anaerobic capacity from work performed alone. Numerous calculations are required when air-braked, rather than friction-braked erogometers are used. Each 1 s power output collected during an all-out sprint on the ergometer is corrected against the criterion of a dynamic calibration rig and adjusted for differences in barometric pressure, ambient temperature and humidity. The Excel template features a series of macros invoked by buttons imbedded in the spreadsheet. Their selection displays various dialogue boxes which request input related to the calculation of oxygen deficit and related variables. Selecting the final macro prints a summary table and charts which include: power output, fatigue index, mechanical work performed, % aerobic contribution to work, oxygen demand, oxygen consumption and anaerobic capacity as determined by the maximal accumulated oxygen deficit.

An object-oriented approach to data display and storage: 3 years experience, 25,000 cases.

Object-oriented programming techniques were used to develop computer based data display and storage systems. These have been operating in the 8 anaesthetising areas of the Adelaide Children's Hospital for 3 years. The analogue and serial outputs from an array of patient monitors are connected to IBM compatible PC-XT computers. The information is displayed on a colour screen as wave-form and trend graphs and digital format in 'real time'. The trend data is printed simultaneously on a dot matrix printer. This data is also stored for 24 hours on 'hard' disk. The major benefit has been the provision of a single visual focus for all monitored variables. The automatic logging of data has been invaluable in the analysis of critical incidents. The systems were made possible by recent, rapid improvements in computer hardware and software. This paper traces the development of the program and demonstrates the advantages of object-oriented programming techniques.

Steady-state pharmacokinetics of interpleural bupivacaine in patients after cholecystectomy.

Venous plasma concentrations of bupivacaine were determined in eight cholecystectomy patients following multiple interpleural bolus instillations of bupivacaine 20 ml 0.5% with adrenaline (5 mg/l) administered at six- to eight-hour intervals. The mean steady-state peak plasma concentration was 2.3 mg/l (range 1.2-3.1 mg/l); however, in three of the eight patients peak plasma concentrations were greater than 3 mg/l. The mean accumulation ratio was found to be 1.6 (range 0.99-2.49), with steady-state occurring within the first 24 hours of drug administration. Mean apparent systemic plasma clearance was 0.16 +/- 0.07 l/kg/h with a mean terminal half-life of 5.8 +/- 2.3 hours measured at steady-state, values which were not significantly different (P greater than 0.05) from those values obtained following single interpleural bolus dose administration.