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Surgery at a chest hospital in Malaya

SNELLING MR, McGLADDERY HM, LIM G, KUMAR JK, HOR KS

Tubercle, 1960 Apr;41:103-8.
PMID: 13832282
Matched MeSH terms: Thorax*
Fulltext Unusual manifestation of cutaneous toxoplasmosis in a HIV-positive patient

Fong MY, Wong KT, Rohela M, Tan LH, Adeeba K, Lee YY, et al.

Trop Biomed, 2010 Dec;27(3):447-50.
PMID: 21399585 MyJurnal

We report a case of unusual cutaneous toxoplasmosis manifestation in a HIV-positive patient. He presented with hard and painful nodular lesions on the arms, hands and chest. Serology tests for anti-Toxoplasma antibody were negative. However, histopathologic examination of the lesion revealed foci of macrophages containing crescent-shaped organisms resembling the zoites of the protozoan parasite Toxoplasma gondii. Ultrastructure examination under electron microscopy and PCR confirmed the organism as T. gondii.

Matched MeSH terms: Thorax/pathology
Fulltext Tracheotomy: an alternative for tracheobronchial foreign body removal

Tang CL, Lee SC, Mohamad Lal A, Thomas RA, Ngui LX, Lim LY

Med J Malaysia, 2014 Oct;69(5):241-3.
PMID: 25638243 MyJurnal

A 6 years old girl accidentally aspirated a plastic whistle while playing. Computed Tomography of thorax showed foreign body at carina level. Rigid bronchoscope under general anesthesia was attempted but unable to extract the whistle through vocal cord. Tracheostomy was later performed and foreign body was removed.

Matched MeSH terms: Thorax
Fulltext Emergency lung-sparing surgical repair of a complete transection of the right mainstem bronchus due to blunt chest trauma

Sachithanandan A, Tan YS, Abdul Muis J, Rapi AR, Mohd Arif MN, Badmanaban B, et al.

Med J Malaysia, 2014 Apr;69(2):92-4.
PMID: 25241820 MyJurnal

Traumatic chest injury with complete tracheo- bronchial disruption is uncommon and occurs in approximately 1% of motor vehicle accidents (MVA) (1,2). Such injuries carry a high mortality and patients rarely survive transfer to hospital. A high index of suspicion facilitates early diagnosis. Early operative intervention is vital for survival. We describe a rare case of traumatic complete disruption of the right mainstem bronchus (RMB) due to blunt chest trauma. The transected airway was reanastomosed emergently avoiding a lung resection.

Matched MeSH terms: Thorax
Fulltext A rare case of retropharyngeal hibernoma

Nazli Z, Norizal MN, Noor Kaslina MK, Abdul Fattah AW

Med J Malaysia, 2015 Apr;70(2):98-9.
PMID: 26162385 MyJurnal

Hibernoma is a slow growing, rare benign tumour, which derived from brown adipose tissue. This tumour is usually found in the area where foetal fat persists such as back, axilla, retro peritoneum and thorax. Hibernoma rarely occurs in the retro pharynx. We report a case of retropharyngeal hibernoma in a 44-year-old male. He presented with obstructive symptoms for six months and a retropharyngeal mass upon examination. His CT scan findings showed a mass in the prevertebral region from level of C2 until C5 causing narrowing of upper aero digestive tract. Histopathological examination reported as hibernoma.

Matched MeSH terms: Thorax
The Cobblestone Heart

Tan WJ, Suz CS, Azza O, Zuki M

Med J Malaysia, 2021 03;76(2):241-244.
PMID: 33742636

Sarcoidosis is a chronic, multisystem disorder. A 38 years old lady presented at Hospital Raja Perempuan Zainab II, Kota Bharu ,Malaysia with cough and breathless for 2 months and constitutional symptoms of weight loss and loss of appetite. She was initially treated as smear negative pulmonary tuberculosis for 5 months. However, her clinical condition deteriorated with worsening New York Heart Association (NYHA) class 1 to class 3. Subsequently, workout of computed tomography( CT) thorax showed multiple perilymphatic distribution of nodules and multiple mediastinal lymphadenopathy coupled with pleura biopsy showed non caseating granuloma and cardiac magnetic resonance imaging (MRI) with positive late gadolinium enhancement revised the diagnosis of pulmonary sarcoidosis with cardiac involvement. Patient's functional status and cough improved with immunosuppresant was given in tapering dose fashion.

