Protection of probiotic bacteria in a synbiotic matrix following aerobic storage at 4 °C.

The survival of single strains of Bifidobacterium breve, Bifidobacterium longum, Lactobacillus acidophilus, and Lactobacillus reuteri was investigated in synbiotics that included 10 mg/ml of fructo-oligosaccharides, inulin and pectic-oligosaccharides in an alginate matrix under refrigerated (4 °C) aerobic storage conditions. When the matrices were cross-linked with calcium (45 mM), 102-103 cfu/ml of L. acidophilus and L. reuteri, and 0-103 cfu/ml of B. breve and B. longum survived refrigerated aerobic storage for 28 days. Following refrigerated storage, acetic (3-9 mM), butyric (0-2 mM), propionic (5-16 mM) and lactic acids (1-48 mM) were produced during the growth of probiotics in BHI broth at 37 °C, suggesting their metabolic activity after storage was stressed. When calcium cross-linking was not used in synbiotics, the matrix remained more gel-like after inoculation when compared to the calcium cross-linked matrix. At least 107 cfu/ml of probiotic bacteria survived after 21 days of storage within these gel-like alginate matrices. Significantly higher levels of B. breve, L. acidophilus and L. reuteri were obtained from the synbiotic matrices supplemented with fructo-oligosaccharides, inulin and pectic-oligosaccharides compared to alginate alone. B. longum survival was the same (~7 logs) in all gel-like synbiotic matrices. These results show that synbiotics protected probiotic bacteria and extended their shelf-life under refrigerated aerobic conditions. Synbiotics represent a viable delivery vehicle for health-promoting bacteria.

Release property and antioxidant effectiveness of tocopherol-incorporated LDPE/PP blend films.

Low-density polyethylene (LDPE)/polypropylene (PP) blend films in various blending ratios containing 3000 mg kg⁻¹ of tocopherol were manufactured by an extrusion process. Tocopherol release properties were characterised and correlated with antioxidant effectiveness in retarding the oxidation of linoleic acid contacting the films at 40°C. The conditions without tocopherol (control) and with instant tocopherol addition corresponding to the amount included in the films were also prepared and compared with the film-contacting solutions. The effect of tocopherol inclusion and the blending ratio on their physical properties was also examined. A wide range of tocopherol diffusivity in 6.6 × 10⁻¹6-4.6 × 10⁻¹4m² s⁻¹ were obtained by blend films. As PP content increases, the diffusivity decreased sharply at the beginning and levelled off later. The slower release of tocopherol in LDPE/PP blend films corresponding to lower tocopherol diffusivity retained the higher tocopherol concentration in the linoleic acid system providing better antioxidant effectiveness of the extended induction period in oxidation. The tocopherol inclusion reduced tensile strength and transparency significantly in an affordable range with higher tensile strength given by a higher PP ratio. LDPE/PP blending can be a useful tool to modulate the release profile of tocopherol and thus the antioxidant effectiveness of the tocopherol-incorporated antioxidant packaging film.

Case report of granular cell tumor of the vulva and review of current literature.

► We present four cases of benign granular cell tumours of the vulva managed between 1998 and 2001. ► We discuss the clinical and histopathological features of this condition. ► Treatment of this condition is primarily surgical.

Tailoring the field and indication of adjuvant pelvic radiation for patients with FIGO stage Ib lymph nodes-negative cervical carcinoma following radical surgery based on the GOG score--a pilot study.

