Rectus sheath haematoma requiring laparotomy

Rectus sheath haematoma is a well‐documented but unusual cause of acute abdomen. Combination of clinical features and appropriate radiological investigations can make for a prompt diagnosis. Most authors advocate conservative management and it has been reported that patients were directly discharged from the emergency department. We report a case of rectus sheath haematoma which progressed with clinical deterioration and necessitated surgical intervention for clot evacuation. Causes, physical signs, radiological features and classification of rectus sheath haematoma are discussed. It may be necessary to continue close clinical monitoring after diagnosis of rectus sheath haematoma.     

Prostate cancer detection upon transrectal ultrasound-guided biopsy in relation to digital rectal examination and prostate-specific antigen level: what to expect in the Chinese population?

We investigated the prostate cancer detection rates upon transrectal ultrasound (TRUS)-guided biopsy in relation to digital rectal examination (DRE) and prostate-specific antigen (PSA), and risk factors of prostate cancer detection in the Chinese population. Data from all consecutive Chinese men who underwent first TRUS-guided prostate biopsy from year 2000 to 2013 was retrieved from our database. The prostate cancer detection rates with reference to DRE finding and PSA level of < 4, 4–10, 10.1–20, 20.1–50 and > 50 ng ml⁻¹ were investigated. Multivariate logistic regression analyses were performed to investigate for potential risk factors of prostate cancer detection. A total of 2606 Chinese men were included. In patients with normal DRE, the cancer detection rates were 8.6%, 13.4%, 21.8%, 41.7% and 85.2% in patients with PSA < 4, 4–10, 10.1–20, 20.1–50 and > 50 ng ml⁻¹ respectively. In patients with abnormal DRE, the cancer detection rates were 12.4%, 30.2%, 52.7%, 80.6% and 96.4% in patients with PSA < 4, 4–10, 10.1–20, 20.1–50 and > 50 ng ml⁻¹ respectively. Older age, smaller prostate volume, larger number of biopsy cores, presence of abnormal DRE finding and higher PSA level were associated with increased risk of prostate cancer detection upon multivariate logistic regression analyses (P < 0.001). Chinese men appeared to have lower prostate cancer detection rates when compared to the Western population. Taking the different risk factors into account, an individualized approach to the decision of TRUS-guided biopsy can be adopted.     

Mental Well‐Being Mediates the Relationship between Perceived Stress and Perceived Health

The association between stress and health has been well researched in the past; however, comparatively few mediators have been tested to understand the underlying mechanism. With increasing awareness on mental well‐being, this study evaluated the relationship between perceived stress and perceived health and examined mental well‐being as a mediator. Two‐hundred undergraduates aged 21 to 26 years completed the English Perceived Stress Scale, Health Status Questionnaire and Asian Mental Well‐Being Scale that assess perceived stress, perceived health and mental well‐being, respectively. Factor analysis and structural equation modelling on the Perceived Stress Scale replicated the reported two‐factor structure after excluding an insignificant item. Linear multiple regression analyses indicated that perceived stress was negatively associated with perceived health. Results showed that mental well‐being partially mediated the relationship between perceived stress and perceived health, although it is acknowledged that this association could be bidirectional. Findings from the present study suggest that future research could focus on reducing stress and improving mental well‐being to alleviate the effect of stress on health. Copyright © 2013 John Wiley & Sons, Ltd.     

Initial experience in children using conventional laparoscopic instruments in single-incision laparoscopic surgery

Background

Single-incision laparoscopic surgery (SILS) has been successfully performed in children using 5-mm reticulating instruments. There are, however, few reports investigating the use of conventional instruments in SILS in the pediatric population.

Methods

We conducted a retrospective review of all consecutive children who underwent SILS from October 2009 to January 2010, with the procedure being solely performed by conventional 3- and 5-mm instruments through a standard access technique.

Results

A total of 19 SILS procedures were successfully performed in children aged 3 to 15 years. They included appendectomy (n = 10), nephrectomy (n = 1), combined cholecystectomy and splenectomy (n = 2), cholecystectomy (n = 1), high ligation for varicocele (n = 2), excision of Meckel diverticulum (n = 1), and staged orchidopexy and exploration for impalpable testis (n = 2). There was one conversion to conventional laparoscopic surgery, and that occurred in our first case of splenectomy. All the patients had smooth recovery from surgery without complications.

Conclusions

Using conventional instruments in SILS is technically feasible in children from simple to complex procedures and may have the potential to popularize this approach by eliminating the mandatory demand for specially designed instruments.     

Restorative role of persimmon leaf (Diospyros kaki) to gamma irradiation-induced oxidative stress and tissue injury in rats

Purpose: To evaluate the efficacy of persimmon leaf extract (PL (as a rich plant source) in modulation of radiation-induced liver injury and some metabolic variations in gamma-irradiated rats.

Materials and methods: PL at a dose of 1000?mg/kg body weight (P₁₀₀₀) was administered to male albino rats via gastric intubation for 15 days after whole body γ-irradiation (6?Gy).

