Objective: To compare the diagnostic image quality between three different water soluble iodinated contrast media in hysterosalpingography (HSG). Material and method: In a prospective randomised study of 204 patients, the diagnostic quality of images obtained after hysterosalpingography were evaluated using Iopramide (106 patients) and Ioxaglate (98 patients). 114 patients who had undergone HSG examination using Iodamide were analysed retrospectively. Image quality was assessed by three radiologists independently based on an objective set of criteria. The obtained results were statistically analysed using Kruskal-Wallis and Mann-Whitney U test. Results: Visualisation of fimbrial rugae was significantly better with Iopramide and Ioxaglate than Iodamide. All contrast media provided acceptable diagnostic image quality with regard to uterine, fallopian tubes outline and peritoneal spill. Uterine opacification was noted to be too dense in all three contrast media and not optimal for the assessment of intrauterine pathology. Higher incidence of contrast intravasation was noted in the Iodamide group. Similarly, the numbers of patients diagnosed with bilateral blocked fallopian tubes were also higher in the Iodamide group. Conclusion: HSG using low osmolar contrast media (Iopramide and Ioxaglate) demonstrated diagnostic image qualities similar to HSG using conventional high osmolar contrast media (Iodamide). However, all three contrast media were found to be too dense for the detection of intrauterine pathology. Better visualisation of the fimbrial outline using Ioxaglate and Iopramide were attributed to their low contrast viscosity. The increased incidence of contrast media intravasation and bilateral tubal blockage using Iodamide are probably related to the high viscosity.

Spirituality and mental adjustment have been widely adopted as coping strategies among women with breast cancer. Little information was available locally on the use of spirituality and mental adjustment as coping mechanisms to fight breast cancer. A cross-sectional study was conducted to assess spirituality and mental adjustment as coping strategies and its association with socio demographic data on 216 women with breast cancer. The Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being (FACIT-Sp) and Mental Adjustment to Cancer (MAC) Scales were used to assess spirituality and mental adjustment. Negative correlation between spiritual well-being and helplessness/hopelessness (r=-0.690; p=0.000), anxious preoccupation (r=-0.277; p=0.000) and avoidance (r=-0.235; p=0.000) and positive correlation between spiritual well-being and fighting spirit (r=0.668; p=0.000) were identified. Socio-demographic factors such as race (p=0.000), religion (p=0.000), academic qualification (p=0.004) and type of surgery (p=0.016) revealed significant relationship with spiritual well-being. Fighting spirit, hopelessness/helplessness and anxious preoccupation also yielded significant relationship with race (p<0.0001), religion (p=0.001) and academic qualification (p=0.024). Helplessness/hopelessness had a significant relationship with stage of disease (p=0.017) and type of surgery (p=0.011). Meanwhile, fatalistic and avoidance showed a strong relationship with age (p=0.014, r=0.167), occupation (p=0.001) and income (p=0.006), race (p=0.007) and academic qualification (p=0.005). It is thus, concluded that spirituality and mental adjustment are two coping strategies widely adopted by Malaysian women after a breast cancer diagnosis and throughout their breast cancer journey. Women with breast cancer, therefore, should be treated holistically rather than just the disease itself.
Breast Neoplasms ; Spirituality ; Adaptation, Psychological

Transforming growth factor beta-1 (TGF-β-1) is a multifunctional cytokine involved in the regulation of growth and differentiation of both normal and transformed cells. The main aim of this study was to determine whether TGF-β-1 or alpha fetoprotein (AFP) or the combination of the two is a better indicator for hepatocellularcarcinoma (HCC). Serum TGF-β-1 and AFP were measured by ELISA in 40 healthy subjects, 23 patients with hepatocellular carcinoma (HCC), 70 patients with hepatitis B, 26 patients with hepatitis C and 16 patients with liver cirrhosis (LC). Patients with liver diseases showed significantly higher serum TGF-β-1 values (>3 fold) compared to control subjects. As for serum AFP, significant elevation was only observed for HCC cases. Serum TGF-β-1 exhibited higher percent sensitivity compared to serum AFP in all liver diseases. Combination of serum TGF-β-1 and AFP increased specificities in all cases studied. In conclusion, serum TGF-β-1 is a more sensitive marker for HCC when compared to serum AFP and its specificity is increased when combined with serum AFP.

