Adolescent ; Adult ; Anticoagulants ; therapeutic use ; Aortic Valve Stenosis ; congenital ; surgery ; Dengue ; complications ; Heart Valve Prosthesis ; Humans ; Male ; Thrombocytopenia ; etiology ; Warfarin ; therapeutic use

PURPOSE: Progressive shortening of telomeres, specialized chromosomal structures that have a function in chromosomal protection, positioning and replication, has been linked to cell senescence and aging. Telomeres are usually replicated by telomerase, the activation of which is essential for cells to overcome cellular senescence; and thus, indefinite proliferation/immortality and malignant progression are associated with telomere activity. However, little is known about the telomerase activity in adenomatous polyp and colorectal cancer. METHODS: To determine whether malignant progression depends on the activation of telomerase or not, we analyzed the telomerase activity in the mucosa of normal colon, adenomatous polyp and colorectal cancer by telomeric repeat amplification protocol (TRAP) assay and enzyme-linked immunosorbent assay (ELISA). RESULTS: Except for one case in which there was severe inflammation, telomerase activity was not detected in any case of histologically normal colonic mucosa. In contrast, enzyme activity was detected in 58.3% (7/12), 75% (15/20) of adenomatous polyps and colorectal carcinomas, respectively. Of these cases of adernomatous polyps, telomerase activity was positive in 40% (2/5) of tubular type, 66.7% (4/6) of villotubular type and 100% (1/1) of villous type; however, the difference in telomerase activity between tubular and villotubular types was not significant. Of these 20 cases of carcinomas, telomerase activity was positive in 100% (2/2) of well differentiated, 71.4% (10/14) of moderately differentiated and 75% (3/4) of poorly differentiated histologies. Taking into consideration the Dukes' classification, there was no significant difference in telomerase activity among stages A, B and C, except for D. CONCLUSION: These results indicate that telomerase activation in colorectal cancer may well correlate with malignant progression. The detection of telomerase activity may serve as a useful auxiliary tool for the diagnosis of colorectal cancer; nevertheless, the histological type of adenomatouspolyps, the histological differentiation and the stage of cancer may not correlate with telomerase activity.
Adenomatous Polyps* ; Aging ; Cell Aging ; Classification ; Colon ; Colonic Neoplasms* ; Colorectal Neoplasms ; Diagnosis ; Enzyme-Linked Immunosorbent Assay ; Inflammation ; Mucous Membrane* ; Polyps ; Telomerase* ; Telomere

BACKGROUND: The diagnosis of aortitis is often delayed as symptoms are largely non-specific. We report a case of Staphylococcal thoracic aortitis in a 73-year-old Chinese woman complicated by aortic dissection. METHODS: The patient presented with pyrexia of unknown origin, and a contrast enhanced computed tomography aortogram revealed a large thrombus at the anterior aspect of the ascending aorta with two large ulcerations as a result of a chronic type A aortic dissection. A hemiarch replacement with a 28 mm Gleweave Vascutek graft was performed with resuspension of aortic valve commisures. Aortic thrombus cultures were positive for coagulase negative Staphylococcus aureaus, and histology showed chronic dissection of the aorta. RESULTS: The patient was treated with intravenous cefazolin for a 6-week duration and made good progress. CONCLUSIONS: This case highlights Staphylococcal infective aortitis complicated by dissection presenting as fever of unknown origin. Timely diagnosis is essential as progression to catastrophic rupture may occur.

Atrial Fibrillation/surgery* ; Catheter Ablation/adverse effects* ; Heart Septal Defects, Atrial/surgery* ; Humans ; Iatrogenic Disease ; Treatment Outcome

Transcatheter aortic valve implantation (TAVI) has become the standard of care for inoperable patients with symptomatic severe aortic stenosis (AS), and an alternative to open aortic valve replacement for patients at high surgical risk. TAVI has also been performed in several groups of patients with off-label indications such as severe bicuspid AS, and as a valve-in-valve therapy for a degenerated surgical bioprosthesis. Although TAVI with CoreValve® prosthesis is technically challenging, and global experience in the procedure is limited, the procedure could be a treatment option for well-selected patients with severe pure aortic regurgitation (AR). Herein, we report Asia's first case of TAVI for severe pure AR in a patient who was at extreme surgical risk, with good clinical outcome at six months.
Adult ; Aortic Valve ; surgery ; Aortic Valve Insufficiency ; surgery ; Aortic Valve Stenosis ; surgery ; Asia ; Echocardiography ; Endocarditis ; complications ; therapy ; Fluoroscopy ; Heart Valve Prosthesis ; Hemodynamics ; Humans ; Male ; Prosthesis Design ; Prosthesis Implantation ; methods ; Treatment Outcome

INTRODUCTIONFebrile neutropenia (FN) remains a major cause of morbidity and mortality in Oncology/Haematology units. We launched a new protocol for FN management that incorporates risk stratification at our institute from October 2008. An audit was performed concurrently to evaluate the protocol and to define the epidemiology of FN locally.