INTRODUCTION: The traditional indications for adjuvant pelvic radiotherapy (RT) for International Federation of Obstetrics and Gynecology (FIGO) stage Ib1 lymph nodes-negative cervix carcinoma following radical surgery based on histopathological factors, such as deep stromal invasion and lymphovascular space invasion (LVSI), were often inconsistently applied. The perceived risk of relapse was subjectively determined. This pilot study attempts to determine if the treatment outcome will be affected when the indication for RT is based on the Gynecologic Oncology Group (GOG) Risk Score (RS) and the field of adjuvant RT is tailored to the RS. MATERIALS AND METHODS: From 1997 to 1999, 55 patients with FIGO stage Ib1 lymph nodes-negative cervical carcinoma limited to the cervix were prescribed RT following radical surgery, based on their RS, as follows: RS <40, RT is omitted; RS >40 to <120, modified (smaller) field RT; and RS >120, standard field pelvic RT. Their incidence and site of recurrence were compared with a similar cohort of 40 patients who were treated prior to 1997. RESULTS: Prior to 1997, of the 40 patients, 10 patients were given standard field RT. There were 2 (5%) recurrent diseases. The mean duration of follow-up was 61.6 months (range, 1 to 103 months). The RS of 23 of the 30 patients who were not given RT were available. The mean RS was 22 with 5 patients having a score of >40. From 1997 onwards, of the 55 patients, 28 (51%) did not require RT, 13 (23%) were treated with modified (smaller) field RT and 14 (26%) were given standard field RT. There were 2 (3.6%) cases of relapse. The mean duration of follow-up was 36.4 months (range, 5 to 60 months). All patients with a RS of <40 did not suffer any relapse. Their survival outcomes were better when compared to patients who did not have any RT in the GOG Study. CONCLUSIONS: The results of this study indicated that postoperative adjuvant RT given to patients with a high GOG RS of >120, significantly improved their 5-year recurrence rate and disease-free survival, as compared with the similar group of patients who were without adjuvant therapy in the GOG study. Patients with a GOG risk-score of <40 may be safely spared from adjuvant pelvic RT. The current treatment protocol did not compromise the outcome in patients, compared with the use of a less precise treatment protocol in the past.

Bowel surgery for epithelial ovarian cancer--an early case series.

OBJECTIVES: The aims of this study were to review our local experience with bowel surgery for epithelial ovarian cancer at the Gynaecological Cancer Centre, KK Women's and Children's Hospital, and to document the outcome of such surgery as well as their complication rates. MATERIALS AND METHODS: The retrospective medical records of 38 patients with epithelial ovarian cancer who underwent surgery including bowel surgery from January 1997 to May 2002 at the Gynaecological Cancer Centre, KK Women's and Children's Hospital, Singapore, were reviewed. RESULTS: Indications for surgery were predominantly debulking of disease. Fifty-eight per cent of patients had primary debulking surgery, 34% had debulking of recurrence and 3% had interval debulking. Only 5% of patients had bowel obstruction as the only indication for surgery. Rectosigmoid resection was the most common bowel operation overall, being performed in 76.3% of patients. The stoma rate for rectosigmoid resection was 61%. The remaining procedures included 7 colectomies, 1 intestinal bypass procedure and 1 intestinal diversion procedure. Optimal debulking (defined as < 1 cm of residual disease) was achieved in the majority (71%). The median operating time was 4 hours. The median blood loss was 1300 mL. The major complication rate was 10.5%. Major complications encountered were as follows: 1 patient (2.6%) had an anastomotic leak, 2 patients (5.3%) had intra-abdominal abscess and 1 patient (2.6%) developed intestinal fistula. Three patients (7.8%) required a re-operation within 30 days. There were 3 deaths (7.8%) within 30 days of surgery. CONCLUSION: Bowel surgery is commonly indicated for epithelial ovarian cancer to facilitate optimal debulking. Such surgery is feasible with acceptable complication rates in our local centre.

FIGO stage 1B2 cervical carcinoma--the KK Women's and Children's Hospital experience.

