Successful split-thickness skin grafting in a contaminated wound with an enterocutaneous fistula.
Explore the source record for details and available documents.
Abdominal Injuries↗
Biomedical subjects
J Lim
Publications and source records attributed to J Lim.
Prognostic value of activated Akt expression in oral squamous cell carcinoma.
BACKGROUND: Akt is a serine/threonine kinase that plays an important role in tumorigenesis and influences prognosis in several cancers. However, its importance in oral squamous cell carcinomas (OSCC) has not been elucidated. AIM: To investigate the association between the expression of activated Akt, clinicopathological factors, and E-cadherin, PCNA (proliferating cell nuclear antigen), and VEGF (vascular endothelial growth factor) expression to verify the validity of Akt as a prognostic factor in OSCC. METHODS: Phosphorylated Akt (p-Akt), E-cadherin, PCNA, and VEGF expression were assessed immunohistochemically in 84 OSCCs. The results were analysed in relation to clinicopathological factors. RESULTS: p-Akt was expressed in 29 cases. It was significantly correlated with lymph node metastasis, TNM stage, and E-cadherin expression. Univariate analysis showed that p-Akt expression, E-cadherin expression, PCNA expression, differentiation, tumour size, lymph node metastasis, TNM stage, and recurrence correlated with prognosis. Multivariate analysis showed that p-Akt expression is an independent prognostic factor in patients with OSCC. CONCLUSIONS: This study revealed that Akt activation is a significant prognostic indicator for OSCC and is correlated with E-cadherin expression. The inhibition of Akt is a possible molecular approach to the treatment of OSCC.
Adult↗
Use of physical restraints in nursing homes: current practice in Singapore.
INTRODUCTION: One of the indicators of quality care in nursing homes is the proper use of physical restraints. Restraints have been associated with multiple complications, such as pressure ulcers, incontinence and immobility. The aim of our study was to assess the indication, use and complications related to physical restraints in Singapore nursing homes. MATERIALS AND METHODS: All residents aged >65 years old from 3 nursing homes were included in the study. A geriatrician reviewed the medical records of all elderly residents on restraints. Nursing staff interviews were also done to assess their knowledge regarding restraint use. A brief medical record review was also done for the elderly residents without restraints. RESULTS: Out of 390 elderly residents, 91 were on physical restraints. The mean age of these residents were 80.1 years; 67% were female, 90.1% were Chinese and 82.4% belonged to functional category IV. Both urinary and faecal incontinence were observed in 97.8% of residents. Forty-six (50.5%) residents had no documented indication for restraints. It was noted that 20 (22%) residents were restrained to prevent dislodgement of the feeding tube, 17 (18.7%) were restrained to prevent falls and 8 (8.8%) were restrained for agitation. There were documented trials of removal of restraints for only 21 (23.1%) residents. Alternative approaches, such as diversion technique, were used for 31 (34.1%) residents to avoid restraint use. CONCLUSION: Our study revealed a high rate of restraint use in the nursing homes. A restraint protocol should be available in every nursing home, requiring physician approval for the long-term application of physical restraints and intermittent reviews by physicians to assess the continued need for restraints.
Aged↗
Role of nasogastric tube in preventing aspiration pneumonia in patients with dysphagia.
