Taking cognizance of the purported variation of phyllodes tumours in Asians compared with Western populations, this study looked at phyllodes tumours of the breast diagnosed at the Department of Pathology, University of Malaya Medical Centre over an 8-year period with regards to patient profiles, tumour parameters, treatment offered and outcome. Sixty-four new cases of phyllodes tumour were diagnosed during the period, however only 30 (21 benign, 4 borderline and 5 malignant) finally qualified for entry into the study. These were followed-up for 4-102 months (average = 41.7 months). Thirteen cases (8 benign, 3 borderline, 2 malignant) were Chinese, 9 (all benign) Malay, 7 (4 benign, 1 borderline, 2 malignant) Indian and 1 (malignant) Indonesian. Prevalence of benign versus combined borderline and malignant phyllodes showed a marginally significant difference (p=0.049) between the Malays and Chinese. Patients’ ages ranged from 21-70 years with a mean of 44.9 years with no significant difference in age between benign, borderline or malignant phyllodes tumours. Except for benign phyllodes tumours (mean size = 5.8 cm) being significantly smaller at presentation compared with borderline (mean size = 12.5 cm) and malignant (mean size = 15.8 cm) (p<0.05) tumours, history of previous pregnancy, breast feeding, hormonal contraception and tumour laterality did not differ between the three categories. Family history of breast cancer was noted in 2 cases of benign phyllodes. Local excision was performed in 17 benign, 2 borderline and 3 malignant tumours and mastectomy in 4 benign, 2 borderline and 2 malignant tumours. Surgical clearance was not properly recorded in 10 benign phyllodes tumours. Six benign and all 4 borderline and 5 malignant tumours had clearances of <10 mm. Two benign tumours recurred locally at 15 and 49 months after local excision, however information regarding surgical clearance was not available in both cases. One patient with a malignant tumour developed a radiologically-diagnosed lung nodule 26 months after mastectomy, was given a course of radiotherapy and remained well 8-months following identification of the lung nodule.

BackgroundFor the treatment of chronic heart failure (HF), both pharmacological and non-pharmacological treatment should be em-ployed in HF patients. Although HF is highly prevalent in nursing home residents, it is not clear whether the recommendations in the guide-lines for pharmacological therapy also are followed in nursing home residents. The aim of this study is to investigate how HF is treated in nursing home residents and to determine to what extent the current treatment corresponds to the guidelines.MethodsNursing home resi-dents of five large nursing home care organizations in the southern part of the Netherlands with a previous diagnosis of HF based on medical records irrespective of the left ventricle ejection fraction (LVEF) were included in this cross-sectional design study. Data were gathered on the (medical) records, which included clinical characteristics and pharmacological- and non-pharmacological treatment. Echocardiography was used as part of the study to determine the LVEF.ResultsOut of 501 residents, 112 had a diagnosis of HF at inclusion. One-third of them received an ACE-inhibitor and 40% used aβ-blocker. In 66%, there was a prescription of diuretics with a preference of a loop diuretic. Focusing on the residents with a LVEF￡ 40%, only 46% of the 22 residents used an ACE-inhibitor and 64% aβ-blocker. The median daily doses of prescribed medication were lower than those that were recommended by the guidelines. Non-pharmacological interventions were recorded in almost none of the residents with HF.ConclusionsThe recommended medical therapy of HF was often not prescribed; if pre-scribed, the dosage was usually far below what was recommended. In addition, non-pharmacological interventions were mostly not used at all.

INTRODUCTION: Alternative agents have been proposed for the management of kidney or ureteral stones. This study aimed to investigate the safety and efficacy of Blumea balsamifera (sambong) compared with a terpene combination drug as treatment for ureterolithiasis. METHODS: Patients with clinically stable kidney function and ureteral stones of ≤ 5 mm were randomized to receive a special terpene combination (Rowatinex ®) or Blumea balsamifera. All patients had a physical examination, and diagnosis of kidney stones was made by ultrasound at baseline and after 6 and 12 weeks of treatment. Primary outcomes were change in stone size and stone-free status, defined as obviously successful expansion of calculi/fragments, documented by ultrasound. RESULTS: After 6 weeks, five patients in the sambong group and six in the terpene group were stone free (p = 0.90). After 12 weeks, seven in the sambong and eight in the terpene group were stone free (p = 0.31). In terms of stone size, there was a significant decrease in the mean diameter in the sambong group (1.81 ± 2.01 mm, p = 0.008 and 1.12 ± 1.43 mm p<0.005) at 6 and 12 weeks, respectively. However, there was no significant difference between the two groups. Urine pH also increased in both groups compared to baseline but the difference was not statistically significant when comparing the two arms. CONCLUSION Blumea balsamifera is comparable with a terpene combination in the dissolution of urolithiasis and is well-tolerated and safe.

OBJECTIVE: The aim of this paper was to create a Portable Gonioscopy System (PGS) that is effcient and cost-effective in documenting iridocorneal angles. METHODS: A 4-mirror gonioscopy prism lens was attached to a portable USB microscope with a built-in camera. The microscope was then connected to a laptop for viewing of the images. A lubricant was instilled and the portable gonioscope was placed parallel to the cornea for viewing and recording of iridocorneal angles. Images were fled and stored in a laptop. RESULTS: The portable gonioscopy system allowed suffcient viewing and recording of the iridocorneal angles. The total cost of producing the portable gonioscopy system was PHP 25,000.00. CONCLUSION Iridocorneal angles can be visualized and recorded using the portable gonioscopy system. This device requires skill and expertise from professional prototypist to create. Like gonioscopy, this system also has a steep learning curve. The researchers are continuously improving the device adding more features and making it more affordable and easier to use.
gonioscopy