Compression of the common bile duct by a stone impacted in the cystic duct is an uncommon cause of obstructive jaundice. We present a case study and review of the literature pertaining to the presentation, diagnosis, and surgical treatment of Mirizzi syndrome.
Recent studies have demonstrated a reduction in the morbidity and mortality of pancreatic resection and improvement in the actuarial 5-year survival for patients with resected ductal adenocarcinoma. We reviewed the clinico-pathological characteristics of patients who underwent resection with curative intent for ductal adenocarcinoma of the pancreas between 1980 and 1993.
Acute scrotal pain and swelling in children is commonly attributed to torsion of the testis or of the testicular appendage. However, following suppurative appendicitis, scrotal abscess secondary to a patent processus vaginalis must be considered.
Spontaneous pneumoperitoneum without peritonitis is a rare phenomenon which poses a dilemma to the surgeons faced with this problem. Two such cases and their outcome are presented. The first case was caused by tracheal rupture during emergency intubation and was treated by observation until complete resolution. The second case was caused by barotrauma during positive pressure ventilation and was treated by laparotomy. Both patients died for reasons unrelated to the pneumoperitoneum. The passage of air from the chest cavity into the abdominal cavity was along the great vessels in the first case and through the diaphragm in the second. A compilation of other aetiologies of pneumoperitoneum without peritonitis as extracted from the literature is presented. In the presence of pneumoperitoneum without peritonitis and when the clinical history does not suggest visceral perforation, an abdominal tap or lavage should be attempted. If negative, continued observation is advised.
This paper examines the effect of age at first calving and milking system on the overall lactation performance and incidence of lactation failure of 442 F1 Bos indicus/Bos taurus dairy crossbreds in Sabah. The two types of crossbred used in the study were imported F1 Sahiwal x Friesian and locally bred Friesian x Local Indian Dairy. Heifers which did not lactate for at least 120 days or produced less than 20 kg of milk during the fourteenth week of lactation were considered to have failed to establish a lactation. The imported and locally bred heifers recorded failure rates of 23.4 and 21.4% respectively. Three milking systems were examined namely machine milking without calf, machine milking with calf and hand milking. They produced failure rates of 30, 12 and 5.6% respectively. The cows that passed recorded 120 day milk production figures of 878, 1,134 and 1,054 kg respectively. The three age groups of less than 30 months, 30 to 34 months and greater than 34 months recorded failure rates of 37, 22 and 10% respectively. The heifers machine milked without their calf which calved at less than 30 months of age recorded a failure rate of 44% while those which calved at greater than 34 months recorded a failure rate of only 17%.
Study site: Tawau and Sebrang Livestock Breeding Centres, Sabah, Malaysia
We describe the clinical presentation, investigation and management of an eventually fatal case of hypercalcemic crisis due to primary hyperparathyridism (PHPT). A 60 year-old lady with history of urolithiasis presented with worsening generalized bone pain, spinal scoliosis and a limp. Laboratory data showed hypercalcemia and raised alkaline phosphatase. Left hip x-ray revealed a subcapital femoral neck fracture. Intact parathyroid hormone was elevated, 187.6 pmol/L (1.6 - 6.9) and ultrasound showed an enlarged right parathyroid gland. Despite initial reduction of serum calcium with saline infusion and multiple doses of intravenous pamidronate, her calcium increased to 4.14 mmol/L a week following application of Buck's traction for persistent left hip pain. She succumbed eventually with serum calcium peaking at 6.28 mmol/L despite multiple therapeutic interventions.
Eagle's syndrome is an uncommon condition resulting from an elongated styloid process, which causes cervico facial pain, tinnitus and otalgia. A 48-year-old female presented to the clinic with bilateral upper neck pain radiating to the ears with tinnitus for almost one-year duration. Examination of the oral cavity revealed atrophic tonsils and palpable bony projection deep in the tonsillar fossa. Plain lateral neck X-ray and CT scan confirmed the presence of bilateral elongated styloid processes, which were subsequently resected surgically through an oropharyngeal approach. The patient was asymptomatic at follow up at 2 years.
A cephalometric study using Downs' analysis was undertaken with lateral cephalometric radiographs for a mixed sample of 50 child, adolescent and young adult Indonesians who presented with Angle Class I occlusions. Significant differences between this study group and the published results from comparative racial types were found for Downs' angle of convexity, Y-axis and incisor inclinations, indicating that Indonesians can be differentiated from other races with similar occlusions by using Downs' analysis.
A prospective observational study examing the incidence, predisposing factors and microbiological aspects of peritonitis complicating acute intermittent peritoneal dialysis (IPD) was performed in Hospital Universiti Sains Malaysia, a referral hospital situated in Northeast Malaysia. Over a 7- month period, a total of 126 acute IPD treatments were included involving 69 patients. The majority of patients suffered from chronic or end stage renal failure (92.7%) and nearly half (47.8%) have underlying diabetes mellitus. Peritonitis occured in 25 treatment sessions giving a frequency of 19.8% of procedures performed. The mean interval between starting dialysis and the first sign of peritonitis was 3.5 days, with 12% of peritonitis occuring before day 3 of treatment. Frequent catheter manipulation and/or leakages were identified as significant predisposing factors for peritonitis and the risk of peritonitis was increased with longer duration of IPD. Gram-negative infections were seen twice more commonly than gram-positive infections. We recommend the use of cloxacillin in combination with either an aminoglycoside or a cephalosporin as empirical antibiotic coverage until culture reports are available.
