A recognized cause of incomplete or cancelled MRI examinations is anxiety and claustrophobic symptoms in patients undergoing MR scanning. This appears to be a problem in many MRI centres in Western Europe and North America, where it is said to be costly in terms of loss of valuable scan time, and has led to researchers suggesting several anxiety-reducing approaches for MRI. To determine the incidence of failed MRI examination among our patients and if there are any associations with a patient's sex, age and education level, we studied claustrophobia that led to premature termination of the MRI examination in the University Malaya Medical Centre (UMMC) in 3324 patients over 28 months. The incidence of failed MRI examinations due to claustrophobia in the UMMC was found to be only 0.54%. There are associations between claustrophobia in MRI with the patients' sex, age and level of education. The majority of those affected were male patients and young patients in the 25-45-years age group. The patients' education level appears to be the strongest association with failed MRI examinations due to claustrophobia, where the majority of the affected were highly educated individuals. Claustrophobia in MRI is more of a problem among the educated individuals or patients from a higher socio-economic group, which may explain the higher incidence in Western European and North American patients.
Gestational trophoblastic disease is a common gynaecological problem in Malaysia. The incidence of molar pregnancy is 2.8 per 1000 deliveries, being more common amongst the Chinese. The preferred method of evacuation is suction curettage; complete evacuation of the uterus was not achieved at the first attempt in 25 per cent of cases. Partial moles in our centre comprised 30 per cent of all moles. This is potentially malignant and needs follow-up for a complete mole. In the management of an invasive mole, chemotherapy should not be withheld in the presence of metastases and failure of regression of hCG. The role of prophylactic hysterectomy and prophylactic chemotherapy in the management of molar pregnancy is discussed "Selective preventive chemotherapy" in patients at "risk" appears appropriate. Chemotherapy remains the main modality of treatment for gestational trophoblastic tumours (GTT). We categorised our patients into low, medium and high-risk groups; survivals were 100, 98, and 61.7 percent respectively. These patients when categorised according to FIGO staging had survivals of 100, 80, 78.6 and 68.2 per cent respectively for stages 1, 2, 3 and 4 respectively. The reasons for the poor survival in the 'high-risk' group are discussed. Colour doppler blood flow studies are now being carried out; its role needs further evaluation. Surgery and radiotherapy have only a limited role in the management of these cases.
The EtOH extract of the leaves of Holarrhena curtisii yielded five new steroidal alkaloids: 17-epi-holacurtine (3), 17-epi-N-demethylholacurtine (4), holacurtinol (5), 3alpha-amino-14beta-hydroxypregnan-20-one (7), and 15alpha-hydroxyholamine (8), in addition to the known compounds, holacurtine (1), N-demethylholacurtine (2), and holamine (6). All eight compounds showed significant cytotoxic and leishmanicidal activities.
The effects of vitamin C and aloe vera gel extract supplementation on induced hepatocarcinogenesis in male Sprague-Dawley rats (120-150 g) by diethylnitrosamine (DEN) and 2-acetylaminofluorene (AAF) was investigated. The severity of the carcinogenesis process was determined by measuring gamma-glutamyl transpeptidase (GGT) and the placental form of glutathione S-transferase (GSTP) histochemically in situ and in plasma and liver fractions. In addition, plasma alkaline phosphatase (ALP) and liver microsomal uridine diphosphate glucuronyl transferase (UDPGT) activity were also determined. Administration of DEN/AAF caused an increase in the surface area and number of enzyme-positive foci (both GGT and GSTP) compared with control. Supplementation of vitamin C or aloe vera gel extract to the cancer-induced rats suppressed this increase significantly (P < 0.05; P < 0.001). Increases in liver UDPGT, GGT, and GSTP activities were also observed with cancer induction that were again suppressed with either vitamin C or aloe vera gel supplementation. Plasma GGT in the DEN/AAF rats were determined monthly for the duration of the experiment and found to be reduced as early as 1 mo with aloe vera gel supplementation and 2 mo with vitamin C supplementation. In conclusion, vitamin C and aloe vera gel extract supplementation were found to be able to reduce the severity of chemical hepatocarcinogenesis.
Nine simple sequence repeat (SSR) markers were developed from Shorea curtisii using two different methods. One SSR locus was isolated by the commonly used method of screening by colony hybridization, and the other eight loci were isolated by a vectorette PCR method. Primer pairs were designed based on the sequences of all these SSR loci. Analysis of 40 individuals of S. curtisii from natural forest in Malaysia revealed that all SSR loci were polymorphic. Four SSR markers, Shc01, Shc04, Shc07 and Shc09, were highly polymorphic. We have also tested the applicability of these SSR printers to other species of Dipterocarpaceae using PCR amplification. Because the flanking region sequences of the S. curtisii SSRs were well conserved within this family, the SSR primers for S. curtisii can be applied to almost all species of Dipterocarpaceae.
