Search

Epithelial ovarian carcinoma is often diagnosed at an advanced stage of disease and is the leading cause of death from gynaecological neoplasia. The genetic changes that occur during the development of this carcinoma are poorly understood. It has been proposed that IGFIIR, TGFbeta1 and TGFbetaRII act as a functional unit in the TGFbeta growth inhibitory pathway, and that somatic loss-of-function mutations in any one of these genes could lead to disruption of the pathway and subsequent loss of cell cycle control. We have examined these 3 genes in 25 epithelial ovarian carcinomas using single-stranded conformational polymorphism analysis and DNA sequence analysis. A total of 3 somatic missense mutations were found in the TGFbetaRII gene, but none in IGFRII or TGFbeta1. An association was found between TGFbetaRII mutations and histology, with 2 out of 3 clear cell carcinomas having TGFbetaRII mutations. This data supports other evidence from mutational analysis of the PTEN and beta-catenin genes that there are distinct developmental pathways responsible for the progression of different epithelial ovarian cancer histologic subtypes., (Copyright 2001 Cancer Research Campaign.)

Tensile neck injuries are amongst the most serious cervical injuries. However, because neither reliable human cervical tensile tolerance data nor tensile structural data are currently available, the quantification of tensile injury risk is limited. The purpose of this study is to provide previously unavailable kinetic and tolerance data for the ligamentous cervical spine and determine the effect of neck muscle on tensile load response and tolerance. Using six male human cadaver specimens, isolated ligamentous cervical spine tests (occiput - T1) were conducted to quantify the significant differences in kinetics due to head end condition and anteroposterior eccentricity of the tensile load. The spine was then separated into motion segments for tension failure testing. The upper cervical spine tolerance of 2400 +/- 270 N (occiput-C2) was found to be significantly greater (p < 0.01) than the lower cervical spine tolerance of 1780 +/- 230 N (C4-C5 and C6-C7 segments). Data from these experiments were used to develop and validate a computational model of the ligamentous spine. The model predicted the end condition and eccentricity responses for the tensile force-displacement relationship. Cervical muscular geometry data derived from cadaver dissection and MRI imaging were used to incorporate a muscular response into the model. The cervical musculature under maximal stimulation increased the tolerance of the cervical spine from 1800 N to 4160 N. In addition, the cervical musculature resulted in a shift in the site of injury from the lower cervical spine to the upper cervical spine and offers an explanation for the mechanism of upper cervical spine tension injuries observed clinically. The results from this study predict a range in tensile tolerance from 1.8 - 4.2 kN based on the varying role of the cervical musculature.

Objective: Our objective was to examine the prevalence of adeno-associated virus (AAV) infection in women with normal cervical smears and those with HPV-associated cervical intraepithelial neoplasia (CIN)., Methods: HPV typing was performed on DNA from cervical smears of 211 women with CIN (CIN 1 = 83, CIN 3 = 128) and 433 healthy women who had a normal cervical smear. HPV typing was performed on all cases and controls using type-specific oligonucleotide primers (HPV 16, 18, 31, 33). AAV DNA was amplified by nested PCR from the same samples. The amplified DNA were separated on 2% agarose gels, blotted, and hybridized to AAV-2 DNA labeled by random priming with [alpha-(32)P]dCTP to confirm specificity of amplification., Results: A total of 131 cases of CIN were positive for one of the HPV types either alone or in combination. HPV 16 was present in 120 (57%) cases, HPV 18 in 15 (7%), HPV 31 in 27 (13%), and HPV 33 in 15 (7%) and there were multiple HPV types detected in 34 (16%) cases. All of the controls were selected to be negative for HPV. A total of 6/433 (1.4%) control cervical smears and 4/211 (1.9%) of CIN (CIN1 = 2; CIN3 = 2) contained AAV DNA. No correlation between AAV and any clinical feature was observed., Conclusions: These results are different from some that have been previously published and suggest that AAV DNA is not frequently present in either normal control cervical samples or cervical intraepithelial neoplasia. This does not support the hypothesis that AAV may be protective against cervical cancer. Further research is necessary to understand the natural history of AAV infection and its role in human disease., (Copyright 2000 Academic Press.)

