Cavernous hemangioma is a vascular tumor composed of large dilated blood vessels and containing large blood-filled spaces. The formation is due to dilation and thickening of the walls of the capillary loops. Most cavernous hemangiomas present at birth or soon after. On the other hand, jugular phlebectasia is an abnormal benign sacculofusiform dilatation of jugular veins. It should be considered as one of the differential diagnosis of neck swelling. Majority of the reported cases occurred in a young child. We reported a case of an elderly woman who was diagnosed clinically as anterior jugular vein phlebectesia. Histologically the mass turned out to be a cavernous hemangioma.
Trichomonas vaginalis, a flagellate protozoan parasite commonly found in the human genitourinary tract, is transmitted primarily by sexual intercourse. Diagnosis is usually by in vitro culture method and staining with Giemsa stain. There are laboratories that use Gram stain as well. We compared the use of modified Field's (MF), Giemsa, and Gram stains on 2 axenic and xenic isolates of T. vaginalis, respectively. Three smears from every sediment of spun cultures of all 4 isolates were stained, respectively, with each of the stains. We showed that MF staining, apart from being a rapid stain (20 s), confers sharper staining contrast, which differentiates the nucleus and the cytoplasm of the organism when compared to Giemsa and Gram staining especially on parasites from spiked urine samples. The alternative staining procedure offers in a diagnostic setting a rapid stain that can easily visualize the parasite with sharp contrasting characteristics between organelles especially the nucleus and cytoplasm. Vacuoles are more clearly visible in parasites stained with MF than when stained with Giemsa.
Primary peritoneal carcinoma (PPC) is a rare tumor that is histologically and immunohistochemically indistinguishable from epithelial ovarian carcinoma. The diagnosis is usually made after excluding gross ovarian involvement or the ovarian involvement is only confined to the surface. A 68-year-old lady presented with right iliac fossa pain and increasing CA125. The CT scan showed bilateral pelvic adnexal masses with peritoneal deposits within the right side of abdomen. She was initially diagnosed as carcinomatosis peritonei from the omental cake removed after exploratory surgery. She was managed as advanced ovarian tumor with peritoneal metastasis and was then administered six cycles of chemotherapy. Surgical intervention included debulking surgery consisting of total abdominal hysterectomy, bilateral salpingooophorectomy and omentectomy and also with right hemicolectomy. The histopathological findings were of primary peritoneal serous carcinoma with only minimal involvement of the serosal surface of the right ovarian capsule. No microscopic invasion into underlying ovarian cortex and stroma was observed. Multiple tumor deposits were also seen over the right paratubal and paraovarian tissue, both parametrium as well as serosal surface of the terminal ileum and periappendicular tissue. Immunohistochemically, the malignant cells were positive to CA125, focally positive to CK7 and negative to CD20 and Calretinin. PPC is one of important differential diagnosis which needs to be considered in cases of advanced ovarian tumor, although the former can only be ascertained after excluding the ovarian involvement microscopically.
Durian may inflict severe body injury when it drops from the tree. This case report describes a patient who presented with facial and penetrating eye injury when a ripe durian fruit dropped onto her face while harvesting the fruits under the tree. The authors emphasized the importance of facial and eye protective devices during durian fruit harvesting season.
PURPOSE: A cross sectional descriptive study, which involved government hospitals and health clinics from Peninsular Malaysia sought to identify the continuing professional education (CPE) needs and their readiness for E-learning. This paper focuses on the first phase of that study that aimed to determine the factors that influence nurses' participation in CPE.
METHODS: Multistage cluster sampling was used to recruit 1,000 nurses randomly from 12 hospitals and 24 health clinics from four states in Peninsular Malaysia who agreed to be involved. The respondent rate was 792 (79.2%), of which 562 (80%) had participated in CPE in the last 12 months.
RESULTS: Findings suggested that updating knowledge and providing quality care are the most important factors that motivate participation in CPE, with respective means of 4.34 and 4.39. All the mean scores for educational opportunity were less than 3.0. Chi-square tests were used to test the association of demographic data and CPE participation. All demographical data were significantly associated with CPE participation, except marital status.
CONCLUSIONS: Implementation of mandatory CPE is considered an important measure to increase nurse's participation in CPE. However, effective planning that takes into consideration the learning needs of nurses is recommended.
