This paper describes the clinical characteristics of 14 cases of malignant melanoma treated in our department during a period of five years from 1997 to 2001 and their prognosis. Excluding one case whose stage could not be defined, five cases recognized at the early stage have survived, and six cases out of eight at the progressive stages were dead within one year after their first visit. When it came to the clinical characteristics, nine cases were primary cutaneous melanomas and five cases were metastatic carcinomas. Acral lentiginous melanomas, histopathologically the most common type of melanoma in Japan, were found in seven cases of the total 14 (50%). Most of the patients were aware of the primary lesions but left them untreated. Generally speaking, malignant melanoma grow rapidly and prognosis is poor because the cure rate by chemotherapy is low. To realize earlier detection and treatment, we thought it is crucial to educate the public, have the general practitioners understanding more about the malignancy of the skin neoplasm and to build up a collaborative relationship between medical professionals.
Melanoma ; seconds ; clinical aspects ; prognostic ; Clinical

Intense myelofibrosis is rarely associated with de novo acute myeloid leukaemia (AML) except in acute megakaryoblastic leukaemia (AML-M7) where there is diffuse marrow fibrosis as a consequence of proliferation of neoplastic myeloid cells. AML associated with significant myelofibrosis developing both de novo or secondary to primary (idiopathic) myelofibrosis is characterised by a fulminant course and extremely poor prognosis, primarily due to treatment-resistant disease. The prognostic value of degree of marrow fibrosis in de novo AML has been poorly investigated. We describe a case of extensive myelofibrosis associated with acute erythroblastic leukaemia (AML-M6) that responded to induction therapy of the leukaemia.
Myelofibrosis ; Acute ; Leukemia, Myelocytic, Acute ; therapeutic aspects ; prognostic

The purpose of this study was to clarify the survival rates and prognostic factors in elderly Japanese patients with hip fractures. This study investigated the outcome of 256 patients aged 60 years and older with surgically treated hip fractures. Information including age, gender, duration of hospitalization, place of residence before fracture and at discharge, and level of mobility before fracture and at discharge was obtained from patient records. The survival of the patients after discharge was determined by mail surveys supplemented with telephone inquiries.The observed survival rates were significantly lower than the expected survival rates (p<0.001, by Mantel Haenszel test). The short-term mortality rates were 6% for six months and 12.7% for one year, which were lower than previously reported rates in Western countries. Significantly higher hazard ratios (HR) for mortality adjusted for age and gender were observed in patients who had lived in places other than their own home before fracture (HR=2.67(1.63-4.3)), were discharged to places other than their own home (Nursing home HR=2.25 (1.24-4.1) or to a non-orthopedic unit (HR=5.95 (3.12-11.34)), those requiring full-time assistance for mobility at discharge (HR=5.71 (3.59-9.01)), and those who had stayed in a hospital for fewer than 40 days (HR=2.20 (1.38-3.51)). After adjusting for the effects of all the potential prognostic factors, discharge to places other than their own home and the lowest level of mobility at discharge remained significant factors causing adverse effects on survival.Therefore, to improve the prognosis, patients should be allowed to recover to a level at which they can ambulate with some assistance, enabling them return to their own homes.
survival aspects ; seconds ; Japanese language ; prognostic ; Mortality Vital Statistics

We report on a right-handed 43-year-old policeman with atypical Marchiafava-Bignami disease (MBD). The typical clinical manifestations of MBD are reduced consciousness, confusion, seizures, psychotic and emotional symptoms, hemiparesis, dysarthria, ataxia, and coma and death. However, our patient had not developed any of the above symptoms except for slowly progressive cognitive impairment mimicking that of Alzheimer disease. The incidence of MBD may be higher and its prognosis less severe than generally believed. MBD has been underdiagnosed and underreported, and nonspecific general symptoms and encephalopathy in an alcoholic might indicate undiagnosed MBD.
Impaired health ; symptoms <1> ; Marchiafava-Bignami disease ; Problem drinker ; prognostic