Results: Irradiated rats showed significant decreases in hepatic glutathione content (GSH), superoxide dismutase (SOD), catalase (CAT) and xanthine dehydrogenase (XDH) activities with significant increases in malondialdehyde (MDA) level and xanthine oxidase (XO) activity designating oxidative stress. In parallel significant increases in serum aspartate and alanine transaminase (AST, ALT), alkaline phosphatase (ALP), γ-glutamyl-transferase (GGT) activities and bilirubin content were recorded indicating liver injury. In addition, hyperglycemia, hypoinsulinemia and dyslipidemia (elevated total cholesterol, triglycerides, low density lipoprotein-cholesterol and Atherogenic Index and decreased high density lipoprotein-cholesterol) were recorded. PL treatment has significantly attenuated radiation-induced oxidative stress in hepatic tissues concomitant with significant amelioration of liver function and metabolic disturbances.

Conclusion: It is concluded that PL may have therapeutic potential to alleviate the severity of radiation-induced liver injury, hyperglycemia, hypoinsulinemia and dyslipidemia.     

Prevalence and time trend of intestinal metaplasia in Hong Kong

Background and Methods:  Upper endoscopy records from 1998 to 2003 were reviewed. The demographic data, endoscopic diagnosis, results of rapid urease test and the absence or presence of intestinal metaplasia (IM) in histology were reviewed, to evaluate the prevalence of IM and Helicobacter pylori (Hp) infection over time in Hong Kong.
Results:  Among 1805 endoscopies performed, 1751 had both rapid urease test and histology available. A significant drop in the prevalence of duodenal ulcers from 17.9% in 1998 to 9.8% in 2003 was found ( P  = 0.015). Prevalence of IM was 13.9%, 5.9% and 9.4% in Hp positive, Hp negative and overall respectively ( P  < 0.05). The prevalence of IM increased with age, and the patterns were similar amongst subjects in 1998–2000 and those in 2001–2003. There was progressive decrease in Hp prevalence from 58% in 1998 to 40% in 2001 ( P  = 0.014), but no further decrease was seen in 2002–3. There was no corresponding decrease in IM prevalence. Instead IM prevalence in 2002–2003 was significantly higher than the prevalence in previous few years ( P  = 0.04).
Conclusion:  The prevalence of IM did not change in the period from 1998 to 2003 despite a drop in the prevalence of Hp infection since 1994.     

Inhibitory effect of Carthamus tinctorius L. seed extracts on bone resorption mediated by tyrosine kinase,COX-2 (cyclooxygenase) and PG (prostaglandin) E2

Anti-bone resorption properties of the Korean herbal formulation, Honghwain (HHI; Carthamus tinctorius L. seed) was biochemically investigated. On processing bone metabolism, PGE2 accelerated production of IL-1beta in fetal mouse osteoblast and stimulated physiological activation substance, IL-1beta. The novel class of Src tyrosine kinase inhibitors, Herbimycin A (HERB) and HHI reduced COX-2 mRNA levels as well as PGE2 production induced by IL-1beta, TNF-alpha and IL-6. HHI inhibited in vitro and in vivo bone resorption by inhibition of phosphorylation of peptide substrates. HHI dose-dependently reduced the hypercalcemia induced in mice by IL-1beta and partly prevented bone loss and microarchitectural changes in young ovariectomized rats, showing that the protective effect on bone was exerted via the inhibition of bone resorption. These results indicate that the synergy between IL-beta, TNF-alpha, IL-6 on PGE2 production is due to an enhanced gene expression of COX-2 and that tyrosine kinase (s) are involved in the signal transduction of COX-2 in mouse calvarial osteoblasts. Thus, HHI as a possible Src family kinase inhibitor may be useful for the treatment of diseases associated with elevated bone loss.     

Parents' perceptions towards their child's use of inhaled medications for asthma therapy

Objective : Understanding patients' and their parents' perceptions towards asthma medication is important in developing strategies to ensure patient compliance. In this study, parents' perceptions towards their children's use of inhaled medication for asthma treatment were evaluated.
Methodology : A questionnaire was administered by interviewing parents of 210 asthmatic children attending the Department of Paediatrics, National University Hospital.
Results : Our results showed that 76/210 (36%) of parents either felt opposed to inhaler therapy and/or preferred oral medications. The main reasons for their reluctance to use inhalers were related to fear of dependence, side effects and overdosage, and the child's dislike for inhalers. A third of these parents felt that inhalers were only indicated for very severe asthma.
Conclusions : We conclude that a significant proportion of parents have reservations regarding the use of inhalers for the treatment of asthma. These factors should be taken into consideration when planning an effective asthma education programme.     

Neonatal neutropenia and thrombocytopenia following maternal hypertension

Objective : To assess the relationship between the subtypes of hypertension in pregnancy and subsequent neonatal haematology.
Methodology : Retrospective review of the haematology of newborns of hypertensive mothers at a tertiary neonatal unit
Results : Over a 2 year period. 249 infants had full blood examinations. Nineteen (7.6%) were neutropenic and 35 (14.1%) thrombocytopenic, including 11 (4.4%) who were both neutropenic and thrombocytopenic. Neutropenia occurred only in infants whose mothers had severe pre-eclampsia and eclampsia or pre-eclampsia with pre-existing hypertension, whereas thrombocytopenia complicated all maternal hypertension subtypes. Two (10%) of the neutropenic infants developed nosocomial infection while seven (20%) of the thrombocytopenic infants bled. Thirteen (68%) of the neutropenic infants compared with 15 (43%) of the thrombocytopenic infants developed their haematological abnormality within 24 h of birth. All but two infants developed the haematological abnormality by the 5th day of life.
Conclusions : Although haematological abnormalities in infants born to hypertensive mothers are uncommon, serious neonatal complications can occur and therefore early haematological screening of these infants is recommended.