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Fulltext The 'CASTLE' tumour: An extremely rare presentation of a thyroid malignancy. A case report

Dualim DM, Loo GH, Suhaimi SNA, Md Latar NH, Muhammad R, Abd Shukor N

Ann Med Surg (Lond), 2019 Aug;44:57-61.
PMID: 31312445 DOI: 10.1016/j.amsu.2019.06.013

Thyroid carcinoma showing thymic-like differentiation (CASTLE) is a rare malignancy of the thyroid gland, and it accounts for 0.1-0.15% of all thyroid cancers. As the name suggests, it has a histological and immunophenotypic resemblance to thymic carcinoma. Preoperative diagnosis of CASTLE can be difficult as its clinical manifestations, and histological characteristic resembles other aggressive and advanced thyroid carcinomas. It is essential to distinguish CASTLE from other aggressive neoplasms as the former has a more favourable prognosis. Immunohistochemical staining with CD5 can help to differentiate thyroid CASTLE from other aggressive thyroid neoplasms. Due to the rarity of this disease, there is no clear definitive treatment strategy. Surgical resection of CASTLE is usually attempted initially. Nodal involvement and extrathyroidal extension are shown to be the main prognostic factors that influenced the survival of patients. Therefore, complete resection of the tumour is vital to reduce local recurrence rates and to improve the chance of long-term survival. Radiotherapy (RT) for CASTLE is an effective treatment. Curative surgery followed by adjuvant RT should be considered in cases with extrathyroidal extension and nodal metastases. With RT, shrinkage of the tumour and reduction of local recurrence rate is possible. With that in mind, we present a case of CASTLE who presented with airway compression symptoms three years after thyroid surgery. He subsequently underwent tumour debulking surgery and a tracheostomy. The patient refused adjuvant chemoradiotherapy, and during our serial follow-up, he is well and symptom-free.

Matched MeSH terms: Neoplasm Recurrence, Local
Fulltext Mapping 18F-Fluorodeoxyglucose metabolism using PET/CT for the assessment of treatment response in non-small cell lung cancer patients undergoing epidermal growth factor receptor inhibitor treatment: a single-centre experience

Subapriya Suppiah, Fathinul Fikri Ahmad Saad, Nur Hafizah Mohad Azmi, Abdul Jalil Nordin

Malaysian Journal of Medicine and Health Sciences, 2017;13(1):9-15.
MyJurnal

Introduction: Specific mutations in the epidermal growth factor receptor (EGFR) characterize a subgroup of nonsmall
cell lung cancer (NSCLC) patients that may be highly responsive to receptor inhibitor therapy. 18F-FDG PET/CT
scans can map the glucose metabolism and treatment response of NSCLC. Therefore, we aimed to assess the pattern
of metabolic response and outcome of inoperable NSCLC treated with epidermal growth factor receptor (EGFR)
inhibitors, using 18F-FDG PET/CT scan. Methods: A retrospective study of inoperable NSCLC patients on EGFR
inhibitor treatment that were referred for wholebody18F-FDG PET/CT scans was conducted based on cases scanned
from January 2011 to June 2014. Comparison was made among serial attenuation-corrected fused PET/CT images for
all study patients throughout the course of their treatment. Comparison based on PERCIST criteria was categorized
into 4 levels ie. complete response (CMR), partial response (PMR), stable disease (SMD), progressive metabolic
disease (PMD). Results: Overall, there were 5 patients identified, mean age: 57.4 years old +/- 2.9 years; The median
survival time from initiation of EGFR inhibitor treatment to death was 17 months. Two patients showed initial partial
metabolic response (PMR), two had progressive metabolic disease (PMD) and one had complete metabolic response
(CMR) after the initiation of treatment. The patient with initial CMR had relapse and PMD 5 months later. Majority of
patients eventually succumbed to their illness. Conclusions: Wholebody18F-FDG PET/CT is able to assess metabolic
treatment response of NSCLC towards EGFR inhibitor treatment.

Matched MeSH terms: Neoplasm Recurrence, Local
Fulltext Total pleurectomy as the surgical treatment for recurrent secondary spontaneous pneumothorax in a child with severe pulmonary Langerhans cells histiocytosis

Abdul Aziz DA, Abdul Rahman NA, Tang SF, Abdul Latif H, Zaki FM, Annuar ZM, et al.

