Tendons ; Rupture ; Ultrasonography

Objectives: Although thrombolytic therapy has been shown to be benefi cial to stroke patients, its safety and effectiveness in stroke patients with cardiac tumor is unknown. This study assessed the safety and effi cacy of intravenous thrombolysis with recombinant-tissue plasminogen activator (rtPa) in stroke patients with cardiac myxoma. Methods: We systematically searched databases for all publications on thrombolysis in patients with cardiac tumor-related strokes. The literature on thrombolysis in ischemic stroke patients with myxoma was systematically analyzed; information on the hemorrhagic transformation and response rates in patients over and under 70 years of age was extracted and compared. Statistical tests were performed to evaluate the odds ratios for these factors. Results: Twelve case reports were identifi ed. Four patients were 70 years of age or older, two (50%) of whom had demonstrated hemorrhagic transformation, which was not found in patients under 60 years of age. The rate of response to treatment was 60% (3/5) in patients under 60 and 25% (1/4) in those ≥70 years of age. The rate of hemorrhagic transformation in the patients ≥70 years of age was higher than that in patients <70 years of age (odds ratio 7). Conclusion: Intravenous thrombolysis in ischemic stroke patients with myxoma who were over 70 years of age was associated with a lower response rate and a higher risk of hemorrhagic transformation.

Children with epilepsy are at increased risk of behavioral problems and psychiatric disorders compared with the general population and those with other chronic illnesses. Depression and anxiety disorders are the most common and require further attention because they carry the risk of reduced quality of life and have far reaching consequences in later life. The wide range of prevalence quoted in the literature refl ects methodologic differences. Risk factors are often multifactorial and include illness severity, coexisting morbidity, and psychosocial factors. Diagnosis remains a challenge, as the presentation is heterogenous and age related. This is complicated by epilepsy issues and associated comorbidity that hamper the use of standardized assessment tools. Multimodal treatment involving psychotherapy and antidepressant therapy currently represents the best approach. The mental health needs of these children are largely unmet; increased awareness and better research are required to determine best practices.

There is growing evidence that antiepileptic drugs used in children that are meant to control seizures can actually cause seizure exacerbate instead. To minimize this problem, clinicians should be familiar with the epilepsy syndromes and the appropriate choice of antiepileptic drugs, avoid certain antiepileptic drugs which consistently aggravate specifi c seizure types and maintain a high index of suspicion of those at high risk as seizure exacerbation can present in diverse forms.

Smoking cessation is a most cost-effective medical intervention and helping our patients stop smoking is a highly worthwhile endeavor. A doctor providing smoking cessation counseling will do well to first realise why many smokers are unwilling (or unable) to quit. This article focuses on why a doctor should emphasise smoking cessation in the prevention and management of chronic obstructive pulmonary disease.

Clinical depression is one of the most common and treatable psychiatric disorders in older adults but tends to be underrecognised and undertreated, leading to impaired functioning, greater service utilisation and increased orbidity and mortality including suicide. Depression in elderly represents a heterogenous group of mood disturbances and often occur in a complex medical psychosocial context. Screening for depression is important especially for high risk populations such as those with chronic debilitating illnesses or major physical illnesses, the recently bereaved and the socially isolated. Screening relies predominantly on the assessment of depressive symptoms as there are few, if any, reliable signs or biological markers for depression. Milder cases of depression can be successfully treated at primary care level with appropriate pharmacological, psychological and social interventions.

The asthma-COPD overlap syndrome presents itself in patients where the asthma is not controlled despite seemingly appropriate measures or a patient who is a smoker and treated as COPD but also has asthmatic features. The asthma-COPD overlap syndrome is more common in the elderly. Such patients are of importance to diagnose because they have a high disease burden compared to asthma alone or COPD alone. Patients with both asthma and COPD should be identified earlier, as these patients have an increased risk for frequent exacerbations and therefore their treatment and follow-up should be optimised before hospital discharge. Also rehabilitation immediately after an exacerbation has been shown to be safe and effective to prevent further exacerbations requiring hospitalisation.

Pulmonary rehabilitation identifies and treats the systemic effects of the disease and the positive outcomes are realised without demonstrable improvements in lung function. It is multidisciplinary, patient centred and provides a comprehensive assessment upon which the three components of exercise training, self-management education, and psychosocial/ behaviour intervention are conducted over a period lasting 6 to 12 weeks. Pulmonary rehabilitation administered after hospital admission for an exacerbation was shown to be able to improve quality of life, improve exercise capacity, and also reduce re-exacerbation and hospital admission. Self-management education may promote long-term adherence to the exercise program.

In Singapore, sexual intercourse with a minor is an offence. An individual, who has knowledge of such an offence, is legally obliged to inform the authorities. This case study involved a minor who suffered from a sexually transmitted disease (STD) after sexual exposure. With her approval, the attending primary care physician reported the offence to the police using an on-line service. The case study also serves to illustrate the ethical and legal issues relating to her management.

Disability in children can be broadly classified into physical and mental disabilities and there are many conditions that result in this. Physical disability is often present in children with cerebral palsy or neuromuscular disorders. With mental disability, the children are not able to learn self help skills and remain dependent on their caregivers for most of the activities of daily living. An extension of this group would include those with moderate to severe autism. In paediatrics, many conditions result in both forms of disabilities with greater consequence and burden to their families. Thus, early rehabilitation incorporating motor learning, education and vocational training, which are inclusive of all aspects of health and neuro-development, is the new paradigm shift. The current emphasis is focused on health and function, and not the disability. Rehabilitation plans are made toward the goals of life in school and community; participation and if possible, contribution to the society in adulthood. Long term care if needed, remains a most challenging task for all involved in the management of children with severe disabilities.