Archive for January, 2011
From a press release from Michigan State University:
EAST LANSING, Mich. — Biopsies in the future may be painless and noninvasive, thanks to smart laser technology being developed at Michigan State University.
To test for skin cancer, patients today must endure doctors cutting away a sliver of skin, sending the biopsy to a lab and anxiously awaiting the results. Using laser microscopes that deploy rapid, ultra-short pulses to identify molecules, doctors may soon have the tools to painlessly scan a patient’s troublesome mole and review the results on the spot, said Marcos Dantus.
The results touting this new molecule-selective technology can be found in the current issue of Nature Photonics, which Dantus co-authored with Sunney Xie of Harvard University.
“Smart lasers allow us to selectively excite compounds – even ones with small spectroscopic differences,” said Dantus. “We can shape the pulse of the lasers, excite one compound or another based on their vibrational signatures, and this gives us excellent contrast.”
In the past, researchers could approach this level of contrast by introducing fluorescent compounds. With the breakthrough using stimulated Raman scattering microscopy, fluorescent markers are unnecessary.
“Label-free molecular imaging has been the holy grail in medicine,” Dantus said. “SRS imaging gives greater specificity and the ability to map a particular chemical species in the presence of an interfering species, such as cholesterol in the presence of lipids.”
Additional potential applications include allowing researchers to closely examine how compounds penetrate skin and hair. Smart lasers also can better identify how drugs penetrate tissue and how drugs and tissue interact, thus mitigating the chances of potential side effects and helping reduce the time required to bring new drugs to market.
I don’ know about you but quite a few of my patients try this and have had some success. Many call it chickweed.
The plant has been used for centuries as a traditional folk medicine to treat conditions such as warts, asthma and several types of cancer.
But for the first time a team of scientists in Australia has carried out a clinical study of sap from Euphorbia peplus, which is related to Euphorbia plants grown in gardens in the UK.
The study of 36 patients with a total of 48 non-melanoma lesions included basal cell carcinomas (BCC), squamous cell carcinomas (SCC) and intraepidermal carcinomas (IEC), a growth of cancerous cells confined to the outer layer of the skin.
Patients had failed to respond to conventional treatment including surgery, or they refused or were unsuitable for surgery because of their age.
The patients were treated once a day for three consecutive days by an oncologist using a cotton bud to apply enough of the E.peplus sap to cover the surface of each lesion.
The initial results were impressive, says findings to be released this week in the British Journal of Dermatology.
After only one month 41 of the 48 cancers had completely gone.
Patients who had some of the lesions remaining were offered a second course of treatment.
After an average of 15 months following treatment, two thirds of the 48 skin cancer lesions were still showing a complete response.
Of the three types of skin cancer tested, the final outcome was a 75 per cent complete response for IEC lesions, 57 per cent for BCC and 50 per cent for SCC lesions.
Side-effects were low, with 43 per cent of patients in no pain as a result of the treatment and only 14 per cent reporting moderate pain, and only one patient encountered severe short-term pain.
In all cases of successful treatment the skin was left with a good cosmetic appearance.
The researchers, from a number of medical institutions in Brisbane, attribute the benefit to the active ingredient ingenol mebutate which has been shown to destroy tumor cells.
British experts said further studies were needed and people should not try this at home as the weed sap can be harmful to the eyes and should not be eaten.
More than 76,500 people are diagnosed with non-melanoma skin cancer in the UK each year, with 90 per cent caused by ultraviolet light exposure.
Lesions usually appear on the areas most exposed to the sun, such as the head, neck, ears, and back of the hands.
Kimberley Carter of the British Association of Dermatologists said:
‘This is a very small test group so it will be interesting to see what larger studies and the development of the active ingredient in E. peplus sap will reveal.
‘Whilst it would not provide an alternative to surgery for the more invasive skin cancers or melanoma, in the future it might become a useful addition to the treatments available to patients for superficial, non-melanoma skin cancers.’
‘Any advances that could lead to new therapies for patients where surgery is not an option are definitely worth investigating.’
‘It is also very important to note that this is definitely not a treatment people should be trying out at home. Exposure of the sap to mucous producing surfaces, such as the eyes, results in extreme inflammation and can lead to hospitalization.’
‘The concentration of the active ingredients in the sap also varies between different plants, with high doses able to cause very severe and excessive inflammatory responses.’
According to Medicare:
Skin lesions and associated items
We will continue current compliance activities (including audits, recovery and review under the Practitioner Review Program) associated with skin lesion excisions, wounds and cryotherapy.
