Surgical excision of skin cancer: the importance of training

Background Skin cancers are the most common malignancy in New Zealand and their treatment imparts a huge burden on the healthcare system both in terms of the cost of surgical intervention and in treatment delivery (estimates are in excess of NZ$33 million per annum for the year 2000). Currently in New Zealand, skin cancers are excised by dermatologists, general practitioners (GPs), GPs with a special interest in skin surgery (GPSIs) and specialist surgeons with diverse training backgrounds including ear, nose and throat, ophthalmic and general surgeons. To date there is scant literature evaluating complete excision rates following surgical treatment of skin cancer between these vocational groups. Objectives To review retrospectively pathology reports from all skin excisions sent to one private pathology laboratory over three consecutive months. The aim was to investigate the margins of excision and completeness of skin cancer surgery performed by each vocational group. Methods A retrospective analysis of skin pathology reports was undertaken for a 3‐month period between April and June 2007. Raw data obtained from the pathology reports included diagnosis, completeness of excision, size of specimens, body site and vocational group of the medical practitioner performing the surgery. Results In total, 1532 lesions were excised: 432 benign and 1100 malignant. Six hundred and seven were from the head and neck. Dermatologists excised 276 lesions of which 93% were malignant, 55% were from the head and neck, and 0% were incompletely excised. GPs excised 633 lesions: 63% malignant, 30% head and neck, 23% incomplete excision of malignant lesions. GPSIs excised 368 lesions: 71% malignant, 35% head and neck, 21·5% incomplete malignant excision. Specialist surgeons excised 255 lesions: 72% malignant, 53% head and neck, 20% incomplete malignant excision. Conclusion GPs and GPSIs excised more benign lesions and had higher incomplete excision rates of skin cancer surgery than dermatologists. Incomplete excision rates for the vocational groups ranged from 0% to 45% depending on site and pathology.     

The perils of a vanishing cohort: a study of social comparisons by women with advanced ovarian cancer

Objective: To examine the role social comparisons play in the experience of ovarian cancer patients and to consider the implications this may have for provision of supportive care services for ovarian cancer patients. Methods: We conducted a longitudinal qualitative study of women with advanced ovarian cancer in Sydney, Australia. Semi‐structured interviews were conducted with women with advanced ovarian cancer over a period of 2.5 years. Social comparisons made by 13 study participants in 33 interviews were extracted and analysed using coding categories based on social comparison theory. Results: Participants favoured downward contrasts and lateral comparisons and avoided downward identifications, upward contrasts and upward identifications. Participants expressed a preference for avoiding contact with ovarian cancer patients, for the company of ‘normal’ others, for normalising information and information that facilitated upward identifications. Conclusions: We suggest that social comparisons made by women with ovarian cancer are influenced by specific clinical factors associated with their diagnosis—in particular, their status as a member of a ‘vanishing cohort’—and argue for further research examining the specific comparison needs and preferences of patients with advanced disease and types of cancer with poor prognoses. Practice implications: These findings raise questions about uniform approaches to the provision of cancer care and suggest that further research may be required to ensure that interventions are appropriately tailored to the supportive care needs of patients with different types and stages of disease. Copyright © 2011 John Wiley & Sons, Ltd.     

按摩针刺联合中药治疗面神经麻痹疗效比较

目的：观察按摩联合中药内服与针刺联合中药内服治疗面神经麻痹疗效比较.方法：将确诊的120例面神经麻痹患者,随机分为按摩联合中药内服组与针刺联合中药内服组,每组各60例.结果：按摩联合中药组总有效率96.6%,针刺联合中药组总有效率86.6%.按摩联合中药组疗效优于针刺联合中药组（P＜0.05）,具有统计学意义.结论：按摩联合中药内服较针刺联合中药内服疗效显著,特别是远期疗效更为明显,且具有操作方便,患者易于接受等优点.     

异位妊娠腹腔镜与传统开腹手术疗效比较

目的：比较异位妊娠腹腔镜手术和传统开腹手术的临床疗效,提高临床治疗水平。方法：选取2008年2月～2010年2月因异位妊娠在本院住院治疗的患者126例,63例采用腹腔镜手术（观察组）,63例采用传统开腹手术（对照组）,两组一般资料差异无统计学意义（P〉0.05）;比较两组的手术时间、下床活动时间和住院时间。结果：手术时间、下床活动时间和住院时间,观察组均短于对照组（P〈0.05）。结论：腹腔镜手术相对于传统开腹手术,具有创伤小、手术时间短、恢复快等优点,是临床治疗异位妊娠的有效方法。     

