Evaluation of clinicians' knowledge and practices regarding medical radiological exposure: findings from a mixed-methods investigation (survey and qualitative study).

OBJECTIVES: To assess the impact of initiatives aiming to increase clinician awareness of radiation exposure; to explore the challenges they face when communicating with patients; to study what they think is the most appropriate way of communicating the long-term potential risks of medical radiological exposure to patients. DESIGN: A quantitative and qualitative evaluation through a survey and focal groups. SETTING: San Juan Hospital and Dr Peset Hospital (Southeast Spain) and clinicians from Spanish scientific societies. PARTICIPANTS: The surveys were answered (a) in person (216: all the radiologists (30), urologists (14) and surgeons (44) working at both participant hospitals; a sample of general practitioners from the catchment area of one hospital (45), and a consecutive sample of radiologists attending a scientific meeting (60)) or (b) electronically through Spanish scientific societies (299: radiologists (45), pneumologists (123), haematologists (75) and surgeons (40)). Clinicians were not randomly selected and thus the results are limited by the diligence of the individuals filling out the survey. PRIMARY AND SECONDARY OUTCOME MEASURES: Clinicians' knowledge and practices regarding medical radiological exposure, and what they considered most appropriate for communicating information to patients. RESULTS: Nearly 80% of the clinicians surveyed had never heard of the European recommendations. Fewer than 20% of the clinicians surveyed identified correctly the radiation equivalence dose of intravenous urography or barium enema. It was reported by 31.7% that they inform patients about the long-term potential risks of ionising radiation. All participants agreed that the most appropriate way to present information is a table with a list of imaging tests and their corresponding radiation equivalence dose in terms of chest X-rays and background radiation exposure. CONCLUSIONS: Medical radiological exposure is frequently underestimated and rarely explained to patients. With a clear understanding of medical radiological exposure and proper communication tools, clinicians will be able to accurately inform patients.

Selectividad de la fototermólisis en el tratamiento de las manchas en vino de Oporto mediante múltiples pulsos de láser de colorante pulsado / Selectivity of photothermolysis in the treatment of port wine stains using multiple pulses with a pulsed dye laser

Introducción. En un 25-50 % de los pacientes con manchas en vino de Oporto tratadas con láser decolorante pulsado (incluso con múltiples sesiones) obtenemos un resultado parcial y frecuentemente insatisfactorio para el paciente. Se han propuesto varios factores que explicarían esta resistencia al tratamiento, como la presencia de vasos profundos, de pequeño calibre o muy gruesos, a los que un solo pulso de láser no logra coagular. Existen modelos matemáticos que sugieren que los multipulsos serían eficaces para coagular estos vasos sin perder la selectividad de la fototermólisis, ya que permiten administrar más energía sobre las estructuras diana, sin lesionar el tejido circundante. El objetivo de este estudio es evaluar la eficacia y la selectividad de la fototermólisis al usar multipulsos. Métodos. Se seleccionaron 12 pacientes con manchas en vino de Oporto. Se trataron varias zonas de cada lesión con láser de colorante pulsado (V-beam 595 nm, Candela®) y distintos parámetros. Inmediatamente después se biopsiaron las zonas tratadas. Resultados. El riesgo de sobre dosificar fue mayor con tamaños del haz pequeños, pulsos largos, intervalo breve entre pulsos y fluencias elevadas. El daño térmico fue menor con tamaños del haz de 10 mm, pulsos cortos, intervalo de 1 minuto entre los pulsos y fluencias bajas. En casos seleccionados, los multipulsos eran eficaces y selectivos, ahí donde el pulso único no lograba coagular los vasos. Conclusiones. Nuestros resultados ponen de manifiesto las enormes posibilidades que los multipulsos ofrecen para el tratamiento de las lesiones vasculares refractarias. Asimismo, definimos los parámetros que intervienen en este complejo proceso termodinámico de interacción del láser con el tejido cutáneo, se señalan cuáles son más seguros y apuntamos su utilidad con otros láseres y patologías cutáneas (AU)

