The College of General Practitioners of Malaysia and the Royal Australian College of General Practitioners held the first Conjoint Member of the College of General Practitioners (MCGP)/Fellow of Royal Australian College of General Practitioners (FRACGP) examination in 1982, later renamed the Conjoint MAFP/FRACGP examinations. The examination assesses competency for safe independent general practice and as family medicine specialists in Malaysia. Therefore, a defensible standard set pass mark is imperative to separate the competent from the incompetent.

Cutaneous tuberculosis is an old and rare infectious disease. Laennec reported the first case of cutaneous tuberculosis in 1826 and M.tuberculosis was discovered by Koch in 18821. Since then, many cases of cutaneous tuberculosis have been described and classified. The different forms of diseases correlate with the immunologic status of the host, host’s prior sensitization, route of disease transmission, layer of skin primarily involved and rate of disease progression. Nevertheless, the most widely accepted classification is based on the mechanism of disease propagation which can be via direct inoculation, through contiguous infection or via hematogenous route2. Bacterial load has also been used to categorize this disease into multibacillary and paucibacillary forms. Diseases under the multibacillary forms include primary inoculation tuberculosis (tuberculous chancre), scrofuloderma, tuberculous perioficialis, acute miliary tuberculosis and tuberculous gumma. Paucibacillary forms include lupus vulgaris, tuberculosis verrucosa cutis and tuberculids. Strains of M. Tuberculosis complex that can be isolated include M.tuberculosis, M. africanum, M. canetti and M. bovis, M. microti and M.bovis BCG.

Spirituality and mental adjustment have been widely adopted as coping strategies among women with breast cancer. Little information was available locally on the use of spirituality and mental adjustment as coping mechanisms to fight breast cancer. A cross-sectional study was conducted to assess spirituality and mental adjustment as coping strategies and its association with socio demographic data on 216 women with breast cancer. The Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being (FACIT-Sp) and Mental Adjustment to Cancer (MAC) Scales were used to assess spirituality and mental adjustment. Negative correlation between spiritual well-being and helplessness/hopelessness (r=-0.690; p=0.000), anxious preoccupation (r=-0.277; p=0.000) and avoidance (r=-0.235; p=0.000) and positive correlation between spiritual well-being and fighting spirit (r=0.668; p=0.000) were identified. Socio-demographic factors such as race (p=0.000), religion (p=0.000), academic qualification (p=0.004) and type of surgery (p=0.016) revealed significant relationship with spiritual well-being. Fighting spirit, hopelessness/helplessness and anxious preoccupation also yielded significant relationship with race (p<0.0001), religion (p=0.001) and academic qualification (p=0.024). Helplessness/hopelessness had a significant relationship with stage of disease (p=0.017) and type of surgery (p=0.011). Meanwhile, fatalistic and avoidance showed a strong relationship with age (p=0.014, r=0.167), occupation (p=0.001) and income (p=0.006), race (p=0.007) and academic qualification (p=0.005). It is thus, concluded that spirituality and mental adjustment are two coping strategies widely adopted by Malaysian women after a breast cancer diagnosis and throughout their breast cancer journey. Women with breast cancer, therefore, should be treated holistically rather than just the disease itself.
Breast Neoplasms ; Spirituality ; Adaptation, Psychological

Although pediatric pulmonary thromboembolism is historically believed to be rare with relatively little information available in the medical literature regarding its imaging evaluation, it is more common than previously thought. Thus, it is imperative for radiologists to be aware of the most recent advances in its imaging information, particularly multidetector computed tomography (MDCT), the imaging modality of choice in the pediatric population. The overarching goal of this article is to review the most recent updates on MDCT diagnosis of pediatric pulmonary thromboembolism.
Humans ; Image Processing, Computer-Assisted ; Multidetector Computed Tomography/instrumentation/*methods ; Pediatrics ; Pulmonary Embolism/physiopathology/*radiography ; Risk Factors

