A 52-year-old man presented with a 2-year history of episodic retraction of his tongue into the throat with a belief that he will die if the retraction is complete. The presentation is similar to koro except that the tongue is involved instead of the penis. It appears that retraction taxon can involve other organs and may not necessarily be culture bound.
It has been noted in the literature that Osteogenesis Imperfecta is frequently mistaken for non-accidental injury. This article serves to illustrate the difficulty in differentiating between the two conditions and that they can occur concomitantly in one patient.
Acquired haemophilia is a rare clinical condition arising from the spontaneous development of inhibitors to factor VIII. We describe two cases encountered in the University Hospital over the past five years. We also review the literature and discuss the therapeutic difficulties faced in dealing with patients with high levels of inhibitors. In one of these patients we also describe, for the first time in this region, a novel method in managing the acute bleeding episode in acquired haemophilia using recombinant factor VIIa.
Moyamoya disease is a rare cause of young strokes. The definitive diagnosis of moyamayo disease is made by cerebral angiography. We report two cases of moyamoya disease in Malaysia.
Clonorchiasis and opisthorchiasis are snail-transmitted trematode infections. The disease is endemic in many parts of Asia. Local case reports have been predominantly in Chinese with a history of travel to endemic countries. Thus far, 20 cases of liver fluke infestation have been reported in this country. This report presents another two cases of clonorchiasis and a case of opisthorchiasis. We also briefly review pertinent aspects of the disease.
Baby walker associated injuries are occurring in Malaysia. Most are not noticed as paediatricians are more concerned with the treatment of the injury and forget the preventive measures required to overcome this problem. We believe that baby walkers should be banned in Malaysia as the risks of injury far outweighs any benefits. We present 4 cases of baby walker associated scalding injuries.
Malignant fibrous histiocytoma is a mesenchymal tumour which can involve the genitourinary organs primarily or by secondary extension. Both conditions are rare. We report four cases of retroperitoneal malignant fibrous histiocytoma involving the kidney by local extension. Diagnosis was difficult because of diverse, non-specific clinical features and may only be reached at operation or post mortem. Prognosis is poor. Although en bloc tumour resection with nephrectomy was possible in two patients, they returned with recurrences.
Continent pouch ileostomy is fashioned for patients who need a proctocolectomy. It is usually indicated for cases of ulcerative colitis and familial adenomatous polyposis where the anal sphincter can no longer maintain normal function or has to be removed. A case of familial adenomatous polyposis with features of Gardner's syndrome is reported. The patient presented with carcinoma of the rectum. Abdominoperineal resection followed by completion pancolectomy was performed. A continent pouch ileostomy was fashioned for him. He resumed work as a labourer within six months. The pouch was troublefree, needed to emptied four to six times a day and was fully continent of fluid, flatus and faeces until his demise three years later from liver secondaries. Continent pouch ileostomy is a better alternative than permanent end ileostomy. All care should be taken to rule out the existence of Crohn's disease. It is proposed that continent pouch ileostomy should be offered to patients needing permanent ileostomy if the expertise is available.
Two cases of leiomyomas of the jejunum presenting with gastrointestinal bleeding of uncertain origin are described. Diagnosis was finally established by selective angiography. Laparotomy and resection of the tumour were successfully performed. The approach and management of this rare tumour are outlined.
We report here a case of lead poisoning in a 20 month old girl who presented with acute encephalopathy and status epilepticus. The major clues leading to the diagnosis were the occupational family history and dense lead lines on X-ray of the long bones. She showed evidence of neurological dysfunction in the initial phase, but she improved steadily, regaining her motor power partially and her vision, although some cognitive and language deficits were already evident. She will need long-term neurological assessment and evaluation to ascertain the extent of permanent brain damage.
An AIDS patient with multiple opportunistic infections (Candida, Pneumocystis carinii and Isospora belli) was identified at the University Hospital, Kuala Lumpur. The patient presented with profuse diarrhoea associated with lethargy, anorexia and weight loss. Routine stool examination showed Isospora belli oocysts. The infection responded to treatment with trimethroprim-sulfamethoxazole but relapse occurred 8 weeks later. This represents the first documented case of isosporiasis to occur in an AIDS patient in Malaysia.
A case of acute gastric volvulus associated with eventration of the diaphragm in a previously well 6 year old child is reported. The child presented with acute abdominal pain, abdominal distension and vomiting. At operation, mesentero-axial type gastric volvulus was found, associated with laxity of the gastro-splenic, gastrohepatic and gastrocolic ligaments and eventration of the left hemidiaphragm. Rapid recovery followed surgery that included release of distension and fixation of the stomach to the anterior abdominal wall. There has been no evidence of recurrence on a 2 year follow-up.
A case of prolonged thrombocytopenia following dengue haemorrhagic fever in a 15 year old boy is reported. The mechanism was presumed to be immunological and he responded dramatically to oral prednisolone.