When planning extraction of teeth with poor prognosis especially lower first permanent molars, it is important to consider the timing of tooth removal and its effect on future occlusion to avoid interventions.
Growing teratoma syndrome is rare and usually it occurs in the younger aged group. The use of chemotherapy following initial surgical resection will yield the diagnosis following tumour enlargement. Complete resection is usually curative and renders better prognosis.
Giant lipomatous lesions of the thigh swelling with extension into retroperitoneum are rare. Lesions can be malignant or benign and can have similar clinical presentation. Treatments options differ and their prognosis varies with histology. We present two cases of liposarcoma and lipoma with the same clinical presentations that underwent surgical resection.
A 17 year old male with ataxia telangiectasia [Louis-Bar Syndrome] is presented here with a review of the literature with regards to the mode of inheritance, clinical manifestations, diagnosis and treatment of this disorder.
Epilepsy is a common neurological disorder in childhood. In a majority, the cause of epilepsy remains a mystery in spite of extensive investigations. The aim of drug treatment is to effectively stop the seizures with minimum of side effects, causing no impairment of long term learning abilities of the child. Up to 30% of children with epilepsy may continue to have seizures in spite of adequate drug therapy. In this review, an overview of the recent advances that affect the diagnosis, prognosis and therapy of childhood epilepsy including the dilemmas of everyday practice is presented.
An analysis is made of parasite counts made on the first day of treatment in a series of 750 cases of acute subtertian malaria. The analysis affords data of the parasitological intensity of the subtertian infections prevalent in the Kuala Lumpur district of the Malay States during 2 years of normal malarial incidence and severity, and suggests:- 1. (a) That parasite counts made on the first day of treatment are of considerable prognostic reliability. 2. (b) That the counts made during the course of treatment are a useful guide to progress but are open to occasional fallacy. 3. (c) That the extreme limit of tolerance of Asiatic adults for the local strains of P. falciparum is probably in the region of three quarters of a million parasites per c.mm. of peripheral blood.
Kenaikan segmen ST di elektrod aVR elektrokardiografi di dalam kes diseksi aorta mempunyai risiko kematian yang tinggi. Ia melibatkan diseksi yang berlaku di akar aorta. Kami melaporkan kes pesakit lelaki muda yang menghidap penyakit darah tinggi, yang datang ke Jabatan Kecemasan dengan sakit dada dan sakit di bahagian kaki. Pemeriksaan fizikal pada bahagian bawah kiri anggota adalah konsisten dengan iskemia akut. Elektrokardiogram menunjukkan serangan jantung akut di bahagian elektrod anterolateral, dan kenaikan ST segmen di elektrod aVR. Ekokardiografi menunjukkan akar aorta yang berukuran 4.51 cm dan kehadiran flap intimal, meningkatkan kebarangkalian diseksi pada akar aorta dan arteri koronari. Tomography Computed Angiogram menunjukkan terdapat diseksi aorta dari akar aorta termasuk flap intimal berhampiran permulaan arteri koronari kiri, hingga ke arteri iliac utama ke arteri iliac kiri. Malangnya, pesakit memilih untuk tidak menjalani pembedahan dan akhirnya meninggal dunia selepas 48 jam di masukkan ke wad. Kes ini menjelaskan bahawa, dalam kes diseksi aorta yang hadir dengan sindrom 'malperfusion', kenaikan segmen ST pada elektrod aVR akan meningkatkan kebarangkalian terjadinya diseksi aorta yang teruk melibatkan akar aorta dan juga arteri koronari, yang menjadikan prognosis pesakit lebih teruk.
Presence of air in the kidney can be problematic as the location of the air in different parts of the kidney greatly affects the subsequent management and outcome of the patient. We present here a case of a patient who had emphysematous pyelitis, in which CT scan was able to display presence of air only in the collecting system, thus differentiating this condition from the more fulminant emphysematous pyelonephritis. This leads to a more favourable prognosis and outcome to the patient.
Age at onset (AAO) is a known prognostic indicator for schizophrenia and is hypothesized to correlate with cognition and symptom severity. TCF4 and AKT1 are schizophrenia risk genes involved in cognitive functions. The current study examined the interactive effects of TCF4 and AKT1 variants with gender, family history of psychiatric disorders and ethnicity on the AAO of schizophrenia.
Myelodysplastic syndromes appear to be a rare group of blood disorders in Malaysia. It usually affects the elderly and some of the cases were reported to evolve into acute leukemia. We describe our experience with five cases, seen and managed by us over a 5-year period. All patients receiving supportive therapy died with one of them definitely known to transform to acute leukemia. The patient who survives till the time of writing received low dose continuous cytosine arabinoside infusion.
The potential of genetic programming (GP) on various fields has been attained in recent years. In bio-medical field, many researches in GP are focused on the recognition of cancerous cells and also on gene expression profiling data. In this research, the aim is to study the performance of GP on the survival prediction of a small sample size of oral cancer prognosis dataset, which is the first study in the field of oral cancer prognosis.