Matched MeSH terms: Thorax
Computed tomography of the thorax with 3D reconstruction in penetrating chest injury

Michael A, Yahya ZO, Mdrazali I, Hanif H

Med J Malaysia, 2017 02;72(1):75-76.
PMID: 28255150 MyJurnal

Penetrating chest wounds is less common but more deadly then blunt trauma. Majority of penetrating chest trauma can be managed conservatively with observation and simple thoracotomy. This case report highlights a bizarre occupational hazard causing a penetrating chest injury and the option of non-invasive management with the aid of computed tomography with 3D reconstruction.

Matched MeSH terms: Thorax
An unidentified foreign body in the chest wall

MCDOUGALL C

Med J Malaya, 1955 Jun;9(4):276-80.
PMID: 13253127
Matched MeSH terms: Thorax*; Thoracic Wall*
A case of pectus excavatum

MCGLADDERY HM

Med J Malaya, 1960 Dec;15:65-9.
PMID: 13773946
Matched MeSH terms: Thorax/abnormalities*
Contactless respiration rate measurement using optical method and empirical mode decomposition

Gan KB, Yahyavi ES, Ismail MS

Technol Health Care, 2016 Sep 14;24(5):761-8.
PMID: 27163300 DOI: 10.3233/THC-161161

BACKGROUND: At the emergency triage center, assessment of the present of the danger signs and measurement of vital signs are measured according to the guidelines. The respiration rate is still posing a challenge to the doctor as it is impractical to use conventional devices. Attaching measurement devices to the patient will induce artificial measurements (self-awareness stress effects) besides being time-consuming. Currently, the medical officers visually count the number of times the chest movement in a minute, sometimes poses cultural challenges especially for female patients.
OBJECTIVE: The main objective of this paper is to develop a robust algorithm to extract respiration rate using the contactless displacement sensor.
METHODS: In this study, chest movements were used as an indicative of inspiration and expiration to measure respiratory rate using the contactless displacement sensor. The contactless optical signals were recorded from 32 healthy subjects in four different controlled breathing conditions: rest, coughing, talking and hand movement to obtain the motion artifacts that the patients may have in the emergency department. The Empirical mode decomposition (EMD) algorithm was used to derive continuous RR signal from the contactless optical signal.
RESULTS: The analysis showed that there is a good correlation (0.9702) with RMSE of 0.33 breaths per minutes between the contact respiration rate and contactless respiration rate using empirical mode decomposition method.
CONCLUSION: It can be concluded that the empirical mode decomposition method can extract the respiration rate of the contactless optical signal from chest movement.

Matched MeSH terms: Thorax/physiology*
Correlation between Hounsfield unit derived from head, thorax, abdomen, spine and pelvis CT and t-scores from DXA

Amin MFM, Zakaria WMW, Yahya N

Skeletal Radiol, 2021 Dec;50(12):2525-2535.
PMID: 34021364 DOI: 10.1007/s00256-021-03801-z

OBJECTIVES: CT examination can potentially be utilised for early detection of bone density changes with no additional procedure and radiation dose. We hypothesise that the Hounsfield unit (HU) measured from CT images is correlated to the t-scores derived from dual energy X-ray absorptiometry (DXA) in multiple anatomic regions.
MATERIALS & METHODS: Data were obtained retrospectively from all patients who underwent both CT examinations - brain (frontal bone), thorax (T7), abdomen (L3), spine (T7 & L3) or pelvis (left hip) - and DXA between 2014 and 2018 in our centre. To ensure comparability, the period between CT and DXA studies must not exceed one year. Correlations between HU values and t-scores were calculated using Pearson's correlation. Receiver operating characteristic (ROC) curves were generated, and the area under the curve (AUC) was used to determine threshold HU values for predicting osteoporosis.
RESULTS: The inclusion criteria were met by 1043 CT examinations (136 head, 537 thorax, 159 lumbar and 151 left hip). The left hip consistently provided the most robust correlations (r = 0.664-0.708, p thorax T7 and lumbar L3 showed average correlations (range of r values is 0.497-0.679, p 0.05.
CONCLUSION: HU values derived from the hip, T7 and L3 provided a good to moderate correlation to t-scores with a good prediction for osteoporosis. The suggested optimal thresholds may be used in clinical settings after external validations are performed.

Matched MeSH terms: Thorax
Fulltext The Evaluation of Physical Stillness with Wearable Chest and Arm Accelerometer during Chan Ding Practice

Chang KM, Chun YT, Chen SH, Lu L, Su HT, Liang HM, et al.

