Photodiagnostic services in the UK and Republic of Ireland: a British Photodermatology Group Workshop Report.

BACKGROUND: Photodiagnostic investigations are essential for the accurate diagnosis of abnormal cutaneous photosensitivity and provide important information for the management of patients with photodermatoses (cutaneous photosensitivity disorders). Although photodiagnosis has been undertaken since the early 1970s, specialist services in the United Kingdom (UK) and Republic of Ireland are limited and there is no formal guidance on diagnostic approach. Indeed, there is a limited literature in this area of methodology and diagnostic practice. OBJECTIVES: The primary objective was to undertake a British Photodermatology Group Workshop to review the role and activities of specialist centres in the UK and Republic of Ireland in order to ascertain whether there were consensus practices. Secondary objectives were to identify key priorities for service, training and research. METHODS: An initial detailed survey review of current activities was undertaken prior to the Workshop and data from this survey were used to inform discussion at the Workshop, which was attended by key photodermatology experts from the UK and Republic of Ireland. RESULTS/CONCLUSIONS: We have undertaken a detailed review of current Photodiagnostic Services in the UK and Republic of Ireland and report on our findings from the 12 centres and we have identified key areas of consensus practice. This is an important step in the process of standardising and optimising procedures and protocols and defining minimum clinical standards for photodiagnostic investigations, which are of such diagnostic importance in Dermatology.

Paraesophageal hernia repair with bifacial mesh.

Background.The paraesophageal hiatus hernias (PHH) are relatively uncommon, but an increased incidence has been reported and they now account for 5-10% of all hiatus hernias. The surgical treatment is recommended for all the patients with this pathology because of high risk of complications: obstruction, incarceration, strangulation or perforation. The use of prostheses is recommended in the process of repairing the giant PHH because the main problem of this operation is the high rate of recurrence. Case presentation.The patient is a 44-year-old male with a large and symptomatic paraesophageal hernia. Diagnosis was confirmed by instrumental examination. An elective laparoscopic repair was carried out by using polypropylene bifacial anti adhesive synthetic mesh (Surgimesh XB Aspide Medical). The postoperative period passed without severe complications. Conclusions.The laparoscopic approach as a therapeutic option can be successfully used in the repair of paraesophageal hernia. A selective use based on clinical experience was recommended, as the technique appeared to be safe, and in case of large hiatus hernia with hiatal defect, greater than 5 cm, the application of synthetic material to minimize the recurrence rate was recommended.

Home phototherapy for psoriasis: a review and update.

A 2006 survey of dermatologists showed that home phototherapy should be used with caution, and that general, nonevidence-based opinions were widespread about this form of therapy. This led to a randomized controlled trial to assess the safety and efficacy of home phototherapy vs. outpatient phototherapy by the same authors in 2009, which concluded that a lower burden of treatment and increased patient satisfaction were associated with home phototherapy. In the UK National Health Service, with a single exception, phototherapy is currently carried out exclusively in hospital. This contrasts with the Netherlands, where home phototherapy is now widely available. NHS dermatology services in the UK have yet to adopt home phototherapy as a treatment option, despite the strong evidence base and robust service models established elsewhere. In this review, we discuss evidence-based papers on home phototherapy, its advantages and disadvantages, economic effectiveness, and a suggested model for service sustainability.

Polymorphism of the IL-8 gene and the risk of ovarian cancer.

Ovarian cancer still represents a challenge in gynecological oncology. Most patients are diagnosed in an advanced tumor stage. No specific screening or prevention strategies for ovarian cancer exist as of yet. Interleukin 8 (IL-8) is a pro-inflammatory chemokine known for its angiogenetic activity, and is supposedly responsible for tumor-associated angiogenesis in several malignant tumors. The aim of the study was to investigate the susceptibility of patients with an IL-8 gene polymorphism to developing ovarian cancer. Four single nucleotide polymorphisms (SNPs) (IL-8 -251, IL-8 +781, IL-8 +1633 and IL-8 +2767) of the IL-8 gene were screened, using the PCR method in 268 patients with ovarian cancer and 426 healthy women as a control group. Significant associations were noted in patients with the IL-8 +781 (T/T) genotype (p=0.0048) with increased frequencies of ovarian cancer, while women with the IL-8 +781 (C/C) allele suffer from ovarian cancer significantly less frequently (p=0.0003). Furthermore, the IL-8 +2767 (T/T) genotype is also associated with a higher risk of ovarian cancer (p=0.0177). Our results indicate, for the first time, that IL-8 polymorphism is associated with ovarian cancer.

Photon transport in cylindrically-shaped disordered meso-macroporous materials.

