Case report. Tumour-induced osteomalacia in a patient with osseous haemangioma.
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Female↗
Biomedical subjects
R Khoo
Publications and source records attributed to R Khoo.
European snapshot homeless survey: results of questions asked of passers-by in 11 European cities.
Passers-by were interviewed outside McDonalds restaurants in 11 European cities during November and December 1998. Eight questions were asked, mainly exploring the stigma levels of a particularly socially and economically excluded group (homeless people) and also the preferred remedies for homelessness. Answers varied, especially between the countries in Western Europe and those in the former Warsaw Pact countries. Stigma levels were very high in Bucharest, Kiev and Zagreb, presumably making resettlement work difficult. People in these cities saw homeless people as 'dangerous': repositories of infectious disease and likely to make unprovoked attacks. Most passers-by also believed homeless people were under threat, especially from the police, sometimes from other passers-by, from exposure to the winters and, in Cambridge, Vienna and Zagreb, from malnutrition. Suggested remedies were increased employment, improved training and increased affordable housing, rather than the imprisonment of beggars.
Attitude to Health↗
"Sandwich" preoperative and postoperative combined chemotherapy and radiation in tethered and fixed rectal cancer: impact of treatment intensity on local control and survival.
PURPOSE: The present "sandwich" preoperative and postoperative chemotherapy and radiation study was undertaken to evaluate the impact of treatment intensity on the local control and survival in tethered or fixed rectal adenocarcinoma (T3, 4 NX M0). METHODS AND MATERIALS: Between 1990 and 1992, 27 patients were treated with this sandwich protocol. Preoperative therapy consisted of 4 weeks of concurrent radiation (40 Gy) and chemotherapy (mitomycin C on day 1, 5-fluorouracil infusion and leucovorin on days 1-4 and days 15-18, respectively), and one cycle of bolus 5-fluorouracil and leucovorin chemotherapy. After surgery, they received 2 additional weeks of radiation (18 Gy) and 4 days of similar chemotherapy. The outcome was compared to another 54 patients who were treated with our previous preoperative chemoradiation protocol (mitomycin C, 5-fluorouracil infusion and 40 Gy of pelvic RT). RESULTS: The complete resectability rate was improved from 91% in the preoperative protocol to 100% in the sandwich protocol, and the pathologic complete response rate (T0 N0 M0) was increased from 4 to 15%. There was no local recurrence in the sandwich protocol. The 4-year local failure rate was 23 vs. 0% (p = 0.005). The 4-year distant failure rate was 47 vs. 28% (p = 0.079). The 2-year and 4-year survival were 63 and 41% for the preoperative protocol, vs. 92 and 72% for the sandwich protocol, respectively (p = 0.014). There were more treatment-related Grade 2 diarrhea, but not Grade 3/4 diarrhea in the sandwich protocol. Two patients (7%) in the sandwich protocol developed late gastrointestinal complications. CONCLUSIONS: More intensive radiation and chemotherapy appeared to improve the resectability, local control, and survival in tethered and fixed rectal cancers. There was a moderate but acceptable increase in the bowel morbidity.
Adenocarcinoma↗
Preoperative concurrent 5-fluorouracil infusion, mitomycin C and pelvic radiation therapy in tethered and fixed rectal carcinoma.
PURPOSE: This is a Phase I/II study of preoperative concurrent radiation and chemotherapy in tethered and fixed rectal carcinoma. This study examined the curative resectability, the acute toxicities during chemo-radiation and the surgical complications. METHODS AND MATERIALS: Between 1986 and 1990, 46 patients were treated with preoperative pelvic radiation (4000 cGy in 20 fractions in 4 weeks), 5-Fluorouracil infusion (20 mg/m2, days 1-4 and 15-18) and Mitomycin C (8 mg/m2, day 1). This was followed by surgery 6 to 8 weeks later. 30 patients had tethered tumors and 16 patients had fixed tumors. RESULTS: After preoperative chemo-radiation, 41 patients (89%) underwent curative resection. Two patients (4%) had no residual tumor found (T0N0M0). Seven patients (15%) had nodal metastases. Two patients developed grade 3 neutropenia (WBC = 1-2 x 10(9)/L) during chemo-radiation. Five patients had delay in perineal wound healing. One patient had an anastomotic leak. Four patients developed stomal stenosis which required surgical revision. The 2-year actuarial survival was 73%. The 2-year local relapse rate was 16%. Patients with fixed carcinoma had a higher incidence of local failure (38% vs. 10%) and the difference was statistically significant (p = 0.0036). The 2-year distant failure rate was 41%, and the rates were similar for both tethered and fixed carcinomas. CONCLUSION: Preoperative pelvic radiation, chemotherapy and surgery could achieve a curative resection rate of 89% in tethered and fixed rectal carcinomas. However, distant metastases remained the major cause of failure.
