MyMedR

Fulltext A concealed giant peritonsillolith masquerading as oropharyngeal tumor

Gan BC, Mohamad I, Lazim NM

Braz J Otorhinolaryngol, 2020 Dec;86 Suppl 1:72-74.

PMID: 29102399 DOI: 10.1016/j.bjorl.2017.09.002

Matched MeSH terms: Diagnosis, Differential

A decision tree for differentiating multiple system atrophy from Parkinson's disease using 3-T MR imaging

Nair SR, Tan LK, Mohd Ramli N, Lim SY, Rahmat K, Mohd Nor H

Eur Radiol, 2013 Jun;23(6):1459-66.

PMID: 23300042 DOI: 10.1007/s00330-012-2759-9

OBJECTIVE: To develop a decision tree based on standard magnetic resonance imaging (MRI) and diffusion tensor imaging to differentiate multiple system atrophy (MSA) from Parkinson's disease (PD).

METHODS: 3-T brain MRI and DTI (diffusion tensor imaging) were performed on 26 PD and 13 MSA patients. Regions of interest (ROIs) were the putamen, substantia nigra, pons, middle cerebellar peduncles (MCP) and cerebellum. Linear, volumetry and DTI (fractional anisotropy and mean diffusivity) were measured. A three-node decision tree was formulated, with design goals being 100 % specificity at node 1, 100 % sensitivity at node 2 and highest combined sensitivity and specificity at node 3.

RESULTS: Nine parameters (mean width, fractional anisotropy (FA) and mean diffusivity (MD) of MCP; anteroposterior diameter of pons; cerebellar FA and volume; pons and mean putamen volume; mean FA substantia nigra compacta-rostral) showed statistically significant (P < 0.05) differences between MSA and PD with mean MCP width, anteroposterior diameter of pons and mean FA MCP chosen for the decision tree. Threshold values were 14.6 mm, 21.8 mm and 0.55, respectively. Overall performance of the decision tree was 92 % sensitivity, 96 % specificity, 92 % PPV and 96 % NPV. Twelve out of 13 MSA patients were accurately classified.

CONCLUSION: Formation of the decision tree using these parameters was both descriptive and predictive in differentiating between MSA and PD.

KEY POINTS: • Parkinson's disease and multiple system atrophy can be distinguished on MR imaging. • Combined conventional MRI and diffusion tensor imaging improves the accuracy of diagnosis. • A decision tree is descriptive and predictive in differentiating between clinical entities. • A decision tree can reliably differentiate Parkinson's disease from multiple system atrophy.

Matched MeSH terms: Diagnosis, Differential

Fulltext A diagnostic workup of perioperative anaphylaxis reveals a selective type 1 hypersensitivity to cefazolin

Meera Thalayasingam, Shek, Lynette Pei-Chi

International e-Journal of Science, Medicine & Education, 2015;9(2):37-39.

MyJurnal

Anaphylaxis in the operating room although infrequent can be potentially fatal. The diagnosis of perioperative anaphylaxis is complex due to a multitude of factors. Firstly, patients under anesthesia cannot verbalize their complaints, the anesthetic agents themselves can alter vital parameters (e.g. heart rate and blood pressure) and cutaneous signs in a completely draped patient may be missed. Secondly, the differential diagnosis of intraoperative anaphylaxis is wide. Conditions such as asthma exacerbation, arrhythmia, hemorrhage, angioedema, mastocytosis, acute myocardial infarction, drug overdose, pericardial tamponade, pulmonary edema, pulmonary embolus, sepsis, tension pneumothorax, vasovagal reaction, venous air embolism, laryngospasm, blood transfusion reaction and malignant hyperthermia need to be considered. Thirdly, the diagnostic workup is challenging due to the multiple medications administered and other exposures encountered such as latex and chlorhexidene. However, through a timely allergy consultation and a systematic approach, identification of the culprit agent and safe alternatives can be established to prevent future occurrences as illustrated in the case below.

