2009

Noraini AR, Gay E, Ferrara C, Ravelli E, Mancini V, Morra E, Muti P, Tahir A, Abdul Jalil N, Rossetti C
Correspondence: Dr Noraini Abdul Rahim, norainichoo2@hotmail.com

ABSTRACT
Introduction To establish the role of positron-emission tomography (PET)-computed tomography (CT) in post-transplant lymphoproliferative disorder (PTLD) patients, compared to conventional imaging (ultrasonography/CT/magnetic resonance imaging) in relation to its accuracy, sensitivity and specificity.
Methods 30 patients (26 males and 4 females), with a median age of 49.5 (range 18–74) years, were retrospectively evaluated. In 29 cases, the diagnosis was confirmed by histopathology. Malignant lymphoma was detected in 20 cases, polymorphic lymphoproliferative disorder in six cases, multiple myeloma in two cases and Hodgkin’s disease in one case. A total of 49 PET-CTs (13 studies for staging at diagnosis and 36 studies at follow-up as assessment post-therapy) were compared to conventional imaging. Imaging results in accordance with disease status were assessed at a median follow-up of 17.8 (range 1.5–42.2) months post-PET-CT. 
Results In 41 of 49 examinations performed for staging and on follow-up, PET-CT and conventional imaging findings were concordant. Compared to conventional imaging, PET-CT showed comparable sensitivity (75 percent vs. 83 percent), similar specificity (100 percent in both modalities) and comparable accuracy (77 percent vs. 85 percent) during staging at diagnosis. PET-CT was found to be superior to conventional imaging modalities at follow-up, with greater sensitivity (100 percent vs. 81 percent), specificity (80 percent vs. 100 percent) and accuracy (97 percent vs. 83 percent). 
Conclusion PET-CT is an accurate diagnostic tool for staging and for the follow-up of PTLD patients. It represents a good alternative imaging method to avoid contrast-related nephrotoxicity in patients who often develop impaired renal function secondary to chronic immunosuppressive therapy. However, further studies are recommended before considering PET-CT as a routine diagnostic tool in PTLD.

Taneja M, Tay KH, Sebastian M, Pasupathy S, Lin SE, Teo T, Low R, Irani FG, Chng SP, Dewan A, Tan BS
Correspondence: Dr Manish Taneja, manish.taneja@sgh.com.sg

ABSTRACT
Introduction This study aims to evaluate our experience with self-expanding nitinol stent- enabled recanalisation of long-length occlusions (30 cm or more) of the superficial femoral artery (SFA). 
Methods 573 patients underwent 842 lower limb interventions from August 2006 to December 2008. A retrospective review of patients undergoing recanalisation of long-length SFA occlusions with self-expanding nitinol stents and an evaluation of their patency and impact on limb salvage, were done. 
Results 22 patients (mean age 62.5 years, male: female ratio 11:11) underwent 22 long-length SFA stenting procedures. The spectrum of critical limb ischaemia included rest pain (five), ulcer (six) and gangrene (11). Length of occlusions varied from 30 cm to 45 cm (average length 36.4 cm). Five patients had stents placed through the ipsilateral popliteal artery approach, and the rest had stents placed through the femoral artery approach. All patients were followed up over an average duration of 12 months. One patient died due to associated medical conditions during this period. Six out of 21 (28.6 percent) of the stents thrombosed completely on one year follow-up. Of these, two patients underwent amputation, one patient had a bypass, and the stent in two patients were recanalised with balloon angioplasty. All remaining patent stents showed varying degrees of stenoses at one year. The overall limb salvage rate at one year following stent placement was 81 percent. 
Conclusion Our experience showed the beneficial result of long-length SFA stent placement with good limb salvage outcome. Repeat interventions may be required to maintain the patency of stents in these patients. 

Shirafkan A, Motahari M, Mojerlou M, Rezghi Z, Behnampour N, Gholamrezanezhad A
Correspondence: Dr Ali Gholamrezanezhad, gholamrezanejhad@razi.tums.ac.ir 

ABSTRACT
Introduction It has been suggested that hypertension (HTN) is associated with certain target organ damage (TOD) and related clinical conditions. On the other hand, left ventricular hypertrophy (LVH) has been considered as an independent risk factor of cardiovascular events and death. The aim of this study was to examine the relationship between HTN-induced LVH and TOD (retinopathy and renal failure). 
Methods We assessed 102 hypertensive subjects (43 males and 59 females) with a mean age of 60.2 +/- 8.8 (range 35–81) years. LVH was defined as a left ventricular mass index (LVMI) of more than 51 and 47 g/(m [to the power of 2.7]), in men and women, respectively. The degree of retinopathy on ophthalmological examination was defined according to the Keith-Wagener classification. Serum creatinine, blood urea nitrogen and urine protein concentrations were also measured. 
Results Hypertensive retinopathy was found in 94 (92.2 percent) cases (Grades I 55.9 percent; II 28.5 percent; III 3.9 percent; IV: 3.9 percent). The mean systolic and diastolic blood pressures and serum creatinine concentration showed significant correlation with the severity of LVH. There was no significant relationship between LVH severity and retinopathy or proteinuria. 
Conclusion The tight control of systolic and diastolic blood pressures in the first step of essential hypertension can assist to postpone LVH. Furthermore, routine measurement of serum creatinine can predict the risk of cardiovascular complications in the hypertensive patient.

