Aged ; Cardiac Catheters ; Combined Modality Therapy ; Coronary Restenosis ; therapy ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Paclitaxel ; administration & dosage ; therapeutic use ; Percutaneous Coronary Intervention ; instrumentation ; Stents ; Treatment Outcome ; Tubulin Modulators ; administration & dosage ; therapeutic use

INTRODUCTIONSince the fi rst imported case on 26 May 2009, pandemic (H1N1) 2009 has spread from travellers and has resulted in sustained community transmission. Singapore began with a strict containment policy where all suspected and confirmed cases of pandemic (H1N1) 2009 were admitted for testing. We describe here the clinical and laboratory characteristics of the fi rst 50 adult cases with confirmed pandemic (H1N1) 2009.

MATERIALS AND METHODSA review was conducted of medical notes of adult patients with confirmed pandemic (H1N1) 2009 by polymerase chain reaction assay from combined nasal and throat swabs admitted to the Communicable Disease Centre, Tan Tock Seng Hospital.

RESULTSFrom 26 May to 18 June 2009, 50 patients with a median age of 27 years old were admitted at a median of 3 days from illness onset. Half were male and all were travellers arriving in Singapore. Non-Singaporean citizens (38%) and other ethnic groups (40%) were over-represented. History of fever was reported in 90% and respiratory symptoms in 92%. Gastrointestinal symptoms were uncommon, present in 4% only. Temperatures on presentation of >or=38.0 degrees C, >or=37.8 degrees C and >or=37.5 degrees C were present in 48%, 56% and 76%, respectively. Only 46% of patients met the United States Centers for Disease Control and Prevention (US CDC) case definition of influenza-like illness (ILI). Clinical and laboratory findings were unremarkable for the majority. All cases were treated with oseltamivir and had uncomplicated recovery.

CONCLUSIONPandemic (H1N1) 2009 had mild clinical and laboratory findings in immunocompetent patients. Use of the US CDC ILI criteria alone would have detected less than half of confirmed cases.

Adult ; Communicable Diseases, Emerging ; epidemiology ; Disease Outbreaks ; Female ; Humans ; Influenza A Virus, H1N1 Subtype ; isolation & purification ; Influenza, Human ; diagnosis ; epidemiology ; Male ; Medical Audit ; Middle Aged ; Polymerase Chain Reaction ; Singapore ; epidemiology ; Young Adult

INTRODUCTIONSeveral randomised controlled trials have demonstrated better outcomes with primary percutaneous coronary intervention (PCI) over fibrinolytic therapy in the treatment of patients with ST-segment elevation myocardial infarction (STEMI) and normal renal function. Whether this benefit extends to patients with impaired renal function is uncertain.

MATERIALS AND METHODSWe studied 1672 patients with STEMI within 12 hours of symptom onset who were admitted to 2 major public hospitals in Singapore from 2000 to 2002. All patients received either upfront fibrinolytic or PCI as determined by the attending cardiologist. Serum creatinine was measured on admission and the glomerular filtration rate (GFR) was determined using the Modification of Diet in Renal Disease equation. The impact of reperfusion strategy on 30-ay mortality was then determined for patients with GFR > or =60 mL min-(1) 1.73 m-(2) and GFR <60 mL min-(1) 1.73 m-(2).

RESULTSThe mean age was 56 +/- 12 years (85% male) and mean GFR was 81 +/- 30 mL min-(1) 1.73 m-(2). Unadjusted 30-day mortality rates for fibrinolytic-treated vs primary PCI-treated patients were 29.4% vs 17.9%, P <0.05, in the impaired renal function group and 5.4% vs 3.1%, P <0.05, in the normal renal function group. After adjusting for covariates, primary PCI was associated with a significantly lower mortality in the normal renal function group [odds ratio (OR), 0.41; 95% confidence interval (CI), 0.19-0.89] but not in the impaired renal function group [OR, 0.70; 95% CI, 0.31-1.60].

CONCLUSIONSPrimary PCI was associated with improved 30-day survival among patients with normal renal function but not among those with impaired renal function. Randomised trials are needed to study the relative efficacy of both reperfusion strategies in patients with impaired renal function.

