Variations in clinical decision-making between cardiologists and cardiac surgeons; a case for management by multidisciplinary teams?

Objective  

To assess variations in decisions to revascularise patients with coronary heart disease between general cardiologists, interventional cardiologists and cardiac surgeons     

Stiff skin syndrome

Stiff skin syndrome is a rare disorder characterized by pronounced skin induration, mild hypertrichosis and limited joint mobility, predominantly on the buttocks and thighs. Many heterogeneous cases have been reported under the name of stiff skin syndrome. We present a case of stiff skin syndrome from China, the diagnosis based on the patient's typical clinical and histopathological features.     

Imbalances in serum angiopoietin concentrations are early predictors of septic shock development in patients with post chemotherapy febrile neutropenia

Background  

Febrile neutropenia carries a high risk of sepsis complications, and the identification of biomarkers capable to identify high risk patients is a great challenge. Angiopoietins (Ang -) are cytokines involved in the control microvascular permeability. It is accepted that Ang-1 expression maintains endothelial barrier integrity, and that Ang-2 acts as an antagonizing cytokine with barrier-disrupting functions in inflammatory situations. Ang-2 levels have been recently correlated with sepsis mortality in intensive care units.     

Combined open surgical and endovascular management of ruptured femoral artery from recurrent vulvar cancer

We report on the case of a 50-year-old woman with exsanguinating haemorrhage from the common femoral artery as a complication of recurrent vulvar cancer in the groin which was managed successfully with combined open surgical and endovascular intervention. She survived another three months and died from progressive disease without further episodes of bleeding. This complication is rare, presents dramatically, and is usually a terminal event. For those cases where intervention is considered appropriate, the option of combined open surgical and endovascular repair should be kept in mind.     

The safety of hydroquinone

Hydroquinone is one of the most effective molecules for the treatment of hyperpigmentary disorders, with over 40 years of efficacy and safety data. Concerns over its safety have been raised because of the fact that it is a derivative of benzene and because of the long-term side-effects observed with cosmetic products containing high concentrations of hydroquinone. However, despite 40-50 years use of hydroquinone for medical conditions, there has not been a single documented case of either a cutaneous or internal malignancy associated with this drug. This article reviews the evidence for the safety of hydroquinone in the treatment of hyperpigmentation conditions.     

放射疗法在经典型皮肤卡勃基氏肉瘤治疗中的应用

目的探讨放射疗法在经典型皮肤卡勃基氏肉瘤（Ｋａｐｏｓｉｓｓａｒｃｏｍａ，ＫＳ）这种罕见肿瘤治疗中的有效性。方法１９８６年６月～１９９６年１２月，法国巴黎第十二大学亨利·孟德尔医院肿瘤科共收治经典型皮肤ＫＳ５例。所有病人均接受４５～７０ＫＶＸ线局部放射治疗，共设４８个照射野，剂量均＜３０Ｇｙ。放疗方式为：第１周１０Ｇｙ，２．５Ｇｙ／次×４，休息１０～１５天后再行第２阶段放疗，追加剂量１５～２０Ｇｙ。结果完全缓解率１００％。皮肤对放射的耐受良好，不影响美观。２例出现射野外新病灶，其中１例行放疗而另１例行长春花碱治疗，均完全缓解。结论放射疗法对ＫＳ可以提供有效的局部控制率并保持皮肤的完整美观，剂量２０～３０Ｇｙ足以使经典型皮肤ＫＳ完全缓解。     

Post‐implantation events of swan‐neck catheters for PD

The first step in PD is the implantation of a peritoneal catheter, a technique that is subject to different possible incidences. We have studied the non‐infectious events or incidences (pericatheter leakage, blood tinged dialysate, catheter displacement, omental wrapping and extra‐peritoneal placement) registered in our unit during a five‐year period (1992–1996) after the implantation of 144 swan‐neck curled catheters in 100 peritoneal dialysis patients, 49 males and 51 females. 70 catheters (48.61 %) were implanted using the blind puncture method and 74 (51.39 %) with the surgical method. All the incidence rates were compared between the two methods to analyse the possible influence of the implantation technique. 21 pericatheter leaks, 19 episodes of blood tinged dialysate, 10 displacements, 7 cases of omental wrapping and 4 extra‐peritoneal placements (all of them after blind punctures carried out by young assistant doctors) were registered, with a total number of 61 incidences (0.42 per catheter). Statistically significant differences were not found either globally or for each type of event when comparing the incidence rates between the two implantation techniques, although extra‐peritoneal placement was close to significant (p = 0.053). None of the incidences were severe. 25 catheters (17.4%) had to be replaced with the removal rates being similar for both techniques. In conclusion, in our experience neither technique shows a clear advantage over the other. Experienced staff members should implant PD catheters.