Sternoclavicular Joint Infection: Classification of Resection Defects and Reconstructive Algorithm

BACKGROUND: Aggressive treatment of sternoclavicular joint (SCJ) infection involves systemic antibiotics, surgical drainage and resection if indicated. The purpose of this paper is to describe a classification of post resectional SCJ defects and highlight our reconstructive algorithm. Defects were classified into A, where closure was possible often with the aid of topical negative pressure dressing; B, where parts of the manubrium, calvicular head, and first rib were excised; and C, where both clavicular, first ribs and most of the manubrium were resected. METHODS: Twelve patients (age range, 42 to 72 years) over the last 8 years underwent reconstruction after SCJ infection. There was 1 case of a type A defect, 10 type B defects, and 1 type C defect. Reconstruction was performed using the pectoralis major flap in 6 cases (50%), the latissimus dorsi flap in 4 cases (33%), secondary closure in 1 case and; the latissimus and the rectus flap in 1 case. RESULTS: All wounds healed uneventfully with no flap failure. Nine patients had good shoulder motion. Three patients with extensive clavicular resection had restricted shoulder abduction and were unable to abduct their arm past 90degrees. Internal and external rotation were not affected. CONCLUSIONS: We highlight our reconstructive algorithm which is summarised as follows: for an isolated type B SCJ defect we recommend the ipsilateral pectoralis major muscle for closure. For a type C bilateral defect, we suggest the latissimum dorsi flap. In cases of extensive infection where the thoracoacromial and internal mammary vessels are thrombosed, the pectoralis major and rectus abdominus cannot be used; and the latissimus dorsi flap is chosen.

Global air monitoring study: a multi-country comparison of levels of indoor air pollution in different workplaces

<p><b>INTRODUCTION</b>A local study completed in Singapore, which was part of an international multi-country study that aims to develop a global assessment of exposure to second-hand smoke in indoor workplaces, gathered data regarding the indoor air quality of public areas. It was hypothesised that air would be less polluted in non-smoking venues compared to places where smoking occurred.</p><p><b>MATERIALS AND METHODS</b>A TSI SidePak AM510 Personal Aerosol Monitor was used to sample and record the levels of respirable suspended particles (RSP) in the air. A broad range of venues were sampled in Singapore. The primary goal of data analysis was to assess the difference in the average levels of RSP in smoke-free and non smoke-free venues. Data was assessed at 3 levels: (a) the mean RSP across all venues sampled compared with the mean levels of smoke-free and non smoke-free venues, (b) levels in venues where smoking occurred compared with similar venues in Ireland, and (c) comparison between smoke-free and non smoke-free areas according to the type of venue. Statistical significance was assessed using the Mann-Whitney U-test.</p><p><b>RESULTS</b>The level of indoor air pollution was 96% lower in smoke-free venues compared to non smoke-free venues. Averaged across each type of venue, the lowest levels of indoor air pollution were found in restaurants (17 microg/m3) and the highest in bars (622 microg/m3); both well above the US EPA Air Quality Index hazardous level of >or=251 ug/m3.</p><p><b>CONCLUSIONS</b>This study demonstrates that workers and patrons are exposed to harmful levels of a known carcinogen and toxin. Policies that prohibit smoking in public areas dramatically reduce exposure and improve worker and patron health.</p>

Induction concurrent chemoradiotherapy using Paclitaxel and Carboplatin combination followed by surgery in locoregionally advanced non-small cell lung cancer--Asian experience

<p><b>INTRODUCTION</b>It has been established that combined chemoradiotherapy treatment benefits selected patients with stage III Non Small Cell Lung Cancer (NSCLC). However, locoregional recurrence still poses a problem. The addition of surgery as the third modality may provide a possible solution. We report our experience of using the triple-modality approach in this group of patients.</p><p><b>MATERIALS AND METHODS</b>This is a retrospective review of 33 patients with stage III NSCLC treated between 1997 and 2005. Patients have good performance status and no significant weight loss. There were 26 males (79 %) with median age of 63 years (range, 43 to 74) and median follow-up of 49 months. Seventy-six percent had Stage IIIA disease. Chemotherapy consisted of paclitaxel at 175 mg/m2 over 3 hours followed by carboplatin at AUC of 5 over 1 hour. Thoracic radiotherapy was given concurrently with the second and third cycles of chemotherapy. All patients received 50 Gray in 25 fractions over 5 weeks.</p><p><b>RESULTS</b>The main toxicities were grade 3/4 neutropenia (30%), grade 3 infection (15 %) and grade 3 oesophagitis (9%). Twenty-five patients (76%) underwent surgery. Of the 8 who did not undergo surgery, 1 was deemed medically unfit after induction chemoradiotherapy and 4 had progressive disease; 3 declined surgery. Nineteen patients (58 %) had lobectomy and 6 had pneumonectomy. The median overall survival was 29.9 months and 12 patients are still in remission.</p><p><b>CONCLUSION</b>The use of the triplemodality approach is feasible, with an acceptable tolerability and resectability rate in this group of patients.</p>

Survival of small-cell lung cancer and its determinants of outcome in Singapore

<p><b>INTRODUCTION</b>The survival and epidemiology of small-cell lung cancer (SCLC) in Singapore has not been described. We aim to present the characteristics as well as determine the survival outcome and important prognostic factors for SCLC patients.</p><p><b>MATERIALS AND METHODS</b>A retrospective analysis of SCLC patients diagnosed from 1999 to 2002 was conducted at the Outram campus, Singapore. Clinical characteristics and treatment data were obtained from case records and survival data were checked with the registry of births and deaths on 30 May 2005.</p><p><b>RESULTS</b>One hundred and eleven patients were analysed. There were 38 (34.2%) limited-disease (LD) patients and 73 (65.8%) extensive-disease (ED) patients. The majority were current or former smokers (94.7% among LD and 94.5% among ED). More patients with LD had good performance status (92% versus 63%, P = 0.0003) and were treated with combined chemotherapy and radiotherapy (82% versus 48%, P = 0.012). The median survival time of LD patients treated with curative chemoradiotherapy was 14.2 months (95% CI, 10.96 to 17.44). Those given prophylactic cranial irradiation had a median survival time of 16.9 months (95% CI, 11.83 to 21.97). For ED patients, the median survival time was 8.17 months (95%CI, 5.44 to 10.89). None of the factors analysed were significant prognostic factors for LD patients while performance status and type of treatment given were significant among ED patients.</p><p><b>CONCLUSIONS</b>We found that the characteristics and survival of SCLC patients in Singapore are fairly similar to that of other countries.</p>