INTRODUCTION: Every year, a large number of patients with dysphagia are placed on feeding tubes to prevent aspiration pneumonia. This prospective study was planned to compare the incidence of aspiration pneumonia and death in patients with dysphagia who were either fed orally or through a nasogastric tube. METHODS: All patients aged 65 years or older, at the point of discharge from the geriatric medicine ward of a hospital, were recruited over a six-month period with a two-month follow-up. Patients diagnosed with dysphagia by the speech therapist were recommended to have either oral feeding with modified diet or nasogastric tube feeding. The incidence of aspiration pneumonia and death among patients on oral feeding, nasogastric tube feeding and patients who refused nasogastric tube feeding were compared. RESULTS: A total of 122 patients completed the study. The rate of aspiration pneumonia and death were, respectively, 31.2 percent in nasogastric tube-fed patients and 10.3 percent in orally-fed patients (Fisher's exact test, p-value equals 0.007). Multivariate analysis showed that the mode of feeding predicted outcome (p-value equals 0.03). The rate of aspiration pneumonia and death were 31.2 percent in nasogastric tube-fed patients and 11.5 percent in those who refused nasogastric tube feeding (Fisher's exact test, p-value equals 0.064). Nasogastric tube-fed patients were more cognitively- and functionally-impaired compared to those on oral feeding. CONCLUSION: In our study, patients on nasogastric tube feeding did not have a better outcome against aspiration pneumonia and mortality when compared to those who were on oral feeding. The poorer outcome of nasogastric tube-fed patients could be attributed to their worse cognitive and functional statuses. Larger studies are needed to refute or confirm the usefulness of nasogastric tube in elderly patients with dysphagia.
Aged↗
Oral appliances for obstructive sleep apnoea.
BACKGROUND: Obstructive sleep apnoea-hypopnoea is a syndrome characterised by recurrent episodes of partial or complete upper airway obstruction during sleep that are usually terminated by an arousal. Nasal continuous positive airway pressure is the primary treatment for obstructive sleep apnoea-hypopnoea, but many patients are unable or unwilling to comply with this treatment. Oral appliances are an alternative treatment for sleep apnoea. OBJECTIVES: The objective was to review the effects of oral appliance in the treatment of sleep apnoea in adults. SEARCH STRATEGY: We searched the Cochrane Airways Group Sleep Apnoea RCT Register. Searches were current as of June 2004. Reference lists of articles were also searched. SELECTION CRITERIA: Randomised trials comparing oral appliance with control or other treatments in adults with sleep apnoea. DATA COLLECTION AND ANALYSIS: Trial quality was assessed and two reviewers extracted data independently. Study authors were contacted for missing information. MAIN RESULTS: Thirteen trials involving 553 participants were included. All the studies had some shortcomings, such as small sample size, under-reporting of methods and data, and lack of blinding. Oral appliances versus control appliances (five studies): Oral appliances reduced daytime sleepiness in two crossover trials (WMD -1.81 [95%CI: -2.72, -0.90]), and improved apnoea-hypopnoea index (AHI) (-13.17 [-18.53 to -7.80] parallel group data - four studies). Oral appliances versus CPAP (seven studies): Oral appliances were less effective than continuous positive pressure in reducing apnoea-hypopnoea index (WMD 13 [95% CI: 7.63, 18.36], parallel studies - two trials; WMD 6.96 [4.82, 9.10] cross-over studies - six trials). However, no significant difference was observed on symptom scores. Nasal continuous positive pressure was more effective at improving minimum arterial oxygen saturation during sleep compared with oral appliance. In two small crossover studies, participants preferred oral appliance therapy to continuous positive airways pressure. Oral appliances versus surgery (one study): Symptoms of daytime sleepiness were initially lower with surgery, but this difference disappeared at 12 months. AHI did not differ significantly initially, but did so after 12 months in favour of OA. REVIEWERS' CONCLUSIONS: There is some evidence suggesting that oral appliance improves subjective sleepiness and sleep disordered breathing compared with a control. Nasal continuous positive airways pressure appears to be more effective in improving sleep disordered breathing than oral appliance. Until there is more definitive evidence on the effectiveness of oral appliances, it would appear to be appropriate to restrict oral appliance therapy to patients with sleep apnoea who are unwilling or unable to comply with continuous positive airways pressure therapy.
Adult↗
Changes in the local morphology of the rectus abdominis muscle following the DIEP flap: an ultrasonographic study.
