Left atrial myxoma almost always arises in the inter-atrial septum. A case is described where it arose from the posterior wall of the left atrium. Clinical presentation was suggestive of mitral stenosis and sub-acute bacterial endocarditis and diagnosis was arrived at necropsy.
Two cases of Syndromes of Ophthalmoplegia , Ataxia and Areflexia were reported. A brief discussion on its clinical feature and differential diagnosis was made.
We report a patient with unusual manifestations of hyperthyroidism which initially suggested lymphoma. The pathophysiology of these features in thyrotoxicosis is discussed. The need to consider thyrotoxicosis in an otherwise unexplained case of lymphoid hyperplasia will be stressed.
A patient with marfanoid habitus was admitted to the General Hospital, Kuala Lumpur in October 1985 for surgical closure of an atrial septal defect. He was suspected to have Marfan Syndrome but there was no involvement of the aorta nor the eye. The clinical features were intermediate between that of the Marfan Syndrome and the Ehler's Danlos Syndrome. It is suggested that this could be a separate distinct entity within the heritable disorders of connective tissue known as the Marfanoid Hypermobility Syndrome.
Obturator hernia is a rare clinical entity usually presenting with strangulation. Preoperative diagnosis is seldom made and this has contributed to a high. mortality. One should suspect a strangulated obturator hernia in an elderly thin female patient presenting with vague abdominal symptoms or intestinal obstruction associated with a positive Howship-Romberg sign. Urgent laparotomy is indicated to establish the diagnosis and for resection of bowel if indicated.
The case notes of twelve jaundiced patients, on whom percutaneous transhepatic cholangiography (PTC) were performed, are reviewed. PTC was carried out to differentiate the patients with intrahepatic cholestasis from those with extrahepatic biliary obstruction, and to identify the site and nature of the block. In eleven cases, the biliary trees were visualised, with the sites of obstruction in those present demonstrated and confirmed at subsequent laparotomies. There was no serious side effect from the procedure. PTC in our hands has proved an invaluable aid in the investigation of the icteric patients.
A case of the Hutchinson-Gilford progeria syndrome (HGPS) in Malaysia is described. A brief discussion of this rare condition and its differential diagnosis follows.
Electrocardiographic features of the Woljf-Parkinson-White syndrome may be seen in normal individuals and in those with congenital or acquired heart disease. Predisposition to tachyarrhythmias and its misinterpretation are common. In this report a case of Wolff-Parkinson-White syndrome in a 25 year old Malay male who presented with cardiac arrhythmias is described. Echocardiographic findings and the role of echocardiography are discussed.
Plexiform granular cell odontogenic tumor of the mandible has recently been described. The cardinal histopathologic feature, as its name suggests, is a monophasic plexiform pattern of granular cells; the principal tumor in the differential diagnosis is granular cell ameloblastoma. Unlike the two previously reported cases of plexiform granular cell odontogenic tumor, which occurred as solid tumors in elderly men, the lesion reported here is a unicystic variant occurring in a middle-aged woman.
We present three cases of Acquired Platelet Dysfunction with Eosinophilia (APDE). The importance of recognising this benign condition, which usually does not require any specific therapy, is stressed to avoid the pitfalls of diagnosing more serious bleeding disorders in children presenting with ecchymosis.
This report deals with the problems of a young man who was clinically euthyroid but biochemically hyperthyroid. The possibility of peripheral resistance to thyroid hormones to explain this paradoxical state is discussed. The importance of recognising this condition to avoid the erroneous diagnosis of thyrotoxicosis and inappropriate therapy is stressed.
Cutaneous larva migrans is a parasitic skin eruption caused by migration of larvae of various nematodes. Diagnosis of cutaneous larva migrans is currently based on the clinical signs of the creeping eruption. We are investigating a new diagnostic technology called optical coherence tomography (OCT) , which is potentially able to visualize structures in the skin with an 8 microm resolution. This technology could therefore potentially allow rapid, non-invasive, in vivo diagnosis of infestations.
Gouty arthritis commonly affects peripheral joints and is associated with hyperuricaemia. Spinal manifestations of gouty arthritis are not common, and majority of published articles worldwide were case reports. This is a case report of spinal gouty arthritis that presented with spinal vertebrae destruction and cauda equina syndrome. The magnetic resonance imaging (MRI) showed destruction of L5/S1end plates with cystic collection mimicking infective changes. The tissue histological examination confirmed presence of urate crystal needles that displayed negative double refraction on light microscopy. Spinal gouty arthritis is part of the differential diagnoses in gouty arthritis patients.
An 8-year-old spayed female Shih Tzu was referred to University Veterinary Hospital (UVH) with history of chronic coughing for more than a year duration. Dry, hacking cough was heard and bilateral wheezing lung sound was noted upon physical examination. Auscultation of heart revealed left apical systolic heart murmur Grade III/VI. A soft, intermittent swelling was observed at ventral neck, cranial to thoracic inlet (protruded upon expiration and collapsed upon inspiration). Thoracic radiography taken showed presence of apical radiolucency at cervical region and bronchial pattern at caudodorsal lungs with left atrium enlargement and right-sided heart enlargement. Echocardiographic examination revealed myxomatous mitral valve disease (MMVD) with mild regurgitation. Based on diagnostic imaging, this case was diagnosed as dynamic lung lobe herniation secondary to chronic coughing concurrent with myxomatous mitral valve disease. Other differential diagnosis that may lead to chronic cough such as of tracheal collapsed and bronchiectasis was not rule out.