Introduction: Chronic Lymphocytic Leukaemia (CLL) is a common type of leukaemia in persons of predominantly European descent but is rare in the Asian population. Disparities in CLL incidence among people of Asian and European descent may be related to the genetic make-up of the two different populations. Hypermethylation event might be one of the silencing mechanisms that inactivate the tumour suppressor genes in CLL. The aim of this study was to determine the hypermethylation status of p16INK4a and p15INK4b among CLL patients and normal individuals. Materials & Methods: A total of 25 CLL patients and 25 normal individuals were recruited for this study and their genomic DNA were extracted from the peripheral blood. The hypermethylation status of p16INK4a and p15INK4b were determined using Methylation Specific-PCR (MS-PCR) whereas DNA sequencing method was applied to selected samples for validation of the MS-PCR results. We also evaluated the association between hypermethylation of these genes with the clinical and demographic characteristics of each group of subjects. Results: Among the CLL patients, p15INK4b partialmethylation occurred in 6 (24%) subjects while methylation occurred in 1 (4%) subject. All the remaining patients were unmethylated at p15INK4b. All the samples showed unmethylation at p16INK4a. Statistically significant associations were found between p15INK4b hypermethylation with the presence of CLL (p=0.01) and with race (p=0.02). Conclusion: Further study using a larger sample size is warranted to explore the significance of DNA methylation incidence among the CLL patients of the Malaysian population. Hence, we suggest that hypermethylation at p15INK4b has a huge influence that kick-starts CLL disease among Malaysians and MS-PCR technique is applicable to be used in methylation study.

Introduction: This study aimed to determine the association between the voriconazole (VRZ) concentration and clinical outcomes, including both the efficacy and safety in invasive aspergillosis (IA) treatment. Methods: The medical records of adult Thai patients with IA and treated with VRZ at the Ramathibodi Hospital, Thailand, between January 2013 and March 2016 were retrospectively reviewed, and their medical, social, demographic, laboratory data, VRZ dosage regimens and concentrations, and clinical outcome were recorded. The association between the VRZ concentration and clinical outcome was then determined. Results: A total of 81 patients were included in this study. Forty (49.4%) patients were male, with median age of 56.1 years. Sixty of them had hematologic malignancies. Forty-seven patients were diagnosed with probable IA. Median blood sampling time for VRZ level measurement was 11.5 h after the last dose administration on day 9. The median duration of treatment and outcome evaluation was 103 days and 73 days, respectively. Overall success and mortality rate were 76.5% and 14.8%, respectively. In the treatment success group, we found the success rate of around 90% with VRZ trough concentration (Ctr) of 3-4 mg/L. Eleven patients developed liver injuries (LI) and the rate of LI increased significantly with VRZ Ctr of more than 5 mg/L. Conclusion: We recommend VRZ trough concentration of 3-4 mg/L, as at this range the patients responded better to the treatment than at > 5.0 mg/L since it was associated with augmented hepatotoxicity.

Fish bone ingestion and impaction are known to everyone. However, such benign incidences have been reported to be associated with multiple potentially life threatening complications. Anatomical features of the oesophagus forms the basis for such incidences. We report here an elderly diabetic gentleman with an unusual left retro-paraoesophageal abscess complicated with oesophageal perforation, mediastinitis and vocal cord paresis which were fundamentally caused by a migrated fish bone into the lower part of the neck requiring therapeutic external neck exploration. Management of this case and its complications are described here comprehensively.

AVF loss and recurrent requirement of AVF constitution increase with HD vintage. Studies in different regions shows different results in the impact of presence of DM on AVF survival. This study showed that age and DM had significant relation with arterial calcification in Iranian patients who had renal failure.

The surgical department of our hospital, the majority of whose patients consist of farmers and their families, treated 100 cases of the diseases of gall -duct and of pancreas in the past 7 years, and studied their causation, post -operative troubles, etc.
They were classified as: 1) cholelitiasis, 2) cases whose major troubles consisting of gall-duct passage obstruction caused by the pathological changes at the head of pancreas or at papilla duodeni, 3) cholangitis, 4) round worm penetration, 5) dyskinesia, 6) swelling of the peripylic lymph nodes, etc. In half of these cases no stone was pre-sent. Changes in the pancreas and at the papilla duodeni seem to require special attention. In many cases of acute pancreatitis and pancreasnecrosis, pancreasenzyme was found in high concentration in gall-bladders; the fact made the author assume that repeated inflammation might cause cholangitis.
Recurrence and post-operative troubles occurred to 17% of the cases with stones and to 19% of those without stones. Accurate diagnosis and application of appropriate treat-ment worked out on the correct understanding of the cause are most important for the cases in which no stone is present.