This study was undertaken to assess the changes in the local morphology of the rectus abdominis muscle following intramuscular dissection of the deep inferior epigastric artery perforators after harvesting of the deep inferior epigastric perforator (DIEP) flap. While the DIEP provides the well-known advantage of use of the lower abdominal tissue with preservation of the integrity of the abdominal wall musculature, postoperative problems such as abdominal asymmetry, bulges and reduced flexion capacity have been found. These changes may be due to rectus abdominis muscle damage from ischemia or denervation. We used ultrasonography to assess the changes in rectus abdominis muscle thickness and contractility, preoperatively, 1-month and 1-year postoperatively. The study group consisted of 17 rectus abdominis muscles in 14 patients subjected to intramuscular dissection of perforators. The control group consisted of 11 intact rectus abdominis muscles in 11 patients who had undergone unilateral DIEP flap elevation, the dissected muscles being part of the study group. We found that the resting muscle thickness in the study group was, significantly increased at 1-month postoperatively, resolving by 1-year follow-up. As these changes were not seen in the control group, the increased muscle thickness is attributed to postoperative oedema that resolves with time. All muscles in the study and control groups retained contractility showing no evidence of muscle denervation. Our date demonstrates that intramuscular dissection of perforator vessels in the DIEP flap leads to minimal changes in the local morphology and contractility of the rectus abdominis muscle.
Adult↗
Effect of posaconazole on cytochrome P450 enzymes: a randomized, open-label, two-way crossover study.
Posaconazole is an antifungal with a wide-spectrum of activity against common and emerging fungal pathogens. In this randomised, open-label, two-way crossover study, the potential for drug interactions with posaconazole via the cytochrome P450 (CYP450) enzyme pathway was evaluated. Thirteen subjects received posaconazole tablets (2 x 100 mg) once daily for 10 days or no treatment; following a 14-day washout period, subjects were crossed over to the alternate treatment. The inhibition spectra of posaconazole were examined using a cocktail of the following probe substrates: caffeine (CYP1A2), tolbutamide (CYP2C8/9), dextromethorphan (CYP2D6 and total CYP3A4), chlorzoxazone (CYP2E1), and midazolam (hepatic CYP3A4). Except for midazolam, which was intravenously infused on Day 10, the cocktail probes were administered simultaneously on Day 9 during both treatment periods. Blood and urine samples were collected at specified times to quantitate probe substrates and/or metabolites. Based on insignificant differences in mean probe ratios, posaconazole did not inhibit CYP1A2, 2C8/9, 2D6, or 2E1. However, the midazolam AUC((tf)) was higher in the posaconazole than no-treatment group (93.4 n gh/ml versus 51.4 ng h/ml, P<0.01), indicating inhibition of hepatic CYP3A4. Drug interactions mediated by various CYP450 are common with the currently available triazole antifungals, however these results suggest that posaconazole may have an improved and more narrow drug interaction profile (CYP3A4 only) compared with other triazoles.
Adult↗
The effect of celecoxib on intrathecal morphine-induced pruritus in patients undergoing Caesarean section.
Pruritus associated with intrathecal opioid administration is particularly common in pregnancy. Nonsteroidal anti-inflammatory drugs (NSAIDs) can reduce the severity of this pruritus but have undesirable side effects. The recent development of drugs that can specifically inhibit the cyclooxygenase 2 isoenzyme have become an attractive alternative. This study was designed to evaluate the efficacy of such a drug (celecoxib) in reducing intrathecal opioid-induced pruritus in a randomised double-blinded study of 60 women undergoing Caesarean section. All of them received spinal anaesthesia with 3 ml of 0.5% hyperbaric bupivacaine and 0.3 mg preservative-free morphine. After delivery of the baby, they received either oral celecoxib 200 mg or placebo. Visual analogue scores for pain and pruritus were measured at 30 min, 2, 4, 8, and 24 h. There was no difference in the severity and onset of pain and pruritus between the two groups. Timing of administration, inadequate dosing and possible altered pharmacokinetics in pregnancy may explain the lack of efficacy.
