Despite the fact that cemento-ossifying fibromas of the maxilla may be quite large and locally aggressive, en-bloc excision is achieved by gentle blunt dissection, with the whole tumour mass peeled out from the adjacent structures. Until recently different fibro-osseous tumours that contained cementum were classified together as "cementomas". In 1992 The World Health Organization adopted a new classification that included these fibromas as benign osseous tumours. While such tumours of the mandible are common, those of the maxilla are rare. They are growth products of periodontal membrane remnant. The triggering mechanism in the formation of cementum outside the periodontal membrane remains unclear. We present a 35-year-old woman who had a giant expanding lobular mass in the right maxilla of 5 years duration. She had visual disturbances and nasal obstruction, and was treated successfully by surgical en-bloc resection of the tumour through an infraorbital transverse incision. The differential diagnosis included fibrous dysplasia, osteoid osteoma, osteoblastoma, chronic sclerosing osteomyelitis, ameloblastoma, squamous cell carcinoma of the maxillary sinus, calcifying epithelial odontogenic tumour (Pindborg tumour) and calcifying odontogenic cyst (Gorlin cyst). Histopathological examination confirmed a cemento-ossifying fibroma.
BACKGROUND:
Type 2 diabetes mellitus (T2DM) is reportedly the leading cause of end-stage renal disease (ESRD) worldwide. However, non-diabetic renal diseases (NDRD) are not uncommon among T2DM patients with renal involvement. Our study aimed to examine the prevalence of NDRD in T2DM and clinical markers for diabetic nephropathy (DN) and NDRD and to determine the role of renal biopsy in T2DM patients and its impact on clinical practice.
METHODS:
We conducted a retrospective analysis of T2DM patients in whom renal biopsies were performed from January 2004 to March 2008 (n = 110).
RESULTS:
Biopsy results were divided into three groups: group I/pure DN (62.7%), group II/isolated NDRD (18.2%), and group III/mixed lesions (19.1%). The causes of NDRD in decreasing order of frequency were acute interstitial nephritis, glomerulonephritides, hypertensive renal disease, and acute tubular necrosis. Significant clinical markers for DN are presence of diabetic retinopathy and longer duration of diabetes. For NDRD, useful clinical markers include the presence of acute renal failure and microscopic hematuria. In the DN subgroup, Indians had significantly shorter duration of diabetes on biopsy compared with Malays and Chinese.
CONCLUSIONS:
NDRD is prevalent in T2DM patients, and given its potentially treatable nature, renal biopsy should be considered in T2DM patients with nephropathy, especially in those with atypical features.
Asian patients have a uniquely high risk for heart disease compared to other ethnicities. Past drug eluting stent trials have examined mainly populations of European heritage. As a significant proportion of the real world population in the SPIRIT V single arm study is Asian, the study provides insight into how this population responds to stenting with the XIENCE V Everolimus Eluting Coronary Stent (EES).
This prospective study investigated the difference in clinical efficiency between Damon™ 3 self-ligating brackets (SLB) compared with Mini Diamond conventional ligating brackets (CLBs) during tooth alignment in straightwire fixed appliance therapy. Twenty-nine patients (10 males and 19 females), aged between 14 and 30 years, were randomly divided into two groups: 14 patients received the SLB and 15 received the CLB. Upper arch impressions were taken for pre-treatment records (T(0)). A transpalatal arch was soldered to both maxillary first molar bands prior to extraction of the maxillary first premolars, followed by straightwire fixed appliances (0.022 × 0.028 inch). A 0.014 inch nickel titanium (NiTi) wire was used as the levelling and aligning archwire. Four monthly reviews were undertaken and impressions of the upper arch were taken at each appointment (T(1), T(2), T(3), and T(4)). Displacements of the teeth were determined using Little's irregularity index (LII). Data were analysed using the Mann-Whitney U-test. In the aligning stage, the CLB group showed significantly faster alignment of the teeth compared with the SLB group at the T(1)-T(2) interval (P < 0.05). However, there were no differences at T(2)-T(3), and T(3)-T(4) for either group (P > 0.05). The CLB group showed 98 per cent crowding alleviation compared with 67 per cent for the SLB after 4 months of alignment and levelling. Mini Diamond brackets aligned the teeth faster than Damon™ 3 but only during the first month. There was no difference in efficacy between the two groups in the later 3 weeks. Alleviation of crowding was faster with CLB than with SLB.
Vitamin E is an essential fat-soluble vitamin that has been shown to induce favorable effects on animal and human immune systems. The objective of this study was to assess the effects of tocotrienol-rich fraction (TRF) supplementation on immune response following tetanus toxoid (TT) vaccine challenge in healthy female volunteers.
This study was undertaken to assess the impact of fluoride mouth rinsing on caries experience in a cohort of schoolchildren 3 years after implementation.
