RESUMEN
A 21-month-old girl developed a local skin reaction after the unheated liquid contents of a broken lava lamp were in contact with her skin overnight. Several weeks later, small umbilicated erythematous papules containing central keratotic spines developed within the affected areas. Biopsy showed a granulomatous foreign body reaction with focal transepidermal elimination. Electron microscopy and energy-dispersive X-ray spectroscopy analysis of the tissue revealed carbon-based material, consistent with substances reported to be present in lava lamp liquid.
Asunto(s)
Carbono/toxicidad , Reacción a Cuerpo Extraño/inducido químicamente , Traumatismos de la Pierna/inducido químicamente , Enfermedades de la Piel/inducido químicamente , Biopsia , Femenino , Humanos , LactanteRESUMEN
BACKGROUND/OBJECTIVES: Dermatologists commonly perform surgical procedures, including Mohs micrographic surgery, in an outpatient, office-based setting. Although this may be widely perceived to be safe and effective, formal data on the practice are limited. The aim of this study was to examine the range of surgical procedures and associated complications in an Australian specialist dermatology and Mohs surgery practice. METHODS: All surgical procedures over a 55-week period were prospectively logged, with data collection on sex, age, type of procedure, body site, diagnosis and complications. All procedures were performed under conditions that were usual for the practice, with a combination of sterile and clean surgical techniques, depending on the procedure. RESULTS: In all, 2370 surgical procedures were performed during the study period, including 934 Mohs surgery cases. Most procedures (68%) were performed on head and neck sites. A total of 56 complications were recorded in 51 patients. Bacterial wound infections occurred in 13 cases (0.5%). Bleeding complications occurred in five cases (0.2%). There were no complications requiring hospital admission or i.v. antibiotics. CONCLUSIONS: This study supports the view that dermatological surgery, including significant procedures such as Mohs micrographic surgery, flaps and grafts, can be performed on an ambulatory basis in an office-based procedure room setting, with low complication rates.
Asunto(s)
Atención Ambulatoria/estadística & datos numéricos , Procedimientos Quirúrgicos Dermatologicos/efectos adversos , Cirugía de Mohs/efectos adversos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Femenino , Hemorragia/etiología , Humanos , Masculino , Auditoría Médica , Persona de Mediana Edad , Estudios Prospectivos , Infección de la Herida Quirúrgica/etiología , Adulto JovenRESUMEN
A 93-year-old woman was noted to have a single pigmented lesion on the posterior aspect of her neck. Clinical examination revealed a 12 x 8-mm flat lesion, with an irregular border and variegated pigmentation. Dermatoscopic examination revealed a lesion with multiple colours, featureless areas and black dots, suggestive of malignant melanoma. With a presumed clinical diagnosis of malignant melanoma, an elliptical excision was performed, with a 1-cm margin. However, histological examination revealed the unexpected diagnosis of pigmented inverted follicular keratosis.
Asunto(s)
Queratosis/diagnóstico , Neoplasias Cutáneas/diagnóstico , Piel/patología , Anciano de 80 o más Años , Dermoscopía , Diagnóstico Diferencial , Femenino , Humanos , Melanoma/diagnósticoRESUMEN
Western Australia has only two superficial radiotherapy units, one of which is located at Fremantle Hospital, and run by the radiation oncologists of Perth Radiation Oncology Centre. A 3-year retrospective review was undertaken of all patients who underwent treatment at this unit from 1999 to 2001. Patients were identified from the unit's log book, and data was collected from their files. For malignant skin conditions, 369 lesions were treated in 259 patients over the study period. The patients' median age was 76 years. A wide variety of conditions were treated, but the most common diagnoses were basal cell carcinoma (237 lesions) and squamous cell carcinoma (92 lesions), most commonly located in the head region. The most frequently used treatment schedule was 36 Gy in six fractions over a 3-week period. Where radiotherapy was administered as primary treatment, the diagnoses had been biopsy-proven in only 53% of cases. Fifty-four patients underwent treatment of benign skin disease over the study period; most commonly keloid scars (41 patients) followed by warts (six patients). We conclude that superficial radiotherapy has a distinct role in dermatology, particularly for skin carcinomas around the nose and eyes, which cannot presently be superseded by electron beam therapy.
Asunto(s)
Carcinoma Basocelular/radioterapia , Carcinoma de Células Escamosas/radioterapia , Neoplasias Cutáneas/radioterapia , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Queloide/radioterapia , Masculino , Persona de Mediana Edad , Radioterapia/métodos , Estudios Retrospectivos , Resultado del Tratamiento , Australia OccidentalRESUMEN
Ninety-seven Perth general practitioners completed a self-administered postal questionnaire that aimed to examine their caseload and management practices for childhood atopic dermatitis (AD). General practitioners saw a median of two new cases and three follow-up consultations per month for childhood AD, and referred a median of 10% of cases to a specialist, usually a dermatologist. Most (77%) recommended emollients for all patients, but only 21% specifically reported advising their use immediately after bathing. Sixty-one percent would use topical corticosteroids in all or most patients, but cream preparations were more commonly used (58%) than ointments (40%). Atrophy was rated as a common or very common side-effect of topical corticosteroid therapy by 23% of general practitioners. Twenty-six percent reported using oral corticosteroids in children with AD. Dietary changes would be recommended in at least a few AD patients by 79% of general practitioners, and 31% would recommend a change from cow's milk to soy in the absence of a history of dietary triggers. We conclude that general practitioners appeared generally well informed about AD management. However, dermatologists, through targeted education, may be in a position to help general practitioners further improve outcomes for these patients.
Asunto(s)
Dermatitis Atópica/terapia , Medicina Familiar y Comunitaria/estadística & datos numéricos , Pautas de la Práctica en Medicina/estadística & datos numéricos , Niño , Preescolar , Dermatitis Atópica/epidemiología , Dermatología , Femenino , Humanos , Lactante , Masculino , Derivación y Consulta/estadística & datos numéricos , Encuestas y Cuestionarios , Australia Occidental/epidemiologíaRESUMEN
Ninety randomly selected general practitioners from the Perth metropolitan area completed a self-administered postal questionnaire aiming to examine the extent of their involvement with epilepsy and how closely their management mirrored best practice guidelines. GPs saw a median of 6 patients with epilepsy, mainly adults. They perceived complementary roles for GPs and neurologists: the GP providing ongoing support and education, monitoring treatment and making dosage adjustments; with the neurologist largely making the formal diagnosis and other management decisions. Only 42% regarded their knowledge of epilepsy as adequate for their practice. About half advised patients on the existence of the Epilepsy Association. Some respondents overestimated the usefulness of EEG. Plasma antiepileptic drug (AED) measurements were overvalued, with 69% of respondents performing plasma levels without regard to symptoms, and 20% would alter AED doses solely on the basis of plasma levels. GPs may tolerate very frequent seizures before referring their patients for more specialised evaluation.