The first national survey on esophageal atresia and tracheoesophageal fistula was conducted to access the current status of its incidence. clinical manifestation, preoperative diagnosis and management, type of its anomaly, associated anomalies, and surgical results and course. The 43 members of the Korea Association of Pediatric Surgeons received questionnaires and registration forms to be filled out on each patient who were born during the three years from January I, 1992 through Decestricurember 31, 1994. Questionnaires composed of six broad areas which include 1) preoperative diagnosis and management, 2) surgical technic, 3) long gap, 4) postoperative management, and 5) complications and courses. A total of 148 cases was returned by 28 members working at 23 institutions and 27 members returped questionnaires. We obtained the following results by analysis of the 148 cases of tracheoesophageal anomalies. The incidence of tracheoesophageal anomaly was about 1/10,000-11,000 in 1994, which is one third of that of anorectal malformations in Korea and the distribution of the patients was almost proportionate to the size of each province. Both sexes are about equally affected. Majority of the members make diagnosis of tracheoesophageal anomaly by taking a simple infantogram with a radiopaque tube in upper pouch and a little under half(46%) prefers to perform echocardiography as a part of preoperative management to identify congenital heart disease and lateralize the aorta. Esophageal atresia with distal TEF(87.50/0) was by far the most common and threre were pure esopahgeal atresia(5.6%), H-type TEF(2.l%), and so on. About half(49%) of the patients had one or more associated anomalies in addition to tracheoesophageal anomalies. Congenital heart disease was associated in 46 cases(31 %), anorectral malfomations in 19 cases(13%), musculoskeletal anomalies in 15 cases(10%), genitourinary anomalies in 10 cases(7%) and gastrointestinal anomalies in 7 cases(5%). Postoperatively, parenteral nutrition and assisted ventilation were given in 66% and 52% of patients respectively. Ninety three(74%) of 126 cases who underwent surgical procedure, experienced one or more complications such as respiratory complication (65%), leak(22%), stricture(21%) and so on. The survival rates related to the Waterston risk categories were 90.2% in grpup A, 71.4-75% in B₁, B₂, and C groups, and 28% in group C₂ and the overall survival rate was 71.4%. Thirty six(28.6%) of 126 cases died of pneumonia/sepsis(12 cases), respiratory failure(l2 cases), and congenital heart disease(4 cases). With short term follow-up, 69% of patients have been excellent whereas remainders of the cases have suffered from some sort of morbidity related to gastroesophageal reflux, recurrent respiratory infection, and esophageal stricure.
Aorta ; Diagnosis ; Echocardiography ; Esophageal Atresia ; Follow-Up Studies ; Gastroesophageal Reflux ; Heart ; Heart Defects, Congenital ; Humans ; Incidence ; Korea ; Parenteral Nutrition ; Surgeons ; Survival Rate ; Tracheoesophageal Fistula ; Ventilation

The survey on branchial anomalies was conducted by Korean Association of Pediatric Surgeons. A total of 173 cases were reported, which were managed by 36 members and cooperators during the three years from January 1, 1993 through December 31, 1995. The following results were obtained by retrospective analysis of the 173 cases of branchial anomalies. The presenting symptoms were cervical mass in 101 cases, pit with or without discharge in 71, cervical abscess in 47 and respiratory difficulty in 3. The average age of the patients with cervical abscess was 52 months. Seventy(79%) of 89 patients with branchial anomalies and a cystic mass had their first clinical manifestations by 1 year of age, while 40(51%) of 78 patients with only a branchial cyst had their first clinical manifestation in first year of life. Radiologic studies were carried out in 77 patients(43%). The preferred diagnostic modalities were ultrasonography(47 patients), simple neck radiogram(l9) and CT scan(17). Preoperative diagnosis was correctly made in 156(91%) of 173 patients. Seventeen patients were incorrectly diagnosed as thyroglossal duct cyst in 5 patients, cystic hygroma in 4, dermoid cyst in 3, and lymphadenopathy in 3. There were no remarkable difference in sex and laterality of presentation but bilateral lesions were found in 9(5%) patients and unusual locations of the anomalies were the manubrium, left subclavicular area, median cervial area, preauricular and parotid area. There were 78(45%) patients with cyst, 52(30%) patients with sinus, 35(20%) patients with fistula and 8(5%) patient with skin tag. Embryological classification was possible in only 64(37%) patients. The 2nd branchial anomaly was present in 50 (78%), the 1st branchial anomaly in 10(18%), and the 3rd or 4th branchial anomaly in 4(6%). Histopathological study of the lining epithelium(N=134) is recorded that 45% were lined with squamous epithelium, 17% with respiratory epithelium, 6% with. squamous and respiratory epithelium, 14% with inflammatory change. Lymphoid tissue was common(62%) in the wall of the lesions. Twelve(7%) of 158 patients had postoperative complications including wound complication, recurrence and facial nerve palsy.
Abscess ; Branchioma ; Child ; Classification ; Dermoid Cyst ; Diagnosis ; Epithelium ; Facial Nerve ; Fistula ; Humans ; Korea ; Lymphangioma, Cystic ; Lymphatic Diseases ; Lymphoid Tissue ; Manubrium ; Neck ; Paralysis ; Postoperative Complications ; Recurrence ; Respiratory Mucosa ; Retrospective Studies ; Skin ; Surgeons ; Thyroglossal Cyst ; Wounds and Injuries

Malignant fibrous histiocytoma (MFH) is a primitive sarcoma originating in the deep soft tissue and composed of fibrocytic and histiocytic cells in a storiform pattern. It is rare but the most common soft tissue sarcoma of adulthood. MFH occurred in various epithelial organs derived from the supportive mesenchymal elements. The lung represents an extremely rare primary site. We have experienced one case of MFH, arising in the lung parenchyme in 67 years old male patient with cough for 6 months. The patient was taken right upper lobe and right middle lobe lobectomy with good post-operative results. But another MFH was recurred in the left upper lobe 3 months after complete resection. So he had been treated with chemotherapy and radiofrequency ablation of tumor. Then he continued to be treated with chemotherapy
Aged ; Catheter Ablation ; Cough ; Drug Therapy ; Histiocytoma, Malignant Fibrous* ; Humans ; Lung* ; Male ; Sarcoma

