Surgery for inflammatory bowel disease in Singapore

Inflammatory bowel disease is uncommon in Asians and reports of surgery in these populations are rare. Eighty-two patients with inflammatory bowel disease were seen in the Department of Colorectal Surgery over a five-year period (1989-1994). Twenty-three patients underwent surgery for their disease. There were 12 males and 11 females with 16 Chinese, 4 Indians and 3 Malays. Twelve had Crohn's disease and 11, ulcerative colitis. The majority of patients with Crohn's disease had emergency surgery for bleeding, perforation, abdominal masses and intestinal fistulae. Fifty percent of these had the diagnosis made intraoperatively or post-operatively. Surgery for ulcerative colitis was indicated because of multiple relapses, non-response to medical treatment, side effects of therapy or malignant change. The median age at surgery of patients with Crohn's disease and ulcerative colitis was 39 years (range 24-84) and 40 (range 18-60) respectively. The median follow-up was 22.4 months (range 9-50). The results of surgical therapy in these patients show that surgery when indicated can be done with minimum morbidity and mortality.     

Comparison of the in vitro fibrinolytic activities of low and high molecular weight single-chain urokinase-type plasminogen activator

The fibrinolytic activity of low molecular weight (LMW) single-chain urokinase-type plasminogen activator (scu-PA) lacking the epidermal growth factor domain and the kringle domain was compared with the activity of high molecular weight (HMW) scu-PA. LMW scu-PA was 1-5 times less active than HMW scu-PA in a fibrin plate method, in a purified fibrin clot lysis assay and in a plasma clot lysis assay. Time course experiments in a chromogenic plasminogen activator assay suggested that LMW scu-PA was less sensitive to activation by plasmin than HMW scu-PA. This was confirmed in a scu-PA activation test, which showed that at a concentration of 40 IU/ml LMW scu-PA required a three-fold higher plasmin concentration for 50% activation in 20 min than did HMW scu-PA. Kinetic experiments in the presence of 0.1 M NaCl showed non-standard Michaelis-Menten kinetics for the activation by plasmin of both HMW and LMW scu-PA. In contrast, standard kinetics was observed at 0.15 M NaCl, showing a 2.6-fold lower catalytic efficiency for LMW scu-PA than for HMW scu-PA. It is concluded that the plasmin activation of LMW scu-PA is about three times slower than the activation of HMW scu-PA. This explains, at least partially, the lower fibrinolytic activity of LMW scu-PA in comparison with HMW scu-PA.     

Cyclin D1, another molecule of the year?

AIM: Testicular germ cell tumours may present as metastases in cervical lymph nodes, yet the primary tumours remain clinically occult. The aim of the study is to alert pathologists and clinicians to this uncommon but important presentation and highlight the clues and the diagnostic adjuncts to its correct diagnosis. METHODS: The clinical, cytological, histological, and immunohistochemical features of two patients with germ cell tumour initially presenting as cervical lymphadenopathy were described and analysed. RESULTS: Both patients were young adult males, who were found to have metastatic undifferentiated carcinoma on fine needle aspiration of the enlarged cervical lymph nodes. The tumour cells in both cases were positive for placental alkaline phosphatase (PLAP) and negative for epithelial membrane antigen (EMA). CONCLUSIONS: Clinicians and pathologists should be aware of the possibility of germ cell tumour when encountering a young adult male with metastatic poorly differentiated carcinoma. Positivity for PLAP and negativity for EMA are helpful adjuncts in arriving at the correct diagnosis.     