Adult↗
Histological effects of tazarotene 0.1% cream vs. vehicle on photodamaged skin: a 6-month, multicentre, double-blind, randomized, vehicle-controlled study in patients with photodamaged facial skin.
BACKGROUND: Topical tazarotene has been shown to offer efficacy in ameliorating multiple effects of photodamage. OBJECTIVES: To evaluate the histological effects of tazarotene cream on photodamaged skin. METHODS: In this multicentre, double-blind, randomized, vehicle-controlled study, 50 patients with photodamaged facial skin (at least mild fine wrinkling and mottled hyperpigmentation, with at least one of these being moderate) were randomized to apply tazarotene 0.1% cream or vehicle cream to their face, once daily for 24 weeks. RESULTS: Blinded assessments showed that tazarotene was less likely than vehicle to be associated with an increase in keratinocytic and melanocytic atypia, and more likely than vehicle to be associated with a reduction in atypia. Between-group comparisons in distribution of change from baseline categories of severity were in favour of tazarotene (P = 0.055 for keratinocytic atypia, P = 0.034 for melanocytic atypia, and P < 0.001 for the number of granular cell layers). Compared with vehicle, tazarotene was associated with an increase in epidermal polarity (P = 0.008) and epidermal thickness (P = 0.012), and a tendency for stratum corneum compaction. Tazarotene was also associated with widened intercellular spaces (reported as epidermal oedema) relative to vehicle (P < 0.001). CONCLUSIONS: Treatment of photodamaged skin with tazarotene is associated with an amelioration of keratinocytic and melanocytic atypia, an improvement in epidermal polarity, and an increase in epidermal thickness.
Adult↗
An unusual case of "giant cell arteritis".
Explore the source record for details and available documents.
Diagnosis, Differential↗
Bone marrow fat and bone mineral density on proton MR spectroscopy and dual-energy X-ray absorptiometry: their ratio as a new indicator of bone weakening.
OBJECTIVE: Bone weakening can be affected by agents other than bone mineral density (BMD). Increased bone marrow fat may have a direct link to bone loss. This pilot study analyzes the relationship between bone marrow fat and BMD in subjects with normal and structurally weakened vertebrae. SUBJECTS AND METHODS: Twenty-six subjects underwent both dual-energy X-ray absorptiometry and proton MR spectroscopy of 71 lumbar vertebrae. Fifteen subjects had normal-appearing vertebrae on MRI, and 11 had signs of bone weakening. RESULTS: We found that high bone marrow fat did not consistently equate with low BMD. Bone marrow fat can indicate bone weakening nearly as well as BMD, but neither parameter alone is suitable to be used independently as an indicator. The bone marrow fat/BMD ratio showed significant diagnostic power to detect bone weakening, even in this relatively small subject sample. CONCLUSION: An inverse relationship between bone marrow fat and BMD could not be confirmed. Bone marrow fat can be used to diagnose reduced bone strength nearly as well as BMD. The bone marrow fat/BMD ratio is a significant diagnostic indicator of bone weakening.
Absorptiometry, Photon↗
The superior gluteal artery perforator flap for the closure of sacral sores.
The purpose of this paper is to report the use of the superior gluteal artery perforator (SGAP) flap in the closure of sacral pressure sores here in Singapore. This fasciocutaneous flap is a refinement of the musculocutaneous flap which is popularly used for the closure of sacral sores. There were minimal complications. This is a reliable flap and gives the option of further reconstructive possibilities should a recurrence occur.
Adult↗
Progression of scoliosis after spinal fusion in Duchenne's muscular dystrophy.
