Mice experimentally envenomed with Hypnale hypnale venom (1× and 1.5×LD₅₀) developed acute kidney injury (AKI) principally characterized by raised blood urea and creatinine. Prolonged blood clotting time and hemorrhage in lungs implied bleeding tendency. Pallor noted in most renal cortices was suggestive of renal ischemia secondary to consumptive coagulopathy. Intravenous infusion of Hemato polyvalent antivenom following experimental envenoming effectively prevented death and AKI in all mice, supporting its potential therapeutic use in envenoming cases.
Vagal nerve schwannoma is extremely rare. The majority of cases present with a slow growing neck swelling without neurological deficit. Magnetic resonance imaging is the gold standard investigation to establish a pre-operative diagnosis. We report a case of a 32-year-old man with an extensive right vagal nerve schwannoma involving the right jugular foramen and parapharyngeal space. The tumour was resected via a transcervical approach. Complete excision of the tumour is the key to prevent recurrence.
Pleomorphic sarcoma is the most common sarcoma. Reports of outcome as well as evaluation of prognostic factors in the literature show great variation. We looked at our experience in treating this tumour at University Malaya Medical Center. This is a review of patients diagnosed with Pleomorphic Sarcoma from January 1990 to December 2005 at University Malaya Medical Center. Outcome measures studied are the overall survival, disease free survival and local recurrence of disease. Prognostic factors for survival and local recurrence which were studied are the tumour size, depth, stage, type of surgery, adjuvant therapy, and surgical margin. There were fifty four patients available for analysis of demographics. The mean age at presentation was 52.3 +/- 16.7 years. There were thirty male patients (56%) and twenty four female patients (44%) in the study population. The patients were predominantly Malay (44.4%) and Chinese (42.6%). There were two Indian patients (3.7%) and five patients from other races (9.3%). Thirty patients had disease affecting the extremities while six patients had disease affecting the trunk. Patients with tumour affecting the trunk had 100% mortality. In patients with tumour affecting the extremity, 46.7% presented with Stage 3 disease. The overall median survival was 39 months. The overall survival rate at 3 years was 53.3% and the 5 years was 30.0%. The disease free survival rate at five years was 27.6%. However, if patients who presented with metastasis were excluded, the 5 year survival rate was 60% while the disease free survival was 53.3%. Recurrence rate was 33.3%. Factors affecting survival was stage, size and location of tumour. No factors were found to correlate with higher local recurrence rate. In conclusion, Pleomorphic Sarcoma is a heterogenous disease with variable outcome. In our centre, late presentation with advanced disease significantly affects the overall outcome of this condition. Tumour size and location are important prognostic factors. Inherent tumour behavior and aggressiveness probably outweigh current treatment modalities as the most important prognostic factor in the management of Pleomorphic Sarcoma.
We report a rare tumour of the nasopharynx- papillary adenocarcinoma. This is usually of low grade and certainly in out patient it behaved so. It is even rarer to have this tumour in a patient with Turner's syndrome in whom there is a high incidence of gynaecological malignancy. It has not previously been documented and the occurrence in this patient is probably coincidental.
Schistosomiasis is a widely prevalent disease in the world and usually involves the gastro-intestinal and urinary tract. The involvement of the female genital tract has been well-established in S. haematobium infections and is rare with S. japonicum infections. This case involves a Filipino female who was admitted to the University Hospital Kuala Lumpur for right iliac fossa pain and was diagnosed initially as acute appendicitis. Ultrasound showed a multi-septated pelvic cyst leading to a provisional diagnosis of ovarian torsion. Intraoperatively a right parovarian cyst was detected and removed. Histology revealed a congested cyst wall with areas of haemorrhage with several viable and calcified eggs of S. japonicum measuring 85 microns x 62 microns. Within the cystic cavity blood admixed with eggs were seen. Confirmation was carried out by using the indirect haemagglutination (IHA) test. This is a first report of upper genital schistosomiasis mimicking an ovarian tumour.