INTRODUCTION: The objectives of this review were to document the surgico-pathological characteristics of surgically resected FIGO stage 1B2 cervical carcinoma and to review our overall experience with this disease. MATERIALS AND METHODS: This is a retrospective review of 35 patients diagnosed and treated from September 1990 to November 2001. RESULTS: The median age was 42 years and the mean tumour diameter was 5.1 cm. Majority were squamous cell carcinomas (65.7%), 28.6% were adenocarcinomas and 5.7% were adeno-squamous carcinomas. The primary treatment comprised radical surgery in 77.1%, radiotherapy in 20% and neoadjuvant chemotherapy followed by radical surgery and adjuvant radiotherapy in 2.9%. Significant surgico-pathological features noted were deep stromal invasion (66.7%), lympho-vascular space invasion (55.6%), parametrial involvement (22.2%), positive margins (3.7%) and pelvic node metastases (33.3%). Postoperative radiation was given to 92.6% of the patients who underwent primary surgery, of whom 29% received concurrent chemotherapy. Radiation toxicity was mild with no grade 3 or 4 toxicity documented. For the patients who had surgery, the recurRence rate was 14.8% (11.1% pelvic and 3.7% distant) and the survival rate was 88.9%. For those who had primary radiation, the rate of persistent disease was 28.6%, the distant recurrence rate was 28.6% and the survival rate was 57.1%. CONCLUSION: FIGO stage 1B2 cervical carcinomas are associated with significant rates of adverse surgico-pathological features. The ideal primary treatment is yet to be established and should be determined by prospective randomised trials.

Endometrioid adenocarcinoma of the uterus: surgico-pathological correlations and role of pelvic lymphadenectomy.

INTRODUCTION: In 1988, FIGO added lymph node surgery to the staging system for endometrial cancer. This change remains controversial to date. From our study we aim to determine the significance of surgico-pathological parameters of endometrioid carcinoma for pelvic nodal metastases and survival, as well as to study the role of pelvic lymphadenectomy in the surgical treatment of this disease. MATERIALS AND METHODS: A retrospective study was conducted in 198 women with endometrioid carcinoma who underwent full surgical staging including pelvic lymphadenectomy. The multiple variant regression analysis and the multi-variant logistic regression analysis were applied in the analysis of relationship. RESULTS: A positive correlation between nodal metastases and grade, myometrial invasion, peritoneal cytology, adnexal involvement, lympho-vascular space involvement and tumour size was found. For survival, significant prognosticators were grade, myometrial invasion, peritoneal cytology, lympho-vascular space involvement, adnexal involvement, associated atypia and pelvic nodal metastases. Thirty-five per cent of the patients had high risk of recurrence based on uterine pathological factors but were node negative. They were spared external beam radiation and its associated morbidities, and were treated with adjuvant vault brachytherapy instead. Six per cent of the patients would have been understaged based on uterine factors alone if pelvic lymphadenectomy had not been done. CONCLUSION: We infer that routine pelvic lymphadenectomy should be considered for all surgically fit patients with endometrioid carcinoma. The accurate staging will allow individualized adjuvant therapy and prevent understaging and overtreatment.

Red eyes as the initial presentation of systemic meningococcal infection.

The present paper is a report of a 14-month-old boy who presented with fever, coryzal symptoms and red eyes. The patient developed a generalized tonic clonic convulsion on day 2 of his illness. Ophthalmological assessment demonstrated bilateral hypopyon and vitreous opacity resulting from endophthalmitis. Cerebrospinal fluid was positive for Neisseria meningitidis (A, C, Y, W 135) by latex agglutination. He was treated with high dose intravenous cefotaxime and intravitreal ceftazidime. He made good recovery and his vision was preserved. In view of the potential morbidity and mortality associated with systemic meningococcal infection, the presence of red eye and hypopyon provides important diagnostic clues indicating the need to investigate beyond superficial conjunctivitis. It should prompt the clinician to recognize endopthalmitis early and accurately diagnose this serious disease.

Simple models for assessing migration from food-packaging films.

Owing to their simplicity, two migration models based on Fick's Second Law have been frequently used for the assessment of migration of additives and contaminants from food-packaging films. While the two models are known to provide accurate estimates of diffusion coefficients for complete migration, they could generate considerable estimation errors for significantly partitioned migration. In this paper, the applicability of the two models to partitioned migration is defined by examining the assumptions and derivations of the two models as well as their errors in estimating diffusion coefficients. Furthermore, a simple migration model, based on more realistic assumptions than the two models, is proposed. The proposed model can provide far better estimates of diffusion coefficients for partitioned migration than the two models.

