1.Pigmented ‘black’ adenoma: a rare cause of conn’s syndrome
Saladina JJ ; Rohaizak M ; Jasmi AY ; Sellymiah A ; Aishah MAS ; Das S ; Naqiyah I ; Shahrun NS
Journal of University of Malaya Medical Centre 2011;14(1):23-25
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
2.Cystic Adenocarcinoma of prostate: a case report
Ng KL ; Sathiyananthan JR ; Dublin N ; Razack AH ; Lee G
Journal of University of Malaya Medical Centre 2011;14(1):21-22
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
3.Reflections on the significance of the relationship between mind and body in medicine
Journal of University of Malaya Medical Centre 2010;13(1):3-11
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
4.Psycholigical distress among cancer patients on chemotherapy
Journal of University of Malaya Medical Centre 2010;13(1):12-18
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
5.A retrospective analysis of patients with advanced renal cell carcinoma treated with temsirolimus
Journal of University of Malaya Medical Centre 2010;13(1):19-23
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
6.Patterns of breast cancer relapse at University of Malaya Medical Centre
Rozita AM ; Marniza S ; Mastura MY ; Wan Zamaniah WI ; Yip CH ; Taib NA
Journal of University of Malaya Medical Centre 2010;13(1):24-32
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
7.Counselling changes in sexual functioning for women with breast cancer
Journal of University of Malaya Medical Centre 2010;13(1):33-37
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
8.Cardiovascular risks among shift and non-shift workers in a public medical centre in Kuala Lumpur
Moy FM ; Hoe VCW ; Tan CPL ; Rosmawati M
Journal of University of Malaya Medical Centre 2010;13(1):45-49
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
9.Severe cutaneous adverse drug reactions: Stevens Johnson Syndrome and toxic epidermal necrolysisa, a report of 4 cases seen at UMMC
Shasha Khairullah ; Rokiah Che Ismail
Journal of University of Malaya Medical Centre 2010;13(1):50-58
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
10.Oncogenic osteomalacia, you say? better start looking then - a case report
Vijay AP ; Tan ATB ; Suhaida AM ; Chan SP
Journal of University of Malaya Medical Centre 2010;13(1):63-68
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.