One hundred and twelve infiltrating ductal carcinoma of breast were studied by the standard avidinbiotin complex immunoperoxidase method on formalin-fixed, paraffin-embedded tissue sections, using a monoclonal antibody to c-erbB-2 oncoprotein. The same tumours were assessed and scored according to the Bloom and Richardson criteria into three histological grades. The distribution of tumours according to grade were: 8 Grade I, 34 Grade II and 70 Grade III. Forty-three (38.4%) tumours showed positive membrane staining for c-erbB-2 oncoprotein. These comprised 7 Grade II and 36 Grade III tumours with c-erbB-2 immunopositivity rates of 20.6% and 51.4% respectively. The oncoprotein was not expressed by Grade I tumours. This study shows a good correlation between c-erbB-2 expression and histological grade, a known prognostic indicator of invasive breast carcinoma. Because the c-erbB-2 oncogene has extensive structural homology to the epidermal growth factor receptor gene, its overexpression can be expected to result in more aggressive tumour behaviour. While it may be regarded as another indicator of poor prognosis breast cancers, its value in the selection of carcinomas less responsive to hormonal therapy and those more suitable for immunotherapy than chemotherapy has been mooted but remains to be clarified.
All post-neonatal children with acute non-traumatic coma admitted over an 8-month period were analysed and followed up for 18-24 months to determine the aetiology and outcome of their coma. One hundred and sixteen children, 72 boys and 44 girls, were recruited. Half the children were under 1 year of age and only 16 (14%) were more than 6 years of age. Eighty cases (69%) were due to infection, 15 (13%) to toxic metabolic causes, six (5%) to hypoxic ischaemic insults, four (3.5%) had intracranial haemorrhage, nine (7.8%) were due to miscellaneous causes and in two (1.7%) the cause was unknown. Seven cases were lost to follow-up. Of the remainder, 39 (35.7%) died, 32 (29.3%) developed permanent neurological deficit, and 38 (35%) were discharged well. The outcome was worst in the infectious group. Age of onset and sex did not significantly affect outcome. Our findings are similar to experience in Japan, where infection accounts for 74% of non-traumatic coma, but differ considerably from Western data on childhood coma where only a third of cases are due to infection.
Retinal changes are common in adult acute leukemia patients at presentation, but their prognostic significance is controversial. A 5-year study has been carried out with newly diagnosed acute leukemia patients aged 12-77 years. Seventy-seven cases (49 AML, 28 ALL) were studied prospectively for the presence of intraretinal hemorrhages (IRH), white-centered hemorrhages, cotton-wool spots, and macular hemorrhages. They were treated according to standard chemotherapy protocols, and then achievement of complete remission (CR) and the duration of overall survival (OS) were compared between the groups with and without these different retinal features. No association was found between the presence of any retinal abnormality and CR induction rate, although there was a trend to a lower CR rate among patients with IRH. The median OS of those with IRH was 72 days, compared with 345 days among those without IRH (p=0.002). A WBC at presentation greater than 50x10(9)/l and age greater than 40 years were also associated with shorter OS (p<0.0001 and p=0.0045, respectively). However, after regression analysis, IRH remained statistically significant as a poor prognostic indicator (p=0.01). We conclude that the presence of IRH is an indicator of poor prognosis in acute leukemia.
Asthma and chronic obstructive pulmonary disease (COPD) are two common illnesses that cause significant morbidity and mortality. Steroids are widely used in both conditions. They act through steroid or glucocorticoid receptors (GR) causing up or down regulation of protein synthesis resulting in an increase in lipocortin 1 and beta 2 adrenergic receptors, and decreased levels and activities of cytokines or cytokine receptors, which reduces the inflammatory process in the airways and decreases bronchial hyperreactivity. Consequently symptoms of airway obstruction are alleviated and lung function is improved. In asthma, steroids have been convincingly shown to be effective in the treatment of both acute exacerbations and chronic condition. In COPD, however, only a subset of patients seem to respond favourably to steroid therapy. Therapeutic trials are therefore recommended before committing to a long-term treatment in order to determine this subset of patients, as no markers of steroid responsiveness can be identified. The inhaled steroids currently available have a good safety profile with significant side effects occurring only occasionally. Such side effects are usually confined to the oropharynx, causing local irritation, candidiasis and dysphonia, which can be easily overcome. Biochemical abnormalities involving bone, adrenal, carbohydrate and lipid profiles have been noted with high doses of inhaled steroids; however, these have no significant clinical effects.
