Current treatments for hidradenitis suppurativa (HS) include prolonged courses of antibiotics, retinoids, immunosuppressants, and biologics. Severe cases that are resistant to prolonged medical treatment pose a therapeutic challenge. We propose radical excision and lateral thoracic flap reconstruction as a treatment option for such cases. In our experience with two patients, good aesthetic and functional outcomes were achieved, with a high level of patient satisfaction. The availability of suitable flap coverage allows for wide resection of all of the hair-bearing skin, leading to a low incidence of residual disease and subsequent recurrence. Following excision of the affected tissue, the ideal reconstructive method in the axilla provides suitable coverage without unacceptable donor site morbidity and also avoids axillary contractures. A long lateral thoracic flap with delay has excellent coverage with minimal donor tissue sacrifice. With a suitable flap coverage option, the management paradigm of intractable HS should shift from prolonged medical treatment to allow decisive radical excision, which will improve the quality of life for patients.
Anti-Bacterial Agents ; Axilla ; Biological Agents ; Contracture ; Hidradenitis ; Hidradenitis Suppurativa ; Humans ; Immunosuppressive Agents ; Incidence ; Patient Satisfaction ; Quality of Life ; Recurrence ; Retinoids ; Skin ; Surgical Flaps ; Tissue Donors

INTRODUCTIONParainfluenza type 3 virus (PIV-3) is an important nosocomial pathogen which causes pneumonia and bronchiolitis in infants. We report an outbreak of PIV-3 respiratory infection which occurred in the neonatal unit of KK Hospital in June 2005. This is the second PIV-3 outbreak in our unit after the fi rst in December 1994.

MATERIALS AND METHODSThe clinical characteristics and outcome of 7 infants tested positive for PIV-3 on nasopharyngeal aspirate in June 2005 were reviewed retrospectively.

RESULTSSeven cases were infected with PIV-3 during this outbreak. The median birthweight of affected infants was 970 g (range, 740 to 2585 g), gestational age was 27 weeks and 4 days (range, 24 to 35 weeks), and postnatal age was 84 days (range, 28 to 250 days). Apnoeas and bradycardias were significant symptoms in 3 infants, 5 infants had progressive respiratory distress while the remaining 2 infants had flu-like illness. Five infants required ventilatory support and there were no deaths. The index case was an infant with chronic lung disease who was on oxygen supplementation and subsequently required ventilatory support with nasal CPAP. Despite implementation of control measures to prevent the spread of infection through early identification with strict cohorting of infected cases, contact tracing/screening, and reinforcement of hand hygiene precautions, the outbreak lasted for 24 days.

CONCLUSIONPIV-3 respiratory infection in preterm infants can present with non-specific symptoms, leading to significant morbidity especially in those with underlying pulmonary pathology. Early recognition of symptoms and diagnosis by physicians, and prompt institution of control measures are necessary to prevent the spread of infection.

Continuous Positive Airway Pressure ; Cross Infection ; epidemiology ; therapy ; Disease Outbreaks ; statistics & numerical data ; Female ; Health Status Indicators ; Humans ; Infant ; Infant, Newborn ; Infant, Premature ; Influenza, Human ; epidemiology ; therapy ; Lung Diseases ; epidemiology ; therapy ; Parainfluenza Virus 3, Human ; Respiration, Artificial ; Respirovirus Infections ; epidemiology ; therapy ; Retrospective Studies ; Risk Factors ; Singapore ; epidemiology

INTRODUCTIONHyperuricaemia in tumour lysis syndrome (TLS) can cause acute renal failure (ARF), necessitating dialysis. Recombinant urate oxidase (rasburicase) converts uric acid to soluble allantoin, which is excreted easily.

CASE REPORTAn 8-year-old boy with stage 3 Burkitt's lymphoma, TLS was successfully treated with hyper-hydration, diuretics and rasburicase, without dialysis. This is the first paediatric case in Kandang Kerbau Women's & Children's Hospital (KKH) in which rasburicase was used. We review the literature on the effectiveness of urate oxidase in avoiding dialysis in TLS.