BMJ Case Rep, 2011;2011.
PMID: 22674944 DOI: 10.1136/bcr.09.2011.4734

Pulmonary Langerhans cell histiocytosis (LCH) in children is more extensive and is a rare cause of spontaneous secondary pneumothorax (SSP) which tends to be recurrent and refractory to conventional treatment. Its occurrence in paediatric patients posed great challenge to the choice of surgical management. Surgery in the form of pleurodesis is only considered if SSP does not improve after chemotherapy and after considering all relevant risk and benefits of surgery to patients. Chemical pleurodesis will not give the expected effect to eradicate SSP in this patient. Therefore mechanical pleurodesis is the treatment of choice. There are various techniques to perform mechanical pleurodesis; from pleural abrasion to pleurectomy. In the authors' experience, bilateral total pleurectomy provided the best outcome for this 9-year-old patient with persistent respiratory distress from SSP due to extensive pulmonary LCH.

Matched MeSH terms: Recurrence
Fulltext A case of recurrent respiratory papillomatosis successfully removed via endoscopic argon plasma coagulation (APC) with no evidence of recurrence

Wong JL, Tie ST, Lee J, Kannan SK, Rashid Ali MR, Ibrahim A, et al.

Med J Malaysia, 2014 Aug;69(4):195-6.
PMID: 25500852 MyJurnal

Recurrent respiratory papillomatosis (RRP) is a benign disease caused by the human papilloma virus (HPV), characterized by the formation of recurrent, epithelial neoplastic lesions in the airways. While benign, they can cause significant airway obstruction in some cases. Difficulties in treatment arise from the recurrent nature of the lesions despite repeated procedures. Other known procedures that result in deep tissue damage also cause unacceptable collateral damage to the underlying airway mucosa. We describe a case of recurrent papillomatosis that was successfully treated with argon plasma coagulation ( APC) when laser and electrocautery ablation had failed in the past. After the papillomatasis was treated with APC, there is no recurrence on repeat scope at 4 months and 9 months after the initial procedure. The procedure was done as a day case and there is no complication from the procedure. The property of the APC that allows it to cause only superficial thermal damage to the tissue makes it a suitable adjunct therapy to the treatment of papillomas, which are usually superficial lesions.

Matched MeSH terms: Neoplasm Recurrence, Local
Fulltext Efficacy of Afatinib in the Treatment of Patients with Non-Small Cell Lung Cancer and Head and Neck Squamous Cell Carcinoma: A Systematic Review and Meta-Analysis

Maarof NNN, Alsalahi A, Abdulmalek E, Fakurazi S, Tejo BA, Abdul Rahman MB

Cancers (Basel), 2021 Feb 08;13(4).
PMID: 33567737 DOI: 10.3390/cancers13040688

Several randomized controlled trials (RCTs) evaluated the afatinib efficacy in patients with advanced non-small cell lung cancer (NSCLC) and recurrent/metastatic head and neck squamous cell carcinoma (R/M HNSCC). This review systemically outlined and meta-analyzed the afatinib efficacy in NSCLC and R/M HNSCC in terms of overall survival (OS) and progression-free survival (PFS) endpoints. Records were retrieved from PubMed, Web of Science, and ScienceDirect from 2011 to 2020. Eight afatinib RCTs were included and assessed for the risk of bias. In meta-analysis, overall pooled effect size (ES) of OS in afatinib group (AG) significantly improved in all RCTs and NSCLC-RCTs [hazard ratios (HRs): 0.89 (95% CI: 0.81-0.98, p = 0.02); I2 = 0%, p = 0.71/ 0.86 (95% CI: 0.76-0.97; p = 0.02); I2 = 0%, p = 0.50, respectively]. ES of PFS in AG significantly improved in all RCTs, NSCLC-RCTs, and HNSCC-RCTs [HRs: 0.75 (95% CI: 0.68-0.83; p < 0.00001); I2 = 26%, p = 0.24; 0.75 (95% CI: 0.66-0.84; p < 0.00001); I2 = 47%, p = 0.15/0.76 (95% CI: 0.65-88; p = 0.0004); I2 = 34%, p = 0.0004, respectively]. From a clinical viewpoint of severity, interstitial lung disease, dyspnea, pneumonia, acute renal failure, and renal injury were rarely incident adverse events in the afatinib group. In conclusion, first- and second-line afatinib monotherapy improved the survival of patients with NSCLC, while second-line afatinib monotherapy could be promising for R/M HNSCC. The prospective protocol is in PROSPERO (ID = CRD42020204547).