MATERIALS AND METHODSCase records of all inpatients with FN between October 2008 and June 2009 were reviewed prospectively. Clinical and microbiological characteristics were collated along with outcomes and programme adherence. Statistical testing was performed using Stata 10.1.

RESULTSThere were 178 FN episodes (50 in patients with solid cancers) from 131 patients. Forty-two (23.6%) episodes were classified as high-risk according to MASCC criteria. Initial blood cultures were positive in 49 (27.5%) episodes, of which gram-negative bacilli (GNB) predominated. Overall compliance to the protocol was 56.7%, with the main issue being disinclination to use oral antibiotics as fi rst-line empirical therapy for low-risk episodes. Overall mortality was 7.3% and infection-related mortality was 4.5%. High-risk FN and the presence of central venous catheters were independently associated with bacteraemia on multivariate analysis, but there were no independent predictors of infection-related mortality.

CONCLUSIONSGNB accounted for the majority of bloodstream infections at our institute, unlike data from developed countries. Uptake of the new FN protocol was satisfactory, although the use of oral antibiotics as fi rst-line empirical therapy can be improved. A better method for predicting infections caused by antibiotic-resistant GNB is urgently required, and antibiotic resistance trends should be monitored to enable the implementation of more appropriate antibiotic regimens over time.

Adult ; Aged ; Aged, 80 and over ; Drug Resistance, Microbial ; Female ; Fever ; drug therapy ; physiopathology ; Gram-Negative Bacteria ; Hospitals, University ; Humans ; Male ; Medical Audit ; Middle Aged ; Neutropenia ; drug therapy ; physiopathology ; Outcome Assessment (Health Care) ; Prospective Studies ; Severity of Illness Index ; Singapore ; Young Adult

Pericarditis and myocarditis are characterised by electrocardiographic changes and elevated cardiac enzymes, respectively, and patients with perimyocarditis often complain of chest discomfort. These findings are nonspecific and often lead to diagnostic difficulties, as ST-elevation myocardial infarction commonly presents in a similar fashion. Clinical differentiation between perimyocarditis and myocardial infarction are especially important because adverse side effects can occur if reperfusion therapy is administered for a patient with acute pericarditis or if a diagnosis of acute myocardial infarction is missed. We herein describe a case of perimyocarditis with ST elevation and raised cardiac markers, which led to two emergency coronary angiographies that were subsequently found to be normal. We include the three serial electrocardiographies (ECGs) performed to show the characteristic features of perimyocarditis and further discuss the importance of identifying typical and atypical ECG features of pericarditis.
Acute Disease ; Aged ; Biopsy ; Blood Pressure ; Coronary Angiography ; Electrocardiography ; Female ; Humans ; Myocardial Infarction ; pathology ; Myocarditis ; diagnosis ; physiopathology

OBJECTIVE: To predict the probability of lymphedema development in breast cancer patients in the early post-operation stage, we investigated the ability of quantitative lymphoscintigraphic assessment. METHODS: This retrospective study included 201 patients without lymphedema after unilateral breast cancer surgery. Lymphoscintigraphy was performed between 4 and 8 weeks after surgery to evaluate the lymphatic system in the early postoperative stage. Quantitative lymphoscintigraphy was performed using four methods: ratio of radiopharmaceutical clearance rate of the affected to normal hand; ratio of radioactivity of the affected to normal hand; ratio of radiopharmaceutical uptake rate of the affected to normal axilla (RUA); and ratio of radioactivity of the affected to normal axilla (RRA). During a 1-year follow-up, patients with a circumferential interlimb difference of 2 cm at any measurement location and a 200-mL interlimb volume difference were diagnosed with lymphedema. We investigated the difference in quantitative lymphoscintigraphic assessment between the non-lymphedema and lymphedema groups. RESULTS: Quantitative lymphoscintigraphic assessment revealed that the RUA and RRA were significantly lower in the lymphedema group than in the non-lymphedema group. After adjusting the model for all significant variables (body mass index, N-stage, T-stage, type of surgery, and type of lymph node surgery), RRA was associated with lymphedema (odds ratio=0.14; 95% confidence interval, 0.04–0.46; p=0.001). CONCLUSION: In patients in the early postoperative stage after unilateral breast cancer surgery, quantitative lymphoscintigraphic assessment can be used to predict the probability of developing lymphedema.
Axilla ; Breast Neoplasms* ; Breast* ; Clinical Study* ; Follow-Up Studies ; Hand ; Humans ; Lymph Nodes ; Lymphatic System ; Lymphedema* ; Lymphoscintigraphy* ; Radioactivity ; Retrospective Studies* ; Unilateral Breast Neoplasms