Various physiological parameters like blood pressure, temperature, blood sugar after onset of stroke have been proposed as possible marker of stroke prognosis to study the glycaemic status after acute stroke and assess the role of glycaemic status along with other clinical parameters in influencing stroke outcome. Forty-two confirmed stroke patients attending hospital within 6 hours of onset of stroke onset were included in the study. The time lag for hospitalization, blood pressure, blood sugar, HbA1c, stroke severity according to Toronto Scale, demographic factors, stroke onset type, type of stroke, past history of stroke, diabetes, and hypertension were recorded. The outcome was whether patient survived at the end of forth week. Twenty-one percent of patients who were not known diabetic found to be hyperglycemic though their HBA1C level was normal. Eighty-nine percent of such patients died. This rate was significantly higher than patients known to be diabetic with raised sugar and HBA1c level (26% patients, 12% mortality). There was strong and significant association between stroke severity and poor outcome. Strong and significant association was also found between stroke severity and blood sugar level. Modeling of stroke outcome using decision tree analysis (QUEST) found stroke severity as most important and significant predictor especially for severe stroke cases. In mild and moderately severe stroke, high sugar level was found to be a predictor, though not statistically significant.This study suggests that stroke severity is the most important predictor of stroke outcome, with high sugar level as a marker of stroke severity.
Cerebrovascular accident ; Biological Markers ; Sugars ; prognostic ; Blood Glucose

Transaminase enzymes, alanine (ALT) and aspartate transaminase (AST), have been reported to be raised and implicated to have prognostic value in hepatocellular carcinoma (HCC). Ki67, a marker of cellular proliferative activity, has also been noted to be increased in HCC. A study was conducted at the Department of Pathology, Faculty of Medicine, University of Malaya, Kuala Lumpur to determine the possible association of proliferative activity, as determined by Ki67, with the transaminase enzymes. 31 cases of histologically diagnosed HCC who underwent tumour resection were retrieved from departmental archives. The patients' ages ranged between 40 to 79 years with a mean of 58.3 years. There was a male preponderance with M:F = 2.9:1. Ethnic Chinese formed 83.9% of the cases. 4 microm sections, cut from the formalin-fixed, paraffin-embedded tumour tissue block of each case, were immunohistochemically stained with Ki67 (DAKO monoclonal MIB-1) using the commercial DakoCytomation EnVision+System-HRP kit. The latest ALT and AST levels, assayed within 7 days prior to tumour resection, were retrieved from the patients' case records. 24 (77.4%) HCC demonstrated elevation of either ALT and/or AST. 27 (87.1%) HCC were immunopositive for Ki67. Ki67 immunoexpression was significantly correlated with raised transaminases (p<0.05). Hypothetically, the mechanism by which this phenomenon may occur may simply be release of transaminases due to destruction of hepatocytes by the cancer. Thus rising levels of the transaminases could signal a more rapid growth of the tumour and these routinely performed tests can be of prognostic value in management of HCC patients.
Aspartate aminotransferase assay ; Alanine aminotransferase measurement ; Primary carcinoma of the liver cells ; prognostic ; Excision

Infection by hepatitis B virus (HBV) is a major global health-care problem. HBV is an accepted factor in the elevated risks for liver disease such as cirrhosis and development of hepatocellular carcinoma. This problem is particularly prevalent in the Asia-Pacific region which includes Malaysia. During infection, the hepatitis B e antigen (HBeAg) is produced in the hosts. This antigen is an important serological marker for diagnosing chronic hepatitis B. Seroconversion to anti-body (anti-HBe) corresponds to the improvement of disease prognosis. However, certain mutations such as the core promoter dual mutations (A1762G1764→T1762A1764), the codon 15 variants (C1858/ T1858) and the precore stop codon mutations (TGG→TAG) can affect the HBeAg expression. This has diagnostic and clinical implications. Besides that, the HBV can be grouped into eight genotypes (A to H). Moreover, genotypic subtypes and recombinants have been observed as well. Studies have observed that these can differ in their affiliations with the mutations above as well as with disease prognosis.
Hepatitis B virus measurement ; Hepatitis B e Antigens ; Infection as complication of medical care ; MALAYSIAN ; prognostic