Matched MeSH terms: Diagnosis, Differential

Fulltext A fatal case of anaphylactic shock caused by the lesser banded hornet, Vespa affinis indosinensis in peninsular Malaysia

Lee HL, Krishnasamy M, Jeffery J

Trop Biomed, 2005 Jun;22(1):81-2.

PMID: 16880759 MyJurnal

The hornets are a group of venomous stinging insects that at times cause human death. A fatal case of a child stung by the lesser banded hornet Vespa affinis indosinesis is reported. Though often covered by the mass media, this constitutes the first scientifically reported case.

Matched MeSH terms: Diagnosis, Differential

A fever from the tropics

Gherardin T

Aust Fam Physician, 2000 Mar;29(3):259.

PMID: 10785992

Shirley is a 42 year old woman who has rung you 5 days after returning from a 3 week resort holiday in Malaysia and Thailand. You saw her before her trip and administered a hepatitis A vaccine and advised her that she did not require anti malarial drugs as she was only going to large cities and beach resorts. She says she has had a high fever, headache and body aches for several days and that she feels exhausted, but is well enough to come to the surgery. When you see her later that morning, she looks fairly well, although she is moving rather gingerly. She says she has been resting, is drinking lots of fluids, has some anorexia, but no other significant symptoms. Examination reveals a temperature of 38 degrees C and she has a fine morbilliform rash on her body, limbs and neck. There are no other abnormal findings.

Matched MeSH terms: Diagnosis, Differential

A foetus in the abdomen of a boy

Lal M

Med J Malaya, 1971 Jun;25(4):307-10.

PMID: 4261309

Matched MeSH terms: Diagnosis, Differential

A four-point clinical criteria distinguishes immune thrombocytopenia from acute lymphoblastic leukaemia

Lum SH, How SJ, Ariffin H, Krishnan S

Med J Malaysia, 2016 02;71(1):28-9.

PMID: 27130741

Immune thrombocytopenia is the most common diagnosis of isolated thrombocytopenia. The dilemma encountered by paediatricians is missing diagnosis of acute leukaemia in children with isolated thrombocytopenia. We demonstrated childhood ITP could be diagnosed using a four point clinical criteria without missing a diagnosis of acute leukaemia. Hence, bone marrow examination is not necessary in children with typical features compatible with ITP prior to steroid therapy. This can encourage paediatricians to choose steroid therapy, which is cheaper and non-blood product, as first line platelet elevating therapy in children with significant haemorrhage.

Matched MeSH terms: Diagnosis, Differential

A large unilateral submandibular mass

Rajandram RK, Sha PP, Hussaini HM, Jabar NA

Oral Surg Oral Med Oral Pathol Oral Radiol, 2014 Apr;117(4):402-6.

PMID: 23183027 DOI: 10.1016/j.oooo.2012.08.456

Matched MeSH terms: Diagnosis, Differential

Fulltext A man with contracted fingers

Loh KY, Kew ST

Aust Fam Physician, 2008 Mar;37(3):150.

PMID: 18345365

An Indian man from Malaysia presented with contracture of his hands. He is 55 years of age and has a history of chronic alcohol consumption. Examination revealed bilateral thickened structure at the palms.

Matched MeSH terms: Diagnosis, Differential

Fulltext A mimicry of melioidosis by Klebsiella ozaenae infection

Ng TH, How SH, Kuan YC, Adzura, Aziz AA, Fauzi AR

Malays J Pathol, 2009 Dec;31(2):147-50.

PMID: 20514860 MyJurnal

Klebsiella ozaenae is a Gram negative bacillus. It has been described as a colonizer of oral and nasopharyngeal mucosa and is a cause of atrophic rhinitis. Klebsiella ozaenae has seldom been isolated from serious infections. However, several reports have stated that Klebsiella ozaenae may cause invasive infections and even mortality. We report a 55-year-old man with Klebsiella ozaenae infection causing abscesses involving the right eye and left kidney and possibly also in the brain, lungs and prostate. The isolates were sensitive to ceftazidime, ciprofloxacin, chloramphenicol, gentamicin and sulfamethoxazole-trimethoprim but resistant to ampicillin. He responded well to 4 weeks of i.v. ceftazidime and i.v. amoxycillin-clavulanic acid. To our knowledge, such a multiorgan infection has not been reported previously for this organism.