TREATMENT AND OUTCOMEOur patient developed rapidly rising serum uric acid (SUA) and progressive renal impairment. Hyper-hydration and rasburicase (0.2mg/kg) were administered. SUA rapidly decreased from 1308 to 437 mmol/L within 12 hours. Urate oxidase has shown better results than allopurinol. There was a need for dialysis in 0.4% to 1.7% of patients with haematological malignancies given rasburicase, compared to 20% in patients given allopurinol.

CONCLUSIONSRasburicase can reverse renal insufficiency. Though expensive, it may be cost-effective by lowering incidence of dialysis, shortening the duration of intensive care and hospitalisation, allowing early chemotherapy.

Burkitt Lymphoma ; complications ; Child ; Humans ; Hyperuricemia ; drug therapy ; Male ; Renal Dialysis ; Singapore ; Treatment Outcome ; Tumor Lysis Syndrome ; physiopathology ; urine ; Urate Oxidase ; metabolism ; pharmacology ; Uric Acid ; analysis ; blood

INTRODUCTIONMedulloblastoma/primitive neuroectodermal tumour is the most common type of malignant brain tumour in children. Long-term survival rates have improved over the years with a combination of surgical, radiotherapeutic and chemotherapeutic treatment modalities in the developed world. This paper aims to analyse the epidemiology and outcome of medulloblastoma in Singapore and compare our results with those reported in the literature.

MATERIALS AND METHODSA 9-year retrospective study was done using data reported to the Singapore Children's Cancer Registry from June 1997 to June 2005. Only 39 children up to the age of 15 years diagnosed histologically with medulloblastoma or primitive neuroectodermal tumour arising from the cerebellum were included in the study. Follow-up data were collected up to June 2006 and analysed using SPSS v 13.0 software.

RESULTSMedulloblastoma/primitive neuroectodermal tumour was the most common type of brain tumour, accounting for 40.7% of all brain tumours diagnosed in children in Singapore. The 5-year event-free survival rate was 44.5%, while the 5- year overall survival rate was 51.5%. Nearly half (41%) of our patients had spinal metastasis at presentation and this was associated with a worse event-free survival (6.3% vs 71.9%, P = 0). Children under 36 months of age had a significantly poorer overall survival (28.8% vs 52.2%, P = 0.041).

CONCLUSIONSThe outcome of medulloblastoma in Singapore was inferior to reported figures in the literature. We need to close identified gaps in care, like standardising assessment and treatment protocols, in order to improve our results. Research into molecular and genetic characteristics may also throw light on whether the disease is inherently more aggressive in our population.

Adolescent ; Child ; Child, Preschool ; Disease Management ; Female ; Humans ; Infant ; Male ; Medulloblastoma ; epidemiology ; physiopathology ; therapy ; Outcome Assessment (Health Care) ; Registries ; Retrospective Studies ; Singapore ; epidemiology ; Survival Rate

INTRODUCTIONAnorectal malformations (ARMs) and low-lying spinal cord (LLC) are commonly associated owing to their common embryonic origin. LLC may lead to tethered cord syndromes (TCS), requiring surgery. This study aimed to review the incidence of LLC in children with ARMs using ultrasonography (US) and magnetic resonance (MR) imaging, the incidence of TCS and the surgical outcomes of these patients after detethering.

METHODSWe conducted a retrospective study of children who underwent surgery for ARMs in 2002-2009 at KK Women's and Children's Hospital, Singapore.

RESULTSOut of 101 (16.8%) ARM patients, 17 had LLC, of which 12 (70.6%) were high ARMs. 12 of the 17 (70.6%) patients had abnormal US and MR imaging findings. Five (29.4%) had normal US but abnormal MR imaging results; in these five patients, MR imaging was performed due to new symptoms and equivocal US findings. These 17 patients subsequently underwent surgical detethering. Three out of seven patients with TCS improved after surgery. None of the 17 patients had any complications.

CONCLUSIONLLC appeared to be associated with high ARMs, although this was not statistically significant. LLC should be investigated for whenever ARM is diagnosed, regardless of its type. Lumbar US is useful for first-line screening for LLC. Abnormal US or onset of new symptoms should subsequently be investigated with MR imaging. Equivocal US findings are also likely to benefit from further MR imaging. Surgery to detether LLC can improve outcome in TCS, while prophylactic detethering for asymptomatic patients with lipoma of the filum terminale has very low surgical risk.