两种腹腔镜辅助阴式子宫切除术与阴式子宫切除术的临床比较

目的：比较两种腹腔镜辅助阴式全子宫切除术（LAVHa和LAVHb）和阴式全子宫切除术（TVH）的特点。方法：回顾性分析2006年2月～2010年1月于本院行全子宫切除术173例患者的临床资料,其中,LAVHa55例,LAVHb58例,TVH60例。结果：各组患者均以子宫肌瘤、子宫腺肌症为主要病因,3组患者手术平均时间比较,差异无统计学意义（P〉0.05）,但LAVHa组患者的平均出血量显著少于TVH组和LAVHb组（P〈0.05）。LAVHa组患者切除子宫的体积显著大于其他两组（P〈0.05）。LAVHa组手术泌尿系统损伤并发症发生率为3.64%,稍高于LAVHb和TVH组,均发生于开展腹腔镜手术初期,总体并发症较其他两组少。结论：LAVHa患者切除的子宫体积较大,不影响手术时间,出血少,总体并发症较少。     

Raltitrexed plus cisplatin is cost-effective compared with pemetrexed plus cisplatin in patients with malignant pleural mesothelioma

Introduction

The National Institute for Health and Clinical Excellence (NICE) has previously recommended pemetrexed plus cisplatin for the treatment of patients with advanced malignant pleural mesothelioma (MPM) and WHO performance status 0-1. Subsequent to this appraisal, randomised controlled trial (RCT) data for raltitrexed plus cisplatin and comparing chemotherapy to active symptom control (ASC) has become available, allowing a more complete analysis of the comparative efficacy and cost-effectiveness of first-line chemotherapy in MPM.

Methods

An adjusted indirect comparison is used to estimate the relative efficacy of raltitrexed plus cisplatin and pemetrexed plus cisplatin. A cost-effectiveness model is used to assess the lifetime costs and health outcomes associated with these comparators and ASC. Patient level data from the EORTC 08983 trial are used to estimate baseline progression and survival rates. Relative treatment effects are taken from RCTs; cost and utility data from the literature.

Results

Raltitrexed plus cisplatin and pemetrexed plus cisplatin were not found to be statistically significantly different with respect to overall response, progression free survival or overall survival. The cost-effectiveness analysis found raltitrexed plus cisplatin to be cost-effective at a cost per quality adjusted life year of £13,454 compared to cisplatin and £27,360 compared to ASC. Pemetrexed plus cisplatin is dominated by raltitrexed plus cisplatin as the raltitrexed combination offers marginally higher quality adjusted life years (QALYs) and life years (LYs) at a substantially lower total cost.

Conclusion

Raltitrexed plus cisplatin is a cost-effective first-line treatment for MPM. This conclusion was maintained across a number of sensitivity analyses.     

吐鲁番出土药价残片探微

以吐鲁番出土原卷图片文献资料为依据,运用文献考证与历史比较的方法对其药价部分予以考察后发现：吐鲁番药价残片反映了唐代天宝年间部分药材的市场价格,如果以常用生活必需品白面作为参照物进行比较,则当时的药价普遍比白面的价格高,常用药品的价格与今天相比则差别不大,但部分珍稀药材的古今价格相差极大。     

不同生境及地区哈蟆油药材中氨基酸成分比较分析△

目的:比较不同生境及地区的哈蟆油药材中氨基酸的含量,为评价该药材质量提供依据。方法:6mol·L-1盐酸110℃水解24h,加衍生化试剂2,4-二硝基氟苯,于60℃水浴中衍生1h,P230II依利特氨基酸自动分析仪测定。结果:同一地区林下产的哈蟆油药材中氨基酸含量,普遍高于稻田产的;相同生境中,林下产哈蟆油药材以吉林产的氨基酸最高;稻田产哈蟆油药材以辽宁产的最高。结论:以哈蟆油药材中氨基酸的含量对其药材质量进行评价,具有一定的实际意义。     

不同土壤性质下羊蹄各部位大黄素含量的比较

目的:建立高效液相色谱法(HPLC)测定羊蹄大黄素含量的方法,并对酸性和碱性土壤环境中羊蹄各部位的大黄素含量进行比较。方法:采用超声提取法制备供试品溶液,运用高效液相色谱法测定羊蹄大黄素含量。Zorbax XDB-C18色谱柱;流动相为甲醇-1%冰醋酸(70∶30);检测波长:254nm;流速:1.5 mL.min-1;柱温:40℃;进样量:20μL。结果:大黄素进样在1μg.mL-1～500μg.mL-1浓度范围内与峰面积线性关系良好(r=0.9995),加样回收率为98.51%,RSD为2.04%(n=6)。酸性土壤条件下羊蹄根、根茎与叶中大黄素含量分别为1.5796mg.g-1、1.4634mg.g-1和0.1223mg.g-1。碱性土壤条件下羊蹄根、根茎与叶中大黄素含量分别为0.4918mg.g-1、0.3162mg.g-1和0.0806mg.g-1。结论:本法适用于羊蹄中大黄素含量的检测。酸性土壤条件下羊蹄大黄素含量明显高于碱性土壤条件,羊蹄根与根茎中大黄素含量高于叶中大黄素含量。