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An in vivo study of a locally-manufactured hydroxyapatite-based material as bone replacement material

Abdul Razak NH, Al-Salihi KA, Samsudin AR

Med J Malaysia, 2004 May;59 Suppl B:119-20.
PMID: 15468847

Defects were created in the mandible of a rabbit model whereby the right side was implanted with hydroxyapatite (HA) while the left side was left empty to act as control. Both the implant and control sites were evaluated clinically and histologically at 4,12,20,22 weeks. Decalcified sections were studied under confocal laser scanning microscope. No reactive cells were evident microscopically in all sections. There was bone ingrowth as early as 4 weeks when viewed by the topographic method. Enhancement of osteoconduction was evident by the presence of abundant capillaries, perivascular tissue and osteoprogenitor cells of the host. At 22 weeks, the implanted defect showed mature bone formation filling almost the whole field. This study demonstrated that the dense HA exhibits excellent biocompatibility as noted by the complete absence of reactive cells. It also promotes osteoconduction.

Matched MeSH terms: Mandible/pathology
Fulltext A strange case of double annular pancreas

Nayak S, Pamidi N, George BM, Guru A

JOP, 2013 Jan;14(1):96-8.
PMID: 23306345 DOI: 10.6092/1590-8577/1281

The pancreas is a soft lobulated gland situated transversely across the upper part of the posterior abdominal wall. Its parts include the head, neck, body and tail. Annular pancreas is a rare condition where the head of the pancreas surrounds the second part of the duodenum like a ring.

Matched MeSH terms: Pancreatic Diseases/pathology*
Medico-legal aspects of histopathology practice

Ong BB, Looi LM

Malays J Pathol, 2001 Jun;23(1):1-7.
PMID: 16329541

Medico-legal problems experienced by histopathologists differ from those of other clinicians as they are rarely in direct contact with patients. Nevertheless, the pathologist owes a duty of care to the patient and is liable for medical negligence. In the absence of local guidelines, it is prudent to follow guidelines published by learned Colleges elsewhere. This is also true when delegating duties to non-pathologists, technical and other support staff. Errors in diagnosis and documentation pose the most common problems in histopathology. In this, liability also depends on many factors including the provision of adequate clinical information by clinicians and competence of laboratory staff. Clinicopathological discussions, participation in quality assurance programmes and adherence to standard operating procedures are important audit activities to minimize and detect errors as well as prevent grievous outcome to patients. Issues also arise over the retention of specimens and reports. In general, wet, formalin-fixed tissues should be kept until histopathological assessment is finalized and preferably after clinicopathological sessions, and even longer if there is potential litigation. Reports should be archival. Paraffin blocks should be kept for at least the lifetime of the patient, and histology slides for at least 10 years, to facilitate review and reassessment. Despite adverse publicity in the foreign press over the use of human organs and tissues for research and education, it is accepted that processed tissues can be used for research and educational purposes provided the patient's identity is kept confidential. Nevertheless, it would be prudent to revise consent forms for surgery and autopsies to include the possibility that tissues removed can be stored or used for research and education. Good medical practice in pathology encourages a willingness to consult colleagues when in doubt, but advises that the treating clinician be informed if histopathological material is referred away for a second opinion. The Telemedicine Act of Malaysia (1997) requires practitioners outside Malaysia providing diagnosis through telepathology to hold a certificate to practice telemedicine issued by the Malaysian Medical Council. It is likely that the medico-legal scene in histopathology will change in the coming years with the advent of other new ancillary investigative techniques.

Matched MeSH terms: Pathology/legislation & jurisprudence*
Managing liver metastases: myth or reality?