A 1 year review of 529 cases of acute appendicitis, treated at the University Hospital in 1990, was performed. Perforation rate was 23.7% and delay in diagnosis was found to be significant. Patients above 50 years of age were particularly at risk. Diagnostic error was 19.3% and it was a problem not only in young women but also in children. Temperature and rectal examinations were not found to be helpful in the diagnosis in contrast to leukocytosis. Waiting time for operation was long (median 7 hours), be it for a perforated or a nonperforated appendicitis.
Two cases of Actinomycosis of the spine with paraparesis are reported. The characteristic radiological features involving both the vertebral bodies and the ribs are seen. Confirmation by means of histopathology and culture was necessary and both patients responded well to penicillin.
A retrospective study of 1000 cases of microscopically diagnosed head and neck cancers in the University Hospital, Kuala Lumpur was done. Head and neck neoplasms comprise 7.1% of all tumours diagnosed in this Hospital and the commonest sites of involvement are the nasopharynx (29.1%), cervical lymph nodes (22.6%), oral cavity (10.2%), thyroid (8.2%) and skin (6.5%). Histologically, 87% of tumours are epithelial in nature. The results of this study show that nasopharyngeal carcinoma is commonest in Chinese males, while oral and laryngeal malignancies occur more frequently in Indians.
A 21-year-old lady was admitted with a one year history of painless swelling in the neck. The clinical features and radiological findings suggested a thyroglossal duct cyst. Histology of the excised duct cyst showed papillary carcinoma. Ultrasound examination of the thyroid gland was normal. The patient is on regular follow-up and is well two years following surgery.
Squamous metaplasia (SM) of thyroid follicular epithelium is known to occur in a variety of non-neoplastic lesions as well in thyroid neoplasms, notably papillary carcinoma (PC). In follicular thyroid tumors, on the other hand, SM is very rare. This case describes cytological and pathological findings in a follicular adenoma (FA) that presented as a cystic lesion with extensive SM. The fine needle aspiration (FNA) cytology sample in this case yielded only necrotic material from the cystic area and squamous cells, which being mostly of immature type, were not recognised as squamous in the cytological smears. The needle missed the solid (neoplastic) component of the lesion and on the whole the cytological picture was considered to be equivocal. FA can now be added to the spectrum of thyroid lesions that can show SM. Awareness of this will enable cytopathologists to consider non-papillary lesions in the differential diagnosis of thyroid nodules that yield squamous cells.
Fifty-nine cases of tuberculous cervical lymphadenitis were analysed histologically. Characteristic epithelioid cell granulomas were seen in all the cases with central areas of caseation necrosis in 96.6% (57/59) of these cases. The diagnosis of tuberculosis was further established by the demonstration of acid-fast bacilli (AFB) in the tissue sections in 29 cases. These AFB, although occasional, were found more frequently within the epithelioid cells as compared with other zones of the granuloma. There was no significant association between necrosis and bacillary content. We conclude that light microscopical assessment is still a useful screening method to diagnose tuberculosis in cases of cervical lymphadenopathy.
Leprosy is a chronic infectious disease and is still a public health problem in Malaysia. In 1926, the Leper Enactment Act was established which required compulsory notification and isolation of leprosy patients. As a result, the National Leprosy Control Centre (NLCC) was built in Sungai Buloh, Selangor. In 1969, the National Leprosy Control programme was launched with the objective of early case finding and decentralisation of treatment of leprosy. The treatment of leprosy patients is integrated with basic Medical and Health services in Malaysia. With the implementation of multiple drug therapy in 1985, the National prevalence rate of leprosy has reduced from 5.7 per 10,000 in 1983 to 1.7 per 10,000 in 1992. The Research Unit in NLCC was established in 1950, where cultivation of Mycobacterium leprae using mouse foot-pad technique is done. This technique is used for assessment of efficacy of chemotherapeutic agents in leprosy. Research activites are also done in collaboration with the Institute for Medical Research in Kuala Lumpur such as isolation of Mycobacterium leprae antigen using T cell clones and phenolic glycolipid antigen.
