Successful treatment of pulmonary artery aneurysms secondary to possible Behçet's disease

Pulmonary artery aneurysm (PAA) secondary to Beh?et's disease (BD) is a rare condition. The commonest presentation is hemoptysis, which can be fatal. Though the classical triad of recurrent oral and genital ulcers and relapsing iritis is present in most patients of BD, isolated pulmonary artery involvement termed as incomplete BD has been reported. Prompt diagnosis and immunosuppressive therapy can cause regression of aneurysm and prevent fatal hemoptysis. We report a case of PAA due to BD who presented with hemoptysis and responded to steroid therapy.     

Fear of cancer recurrence among cancer survivors in Singapore

INTRODUCTIONFear of cancer recurrence (FCR) among cancer survivors is a persistent and distressing psychosocial concern that affects recovery and quality of life. The prevalence of FCR in Singapore is unknown. This cross-sectional study was designed to examine FCR and identify factors associated with FCR in mixed-cancer survivors locally.METHODSCancer survivors in remission (n = 404) were assessed for: FCR using the Fear of Cancer Recurrence Inventory (FCRI); emotional distress using the Hospital Anxiety and Depression Scale; and quality of life using the World Health Organization Quality of Life-BREF. Clinical and severe/pathological FCR was determined based on the severity scale of FCRI, known as FCRI-Short Form. Multivariate logistic regression was performed to examine factors associated with FCR.RESULTSThe mean score on the FCRI was 59.5 ± 30.4. 43.6% of cancer survivors had clinical FCR and 32.1% had severe/pathological FCR. Younger age (odds ratio [OR] 0.952, 95% confidence interval [CI] 0.911–0.995, p < 0.05), higher educational status (OR 2.55, 95% CI 1.15–5.65, p < 0.05) and higher levels of emotional distress (OR 1.17, 95% CI 1.10–1.24, p < 0.001) were significantly associated with severe/pathological levels of FCR.CONCLUSIONThe present study is the first to determine levels of FCR among cancer survivors in Singapore. While the total FCR scores were similar to those of international studies, severe/pathological levels of FCR were found to be four times higher. These findings highlight a problem that is not widely recognised or acknowledged, but which deserves greater attention.     

Risperidone and megacolon

Risperidone is an atypical anti-psychotic medication with both 5HT2 receptor and D2 dopamine receptor antagonism. Its use has been reported to be generally safe with very few gastro-intestinal (GI) adverse or side effects. In this paper, we describe a case of megacolon associated with the use of risperidone. A 44-year-old man suffering from schizophrenia was treated with risperidone and developed gross abdominal distension after twenty-five days. Abdominal X-ray and colonoscopy showed megacolon. He improved following a surgical decompression and a reduction of risperidone dosage. We discuss the neuro-electro-physiological mechanisms of gastro-intestinal motility and conclude that the risperidone-associated megacolon may be dose-related and that there should be a heightened awareness of such possible GI complication when using risperidone.     

Cutaneous metastases from a hypopharyngeal malignancy

We present an unusual case of carcinoma of the piriform fossa, presenting with cutaneous metastases. These metastases are very rare, present in the late stages of disease, and are usually associated with distant metastases and poor prognosis. They often suggest aggressive disease. We believe that cutaneous metastases from a malignancy in the piriform fossa are more unusual than those from other sites of the head and neck.     

Referral patterns in vestibular schwannomas --10 years on

Diagnostic imaging techniques, symptom awareness and education of local sources of referral in vestibular schwannomas, including general practitioners, have all improved in the last 10 years. The referral patterns in vestibular schwannomas in Cambridgeshire in the period 1981-1993 has been reported.(1) A direct comparison was made with regard to referral patterns seen in the last 10 years paying particular emphasis to source of referral, diagnosis at referral and symptoms/size at presentation. The incidence of vestibular schwannomas in the region is compared and discussed. Patients' managed by the 'watch and wait' policy were particularly scrutinized, as they were not discussed previously. Retrospective analysis of computerized database was used. We have demonstrated an increase in the proportion of referrals with known vestibular schwannoma to 90% of all referrals. No significant change in length of history prior to referral, source of referral or principal presenting symptom were found. An overall decrease in tumour size was found but an increase in the percentage with larger tumours (>4.5 cm). We attribute the significant findings to an increase in availability of magnetic resonance (MR) scanners in the country during the past 10 years. It appears that some tumours would still present with no symptoms until late and therefore will elude identification until large in spite of a low threshold for MR scanning.