Primrose JN

Med J Malaysia, 2005 Jul;60 Suppl B:67-9.
PMID: 16108177
Matched MeSH terms: Liver Neoplasms/pathology
A retrospective study of the accuracy of sonographic chorionicity determination in twin pregnancies

Menon DK

Twin Res Hum Genet, 2005 Jun;8(3):259-61.
PMID: 15989753

The aim of this study was to determine the accuracy of sonographic chorionicity determination in the largest sample of twin pregnancies to date. We retrospectively analyzed 463 twin pregnancies delivered over a 6-year period to determine in each case what the antenatal sonographic prediction of chorionicity was, and then what the subsequent post partum pathological diagnosis of chorionicity was. Out of 436 twin pregnancies, 428 were correctly diagnosed for chorionicity as confirmed by pathology reports. Sonography as a screening tool for monochorionic twin pregnancies has a sensitivity of 100%, a specificity of 97.9% and a predictive value positive of 88.2%. Transvaginal scanning in the first trimester determined twin chorionicity with a sensitivity and a specificity of 100%. This study has confirmed in the largest sample to date that sonographic chorionicity determination is best done in the first trimester using vaginal scans, where it has 100% accuracy.

Matched MeSH terms: Chorion/pathology
Prospective study comparing scrape cytology with frozen section in the intraoperative identification of parathyroid tissue

Rohaizak M, Munchar MJ, Meah FA, Jasmi AY

Asian J Surg, 2005 Apr;28(2):82-5.
PMID: 15851358

Intraoperative identification of parathyroid tissue is crucial during parathyroid surgery. Frozen section is the most common tool, but is time-consuming and expensive. Scrape cytology is a modification of imprint cytology that provides rapid and cheap intraoperative identification of parathyroid tissue, but its reliability remains controversial. We assessed the sensitivity and specificity of scrape cytology in the intraoperative identification of parathyroid tissue.

Matched MeSH terms: Parathyroid Glands/pathology*
Craniofacial morphology, head posture, and nasal respiratory resistance in obstructive sleep apnoea: an inter-ethnic comparison

Wong ML, Sandham A, Ang PK, Wong DC, Tan WC, Huggare J

Eur J Orthod, 2005 Feb;27(1):91-7.
PMID: 15743868

The aim of this study was to measure craniofacial morphology and nasal respiratory resistance (NRR) in Malay, Indian and Chinese subjects with obstructive sleep apnoea (OSA). The sample consisted of 34 male subjects, 27-52 years of age (Malay n = 11, which included five mild and six moderate-severe OSA; Indian n = 11, which included six mild and five moderate-severe OSA; and Chinese n = 12, which included six mild and six moderate-severe OSA) diagnosed using overnight polysomnography. After use of a decongestant, NRR was recorded using anterior and posterior rhinomanometry. Standardized lateral cephalometric radiographs were used to record linear and angular dimensions. Malay subjects with moderate-severe OSA had a shorter maxillary (sp-pm) and mandibular (gn-go) length when compared with a mild OSA reference sample (P < 0.05). The hyoid bone was located more caudally in the Chinese moderate-severe subjects (hy-NL, hy-ML)(P < 0.05), and may be a useful diagnostic indicator for severity in this racial group. No pattern of differences for NRR was seen between the moderate-severe and mild OSA subjects. The consistently lower values for nasopharyngeal resistance in all the moderate-severe subjects when compared with the mild group may indicate that some compensation at this level of the airway had taken place. Strong positive correlations between craniocervical angulation (NL/OPT) and total airway resistance and the turbulent component of flow (k(2)) suggest that head posture is sensitive to fluctuations in airway resistance (P < 0.01).

Matched MeSH terms: Facial Bones/pathology*; Head/pathology*; Hyoid Bone/pathology; Mandible/pathology; Maxilla/pathology; Nose/physiopathology*; Skull/pathology*; Sleep Apnea, Obstructive/pathology; Sleep Apnea, Obstructive/physiopathology
Thermal distribution analysis of three-dimensional tumor-embedded breast models with different breast density compositions

Wahab AA, Salim MI, Ahamat MA, Manaf NA, Yunus J, Lai KW

Med Biol Eng Comput, 2016 Sep;54(9):1363-73.
PMID: 26463520 DOI: 10.1007/s11517-015-1403-7

