MyMedR

Primary biliary cirrhosis and auto immune hepatitis overlap syndrome mimicking cholangiocarcinoma

Adel A, Zamri Z, Azlanuddin A, Bong JJ

Clin Ter, 2013;164(6):e493-5.

PMID: 24424229 DOI: 10.7417/CT.2013.1643

Primary Biliary Cirrhosis (PBC) and Auto Immune Hepatitis (AIH) are autoimmune diseases of the liver which highlighted with slow destructive process of intra hepatic small bile ducts. As a result of these damages cholestasis and over the time tissue damage will happen, which leads to scarring, fibrosis and finally cirrhosis. Some patients may present with clinical and biochemical features of both conditions, which is called "Overlap syndrome". Here we are reporting a case of PBC-AIH overlap syndrome that primarily diagnosed as gallbladder carcinoma and went under operation and finally histological examination revealed to be PBC.

Matched MeSH terms: Diagnosis, Differential

Squamous cell carcinoma of the larynx with sarcoma like stroma

Ahluwalia HS, Kandiah S, Kaur H

Med J Malaysia, 1977 Dec;32(2):172-4.

PMID: 614488

Matched MeSH terms: Diagnosis, Differential

Granulomatous peritonitis due to Ascaris eggs

Ahluwalia HS

Med J Malaya, 1965 Jun;19(4):316-7.

PMID: 4220859

Matched MeSH terms: Diagnosis, Differential

Fulltext Myalgia Cruris Epidemica: an unusual presentation of dengue fever

Ahmad R, Abdul Latiff AK, Abdul Razak S

Southeast Asian J. Trop. Med. Public Health, 2007 Nov;38(6):1084-7.

PMID: 18613550

We describe a 5-year-old girl who had sudden onset difficulty in walking after 3 days of febrile illness. In the emergency department her creatine kinase level was elevated but urine myoglobin was normal. She was diagnosed as having benign acute childhood myositis. Because of poor oral intake and dehydration, she was admitted to the pediatric ward. The next day she had a petechial rash over the antecubital fossa, and dengue IgM back was positive. She was treated conservatively and recovered uneventfully. Despite dengue fever being endemic in Malaysia, this is the first case report of myositis following dengue infection in Malaysia.

Matched MeSH terms: Diagnosis, Differential

Fulltext The relationship between alvarado score and pain score in managing adult acute appendicitis in the Emergency Department

Ahmad, K.I., Shamsul, A.S., Ismail, M.S.

Journal of Surgical Academia, 2011;1(1):15-24.

MyJurnal

Acute appendicitis is one of the most common differential diagnoses for acute abdominal pain made by emergency doctors. Suspected cases require surgical referral for observation or definitive intervention to prevent complications. A high index of suspicion and good clinical skills with the aid of scoring systems allows early decision making, which includes optimal pain control. The objective of this study was to identify the pain score and is relationship to the cut-off points of the Alvarado scoring system so that justifies early surgical referral or discharge for suspected acute appendicitis from the Emergency Department of Universiti Kebangsaan Malaysia Medical Centre (UKMMC). This was a cross sectional study of acute abdominal pain from June 2007 to September 2008. All patients who fulfilled the criteria and consented to the study were assessed for Alvarado score, verbal numerical pain score (VNRS) and their subsequent management. Patients with an Alvarado score of ≥7 were likely to have acute appendicitis (80.1% sensitivity and 52.63% specificity) and those with the score of ≤3 were unlikely to have acute appendicitis. The median pain score was 7.00 (IQR: 5.00-8.50) but 72.5% did not receive any analgesia. There was no direct relationship between the pain score with Alvarado score. Oligoanalgesia in patients with acute appendicitis still exist in Emergency Department of UKMMC.

Matched MeSH terms: Diagnosis, Differential

Corneal thickness and volume in subclinical and clinical keratoconus

Ahmadi Hosseini SM, Mohidin N, Abolbashari F, Mohd-Ali B, Santhirathelagan CT

Int Ophthalmol, 2013 Apr;33(2):139-45.