Inhibition of Saccharomyces cerevisiae by slow release of propyl paraben from a polymer coating.

The inhibition of Saccharomyces cerevisiae by slow release of propyl paraben from a styrene-acrylate copolymer coating was examined and compared with the inhibition by direct addition of propyl paraben. Under slow release condition, a slow but continuous microbial inhibition was observed, whereas a cell outgrowth was observed under direct addition condition after a sufficient incubation time. S. cerevisiae cells isolated from the culture under direct addition condition were more tolerant of propyl paraben than cells isolated from the culture under slow release condition. The equilibrium propyl paraben concentrations under both conditions were 150 ppm. The release kinetics of propyl paraben from the coating at 30 degrees C was found to be controlled by Fickian diffusion within the coating. The estimated partition and diffusion coefficients were 4.65 x 10(-3) and 2.01 x 10(-10) cm2/s, respectively.

A comparative study of cervical cytology, colposcopy and PCR for HPV in female sex workers in Singapore.

This study examined the prevalence of human papillomavirus (HPV) infection in a cohort of female sex workers in Singapore. HPV infection was diagnosed by clinical examination, Papanicolaou (Pap) smears, histology and polymerase chain reaction (PCR). One hundred and eighty-seven female sex workers who came for their routine medical screening were enrolled into the study. PCR was positive for HPV in 27 (14.4%), 20 of these had a single HPV type detected, while 7 had multiple types of HPV detected. The most common HPV types identified were types 16, 58 and 18. In conclusion, HPV infection is moderately prevalent among sex workers as tested by PCR, but routine screening with Pap smears does not appear to be a sensitive method of diagnosis for HPV infection.

Kielland's forceps delivery: is it a dying art?

A retrospective study in the use of Kielland's Forceps for rotation of the foetal head and mid-cavity delivery in Kandang Kerbau Hospital, Singapore from 1987-1990 is presented. Out of a total of 53,889 singleton births during this period, Kielland's Forceps was used for delivery in 137 (0.25%) patients with an incidence of 0.65% in the primiparae and 0.07% in the multiparae. Primiparity, induction of labour and epidural analgesia were associated with a significantly higher incidence of rotational delivery by Kielland's forceps. The success rate of Kielland's forceps delivery was 93.4% (128 of 137). There was no maternal or perinatal mortality. About one-third of the mothers experienced postpartum morbidity, commonest being retention of urine, postpartum haemorrhage and vaginal lacerations. Traumatic injuries were present in about one-quarter of the babies and were minor. Out of a total of 306 mid-cavity deliveries for occipito-transverse malposition, Kielland's forceps accounted for 38.2% (117), vacuum extraction 30.7% (94), manual rotation followed by Neville-Barnes forceps 11.1% (34) and Caesarean section 20.0% (61). The junior specialists tended to use vacuum extraction for rotational delivery more than the senior specialists.

Primary malignant lymphoma of the cervix uteri: a case report.

Primary reticuloendothelial disease of the genital tract is an extremely rare condition. We encountered one such patient with diffuse large cell malignant lymphoma of the cervix uteri who presented with irregular vaginal bleeding. After complete haematological and radiological investigations, satisfactory treatment of the Stage I disease was achieved with total hysterectomy, bilateral salpingo-oophorectomy and post-operative pelvic irradiation.

Diffusion of small solutes in polymer-containing solutions.

Diffusion processes involving polymers are common in scientific and engineering separations and are a major component of biological functions. Analyses of these systems are usually based on versions of the Stokes-Einstein equation, although order of magnitude deviations have been observed. Presented here is a theoretical correction to the Stokes-Einstein equation containing a "local viscosity" function that combines diffusional hydrodynamics with Maxwell's treatment of electrical resistance in inhomogeneous regions. The resulting equation accurately predicts experimental diffusion data within tight bounds for polymer concentrations from 0 to 9 percent. It requires knowledge only of thermodynamics and of pure solvent and solution viscosities.