Breast cancer is the most common cancer among women globally, and the number of young women diagnosed with this disease is gradually increasing over the years. Mammography is the current gold-standard technique although it is known to be less sensitive in detecting tumors in woman with dense breast tissue. Detecting an early-stage tumor in young women is very crucial for better survival chance and treatment. The thermography technique has the capability to provide an additional functional information on physiological changes to mammography by describing thermal and vascular properties of the tissues. Studies on breast thermography have been carried out to improve the accuracy level of the thermography technique in various perspectives. However, the limitation of gathering women affected by cancer in different age groups had necessitated this comprehensive study which is aimed to investigate the effect of different density levels on the surface temperature distribution profile of the breast models. These models, namely extremely dense (ED), heterogeneously dense (HD), scattered fibroglandular (SF), and predominantly fatty (PF), with embedded tumors were developed using the finite element method. A conventional Pennes' bioheat model was used to perform the numerical simulation on different case studies, and the results obtained were then compared using a hypothesis statistical analysis method to the reference breast model developed previously. The results obtained show that ED, SF, and PF breast models had significant mean differences in surface temperature profile with a p value <0.025, while HD breast model data pair agreed with the null hypothesis formulated due to the comparable tissue composition percentage to the reference model. The findings suggested that various breast density levels should be considered as a contributing factor to the surface thermal distribution profile alteration in both breast cancer detection and analysis when using the thermography technique.

Matched MeSH terms: Breast Neoplasms/pathology
Blue Legs in a 60-Year-Old Gentleman

Kwan Z, Wong SM, Robinson S, Tan LL, Looi LM, Ismail R

Ann Acad Med Singap, 2015 Dec;44(12):577-9.
PMID: 27090079
Matched MeSH terms: Hyperpigmentation/pathology
Accuracy of single and parallax film and digital periapical radiographs in diagnosing apical periodontitis - a cadaver study

Kanagasingam S, Hussaini HM, Soo I, Baharin S, Ashar A, Patel S

Int Endod J, 2017 May;50(5):427-436.
PMID: 27063356 DOI: 10.1111/iej.12651

AIM: To compare the accuracy of film and digital periapical radiography (PR) in detecting apical periodontitis (AP) using histopathological findings as a reference standard.
METHODOLOGY: Jaw sections containing 67 teeth (86 roots) were collected from nine fresh, unclaimed bodies that were due for cremation. Imaging was carried out to detect AP lesions using film and digital PR with a centred view (FP and DP groups); film and digital PR combining central with 10˚ mesially and distally angled (parallax) views (FPS and DPS groups). All specimens underwent histopathological examination to confirm the diagnosis of AP. Sensitivity, specificity and predictive values of PR were analysed using rater mean (n = 5). Receiver operating characteristics (ROC) analysis was carried out.
RESULTS: Sensitivity was 0.16, 0.37, 0.27 and 0.38 for FP, FPS, DP and DPS, respectively. Both FP and FPS had specificity and positive predictive values of 1.0, whilst DP and DPS had specificity and positive predictive values of 0.99. Negative predictive value was 0.36, 0.43, 0.39 and 0.44 for FP, FPS, DP and DPS, respectively. Area under the curve (AUC) for the various imaging methods was 0.562 (FP), 0.629 (DP), 0.685 (FPS), 0.6880 (DPS).
CONCLUSIONS: The diagnostic accuracy of single digital periapical radiography was significantly better than single film periapical radiography. The inclusion of two additional horizontal (parallax) angulated periapical radiograph images (mesial and distal horizontal angulations) significantly improved detection of apical periodontitis.

Matched MeSH terms: Periapical Periodontitis/pathology
Fulltext Front to back ocular injury from a vaping-related explosion

Khairudin MN, Mohd Zahidin AZ, Bastion ML

BMJ Case Rep, 2016 Apr 05;2016.
PMID: 27048399 DOI: 10.1136/bcr-2016-214964

We describe a case of extensive ocular injury secondary to an electronic cigarette (e-cigarette)-related explosion. The explosion was the result of modifications made to a heating element of the e-cigarette device by a non-professional. Extensive ocular injuries that result from an explosion of an e-cigarette device can potentially cause significant and permanent visual impairment.

