The recognition and management of melanoma and other skin lesions by general practitioners in New Zealand

AIM

To assess current levels of knowledge and management practices with respect to melanoma and other skin cancers, in a representative sample of New Zealand general practitioners.

METHODS

A self-administered questionnaire was sent to a random sample of 900 general practitioners. The questionnaire included 12 cases with coloured photographs of skin lesions and a brief presenting history. Responders were asked to assess probable diagnosis, need for biopsy and management of the lesion. Other attitudinal and relevant background information was also gathered. The questionnaire was sent to a comparison sample of 35 dermatologists.

RESULTS

The overall response rate was 66% among the general practitioners and 68% among the dermatologists. The sample responding was representative of the larger population of doctors practising in New Zealand. Correct decisions whether or not to biopsy lesions (mean score of 10.1 out of 12) were significantly higher than the number of correct diagnoses (mean 8.4). Correct identification and recognition of the need to biopsy melanomas was high. Diagnostic skills and recognition of the need for biopsy were somewhat lower among general practitioners aged 50 years and over than among younger doctors. Doctors who had experience of a patient with melanoma had higher diagnostic skills and made more correct biopsy decisions. The general practitioners' scores for correct biopsy decisions were similar to those of the dermatologists sampled, although their diagnostic skills were somewhat lower, particularly with respect to nonmelanoma skin cancers.

CONCLUSION

The findings indicate a high level of expertise in terms of diagnosis of skin lesions and identification of need to biopsy suspicious lesions among general practitioners in this country.

Application of silver acetate autometallography and gold-silver staining methods for in situ DNA hybridization

In situ hybridization using biotinylated DNA probes has become an important tool in histopathology. It is well known that the sensitivity of the methods used to demonstrate viral DNA in formalin-fixed and paraffin-embedded specimen depends strongly on the detection system used. In the present study, an optimized in situ DNA hybridization protocol was combined with four different approaches of gold-silver staining methods. For silver enhancement, the recently described method of silver acetate autometallography, a technique allowing highly efficient development without the necessity of dark room illumination has been used. The most efficient detection method found in our experiments was the use of gold-adsorbed anti-biotin antibodies with subsequent silver enhancement. This staining procedure can be completed in 5 hours including hybridization and is a highly sensitive alternative to peroxidase and alkaline phosphatase detection systems.

[Eosinophilic fasciitis (Shulman's syndrome)]

A 36-year-old man had noted a firm and painful swelling of the upper and lower limb, increasing over the previous few weeks. He had no fever, but the erythrocyte sedimentation rate was slightly increased (20 mm in the first hour). In addition there was a mild normochromic, normocytic anaemia (13 g/dl) and thrombocytosis (517,000/microliters). Gamma-globulin fraction was raised to 26%. The blood eosinophilia of 44% and the histological findings in a wedge biopsy of the lower leg (oedematous widened connective tissue septa, inflammatory infiltrate with eosinophilic granulocytes) established the diagnosis of eosinophilic fasciitis (Shulman syndrome). During oral treatment with prednisone (100 mg/d) the clinical symptoms regressed and the eosinophilia in peripheral blood disappeared. In the course of the subsequent seven months the prednisone dose was reduced gradually to 10 mg daily. But, because the symptoms did not entirely disappear the prednisone dose had to be increased temporarily for four times until there was a further, stepwise, reduction of the symptoms. But mild induration of the lower leg persisted. Maintenance treatment with prednisone, 10 mg daily, has been continued in order to avoid recurrence.

Bioassay for determination of human serum luteinizing hormone (LH): a routine clinical method

Serum levels of LH are used as marker of a number of pathological conditions. In the past many methods (RIA, IRMA, ELISA) have been employed to measure serum LH, these procedures, however, suffer from the drawback that they determine the immuno reactive and not the bioactive part of the hormone. An improved in vitro bioassay method for the estimation of serum LH has been described. The underlying mechanism of the assay is testosterone production by mouse Leydig cells in the presence of added LH. The method has been significantly improved in terms of sensitivity (0.2 IU/l) and simplicity; the assay is simple and does not require any special instruments and can be set up in any endocrinological laboratory.

[Steps for solutions and hindrances in progress in relation to an implantable bio-artificial hemofilter-intestine-hybrid kidney]

On the view of 1989 older and modern developments to a bioartificial implantable hybrid kidney are presented. To the realization proof of the implantable hemofilter-intestine-hybrid kidney the routes were described in an experimental rat model to the plasmakinetic simulation of the urea and sodium level as a marker of the hybrid kidney functions. The results of the bioartificial hemofilter-intestine-hybrid kidney development are presented, but significant detail problems must be solved, especially the hemofilter biocompatibility problem.