Introduction:Lymphatic filariasis (LF) is a neglected tropical disease that can cause significant morbidity. In Malay-sia, National Programme for the Elimination of Lymphatic Filariasis started in 2001 with the initial target of achiev-ing Lymphatic Filariasis elimination status by 2018 but it has been revised to year 2020. Mass Drug Administration (MDA) Programme was performed from 2004 to 2008 in all endemic areas (Red Implementation Unit, IU) in Malay-sia including Terengganu state to stop disease transmission. Transmission Assessment Surveys (TAS) were conducted later on and for Terengganu, they were done in 2011 (TAS 1), 2015 (TAS 2) and 2017 (TAS 3) and had passed all the surveys based on critical cut off (CCO) point given. Methods: A cross sectional analysis of 10-year Terengganu filariasis records (2009-2018) was initiated in June 2019 using data source from eVekpro and filariasis cases line-list-ing. Results: Majority of filariasis cases in Terengganu were among males (n=147, 76.6%) with the highest number among 30-39 year-old age group (n=35, 18.2%). Majority of cases were Malaysian citizens (n=162, 84.4%) with main filariasis species identified were Brugia Malayi (n=149, 77.6%). The number of cases diagnosed was slightly higher from Green Implementation Unit area (n=102, 53.1%) compared to Red Implementation Unit area. Conclu-sion: The number of lymphatic filariasis cases among Terengganu citizens was below critical cut off point after the accomplishment of MDA programme and in accordance with the aim of lymphatic filariasis elimination status in Malaysia by 2020.
A central composite design (CCD) was employed to optimize the biosorption of Pb(II) ions onto immobilized cells of Pycnoporus sanguineus. The independent variables were initial Pb(II) concentration, pH and biomass loading. The combined effects of these variables were analyzed by response surface methodology (RSM) using quadratic model for predicting the optimum point. Under these conditions the model predicted a maximum of 97.7% of Pb(II) ions removal at pH 4, 200mg/L of initial Pb(II) concentration with 10g/L of biosorbent. The experimental values are in good agreement with predicted values within +0.10 to +0.81% error.
Biosorption of cadmium (II) ions from aqueous solution onto immobilized cells of Pycnoporus sanguineus (P. sanguineus) was investigated in a batch system. Equilibrium and kinetic studies were conducted by considering the effect of pH, initial cadmium (II) concentration, biomass loading and temperature. Results showed that the uptake of cadmium (II) ions increased with the increase of initial cadmium (II) concentration, pH and temperature. Langmuir, Freundlich and Redlich-Peterson isotherm models were used to analyze the equilibrium data at different temperatures. Langmuir isotherm model described the experimental data well followed by Redlich-Peterson and Freundlich isotherm models. Biosorption kinetics data were fitted using pseudo-first, pseudo-second-order and intraparticle diffusion. It was found that the kinetics data fitted well the pseudo-second-order followed by intraparticle diffusion. Thermodynamic parameters such as standard Gibbs free energy (Delta G0), standard enthalpy (Delta H0) and standard entropy (Delta S0) were evaluated. The result showed that biosorption of cadmium (II) ions onto immobilized cells of P. sanguineus was spontaneous and endothermic nature.
Objective: To review the clinical characteristic of vertigo in children.
Method: A retrospective observational study was done on children who presented to a specialised vertigo clinic over period of six years. The patients’ case notes were retrieved from the medical record unit and reviewed. All patients were seen by an otologist who thoroughly took down history, completed ear, nose, throat and neurological examination.
Result: Seven different causes were identified in 21 patients (86%) while no diagnosis was reached in three patients (12.5%). The most common cause of giddiness was childhood paroxysmal vertigo (33%) followed by benign paroxysmal positional vertigo (16.6%) and sensorineural hearing loss (12.5%). Other causes include chronic suppurative otitis media and anxiety disorder each accounting for 8.3%, one case of cholesteatoma and another case of ear wax each accounting for 4.1%.
Conclusion: It is not uncommon for the children to be affected by vertigo. Management of vertigo in children should include a detailed history, clinical examination, audiological and neurological evaluation. Imaging should be performed in selected patients. The main cause of vertigo in our series is CPV. The outcome of most of the patients is good.
The ability of Pycnoporus sanguineus to adsorb heavy metals from aqueous solution was investigated in fixed-bed column studies. The experiments were conducted to study the effect of important design parameters such as column bed height, flow rate and initial concentration of solution. The breakthrough profiles were obtained in these studies. A mathematical model based on external mass transfer and pore diffusion was used for the prediction of mass transfer coefficient and effective diffusivity of metals in macro-fungi bed. Experimental breakthrough profiles were compared with the simulated breakthrough profiles obtained from the mathematical model. Bed Depth Service Time (BDST) model was used to analyse the experimental data and evaluated the performance of biosorption column. The BDST model parameters needed for the design of biosorption columns were evaluated for lead, copper and cadmium removal in the column. The columns were regenerated by eluting the metal ions using 0.1 M hydrochloric acid solution after the adsorption studies. The columns were subjected to repeated cycles of adsorption of same metal ions and desorption to evaluate the removal efficiency after adsorption-desorption.
Arterio-venous malformation (AVM) of the head of the pancreas is a rare condition that may cause upper gastro-intestinal tract (GIT) bleeding. A 45-year-old man with a large AVM at the pancreato-biliary region is described. The patient had recurrent episodes of hematemesis and melena. Enlargement of the AVM was documented by serial abdominal CT scans performed after each bleed. Whipple procedure was successfully performed in this patient.