A consecutive series of 85 patients with Duchenne's muscular dystrophy who underwent spinal fusion over a period of 16 years was followed up with regard to the progression of the scoliosis and pelvic obliquity. Of 74 patients with adequate radiographic follow-up, 55 were instrumented with the Luque single-unit rod system and 19 with the Isola pedicle screw system; seven were instrumented to L3/4, 42 to L5, 15 to S1 and 10 to the pelvis with intrailiac rods. The mean period of follow-up was 49 months (SD 22) before and 47 months (SD 24) after operation. There was one peri-operative death and three cases of failure of hardware. The mean improvement in the Cobb angle was 26 degrees and in pelvic obliquity, 9.2 degrees. Fusion to L3/4 achieved a poorer correction of both curves while intrapelvic rods, achieved and maintained the best correction of pelvic obliquity. Fusion to S1 did not provide any benefit over more proximal fusion excluding the sacrum, with regard to correction and maintenance of both angles. The Isola system appeared to provide and maintain a slightly better correction of the Cobb angle.
Adolescent↗
A case of ductal carcinoma in situ of breast with Poland syndrome.
INTRODUCTION: A 51-year-old woman was diagnosed with a rare case of multi-focal ductal carcinoma in situ (DCIS) of the breast associated with Poland syndrome. CLINICAL PICTURE: Physical examination showed mild hypoplasia of the left breast with microcalcifications on mammogram. Intraoperatively, there was complete absence of the pectoralis major, which precluded the insertion of a breast implant. TREATMENT AND OUTCOME: She underwent a skin-sparing mastectomy and autologous microsurgical free flap reconstruction with deep inferior epigastric perforator (DIEP) flap. Postoperative recovery was uneventful with no evidence of recurrence at 6 months. CONCLUSION: This is the first reported case of DCIS of the breast with Poland syndrome. We performed a skin-sparing mastectomy with immediate DIEP flap recontruction. Patient recovered well postoperatively with no evidence of recurrence at 6 months.
Breast Neoplasms↗
Patients who talk and deteriorate: a new look at an old problem.
BACKGROUND AND METHODS: We sought to review established prognostic indicators applied to Asian population, and to identify new risk factors for deterioration in patients who talked and deteriorated after traumatic brain injury (TBI). This retrospective study used our prospectively maintained TBI database. From August 1999 to July 2001, 324 patients were admitted to the neurosurgical intensive care unit (ICU). Thirty-eight patients (11.8%) talked between injury and subsequent deterioration into coma. Independent outcome predictors were studied. RESULTS AND CONCLUSION: Fourteen patients had subdural haematomas, 9 extradural haematomas, 19 contusions/haematomas and 3 subarachnoid haemorrhages. 81.5% of the patients had mass lesions potentially requiring surgery. Twenty patients had good functional recovery at 6 months (Glasgow Outcome Score 4 and 5); 18 were dead or vegetative. Age, gender, type of intracranial lesion and presence of coagulopathy were significantly correlated with outcome. Intracranial haematomas continue to be most significant in patients who talk and deteriorate. Coagulopathy was the strongest prognostic predictor of poor outcome with fibrinolytic parameters being reliable prognostic markers of head injury. Early identification, continued monitoring and treatment of coagulopathy should be our new look at improving outcome of these patients.
Adolescent↗
Adenotonsillectomy for obstructive sleep apnoea in children.
BACKGROUND: Current treatment of sleep apnoea in children consists of largely surgical based treatments. Adenotonsillectomy is the most commonly used intervention to treat sleep apnoea in children. OBJECTIVES: To determine the efficacy of adenotonsillectomy in the treatment of obstructive sleep apnoea in children. SEARCH STRATEGY: The Cochrane Airways group specialised register was searched with pre-specified terms. SELECTION CRITERIA: Randomised trials recruiting children with a diagnosis of obstructive sleep apnoea. DATA COLLECTION AND ANALYSIS: A total of 196 references were identified from electronic searching. Twenty studies were retrieved and none met the inclusion criteria of the review. MAIN RESULTS: Due to the absence of randomised trial data, no results could be ascertained. REVIEWER'S CONCLUSIONS: At present there is still debate as to the polysomnographic criteria required to diagnose significant obstructive sleep apnoea in children. Also the natural history of the condition has not been fully delineated. There is an absence of randomised controlled trials investigating the efficacy of treatment of obstructive sleep apnoea with adenotonsillectomy in children and, therefore, further research is required before recommendations for the treatment of obstructive sleep apnoea in children can be formulated.