Objective: To optimize the delay time before the initiation of arterial phase scan in the detection of focal liver lesions in contrast enhanced 5 phase liver CT using the bolus tracking technique. Patients and Methods: Delay - the interval between threshold enhancement of 100 hounsfield unit (HU) in the abdominal aorta and commencement of the first arterial phase scan. Using a 16 slice CT scanner, a plain CT of the liver was done followed by an intravenous bolus of 120 ml nonionic iodinated contrast media (370 mg I/ml) at the rate of 4 mL/s. The second phase scan started immediately after the first phase scan. The portal venous and delay phases were obtained at a fixed delay of 60 s and 90 s from the beginning of contrast injection. Contrast enhancement index (CEI) and subjective visual conspicuity scores for each lesion were compared among the three groups. Results: 84 lesions (11 hepatocellular carcinomas, 17 hemangiomas, 39 other hypervascular lesions and 45 cysts) were evaluated. CEI for hepatocellular carcinomas appears to be higher during the first arterial phase in the 6 seconds delay group. No significant difference in CEI and mean conspicuity scores among the three groups for hemangioma, other hypervascular lesions and cysts. Conclusion: The conspicuity of hepatocellular carcinomas appeared better during the early arterial phase using a bolus tracking technique with a scan delay of 6 seconds from the 100 HU threshold in the abdominal aorta.

Background: Synovial sarcoma (SS) is a rare cancer and accounts for 5-10% of adult soft tissue sarcomas. Making an accurate diagnosis is difficult due to the overlapping histological features of SS with other types of sarcomas and the non-specific immunohistochemistry profile findings. Molecular testing is thus considered necessary to confirm the diagnosis since more than 90% of SS cases carry the transcript of t(X;18)(p11.2;q11.2). The purpose of this study is to diagnose SS at molecular level by testing for t(X;18) fusion-transcript expression through One-step reverse transcriptase real-time Polymerase Chain Reaction (PCR). Method: Formalin-fixed paraffin-embedded tissue blocks of 23 cases of soft tissue sarcomas, which included 5 and 8 cases reported as SS as the primary diagnosis and differential diagnosis respectively, were retrieved from the Department of Pathology, Tengku Ampuan Afzan Hospital, Kuantan, Pahang. RNA was purified from the tissue block sections and then subjected to One-step reverse transcriptase real-time PCR using sequence specific hydrolysis probes for simultaneous detection of either SYT-SSX1 or SYT-SSX2 fusion transcript. Results: Of the 23 cases, 4 cases were found to be positive for SYT-SSX fusion transcript in which 2 were diagnosed as SS whereas in the 2 other cases, SS was the differential diagnosis. Three cases were excluded due to failure of both amplification assays SYT-SSX and control β-2-microglobulin. The remaining 16 cases were negative for the fusion transcript. Conclusion: This study has shown that the application of One-Step reverse transcriptase real time PCR for the detection SYT-SSX transcript is feasible as an aid in confirming the diagnosis of synovial sarcoma.

Essential oil from Cymbopogon nardus was evaluated for activity against Trypanosoma brucei brucei BS221 (IC50 = 0.31 ± 0.03 μg/mL) and cytotoxic effect on normal kidney (Vero) cells (IC50 = >100 μg/mL). The crude essential oil was subjected to various chromatography techniques afforded active sub fractions with antitrypanosomal activity; F4 (IC50 = 0.61 ± 0.06 μg/mL), F6 (IC50= 0.73 ± 0.33 μg/mL), F7 (IC50 = 1.15 ± 0 μg/mL) and F8 (IC50 = 1.11 ± 0.01 μg/mL). These active fractions did not exhibit any toxic effects against Vero cell lines and the chemical profiles investigation indicated presence of α-and γ-eudesmol, elemol, α-cadinol and eugenol by GC/MS analysis.

In a very closed and overcrowding environment, influenza transmission during Hajj season is almost inevitable. The aim of this study was to determine the association between pre-morbid conditions and influenza-like illness (ILI) amongst Hajj pilgrims. A cross-sectional study was conducted amongst Malaysian Hajj pilgrims in year 2007. Survey forms were distributed at Madinatul-Hujjaj, Jeddah and Tabung Haji Clinic, Medina, Saudi Arabia where pilgrims stay on transit before returning to Malaysia. Allergic rhinitis was significantly associated with sore throat (p=0.047), longer duration of cough (p= 0.017) and runny nose (p=0.016). Pilgrims who suffered from chronic obstructive pulmonary diseases (COPD) had significant association with longer duration of cough (p=0.041) and those with diabetes mellitus had significant association with longer duration of sore throat (p=0.048). Underlying asthma was significantly associated with severe influenza like illness requiring admission to hospital for further treatment of respiratory symptoms (p=0.016). Based on these findings, we suggest those with underlying asthma should be discouraged from participating in the hajj and they should seek early treatment if they develop respiratory symptoms.

INTRODUCTIONTo review the perioperative and short-term outcome of all laparoscopic partial nephrectomies (LPN) performed in a single institution.