[Phospholipid content of subcellular structures in skeletal muscles after halothane loading in Landrace swine in relation to mating variants and genotype]

Membraneous phospholipids of subcellular structures were determined from the musculature of German Landrace pigs of the GDR, following exposure to halothane. Mating variants A (H+ male X H+ female), B (H+ male X H- female), and C (H- male X H+ female) were used for positive responders (MHS), while variants B, C, and D (H- male X H- female) were used for negative responders (MHN). Four phospholipid fractions were recorded from the muscle samples for mitochondria and microsomes (according to SR section). Differences between the MHS and MHN groups for the above fractions and without consideration of mating variants and genotype were not observed, although unambiguous responses were exhibited by all animals, either positive or negative to halothan. Significant differences with regard to the above phospholipid fractions were recordable only for variant A (MHS group) as compared to D (MHN), in other words, for the homozygous genotypes, once the above results had been rearranged within MHS and MHN along with different mating variants and genotypes. However, no unambiguous results were obtainable for the heterozygous genotypes of mating variants B and C. Possible underlying reasons are discussed in some detail. The results obtained from mating variants A and D are likely to confirm earlier findings and seem to suggest that the sarcoplasmic reticulum is the primary site of origin of susceptibility to halothane or malignant hyperthermia.

Vascularization of male gonads in Blennius pavo (Teleostei, Blenniidae) as revealed by scanning electron microscopy of vascular corrosion casts

The vascular architecture of male gonads of Blennius pavo is studied by scanning electron microscopy of vascular corrosion casts. Arterial supply to the gonads is by a branch of the first ventral segmental artery of the tail. From the surface of the gonads, this vessel gives rise to branches which supply testes, spermatic ducts, testicular glands, blind pouches, urogenital sinus and urogenital papilla. The testis has a rope-ladder-like capillary network around the seminiferous tubules, while in the testicular gland the capillary network is irregular in form. The spermatic ducts are found to have an exterior capillary network located in the compact connective tissue layer and an interior one, lying subepithelially. Urogenital sinus and urogenital papilla show a multilayered capillary network. Angioarchitecture in mature and immature gonads does not differ.

The effect of gossypol acetic acid on the different stages of the spermatogenic cycle in the rat

The reversibility of the effect of gossypol on testicular histology and fertility was studied in rats. Adult males of proven fertility were treated orally with gossypol acetic acid (15 mg/kg) for 9 or 16 weeks (groups 1 and 2, respectively). Another groups of animals (group 3) was given gossypol (15 mg/kg) for 16 weeks and killed 6 weeks after the end of treatment. Control animals (group 4) were given the vehicle only by oral intubation. In the mating studies, although only 33% of the animals in group 1 were infertile, 100% infertility was observed following 16 weeks of gossypol treatment (group 2). All animals in group 3 regained their fertility 6 weeks after cessation of drug treatment. Damage was observed to 15.7% of the seminiferous tubules after 9 weeks of drug treatment, and to 78% after 16 weeks of treatment. Extensive vacuolization, increased numbers of lipid droplets, degeneration of germ cells, loosening of the epithelium, and a significant decrease in the number of pachytene spermatocytes (stages VII-X) and spermatids (steps 7-10 at stages VII-X) were observed after gossypol treatment. There was a decrease in the diameter of only stage VIII seminiferous tubules after 9 weeks of treatment, whereas a reduction was observed in the tubules of all stages after 16 weeks of gossypol treatment. In the recovery phase, the diameter of seminiferous tubules was similar to that of controls, except for tubules at stage VIII. No change in the area of the lumen of the seminiferous tubules and lipid bodies was observed after 9 weeks of drug treatment, but a marked reduction in the area of the lumen (stages II-X) and an increase in lipid bodies (all stages) was observed after 16 weeks of gossypol treatment. Six weeks after cessation of treatment, the area of the lumen and the number of lipid bodies were comparable to values in controls. A reduction in the area of the epithelium was restricted to just a few stages (VIII-XIV) in treated animals at 9 weeks, whereas after 16 weeks the area of the epithelium was decreased in all tubules. In the recovery phase, except for tubules at stage VIII, the area of the seminiferous epithelium was comparable to that in controls.

