Presence of a hypofunctioning pigmented adenoma are commonly asymptomatic and is usually only found during an autopsy. In contrast, hyperfunctioning pigmented adenoma is a rare clinical entity and in the majority of cases results in Cushing‟s syndrome. In this case study, we report a 66-year-old male who presented instead with the clinical and biochemical features of Conn‟s syndrome. On laparoscopic adrenalectomy, it was found that the tumour had a functioning black adenoma which does not usually present with Conn‟s syndrome but rather to that of a Cushing‟s. The intraoperative changes and histopathological findings are discussed.
Laparoscopy

Prostate cancer is not uncommon amongst the elderly men. Diagnosis is made using histopathology specimens of Transrectal Ultrasound guided biopsy of the prostate gland. However, prostate cancer presenting as a intra-prostatic cysts are rare. We report a case of elderly gentleman who presented with malignant intra-prostatic cysts.
Prostatic Neoplasms

In the last three centuries, medicine has focused predominantly on the physical body as the source of disease, placing very little importance on the mind. However, the significance of mind-body interactions in medicine is now increasingly being recognised. True health must include both the physical body and the mind. This article traces our concepts of the relationship between mind and body since primitive times and explores its relevance to the maintenance of health.
Mind-Body Relations, Metaphysical

Distress has become a major issue in cancer population. Patients may suffer from either physical, psychological distress or both. Cancer patients who are undergoing chemotherapy are more likely to experience psychological distress. This could be due to the negative effects of chemotherapy agents, the uncertainty of post-treatment, and the occurrence of psychosocial problems. As a result, the patient may experience a normal reaction such as sadness or may develop common psychiatric disorders such as depression and anxiety
Neoplasms

The clinical experience of the novel drug temsirolimus on eight patients with metastatic renal cell carcinoma and who were refractory to other forms of treatment is reported. Although none of the patients showed complete or partial response, three patients had stable disease. One patient was prematurely withdrawn due to pneumonitis. Five patients died during the period of observation of twenty months and the median survival time from start of treatment was ten months. Three patients showed no evidence of adverse events (AE). Five patients showed dyslipidemia and two had pneumonitis for which, the drug had to be withdrawn in one of them. None had significant leucopenia. We conclude that temsirolimus has activity even in heavily pretreated patients in advanced renal cell carcinoma and in addition, has the benefits of ease of administration and good tolerability.
Clear-cell metastatic renal cell carcinoma

Despite being the major cause of cancer-related death in Malaysian women, local data on patterns of breast cancer relapse and their long term outcomes are still scarce. We conducted a retrospective study on all patients treated for non-metastatic invasive breast cancer in 1999- 2000 at the University of Malaya Medical Centre (UMMC), who subsequently developed relapse. We sought to analyse the patterns of relapse, their associated clinicopathological features and the overall survival ratefollowing the relapses. Univariate and multivariate analyses were used to analyse demographics and clinicopathological factors. Survival was analysed using the Kaplan and Meier method and compared by the log rank test. A total of 268 patients with a mean age of 50, were identified for the study. At a median follow-up of 50 months, 73 patients (27.2%) had relapsed. Local, regional and distant relapse rates were 5.5%, 1.9% and 19.8% respectively, whereas, the 5-year survival rates were 61%, 40% and 21% respectively (p < 0.01). Most relapses occurred within the first five years of diagnosis. Patients with long disease-free interval had better survival. The most common distant relapse site was the lungs while bone was the distant relapse site with the best prognosis. Disease stage, nodal status and oestrogen receptor status were found to have correlation with the risk of relapse. We concluded that the survival of patients with relapsed breast cancer was associated with the site(s) of first relapse and the disease free interval and clinicopathological factors can be used to predict the risk of relapse.
Breast Neoplasms

As women with breast cancer are living longer, issues beyond survivorship like the much neglected sexual functioning and issue of quality of life have become increasingly important. Experiences of significant alterations in sexual functioning need to be addressed. However, these sexual issues are often not acknowledged in our traditional medical model of health care delivery. This paper briefly reviews the changes in sexual functioning after a diagnosis of breast cancer, with implication for clinical practice and medical curicula
counseling

Night work and rotating shift work are found to be detrimental to the health of workers. A cross sectional analytical study was conducted among the employees of a public medical centre in Kuala Lumpur. A total of 380 employees participated in the health screening and questionnaire survey. The majority of the respondents were Malays, females, and with mean age of 49 years old. The shift workers persistently had higher but non-significant proportions of being overweight/ obesity and unhealthy clinical indicators such as systolic and diastolic blood pressure, fasting blood glucose and lipid profile except waist circumferences and HDL-cholesterol. There were also slightly more shift workers diagnosed with diabetes mellitus, hypertension or coronary heart disease (p>0.05). Although the present study could not provide established evidence for a relationship between shift work and cardiovascular risks, this could serve as a pilot study for future studies in this area.
Health Education

Prescribing medication is not without its adverse effects. Complications due to drug therapy are on the rise in Malaysia, especially when antibiotics are used indiscriminately. We reviewed cases admitted to the Acute Medical Ward of University of Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia, over a two-month period from March to April 2009. The authors found that Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) were the most common severe adverse cutaneous reactions due to ingestion or parenteral use of drugs. In this report, is a brief description of the two conditions and ways to manage them. The authors have come to a conclusion that judicious use of medications with adequate patient education is important in order to avoid these adverse effects
Health Education

Tumour-induced or oncogenic osteomalacia (OOM) is a rare paraneoplastic syndrome characterized by bone pain and muscle weakness. A biochemical profile consisting of normocalcaemia, hypophosphataemia, phosphaturia, increased serum alkaline phosphatase and inappropriately low serum levels of 1, 25-dihydroxyvitamin-D is diagnostic. OOM is usually caused by an osseous or soft-tissue tumour of mesenchymal origin that secretes phosphaturic substances leading to increased urinary phosphate wasting. These tumours are small and slow growing. The diagnosis continues to be easily missed and when eventually made, localization of the tumour can be difficult. We describe the case of a young man who presented with severe generalized pain associated with muscle weakness. He was extensively investigated and eventually diagnosed to have OOM 3 years after initial presentation. Specialized investigations were necessary to localize the offending tumour.