Yeap R, Low WY
Correspondence: Dr Reiko Yeap, reiko_yeap@imu.edu.my

ABSTRACT 
Introduction This study examines the general public’s knowledge of mental health and explores effective tools to promote good mental health through a household survey of a representative sample of the Malaysian population residing in Klang Valley, Malaysia. 
Methods A total of 587 respondents, aged 18 years and older, responded to a series of questions in relation to mental health issues. Respondents were requested to specify how they learned about the information. Following that, an attitude scale was presented to the participants, and they were requested to rate how much they agreed to the statements. 
Results The findings indicated that the majority of the respondents did not have good knowledge of mental health. However,all respondents displayed a neutral attitude towards mental health issues. It was found that ethnic background, religion, educational level and residential location were the few demographic characteristics found to be significantly related to either the respondent’s knowledge or attitude towards mental health issues. With regard to seeking help, while the respondents’ ethnic background influenced their decisions, younger respondents and respondents with better attitude towards mental health were more willing to seek help. 
Conclusion This study has implications for promoting the understanding of the general mental well-being as well as the importance of seeking help for mental health in the local population. Steps should be taken to improve the public’s understanding of, and attitude towards mental health. These include the presentation of a positive image and the dissemination of accurate information by the mass media, the primary source for information on mental health.

Loh CH 
Correspondence: Dr Loh Chee Hong, seanchloh@gmail.com

ABSTRACT
Introduction In a country dominated by western healthcare, interest in traditional Chinese medicine (TCM) is growing. The increasing popularity of TCM, occasionally used with conventional medicine, needs to be assessed, especially in a vulnerable paediatric population. This paper sought to evaluate the use of TCM in children, mainly to determine the common conditions they seek TCM, the pattern of acupuncture or herbal usage for various age groups, the extent of concurrent usage of TCM and conventional medicine, and the reasons for TCM use. Paediatricians’ perceptions of TCM will allow us to gauge the acceptability of TCM by those who practise conventional medicine. These are assessed in another arm of this study, with a set of predictive characteristics for their personal TCM use, their perceptions of herb/acupuncture safety, and their own referral to TCM eventually determined.
Methods An anonymous questionnaire was administered on 300 parents awaiting consultation at a large TCM clinic. Next, a separate qualitative questionnaire survey form was posted to 100 paediatricians.
Results Herb usage in children is very common (84.3 percent) and 80 percent of parents admitted concurrent usage of TCM and conventional medicine for their children. Drug-herb interactions was an issue of concern for paediatricians. Paediatricians with a higher level of self-reported TCM knowledge were more likely to refer for a cure.
Conclusion This was the first study to determine the characteristics of children attending a large TCM clinic in a country which is dominated by western healthcare. It also provided insight into the perceptions of TCM among paediatricians in Singapore. Specifically, it gave us an idea of the predictor traits that determine their referral patterns to TCM and their perceptions of herb and acupuncture safety.

Tan VAK, Gerez IFA, Van Bever HP
Correspondence: Prof Hugo P Van Bever, paevbhps@nus.edu.sg

ABSTRACT
Introduction Adverse drug reactions (ADRs) are a common medical problem in children, affecting up to 15 percent of children, according to the literature. However, most studies on ADRs were performed in a hospital setting, and studies in the general population are limited. The current study aims to estimate the prevalence of ADRs in a large number of non-selected Singaporean children.
Methods School children, aged 7–16 years, from 25 random schools were screened via a self-reported questionnaire on ADRs, and parents of the selected children were then followed up with a telephone interview to obtain additional information on specific manifestations, diagnosis and allergy testing.
Results The prevalence of an ADR in children was 5.4 percent, with 56.7 percent of cases reporting an ADR to beta-lactam antibiotics. Dermal manifestations were reported in 60 percent of all ADRs, while multiple drug allergies accounted only for 3.8 percent. Only 6.9 percent of the children who experienced an ADR were referred to a hospital for further investigations.
Conclusion ADRs were associated with a positive history of atopy, increased income level and Chinese and Indian ethnicity, but not with gender or age. It is striking that most children suffering from a clinical ADR were not investigated further or referred for diagnostic tests. Many parents were unaware of the availability of drug allergy tests and feared compromising their children’s health. This certainly could attribute to the high incidence of the over-reporting of ADRs in the general population.

Keywords: adverse drug reaction, antibiotics, beta-lactam antibiotics, drug allergy, skin reactions
Singapore Med J 2009; 50(12): 1158-1161

Asma A, Marina MB, Mazita A, Fadzilah I, Mazlina S, Saim L
Correspondence: Dr Asma Abdullah, asmaent@yahoo.com.

ABSTRACT
Introduction This study aims to review the management and discuss the outcome of patients with iatrogenic facial nerve palsy. 
Methods 11 patients with iatrogenic facial nerve palsy (FNP) were evaluated retrospectively in a tertiary centre between June 1995 and September 2008. All the cases were referred from other centres. 
Results Ten patients had iatrogenic immediate FNP secondary to mastoidectomy and one had FNP secondary to superficial parotidectomy. Of the ten cases, three had concomitant profound sensorineural hearing loss and one had concomitant labyrinthine fistula. Ten patients underwentfacialnerveexplorationandonepatient was managed conservatively. The second genu was the commonest site of injury (60 percent). Facial nerve recoveries were achieved to Grade I House Brackmann classification in five cases, Grade II in two cases and Grade III in two cases postoperatively. One case defaulted follow-up. One patient, managed conservatively, recovered to FNP Grade II after five months post-injury. 
Conclusion Mistakes that most likely occurred during mastoid surgery are drilling towards the antrum, causing injury to the facial nerve at the second genu. Early facial nerve exploration and neurolysis resulted in good facial nerve recovery.