2009

Pang AS
Correspondence: Dr Pang Ah-San, pangahsan@gmail.com

ABSTRACT
Loss of a normal swallowing reflex as in dysphagic stroke is the commonest indication for long-term tube feeding. For this, either the nasogastric tube or the percutaneous endoscopic gastrostomy tube is used, with the former being uncomfortable. The latter tube is neither secure nor easy to change. A new feeding tube invented in Singapore uses a loop and lock configuration to make it comfortable for the patient, impossible to pull out accidentally, and easy to change. This third-generation feeding tube has the potential to be the new global standard.

Keywords: aspiration, enteral nutrition, feeding tube, gastrostomy, pneumonia, stroke
Singapore Med J 2009; 50(7): 740-742

Koohdani F, Sasani F, Mohammad K, Mehdipour P
Correspondence: Dr Fariba Koohdani, fkoohdan@sina.tums.ac.ir

ABSTRACT
Introduction This study aims to compare Ki-67 antigen expression and K-ras mutation in lung tumours induced by the interfering effects of urethane followed by sodium nitrite, sodium chloride and vitamin D3.
Methods The samples were classified into six groups: control (C) group; urethane only (U) group; urethane and vitamin D (U+D) group which received 3.5 mg/kg vitamin D3 for four weeks; urethane and sodium nitrite (U+NS) group which was given sodium nitrite (50mg/L); urethane and physiological serum (U+NaCl) group; and sodium nitrite and physiological serum (NS+NaCl) group which was given 50 mg/L sodium nitrite and physiological serum, instead of water. The four carcinogen groups receiving urethane were injected intraperitoneally with 600 mg/kg of urethane three times. After 20 weeks of intervention, the mice were killed; the tissues were removed and examined for histopathological changes and comparison of Ki-67 antigen expression and mutations in the exon 1 of the K-ras gene in lung tumours.
Results There were significant differences in the Ki-67 index between the C group and the U (p-value is less than 0.006, 95 percent confidence interval [CI] -432.9 to -55.6), U+D (p-value is less than 0.05, 95 percent CI -408.3 to -4.6), U+NS (p-value less than 0.02, 95 percent CI -415.7 to -27.2), U+NaCl (p-value less than 0.002, 95 percent CI -478.8 to -90.3) groups. There was no difference between the C and NS+NaC1 groups. There was no mutation in the exon 1 of K-ras gene of the lung tumours.
Conclusion The expression of Ki-67 antigen was found to be increased by urethane in the present study. However, a study on a larger sample size may show anti-tumourogenic effect of vitamin D3. However, the K-ras exon 1 mutations do not play any role in the interfering effects of urethane followed by sodium nitrite and sodium chloride.

Keywords: carcinogens, K-ras genes, Ki-67 antigen, lung tumour, vitamin D, urethane
Singapore Med J 2009; 50(7): 729-733

Htwe TT, Hamdi MM, Swethadri GK, Wong JOL, Soe MM, Abdullah MS
Correspondence: Dr Than Than Htwe, lavenderhtwe@yahoo.com

ABSTRACT
Introduction Thyroid cancer is the most common among all endocrine malignancies. The worldwide prevalence of goitre in the general population is estimated at 4–7 percent and the incidence of malignancy in goitrous thyroid is about ten percent. It is postulated that goitrous thyroid is a precursor lesion to the development of malignant thyroid diseases. As Sarawak is a state well known for endemic goitre, this study focused on establishing the incidence of thyroid malignancy among goitrous thyroid swellings.
Methods This study was a hospital-based retrospective study on the archived collection of the surgically-removed thyroid specimens from the Sarawak General Hospital, Malaysia. Cases were grouped into cancer and non-cancer groups. The cancer group included papillary thyroid carcinoma (PTC), PTC follicular variant, follicular carcinoma and anaplastic carcinoma (ANA).
Results A total of 820 thyroid cases which underwent surgical removal in years 2000 to 2004 were collected. Of these, 143 (17.4 percent) were male and 677 (82.6 percent) female. It was observed that the highest prevalence of thyroid swelling cases occurred in the age group 41–60 years while the lowest prevalence occurred in the age group under 21 years, 371 (45.2 percent) vs. 31 (3.8 percent). By ethnicity, the Ibans and Malays were found to have a higher prevalence at 275 (33.5 percent) and 196 (23.9 percent), respectively, while the lowest prevalence was observed in Indians, 11 (1.3 percent). 55 cases (6.7 percent) were found to be cancerous and the rest (93.3 percent) were non-cancerous thyroid swellings. Histologically, the highest incidence of carcinoma was PTC (4.0 percent) and the lowest was ANA (0.2 percent).
Conclusion Based on our observations, although goitrous thyroid swelling is quite a common problem in Sarawak, thyroid malignancy is not a major issue. Among thyroid malignancies, PTC is the most common histological type of malignancy.