PMID: 23138667 DOI: 10.1007/s10792-012-9654-x

To evaluate corneal thickness and volume in subclinical and clinical keratoconus in Asian population with the aim of discriminating between normal and ectatic cornea. Eyes were placed into one of the following three groups: normal, subclinical, and mild-moderate keratoconus. Pentacam Scheimpflug imaging (Oculus Inc., Wetzlar, Germany) was performed for each participant to record thinnest corneal thickness, central corneal thickness, corneal volume (CV), peripheral corneal thickness (PCT) and percentage thickness increase (PTI) at 2, 4, 6, and 8 mm. The data were exported to SPSS for statistical analysis. Subjects comprised 52 normal, 15 subclinical keratoconus, and 32 mild-moderate clinical keratoconus eyes. Our results indicated that corneal thickness (CT) distribution, PTI, and CV in normal eyes were significantly different compared with subclinical and clinical keratoconus (P < .05). Overall, subclinical group exhibited lower CT distribution and volume, and higher PTI in comparison with normal eyes. However, they showed higher CT distribution and volume, and lower PTI compared with keratoconus group. In addition, there was a smaller change in PCT and PTI from the thinnest point of the cornea to the periphery. The results of the present study indicate that CT parameters and CV were significantly different in normal versus subclinical group and in normal versus keratoconus group. These findings could help clinicians to better discriminate between normal and ectatic cornea.

Matched MeSH terms: Diagnosis, Differential

Loss of weight in a female heavy smoker with diffuse interstitial pulmonary fibrosis

Al-Adsani A, Dahniya MH, Al-Adsani N

Postgrad Med J, 2001 Feb;77(904):127, 137-8.

PMID: 11161092

Matched MeSH terms: Diagnosis, Differential

Thyrotoxicosis presenting as hypokalaemic paralysis and hyperlactataemia in an oriental man

Al-Jubouri MA, Inkster GD, Nee PA, Andrews FJ

Ann. Clin. Biochem., 2006 Jul;43(Pt 4):323-5.

PMID: 16824287 DOI: 10.1258/000456306777695681

A 35-year-old Malaysian man presented with rapid onset of flaccid quadriparesis associated with nausea and vomiting. General blood tests revealed severe hypokalaemia (serum potassium 1.5 mmol/L) and hypophosphataemia (serum phosphate 0.29 mmol/L) as a potential cause of the flaccid paralysis. Arterial blood gases showed mixed acid base disturbance of respiratory alkalosis and metabolic acidosis with hyperlactataemia. Thyrotoxic periodic paralysis (TPP) was suspected as the underlying cause of this presentation and thyroid function tests showed severe hyperthyroid results (free T4 > 77.2 pmol/L, free T3 19.3 pmol/L, thyroid-stimulating hormone [TSH] < 0.05 mIU/L). Treatment with intravenous potassium and phosphate infusion and oral propranolol resulted in rapid resolution of his symptoms. A discussion of the clinical and pathophysiological features and treatment of TPP (a very rare encounter in UK clinical practice) is presented, and to our knowledge associated hyperlactataemia has not been previously described.

Matched MeSH terms: Diagnosis, Differential

Disseminated tuberculosis - diagnostic challenges of atrial tuberculoma masquerading as atrial myxoma

Alaga A, Yew YX, Razul MK

J R Coll Physicians Edinb, 2017 Dec;47(4):353-355.