Adult ; Angioplasty, Balloon, Coronary ; Antifibrinolytic Agents ; therapeutic use ; Electrocardiography ; Female ; Glomerular Filtration Rate ; Humans ; Male ; Middle Aged ; Myocardial Infarction ; complications ; drug therapy ; surgery ; Registries ; Renal Insufficiency, Chronic ; complications ; Retrospective Studies ; Survival Analysis

We analyzed the efficacy and toxicity of a modified Cancer and Leukemia Group B (CALGB) 19802 regimen in adult acute lymphoblastic leukemia (ALL). From February 2002 to August 2005, 25 adults with untreated ALL were enrolled in the study. Compared to the original regimen, the modified CALGB 19802 regimen consisted of a 4-drug induction (cyclophosphamide, daunorubicin, vincristine, and prednisone) instead of a 5-drug induction (L-asparaginase was added to the previous regimen). This was followed by high-dose methotrexate (1,000 mg/m(2)X3 days) and cytarabine (2,000 mg/m(2)X4 days) for the consolidation cycles. High-dose systemic and intrathecal methotrexate was given for central nervous system prophylaxis. Twentythree patients (92%) achieved a complete remission (CR), and two patients (8%) had refractory disease. With a median follow-up of 21.5 months, 10 patients (40%) were alive and continued to be in CR. The 3-yr probability of an event-free survival and the overall survival were 39.0% and 47.4%, respectively. Treatment related mortality and major grade 3 to 4 neurotoxicity occurred in 1 patient and 3 patients, respectively. The modified CALGB 19802 regimen demonstrated a high remission rate and a favorable survival rate.
Adolescent ; Adult ; Aged ; Antineoplastic Combined Chemotherapy Protocols/*therapeutic use ; Cyclophosphamide/*administration & dosage ; Daunorubicin/*administration & dosage ; Disease-Free Survival ; Female ; Humans ; Male ; Middle Aged ; Precursor Cell Lymphoblastic Leukemia-Lymphoma/*drug therapy ; Prednisone/*administration & dosage ; Remission Induction ; Treatment Outcome ; Vincristine/*administration & dosage

Epididymal maturation is associated with the activation of a cAMP-induced tyrosine phosphorylation cascade, which is ultimately associated with the expression of capacitation-dependent sperm functions, such as hyperactivated movement and acrosomal exocytosis. As spermatozoa progress through the epididymis they first acquire the capacity to phosphorylate tyrosine on targets on the principal piece, followed by the midpiece. By the time these cells have reached the cauda epididymidis they can phosphorylate the entire tail from neck to endpiece. This particular pattern of phosphorylation is associated with the ontogeny of fully functional spermatozoa that are capable of fertilizing the oocyte. Proteomic analyses indicate that this change is associated with the phosphorylation of several mitochondrial proteins, creation of a mitochondrial membrane potential and activation of mitochondrial free radical generation. At least in rodent species, activation of sperm mitochondria appears to be a particularly important part of epididymal maturation.
Acrosome Reaction ; Aging ; Animals ; Epididymis ; growth & development ; physiology ; Humans ; Male ; Mammals ; Mice ; Proteome ; Sperm Capacitation ; physiology ; Spermatozoa ; physiology

The association between a multiple myeloma and a secondary solid tumor is not well established. Some reports showed an increased risk of secondary solid neoplasms in multiple myeloma patients, but others have not. Three cases of the synchronous occurrence of multiple myelomas and solid tumors, namely, a small cell carcinoma of the lung, an adenocarcinoma of the colon and a squamous carcinoma of the pyriform sinus were experienced at our hospital. Therefore, herein is reported the clinical courses and treatment results. The stage of multiple myeloma was Durie-Salmon stage I in all of three cases; therefore, the solid tumors were treated as a primary target because the prognosis of early stage multiple myeloma is generally better than that of advanced solid tumor, while a smoldering or stage I myeloma do not need primary therapy until progression of the multiple myeloma. Two patients died of their solid tumors, but one patient is alive.
Adenocarcinoma ; Carcinoma, Small Cell ; Carcinoma, Squamous Cell ; Colon ; Humans ; Lung ; Multiple Myeloma* ; Neoplasms, Multiple Primary ; Neoplasms, Second Primary ; Prognosis ; Pyriform Sinus