We performed a cross-sectional study of the demography, clinical and laboratory features of patients with polymyositis and dermatomyositis followed up in our centre from 2006 to 2009. There were 12 cases, with the majority of them (58.3%) being woman. They have a mean age of 57.8 years and mean disease duration of 11.83 (SD 9.92) months. Our patients comprised of multi-ethnic groups with predominantly Chinese (83.3%), Sarawak natives (8.3%) and Malays (8.3%). They have a mean lag time to diagnosis of 3.67 (SD 4.27) months. Nine (75%) patients had dermatomyositis and 3(25%) had polymyositis. The common clinical manifestations found in our patients were proximal myopathy (100%), neck weakness (33.3%), dysphagia (33.3%) and interstitial lung disease (33.3%). For the nine patients with dermatomyositis, the most common dermatological manifestations were shawl sign (88.9%) and V sign (88.9%). Muscle enzymes were raised in 91.7% of patients. Electromyographies were carried out in four patients, and only one of our patients had muscle biopsy. Only 41.7% of our patients have positive ANA. The majority received prednisolone (100%) and hydroxychloroquine (58.3%). Malignancy occurred in five (three nasopharyngeal carcinomas, one sigmoid colon cancer and one lung cancer) out of the nine dermatomyositis patients but none in the polymyositis group. The mortality rate in our group was 4(33.3%) over the 4-year period. This study demonstrated the rarity of PM/DM in our centre with considerable lag time to diagnosis in our patients. Despite lack of muscle biopsy in our centre, our centre achieved appropriate diagnosis and management of PM/DM.
Hypertensive disorders in pregnancy contributes to about 12% of maternal deaths in Malaysia and similarly worldwide. Early detection and adequate management are preventable strategies. Biochemical markers of abnormal angiogenesis would be more specific in early detection than routine blood pressure and proteinuria measurements. The aim of this study was to estimate maternal plasma PlGF and sFlt-1 levels in pregnant women with gestational hypertension at three intervals of pregnancy and correlate these biomarker levels with placental morphometry.
Introduction: Rheumatoid arthritis (RA) is a systemic disease of unknown cause. A variety of pulmonary disorders have been described in association with RA. Among the most common are interstitial lung disease
(ILD) and bronchiectasis.
Objectives: This study aims to determine the characteristics of RA patients with lung disease in relation to clinical characteristics, pulmonary function test (PFT) and high resolution computed tomography (HRCT) thorax.
Method: This is a 6-months cross-sectional study involving 63 consecutive RA patients in an outpatient rheumatology clinic. Patients had a mean disease duration of 5 years and above. Disease activity and severity
was assessed by Disease Activity Score 28 (DAS28), Health Assessment Questionnaire (HAQ) and Rheumatoid Arthritis Articular Damage (RAAD) score. Full pulmonary function test (PFT) and HRCT of thorax were performed.
Conclusions: The prevalence of RA-ILD is 44% and 67% of patients are asymptomatic. There was significant higher proportion (68%) in patients of Chinese ethnicity who have ILD. Diffusion capacity of carbon monoxide
was abnormal in all patients and forced expiratory flow (FEF)25–75% was low in 16%. Restrictive pattern was 66.7% by PFT. The most common HRCT findings were reticulation (46%) followed by ground glass opacities
(38.1%) and bronchiectasis (28.6%). There was no association between ILD and male gender, duration of the disease, smoking, rheumatoid factor, extra-articular manifestations, disease activity or severity.
Key words: high resolution computed tomography, interstitial lung disease, lung function test, rheumatoid arthritis.
Study site: Rheumatology clinic, Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM), Kuala Lumpur, Malaysia
Major reconstructive surgery may be extensive and prolonged, and it may cause edema and compromise the flap pedicle if closed under tension. Glycerol-preserved skin allograft (GPA) can provide a means for tension-free closure and temporary cover of the wound. Seven years of analysis on GPA used in conjunction with major reconstruction was undertaken to highlight its indications, results, and outcomes. Forty-seven patients were included, aged between 9 and 73 years. Majority of patients had reconstruction following tumor resection and trauma. The main indication for use of GPA was temporary, loose cover of the wound in 44% of cases; flap pedicle protection in 31% of cases; donor site wound cover in 10%; flap monitoring in one case; and management of flap-related complications in 6% of cases. Free flap reconstruction was performed in 72% of cases. In conclusion, GPA is a useful adjunct in reconstructive surgery. It can be used temporarily to allow tension-free wound closure, as well as to protect the flap pedicle until edema subsides and the pedicle becomes stable. This latter approach allows secondary wound closure and good esthetic outcome.
This study compares clinico-pathological features in young (<40 years) and older patients (>50 years) with colorectal cancer, survival in the young and the influence of pre-operative clinical and histological factors on survival.
