Granulomatous cervicofacial lymphadenitis in children: a nine-year study in Singapore

INTRODUCTION

Granulomatous cervicofacial lymphadenitis (GCL) is not uncommon in children. Nontuberculous mycobacteria (NTM) seem to be the predominant cause. We sought to study the clinical and microbiological profile of patients with GCL, and identify features that may impact outcome.

METHODS

Children aged < 16 years who presented to KK Women’s and Children’s Hospital, Singapore, between January 1998 and December 2006, and who had GCL were identified from laboratory records. Clinical and laboratory data was collected and analysed for risk factors for patients with positive lymph node cultures, and for patients with and without recurrence after treatment.

RESULTS

In all, 60 children were identified, with a median age of 56 (interquartile range [IQR] 34–101) months. Median duration of symptoms before presentation was 5 (IQR 4­–8) weeks. The majority presented with single (73.3%) or unilateral (96.7%) lymphadenopathy, located in the submandibular, preauricular/parotid or infra-/post-auricular region (76.7%). Out of 51 patients, 26 (51.0%) had a tuberculin skin test reading of ≥ 10 mm. Out of 52 patients, 10 (19.2%) had positive mycobacterial cultures, which included seven isolates of NTM. Out of 34 cases, tuberculous polymerase chain reaction was positive in 11 (32.4%). With regard to recurrence after initial treatment, age < 5 years at presentation was found to be a predictor for recurrence (p = 0.008), while initial complete excision of affected nodes predicted no recurrence (p = 0.003).

CONCLUSION

In our study, younger age was noted to be associated with a higher chance of recurrence, while complete excision of the involved node at initial presentation predicted non-recurrence.     

Surgery in the Elderly

The geriatric patient with a remediable surgical lesion should not be denied the benefits of surgery, provided he has a thorough preoperative evaluation and correction of any physiologic imbalances and receives careful intraoperative and postoperative management. Surgery in these patients, however, does present problems such as those associated with anesthesia; peptic ulcer; biliary, colonic and rectal disease, and massive gastrointestinal bleeding.     

Synthesis, antiviral, antituberculostic and antibacterial activities of some novel, 4-(4'-substituted phenyl)-6-(4"-hydroxyphenyl)-2-(substituted imino) pyrimidines

A variety of novel 4-[(4'-substituted phenyl)-6-(4"-hydroxyphenyl)-2-substituted imino] pyrimidines were synthesized by reacting 4-(4'-substituted phenyl)-6-(4"-hydroxyphenyl)-2-aminopyrimidines with different substituted aromatic aldehydes, with coumarin and with chloroisatin. The 4-(4'-chlorophenyl)-6-(4"-hydroxyphenyl)-2-aminopyrimidines were synthesized by reacting 3-(4'-substituted phenyl)-1-(4"-hydroxyphenyl)-2-propen-1-ones with guanine hydrochloride. The 3-(4'-substituted phenyl)-1-(4"-hydroxyphenyl)-2-propen-1-ones were synthesized by reacting 4-hydroxyacetophenone with different para substituted aromatic aldehydes. Spectral data (IR, NMR, and mass spectra) confirmed the structures of the synthesized compounds. The synthesized compounds were investigated for their antiviral, antituberculostic and antibacterial activities. The results indicated that the synthesized compounds have mild to potent activities with reference to their appropriate reference standards. However, mechanism related studies could be carried out to predict the structure activity relationship for all the compounds.     

Cross-chest liposuction in gynaecomastia

Background:

Gynaecomastia is usually treated with liposuction or liposuction with excision of the glandular tissue. The type of surgery chosen depends on the grade of the condition.

Objective:

Because gynaecomastia is treated primarily as a cosmetic procedure, we aimed at reducing the invasiveness of the surgery.

Materials and Methods:

The technique complies with all recommended protocols for different grades of gynaecomastia. It uses liposuction, gland excision, or both, leaving only minimal post-operative scars. The use of cross-chest liposuction through incisions on the edge of the areola helps to get rid of all the fat under the areola without an additional scar as in the conventional method.

Results:

This is a short series of 20 patients, all with bilateral gynaecomastia (i.e., 40 breasts), belonging to Simon''s Stage 1 and 2, studied over a period of 2 years. The average period of follow-up was 15 months. Post-operative complications were reported in only two cases, with none showing long-term complications or issues specifically due to the procedure.

Conclusions :

Cross-chest liposuction for gynaecomastia is a simple yet effective surgical tool in bilateral gynaecomastia treatment to decrease the post-operative scars. The use of techniques like incision line drain placement and post-drain removal suturing of wounds aid in decreasing the scar.     

The results of surgery in advanced carcinoma of the larynx

The present prospective study evaluates the results of surgery along, versus the salvage surgery (in radiationfailed cases in advanced carcinoma of the larynx. The results were distinctly superior in the former group than in the latter group (61% versus 44%). In stage II disease results of therapy were equally good in both groups. However, the number of disease-free survivors during 12–36 months of follow up dropped considerably as the stage of the disease increased in both groups, more so in radiation failed salvage surgery group (Stage III 77% and 44%; stage IV 30% and 0%). The overall results of therapy were worse in supraglottic cancers than in either glottic or transglottic lesions (30%, 62% and 60% respectively). The pyriform fossa and post cricoid cancers treated during the same period have not been included in the present paper.     

Bacterial pathogens isolated from cockroaches trapped from paediatric wards in peninsular Malaysia

A survey was conducted in 4 paediatric wards in Malaysia to determine the distribution of various species of cockroaches and to examine their gut contents for bacteria. Cockroaches were trapped from food dispensing areas (kitchens), store rooms, cupboards and open wards. 104 cockroaches were caught, consisting of Periplaneta americana (67.3%), Blattella germanica (26%), P. brunnea (4.8%), and Supella longipalpa (1.9%). Bacteria were isolated from all cockroaches except 3 P. americana. Many bacterial species were identified, including the pathogenic and potentially pathogenic species Shigella boydii, S. dysenteriae, Salmonella typhimurium, Klebseilla oxytoca, K. ozaena and Serratia marcescens.     

Peroxo salts as initiators of vinyl polymerization, 1. Effect of Ag(I) and Cu(II) on the polymerization of acrylamide initiated by peroxodisulfate ions

The kinetics of polymerization of acrylamide initiated by potassium peroxodisulfate, in the presence and absence of Ag(I) and Cu(II) ions, was studied. The rate law for the polymerization was established. Cu(II) ions were found to reduce both the rate and degree of polymerization.     

Phage types of Salmonella typhi isolated in Malaysia over the 10-year period 1970-1979.

The pattern of phage types of 2553 strains of Salmonella typhi isolated over the 10-year period 1970-9 was studied. During the period 29 different phage types were encountered, not including the categories of ''untypable strains'', ''degraded Vi-strains'' and Vi negative strains. For the period as a whole, the commonest phage types encountered were A (20.9%), E1 (14.8%), D1 (10.3%), degraded Vi positive strains (10.3%), untypable Vi strains (7.3%), C4 (7.1%), D2 (4.4%), E2 (3.9%) and type 25 (2.6%). There were phage types which appeared in the early years of the period and then disappeared (types B2, D9 and D1-N). Others only made their appearance in recent years (K1 and 53). Notable differences were also seen in the predilection of some phage types for certain geographical areas.