Ten-Second Skin Cancer Test

A NEW 10-second test for skin cancer will soon revolutionise diagnosis of the disease and possibly save thousands of lives. The computer-based technology for the test can help detect melanoma, the most dangerous form that kills 1,600 people a year in the UK.

The SIAscope-2 - developed by Astron Clinica, Birmingham University and Addenbrooke's Hospital in Cambridge - uses a unique form of "smart" spectral imaging. This gives the doctor some maps of different components such as blood, collagen and pigment and which can increase clinicians' confidence in their diagnosis.

Over the past 15 years the number of cases of malignant melanoma has doubled and, among those aged 20-34, it's the third most common cancer among women and the fourth most common in men. The key to treatment is early diagnosis. The problern is that early melanomas closely resemble other conditions, such as benign pigmented skin lesions or moles.

The SIAscope-2 incorporates 12 colors and wavelengths of light to investigate suspicious sites on the skin; a handheld camera that is focused on the lesion and rapidly takes a series of pictures at different wavelengths ranging from blue to near infrared. It works by measuring the spectral reflectance of more than 350,000 points in an area of skin.

An optical model of the skin is then applied to this date to produce images of different components of the skin. A computer processes the data in five seconds, converting it into color-enhanced images of the mole on a laptop computer screen.

Different colors show different types of skin factor, including levels of pigmentation, collagen and blood patterns. It will, for example, show if there are high levels of melanin pigment deep under the mole, a high-risk factor for melanoma. The SIAscope-2 was recently launched in San Francisco, United States, following successful trials in Massachusetts General Hospital in Boston, and hospitals across Europe.

Thomas Carter, clinical trials manager of Astron Clinica, said: "As with many parts of the world, the US has a serious problem with the management of melanoma and skin cancer in general. If our clinical trials in Europe are any guide, we should be able to help improve patient care in these vital areas of US dermatology."

Independent international clinical trials have shown that clinicians using SIAscopy have improved accuracy above those using dermoscopy or other techniques for the diagnosis of melanoma. So far, the device has shown great efficiency in reducing the number of melanomas "missed" by consultant dermatologists, while improving their confidence in the diagnosis of benign lesions.

Research has also shown great promise in the use of the SIAscope-2 in helping to determine the best type of treatment for BCCs and in determining the effectiveness of photo-therapy for psoriasis patients.

Laser Treatment Keeps Acne at Bay

RESEARCH suggests that single-dose laser therapy could dramatically reduce inflammatory facial acne for up to three months. Effective new treatments are required for people with acne, a common skin disease that can result in social isolation, employment difficulties and even, occasionally, suicide.

Today, mild to moderate acne is treated with combinations of topical creams and oral antibiotics - treatment that is often unpopular because the preparations need to be taken every day for several months and can cause skin irritation. Furthermore, there is concern that the bacterium responsible for acne is becoming resistant to many of the commonly prescribed antibiotics.

Pulsed-dye laser therapy (PDL) had been thought to be potentially effective for treating acne but no previous studies had assessed its benefit. In research published in The Lancet. consultant dermatologist Dr Tony Chu from London's Hammersmith Hospital and colleagues recruited 41 adults with mild-to-moderate facial inflammatory acne. 31 patients received one dose of PDL, the remaining 10 patients received fake treatment.

PDL treatment resulted in a halving of scores on an acne scale at three months follow-up: the fake treatment had no effect on the acne scale. PDL therapy was well tolerated and had the largest effect within four weeks of treatment. Dr Chu said: "Our results suggest that this laser treatment could be developed as a new therapeutic approach that would allow simultaneous treatment of both active acne and associated scarring. We believe that laser treatment should be further explored as an adjuvant or alternative to daily conventional pharmacological treatments."

In an accompanying commentary in The Lancet. Guy F Webster, from Jefferson Medical College. Philadelphia, US, concluded: "The possibility that laser treatment is effective in acne is important in health economics terms. Infrequent treatments that make drugs unnecessary would benefit all concerned (except drug companies). But we are not yet at the point where acne patients are going to throw out their antibiotics and line up for the laser. More work is certainly needed, both to confirm the clinical benefit and best regimen and to elucidate its mechanism."'

Arthritis Scientists Win "US Nobel" Prize

TWO leading biomedical researchers have received a prestigious award for an effective treatment for rheumatoid arthritis. They are Emeritus Professor Sir Ravinder Maini and Professor Marc Feldmann, both based at the Kennedy Institute of Rheumatology, a division of Imperial College London's Faculty of Medicine, at Charing Cross Hospital.