Matched MeSH terms: Blast Injuries/pathology*
Audit of Turnaround Time for a Training Oral Histopathology Laboratory in Malaysia

Chan SW, Liew LH, Wong GR, Kallarakkal TG, Abraham MT, Ramanathan A, et al.

Int. J. Surg. Pathol., 2016 Aug;24(5):401-9.
PMID: 27006298 DOI: 10.1177/1066896916639372

BACKGROUND: Turnaround time (TAT) is the benchmark to assess the performance of a laboratory, pathologists, and pathology services, but there are few articles on TAT of surgical pathology, particularly in relation to oral or head and neck specimens. This study investigates the TAT for oral histopathology reporting in an academic institution's training laboratory and offers recommendations to achieve better overall quality of diagnostic services.

METHODS: This study examined data obtained from biopsy request forms for specimens received from the Oro-Maxillofacial Surgery Department of Hospital Tengku Ampuan Rahimah Klang in the Oral Pathology Diagnostic Laboratory of the Faculty of Dentistry, University of Malaya, over a period of 3 years between January 2012 and October 2014.

RESULTS: TAT for surgical and decalcified specimens were increased significantly compared to biopsies. Additional special handling did not influence TAT, but increased specimen volume resulted in greater TAT. Slide interpretation was the most time-consuming stage during histopathology reporting. Overall, mean TAT was acceptable for most specimens, but the TAT goals were less than satisfactory.

CONCLUSION: A TAT goal appropriate for this laboratory may hence be established based on this study. Collective efforts to improve the TAT for various specimens are essential for better laboratory performance in the future.

Matched MeSH terms: Pathology, Surgical/standards*
Fulltext Invasion characteristics of a Plasmodium knowlesi line newly isolated from a human

Amir A, Russell B, Liew JW, Moon RW, Fong MY, Vythilingam I, et al.

Sci Rep, 2016 Apr 21;6:24623.
PMID: 27097521 DOI: 10.1038/srep24623

Plasmodium knowlesi is extensively used as an important malaria model and is now recognized as an important cause of human malaria in Malaysia. The strains of P. knowlesi currently used for research were isolated many decades ago, raising concerns that they might no longer be representative of contemporary parasite populations. We derived a new P. knowlesi line (University Malaya line, UM01), from a patient admitted in Kuala Lumpur, Malaysia, and compared it with a human-adapted laboratory line (A1-H.1) derived from the P. knowlesi H strain. The UM01 and A1-H.1 lines readily invade human and macaque (Macaca fascicularis) normocytes with a preference for reticulocytes. Whereas invasion of human red blood cells was dependent on the presence of the Duffy antigen/receptor for chemokines (DARC) for both parasite lines, this was not the case for macaque red blood cells. Nonetheless, differences in invasion efficiency, gametocyte production and the length of the asexual cycle were noted between the two lines. It would be judicious to isolate and characterise numerous P. knowlesi lines for use in future experimental investigations of this zoonotic species.

Matched MeSH terms: Erythrocytes/pathology
Fibroblast activation and senescence in oral cancer

Prime SS, Cirillo N, Hassona Y, Lambert DW, Paterson IC, Mellone M, et al.

J Oral Pathol Med, 2017 Feb;46(2):82-88.
PMID: 27237745 DOI: 10.1111/jop.12456

There is now compelling evidence that the tumour stroma plays an important role in the pathogenesis of cancers of epithelial origin. The pre-eminent cell type of the stroma is carcinoma-associated fibroblasts. These cells demonstrate remarkable heterogeneity with activation and senescence being common stress responses. In this review, we summarise the part that these cells play in cancer, particularly oral cancer, and present evidence to show that activation and senescence reflect a unified programme of fibroblast differentiation. We report advances concerning the senescent fibroblast metabolome, mechanisms of gene regulation in these cells and ways in which epithelial cell adhesion is dysregulated by the fibroblast secretome. We suggest that the identification of fibroblast stress responses may be a valuable diagnostic tool in the determination of tumour behaviour and patient outcome. Further, the fact that stromal fibroblasts are a genetically stable diploid cell population suggests that they may be ideal therapeutic targets and early work in this context is encouraging.

