Hepatic adenomatosis is a rare, benign tumour of the liver. It was first described by Flejou et al as multiple adenomas in an otherwise normal liver parenchyma. Although benign, it can present as a diagnostic
challenge because the lesions can be diffi cult to distinguish from other hepatic tumours. Patients can be
asymptomatic and the diagnosis may only be made incidentally. We describe the case of 40-year-old Malay lady who was incidentally found to have hepatomegaly. Radiological examinations revealed a complex left ovarian cyst with multiple liver lesions. Biopsy of the liver lesion showed features of hepatic adenomatosis. Literature review was done and the dilemma in managing her was discussed.
The objective of this study was to compare in-patient drug use patterns, costs, and outcomes associated with risperidone or olanzapine in a naturalistic clinical setting. Retrospective chart reviews of 92 patients with psychotic disorders were conducted at the University of Malaya Medical Centre (UMMC). Data was collected from patients who were hospitalized and for whom risperidone or olanzapine was the drug of first choice for long-term pharmacologic treatment. Proportion of patients for whom efficacy of the studied treatment could be established (as rated by the treating physician) was higher, but not significantly, with risperidone compared to olanzapine (p = 0.46). The average dose of the studied medication was 2.9 ± 1.0 mg/day for risperidone and 9.7 ± 2.4 mg/day for olanzapine. The total cost was significantly higher (p
Pruritus is a lesser known symptom of hyperthyroidism, particularly in autoimmune thyroid disorders. This is a case report of a 27-year-old woman who presented with generalised pruritus at a primary care clinic. Incidental findings of tachycardia and a goiter led to the investigations of her thyroid status. The thyroid function test revealed elevated serum free T4 and suppressed thyroid stimulating hormone levels. The anti-thyroid antibodies were positive. She was diagnosed with Graves' disease and treated with carbimazole until her symptoms subsided. Graves' disease should be considered as an underlying cause for patients presenting with pruritus. A thorough history and complete physical examination are crucial in making an accurate diagnosis. Underlying causes must be determined before treating the symptoms.
A 57-year old woman presented with acute bleeding from the left ear associated with reduced hearing and tinnitus. She also complained of redness and discomfort of her left eye; but there was no visual loss. A day before, she was slapped on the left side of her face. Previously, she did not have any hearing or visual problem.
Osteosarcoma is a primary malignant neoplasm of the bone. Osteosarcoma of the jaws especially those of maxilla is rare. The diagnosis of osteosarcomas is difficult and challenging. In this case report we highlight a rare case of osteosarcoma of the maxilla in a 29 year old male patient which was highly aggressive and was initially diagnosed as rhabdomyosarcoma. This case highlights the difficulty in diagnosing osteosarcoma merely from incisional biopsy specimens which may not be representative of the whole tumour. Limited clinical information at incisional biopsy also adds to the difficulty in arriving at the definitive diagnosis. We further discuss the treatment modalities followed in this case.
The purpose of this study was to examine the effect of stimulus sweep direction on the fine structure of the 2f1-f2 distortion product otoacoustic emission (DPOAE). It was hypothesised that the DPOAE fine structure could be shifted if the stimulus sweep changed from one direction to the other. In the present study, ascending, descending and random frequency sweeps were used, with f2 frequency varying between 992 Hz and 2496 Hz and f2/f1 fixed at 1.22. DPOAE fine structure was recorded at 16 Hz intervals. Screening, spontaneous otoacoustic emission (SOAE) and DPOAE measurements were carried out on 19 ears of 19 subjects aged between 22 and 30 years. Data from 14 ears that had at least one significant peak or valley in their DPOAE fine structure were included in the main analysis. Of these, five ears showed at least one occurrence of SOAE over the frequency span 600 Hz to 2500 Hz. Data for ears with and without SOAEs were grouped and analysed separately. The results showed no effect of sweep direction on DPOAE fine structure. No significant differences were observed in peak or valley frequencies, peak height or valley depth between the three stimulus sweep conditions (p > 0.05). There was also no significant effect of stimulus sweep direction on DPOAE level at the point at which SOAE frequency equalled DPOAE frequency (p > 0.05). In conclusion, the study found no effect of stimulus sweep direction on the fine structure of the 2f1-f2 DPOAE, either in ears with or without SOAEs. Therefore, future measurements of this fine structure may use either sweep direction.
Being a student, especially postgraduate student, could expose to stress, and being international postgraduate student would exposed to more stress to the student. This study was conducted to assess stress level among international postgraduate students and its associated factors. A cross sectional study was conducted among international postgraduate students registered at UKMMC, Cheras campus, Kuala Lumpur. Questionnaires were distributed to 119 students,. Main international student are Arabs (52.4%). The stress prevalence is 54.8%. Younger age group are more stressful with mean age 33.94 (P=0.004), while shorter duration is associated with stress, P=0.035. Relationship with neighbour and relationship with local colleagues are shown to be associated with stress with P value 0.011 and 0.005 respectively. This study reveals the presence of significant prevalence of stress among international postgraduate students. The student socio-demographic character that has shown to be associated with stress in this study was age. The poor relationships with local colleagues as well as the poor relationships with the neighbours have shown to contribute to the stress among international students.
We report two paediatric patients with massive head and neck plexiform neurofibromas who underwent surgical excision. We wish to highlight issues and implications pertaining to the surgery, in particular, the management of intraoperative bleeding often encountered in these cases.
\Elderly abuse exists in our society but is hardly ever reported. This problem often remains undetected because of poor public awareness and lack of knowledge among health care personnel. This article addresses the definition of elderly abuse, characteristics of the abused elderly and their abusers as well as strategies to detect and manage it. Collaboration between health care professionals and government bodies is needed to identify and manage elderly abuse. Ultimately, a legislative "Elder Protective Act" should be implemented to safeguard the rights of our vulnerable elderly.