We describe an unusual case of osteosarcoma in a Jehovah's Witness patient who underwent chemotherapy and major surgery without the need for blood transfusion. This 16-year-old girl presented with osteosarcoma of the right proximal tibia requiring proximal tibia resection, followed by endoprosthesis replacement. She was successfully treated with neoadjuvant chemotherapy and surgery with the support of haematinics, granulocyte colony-stimulating factor, recombinant erythropoietin and intraoperative normovolaemic haemodilution. This case illustrates the importance of maintaining effective, open communication and exploring acceptable therapeutic alternative in the management of these patients, whilst still respecting their beliefs.
Plasmodium knowlesi is a cause of symptomatic and potentially fatal infections in humans. There are no studies assessing the detailed parasitological response to treatment of knowlesi malaria infections in man and whether antimalarial resistance occurs.
Ocular hypertension caused by endogenous Cushing syndrome from an ectopic adrenocorticotropic hormone-producing tumor is rare. We report an 11-year-old boy who presented with intraocular pressures (IOPs) of 50 mm Hg in both eyes. Surgical resection of the tumor was performed with subsequent normalization of serum cortisol and IOP levels.
To investigate the anxiety among mothers whom their babies have failed test results in the first stage of Universal Neonatal Hearing Screening Program.
PURPOSE: To evaluate changes in anterior chamber depth (ACD) and intraocular pressure (IOP) after phacoemulsification in eyes with occludable angles and compare the results with those in eyes with normal open angles.
SETTING: Eye Clinic, Ipoh General Hospital, Ipoh, Perak, Malaysia.
METHODS: Patients with nonglaucomatous eyes with open angles or with occludable angles were recruited. Ocular biometric measurements (ACD, axial length [AL], lens thickness and position) and IOP (tonometry) were performed preoperatively and 1 day and 1, 4, 9, and 12 weeks postoperatively.
RESULTS: The open-angle group and occludable-angle group each comprised 35 patients. The occludable-angle group had a shallower ACD, shorter AL, thicker and relatively anterior lens position, and higher IOP preoperatively; postoperatively, there was a significant increase in ACD and a significant reduction in IOP (P
We sought to develop a smoking-cessation intervention for male Chinese restaurant workers in New York City that required no seeking out by participants; provided support over a relatively long period of time; and was responsive to participants' cultural backgrounds and daily lives. The resulting intervention consisted of a minimum of 9 proactive phone counseling sessions within a 6-month period for each participant recruited at his worksite. All activities were conducted in Chinese languages. The efficacy of this proactive phone-counseling intervention was assessed in a pretest/posttest design comparing baseline smoking with smoking 6 months after the intervention ended. Of 137 male employees recruited at their restaurants, 101 (median age 40.5) participated in the phone-counseling intervention in 2007-2008, with 75 completing the program with at least 9 counseling calls. We found a linear increase in smoking cessation from 0% at Call 1 to 50.7% at Call 9 for 75 men who completed the program, and we found for all 101 participants a 32.7% intent-to-treat cessation rate for 6 months post-end of program, adjusted to 30.8% by saliva cotinine assessments. The results indicate that combining field outreach with phone counseling over an extended period of time can facilitate smoking cessation for population groups whose environments do not support efforts to quit smoking.
We present the results and conclusions of an observational prospective cohort design study using self-administered questionnaires to determine correlation between psychosocial factors and cancer outcome among 80 consecutive newly diagnosed treatment naïve cancer subjects who were being referred to the Oncology Clinic, Hospital Universiti Kebangsaan Malaysia. Subjects were recruited over a period of 43 weeks from October 2000 till July 2001. Follow-up assessments were carried out at 6-months and 12 to 26 months later. The prediction of survival time was performed by the Cox Regression Analysis method with adjustments for biological and psychosocial risk factors. It was noted that depression (p = 0.001), stage 4 cancer disease (p = 0.016), neurological (p = 0.032), gastrointestinal tract (p = 0.04), head and neck (p = 0.011), gynaecological (p = 0.005) and bone and soft tissue (p = 0.030) malignancies were independent and statistically significant prognostic factor of survival during the study period. It was further shown than depressed patients were found to have almost four fold greater risk of dying than non-depressed patients and patients with stage 4 cancer illness have a five fold greater risk of dying than patients with stage 1 disease. Furthermore, based on tumour types subjects with neurological, gynaecological, head and neck, bone and soft tissue and gastro intestinal tract malignancies were found to have approximately thirty-six, twenty-five, twenty-two, sixteen and seven fold greater risk of dying respectively when compared to subjects with genitourinary cancers. This study further affirms the need for health care providers to be aware of the psychological aspects of the cancer patient and provide appropriate therapy so as to ensure that this group of individuals would have enhanced survival rates.
Study site: Oncology clinic, Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM)
Choanal stenosis has recently been recognized as a late complication of radiation therapy for nasopharyngeal carcinoma. The management of velopharyngeal stenosis is challenging with high risk of restenosis. We report a case of velopharyngeal stenosis post-radiotherapy and illustrated the use of mitomycin-C to prevent restenosis. Mitomycin-C application has being shown useful adjunct to surgical technique in managing nasopharyngeal stenosis for surgeons.