Matched MeSH terms: Mouth Neoplasms/pathology*; Mouth Neoplasms/physiopathology
Editorial Comment from Dr Goh to Usefulness of sonourethrography for penile abscess as a result of xanthogranulomatous granuloma in the corpus cavernosum of an adult: A case report

Goh EH

Int J Urol, 2015 Aug;22(8):792-3.
PMID: 26010227 DOI: 10.1111/iju.12825
Matched MeSH terms: Granuloma/pathology*
Fulltext Palatal ecchymosis associated with irrumation

Muthu K, Kannan S, Muthusamy S, Sidhu P

Indian J Dermatol Venereol Leprol, 2015 Sep-Oct;81(5):505-7.
PMID: 26261150 DOI: 10.4103/0378-6323.162343
Matched MeSH terms: Palate/pathology*
Treating pulmonary embolism in Pacific Asia with direct oral anticoagulants

Cohen A, Jeyaindran S, Kim JY, Park K, Sompradeekul S, Tambunan KL, et al.

Thromb Res, 2015 Aug;136(2):196-207.
PMID: 26139085 DOI: 10.1016/j.thromres.2015.05.024

Pulmonary embolism (PE) is the principal preventable cause of in-hospital deaths. Prevalence of PE in Asians is uncertain but undoubtedly underestimated. Asians and Caucasians have similar non-genetic risk factors for PE, and there is mounting evidence that PE affects Asians much more commonly than previously supposed; incidence, especially among high-risk patients, may approach that in Caucasians. Furthermore, PE incidence in Asia is increasing, due to both increased ascertainment, and also population ageing and growing numbers of patients with predisposing risk factors. Despite being warranted, thromboprophylaxis for high-risk patients is not routine in Pacific Asian countries/regions. There also appears to be scope to implement venous thromboembolism (VTE) management guidelines more assiduously. Anticoagulants, primarily heparins and warfarin, have been the mainstays of VTE management for years; however, these agents have limitations that complicate routine use. The complexity of current guidelines has been another barrier to applying evidence-based recommendations in everyday practice. Updated management approaches have considerable potential to improve outcomes. New oral anticoagulants that are easier to administer, require no, or much less, monitoring or dose-adjustment and have a favourable risk/benefit profile compared with conventional modalities, may offer an alternative with the potential to simplify VTE management. However, more information is required on practical management and the occurrence and treatment of bleeding complications. Increasing recognition of the burden of PE and new therapeutic modalities are altering the VTE management landscape in Pacific Asia. Consequently, there is a need to further raise awareness and bridge gaps between the latest evidence and clinical practice.

Matched MeSH terms: Pulmonary Embolism/pathology
Fulltext Shape Optimization for Additive Manufacturing of Removable Partial Dentures--A New Paradigm for Prosthetic CAD/CAM

Chen J, Ahmad R, Suenaga H, Li W, Sasaki K, Swain M, et al.