Scanning electron microscopy (SEM) examination of a paratype specimen (gravid female) of the philometrid nematode Paraphilometroides nemipteri Moravec et Shaharom-Harrison, 1989, the type species of Paraphilometroides Moravec et Shaharom-Harrison, 1989, made it possible to recognise the true structure of the cephalic end and the shape of cuticular ornamentations on the body. In contrast to other philometrid genera, the cephalic end is angular in lateral view and rounded in dorsoventral view; large external cephalic papillae are fused together to form a marked dorsal and a ventral ala, each bent into a curve; six minute internal papillae, including a pair of previously not reported lateral papillae, were found; amphids were indistinct. Cuticular ornamentations (inflations) were found to be transversely elongated. These features, especially the unique cephalic structure, clearly distinguish Paraphilometroides from other philometrids and confirm the validity of this genus. Moravec and Shaharom-Harrison (1989) erected the hitherto monotypic philometrid genus Paraphilometroides Moravec et Shaharom-Harrison, 1989 with the type species P. Nemipteri Moravec et Shaharom-Harrison, 1989, described from females found in the fins and operculum of the marine fish (notchedfin threadfin bream) Nemipterusperonii (Valenciennes) from off the South China Sea coast, Malaysia. The male of P. nemipteri remains unknown. The authors distinguished Paraphilometroides from the related genus Philometroides Yamaguti, 1935 mainly by the unusual structure of the female cephalic end, which is unique within the family Philometridae (see Moravec 2006). However, P. nemipteri was studied only by light microscopy (LM), whereas some details of the cephalic structure, especially the cephalic papillae of gravid philometrid females are usually difficult to observe by LM due to a various degree of their reduction and atrophy (Moravec 2004); in the past, some philometrid species were even reported to have no cephalic papillae. Consequently, the only reliable method to study the cephalic structures in philometrids is the use of scanning electron microscopy (SEM). Therefore, one of the ethanol-preserved paratype specimens (gravid female) of P. nemipteri, deposited in the Helminthologi-cal Collection of the Institute of Parasitology, Biology Centre
In 1999, Furnham and Mak published a review of 14 content-analytic studies of sex roles stereotyping in television commercials. All these studies were based on the McArthur and Resko (1975) content categories. This paper updates that review considering 30 studies in over 20 countries published between 2000 and 2008. Studies were from Australasia, Austria, Bulgaria, Ghana, Hong Kong, Japan, Kenya, Korea, Malaysia, Mauritius, New Zealand, Poland, Russia, Serbia, Singapore, South Africa, Spain, Saudi Arabia, Sweden, Taiwan, Thailand, Turkey, the United Kingdom and the United States. They examined over 8,000 advertisements. National and cultural differences in gender stereotypes are also considered in the light of this data. The popularity of, and the problems associated with, the research paradigm are considered.
OBJECTIVES: To evaluate the trends of disease-modifying anti-rheumatic drugs (DMARDs) used in the treatment of rheumatoid arthritis (RA).
METHODS: Patients who fulfilled the ACR criteria for RA from 1995 to 2006 and who attended the Rheumatology clinic at Ipoh Hospital were selected and their records were evaluated to determine the changing trends in the use of DMARDs.
RESULTS: 128 patients with RA were identified. The most commonly prescribed DMARD as monotherapy was sulphasalazine (47.7%), followed by methotrexate (35.9%) and hydroxychloroquine. Methotrexate and sulphasalazine were the most frequently prescribed DMARDs, of which the use of methotrexate has increased 6 folds from 1997 to 2007 and the use of sulphasalazine remains around 30% to 50%. The combination of methotrexate with leflunomide has significantly increased in usage by 4 folds during the study period whilst methotrexate with sulphasalazine combination usage had slightly declined.
CONCLUSION: DMARDs are still the cornerstone in the treatment of RA. Changes in the trend and aggressive use of DMARDs has been markedly influenced by the patient's awareness of early treatment, the incapacitating damage, availability of recently introduced leflunomide and the advancement of current recommended treatment protocol.
Study site: Rheumatology clinic, Hospital Raja, Parmaisuri Bainum (HRBP), Ipoh, Perak, Malaysia
A 36-year-old Malaysian woman with erosive arthritis presented with multiple asymptomatic skin colored papulonodules on the hands, elbows, knees, ears, and feet; many macules, papules, and plaques were photodistributed. Progressive, erosive arthritis began about 18 months after the onset of skin involvement. Initially the patient was diagnosed to have dermatomyositis due to her skin findings, but later proved to have multicentric reticulohistiocytosis based on the typical histopathological features of histiocytic multinucleated giant cells with eosinophilic ground glass cytoplasm on skin biopsy. Workup for associated diseases including malignancies was negative. Her skin lesions and joint pain responded to treatment with methotrexate and prednisolone.
Children who would benefit from a haematopoietic stem cell transplantation often lacked a compatible sibling donor. Unrelated cord blood transplantation was offered as an alternative donor source for patients with a variety of malignant and non-malignant diseases who had no further treatment options. Cord blood units were sourced from various international cord blood registries. The median nucleated and CD34+ cell doses were 8.7 x 10(7)/kg and 2.6 x 10(5)/kg respectively. In spite of adequate cell doses, a high rate of non-engraftment of 32% was observed. Acute graft-versus-host disease (GVHD) occurred in 14 out of the 15 patients who engrafted with 53% being grade III to IV GVHD. The five year disease free survival was 40.7% with infection and GVHD being the commonest causes of death. The five year disease free survival was 20.5% and 60.7% for malignant and non-malignant diseases respectively.