Matched MeSH terms: Diagnosis, Differential

Fulltext A misdiagnosed infection mimicking "tree man disease"

Lim JA, Ismail Z, Ibrahim CN, Chong SE, Wan Abdullah WNH

PLoS Negl Trop Dis, 2017 06;11(6):e0005543.

PMID: 28617806 DOI: 10.1371/journal.pntd.0005543

Matched MeSH terms: Diagnosis, Differential

A model to predict the probability of acute inflammatory demyelinating polyneuropathy

Tan CY, Sekiguchi Y, Goh KJ, Kuwabara S, Shahrizaila N

Clin Neurophysiol, 2020 01;131(1):63-69.

PMID: 31751842 DOI: 10.1016/j.clinph.2019.09.025

OBJECTIVE: We aimed to develop a model that can predict the probabilities of acute inflammatory demyelinating polyneuropathy (AIDP) based on nerve conduction studies (NCS) done within eight weeks.

METHODS: The derivation cohort included 90 Malaysian GBS patients with two sets of NCS performed early (1-20days) and late (3-8 weeks). Potential predictors of AIDP were considered in univariate and multivariate logistic regression models to develop a predictive model. The model was externally validated in 102 Japanese GBS patients.

RESULTS: Median motor conduction velocity (MCV), ulnar distal motor latency (DML) and abnormal ulnar/normal sural pattern were independently associated with AIDP at both timepoints (median MCV: p = 0.038, p = 0.014; ulnar DML: p = 0.002, p = 0.003; sural sparing: p = 0.033, p = 0.009). There was good discrimination of AIDP (area under the curve (AUC) 0.86-0.89) and this was valid in the validation cohort (AUC 0.74-0.94). Scores ranged from 0 to 6, and corresponded to AIDP probabilities of 15-98% at early NCS and 6-100% at late NCS.

CONCLUSION: The probabilities of AIDP could be reliably predicted based on median MCV, ulnar DML and ulnar/sural sparing pattern that were determined at early and late stages of GBS.

SIGNIFICANCE: A simple and valid model was developed which can accurately predict the probability of AIDP.

Matched MeSH terms: Diagnosis, Differential

A morphological and immunohistochemical study of plasma cell proliferative lesions

Boo K, Cheng S

Malays J Pathol, 1992 Jun;14(1):45-8.

PMID: 1469918

Monoclonal plasma cell proliferative diseases such as multiple myeloma and plasmacytoma can involve extramedullary sites at the time of first presentation, or subsequently in the course of the disease. Under such circumstances, they can mimic primary or metastatic carcinomas, neuroendocrine or neuroectodermal tumours and lymphomas, and the pathologist often has to resort to immunohistochemistry as an aid to diagnosis. We studied the morphology and immunohistochemical properties of 10 cases of previously confirmed monoclonal plasma cell proliferative lesions retrieved from the files of the Department of Pathology, University of Malaya. Serial 4u thick paraffin sections were stained with H&E, the Unna-Pappenheim technique for nucleic acid and a panel of antibodies using a standard immunoperoxidase technique. Light chain restriction was demonstrable in most of the cases. Seven (70%) showed kappa and 2 (20%) lambda light chain restriction. The remaining case was not stainable with most of the antibodies in the panel. The majority (80%) of cases showed accompanying IgG heavy chain in the cytoplasm, while 1 case had IgA. Seven (70%) showed membrane positivity with antibody to epithelial membrane antigen (EMA) and 7 (70%) cytoplasmic positivity with antibody to vimentin. This study enhances our awareness that neoplastic plasma cells can be positive for EMA and vimentin, and cautions us from misinterpreting these lesions as carcinomas or sarcomas. Notwithstanding that, immunohistochemical staining for kappa and lambda light chains can be helpful in differentiating monoclonal plasma cell proliferations from polyclonal ones.