Sensors (Basel), 2016 Jul 20;16(7).
PMID: 27447641 DOI: 10.3390/s16071126

Chan Ding training is beneficial to health and emotional wellbeing. More and more people have taken up this practice over the past few years. A major training method of Chan Ding is to focus on the ten Mailuns, i.e., energy points, and to maintain physical stillness. In this article, wireless wearable accelerometers were used to detect physical stillness, and the created physical stillness index (PSI) was also shown. Ninety college students participated in this study. Primarily, accelerometers used on the arms and chest were examined. The results showed that the PSI values on the arms were higher than that of the chest, when participants moved their bodies in three different ways, left-right, anterior-posterior, and hand, movements with natural breathing. Then, they were divided into three groups to practice Chan Ding for approximately thirty minutes. Participants without any Chan Ding experience were in Group I. Participants with one year of Chan Ding experience were in Group II, and participants with over three year of experience were in Group III. The Chinese Happiness Inventory (CHI) was also conducted. Results showed that the PSI of the three groups measured during 20-30 min were 0.123 ± 0.155, 0.012 ± 0.013, and 0.001 ± 0.0003, respectively (p < 0.001 ***). The averaged CHI scores of the three groups were 10.13, 17.17, and 25.53, respectively (p < 0.001 ***). Correlation coefficients between PSI and CHI of the three groups were -0.440, -0.369, and -0.537, respectively (p < 0.01 **). PSI value and the wearable accelerometer that are presently available on the market could be used to evaluate the quality of the physical stillness of the participants during Chan Ding practice.

Matched MeSH terms: Thorax*
Fulltext Deep Mining Generation of Lung Cancer Malignancy Models from Chest X-ray Images

Horry M, Chakraborty S, Pradhan B, Paul M, Gomes D, Ul-Haq A, et al.

Sensors (Basel), 2021 Oct 07;21(19).
PMID: 34640976 DOI: 10.3390/s21196655

Lung cancer is the leading cause of cancer death and morbidity worldwide. Many studies have shown machine learning models to be effective in detecting lung nodules from chest X-ray images. However, these techniques have yet to be embraced by the medical community due to several practical, ethical, and regulatory constraints stemming from the "black-box" nature of deep learning models. Additionally, most lung nodules visible on chest X-rays are benign; therefore, the narrow task of computer vision-based lung nodule detection cannot be equated to automated lung cancer detection. Addressing both concerns, this study introduces a novel hybrid deep learning and decision tree-based computer vision model, which presents lung cancer malignancy predictions as interpretable decision trees. The deep learning component of this process is trained using a large publicly available dataset on pathological biomarkers associated with lung cancer. These models are then used to inference biomarker scores for chest X-ray images from two independent data sets, for which malignancy metadata is available. Next, multi-variate predictive models were mined by fitting shallow decision trees to the malignancy stratified datasets and interrogating a range of metrics to determine the best model. The best decision tree model achieved sensitivity and specificity of 86.7% and 80.0%, respectively, with a positive predictive value of 92.9%. Decision trees mined using this method may be considered as a starting point for refinement into clinically useful multi-variate lung cancer malignancy models for implementation as a workflow augmentation tool to improve the efficiency of human radiologists.

Matched MeSH terms: Thorax
Fulltext A case of primary pleural synovial sarcoma with endobronchial recurrence

Wan JL, Lam YF, Foong KW, Abdul Ghani N, Lachmanan K

Respirol Case Rep, 2020 Apr;8(3):e00547.
PMID: 32166036 DOI: 10.1002/rcr2.547

Primary pleural synovial sarcoma (PPSS) is an extremely rare malignancy without a known cause. The diagnosis is made after excluding metastasis from an extra-thoracic sarcoma. We report a case of a 67-year-old gentleman who presented with an incidental finding of a left lung mass on a routine chest X-ray. A computed tomography (CT) of the thorax and whole-body positron emission tomography (PET)-CT was done confirming a left lung mass with no other extra-thoracic involvement. A lobectomy was performed with a diagnostic and therapeutic intent. The histopathological examination and immunohistochemistry study revealed a pleural-based tumour with features suggestive of synovial sarcoma. Subsequently, he underwent post-operative radiotherapy. However, three months later, he developed an endobronchial recurrence, complicated by post-obstructive pneumonia resulting in his demise. This case highlights a rare form of malignancy with a rare site of recurrence.

