We report a rare case of base of tongue tuberculosis following pulmonary tuberculosis. Patient presented to us with chief complaints of sore throat and pain on swallowing for period of 3 months. On examination with 70 degree telescope, we observed an ulcer on right side of base of tongue. The edges of the ulcer appeared to be undermined with whitish slough at the centre of the ulcer. Examination of neck showed a multiple small palpable middle deep cervical lymph nodes on right side of neck. Biopsy of the ulcer was taken, which showed granulomatous inflammation, suggestive of tuberculosis. Laboratory investigations revealed a raise in erythrocyte sedimentation rate, sputum for acid fast bacilli was strongly positive. Chest X ray was performed for patient showed multiple areas of consolidation. Patient was referred to chest clinic for further management of tuberculosis and was started on anti-tuberculous drugs. In conclusion tuberculosis of oral cavity is rare, but should be considered among one of the differential diagnosis of the oral lesions and biopsy is necessary to confirm the diagnosis.
This study reviews forensic entomological specimens analysed by the Department of Parasitology & Medical Entomology, Universiti Kebangsaan Malaysia for the year 2004. A total of 10 cases (6 males and 4 females) were observed for the entomological specimens. Various types of death scenes were obtained including indoor and outdoor area such as bushes field, rubbish dumping site, and aquatic areas. Identified fly species collected from the death sites were blow flies, Chrysomya megacephala, Chrysomya rufifacies and Lucilia cuprina and unknown sarcophagid larvae, with Ch. megacephala being the most common species found in the ecologically varied death scene habitats. The post-mortem interval (PMI) estimation ranged from one to five days, based on the entomological specimens collected.
A previously healthy 52-year-old man had a chest radiograph for medical check-up and found to have a right-sided aortic arch. Computed tomography of the thorax revealed a right-sided aortic arch with aberrant left subclavian artery originated from Kommerell's diverticulum. Barium swallow examination showed compression of the posterior wall of the esophagus. He was asymptomatic and no surgical intervention was performed.
Psoralen and ultraviolet light A (PUVA) was the mainstay of vitiligo treatment before the introduction of narrowband UVB(NB-UVB). Eighteen patients treated with NB-UVB in Hospital Kuala Lumpur were retrospectively analyzed. Eight patients had Fitzpatrick skin phototype III and 10 with phototype IV. The mean duration of disease was 7.3 +/- 5.4 years, and the mean body surface area affected was 19.3 +/- 16.2%. Mean duration of treatment was 14.3 +/- 9.6 months, number of session 113.5 +/- 88.6 times and cumulative dose 111.7 +/- 108.5 J/ cm2. Concomitant topical steroid was used in 88.9% patients. Repigmentation was moderate in 6 (40%) patients, good in 3 (20%), while 3 (20%) achieved excellent results. One patient (6.6%) showed no response and 2 (13.3%) showed poor repigmentation. Three patients developed side effects. NB-UVB phototherapy results in satisfactory repigmentation in our vitiligo patients and should be offered as a treatment option.
Ureteritis cystica is a rare, benign, proliferative condition. We report the case of a 51-year-old female who complained of dysuria and frequency for the last 10 years. The symptoms, however, increased in severity and frequency over the past one year. Urine culture and sensitivity showed presence of Escherichia Coli which was sensitive to augmentin and ciproflaxocin. The urinary tract ultrasonography and intravenous urography revealed bladder diverticula with multiple small, smooth well defects with sharp borders that protruded into the lumen along the proximal and mid left ureter. This finding was later confirmed by retrograde pyelogram. She was treated and currently is on long term antibiotic therapy. The diagnostic features and management of ureteritis cystic is being discussed in detail.
Cavernous hemangioma is a vascular tumor composed of large dilated blood vessels and containing large blood-filled spaces. The formation is due to dilation and thickening of the walls of the capillary loops. Most cavernous hemangiomas present at birth or soon after. On the other hand, jugular phlebectasia is an abnormal benign sacculofusiform dilatation of jugular veins. It should be considered as one of the differential diagnosis of neck swelling. Majority of the reported cases occurred in a young child. We reported a case of an elderly woman who was diagnosed clinically as anterior jugular vein phlebectesia. Histologically the mass turned out to be a cavernous hemangioma.
The use of 0.5 mg/0.05 ml of ranibizumab intracamerally, to induce regression of iris neovascularisation in a non-diabetic patient, is reported. A 55-year-old Malay man presented with left eye rubeosis and hyphaema secondary to ischaemic remnant retinal flap in his silicone filled pseudophakic eye. Regression of rubeosis and resolution of hyphaema was noted within 4 days of injection of intracameral ranibizumab, allowing repeat vitrectomy to be performed without much bleeding, thus facilitating removal of his intraocular lens and laser to remaining flap. One month postoperatively he remained comfortable with counting fingers vision similar to the pre-hyphaema period.
