Molecular Detection of Coxiella burnetii from Farm Animals and Ticks in Malaysia.

Coxiella burnetii, the causative agent of Q fever, is an intracellular bacterium of medical and veterinary importance. The reservoirs of C. burnetii are extensive which include mammals and arthropods, particularly ticks. As the organism is difficult to culture, this study was aimed to detect C. burnetii DNA in animal (mainly blood and vaginal samples of cattle, goats and sheep) and tick samples obtained from farm animals, wild rodents and vegetation. Two polymerase chain reaction (PCR) assays targeting IS1111 transposon-like gene (TransPCR) and com1 gene (OMP-PCR) were used for C. burnetii detection. Sequence determination of the amplified fragments and a real-time PCR assay were used to confirm PCR findings. C. burnetii DNA was detected from 9.1% of cattle blood and 4.2% vaginal samples, respectively. A small percentage (5.8%) of ticks (including Amblyomma, Dermacentor, Rhipicephalus and Haemaphysalis spp.) haboring C. burnetii were identified in this study. This study provides molecular evidence on the presence of C. burnetii in cattle and ticks. The possible zoonotic transmission of C. burnetii is yet to be investigated.

The spectrum of Sertoli cell tumors in children.

The spectrum of Sertoli cell tumors in children covers a wide range of testis and ovarian tumors classified as sex cord-stromal tumors. Sertoli cell tumor of the testis is extremely rare in the pediatric population. The American Academy of Pediatrics Section on Urology Prepubertal Testicular Tumor Registry has reported a total of six cases of Sertoli cell tumor of the testis, accounting for 1.3% of the 430 cases reported to the registry as of October 1996. Despite their rarity, Sertoli cell variants of sex cord-stromal tumors have generated keen interest because of their variable histologic appearance and biologic behavior, including endocrine activity. Because sex cord-stromal tumors occur in the ovary and testis, a primitive cellular origin to these tumors is likely in males and females.

Mechanism of pulmonary vein stenosis in infants with normally connected veins.

We used microscopy, immunohistochemistry, and cell culture to identify the mechanism of restenosis in 4 infants with isolated pulmonary vein stenosis. Recurrent obstruction appears to be due to myofibroblastic proliferation in this fatal disease.

Alfentanil given immediately before the induction of anesthesia for elective cesarean delivery.

Opioids are routinely omitted at the induction of general anesthesia for cesarean delivery because of concerns about neonatal respiratory depression. The subsequent unmodified maternal stress response to tracheal intubation reduces placental perfusion. The short-acting opioid alfentanil may afford advantages at the induction, without subsequent neonatal depression. In this double-blinded study of elective cesarean deliveries, 40 patients were allocated randomly to receive either alfentanil 10 microg/kg (n = 18) or placebo (n = 22), 1 min before the induction of anesthesia with thiopental 4 mg/kg and succinylcholine 1.5 mg/kg. Anesthesia was maintained with 50% nitrous oxide, 0.5% isoflurane in oxygen, and atracurium. Neonates were assessed by using Apgar scores, Neurologic and Adaptive Capacity Scores, and umbilical cord blood gas and catecholamine analysis. After intubation, mothers receiving alfentanil had a smaller increase in mean arterial blood pressure, (11 +/- 15 vs 31 +/- 13 mm Hg, P < 0.001) and lower plasma norepinephrine concentrations, (336 +/- 152 vs 486 +/- 241 pg/mL, P < 0.05). Neonates in the alfentanil group had greater umbilical arterial oxygen tensions (27.8 +/- 7.0 vs 22.6 +/- 7.4 mm Hg), slightly reduced Apgar scores (both P < 0.05), but similar Neurologic and Adaptive Capacity Scores. One neonate in the alfentanil group required naloxone. The maternal stress response was attenuated in the alfentanil group but at the cost of early neonatal depression. However, all neonates should be monitored for possible immediate, but transient, respiratory depression.

Large-cell calcifying Sertoli cell tumor of the testis: case report and review of the literature.

Large-cell calcifying Sertoli cell tumor (LCCSCT) is a rare sex cord-stromal tumor found predominantly in the pediatric population. This tumor has distinctive histopathologic features and clinical associations. LCCSCT has also been noted in association with the Carney complex, and in patients with Peutz-Jeghers syndrome. The propensity to metastasize is low, and radical orchiectomy has traditionally been the treatment of choice.

Hypoplastic dysplastic kidney with a vaginal ectopic ureter identified by technetium-99m-DMSA scintigraphy.

Ectopic insertion of a ureter draining a hypoplastic dysplastic kidney is a significant cause of urinary incontinence in girls. In this case, such a kidney was detected with 99mTc-DMSA scintigraphy but not by intravenous pyelography. Scintigraphy facilitated further delineation of the anatomy with CT prior to nephrectomy. Based on this case and a literature review, we suggest that 99mTc-DMSA scintigraphy be performed early when evaluating girls with urinary incontinence.

Plasma catecholamine levels during functional endoscopic sinus surgery.