The compliance with drug regimens and follow-up visits of 225 known cases of relapsed schizophrenia was assessed. About 27% of the patients met the criteria for good compliance. The compliance was found to be significantly related to the patients' view of usefulness of the medication, treatment duration of less than 5 years, dosage schedule of once or twice per day and the supervision of medication at home. Patients with poor compliance who were prescribed drug dosage of not more than twice per day throughout follow-up and underwent counseling to enhance treatment compliance had a significantly lower relapse rate than the controlled group at the end of 1 year of follow-up. The importance of family support and understanding patients' cultural background in ensuring good compliance was highlighted.
The correlation of clinical and demographic variables of thought disorder was studied in 45 Research Diagnostic Criteria (RDC) schizophrenics. Thought disorder was assessed by the scale for the assessment of Thought, Language and Communication (TLC). Negative thought disorder was significantly correlated with the rural background. Individual TLC items like Distractible speech, Illogicality, Clanging, Neologisms, etc. were correlated with the literate group and perseveration with the illiterate group. No significant correlation was noted between thought disorder and clinical variables.
Two hundred Malaysian patients representing 227 ears with previously untreated cholesteatoma disease were analysed retrospectively in terms of i) type of disease, i.e. primary acquired attic defect or posterior superior retraction pocket and secondary acquired type cholesteatoma; ii) positive history of previous middle ear effusion, atelectasis or grommet insertion; and iii) likelihood of complications as initial presenting feature. The high 47.1% incidence of secondary acquired cholesteatoma disease in our patients contrasts with the predominance of primary acquired cholesteatoma in the Caucasian patient. Correlation of these two disease types with a positive history showed a significant positive association between the primary acquired group and a positive history; and conversely a significant negative association for the secondary acquired type. This supports a role for the retraction theory in primary acquired cholesteatoma but negates this theory in secondary acquired cholesteatoma. Secondary acquired cholesteatoma had a significantly higher (35.5%) complication rate against 15.8% in the primary acquired type (p = 0.001). This fact together with a 47.1% incidence of secondary acquired disease, low otolaryngologist population ratio and patient attitudes to disease account for the high total complication rate of 27.3%.
It has been known that intrahepatic biliary lithiasis (IHBL) is prevalent in East Asia including Japan, South Korea, Taiwan, Malaysia, Hong Kong, and Singapore. In contrast, the entity has drawn little attention in Europe and the United States where only scattered reports appear. IHBL can be placed in the category of the benign disease. Its distinctive clinical picture is an intractable course necessitating multiple surgical interventions because recurrence is usual, rather than exceptional. This is in distinct contrast to ordinal stones which originate in the gallbladder. Patients with IHBL do not rarely die of progressive hepatic damage resulting from longstanding obstructive jaundice, cholangitis, liver abscess, septicemia, and so forth.
A retrospective study of intraocular foreign bodies treated at the University Hospital over 10 years from 1970 - 1979 was carried out. Of the 48 cases reviewed, nine were anterior chamber foreign bodies while the rest were posterior segment foreign bodies. The anterior chamber foreign bodies had better visual prognosis as compared to the posterior segment foreign bodies. Most of the patients were young Chinese males and most of the injuries were due to accidents at work involving the 'hand hammer' (includes other implements used as a hammer).
3 cases of perforating injury with retention of intra-ocular foreign body are presented. Their clinical presentation, management and final visual results are discussed. Despite the generally poor prognosis associated with these injuries, some cases surprisingly have good visual results.
The objectives of this Malaysian study were to investigate the relationship between severity of trauma and interval before treatment, and the effect of delayed treatment on prognosis. A total of 123 traumatized permanent incisors were observed over a 24-month period. Results of this study suggest that the interval between trauma and emergency treatment is directly related to the severity of injury and the level of dental awareness of the patients. However, prognosis of these teeth is greatly influenced by the interval between trauma and initial treatment. Pathological pulp changes in these teeth can occur as late as two years after injury and this justifies the necessity for a long observation period following treatment.
A survey to assess the degree of occupational and physical rehabilitation was conducted on patients treated on chronic haemodialysis, using the semiquantitative Karnovsky scale. The survey revealed that over 90% of patients achieved good rehabilitation and returned to employment or to household duties. Chronic haemodialysis is effective in prolonging life and most patients were rehabilitated with useful levels of physical activity.
Long-term ventilatory support of a child with bronchopulmonary dysplasia is described. Dedicated nursing care and emotional support of child and family were two important factors in the management of the child in intensive care, and in the weaning of the child from the ventilator.