Anxiety Disorders have been said to account for the majority of psychiatric cases treated in out patient clinics all over the world. However not much input Is being given to it in the teaching of futufe doctors mainly because although it is common it is not generally seen by students posted to psychiatry wards in Malaysia. The students have the advantage of visiting patients in the wards daily but may only spend about 20% of the entire psychiatry posting in the clinics. As such, emphasis in identifying and treating anxiety disorders becomes diminished. More time is spent on discussing management issues of schizophrenia and bipolar disorders when the likelihood of students treating anxiety disorders in primary care and family physician clinics are more after they graduate. This short editorial looks at the current trend in combining psychotherapy and pharmacotherapy in anxiety pathology for the benefit of both practicing doctors and students.
Leiomyosarcoma is a rare cancer and the presence of this type of cancer in the breast is even rarer. Due to its rarity, the management options for leiomyosarcoma of the breast are not well documented. Literature review was done to establish the best treatment options for this type of breast cancer.
We report a case of chemotherapy induced acute pan-creatitis in a child with acute lymphoblastic leukaemia. L-asparaginase is the most likely incriminating drug.
Helicobacter pylori (HP) was first described in 1983 by Warren and Marshall.' It is a spiral-shaped bacterium measuring 2-4p,m x 0.5-1.0μm. Since it was discovered, the organism has rarely been isolated from sites other than the stomach.2 Available evidence, therefore, points to the human stomach as the normal habitat of this bacterium. The infection is contracted primarily in childhood.' It has been shown that colonisation by HP is rare under the age of five years, but thereafter, it becomes gradually more frequent, and by sixty years of age more than 50% of individuals may be affected
Objective: This is a case report discussing the comorbidity of obsessive compulsive disorder (OCD) and schizophrenia. Such clinical phenomenon merits recognition as a distinct subgroup of schizophrenia with unique challenges and treatment needs. Method: A case report presenting schizophrenia with preceding obsessive-compulsive disorder over five years. Results: This report describes the clinical course and treatment challenges of a patient with obsessive compulsive schizophrenia (OCS). Conclusion: This case illustrates that OCS is a complex disorder with atypical clinical characteristics. In managing this patient, several clinical dilemmas including diagnostic ambiguity, problems with pharmacotherapy and difficulties in his rehabilitation were highlighted.
Foreign body ingestion in the majority of children is often witnessed or suspected and may present with vomiting or choking. An unusual mode of presentation with haemetemesis and maelena in a 10 month old child is described here.
Cement and concrete has been widely used as shielding material in reactor nuclear in order to minimize exposure to individuals. In this paper we present boron based concrete as neutron shielding for nuclear reactor applications. Concrete specimens with dimension of 10x10x10 cm were used and irradiated with neutron radiation of 252-californium. Characterization of physical, mechanical and radiation attenuation properties of concrete were carried out. The results show that the shielding performance is better than ordinary concrete. From the result, we confirmed that the performance of the concrete/boron carbide is suitable for practical use.
A surgeon’s experience plays an important role in breast conserving surgery (BCS). The common conception is that, the more junior is the operating surgeon, the surgical margin will be wider or closer to the tumour edge. Thus the aim of this study is to look into the adequacy of surgical margin performed by different level of surgeons’ experience in patients whom underwent wide local excision (WLE) and hook-wire localization (HWL) in our surgical unit. The surgical experience of the operating surgeon and their surgical margins will be analyzed. This is a retrospective study from January 2000 to December 2012. Eighty-eight patients with early breast cancer underwent WLE and HWL by 3 different groups of surgeons (breast surgeons, junior surgeons and surgical registrars) were included. The surgical margins were analyzed for involved-margin, closed-margin or excessed-margin.The incidence of involved-margin, closed-margin and excessed-margin is the lowest among breast surgeons compared to other groups. However, the results were not statistically significant. The incidence of involved surgical margin is significantly higher within junior surgeons for HWL compared to the breast surgeons. The incidence of involved, closed or excessed surgical margin were lowest when performed by breast surgeon but not significantly different between the three groups. However, for HWL the breast surgeons significantly better compared to the other groups.
We report a case of rare, Mullerian vaginal cyst with intracystic haemorrhage in the absence of endometrial components. To date, this is the second case reported in the literature. A 51-year-old post-menopausal woman with history of anterior vaginal wall cyst was misdiagnosed to have cystocele. The cyst was excised and the content was old blood mixed with mucous. Histopathological examination revealed a Mullerian vaginal cyst without endometrial component. Thus, diagnosis and management of vaginal cyst was revisited and discussed.
A survey on the diversity of marine macrogastropoda
in Pulau Songsong, Pulau Bidan and Pulau Telor on the
Northern Straits of Malacca was conducted. Specimens
were collected on rocky shores following NaGISA protocol
and the number of marine macrogastropod were recorded.
Distances and the number of the same species were
converted into Relative Abundance unit (individuals per
100 m2
). A total of 15 species of marine macrogastropoda
were found from seven families namely Neritidae,
Trochidae, Ceriitidae, Littorinidae, Turbinidae, Muricidae
and Potamididae. Seven macrogastropoda species were
newly recorded from these three islands. Morula marginatra
was the most dominant species and Pulau Songsong had
the highest genera and species diversity among the three
islands. (Copied from article).
Dysphagia is a common symptom in patients presenting to the otorhinolaryngolgy clinic. However, vascular causes (dysphasia lusoria) are relatively rare. W report a case of dysphagia caused by a saccular aneurysm of the descending thoraric aorta. The outline of management is discussed.