Emphysematous pyelonephritis is a severe, potentially fatal necrotizing pyelonephritis with a variable clinical presentation, ranging from mild abdominal pain to septic shock. The majority of cases occur in diabetics with poor glycemic control, while a small percentage may be due to urinary tract obstruction. We present a case of a 57 year old male patient, diabetic on treatment, presenting with left fl ank pain and poor stream of urine since one week. Laboratory tests revealed that the patient had electrolyte imbalance, ketoacidosis and high blood sugar. Urine culture was positive for Escherichia coli with a signifi cant colony count. Radiological examination gave a diagnosis of Left Type 1 Emphysematous Pyelonephritis. Inspite of giving vigorous resuscitation and antibiotics with nephrostomy, the patient had to undergo nephrectomy due to extensive renal parenchymal destruction. The nephrectomy specimen was studied in detail to know the histopathological fi ndings in a case of diabetic patient with emphysematous pyelonephritis. We present this case not only because of it being a rare complication of diabetes, but also to focus on the histopathological fi ndings of the same, documentation of which is limited in literature.

As a technically demanding skill, microsurgery is taught in the lab, in the form of a course of variable length (depending on the centre). Microsurgical training courses usually use a mixture of non-living and live animal simulation models. In the literature, a plethora of microsurgical training models have been described, ranging from low to high fidelity models. Given the high costs associated with live animal models, cheaper alternatives are coming into vogue. In this paper we describe the use of the chicken aorta as a simple and cost effective low fidelity microsurgical simulation model for training.
Animal Experimentation ; Animals ; Aorta ; Chickens ; Microsurgery ; Models, Animal ; Pyridines ; Thiazoles

Summary Trichorrhexis nodosa (TN) is a hair shaft disorder characterized by fragile hair with nodes on the hair shaft. Here we report a case of aquired localised trichorrhexis nodosa and describe the importance of noninvasive tools like trichoscopy and light microscopy in the diagnosis of an isolated TN.
Hair Diseases--diagnosis

Microsurgery training in Singapore began in 1980 with the opening of the Experimental Surgical Unit. Since then, the unit has continued to grow and have held microsurgical training courses biannually. The road to becoming a full-fledged reconstructive surgeon requires the mastering of both microvascular as well as flap raising techniques and requires time, patience and good training facilities. In Singapore, over the past 2 decades, we have had the opportunity to develop good training facilities and to refine our surgical education programmes in reconstructive microsurgery. In this article, we share our experience with training in reconstructive microsurgery.
Education ; Microsurgery* ; Singapore*

Summary Dilated pore of Winer is a benign adnexal tumour of follicular differentiation. It has typical clinical feature of asymptomatic, solitary enlarged pore with a keratin plug. Dermoscopy offers further assistance in diagnosis. In this case on dermoscopy, well defined lamellated central blackish area arranged in concentric circles, surrounded by a bluish grey halo was seen with a rim of hyperpigmentation.
Dermoscopy

Background: As the number of patients getting tattooed is increasing, so is the number of patients seeking removal of tattoos. The primary objective of this study was to assess the reasons as to why patients got tattoos and also seek tattoo removal. The secondary objective was to study the demographics and the knowledge they had regarding tattoo removal. Methods: A cross sectional study was done among 250 consecutive patients who attended the Dermatology centre seeking tattoo removal. A questionnaire was used to fill in the details. Results: 167 males and 83 females were included in the study. Majority of patients were in the age group of 21 to 30 years (43.8%) followed by 31-40 years (26.7%). 56.6% of patients had got tattoos in the third decade and 35.1% in the second decade. 52.6% of those seeking tattoo removal had got their tattoos from amateur artists, village fairs or roadside tattoo shops. 45.8% did not have a specific reason for getting a tattoo and were decorative tattoos. 34.7% had names of their beloved or family members. 29.5% were seeking removal for professional reasons and 23.1% due to changes in relationship status. Conclusion Patients seek tattoo removal mainly for professional reasons, changes in personal relationships when they have name tattoo and due to complications. Most of the patients were in the third decade of life. It is important to educate school going children ang youngsters regarding the permanent nature of tattoo and its complications.
Tattooing ; Laser Therapy

Nocardia species are gram-positive, aerobic, acid-fast bacteria which exist as saprophytes in nature. Invasive disseminated infections are particularly common in immunocompromised or debilitated hosts. Superficial infections with Nocardia species occur as a result of local trauma and contamination of the wound. Clinically, it may manifest as an acute infection (abscesses or cellulitis), mycetoma, or sporotrichoid infection. Herein we report a rare case of cutaneous nocardiosis following surgery mimicking a hypertrophic scar.

The widespread use of microsurgery in numerous surgical fields has increased the need for basic microsurgical training outside of the operating room. The traditional start of microsurgical training has been in undertaking a 5-day basic microsurgery course. In an era characterised by financial constraints in academic and healthcare institutions as well as increasing emphasis on patient safety, there has been a shift in microsurgery training to simulation environments. This paper reviews the stepwise framework of microsurgical skill acquisition providing a cost analysis of basic microsurgery courses in order to aid planning and dissemination of microsurgical training worldwide.
Costs and Cost Analysis* ; Delivery of Health Care ; Education ; Microsurgery* ; Mortuary Practice ; Operating Rooms ; Patient Safety

Purpura fulminans is a serious condition that can result in severe morbidity in the pediatric population. Although autologous skin grafts remain the gold standard for the coverage of partial- to full-thickness wounds, they have several limitations in pediatric patients, including the lack of planar donor sites, the risk of hemodynamic instability, and the limited graft thickness. In Singapore, an in-house skin culture laboratory has been available since 2005 for the use of cultured epithelial autografts (CEAs), especially in burn wounds. However, due to the fragility of CEAs, negative-pressure wound therapy (NPWT) dressings have been rarely used with CEAs. With several modifications, we report a successful case of NPWT applied over a CEA in an infant who sustained 30% total body surface area full-thickness wounds over the anterior abdomen, flank, and upper thigh secondary to purpura fulminans. We also describe the advantages of using NPWT dressing over a CEA, particularly in pediatric patients.