by the Department of Hand and Reconstructive Microsurgery at the Singapore National University Hospital. A retrospective analysis was done. Information captured included clinical data, hand dominance, AO classification of fractures, mechanism of injury, associated injuries as well as treatment modalities.Results: Of the 431 fractures, 238 were males, 181 were females. These fractures occur at all ages, peaking at the 50 to 60 years age group. The peak incidence of distal radius fractures in females occurred in the perimenopausal age group, whereas the incidence for males peaked between age of 30 to 50. By AO classification, 53% were type A; 13% were type B and 32% were type C. A fall on the outstretched hand from a standing position is the most common mechanism of injury. As the intensity of the injury mechanism increased, the percentage of type C fractures increased correspondingly. Older patients were more likely to be treated conservatively compared to younger patients. AO severity classification correlated well with the clinician's decision to surgically fix the fracture. No correlation between hand dominancy and fracture site found was found. Conclusion:We compared our data with that of previous similar studies, and found similarities as well as differences in results. Nevertheless, the epidemiogical data gathered in this study has added to our knowledge of distal radius fractures in an Asian population.

Background: The potential value of lithium treatment in particular aspects of unipolar major depressive disorder remains uncertain. Methods: With reports of controlled trials identified by systematic searching of Medline, Cochrane Library, and PsycINFO literature databases, we summarized responses with lithium and controls followed by selective random-effects meta-analyses. Results: We identified 36 reports with 39 randomized controlled trials: six for monotherapy and 12 for adding lithium to antidepressants for acute major depression, and 21 for long-term treatment. Data for monotherapy of acute depression were few and inconclusive. As an adjunct to antidepressants, lithium was much more effective than placebo (p<0.0001). For long-term maintenance treatment, lithium was more effective than placebo in monotherapy (p=0.011) and to supplement antidepressants (p=0.038), and indistinguishable from antidepressant monotherapy. Conclusions: The findings indicate efficacy of lithium as a treatment for some aspects of major depressive disorder, especially as an add-on to antidepressants and for long-term prophylaxis. It remains uncertain whether some benefits of lithium treatment occur with many major depressive disorder patients, or if efficacy is particular to a subgroup with bipolar disorder-like characteristics or mixed-features.

Grading of breast cancer based on the modified Scarff, Bloom, and Richardson system provides invaluable prognostic information. Recent evidence suggests that most tumours do not usually progress between grades and that groups of tumours within each grade are biologically distinct. This study has explored one potential aspect of biological tumour heterogeneity within grade by examining the relationship between cell polarity, the cell adhesion molecule E‐cadherin, a major effector of cell polarity, and outcome, in 149 grade I infiltrating ductal breast carcinomas. Polarity was evaluated by studying the degree to which three features of polarized epithelial cells—nuclear ordering, basal positioning of nuclei within cells, and apical snouting/blebbing—were present in these tumours. E‐cadherin expression was investigated using the antibody HECD‐1. A low degree of tubule formation was correlated with poor nuclear ordering ( p< 0·01). The three histological features—nuclear ordering, basal nuclei, and apical blebbing—were all correlated with each other (all p< 0·0001). Polarity measurements did not correlate with survival. E‐cadherin expression did not correlate with polarity and negative tumours were still able to form tubules. Surprisingly, strong E‐cadherin immunostaining correlated with poor survival, tumour size, and nodal status. On univariate parametric (Weibull) survival models, high E‐cadherin scores and tumour size were both significant predictors of survival in this group. Copyright © 1999 John Wiley & Sons, Ltd.

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