This is a case series of 45 patients with surgically confirmed necrotizing enteritis admitted at the Davao Medical Center from January 1984 to December 1991. Twenty nine cases (64 percent) were in the age-group 5-15 years. Male: female ratio was 1.8. The highest monthly occurrence was in May, and 1990 recorded 17 cases (37.8 per cent). Bloody diarrhea and skin mottling were associated with extremely high mortality (93 per cent). Thirty five cases underwent resection and primary anastomosis. In ten cases, the involved intestinal segment improved with application of heat through packs and normal saline. There were 15 deaths, 12/35 (34.2 percent) were in those in whom resection was done, and 3/10 (30 per cent) among the nonresected cases. Overall mortality was 33.3 per cent (15/45). (Author)

Human ; Male ; Female ; Adolescent ; Child ; Child Preschool ; Hot Temperature ; Enteritis ; Intestines ; Diarrhea ; Death

Tendon is a dense connective tissue that connects muscle to bone. Tendon can adapt to mechanical forces passing across it, through a reciprocal relationship between its cellular components (tenocytes and tenoblasts) and the extracellular matrix (ECM). In early development, the formation of scleraxis-expressing tendon progenitor population in the sclerotome is induced by a fibroblast growth factor signal secreted by the myotome. Tendon injury has been defined as a loss of cells or ECM caused by trauma. It represents a failure of cells and matrix adaptation to mechanical loading. Injury initiates attempts of tendon to repair itself, which has been defined as replacement of damaged or lost cells and ECM by new cells or new matrices. Tendon healing generally consists of four different phases: the inflammatory, proliferation, differentiation and remodelling phases. Clinically, tendons are repaired with a variety of surgical techniques, which show various degrees of success. In order to improve the conventional tendon repair methods, current tendon tissue engineering aims to investigate a repair method which can restore tissue defects with living cells, or cell based therapy. Advances in tissue engineering techniques would potentially yield to a cell-based product that could regenerate functional tendon tissue.
Tissue Engineering

Obesity and overweight are considered health risks for non-communicable diseases. Most clinical practice guidelines suggest lifestyle modification as the primary management and as an adjunct to pharmacologic treatment. Using the SMART-EST goaloriented action plan and lifestyle medicine may improve weight reduction outcomes. The case presented had clinical criteria (3/5) for metabolic syndrome, diagnosed previously as obese stage II, asthma moderately uncontrolled, prediabetes, and mild dyslipidemia. Baseline weight and waist-to-hip ratio were taken and interpreted as obese stage II with a very severe risk for comorbidity. The diagnostics used were fasting plasma glucose, lipid profile, HbA1c, and 2-D echocardiography on the eight months of intervention only. Using the SMART-EST action plan plus Lifestyle medicine approaches as non-pharmacologic management for metabolic syndrome. There was an 11.4 % reduction in weight, improved fasting glucose, lipid profile, and 2-D echocardiography within the eight months of intervention.
Metabolic syndrome

OBJECTIVE: The detection rate of the current standard systematic 12 core transrectal ultrasound (TRUS)guided prostate biopsy remains low despite numerous modifications of the technique. This non-randomized experimental study evaluated the accuracy of standard TRUS-guided systematic prostatebiopsy as performed by selected urologists in obtaining samples representative of the peripheral zoneof the prostate, by analyzing virtual biopsies performed on a prostate phantom model. MATERIALS AND METHODS: Thirty (30) urologists (26 consultants and 4 senior residents) were invited toperform two consecutive simulation TRUS guided 12-core biopsies on a phantom prostate model.The task was to hit twelve equal sized spherical targets which would correspond to the lateral andextreme lateral areas of the base, mid gland and apex of the peripheral zone of the phantom prostate,which would represent the usual biopsy technique. Degree of agreement (kappa) was computed.Eight (8) operators had below satisfactory kappa values and were excluded from the succeedinganalysis. Accuracy was calculated by dividing the number of accurately hit targets by the number ofvirtual cores (12). Data were encoded in MS Excel and Stata MP v.14 was used for data analysis. RESULTS: Overall, the mean accuracy was 63.17% and median accuracy was 60% (95% CI: 49.2-65.15)for the 22 operators included in the study. The lateral regions, particularly the midgland (95.8%-100% accuracy) were the most frequently biopsied areas and were often resampled. The targets at theprostatic base were missed by most operators (36.05% accuracy). CONCLUSION Systematic TRUS guided prostate biopsy, in the manner that it is performed, has itsinherent flaws, compounded by limitations in imaging capability and intra-operator variabilityresulting in low accuracy rates. A shift to newer prostate biopsy technique and methodologies withsignificantly higher accuracy rates is recommended.

INTRODUCTION: XELOX is non-inferior to FOLFOX-4 as a first-line treatment for metastatic colorectal cancer. This study compares the costs associated with XEL0X+/-bevacizumab versus FOLFOX4+/-bevacizumab in a non-reimbursed, out of pocket Philippine health care system.
METHODS: This is a cost-minimization analysis using Philippine General Hospital as base case and a typical Filipino patient of 60 kg with BSA 1.66. The outcome data were derived from the N016966 trial. These included the drugs capecitabine, 5-fluorouracil, oxaliplatin, and bevacizumab (BEV); chemotherapy cycles and corresponding hospital admission for each regimen; resources associated with treatment of adverse events such hospital days, ambulatory consultations, concomitant
medication, and central venous line insertion/removal, with costs and charges based on the local setting.
RESULTS: Highest cost (direct and/or indirect) was for FOLFOX4+BEV, followed by XEL0X+BEV, FOLFOX4, and then XELOX. The use of XELOX resulted in a cost saving of PhP 158,642 per patient compared with FOLFOX4. The use of XEL0X+BEV resulted in a cost saving of PhP 186,144 per patient compared with FOLFOX4+BEV.
CONCLUSION: XEL0X+/-BEV is less costly than FOLFOX4-F/-BEV in an out-of-pocket Philippine tertiary hospital setting from the patient's perspective.