During an outbreak of hand-foot-mouth disease caused by enterovirus 71 (EV-71) in 1997, 4 children presented with sudden cardiopulmonary collapse and minimal neurologic features. All children received cardiopulmonary resuscitation but died within a few hours of admission. Postmortem studies showed infection by EV-71 with extensive damage to the medulla and pons. We postulate an etiologic link between EV-71 and brainstem encephalomyelitis as the cause of pulmonary edema and death.
AIM: To evaluate the anthropometric measurements and dietary intake of the free-living elderly in a Chinese community.
METHOD: A survey was carried out on 48 male and female subjects aged 60 to 96 years using anthropometric, dietary intake and questionnaire techniques.
RESULTS: The study indicated female subjects to have more health problems, like pain at the joints (33%), hypertension (17%) and diabetes (27%) as compared to the male subjects. Dietary intake analysis showed the Chinese male subjects to have a higher energy intake (1,623 kcal) compared to the females (1,197 kcal) even though they did not fulfill the recommended dietary intake. The intake for energy, fats and carbohydrates, was found to be significantly different (p < 0.05) between both sexes. Anthropometric measurements indicated male elderly subjects to be significantly heavier (p < 0.05, 55.4 kg) and taller (161.8 cm) than female elderly subjects (49.5 kg; 146.2 cm respectively). About half of the elderly were normal in their BMI (male 55.6%; female 50%) and only 6.6% of the female subjects were obese. More male subjects were found to be underweight (33%) compared to female subjects (17%). Waist hip ratio was 0.92 for male and 0.87 for female.
CONCLUSION: Our study showed that female elderly subjects had more health problems compared to male elderly subjects. On the whole, the elderly did not fulfill the recommended amount for energy intake while the percentage for carbohydrates, fats and protein from the total calorie intake were not in accordance with the healthy diet guidelines. Anthropometrically, male subjects were heavier and taller than female subjects. Looking at body mass index, most of the male elderly subjects were in the normal to underweight range. With these results, more research is warranted to give a clearer picture of the Chinese elderly in the country.
Study site: Kampung Baru Tabuh Naning, Alor Gajah, Malacca
MeSH terms: Aged; Aged, 80 and over; Arthritis/complications; Body Constitution; Body Height; Body Weight; Energy Intake; China/ethnology; Diet; Dietary Carbohydrates/administration & dosage; Dietary Fats/administration & dosage; Ethnic Groups*; Female; Health Status; Humans; Hypertension/complications; Malaysia; Male; Middle Aged; Nutritional Physiological Phenomena*; Obesity/complications; Surveys and Questionnaires; Sex Factors; Body Mass Index; Nutrition Policy; Diabetes Complications
To determine the incidence of insulin dependent diabetes mellitus (IDDM) in children 0-12 years of age in Singapore, which has a population of 2.9 million.
MeSH terms: Child; Child, Preschool; China/ethnology; China/epidemiology; Diabetes Mellitus, Type 1/genetics; Diabetes Mellitus, Type 1/epidemiology*; Ethnic Groups/statistics & numerical data; Female; Health Surveys; Hong Kong/epidemiology; Humans; India/ethnology; Infant; Japan/epidemiology; Malaysia/ethnology; Male; Registries; Seasons; Sex Factors; Singapore/epidemiology; Incidence; Confidence Intervals
Maple syrup urine disease (MSUD) is an inherited metabolic disorder characterised by a severe, usually lethal, neonatal course unless dietary intake of branched chain amino acids is restricted. We describe a patient with MSUD who had computed tomography (CT) changes of diffuse white matter hypodensity, particularly in the deep white cerebellar matter, brain stem, cerebral peduncles, thalamus and posterior limb of the internal capsule. With dietary treatment, there was neurological improvement with simultaneous disappearance of the oedema. These CT changes are typical of MSUD, hence are relevant findings in the neuroradiologic differential diagnosis of a possible metabolic disorder.
A case of chondrosarcoma of the nasal septum is presented with the result of treatment. The patient was admitted for a growth in the nose of four years' duration. Fine needle aspiration for cytological examination was suggestive of squamous cell carcinoma. She was treated with lateral rhinotomy and wide excision followed by septorhinoplasty. Histological examination showed that the lesion was chondrosarcoma. The patient remained free of disease 26 months after surgery.
The effect of the mannose-binding champedak (Artocarpus integer) lectin-M on the cellular proliferation of murine lymphocytes was investigated in this study. Our data demonstrated that the lectin was the main mitogenic component in the crude extract of the champedak seeds. It stimulated the proliferation of murine T cells at an optimal concentration of 2.5 microg/ml in a 3 day culture. Lectin-M appeared to be a T-cell mitogen as it does not induce significant DNA synthesis when cultured with spleen cells from the nude mouse. In the absence of T cells, the lectin was incapable of inducing resting B cells to differentiate into immunoglobulin secreting plasma cells.
