Sialoblastoma

Sialoblastoma should be considered in the diagnosis of a perinatal neck swelling that appears to be contiguous with the submandibular salivary gland. These are exceedingly rare perinatal salivary tumors of epithelial origin with variable biologic behavior including the potential for local and systemic recurrence.We report the case of a 3-month-old boy who presented with a submandibular swelling of insidious onset that was initially thought to be a lymph node enlargement.     

A prospective study assessing anal plug for containment of faecal soilage and incontinence

Objective  Faecal incontinence is a common and embarrassing problem for many individuals. Some patients remained symptomatic despite the availability of different treatments. There is a limited range of commercially available products designed to cope with faecal incontinence. The anal plug has been developed to contain the loss of stool. This study aimed to evaluate the use of anal plug in Asian patients with intractable faecal soilage and incontinence judged by clinical and functional outcomes.
Method  A prospective study of consecutive patients with intractable faecal incontinence was carried out. Suitable patients tested the anal plug for 3 weeks. They completed a structured questionnaire on its use including the ASCRS quality of life questionnaire for faecal incontinence.
Results  Thirty patients, median age 63 (interquartile range 52–70) years, participated in the trial. Nineteen of 30 patients were comfortable wearing the plug, seven patients withdrew from the study because of discomfort, and four had tolerable discomfort and managed to complete the trial protocol. Patients who tolerated the plug found that it was highly successful in controlling faecal incontinence. Twenty-one of 30 patients wished to continue to use the plug regularly after the study. There was a trend toward improvement in quality of life scores during the study.
Conclusion  The anal plug was effective in containing faecal incontinence and was well tolerated in the majority of patients selected for this treatment.     

A retrospective review of 287 consecutive children in singapore presenting with intermittent exotropia.

BACKGROUND: Intermittent exotropia, X(T), is a relatively common form of strabismus among children in Singapore. The purpose of this study is to see how children presenting with this condition fared during a period of 5 years. METHODS: The medical records of all children younger than 16 years who presented to the eye clinic at the Singapore National Eye Centre with X(T) between January 1992 and December 1995 were reviewed retrospectively. RESULTS: A total of 287 patients satisfied the entry requirements of this study. Estimated age of onset of exotropia was documented in 161 subjects. The mean age of estimated onset was 3.0 +/- 2.5 years. The mean age of presentation was 6.1 +/- 3.1 years. The mean amount of distant exotropia was 36.4 +/- 12.5 prism diopters (PD). Seventy-two percent of children had poor/no distant control. During a 3-year period, the size of exotropia appears to remain constant (within 5 PD of original) in 48% and improved >5 PD in 32%. Control of distant exotropia remained the same in 63%, improved in 17% and worsened in 20%. Near exotropia was initially present in only 35.5%. The mean amount of near exotropia, when present, was 25.9 +/- 13.7PD. Near control remained the same in 65% and worsened in 22%. More variation was observed in subjects presenting before 5 years of age. One hundred sixty-two (56.4%) subjects underwent surgery. The mean age of surgery was 8.0 +/- 2.6 years. Surgery resulted in a final strabismus size between 10 PD exotropia and 5PD esotropia in 65.2% at 1 year postoperation. CONCLUSION: Half the subjects presenting with an intermittent exotropia eventually had surgery. In the remaining nonsurgical subjects, intermittent exotropia, once present, appeared to be a relatively stable condition.     

Emergence of herpes simplex type 1 as the main cause of recurrent genital ulcerative disease in women in Northern Ireland.

BACKGROUND: Genital herpes is a common infection affecting some 20% of sexually active people. Although herpes simplex virus (HSV) types 1 and 2 can both establish genital latency, reactivation from the sacral ganglia favours HSV-2. Over the past decade the incidence of type 1 genital infection in women has greatly increased. OBJECTIVES: To determine whether the increased prevalence of HSV-1 genital infection was benign or influencing the pattern of virus recovery in recurrent infection. STUDY DESIGN: A retrospective analysis of laboratory computer records was undertaken. Patients attending six genitourinary medicine (GUM) departments, over an 80 months period, were identified. Recurrent infection was confirmed where virus was recovered from at least two separate episodes of genital ulceration that were separated by an interval of 12 or more weeks. Episodes were further analysed for frequency, age, gender and virus type. RESULTS: Sixty nine patients with recurrent genital herpetic infection were identified. HSV-1 and HSV-2 were predominantly recovered from recurrent genital infections in females (34 HSV-1 vs. ten HSV-2) and males (one HSV-1 vs. 24 HSV-2), respectively (P>0.001). The mean age of females and males, at the initial diagnosis, was 26 and 39 years. There was no difference in the recurrence rate by type. CONCLUSIONS: HSV-1 has become the commonest cause of recurrent genital ulceration in Northern Ireland, almost entirely due its recent increased prevalence in women over the last decade. Women are experiencing genital herpetic infections at an earlier age than men.     

