Patient satisfaction with receiving skin cancer diagnosis by letter: comparison with face-to-face consultation.

Providing patients with clear and concise information is central to modern medical practice. Patients diagnosed with skin cancer are traditionally told their result by face-to-face consultation in the outpatient clinic. Previous studies have shown poor patient satisfaction with the traditional outpatient consultation. The skin oncology service at Kingston Hospital uses two different methods to inform selected patients of their skin cancer diagnosis. Those diagnosed with thin melanoma (MM) or squamous cell carcinoma (<2 cm) (SCC) are informed by letter (with an accompanying information leaflet), or seen in outpatient clinic for a face-to-face consultation. However, it is unclear which of these methods patients prefer. We performed a retrospective postal questionnaire survey to elicit the views of patients that had been informed of their skin cancer by these two methods. Patients had been diagnosed with either MM or SCC between February 2005 and March 2006. Demographic details and patient satisfaction using five-point Likert scales were determined. Of the eligible 118 patients, 90 (76%) completed the questionnaire. Questionnaires from five respondents were incorrectly completed and excluded from further analysis. Of the final 85 patients, 41 (48%) were told their diagnosis via face-to-face consultation (clinic) and 44 (52%) by letter. The demographic profile of both groups was similar (P>0.05). Patients of both groups had a similar expectation of being told a skin cancer diagnosis (P>0.05). A high level of satisfaction was expressed for both methods of communication, with no difference between the groups (P>0.05). In the letter group, patients placed more value on convenience than preference to seeing a doctor (P<0.001). The option of contacting a support nurse was also cited as a reassuring feature. The findings of this study suggest disclosure of skin cancer diagnosis by letter has high satisfaction, for selected patients. Using this method of communication may ultimately lessen the burden on outpatient service.

Accuracy of three-dimensional measurements using cone-beam CT.

OBJECTIVES: Lesions causing intraosseous defects in the head and neck region are difficult to diagnose using two-dimensional radiography, and three-dimensional (3D) data provided by CT is useful but often difficult to obtain. Recently, cone-beam CT (CBCT) was made available, with the potential to become a practical tool in dentistry. However, there is limited evidence to prove that defect volume can be determined accurately. Therefore, this in vitro validation study aimed at establishing whether linear and 3D CBCT, using volumetric measurements, is accurate for determining osseous defect sizes. METHODS: Depth and diameter of simulated bone defects in (i) an acrylic block and (ii) a human mandible were blindly measured electronically by five examiners using CBCT. Linear measurements were compared with predetermined machined dimensions. Using software, volume extraction was performed by another examiner on the acrylic phantom and compared with known dimensions. Data were analysed using paired t-tests. RESULTS: Using the acrylic block, mean width accuracy was -0.01 mm (+/- 0.02 SE) and mean height difference was -0.03 mm (+/- 0.01 SE; P > 0.05). For the human mandible, mean width accuracy was -0.07 mm (+/- 0.02 SE) and mean height accuracy was -0.27 mm (+/- 0.02 SE; P < 0.01). Volume accuracy was -6.9 mm3 (+/- 4 SE) for automated calculations and -2.3 mm3 (+/- 2.6 SE) for the manual measurements (P < 0.001). CONCLUSIONS: CBCT has the potential to be an accurate, non-invasive, practical method to reliably determine osseous lesion size and volume. Further clinical validation will lead to a vast array of applications in oral and maxillofacial diagnosis.

[Specific effects of boxing on functional parameters of the locomotor system]. / Boxsportartspezifische Auswirkungen auf funktionelle Parameter des Bewegungsapparats.

PROBLEMS: Boxer that take part on contests regularly are characterized by high strains on the locomotor system. Especially the area of shoulder girdle and neck can be overused by the fighting posture and standard techniques, that are often associated with non-physiological patterns. METHODS: Of 11 young boxers (age 14.6 +/- 0.6 years; 7.3 +/- 0.6 training units per week) and a control group (CG) of 52 male pupils (age 15.4 +/- 0.4 years) the static of head, shoulder girdle, and pelvis was detected by somatoscopy. Additionally, cyclical rotations of the cervical spine were measured using the 3-d-motion recording system CMS70 (Zebris, Germany) and the active range of motion was analysed. RESULTS: In comparison to the CG, head and shoulder of the boxers were ventralised more often (p < 0.01). Furthermore, highly significant group differences in the bilateral position of the shoulder heights and the iliac crests were detected in the frontal plane. On average, the active maximal rotation of the boxers was decreased by 17.8 degrees (p = 0.006; d = 0.800). DISCUSSION: Our study was able to detect significant differences in the analysed functional parameters of the locomotor system that may be explained by boxing specific strains and which are prerequisites of optimal performance. As long-term pathologic effects can not be excluded, adequate compensational exercises should be integrated in the training.

Treatment of mature port wine stains with the PhotoDerm VL.

