This is a review of the positive biopsy rate of nonpalpable breast lesions detected on mammography. The histology of 130 hookwire excision biopsy from 1990 to 1995 and the cytology of 39 stereotactic fine needle aspiration cytology in 1995 were reviewed. The yearly positive biopsy rate of each procedure was determined. In 1990, the positive biopsy rate for hookwire excision biopsy was 15%, in 1991 20%, in 1992 11%, in 1993 17%, in 1994 33% and in 1995 39%. In 1995, the positive biopsy rate for stereotactic fine needle aspiration cytology was 21%. The positive biopsy rate for hookwire excision biopsy had improved from 15% in 1990 to 39% in 1995.
MeSH terms: Biopsy/methods; Breast/pathology*; Breast Diseases/pathology*; Breast Diseases/radiography*; Female; Humans
We report our experience with intralesional injection of bleomycin in the treatment of neck lymphangioma. From May 1995 to April 1998, 11 patients aged between 6 to 22 months were treated with intralesional bleomycin injection. Ultrasonography and computed tomography were used to assess and select the cases suitable for sclerotherapy. Patients with lesions encasing the internal jugular vein and the carotid artery were chosen. With the patient under sedation and using ultrasound guidance, the cysts were aspirated and bleomycin was injected at a dose of 0.5 mg/kg body weight. The number of procedures varied from 1 to 4 over a period of 8 months to 1 year. Patients were initially followed-up 3 monthly, then 6 monthly and subsequently yearly. In 4 patients, the neck mass was no longer visible (excellent response). In 5 patients, the neck mass had reduced to a size (more than 50% reduction) that was cosmetically acceptable (good response). There were 2 failures (poor response). There were no complications. Our results suggest that intralesional injection of bleomycin can be effectively used to treat selected cases of neck lymphangiomas.
MeSH terms: Antibiotics, Antineoplastic/administration & dosage*; Antibiotics, Antineoplastic/therapeutic use; Bleomycin/administration & dosage*; Bleomycin/therapeutic use; Drainage; Head and Neck Neoplasms/drug therapy*; Head and Neck Neoplasms/surgery; Humans; Infant; Lymphangioma/drug therapy*; Lymphangioma/surgery; Injections, Intralesional
The bioavailability of a generic preparation of ketoconazole (Zorinax from Xepa-Soul Pattinson, Malaysia) was evaluated in comparison with the innovator product (Nizoral from Janssen Pharmaceutica, Switzerland). Eighteen healthy male volunteers participated in the study conducted according to a two-way crossover design. The bioavailability was compared using the parameters, total area under the plasma concentration-time curve (AUC0-infinity), peak plasma concentration (Cmax) and time to reach peak plasma concentration (Tmax). No statistically significant difference was observed between the values of the two products in all the three parameters. Moreover, the 90% confidence interval for the ratio of the logarithmic transformed AUC0-infinity and Cmax values of Zorinax over Nizoral was found to lie between 0.82-1.04 and 0.83-1.02, respectively, being within the acceptable equivalence limit of 0.80-1.25. These findings indicate that the two preparations are comparable in the extent and rate of absorption. In addition, the elimination rate constant (ke) and apparent volume of distribution (Vd) were calculated. For both parameters, there was no statistically significant difference between the values obtained from the data of the two preparations. Moreover, the values are comparable to those reported in the literature.
Severe bronchiolitis requiring mechanical ventilation is uncommon and is associated with the risk of barotrauma. We report our experience with 25 (42%) of 60 infants admitted to the Paediatric Intensive Care Unit (PICU) with severe bronchiolitis who required mechanical ventilation. Eighteen patients (72%) had severe hypoxaemia (PaO2/FiO2 < 250). The mean airway pressure required ranged from 5.8 to 15.6 cmH2O with median ventilation duration of 4.0 days (range 2.0-14.0 days). Oxygenation improved significantly within 12 hours of intubation. There was only one death. Mechanical ventilation is required in a subset of patients for severe bronchiolitis and is effective and generally well tolerated.
This retrospective study documents a strong correlation between tuberculin reactivity and the subsequent development of active tuberculosis in student nurses. 12% of the 25 student nurses with tuberculin reactions above 20 mm developed tuberculosis over a period of 2 years, compared to only 0.3% of the 341 student nurses with reactions of 20 mm or less. The implications of these findings for preventive therapy are discussed.
Near-miss cases in life-threatening obstetric patients occurring over a one year period are analysed retrospectively with regards to morbidity measured in terms of hospital stay, utilisation of high dependency ward and intensive care beds and adequacy of clinical management. One-hundred and twenty two cases occurred among 9932 deliveries. Massive obstetric haemorrhage (54.2%) and hypertensive disorders of pregnancy (36.9%) were the two main diagnostic groups. Seventy one (58.2%) cases were referred from peripheral centres for obstetric management and 77 (63.1%) were not booked at this hospital for antenatal care. A majority were not ill-looking (92 cases) at the time of admission but turned for the worse in the course of labour. Interventional measures taken in clinical management were considered appropriate in all cases. Delay in instituting treatment was present in 6 cases. Remediable measures were recognised in 15 (12.3%). This study, apart from supplementing mortality audits, demonstrates that high risk obstetric patients can be triaged at the time of admission to labour wards by trained midwives and junior doctors in busy obstetric units without compromising standards of care.
Study site: Obstetric and Gynaecologic Unit in Ipoh Hospital.
Much has been said in various anaesthetic journals about the need to teach medical undergraduates in areas such as basic life support skills and resuscitation. Anaesthesiology as a specialty can contribute significantly in this aspect of teaching. The question is how should it be incorporated into the existing curriculum, given the fact that anaesthesiology constitutes a minor role in the undergraduate medical curriculum? This article attempts to answer this question and proposes the possible integration of anaesthesiology with the other major clinical specialties. This curriculum forms the basis of anaesthesiology curriculum at the Kulliyah of Medicine, International Islamic University Malaysia (IIUM).
