2009

Shariff AH, George J, Ramlan AA
Correspondence: Dr Mohamad Shariff A Hamid, ayip@um.edu.my 

ABSTRACT 
Introduction The purpose of this study was to investigate the pattern of musculoskeletal injuries sustained by Malaysian badminton players. 
Methods This is a retrospective case notes review of all badminton players who attended the National Sports Institute (NSI) Clinic, Kuala Lumpur, Malaysia, and were diagnosed with musculoskeletal injuries. 
Result In a two and a half year period, from January 2005 to June 2007, 469 musculoskeletal injuries were diagnosed among badminton players at the NSI Clinic. The mean age of the players who attended the clinic was 19.2 (range 13–52) years. Approximately 60 percent of the injuries occurred in players younger than 20 years of age. The majority of injuries (91.5 percent) were categorised as mild overuse injury and mostly involved the knee. 
Conclusion The majority of the injuries sustained by badminton players in this study were due to overuse, primarily in the knee. The majority of the injuries were diagnosed in younger players and occurred during training/practice sessions. There was no difference in terms of incidence and types of injuries between the genders. 

Yong MH, Hwang WS, Knight LA, Fung W, Chan MY, Seow WT, Chui CH
Correspondence: Dr Chui Chan Hon, chchui@surgeryforchildren.com 

ABSTRACT
Introduction Neuroblastoma is the most common extracranial solid tumour in children, accounting for about 5.3 percent of all childhood cancers in Singapore. Several genetic abnormalities have been reported as prognostic markers, including amplification of the MYCN gene, deletion of the short arm of chromosome 1 (1p) and gain of the long arm of chromosome 17 (17q). However, the correlation between tumour histology and these genetic parameters remains to be established in our local population. 
Methods 14 untreated primary neuroblastoma tumours, diagnosed consecutively in our hospital between 2003 and 2007, were included for this study. Tumour tissues were classified histologically as favourable or unfavourable, according to the modification of World Heath Organization Classification of Tumours, by associating the degree of differentiation and mitotic karyorrhectic index of the neuroblastoma to the age of the patient. Fluorescence in situ hybridisation analysis for MYCN, 1p status and 17q status were subsequently performed on tumour touch imprints. 
Results Five tumours with favourable histology were all negative for the three genetic parameters being investigated. The other nine tumours showing unfavourable histology exhibited one or more of the three genetic parameters. All MYCN amplified tumours either had additional 1p deletion and/or 17q gain. 
Conclusion Our limited data suggests that 1p deletion and 17q gain are reliable independent parameters correlating with an unfavourable histology and poor clinical outcome. The use of 1p deletion and 17q gain studies, in addition to MYCN amplification studies, should be considered routinely in predicting prognosis in neuroblastomas. 

Chong VH, Abdullah MS, Telisinghe PU, Jalihal A 
Correspondence: Dr Chong Vui Heng, chongvuih@yahoo.co.uk
 

ABSTRACT
Introduction The incidence of colorectal cancer (CRC) is reported to be increasing. This study assessed the incidence and trend of CRCs in Brunei Darussalam, a developing nation.
Methods All histologically-confirmed CRCs over a 22-year period (1986–2007) were identified from the National Cancer and the Department of Pathology registries and retrospectively reviewed.
Results There was a total of 576 (male 59.0 percent, mean age 59.6 +/- 14.8 years, adenocarcinoma 97.6 percent, rectum 31.4 percent) CRCs diagnosed during this period. There was an increasing trend in the mean age at diagnosis, 55.2 +/- 17.5 years in 1986 to 62.0 +/- 13.0 years in 2007, but this was not significant (p-value equals 0.150, ANOVA). 18.8 percent were diagnosed in patients aged 45 years or below. There was no difference in the age at diagnosis between the genders (p-value equals to 0.432) and tumour sites, colon vs. rectum (p-value equals to 0.279). Overall, there was an increase in the age standardised rate (ASR) from 10.36 (1986–90) to 13.75 (1991–95), 15.90 (1996–2000), 16.87 (2001–05) and 24.31 per 100,000 (2006–07). Among the ethnic groups, the Chinese had higher ASRs (41.44) compared to the Malays (including the indigenous groups) with 15.46 per 100,000. The mean age of the Chinese (62.6 +/- 14.0 years) was significantly higher than that of the Malays (58.2 +/-14.9 years, p-value equals to 0.001) at diagnosis. The age-specific incidence rates for the genders were comparable, except for the age groups of older than 55–59 years, where the rate for males was higher.
Conclusion The incidence of CRC is increasing in our local setting with differences observed among the ethnic groups. The Chinese had a higher incidence but developed CRC at a later age. These have important implications if screening for CRC is to be considered in our local setting.