Matched MeSH terms: Neoplasm Recurrence, Local
Fulltext Predictors of SLE relapse in pregnancy and post-partum among multi-ethnic patients in Malaysia

Shaharir SS, Mohamed Said MS, Mohd R, Abdul Cader R, Mustafar R, Abdul Rahman R

PLoS One, 2019;14(9):e0222343.
PMID: 31539383 DOI: 10.1371/journal.pone.0222343

Flare of Systemic Lupus Erythematosus (SLE) may occur during pregnancy and puerperium. We studied the prevalence and factors associated with SLE relapse during pregnancy and post-partum period in a multi-ethnic SLE cohort. Consecutive SLE patients who attended the outpatient clinic were reviewed for previous history of pregnancies in our institution. Patients who had a complete antenatal, delivery, and post-partum follow up were included. Their medical records were retrospectively analysed to assess the disease activity at pre-pregnancy/conception, during antenatal, and post-partum period. Presence of flare episodes during pregnancy and puerperium were recorded. The pregnancy outcomes recorded include live birth, foetal loss, prematurity and intra-uterine growth restrictions (IUGR). Univariate and multivariable logistic regression with generalized estimating equations (GEE) analyses were performed to determine the factors associated with disease relapse and the pregnancy outcomes. A total of 120 patients with 196 pregnancies were included, with a live birth rate of 78.6%. Four (2.0%) were diagnosed to have SLE during pregnancy. The flare rate in pregnancy was 40.1% while post-partum 17.4%. Majority of the relapse in pregnancy occurred in haematological system (62.3%) followed by renal (53.2%), musculoskeletal (22.1%), and mucocutaneous (14.3%). In GEE analyses, active disease at conception was the independent predictor of SLE relapse during and after pregnancy, whereas older maternal age and Malay ethnicity were associated with higher flare during post-partum. HCQ use was significantly associated with reduced risk of flare in univariate analysis but it was no longer significant in the GEE analyses. Presence of disease flare in pregnancy was significantly associated with prematurity. In conclusion, pregnancy in SLE need to be planned during quiescent state as pre-pregnant active disease was associated with disease relapse in both during and after pregnancy. Malay patients had an increased risk of post-partum flare but further larger prospective studies are needed to confirm the association between pregnancies in the different ancestral background.

Matched MeSH terms: Recurrence
Fulltext Predictors of recurrence of major depressive disorder

Lye MS, Tey YY, Tor YS, Shahabudin AF, Ibrahim N, Ling KH, et al.

PLoS One, 2020;15(3):e0230363.
PMID: 32191745 DOI: 10.1371/journal.pone.0230363

A total of 201 patients with major depressive disorder from four hospitals in Malaysia were followed up for 5 years to determine the prognostic factors of recurrent major depressive disorder that could potentially contribute to improving the management of MDD patients. For each individual patient, at the time of recruitment as part of a case-control study, information was collected on recent threatening life events, personality and social and occupational functioning, while blood samples were collected to genotype single nucleotide polymorphisms of vitamin D receptor (VDR), zinc transporter-3 (ZnT3), dopamine transporter-1 (DAT1), brain-derived neurotropic factor (BDNF), serotonin receptor 1A (HT1A) and 2A (HT2A) genes. Kaplan-Meier and Cox-regression were used to estimate hazard functions for recurrence of major depressive disorder. Individuals with severe MDD in previous major depressive episodes had five and a half times higher hazard of developing recurrence compared to mild and moderate MDD (HR = 5.565, 95% CI = 1.631-18.994, p = 0.006). Individuals who scored higher on social avoidance had three and a half times higher hazard of recurrence of MDD (HR = 3.525, 95% CI = 1.349-9.209; p = 0.010). There was significant interaction between ApaI +64978C>A single nucleotide polymorphism and severity. The hazard ratio increased by 6.4 times from mild and moderate to severe MDD for A/A genotype while that for C/A genotype increased by 11.3 times. Social avoidance and severity of depression at first episode were prognostic of recurrence. Screening for personality factors at first encounter with MDD patients needs to be considered as part of the clinical practice. For those at risk of recurrence in relation to social avoidance, the psychological intervention prescribed should be customized to focus on this modifiable factor. Prompt and appropriate management of severe MDD is recommended to reduce risk of recurrence.

