Tele-Derm National: A decade of teledermatology in rural and remote Australia.

OBJECTIVE: To identify the current scope of Tele-Derm, the types of dermatological complaints experienced in the rural primary care setting, and to assess the quality of patient clinical information provided to the consultant dermatologist. DESIGN: Retrospective case analysis. SETTING: Tele-Derm National is an initiative of the Australian College of Rural and Remote Medicine and has been providing online educational and consultational services in dermatology to doctors Australia-wide for over a decade. PARTICIPANTS: Patient cases that were submitted to Tele-Derm for specialist dermatologist advice. INTERVENTIONS: Audit of submitted cases. MAIN OUTCOME MEASURES: The types of patient presentations and reason for submission for specialist opinion were analysed. The quality of clinical information provided was also evaluated. RESULTS: A total of 406 cases submitted over 2012-2013 were analysed. Most patients were from the outpatient setting with 'rash' or dermatitis (66%). Almost one-third of patients were paediatric cases. The average time from submission to dermatologist reply was 5.5 hours. Clinical photos were provided in 83% of cases and 73% of these were assessed as being of good quality. Management advice was provided in 77% of cases, of which reference to the case-based learning modules on Tele-Derm was made in 21% of cases. Patient outcome was largely unknown (83%). CONCLUSION: This study identified some of the common dermatological complaints presenting to rural and remote primary care doctors in Australia. The unique addition of professional development in Tele-Derm can be used as an adjunct to advice provided to the rural doctors seeking advice for patient management.

Regenerative matching axial vascularisation of absorbable 3D-printed scaffold for large bone defects: A first in human series.

BACKGROUND: We describe the first clinical series of a novel bone replacement technique based on regenerative matching axial vascularisation (RMAV). This was used in four cases: a tibial defect after treatment of osteomyelitis; a calvarial defect after trauma and failed titanium cranioplasty; a paediatric tibial defect after neoadjuvant chemotherapy and resection of Ewing sarcoma; and a paediatric mandibular deficiency resulting from congenital hemifacial microsomia. METHOD: All patients underwent reconstruction with three-dimensional (3D)-printed medical-grade polycaprolactone and tricalcium phosphate (mPCL-TCP) scaffolds wrapped in vascularised free corticoperiosteal flaps. OUTCOME: Functional volumes of load-sharing regenerate bone have formed in all cases after a moderate duration of follow-up. At 36 cm, case 1 remains the longest segment of load bearing bone ever successfully reconstructed. This technique offers an alternative to existing methods of large volume bone defect reconstruction that may be safe, reliable, and give predictable outcomes in challenging situations. It achieves this by using a bioresorbable scaffold to support and direct the growth of regenerate bone, driven by RMAV. CONCLUSION: This technique may facilitate the reconstruction of bone defects previously thought unreconstructable, reduce the risk of long-term implant-related complications and achieve these outcomes in a hostile environment. These potential benefits must now be formally tested in prospective clinical trials.

Narrative review of the epidemiology/biology of basal cell carcinoma: a need for public health consensus.

Basal cell carcinoma (BCC) is the most common skin malignancy afflicting modern Australian society. The most influential response to rising BCC incidence rates has been through public health primary prevention campaigns (PPC) which have persevered since the 1980s. These campaigns are widely heralded a success but clinical data quantifying these benefits are limited due to an absence of legislation around BCC reporting. A non-systematic search of the literature was conducted identifying articles investigating the incidence and clinical characteristics of BCC over the past 40 years, as well as the economic viability of the PPC. There is robust evidence supporting stabilizing rates of BCC incidence in Australia. Similarly, multiple studies have shown the economic benefits of PPC through cost analysis. Anatomical and histological data are reported inconsistently, consequently limiting analysis of changes in BCC clinical characteristics. The consensus throughout the literature is that BCC is a significant public health issue that requires legislative reform. This narrative literature review serves to highlight the need for statutory changes around non-melanocytic skin cancer data collection to enable appropriate analysis and evaluation of current management strategies.

Laparoscopic Management of Hepatic Abscess From Ingested Chicken Bone.

A 68-year-old man presented to the hospital with severe right upper abdominal pain, fevers, nausea and lethargy. He deteriorated into septic shock and was found to have a hepatic abscess on computer tomography imaging. After multiple investigations and continual deterioration, he underwent an exploratory laparoscopy which revealed a chicken bone within the liver parenchyma resulting in a large hepatic abscess. The patient required a second laparoscopic washout and prolonged antibiotics, subsequently recovering well. This rare case highlights the difficulty in diagnosing hepatic abscesses caused by gastrointestinal foreign bodies, and successful management with laparoscopic surgery.

Extraperitoneal parastomal metastasis of malignant peritoneal mesothelioma.

A 75-year-old man was referred to surgical outpatient department with what was thought to be a parastomal hernia. Through further investigations with CT and biopsy, it was identified that the parastomal mass was metastatic peritoneal mesothelioma in the abdominal wall and subcutaneous tissue. The patient had a significant surgical history including a previous abdominoperineal resection with end colostomy 9 years prior and a right hemicolectomy for small bowel obstruction the previous year which diagnosed peritoneal mesothelioma. Peritoneal mesothelioma often spreads throughout the abdominal cavity and rarely spreads outside the peritoneum, with this being the first case describing parastomal metastasis. Given the patient's surgical background, this is possible to have contributed to seeding the spread of peritoneal mesothelioma.