Matched MeSH terms: Thorax
Fulltext Vanishing lung syndrome Masquerading as bilateral pneumothorax: A case report

Muhamad NI, Mohd Nawi SN, Yusoff BM, Ab Halim NA, Mohammad N, Wan Ghazali WS

Respir Med Case Rep, 2020;31:101276.
PMID: 33209576 DOI: 10.1016/j.rmcr.2020.101276

Vanishing lung syndrome (VLS) is a rare condition characterized by giant emphysematous bullae. It is frequently misdiagnosed as pneumothorax. We describe a case of a 30-year-old male who presented with shortness of breath, reduced effort tolerance, and pleuritic chest pain for three months. He was initially diagnosed with bilateral pneumothorax based on clinical examination and chest radiograph findings. However, further imaging with a high resolution computed tomography (HRCT) of the thorax confirmed bilateral giant emphysematous bullae. Our patient subsequently underwent video-assisted thoracoscopic surgery (VATS) and bullectomy. In this report, we discuss the clinical presentations, radiological features, and the management of VLS. We also highlight the differentiating features of VLS from a pneumothorax.

Matched MeSH terms: Pneumothorax; Thorax
Evaluation of a new predictive equation for automated calculation of size-specific dose estimate (SSDE) in CT imaging

Osman ND, Abdulkadir MK, Shuaib IL, Nasirudin RA

Radiography (Lond), 2024 Jan;30(1):237-244.
PMID: 38035439 DOI: 10.1016/j.radi.2023.11.012

INTRODUCTION: The adoption of size-specific dose estimate (SSDE) in clinical practice is still limited owing to the tedious and complex manual measurement of individual patient size for the clinical calculation of SSDE. Thus, the automation of SSDE is imperative. This study aims to evaluate a predictive equation for the automated calculation of SSDE.
METHODS: A user-friendly software was developed to accurately predict the individual size-specific dose estimation of paediatric patients undergoing computed tomography (CT) scans of the head, thorax, and abdomen. The software includes a calculation equation developed based on a novel SSDE prediction equation that used a population's pre-determined percentage difference between volume-weighted computed tomography dose index (CTDIvol) and SSDE with age. American Association of Physicists in Medicine (AAPM RPT 204) method (manual) and segmentation-based SSDE calculators (indoseCT and XXautocalc) were used to assess the proposed software predictions comparatively.
RESULTS: The results of this study show that the automated equation-based calculation of SSDE and the manual and segmentation-based calculation of SSDE are in good agreement for patients. The differences between the automated equation-based calculation of SSDE and the manual and segmentation-based calculation are less than 3%.
CONCLUSION: This study validated an accurate SSDE calculator that allows users to enter key input values and calculate SSDE.
IMPLICATION FOR PRACTICE: The automated equation-based SSDE software (PESSD) seems a promising tool for estimating individualised CT doses during CT scans.

Matched MeSH terms: Thorax
THE CONSISTENCY OF EXPOSURE INDICATOR VALUES IN DIGITAL RADIOGRAPHY SYSTEMS

Jamil A, Mohd MI, Zain NM

Radiat Prot Dosimetry, 2018 Dec 01;182(4):413-418.
PMID: 29767799 DOI: 10.1093/rpd/ncy082

After years of establishment of computed radiography (CR) and digital radiography (DR), manufacturers have introduced exposure indicator/index (EI) as a feedback mechanism for patient dose. However, EI consistency is uncertain for CR. Most manufacturers recommended EI values in a range of numbers for all examination, instead of giving the exact range for a specific body part, raising a concern of inappropriate exposure given to the patient in clinical practice. The aims of this study were to investigate the EI consistency in DR systems produced in constant exposure parameters and clinical condition, and to determine the interaction between the anatomical part and EI. A phantom study of skull, chest, abdomen and hand was carried out and four systems were used for comparison-Fuji CR, Carestream CR, Siemens DR and Carestream DR. For each projection, the phantom positioning and exposure parameters were set according to the standard clinical practice. All exposure parameters and clinical conditions were kept constant. Twenty (20) exposures were taken for each projection and the EI was recorded. Findings showed that EI is not consistent in DR systems despite constant exposure parameters and clinical condition except in Siemens DR, through skull examination. Statistical analysis showed a significant interaction between anatomical parts and EI values (P < 0.05). EI alone was proven to be less reliable to provide technologist a correct feedback on exposure level. The interaction between anatomical parts and EI values intensifies the need for an anatomical-specific EI values set by all manufacturers for accurate feedback on the exposure parameters used and the detector entrance dose.