Menon SK, Sarathi V, Bandgar TR, Menon PS, Goel N, Shah NS
Correspondence: Dr Tushar R Bandgar, drtusharb@gmail.com 

ABSTRACT 
Introduction Autoimmune hypophysitis (AH) is a rare primary autoimmune inflammatory disorder involving the pituitary gland. 
Methods A retrospective analysis of the clinical features and outcome of patients diagnosed with AH between 1988 and 2006, was carried out. 
Results 15 patients (14 females and one male) with AH were identified. Three patients presented in the peripartum period. Headache, vomiting and visual field defects, suggestive of an expanding sellar mass, were the most common presenting symptoms (67 percent). The most common deficient hormone was adrenocorticotropic hormone (ACTH) (67 percent), followed by thyroid stimulating hormone (53 percent) and gonadotropins (40 percent). Imaging revealed a definite, enhancing sellar mass in 87 percent of the patients and stalk thickening in 33 percent of the patients. Three patients underwent surgery. On serial monitoring, the sellar mass regressed or disappeared spontaneously without any immunosuppressive treatment in the other ten patients with a definite sellar mass. 
Conclusion We report a higher female to male ratio and a lower incidence of peripartum cases in our series. Symptoms of mass effect were the most common presentation, while ACTH was the most commonly-deficient hormone. Surgery was rarely needed, and most patients experienced a spontaneous resolution of the mass. 

Abdul Wahab NA, Rashid MFN
Correspondence: Mr Noor Alaudin Abdul Wahab, alaudin@medic.ukm.my 

ABSTRACT 
Introduction The present study aimed to obtain preliminary tympanometric data of young Malay adults and to compare the results between genders. 
Methods 96 undergraduate students (49 males and 47 females), aged 19–25 (mean and standard deviation 21.14 +/- 1.31) years, participated in this study. Otoscopic examination, pure tone audiometry, qualitative tympanogram and ipsilateral acoustic reflex were measured to ensure a clear ear canal, normal hearing and normal middle ear function, prior to tympanometric measurement. As a result, a total of 154 ears (80 ears from males and 74 ears from females) were selected for further statistical analyses. The tympanometric parameters measured were peak compensated static acoustic admittance (Peak Y_tm), tympanometric width (TW) and equivalent ear canal volume (V_ea). 
Results The results showed that the mean Peak Y_tm, V_ea and TW for males were 0.81 mmhos, 1.48 cubic cm and 113.67 daPa, respectively. The mean Peak Y_tm, V_ea and TW for females were 0.63 mmhos, 1.12 cubic cm and 98.04 daPa, respectively. Males were found to have significantly higher mean V_ea and mean Peak Y_tm than females. However no significant gender difference was observed in the mean TW. 
Conclusion The current study suggests that young Malay adults may require gender-specific Peak Y_tm and V_ea values when implementing a quantitative approach in tympanogram interpretation.

Mazita A, Wan Fazlina WH, Abdullah A, Goh BS, Saim L
Correspondence: Dr Mazita Ami, mazitaami@yahoo.com 

ABSTRACT 
Introduction The purpose of this study was to review the results of our patients with congenital canal atresia after implantation of bone-anchored hearing aids (BAHA). The occurrence of complications was also reviewed. 
Methods This was a retrospective analysis of the first 16 patients who had BAHA implantation at Universiti Kebangsaan Malaysia Medical Centre, Malaysia. Audiometric assessment was done preoperatively and postoperatively for each patient using the standard procedure. The surgical procedure was described and its complications discussed. 
Results The 16 patients consisted of 11 male and five female patients. Their mean age was 8.9 years at the time of the surgery. The main indication was bilateralcanal atresia.11patients had implantation of BAHA performed in two stages, while the other five patients had it as a single-staged procedure. The complications that occurred were failure of osseointegration (one patient), granulation tissue overgrowth into the abutment (two patients) and cellulitis surrounding the abutment (three patients). The average preoperative unaided air conduction threshold was 64.9 dB and the average postoperative aided hearing threshold was 29.7 dB. The overall mean functional gain was 35.2 dB. 
Conclusion BAHA has many advantages over the conventional hearing aid in the form of cosmesis, discomfort and hearing gain. It is a reliable hearing rehabilitation tool with good predictable hearing outcome in patients with bilateral canal atresia, especially those unsuitable for canalplasty. Despite its higher cost and the need for surgical implantation, its use is justifiable in properly selected patients. 

