Reliable test of clinicians' mastery in skin cancer diagnostics.

Differentiating between benign and malignant skin lesions can be very difficult and should only be done by sufficiently trained and skilled clinicians. To our knowledge there are no validated tests for reliable assessments of clinicians' ability to perform skin cancer diagnostics. To develop and gather validity evidence for a test in skin cancer diagnostics, a multiple-choice questionnaire (MCQ) was developed based on informal interviews with seven content experts from five skin cancer centers in Denmark. Validity evidence for the test was gathered from May until July 2019 using Messick's validity framework (content, response process, internal structure, relationship to other variables and consequences). Item content was revised through a Delphi-like review process and then piloted on 36 medical students and 136 doctors using a standardized response process. Results enabled an analysis of the internal structure and relationship to other variables of the test. Finally, the contrasting groups method was used to investigate the test's consequences (pass-fail standard). The initial 90-item MCQ was reduced to 40 items during the Delphi-like review process. Item analysis revealed that 25 of the 40 selected items were level I-III quality items with a high internal consistency (Cronbach's α = 0.83) and highly significant (P ≤ 0.0001) differences in test scores between participants with different occupations or levels of experience. A pass-fail standard of 12 (48%) correct answers was established using the contrasting groups' method. The skin cancer diagnostics MCQ developed in this study can be used for reliable assessments of clinicians' competencies.

Sentinel node detection in melanomas using contrast-enhanced ultrasound.

BACKGROUND: Sentinel node (SN) biopsy has proven to be a useful clinical method based on the combination of radionuclide tracer principles and the dye technique. Contrast-enhanced ultrasound (CEUS) has been used successfully for detection of SN in animals, but the use of CEUS has not been reported in humans. PURPOSE: To investigate the possible use of CEUS in detecting SN in patients with malignant melanomas (MM), and to improve the method by using different concentrations of contrast agent and various positions of the extremity. MATERIAL AND METHODS: Ten patients with MM on an extremity and one healthy volunteer were included. One milliliter of a contrast agent (Sonovue; Bracco, Milan, Italy) was injected subcutaneously on both sides of the scar from the excised tumor. Contrast-enhanced lymph channels and lymph nodes (LNs) were searched for using low-mechanical-index CEUS and by stimulated acoustic emission. Afterward, lymphoscintigraphy was performed and the patient operated. During surgery, the SNs were located via scintigraphic findings, gamma-probe signals, and blue-dye visualization of lymph channels and LNs. Before the human study, a study of 10 mice was performed to exclude possible tissue damage, as the contrast agent was not registered for subcutaneous administration. RESULTS: In one patient, two contrast-enhanced inguinal LNs were visualized by CEUS, corresponding to two inguinal SNs found by scintigraphic imaging. No contrast-enhanced lymph channels or LNs were visualized in any other patients or in the volunteer. No tissue damage was observed in the 10 mice. CONCLUSION: This study does not support the use of CEUS for detection of SNs in humans. However, the application of CEUS for the investigation of SNs is still not fully explored in humans, and an alternative setup and/or contrast agent might provide better results.

[Treatment of phimosis with a steroid creme in boys]. / Behandling af phimosis hos drenge med steroidcreme.

UNLABELLED: The current treatment of phimosis in Denmark is surgical. Reports of success rates of 70-80% with topical steroids have prompted us to carry out the present study. METHODS: Parents of boys, who were referred because of phimosis, volunteered to participate in an open trial of topical clobetasol 0.05%, along with gentle mobilisation of the foreskin once daily for 4-6 weeks. Fifty-five boys completed the treatment. The results were recorded at clinical follow-up four and six weeks later, and a long-term follow-up was done by questionnaire sent after 9-11 months. RESULTS: At six weeks of treatment, 42 had a fully retractable foreskin, 11 a partially retractable foreskin, and two had unchanged phimosis. Ten patients had a circumcision or plasty. At long-term follow-up, 12 had a symptomatic recurrence. Four of these were given surgical treatment and eight had a repeat topical treatment, which was effective in six. The overall effect was independent of the degree of phimosis. Four patients with obvious sacrified foreskin failed. Twelve patients had agglutinations, which became apparent after the treatment for phimosis. We recorded no systemic and very few local side effects. The patients and parents found the treatment convenient and satisfactory. CONCLUSION: Topical clobetasol 0.05% once a day for 4-6 weeks can be recommended as primary treatment in phimosis in boys without scarification of the foreskin. The treatment may be repeated as necessary.

Fracture of the femoral neck: optimal screw position and bone density determined by computer tomography.

The bone density of five proximal femurs from female cadavers was measured with computed tomography using a pixel size of 1.2 mm. A three dimensional reconstruction was performed along four well-defined axes. The region of maximal relative bone density correlated well with a previous report of the optimal position of a screw when treating a fracture of the femoral neck.

Formation of impacted fractures of the femoral neck: an experimental study.

Nine femoral-neck specimens were exposed to a fracturing force applied to the femoral head, perpendicular to the axis of the femur, simulating a fall onto the greater trochanter. The mechanical strength and fracture type were investigated in a universal testing machine. In all nine specimens, the superior (cranial) cortex of the femoral neck fractured first, followed by some compression and fracture of the inferior cortex, whereby impacted fractures had been formed. After application of additional force, dislocated fractures occurred. This method may be of value in experimental studies of impacted fractures of the femoral neck. RELEVANCE: This study describes an experimental procedure for formation of impacted femoral neck fractures. Hopefully this technique may be employed in further examining the nature and biomechanics of impacted hip fractures. The ultimate aim would seem to be a classification with regard to which fractures require surgery and which may be treated conservatively.

[Migration of suture material from the abdominal cicatrix to the urinary tract]. / Migration af suturmateriale fra bugvaegscikatrice til urinvejene.

Migration of foreign material to the genitourinary tract, often from the gastrointestinal tract through a fistula or perforation is well known. In this case, migration of a non-absorbable suture material from the abdominal wall to the urethra is illustrated. The possible mechanism was insufficient closure technique.