BACKGROUND: Melanoma is a malignant tumor ranked as the top cause of skin cancer death and is increasing in incidence in most races. Rarity and atypical presentation in Non-Caucasians lead to delayed diagnosis and poor survival rates in these populations. This is the first study in the Philippines to document and describe both clinical and histopathologic profile of melanoma in Filipinos. Data gathered and analyzed may be used as basis for future research on prevention and treatment of this deadly disease among Filipinos.
OBJECTIVE: To determine the epidemiology, clinical and histopathologic characteristics of melanoma patients in the Philippine General Hospital.
METHODS: Melanoma patient records and biopsies from the Department of Laboratories-Pathology Services and Section of Dermatology- Dermatopathology Unit of the Philippine General Hospital from 2004 to 2009 were reviewed.
RESULTS: Fifty-eight melanoma cases were identified. Based on the medical records retrieved, 35% were males and 23% females, while 42% had missing information. Most were in the fifth decade with a mean age of 52.8 years. The most common sites were the feet and trunk. Seven patients had recorded metastasis. The most common histopathologic characteristics noted was presence of angiolymphoid spread (70%), followed by presence of tumor-infiltrating lymphocytes (42%), ulceration (37%), high mitotic rate (35%), neurotropism (14%) and co-existing nevus (2%). Vertical growth phase was seen in 49% while 16% had a radial growth phase.
CONCLUSION: Melanoma has a lower prevalence rate in the population studied, but most presented with clinical and histopathologic features consistent with advanced stages.

Human ; Male ; Female ; Aged 80 And Over ; Aged ; Middle Aged ; Adult ; Dermatology ; Lymphocytes, Tumor-infiltrating ; Melanoma ; Nevus ; Nevus, Pigmented ; Prevalence ; Skin Neoplasms

INTRODUCTION: Post-anaesthesia care unit (PACU) delirium is a potentially preventable condition that results in a significant long-term effect. In a multicentre prospective cohort study, we investigate the incidence and risk factors of postoperative delirium in elderly patients undergoing major non-cardiac surgery. METHODS: Patients were consented and recruited from 4 major hospitals in Singapore. Research ethics approval was obtained. Patients older than 65 years undergoing non-cardiac surgery >2 hours were recruited. Baseline perioperative data were collected. Preoperative baseline cognition was obtained. Patients were assessed in the post-anaesthesia care unit for delirium 30-60 minutes after arrival using the Nursing Delirium Screening Scale (Nu-DESC). RESULTS Ninety-eight patients completed the study. Eleven patients (11.2%) had postoperative delirium. Patients who had PACU delirium were older (74.6±3.2 versus 70.6±4.4 years, P=0.005). Univariate analysis showed those who had PACU delirium are more likely to be ASA 3 (63.6% vs 31.0%, P=0.019), had estimated glomerular filtration rate (eGFR) of >60mL/min/1.73m2 (36.4% vs 10.6%, P=0.013), higher HbA1C value (7.8±1.2 vs 6.6±0.9, P=0.011), raised random blood glucose (10.0±5.0mmol/L vs 6.5±2.4mmol/L, P=0.0066), and moderate-severe depression (18.2% vs 1.1%, P=0.033). They are more likely to stay longer in hospital (median 8 days [range 4-18] vs 4 days [range 2-8], P=0.049). Raised random blood glucose is independently associated with increased PACU delirium on multivariate analysis.
Aged ; Anesthesia ; Anesthesia Recovery Period ; Delirium/etiology* ; Humans ; Incidence ; Postoperative Complications/etiology* ; Prospective Studies ; Risk Factors

INTRODUCTION: Post-anaesthesia care unit (PACU) delirium affects 5%-45% of patients after surgery and is associated with postoperative delirium and increased mortality. Up to 40% of PACU delirium is preventable, but it remains under-recognised due to a lack of awareness of its diagnosis. The nursing delirium screening scale (Nu-DESC) has been validated for diagnosing PACU delirium, but is not routinely used locally. This study aimed to use Nu-DESC to establish the incidence and risk factors of PACU delirium in patients undergoing non-cardiac surgery in the surgical population. METHODS: We conducted an audit of eligible patients undergoing major surgery in three public hospitals in Singapore over 1 week. Patients were assessed for delirium 30-60 min following their arrival in PACU using Nu-DESC, with a total score of ≥2 indicative of delirium. RESULTS: A total of 478 patients were assessed. The overall incidence rate of PACU delirium was 18/478 (3.8%), and the incidence was 9/146 (6.2%) in patients aged > 65 years. Post-anaesthesia care unit delirium was more common in females, patients with malignancy and those who underwent longer operations. Logistic regression analysis showed that the use of bispectral index (P < 0.001) and the presence of malignancy (P < 0.001) were significantly associated with a higher incidence of PACU delirium. CONCLUSION In this first local study, the incidence of PACU delirium was 3.8%, increasing to 6.2% in those aged > 65 years. Understanding these risk factors will form the basis for which protocols can be established to optimise resource management and prevent long-term morbidities and mortality in PACU delirium.
Female ; Humans ; Delirium/epidemiology* ; Postoperative Complications/etiology* ; Singapore/epidemiology* ; Prospective Studies ; Anesthesia/adverse effects* ; Risk Factors ; Neoplasms