Potential role of glial cell line-derived neurotrophic factor receptors in Müller glial cells during light-induced retinal degeneration

Glial cell line-derived neurotrophic factor (GDNF), neurturin (NTN) and their receptors (GFRalpha1, GFRalpha2 and Ret) play an important role in the survival of neurons in the central and peripheral nervous system. For example, GDNF as well as other trophic factors promotes photoreceptor survival during retinal degeneration. Recent studies have proposed that part of neurotophic rescue of photoreceptors may be indirect, mediated by interaction of the neurotrophic factors with other cell types, that in turn release secondary factors that act directly on photoreceptors. In the present study, we examined the GDNF receptor expression in control and light-damaged retina, and found that GFRalpha2 protein is upregulated in retina-specific Müller glial cells during photoreceptor degeneration. We also examined the effect of GDNF or NTN on cultured Müller cells. Exogenous GDNF increased brain-derived neurotrophic factor, basic fibroblast growth factor and GDNF, but not NTN mRNA production. On the other hand, NTN increased NTN, but not GDNF mRNA production in cultured Müller cells. These observations suggest that GDNF, NTN and their receptors are involved in the regulation of trophic factor production in retinal glial cells, and that functional glia-neuron network may utilize GDNF family for the protection of neural cells during retinal degeneration.     

Prevalence of wheeze,night cough and doctor-diagnosed asthma in pre-school children in Kota Bharu

While many studies of the prevalence of wheeze have been conducted in schoolchildren, there have been few in pre-school children. Most children with asthma develop symptoms before the age of 5 years and many pre-school wheezers continue to wheeze in the early school years. Among the latter, those children who continue to wheeze at school age have poorer lung function than those who don't. It is thus appropriate to enquire more fully about wheeze in this age-group where its incidence is high and its relation with asthma less well defined. The objective of this study was to investigate the prevalences of wheeze, night cough and doctor diagnosed asthma in pre-school children. A cross-sectional study was conducted in five primary health clinics in the district of Kota Bharu from April to October 1998. Nurses from these clinics distributed Bahasa Malaysia questionnaires containing questions on asthma symptoms to preschool children aged 1-5 years during their home visits. The respondents were parent(s) or carer(s) of the child. The response rate was 100% and a total of 2,878 responses were analysed. The prevalence of symptoms and doctor diagnosed asthma were as follows: ever wheezed 9.4% (95% confidence interval (CI) 8.3-10.4%); current wheeze 6.2% (95% CI 5.2 to 7.0%); night cough 10.2% (95% CI 9.1 to 11.4%); and doctor diagnosed asthma 7.1% (95% CI 6.2 to 8.0%). There were no significant differences in prevalence between males and females, or among age groups. The prevalence of night cough in children with no history of wheeze was 6.9%. The cumulative and current prevalences of wheeze were similar to, and those of night cough and doctor-diagnosed asthma significantly lower than, those reported for Kelantan schoolchildren. These findings provide a baseline for assessing future symptoms trends, and perhaps also the validity of diagnosing asthma in this age group.     

肾错构瘤的诊断与病理学基础的关系

肾错构瘤是肾脏最为常见的良性肿瘤,肾细胞癌是最常见的恶性肿瘤,二者的治疗方法和预后截然不同。但在临床诊断的时候,相互之间常有误诊,给工作带来一定的麻烦。我院从1990年5月至2000年6月,共收治肾错构瘤患者62例,现将它们的临床诊断、治疗与病理学基础进行分析,以减少误诊的     

Survival of childhood leukemia in Singapore

The objective of this study was to evaluate the treatment outcome of children with acute leukemias at a university hospital in Singapore. Between January 1988 and January 1994, 66 children were treated, comprising 13 cases of acute myeloid leukemia (AML) and 53 of acute lymphoblastic leukemia (ALL). The 2-year disease-free survival (DFS) was computed according to the Kaplan-Meier method. The results showed that the survival for AML was poor, with a 2-year DFS of only 30%. The major cause of death for AML was leukemia and leukemia-related complications, such as hemorrhage and severe infections. In contrast, a 62% 2-year DFS was achieved for ALL. It was found that marked hepatosplenomegaly (enlarged liver and/or spleen ≥10 cm below the costal margin) at presentation correlated with a significantly shortened survival in our patients with ALL. The major cause for treatment failure in ALL was recurrence of disease. We conclude that the DFS for our patients with ALL at 2 years was fair. The treatment results for AML were poor, but the numbers are too small to make any definite conclusions. © 1996 Wiley-Liss, Inc.     

Bilateral severe fibrinous anterior uveitis--an unusual complication of pamidronate therapy exacerbated by topical latanoprost.

AIM: The aim of this study was to report a case of severe bilateral fibrinous anterior uveitis following pamidronate therapy in a patient on latanoprost. METHODS: This study is presented as an interventional case report. RESULTS: Clinical examination showed bilateral severe fibrinous uveitis following an intravenous infusion of disodium pamidronate. Ocular signs and symptoms responded to stopping latanoprost and treatment with oral prednisolone (60 mg) and hourly topical prednisolone acetate 1%. The reintroduction of latanoprost resulted in a recurrence, which was stopped with subsequent improvement. CONCLUSIONS: Mild anterior uveitis is an unfamiliar adverse effect of pamidronate therapy. However, severe fibrinous uveitis has not been previously described. This may be due to the compounding effect of latanoprost. This case highlights the importance of history taking and awareness of the otherwise uncommon side effect of this commonly prescribed medication.