1.Phyllodes tumours of the breast: retrospective analysis of a University Hospital’s experience
Toh YF ; Cheah PL ; Looi LM ; Teoh KH ; Tan PH
The Malaysian Journal of Pathology 2016;38(1):19-24
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.
2.Correlation of p16INK4a immunoexpression and human papillomavirus (HPV) detected by in-situ hybridization in cervical squamous neoplasia
Cheah PL ; Koh CC ; Nazarina AR ; Teoh KH ; Looi LM
The Malaysian Journal of Pathology 2016;38(1):33-38
Persistence and eventual integration of high-risk HPV (hrHPV) into the cervical cell is crucial
to the progression of cervical neoplasia and it would be beneficial to morphologically identify
this transformation in routine surgical pathology practice. Increased p16INK4a (p16) expression is a
downstream event following HPV E7 binding to pRB. A study was conducted to assess the correlation
between hrHPV detection using a commercial in-situ hybridization assay (Ventana INFORM HPV
ISH) and p16 immunoexpression (CINtec Histology Kit) in cervical squamous intraepithelial lesions
and squamous carcinoma. 27 formalin-fixed, paraffin-embedded cervical low-grade squamous
intraepithelial lesions (LSIL), 21 high-grade squamous intraepithelial lesions (HSIL) and 51 squamous
carcinoma (SCC) were interrogated. hrHPV was significantly more frequent in HSIL (76.2%) and
SCC (88.2%) compared to LSIL(37.0%). p16 expression was similarly more frequent in HSIL
(95.2%) and SCC (90.2%) compared to LSIL(3.7%). That the rates of hrHPV when compared with
p16 expression were almost equivalent in HSIL and SCC while p16 was expressed in only 1 of the
10 LSIL with hrHPV, are expected considering the likelihood that transformation has occurred in
HSIL and SCC but does not occur in majority of LSIL.
3.Bridging the gap between primary and specialist care--an integrative model for stroke.
Narayanaswamy VENKETASUBRAMANIAN ; Yan Hoon ANG ; Bernard Pl CHAN ; Parvathi CHAN ; Bee Hoon HENG ; Keng He KONG ; Nanda KUMARI ; Linda Lh LIM ; Jonathan Sk PHANG ; Matthias Phs TOH ; Sutrisno WIDJAJA ; Loong Mun WONG ; Ann YIN ; Jason CHEAH
Annals of the Academy of Medicine, Singapore 2008;37(2):118-127
Stroke is a major cause of death and disability in Singapore and many parts of the world. Chronic disease management programmes allow seamless care provision across a spectrum of healthcare facilities and allow appropriate services to be brought to the stroke patient and the family. Randomised controlled trials have provided evidence for efficacious interventions. After the management of acute stroke in a stroke unit, most stable stroke patients can be sent to their family physician for continued treatment and rehabilitation supervision. Disabled stroke survivors may need added home-based services. Suitable community resources will need to be harnessed. Clinic-based stroke nurses may enhance service provision and coordination. Close collaboration between the specialist and family physician would be needed to right-site patients and also allow referrals in either direction where necessary. Barriers to integration can be surmounted by trust and improved communication. Audits would allow monitoring of care provision and quality care enhancement. The Wagner model of chronic care delivery involves self-management support, shared clinical information systems, delivery system redesign, decision support, healthcare organisation and community resources. The key and critical feature is the need for an informed, activated (or motivated) patient, working in collaboration with the specialist and family physician, and a team of nursing and allied healthcare professionals across the continuum of care. The 3-year Integrating Services and Interventions for Stroke (ISIS) project funded by the Ministry of Health will test such an integrative system.
Delivery of Health Care, Integrated
;
organization & administration
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Evidence-Based Medicine
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Humans
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Ischemic Attack, Transient
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Medicine
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Middle Aged
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Models, Organizational
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Neurology
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Primary Health Care
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Rehabilitation Nursing
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Singapore
;
Specialization
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Stroke
;
nursing
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Stroke Rehabilitation