Plasma adrenaline and noradrenaline concentrations were measured in 10 consecutive patients during functional endoscopic sinus surgery (FESS). Surgery was preceded by nasal packing with 5 ml 2% cocaine solution, followed by infiltration with 1:80,000 adrenaline and 2% lignocaine. All patients showed a marked rise in plasma adrenaline concentration within 4 min of commencing infiltration, which was not related to the patient's sex, age, weight, the total amount injected, nor the amount injected into the nose. Surgeons should be aware of this marked, but unpredictable, systemic absorption of locally infiltrated vasoconstrictors. Pulse and ECG monitoring should be considered mandatory for such procedures, even when surgery is performed under local anaesthesia.

Cytophagic histiocytic panniculitis: a diagnostic dilemma.

Cytophagic histiocytic panniculitis (CHP) is a recently recognized entity that frequently poses a perplexing diagnostic problem. Although the classical case presents with a relapsing fever, subcutaneous nodules, pancytopenia and liver dysfunction, most patients have in addition a multitude of other manifestations which confuse the clinical picture. Notwithstanding the variable clinical course, the disease frequently terminates in fatal hemorrhage. Diagnosis is based on histological features. A lobular panniculitis with an infiltrate of cytologically benign cytophagocytic histiocytes in skin nodules is the sine qua non of CHP. Hence, a deep skin biopsy which includes subcutaneous fat is mandatory to establish the diagnosis. Published information regarding this newly described entity remains scarce and we report two cases of CHP, one occurring in a 30-year-old Kadazan man and another in a 17-year-old Chinese woman seen at the University Hospital, Kuala Lumpur. The latter case presented with exudative ascites, an unusual feature, possibly due to intra-abdominal panniculitis. In addition, we record the development of cirrhosis in the same patient.

Systemic absorption of glycine irrigation solution during endometrial ablation by transcervical endometrial resection.

OBJECTIVE: To study systemic absorption of glycine irrigation solution and its consequences during transcervical endometrial resection (TCER). DESIGN, SETTING, PATIENTS: A prospective study of 20 consecutive female patients who underwent elective TCER in a teaching hospital. METHOD: During the operation, patients were monitored with electrocardiography, automated oscillotonometry, pulse oximetry, capnography and a central venous pressure recorder. Plasma sodium and potassium levels were measured at 15-minute intervals. Blood haemoglobin concentration, serum osmolality, and plasma sodium, potassium and glycine concentrations were measured before and after surgery. RESULTS: Plasma glycine concentration increased in all patients after TCER. The highest concentration recorded was 5575 mumol/L. The increase correlated only with the maximum intraoperative decrease in plasma sodium, which was 7 mmol/L in two patients whose plasma glycine level increased by 3001 mumol/L and 5335 mumol/L. CONCLUSION: Systemic absorption of glycine irrigation solution occurred in all patients during TCER. Serial measurement of plasma sodium was necessary to detect this complication. A decrease in plasma sodium level by 7 mmol/L or more during surgery would indicate fluid absorption that could cause severe hyperglycinaemia and other potential complications.

Fibroadenomatoid mastopathy: another distractive breast lesion?

Although most anatomical pathologists have encountered breast lesions with the composite histological features of fibroadenoma (FA) and fibrocystic change (FC), referred to as fibroadenomatosis or fibroadenomatoid mastopathy (FAM), little is known about its prevalence or clinico-pathological significance. In a retrospective histological review of 400 consecutive breast lesions, among both East and West Malaysians, coded either as FA or FC in the files of the Department of Pathology, University of Malaya, we found 45 (11.3%) cases of FAM. Typically, FAM lesions showed fibroadenomatoid foci in a background of fibrocystic change. The finding of FAM among lesions coded as FC was higher (18.5%) than among FA (4%). The mean age of patients with FAM (32.1 years) was similar to FC (35.1 years) but significantly older than that of FA (26.1 years). The notion that FA and FC are lesions at two ends of a spectrum of growth disorder of breast related to oestrogen-progesterone interplay, and that FAM occupies a position intermediate between the two, may explain its morphological and age patterns, but remains speculative. It is hoped that increasing awareness of this condition will lead to better understanding of breast pathophysiology. Nevertheless, until its biological nature, histogenesis and malignant potential are more clearly understood, defining FAM as a distinct form of breast disease may not be meaningful to patient management.

Clinical efficacy of sulfadoxine-pyrimethamine in the treatment of falciparum malaria in Sabah, Malaysia.

One hundred and ten consecutive patients with falciparum malaria were treated with Fansidar and primaquine. Of the 61 patients who were followed up at one week, 4 (6.6%) failed to clear their parasitaemia (1 R III and 3 R II treatment failures). Of the subsequent 40 patients who were seen again at one month, another 3 (7.5%) had recrudesced (R I treatment failure). A total of 7 patients thus experienced some form of treatment failure in the cohort of 40 who completed the one month follow up. Only 1 of these 7 patients (with R III treatment failure) failed to respond to repeat Fansidar treatment, and may be the only one with true Fansidar resistance. The overall treatment failure rate of 17.5% (95% confidence interval: 6-29%) in the cohort who completed the study is consistent with the known clinical efficacy of Fansidar. These results suggest no significant Fansidar resistance in falciparum malaria found in Sabah.