Biomedical subjects
Publications and source records attributed to C S Seow.
Melioidosis is a tropical infectious disease caused by the gram-negative bacterium Burkholderia pseudomallei. It is endemic in many parts of the world, including Southeast Asia, and has a mortality rate of about 45%. We report a case of localized nonfatal cutaneous melioidosis presenting as a persistent ulcer in an otherwise healthy young woman.
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INTRODUCTION: Since the introduction of BCG vaccination in 1921, there have been numerous reports of cutaneous complications. Although common local effects such as erythema, soreness and local abscesses are well known, the incidence of cutaneous granulomas and BCG-induced lupus vulgaris is rare. PATIENTS AND METHODS: This is a retrospective analysis of our local experience in dealing with cases of cutaneous granulomas following BCG vaccination. Cases were seen at a local tertiary level dermatological referral centre. RESULTS: There were 14 cases seen over an 8-year period. Of these cases, 4 were clinically suggestive of BCG-induced lupus vulgaris, but only 1 of these cases was confirmed by culture. All but one of these cases had developed these complications after multiple BCG vaccinations. The 3 suspected but unconfirmed cases were treated with isoniazid. The 1 case of confirmed BCG-induced lupus vulgaris was treated with rifampicin and ethambutol, as sensitivity testing revealed resistance to isoniazid. All 4 cases responded well to treatment. The other 10 cases of vaccine-induced cutaneous granulomas responded to local symptomatic treatment. CONCLUSIONS: Although local effects such as induration and pustule formation at the injection site are not rare, the development of cutaneous granulomas is uncommon. Incidence of complications increases with multiple vaccinations. Cases usually respond to local symptomatic therapy, while more aggressive lesions responded to the use of oral isoniazid. Confirmed cases of BCG-induced lupus vulgaris should be treated based on antibiotic sensitivity profile.
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OBJECTIVE: To investigate the current practice of chemical lumbar sympathectomy by vascular surgeons in Scotland. DESIGN AND SUBJECTS: Postal questionnaire survey of all practising vascular surgeons in Scotland (n = 40) identified from the list of members of the Vascular Society of Great Britain and Ireland. RESULTS: Most surgeons (30 of the 34 respondents, 88%) practise chemical lumbar sympathectomy. Their main indications are in line with current recommendations in relevant publications. Controversial areas include its use as an adjunct to operation and in treating diabetic feet. The procedure is done by vascular surgeons (16 of 34 respondents, 47%) and anaesthetists or radiologists (14 of the 34 respondents, 41%). There is a wide variation in the technical aspects of the procedure. All respondents make a clinical assessment of outcome. CONCLUSION: The role of chemical lumbar sympathectomy is likely to remain controversial because of the lack of a valid prognostic marker, technical variability, and the fact that it is often used in elderly patients.
Most Spigelian hernias occur below the level of the umbilicus close to the level of the arcuate line. We report a case diagnosed by computed tomography in an unusually high anatomical location due to a previous drain site incision.
BACKGROUND: Candidal infections of the skin/nails and vagina are very common worldwide. Various in vitro test systems are available to help to determine the antifungal activity of drugs. The minimum inhibitory concentration (MIC) is a standard measure of the in vitro potency of drugs against yeasts. METHODS: Vaginal smears and skin/nail scrapings of 50 consecutive patients with candidal vaginitis and 46 consecutive patients (28 women, 18 men) with cutaneous/nail candidosis were used in the study. Direct microscopy and culture from vaginal smears and skin scrapings were performed on all patients. The MICs were determined using the broth dilution method. RESULTS: For vaginal candidosis, the mean age of the patients was 28.2 years (range, 9-49 years). Candida albicans accounted for 58% of the isolates, C. glabrata for 32%, C. tropicalis for 6%, and C. parasilosis for 4%. At the MIC of < or = 4 mg/L, 65-95% of C. albicans, 66-94% of C. glabrata, 33-100% of C. tropicalis, and 0-50% of C. parasilosis were susceptible to the drugs tested (ketoconazole, itraconazole, nystatin, amorolfine, clotrimazole, and miconazole). For cutaneous/nail candidosis, the mean age of the patients was 45 years (range, 19-82 years). C. albicans made up 59% of the isolates, C. parasilosis 20%, C. krusei 13%, C. glabrata 4%, and C. tropicalis 4%. At the MIC of < or = 4 mg/L, 59-96% of C. albicans, 100% of C. glabrata, 83-100% of C. krusei, 89-100% of C. parasilosis, and 100% of C. tropicalis were susceptible to the drugs tested (ketoconazole, itraconazole, nystatin, amorolfine, clotrimazole, and miconazole). CONCLUSIONS: C. albicans is the most common Candida species causing cutaneous/nail and vaginal candidosis in Singapore. The in vitro antifungal activities of ketoconazole, itraconazole, nystatin, amorolfine, clotrimazole, and miconazole are similar against the various Candida species. C. parasilosis in vaginal candidosis appears to be less susceptible. Here, itraconazole and amorolfine may be more effective.
