Granular Cell Tumor of the Breast: A Case Report Describing Dynamic MR Mammography.

A case of granular cell tumor of the breast in a 36-year-old woman is reported. The patient presented with a hard mass,1.5 cm in diameter in the upper-outer quadrant of the left breast.

Expression of cell-cycle regulators p27 and cyclin E correlates with survival in gastric carcinoma patients.

Background: Cell-cycle control is important in carcinogenesis and cancer progression. p27 and cyclin E are cell-cycle regulators, which control the G1-S phase transition. Recently, these two factors were found to be affected in many human cancers.

Surgical approach and results of surgery in adenocarcinoma of the gastro-oesophageal junction.

Aim Of Study: This paper attempts to determine the appropriate surgical procedure in relation to the pathological types of adenocarcinoma of the gastro-oesophageal junction in Singapore.

Methods: Data on population characteristics, clinical presentation, pathology, surgical procedures and results of treatment were gathered from the case records of a personal series of 32 patients resected for adenocarcinoma of the gastro-oesophageal junction.

Results: The 32 patients with adenocarcinoma of the gastro-oesophageal junction (Type I, 9; II, 20 and III, 3), presented at a late stage (Stage I-II, 5; III, 14; IV, 13).

Analysis of variation in success rates in conjunctival autografting for primary and recurrent pterygium.

Aims: To evaluate the success rates of conjunctival autografting for primary and recurrent pterygium performed in a tertiary ophthalmic centre.

Methods: The outcome of 139 cases with primary pterygia and 64 cases with recurrent pterygia who underwent excision with conjunctival autografting was retrospectively reviewed. Outcome was evaluated in terms of recurrence of pterygia onto the cornea.

Hospital acquired pneumonia in the medical intensive care unit--a prospective study.

Aim Of Study: The aim of the study was to define the prevalence, risk factors, spectrum of organisms and sensitivity patterns, and the outcome in patients with severe hospital acquired pneumonia (HAP) in the Medical Intensive Care Unit (SCU) in a hospital in Singapore.

Method: Consecutive patients admitted to the MICU over a 6-month period were studied and assessed daily to determine whether patients had developed HAP based on defined clinical criteria. Sputum or endotracheal aspirate was obtained and results recorded from each patient on admission and every subsequent three days throughout the stay in the MICU.

Postoperative inflammation: extracapsular cataract extraction versus phacoemulsification.

Purpose: To quantitatively compare postoperative inflammation after extracapsular cataract extraction (ECCE) with that after phacoemulsification in an Asian population.

Setting: Singapore National Eye Center, Singapore.

Methods: In this prospective, randomized, double-masked clinical trial, patients having cataract surgery were randomized to receive ECCE (n = 16) or phacoemulsification (n = 18).

Comparison of sevoflurane with propofol for laryngeal mask airway insertion in adults.

Unlabelled: We performed a prospective, randomized, controlled trial to compare the quality and ease of laryngeal mask airway (LMA) insertion after either rapid inhaled sevoflurane or i.v. propofol induction of anesthesia.

The athlete's heart: is this an entity in paediatrics?

A case report of a boy who demonstrates features of an athlete's heart, associated with dilatation of the coronary artery, is presented. The importance of distinguishing this benign condition from pathologic causes such as cardiomyopathy, and risk of sudden death in these athletes is discussed.

Single vital capacity inhalational anaesthetic induction in adults--isoflurane vs sevoflurane.

Purpose: To evaluate whether isoflurane is as suitable as sevoflurane for the single vital capacity breath (VCB) method of inhalational induction in patients premedicated with midazolam.

Methods: A randomised, controlled, double-blind study involving 67 ASA I-II patients aged between 18-50 yr undergoing elective surgery under general anaesthesia. All participants received premedication with 0.

Acute hyponatraemia secondary to cerebral salt wasting syndrome in a patient with tuberculous meningitis.

A 30-year-old HIV-positive man presented with acute hydrocephalus secondary to tuberculous meningitis, for which an external ventricular drain was inserted. He developed marked natriuresis in the postoperative period, which resulted in acute hyponatraemia (131 to 122 mmol/l) and a contraction of his intravascular volume. A diagnosis of cerebral salt wasting syndrome was made, and he responded to sodium and fluid loading.