Matched MeSH terms: Thorax/radiation effects
Fulltext Optimised genetic algorithm-extreme learning machine approach for automatic COVID-19 detection

Albadr MAA, Tiun S, Ayob M, Al-Dhief FT, Omar K, Hamzah FA

PLoS One, 2020;15(12):e0242899.
PMID: 33320858 DOI: 10.1371/journal.pone.0242899

The coronavirus disease (COVID-19), is an ongoing global pandemic caused by severe acute respiratory syndrome. Chest Computed Tomography (CT) is an effective method for detecting lung illnesses, including COVID-19. However, the CT scan is expensive and time-consuming. Therefore, this work focus on detecting COVID-19 using chest X-ray images because it is widely available, faster, and cheaper than CT scan. Many machine learning approaches such as Deep Learning, Neural Network, and Support Vector Machine; have used X-ray for detecting the COVID-19. Although the performance of those approaches is acceptable in terms of accuracy, however, they require high computational time and more memory space. Therefore, this work employs an Optimised Genetic Algorithm-Extreme Learning Machine (OGA-ELM) with three selection criteria (i.e., random, K-tournament, and roulette wheel) to detect COVID-19 using X-ray images. The most crucial strength factors of the Extreme Learning Machine (ELM) are: (i) high capability of the ELM in avoiding overfitting; (ii) its usability on binary and multi-type classifiers; and (iii) ELM could work as a kernel-based support vector machine with a structure of a neural network. These advantages make the ELM efficient in achieving an excellent learning performance. ELMs have successfully been applied in many domains, including medical domains such as breast cancer detection, pathological brain detection, and ductal carcinoma in situ detection, but not yet tested on detecting COVID-19. Hence, this work aims to identify the effectiveness of employing OGA-ELM in detecting COVID-19 using chest X-ray images. In order to reduce the dimensionality of a histogram oriented gradient features, we use principal component analysis. The performance of OGA-ELM is evaluated on a benchmark dataset containing 188 chest X-ray images with two classes: a healthy and a COVID-19 infected. The experimental result shows that the OGA-ELM achieves 100.00% accuracy with fast computation time. This demonstrates that OGA-ELM is an efficient method for COVID-19 detecting using chest X-ray images.

Matched MeSH terms: Thorax/physiopathology; Thorax/virology
Fulltext Anterior penetrating chest injury with left ventricular thrombus

Ruth Sabrina, S., Nik Azlan, N.M., Adi, O.

Medicine & Health, 2013;8(1):28-32.
MyJurnal

Urban cities are synonym with a high incidence of penetrating chest injuries either from accidents or interpersonal violence. The outcome of penetrating chest wound can vary from immediate death to a prolonged morbidity. We here report a case of 39-year-gentleman who presented to Emergency Department Hospital Raja Permaisuri Bainun, Ipoh, Perak after being stabbed to the chest. His anterior penetrating chest wound was located at the 5th intercostal space medial to the midclavicular line. The stab wound penetrated the myocardium, causing minimal myocardial rupture. He also suffered from left haemothorax and hemopericardium. The haemothorax was drained with insertion of 32 French chest tube. The patient was admitted under the cardiothoracic team and discharged five days later without surgical intervention. He presented again to the Emergency Department with complains of shortness of breath and pleuritic pain. A left ventricular thrombus was detected via echocardiography. Unfortunately, he took his own discharge. Five days later he came again to Emergency Department with sporadic of loss of vision. The mural thrombus dislodged and embolized to the retinal artery causing amaurosis fugax. The patient was treated with aspirin 150mg and his symptoms subsequently resolved.

Matched MeSH terms: Hemothorax; Thorax
Fulltext Single rare central lesion with triple common aerodigestive symptoms

Mohamad I, Mohamad IS, Nik Hassan N

Malays Fam Physician, 2018;13(1):57-58.
PMID: 29796215 MyJurnal

An elderly gentleman with a known history of
well-controlled hypertension presented with
a three-week history of hoarseness associated
with mild breathlessness. There was no episode
of cyanosis, no noisy breathing, and no
reduction in effort tolerance. There was also no
history of chest pain or orthopnea. He denied
any feeling of food stuck in his throat or chest,
and he had no history of choking sensations
during meals. He, however, was unable to
count from 1 to 10 in one breath, and lung
auscultation revealed reduced air entry on both
sides. A chest radiograph was then obtained. (Copied from article).

Matched MeSH terms: Thorax

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