Matched MeSH terms: Diagnosis, Differential

Fulltext A new clinical test for radial tunnel syndrome--the Rule-of-Nine test: a cadaveric study

Loh YC, Lam WL, Stanley JK, Soames RW

J Orthop Surg (Hong Kong), 2004 Jun;12(1):83-6.

PMID: 15237127 DOI: 10.1177/230949900401200115

Radial tunnel syndrome refers to pain on the lateral aspect of the forearm as a result of compression of the posterior interosseous nerve within a tunnel with specific anatomical boundaries. Diagnosis of the condition is difficult because of its close association with lateral epicondylitis, which warrants different methods of treatment. Based on a cadaveric study, a new clinical test, the Rule-of-Nine test, is proposed to improve the diagnostic accuracy in radial tunnel syndrome. The test involves constructing 9 equal squares on the anterior aspect of the forearm and noting those squares where tenderness can be elicited.

Matched MeSH terms: Diagnosis, Differential

A patient presenting with hoarseness. Diagnosis: sarcoidosis

Lim KH, Liam CK, Wong CM

Postgrad Med J, 2000 Aug;76(898):512, 518-9.

PMID: 10908387

Matched MeSH terms: Diagnosis, Differential

A previously unknown reovirus of bat origin is associated with an acute respiratory disease in humans

Chua KB, Crameri G, Hyatt A, Yu M, Tompang MR, Rosli J, et al.

Proc Natl Acad Sci U S A, 2007 Jul 03;104(27):11424-9.

PMID: 17592121

Respiratory infections constitute the most widespread human infectious disease, and a substantial proportion of them are caused by unknown etiological agents. Reoviruses (respiratory enteric orphan viruses) were first isolated from humans in the early 1950s and so named because they were not associated with any known disease. Here, we report a previously unknown reovirus (named "Melaka virus") isolated from a 39-year-old male patient in Melaka, Malaysia, who was suffering from high fever and acute respiratory disease at the time of virus isolation. Two of his family members developed similar symptoms approximately 1 week later and had serological evidence of infection with the same virus. Epidemiological tracing revealed that the family was exposed to a bat in the house approximately 1 week before the onset of the father's clinical symptoms. Genome sequence analysis indicated a close genetic relationship between Melaka virus and Pulau virus, a reovirus isolated in 1999 from fruit bats in Tioman Island, Malaysia. Screening of sera collected from human volunteers on the island revealed that 14 of 109 (13%) were positive for both Pulau and Melaka viruses. This is the first report of an orthoreovirus in association with acute human respiratory diseases. Melaka virus is serologically not related to the different types of mammalian reoviruses that were known to infect humans asymptomatically. These data indicate that bat-borne reoviruses can be transmitted to and cause clinical diseases in humans.

Matched MeSH terms: Diagnosis, Differential

A proposed hierarchical fuzzy inference system for the diagnosis of arthritic diseases

Lim CK, Yew KM, Ng KH, Abdullah BJ

Australas Phys Eng Sci Med, 2002 Sep;25(3):144-50.

PMID: 12416592 DOI: 10.1007/BF03178776

Development of computer-based medical inference systems is always confronted with some difficulties. In this paper, difficulties of designing an inference system for the diagnosis of arthritic diseases are described, including variations of disease manifestations under various situations and conditions. Furthermore, the need for a huge knowledge base would result in low efficiency of the inference system. We proposed a hierarchical model of the fuzzy inference system as a possible solution. With such a model, the diagnostic process is divided into two levels. The first level of the diagnosis reduces the scope of diagnosis to be processed by the second level. This will reduce the amount of input and mapping for the whole diagnostic process. Fuzzy relational theory is the core of this system and it is used in both levels to improve the accuracy.