Keywords: goitre, papillary thyroid carcinoma, thyroid cancer, thyroid malignancy
Singapore Med J 2009; 50(7): 724-728

Suthahar A, Gurpreet K, Ambigga D, Maniam T, Dhachayani S, Fuad I, Adlina S
Correspondence: Dr Suthahar Ariaratnam, suthahar@salam.uitm.edu.my

ABSTRACT
Introduction The aim of this paper was to determine the sociodemographic and cancer characteristics of patients with cancer at a tertiary care centre.
Methods For the study, 80 newly-diagnosed cancer patients were selected and interviewed using structured questionnaires that included sociodemographic and cancer characteristic profiles. At the end of the study period of two years, the survivorship status of the patients was determined.
Results Gender, occupational status, type of cancer and stage of cancer were found to be significantly associated with the survival status among the study group of cancer patients. Results of logistic regression analysis showed that deceased patients were significantly more likely to be pensioners rather than employed, aged 60–69 years rather than 40–49 years, to have all other types of cancer rather than breast cancer, and to be in Stage 3 or 4 of the disease rather than in Stage 1 of the disease.
Conclusion There is a greater necessity for psychosocial research in order to achieve optimal health for patients with cancer, and in turn, to improve the survival of cancer patients.

Keywords: cancer characteristics, cancer profile, sociodemographic profile, survivorship status, tertiary care
Singapore Med J 2009; 50(7): 720-723

Joshi SD, Joshi SS, Athavale SA
Correspondence: Dr Subhash D Joshi, sdjoshi_2003@hotmail.com

ABSTRACT
Introduction A sound knowledge of the normal and variant liver anatomy is a prerequisite to having a favourable surgical outcome. Knowledge of the commonly-occurring variations assumes even more significance in the era of diagnostic imaging and minimally-invasive surgical approaches. Although the segmental anatomy of the liver has been extensively researched, very few studies have dealt with the surface variations of the liver.
Methods 90 formalin-fixed livers were utilised for the study. Variations regarding the shapes of the caudate and the quadrate lobes as well as the normal fissures were observed. The presence of the accessory fissures and any other variations on the surface of the livers were noted.
Results Varied shapes of the caudate and the quadrate lobes were encountered. Notching along the inferior border of the caudate lobe was seen in 18 percent of livers, a vertical fissure was observed in 30 percent, and prominent papillary process was seen in 32 percent. Accessory fissures and grooves were more common in the right lobe. Multiple prominent vertical grooves were observed on the anterosuperior surface of the liver in six percent of livers. Quadrate lobe was absent in four percent, and in two cases, it was found to be deeply buried. Presence of a pons hepatis, bridging the left and the quadrate lobes, was observed in 30 percent of the livers examined.
Conclusion Our study is expected to serve as a guide for proper interpretations of liver images using various imaging modalities. It will also be useful to the operating surgeons to be aware of the frequently-occurring morphological variations on the liver surface.

Keywords: accessory fissures, caudate lobe, liver anatomy, papillary process, pons hepatis, quadrate lobe
Singapore Med J 2009; 50(7): 715-719

Chakraborty PP, Bandyopadhyay D
Correspondence: Dr Partha Pratim Chakraborty, docparthapc@yahoo.co.in

ABSTRACT
Introduction Various diseases associated with human immunodeficiency virus (HIV) infection are often difficult to diagnose. A poor immune response, atypical presentations and opportunistic pathologies all contribute to this difficulty. We tried to evaluate the utility of routine abdominal ultrasonography (US) in new and follow-up HIV cases, and compared the results among those with a clinical need for US and those where US was performed as a routine screening.
Methods 150 consecutive seropositive patients were subdivided into four groups depending on the necessity of abdominal US on the initial workup, i.e. Group A (38 patients) or B (112 patients), and whether they were newly-diagnosed HIV patients or follow-up patients, i.e. Group X (62 patients) or Y (88 patients), giving us subgroups, AX (22 patients), AY (16 patients), BX (40 patients) and BY (72 patients).
Results The prevalence of significant US findings was higher in those with CD4 less than 200 cells/ml (77.8 percent) compared to those with CD4 200–500 cells/ml and CD4 more than 500 cells/ml (65.5 percent and 37 percent, respectively). 24 out of 38 patients with clinical indications and 71 out of 112 patients without any obvious clinical need for US, had positive findings on US, the majority of which had a major therapeutic impact.
Conclusion We conclude that abdominal US is a simple and cost-effective tool in resource-poor countries like India, where HIV care is becoming more and more important.

Keywords: acquired immunodeficiency syndrome, active anti-retroviral therapy, anti-retroviral therapy, highly hepatic venous thrombosis, highly-active anti-retroviral therapy, human immunodeficiency virus, ultrasonography
Singapore Med J 2009; 50(7): 710-714