In 2010–2011 we will develop and implement compliance strategies focussing on upcoding of skin lesion and flap repair items and billing an item that is not substantiated by the required histopathology test.
We released a new eLearning product in late 2009 covering consultation items and the treatment of skin lesions. We will monitor the need for additional education tools to address other aspects of billing for these services.
This article highlights how one should not look at a mole in isolation but in the context of the patient’s other moles. I certainly know that I am less inclined to excise an atypical looking mole if all the other moles look the same.
What do you think.
Dermoscopy of Patients With Multiple Nevi
Improved Management Recommendations Using a Comparative Diagnostic Approach
Giuseppe Argenziano, MD; Caterina Catricalà, MD; Marco Ardigo, MD; Pierluigi Buccini, MD; Paola De Simone, MD; Laura Eibenschutz, MD; Angela Ferrari, MD;Giustino Mariani, MD; Vitaliano Silipo, MD; Iris Zalaudek, MD
Arch Dermatol. 2011;147(1):46-49. doi:10.1001/archdermatol.2010.389
Objective To assess the outcome on management recommendations of a comparative approach vs a morphologic approach in evaluating dermoscopic images of lesions from a series of patients with multiple nevi.
Design In a 2-step study, 6 experienced dermoscopists were asked to provide management recommendations (excision or follow-up) for a series of lesions from patients with multiple nevi based on dermoscopic images of the lesions. In the first step, participating dermoscopists evaluated individual images of lesions based only on morphologic structure (morphologic approach). In the second step, the same lesions were grouped by patient, allowing the participants to evaluate the lesions in the context of other nevi from the same patient (comparative approach).
Setting Academic referral center.
Patients Seventeen patients with 190 lesions (184 monitored nevi, 4 excised nevi, and 2 excised melanomas).
Main Outcome Measure Using pooled data from each step, excision recommendation rates for the comparative approach and the morphologic approach were calculated.
Results Using the morphologic approach, 55.1% of overall recommendations favored excision; using the comparative approach, the rate decreased to 14.1%. The 2 melanomas included in the study were correctly judged to merit excision by all participants in step 1 and in step 2.
Conclusion Among patients with multiple nevi, evaluation of equivocal lesions in the context of a patient’s other nevi results in a lower rate of excision recommendations compared with evaluation of individual lesions based on morphologic structure alone.
Newborns with low levels of vitamin D have higher rates of respiratory infection and wheezing than infants born with more vitamin D in their systems.
As reported in the LA Times
Even as a high-profile panel of experts recently disputed the conventional wisdom that Americans don’t get enough vitamin D — and that vitamin D deficiencies create greater risk of disease — new research shows that newborns with low levels of vitamin D have higher rates of respiratory infection and wheezing than infants born with more vitamin D in their systems.
There was no correlation, however, between low vitamin D levels and asthma.
The study, published Monday in the journal Pediatrics, expanded on earlier work by Dr. Carlos Camargo of the Massachusetts General Hospital in Boston that had shown that babies born to mothers who took vitamin D supplements were less likely to develop wheezing during childhood.
This time around, instead of focusing on supplement intake, Camargo and his team looked at the levels of vitamin D in newborn cord blood samples collected from a group of 922 children in New Zealand who had participated in a study on asthma and allergies between 1997 and 2001.
In addition to allowing researchers to collect cord blood, the babies’ mothers had filled out periodic questionnaires about their children’s health up until the children turned 5. The researchers mined these data to determine rates of wheezing, infections and asthma in the group and correlate them with vitamin D levels in the cord blood.
They found that the lower the amount of vitamin D, the higher the risk of wheezing. Newborns with particularly low levels of the vitamin — about one in five — were twice as likely to develop respiratory infections such as colds, coughs and ear infections during the first three months of life, the team reported. Those babies also had an increased risk of other types of infections.
The researchers found higher levels of vitamin D in children born to slightly older mothers and to mothers of European ethnicity. They observed lower levels in kids born in winter and in children of lower socioeconomic status.
The paper reported that the team was surprised that children with less vitamin D in their cord blood didn’t also develop asthma at a higher rate than other babies. In the past, some had speculated that vitamin D deficiency might be a cause of the high incidence of asthma in the world today.
But even though asthma doesn’t appear to result directly from low vitamin D levels, treating asthmatic kids with vitamin D could still be effective because it might reduce respiratory infections that can exacerbate the condition, the authors wrote.