PLoS One, 2015;10(7):e0132552.
PMID: 26161878 DOI: 10.1371/journal.pone.0132552

With ever-growing aging population and demand for denture treatments, pressure-induced mucosa lesion and residual ridge resorption remain main sources of clinical complications. Conventional denture design and fabrication are challenged for its labor and experience intensity, urgently necessitating an automatic procedure. This study aims to develop a fully automatic procedure enabling shape optimization and additive manufacturing of removable partial dentures (RPD), to maximize the uniformity of contact pressure distribution on the mucosa, thereby reducing associated clinical complications. A 3D heterogeneous finite element (FE) model was constructed from CT scan, and the critical tissue of mucosa was modeled as a hyperelastic material from in vivo clinical data. A contact shape optimization algorithm was developed based on the bi-directional evolutionary structural optimization (BESO) technique. Both initial and optimized dentures were prototyped by 3D printing technology and evaluated with in vitro tests. Through the optimization, the peak contact pressure was reduced by 70%, and the uniformity was improved by 63%. In vitro tests verified the effectiveness of this procedure, and the hydrostatic pressure induced in the mucosa is well below clinical pressure-pain thresholds (PPT), potentially lessening risk of residual ridge resorption. This proposed computational optimization and additive fabrication procedure provides a novel method for fast denture design and adjustment at low cost, with quantitative guidelines and computer aided design and manufacturing (CAD/CAM) for a specific patient. The integration of digitalized modeling, computational optimization, and free-form fabrication enables more efficient clinical adaptation. The customized optimal denture design is expected to minimize pain/discomfort and potentially reduce long-term residual ridge resorption.

Matched MeSH terms: Mandible/pathology
A probable case of poliomyelitis imported to Malaysia

Tay CG, Ong LC, Goh KJ, Rahmat K, Fong CY

J Clin Neurosci, 2015 Dec;22(12):1994-5.
PMID: 26254091 DOI: 10.1016/j.jocn.2015.07.001

We report a previously well 10-month-old Somalian girl who acquired asymmetric lower limb weakness in July 2013 in Mogadishu, Banadir, before arriving in Malaysia at 12 months of age. In May 2013, there was a wild poliomyelitis outbreak in that area, as reported by the World Health Organization. Laboratory investigation, including cerebrospinal fluid, was unremarkable, and electrophysiological studies showed active axonal denervation in the left lower limb. The whole spine T2-weighted MRI revealed non-enhancing hyperintensities of the bilateral anterior horn cells, predominantly on the left side at T11-12. The viral isolations from two stool specimens at her presentation to our centre, 2 months after the onset of illness and 2 weeks apart, were negative. Despite lacking the acute virological evidence of poliomyelitis, in view of the girl's clinical, electrophysiological and classical spinal neuroradiological features, together with her temporal relationship with a World Health Organization reported wild poliomyelitis outbreak, we believe these findings are consistent with a diagnosis of imported poliomyelitis. A review at 30 months of age showed persistent left lower limb monoplegia with little recovery. Our patient reiterates the importance of maintaining awareness of wild polio importation, and keeping abreast of the latest news of global poliomyelitis outbreaks when treating patients with flaccid paralysis, even if they arrive from non-endemic poliomyelitis areas.

Matched MeSH terms: Poliomyelitis/pathology; Poliomyelitis/physiopathology
Fulltext Multidisciplinary approach for management of a patient with fibrous dysplasia of maxilla

Eachempati P, Aggarwal H, Shenoy V, Baliga M

BMJ Case Rep, 2015 Aug 05;2015.
PMID: 26245286 DOI: 10.1136/bcr-2015-210330

Fibrous dysplasia is a non-neoplastic hamartomatous developmental fibro-osseous lesion of bone. Monostotic fibrous dysplasia is more common than the polyostotic form and usually involves jaw bones, ribs and femur. Maxillary lesions may extend to involve the maxillary sinus, zygoma, sphenoid bone and floor of the orbit and require surgical intervention resulting in an acquired defect of the involved site. A multidisciplinary team approach involving an oral pathologist, oral surgeon, oral medicine expert and maxillofacial prosthodontist is required for successful treatment and rehabilitation of such patients. This article describes a case of a patient with fibrous dysplasia of the left maxilla, which was successfully managed by integrating surgical intervention and postoperative rehabilitation, with a surgical obturator and an interim partial denture prosthesis that successfully limited the detrimental effects of surgery, and helped the patient in resocialisation, thereby improving her quality of life.

Matched MeSH terms: Maxilla/pathology*

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