Screening mammogram microcalcification due to basal cell carcinoma of the skin.

Basal cell carcinoma is the most common skin malignancy worldwide, typically presenting as a pearly or translucent papule. Histologically, approximately 21% contain areas of microcalcification. We report a case of a woman presenting with microcalcification on screening mammography that was suspicious. Repeated core biopsies did not obtain microcalcification, and a diagnostic excision of breast tissue and overlying skin revealed an intradermal basal cell carcinoma containing the microcalcification. No breast malignancy was present. We believe this is the second such reported case in the literature and the first to be reported in Europe.

Adjuvant intraoperative photodynamic therapy in experimental colorectal cancer using a new photosensitizer.

BACKGROUND: Photodynamic therapy is a promising anticancer modality. The effect of adjuvant intraoperative photodynamic therapy (AIOPDT) using photosensitizers Photofrin or mesotetra (hydroxyphenyl) chlorin (m-THPC) was evaluated in a mouse model of local recurrence of colorectal cancer. METHODS: Animals were injected with either photosensitizer 24 h before surgery. Standard excision included removal of all visible tumour by a surgeon blinded to both the drug and subsequent light treatment. Following surgery the tumour beds were illuminated with either 70 J cm-2 of 510-nm light (Photofrin) or 2.5 J cm-2 of 652-nm light (m-THPC). Control groups had either surgery only, surgery and Photofrin only, surgery and m-THPC only, or surgery and either 652-nm or 510-nm light. RESULTS: After a 70-day observation period, the local recurrence rates were 25-26 per cent in the photodynamic therapy groups compared with 80-90 per cent in the control groups (P < 0.001). CONCLUSION: AIOPDT using either Photofrin or m-THPC was equally effective in reducing local recurrence in this model. Since treatment time with m-THPC was only 25 s compared with 11 min with Photofrin, the use of the former new photosensitizer increases the practicality of AIOPDT and could enable the laser to be replaced with cheaper, less intense light sources.

Photodynamic therapy for malignant tumours of the ampulla of Vater.

Ten patients with ampullary carcinoma, not suitable for surgery, were treated with endoscopic photodynamic therapy (PDT) to evaluate the feasibility and safety of treatment. Patients received 4 mg kg-1 of haematoporphyrin derivative intravenously. Two days later, a duodenoscopy was performed and red (630 nm) light delivered to the tumour at fixed energy densities of 50 J or 200 J cm-1 per application, depending on the type of optical fibre used. The tumours were treated by three or four light applications at each session. Treatment was repeated up to five times at intervals of three to six months. The sole complication of PDT was moderate skin photosensitivity, which occurred in three patients. Tumour size was assessed at four to eight weekly intervals. In the absence of macroscopic tumour, biopsy specimens were taken. In three patients with small tumours confined to the ampulla, remission was obtained for periods ranging from eight to 12 months. In a further four patients with small tumours bulk was greatly reduced. There was little response in three patients with extensive duodenal involvement. Therefore PDT for ampullary carcinoma is both feasible and safe, and with refinement may prove curative for small tumours.

Adjuvant intraoperative photodynamic therapy in experimental colorectal cancer.

A reliable animal model for quantitative assessment of local recurrence of colorectal cancer was developed using colo26 tumour in BALB/c mice. The effect of adjuvant intraoperative photodynamic therapy to potentially curative surgery on local recurrence was examined in four study and four control groups. Study groups received 15 mg kg-1 Photofrin (a photosensitizing drug) 24 h before surgery. After 'curative' tumour excision, the tumour beds were illuminated with either 630 nm or 510 nm laser light each at 40 and 70 J/cm-2. Controls received surgery only, surgery and Photofrin only or surgery and either 630 nm or 510 nm light. The local recurrence rates at 70 days were 17-33 per cent in the study groups compared with 83-100 per cent in the control groups (P < 0.001; log rank test). Photodynamic therapy is capable of reducing local recurrence following potentially curative excision of tumour in this model.

Adjuvant intraoperative photodynamic therapy for colorectal carcinoma: a clinical study.