One-hundred-and-thirty-one female stroke patients were identified in a retrospective analysis of female medical admissions to the Penang General Hospital during 1983. The hospital medical admission rate of women with stroke was significantly higher amongst the Chinese than the Malays [p < 0.001) or the Indians (p < 0.001). A higher proportion of Indians than Chinese or Malays presented within 24 hours of the onset of illness. The case fatality rate at discharge was 34% when patients taken home moribund were included as fatal cases. Such cases where patients were taken home at their own risk (AOR) were common among the Malays and the Chinese but did not occur amongst the Indians.
Study site: female medical wards, Penang General Hospital
Six children who survived severe acute bronchiolitis in infancy and early childhood continued to have persistent symptoms of breathlessness, cough and wheeze resistant to bronchodilator therapy. Hyperinflation of the chest, widespread crepitations and rhonchi were persistent clinical features. Failure to thrive was a problem in most. At presentation clinical measles was diagnosed in one child and adenovirus titres were raised in another; the aetiological agents in the others were not known. Lung biopsy from the child with measles showed features of severe bronchiolitis. The clinical and radiological features and course of the illness were consistent with those of bronchiolitis obliterans. Although illness was prolonged the long term prognosis was satisfactory with the majority of children showing improved chest signs, growth and general health after four to eight years of follow up.
The medical-and-demographic processes as a starting point for the planning of means and resources for the short- and average-term future are forecasted in the paper on the basis of long-term peculiarities of the natural-science data and with respect for the social-and-economic crisis now underway in the country.
Introduction: Oral squamous cell carcinoma (OSCC) is a major health problem worldwide. The overall survival rate remains at 50% despite numerous studies and various treatment modalities in OSCC. The presence of lymph node metastasis in OSCC is well established as an independent prognostic factor. This present study aims to investigate the association of four tumour antigens; FJX-1, GNα12, IFITM3 and MAGED4B with the sociodemographic and clinicopathological parameters of OSCC. The potential use of these markers as a prognostic indicator of patient sur-vival and lymph node metastasis in OSCC was explored. Methods: 35 cases of OSCC with available formalin-fixed paraffin-embedded (FFPE) specimens involving the tongue, buccal mucosa, gingiva, alveolus and floor of mouth were evaluated by immunohistochemistry for FJX-1, GNA12, IFITM3 and MAGED4B expression. Assessment of the expression of these tumour antigens was based on the cellular sub-site, intensity and percentage of staining in the OSCC samples. Results: The expression of all four tumour markers were expressed in all samples (n=35) but none statistically associated with any clinicopathological or socio-demographic parameters. Survival analysis using Kaplan-Meier test showed high expression of GNA12, IFITM3 and MAGED4B individually with poor prognosis in OSCC patients. A combination of markers, GNA12 and MAGED4B demonstrated a significant association with pa-tient survival in OSCC (p=0.014). Multivariate analysis after adjustment for selected socio-demographic factors (age, gender, risk habits and sub-sites of the oral cavity) revealed that high expression of both MAGED4B and GNA12 remained as an independent prognostic factor for poor prognosis in OSCC (HRR =5.231, 95% CI 1.601,17.084; p=0.006). Conclusion: We concluded that high combined expression of both marker (Gα12 and mAGED4B) might be used as an independent prognostic indicator in OSCC.
Triple negative breast cancer (TNBC) is one of the most aggressive types of breast cancer. Owing to the absenteeism of hormonal receptors expressed at the cancerous breast cells, hormonal therapies and other medications targeting human epidermal growth factor receptor 2 (HER2) are ineffective in TNBC patients, making traditional chemotherapeutic agents the only current appropriate regimen. Patients' predisposition to relapse and metastasis, chemotherapeutics' cytotoxicity and resistance and poor prognosis of TNBC necessitates researchers to investigate different novel-targeted therapeutics. The role of small interfering RNA (siRNA) in silencing the genes/proteins that are aberrantly overexpressed in carcinoma cells showed great potential as part of TNBC therapeutic regimen. However, targeting specificity, siRNA stability, and delivery efficiency cause challenges in the progression of this application clinically. Nanotechnology was highlighted as a promising approach for encapsulating and transporting siRNA with high efficiency-low toxicity profile. Advances in preclinical and clinical studies utilizing engineered siRNA-loaded nanotherapeutics for treatment of TNBC were discussed. Specific and selective targeting of diverse signaling molecules/pathways at the level of tumor proliferation and cell cycle, tumor invasion and metastasis, angiogenesis and tumor microenvironment, and chemotherapeutics' resistance demonstrated greater activity via integration of siRNA-complexed nanoparticles.