PMID: 29537407 DOI: 10.4997/JRCPE.2017.410

A 47-year-old female, with multiple comorbidities, presented with a cough of two months, loss of weight and appetite. She was treated for pneumonia. A chest X-ray showed bilateral reticulonodular opacities. She was noted to have a vague central abdominal mass and a systolic murmur over the mitral region. Ultrasonography and computed tomography of the abdomen showed an omental mass and loculated ascites. Oesophagoduedenoscopy showed antral gastritis and during colonoscopy the surgical team was unable to advance the scope beyond 40 cm due to external compression. An echocardiogram showed a right atrial mass and a pericardial effusion over the posterior wall. A possible diagnosis of atrial myxoma was made. Sputum acid-fast bacillus was negative. The patient was treated empirically for disseminated tuberculosis and scheduled for bronchoscopy by the pulmonology team. The patient showed remarkable improvement after day 7 of anti-tuberculosis medication. GeneXpert study came back as positive. CT abdomen and echocardiogram repeated after 2 weeks of treatment showed reduction in the mass.

Matched MeSH terms: Diagnosis, Differential

A Unique Interaction of IVS-I-1 (G>A) (HBA2: c.95+1G>A) with Hb Adana (HBA2: c.179G>A) Presenting as Transfusion-Dependent α-Thalassemia

Alauddin H, Kamarudin K, Loong TY, Azma RZ, Ithnin A, Jalil N, et al.

Hemoglobin, 2018 Jul;42(4):247-251.

PMID: 30623696 DOI: 10.1080/03630269.2018.1528985

Nondeletional α-globin mutations are known to cause more serious clinical effects than deletional ones. A rare IVS-I-1 (G>A) (HBA2: c.95+1G>A) donor splice site mutation interferes with normal splicing of pre mRNA and results in activation of a cryptic splice site as well as a frameshift mutation. Hb Adana [HBA2: c.179G>A (or HBA1)] is a highly unstable variant hemoglobin (Hb) resulting from a mutation at codon 59 on the HBA2 or HBA1 gene, recognized to cause severe α-thalassemia (α-thal) syndromes. We report a unique case of compound heterozygosity for these two mutations in a 9-year-old boy who presented with a Hb level of 5.3 g/dL and hepatomegaly at the age of 15 months. He required regular blood transfusions in view of a Hb level of <7.0 g/dL and failure to thrive. He had thalassemic red cell indices and peripheral blood film. The Hb electrophoresis only showed a raised Hb F level (3.3%) and a pre run peak but the Hb H inclusion test was negative. His father had thalassemic red cell indices but a normal Hb level. His mother had almost normal Hb levels and red cell indices. Hb Adana involving the HBA2 gene was detected by mutiplex amplification refractory mutation system-polymerase chain reaction (ARMS-PCR) in the proband and his father. DNA sequencing of the HBA2 gene confirmed the IVS-I-1 mutation in the proband and his mother. This case highlighted the unique interaction of the IVS-I-1 mutation with Hb Adana in a young Malay boy presenting with transfusion-dependent α-thal.

Matched MeSH terms: Diagnosis, Differential

Fulltext Large perineal and gluteal angiomyxoma: the role of diagnostic imaging and literature review

Alhabshi SM, Abd Rashid M

BMJ Case Rep, 2013;2013.

PMID: 23429032 DOI: 10.1136/bcr-2013-008680

Aggressive angiomyxoma is a benign soft tissue tumour usually affecting the pelvis and perineum predominantly in women. Because of its variable presentation, this tumour is often clinically misdiagnosed as liposarcoma. We describe a case of a 38-year-old woman who presented with a large perineal and gluteal mass which increased in size in one year. Ultrasound showed hypoechoic mixed solid and cystic mass. Contrasted CT and MRI examinations showed typical appearance of swirling and layering pattern. She had undergone TAHBSO as the mass was difficult to dissect intra-operatively. The post-operative specimen confirmed to be an aggressive angiomyxoma.

Matched MeSH terms: Diagnosis, Differential

Semi-quantitative and qualitative assessment of breast ultrasound elastography in differentiating between malignant and benign lesions

Alhabshi SM, Rahmat K, Abdul Halim N, Aziz S, Radhika S, Gan GC, et al.

Ultrasound Med Biol, 2013 Apr;39(4):568-78.