Patients above the age of 60 with displaced femoral neck fractures are treated by hemiarthroplasty in Singapore because of our low life expectancy. This study evaluates the morbidity and mortality of 110 such patients operated on in our department between January 1990 and December 1992. It has clinical significance because of the rapidly ageing population of Singapore. The mean age was 78 years with a female preponderance of 5:1. They were predominantly Chinese. None of the patients were Malay. This is the first study showing that such fractures are rare among Malays. Most fractures were due to trivial trauma. Fifty-eight per cent had co-existing illness(es). The mean hospitalization stay was 20 days. There were considerable and local complications in 15 patients. Twenty-five patients died. Of the remaining patients, 17 (20 per cent) were unable to regain independent ambulation. The mortality rate at 3, 6 and 12 months was 6.4 per cent, 9.1 per cent and 15 per cent respectively. Males showed a significantly higher mortality rate than females. Also, patients living in government-built high rise flats had a significantly higher mortality rate than those residing in privately owned homes.
BACKGROUND: Superficial cutaneous fungal infection, principally dermatophytosis, is an extremely common skin disease. Various in vitro test systems have been developed in recent years to determine the antifungal activity of various drugs. The minimum inhibitory concentration (MIC) obtained may give an indication of the in vivo potency of the drugs. METHODS: One hundred patients (69 men and 31 women) with a clinical diagnosis of dermatophytosis were entered into the study. Direct microscopy and culture were done on all patients. The MICS were determined using the broth dilution method. RESULTS: The age range was 1-76 years. The most common diagnosis was tinea corporis (36%), followed by tinea cruris (22%), and tinea pedis (19%). The most common fungus isolated was T. rubrum (58%), followed by E. floccosum (14%), and T. mentagrophytes (10%). The majority of the isolates was sensitive to the three drugs tested (griseofulvin, ketoconazole, and itraconazole). Of the isolates, 82% were sensitive to griseofulvin, 78% to ketoconazole, and 81% to itraconazole, all at a concentration of < 0.25 micrograms/mL. For T. rubrum, there were four isolates that had an MIC of > or = 64 micrograms/mL to griseofulvin, seven isolates and nine isolates with an MIC > or = 64 micrograms/mL to ketoconazole and itraconazole, respectively. T. interdigitale was relatively resistant to the three drugs in vitro with four of seven isolates having an MIC > or = 4 micrograms/mL with griseofulvin, one of seven isolate with an MIC > or = 64 micrograms/mL with ketoconazole, and three of seven isolates with an MIC > or = 32 micrograms/mL with itraconazole. CONCLUSIONS: The in vitro antifungal activity of griseofulvin, ketoconazole, and itraconazole are similar against dermatophytes in Singapore. Griseofulvin may be given as the first-line drug for treating such infections in Singapore.
Histoid leprosy is a rare variant of lepromatous leprosy. This is the first documented case of histoid leprosy in Singapore. The patient was diagnosed as borderline leprosy in 1973, remained untreated and progressed to lepromatous leprosy. The characteristic histoid lesions were firm pruriginous nodules on the dorsum of his feet. The histology showed a pseudocapsulated tumour with fibroblasts and histiocytes filled with lepra bacilli. Electron microscopy showed fibroblasts, macrophages with bacilli and plasmacytoid cells with active endoplasmic reticulum. He was found to be dapsone-resistant and the lesions cleared with clorphazimine. Immunological defects were not detected.
An interesting cultural practice of implanting foreign bodies under the skin of the penis for enhancing sexual excitement in the man's sexual partner is described. Recognition of this is important to venereologists because of their primary concern with the genital area. The term artificial penile nodule has been suggested for the condition resulting from this practice.
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