PR35THE INCIDENCE OF NON‐MELANOMA SKIN CANCER IN NEW ZEALAND

Background It is estimated that skin cancers cost $33 million per annum to the New Zealand healthcare system. Basal cell carcinoma and squamous cell carcinoma are the commonest types of non melanoma skin cancers (NMSCs). Anecdotal evidence indicates that there has been a doubling in the incidence of NMSCs in New Zealand over the last decade. Because of the high incidence mandatory reporting of NMSCs to the National Cancer Registry is not required. This lack of accurate data has led to poor health care policies and strategies including funding and workforce planning. Aims The aims of this study are to (1) present the latest statistics on NMSCs in New Zealand, including the incidence across different regions over the last decade, patient demographics, anatomic distribution of NMSCs, incidence and sites of metastasis, and disease‐specific survival; to (2) the histopathology of NMSCs, including surgical margins, histologic grade, and perineural, lymphatic, and vascular invasion; and (3) the relative role of different faculties treating NMSCs. Method This project has been approved by the multi‐centre ethics committee. A retrospective review was conducted from patients’ histology records from public and private pathology laboratories within defined catchment areas. Criterion for analysis is a confirmed diagnosis of NMSC treated surgically. A Microsoft Access database is created that will facilitate subsequent data retrieval and analysis. Results and Conclusion It is hoped that this up‐to‐date data will form the framework for the development of sound and sustainable healthcare policies of management of NMSCs including management strategies and workforce planning, and research direction on this common disease.     

Validity and reliability of the Bengali version of the Hepatitis Quality of Life Questionnaire

Purpose  

Hepatitis B virus (HBV) is endemic in Bangladesh, and the quality of life (QoL) of these patients remains unknown as there is no instrument available in the native language. In this study, we translated the 56-item Hepatitis Quality of Life Questionnaire (HQLQ) into Bengali and evaluated its validity and reliability.     

应用前列腺素E1注射治疗勃起功能障碍8年经验

目的观察前列腺素E1(PGE1)注射治疗勃起功能障碍(ED)的长期疗效、副作用及预后。方法使用PGE1行阴茎海绵体注射,阴茎硬度检查仪(Rigiscan)连续记录1h,并根据观察结果,调查PGE1注射剂量,确定每例患者合适的注射量,掌握注射方法后回家自行注射。共筛选出ED患者410例,随访患者阴茎勃起情况、药量调整和副作用。结果410例ED患者中,心理性139例,静脉性83例,动脉性36例,神经性78例,混合性74例。对治疗满意的患者有256例(62.44%),其中21例(5.1%)在使用PGE15次后停用,并能达到满意的性生活而治愈。293例(71.46%)患者自述注射时有胀痛感。171例(43.17%)因疼痛(105例)、操作不便(25例)、副作用顾虑(37例)和其他原因(4例)而于6个月后放弃治疗。204例(49.76%)患者使用时间已超过1年,24例(5.85%)患者使用时间已超过5年,7例(1.7%)使用已有8年。未发现阴茎异常勃起和阴茎海绵体纤维化。注射损伤阴茎表面血管致瘀斑者有20例。有27例患者失访。结论PGE1是治疗ED的一种安全有效的药物,可以长期使用。其最常见的副作用是阴茎疼痛。Rigiscan能帮助确定PGE1的注射剂量。     

PR01“A PICTURE SPEAKS A THOUSAND WORDS”– THE USE OF DIGITAL PHOTOGRAPHY AND THE INTERNET IN MONITORING FREE TISSUE TRANSFER

Purpose Post operative monitoring is crucial for the success of microsurgical free tissue transfer. Sophisticated and expensive methods are available for monitoring. We propose a novel technique using digital photography and the internet as a reliable and cost effective method to monitor free tissue transfers. Methods 163 micro‐vascular procedures were monitored using this technique over 8 months. Serial photographs taken to show flap color. Capillary refill time, pin prick‐ bleed time and color and hand held Doppler signal was recorded in the movie mode of a standard 5 mega pixel camera with duration of 15 seconds. Data was sent to the surgeon at regular intervals and or as deemed necessary. Results Analysis of the 67 cases is presented. 5 re‐explorations were done. The early diagnosis of venous congestion was possible using this technique. Timely intervention contributed to the success of the re‐explorations and these flaps could be salvaged. The file size of images was in the range of 1 MB–6 MB. The file size of an entire set of images ranged about 7 MB–9 MB. These were sent across the ADSL internet lines. Conclusion The use of the digital images and the internet allow reconstructive surgeons to have a reliable picture of the state of their free tissue transfers. This permits decrease in observer error and saves valuable time which otherwise needs to be spent to verify situations of doubt and offers an ideal solution to the logistic problem of having to visit the patient in case of doubt.     

