MyMedR

Fulltext Proptosis: a rare presentation of metastatic renal cell carcinoma

Ho CC, Krishna KK, Praveen S, Goh EH, Lee BC, Zulkifli MZ

Med J Malaysia, 2010 Sep;65(3):229-30.

PMID: 21939176

We present a case of a middle-aged man who was incidentally found to have right renal solid mass while investigating for his left eye proptosis. Computerised tomography (CT) scan confirmed the diagnosis of renal cell carcinoma and the tumour was successfully excised via open surgery. The histopathology examination revealed the 10x7x8 cm mass to be a clear cell type renal cell carcinoma. The rare presentation of this metastatic renal cell carcinoma, its diagnosis and management will be discussed.

Matched MeSH terms: Diagnosis, Differential

Fulltext Unusual parapharyngeal lesion: aberrant thyroid gland

Feisal TK, Prepageran N, Shahrizal T, Zulkiflee AB

Singapore Med J, 2008 May;49(5):e137-8.

PMID: 18465039

An ectopic location of the thyroid gland usually occurs in the midline, starting anywhere from the tongue to the diaphragm. The occurrence of an ectopic thyroid gland in a non-midline site is extremely rare. We report a 32-year-old Malay woman with an aberrant thyroid gland presenting as a parapharyngeal lesion. She had a normally functioning thyroid gland. An ectopic thyroid should be considered as one of the differential diagnoses in the parapharyngeal mass.

Matched MeSH terms: Diagnosis, Differential

Usefulness of stable microbubble test of tracheal aspirate for the diagnosis of neonatal respiratory distress syndrome

Boo NY, Cheong KB, Cheong SK, Lye MS, Zulfiqar MA

J Paediatr Child Health, 1997 Aug;33(4):329-34.

PMID: 9323622

OBJECTIVES: To compare the overall accuracy of the stable microbubble test (SM test) with measurement of level of surfactant protein A (SP-A) of tracheal aspirate for the diagnosis of respiratory distress syndrome (RDS).

METHODOLOGY: Tracheal aspirates were obtained from neonates on ventilatory support. The SM test was carried out on specimens of tracheal aspirate immediately after collection. Levels of SP-A in tracheal aspirates were determined by enzyme-linked immunosorbent assay (ELISA) method. The results of the SM test and SP-A level of the tracheal aspirates were compared against the clinical diagnosis of RDS based on clinical, radiological and bacteriological findings.

RESULTS: Both the median microbubble counts (6 microbubbles/mm2, range = 0-90) and median SP-A levels (100 micrograms/L, range = 0-67447) of infants with RDS were significantly lower than those of infants with no obvious lung pathology (P < 0.0001), and pneumonia (P < 0.0001). The SM test of tracheal aspirates had higher overall accuracy for the diagnosis of RDS than measurement of SP-A levels (94.6% vs 82.4%). When the receiver operating characteristic (ROC) curves of both tests for RDS were compared, the area under the ROC curve of the SM test was larger (0.9689) than that of the SP-A method (0.8965).

CONCLUSIONS: This study showed that the SM test of tracheal aspirate was a useful bedside diagnostic test for RDS. It could be carried out at any time after birth on infants requiring ventilatory support.

Matched MeSH terms: Diagnosis, Differential

Fulltext Intravenous immunoglobulin in the treatment of acute disseminated encephalomyelitis

Kanaheswari Y, Baizura J, Zulfiqar A

Med J Malaysia, 2004 Mar;59(1):103-7.

PMID: 15535344

We describe a case of acute disseminated encephalomyelitis in a child. This case is unusual in that the illness was characterised by recurrent episodes rather than a monophasic course and that the choice of treatment was intravenous immunoglobulin over corticosteroids. The rapid and remarkable recovery is highlighted and a review of the treatment for this rare condition is discussed.

Matched MeSH terms: Diagnosis, Differential

Fulltext Primary extraskeletal Ewing's sarcoma/primitive neuroectodermal tumour of breast

Ikhwan SM, Kenneth VK, Seoparjoo A, Zin AA

BMJ Case Rep, 2013 Jun 21;2013.

