Lead exposure in clinical imaging - The elephant in the room.

PURPOSE: Radiation Protection Apparel (RPA) is used during diagnostic imaging and interventional procedures to minimise incidental radiation exposure. The majority of RPA in use are lead-containing, which has until now been considered safe. A recent single-centre study has demonstrated that the external surface of 63 % of RPA was contaminated with lead dust. The purpose of this study was to reproduce this investigation with a larger sample size across Europe and assess whether decontamination procedures were possible. METHOD: The routine RPA Quality Control (QC) process was adapted to include lead dust contamination tests and decontamination if present. The presence of lead dust was determined using a commercially available colorimetric method. RPA that failed initial QC or could not be decontaminated were removed from use. RESULTS: From June to October 2019, 728 RPA from 85 imaging centres from five countries underwent initial QC. Of these, 712 were tested for lead dust contamination which was present on 162 (23 %). Following cleaning, 85 (12 %) remained contaminated and were removed from use. Linear regression analysis shows a significant correlation between type of RPA and contamination, (p = 0.0015). There was no correlation between contamination and imaging department, year of manufacture, country and RPA condition (p-values 0.98, 0.90, 0.94 and 0.14 respectively). CONCLUSIONS: Lead dust contamination is present on 23 % of RPA that would pass routine QC procedures. Approximately half were not amenable to decontamination and were removed from use. Procedures were introduced for the routine handling of RPA, and updated QC steps for assessment and cleaning. Lead-free RPA should be considered.

Sun Exposure Habits and Sun Protection Practices of Skaters.

Beach activities and outdoor sports are risk factors for developing skin cancer. Skateboarding is among the most popular sports among adolescents. The aim was to analyse the sun exposure habits and sun protection practices of skaters, in comparison with corresponding sun exposure and protection practices on the beach. This cross-sectional study is based on health surveys carried out into sun exposure and protection practices among young skateboarders. The study population was composed of 102 skaters, of whom 84 (82.4 %) were male. Fifty-eight (56.8 %) of the participants reported having suffered at least one sunburn event the previous summer. Eighty-seven (91.6 %) said they practiced outdoor sports more than 90 days per year, while only six (6.1 %) spent this long at the beach. Forty-nine (52.1 %) practiced outdoor sports for 5 or more hours a day compared to 42 (43.3 %) who spent comparable periods at the beach. A long-sleeved shirt was worn more frequently during sports than at the beach. Keen skaters are a risk group for the development of skin cancer due to excessive sun exposure, high rates of sunburn and scant use of sun protection measures. Specific educational and behavioural interventions should be aimed at this risk group.

Lesiones ampollosas en el dorso de las manos / Bullous lesions on the back of the hands

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Placas eritematosas parduzcas atróficas de 40 años de evolución / Rownish-erythematous atrophic plaques, developed over 40 years

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Enfermedad de Paget extramamaria perianal: respuesta a radioterapia / Extramammary Paget´s disease of the perianal region: response to radiotherapy

Presentamos el caso de una mujer con enfermedad de Paget extramamaria gigante, de localización perianal. Dada la edad de la paciente, la localización y el gran tamaño del tumor, se indicó tratamiento con radioterapia. Concluimos que ésta constituye una buena alternativa terapéutica, que debe tenerse en cuenta en los pacientes de edad avanzada o con tumores inoperables (AU)

Fibroblastoma de células gigantes inguinal / Inguinal giant cell fibroblastoma

El fibroblastoma de células gigantes es un tumor mesenquimal benigno de origen desconocido que suele aparecer en las dos primeras décadas de la vida. Aunque tiende a recidivar localmente, su capacidad metastásica no se ha confirmado. Se presenta el caso de un varón de 6 años de edad, remitido desde el servicio de cirugía plástica a nuestra consulta por presentar una lesión tumoral sobre cicatriz quirúrgica en región inguinal izquierda. El paciente había sido intervenido hacía 2 meses de una tumoración en esa localización, que fue clasificada como fibroblastoma de células gigantes. La biopsia cutánea realizada confirmó la sospecha de recidiva local del tumor. Se revisan las características clinicopatológicas e histogenéticas de este tumor, así como las distintas opciones terapéuticas (AU)

Signo de Leser-Trélat asociado a síndrome de Sézary / Sign de Leser-Trélat associated with Sézary syndrome

Se denomina signo de Leser-Trélat a la profusión de queratosis seborreicas secundaria a un proceso neoplásico. Aunque clásicamente el cuadro se ha incluido dentro de las dermatosis paraneoplásicas facultativas, durante las últimas décadas se ha debatido su carácter paraneoplásico. Se presenta el caso de un varón de 82 años en el que la aparición brusca de múltiples queratosis seborreicas llevó a sospechar la posibilidad de una neoplasia subyacente. Estudios posteriores nos llevaron al diagnóstico de un síndrome de Sézary asociado. La aparición simultánea de la dermatosis y el tumor y el curso evolutivo paralelo que se observa entre ambos procesos, hablan a favor de la existencia del signo de Leser-Trélat y de su importancia en la práctica clínica como marcador de neoplasia (AU)