They began working together 20 years ago to establish what molecules in rheumatoid arthritis were driving the inflammation and joint destruction, seeking new avenues of treatment. Their research was funded by long-term core support by the Arthritis Research Campaign.

The two have received the prestigious 2003 Albert Lasker Award for Clinical Medical Research from the United States for their discovery of anti-TNF (tumour necrosis factor) treatment as an effective treatment for rheumatoid arthritis and other related diseases. The Lasker Awards for basic clinical and medical research have come to be known as "America's Nobels" and 66 recipients of the Lasker award since 1946 have gone on to receive Nobel prizes. They were first awarded in 1946.

This is only the third time that rheumatology research has been honoured with a Lasker Award. The first was for the discovery of corticosteroid in 1949; the second for joint replacement surgery in 1974, and anti-TNF treatment is the third.

Rheumatoid arthritis is a chronic inflammatory disease affecting the immune system. It affects about 400,000 people in the UK, causing much pain, and progressive joint damage leading to chronic disability and reduced life expectancy. Previous treatment options still left almost half of all patients with symptoms of continuing disease, deterioration of physical function and progressive joint damage.

In a series of experiments using tissue taken from joints, Feldmann and Maini investigated the role of cytokines, protein messenger molecules that drive inflammation, and found that a number of pro-inflammatory cytokines were indeed present in the inflamed joints. They found that a single cytokine, TNT, was capable of driving the disease process. This led them to seek ways of proving this concept in patients and, through collaboration with a US biotech company, used a monoclonal antibody to block TNF.

A series of clinical trials starting in 1992 at Charing Cross Hospital, and later extending to mainland Europe and the US, led to the development of three anti-TNF drugs, infliximab, etanercept and adalimumab. These are effective in most patients, even those resistant to all previous treatment. Most importantly, this new class of drug protects the joints from further destruction.

Because TNF is also involved in other chronic inflammatory diseases, Maini and Feldmann's pioneering work has led to anti-TNF therapy being used routinely now for Crohn's inflammatory bowel disease, psoriatic arthritis and ankylosing spondylitis as well as for children with chronic arthritis.

Many other diseases have also responded to anti-TNF therapy in early stage clinical studies. It is now seen that monoclonal antibodies - such as infliximab that Maini and Feldmann used with success - can also be employed long term, and problems anticipated with injecting antibodies chronically can be overcome, especially if immunosuppressive drugs such as methotrexate are used in conjunction with it.

Conjoined Indonesian Twins could be out of Intensive Care Soon

Three days after operation, separated Indonesian girls are 'active and lively', grabbing at toys and talking.

Just three days after the 10-hour operation to separate them, Anggi and Anjeli of Indonesia are already drinking milk, grabbing at toys and talking to their parents. 'They are so active and lively, they look as though they haven't had an operation,' said Dr K.C. Tan, who brought together the 15-member surgical team that separated the 15-month-old conjoined twins.

The scene is a far cry from the days leading up to the operation, when no one knew if both girls were going to survive. After the operation, two paediatric intensive care specialists had expected a couple of sleepless nights keeping the girls alive. A heart surgeon was also on standby in case Anjeli, who has a congenital heart problem, started to suffer from lack of oxygen.

But one of the specialists, Dr Kenny Ee, said: 'Thanks to the very good surgeons, we had fewer problems after the operation. Both children came out very well and are very stable.' The surgi,:al team included two senior doctors from the National University Hospital and Dr Edward Kiely from London's Great Ormond Street Hospital for Children, who has successfully separated 19 pairs of conjoined twins.

At a press conference yesterday, Dr Tan described how doctors had feared that Anjeli's heart might not withstand the stress of surgery. But she coped well. In fact, most of the 400ml of blood they needed during the operation went to her sister Anggi. Doctors were also prepared to give up all three of the conjoined twins' legs to patch up the gaping hole in their abdomens. Fortunately, one leg was sufficient. If the girls continue to do well, they should be out of intensive care by this weekend and could start physiotherapy to strengthen their legs next week.

Dr Tan said he expects the girls to return to their home in rut-al Sumatra in six weeks. Their stay and treatment here has cost their sponsor, Mc.dan businessman Olo Panggabean, close to $1 million. For the girls' parents - Subari, 41, an itinerant hawker, and Madam Nurhameini - the concern now is the cost of future treatment, including getting the girls artificial legs.

They might not need to just yet, as Dr Tan said children often prefer to hop around on crutches. 'They will want the leg only when they are old enough to go dating,' he said. Although the girls may have problems bearing children, it is possible as they will both be sexually functional, he said.

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