Matched MeSH terms: Recurrence
Consolidation radiotherapy for advanced-stage aggressive B-cell non-Hodgkin lymphoma: A systematic review and meta-analysis

Yap E, Law ZK, Aslan Abdullah NM, Abdul Wahid SF

EXCLI J, 2017;16:1233-1248.
PMID: 29285019 DOI: 10.17179/excli2017-805

Patients with advanced aggressive B-cell non-Hodgkin lymphomas (NHL) are usually treated with rituximab in combination with chemotherapy. However, disease relapse rates are high. Radiotherapy (RT) has been shown to be efficacious in treating early-stage NHL but its role in advanced stage diseases is unclear. We performed a systematic review of randomized controlled trials (RCTs) comparing chemotherapy with RT to chemotherapy alone in patients with newly diagnosed advanced aggressive NHL. We searched online databases and pooled similar outcome estimates. For time-to-event outcomes, we estimated hazard ratios (HR) for overall survival (OS) and event-free survival (EFS) using the fixed-effect model. Two RCTs involving 254 patients met inclusion criteria. The trials were single-centre RCTs with follow-up period of five and ten years. Both trials were conducted in the pre-rituximab era. Patients treated with consolidation RT had better OS (HR for mortality 0.61; 95 % CI 0.38 to 0.97) and EFS (HR for mortality 0.67; 95 % CI 0.46 to 0.98) compared to those who received no RT. There was an apparent benefit of RT on local control (OR 0.09; 95 % CI 0.04 to 0.20); although this was estimated as a dichotomous rather than time-to-event outcome. Limited evidence shows benefits of consolidation RT in advanced aggressive NHL. However, we were not able to estimate the effect size with confidence due to small number of trials and sample size. We cannot recommend routine consolidation RT in advanced aggressive NHL. More RCTs with the inclusion of rituximab and PET-CT monitoring are needed.

Matched MeSH terms: Neoplasm Recurrence, Local
Rehabilitation of an extraoral and intraoral defect complicated with microstomia. A study case

Abdulhadi LM

Eur J Prosthodont Restor Dent, 2012 Jun;20(2):81-5.
PMID: 22852525

A 72-year-old man was referred from the surgery department for rehabilitation following surgical resection of Basaloid carcinoma. The first surgical intervention involved the anterior palatal region and was restored with a simple obturator. Two years later further surgery was undertaken to excise a recurrent tumor in the nose and part of the cheek. This resulted in an exposed nasal cavity and maxillary sinus. In addition, there was a small oral aperture composed of thin tissue that stretched to its maximum due to scar formation. The defect was restored with a full thickness skin flap but it subsequently broke down leaving the midface exposed with limited mouth opening due to tissue contraction and scar formation after the flap operation. The defect was rehabilitated with Co-Cr obturator intraorally and a silicone nose retained to the naso-palatal extension of the obturator by a magnet extraorally. This resulted in practically good retention, placement, and adaptation of the two parts of the prosthesis.

