Background Telemedicine is the practice of healthcare using interactive processes of communication to facilitate healthcare delivery, including diagnosis, consultation and treatment, as well as ...education and transfer of medical data. The aim of teledermatology, just as telemedicine, is to promote best practice procedures and to improve the consistency and competence of health care.
Aim To investigate the diagnostic additive value of second opinion teleconsulting in patients with challenging dermatoses, among dermatologists working in two different dermatology departments.
Setting Thirty‐three cases of patients with challenging inflammatory and neoplastic skin diseases at the University of L’Aquila Department of Dermatology were sent for teleconsultation to the Department of Dermatology, Medical University of Graz, Austria.
Methods All cases were selected in the outpatient service in L’Aquila. After face‐to‐face consultation with a local colleague had been completed, images were sent using a store‐and‐forward (SAF)‐based system (http://www.telederm.org) to Graz. Histopathological examination together with follow‐up of the patient represents the diagnostic gold standard for this study.
Results Telediagnosis was correct in 26 of 33 (78.8%) cases. Sixteen of 33 cases (48.5%) had already been diagnosed face‐to‐face by at least one of the two dermatologists in L’Aquila. In 10 of 33 cases (30.3%), the correct diagnosis was made in teleconsultation only.
Conclusions Second opinion teleconsulting may represent an additive value in the diagnosis of numerous challenging inflammatory and neoplastic skin diseases. It may be particularly useful as a best practice model for smaller departments in order to discuss and/or to confirm diagnoses and also for the management of patients with unusual difficult dermatoses.
A non-commercial teledermatology network based on store-and-forward operation was established in April 2002. The aim was to create an easy-to-use platform for teleconsultation services, where ...physicians could seek diagnostic advice in dermatology from a pool of expert consultants and where they could present and discuss challenging dermatology cases with special emphasis on diagnosis and therapy. An online moderated discussion forum was added in October 2003. During the first two years, 348 health-care professionals from 45 countries registered to use the Website. A total of 783 requests for consultations were answered; 285 requests concerned pigmented skin lesions, 440 requests were from the whole range of clinical dermatology and 58 requests were about non-melanoma skin cancer. Of a total of 133 requests analysed, 80 (60%) were answered within one day, 47 (35%) within one week, five (4%) within two weeks and one (1%) consultation was answered in more than two weeks. Our experience with a discretionary, non-commercial, multilingual Website for open-access teleconsulting in dermatology appears to be successful. The Website represents an example of user-generated content, together with active interaction between users, who can present and discuss cases with remote colleagues.
Basal cell carcinoma: clinical and pathological features Di Stefani, A; Chimenti, S
Giornale italiano di dermatologia e venereologia : organo ufficiale, Societa italiana di dermatologia e sifilografia
150, Številka:
4
Journal Article
Basal cell carcinoma (BCC) is a slow-growing, locally invasive malignant epidermal skin neoplasm that represents the most common malignancy in Caucasians. The clinical presentation of BCC can be ...extremely variable: nodular, ulcerative, superficial, morpheiform, pigmented, and fibroepithelioma of Pinkus are the main clinical variants described. Clinical factors influencing negatively prognosis of BCC are: anatomic location, recurrence and/or persistance at site after treatment, and tumor size. A precise correlations between clinical and histopathological variants is not always possible, especially in biopsy samples. From a histopathological point of view various subtypes has been described: nodular, superficial, infiltrating, morpheiform, micronodular, fibroepithelial BCC and basosquamous carcinoma. A classification system based by growth pattern allows the identification of high-risk subtypes with potential tumor recurrence and aggressive biologic behavior such as infiltrating, morpheiform, micronodular and basosquamous subtypes. Further histopathological aspects determining high risk clinical morbidity are the level of invasion, perineural and lymphovascular invasion, involved surgical margins. The awareness of these clinicopathological features is helpful to better select the appropriate treatment management.