MATERIALS AND METHODSThirteen consecutive patients who underwent LPN since the beginning of the programme in March 2002 to January 2008 were enrolled. Demographic, perioperative and follow-up data were retrospectively collected. Transperitoneal approach was used in all cases, and vascular control was achieved with the use of a laparoscopic Satinsky clamp or vascular tape. The tumour was excised using cold scissors. Transected intrarenal vessels were suture ligated and the parenchymal defect was closed primarily with absorbable suture over a bolster.

RESULTSThirteen patients underwent a total of 14 LPN. The median age of patients was 60 years (range, 41 to 77). The mean tumour size was 24 +/- 11.4 (2SD) mm. The mean operative time was 228 +/- 129 (2SD) minutes and median warm ischaemia time was 35 minutes (range, 24 to 68). Postoperatively, serum haemoglobin level decreased by a mean of 1.4 +/- 2.5 (2SD) gm/dL and serum creatinine increased by a mean of 22.5 +/- 25.8 (2SD) micromol/L. Twelve out of 13 (92%) patients achieved their baseline serum creatinine level within 1 month postoperatively. There was 1 open conversion (7%), and 2 patients (14%) required blood transfusion perioperatively. Two patients (14%) had transient fever postoperatively due to basal atelectasis. No other complications were encountered. Median patient hospital stay was 4 days (range, 2 to 10). Eleven out of 14 (79%) of the tumours were renal cell carcinoma (RCC). At a median follow-up of 12 months (range, 6 to 53), all except 1 patient with RCC were disease-free.

CONCLUSIONSOur experience has shown that laparoscopic partial nephrectomy is a safe, feasible technique in our centre for patients with small exophytic renal tumours. Patients can be discharged early with preservation of renal function and good early cancer control.

Adult ; Aged ; Carcinoma, Renal Cell ; surgery ; Female ; Hospitals, General ; Humans ; Kidney Neoplasms ; surgery ; Laparoscopy ; methods ; Length of Stay ; Male ; Middle Aged ; Nephrectomy ; methods ; Retrospective Studies ; Singapore

Clinacanthus nutans (C. nutans) leaf extracts have been widely used by cancer patients in Malaysia and local practiceclaims a cure to cancer. There were several studies done to determine the cytotoxicity potency of C. nutans extracts onvarious types of cells. However, there is still lacking on the knowledge regarding the combination effect of C. nutanswith anticancer drugs. Thus, the study was carried out to determine the cytotoxicity potency of C. nutans extracts andpaclitaxel (PTX) alone and, in combination on MDA-MB-231 cells. The cells were treated with 100% ethanol extract ofC. nutans (CNE) and water extract of C. nutans (CNA), PTX and combination of both extracts and PTX for 72 hours andthe cytotoxic activity was determined using SRB assay. Result showed that CNE had little cytotoxic activity, whereas CNAshowed no cytotoxic activity on MDA-MB-231 cells. For combination treatment of C. nutans extracts and PTX, only CNEshowed significant enhanced PTX-induced cytotoxicity (p < 0.05), meanwhile CNA inhibited PTX-induced cytotoxicitysignificantly (p < 0.05). As a conclusion, CNE was able to increase PTX potency to inhibit the viability of MDA-MB-231cells.

Introduction: The number of breast cancer survivors in developing Asian countries is still lacking compared to Western countries. Health-related quality of life (HRQoL) of cancer patients is one of the significant predictors of survival. Hence, this study was conducted to determine HRQoL status among breast cancer survivors of different diagnosis duration in East Coast of Peninsular Malaysia. Methods: Cross-sectional data were collected for 128 breast cancer survivors, aged 37 to 72 years who were recruited by using purposive sampling method at two main government hospitals in Kelantan (n=67) and Terengganu (n=61). The validated European Organization for Research and Treatment of Cancer Quality of Life Questionnaires (EORTC QLQ–C30) and Breast Cancer Supplementary Measure (EORTC QLQ-BR23) which had been translated into the Malay language were used to measure HRQoL. Independent t-test was used to compare HRQoL status among short term (≤5 years duration since diagnosis) and long term (>5 years duration since diagnosis) breast cancer survivors. Results: Overall, our breast cancer survivors reported good HRQoL, with high scores for global health status, functional status and low symptoms scores. Long term breast cancer survivors had better social functioning compared to short term survivors (p=.038). Nevertheless, there was no significant difference found for other HRQoL status between short and long term breast cancer survivors. Conclusion: Breast cancer survivors in East Coast of Peninsular Malaysia generally experienced good HRQoL. The relatively similar HRQoL status between long-term and short-term survivors indicated a constant HRQoL profile among survivors throughout their survivorship.