Acute myeloid leukaemia (AML) is the most common subtype of acute leukaemias with a poor outcome. Msi2 protein is a newly discovered prognostic marker and it has been considered as a new target for therapy in AML. The study of Msi2
protein expression in AML cases has not been performed in Malaysia, to date. The main aim of the present study was to observe the expression of Msi2 protein in AML patients by immunohistochemistry (IHC) and to correlate its expression
with the well-established prognostic and clinical parameters in AML as well as the overall survival (OS). Sixty four bone marrow trephine biopsy sections were immunostained for Msi2 protein. The percentage of blasts with positive reaction
and the intensity of the cytoplasmic and nuclear staining were evaluated. The expression of Msi2 protein was found in 95.3% cases with Msi2 pattern varying between the cases. In 71.9% of cases, the blasts showed total cellular positivity and 23.4% cases showed only cytoplasmic positivity. Majority showed high expression of Msi2 for cytoplasmic staining. Interestingly, there was significant correlation between total cellular staining and the intermediate cytogenetic subgroup (P=0.04). In conclusion, the results showed that the majority of the patients had high expression of Msi2 but this did not correlate to OS. However, the Msi2 expression correlated to the cytogenetic findings. The results suggest future extensive research to be conducted in order to ascertain the exact role of Msi2 positive blast cells in AML in our population and their association with prognosis and outcome.
Keywords: AML, cytogenetics, immunohistochemistry, Msi2 protein
Resistance to anti-HER2 targeted therapy imposes a crucial limitation to the successful treatment of HER2 positive breast cancer. The expression of HER4 and its prognostic value is controversial in breast cancer. The role of HER4 in trastuzumab treatment and resistance in HER2-positive breast cancer has been recently studied. HER4 activation, cleavage and nuclear translocation have been demonstrated mediate trastuzumab resistance in HER2 positive breast cancer. In addition, nuclear HER4 is suggested could be a novel predictive and prognostic biomarker in HER2 positive breast cancer patients. Understanding the role of HER4 may offer useful insights to cancer treatment in HER2-positive breast cancer and other cancers.
Primary cutaneous anaplastic large cell lymphoma (PC-ALCL) is relatively a rare tumour of head and
neck region. Without histopathological confirmation, it appears and behaved as like malignant epithelial tumor of
the head and neck region as will be illustrated in the present case. Cutaneous involvement of the tumor with
distant metastasis has made the prognosis unfavorable. This isolated case of head and neck PC-ALCL was
highlighted as it has a tendency to behave aggressively and early diagnosis and treatment is crucial to avoid poor
Malignant melanoma (MM) of parotid gland is a rare condition. This pathology is often a result of secondary metastasis from primary lesions in the head and neck skin. A MM arising de novo in parotid gland is very rare. This malignant tumour is more prevalent in adults rather than children and it tends to have several distinct features. Treatment options are limited especially for an advanced lesion. Despite best treatments this condition carries a poor prognosis. This case details our experience in treating a child with MM of parotid gland without other primary cutaneous lesions.
This paper offers a technique to construct a prediction interval for the future value of the last variable in the vector r of m variables when the number of observed values of r is small. Denoting r(t) as the time-t value of r, we model the time-(t+1) value of the m-th variable to be dependent on the present and l-1 previous values r(t), r(t-1), …, r(t-l+1) via a conditional distribution which is derived from an (ml+1)-dimensional power-normal distribution. The 100(α / 2)% and 100(1−α / 2)% points of the conditional distribution may then be used to form a prediction interval for the future value of the m-th variable. A method is introduced to estimate the above (ml+1)-dimensional power-normal distribution such that the coverage probability of the resulting prediction interval is nearer to the target value 1- α .
Informed consent has been recognised as an essential part of clinical practice, giving ethical and legal legitimacy to medical intervention. There is no universal standard on the amount and type of information that a patient is entitled to and needs to be adequately disclosed. This article proposes nine information that will assist the doctor in providing adequate information for a patient to evaluate whether to authorise medical intervention. The recommended infor- mation are: (i) diagnosis, prognosis and its uncertainties; (ii) nature of proposed medical intervention; (iii) the expect- ed benefit of proposed medical intervention; (iv) the potential risk of proposed medical intervention; (v) alternative to proposed medical intervention; (vi) progress of proposed medical intervention; (vii) opportunity for a second medical opinion and to seek further details; (viii) costs of proposed and alternative medical intervention; and (ix) the person responsible for implementing medical intervention.
Papillary thyroid carcinoma (PTC) associated with familial adenomatous polyposis (FAP) is rare. It is usually associated with the cribriform-morular variant of PTC, with unusual patterns on detailed histology examination. This variant is known to have a good prognosis. Papillary thyroid carcinoma associated with FAP commonly occurs in females in their 30s and rarely in the elderly. We report a case of a 69-year-old female presenting with thyroid swelling and a history of FAP.