PMID: 23813511 DOI: 10.1136/bcr-2013-009584

Primary primitive neuroectodermal tumour (PNET) and extraskeletal Ewing's sarcoma belongs to the Ewing's family of tumours. Primary tumours arising from breast are very rare. There are only a few case reports published on primary extraskeletal Ewing's sarcoma and PNET arising from breast. We present an extremely rare case of an inoperable primary Ewing's sarcoma arising from left breast with contralateral breast, lymphatic and lung metastasis.

Matched MeSH terms: Diagnosis, Differential

Fulltext Case series of naturally acquired Plasmodium knowlesi infection in a tertiary teaching hospital

Azira NM, Zairi NZ, Amry AR, Zeehaida M

Trop Biomed, 2012 Sep;29(3):398-404.

PMID: 23018503 MyJurnal

Plasmodium knowlesi is a simian malaria parasite and is recently recognized as the fifth malaria parasite infecting humans. Manifestation of the infection may resemble other infection particularly dengue fever leading to inappropriate management and delay in treatment. We reported three cases of naturally acquired P. knowlesi in Hospital Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia. Clinical manifestations were quite similar in those cases. Microscopically, the diagnosis might be challenging. These cases were confirmed by polymerase chain reaction method which serves as a gold standard.

Matched MeSH terms: Diagnosis, Differential

Fulltext Foreign body aspiration in an adult: the great mimic

Ngoo KS, Ramzisham AR, Joanna OS, Zamrin DM

Med J Malaysia, 2008 Mar;63(1):61-2.

PMID: 18935737 MyJurnal

A middle-aged lady presented with a three-month history of chronic cough. After a long and extensive investigation, CT thorax revealed collapse consolidation of the right lower lung lobe and bronchoscopy showed a polypoidal tumour within the involved bronchus. Thoracotomy and segmental lung resection revealed a peanut in the airways of the fibrotic and infected lung tissue. In view of the rarity of the food particle aspiration in a healthy adult, the delay in presentation and diagnosis in our patient, we would like to highlight this particular case. A high index of suspicion of FBA is necessary to avoid unnecessary anxiety, extensive investigations and overzealous treatment as well as to promote lung conservation.

Matched MeSH terms: Diagnosis, Differential

Fulltext Infected intraparenchymal bronchogenic cyst mimicking recurrent lung abscess in a young adult

Ramzisham AR, Johann KF, Talal AR, Joanna OS, Zamrin DM

Med J Malaysia, 2007 Dec;62(5):416-7.

PMID: 18705480 MyJurnal

A 23 year old female with a past history of a lung abscess diagnosed at the age of 13 years presented with recurrent episodes of productive cough. Chest radiograph and a high resolution CT scan of the thorax led to the diagnosis of a left lower lobe lung abscess. She underwent a successful thoracotomy and a left lower lobe lobectomy. Histopathological examination revealed the diagnosis of an infected congenital bronchogenic cyst. The recent literature on this is reviewed.

Matched MeSH terms: Diagnosis, Differential

Fulltext Two variants of uterine leiomyoma in Malaysia's last Sumatran rhinoceros (Dicerorhinus sumatrensis)

Salleh A, Zainuddin ZZ, Mohamed Tarmizi MR, Yap KC, Zamri-Saad M

Vet Q, 2020 Dec;40(1):250-257.

PMID: 33045934 DOI: 10.1080/01652176.2020.1836431

Following its capture in March 2014, an adult female Sumatran rhinoceros frequently showed profuse vaginal bleeding. An ultrasonography suggested the presence of multiple reproductive lesions, including two uterine masses which were suspected to be leiomyomas. Soon after, an open pyometra was confirmed. Later in November 2019, the patient died and necropsy confirmed the presence of two uterine masses; one was located at the cervico-uterine junction and another in the uterine body, with pyometra, and cystic endometrial hyerplasia. Based on histological, special stains, and immunohistochemical examination, it was shown that one of the masses was composed of large, ovoid and polyhedral neoplastic mesenchymal cells with eosinophilic cytoplasm and a few binucleated cells surrounded by collagen fibres. It was tested positive for SMA and vimentin, while negative for desmin, cytokeratin AE1/AE3, EMA, CD34, and S100. The other mass was composed of mesenchymal cells undergoing myxoid degeneration as evidenced by the presence of glycosaminoglycan-rich matrix. It was tested positive for SMA, vimentin, partially positive for desmin, and negative for the other markers. With the aid of human medical nomenclature, these masses were diagnosed as epithelioid leiomyoma and myxoid leiomyoma, respectively. This report provides a clinical presentation, and histologic descriptions of the two variants of leiomyomas that have not been reported in veterinary medicine.