The local recurrence rate of colorectal carcinoma after surgery is unacceptable in most series, and adjuvant therapies have made only a small impact on this. There is experimental evidence that adjuvant intraoperative photodynamic therapy (AIOPDT) may be effective. AIOPDT involves systematically photosensitizing the patient preoperatively with a drug (HpD) which relatively localizes to tumour and is activated using visible light. At operation the resected tumour bed is illuminated with a predetermined uniform light energy density to eradicate microscopic tumour deposits left at the lateral resection margin. We have previously investigated technical and biological factors leading to this clinical trial. Seventeen patients have received AIOPDT in a potentially effective dose, and safety and technical matters have been investigated. Cutaneous phototoxicity occurred in 3 patients. Three patients had anastomotic breakdown, none considered attributable to PDT. The intraoperative technique was a practical option. AIOPDT carried a low patient morbidity and should be investigated in prospective clinical trials to determine if local recurrence rates can be decreased.

Accurate measurement of surface areas of anatomical structures by computer-assisted triangulation of computed tomography images.

There is a need for accurate surface area measurement of internal irregular anatomical structures in order to define light dosimetry in adjunctive intraoperative photodynamic therapy (AIOPDT). No satisfactory preoperative method exists of measuring this parameter. We have investigated whether computer-assisted triangulation of serial sections generated by computed tomography (CT) scanning can give an accurate assessment of the surface area of the walls of the true pelvis after anterior resection and before colorectal anastomosis. We have shown that the technique of paper density tessellation is an acceptable method of measuring the surface areas of phantom objects, with a maximum error of 0.5%, and is used as the gold standard. Computer-assisted triangulation of CT images of standard geometric objects and accurately-constructed pelvic phantoms gives a surface area assessment with a maximum error of 2.5% compared with the gold standard. The CT images of 20 patients' pelves have been analysed by computer-assisted triangulation and this shows that the surface area of the walls varies from 143 cm2 to 392 cm2. Simple step-like analysis of images and approximation to geometric shapes with subsequent calculation give unacceptably high errors. The surface area of an internal, rigid, irregular surface area for illumination in AIOPDT can be accurately measured preoperatively by computer-assisted triangulation of CT images.

Acute urinary retention: which catheter?

There is no scientific data on which is the best method and catheter to use in acute urinary retention in males. We therefore compared the efficiency of a size 12 G latex rubber balloon catheter with a similar calibre but more expensive catheter made of polyvinyl-chloride (PVC). A total of 50 patients was studied and a 100% successful catheterisation rate was recorded at first attempt with both catheters, with no significant complications. The importance of the correct management of acute urinary retention, especially adequate analgesia, is stressed and it is concluded that either catheter is satisfactory.

High prevalence of abdominal aortic aneurysm in men with peripheral vascular disease: screening by ultrasonography.

A study was carried out to see if an ultrasonic examination of the abdominal aorta was indicated in every patient who attended an outpatient clinic with peripheral vascular disease (PVD). One hundred consecutive patients were studied and compared with a control group. The incidence of abdominal aortic aneurysm (AAA) in the control group was 2 per cent. In the study group, the male patients had an incidence of 20 per cent of aneurysm and ectasia, while the female patients had an incidence of 12 per cent. Of all the abnormal aortas found by ultrasound, only 31 per cent were palpable clinically. Two aneurysms that required operation were found, while the remainder are to be followed by regular ultrasound assessment. Further studies are necessary to conclude if screening of a high risk group, such as patients with PVD, is worthwhile.

Lung function and radiographic change in chrysotile workers in Swaziland.

The effect on lung function and radiographic indices of exposure to chrysotile asbestos was investigated by cross-sectional studies in two groups of men at Havelock Mine, Swaziland. The first group consisted of 214 employees and ex-employees, mean age 52, who had been employed for at least 10 years, and whose dust exposure ranged from minimal for surface workers to very heavy for those in the grading and bagging sections of the mill. In this group 29% had category 1 or more simple pneumoconiosis and 4.5% category 2 or more. For surface and mine workers, the estimated annual deterioration in FEV1 and FVC and the increase in category of pneumoconiosis was similar to that due to age alone, while the heaviest exposure almost doubled the decline in lung function and trebled the rate of progression of pneumoconiosis. The second group consisted of 224 men, mean age 33, all currently working in the mill and having been employed there for at least a year. In this group 30% had category 1 or more simple pneumoconiosis, and 2.7% category 2. Exposure in the dustiest sections of the mill more than doubled the estimated annual decline in lung function and doubled the rate of progression of pneumoconiosis.