To compare the development, monitored by radiography and computed tomography, of the antebrachia and elbow joints in seven Labrador Retrievers with healthy elbow joints and in seven Labrador Retrievers that developed medial coronoid disease (MCD), in order to determine whether disturbances in the development of the antebrachia and elbow joints, between the age of six and 17 weeks may lead to medial coronoid disease.
A total of 676 palpable breast lumps seen in the Breast Clinic, University Hospital, Kuala Lumpur from August 1993 to August 1994 were subjected to fine needle aspiration cytology. Fifty-four were reported as inadequate, 501 benign, 95 malignant and 26 suspicious. One hundred and eighty-seven aspirates had histological correlation, while 34 of the malignant aspirates had clinical correlation. The majority of the other 455 patients were followed up for a period of 60 to 72 months without any malignancies becoming apparent. For analysis, only the 221 cases with histological or clinical correlation were included, (the suspicious category was included into the positive group and the inadequate cases were excluded), giving a sensitivity of 91.7%, a specificity of 91.7% and a diagnostic accuracy of 91.7%. Breast cytology was an accurate and rapid method of diagnosis of breast diseases, and in a busy surgical unit with limited operating time, it allowed for the triage of patients with breast complaints in deciding which cases needed early open biopsy. A negative cytology does not exclude the possibility of cancer, as there was a false negative rate of 11%. However by utilising a diagnostic triad of clinical examination, radiological assessment and fine needle aspiration cytology, the risk of missing a malignancy is small.
Vaginal hysterectomy for the large uterus is seldom performed in Malaysia. The traditional operation is abdominal hysterectomy. This is a personal series of vaginal hysterectomies for enlarged uterus of more than 12 weeks size (>280g) carried out in a private hospital between 1/1/97 to 30/9/2000. A total of 40 cases were done with the weights of the uterus ranging from 290g to 790g. The mean weight of the uterus was 434g. The average operating time was 92.1 min. The complications were minimal with 2 cases of blood transfusion for intra-operative hemorrhage, 1 case of fever and 1 case of bladder perforation. This series demonstrates feasibility and safety of the operation. The excellent recovery due to the absence of an abdominal scar should be a strong incentive for specialists to learn the skill.
Infantile myofibromatosis (IMF) is a rare tumour with a wide spectrum of disease activity ranging from a solitary cutaneous nodule through to a multicentric form with widespread visceral involvement. It is characterised by its unique ability to spontaneously regress and has a typical histological appearance of actin-positive fibroblasts arranged in whorls or fascicles and vessels in a pericytomatous pattern. A male infant with multiple lesions involving the subcutaneous tissue and bone from birth is described and followed-up for two years. Treatment of IMF is dependent on the location of the tumour/s with surgery or chemotherapy reserved for rapidly progressive or symptomatic disease. However, due to the low rate of recurrence and the possibility of spontaneous tumoral regression, therapeutic abstention, as practised in our patient, is justified.
An elderly gentleman with adenocarcinoma of the rectum who had abdominoperineal resection presented with scrotal skin and penile metastasis. Adenocarcinoma of the rectum metastasizing to the groin and penis is very rare and few cases have been reported.
A 34-year-old multigravid woman with symptomatic primary biliary cirrhosis (PBC) of the liver had a successful pregnancy. A healthy baby was born prematurely at 36 weeks of gestation. Six months prior to the conception of this pregnancy, stage III PBC had been diagnosed. Portal hypertension and liver cirrhosis had not developed. It is uncommon for pregnancy to occur in the presence of PBC. In the case presented, the outcome of pregnancy was good and the liver function had not been significantly affected by the pregnancy.
A 37-year-old Chinese male presented with an acute abdomen. Surgical exploration revealed duodenal perforation, extensive small bowel infarction and peritonitis. Histopathology of the resected bowel showed characteristic features of classic polyarteritis nodosa. The latter also involved mesenteric arteries in the form of tiny aneurysms. Steroids could not be started due to: (i) overwhelming microbial infections and (ii) fear of more perforations in other areas of the bowel. Such a presentation of polyarteritis nodosa is uncommon. Its recognition prior to surgery, management and prognosis is discussed.
Our experience with 1,094 consecutive fine needle aspirations (FNAs) of the breast in 918 cases is presented. Correlation between the FNA cytology and subsequent histology of the lesions was available in 211 cases. FNA had a sensitivity rate of 87.3%, a specificity rate of 99.3% and a positive predictive value of 98.2%. A false negative diagnosis rate of 5.1% occurred. The overall diagnostic accuracy rate was 95.7%.
The deliberate inhalation of solvents among children and adolescents "for kicks" is becoming more common in the West. It was generally regarded as a relatively harmless practice and consequently little attention had been paid to the isolation of the toxic agent from the variety of substances used. It is now well recognised that solvent abuse not only can result in sudden death but also cause pathological changes to the liver, kidney, brain, heart and lungs. A case of toluene associated death in Malaysia is discussed both from a medico-legal and pathological standpoint.
Internal jugular vein ectasia is a venous anomaly commonly presenting as a unilateral neck swelling in children and adults. Literature reports of bilateral presentation are rare. Bilateral Doppler ultrasonography is the diagnostic investigation of choice. The possible pathology, aetiology and management are discussed. Conservative management of bilateral cases is recommended in uncomplicated cases.
Juvenile xanthogranuloma is a benign cutaneous growth presenting as papules or nodules. It is characterized by an intradermal collection of lipid-laden macrophages and varying degrees of fibroblastic proliferation. We have recently observed two patients with xanthogranulomas: one was found to have a papular type and the second patient had multiple nodular growths. We present these cases, which should be considered in the differential diagnosis of skin nodules.
Required learning of the basic medical sciences based on five clinical problems was compiled by teachers and subsequently derived as 'learning needs' by students during the problem-solving process. These lists of topics were compared in terms of number of lecture-hours and when these were taught in the traditional curriculum. The findings indicate that learning from problems is not entirely free-rein and can be largely determined by teachers; topics taught earlier in the course appeared more frequently than latter topics and there was a tremendous overlap of topics in both the traditional and problem-based list. Regardless of whether lectures have been given or not, students recalled facts better if they had encountered the related clinical problem. This study also reveals that problem-based learning can be as efficient as lectures in content coverage and concludes that the lecture method be retained provided the topics are selective and are derived and sequenced appropriately with clinical problems. Problem-solving should be adopted as a teaching strategy.
Two patients with ascending aortic aneurysms due to cystic medical necrosis are described. One of them was phenotypically normal while the other had features of Marfan's syndrome. Both were disabled by dyspnoea and angina which required corrective surgery.