Matched MeSH terms: Neoplasm Recurrence, Local
Fulltext Subperiosteal Drainage versus Subdural Drainage in the management of Chronic Subdural Hematoma (A Comparative Study)

Chih AN, Hieng AW, Rahman NA, Abdullah JM

Malays J Med Sci, 2017 Mar;24(1):21-30.
PMID: 28381926 DOI: 10.21315/mjms2017.24.1.3

INTRODUCTION: Symptomatic chronic subdural hematomas (CSDH) remain one of the most frequent diagnoses in current neurosurgical practice. Burr-hole craniostomy with irrigation and placement of close-system drainage is the current recommended surgery for symptomatic CSDH. The aim of this study is to perform a direct comparison between two surgical techniques in the treatment of symptomatic CSDH, which have been proven in previous studies to be efficient. Our main objective was to compare the efficacy of placement of a subperiosteal drain (SPD) and a subdural drain (SDD) following single burr-hole craniostomy and irrigation, and to demonstrate any significant differences in terms of overall surgical complications, functional outcome at three months and mortality rate.
MATERIALS AND METHODS: The study was carried out in two local neurosurgical centres. The SPD group was performed in Hospital Umum Sarawak (HUS) and the SDD group was performed in Hospital Sultanah Aminah Johor Bahru (HSAJB), from 1 January 2012 till 30 January 2014 with a total of 30 patients in both treatment groups.
RESULTS: Overall, there were no statistically significant difference in terms of patient general characteristics, pre-operative and post-operative symptoms, Markwalder grades, post-operative hematoma volume and recurrence, mortality and functional outcome at discharge and at three month follow-up between both groups. Albeit not achieving statistical significance, we observed a lower rate of surgical complication especially for post-operative intracranial hematoma with placement of the SPD system.
CONCLUSIONS: Our study concludes that both treatment methods proved to be highly effective in the treatment of CSDH. However, with a lower overall surgical complication rate, treatment with single burr-hole craniostomy, irrigation and placement of the SPD system can be considered a treatment of choice for the management of symptomatic CSDH.

Matched MeSH terms: Recurrence
Fulltext Appraisal of clinical profile and management of juvenile nasopharyngeal angiofibroma in malaysia

Hassan S, Abdullah J, Abdullah B, Jihan Wd S, Jaafar H, Abdullah S

Malays J Med Sci, 2007 Jan;14(1):18-22.
PMID: 22593647 MyJurnal

Juvenile nasopharyngeal angiofibroma (JNA) is a benign but locally invasive tumour. Patients are usually in their adolescent age and present with epistaxis and nasal blockage. Diagnosis is based on clinical evaluation and the C.T. scan findings. Pre-operative superselective embolisation (SSE) and surgical excision is the treatment of choice. The out patient clinic of ORL-HNS hospital of University Science Malaysia received 25 referrals, all male, majority between 9-13 years of age and few adolescents. Clinically the patients were consistent with symptoms of recurrent epistaxis and nasal blockage. They reported from October 1998 to October 2001 from with in the state of Kelantan and the nearby states of Pahang, Kedah and Terenganu. Diagnosis was mostly made on typical radiological findings and the tumours were classified accordingly into four stages. SSE and surgical excision was carried out in all cases. Regular follow-up helped us to identify early recurrences which were treated with salvage surgery or radiotherapy in one case with extensive intracranial extension. A retrospective review of presenting features, diagnostic difficulties, surgical approaches and its outcome is presented. Maxillary swing procedure performed in three cases as a new surgical option in the management of JNA is also discussed.
Study site: ENT clinic, Hospital Universiti Sains Malaysia (HUSM), Kelantan, Malaysia

Matched MeSH terms: Recurrence
Fulltext Detection of human papillomavirus, p53 and c-erbb-2 protein expression in juvenile laryngeal papillomatosis: a report of 2 cases

Siti Aishah Md Ali, Ilina Isahak, Dahlan Sabi, Fatimah Sahlan, Lokman Saim, Abdullah Sani Mohamed