In parallel with the neo-liberal retrenchment of the welfarist state, an increasing emphasis on the responsibility of individuals in managing their own affairs and their well-being has been evident. In the health arena for instance, this was a major theme permeating the UK government's White Paper Choosing Health: Making Healthy Choices Easier (2004), which appealed to an ethos of autonomy and self-actualization through activity and consumption which merited esteem. As a counterpoint to this growing trend of informed responsibilization, constrained choices (constrained agency) provides a useful framework for a judicious balance and sense of proportion between an individual behavioural focus and a focus on societal, systemic, and structural determinants of health and well-being. Constrained choices is also a conceptual bridge between responsibilization and population health which could be further developed within an integrative biosocial perspective one might refer to as the social ecology of health and disease.
A new megophryid species, Leptolalax kecil, is described from the Cameron Highlands of Peninsular Malaysia on the basis of acoustic and morphological characteristics. It has an advertisement call dissimilar to that of other, congeneric species, and is the smallest of the known Leptolalax. It is similar to L. pluvialis from Vietnam in small body size, but differs from it in ventral color, and in the size and color of the pectoral gland. The distributional pattern of the new species Is discussed.
This study was designed to assess the total anal sphincter-saving technique of ligating the intersphincteric fistula tract for the treatment of fistula-in-ano.
Nasal polyp is one of the common causes of nasal obstruction. The diagnosis is usually made on clinical ground and rarely needs histological examination. However, when a candidate is selected for the surgical option of polyp removal, there is tendency to send all specimens for routine histological examination. The objective of this study was to assess the necessity of routinely performed histological examination in all nasal polyp specimens. A retrospective review of all nasal polyp histological reports was done from patients who underwent polypectomy or functional endoscopic sinus surgery in Universiti Sains Malaysia Hospital between January 2000 to July 2006. It consisted of 95 patients. Majority of the reports came back as inflammatory nasal polyp (93.6%) and other varieties of benign nasal mass (5.3%). However, one specimen was noted to be malignant (1.1%). In conclusion all nasal polyp specimens should be sent for histological examination in order to confirm the diagnosis.
The caesarean section rate in Malaysian public hospitals has increased to 15.7% from 10.5% in the year 2000. There are inter-state variations in the rate ranging from a high of 25.4% in Melaka to 10.9% in Sabah. The West Coast states generally had a higher caesarean section rate than the East Coast states as well as East Malaysia. It would be prudent for Malaysia to implement stringent caesarean audits to ensure that rising caesarean section rates are kept in check.
Acute laryngeal injury is a rare, potentially lethal injury. It often poses difficulty in airway management. Commonly described are external laryngeal or blunt injuries. We report a case of penetrating neck injury resulting in complete transection of cricoid cartilage. A lady presented with a large, deep slash wound in her neck from a knife injury. There was complete laryngotracheal separation. The airway was secured before she was taken to the operating theatre. A tracheostomy was performed. Exploration revealed the cricoid ring was cut horizontally into two. Anastomosis of the cartilaginous framework was undertaken. Fibreoptic laryngoscopy showed bilateral vocal cords paralysis. After two months the patient recovered without airway compromise, she regains her voice. Repeat laryngoscopy showed good mobility of the vocal cords. In conclusion surgical reconstruction should be meticulously done to ensure good respiratory and phonatory abilities.
We describe a new species of torrent-dwelling ranid frog of the genus Meristogenys from the Crocker Range, western Sabah, northern Borneo. The new species, Meristogenys maryatiae, differs from congeners by the combination of: small body, males 31-37 mm and females 65-66 mm in snout-vent length; head narrower than long; eyes moderate, diameter subequal to snout; iris unicolored; legs long; ventral surface of tibia without heavy pigmentation; rear of thigh blotched dark brown and cream; toes fully webbed; outer metatarsal tubercle present; larval dental formula 7(4-7)/6(1).
A 24-year-old lady presented with four days history of fever, non-pruritic rash, ankle pain and swelling. She had consumed herbal supplement five days before the onset of symptoms. Examinations revealed erythematous maculo-papular lesions of varying sizes on sun exposed areas. Patient was suspected to have Drug Induced Lupus Erythematosus (DILE) and subsequently symptoms subsided rapidly on withholding the herbal medication.
Medullary carcinoma is a rare breast carcinoma with a syncytial growth pattern and high-grade cytology. It can be difficult to diagnose and may be missed on conventional imaging as the findings may overlap with benign lesions i.e. fibroadenomas. The authors report a case of a 25-year-old female who presented with multifocal breast lumps diagnosed with medullary carcinoma and fibroadenomas. Imaging and pathological correlation with contrast-enhanced MRI are presented in the diagnosis of these lesions.