Port wine stains (PWS) are congenital vascular naevi. Their presence is the cause of significant psychological morbidity due to their cosmetic appearance. The flashlamp-pumped dye laser (FPDL) is considered to be the treatment of choice for PWS. However, there is a recognized morbidity related to the use of the FPDL. The PhotoDerm VL is a broad spectrum, non-coherent, intense pulsed light source which has been shown to be an effective tool in the treatment of a number of vascular lesions including PWS. Our strategy was to assess the effectiveness of the PhotoDerm VL in the treatment of mature PWS in three fair skinned subjects. Three patients with mature PWS were recruited. They were treated at 6-weekly intervals with the PhotoDerm VL machine using predetermined parameters and assessed at each visit prior to treatment. In all three patients there was at least a 50% improvement in the clinical appearance of the lesions as assessed by both operator and patient. No complications were reported. Further treatments in two patients, however, failed to produce any further clinical improvement. We conclude that the PhotoDerm VL appears to be a promising treatment for PWS with no post-operative complications. However, a comparative study with the FPDL needs to be undertaken to determine the most effective therapy option for patients with this disfiguring cutaneous lesion.

Sarcoidosis presenting as palmar erythema.

Sarcoidosis, a multisystem disease of unknown aetiology, is characterized by the formation of non-caseating granulomas which may involve any organ of the body. The commonest sites of predilection are the lungs, skin and lymph nodes. We now report a patient who presented with palmar erythema which on biopsy confirmed the presence of non-caseating granulomas and who responded to systemic corticosteroids. We are unaware of any previous report in the literature of sarcoidosis presenting in this way.

Cutaneous and cerebral haemangiomas associated with eruptive angiokeratomas.

We report a patient with multiple cutaneous and cerebral haemangiomas associated with angiokeratomas. As far as we are aware this patient is unique as the association of cutaneous and cerebral haemangiomas with angiokeratomas has not been previously described.

Reticulohistiocytoma and multicentric reticulohistiocytosis. Histopathologic and immunophenotypic distinct entities.

The clinicopathological and immunohistochemical features of four patients with systemic multicentric reticulohistiocytosis (MR) were compared with five cases of solitary and one case of multiple reticulohistiocytoma (RH), which were confined to the skin only. The MR cases mostly affected the limbs of older women, while RH affected young male adults without preference to site. Characteristically, both entities consisted of oncocytic mononuclear histiocytes (with granular eosinophilic cytoplasm similar to oncocytic thyroid cells) and multinucleated histiocytes with a ground-glass appearance, which appeared to be much larger (> 200 microns) and bizarre in cases of RH compared with cases of MR (50-100 microns). In RH a variable number of vacuolated, spindle-shaped, and xanthomatized mononuclear histiocytes were also present. Immunohistochemical profiles showed positivity of mononuclear histiocytes with HHF35, factor XIIIa, and LN3 (HLA-DR), with a variable number of multinucleated histiocytes in RH showing binding with peanut agglutinin. In mono- and multinucleated histiocytes in both entities macrophage markers KP1 (CD68), KiM1P, HAM56, lysozyme, and alpha 1-antitrypsin were positive. However, macrophage markers MAC387 (L1 antigen) and Leu-M1 (CD15) were negative. Vimentin was universally positive in both conditions, with all other markers (S100, desmin, smooth muscle-specific actin, and QBEnd 10 [CD34]) negative. This study shows that histology supplemented by immunocytochemistry delineates MR from RH and immunohistochemical profiles indicate a cell lineage relationship between RH and adult xanthogranuloma.

Palmoplantar and perioroficial keratoderma with corneal epithelial dysplasia: a new syndrome.

A case is reported of a male infant with congenital palmoplantar keratoderma and nail dystrophy who developed progressive perioral and perineal keratoderma. In addition, bilateral corneal epithelial dysplasia led to severe corneal scarring and impairment of vision. This syndrome has not been previously described.

Endemic placenta accreta in a population of remote villagers in Papua New Guinea.

Using a combination of prospective registration of definite cases (n = 47) and retrospective identification of probable cases (n = 22) over a 6.5-year period, we have estimated that the rate of placenta accreta in the Milne Bay Province of Papua New Guinea is at least 1.6 per 1000 births, and probably in excess of 2.3 per 1000. This is substantially higher than other reported estimates of the frequency of this condition, which causes significant maternal morbidity. The study population of 130,000 consisted mainly of subsistence cultivators who live in remote hamlets, and included about 27,600 women between the ages of 15 and 49 years. A number of factors seem likely to be important in the aetiology of the condition in Milne Bay Province, including infection associated with previous childbirth and abortion. Over three-quarters of the cases would have been prevented if all women of para greater than or equal to 4 or with a history of retained placenta had used effective contraception. Better obstetric care, including early treatment of postpartum sepsis and incomplete abortion, may also help to reduce the frequency of placenta accreta in this population.