Medicine & Health, 2006;1(1):67-74.
MyJurnal

The association of human papillomavirus (HPV) with juvenile laryngeal papillomatosis has been well documented. We report two cases of juvenile laryngeal papillomatosis and correlated these cases with presence of HPV, p53 and c-erbB-2 proteins. The first case was a one-year-old male patient and the second a six-year-old female patient. Formalin-fixed paraffin-embedded biopsy specimens were tested for the presence of HPV genome by the technique of in situ hybridisation using wide spectrum and type specific biotinylated probes while the immunohistochemical expression of p53 (D07, 1:50) and c-erbB-2 (DAKO A0485, 1:300) proteins were evaluated with commercially available antibodies. Histologically the tumours in both cases showed papillary configuration of squamous papilloma. The first case detected HPV type 6, HPV type 11 and p53 protein expression while the second case showed only HPV type 6. Both cases of HPV showed positive signals confined to the nuclei in the superficial squamous epithelium. The first case showed p53 positivity seen from the basal region up to one third of the epithelium of laryngeal papillomas and the subsequent recent repeat biopsy showed the positivity of p53 had extended throughout the upper layers of the epithelium. Expression of c-erbB-2 protein was not detected in both cases. These findings were similar as in other studies where follow-up of the cases was recommended since they tend to recur.

Matched MeSH terms: Neoplasm Recurrence, Local
Fulltext Targeting bladder cancer stem cells using Newcastle disease virus

Arcana Thirumorthy, De-Ming Chau, Khatijah Yusoff, Abhi Veerakumarasivam

Malaysian Journal of Medicine and Health Sciences, 2019;15(108):24-24.
MyJurnal

Introduction: Bladder cancer is associated with high risk of tumour recurrence and therapeutic resistance. Cancer stem cells (CSC) within a particular tumour are postulated to drive tumorigenesis and influence tumour behaviour. Recent studies have shown that Newcastle disease virus (NDV) is able to selectively kill and exert a strong oncolytic effect against various cancer types. However little is known about the oncolytic effect of NDV against CSC. In this study, the oncolytic effect of NDV against putative bladder CSC was examined. Methods: Putative bladder CSC was selectively grown in the form of 3D-spheroids from six different bladder cancer cell lines. The spheroid cells were characterised for their stemness properties to ensure that these cells truly represent CSC. This was conducted via the analysis of CSC associated genes and cell surface markers expression. Subsequently, the oncolytic effect of the wild-type NDV-AF2240 strain against the bladder cancer spheroids was investigated. Results: All the spheroids expressed significantly high levels of CSC-associated genes. Flow-cytometry analysis revealed that the expression pattern of the CSC-associated surface markers was different in the spheroid cells; suggesting heterogeneity in the expression signatures of these cells. The infection of spheroids with NDV showed that the NDV was able to target bladder cancer spheroids but there was a spectrum of response across the different spheroids. Intriguingly, NDV was able to persistently infect bladder cancer spheroids that were not sensitive towards NDV infection as the presence of NDV viral genes were detected in the spheroid cells. The NDV persistently infected bladder cancer spheroids were resistant to superinfection and developed an antiviral state by expressing low levels of interferon-beta (IFN-b). NDV persistency of infection affects the process of epithelial to mesenchymal transition (EMT) of cancer cells as the spheroid forming ability of an established NDV persistently infected bladder cancer cell line, EJ28-PI was shown to be impaired. The EJ28-PI cells expressed significantly high levels of the EN2 gene. Knockdown of the EN2 expression reduced the viability of EJ28-PI cells; suggesting a role for EN2 in mediating NDV persistency of infection in cancer cells. Conclusion: Bladder CSC gene expression signatures influence the efficacy of NDV-mediated oncolysis. Our current work is focused on identifying genes and signalling pathways that influence NDV-mediated oncolysis us-ing whole-transcriptomic sequencing. The findings of this study can potentially be used to enhance the efficacy of NDV-mediated oncolysis and accelerate the translation of NDV as an oncotherapeutic agent in the clinic.

Matched MeSH terms: Neoplasm Recurrence, Local
Fulltext Melioidosis in Colombia, description of a clinical case and epidemiological considerations

Rodríguez JY, Álvarez-Moreno CA, Cortés JA, Rodríguez GJ, Esquea K, Pinzón H, et al.

Biomedica, 2019 05 01;39:10-18.
PMID: 31529845 DOI: 10.7705/biomedica.v39i3.4534

Melioidosis is an infectious disease caused by Burkholderia pseudomallei whose clinical diagnosis can be difficult due not only to its varied clinical presentation but also to the difficulties in the microbiological diagnosis.Thus, it may be necessary to use molecular techniques for its proper identification once it is suspected.
There are few antibiotics available for the treatment of this disease, which must be used over a long period of time. Although it is known to be endemic in Thailand, Malaysia, Singapore, Vietnam, and Australia, in Colombia there are few reported cases.
We describe a case of melioidosis in the northern region of Colombia. Additionally, we review its clinical characteristics and treatment and we describe the local epidemiology of this disease.