Anorectal Malformations ; Anus, Imperforate ; epidemiology ; surgery ; Female ; Humans ; Incidence ; Infant ; Lumbar Vertebrae ; Magnetic Resonance Imaging ; Male ; Neural Tube Defects ; diagnosis ; diagnostic imaging ; epidemiology ; surgery ; Neurosurgical Procedures ; adverse effects ; Retrospective Studies ; Sensitivity and Specificity ; Singapore ; epidemiology ; Treatment Outcome ; Ultrasonography

INTRODUCTIONStenotrophomonas maltophilia is an aerobic gram-negative bacillus that is a frequent coloniser of fluids used in the hospital setting. It causes infection in immunosuppressed hosts, especially those who are neutropaenic, on chemotherapy and broad spectrum antibiotics. Skin and soft tissue manifestations of Stenotrophomonas maltophilia infection are becoming an increasingly recognised entity; the clinical spectrum ranges from mucocutaneous, skin to soft tissue infections.

MATERIALS AND METHODSWe present a case of an 8-year-old girl with acute myeloid leukaemia who developed metastatic skin lesions secondary to Stenotrophomonas maltophilia bacteraemia. The authors reviewed a total of 24 reported cases of mucocutaneous, skin and soft tissue infections by Stenotrophomonas maltophilia. The presentations include metastatic cellulitis, primary cellulitis and infected mucocutaneous ulcers.

RESULTSThis is the first locally reported case of metastatic nodular skin lesions caused by Stenotrophomonas maltophilia bacteraemia. This is also the first reported paediatric case of embolic skin lesions caused by Stenotrophomonas maltophilia. Of the 6 cases of Stenotrophomonas maltophilia bacteraemia seen in the paediatric oncology patients from year 2000 to 2004 at our hospital, only 1 case developed metastatic skin lesions.

CONCLUSIONStenotrophomonas maltophilia skin infection should be included into the list of differential diagnoses for metastatic skin lesions in neutropaenic patients, especially with an underlying haematologic malignancy who has received recent chemotherapy and broad spectrum antibiotics. Haematologic malignancy, transplantation, neutropaenic, immunosuppressive therapy and a high severity of illness score were important prognostic factors.

Acute Disease ; Anti-Infective Agents ; therapeutic use ; Bacteremia ; epidemiology ; microbiology ; Cellulitis ; epidemiology ; microbiology ; Child ; Comorbidity ; Female ; Gram-Negative Bacterial Infections ; complications ; Humans ; Leukemia, Myeloid ; epidemiology ; Neutropenia ; epidemiology ; Prognosis ; Skin Diseases, Bacterial ; epidemiology ; Stenotrophomonas maltophilia ; Trimethoprim, Sulfamethoxazole Drug Combination ; therapeutic use

INTRODUCTIONThe development of secondary tumours as a result of radiation therapy is a rare but serious complication.

CLINICAL PICTUREThis is a case report of a 45-year-old Chinese male who developed postirradiation sarcoma of the sphenoid bone in less than 5 years after radiation therapy for Stage T3N1M0 nasopharyngeal carcinoma.

DISCUSSIONIn the literature, the only case of postirradiation osteosarcoma of the sphenoid bone was after radiation therapy for craniopharyngioma. There was no previously reported case of postirradiation sarcoma of the sphenoid bone after radiation therapy for nasopharyngeal carcinoma.

CONCLUSIONThis is the first case of postirradiation malignant fibrous histiocytoma of the sphenoid to be reported. Of about 3000 patients treated with radiotherapy for nasopharyngeal carcinoma over a 10-year period in Singapore, only 1 patient developed postirradiation tumour of the sphenoid bone.

Bone Neoplasms ; etiology ; secondary ; Fatal Outcome ; Histiocytoma, Malignant Fibrous ; etiology ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Nasopharyngeal Neoplasms ; pathology ; radiotherapy ; Neoplasms, Radiation-Induced ; etiology ; Sphenoid Bone ; pathology ; Spinal Neoplasms ; radiotherapy ; secondary