Background. In 25 % to 50 % of patients with port wine stains treated with pulsed dye laser (even in multiple sessions), only a partial improvement is obtained that is often unsatisfactory for the patient. Various factors have been proposed to explain the resistance to treatment, such as the presence of deep, small-caliber, or very thick vessels that cannot be coagulated with a single laser pulse. Certain mathematical models suggest that multiple pulses would be effective in coagulating those vessels without losing the selectivity of photothermolysis, since more energy could be delivered to the target structures without damaging the surrounding tissue. The aim of this study was to assess the efficacy and selectivity of photothermolysis with multiple laser pulses. Methods. Twelve patients with port wine stains were included in the study. Various areas of each lesion were treated with pulsed dye laser (Candela V-beam, 595 nm) using different parameters. Immediately after wards ,the treated areas were biopsied. Results. The risk of exceeding an appropriate dose was greater with small spot size, long pulse duration, short intervals between pulses, and high fluences. Heat damage was less with spots of 10 mm, short pulses, intervals of 1 minute between pulses, and low fluences. In selected cases, multiple pulses were effective and selective where single pulses did not successfully coagulate the vessels. Conclusions. Our results indicate the enormous possibilities of multiple laser pulses for the treatment of refractory vascular lesions. In addition, we have addressed the variables defining the complex thermodynamic interaction between the laser and the cutaneous tissue and indicated the safest parameters. We discuss the possible usefulness of this approach with other lasers and skin diseases (AU)

[Selectivity of photothermolysis in the treatment of port wine stains using multiple pulses with a pulsed dye laser]. / Selectividad de la fototermólisis en el tratamiento de las manchas en vino de Oporto mediante múltiples pulsos de láser de colorante pulsado.

BACKGROUND: In 25 % to 50 % of patients with port wine stains treated with pulsed dye laser (even in multiple sessions), only a partial improvement is obtained that is often unsatisfactory for the patient. Various factors have been proposed to explain the resistance to treatment, such as the presence of deep, small-caliber, or very thick vessels that cannot be coagulated with a single laser pulse. Certain mathematical models suggest that multiple pulses would be effective in coagulating those vessels without losing the selectivity of photothermolysis, since more energy could be delivered to the target structures without damaging the surrounding tissue. The aim of this study was to assess the efficacy and selectivity of photothermolysis with multiple laser pulses. METHODS: Twelve patients with port wine stains were included in the study. Various areas of each lesion were treated with pulsed dye laser (Candela V-beam, 595 nm) using different parameters. Immediately afterwards, the treated areas were biopsied. RESULTS: The risk of exceeding an appropriate dose was greater with small spot size, long pulse duration, short intervals between pulses, and high fluences. Heat damage was less with spots of 10 mm, short pulses, intervals of 1 minute between pulses, and low fluences. In selected cases, multiple pulses were effective and selective where single pulses did not successfully coagulate the vessels. CONCLUSIONS: Our results indicate the enormous possibilities of multiple laser pulses for the treatment of refractory vascular lesions. In addition, we have addressed the variables defining the complex thermodynamic interaction between the laser and the cutaneous tissue and indicated the safest parameters. We discuss the possible usefulness of this approach with other lasers and skin diseases.

Dermatofibromas eruptivos múltiples asociados al virus de la inmunodeficiencia humana. Presentación de dos casos / Multiple eruptive dermatofibromas in 2 patients infected with the human immunodeficiency virus