Matched MeSH terms: Diagnosis, Differential

Fulltext A case of alkaptonuria with root canal stenosis

Koh KB, Low EH, Ch'ng SL, Zakiah I

Singapore Med J, 1994 Feb;35(1):106-7.

PMID: 8009267

Spinal involvement in alkaptonuria is common. Patients usually present in the third or fourth decade with spondylosis or acute intervertebral disc prolapse. Alkaptonuria with root canal stenosis has however hitherto not been reported. We wish to report one such patient.

Matched MeSH terms: Diagnosis, Differential

Fulltext Bleeding small bowel cavernous haemangioma following blunt trauma to the abdomen presenting as subacute intestinal obstruction in a child

Abdul Aziz DA, Khandasamy Y, Tamba RP, Zaki FM

BMJ Case Rep, 2011;2011.

PMID: 22679168 DOI: 10.1136/bcr.08.2011.4672

The authors report a case of a 6-year-old girl who developed subacute intestinal obstruction after a trivial blunt trauma to her abdomen. Her normal vital signs masked the presence of intestinal bleeding. An incidental finding at surgery of a haematomatous polypoid vascular growth of the ileum was subsequently confirmed to be cavernous haemangioma of the small bowel. Surgical resection was curative in this patient.

Matched MeSH terms: Diagnosis, Differential

Prospective diagnostic study on the use of narrow-band imaging on suspicious lesions during colonoscopy examination

Yaacob H, Ikhwan SM, Hashim MN, Syed Abd Aziz SH, Wan Zain WZ, Tuan Sharif SE, et al.

Asian J Endosc Surg, 2018 Nov;11(4):318-324.

PMID: 29424061 DOI: 10.1111/ases.12463

INTRODUCTION: Colonoscopy is the gold standard to detect colorectal neoplasm. Narrow-band imaging (NBI) has a good diagnostic accuracy to differentiate between neoplastic and non-neoplastic colorectal lesions. This study explores the diagnostic validity of NBI colonoscopy as well as its associated factors related to neoplastic and non-neoplastic colorectal lesions.

METHODS: This study enrolled 100 patients in a single-center tertiary teaching hospital. Patients presented for screening colonoscopy, and those with suspicious colorectal lesions were included in this study. During colonoscopy, the most suspicious lesion in each patient was analyzed using the NBI system based on Sano's classification. Each lesion was biopsied for histopathological analysis, the gold standard. Endoscopic images were captured electronically. The sensitivity, specificity, and diagnostic accuracy of NBI colonoscopy were assessed. Other associated factors related to neoplastic and non-neoplastic lesions were analyzed accordingly.

RESULTS: The sensitivity and specificity of the NBI were 88.2% and 71.9%, respectively. The area under the receiver-operator curve was 0.801, indicating that NBI has a good ability to differentiate between disease and non-disease. There are significant associations between histopathological examination outcomes and both presenting symptoms, especially weight loss, and lesion site, even after other variables were controlled (P

Matched MeSH terms: Diagnosis, Differential

Fulltext Spontaneous bladder perforation: a rare complication of tuberculosis

Kong CH, Ali SA, Singam P, Hong GE, Cheok LB, Zainuddin ZM

Int J Infect Dis, 2010 Sep;14 Suppl 3:e250-2.

PMID: 20117032 DOI: 10.1016/j.ijid.2009.10.006

Spontaneous bladder perforation secondary to tuberculosis (TB) is very rare. Only three cases have been reported so far in the literature. Due to its rarity, the diagnosis of spontaneous bladder perforation is often missed. Confirmation of TB via culture takes a long time and starting empirical treatment for TB is necessary. We relate our experience with a young woman who presented with clinical features of a perforated appendix and was only diagnosed with bladder perforation during laparotomy. She also had distal right ureteral stricture and left infundibular stenosis. The provisional diagnosis of TB was attained via typical histopathological features and a positive Mantoux test. She was started empirically on anti-TB treatment and recovered without any complications. Urine culture after 6 weeks confirmed the diagnosis of TB.