Matched MeSH terms: Diagnosis, Differential

Fulltext A rare case of TB elbow synovitis in a patient with rheumatoid arthritis: a case report

Meryl Grace Lansing, Malehah Mohd Noh, Mohd Hakimi Nordin

Malaysian Journal of Medicine and Health Sciences, 2019;15(106):96-96.

MyJurnal

Introduction: Tuberculosis (TB) of the elbow joint is uncommon. Prompt diagnosis and treatment are important to prevent joint destruction and preserve function. We present a case of TB synovitis of the elbow joint in a patient with active rheumatoid arthritis (RA). Case description: A 56-year-old woman with a known seropositive RA on metho-trexate and Leflunomide was seen in the outpatient rheumatology clinic as part of her monthly follow-up. She com-plained of persistent bilateral elbow pain and swelling, despite optimisation of her disease-modifying antirheumatic drugs (DMARD) and steroid therapy. The suspicion for another diagnosis for her elbow symptoms stems from the persistent pain and swelling amidst increased titration of methotrexate and prednisolone dosages. Ultrasound scan of her elbows revealed bilateral complex olecranon bursitis with active synovitis. The left elbow aspiration yielded cloudy yellowish synovial fluid and the sample was sent for fluid culture, acid-fast bacilli (AFB) stain, and GeneXpert. No AFB was seen but the GeneXpert test confirmed the presence of Mycobacterium Tuberculosis. Thus, a diagnosis of TB synovitis of the left elbow was made, and she was promptly started on anti-tubercular therapy (ATT) consisting of Rifampicin, Isoniazid, Ethambutol and Pyrazinamide with the aim to complete 9 months of ATT. Conclusion: The diagnosis of tuberculous synovitis is challenging. In the absence of constitutional or respiratory symptoms, joint TB is usually low on the initial differential diagnosis in patients presenting with joint pain and swelling. The diagnosis is made even more difficult in patients with concomitant rheumatoid arthritis. This case demonstrates the importance of a high index of suspicion for TB, particularly when evaluating patients in high TB prevalence area with an underlying immunosuppressive state.

Matched MeSH terms: Diagnosis, Differential

Fulltext A rare case of Von Hippel Lindau disease

Abdul Ghani R, Norazmi MK, Norlaila M

Med J Malaysia, 2006 Jun;61(2):254-7.

PMID: 16898326 MyJurnal

Pheochromocytoma is a rare catecholamine-secreting tumour typically arising within the adrenal medulla. It may occur sporadically or be associated as part of a tumour syndrome including Von Hippel Lindau (VHL), Multiple Endocrine Neoplasia (MEN) 2 and Neurofibromatosis Type 1. VHL is associated with multi-organ involvement of benign and malignant tumours characterized by the presence of retinal angiomas, hemangioblastomas of the cerebellum and spinal cord, renal cell carcinomas, pheochromocytomas and other cystic lesions in the kidneys, pancreas, and epididymis. It is a rare disorder with prevalence estimated at 2-3 per 100,000. This case report describes a 37 years old Chinese gentleman who presented to our institution for further management of bilateral pheochromocytoma and retinal angioblastoma with problems of duodenal ulcer and anaemia. There was no family history of similar problems. With these features the criteria for the diagnosis of von Hippel Lindau disease was established.

Matched MeSH terms: Diagnosis, Differential

Fulltext A rare case of chondrosarcoma of the clavicle

Amalourde A, Vinayaga P, Naveed N, Jamal A, Looi LM, Sengupta S

Med J Malaysia, 2004 Dec;59 Suppl F:60-2.

PMID: 15941166 MyJurnal

Although all types of tumour and tumour-like conditions have been described to occur in the clavicle, they only contribute to less then 0.5% of all skeletal tumours. The incidence of primary chondrosarcoma of the clavicle is extremely rare. To our knowledge it has not been reported in Malaysia. We would like to highlight the possibility of chondrosarcoma as a differential diagnosis for a clavicular lesion.

Matched MeSH terms: Diagnosis, Differential

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