PMID: 23384468 DOI: 10.1016/j.ultrasmedbio.2012.10.016

The purpose of this study was to evaluate the diagnostic value of qualitative and semi-quantitative assessment of ultrasound elastography in differentiating between benign and malignant breast lesions. This prospective study was conducted in two tertiary medical centers. Consecutive B-mode ultrasound and real-time elastographic images were obtained for 67 malignant and 101 benign breast lesions in 168 women. Four experienced radiologists analyzed B-mode ultrasound alone and B-mode ultrasound combined with elastography independently. Conventional ultrasound findings were classified according to the American College of Radiology Breast Imaging Reporting and Data System classification. The elastographic assessment was based on qualitative and semi-quantitative parameters (i.e., strain pattern, width ratio, strain ratio). The sensitivity and specificity of combined elastography and conventional ultrasound were significantly higher than that of conventional ultrasound alone. The sensitivity, specificity, positive predictive value and negative predictive value was 97%, 61.4%, 62.5% and 96.8%, respectively, for conventional ultrasound and 100%, 93%, 99% and 90%, respectively, for combined technique. The semi-quantitative assessment with strain ratio and width ratio in elastography were the most useful parameters in differentiating between benign and malignant breast lesions. Cut-off point values for width ratio of more than 1.1 and strain ratio of more than 5.6 showed a high predictive value of malignancy with specificities of 84% and 76%, respectively (p

Matched MeSH terms: Diagnosis, Differential

Giant Cell Tumor of the Ribs and Aneurysmal Bone Cyst Presenting With Hemothorax in a Child

Alias H, Doris Lau SC, Loh CK, Ishak MI, Mohammed F, Jamal R, et al.

J Pediatr Hematol Oncol, 2017 11;39(8):e463-e465.

PMID: 28859035 DOI: 10.1097/MPH.0000000000000960

Giant cell tumor (GCT) is one of the most common tumors of bone and is the most common precursor of aneurysmal bone cysts (ABC). The clinical behavior of concurrent GCT and ABC can be very aggressive in children. GCT of the ribs, with or without ABC, is rarely seen in children. We report a case of an 8-year-old girl with GCT and associated ABC of the ribs who presented with sudden onset of chest pain and breathlessness due to a hemothorax. The patient was successfully treated by surgical resections and arterial embolization. She has remained well for 4 years after the initial surgery.

Matched MeSH terms: Diagnosis, Differential

Fulltext Ultrasound of the cold thyroid nodule

Alif AK, Meah F

Med J Malaysia, 1984 Jun;39(2):123-6.

PMID: 6392839

Matched MeSH terms: Diagnosis, Differential

Fulltext Tuberculous orchitis in chronic renal failure

Alper M, Balbay O, Akman Y, Arbak P, Cam K

Med J Malaysia, 2004 Mar;59(1):118-9.

PMID: 15535348

Tuberculosis confined to the testes with no epididymal involvement is uncommon. Chronic renal failure patients requiring hemodialysis have increased risk for developing tuberculosis. We report a 47-year old chronic renal failure man presenting with right testicular tuberculous orchitis. A high index of suspicion is required to recognize the unusual presentation of tuberculosis in this group of patients, and routine screening for tuberculosis may be recommended in patients undergoing hemodialysis.

Matched MeSH terms: Diagnosis, Differential

The Utility of Diagnostic Laparoscopy in Post-Bariatric Surgery Patients with Chronic Abdominal Pain of Unknown Etiology

Alsulaimy M, Punchai S, Ali FA, Kroh M, Schauer PR, Brethauer SA, et al.

Obes Surg, 2017 Aug;27(8):1924-1928.

PMID: 28229315 DOI: 10.1007/s11695-017-2590-0

PURPOSE: Chronic abdominal pain after bariatric surgery is associated with diagnostic and therapeutic challenges. The aim of this study was to evaluate the yield of laparoscopy as a diagnostic and therapeutic tool in post-bariatric surgery patients with chronic abdominal pain who had negative imaging and endoscopic studies.