A 43-year-old woman developed abdominal pain and diarrhea following a travel to Malaysia. Examinations in another hospital proved no evidence of infection, an empirical antibiotic therapy with ciprofloxacin yielded no benefit. One and a half year later, the patient was admitted to our department because of persistent diarrhea and wasting. Laboratory tests showed megaloblastic anemia, folate deficiency and steatorrhea. Stool specimens for bacterial pathogens and parasites were negative. Endoscopy and biopsy from the distal portion of the duodenum revealed broadening and shortening of the villi and an increased infiltration of the lamina propria by chronic inflammatory cells (plasma cells and lymphocytes). In conclusion, diagnosis of tropical sprue was established. The therapy comprised of tetracycline for six weeks and folic acid for six months. Subsequently, the diarrhea disappeared, the patient continuously gained weight and was free of any complaints. The complete remission following this regimen proved the suspected diagnosis. Differential diagnosis in any patient who recently returned from the tropics may be a challenge. Tropical sprue predominantly occurs during or after a longer stay in endemic areas. However, if chronic diarrhea and signs of malabsorption develop after a short journey to India, South-East Asia and parts of the Caribbean, tropical sprue has to be considered, too.
Pericoronitis is the most common odontogenic problem associated with the wisdom tooth in young men and women. Patients may present with problems associated with infection, swelling and pain. However, other associated pathology such as caries, periodontal disease and referred pain from the temporomandibular joint must be investigated when treating pain from the wisdom tooth. The authors wish to present a case in which the pain from a wisdom tooth was due to a fractured dens evaginatus. The importance of this dental anomaly should not be overlooked.
A collaborative national survey initiated by the University of Malaya and the Ministry of Health was conducted from 1993 to 1995 to establish baseline patient dose data for seven common types (12 projections) of X-ray examinations in Malaysia. A total of 12 randomly selected public hospitals and 867 patients were included in this survey. The entrance surface doses (ESD) received by the patients were measured using thermoluminescent dosemeters (TLDs) attached to the patient's skin. Histograms are presented showing wide, positively skewed distributions of measured entrance surface doses for each examination. Mean, median, first and third quartile values of ESD and median effective dose are reported. Survey results are generally comparable with those reported in the UK, USA and by the International Atomic Energy Agency (IAEA). The results also provide information on dose level for a lower weight population (mean weight 60 kg) compared with the international reference dose values based on a 70 kg standard. The findings support the importance of the on-going national quality assurance programme to ensure doses are kept to a level consistent with optimum image quality. The data will also be useful for the formulation of national guidance levels as recommended by the IAEA. Furthermore, this study provides patient dosimetry information on healthcare level II countries.
A polymerase chain reaction assay based on the enzyme-linked immunosorbent assay (PCR-ELISA) has been developed to detect Brugia malayi infection in an area of low endemicity in Malaysia. Blood samples from 239 subjects were tested: 192 amicrofilaraemic individuals, 14 microfilaraemic persons and 3 chronic elephantiasis cases from endemic areas and 30 city-dwellers (non-endemic controls). PCR products were examined by ELISA and Southern hybridization. In the PCR-ELISA, digoxigenin-labelled PCR products were hybridized to a biotin-labelled probe. This was followed by incubation in streptavidin-coated microtitre wells and detection using anti-digoxigenin-peroxidase and ABTS [2,2'-azinobis(3-ethylbenzthiazoline-6-sulphonic acid)]. All microfilaraemic samples were positive by PCR-ELISA and Southern hybridization and all samples from non-endemic subjects and chronic elephantiasis patients were negative. The PCR-ELISA detected 12 times as many B. malayi infections as did thick blood film examination. Nineteen of the 194 samples from the endemic area gave positive results by both PCR-ELISA and Southern hybridization, and an additional 5 samples were positive by PCR-ELISA only. The PCR-ELISA was specific and sensitive, detected more infections, and was more reproducible than Southern hybridization.
BACKGROUND: The diverse range of diseases that affect the salivary glands may lead to problems and pitfalls in cyto-diagnosis. While false negative diagnosis of cystic salivary gland tumors is well known, false positive cytodiagnosis in nonneoplastic salivary cysts is less well documented.
CASE: An 85-year-old female presented with a painless left parotid gland swelling of three months' duration. Fine needle aspiration cytology yielded fluid, smears of which showed keratinizing squamous cells with nuclear atypia leading to a cytologic diagnosis of cystic squamous cell carcinoma. A total radical parotidectomy followed. Histopathologic study showed cystic dilatation of many of the salivary ducts, which were lined with metaplastic squamous epithelium that showed atypia. There was no evidence of squamous cell carcinoma.
CONCLUSION: Squamous metaplasia is known to occur in benign salivary gland lesions, such as pleomorphic adenoma and Warthin's tumors, as well as in salivary duct cysts and necrotizing sialometaplasia. However, atypical squamous metaplasia of salivary duct cysts mimicking squamous cell carcinoma on cytology is unusual.