This study was designed to assess the total anal sphincter-saving technique of ligating the intersphincteric fistula tract for the treatment of fistula-in-ano.
A 48 a year old Malay gentleman, was investigated for recurrent unexplained right pleural effusion. Initial investigations showed exudative pleural effusion with neutrophil predominance. Tuberculosis (TB) workout were negative. Pleuroscopy showed multiple adhesions with granulomatous deposits at the parietal pleural surface. Adhesions were released by forceps. A chest tube was inserted. Intrapleural streptokinase instilled for three consecutive days. TB treatment was initiated. There was clinical and radiological improvement and he was discharged well after one week of hospitalization. He remained well at follow-up two months later.
Nasal polyp is one of the common causes of nasal obstruction. The diagnosis is usually made on clinical ground and rarely needs histological examination. However, when a candidate is selected for the surgical option of polyp removal, there is tendency to send all specimens for routine histological examination. The objective of this study was to assess the necessity of routinely performed histological examination in all nasal polyp specimens. A retrospective review of all nasal polyp histological reports was done from patients who underwent polypectomy or functional endoscopic sinus surgery in Universiti Sains Malaysia Hospital between January 2000 to July 2006. It consisted of 95 patients. Majority of the reports came back as inflammatory nasal polyp (93.6%) and other varieties of benign nasal mass (5.3%). However, one specimen was noted to be malignant (1.1%). In conclusion all nasal polyp specimens should be sent for histological examination in order to confirm the diagnosis.
A qualitative ethnomedical survey was carried out among a local Orang Asli tribe to gather information on the use of medicinal plants in the region of Kampung Bawong, Perak of West Malaysia in order to evaluate the potential medicinal uses of local plants used in curing different diseases and illnesses.
Repair of an abdominal aortic aneurysm in a renal transplant recipient poses many different problems due to warm ischaemia to the grafted kidney. This is a case of 50-year-old gentleman who had a pervious renal transplant with abdominal aortic aneurysm. To reduce the effects of warm ischaemia on the transplanted kidney, an axillo unifemoral bypass was done prior to aneurysm repair. This ensured continued perfusion to the transplanted kidney. The post operative period was complicated by Methicillin Resistant Staphyloccus Aureus infection of the graft.
A 57 year old man presented with postinfarction ventricular septal infarct (VSD) a week after myocardial infarction and thrombolytic therapy. Coronary angiography confirmed double vessel disease. He underwent surgical repair of the VSD and coronary artery bypass grafting. Two days postoperatively, he deteriorated due to recurrence of VSD. Reoperation was carried out with satisfactory results. The surgical management is described with a review of the relevant literature.
Uterine fibroid or leiomyoma is the commonest benign uterine tumour. Its occurrence in the postmenopausal age group is rare and if enlargement of the fibroid noted during this time, the diagnosis of leiomyosarcoma is provisional until proven otherwise. A case of a postmenopausal woman with a huge uterine fibroid associated with polycythaemia is presented whereby the mass was noted to increase in size within 2 years. The patient was otherwise well except for the growing uterine mass. She had venesection done to treat her polycythaemia and later underwent surgery for total abdominal hysterectomy and bilateral salpingoophoorectomy. The histopathology report confirmed leiomyoma of uterus with no evidence of sarcomatous changes. It was suggested that large uterine myoma may cause secondary polycythaemia by three postulated mechanisms, i.e. presence of hypoxia suggesting shunting within the tumour, second, the uterine fibroid was compressing the ureters resulting in inappropriate excessive production of erythropoietin by the kidneys, and third, the tumour itself may have been producing the erythropoietin.
Tubercular tenosynovitis is an uncommon condition and usually affects the upper limb. We report a case of a patient with Systemic Lupus Erythematosus who presented with wrist swelling. The clinical findings were suggestive of rheumatoid nodules, but the radiographic finding of calcification associated with the nodules and marked erosive changes primarily of the radio-carpal joint with sparing of the metacarpal joints led the radiologist to believe that the nodules may not be rheumatoid nodules. The presence of solid and fluid nature of the nodule and hyperechoic small echogenic foci (matted rice bodies within thickened synovium) on ultrasound suggested the presence of chronic synovitis of tuberculous infection rather than rheumatoid nodule as in our case. We recommend the use of ultrasound to determine the nature of nodular swellings seen clinically in patients with arthropathy.
The femoral nerve usually divides into anterior and posterior branches below the inguinal ligament. In the present case, we report the anomalous higher branching pattern of the femoral nerve on both sides of a 52 year male cadaver. The femoral nerve divided into the anterior and posterior branches above the inguinal ligament. Such a higher division of femoral nerve is a rare finding and it may be important for surgeons, orthopaedicians and anaesthetists in day to day clinical practice.