Does the histopathological subtype of primary basal cell carcinoma predict the subtype of secondary tumours? What role do genetic mutations play?

Background: Basal cell carcinoma (BCC) is one of the most common malignancies in the world. The frequency of histopathological subtypes and the distribution on the body of BCC has been well documented. Less has been written on the nature of secondary tumours. The genetics of BCC is starting to be understood, particularly with the advent of newer medical treatments (hedgehog inhibitors). Objectives: To determine if primary basal cell carcinoma histopathological subtype predicts secondary tumour subtype, as well as their anatomical distribution. Methods: A retrospective case series of patients over the age of 18 was performed from 2009 to 2014, with at least two separate diagnoses of BCC. Results: In 394 identified patients, a total of 1355 BCCs arose in the cohort over the 6-year study period. The number of secondary BCCs per patient ranged from 2 to 19 tumours. Nodular BCC was the most likely to reoccur in secondary tumours (53.3%), followed by mixed subtypes (45.7%). Conclusions: Within our study, we did find a predisposition for secondary BCCs to be of the same histopathological subtype as the primary, particularly with respect to nodular and mixed tumours. Furthermore, we found that secondary tumours were also more likely to occur on the same anatomical site as the primary tumour. We are only just beginning to under the genetic mutations involved in subtype formation.

Comparison of 90-s versus 5-min intraoperative 5-fluorouracil in trabeculectomy.

To compare the relative efficacy of trabeculectomy surgery with 90-s and 5-min intraoperative exposure time to 5-fluorouracil. This was a retrospective, non-randomized comparative study. 41 eyes of 33 consecutive patients in the study group were compared to 40 eyes of 30 consecutive patients in the historical control group. Both groups were exposed to 5-fluorouracil (50 mg/ml) during trabeculectomy surgery. The exposure time was 90 s for the study group and 5 min for the control group. Three criteria were used to define surgical success: IOP (intraocular pressure) less than 21 mmHg; IOP less than 21 mmHg with more than 30% reduction in pressure; and IOP less than 15 mmHg with more than 30% reduction. The number of antiglaucoma medications, visual acuity, complications, and interventions were recorded at regular intervals. Mean preoperative IOP was 21.6 +/- 4.8 in the 90-s group and 21.2 +/- 4.9 in the 5-min group. Mean follow-up was 28.2 +/- 5.1 months in the 90-s group and 48.0 +/- 4.9 months in the 5-min group. During the first 30 postoperative months, there were no statistically significant differences in IOP and requirement for antiglaucoma medications between the two groups. The 90-s group had shorter survival rates using the 1st success criteria, but no significant difference was detected when the more stringent 2nd and 3rd criteria were applied. Choroidal effusions were significantly less common in the 90-s group (P = 0.0076). The results of this small study suggest that a 90-s application of 5-fluorouracil may be as effective as a 5-min one in trabeculectomy.

Scedosporium apiospermum traumatic endophthalmitis successfully treated with voriconazole.

We describe a case of traumatic endophthalmitis due to Scedosporium apiospermum that was successfully treated with a combination of intravitreal and systemic voriconazole. A high dose of 200 microg was used intravitreally without any apparent complications. A brief overview of voriconazole use for treatment of ocular infections is presented, and a comparison is made with antifungal agents traditionally used in ophathalmology.

Seropositivity rates for Bartonella henselae, Toxocara canis and Toxoplasma gondii in New Zealand blood donors.

BACKGROUND: Bartonella henselae, Toxocara canis and Toxoplasma gondii organisms can all cause vision-threatening posterior segment disease. Diagnosis relies heavily on clinical findings, but detection of antibodies in the patient's serum may be helpful in some cases. The significance of a positive serology result depends on the seroprevalence in the general population. Seroprevalence rates for these organisms vary widely around the world and this study aimed to determine the rates for a New Zealand population. METHODS: One hundred and forty healthy blood donors from the Waikato region in the North Island of New Zealand had their serum tested using an indirect latex agglutination test for detection of T. gondii antibodies, an indirect immunofluorescent assay for B. henselae antibodies and an enzyme-linked immunosorbent assay test for T. canis antibodies. RESULTS: Seropositivity rates for T. canis, T. gondii and B. henselae in this New Zealand population were 0.7 +/- 1.65%, 42.9 +/- 8.12% and 5 +/- 3.61%, respectively. CONCLUSION: Seropositivity rates for T. gondii and B. henselae in New Zealand are similar to rates reported in some other countries; however, T. canis seroprevalence may be lower than reported elsewhere in the world.

Relationship between second-generation frequency doubling technology and standard automated perimetry in patients with glaucoma.

PURPOSE: The aim of the study was to establish the correlation between visual filed loss as shown by second-generation Frequency Doubling Technology (Humphrey Matrix) and Standard Automated Perimetry (Humphrey Field Analyser) in patients with glaucoma. Also, compared were the test duration and reliability. METHODS: Forty right eyes from glaucoma patients from a private ophthalmology practice were included in this prospective study. All participants had tests within an 8-month period. Pattern deviation plots and mean deviation were compared to establish the correlation between the two perimetry tests. Overall correlation and correlation between hemifields, quadrants and individual test locations were assessed. RESULTS: Humphrey Field Analyser tests were slightly more reliable (37/40 vs. 34/40 for Matrix)) but overall of longer duration. There was good correlation (0.69) between mean deviations. Superior hemifields and superonasal quadrants had the highest correlation (0.88 [95% CI 0.79, 0.94]). Correlation between individual points was independent of distance from the macula. CONCLUSION: Generally, the Matrix and Humphrey Field Analyser perimetry correlate well; however, each machine utilizes a different method of analysing data and thus the direct comparison should be made with caution.

Career choices of New Zealand junior doctors.

AIMS: To report career preferences of New Zealand junior doctors, determine what factors influenced their choice, and determine at what stage of their career that choice was made. METHODS: A structured questionnaire with anonymous replies was sent to final year medical students as well as to junior doctors in their first to fourth postgraduate year. Questions were based around choice of future career, timing, and certainty of this choice and the factors influencing it. RESULTS: Of the 400 questionnaires distributed, 256 (64%; 95%CI: 59-69%) were returned. The most popular career choice was medicine (44%; 95%CI: 38-50%), followed by surgery (34%; 95%CI: 29-40%), general practice (30%; 95%CI: 25-36%), paediatrics (29%; 95%CI: 24-35%), and obstetrics and gynaecology (20%; 95%CI: 16-25%). The choice of a career was mostly based on interest in that specialty. Most (70%; 95%CI: 64-75%) final year medical students; and 52% (95%CI: 41-63%), 45% (95%CI: 33-60), and 17% (95%CI: 9-33%) of doctors in postgraduate year 1, 2, and 2+ respectively; had not made a definite career choice. Sixty-nine percent (95%CI: 63-75%) of respondents stated that they plan to work overseas, mostly to travel (70%; 95%CI: 63-77%) and to further their professional training (58%; 95%CI: 59-73%). CONCLUSIONS: Career aspirations of New Zealand junior doctors were similar to those reported by overseas studies. Adequate guidance throughout medical training and opportunity to gather work-experience over several specialties should be encouraged.