Typical magnetic resonance features of a haemangioblastoma, an uncommon nerve root lesion: case report and literature review

Haemangioblastomas are uncommon tumours of the central nervous system. Nerve root haemangioblastomas with both intradural and extradural components are extremely rare. We present a case of a C2 nerve root haemangioblastoma in a 64-year-old man where the preoperative diagnosis was a spinal meningioma. An unexpectedly vascular tumour was found at initial procedure. Urgent catheter angiography was performed and the tumour was embolized prior to complete excision at a subsequent procedure.

Exchanging dual-lumen central venous catheters: how I do it

The management of a blocked long-term central venous catheter has traditionally been removal and re-siting, even when device failure is not associated with venous thrombosis or sepsis. It is not possible to 'railroad' a split dual-lumen central venous catheter down a long tortuous s.c. tunnel. Our exchange technique was designed to salvage the tunnel and venous access site in a long-term catheter that has had uncomplicated primary device failure. In this technique we divide the dual-lumen catheter and secure the venous access site and the s.c. tunnel with separate peel-away sheaths. The new catheter is then introduced in the conventional manner through the two peel-away sheaths, which are then removed. The key advantage of the technique is that it preserves one of the few central venous access sites available. This article describes exchange of an internal jugular catheter, but the same technique is applicable to subclavian catheters.

Survey on mammographic screening among women aged 40 to 65 years old at polyclinics

INTRODUCTION

Breast cancer is the commonest female cancer in Singapore. It is steadily rising with an incidence of 53.1 cases per 100,000 persons per year among women. Screening for detection of early lesions which are highly curable helps to reduce mortality.

METHODS

Over three afternoon sessions in December 2003, 224 female patients aged 40-65 years, participated in interviews conducted by the National Healthcare Group Polyclinics, Singapore. The survey sought information on mammographic screening history, the time interval since the previous mammographic screening, and the reasons for not going for the screening.

RESULTS

The survey found that only 26.4 percent (28 out of 106) among those aged 40 to 49 years had mammographic screening done within the past one year, and 43.2 percent (51 out of 118) among those aged 50 to 65 years had screening done within the last two years. Chinese women were twice more likely than Malay women to have a mammogram done. The commonest reasons for not wanting to have mammographic screening among women who did not have a mammogram done or had mammogram done more than two years ago, were lack of time (42.5 percent), fear of pain during the procedure (26.9 percent), and the belief that cancer would not happen to them (24.6 percent).

CONCLUSION

Despite publicity on breast cancer being the commonest cancer among women in Singapore and cure being possible if the malignancy was detected early, close to half of the women aged 40-65 years old who attended the National Healthcare Group Polyclinics did not have mammographic screening done. One-quarter of the women who did not have mammogram screening did not do so as they did not think cancer would happen to them.

Managing peripherally inserted central catheter-related venous thrombosis: How I do it

Imaging-guided insertion of central venous catheters, either in the form of a peripherally inserted central catheter (PICC) or through a subclavian or a jugular approach, is becoming the preferred method of acquiring long-term venous access for a variety of therapeutic purposes. The most significant complication from central venous catheters is thrombosis of the catheterized vein. Venous thrombosis related to the insertion of PICC lines is conventionally treated with line removal followed by anticoagulation. Direct thrombolysis with urokinase, using the lumen of the PICC line to facilitate the insertion of the infusion catheter is a simple, safe and effective treatment option. In this article, we describe our experience with this procedure and the technique used.

The field testing of Denver Developmental Screening Test Singapore: a Singapore version of Denver II Developmental Screening Test

The Denver Developmental Screening Test, Singapore (DDST, Singapore), a Singapore version of the Denver II Developmental Screening Test, was field-tested, using trained staff nurses as testers, on 2459 children (known cases excluded), in 5 key ages of 3 months, 9 months, 17 months, 37 months and 60 months. Only 2.6% (65) of the parents suspected developmental problems in their children before screening. Taking children with "questionable" (7.2%), "abnormal" (3.7%) and "untestable" (1.7%) scores as the screened-out cases, the DDST, Singapore had a screened-out rate of 12.6%. A total of 171 screened-out cases and 168 "normal" children were also evaluated by the Development Assessment Clinic (DAC) of the Singapore General Hospital and the results were compared in these 2 groups of children. Among the screened-out cases, 16.6% were confirmed or suspected to have neuro-developmental disorders (NDDs) by the DAC. The computed NDD rate in the study sample was 5.3%. Based on a single DDST, Singapore test result, there was a high false positive rate of 83.5% and lower false negative rate of 3.7% compared to the DAC assessment. However, the high false positive rate would be significantly reduced by doing a repeat screening test on the "questionable" cases and having the screened-out cases assessed by trained primary health care doctors. In conclusion, no major revision is needed in the scoring criteria suggested in the current version of DDST, Singapore. It is a useful tool in identifying children who will otherwise be missed without formal screening.

Reduction of inflammation and pyrexia in the rat by oral administration of SDZ 224-015, an inhibitor of the interleukin-1 beta converting enzyme

1. The aim of this study was to determine whether a synthetic inhibitor of the interleukin-1 beta converting enzyme (ICE) displays oral activity in models of inflammation. 2. To this end, the ICE inhibitor, SDZ 224-015, was examined in rat paw oedema, pyrexia and nociception tests. 3. SDZ 224-015 (0.3-300 micrograms kg-1) potently reduced carrageenin-induced paw oedema, with an oral ED50 of approximately 25 micrograms kg-1. This effect was independent of endogenous glucocorticoid, as shown by retention of activity upon adrenalectomy. 4. Pyrexia induced by lipopolysaccharide (0.1 mg kg-1 s.c.) or by interleukin-1 beta (100 ng i.v.) was also reduced, over a similar dose-range to oedema (oral ED50s 11 micrograms kg-1 and 4 micrograms kg-1 respectively). 5. SDZ 224-015 (0.2-5 mg kg-1, p.o.) displayed analgesic activity in the Randall-Selitto yeast-inflamed paw pressure test, significant at a dose of 1 mg kg-1, p.o. 6. Thus, SDZ 224-015 has potent oral activity in several acute models for inflammation, suggesting that ICE inhibitors may constitute a novel type of anti-inflammatory agent.

Expression, refolding, and autocatalytic proteolytic processing of the interleukin-1 beta-converting enzyme precursor

The interleukin-1 beta-converting enzyme is a heterodimeric cysteine protease that is produced as a 45-kDa precursor. The full-length precursor form of the enzyme was expressed in Escherichia coli as insoluble inclusion bodies. Following solubilization and refolding of the 45-kDa protein, autoproteolytic conversion to a heterodimeric form containing 10- and 20-kDa subunits was observed. This enzyme had catalytic activity against both natural (interleukin-1 beta precursor) and synthetic peptide substrates. The inclusion of a specific inhibitor (SDZ 223-941) of the converting enzyme in the refolding mixture prevented proteolytic processing to the 10-/20-kDa form. Similarly, refolding under nonreducing conditions also prevented processing. Time course experiments showed that the 10-kDa subunit was released from the 45-kDa precursor before the 20-kDa subunit, implying that the N-terminal portion of the precursor is released last and may play a regulatory role.