Xelox ; Folfox ; Colorectal Neoplasms ; Capecitabine ; Fluorouracil ; Oxaliplatin ; Bevacizumab

Introduction: In order to overcome the stability problems of oils and fats, synthetic antioxidants such as butylated hydroxyanisole (BHA), butylated hydroxytoluene (BHT) and tert-butyl hydroquinone (TBHQ) have widespread use as food additives in many countries. Recent reports reveal that these compounds may be implicated in many health risks, including cancer and carcinogenesis. Hence, there is a move towards the use of natural antioxidants of plant origin to replace these synthetic antioxidants. Methods: In this study, roselle seed oil (RSO) and extract (RSE) were mixed with sunflower oil, respectively to monitor degradation rate and investigate antioxidant activity during accelerated storage. Results: The antioxidant activity was found to stabilise sunflower oil of various samples and in the order of RSE>RSO>tocopherol>sunflower oil. The total percentage increased after 5 days of storage period in free fatty acid (FFA), peroxide value (PV) and anisidine value (AV). Total oxidation value (TOx) of sunflower oil supplemented with 1500 ppm RSE was 33.3%, 47.7%, 14.5%, and 45.5%, respectively. While the total percentage increased under different analysis methods, sunflower oil supplemented with 5% RSO was 17.2%, 60.4%, 36.2% and 59.0% in the order of FFA, PV, AV and TOTOX. Both RSO and RSE were found to be more effective in stabilisation of sunflower oil compared to tocopherol. Total phenolic content of RSE was 46.40 ± 1.51 mg GAE/100g of oil while RSO was 12.51 ± 0.15 mg GAE/100g of oil. Conclusion: The data indicates that roselle seed oil and seed extract are rich in phenolics and antioxidant activities and may be a potential source of natural antioxidants.

Although it is common to have extra-hepatic metastasis of hepatocellular carcinoma (HCC) at the time of presentation, it is extremely rare to have extra-hepatic metastatic HCC without a detectable primary in the liver. We report a unique case in which a patient presented with bilateral large adrenal masses which were subsequently proven to be metastases from HCC. However, there was no tumour seen in the liver on imaging.
Carcinoma, Hepatocellular

INTRODUCTIONIdentifying malignancy either preoperatively or intraoperatively can have a significant impact on the management of salivary gland tumours. We review our experience with fine needle aspiration cytology (FNAC) and frozen section (FS) for salivary gland lesions. We analyse the accuracy of both modalities and their influence on management.

MATERIALS AND METHODSRetrospective review of 114 patients who underwent salivary gland surgery, 91 with intraoperative FS and 68 with preoperative FNAC. Both sets of results were compared against each other and the final histopathological diagnosis.

RESULTSThe accuracy of FS was 92.3%, with a sensitivity and specificity of 62.5% and 100%. Histologic concordance was 92.4% for benign lesions, and 100% for malignant tumours. The accuracy of FNAC was 89.7%, with a sensitivity and specificity of 100%. The non-diagnostic rate was 10.3%. Histologic concordance for FNAC was inferior to that for FS, with only 64.2% of benign lesions and 50% of malignant tumours correctly identified. FNAC did not alter the management of benign disease even when a correct diagnosis was obtained.

CONCLUSIONOur results suggest that FNAC and FS are complementary in usefulness for malignant tumours. However, FNAC does not influence the management of benign lesions and routine FNAC for every patient may not be cost-effective.

Biopsy, Fine-Needle ; standards ; Frozen Sections ; Humans ; Intraoperative Care ; Retrospective Studies ; Salivary Gland Neoplasms ; diagnosis ; pathology ; Salivary Glands ; pathology ; Sensitivity and Specificity ; Specimen Handling

INTRODUCTIONErythroderma is a generalised inflammatory reaction of the skin secondary to a variety of causes. This retrospective study aims to characterise the features of erythroderma and identify the associated causes of this condition in our population.

MATERIALS AND METHODSWe reviewed the clinical, laboratory, histological and other disease-specific investigations of 225 inpatients and outpatients with erythroderma over a 7.5-year period between January 2005 and June 2012.

RESULTSThe most common causative factors were underlying dermatoses (68.9%), idiopathic causes (14.2%), drug reactions (10.7%), and malignancies (4.0%). When drugs and underlying dermatoses were excluded, malignancy-associated cases constituted 19.6% of the cases. Fifty-five percent of malignancies were solid-organ malignancies, which is much higher than those previously reported (0.0% to 25%). Endogenous eczema was the most common dermatoses (69.0%), while traditional medications (20.8%) and anti-tuberculous medications (16.7%) were commonly implicated drugs. In patients with cutaneous T-cell lymphoma (CTCL), skin biopsy was suggestive or diagnostic in all cases. A total of 52.4% of patients with drug-related erythroderma had eosinophilia on skin biopsy. Electrolyte abnormalities and renal impairment were seen in 26.2% and 16.9% of patients respectively. Relapse rate at 1-year was 17.8%, with no associated mortality.

CONCLUSIONOur study highlights the significant proportion of malignancy-related erythroderma in those whom common underlying causes such as dermatoses and drugs have been excluded. In cases of drug-related erythroderma, traditional medications and antituberculous medications are common causes in our population. Renal impairment and electrolyte abnormalities are commonly seen and should be monitored in patients with erythroderma.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Child ; Child, Preschool ; Dermatitis, Exfoliative ; diagnosis ; etiology ; Female ; Humans ; Infant ; Male ; Middle Aged ; Retrospective Studies ; Young Adult