A retrospective histological analysis of colonic biopsies received by the Department of Pathology, University of Malaya during the 4-year-period between 1990 and 1993 revealed nine cases of microscopic colitis (MC). The ages of the patients ranged from 18 to 53 years. Seven patients were females with a female to male ratio of 3.5 :1. The main clinical symptom was chronic diarrhoea of duration varying from 4 months to 5 years. None of the patients had any systemic illness or were on any prior medication. Colonoscopy and barium enema observations in all the subjects were essentially normal. Colonic biopsies showed diffuse plasmacytic infiltration of the lamina propria, intraepithelial lymphocytic infiltration and normal crypt pattern. To the best of our knowledge, this is the first documented report on MC from Malaysia. It is envisaged that better recognition of this condition by histopathologists would reduce the numbers in the often diagnosed category of "nonspecific colitis".
Sudden maternal death from amniotic fluid embolism is a rare but serious complication which usually occurs during late pregnancy, often during labour or shortly after, with more than 80% mortality. Such a death causes immense stress to both the relatives and the attending doctors as it is sudden and unexpected. Three such deaths are discussed here. Traditionally, it was believed that this complication usually occurred in prolonged and difficult labour, but there is evidence contrary to this, and it is not possible to predict when and where this fatal complication will occur. Current views and various pathophysiologic mechanisms leading to the fatal outcome are also discussed.
Patients at high risk of recurrence or metastases following radical surgery for Stage 1B and 2A cervical carcinoma include those with pelvic node metastases, lymphatic or vascular space permeation in the cervix by tumour cells, large size of the primary tumour, involvement of the full thickness of the cervix and parametrial spread. We report the initial results of adjuvant chemotherapy using a combination of cisplatinum, bleomycin and vinblastine in 22 patients who had undergone Wertheim radical hysterectomy and were thought to be at high risk of developing recurrence. The mean duration of follow-up was 23 months. All are alive after follow-up ranging from 13 to 43 months. Three patients developed recurrences--one in the pelvis, another at the posterior aspect of the urethral meatus and the third developed pulmonary secondaries at 20 to 23 months after surgery. Toxicity from the chemotherapy was acceptable.
Histopathological features in 89 cases of Stage 1B and early 2A invasive carcinoma of the cervix who underwent Wertheim radical hysterectomy and pelvic lymphadenectomy were studied. Depth of tumour invasion and lymphatic/vascular space permeation by tumour cells were significantly associated with lymph node metastases. The other features such as tumour type, and stromal leucocytic reaction showed no significant relationship to the presence of lymph node metastases.
A 47-year old man had hypersplenism from massive splenomegaly, the cause of which was undetermined for 2 years. He was initially asymptomatic though there was mild pancytopenia. However, 18 months after presentation he manifested both clinical and haematological deterioration, almost succumbing to sepsis. Splenectomy finally provided a definite diagnosis of follicular lymphoma and also restored his blood counts to within normal range.
Colorectal cancer (CRC) is one the most commonly diagnosed cancers worldwide and the number is increasing every year. Despite advances in screening programs, CRC remains as the second leading cause of cancer deaths in the United States. Oxidative stress plays an important role in the molecular mechanisms of colorectal cancer (CRC) and has been shown to be associated with Blastocystis sp., a common intestinal microorganism. In the present study, we aimed to identify a role for Blastocystis sp. in exacerbating carcinogenesis using in vivo rat model. Methylene blue staining was used to identify colonic aberrant crypt foci (ACF) and adenomas formation in infected rats whilst elevation of oxidative stress biomarker levels in the urine and serum samples were evaluated using biochemical assays. Histological changes of the intestinal mucosa were observed and a significant number of ACF was found in Blastocystis sp. infected AOM-rats compared to the AOM-controls. High levels of urinary oxidative indices including advanced oxidative protein products (AOPP) and hydrogen peroxide were observed in Blastocystis sp. infected AOM-rats compared to the uninfected AOM-rats. Our study provides evidence that Blastocystis sp. has a significant role in enhancing AOM-induced carcinogenesis by resulting damage to the intestinal epithelium and promoting oxidative damage in Blastocystis sp. infected rats.