Matched MeSH terms: Recurrence
Overall Survival and Local Recurrence Among Breast Cancer Patients in Hospital Sultanah Nora Ismail Batu Pahat, 2007-2013

Balasundram S, Salekan K, Ahmad Shariffuddin FN, Taib NA, Adnan TH

Asian Pac J Cancer Prev, 2018 Sep 26;19(9):2409-2415.
PMID: 30255693

Objective: To gauge surgical outcome in breast cancer patients with particular reference to overall survival and
recurrence free survival among breast cancer patients in Hospital Sultanah Nora Ismail Batu Pahat, Johor, Malaysia.
Methods: Patients undergoing ablative breast cancer surgery were identified and clinical records were assessed.
Inclusion criteria for enrolment were stage I-IV breast malignancy necessitating resection with or without radiotherapy/
chemotherapy from 2007 to 2013. All individuals had a pre-operative assessment. The post operative assessment period
ranged from 1 year to 5 years. Survival distributions were analyzed using Kaplan-Meier curves. Results: A total of
121 patients were included in this study, with an age range of 28-78 years. Some 98% had undergone local excision/
lumpectomy/ mastectomy with axillary clearance. While 81% of patients underwent chemotherapy, only 69% had
radiotherapy. Tumours were oestrogen receptor positive in 58% of cases and progesterone receptor positive in 62%.
Local recurrence was detected in 10%. The mean age at diagnosis was 51.3 + 10.4 years. The overall survival analysis
was based on 22 deaths among the 121 patients (18.2%). Three-year and five-year survival rates were 87.6% and 78.4%,
respectively. Analysis of recurrence-free-survival (RFS) was based on 12 events among 121 patients. The Kaplan-Meier
RFS analysis revealed that in 90% of the patients with recurrence, it occurred within 45 months. The five year RFS
rate was 84.5%. The median time taken from diagnosis to ablative surgery was 51 days (upper limit of 791 days).
Only distant metastasis was a significant factor that impacted on both overall survival and recurrence-free survival
(p<0.001). Conclusion: Overall survival among our breast cancer patients in our facility is comparable to other in
other tertiary centres in the country. A trend for earlier detection was noted.

Matched MeSH terms: Neoplasm Recurrence, Local/mortality*; Neoplasm Recurrence, Local/pathology*
Brucellosis-induced autoimmune haemolytic anaemia (AIHA)

Mak WW, Adrian MM, Ahlam K

Med J Malaysia, 2019 Oct;74(5):443-344.
PMID: 31649226

Brucellosis is a rare zoonotic infection caused by small, fastidious Gram-negative coccobacilli of the genus Brucella that may be associated with haemolytic complications including thrombotic microangiopathy and haemolytic anaemia. We describe a patient with culture confirmed brucellosis who presented with malaise, high grade fever, hepatosplenomegaly and Coombs-positive autoimmune haemolytic anaemia. The patient was successfully treated with combination of doxycycline and rifampicin with no further episodes of relapses or haemolysis. Although rare, the possibility of brucellosis should always be kept in mind in patients with risk factors who present with haemolysis and endemic area.

Matched MeSH terms: Recurrence
Fulltext Intrahepatic stones: the UKM experience

Din J, Qureshi A, Daud A, Ahmad H

Med J Malaysia, 2000 Dec;55(4):473-7.
PMID: 11221160

Intrahepatic stones remain a major source of morbidity and mortality. With improving techniques in hepatobiliary surgery, the management and the outcome of intrahepatic calculi is reviewed. Forty-nine cases referred from all over Malaysia between January 1993 to June 1996 were analyzed retrospectively. There were thirty-two females and seventeen males. The median age was 46 years. Biliary diseases encountered in association with intrahepatic calculi included benign strictures (n = 14), ascariasis (n = 3), cholangiocarcinoma (n = 1), Caroli's disease (n = 1), and thalassaemia, (n = 1), fifty-six percent of stones were located in both the intrahepatic ducts while 34% were found in the left intrahepatic duct. Thirty-one patients underwent common bile duct exploration either alone or in combination with liver resection or bilioenteric anastomosis. Despite the various combinations of surgical and non-surgical intervention 28 (57.1%) patients had residual stones. Despite the availability of newer techniques in hepatobiliary surgery, residual stones were common, resulting in higher treatment costs.