We theoretically and experimentally investigate light diffusion in disordered meso-macroporous materials with a cylindrical shape. High Internal Phase Emulsion (HIPE)-based silica foam samples, exhibiting a polydisperse pore-size distribution centered around 19 µm to resemble certain biological tissues, are realized. To quantify the effect of a finite lateral size on measurable quantities, an analytical model for diffusion in finite cylinders is developed and validated by Monte Carlo random walk simulations. Steady-state and time-resolved transmission experiments are performed and the transport parameters (transport mean free path and material absorption length) are successfully retrieved from fits of the experimental curves with the proposed model. This study reveals that scattering losses on the lateral sides of the samples are responsible for a lowering of the transmission signal and a shortening of the photon lifetime, similar in experimental observables to the effect of material absorption. The recognition of this geometrical effect is essential since its wrong attribution to material absorption could be detrimental in various applications, such as biological tissue diagnosis or conversion efficiency in dye-sensitized solar cells.

Successful renal transplant in a patient with non-Herlitz junctional epidermolysis bullosa.

Non-Herlitz junctional epidermolysis bullosa (NH-JEB) is a very rare inherited disorder, with an array of complications. We present the case of a 33-year-old patient of Chinese origin, diagnosed with NH-JEB in childhood, who developed severe IgA nephropathy. His renal impairment was initially treated by haemodialysis. He underwent successful renal transplantation, resulting in normalization of his renal function. To our knowledge, this is the first report of renal transplantation in a patient with epidermolysis bullosa, which should support use of this intervention in other similar cases.

[Nutritional status evaluation in maintenance hemodialysis patients]. / Evaluarea starii de nutritie la pacientii cu insuficienta renala cronica terminala tratati prin hemodializa.

UNLABELLED: Protein-calorie malnutrition is a common complication and an important predictive factor for mortality in patients with end-stage renal disease on maintenance dialysis. Therefore, nutritional status needs to be regularly assessed in these patients by using several methods. If malnutrition is diagnosed, its causes should be thoroughly searched for and properly treated. MATERIAL AND METHOD: This cross-section study aimed at evaluating the nutritional status and the possible risk factors for malnutrition in 149 (82 men) hemodialysis patients by anthropometry, biochemical tests and bioelectrical impedance analysis (BIA). The patients' height (H), post-dialysis body weight (BW), mid-arm circumference (MAC), tricipital skin-fold thickness (TST) were measured and a 3-category subjective global assessment (SGA) was performed. Body mass index (BMI), mid-arm muscle circumference (MAMC), corrected mid-arm muscle area (cMAMA) and anthropometry-estimated percent body muscle mass (% AMM) were calculated from the above measurements by using specific equations. Biochemical tests included protein equivalent of nitrogen appearance (nPNA), and predialysis serum albumin, creatinine, total cholesterol, bicarbonate, and hemoglobin (Hb) levels. We used BIA to estimate body composition - i.e. percent body fat (% BBF), fat-free mass (% FFM), body cell mass (% BCM), extracellular mass (% ECM), muscle mass (% BMM)--and the phase angle (PhA). T-test was used to make comparisons and Pearson coefficient to analyze the correlations. P < 0.05 was considered statistically significant. RESULTS: The male patients had a higher mean muscle mass--as estimated by serum creatinine (9.8 s 8.3 mg/dl; P < 0.0001) and by % BMM (41.7% vs 34.7%)--and a lower fat mass--as estimated by TST (0.95 cm vs 1.2 cm; P = 0.016) and by % FAT (16.7% vs 31.3%; P < 0.0001) than the female patients. Age was found to be positively correlated with BMI (P = 0.001), but inversely correlated with % BCM (P = 0.013) and with % AMM (P = 0.003). Patients with diabetes had lower % BCM than those without diabetes (32.9 vs 35.9%; P = 0.041). The presence of heart failure was associated with significantly reduced MAMC (22.0 vs 23.6 cm2; P = 0.045), % AMM (28.5 vs 32.1; P = 0.021), % BCM (33.0 vs 36.1% ; P = 0.034), BMM/H2 (8.6 vs 9.4 kg/m2; P = 0.013), nPNA (1.17 vs 1.34 g/kg-d ; P = 0.047), serum albumin (39.7 vs 42.4 g/l; P = 0.010), serum creatinine (8.1 vs 9.4 mg/dl; P = 0.008) and Hb (10.5 vs 11.2 g/dl; P = 0.017). The serum Hb level was positively correlated with BMI (P = 0.005), BMM/H2 (P = 0.009), serum albumin (P = 0.002) and serum creatinine (P = 0.011). Also, patients with category B-SGA were older (63.7 vs 50.1 y.o.; P < 0.0001) and had more heart failure (42% vs 13%; P = 0.013) than those with category A-SGA. In hemodialysis patients, advancing age, diabetes, heart failure and decreasing Hb levels are associated with worse nutritional status, as estimated by anthropometry, biochemical markers and BIA. Whether treatment of comorbidities such as heart disease and anemia may improve nutritional status in these patients is an important issue that deserves further research.