METHODS: A retrospective analysis was performed on post-bariatric surgery patients who underwent laparoscopy for diagnosis and treatment of chronic abdominal pain at a single academic center. Only patients with both negative preoperative CT scan and upper endoscopy were included.

RESULTS: Total of 35 post-bariatric surgery patients met the inclusion criteria, and all had history of Roux-en-Y gastric bypass. Twenty out of 35 patients (57%) had positive findings on diagnostic laparoscopy including presence of adhesions (n = 12), chronic cholecystitis (n = 4), mesenteric defect (n = 2), internal hernia (n = 1), and necrotic omentum (n = 1). Two patients developed post-operative complications including a pelvic abscess and an abdominal wall abscess. Overall, 15 patients (43%) had symptomatic improvement after laparoscopy; 14 of these patients had positive laparoscopic findings requiring intervention (70% of the patients with positive laparoscopy). Conversely, 20 (57%) patients required long-term medical treatment for management of chronic abdominal pain.

CONCLUSION: Diagnostic laparoscopy, which is a safe procedure, can detect pathological findings in more than half of post-bariatric surgery patients with chronic abdominal pain of unknown etiology. About 40% of patients who undergo diagnostic laparoscopy and 70% of patients with positive findings on laparoscopy experience significant symptom improvement. Patients should be informed that diagnostic laparoscopy is associated with no symptom improvement in about half of cases.

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

Fulltext Systematic Epstein-Barr virus-positive T-cell lymphoproliferative disease presenting as a persistent fever and cough: a case report

Ameli F, Ghafourian F, Masir N

J Med Case Rep, 2014;8:288.

PMID: 25163591 DOI: 10.1186/1752-1947-8-288

Systemic Epstein-Barr virus-positive T-cell lymphoproliferative childhood disease is an extremely rare disorder and classically arises following primary acute or chronic active Epstein-Barr virus infection. It is characterized by clonal proliferation of Epstein-Barr virus-infected T-cells with an activated cytotoxic phenotype. This disease has a rapid clinical course and is more frequent in Asia and South America, with relatively few cases being reported in Western countries. The clinical and pathological features of the disease overlap with other conditions including infectious mononucleosis, chronic active Epstein-Barr virus infection, hemophagocytic lymphohistiocytosis and natural killer cell malignancies. We describe the rare case of systemic Epstein-Barr virus-positive T-cell lymphoproliferative childhood disease in a 16-year-old Malay boy.

Matched MeSH terms: Diagnosis, Differential

Fulltext Churg-Strauss syndrome presenting with conjunctival and eyelid masses: a case report

Ameli F, Phang KS, Masir N

Med J Malaysia, 2011 Dec;66(5):517-9.

PMID: 22390118 MyJurnal

Churg-Strauss syndrome, a small and medium vessel vasculitis, was first described by Churg and Strauss in 1951. It is characterised by the presence of asthma, prominent tissue and blood eosinophilia, systemic vasculitis, and pulmonary and systemic necrotising allergic granulomas. Involvement of the skin, heart and gastrointestinal tract is well documented, but ocular presentation is unusual. We describe a 40-year-old lady who presented with recurrent upper eyelid swelling due to conjunctival lesions. Although she has chronic asthma, Churg-Strauss syndrome was never suspected. The diagnosis of Churg-Strauss syndrome was only made following histological examination of the conjunctival lesions.

Matched MeSH terms: Diagnosis, Differential

Fulltext Symptomatic intra-articular ganglion cyst of the knee

Aminudin CA, Samsudin OC, Hyzan MY, Hamzaini AH, Zahiah M

Med J Malaysia, 2004 Dec;59 Suppl F:57-9.

PMID: 15941165

We are reporting a case of a patient with a symptomatic intra-articular ganglion of the knee arising from infrapatellar fat pad. Plain radiograph and Magnetic Resonance (MR) images were correlated with arthroscopic examination and histological findings. The cyst was removed and post operatively patient regained full extension.

Matched MeSH terms: Diagnosis, Differential

Displaying publications 21 - 40 of 808 in total