Kuan WS, Mahadevan M
Correspondence: Dr Kuan Win Sen, kuanwinsen@hotmail.com 

Tan PC, Yow CM, Omar SZ 
Correspondence: Prof Peng Chiong Tan, pctan@um.edu.my

ABSTRACT
Introduction Coitus and orgasm in late pregnancy are believed to facilitate the onset of labour. We aim to evaluate the relationship at term of reported coitus and orgasm with spontaneous labour. 
Methods Women at term scheduled for non-urgent labour induction were asked to keep a coitus and orgasm diary. These women were recruited for a randomised trial on the effect of coitus to promote spontaneous labour. For this analysis, the women were categorised into coitally-active and abstinent groups according to their coital diary. Spontaneous labour prior to the date of scheduled labour induction was the primary outcome. Labour, delivery and neonatal outcome were also evaluated. Multivariable logistic regression analysis was used to control for significant variables.
Results On univariate analysis, the inverse association of coitus with spontaneous labour was borderline (odds ratio [OR] 0.6; 95 percent confidence interval [CI] 0.3–1.0; p-value is 0.052). Orgasm was not associated with spontaneous labour (p-value is 0.33). After adjustment, coitus (adjusted OR 0.4; 95 percent CI 0.2–0.8; p-value is 0.009) displayed a significant inverse association with spontaneous labour. Coitus and orgasm were not associated with any other adverse pregnancy outcome.
Conclusion Women who reported coitus were less likely to go into spontaneous labour prior to their scheduled labour induction. Reported coitus and orgasm were not associated with adverse pregnancy outcome.

Thia EWH, Loi K, Wang JJ, Siow A 
Correspondence: Dr Anthony Siow, anthonysiow@gmail.com

ABSTRACT
Introduction Ectopic pregnancy is an acute emergency in the first trimester where surgery is the mainstay of treatment. With the advent of improved diagnostic techniques like high-resolution transvaginal ultrasonography and expedient serum human chorionic gonadotrophin (HCG) assay, ectopic pregnancy is now diagnosed early. At this stage, the conceptus is often small, causing minimal or no symptoms. Medical management may then present an appealing alternative to surgery. Methotrexate has been widely used to treat ectopic pregnancy. A methotrexate ectopic treatment protocol was introduced by the Minimally Invasive Surgery Centre at KK Women’s and Children’s Hospital, Singapore. We present the results of this treatment.
Methods A prospective review of 110 cases of medical management of ectopic pregnancy since the implementation of the treatment protocol was undertaken. Demographical data, clinical presentation, treatment progress and outcome were captured using a computer database. All patients were managed as outpatients, and a telephone call-out service was provided to ensure that treatment side effects were monitored and potential treatment failures were identified early.
Results From August 2003 to October 2006, 93 (84.5 percent) patients with ectopic pregnancy were successfully treated with intramuscular methotrexate. 16 patients eventually required surgery and only one patient defaulted on follow-up. There was no major side effect detected in this cohort. The minor side effects reported included mucositis (19.1 percent) and abdominal pain (28.2 percent).
Conclusion Methotrexate treatment of ectopic pregnancy is safe. Our treatment protocol enabled us to achieve a reasonable treatment success rate of 84.5percent.

Wee WW, Kanagalingam D 
Correspondence: Dr Wei-Wei Wee, wcube@hotmail.com 

ABSTRACT 
Introduction The development of anti-D antibodies results from foetomaternal sensitisation occurring in rhesus (Rh) negative blood group women who carry an Rh-positive foetus. Despite guidelines on Rh immunoprophylaxis, isoimmunisation continues to occur, suggesting that the guidelines are not being fully applied by obstetricians. This study aims to establish the adequacy of knowledge on Rh immunoprophylaxis among obstetricians and trainees in obstetrics and gynaecology in Singapore, and their usual practice in the care of an Rh-negative mother; and hence to audit their practice in accordance with evidence-based guidelines. 
Methods An anonymous questionnaire survey auditing obstetricians’ knowledge of guidelines on anti-D prophylaxis and their usual practice in the clinical setting. 
Results The mean score achieved on the questionnairewas75.9percent.Manyobstetricians did not know that anti-D immunoglobulins (Ig) should be given within 72 hours of a sensitising event for successful immunoprophylaxis. In clinical practice, all the obstetricians who participated in the questionnaire would offer anti-DIg prophylaxis to Rh-negative women both antenatally and postnatally. However, only 12.7 percent of them would routinely perform a Kleihauer test in Rh-negative women following delivery. 
Conclusion The knowledge on anti-D prophylaxis among obstetricians can be improved. A continual system of education to raise awareness of evidence-based practices as well as clinical audit has been implemented to address this.