This report present the result of the national survey of pediatric surgeons' preferences on diagnosis and treatment of Hirschsprung's disease(HD) carried out in 1993. The questionnaires were sent to twenty-seven members of the Korean Association of Pediatric Surgeons (KAPS) working in twenty-four institutions. The questionnaires were designed to determine the individual surgeon's preference for the methods of diagnosis and treatment of the disease. Twenty-three pediatric surgeons from twenty institutions returned completed forms. The total number of patients diagnosed with HD in 1992 was 190 in this group. The estimated incidence of HD was 1/3,900. The most important symptom was delayed meconium passing and the most preferred diagnostic procedure was barium study. Anorectal manometric examination was carried out by 13 pediatric surgeons and 19 confirmed the diagnosis before operation by rectal biopsy, 12 with full-thickness biopsy and 7 with suction. Frozen section biopsy during operation was done by 22 surgeons. Eight surgeons did one stage operation if the age of the patient is suitable. Definitive operation was usually done at the age of 6 to 11 months. The most preferred operation was Duhamel procedure done by 19. Enterocolitis was the most serious complication of HD. Most of patients had normal continence within 6 to 12 months after operation. The follow-up period was less than 6 years in 16 surgeons. The results were presented at the 9th annual meeting of KAPS in June of 1993. This is the first national survey of HD and it can provide guidelines of diagnosis and treatment of Hirschprung's disease even though it is not a detailed study of patient data.
Barium ; Biopsy ; Diagnosis ; Enterocolitis ; Follow-Up Studies ; Frozen Sections ; Hirschsprung Disease ; Humans ; Incidence ; Korea ; Meconium ; Suction ; Surgeons

To understand the current status of neonatal surgery in Korea, a suvey was made among the 27 members of Korean Association of Pediatric Surgeons. Response rate among surgeons was 78 perecnt, eighteen hospitals participated in this study. Five hundred and three cases of neonatal surgical patients were analyzed. In Korea, about 50% of cases were treated at the hospital in the capital city area. Regional number of patients were closely related to the regional population. Imperforate anus(19%), atresia/stenosis of gut(12%), and Hirschsprung's diseases(12%) were sitting at the top in the list. Majority of operation was done within the first week of life, especially during the first 24 hour period. Eighty per cent was major or so called index cases. Mortality in so-called index cases was 17%. High mortality was observed in patients with diaphragmatic hernia(47%), gastrointestinal perforation(65%) and esophageal atresia(28%). Low birth weight babies showed higher mortality in gastro -intestinal perforation, esophageal atresia and abdominal wall defect. These were compared to 1993 survey of Japanese Society of Pediatric Surgeons.
Abdominal Wall ; Asian Continental Ancestry Group ; Esophageal Perforation ; Humans ; Infant, Low Birth Weight ; Infant, Newborn ; Korea ; Mortality ; Surgeons

Objective: Glucagon in mammals and its homolog (adipokinetic hormone [AKH] in Drosophila melanogaster) are peptide hormones which regulate lipid metabolism by breaking down triglycerides. Although regulatory mechanisms of glucagon and Akh expression have been widely studied, post-transcriptional gene expression of glucagon has not been investigated thoroughly. In this study, we aimed to profile proteins binding with Gcg messenger RNA (mRNA) in mouse and Akh mRNA in Drosophila. Methods: Drosophila Schneider 2 (S2) and mouse 3T3-L1 cell lysates were utilized for affinity pull down of Akh and Gcg mRNA respectively using biotinylated anti-sense DNA oligoes against target mRNAs. Mass spectrometry and computational network analysis revealed mRNA-interacting proteins residing in functional proximity. Results: We observed that 1) 91 proteins interact with Akh mRNA from S2 cell lysates, 2) 34 proteins interact with Gcg mRNA from 3T3-L1 cell lysates. 3) Akh mRNA interactome revealed clusters of ribosomes and known RNA-binding proteins (RBPs). 4) Gcg mRNA interactome revealed mRNA-binding proteins including Plekha7, zinc finger protein, carboxylase, lipase, histone proteins and a cytochrome, Cyp2c44. 5) Levels of Gcg mRNA and its interacting proteins are elevated in skeletal muscles isolated from old mice compared to ones from young mice. Conclusion Akh mRNA in S2 cells are under active translation in a complex of RBPs and ribosomes. Gcg mRNA in mouse precursor adipocyte is in a condition distinct from Akh mRNA due to biochemical interactions with a subset of RBPs and histones. We anticipate that our study contributes to investigating regulatory mechanisms of Gcg and Akh mRNA decay, translation, and localization.