This study was performed to investigate the effect of tail docking in the weaner and finishing phase in 448 heavy pigs (slaughtered at 40 weeks of age and 170kg) reared under challenging conditions ...that were previously considered as risk factors for tail biting (e.g., male gender, high stocking density, fully slatted floor and poor health). The finishing unit had a history of mortality higher than 5%, mainly due to Porcine Reproductive and Respiratory Syndrome, Influenza and Actinobacillus pleuropneumoniae circulation. In both units, a rack with straw and a metal chain were constantly available in all pens. A 2×2 factorial design was adopted to test the effects of gender and tail presence on blood measures (cortisol, haptoglobin, and albumin/globulin ratio), behaviour and skin lesions. Tail docking did not have an effect on the physiological measures, conflicts, and ear and tail biting behaviours at the weaner phase or at fattening. However, in the last days of the weaner phase, an outbreak of tail biting triggered by a “biter” was recorded in one pen of barrows. At fattening, tail docking did not produce any significant difference regarding skin lesions on the ears, the front, the middle and the back third of the animals. Nevertheless, undocked animals showed a higher prevalence of mild tail lesions (P<0.01) and a lower frequency of belly nosing behaviour (P=0.04). In undocked animals, the average frequency of severe tail lesions was 3.6%, whereas the average frequency of mild tail lesions was 18.57%. Two peaks were detected at 12 and 32 weeks of age (P=0.01), i.e., at the beginning and in the middle of the fattening period. Overall, the behavioural activities of exploring chain decreased throughout the fattening cycle (P=0.02), whereas the activity of exploring straw in the rack increased according to age (P=0.05). The frequency of ear biting showed a decrease (P=0.02), whereas the frequency of lying behaviour increased (P=0.04). The mortality was approximately 5%: 4.5% in undocked vs. 5.5% in docked pigs; 6.5% in barrows vs. 3.5% in females. The straw consumption was 5g/pig/day at the weaner phase and 30g/pig/day at fattening. The results did not demonstrate a generalised welfare endangerment directly related to tail biting in undocked heavy pigs housed under challenging conditions.
•A lack of docking had no effect on physiology and behaviour at the weaner phase.•At fattening, undocked pigs had a higher prevalence of mild tail lesions (18.57%).•At fattening, a lack of docking decreased the frequency of belly nosing.•At fattening, a lack of docking had no effect on mortality and blood measures.•Straw consumption was 5g/pig/day at the weaner phase and 30g/pig/day at fattening.
The aim of this study was to evaluate the correlation between the clinical motor phenotypes of Parkinson's disease (PD) and ¹²³I-MIBG myocardial uptake. In total, 53 patients with PD 31 males and 22 ...females, mean age 62±10 years; 19 Hoehn & Yahr (H&Y) stage 1, 9 stage 1.5, 15 stage 2 and 10 at stage 3 were examined and subdivided into different clinical forms on the basis of dominance of resting tremor (n=19, TDT) and bradykinesia plus rigidity (n=34, ART). This status was correlated with the semi-quantitative analysis of ¹²³I-MIBG myocardial uptake. An age-matched control group of 18 patients was recruited (8 males and 10 females, mean age 62.4±16.3 years). ¹²³I-MIBG myocardial uptake significantly correlated with disease duration in early (r²=0.1894; P=0.0028) and delayed images (r²=0.1795; P=0.0037) in PD patients, while no correlation was found when considering age at examination, UPDRS III motor examination section score and H&Y score. PD patients showed a reduced ¹²³I-MIBG myocardial uptake compared to the control group in early (P=0.0026) and delayed images (P=0.0040), and ¹²³I-MIBG myocardial uptake was significantly lower in delayed images in TDT patients compared with ART patients (P=0.0167). A decrease was detected in the heart-to-mediastinum (H/M) ratio in delayed images compared to that of the early images in TDT patients (P=0.0040) and in the whole PD population (P=0.0012), while no differences were found in ART patients (P=0.1043). The results of the present study revealed that the cardiac sympathetic system is more severely impaired in TDT than in ART patients and ¹²³I-MIBG molecular imaging has the potential help in improving therapeutic planning in these patients.
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