Adenoidectomy↗
Oral appliances for obstructive sleep apnoea.
BACKGROUND: Obstructive sleep apnoea-hypopnoea is a syndrome characterised by recurrent episodes of partial or complete upper airway obstruction during sleep that are usually terminated by an arousal. Nasal continuous positive airway pressure is the primary treatment for obstructive sleep apnoea-hypopnoea, but many patients are unable or unwilling to comply with this treatment. Oral appliances are an alternative treatment for sleep apnoea. OBJECTIVES: The objective was to review the effects of oral appliance in the treatment of sleep apnoea in adults. SEARCH STRATEGY: We searched MEDLINE 1966-2003, and the Cochrane Airways Group Sleep Apnoea RCT Register. Searches were current as of July 2003. Reference lists of articles were also searched. SELECTION CRITERIA: Randomised trials comparing oral appliance with control or other treatments in adults with sleep apnoea. DATA COLLECTION AND ANALYSIS: Trial quality was assessed and two reviewers extracted data independently. Study authors were contacted for missing information. MAIN RESULTS: Twelve trials involving 509 participants were included. All the studies had some methodological shortcomings. Oral appliances improved apnoea-hypopnoea index compared with inactive control (-13.17 AHI [-18.53 to -7.80] parallel group data - four studies). Oral appliances reduced daytime sleepiness in two trials (WMD -1.77 [95%CI: -2.91 to -0.62]). Oral appliances were less effective than continuous positive pressure in reducing apnoea-hypopnoea index (WMD 13 [95% CI: 7.63, 18.36], parallel studies - two trials; WMD 6.75 [4.93, 8.57] cross-over studies - six trials). However, no significant difference was observed on symptom scores (3 trials). Nasal continuous positive pressure was more effective at improving minimum arterial oxygen saturation during sleep compared with oral appliance. In two small crossover studies, participants preferred oral appliance therapy to continuous positive airways pressure. REVIEWER'S CONCLUSIONS: There is some limited evidence suggesting that oral appliance improves subjective sleepiness and sleep disordered breathing compared with a control. Nasal continuous positive airways pressure appears to be more effective in improving sleep disordered breathing than oral appliance. Until there is more definitive evidence on the effectiveness of oral appliances, it would appear to be appropriate to restrict oral appliance therapy to patients with sleep apnoea who are unwilling or unable to comply with continuous positive airways pressure therapy.
Adult↗
Effects of Jaoga-Yukmiwon(R), a Korean herbal medicine, on chondrocyte proliferation and longitudinal bone growth in adolescent male rats.
Externally visible growth of the body is the result of proliferation of chondrocytes and longitudinal bone growth. The effects of the Korean herbal medicine, Jaoga-Yukmiwon((R)), on the growth of adolescent rats were investigated in the present study. The proliferation ratio of chondrocytes was calculated from 5-bromo-2'-deoxyuridine incorporation during DNA synthesis. The 5-bromo-2'-deoxyuridine incorporation ratio of the control group was 21.1 +/- 3.5%, and Jaoga-Yukmiwon((R)) administration markedly increased the ratio to 34.5 +/- 4.6% (p < 0.05). The bone formation rate of longitudinal bone was estimated by labelling with tetracycline, which binds to newly formed bone. The bone formation rate in the tibia of Jaoga-Yukmiwon((R))-administered rats was increased to 405.1 +/- 4.3 micro m (p < 0.05) from 292.2 +/- 11.8 micrometer (control value). The height of the growth plate in the administrated rats was increased to 614.6 +/- 10.0 micro m (p < 0.05) from 552.3 +/- 17.1 micro m. The bone morphogenetic protein-2 immunostaining in the growth plate was also increased. These results suggest that Jaoga-Yukmiwon((R)) may promote longitudinal bone growth during the developmental period.
Animals↗