Background: This study was done to look at prevalence and factors affecting functional dependence. The data in this paper were part of the 'Community Study on State of Health, Function, Cognitive and Social State of Elderly People in Singapore' conducted in Singapore between September 1992 and December 1993., Patients: Four hundred and one elderly, aged 60 years and above were studied. Sixty-eight subjects (17%) were dependent in at least one function of Activities of Daily Living (ADL) as measured by the Barthel's Index (BI)., Results: The most common problem identified using this index was urinary incontinence. Forty subjects (10.4%) were dependent in at least one Instrumental Activities of Daily Living (IADL) function. The most common mode of transportation was by public transport, of which travelling by bus was the most common (59.9%) and mass rapid transit (MRT) was the least common (4%). Female gender and age > or = 75 were significant factors associated with dependence measured on Barthel's index but not on IADL., Conclusion: Results of this study were also compared with two previous surveys done in Singapore. Discrepancies in results noted could be attributed to different definitions in which the functions were assessed. We should aim to standardise the definition and measures of function in the local context in order to measure changes in the elderly population.

Majority (90.5%) of the elderly living in the community in Singapore had a positive (satisfactory to good) perception of their health. This study found that age (70 years or older), recent hospitalisation, regular medical follow-up, hearing impairment, presence of chronic medical conditions (like musculo-skeletal problems, hypertension, ischaemic heart disease and chronic obstructive lung disease), impairment in activities of daily living, history of falls, those on regular medications and those with financial difficulties all adversely influenced perception of health. Those able to participate in regular outdoor leisure activities have a positive influence. Factors that did not significantly influence perception of health were gender, health-promoting activities, work, poor eyesight, cognitive impairment, urinary incontinence, diabetes, history of stroke and the ability to use public transport.

Aim: Falling is a serious medical problem for elderly persons. This study was done to look at prevalence and risk factors for falls in community dwelling elderly in Singapore., Method: A random sample of 3,000 persons aged 60 years and above was chosen from a database based on the 1990 population census. Letters were sent out to 2,582 subjects who had local and complete addresses. In the letter, they were informed about the purpose of the survey, and invited to participate in a questionnaire and clinical health screening at an appointed date at a polyclinic. Participants were reminded the day before their appointment by telephone, and a new appointment could be given at the subject's convenience., Results: We found a prevalence rate of falls of 17.2%. Two-thirds of these had single falls, while one-third had recurrent falls, defined as having more than one fall within the previous one year. The following factors were found to be significantly associated with increase falling in the elderly: age > or = 75 years (O.R. = 1.82, 95% C.I. 0.95-3.50), female sex (O.R. = 2.5, 95% C.I. 1.40-4.48), Malay race (O.R. = 2.66, 95% C.I. 1.21-5.86), poor vision (O.R. = 1.7, 95% C.I. 0.99-2.90), Barthel's score of less than 20 (O.R. = 1.76, 95% C.I. 0.94-3.28), those taking 2 or more drugs daily (O.R. = 2.1, 95% C.I. 1.22-3.72) and the presence of hypertension (O.R. = 1.78, 95% C.I. 1.06-3.01). Fall rate is also twice as high in women as in men. At the same time, we found that women in the group we studied also tend to exercise less than the men. Fallers also had significantly more mobility and activities of daily living (ADL) disabilities (reflected by a lower Barthel's score) and this is consistent with other results. The only factor that reduced the risk of falling was regular exercise (O.R. = 1.64, 95% C.I. 0.93-2.93)., Conclusion: In our study, we found differences between the group with single and recurrent falls. In the group with single falls, the fall tend to occur outdoors (O.R. = 2.97, 95% C.I. 1.03-8.60) and during the day (O.R. = 3.47, 95% C.I. 1.20-10.0), tend to be accidental (O.R. = 3.16, 95% C.I. 1.05-9.50) and tend to seek medical attention (O.R. = 3.68, 95% C.I. 1.23-11.0). Overall, 32 persons (46.4%) seek medical treatment after their falls, and of these, 65.6% were women. Risk factors for falls should be screened for all elderly.