The author obtained by door-to-door visits the actual incidence of illness among the entire population of Naguri-mura, Saitama prefecture, a village where forest management is their main occupation, during the month of August, 1957 (the then population consisting of 3401 persons) and of May, 1958 (3290 persons). With a view to confirming the authenticity of the data the author obtained by his personal inquiry, he concurrently conducted another investigation of the same subject on the basis of the medical records of the people's health insurance and other kinds of insurances. A comparative study conducted on the results of the above-mentioned two investigations is concluded as follows.
1. Reports on the visits to doctors obtained by the personal inquiry and the results of investigation based on medical records showed about 80% level of congruity on the occasion of the August investigation which was carried out without any previous notice, and about 93% level of congruity at the next May investigation when the villagers were given special instruction and also got more or less familiar with it.
2. Agreement in the names of diseases reported at the personal inquiry and given in the medical records was 63% level for the August investigation and 80% level for the May investigation; the rates of the females were always 10-7% lower than those of the males.
3. About 10% of the cases failed to give correct names of their illness on account of the dim concept they had in regard to the nature of diseases.
4. Those who reported to have consulted doctors while they actually had not turned out to be 17% in the August investigation and 14% in the May investigation-no remarkable difference was obtained.
5. Those who replied as perfectly healthy although in fact found out to have consulted doctors were as many as 37% in the August investigation and 20%in the May investigation.

This is a study on the incidence, during the whole month of May, 1958, of 11 different kinds of symptoms associated with the so-called Nofusho (a kind of farmers' occupational syndrome) among the inhabitants of Naguri-mura, Saitama Prefecture, a village where they make livelihood almost exclusively from forest management. It covered 2099 persons, the entire population of the village excluding the infants less than 9 years of age. The survey was made by means of personal interviews at their own homes. Taking into consideration the outcome of the study on the incidence of diseases conducted concurrently also by means of door-to-door visits, especially paying attention to the cases who were not brought to doctors' attention, the following conclusion was obtained.
1. The incidence of respective symptoms was: stiffness of shoulders 29.4%, lumbago. 20.6%, joint pain 14.2%, pyrosis 13.0%, paraesthesia 12.2%, vertigo 11.5%, nocturia 11.0%, cold limbs 8.9%, and so on.
2. Those who complained one or more symptoms associated with Nofusho turned out to be 50.0% in males and 55.1% in females.
3. Tentatively classifying those who had 3 or more symptoms as Naushei cases, the incidence of Nausho was 18.6% in males and 22.4% in females-i. e. more common in females.
4. The total number of days within the month on which those on and above 40 years of age actually suffered from such symptoms were: not more than 5 days with half of the patients, and their sufferings were deemed as temporary, but in case of the remaining half, they continued for more than 20 days.

With a view to learning the status, on a wide scale, of the new-infection of hookworms in a rural district, the author examined the pupils of lower secondary schools in Ichiharagun, Chiba Prefecture, and obtained the following results: 1. The ratio of hookworm-ova positive cases was as high as 29.7%of all the pupils examined. By sex, it was higher in the male group than in the female group; and farmers'children showed a higher percentage than non-farmers'.
2. The percentage of new-infection was 2.2%at the minimum, 28.0%at the maximum, 12.4%on an average.In the 20 schools of all the 21 examined, percentages were not higher than 20%.And a significant correlation was found between the total infection rate and the rate of new-infection.
3. The rate of new-infection was also higher among the male than among the female examinees. By their family occupation, it was higher among farmers' children.
4. Distribution of different species among the group of people newly infected with hookworms was closely correlated with such distribution picture in the corresponding area.

In Ichihara-gun, Chiba Prefecture, a rural district, two villages where no anti-hookworm measure had hitherto been taken were selected for the study. The inhabitants of these two villages were first given mass anthelmintic treatment twice, but after that no more anti-hookworm measure was taken. In such natural conditions, theconditions of newand re-infection were observed for more than one year's time byway of stool examination.
1. The hookworm egg-positive rates: 82.4% for Itohisa, Miwa-machi, and 41.2% for Nakano, Shitsu-mura. Both species were present, but Necator americanus predominated in either of the two areas.
2. The cumulative rates of new-and re-infection for the whole year: It was higher in Itohisa (36.9%) than in Nakano (8.4%). But, in the two other villages where antihookworm measures had been executed over a long period of time, such rate was extremely low.
3. The seasonal fluctuations of the rates of new-and re-infection: In both of these subject villages it was higher in the warmer season including the wet season, i. e. mid-April to mid-July.
4. Analysis of the rates of new-and re-infection by modesof living: In Itohisa, school children showed a higher rate of new-infection, and the adults of the same area presented the higher rates of both new-infection andre-infection.In Nakano, no significant difference was seen between school children and adults, but one thing to be noted is that the cases of conversion to positive among school children were all of them new-infection cases.
5. New-and re-infection rates by sex: No particular difference was recognized in either of the two areas.
6. Classification of new-and re-infection cases by species: In bothof the villages, majority of the cases carried Necator americanus only.