Serological prevalence of leptospiral infection in domestic animals in West Malaysia

A cross-sectional serological survey of domestic animals in West Malaysia revealed that 25.5% of the animals examined had agglutinating antibodies to one or more antigens belonging to Leptospira interrogans. Significant prevalence of infection was observed in cattle (40.5%), buffaloes (31%) and pigs (16%). The Sejroe serogroup was shown to be the principal one involved in cattle and buffaloes, and to a lesser extent the Tarassovi and Pomona serogroups. Evidence of infection in domestic animals by strains bearing the other seven antigens appeared insignificant and was indicative of sporadic infection. A majority of the large (semi-intensive) cattle and buffalo farms demonstrated a high prevalence of leptospiral infection. In both species of domestic animals mentioned above, the prevalence of infection was significantly higher (P = 0.01) in the semi-intensive farms than in the smallholdings. Amongst cattle, the droughtmasters had the highest prevalence whilst the Kedah-Kelantan (an indigenous breed) had the lowest prevalence of leptospiral infection. In general, the temperate breeds of cattle had a significantly (P = 0.01) higher prevalence of infection than local breeds. Leptospiral infection in goats and sheep was shown to be sporadic, and the Pomona serogroup was the principal leptospiral serogroup involved in these small ruminants. The prevalence of infection in pigs was observed to decline during the study period, and it is suspected that pigs in West Malaysia are the maintenance host for serovar pomona whilst cattle are the maintenance host for serovar hardjo. Overall, it appears that domestic animals in Malaysia will play a bigger role in the epidemiology of leptospiral infection with the advent of sophisticated farming.

[Coronary surgery in females]

In the last three years, of a total of 617 patients undergoing surgery for ischemic heart disease, 53 were women (8.6%). With one exception, all were in or shortly before the menopause. As compared with men, the women were found to have a preponderance of risk factors. The most unfavorable combination, that of hypertension and hypercholesterolemia, was present in one-third of the patients. Hospital mortality for isolated revascularization was higher in women at 4.9% than in men at 1.5%. The one-year survival rates, however, of 94.4% and 95%, respectively, did not differ between the two sexes. In women, the number of grafts per patient was 2.1 as compared with 2.9 in men. Complete revascularization was achieved less frequently in women than in men; similarly graft patency rate at one year of 66% in women was less than the 84% observed in men. The more marked coronary sclerosis as well as morphologic characteristics of coronary arteries in women construe a special challenge to the surgeon and prerequisite a high degree of technical skill.

Skin peptides in Xenopus laevis: morphological requirements for precursor processing in developing and regenerating granular skin glands

The biosynthesis of the peptides caerulein and PGLa in granular skin glands of Xenopus laevis proceeds through a pathway that involves discrete morphological rearrangements of the entire secretory compartment. Immunocytochemical localization of these peptides during gland development indicates that biosynthetic precursors are synthesized in intact secretory cells, whereas posttranslational processing requires morphological reorganization to a vacuolated stage. The bulk of the processed secretory material is then stored in vacuolae-derived storage granules. In the mature gland, storage granules are still formed at a low level. However, in this case processing takes place in a distinct cytoplasmic structure, the multicored body, which we suggest to be functionally equivalent to vacuolae. When granular glands regenerate after having lost all their storage granules upon strong stimuli, another morphological pathway is used. 2 wk after gland depletion, secretory cells become arranged in a monolayer that covers the luminal surface of the gland. Storage granules are formed continuously within these intact secretory cells. Here, precursor processing does not require a vacuolated stage as in newly generated glands but occurs in multicored bodies. Most storage granules seem to be formed in the third week of regeneration. The high biosynthetic activity is also reflected by the high activity of the putative processing enzyme dipeptidyl aminopeptidase during this period of regeneration.

The angioarchitecture of the choroid plexus of the lateral ventricle of the rabbit. A scanning electron microscopic study of vascular corrosion casts

The vascularization of the choroid plexus of the rabbit's lateral ventricle has been studied by scanning electron microscopy of vascular corrosion casts. Based on the vascular patterns discerned, the plexus was subdivided into 6 different parts: the inferior, lateral, central and superior parts, the free margin and the lingula. These differ in structure and localization. While the arterial supply of the inferior part is via the anterior choroidal artery, the central and superior part are supplied by the posterior choroidal arteries. Three main veins leave the plexus and drain to the basilar vein from the inferior part and to the internal cerebral vein from the inferior, central and superior part. Capillary diameters were typically 10-15 micron. Regular nodular thickenings up to 24 micron in diameter were seen in the free margin and the superior, lateral and inferior parts. 'Garland' shaped capillary configurations sheathing arteries as well as veins were found all over the plexus. It is suggested that these 6 different parts of the plexus described here may reflect functionally different areas.

Effect of gossypol on bull spermatozoa in vitro

Gossypol acetic acid in a concentration of 1,000 microgram/ml solvent is able to immobilize 1 ml of native bull semen (sperm concentration: 8.5 X 10(8)/ml; motility rate: 87.4%) within 30 min. After GAA treatment the spermatozoa show severe morphological damage on the membrane system, on the acrosomal complex and on the tubular complex of the end piece. The working mechanism of GAA can be assumed to be inactivation of enzyme activities or in direct reactions with plasma membrane material.