Esmolol resistance during anesthesia for thoracoscopically assisted coronary artery bypass grafting.

The anesthetic technique for two patients who underwent thoracoscopic harvesting of the LIMA followed by a mini-thoracotomy for surgical myocardial revascularization of isolated LAD artery stenosis is reported. Both patients unexpectedly showed esmolol resistance during anastomosis of the LIMA to the LAD artery. However, excellent graft patency, early extubation, and rapid recoveries were achieved.

Necrotizing fasciitis--an unusual presentation of miliary mycobacterium tuberculosis.

We report an immunocompromised patient who presented with necrotizing fasciitis as the initial presentation of miliary tuberculosis. The diagnosis of miliary tuberculosis was delayed resulting in prolonged morbidity and hospital stay. The lesson from this report is that tuberculosis should be recognised as an uncommon cause of necrotizing fasciitis in an immunocompromised patient, especially if the response to prompt and standard initial treatment is unsatisfactory.

Disposition of intravenous metronidazole in Asian surgical patients.

Steady-state peak and trough concentrations of metronidazole and its metabolites were measured in the sera of 54 surgical patients who were on intravenous metronidazole, 500 mg every 8 h. These patients had no significant renal or hepatic impairment. High-pressure liquid chromatography was used to determine the concentrations of metronidazole and its metabolites.

The chemical composition of gallstones: its relevance to surgeons in Southeast Asia.

This paper describes the methods in the study of the chemical composition of gallstones and the application of this knowledge to the practising surgeon in Southeast Asia. There are three types of stone in this part of the world. Inspecting with the naked eye, the surgeon is usually able to recognize accurately the stone type--cholesterol, black pigment and brown pigment.

Paracetamol and its metabolites in saliva and plasma in chronic dialysis patients.

1. Many pharmacokinetic studies on paracetamol are based on saliva paracetamol concentrations. The utility of saliva in patients with chronic renal failure is unclear.

Role of oral sodium phosphate and its effectiveness in large bowel preparation for out-patient colonoscopy.

The aim of our study was to determine the tolerance and efficacy of oral sodium phosphate compared with polyethylene glycol electrolyte (PEG) solution on out-patient colonoscopy. Seventy-nine patients (35 male, 44 female) for elective out-patient colonoscopy were randomized to receive either PEG (GoLYTELY) solution or oral sodium phosphate (Fleet PhosphoSoda) before the procedure. Patients subsequently completed a questionnaire to assess tolerance to either regimen.

Glycoprotein complexes interacting with cellulose in the "cell print" zones of the Dictyostelium discoideum extracellular matrix.

Cellulose is one of the commonest structural biopolymers. How cellulose is organized in extracellular matrices is a mystery. Here we investigate a model system, the extracellular matrix (ECM) of Dictyostelium discoideum which is composed of proteins and cellulose.

Tuberculosis and invasive pulmonary aspergillosis in a young woman with a myelodysplastic syndrome.

A 29-year-old Chinese woman developed pyrexia, multiple skin abscesses and bilateral fine nodular lung infiltrates about 3 months after the commencement of therapy for idiopathic thrombocytopenic purpura (ITP). Pseudomonas aeroginosa was isolated from the abscesses but multiple blood and sputum cultures, as well as a broncho-alveolar lavage did not yield any microorganisms. The persistence of fever and pulmonary infiltrates warranted an open lung biopsy which provided a definitive diagnosis of tuberculous-aspergillus granulomatous lung disease.

Antimicrobial resistance problem in a university hospital.

In a study conducted in 1991 in the National University Hospital, Singapore, the susceptibilities of a total of 2156 recent clinical isolates were tested against 25 antimicrobial drugs. The organisms were those isolated from routine specimens received in the microbiology laboratory. About 40% Staphylococcus aureus isolations in the hospital were resistant to methicillin.

Radical surgery for gastric cancer in Singapore.

This study was conducted to define the pattern and results of gastric cancer surgery in Singapore by reviewing the epidemiological data from the Singapore Cancer Registry together with a review of a personal series of 182 patients operated on over a 14 1/2-year period. As in Japan and the West, the incidence of gastric cancer is decreasing in Singapore; it was 2.3% per year for men and 1.