Herein, a case of solitary, unilateral renal metastasis in a patient with curatively resected thoracic esophageal carcinoma, who achieved a pathological complete remission after neoadjuvant concurrent chemoradiotherapy, is reported. The kidney is the 4th or 5th most common visceral metastasis site of a primary esophageal carcinoma. More than 50% of renal metastases typically show bilateral involvement. Solitary, unilateral renal metastasis is extremely rare. Renal metastases from a primary esophageal carcinoma are usually latent and its diagnosis is very unusual in a live patient. The solitary renal metastasis in this case was not accompanied by metastases to other sites. The value of a nephrectomy in solitary renal metastasis of esophageal cancer is not known due to the rarity of such cases. A nephrectomy could be justified in limited situations, such as with uncertainty of histological diagnosis, severe life-threatening hematuria, which cannot be controlled by embolization, or solitary renal metastasis with a long disease-free interval.
Carcinoma, Squamous Cell* ; Chemoradiotherapy ; Diagnosis ; Esophageal Neoplasms ; Hematuria ; Humans ; Kidney ; Neoplasm Metastasis ; Nephrectomy ; Uncertainty

BACKGROUND: The significant improvement in the treatment of adults with acute myeloid leukemia (AML) has been achieved in recent years. However, many patients still fail to achieve a complete remission and long term survival because of either toxic death during aplasia periods of induction chemotherapy or resistance to induction chemotherapy. The P-glycoprotein (Pgp) associated with Multidrug Resisitance (MDR) gene is the best characterized mechanism of resistance to induction chemotherapy. In this study, the authors effort to examine the functional activity of Pgp using the rhodamine123 functional efflux assay and discuss for the predictive value of MDR functional assay for treatment outcomes of AML. METHODS: Between January 1996 and June 2003, 45 patients with AML were enrolled in this study. For evaluation of functional MDR activity using the rhodamine123 functional efflux assay, mononuclear cells isolated from bone marrow aspirates of 45 patients were used. All patients were received induction chemotherapy and consolidation therapy with high dose chemotherapy or stem cell transplantation. RESULTS: Among the 45 AML patients, 30 (66.7%) patients showed positive functional MDR activity and 15 (33.3%) patients negative functional MDR activity. Complete remission rate was lower in the group with positive functional MDR activity than negative, but no statistical significance was observed (P=0.453). Survival time in both groups was investigated. Leukemia free survival was 40.9 months in negative group and 18.7 months in positive group (P=0.336). Overall survival was 48.5 months and 26.6 months respectively (P=0.513). CONCLUSION: The functional MDR activity using the rhodamine123 functional efflux assay does not significantly affect induction rate and survival rate of AML patients.
Adult ; Bone Marrow ; Drug Resistance, Multiple* ; Drug Therapy ; Humans ; Induction Chemotherapy ; Leukemia ; Leukemia, Myeloid, Acute* ; P-Glycoprotein ; Remission Induction* ; Stem Cell Transplantation ; Survival Rate

Metastasis of breast cancer to the stomach is relatively uncommon and typically occurs in patients with disseminated diseases. This may cause difficulty in differentiating it from primary gastric carcinoma. The correct diagnosis of the primary source is important, since the treatment and prognosis of metastatic breast cancer is quite different from those of metastatic gastric cancer. Immunohistochemical staining with GCDFP-15 (gross cystic disease fluid protein-15) can be used to differentiate primary gastric carcinoma and gastric metastasis from breast cancer. We report two cases of gastric metastasis of breast cancer by describing their clinical course, illustrating the histologic findings, and showing the results of immunohistochemical staining with GCDFP-15.
Breast Neoplasms* ; Breast* ; Diagnosis* ; Humans ; Neoplasm Metastasis* ; Prognosis ; Stomach ; Stomach Neoplasms

We studied the nonenzymatic glycosylation of lens epithelial basement membranes (LEBM) of senile cataractous lenses of both diabetic and nondiabetic patients. The human LEBMs were isolated from surgically removed senile cataracts and purified by osmotic lysis and detergent treatments. Glycosylation assay of LEBMs was done using the colorimetric method of Fluckiger and Winterhalter. The glycosylation value ranged from 16.39 to 92.56 n mol/mg protein overall, with a mean of 63.54 +/- 24.56 n mol/mg protein for the diabetic specimens and a mean of 29.97 +/- 14.48 n mol/mg protein for the nondiabetic controls (P = 0.009). The study confirms our previous observation of in vivo glycosylation of the LEBM and further establishes that diabetic patients have a twofold increase in the amount of LEBM glycosylation when compared to their nondiabetic counterparts.
Aged ; Basement Membrane/metabolism ; Cataract/metabolism ; Diabetes Mellitus, Type 2/*metabolism ; Epithelium/metabolism ; Female ; Glucose/metabolism ; Glycosylation ; Humans ; Lens, Crystalline/*metabolism ; Male