Matched MeSH terms: Recurrence
Effectiveness of adjunct psychotherapy for cancer treatment: a review

Chen Y, Ahmad M

Future Oncol, 2018 Jun;14(15):1487-1496.
PMID: 29767550 DOI: 10.2217/fon-2017-0671

Psychotherapies were offered to alleviate psychological and physical symptoms; however, most psychological interventions were only delivered after cancer treatment. Newly diagnosed cancer patients experienced psychological distress while waiting for treatments. This review paper focused on randomized control trial studies, aimed to investigate the effectiveness of psychological intervention among newly diagnosed cancer patients. Eight randomized control trial papers were found in recent 10 year period through electronic database. A moderate to large effect size was detected on the outcomes, ranging from 0.43 to 0.89. This indicated that psychological-based prehabilitation with standard care yielded better outcomes than standard care alone. Psychological-based prehabilitation provides evidence in its effectiveness to reduce psychological distress, functional impairment, recurrence of cancer, numbers of immune reactivity and sleeping quality; however, inconsistent with longer survival result among cancer patients. In conclusion, psychological-based prehabilitation before cancer treatment is necessary for better treatment outcome, and future research is needed to investigate more directly the outcome.

Matched MeSH terms: Recurrence
Fulltext The role of attention deficit hyperactive disorder in developing substance use disorder: a case report

Rakesh, S., Hazli, Z., Ahmad Nabil, M.R.

Malaysian Journal of Psychiatry, 2015;24(1):91-95.
MyJurnal

Objective: Individuals with ADHD are known to have more risk of developing substance use disorder (SUD). However the underlying mechanisms behind it are not straightforward. Method: We report a case of an adult with ADHD, who has a long standing history of polysubstance use, since the age of 10. He had multiple relapses, even after numerous efforts undertaken to keep him drug-free. Result: ADHD symptoms were not optimally treated during admission. He had preference towards opioid-based and amphetamine-type substances in order to attain euphoria. Conclusion: Taking into account the biological and psycho-social condition of this man, we discussed the role of ADHD from the perspective of dysfunctional rewards system and other possible factors in explaining his drug-craving behavior.

Matched MeSH terms: Recurrence
Fulltext A rare presentation of gliosarcoma in a young adult

Nor Haizura Abd Rani, Fadhli Mustaffa, Chuan Wui Teoh, Flora Li Tze Chong, Nornazirah Azizan, Firdaus Hayati, et al.

Malaysian Journal of Medicine and Health Sciences, 2019;15(106):75-75.
MyJurnal

Introduction:Gliosarcoma is a rare malignant brain tumor. The clinical presentation is acute with rapid progression of symptoms. Commonly affecting the elderly, it is rare to happen in youngsters. Case description: A 28-year-old radiographer presented to us with two episodes of unprovoked seizure. He denied any medical illnesses, or trauma, fall, motor vehicle accident and fever prior to these attacks. The computed tomography (CT) of brain was normal. He was managed as epilepsy and remained symptom-free for 3 years until the unprovoked seizure recurred. Another CT of brain performed and revealed a right parietal intracranial mass. This finding was supported by magnetic reso-nance imaging scan. The histologic examination showed a biphasic pattern of glial with predominant sarcomatous component giving a diagnosis of gliosarcoma of the brain. He had completed six cycles of adjuvant chemotherapy and was asymptomatic during clinic follow up with no tumor recurrence. Conclusion: Individuals with high risk of radiation exposure particularly radiographer as in our case requires a special attention when it comes to the diagnosis of malignancy. Despite of indolent clinical presentations, a close monitoring is needed to avoid mismanagement and subsequent morbidities.

Matched MeSH terms: Neoplasm Recurrence, Local

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