Los dermatofibromas eruptivos múltiples (DFEM) constituyen una entidad clínica infrecuente que consiste en la aparición de varias lesiones en un corto espacio de tiempo. Baraf y Shapiro los definen en 1970 como la aparición de al menos 15 dermatofibromas en pocos meses. Dado que esta cifra podría pasar por alto casos incipientes, se ha propuesto que el hallazgo de 5 a 8 dermatofibromas en 4 meses sea suficiente. Este hallazgo clínico suele aparecer en el contexto de enfermedades autoinmunes (lupus eritematoso) así como en enfermos positivos para el virus de la inmunodeficiencia humana (VIH) o en tratamiento con ciertos fármacos, pero también se han descrito DFEM en pacientes sanos. Presentamos dos casos de dermatofibromas eruptivos múltiples asociados a infección por el VIH, siendo esta condición desconocida previamente en uno de los pacientes, por lo que creemos que la aparición de estas lesiones cutáneas podría ayudar al diagnóstico precoz de enfermedades autoinmunes o situaciones de inmunosupresión

Multiple eruptive dermatofibromas are an uncommon clinical entity in which several lesions appear in a short period of time. Baraf and Shapiro defined them in 1970 as the appearance of at least 15 dermatofibromas in a few months. Given that incipient cases might be omitted, appearance of 5 to 8 dermatofibromas in 4 months has been proposed as sufficient to establish diagnosis. Although this entity has been reported in healthy subjects, it usually appears with underlying autoimmune diseases (lupus erythematosus), human immunodeficiency virus (HIV) infection, or treatment with certain drugs. We report 2 cases of multiple eruptive dermatofibromas associated with HIV infection. One of these patients was unaware of being infected with HIV, and so we believe that the appearance of these skin lesions could help early diagnosis of autoimmune diseases or patients with immunodepression

[Multiple eruptive dermatofibromas in 2 patients infected with the human immunodeficiency virus]. / Dermatofibromas eruptivos múltiples asociados al virus de la inmunodeficiencia humana. Presentación de dos casos.

Multiple eruptive dermatofibromas are an uncommon clinical entity in which several lesions appear in a short period of time. Baraf and Shapiro defined them in 1970 as the appearance of at least 15 dermatofibromas in a few months. Given that incipient cases might be omitted, appearance of 5 to 8 dermatofibromas in 4 months has been proposed as sufficient to establish diagnosis. Although this entity has been reported in healthy subjects, it usually appears with underlying autoimmune diseases (lupus erythematosus), human immunodeficiency virus (HIV) infection, or treatment with certain drugs. We report 2 cases of multiple eruptive dermatofibromas associated with HIV infection. One of these patients was unaware of being infected with HIV, and so we believe that the appearance of these skin lesions could help early diagnosis of autoimmune diseases or patients with immunodepression.

Placa eritematoescamosa plantar / Plantar erythematosquamous plaque

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[Therapeutic application of botulogenic toxin]. / Empleo terapéutico de la toxina botulínica.

Botulogenic toxin infiltration for the treatment of idiopathic local hyperhidrosis is a safe and well tolerated procedure, with minimum side effects and with an effectiveness demonstrated throughout the years, especially in axillary hyperhidrosis; in the majority of patients with this condition is an effective alternative to surgery. In other locations, the results are more modest and the clinical experience more limited, which forces us to advise the surgery as alternative with an incidence far from desirable.

Empleo terapéutico de la toxina botulínica / Therapeutic application of botulogenic toxin

La infiltración con toxina botulínica para el tratamiento de la hiperhidrosis local idiopática nos aporta un procedimiento seguro, bien tolerado, con mínimos efectos secundarios y con eficacia contrastada a largo plazo, sobre todo en el caso de la hiperhidrosis axilar, representando en la mayoría de pacientes una alternativa eficaz a la cirugía. En otras localizaciones, los resultados obtenidos son más discretos y la experiencia clínica es más escasa, viéndonos obligados con más frecuencia de la deseable a aconsejar la cirugía como alternativa

Botulogenic toxin infiltration for the treatment of idiopathic local hyperhidrosis is a safe and well tolerated procedure, with minimum side effects and with an effectiveness demonstrated throughout the years, especially in axillary hyperhidrosis; in the majority of patients with this condition is an effective alternative to surgery. In other locations, the results are more modest and the clinical experience more limited, which forces us to advise the surgery as alternative with an incidence far from desirable