Aim: To determine the prevalence, presentation, causes and consequences of hypoglycaemia in the elderly, and to make preventive recommendations., Method: Retrospective review of case records., Results: The definition of hypoglycaemia is defined as symptoms with a capillary blood sugar of less than 3 mmol/L measured on the Reflolux II or Accutrend glucometer. Out of 1,919 admissions to our department from November 1993 to January 1996, there were 45 cases of hypoglycaemia. The average age was 76.2 years (range 66 to 89 years); 32 were females, 13 males, 35 had diabetes mellitus and 10 were non-diabetics. Forty patients presented with neuroglycopaenic symptoms and 5 patients presented with adrenergic symptoms. Thirteen patients presented were solely due to drugs (mainly glibenclamide); 9 cases were due only to disease (mainly psychiatric illnesses with poor intake); 23 cases were due to both drugs and diseases (mainly a combination of glibenclamide, tolbutamide and psychiatric illness with poor intake, renal failure, gastroenteritis and sepsis). All were easily reversed with an intravenous bolus of 50% glucose or continuous 10% glucose infusions. Forty-three patients did not suffer any morbidity, one suffered a stroke and another fell because of giddiness., Conclusion: We recommend that: (1) the importance of having regular meals be emphasised to elderly patients and their carers, especially if they are taking hypoglycaemic agents; (2) regular home glucose monitoring for diabetic patients; (3) assessment and monitoring of renal function before prescribing hypoglycaemic agents; (4) avoidance of the use of long or medium acting sulphonylureas eg. chlorpropamide, glibenclamide in the elderly; (5) adjustment of hypoglycaemic agents (in consultation with a trained nurse/doctor) if the patient suffers from gastroenteritis and (6) less stringent blood glucose control in those with psychiatric illnesses who may have variable food intake.

An elderly woman with an acute abdomen due to a perforated peptic ulcer is discussed to illustrate the problem of atypical presentation of illness in the elderly. The importance of not dismissing non-specific symptoms and signs such as confusion, restlessness, abdominal distention and non-localising abdominal tenderness in the elderly, is highlighted. In addition, the useful radiological features of pneumoperitoneum are described. The need for functional assessment and rehabilitation are emphasised as important components in the practice of geriatric medicine.

A retrospective study of 100 elderly stroke patients admitted to a rehabilitation centre in Singapore was done to study the characteristics of the patients and the factors associated with the outcome. The mean age of the patients was 72.7 +/- 5.4 years with an equal sex ratio. There was a predominance of Chinese. Two or more concomitant diseases were present in 43% of the patients with a markedly high prevalence of hypertension. Majority had unilateral motor deficit, and cerebral infarcts were seen in 66% of the scans done. Altogether 79% of the patients improved on their level of self-care in activities of daily living (ADL) while 60% showed improvement in their level of mobility. Patients with good prognosis were those who were assessed to be at least partially independent in ADL prior to rehabilitation and those who showed improvement in the motor power of their affected limbs during rehabilitation. Those with dense hemiplegia at the outset were likely to remain dependent. Age, sex, delay in rehabilitation, duration of rehabilitation, presence of dysphasia and sides of deficit had no bearing on the outcome.

Thirteen non-obese, non-insulin-dependent diabetic patients were given guar granulate in an average dose of 7.1 grams daily for 8 weeks. The mean fructosamine fell from 3.3 +/- 0.69 mmol/L (p less than 0.01). Mean glycosylated haemoglobin (HbA1c) fell from 8.17 +/- 2.2% preguar to 7.67 +/- 1.81% (1 = ns) and to 7.39 +/- 1.23% (p = ns) at 8 weeks and 12 weeks postguar respectively. Eight weeks after the discontinuation of guar fructosamine rose to 3.61 +/- 0.95 mmol/L (p less than 0.05) while HbA1c rose to 8.23 +/- 2.08% (p = 0.05). There were no significant changes in fasting blood glucose, lipids, and body weight. Mild gastrointestinal side-effects occurred in 11 patients during the treatment with guar. It is concluded that daily ingestion of low dose guar modestly improves glycaemic control, such improvement dissipating by 8 weeks following cessation of its use.

A survey was conducted to study certain characteristics of geriatric patients admitted to two medical departments in Singapore. The aim was to create awareness as well as to provide a better understanding of these elderly as more and more doctors would have to attend to them. Our results show that about 27% of admissions were geriatric patients. The typical geriatric patient in this study was about 75 years old (mean age 74.6 years) and was likely to present with breathlessness due to heart disease or pneumonia. The overall duration of stay in hospital was 10 days and only about 6% of the patients had "discharge" problems needing assistance from the Medical Social Worker. About one in five patients died in hospital, usually from pneumonia or ischaemic heart disease.