Severe, persistent back pain following back surgery is often referred to as Failed Back Surgery Syndrome (FBSS). Conservative measures such as physiotherapy, back strengthening exercises, transcutaneous electrical nerve stimulation and epidural steroids may be inadequate to alleviate pain. Spinal Cord Stimulators were implanted into two patients suffering from FBSS. Both patients responded successfully to spinal cord stimulation with reduction of pain and disability.
MeSH terms: Adult; Back/surgery*; Back Pain/radiography; Back Pain/therapy*; China/ethnology; Electric Stimulation Therapy*; Female; Hospitals, University; Humans; Malaysia; Malaysia/ethnology; Postoperative Complications/surgery*; Spinal Cord/physiopathology*; Spinal Cord/radiography; Thoracic Vertebrae/radiography
This is a case report of an unusual case of a patient with dextrocardia and "situs inversus totalis" who presented with unstable angina. Coronary angiography revealed severe main stem and severe triple vessel coronary artery disease. The patient later underwent successful emergency coronary artery bypass graft surgery. To the authors' knowledge this is the first reported case in Malaysia and also, the first ever report in the literature of multiple vessel coronary artery grafting, including the use of the right internal mammary artery.
A 56-year-old Chinese lady with valvular heart disease and atrial fibrillation was referred to us from a private hospital for further management of autoimmune haemolytic anaemia. Physical examination and laboratory investigations did not support the diagnosis of haemolytic anaemia. However, direct antiglobulin test (DAT) was strongly positive with anti-IgG and negative with anti-C3d. There was also mild anaemia and reticulocytosis, which was attributable to persistent haematuria. The DAT became positive after commencing Unasyn and cessation was associated with decreasing reactivity of the positive DAT. We believe that the positive DAT in this patient was most likely due to the Unasyn therapy.
Swyer-James-MacLeod syndrome is a rare complication of respiratory tract infection occurring in early childhood. We report two children with chronic cough and recurrent wheezing who fulfilled the diagnostic criteria for this disorder: 1) Unilateral loss of lung volume with hyperlucency on chest x-ray. 2) Unilateral reduction in vascularity on CT scan of the chest. 3) Unilateral loss of perfusion on Technetium 99c lung scan.
Pericardial rupture after blunt chest trauma is described in the literature. This case report summarises our experience with a 22-year old male patient who suffered blunt chest trauma during a motor vehicle accident. On admission no serious injuries could be detected, but 3 hours later, displacement of the heart to the right hemithorax combined with sudden cardiac failure appeared. Emergency thoracotomy revealed a right-sided rupture of the pericardium with complete herniation of the heart into the right pleural cavity and consequent strangulation by the margins of the pericardial defect.
There are a number of differential diagnoses for crystal deposits in the cornea. With the presence of a corneal epithelial defect, the differential diagnosis can be narrowed down to either infective causes or deposits from topical medications. This report describes a case of crystal deposits in the cornea from the use of Vitamin C eye drops.
The management of a case of antenatally diagnosed meconium peritonitis (MP) due to intrauterine intestinal perforation secondary to bowel atresia is reported. The literature is reviewed with reference to the significance and outcome of antenatally diagnosed MP.
A 52 year old hypertensive Malay man, a smoker who presented with a one month history of mild chest discomfort not related to exertion and had a positive stress test with ST segment depression in the lateral leads. Coronary angiography showed stenosis in the right coronary artery and a coronary aneurysm in the proximal segment of his left anterior descending. The aneurysm was situated just distal to a stenotic lesion. The aneurysm is most likely related to atherosclerotic coronary artery disease. The patient was treated with oral nitrates, aspirin, angiotensin converting enzyme inhibitor and warfarin to prevent thromboembolism related to the coronary aneurysm. He remains asymptomatic one year after diagnosis.
Alzheimer's disease (AD) has become recognised as a major cause of morbidity and mortality in the ageing population worldwide. Over 20 million people worldwide are affected by AD, which ensures that the disease imposes a major economic burden. Alzheimer's disease is a progressive neurodegenerative disorder with characteristic clinical and neuropathological features. Neurofibrillary tangles, neuritic plaques and amyloid angiopathy occur in varying severity in brains of patient's with Alzheimer's disease. Biological markers of AD allowing an early definitive premorbid diagnoses are currently not available. Memory loss for recent events is invariable and often the earliest prominent symptom. Language disorders, difficulties with complex tasks, depression, psychotic symptoms and behavioral changes are other common manifestations of AD. Diagnosis involves the early detection of cognitive decline and ruling out other causes of dementia like vascular dementia, Lewy body dementia, fronto-temporal degeneration or reversible causes like hypothyroidism. Acetylcholinesterase inhibitors have shown to be effective in mild to moderate AD in improving the cognitive function of patients in clinical trials. Caregiver intervention programs have considerable potential to improve both the caregiver and patient quality of life.
An analysis of birth weight was undertaken on secondary data derived from the Malaysian Family Life Survey II. A total of 1629 last singleton live birth infants was analysed with the aim of identifying from the variables available potential risk factors for low birth weight. Univariate and subsequently multivariate analyses were carried out for this purpose. The incidence of low birth weight was 11.8 percent. Race, parity and prematurity were found to be significantly associated with low birth weight after controlling of the other variables. The findings indicate that more work needs to be done to establish the underlying reasons for low birth weight in Malaysia.
Study name: Malaysian Family Life Survey (MFLS-2)