Validation of the diagnostic criteria for atopic dermatitis in the adult Thai population

Atopic dermatitis is a chronic inflammatory skin disorder, for which it is difficult to obtain epidemiologic findings. In a previous study, we suggested the following diagnostic criteria for atopic dermatitis in the adult Thai population: visible flexural dermatitis, a history of flexural dermatitis, a rash of more than six months duration and visible dry skin. However these criteria were not validated against physicians' diagnoses. In the present study, we validated these diagnostic criteria for atopic dermatitis in the Thai population in a clinical setting. A case-controlled study was performed on a total of 259 patients; 33 subjects with active atopic dermatitis, 26 with inactive atopic dermatitis, 100 controls presenting with an inflammatory skin disorder other than atopic dermatitis and 100 controls without any skin disease. Each patient was examined according to the above criteria. Sensitivity, specificity, relative value, positive predictive value, and negative predictive value were calculated for each individual criterion and for composite criteria. Our data confirmed that in order to achieve satisfactory sensitivity and specificity for diagnosing atopic dermatitis in Thai people older than 13 years, a patient must have a history of flexural dermatitis plus two or more of the other mentioned criteria.     

Unit cost of Mohs and Dermasurgery Unit

Background Appropriate pricing for medical services of not‐for‐profit hospital is necessary. The prices should be fair to the public and should be high enough to cover the operative costs of the organization. Objective The purpose of this study was to determine the cost and unit cost of medical services performed at the Mohs and Dermasurgery Unit (MDU), Department of Dermatology, The University of Texas – MD Anderson Cancer Center, Houston, TX from the healthcare provider’s perspective. Methods MDU costs were retrieved from the Financial Department for fiscal year 2006. The patients’ statistics were acquired from medical records for the same period. Unit cost calculation was based on the official method of hospital accounting. Results The overall unit cost for each patient visit was $673.99 United States dollar (USD). The detailed unit cost of nurse visit, new patient visit, follow‐up visit, consultation, Mohs and non‐Mohs procedure were, respectively, $368.27, $580.09, $477.82, $585.52, $1,086.12 and $858.23 USD. With respect to a Mohs visit, the unit cost per lesion and unit cost per stage were $867.89 and $242.30 USD respectively. Conclusions Results from this retrospective study provide information that may be used for pricing strategy and resource allocation by the administrative board of MDU.     

The effect of pre-operative topical anaesthetic cream on the ablative width and coagulative depth of ablative fractional resurfacing laser

Topical anaesthetic cream (TAC) is commonly used as a pre-treatment of ablative fractional resurfacing (AFR) laser. Most of anaesthetic cream contains distilled water as major component. Therefore, pre-operative TAC may interfere the photothermal reaction in the skin treated with fractional carbon-dioxide (FCO₂) laser and fractional erbium-doped yttrium aluminium garnet (FEr:YAG) laser. The objective of the study was to compare the ablative width (AW) and coagulative depth (CD) of AFR laser with and without pre-treatment with TAC. Four Thai females who underwent abdominoplasty were included in the study. The excised skin of each subject was divided into four areas. TAC (eutectic mixture of local anaesthesia; EMLA) with 1-h occlusion was applied only on the first and second areas. The first and third areas were treated with FCO₂ at 15 mj and 5% density. The second and fourth areas were treated with FEr:YAG at 28 J/cm² and 5% density. Six biopsied specimens were obtained from each area. A total of 96 specimens (24 specimens from each area) were collected from four patients and examined randomly by two dermatopathologists. The ablative width and coagulative depth from each specimen were determined. In FCO₂-treated specimens, the mean AW of the specimens that were pre-treated with TAC and control was 174.86?±?24.57 and 188.52?±?41.32 μm. The mean CD of the specimens that were pre-treated with TAC and control was 594.96?±?111.72 and 520.03?±?147.40 μm. There were no significant differences in AW and CD between both groups (p?=?0.53 and p?=?0.15). In FEr:YAG-treated specimens, the mean AW of the specimens that were pre-treated with TAC and control was 381.11?±?48.02 and 423.65?±?60.16 μm. The mean CD of the specimens that were pre-treated with TAC and control was 86.03?±?29.44 and 71.59?±?18.99 μm. There were no significant differences in AW and CD between both groups (p?=?0.16 and p?=?0.24). The pre-treatment with TAC provided no statistically difference from the control group on AW and CD of both FCO₂ and FEr:YAG laser irradiation. However, there was a tendency to have narrower AW and deeper CD of the areas that were pre-treated with TAC when comparing to that of the control.     

Surgical pearl: a simple means of disarming the "locked and loaded" needle

Background  Surgery, in any setting, has several inherent risks not only to the patient, but the physician and his assistants as well. Safe handling and management of the sharps to prevent inoculation injuries is one of these risks, in particular: 1) instrument hand-off of the needle and needle driver between the physician and his assistants; 2) retrieval of instruments from the surgical tray.
Objective  The authors' review a simple means of disarming the needle loaded in the needle driver to reduce sharps injury.
Methods  Before the needle and needle driver are either handed off to the assistant or returned to the surgical tray, pivot the needle 90 degrees toward the instrument joint. The needle's point should be directed toward and touching the needle driver, and thereby, disarming the needle. To avoid dulling the needle, the point should not be grasped by the needle driver.
Conclusions  Disarming the loaded needle may reduce the chance of sharps injury during instrument hand off and retrieving instruments from the surgical tray.     

Physical means of treating unwanted hair

Unwanted facial and body hair is a common problem, generating a high level of interest for treatment innovations. A wide range of modalities for the management of unwanted hair have been advocated over the years with varying degrees of clinical success. Most recently, lasers and light sources have been used to address this problem with improved clinical success rates in properly selected patients. The full range of temporary and permanent hair removal techniques will be outlined in this review of physical means of treating unwanted hair.     

A split axilla comparison study of axillary hair removal with low fluence high repetition rate 810 nm diode laser vs. high fluence low repetition rate 1064 nm Nd:YAG laser

Background A low fluence, high repetition rate 810 nm diode laser using constant motion technique has been recently introduced with advantages of less treatment discomfort and fewer side effects compared with traditional laser hair removal. Objective To compare hair reduction and side effects of low fluence high repetition rate 810 nm diode with high fluence low repetition rate 1064 nm Nd:YAG lasers. Methods Forty‐nine subjects were randomly received five monthly treatments with diode laser on one side of their axilla and long‐pulsed Nd:YAG laser on the other side. Hair count was recorded at baseline, 1‐ and 6‐month follow‐up visits. Results Percentage of axillary hair reduction at 1‐month follow‐up visit after receiving diode and Nd:YAG laser treatment were 71.0% and 82.3%, respectively, and at 6‐month follow‐up were 35.7% and 54.2%, respectively. There were significant differences in hair reduction between both laser systems at 1‐ and 6‐month follow‐ups (P < 0.001 and P < 0.001, respectively). Patients reported lower pain on the diode laser side (P < 0.001). Side effects of both laser systems were mild and transient erythema and swelling. Conclusions High fluence low repetition rate Nd:YAG laser was superior in hair reduction and provided higher patient satisfaction. However, low fluence high repetition rate diode laser was less painful.