Characterisation of basic proteins from Spiroplasma melliferum using novel immobilised pH gradients

Two-dimensional polyacrylamide gel electrophoresis (2-D PAGE) has become the method of choice for efficient separation of complex protein mixtures. Previously, analysis of the Spiroplasma melliferum proteome (protein complement of a genome) has been performed with pH 3-10 and narrow range pH 4-7 IPG gel strips. We report here on the use of novel 18 cm basic (pH 6-11) immobilised pH gradients (IPG) to increase the resolution of protein spots visible within 2-D gels. These gradients were synthesised to emulate the gradient of commercially available IPG gel strips in a 5 cm region of overlap so as to attempt construction of a more complete map of cellular protein expression. Approximately 50 additional gene products were detected from S. melliferum that were not previously well-resolved or visible using wide-range pH 3-10 IPG gel strips. Twenty-seven of these were electrotransferred to polyvinylidene difluoride (PVDF) membrane and analysed by N-terminal protein microsequencing. Protein spots with an initial peak yield of as little as 100 femtomoles (fm) were sequenced to 5-10 amino acid residues, demonstrating the importance of improved sample handling procedures and analytical technologies. Many essential metabolic enzymes were shown to have basic pI, including: glyceraldehyde-3-phosphate dehydrogenase, pyruvate kinase, carbamate kinase and lactate dehydrogenase. A very basic protein (pI approximately 11.0) was identified as uridylate kinase, an enzyme indirectly associated with pyrimidine biosynthesis and thought be absent in some members of the bacterial class Mollicutes. The advent of novel basic (pH 6-11) IPGs has allowed the visualisation of a significantly greater percentage of the 'functional proteome', that portion of the total protein complement of a genome actively translated within a specific time frame, on 2-D electrophoresis gels. This will aid in the characterisation of translated gene products in conjunction with genome sequencing initiatives.     

Relationship between cardioventilatory coupling and respiratory sinus arrhythmia

The clinical data, microbiological results and antibiotic treatment of 65 children who have required incision and drainage of suppurative head and neck abscesses was retrospectively investigated with the aim of developing a more effective clinical protocol of treatment, improving speed of resolution and rationalizing the need for surgical intervention. A positive culture grew in 78% of children and of these 45% were Staphylococcus aureus, 9% Streptococcus pyogenes, and 8% atypical mycobacteria. Only 3% of the samples grew anaerobes. All isolates of S. aureus were sensitive to Flucloxacillin and all isolates of S. pyogenes were sensitive to penicillin. All anaerobes were Metronidazole sensitive. In 40% of the children there were no localizing symptoms which could guide the treatment, therefore we recommend Flucloxacillin and Metronidazole as the antibiotic regimen of choice in acute suppurative lymphadenitis. The increasing incidence of atypical mycobacterial lymphadenitis is noteworthy.     

Familial adenomatous polyposis

BACKGROUND: Congenital lobar emphysema is an unusual condition and its pathogenesis remains unknown. The variety of findings in pathology studies of the resected specimens led to increasing academic interest. About 50 per cent of the cases have no definitive diagnosis in pathology. The most recent theory proposes an increased number of alveoli within each acinus (polyalveolar lobe). PURPOSE: The aim of this paper is to report the morphometric measures of surgical specimens of 12 patients with congenital lobar emphysema, using the Emery and Mithal technique (radial alveolar count). METHODS: We made a case-control study, classifying the cases by age. Mann-Whitney's U test and linear regression techniques were used in data analysis: Mann-Whitney's U in comparing the cases and respective controls and linear regression to evaluate the influence of age in the measures found. RESULTS: The results revealed a significantly higher radial alveolar count than expected for the age group under 3 years; no difference was observed in the age group between 3 and 7 years and in children older than 7, the radial alveolar count was lower than expected. The normal development of the lung consists in an increasing number of alveoli increase from birth until adulthood, but this number remains constant, independent of age in congenital lobar emphysema. CONCLUSIONS: Such findings allow us to conclude that polyalveolar lobe can and must be diagnosed by a simple and practical method, such as the radial alveolar count, which decreases the incidence of the unknown etiology. The findings of an increased number of alveoli on patients younger than 3 is related to congenital lobar emphysema, since the number of alveoli does not increase in congenital lobar emphysema, just the opposite to what one would expect in the normal development of the lung.