A Prospective Randomized Trial of Steroid-Free Maintenance Regimens in Kidney Transplant Recipients—An Interim Analysis

We compared three maintenance immunosuppressive regimens in a rapid discontinuation of prednisone protocol. From March 1, 2001, through December 31, 2003, 239 first and second kidney transplant recipients (166 LD; 73 DD) were randomized. All recipients were treated with Thymoglobulin; all received steroids intraoperatively and for 5 days postoperatively. Randomization was to cyclosporine-mycophenolate mofetil (n = 85); high-level tacrolimus (TAC) (8-12 ng/mL)-low-level sirolimus (SRL) (3-7 ng/mL) (n = 72); or low-level TAC (3-7 ng/mL)-high-level SRL (8-12 ng/mL) (n = 82). We found no difference at 24 months between groups in patient, graft, death-censored graft, or acute rejection-free graft survival, or in kidney function. Wound complications were more common in SRL-treated recipients (p = 0.02); we found no other differences between groups in complication rates. Our data suggest that excellent patient and graft survival and low rejection rates can be obtained using a variety of maintenance protocols without prednisone.     

包皮过长和包茎组织中触觉小体观察

目的观察包茎和包皮过长组织中触觉小体差异情况。方法收集21~25岁年龄组包皮标本44例,按包皮解剖形态分为:①包茎组21例;②包皮过长组23例。用免疫组化方法对两组包皮标本中的触觉小体进行染色,在放大100倍的视野下观察和统计两组包皮标本中触觉小体总数以及视野的总数,并用卡方检验对两组间的差异进行统计学分析。结果两组标本中,分别有8个(8/21包茎组)和10个(10/23包皮过长组)标本中未发现触觉小体,其差异无显著性(P=0.717)。包茎组和包皮过长组中触觉小体的密度分别为33.1%和21.1%,差异具显著性(P=0.022)。结论包茎中触觉小体密度较包皮过长明显升高可能是一种生理性代偿机制,而两种包皮组织中触觉小体的消失可能遵循同一规律。     

Selective photothermolysis: contribution to the treatment of flat angiomas (port wine stains) by laser

Since 1962, lasers have been used in dermatology and have become the first choice in the treatment of superficial, vascular ectasia. Lasers are unique sources of light; they are coherent, monochromatic, collimated and intense. By careful selection of wavelength, pulse duration, and intensity, it is often possible to selectively confine a laser effect to a specific histologic structure in tissue, depending upon the tissue properties. The ideal treatment of Port Wine Stains (PWS) should irreversibly damage the ectatic vessels but minimize heating of the epidermis and superficial dermis. A theory, called selective photothermolysis, predicts the optimal combination of laser parameters of achieving this ideal treatment of PWS to be a wavelength of 577 nm, a pulse duration of 0.35-10 msec, and an energy per surface area of about 7-8 J/cm2. Laser wavelength: The wavelength of 577 nm is preferred because it: maximizes the selective absorption by hemoglobin, minimizes absorption by epidermal melanin, provides sufficient depth of penetration in the blood to coagulate 0.1 mm vessels allows penetration of light into dermis up to 1 mm. Laser pulse duration: A pulse-width in the range of 0.35-10 msec allows the temperature elevation to be uniform inside the vessel and to be confined to the vessel area. Shorter pulses superheat the red blood cells causing explosive boiling and hemorrhage. Longer pulses allow heat to diffuse away from vessels, requiring greater energies per pulse to achieve vessel damage. An increased energy per pulse increases the risk of excessive damage to surrounding tissue.(ABSTRACT TRUNCATED AT 250 WORDS)