Adenocarcinoma↗
The management of blunt splenic trauma.
Seventy cases of blunt splenic trauma were retrospectively reviewed for the period 1979-1984. There were 57 adults and 13 children. Motor vehicle accidents were implicated in 62%. Forty-five splenectomies and eight splenorrhaphies were performed. The patients fell into two groups. Group A, numbering 48 patients, were those operated upon within 24 hours of injury. The mortality rate was 16%, and no deaths were attributable to splenic injury. Indications for surgery were hemodynamic instability in 46% and positive peritoneal lavage in 40%. Group B included 22 patients, 17 of whom were managed nonoperatively with no deaths. Five patients eventually went to laparotomy. Fifty per cent of all patients had associated intra-abdominal injury but only 17% needed repair; 31% of patients were initially managed conservatively with a 77% success rate and no mortality. It is concluded that conservative management is safe in stable patients with blunt splenic trauma.
Accidents, Traffic↗
Incidence of hypothyroidism after radioactive iodine therapy for thyrotoxicosis in Hong Kong Chinese.
The incidence of hypothyroidism in 1396 Chinese patients in Hong Kong treated for hyperthyroidism with 131I therapy is presented using the life-table method of analysis. One year after therapy only 6% of patients were hypothyroid, but the subsequent annual incidence was 3.5%, emphasising the need for life-time surveillance of these patients. A higher incidence of subsequent hypothyroidism was found in patients with diffuse surgical treatment, the total dose or number of doses of 131I, the severity of thyrotoxicosis and the age of the patient did not influence the rate of onset of hypothyroidism. The data suggest that in order to minimise the occurrence of hypothyroidism a lower dose of 131I per gram of thyroid mass should be used for patients with small diffuse glands.
Adult↗
Radiotherapy of carcinoma of the Larynx.
123 patients suffering from carcinoma of the larynx were treated by radical radiotherapy at Queen Mary Hospital in Hong Kong between 1970 and 1977. The results are presented. 69(56.1%) were in the supraglottic, 53(43.1%) in the glottic, and 1(0.8%) in the subglottic regions. The incidence of cigarettes, heroin, and opium smoking, and that of alcohol consumption is analysed. The overall actuarial 5-year survival rate for supraglottic cancer was 47.7%, and 80.4% for glottic cancer. The solitary patient with subglottic cancer was alive 9 years after radical radiotherapy.
Adult↗
A socio-epidemiologic survey of veneral diseases among national servicemen attending a VD hospital in Singapore.
Between September 22 and October 29, 1976, a socio-epidemiologic survey of venereal diseases (VD) was carried out at a hospital for VD and skin diseases in Singapore. The study subjects comprised 401 national servicemen from the Singapore Armed Forces who were selected by periodic stratified random sampling from among army patients at the hospital. These subjects were divided into two groups, one consisting of those suffering solely from venereal diseases and the other from non-venereal skin diseases only. Studies were made to compare the personal characteristics, educational and social backgrounds and sexual behavior between these two groups. On the basis of the results, a profile of a soldier likely to contract venereal diseases was made. The study showed that soldiers have inadequate knowledge of venereal diseases. Suggestions are made to improve education as to venereal diseases and to reduce risk of infection in the armed forces.
Adult↗
Mental illness: diagnosis or value judgment?
This article is concerned with the definition of mental illness. Although it seems that it cannot be defined clearly in a legal or scientific way, this does not necessarily mean that health treatment is arbitrary and ill-founded.
Attitude to Health↗