Quantification of microvascular changes in the skin in patients with psoriasis

It has been suggested that there is a widespread abnormality of the capillaries in the skin of patients with psoriasis. This study was carried out to obtain more evidence on this point. Lesions of 20 patients with typical psoriasis, and uninvolved skin 3 cm from these lesions, were biopsied and compared with biopsies from 10 normal healthy control subjects. The dermal microvasculature was quantified in all these biopsies with regard to endothelial and luminal volume relative to the volume of dermal components of skin using stereological point counting methods utilizing the Delesse principle. The values for endothelial volume in specimens taken from the centre of the lesions did not differ significantly from those taken from the margins (33.6 x 10(-3) and 35.8 x 10(-3), respectively). The same was true for the luminal volume from the two sites (9.1 x 10(-3) and 10.0 x 10(-3), respectively). There was a highly significant difference, however, between the value for endothelial volume in biopsies from psoriatic patients compared to controls (P less than 0.001) and specimens from uninvolved psoriatic skin also showed a highly significant difference (P less than 0.001) from involved areas. There was no significant difference between uninvolved areas in psoriasis patients and control specimens. Significant differences were also found between values for control subjects and those for both involved and uninvolved psoriatic skin for luminal volume (P less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)     

Case Report: Giant choledochal cyst

We report an adult female with a rare giant choledochal cyst. The patient presented following a normal pregnancy with the classical triad of an abdominal mass associated with jaundice and right upper quadrant abdominal pain. The cyst was excised using an intramural technique and biliary reconstruction achieved with a Roux-en-Y hepaticojejunostomy. Our patient has remained well with no evidence of malignancy over a 12 year review period. The aetiology and current management of this condition are discussed.     

Utilization of radiotherapy for rectal cancer in Greater Western Sydney 1994–2001

Background and purpose: Despite evidence for the efficacy of radiotherapy in stages II and III rectal cancer, utilization rates remain low. The aim of this study is to examine patient, provider and service factors affecting utilization of radiotherapy in rectal cancer patients. Materials and methods: Patients with a diagnosis of curable rectal cancer were identified from the colorectal tumor databases of three Sydney Area Health Services between 1994 and 2001. Data were collected on tumor characteristics such as site and stage, provider factors such as type of surgery and surgeon caseload, and patient factors including socioeconomic status and access to radiotherapy. Results: Thirty‐five percent of stage II and 57% of stage III rectal cancer patients received radiotherapy. Independent determinants of utilization were age less than 70 years (odds ratio, 2.96; 95% confidence interval, 1.75–5.03), high‐volume surgeons (OR, 1.95; 95% CI, 1.17–3.24), stage III disease (OR, 2.06; 95% CI, 1.25–3.41) and abdominoperineal resections (OR, 3.67; 95% CI, 1.94–6.94). Conclusion: Radiotherapy utilization rates remain low. Age, and being referred to a surgeon with a high caseload, has a greater impact on radiotherapy utilization than other provider, socioeconomic or service factors.     

Voice gains following thyroplasty may improve over time1

Type I thyroplasty for unilateral vocal fold paralysis restores voice. The purpose of this study was to evaluate measures of voice before thyroplasty, and at 3 months and 1 year after surgery. Of interest was whether vocal improvement in the first weeks after surgery was maintained or even enhanced over time. A total of 40 patients with unilateral paralysis underwent type I thyroplasty with or without arytenoid adduction. Perceptual, acoustic and aerodynamic measures of voice were studied. Perceptual analysis determined that optimal postoperative voice quality evolved over the first year. Acoustic indices of perturbation demonstrated progressive improvement over 12 months, whereas pitch and intensity ranges were increasingly extended. Postoperative glottal flow rates were normalized and phonation times were significantly longer, with benefits maintained over time. All perceptual, aerodynamic and acoustic measures of voice were improved 3 months after thyroplasty, with many measures further improved at 1 year. Such findings provide evidence that voice outcome progressively evolves over the first 12 months after surgery.