Matched MeSH terms: Diagnosis, Differential

Delayed traumatic extradural haematomas

Chandrasekaran S, Zainal J

Aust N Z J Surg, 1993 Oct;63(10):780-3.

PMID: 8274120

A total of 76 patients with traumatic extradural haematoma were treated within a period of 3 years. Four patients developed delayed extradural haematomas. These cases are reported in view of the unusual sequence and the importance of early diagnosis.

Matched MeSH terms: Diagnosis, Differential

Fulltext Unicystic ameloblastoma: a new entity?

Zain R

Med J Malaysia, 1986 Dec;41(4):370-3.

PMID: 3670162

This article consists of two selected case reports of a recently named odontogenic tumour, unicystic ameloblastoma. The clinical and radiographic findings of the two cases mimic that of odontogenic cysts but not dentigerous cysts as in most reported, cases. Histologically, either a normal or ameloblastomatous cyst lining is evident. Other features of ameloblastoma are present within the cyst wall or as luminal nodules within the cystic space. A review of the literature indicates that this is a non-aggressive tumour with a low recurrence rate.

Matched MeSH terms: Diagnosis, Differential

Fulltext A rare case of disciform keratitis in a silicone-filled eye presenting with 'sticky oil' on the endothelium

Bastion ML, Zahidin AZ

BMJ Case Rep, 2010;2010.

PMID: 22750927 DOI: 10.1136/bcr.11.2009.2497

An unusual case of disciform keratitis developing in a patient with silicone oil-filled eye following vitrectomies for posterior globe rupture.

Matched MeSH terms: Diagnosis, Differential

Fulltext Symptomatic intra-articular ganglion cyst of the knee

Aminudin CA, Samsudin OC, Hyzan MY, Hamzaini AH, Zahiah M

Med J Malaysia, 2004 Dec;59 Suppl F:57-9.

PMID: 15941165

We are reporting a case of a patient with a symptomatic intra-articular ganglion of the knee arising from infrapatellar fat pad. Plain radiograph and Magnetic Resonance (MR) images were correlated with arthroscopic examination and histological findings. The cyst was removed and post operatively patient regained full extension.

Matched MeSH terms: Diagnosis, Differential

Fulltext Practical way of creating differential diagnoses through an expanded VITAMINSABCDEK mnemonic

Zabidi-Hussin ZA

Adv Med Educ Pract, 2016;7:247-8.

PMID: 27217805 DOI: 10.2147/AMEP.S106507

Having an organized, structured thinking process is critical in medicine. It is through this thinking process that enables one to go through the method of history-taking, which will eventually lead to making a definitive diagnosis and all other processes that follow. The use of mnemonic has been found to be useful for this purpose. The mnemonic VITAMINSABCDEK, is a convenient and practical way to assist in expanding the differential diagnoses and covers all possible causes of an illness. It is also easy to remember, as the vitamins whose letters are represented in this mnemonic cover the entire range of vitamins known.

Matched MeSH terms: Diagnosis, Differential

Fulltext Molybdenum cofactor deficiency in a Malaysian child

Ngu LH, Afroze B, Chen BC, Affandi O, Zabedah MY

Singapore Med J, 2009 Oct;50(10):e365-7.

PMID: 19907877

Molybdenum cofactor deficiency is a rare autosomal recessive disorder with devastating neurological manifestations, characterised by neonatal-onset encephalopathy mimicking hypoxic-ischaemic insult, intractable seizure, and feeding and respiratory difficulties. It is often fatal in the early life. We report an affected 8-year-old boy, who presented with severe neurological manifestations since birth, but without clinically-significant seizure. Molybdenum cofactor deficiency must be included in the differential diagnosis of patients presenting with unexplained encephalopathy in the newborn period, and whose neuroimaging findings are consistent with hypoxic ischaemic encephalopathy. The classic laboratory hallmark of this disorder is low serum uric acid, positive urine sulphite dipstick test, and elevated urinary S-sulphocysteine, hypoxanthine and xanthine.

Matched MeSH terms: Diagnosis, Differential

Hydatidiform mole: problems in early diagnosis

Yusof K

Med J Malaysia, 1973 Jun;27(4):275-9.

PMID: 4270785

Matched MeSH terms: Diagnosis, Differential

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